School Food Standards

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School Food Standards

• Willow Dene School Case Study
• 19th March 2008

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School food standards 19-3-08

• Willow Dene
• Large primary generic special school
• Current roll of 168 of which 40 have ASD 20
  PMLD/complex medical needs and 40 SLD/MLD
• Significant number of children with feeding
  difficulties gastrostomy or naso-gastric tubes
• Large staff group 29 teachers 71 teaching
  assistants health care assistant 28 lunchtime
  support staff 4 outreach projects large school
  based therapy and nursing teams
• 53 free school meals 52 ethnic background

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School food standards 19-3-08

• Aim of project
• Improve the quality of food available to children
  across the school
• Healthier options at lunchtime
• Healthier options for snacks/morning break
• Improving developing eating and drinking
  programmes for individual children
• Extending diets of children with ASD
• Training staff in eating and drinking routines
  and the use of specialist equipment
• Involve staff, children, parents, other
  professionals in audit and development throughout
  the project
• Since developed to take account of food standards
  new standards

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School food standards 19-3-08

• Position When we Started
• Pre-prepared, processed school meals
• Salad bread available everyday
• Puddings and limited availability of fruit
• Biscuits crisps and other high calorie snack
  foods used predominantly for morning breaks
• Juice drunk rather than water not all classes
  had easy access to drinking water
• Children eating unbalanced packed lunches own
  and school packed lunches for educational visits
• School fruit vegetable scheme in place
• Some individual eating drinking programmes in
  place member of SaLT team dysphagia specialist

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School food standards 19-3-08

• School Lunches
• Identified member of senior leadership team to
  oversee all aspects of food provision across the
  school
• Whole school audit school lunches packed
  lunches snacks and drinks
• Introduction of Jamie Oliver menus fruit and
  yoghurt for pudding
• Introduction of photographic menu planers and
  menu cards
• Set up data base of individual pupil medical and
  dietary needs
• Developed a whole school food policy

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School food standards 19-3-08

• Involved children, parents and other
  professionals in the audit, drawing up the policy
  and development of project
• Staff training practical food awareness food
  hygiene and food safety nutrition and diet
• Heated packed lunch survey, leading to guidelines
  and staff training to ensure compliance with
  health safety regulations
• Opted not to have vending machines or tuck shop
  at this point in time
• Continued with fruit scheme

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School food standards 19-3-08

• After a while became clear that the new menus
  werent meeting the needs of all children
• Cycle of menu monitoring monitoring of
  childrens food choices introduced
• Meetings held with cook and catering manager to
  look at survey/monitoring outcomes
• Menus altered and some choices removed e.g. fish
  dishes, and replaced with option children would
  eat
• Monitoring highlighted a number of difficulties
  with food needing to be pureed or mashed for
  children with PMLD
• Involved Speech Language therapy team
• For 2 weeks SaLT and school staff ate school
  lunch options and experimented with puree and
  mashing

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School food standards 19-3-08

• Established menu of foods suitable for children
  on puree mashed and soft/solid diets
• Menu cross referenced with childrens individual
  eating/drinking plans
• Continuing with 2 week programme of menu
  monitoring each term each term has a different
  focus e.g. taste texture last term balance of
  food groups this term
• Reviewed individual eating/drinking plans and
  made more easily accessible by writing them up in
  the format of place mats e.g.

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School food standards 19-3-08
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School food standards 19-3-08
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School food standards 19-3-08

• Multi-Professional Involvement and School Based
  Clinics
• Involved SaLT at an early stage information
  given to other services including nursing team
• Nursing team provided information to and had
  access to data base of medical needs and dietary
  requirements
• Rolling programme of school medicals with
  community paediatricians and contact with
  dietician
• Discussions with nursing team team manager
  about the structure and functions of the team in
  school
• Set up system whereby each class has a named
  member of the nursing team as a link nurse and
  each member of the nursing team took on an area
  of specialism nutrition/healthy living
  epilepsy infection control continence
  respiratory issues

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School food standards 19-3-08

• Healthy living Sue Ward
• Sue had dinner with every class in the school
  familiarisation and identification of individual
  children for support and general issues raised
  profile of self and healthy eating input into
  menu monitoring
• Children weighed as part of school medicals
  identified children requiring support/intervention
  
• Established ½ termly Healthy Eating and
  Enteral Feeding clinics at schools
• Healthy Eating clinic deals with children who
  present as overweight or have difficulty
  moderating their eating e.g. restricted diets
  which are impacting on health/lifestyle
• attended by paediatrician Sue parents school
  staff and other professionals as necessary
• Mail shot to parents/school staff

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School food standards 19-3-08

• Children referred via school medicals parents
  can self refer school staff able to refer
  children to clinic
• Identified children for first clinics contacted
  parents
• At clinic discuss issues look at eating
  patterns agree diet plans regularity of weight
  monitoring incentives advice for parents and
  staff provide information about
  nutrition/healthy eating and lifestyle
• Sue follows up each child 6 weeks after their
  clinic appointment to ensure everything is on
  track provide encouragement, further advice and
  information as necessary (e.g. cookery classes
  prompt sheets)
• Clinic is over-subscribed and very popular
• 100 positive feedback and good success rate

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School food standards 19-3-08

• Enteral Feeding clinic also established - deals
  with children who are enterally fed underweight
  refusing to eat or have restricted diets
• Run by dietician and Sue attended by parents
  school staff and other professionals as necessary
  
• Clinic is over-subscribed and very popular
• 100 positive feedback and good success rate
• Positive benefits to clinics being run at school
  less stressful for parents and children
  children missing less school time regular
  multi-professional input for staff available for
  quick consultation advice problems solved
  quickly
• Clinics specialisms lead to professional
  development opportunities staff feeling more
  valued and better relationships

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School food standards 19-3-08

• Snacks Drinks
• Also worked with staff to improve variety and
  healthiness of morning snacks and drinks
• Reduced use of biscuits and crisps increased use
  of fruit including dried fruit such as raisins
• Some classes are trialling healthy options no
  biscuits or crisps introduced healthy savoury
  snacks e.g. go ahead cheese triangles fruit
  squeezers smoothies pureed fruit and
  vegetables soups organic/ no preservatives
• Using organic juices and cordials fresh juices
• Improved access to fresh drinking water
  available al the time for staff and children

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School food standards 19-3-08

• Curriculum
• Long term curriculum map written with PSHE at the
  core. Focuses on daily personal care and
  independence skills schemes of work include
  choice making, relationships and healthy
  lifestyles
• Planned schemes of work across the curriculum
  linked to healthy eating, balanced diet, food
  preparation, the design and making of healthy
  meals and opportunities to learn about different
  types of foods
• Increase in amount of physical activity
• Environment
• New dining furniture
• Filtered water taps in each staffroom
• Displays relating to food and healthy lifestyles
• Better cleaning cleaners and kitchen staff

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School food standards 19-3-08

• Staff training
• Delivered extensive and ongoing staff training
  programme
• practical food awareness food hygiene and food
  safety nutrition and diet
• dysphagia training delivered to all staff
  (including midday staff) by SaLT
• training for class teams to meet individual
  childrens needs
• rolling medical training plan e.g. gastro feeds
  now done by class staff so children not removed
  from their peer group for feeds sit with class
  at lunch time and majority have oral tasters at
  same time
• diabetes day with PCT and borough staff
• ASD nutrition and diet

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School food standards 19-3-08

• Other developments
• Enteral feeds carried in regular lunch boxes.
  Boxes provided by school, are chosen by and
  belong to individual the individual children
• Have purchased an assessment kit for eating and
  drinking so are able to try out different
  things quickly
• Have set up a dedicated central budget for
  equipment needs able to purchase items needed
  for individual children quickly and efficiently
  once they have been identified and approved by
  therapists
• Set up system for staff to raise concerns about
  school dinners and link member of the admin team
  who liaises with the cook and maintains the data
  base of individual dietary requirements (dairy
  gluten free allergies special diets e.g.
  ketogenic diet etc)

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School food standards 19-3-08

• Promotion/Communication
• Healthy school section of the newsletter and
  dedicated healthy schools newsletter letters
  to parents
• Notes in Home School Contact Books phone calls
• Special certificates
• Standing item on 6 monthly individual child
  multi-disciplinary meetings, annual reviews and
  parents evenings
• Healthy eating drinking displays in classrooms
  healthy meals this is me, this is what I like
  to eat
• Displays for parents evenings
• Presentation by lead staff and parent at PCT
  training day on children with complex eating
  drinking problems

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School food standards 19-3-08

• Where next?
• Looking at portion sizes and quantity (as well as
  quality)
• Further review of special menus finger foods
  vegetarian options halal diet
• Review and extend range of fruit offered
• Ongoing refinement of menu choices e.g. meat
  curry and vegetable curry on same day
• Puree lessons for the new cook
• Growing and sourcing local organic food
• With dietician have started to look ways to boost
  calorific intake for children who are calorie
  deficient without going back to cake and
  custard e.g. through the use of oil and cream

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School food standards 19-3-08

• Sourcing healthier sauces and dressings organic
  and no additives alternatives to Heinz ketchup
• Trialling the use of gadgets e.g. to puree raw
  fruit and vegetables children to chew solids
  without the risk of aspiration
• Ongoing awareness raising, monitoring, staff and
  parent training
• Cookery lessons for parents
• Cookery book in collaboration with Extended
  Schools Cluster group
• Nutrition and diets for children with ASD
• Healthier packed lunches
• Money it is definitely more expensive!

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School food standards 19-3-08

• Successes
• Children eating more on a daily basis less food
  wastage more healthy diets at school and at home
• Children are more willing to try different or
  unfamiliar foods
• Childrens stress and anxiety around mealtimes
  have been reduced less disruption noise levels
  have reduced more social and communication
  skills used
• Better environment cleaner new furniture
• Improved relationships and collaborative working
  with catering staff school staff parents
  therapy and nursing teams
• Positive feedback from parents
• Children have become more independent and
  responsible around mealtimes e.g. helping set up
  taking specialist equipment and communication
  aids clearing and maintaining the environment
  providing feedback

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School food standards 19-3-08

• Successes!
• Brett

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School food standards 19-3-08
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School food standards 19-3-08
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School food standards 19-3-08

• Billy
• ASD and SLD
• When he started at Willow Dene Billy only ate a
  specific brand of shepherds pie
• When new menus started staff gradually introduced
  small amounts of different foods, encouraged
  tasting and rewarded all efforts
• Billy now eats anything and everything in large
  quantities
• Mum followed the same programme at home once we
  had achieved some success in school
• Family are delighted with progress
• Mum part of Healthy Schools external moderation
  day

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School food standards 19-3-08

• Katherine
• Retts Syndrome
• Extremely overweight
• Mum and school staff attended the Healthy Eating
  Clinic together
• Decided on course of action to be followed at
  home and school included cutting out snacks
  (usually toast) and replacing with food and
  increasing level of exercise
• Lost weight
• Developed health choice making chooses fruit
  even when offered other non-healthy choice

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School food standards 19-3-08

• Kabir
• Severe learning difficulties severe visual
  impairment wheelchair user
• Significantly overweight
• Mum attended Healthy Eating clinic
• Diet healthy but very large portions
• In conversation discovered mum didnt understand
  about European foods
• Found cookery course for mum to attend covered
  food groups fat content portion size and menus
• Kabir has lost weight and is becoming more mobile