Recently, our Safe at School Director, Crystal Jackson, got the chance to chat with Fran Cogen, MD, CDE, Director of Diabetes Services and Interim Co-Chief of Pediatric Endocrinology at Children’s Hospital. Dr. Cogen’s practice serves approximately 1,800 patients in the D.C./Maryland/Virginia metro area, with 85 percent of those patients living with type 1 diabetes. Dr. Cogen has been working with diabetes patients since 2002 and is also a member of the ADA’s Safe at School Working Group. Ms. Jackson and Dr. Cogen spoke about the Safe at School program, diabetes management in schools and how parents can work with schools as a team—check out part two of this interview series.
Fran Cogen, MD, CDE
Crystal Jackson: Would you say that, in addition to having experience in helping students manage their diabetes, training is a critical component for school staff AND school nurses?
Fran Cogen: Yes, I think it’s very important for anyone taking care of a child during school and afterschool activities to be adequately trained to manage, or for nurses to be able to delegate insulin and glucagon administration, how to recognize and treat a low, and how to deal with ketones, which are the main emergency situations in school.
CJ: What about managing diabetes on field trips?
FC: We get a lot of complaints that there’s no trained staff to accompany students on field trips, and that the parents must go. That is simply unacceptable, because field trips and other school-sponsored activities are under the school’s jurisdiction. A parent should not be required to accompany a child on a field trip. A school nurse or other school staff members trained to give glucagon, provide other necessary care and handle emergencies should be assigned to be present on the field trip.
CJ: When parents of patients voice these concerns, what advice do you usually give, and where do you send them?
FC: The first thing is to complete the Diabetes Medical Management Plan. We try to get parents to work with the schools on 504 plans before there is conflict. If things are not going well, then they call my diabetes team. Our nurse educators talk to the school to see if we can resolve the conflict. If we can’t, then our physicians will attempt to resolve the conflict. Fortunately, on most occasions, our diabetes nurse educators can resolve the problem. If that doesn’t work, the next step is for the parent to go speak to the person who supervises the [school] nurse, such as the principal. If the issue continues to remain unresolved, then we phone Crystal Jackson [laughs]. Seriously, I urge them to call the American Diabetes Association at 1-800-DIABETES.
CJ: Is one of your strategies when advising parents on sending kids back to school to be proactive and to get their Diabetes Medical Management Plans and 504 plans in order?
FC: Yes, because conflict is decreased and you begin a collegial relationship with the school nurse and principal. We strongly suggest that the parent NOT use the 504 plan as a threatening document to their child’s school. Many schools say, “we don’t need a 504 plan,” but we think it’s a very good idea, because then you can get your concerns and requests in place and in writing.
CJ: When did you first get involved with Safe at School, and why?
FC: I think I first got involved when a D.C. patient’s mother had to go into their child’s school and give insulin injections. My team became involved to provide the training of the D.C. Public Schools’ staff.
CJ: Schools are required to train certain staff. Can you talk about the training that your staff developed and how you deliver it?
FC: We developed an online training for the DCPS as well as a return demonstration, which is one of the key components of diabetes management in our curriculum. We offered a two-day session in D.C., in which school staff first did online training. Then we had different hands-on stations wherein our staff demonstrated how to do insulin injections, glucagon, insulin pumps, etc. If I had to make an ideal training recommendation, I think it is necessary to have a didactic component which you do online, and then have the appropriate diabetes team to come and do hands on demonstrations.
CJ: What do you think the biggest barrier to the school’s ability to provide needed care is?
FC: Not having a nurse or back-up staff at each school who have been trained to provide care to the student in accordance with the student’s DMMP.
CJ: Do you think just having a school nurse is enough? Is there another side of the equation?
FC: I think there have to be redundancies. In my vision, there’s a school nurse, however, if she’s sick or unavailable it is necessary to have a few trained people as backup, particularly for field trips. One great way to [choose surrogates] is to train willing teachers and administrative staff, as well as athletic coaches and those who will be with the kids after-hours.
Interested in learning more about our Safe at School program? Check out our resources here.