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High School, 504s, testing and implementation

Discussion in 'Parents of Children with Type 1' started by Sarah Maddie's Mom, Sep 19, 2013.

  1. Sarah Maddie's Mom

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    A lot of us have test/quiz provisions in our kid's 504 that set "out of range" zones for permitting rescheduling of tests/quizzes.

    I'm curious about how other teens manage this. How is your kid about checking bg and communicating with the teacher about being out of range. Who determines when a 250 or 300 is a "no go"? Is your child good about advocating for themselves when they are having a bad D day and there's a test? Do you think your kid's teachers understand why testing when high or low is a bad idea? Does your nurse step in to educate or do you communicate directly with the teachers?

    We've always had this one down at least on paper, but the actual implementation hasn't always gone so well. Just looking to see how this is working out for other High Schoolers.
     
  2. ksartain

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    I teach at a high school, so I can give you a glimpse of that side of it if you would like. Obviously, I could not speak for every school, but there is someone like me IN every school. ;)
     
  3. KatieSue

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    We have it in her 504 but honestly so far it's never come up so I don't know. It is also in her 504 that she needs to test an hour before a school test so there is time to either increase or decrease her blood sugars. And I'm sure 99% of the time she doesn't do this.

    The way it's supposed to work is she's supposed to let the teacher know she's high/low when taking the test. Then if the grade is bad she has the option to retake. But since it's never actually happened I can't say how they actually work with it.

    With other things like bathroom breaks, eating in class, water, ducking out to stop her pod or cgm from beeping she's never had any issues. She does advocate for herself. A couple of times teachers have forgotten so she's just reminded hey I'm diabetic I'm allowed to do this and it's been fine.
     
  4. 4MyBoys

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    Gregory is in 9th grade. He does not take a test or a quiz if his BG is lower than 80 or higher than 220. It is in his 504 that he needs to test his BG (not CGM) and write it on the top of every test or quiz. If he does not do it automatically, the teacher is supposed to remind him. Gregory's teachers have been wonderful about it for the last two years in Jr. High and so far in the high school. We make it an absolute so it is easy for Gregory to advocate for himself. We do not allow for him to decide that he OK to take it if his BG is high, and we explain to the teachers (we have a meeting before the first day of classes) that he is not allowed to override the 504 and say he is OK because he could be feeling pressure to just take it, or he might think he is fine but not really be fine. If his cognitive ability is affected by the high, he might not be able to determine how affected he is. We have made it an absolute from the first day because in 7th grade he decided he was fine and took a unit science test when his BG was 240. He missed every balancing chemical equations question on the test and he had gotten a 100 on the balancing equations quiz a few days before the test. Gregory is a very good student, so the teacher called me about it. Just to see, he asked Gregory to stop in after school to try that page again (not to change his grade) and Gregory got every one correct. Gregory must lose concentration when he is high. He knew how to balance the equations, but could not pay enough attention to the details to do it right.
    We live in NY and we have Regents exams that need to be taken at an exact time one day. We have a stop time provision in his 504 that he has to sit down, put his name on the test and alert a proctor of his high/low BG and they will record his stop time on the test and the three hours will resume when Gregory's blood sugar is in a good spot to restart the test, even if it is seven hours later. I hope this helps! -Allison
     
  5. sincity2003

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    This is the one provision of our proposed 504 that the school district is fighting, so I can't really answer how to make sure it's implemented. I do now that DS' blood sugar was 479 the night before a standardized test last year and it was 350 when we sent him to school and he took the test and scored low on it, considering his year-long grades. I've pointed that out to the school (because they wan't "multiple medical incidents" before helping us), but they do not see the correlation between BG and test scores, no.
    Also, the nurse here doesn't advocate for anyone but herself, so that's a no go too.

    I'll be following this thread with interest.
     
  6. Amy C.

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    We had it in place in high school, but never used it. It was in writing only to get accommodations for the college entrance exams.

    My son ended up using them for only 1 of the 6 college entrance tests he took.

    I shouldn't have bothered.
     
  7. misscaitp

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    In high school, it was in my 504 to not take an exam if my blood sugar was above 250 or below 70. The only one that I really used was below 70, though there were times where if my blood sugar was really high I would make up the test after school or whenever my blood sugar was more stable. There was no writing blood sugars on a test, usually the nurse would email the teacher if I was unable to take a test.

    For state testing I would test as soon as I entered the school, and the 504 team decided that if my blood sugar was out of range I would take the test on a make-up day.

    What to do during standardized testing was actually the longest part of the initial 504 meeting, not because of reluctancy to add it but how to work around diabetes.
     
  8. Sarah Maddie's Mom

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    Always interested, especially if you've had dealing with a D kid with accommodations at school, but also as a D mom with experience in the classroom :cwds:

    I think it's really hard, during a busy school day to be forward thinking enough to say, "oh, in an hour I have that History test so I better check and document now" - especially if there's a meal or PE in between the bg check and the test. And I think our school would pitch a fit if we proposed retesting due to highs or lows - they are cool with delaying or rescheduling if way out of range but probably not for do-overs. It's good to know the options though, thanks :cwds:

    Interesting. You're not worried about the teachers getting to up in his face about D stuff? I think mine would resent being told she had to pass on a test if she was a bit high but generally felt ok. Sometimes a 250 is a problem, sometimes not so much...And when we discussed standardized testing we were told she had two options -1. permitted tester and juice/tabs to treat but without stop the clock and with the group, or 2. stop the clock in a separate individual testing room. Thanks for the post. I appreciate seeing your experience. :cwds:

    I'm sorry your school isn't being more supportive. I hope you get some strategies out of the other people's comments.:cwds:

    So in your case the nurse played a pretty big role... this is all interesting, so different in each case. Thanks:cwds:


    I really think that this provision is one of the easiest to write, but the most difficult and individual to implement. So much depends on the type of kid, the flexibility of the administration, the role of the nurse, the culture of the school I suppose.

    Thanks for all the examples. I appreciate it.;)
     
  9. obtainedmist

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    DD was dx'd the summer of her junior year HS. We didn't even KNOW about a 504, we were just busy keeping our head above water that summer. She just had one instance when she went low during a test (she had forgotten to test before). She went to the teacher the next day and explained what might have impacted her results. The teacher's approach was to wait and grade the test to see if she under achieved from her work previously. It wasn't much of a problem, but really taught dd to test before so she would never be in that situation again.
     
  10. ChaosRules

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    My son is a HS senior right now, dx in 7th grade. I had never heard of a 504 until the HS nurse told us we should have one, specifically for the standardized testing. She said he might need stop the clock breaks. She was awesome! But she left just before school started last year, I don't know why. So incredibly disappointing.

    But anyway, it isn't in his 504 plan about high/low and regular tests. It will be this year, though - thanks!

    His 504 just basically gives him stop the clock breaks in classroom tests, and of course, permission to leave class whenever he feels he needs to, without explaining himself. In the past, the nurse has sent out an e-mail to his teachers at the beginning of each year explaining why he might suddenly leave class, not waiting for a good break in the lecture, and possibly not saying a word, since it may be urgent and he may not be thinking clearly enough to remember to say something about where he's going and why.

    But honestly, it's very rare that taking care of his diabetes interferes with being a regular student (other than that he gets to leave class early for lunch!).

    For the standardized tests, he tests in a separate room so that he can take a break if he needs to. Except for one ACT exam, he was registered on stand-by, so he couldn't have any special accommodations, but luckily he didn't have any problem at all.

    Thanks for this thread!
     
  11. ksartain

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    A lot of the school side depends on the counselors and administration. If the counselor communicates the 504 plans to the teachers adequately, there shouldn't be any problems. Teachers are required each year to notify the counselor whether or not the student used any of their 504 provisions and their notes are supposed to go into the student's file. On standardized testing, there is a spot on each 504 sheet where teachers are to notate what provisions were allowed and which ones were used.

    99% of teachers know that 504 plans are legal documents and must be followed. Typically, though, we are not given those plans until 2-3 weeks into the school year, so your child's teacher, unless you meet with them at the beginning of the year, may not know for a bit who has a 504. Because of this, it is imperative that parents communicate with teachers before the first day of school to let them know that your child is diabetic and may require accommodations.

    From the teacher side, though, please understand that we deal with students who use their diabetes to an extreme. I have seen students who intentionally eat sugared snacks in the morning and do not give themselves insulin, so they can get out of a test. One high school student, who was diagnosed at a young age and was very well aware of all things related to his diabetes, took such advantage of his accommodations that his father had to be called in to set different boundaries. This student had a pump and would keep taking the batteries out or mess with the tubing until it kinked, making him call his dad two-three times per day. His dad came up every single day with the carb counts of lunch and what this student should eat yet this student never came to pick up that sheet. He would eat whatever he wanted, then have to call his dad because his sugar was 450 and up.

    On the other hand, we've had students who we would never know had diabetes if it weren't for their 504. They never used accommodations, made straight A's, rarely missed school, etc.

    In my school now, we have three T1D students. Two, no one would ever know. The third, however, "uses" it constantly. We've already conferenced with her mom to set boundaries and we're 4 weeks into school. This particular student is similar to the student mentioned above who did everything he could to get out of class, tests, etc.

    We do everything we can to accommodate T1D students. As the mom of one in elementary school, I'm particularly sensitive to their needs. I am the first responder here at my school if anything were to happen to one of our three students. When students tread the line of using their accommodations and taking advantage of them, it's a sticky situation for teachers. It takes parent communication and involvement and a well done 504 to protect everyone in these situations.
     
  12. Heather(CA)

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    I guess we are a little more relaxed about it...The teachers email me if they see a test score out of the norm. (I can also check the website)

    But, we have been REALLY lucky with the schools where we live. If he had any lows/highs that day he could retake a bad test score. It hasn't been a big issue luckily
     
  13. Sarah Maddie's Mom

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    I appreciate the view from the other side. In a way, your post confirms my fears.

    Writing the test provisions of a 504 is easy, figuring out how to implement them in a way that is fair, to everyone, is hard. If it's easy for you to view some of the D kids in your school as taking advantage of their accommodations, and you have a D child yourself, then how quickly must outsiders assume that the only good accommodation is one not used?:(
     
  14. ksartain

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    I definitely did not mean to be judgemental. I obviously didn't word it correctly. Maybe "abused" accommodations would be better than "used". I definitely want and believe students should be able to use their accommodations. That's why they are available. With the example of the student I mentioned before, he always received his accommodations whenever he needed them. As far as I know, there was not a time when they were not offered.

    As far as standardized testing, yes, there is a spot on what they call an Accommodation Sheet that lists accommodations granted to the student, whether or not they were offered, and whether or not they were taken. With a 504, it is not used to say "This student didn't use it, so they can't have it anymore." It's just to show the school offered it as required by law and to detail whether or not the student used it.

    I did not say, nor did I mean to imply that a good accommodation is one that is not used. If that's how it came across, then I obviously worded my post poorly.
     
  15. Sarah Maddie's Mom

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    I appreciate that you didn't intend to sound judgmental and perhaps I read into your post, yet I do think it's not insignificant that even a parent of a CWD could fall into describing 504 accommodations as being used to "take advantage"

    Still I appreciate the post and your honesty about what you have observed.
     
  16. swimmom

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    It's really hard because a post-breakfast 220 might not impair cognition for my daughter, but a similar high from a missed bolus or kinked canula might. I would advise going to the nurse's clinic if the child feels distracted or otherwise unwell enough not be able to competently take a test. That way, the student and the teacher don't have to hash out the 504 in the class while everyone else is testing and it can be dealt with as a medical issue (and the high or low corrected appropriately).

    We have language in her 504 that lets her determine if she's capable within a framework of #s. She's only used it once and that was 3 years ago for a state mandated standardized test (she had a site failure and was in the 300's). She went to the nurse and called home.

    If the student goes ahead and takes the test and does poorly, I would think that would be more complicated to handle. Unfortunately, when their judgement is impaired due to a high, well...their judgement is impaired. They may not stop and realize that taking that test isn't such a good idea.
     
  17. Megnyc

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    I just wanted to share a personal anecdote about testing with out of range blood sugars. I was to be excused from tests if I had a symptomatic high or low. I never used it.

    I took the PSAT with blood sugars in the 400s and ketones in the 2-3 range. For anyone who doesn't know, the PSAT is used to determine national merit scholarships (and several other scholarship programs use the scores as well). You only get one shot at taking it junior year (for national merit consideration) and as far as I know there is no such thing as retaking it for that purpose. Based on my SAT scores (taken a few months before the PSAT) I should have been well above the cutoff for my state. I ended up right on the border for being a semifinalist. Probably because it is really difficult to concentrate when your vision is blurry, you have a horrible stomach ache, and you can't stop drinking water :rolleyes:. Fortunately, I ended up being a finalist and did get the scholarship. That money covers the majority of my expenses for college. I was literally one question away from not getting it though.

    Anyway, that is one case where it was extremely stupid for me to not just take the test a few days later. Just thought I would share because the PSAT is usually given during the school day but the costs of not doing well on it can be a lot higher than the costs of "failing" a normal high school test....
     
    Last edited: Sep 22, 2013
  18. moco89

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    Information to put on exams and quizzes

    I agree with megnyc. In addition to what she stated, high blood glucose doues cause delays in your ability to process information efficiently and your working memory (short-term memory, basically), and this is proven in studies.

    Unfortunately, there have not been more recent, updated, studies done on increases or decreases (and the rate of increase or decrease--the "derivative"--calculus term) in blood glucose based on CGM (or even meter readings), which I would imagine would be a bigger factor in glucose-related cognitive issues (technically, impairments).

    _____________________________________________________________________________________

    1. I agree with the individual who stated that a meter BG value be take before the exam or quiz and written on the top of the exam or quiz, with units after the number, and the time that the BG was performed. In addition, I would also take a meter BG right when the exam or quiz is turned in, for records and to evaluate factors such as food, insulin dosing, and stress.

    2. In addition, I would recommend that children that use the CGM add additional information, such as the CGM glucose value, the rate of change of the blood glucose (directional arrows) next to the CGM glucose value, and the (approximate) readings of the CGM, with directional arrows, in 15 minute intervals, over the previous two hours. When turning in the exam, I would recommend that the student write down the most recent CGM glucose value. I would also write down the approximate (or exact, if you have a Medtronic CGM) CGM glucose values, at 15 minute intervals.

    3. Children with diabetes who use an insulin pump should write down the current insulin on board (IOB) and current basal rates when the meter blood glucose test is performed prior to the exam or quiz, and after the exam has ended.
    ____________________________________________________________________________

    This is exactly how I would recommend writing down the information (or by applying a generic pre-made address label sticker with these headings, to save time, an example of printable generic address labels), on the top of the graded in-class assignment:

    NOTE: ~ is the symbol that goes in front of number, if the value is approximated.

    ___________________________________________________________________________

    _______________________________

    Meter Blood Glucose Values [mg/dL]
    ______________________________


    * 1:15 PM: 178 mg/dL (approximate exam start time)

    * 2:02 PM: 231 mg/dL (High Meter BG Value--consider marking value with a colored sticker, or highlighting after exam!) (approximate exam end time)


    __________________________

    CGM Glucose Values [mg/dL]
    __________________________


    * 11:15 AM: ~ 90 mg/dL

    * 11:30 AM: ~ 90 mg/dL

    * 11:45 AM: ~ 95 mg/dL

    * 12:00 PM: ~ 95 mg/dL

    * 12:15 PM: ~ 100 mg/dL

    * 12:30 PM: ~ 105 mg/dL

    * 12:45 PM: ~ 105 mg/dL

    * 1:00 PM: ~ 110 mg/dL

    * 1:15 PM: 110 mg/dL (→) (approximate exam start time)

    * 1:27 PM: ~ 190 mg/dL

    * 1:42 PM: ~ 205 mg/dL (↑) (HIGH CGM VALUE and UPWARDS TREND ARROW)--consider marking with colored sticker, or highlighting before exam!)

    * 1:57 PM: ~ 210 mg/dL

    * 2:02 PM: 217 mg/dL (↑) (approximate exam end time)

    ____________________________

    Insulin On Board (IOB) [Units]
    ___________________________


    * 1:15 PM: 3.05 U (approximate exam start time)

    * 2:02 PM: 1.20 U (approximate exam end time)

    ____________________

    Current Basal Rates

    (U/H)

    (the past 24 hours

    until exam end time)

    ___________________


    * 12 AM-8:15 AM:: 0.65 U/H

    * 8:15 AM-12:05 PM: 0.5 U/H (temporary basal rate--consider marking with colored sticker, or highlighting after exam!)

    * 12:05 PM-6 PM: 0.6 U/H

    ______________________________________________________________________
    I believe that this information, when overseen by a parent, is critical in developing a proper (and the best) 504 plan for future years, and can help develop a protocol or an algorithm tailored for your child for all quizzes and exams, through analysis and evaluation of these values. This will help avoid future problems due to blood glucose excursions. This will also help prepare the child for exams during college, and develop responsibility. This idea would be especially important for planning for standardized testing, such as for the SAT and the ACT which is used as a determinant for generous scholarships by most schools. I was a recipient of a very generous scholarship, just like megnyc. There is no reason with the technology available today that a child with diabetes cannot be as successful as anyone else, with a supportive, loving, family.
     
    Last edited: Sep 22, 2013
  19. hawkeyegirl

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    I refuse to believe that this is necessary for my child to be as successful as anyone else (whatever that means). I cannot imagine my child sitting there for 15 minutes writing a complete summary of his BGs and pumps settings for that day on tests.
     
  20. Megnyc

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    Maybe I am missing something but what would all that information be used for?
     

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