Laura Thompson (00:21):

<Silence> Hello everyone and welcome to our webinar today. My name is Laura Thompson. I’m the marketing manager here at Health-e Pro. And today’s webinar I’m really excited about. We are leaning into the theme with Halloween of From Scary to Clarity, A Guide to Allergy Friendly Menus with our friends here at Nourish Partners, Lisa Woodbury and Angela Gomez. So we are so excited for this today. We have gotten a lot of questions over the last few years around when we do these webinars. We have a survey at the end asking, what are some topics you would like to hear about? And so with that, we’ve gotten a lot of questions over the years that can you tackle something with allergies? And so that is what we are doing today. And when we were introduced to the folks at Nourish Partners, we were thrilled that they have such competence and confidence in this area.

Laura Thompson (01:08):

And we’re really excited for this webinar today. So for a little bit of housekeeping for starters, this webinar is going to be recorded. So if you have to leave or if you wanna pass this along to a colleague this will be sent to all registrants in an email that will come tomorrow. So it’ll have a landing page that will have the recording, it will have the slides. Eventually, we’ll get the transcript transcript up possibly next week, as well as some resources that are going to be shared in this webinar today. If you have any questions, and we will have a q and a at the end of this webinar. For the last 15 minutes or so, please put the questions in the q and a at the bottom of your screen. Also, if you want to give us any feedback for the webinar or a topic you would like to hear for a future webinar, please take that survey at the end so we can get some feedback of what topics are interesting to you and would be helpful for you in your job.

We’re also going to post at the end of this webinar a link to our next webinar, which is going to be November 18th with David Dowling. He’s coming back for round two last time he spoke on conflict resolution. So we’re gonna post a link to that at the end of this webinar in case if you want to register for that. So that covers any housekeeping things. Again, if you have any questions, put them in the q and a box at the end. And Angela, I will pass it along to you now.

Angela Gomez (02:28):

Thank you so much, Laura, and good morning or good afternoon from wherever you’re joining us from. I just wanted to give you a warning that Health-e Pro team had this great idea to do the Halloween theme and we ran with it. So it’s gonna be corny but fun. We don’t take ourselves too seriously, so we hope you enjoy it as much as we did building it. So my name is Angela, not normally abnormal Angela, but just for Halloween I’m a Registered Dietitian who specializes in school nutrition. I’m a second career Dietitian and I’ve been a menu planner my entire career. I’m going on eight years of being in school nutrition. I’ve been in big districts, small districts. I’ve been on the industry side of things as a consultant. And now I am back in the school district as a nutrition and wellness supervisor with Alhambra Elementary School District in Phoenix, Arizona.

Angela Gomez (03:27):

So this is Lightning, Lisa, and unfortunately she wasn’t able to to join us today, but she did help build this. She is the owner and a Dietitian, a Registered Dietitian as well who specializes in K-12. And she’s the owner of Nourish Partners. So today’s objectives are to implement practical tips for reviewing medical statements, to understand strategies for creating appealing menus for special diets or meal modifications, and to learn ideas to, for supporting students and families with empathy, not just paperwork. This is a really rough agenda. We’re gonna be going over special diet scaries, incomplete medical statements, no diagnosis on the medical statement, no medical statement, texture modifications, multiple unsafe foods when an accommodation is no longer necessary. And then general special diet scaries. So in the chat box, I wanna know what spooks you the most about special diets, AKA meal, modifications, and hopefully we touch on some of the things that spook you the most. But I really wanted to see what scares you the most and help us out.

Angela Gomez (04:46):

Untrained staff. Yes. Staff not following special menus properly. Yeah. Not receiving substitutions, making sure the food item is safe. Hidden ingredients. Yes. No cross contact mistakenly given an allergen. Not reading labels. The reactions to the allergy is really scary when you don’t have clarity. Yes, the amount of special diet types. It can be, it can be a lot providers changing ingredients without notifying us. Yes, yes. A child getting sick due to a miscommunication. You all, you all are putting in such good ones and are, are really spooky to me as well. And some of what you mentioned, from my experience, guesstimated <laugh> what you all might say on this screen, and you all have covered a lot of it. Thank you. Thank you for jumping in there. Okay, so menus start with medical statements. So at first I’m gonna talk a little bit about medical statements because truly we can’t build that special diet menu without some kind of guidance.

Angela Gomez (05:59):

So again, medical statements are a guide for student safety. They may look different from state to state. So make sure to check with your state agency to make sure that you have everything you need on the medical statement that’s appropriate. Medical statements set parameters for the menus. It indicates areas that we need additional training for our team. They’re a form of written communication for the care team, so other folks on campus such as nurses, speech therapists, etc. And they are documentation for administrative reviews because they allow us to deviate from the meal pattern. Okay, so our first specialized scary is an incomplete medical statement. <Laugh>, I’m laughing because I know so many of us have received these. So let’s talk about one example of an incomplete medical statement. It would be this milk mayhem. So the medical statement says, just avoid milk, but it doesn’t list a safe fluid milk substitute.

Angela Gomez (07:02):

It doesn’t say whether or not to avoid all milk based items like cheese or yogurt. And it doesn’t say whether or not milk in baked goods is safe to serve. So what do you do? The first question for us is always, how can we keep our student the safest, still get reimbursed and not get a finding during an audit? So here’s where we can find some clarity. Do we have written permission to contact the medical provider or does the nurse or someone else on campus? So I know at my current school district in the top half of the medical statement we have where the parent or guardian the family can sign that says that we can contact the medical provider specific for the information on this form. That might be something your state agency will allow you to add. Maybe it’s not allowed in your state, but definitely worth checking out are they an older student who might be able to answer some of our questions. In the meantime, we really wanna speak with an adult, but if in the meantime we can talk to the student or let the student know like, Hey, we’re trying to get ahold of your family. Can you let them know? Or here’s my card, can you have them call us?

Angela Gomez (08:17):

And then another way to find clarity is starting with the strictest safest menu until you get more answers. So usually what that looks like for me is I go to my milk free menu. It doesn’t have any milk in any baked product, it has no milk derived ingredients, and I’m going to give a nutritionally equivalent soy milk, for instance, until I get more clarification from the family. So we have 15 recipes that we put up on Health-e Pro’s Global Database that we’re so excited to share with you. And one of them is the nopales or the cactus tacos. And what I’d like to mention here is that tacos can easily be made without any milk derived ingredients. You can leave off cheese on tacos and you can actually add salsa, which is a delicious milk free ingredient. There are some creamier salsas that some folks might make, but in general, that will bring like more moisture and flavor to the dish, which a milk derived ingredient would do.

Angela Gomez (09:20):

Right? And also with this is you can have beans that go with a taco to meet your Meat/Meat Alternate. Okay, our next scary is no diagnosis on the medical statement. And this is a common misconception that I see in school nutrition. So families are actually not required to disclose the student’s diagnosis in order for us to start accommodating. And you can find that on one of my favorite USDA guidance. It’s their q and a specific to accommodating disabilities and school meal programs. And everything is in plain language, which is my favorite <laugh>. It’s not a USDA memo, it’s in plain language. And it says, when is the medical statement required? And on the highlighted section, it says, the state agency may not require that the written medical statement provide a specific diagnosis by name or use the term disabled or disability. And if it is mentioned on the medical statements, great, but it doesn’t have to be.

Angela Gomez (10:25):

And what’s important to note is that not all students are born with a disability that needs some sort of food accommodation. If students all of a sudden start getting seizures, that can cause regression in feeding skills or require a specialized diet. If a student gets a tick bite and they get alpha gal syndrome they may become allergic to meat, animal fat and or milk. This tick is more common in the, the southeast the of our nation eating disorders can start at any time and might need a meal accommodation. And then trauma induced changes to feeding behaviors can also happen, which might lead to an accommodation.

Angela Gomez (11:11):

Okay? So I wanted to quickly compare perspectives and then we’ll get to the clarity portion of this. So for school nutrition professionals, what might be going through some of our heads, or a lot of our heads is we wanna know the severity, right? That’s why we, we would wanna see what the diagnosis is on a medical statement. We would wanna know if it’s life-threatening or not, right? Like, how serious is this? We’d wanna know what to look for in case the student accidentally ingest or touches their unsafe food or beverage. So symptoms, we want clear, concise directives, but we might receive different information from the family versus what they submit in the medical statement. We wanna know specific substitutes for foods and beverages, and we want answers quickly so we can feel confident in building a menu and serving the student, right? And we want that for our team as well.

Angela Gomez (12:07):

Now, for a student and their family, this might be their, their perspective. On the other side of this diagnosis and medical conditions are very personal due to stigma, bullying and systems not built to support disabilities. There might not be a formal diagnosis yet. Not everyone has access to affordable healthcare or specialized healthcare. Families might be experiencing medical gaslighting inadequate care. They might be going to appointments saying something’s not right, but they’re not getting answers. A family may lack access, again, like I said, to specialized healthcare. And the family might not have reliable transportation or money for multiple copays or even live close to specialized care, especially if they’re in a rural area.

Angela Gomez (12:54):

So all that to say that there’s multiple perspectives in play and implementing these meal modifications can create an additional level of com complexity into operations. There’s no doubt about that. However, we can empower our team to feel confident in our processes, our SOPs, our policies. And while this can feel challenging or scary, just just remember, and I know a lot of us, we have so much compassion in school nutrition, but it’s, it’s nice to just remind ourselves that the family on the other side is likely just feeling as nervous, anxious, and overwhelmed by putting their child’s safety in someone else’s hands. And really the ultimate goal, right, is we want students to feel comfortable and confident eating in our cafeterias. We want the families to feel comfortable and confident in the foods that the children deserve and need access to. And of course, for all of our students, our top priority is student safety and inclusion.

Angela Gomez (13:53):

Okay? So the clarity in this, what are some tangible ways to find clarity in this situation when there’s not a disability or diagnosis listed on a medical statement? This is one of my favorite go-to open-ended question, is what else is important for the food service department to know in order to keep your students safe in our cafeteria? And there’s a lot of times that I’ll find some additional information that was really necessary for me to know just by leaving this open-ended. So open-ended, not a yes or no question, but just a what, how, a why those questions, starting with those words. So again, this opens the door for families to share what they feel comfortable sharing. And this may leave room for you to ask more follow up questions. So definitely check with your state agency. But some examples of some questions that you can ask families if you, if you feel uncomfortable not having that disability or diagnosis on the medical statement, which is not required by USDA, is does your student have any related medications in the nurse’s office? So you might find out, oh, that they have an epinephrine or a brand name of that would be an EpiPen. You might be able to ask, has your student been prescribed epinephrine? And if they have, that lets us know that this is a potentially life-threatening food allergy. And another great open-ended question is, what symptoms occur if your student accidentally ingest or touches foods or beverages that contain this ingredient? Again, giving us that information without having that diagnosis.

Angela Gomez (15:32):

All right! Next scary is no medical statement, which I know a lot of us, a lot of us deal with. So here’s the scenario. You and your team called and emailed with no response from the family, or their voicemail isn’t set up, or you got a busy signal, or sometimes the voice of mailboxes is full, which I’m fully guilty of. No judgment there at all, <laugh>. So what do you, what do you do in these situations? Well, we’re gonna look to USDA for guidance again in that Q and a number 31, it says, may schools claim a meal outside the regular meal pattern for reimbursement while waiting for the child’s parent or guardian to submit a medical statement. The answer is yes. And I highlighted this really important part. USDA says that schools should not unduly delay a child’s meal modification while waiting for the family to submit a medical statement, which I know is tough, right?

Angela Gomez (16:32):

That’s the information we need to build these menus, these safe menus that we wanna build. So how do we find clarity? Do they have a 504 or an IEP plan that you might be able to access from the 504 or IEP coordinator? Does someone else on campus have a good relationship with the family? Can they, can they help us get ahold of them? Sometimes it’s someone at the front office who they see the kiddo being dropped off regularly by their family member. Can they help us out? Can we accommodate while still meeting the meal pattern? And sometimes we can’t. Sometimes it’s easier than other things to accommodate while still meeting the meal pattern, for instance, lactose free and the student just needs a lactose free milk substitute. Lactose free milk is already nutritionally equivalent to cow’s milk. So that could be something that, that we start while we wait for the parent note or the medical statement.

Angela Gomez (17:31):

And can we have a reimbursable meal or a recipe that’s free of the top nine allergens in inventory on site or at the warehouse so that when we find out that that’s what’s going on for the student, we don’t have clarity. We know at least this recipe is free of the top nine allergens. That can look like a shelf stable meal, a grab and go, or some type of salad. So we have an example. This is one of a, this is part of a recipe, one of our recipes, and it’s an apple sauce vinaigirette. And so a lot of pre-made salad dressings, in my experience, I see that they have milk or soy in them. So this applesauce vinaigrette doesn’t, it’s easy nine ingredients and school cafeterias are full of apples and applesauce <laugh>. So readily available ingredients.

Angela Gomez (18:25):

Okay? The next one is texture modifications. And this one makes me nervous even as a, as a Dieititian. Because not only might students come to us with life-threatening allergies or they have a celiac disease, they might also need texture modifications. So here’s our scenario. You receive a medical statement that requires a level three moderately thick texture modification. What do you do? Right? <laugh>. And it’s like level what? Excuse me, <laugh>. So I recommend finding your in real life resources. If you have a campus or district speech language pathologist or an occupational therapist or a nurse that has experience with this, can they share some of the resources that they find valuable? Can they maybe provide training to the team at a manager’s meeting at a back to school meeting or an all staff meeting? Can you ask your team if they have any experience accommodating texture modifications? You know, you might have some, some kitchen managers who have been at that district, at your district for years and they have plenty of experience doing this. Can they support the team? Can they train the team? And of course, you can reach out to a fellow director or Dietitian. Maybe they’re in a neighboring district who, you know, manages text or modifications or do or does this really well. Or maybe it’s a Dietitian consultant or a chef consultant that can support you with this.

Angela Gomez (20:04):

And you can invest in staff training to be proactive. So before you text modification, you can be ahead of the game and have some training on texture modifications. And then I also already mentioned hire consultants got ahead of myself. So these are online resources that have clickable links and we’ll have these links at the very, very end of it too. But the International Dystasia Diet Standardization Initiative or IDDSI has some really user-friendly videos and their slides. But these are some resources that you, you can start with. All right, our next one is multiple unsafe foods. So what do we do with these super restrictive diets? You have this student, they have to avoid milk, wheat, soy, and pineapple. Where do, where do we start with that? So some advice I got when I first started out from my first director that I worked for was literally just ask the family what they eat at home.

Angela Gomez (21:22):

And then on our part we can see what can be turned into school meals. Okay? Are they having like some kind of rice bowl? Oh yeah, easy. We can do the fajita chicken with rice and a salsa and we can accommodate the student. Do they have any go-to brands that they eat at home that you can look into? You can see if, if you have access to those brands, if your distributor does or if you have a nearby store. And you can also find out where they, what stores they get their food from to see if those are nearby for you as well. You can also, like I mentioned previously, start with the most restrictive recipes and menus you already have. And then build the menu from there. That’s always been really helpful to me. So if I have like a milk free and an egg free menu, for instance, and I have a kiddo who needs to avoid milk egg, and I don’t wanna say soy, ’cause soy is a hard one and strawberries for instance, I’m gonna start with that menu and build that individualized menu from there.

Angela Gomez (22:25):

And then also research what’s outside of your distributor if they don’t have those options. Local grocery stores, membership based stores and online stores. Okay, here’s the, here’s my, here’s my more fun tips here that are, have some visuals with them. So before the meal modification you can note which meal modifications your district needs most. At my school district, it’s a lot of, we have a lot more gluten-free kiddos than anything else. So I’m gonna make sure to make a cycle menu for gluten-free. ’cause I know that we’re gonna get those probably new and also we’re just gonna have ’em year round. You can start with more allergen friendly foods during the meal planning process. So when you’re attending food shows, do it with intention. Be like, man, we really don’t have enough soy free. And we have these kiddos that have soy free.

Angela Gomez (23:24):

So having that written down or something. And just ask these vendors at the foods, do you have any of this? Do you have any of that? We’re looking for this. You can meet with brokers and kind of relay that information to manufacturers. I know we recently met with a broker at our school district. We don’t serve pork and frosted mini wheats. I I just found this out. The gelatin in there is actually pork based. So we couldn’t serve that. And so we told the broker like, Hey, we would, we would serve this, but we can’t because we don’t serve pork and there’s pork based gelatin in here. Can you relay that message to the manufacturer? ’cause Maybe if they know that schools are requesting that, then they can make that change. And then of course, before the meal modification, think about your recipes that you’re creating when you’re adding new recipes and how they can be modified.

Angela Gomez (24:15):

And so I have some examples here. Looking to go to an all beef patty instead of a beef and soy patty, if possible, would be an easy way to accommodate our students. We know, okay, it’s all beef or all beef hotdog. It doesn’t have soy. That’s okay for our soy-free kids. Having refried beans without cheese, you’d be able to accommodate more students that way. Having unbred meat, meat, alternate options. So having some grilled chickens or that fajita chicken instead of only breaded chicken. I know the breaded chicken’s delicious. And the kids like that. <Laugh> don’t only take it away <laugh>. We can avoid adding cheese to everything. <Laugh>. Again, I say this, I love cheese so much, it doesn’t love me back, but I really love cheese and I get like, sometimes we just have to throw it on there ’cause it’s, it’s a one Meat/Meat Alternate and we have to do what we have to do, but maybe not all our recipes so that they’re more friendly for our lactose-free kiddos or our kids that have milk allergies. And then also baking with alternatives. And my specific example is baking with egg alternatives. Could be a start. That way you know that these recipes are already accommodating and they’re going on the standard menu.

Angela Gomez (25:31):

Another place to start is with meal components. So these are just some of mine. I’ve already shared some of them. These are some of my go-tos. So some of my go-to grains when there’s multiple allergens or multiple foods that need to be avoided are corn tortillas, corn tortilla chips, rice and quinoa. These are my go-tos. Some makeshift meat, meat alternates. I already mentioned the a hundred percent meat products when we can, our BPLs, our bean peas and lentils, our seeds, our pepita seeds, our sunflower seeds, our nut-free butters, our modified milk options. Of course, we have to go with the milk substitute that is on the medical statement, but I’m starting with lactose-free milk. We get those in, we have those regularly. At the school district, I’m at finding that nutritionally equivalent soy milk, finding a nutritionally equivalent pea protein milk. There was one pea protein milk that was so close and they might have adjusted it to be nutritionally equivalent. Now they may have adjusted, I, I don’t wanna name the brand because I’m not sure <laugh>, but there might be a pea protein milk that is nutritionally equivalent if the kiddo has to avoid milk and soy, for instance. And then we can have clever condiments too. Hummus. Hummus can also be a Meat/ Meat Alternate or a BPL, but we can have it as a condiment if we do quick pickled or fermented foods as a condiment. Salsa, hot sauce, chutney and vinaigrette.

Angela Gomez (27:02):

Another starting place is looking to vegan recipes, which not all of them, but a lot of ’em might have some allergens out of the mix. So if a kid has multiple foods they need to avoid think of we have three potential food allergens here that we can think of. So egg, some vegan substitutes are applesauce or aquafaba, the canned bean juice for milk. No, I wanna explain this one. <Laugh>, I put avocado, but that’s not necessarily like a, a recipe, a baking recipe <laugh> substitute. However, if you have access, if your school district has access to avocado, that can add creaminess. So if we can’t put mayo on a sandwich, for instance, that avocado texture is gonna add that creaminess that mayo has for a student that’s egg free, for instance. And then same thing, nutritional yeast. Again, that’s more of a cheesy flavor that we can add for milk free students.

Angela Gomez (27:59):

And then wheat looking to our corn starch or our rice flour. This year at our school district, we made a homemade Turkey gravy. And my, my request was, can we please not thicken it with wheat flour? Can we do corn starch instead? And of course the kitchen staff knocked it all apart, like, oh yeah, that’s easy. So just thinking of those stuff, that stuff ahead of time in preparation for students who might have multiple allergens. An example we have with one of our recipes is we have this delicious vegan chocolate dip created by our colleague Janelle. And it’s a simple scratch recipe that can be offered on the standard menu, right? So it can be offered on the standard menu and an allergen-free menu. It’s using cocoa powder instead of chocolate chips because chocolate chips usually contain milk. It’s an easy grab and go or a separate option so you can use it on multiple menus and students love it.

Angela Gomez (29:03):

All right, so we got one of these questions submitted to us at registration, which thank you so much. Those are super helpful when you all do that. And Health-e Pro is great. They, they look at those questions and take ’em seriously. So keep doing that for their future webinars. But one of the questions was accommodations are no longer needed. So you had the student who had to avoid X, Y, and Z and now they don’t need to anymore. And that could be because they were trialing stuff to figure out what was going on with a kid. That could be, there are some food allergens that children are more likely to, to grow out of, like milk, for instance. So there’s a lot of reasons that can happen. What we’re gonna do is look to USDA <laugh>. So USDA number 24 says, if a child no longer needs a meal modification, can the SFA stop providing meal modifications without the state license healthcare professionals approval? So USDA says, yes, we can. We do not require that. They do recommend obtaining obtaining written documentation, which I totally do too. I’m like, I don’t care if the parent writes it in pencil on a Post-it and I scan that in <LAUGH> and upload that document. Getting that in writing is, is really important just for us to cover our bases to communicate it with the care team and other people on campus.

Angela Gomez (30:30):

So here’s, here’s where we find clarity in this. I highly encourage you to contact your state agency because they might have stricter or more strict requirements than the USDA. And if they do, please, please, please follow that. And again, ask the family to provide this request in writing, save it for your records, log it, and then inform the family when this change will go into effect just so they know in case in case they’re like, Hey, you know, we told you this like a day ago. It’s like, okay, okay, like we’ll get to it here, right? Just being transparent and upfront about that is, is an extra step. Inform the families is something that I always do. Should anything change, please contact me immediately. Please tell me. I want them to tell me first so that it’s not delayed in getting to me.

Angela Gomez (31:24):

So I usually have them tell me first and then I share that medical statement with them again. I’m like, here’s where you can find it on our website. I’ve attached the PDF I give it to them <laugh> so that they have it. I’m like, should anything change, please let us know. Again, just to remind them. All right, now we’re gonna go over our general special diet scaries, like in the beginning you all listed so, so many. So here’s another question that came up. It’s a very good one that came up during registration and it’s liability statements, right? That is, that is a concern for us. So some possible resources would be a lawyer and your state agency, honestly preferably both to be safest. So does your district or organization have access to a lawyer where you can ask them this, this very specific question and even be like, Hey, this is the statement we drafted up.

Angela Gomez (32:22):

Is there anything that we need to modify? Is there something else we need to have on our website? If you have access to a lawyer, fantastic, please, please utilize them. I feel like child nutrition probably doesn’t utilize in general the lawyer as much as like other people in the district do. So let’s take advantage of that if we can. <Laugh>. and then your state agency, can they review statements on your menus? Do you, are you in contact? Do you have like an amazing rep? You’re like, please, can you review this? Or maybe the state agency has examples from other schools in your state that they can share with you to help you with ideas. One statement that I put on our menus is based on the information provided by manufacturers. This menu does not contain any blank containing ingredients. So that’s just me letting the family know, like this is as up to date as we can possibly be given the information that we have.

Angela Gomez (33:22):

Again, lawyer and state agency though, I just didn’t, I just wanted to give you <laugh> an example that I, that I utilize. All right? Food and money waste. So sometimes when we’re thinking of these really restrictive diets, we’re also thinking of the waste that there might be, or they might go bad really soon. So looking for shelf stable or non-perishable items. Again, when you’re at the food shows, looking for those being really intentional. If you’re doing some more speed scratch or scratch cooking, you can test the recipes for freezability, which I put in parentheses ’cause I don’t, I don’t know if that’s a word. Okay, <laugh>. But if you test the recipes for freezability place the item that you get that’s working for a student with multiple foods, they have to avoid, place it on the standard menu, place it on the salad bar place it in your supper menu.

Angela Gomez (34:18):

So use that, that product or that recipe multiple times as many times as you can. And then sharing is carrying of course. Can you split cases between sites of food? So stuff isn’t, so food isn’t going or beverages aren’t going bad quickly where it’ll be wasted. Another question that comes up a lot is natural flavoring and spices. Gosh, I wish they did this differently. I’m with you. This is confusing, I don’t like it. I wish I could change it. If FDA’s listening, please, please change it. Alright, so if the natural flavoring or spice contains any of the top nine allergens, they have to list it in the ingredient list. So if it is intentionally added, they need to put it on that ingredient list. And the example shows the two ways that manufacturers get to choose to put that on the ingredient list. They can put natural flavoring and then in parentheses put wheat.

Angela Gomez (35:18):

Or the other way they can choose to do it is have natural flavoring listed in the ingredient list. And then after the ingredient list it’ll say contains wheat. Those are two ways they can do it. However, it gets a little sticky when a student has an allergen outside of the top nine. If they have an allergen out outside of the top nine, you just might get natural flavoring and spices and not know what that is. An example of that that I ran into this year was pectin. I have a student that has to avoid apples and grapes and I saw an item and it had pectin and I was like, what is pectin and what does it mean out <laugh>? And I did some research and it can be made out of citrus or apples. So it’s not gonna say contains apple in that statement because apple is not one of the top nine allergens. So if that happens, you need to contact the manufacturer and see what the ingredients are. If you’re having trouble with the manufacturer, our brokers and distributors have these great relationships with manufacturers and so lean on them, lean on them and say, Hey, I really need your help with this. And I, I kind of need a ASAP to support the student.

Angela Gomez (36:33):

Okay, this is another thing. I keep forgetting to share this, but it’s a consumer’s dictionary of food additives. I like this book because it tells me what foods are made out of or ingredients that I don’t know. And I like having this resource in addition to the internet <laugh>, but I like having this resource on hand because some of the resources that, that I’ve been going to lately have changed or the links don’t work anymore. And so that makes me nervous. And so having this consumer dictionary food additives is really helpful. And Laura dropped in the chat. There’s a new book and you can also find used versions of these books too. I think I got it used. It wasn’t too bad. I think it was like under 10 bucks. Another thing is coconut is it a tree nut, is it not <laugh>? Well, FDA was classifying it as a a tree nut, but it is, it’s a fruit. So it’s not technically a tree nut. FDA was doing that, they stopped doing that. This this January. And so it’s not, it’s not a tree nut anymore. However, I still recommend confirming with the family or the medical provider if a tree nut student can be served coconut. I just think it’s a best practice to, to do. And this is such a recent change.

Angela Gomez (38:00):

The other big one is soy oil, which seems to be in everything and soy less than and soy allergies. So FARE. One of my favorite, favorite food allergy resources of all time that they’re the food allergy research and education nonprofit. They say that highly refined soy oil is not required to be labeled as an allergen. So that’s why you’ll see a lot of our products that we serve as soybean oil, but it doesn’t have contain soy. A contained soy statement or parentheses soy, because it doesn’t have to be. And studies show that most people with soy allergy can safely eat highly refined, strong emphasis on highly refined soy oil as well as soy lecithin the soy oils that folks with the soy allergy have to avoid Are the cold pressed expelled or extruded soy oils, also known as gourmet soy oils. I always ask the family or the medical provider if soybean oil and soy lecithin are safe to serve.

Angela Gomez (39:05):

I always get that clarity for them. I document it, I document their answer as well the date, the time I spoke with them. But if they have to avoid soybean oil, soy lecithin, they’re gonna have a lot less choices. And I also share that with the family, like, hey, great, we can accommodate this, but now this might be like a one week menu cycle for your student. You know, just, I just like to be upfront so there’s less surprises and that families know that we’re doing the best we can with what we have.

Angela Gomez (39:36):

Another one is wheat-free and gluten-free. These are not, these are not the same. And I wanna save enough time for questions. So I’ll, I won’t read everything on this table, but what I wanna emphasize is a gluten-free product is a wheat free product. I’m taking a pause so we can process that <laugh>, but a wheat free product is not a gluten-free product. So gluten is a protein that’s found in wheat, rye, barley, I never know how to say this word. And I have celiac should know, triticale <laugh> and other cross breads of these grains. So that’s why a gluten-free product is a wheat-free product, but a wheat-free product is not a gluten-free product. So really important to note.

Angela Gomez (40:20):

So here we have a gluten-free menu that I made a cycle menu for this school year for the Alhambra Elementary School District that I just wanna share with you. Again, someone at registration asked for a menu example, which I think was a great request. So a couple things I wanted to point out to you is for this gluten-free menu, unfortunately I was only able to do a one week cycle for breakfast. We do breakfast in the classroom for all our sites and we only have one day a week where we’ll do something hot. And so it’s hard to find some cold gluten-free options that are out there. At least for me and what I had access to, however, I was able to do a four week cycle for lunch, which I always get really excited about when I’m able to give these students a need accommodations, if I’m able to give them like three or four weeks of different food items, I am jazzed.

Angela Gomez (41:13):

I’m not kidding. <Laugh>, I get so excited about it because no one wants to eat the same thing over and over again. You know, well some people do and that’s okay, but I want these students to have an option <laugh>. Okay, I also wanted to emphasize that I have gluten-free specific recipes in here. This one is, sorry, it’s small. Oh, I did the gluten-free chicken tenders with mashed potatoes and the gluten-free homemade Turkey gravy instead of the popcorn chicken bowl. So again, it’s similar items that are on the standard menu and it’s a gluten-free safe version, but also I have standard menu recipes on here on the same day that they’re served for the standard menu. So this one is our chicken pozole, which is delicious. It’s homemade by the way. We’re doing that Thursday. It’s so good. Our chicken pozole is served with corn tortilla chips and that’s on the standard menu and available for our gluten-free students and a lot of our other students who have other foods they need to avoid as well.

Angela Gomez (42:17):

Okay, really quickly, we had this great question come through and I thought it would be best to throw it out to the group because we all have knowledge to share, we all have experience in school nutrition. And so I wanna know, how do you currently identify your students with meal modifications as they go through the line? And while you all drop that in the chat right now, I’ll share what we do. So we are completely CEP, so all of our students eat breakfast and lunch for free and we still have students scan. So we have students scan their IDs and then a popup will come with an alert. A neighboring school district told me about this idea. And I like this site. It’s part of their part process that the nurse walks the student down to meet all the, the cafeteria staff as an extra precaution.

Angela Gomez (43:15):

So that might be really good if you don’t have pictures popping up on your screen and kids scanning in. Someone has a small student population, so I generally don’t like to make assumptions, but I’m gonna assume that with a smaller student population that staff knows the, the students extra, extra well. POS alerts. Yes. Small school as well. Pin numbers entered. Yeah, pop up on the POS. Yeah, so very similar. So I’m seeing use utilizing the POS for popups with a scan card or a student pin. I’m seeing just knowing our students really well, which is really, really one of the best things honestly, on campus. We are one of the ones that know our students. Most of the students on campus really, really well already. Someone has a sheet for each grade that identifies the student and the diet they need at the serving line.

Angela Gomez (44:11):

That’s great. We also have a special diet folder that’s a teal folder that we put together that has information, information for students. Wow. Thank you so much everyone for, for sharing. There’s some great tips and tips in there. Thank you so much. Okay, so we’ve moved through some, just some of our special diet scaries now what, so we’re gonna launch a poll here and please if you can, this is voluntary, of course, <laugh>, this is not your final grade, it’s not a quiz number one through seven. We wanna know which one do you wanna focus on. And so it would be creating a special diet cycle menu focusing on one area of special diets to train on the school year, improving communication with families, updating special diet policy procedures and or SOPs, auditing those policies, procedures and SOPs or trying at least one of our 15 recipes and Health-e Pro’s global database. Just go ahead and select that poll.

Laura Thompson (45:18):

We’re gonna leave it up for a few more seconds. We’re getting a lot of responses coming through. It’s fun on my end. I’m seeing the numbers and I’ll share them here in a minute.

Angela Gomez (45:25):

I know I’m just eagerly waiting on my side. Laura, just eagerly waiting. I love to see poll results. Another, another goofy thing I like to do.

Laura Thompson (45:34):

<Laugh>. All right, this is fascinating. Okay, I’m going to go ahead and end the poll now and then we’ll get to go from there.

Angela Gomez (45:43):

What are the results? Okay, awesome. Okay, so the most are create a special diet menu cycle with 39% the next highest at 20% updating special diet policy procedures and SOPs. And then the third top one is try at least one of our 15 recipes in the Health-e Pro Pros global database. Thank you for that one, y’all <Laugh>. Thank you. Awesome. Okay, so now based off your answer, I wanted to share the resources that compliment your answer here, <laugh>. So in the chat you’ll get dropped links to this. So what we did is we took our 15 meal modification or special diet recipes, and I created a one week breakfast or lunch menu cycle or gluten-free, egg free and milk free that you can take a look at. Here, thank you so much, Laura. So the first one that got dropped was the one week egg free menu.

Angela Gomez (46:46):

And then I just wanna note on this, and some of them I gave like a general, like gluten-free bagel with cream cheese. I, I’m leaving it up to you all and what you have access to to find out, but it was just to give you an idea if I didn’t have a recipe in place. Thank you so much, Laura. Okay. If you selected training or number two, one of my favorite handouts that I have in that folder is tips for avoiding your allergen. And this is from FARE and it’s in English and in Spanish. And FARE actually has a lot of resources in both English and Spanish and then other languages as well. Love this. It talks about like for instance, if someone’s on a wheat free diet to look for something, if it says bulgar in the ingredient list, then the student can’t have it.

Angela Gomez (47:36):

Love this resource. Thanks for dropping it in the chat, Laura. The third one is a lactose intolerance tip sheet, and this is to help with improving communications. So the first page of the lactose intolerance tip sheet that we created here at Nourish Partners talks about that. A lot of folks get mixed up with lactose- free and a milk allergy. And then the second page is some like family follow-up suggestions and then some internal notes of like, okay, what, what milks do we have on hand that you can utilize the other resource if you’re looking to update your special diet policies, SOPs, FARE, we release this resource Food Allergy management in schools. It’s super helpful. I love this. If you released it like a year or so ago, it’s one of my go-tos. And then if you wanted to audit your current policies and procedures, we have this policy audit worksheet that we developed at Nourish Partners that you can kind of walk through and get inspired to please add to, to look at what you need, what’s missing or what could be better.

Angela Gomez (48:47):

And then of course we have the 15 allergen friendly recipes. So we put this on a one pager, PDF, and you can click those recipes and it’ll take you to directly where they’re at in the global database. All right, these are the training topic codes. This is Ms. Leeza who we missed on this webinar, but this is how you can contact her. She is the owner and founder of Nourish Partners. Nourish Partners is most active on Instagram and LinkedIn, so you can find us there as well. This is me, my face again. And these are our Instagram handle and Facebook handle that you can use your phone to, to get to the QR code. And it’s Alhambra Elementary School District. And so it’s AESD Child Nutrition. All right. Questions? Questions. What do we have? Alright.

Laura Thompson (49:41):

Thank you so much for all of that fantastic content. I know as we were working on this webinar together and I was seeing these, I was like, this is jam packed with good stuff. So I know that there are a lot of links that we’ve been dropping in the chat. These links will also be available in the slides that will be made available tomorrow in the email that comes out to you. So let’s, let’s tackle a few of the questions. I know we got a lot as people were registering, they were able to submit questions as well as some that we’ve been getting in the Q and A so far. So if you have a question, feel free to put it in the q and a and we’ll start tackling some of these. And also just a quick note, I do believe freezability is a word. I know I use it all the time, so I’m gonna go with yes, it is a word. Oh

Angela Gomez (50:20):

My gosh, you, you, hold on, Laura, you use it all the time. How do you use it?

Laura Thompson (50:23):

Yeah, because I I meal prep and free stuff all the time. Okay. <Laugh>, is this a freezability kind of issue here? Does this, is this recipe going to work with freezing it? So I do use it all the time.

Angela Gomez (50:32):

You heard it here folks. Laura’s a freezability. We’re an expert.

Laura Thompson (50:35):

Bring it.

Angela Gomez (50:36):

I’m good. <Laugh>.

Laura Thompson (50:37):

Bring it on. All right, so this was one question that came up when you were talking about documentation and getting the right forms and all of that. And the question is, what if the family says the child needs accommodations but will not turn in the form? What do you do at that point?

Angela Gomez (50:51):

Yeah, so that’s a tough one. And technically like we can’t force anyone to turn in the form <laugh>, just like we can’t do it with meal applications. So I would document, document as much as possible, your communication with the family, any emails, phones, again, the date who they’re speaking with. I would also tag in your state agency and see, hey, like how do you want us to handle the situation so that they can give you the best information? So also so they know that if you have an administrative review coming up and they see that you’ve made all your your best efforts. Some other things that I’ll do is I will remind. Folks maybe at the end of the school year, like, Hey, here’s the form again. When you go to your doctor for the annual visit, you know, here you go. Like a gentle, a gentle nudge. And then the other thing we can do is if we can meet the meal pattern, even if it has to, if we have to do, you know, only a two week cycle or something, if we can meet the meal pattern, then we can still get reimbursed without that medical statement.

Laura Thompson (51:57):

Awesome. That is very helpful. Thank you. This is a great question that just came through that I know I was thinking about it as well when you were talking about the different milks. Can you talk more about nutritionally equivalent milk? We just order soy or almond milk cartons when they need a substitute?

Angela Gomez (52:14):

Yes, yes. This is a great question. So I think I always get confused if it’s nine or 11, there’s nine or 11 nutrients in cow’s milk and USDA has this chart and the milk substitute has at a minimum to meet the same nutrient requirements of that cow’s milk has. I wish I had it. I I know, I know I can find it if I search for it real quick. Maybe in, in a search engine, if you put in nutritionally equivalent milk substitute, I usually put in like USDA NSLP in there as well. You might get it that pops up so you can see that table. But the milk has to meet the minimum of what’s listed on that table in order to be considered nutritionally equivalent. I can tell you that I have not seen an almond milk that is nutritionally equivalent. Doesn’t mean it doesn’t exist, but for instance, a nutritionally equivalent milk has to have at least eight grams of protein per one cup and almond milk i, I know generally doesn’t have that. Soy milks are usually close. But I have had some instances where soy milk didn’t meet it for all the nutrients.

Laura Thompson (53:31):

Right. Thank you. Welcome. Here’s another question too. And I, I know I’ve seen this come through in, in various forms and I’ve seen it in other places over the years, but if you’re starting to get these medical statements and you’re feeling overwhelmed, what is the first step you take so that you’re less overwhelmed and you’re like, okay, at least I’m moving in the right direction. What’s the first thing you would do or recommend someone to do so that they’re not as overwhelmed with all of this that they’re trying to tackle?

Angela Gomez (53:55):

Yeah, I hear you because this is me at the beginning of every school year when these come flooding in, especially like the preschool kiddos and the, sorry kiddos. So I’m with you. And what I do to kind of ease my mind is over the summer if you, if you work in the summer, I try to get some of the cycle menus mapped out before I get those students. So I’ll get a gluten-free cycle menu, a milk free cycle menu, maybe an egg free cycle menu. And I spend my summer making sure that I looked at all those ingredient labels again, that I have those menus ready. So then when I start to get those medical statements that that’s one less thing I have to do. Now it doesn’t help with like individual student menus. Well not directly, indirectly it does because if you have an individual student menu that you need to make but you already made the milk free menu cycle and that individual student needs to avoid milk and egg, well half of your work is done for you because you already have reviewed the milk free items. Now you just need to review ’em to see if they don’t have egg. So just kind of prepping in the summer would be one of my tips to start with.

Laura Thompson (55:06):

That’s a really fantastic tip. Thank you. Here’s another question that I think is a really good one. It’s what type of training do you provide your staff and do you have specific training resources for staff trainings?

Angela Gomez (55:19):

Yes. Yes we do. So this year I was very intentional about using that summertime <laugh> to plan out for each of our managers meeting our monthly managers meeting. I have topics that I wanna hit. So I started out with food labels first. In September I did lactose free versus milk free. And then with that they have their teal binder where I have added fair resources. It’s a lot of FARE resources honestly in there, FARE resources and then any resources that I’ve made that are specific to our students or our community making sure I had ’em in English and Spanish so that all staff members can read it and process it in the way that works best for them. That was some of what I did. I don’t know if I fully answered the question ’cause I started going off, but <laugh>

Laura Thompson (56:13):

<Laugh>. But I think that’s very helpful just to know what are some of the sources. And I’m sure from looking at those sources you can find others as well. So thank you for that. Yes. just as a note too as well, if you’re looking in the chat, there are links for professional development certificate for this webinar that Tyler dropped in a few minutes ago, as well as a link to the next webinar if you would like to join that next month on conflict resolution. Here’s another question that came through that I’m intrigued by and it goes back to the documentation question. Can school nutrition use the form that is turned into the school nurse that is from the doctor? Or does it have to be a specific document for school nutrition?

Angela Gomez (56:51):

Yeah, this is a great question. So for us in Arizona, we can accept a parent note if the student needs a substitute for like lactose free milk, we can accept that that’s acceptable. However, if it is anything else, it has to be the medical statement. So I would say it’s going to be a medical statement and whatever they submit to the nurse, please save and keep that for your records. Most definitely. But USDA requires us to have a medical statement again, if we can get one, but whatever document documentation you receive, especially when it’s in writing, please save that.

Laura Thompson (57:33):

Awesome. Well Angela, this has been absolutely fantastic. I echo many of the comments that we’ve been seeing in the chat that this has been very helpful. It’s been amazing. I’m echoing again, other comments. There was so much density and so many resources in here. And again, these links will be shared in these slides that will be provided in the email that goes out tomorrow. So if you’re feeling like you’re missing some of the links, you’ll be able to get to them. And again, thank you so much Angela and thank you everyone for coming and sharing your questions and for submitting the questions when you registered. ’cause It helps us know what, what would be helpful for you, how can we help provide resources that make your job easier. And thank you so much Angela and our friends at Nourish Partners. And if you have Health-e Pro, we now have 15 allergy friendly menu or recipes, excuse me, in Health-e Pro in the global database that we would love for you to check out. I know they looked really good to me. I also know I really wanna try the apple sauce vinaigrette. That just sounds awesome. So thank you so much everyone for joining us today. We are thrilled you are here. We hope you got a lot of resource and value out of it. And thank you so much everyone.

Angela Gomez (58:36): Yes, thank you so much.

Laura Thompson (58:39): Thank you. See you next time.