Institutional ethnography, diabetes, school health support services, children, healthcare work


Using institutional ethnography and its approach to mapping institutional sequences (Smith, 2005; Turner, 2006), this paper examines the social organization of School Health Support Services (SHSS) for children with diabetes in Ontario schools. The inquiry starts with my own situated experience as a mother of a child with diabetes starting kindergarten, and the trouble of securing the health supports necessary to care for my child’s health and safety while she is at school. The paper takes up two specific texts—the Community Care Access Centre (CCAC) Referral Form and the CCAC Medical Orders for Services at School—to explore and describe how I am drawn into the work of securing, advocating, and supporting the delivery of health support services for my child at school. The paper makes visible how the CCAC Medical Orders for Services at School is an authorized standardized text that stands in for and subdues parents’ experiential knowledge of what is needed to ensure the safety of children with diabetes at school. While the public school system in Canada is formally committed to the equality of access to education for every child without discrimination irrespective of the child’s health conditions and/ or disabilities (Canadian Charter of Rights and Freedoms, 1982), what is shown is how parents’ voluntary and supplementary healthcare work and unauthorized knowledge is incorporated into the institutional complex of School Health Support Services and secures the safety of children with diabetes at school. Parents’ work and knowledge is essential for the institution of public schooling to operate as it does, and sustains the official ideal of equal and inclusive education for all. However, there is a difference between how and whether parents can deliver their knowledge and resources.

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