Role of Principals

Principals have the ultimate responsibility over the duty of care that schools undertake on behalf of students, which includes ensuring that there is a supportive environment for students with type 1 diabetes that allows them to fully participate in their education.

A principal should make sure the school is complying with relevant laws and policy. The principal should also ensure that school staff implement measures to support students with type 1 diabetes in the school setting to ensure their safety as well as the safety of other students and staff. This includes understanding and complying with key legal duties and policies relevant to the student’s type 1 diabetes and health needs.

There are a range of legal obligations that schools are expected to meet, including:

• the law concerning the administration of medications in the school setting
• the obligation to obtain appropriate consents to authorise staff providing support to students and for sharing information between key stakeholders
• the duty to make reasonable adjustments under anti-discrimination law and
• the obligation to discharge the school’s legal duty of care.

There are four key principles that can guide principals to ensure relevant legal and policy requirements are met including:

1. Understanding the law and creating a supportive environment
   Principals have a central role in making sure the school is a supportive environment where students are empowered to fully participate in their learning and where staff feel confident they have the knowledge and training to keep all their students healthy and safe.
2. Implementing a student’s diabetes management plan
   Each student with type 1 diabetes will have an individual diabetes management plan. Principals ensure the plan is effectively implemented in the school setting and that appropriate measures are in place to enable staff to support the student’s health and well-being needs as set out in the student’s diabetes management plan.
3. Ensuring that school staff  have access to training and education
   The school principal ensures that all school staff who play a role in supporting a student with type 1 diabetes are appropriately trained so that staff are able to meet their duty of care to students.
4. Communication
   Principals also have an important role in helping other members of the student’s school diabetes team, including parents and carers and health professionals, communicate with each other so that they understand each other’s roles and responsibilities and to also ensure that any changes or adjustments to the child’s needs are communicated effectively to school staff.

Understanding legal obligations

There are different laws that need to be considered concerning the support of students with type 1 diabetes and the administration of insulin in the school setting.

The key areas are listed below:

• Anti-discrimination law
  This area of the law outlines obligations for school staff and education authorities to ensure that students do not experience discrimination because of their health condition. These laws require schools to make reasonable adjustments to accommodate students with type 1 diabetes. >> Read More
• Medications and poisons law
  These laws explain who can administer medications to others (in this case, insulin, glucagon etc.) and who is permitted to possess the medications and how the medications must be stored.  >> Read More
• Consent
  These principles are relevant in determining who can assist students with type 1 diabetes support whilst they are at school and ensuring that consent is obtained to the sharing of information with appropriate stakeholders such as the external treating team. >> Read More
• Duty of care
  Schools owe a non-delegable duty of care to their students and the responsibility to discharge this ultimately rests with the school principal. School staff also owe a duty of care to students. Both of these duties require the implementation of measures to ensure a safe environment and to minimise avoidable risks of harm to students and staff.  >> Read More

Anti-discrimination law

Each Australian state and territory has anti-discrimination or equal opportunity legislation that prohibits discrimination on the basis of a range of protected attributes, including disability (or impairment in some Acts), in protected areas including education.

There is also federal legislation – the Disability Discrimination Act 1992 (Cth) (‘DDA’) – which sets the benchmark for what is required by schools to avoid disability discrimination. This legislation requires schools to make reasonable adjustments for students with disabilities that support them to participate and achieve at school. For the purpose of these laws, type 1 diabetes is considered to be a disability.

The Disability Standards for Education 2005 (Cth) are important standards that have been developed under the federal legislative framework and similarly emphasise that education providers are required to make reasonable adjustments. If a school acts in accordance with the Disability Standards for Education, then the school will also be compliant with the Disability Discrimination Act 1992 (Cth). This is important as compliance with this federal legislation trumps the operation of state or territory legislation to the extent of any inconsistency between federal law and state/territory laws.

Understanding ‘reasonable adjustments’

‘Reasonable adjustments’ is an important term for schools, parents or carers and health professionals to understand so they can all work together to make the school experience safe, positive and rewarding for students with diabetes. These reasonable adjustments will be informed by the treatment regime outlined in the student’s diabetes management plan and will be different for each student with diabetes.

Reasonable adjustments are the supports and actions that the school and parents or carers agree the school will make to ensure that students with type 1 diabetes can best manage their condition and don’t miss out on school opportunities. Different students will have different needs for the management of their type 1 diabetes at school. There are a number of key considerations a school should make in determining whether the school is required to make a reasonable adjustment. Importantly, principals should balance the interests of all parties affected and to consider all relevant circumstances, including:

• the impact of the student’s disability – which might include, for example, a student’s inability to self-manage their type 1 diabetes
• the views of the student or their parent or carer which requires ongoing consultation between the school, the parents or carers, and the student
• the impact of the adjustment on the student’s educational opportunities – which might include for example, the adjustment enabling a student to partake in school activities or educational opportunities
• the effect of the proposed adjustment on anyone else, such as the educational provider, school staff or other students
• the cost and affordability of making the adjustment and
• any other relevant circumstances.

The Disability Standards for Education requires schools to engage in consultation, so it is important that schools, parents or carers and students, where appropriate, discuss and agree on the proposed adjustments. Adjustments need to be reasonable for the school, based on all of the circumstances as well as of benefit to the student.

Supporting blood glucose monitoring and administering or supervising the administration of insulin at school can be seen as a supportive action and therefore a reasonable adjustment which helps a student’s enrolment and participation at school.

Examples of reasonable adjustments might include:

• additional communication between school staff and the student’s parents or carers
• supporting the use of continuous glucose monitors in the school setting including allowing students to use mobile devices to sync with their continuous glucose monitors
• supporting the use of insulin pump therapy for the administration of insulin
• supervising or administering insulin by way of injection or via pump
• allowing students to access food during class or during other activities
• allowing students access to their medical equipment during class time
• providing additional breaks to allow students to check their blood glucose levels and for the administration of insulin;
• allowing the student to have extra toilet breaks
• providing an appropriate area that the student can use to check their blood sugar and/or administer their insulin (if they wish to use it) and
• giving extra time or special consideration on exams and assignments.

(This is not an exhaustive list)

Duty of care

The school’s legal duty of care to students and staff includes the duty to create a safe environment and to take reasonable precautions to avoid exposing students and staff to foreseeable risks of harm. The school’s duty encompasses a non-delegable duty of care which means the school has the ultimate responsibility for the safety and well-being of students even if specific responsibilities are delegated to particular staff members. Additionally, it means all school staff owe a duty of care to students and others in the school environment, which also requires that all school staff take reasonable steps to avoid foreseeable harm.

There are foreseeable risks of harm for students with type 1 diabetes. This means that the school and school staff must take reasonable precautions to protect students and staff against such risks of harm. The school should implement processes and safeguards to support students with type 1 diabetes, to ensure their safety, as well as for the safety of other students and staff.

The school’s non-delegable duty of care to students also means that if there is a failure to implement appropriate safeguards and measures to support a student with type 1 diabetes the school is likely to be liable if that student suffers harm as a consequence of the failure. This is the case even if the harm arises due to the actions of another person, such as a school staff member.

Although individual staff members owe a duty of care to students, generally the school or school authority is vicariously liable for the negligence of school staff performing duties in the course of their employment.

This is likely to include circumstances where a designated staff member makes an error in administering insulin or is unable to properly administer or supervise the administration of insulin due to a lack of appropriate training. This may also impact on the school’s non-delegable duty if there were a failure to organise the appropriate training.

The non-delegable duty of care that exists in the school setting requires that principals:

• understand their obligations under the law
• effectively communicate with all school staff about the needs of students with type 1 diabetes and any adjustments that have been agreed between the school, parents or carers and the student to support the student’s participation at school
• ensure that all school staff understand their duty of care to the student
• ensure that all school staff undergo at least Level 1 Diabetes in Schools training so that staff can identify when a student with type 1 diabetes needs assistance and know what to do should a student need emergency or urgent attention due to their type 1 diabetes
• identify staff members willing to undertake further training to become ‘designated staff’ who will assist students with daily type 1 diabetes management needs such as blood glucose monitoring and/or administration of insulin as defined in their diabetes management plan
• facilitate good relationships and communication between school staff, parents or carers and health professionals
• work in consultation with parents or carers and students (where appropriate) to implement reasonable adjustments to support students with type 1 diabetes and ensure that they are able to participate at school
• ensure that any requests for changes to clinical aspects of the student’s diabetes management plan raised by parents or carers are confirmed with the student’s clinical treating team – this is necessary to ensure that such changes are appropriate and that staff supporting the student are meeting their duty of care to the child and
• ensure that there are appropriate arrangements concerning the accessibility and storage of medications in the school setting to balance the needs of students with type 1 diabetes as well as safeguard the safety of other students and staff.

Poisons law: administration of medication, including insulin

Insulin is a schedule 4 medication (requiring a prescription). Each state and territory has its own legislation that details who may administer schedule 4 medications to others. This legislation does not distinguish between medications that are administered orally and medications administered by other means (such as those administered by injection). Registered health professionals are permitted to administer schedule 4 medications under the legislation.

The legislation also permits other people, such as support people, to administer medications in circumstances where the person for whom the medication is prescribed is unable to do so themselves. These provisions allow designated school staff to administer insulin, providing that certain conditions are met.

To comply with the poisons and medications legislation in Australia it is therefore necessary that the school:

• obtains the consent of parents or carers to permit school staff to assist with insulin administration
• ensures that the designated staff member receives training to enable them to competently and safely administer insulin
• checks that the medication for a student is prescribed by a registered health professional and
• requires that the person administering the medication follows the health professional’s instructions on the medication’s label.

For a student with type 1 diabetes, this information will be detailed in the diabetes management plan signed off by the health professional and provides additional instructions for administering the medication, which may not be outlined on the label of the medication.

Complying with poisons legislation

There are a number of requirements that must be considered to ensure schools comply with the poisons legislation for the administration of insulin including:

• obtaining the consent of the parent or carer, or where appropriate, of the student, to permit school staff to assist with the administration of insulin and related procedures as outlined in the student’s diabetes management plan
• ensuring that all designated staff – that is, school staff who assist with a student’s type 1 diabetes management and administer insulin – are appropriately trained at Levels 1 and 2 (and if appropriate Level 3) through the Diabetes in Schools program, and that this training is regularly updated
• ensure that there is a diabetes management plan in place for the student, which details the student’s needs, provides information about the student’s treatment regime and the administration of insulin (and the mode of administration), and is completed and signed off by the student’s treating health professionals
• that there are appropriate systems in place surrounding the storage of insulin at school, including the need to ensure that it is readily available for the student(s) if needed urgently or in an emergency and
• that there are facilities for the safe disposal of sharps/needles.

Many of these requirements concerning the administration and storage of medications are likely to be outlined in relevant policy and guidance issued by the state or territory departments of education (or other relevant state or territory departments), of which a school should comply with whilst noting that such policy and guidance may not always address some of the more specific factors that require attention in the context of supporting students with type 1 diabetes in the school setting.

While the law can seem complex, the solutions for schools do not need to be.

Appropriate guidance, advice and training is available through the Diabetes in Schools Program.

A students’ diabetes management plan

Development and implementation of the diabetes management plan

The diabetes management plan is integral to supporting students with type 1 diabetes in the school environment. It is also an important aspect of ensuring schools are fully equipped to be able to meet the needs of children with type 1 diabetes. The diabetes management plan will usually be devised by the student’s clinical treating team and will detail the student’s treatment regime as well as other key information.

The training available through the Diabetes in Schools Program assists school staff with understanding key aspects of the student’s diabetes management plan and how to implement it safely and effectively to support the student.

Once a student has been diagnosed with type 1 diabetes and a diabetes management plan is developed, or where a student already diagnosed with type 1 diabetes is transitioning to a new school, the school will need to communicate with the student and their parents or carers, along with the clinical treating team, to ensure that the diabetes management plan is effectively implemented in the school environment. This will ensure that the student receives the support they require to effectively manage their type 1 diabetes.

There are several steps that the principal should take to identify students with type 1 diabetes in the school environment and implement the diabetes management plan, including:

• ensuring that the school has a process to identify the enrolment or transfer of new students with type 1 diabetes at the school
• ensuring that inquiries are made to obtain the student’s diabetes management plan, which will be completed by the student’s clinical treating team. This should be requested from the student’s parents or carers who should be made aware that the school is not able to adequately support the student without the diabetes management plan and any updates to that plan
• ensuring that the student’s diabetes management plan is implemented in the school environment and that the adjustments needed to implement it are documented – this should occur in consultation with the student’s parents or carers, noting that as outlined above the school has met its obligations to make reasonable adjustments to accommodate the student’s needs
• ensuring that the student is provided with the support necessary to implement the details outlined in the diabetes management plan, as agreed during consultation with the student’s parent or carer and the student (where relevant)
• ensuring that for existing students who are newly diagnosed with type 1 diabetes, the student is able to return to school at the earliest opportunity. This requires that the principal makes inquiries to obtain the student’s diabetes management plan, documents and implements the plan in consultation with the student’s parents or carers, and ensures that the necessary education and training for designated staff is undertaken at this time
• acknowledging that it is unreasonable for schools, principals or school staff to expect that parents or carers attend the school (and forego employment) to facilitate the school’s transition to supporting the student or to expect their attendance on an ongoing basis to support the student at the school
• ensuring that the student’s diabetes management plan is regularly reviewed by designated staff to ensure it is current and that inquiries are made with the student’s parents or carers at regular intervals to check whether an updated plan has been developed – and ensuring that any updates are implemented effectively based on the process above
• ensuring that any necessary emergency measures and a diabetes emergency action plan is in place; the details of which should be communicated to all staff so that they aware of the action to take should a type 1 diabetes emergency occur.

Ensure that consent is documented in the management plan

An important part of implementing the diabetes management plan is to ensure that sufficient consent is obtained to render the school’s actions lawful in terms of providing support to the student. This can be achieved by:

• obtaining consent from the student’s parents or carers that allows school staff to provide physical support and assistance to manage a child’s type 1 diabetes and administer insulin
• documenting the consent from the student’s parents or carers in the diabetes management plan and retaining a copy for the school’s records
• ensuring that the consent is specific to what was agreed between the parents or carers and the principal, and details how the student’s type 1 diabetes will be managed in the school environment and by whom – and that this is updated should there be a change in the school staff who support the student
• ensuring that the consent of the parents or carers authorises disclosure of private and confidential information concerning the student’s type 1 diabetes and health needs to other parties including school staff, external agencies (such as the education department or the child’s clinical treating team) and other relevant third parties (such as those providing type 1 diabetes education and training to school staff) so far as is reasonable and required for the effective implementation of the diabetes management plan in the school setting.

Providing training

The training of school staff for the provision of a safe and supportive environment

To ensure that students with type 1 diabetes are safe in the school environment and supported for maximum possible participation in educational and school activities school staff require appropriate education and training about type 1 diabetes management. School principals and school staff owe a duty of care to students and are required to make changes to the usual standard school practices to accommodate the needs of students with type 1 diabetes – these are called reasonable adjustments concerning student’s health needs.

Basic training and awareness – all staff

All school staff should complete Level 1 Introductory training so that they have a basic understanding of type 1 diabetes and how it impacts the lives of students. This training is essential so that any staff member is able to identify when a student requires support, assistance or medical care. All front line staff, including office staff, should receive this basic training. This knowledge is important in ensuring that school staff understand the symptoms associated with a child’s type 1 diabetes including recognising the signs of hypoglycaemia or hyperglycaemia. It also helps normalise type 1 diabetes and reduce misunderstandings to avoid stigma and discrimination. In addition, the training can help with providing the education and understanding that may be needed for the school and for staff members to discharge their legal duty of care.

Principals should also ensure that all school staff are aware of who within their school are the designated staff members so that they know who is able to provide assistance with insulin administration or other support. All staff should also be aware that students with type 1 diabetes will have an individual diabetes management plan which has been agreed between the student, parents or carers, principal and the clinical treating team and that the diabetes management plan may require them to make adjustments to support the student in the school environment.

Training for designated staff

Designated staff members who have been identified by the principal and have agreed to take on the responsibility of providing specific assistance in supporting a child’s type 1 diabetes in the school setting require additional training to carry out those responsibilities. The principal is responsible for identifying designated staff, although teachers and other staff may volunteer to provide specific assistance. If not, the principal will need to ensure that there are staff available to support the student as required. It should be noted in some states, responsibility for supporting student health needs will already be agreed as part of the staff member’s condition of employment.

Designated staff require a higher level of knowledge and understanding about type 1 diabetes and how it impacts on students to enable them to confidently assist with a student’s diabetes management plan and diabetes action plan. This training offered online in Level 2 Intermediate training will include, for example, understanding the monitoring of blood glucose levels, the actions to take in response to elevated or lowered levels, and the safe administration of insulin. Sometimes this may involve the designated staff member administering the injection, but in many cases it will involve helping the student to self-administer insulin.

Training requirements for schools and school staff

Principals should ensure that:

• all school staff complete Level 1 Diabetes in Schools training so that they have a basic understanding of type 1 diabetes and how it impacts on students
• all school staff are familiar with the actions that they must take when students with type 1 diabetes require urgent or emergency assistance due to their health condition
• staff are aware of the people in the school who are designated to provide specific assistance to students with type 1 diabetes and can administer insulin when necessary
• principals should ensure that an appropriate number of designated staff, relative to the size of the school and the number of students with type 1 diabetes, undertake Level 2 Diabetes in Schools training to assist with supporting students with type 1 diabetes.

Communication and managing relationships

It is important that the school staff, parents or carers and clinical treating team are able to effectively communicate and come to an agreement about what needs to happen at school in terms of supporting a student with type 1 diabetes. This includes the process of implementing the student’s diabetes management plan, making reasonable adjustments and keeping parties updated when there are changes. In some cases, it may not always be possible to reach an agreement on all of these aspects.

If there is a disagreement that cannot be resolved between the child’s clinical treating team, parents or carers and the school’s leadership it may need to be escalated to more formal mediation processes.

Most state and territory Departments of Education, Catholic Education Commissions and Independent School Associations have formal processes to escalate disagreements between parents and schools. Schools and parents are encouraged to use these existing education-based processes to try to come to an agreement on what is needed to support the student.

Additional information

The Diabetes in Schools website contains links to other useful resources from other diabetes organisations from across the country.

In addition, guidance about supporting students with health conditions may be available from Departments of Education, Catholic Education Commissions, Independent School Associations, Diabetes Australia State and Territory organisations in your state and territory.

The Diabetes in Schools program provides three levels of training to independent, catholic and public schools.

All school staff are required to have a basic awareness of type 1 diabetes and know how to recognise the signs of emergencies such as hypoglycaemic episodes. Additional training for designated staff is available face-to-face or online.