Sped Diabetic Student Requesting Escort

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I have a newly registered student who is 17 years old in the 9th grade. He was homeschooled last year and has been demoted from 11th to 9th grade recently. His aunt is his guardian is very protective, demanding, and critical of the district. She is requesting another ARDS to get him a private escort. Hx: sped in general classes, behavioral issues ( wants to act like a gang member, gets upset easily and walks off, etc. But he is normal in carrying a cellphone around and texting friends, does his homework, etc. ). He was hospitalized last month before he came to me for being suicidal after trying to stick himself at home with 3 insulin needles, and we were never told why. He can't be trusted to come to the clinic before breakfast and lunch daily consistently at the correct time. I have had to hunt him down in the cafeteria, in the hallway, etc. I have 5 other diabetics at this high school with approx 1800 students shared with the other RN. I know every child has to have equal access to an education and all that but how far can a parent demand the district hire a private escort for their student? He is in regular classes but doesn't really want an escort telling him where to go, while the aunt is demanding one. Have you ever experienced anything like this?

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Specializes in school nursing, ortho, trauma.

to play a little devil's advocate here, it sounds like this child has the potential of being very non-compliant and perhaps even a danger to himself. I can see why his aunt would want him to have a 1:1, however, i do recognize the fact that this student is 17 and having that 1:1 would probably humiliate him.

Perhaps there is a middle ground that can be struck so that his compliance in coming to you for checks can be attained, his safety is ensured, his behaviors are kept in check, AND he is given at least some degree of the autonomy he desires.

In the past, I have done things like request that a shared 1:1 work out a schedule where they are shadowing a student at certain times of the day and/or checking in with that student to ensure they are doing what they they need to throughout the day,

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Specializes in Med-surg, school nursing..

I would have the diabetic supplies kept in your office, if he doesn't have access to them throughout the day then he can self administer and overdose on insulin.

I would talk to aunt and student. Give him a week. If within that week he can prove to you that he can come down without being tracked down, hold off on the escort. It could very well be that maybe he can't tell time? Have him set an alarm on his phone with the times that he needs to come to you (setting it for a few minutes before he is supposed to actually be there). I would be firm with him and let him know that if he cannot do this, an escort will be needed.

ALL OF THAT SAID TO SAY THIS:

An escort may not even be an option, this is something that your admin needs to hear about before you take it to aunt or student. If there isn't a true need, they may not be able to provide the staff to do this. If it's just the aunts preference...

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@Flare I like the idea of a student shadow for certain times of the day. His own peer, less noticeable, some autonomy, and saving money for the district.

@OyWiththePoodles Yes, his supplies are always kept in the clinic and he has been given a week and screwed it up being very inconsistent. The administration is involved and attended his last meeting but didn't want to pay for additional personnel. They want the aunt and student to get their act together.

He wants to walk into (the clinic) whatever time he wants because as he told me once, This (diabetes monitoring) is not more important to me than my friends and hanging out (skipping with girls) when I want. He can tell time very well and carries his very used cellphone. He is just purposely non-compliant and the guardian knows this but wants to force the district to hire and pay a 1:1 and they don't want to. But I'm caught in the middle. The guardian requested an Ard for next week for 45 minutes so we will see what happens. The last one, 3 weeks ago, the student walked out when the word escort was mentioned. What schools put up with is unbelievable.

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Sounds like he needs an IEP eval, STAT. That will at least be a good starting point for him.

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Specializes in School Nursing, Home Health.

This is so hard because we aren't hired to be babysitters... I had a diabetic who kept skipping school before getting her insulin. One time she was in the 400's and at home alone.

Mom asked how she left school. I just replied "ma'am, we have 1.400 students, 3 principles, 3 security guards and 1 nurse. We can't keep an eye on one student in particular".

I firmly believe we can't force the kids to do anything. You can only educate the best you can (and document). So you are basically giving them a platter with options, yet, you can't force them to take anything.

As far as an escort, for my kids we saw they require an escort if they aren't feeling well.

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@Avill. Right, who said we have to watch your kid out of 1800 at the high school when he is noncompliant and he has ran away from home. And she has called the police on him. I'm thinking what the world.

Oh I forgot to mention, he was discharged from the hospital and labeled suicidal, he was given a psychiatric referral. That was 3 weeks ago. When I mentioned it 2 days ago, all I heard was excuses. "We just signed up with Medicaid. They haven't escalated his referral to an emergency issue yet, blah blah blah yad dey yah." But I demand an escort. No ma'am.

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On 10/25/2019 at 2:24 PM, Dimple58 said:

What schools put up with is unbelievable.

It really is.

I was just lamenting about this to my boyfriend last week. Had a parent not show up for an IEP meeting. The meeting had already been rescheduled once. This is for a very high needs preschool student so there were a lot of people there for the meeting- psych, OT, PT, ST, nurse, and the teacher that we had slated for this student when they start (child is not quite 3). We had two hours blocked out on the calendar for this and they don't show. No call and didn't answer when we called.

When I was talking about it to my boyfriend, he was like "Oh, I guess they're out of luck then!" but NOPE. We will just continue to accommodate to them because that's what we have to do.

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Specializes in NICU, ICU, PICU, Academia.
On 10/25/2019 at 3:24 PM, Dimple58 said:

@Flare I like the idea of a student shadow for certain times of the day. His own peer, less noticeable, some autonomy, and saving money for the district.

@OyWiththePoodles Yes, his supplies are always kept in the clinic and he has been given a week and screwed it up being very inconsistent. The administration is involved and attended his last meeting but didn't want to pay for additional personnel. They want the aunt and student to get their act together.

He wants to walk into (the clinic) whatever time he wants because as he told me once, This (diabetes monitoring) is not more important to me than my friends and hanging out (skipping with girls) when I want. He can tell time very well and carries his very used cellphone. He is just purposely non-compliant and the guardian knows this but wants to force the district to hire and pay a 1:1 and they don't want to. But I'm caught in the middle. The guardian requested an Ard for next week for 45 minutes so we will see what happens. The last one, 3 weeks ago, the student walked out when the word escort was mentioned. What schools put up with is unbelievable.

My (formerly) non-compliant teen grandson once spent a VERY uncomfortable hour trapped in the car with grandma (me) telling him all about how impotence is a consequence of out of control T1DM.

It is stunning how quickly he turned around!

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Specializes in School Nurse, past Med Surge.
On 10/25/2019 at 3:24 PM, Dimple58 said:

he told me once, This (diabetes monitoring) is not more important to me than my friends and hanging out (skipping with girls) when I want.

He is just purposely non-compliant and the guardian knows this

Talk to him about how uncontrolled diabetes can lead to impotence. That may get him to take things more seriously.

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Specializes in ICU/community health/school nursing.

So....I transferred to a special education position. I am shocked at how much we accommodate parents who have kids with SPED diagnoses - even when we have no doctors' orders to do so.

While I don't disagree with the premise (kid is probably a danger to himself)...what do the orders say? Pretty sure they don't say have someone escort this almost grown man to the clinic. And a 504 is predicated on MD orders. In my district, the dx of diabetes would get the 504 anyway. Are the teachers willing/able to assist by calling you when sweet pea comes down? Is he relatively compliant in visiting? If not - having someone physically escort him is a threat that might work. If you have someone to do it. And by that, I mean someone who isn't you! Are there any teachers with whom he has rapport?

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Specializes in School nursing.
4 minutes ago, ruby_jane said:

So....I transferred to a special education position. I am shocked at how much we accommodate parents who have kids with SPED diagnoses - even when we have no doctors' orders to do so.

While I don't disagree with the premise (kid is probably a danger to himself)...what do the orders say? Pretty sure they don't say have someone escort this almost grown man to the clinic. And a 504 is predicated on MD orders. In my district, the dx of diabetes would get the 504 anyway. Are the teachers willing/able to assist by calling you when sweet pea comes down? Is he relatively compliant in visiting? If not - having someone physically escort him is a threat that might work. If you have someone to do it. And by that, I mean someone who isn't you! Are there any teachers with whom he has rapport?

That might the middle ground vs a fulltime 1:1. Is there a teacher/staff member that he trusts that will "conveniently" stop by to remind him and escort for the his glucose check?

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