Hospital-to-School Transition for Children with Chronic Medical Conditions

Recommendations for Duke Hospital School

Hospital-to-School Transition Practices By Jillian Froelick, University of North Carolina at Chapel Hill

Advisor: Ann Skinner, M.Ed, Duke Center for Child and Family Policy

1

Summary of Research

As medical interventions become increasingly

successful in treating chronic medical conditions, a

significant population of children have emerged who

are in need of academic support during

hospitalization. This need has resulted in a need for

hospital-to-school transition as children end

treatment and recover. This project examines recent

literature to evaluate characteristics of a successful

transition program and interviews stakeholders, who

could do well to act as a “team” for every child,

from two hospital schools to evaluate existing

transition program benefits and weaknesses.

Children, parents, hospital schoolteachers and

school interventionists from Duke University

Hospital and Cincinnati Children’s Hospital

participated in nine interviews in person or over the

phone. As literature suggested, patients reported

hospital-to-school transition programs are in need of

frequent and meaningful collaboration and

2

communication between team members and standard

protocols for navigating the transition process. As the

literature failed to reveal, emotional support and

programming for the patients could also benefit children

and families. Recommendations for Duke Hospital

School include:

èAdditional collaboration between the patient’s

school and hospital team members through

emails, meetings, scheduled updates and a

possible reorganization of staff responsibilities.

èEncouraging existing positive relationships

between children and any hospital or school staff

with whom they have a supportive relationship

with to address the child’s emotional needs

through the hospital-to-school transition.

Context/Importance

Page 2

Research Results (continued on page 3)

Page 5

Jillian Froelick School Research Partnership, Fall 2013 Policy Brief

Page 3-4 Sources Consulted

Common Elements

from Research

• Communication and collaboration • Teacher training • School-established protocol for

children with chronic medical conditions

• Emotional, academic and social Support

Recommendations

;

Jillian Froelick School Research Partnership, Fall 2013 Policy Brief

2

Children with chronic illnesses have a five-year survival rate of at least 80% as of 2002, whereas in 1975 these

same conditions resulted in a 59% five-year survival rate (Elam & Irwin, 2011). As of 2010, almost half of all

children with chronic medical conditions report falling behind in their schoolwork and approximately two

percent of children with chronic medical conditions are not able to attend school regularly (McCabe & Shaw,

2007). A growing population of children who are surviving life-threatening illnesses are in need of effective

transition programs to prepare the child for re-entry after treatment and recovery. Children who utilize hospital

schools are educated with the hope that the hospital school program will prepare the child to return to school

smoothly, and transition programs attempt to utilize effective practices in helping the child acclimate back into

their school environment. Transition programs vary by hospital school and little literature is available that

compares multiple hospital school programs to reveal best practices. Research that evaluates specific aspects of

certain programs is available, but this project begins to compare hospital school transition programs and consult

relevant team members to recommend successful characteristics for Duke Hospital School based on a comparison

of programs and evidence-based practices.

Context

Four hospital schoolteachers, two parents, two children and one school

interventionist from Cincinnati Children’s Hospital and Duke Children’s Hospital

participated in interviews. Common in all nine interviews was either a desire or

realization that communication and collaboration between team members was

absolutely essential for a successful hospital-to-school transition program. Team

members suggested increased communication between families, schoolteachers,

school administrators, doctors, nurses, hospital school staff, mental health

professionals and social workers. More team members are involved in a child’s

hospitalization and transition of course, but the above listed team members could do

well to frequently communicate through emails, phone calls, video conferencing and

in-person meetings. Regular communication would encourage school faculty to be

knowledgeable and prepared to receive a child after hospitalization and would ensure

hospital caregivers and school educators had a common understanding of the child’s

capabilities, strengths, challenges and progress throughout hospitalization and

recovery. School faculty and hospital staff have equal amounts to gain from one

another throughout transition, and the child would benefit academically, socially and

emotionally from collaboration and communication between team members.

Research Results Participants

Children

2

Parents

2

Hospital

Schoolteachers

4

School Interventionist

1

;

Jillian Froelick School Research Partnership, Fall 2013 Policy Brief

3

Recommendations

Sed et tellus at quam sagittis pharetra. Donec faucibus sagittis justo.

1

Two essential themes to a successful hospital-to-school

transition program that interview participants and

literature revealed were frequent and meaningful

collaboration and communication and emotional support

during the transition process. Recommendations for Duke

Hospital are based on both these characteristics and

practices that will require little to no financial cost. Duke

Hospital School may encourage communication through

copying team members on all emails relevant to the

child’s progress, through school visits from hospital staff

and scheduled conversations between hospital and school

staff after the child’s release from the hospital. Hospital

schoolteachers regularly feel strained in terms of

responsibilities and available time, which is important to

consider in implementing these recommendations.

Copying the child’s schoolteacher, social worker and/or

any other relevant team members would be time efficient

and would allow team members to communicate about the

child’s progress on a regular basis, encouraging positive,

collaborative relationships. To ask hospital schoolteachers,

social workers and nurses to visit every patient’s school is

a large time commitment and use of resources during the

day when professionals could assist children within the

hospital. In lieu of school visits, team members could

2

consider scheduling a timeline of updates with the child’s

schoolteacher after the patient has finished treatment to

discuss the child’s progress, concerns and possible

interventions.

To address the participant’s desire for emotional

support, Duke Hospital School has a range of options that

require varying degrees of resources. Ideally, Duke

Hospital School would have a team of mental health

professionals who could visit children’s schools and

homes after treatment to observe the transition process

and address any emotional or social concerns. This

approach would require significant financial resources to

hire professionals for such specific programming. Duke

Hospital School could encourage existing relationships

children have with team members while they are within

the hospital so that once the child enters the transition

process, a designated advocate could regularly check-in

with the patient and their family and could suggest

resources that could benefit the child and family.

Additionally, interviews revealed a need for emotional support and programming during the

transition process. One participant said they felt, “alone, and isolated…like there was no one there to

support me once I was healthy.” Often, a child’s social, emotional, psychological, and physical needs are all

well met during hospitalization and treatment. Once a child survives their chronic medical condition and

recovers, however, that same comprehensive support is often no longer available. As children navigate the

transition process, the child is often isolated from their friends and school environment, may experience

survivor’s guilt and are still coping with a chronic medical condition that is, according to one participant,

“never over.” Developing a program, whether formal or informal, to assign an advocate for every child could

benefit the child’s emotional experience after hospitalization. Children who had a close relationship with a

schoolteacher, nurse or hospital schoolteacher that allowed the child to consult an adult about their emotional

and social needs during transition fared better in the transition process and re-entered school more

successfully and smoothly than patients who felt no emotional support during the transition process.

In Summary: • Copy team members on emails. • Schedule regular conversations between

hospital and school.

• Designate an advocate for every child.

;

Jillian Froelick School Research Partnership, Fall 2013 Policy Brief

4

Recommendations Considerations Possible?

Communications and Collaboration

Copy Team Members and Supporters on

Relevant Emails

No extra financial cost, small time commitment

while encouraging communication and

collaboration between team members.

✔

Hospital School Teachers, Social

Workers and Nurses Complete

School Visits

Large financial and time commitment, takes away professionals from work

within the hospital during the day, although this programming would

encourage communication.

✗

Schedule Updates between Hospital

and School

Small to moderate time commitment, no extra

financial cost and advantageous for the child

and school to use the hospital staff as a resource.

✔

Emotional Support and Intervention

Psychologist Visits Post-Treatment

and Hospitalization

Large financial cost would require an additional team

of psychologists for transition process.

✗

Designate a Child “Advocate”

No financial cost as this programming would utilize existing staff members, but

would require a small to moderate time commitment

during the transition to reach out to the child,

family and school.

✔

3

Figure 1

What Can Duke

Hospital School Do?

• Encourage communication between Duke Hospital School and child’s previous schooling environment through email copying, in-person, phone scheduled conversations and video conferencing.

• Address children’s emotional needs throughout the transition period.

• Collaborate with other hospital schools that are similarly structured.

;

Jillian Froelick School Research Partnership, Fall 2013 Policy Brief

5

4

Bryner,J.,DiFusco, L. A., Fleming, R., Robarge, D. M., Selekman, J., Selser, K., Westendorf, G., & Wyckoff, L. (2012). Transition planning for students with chronic health conditions. In K. Selser (Ed.), National Association of School Nurses. Retrieved from http://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNIssueBriefsFullView/tabid/445/ArticleId/303/Transition-Planning-for-Students-with-Chronic-Health-Conditions-2012

Campbell, L., & St. Leger, P. (2008). Evaluation of a school-linked program for children with cancer. Health Education, 108(2), 117-129. doi: 10.1108/09654280810855577. Retrieved from http://search.proquest.com.proxy.lib.duke.edu/docview/1019989112

Cancer and blood diseases institute: Hospital school program. Retrieved from Cincinnati Children's website: http://www.cincinnatichildrens.org/service/c/cancer-blood/patients/school-intervention/.

Clemens, E. V. (2010). Tough transitions: Mental health care professionals' perception of the psychiatric hospital to school transition. Residential treatment for children & youth, 27(4), 243 - 263. doi: 10.1080/0886571X.2010.520631. Retrieved from http://unc.summon.serialssolutions.com.libproxy.lib.unc.edu/document/show?id=FETCHMERGED-LOGICAL-c1223-3a65de2aa96903338439439ff3737cb91c42623214fbb02e32d837f50e8dc77f1&s.cmd=setRangeFilter%28PublicationDate%2C2008%3A%2A%29&s.q=school+transition+from+hospital+schools

Cohen, M. S. (1999). Families coping with childhood chronic illness: A research review. Families, Systems, & Health, 17(2), 149-164. doi: 10.1037/h0089879

Duke hospital school. Retrieved from Durham Public Schools website: http://www.dpsnc.net/schools/school-profiles/secondary-school-list/hospital-school.

Elam, M. & Irwin, M.K. (2011). Are we leaving children with chronic illness behind?. Cincinnati Children's Hospital Medical Center.

Elam, M., & Irwin, M. K. (2013, September). School support for students with chronic medical conditions. Council for Exceptional Children.

Green, J., Nisselle, A., & Scrimshaw, C. (2011). Transforming children’s health spaces into learning places. Health Education, 111(2), 103-116. doi: 10.1108/09654281111108553. Retrieved from http://ehis.ebscohost.com.libproxy.lib.unc.edu/ehost/detail?sid=a4fae3be-afd5-4ded-b50f-5d0f523c6852%40sessionmgr111&vid=1&hid=106&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=eric&AN=EJ922519

Hamlet, H. S., Gergar, P. G., & Schaefer, B. A. (2011). Students living with chronic illness: the school counselor’s role. Professional School Counseling, 14(3), 202-210. Retrieved from http://go.galegroup.com.proxy.lib.duke.edu/ps/i.do?action=interpret&id=GALE|A250134008&v=2.1&u=duke_perkins&it=r&p=AONE&sw=w&authCount=1

Hardy, K. K. Children's National Medical Center, (2013). Learning issues in children with cancer: What medical providers and school staff can do to promote academic success for survivorsThe George Washington University Medical Center.

Marchitto, C. (2010). Transitioning the needs of children with chronic illness: Exploring communication between hospitals and school settings. (Master's thesis, Providence College), Available from Digital Commons. Retrieved from http://digitalcommons.providence.edu/cgi/viewcontent.cgi?article=1058&context=socialwrk_students

McCabe, P. C. & Shaw, S.R. (2007). Hospital-to-school transition for children with chronic illness: Meeting the new challenges of an evolving health care system. Psychology in the Schools, 45(1), 74-87. doi: 10.1002/pits.20280. Retrieved from http://onlinelibrary.wiley.com.libproxy.lib.unc.edu/doi/10.1002/pits.20280/abstract

Savina, E. A., & Simon, J. B. (2010). Transitioning children from psychiatric hospitals to schools: The role of the special educator. Residential Treatment for Children & Youth, 27(1), 41-54. doi: 10.1080/08865710903508084. Retrieved from http://ehis.ebscohost.com.libproxy.lib.unc.edu/ehost/detail?sid=c24a5201-abad-46db-ac59-85da0cb33ce3%40sessionmgr198&vid=1&hid=106&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=eric&AN=EJ871329

Sources Consulted