Commentary
Educational services for hospitalized children Savithiri Ratnapalan MBBS MEd MRCP FRCPC FAAP1,2, Meera S Rayar MD3, Michael Crawley BEd MA1,4
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llness and hospitalization lead to loss of school days and education for some children. This issue has been addressed in published literature for more than three decades (1). Regular school attendance and swift school re-entry are considered to be important mechanisms for helping children cope with hospitalization and the management of their illness (2,3). Helping children stay connected with regular academic and social activities has been shown to reduce difficulties during school re-entry (4). Access to a teacher and being able to continue school within the hospital provides children with a sense of normalcy during the hospital stay. However, evaluating these educational services for children in Canadian hospitals seems less obvious compared with our counterparts in other countries, some of whom use Canadian educational researchers to assess hospitalbased educational services (5,6). In an attempt to accommodate the educational needs of children and young people in hospitals, many paediatric hospitals have teachers who provide one-on-one teaching either in a hospital classroom or at the bedside of children who are hospitalized for extended periods. The involvement of a teacher in a patient’s total care enhances the student’s learning potential while ill, and facilitates a smoother return to school. Sometimes, the teacher’s responsibility may include course selection or rearranging timetables, work completion, test or examination proctoring, and/or initiating an Identification, Placement, and Review Committee if the illness has affected the patient’s learning abilities. By providing this liaison work, the hospital teacher can facilitate the school program at a time when the parents are possibly very preoccupied with workplace demands and other children at home, in addition to caring for a sick hospitalized child. We hypothesized that the information on educational services available to hospitalized children was not uniform across Canada, and that the information on these services was not easily accessible. We wanted to assess educational service information available to inpatient or outpatient children in Canadian paediatric hospitals that are accessible on the Internet. ServiceS AvAilAble in cAnAdiAn children’S hoSpitAlS A list of children’s hospitals was obtained as identified by the Canadian Paediatric Society Web site . The hospital Web sites were searched
using key terms: school, inpatient education, schoolroom, classroom, teacher, class, tutor, day programs and child life. The regional public and Catholic school board for the area of the hospital location was determined by Internet search. Each school board Web site was searched using key terms: hospital name, hospital, special education and alternative program. A Google search was conducted in English and French using search terms such as inpatient education, day programs, and more specifically, eating disorders, substance abuse and other medical programs. The searches were conducted over two weeks in January 2008 and again in the last week of March 2008 to identify any new information. The hospitals were contacted directly if there was no published information available to validate unposted services. All the information obtained on inpatient education and day programs in each hospital was summarized and tabulated (Table 1). Alberta, British Columbia, Newfoundland and Labrador, Nova Scotia and Saskatchewan had this information published on the hospital and school board Web sites. Manitoba presented the information on the school board Web site but the hospital Web site was under construction. Hospital Web site information varied in Ontario, although most hospitals and school boards had the information. New Brunswick, Northwest Territories, Nunavut, Prince Edward Island and Yukon had no information. Telephone interviews were conducted for hospitals in New Brunswick, Northwest Territories, Nunavut, Prince Edward Island and Yukon. There were no official school programs in New Brunswick or Prince Edward Island. Volunteers, most of whom were retired teachers, served the needs of children admitted to the Queen Elizabeth Hospital in Charlottetown, Prince Edward Island. The Northwest Territories and Nunavut have no educational services for hospitalized children. Quebec had information on teaching programs in the Montreal Children’s Hospital but no information on teaching programs in the French-speaking hospitals. Quebec had information on teaching programs in three Montreal facilities when the hospitals were telephoned directly. The Montreal Children’s Hospital and the Centre hospitalier universitaire Sainte-Justine are under the McGill University Health Centre umbrella and they share five teachers, three
1The
Hospital for Sick Children; 2University of Toronto, Toronto; 3McMaster University, Hamilton; 4Toronto District School Board, Toronto, Ontario Correspondence: Dr Savithiri Ratnapalan, Division of Emergency Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8. Telephone 416-813-7532, fax 416-813-5043, e-mail
[email protected] Accepted for publication February 6, 2009 Paediatr Child Health Vol 14 No 7 September 2009
©2009 Pulsus Group Inc. All rights reserved
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TABLE 1 Educational services for hospitalized and ill children in Canada Province, hospital
Inpatient
Outpatient
Alberta Children’s Hospital (Calgary School Board, Calgary Roman Catholic Separate School District No 1)
Dr Gordon Townsend School: (kindergarten to grade 12) for students with physical/rehabilitation requirements, mental health concerns and/or eating disorders
Calgary Eating Disorder Program: for students aged 14 years and older Adolescent Day Treatment Program: for adolescents with severe mental health issues
Stollery Children’s Hospital (Edmonton Public Schools)
Stollery Children’s Hospital: children who are physically able must attend in-hospital school. Bedside teaching is also available Alberta Children’s Hospital (Highwood School Program): for adolescent patients in general and forensic psychiatry treatment programs
Paediatric Daypatient (Unit 201): run through Glenrose School, this program is for students who require intensive tertiary rehabilitation services but do not require 24 h nursing care
Glenrose Rehabilitation Hospital Educational Services: (kindergarten to grade 12) provides services for youth admitted to a range of programs, including school rehabilitation services, child and family psychiatry, paediatric brain injury and orthopaedic rehabilitation
Child and Adolescent Mental Health – Day patient: (ages six to 12 years) for children who require psychiatric rehabilitation treatment after inpatient stay
Inpatient Unit 301: (ages six to 12 years) offers mental health interventions along with school programs
Catholic Board of Alternative and Adult Education Services: provides the educational component at the Alberta Alcohol & Drug Abuse Commission youth treatment intensive day program and the Alberta Alcohol & Drug Abuse Commission residential treatment program
BC Children’s Hospital School: inpatient elementary and secondary students in the hospital for five days or more. Also available for siblings of students from other districts or students in other Vancouver hospitals
Capella Program – Eating Disorders Youth substance use disorder clinic: (ages 12 to 17 years) provides schooling and support for transition to a community school
Alberta
British Columbia Children’s and Women’s Health Centre of British Columbia (Vancouver School Board, Independent schools)
Child Psychiatry Inpatient unit: for students six to 13 years of age Shaughnessy Hospital Adolescent Psychiatric Unit: (ages 13 to 19 years) for inpatient psychiatric unit GF Strong Rehabilitation Centre School: for secondary students who have recently transferred from hospital settings to the Rehabilitation Centre Sunny Hill School: for students under long-term care admitted for respite care Canuck Place: for students admitted with progressive, life-threatening illness, requiring respite and palliative care
Manitoba Winnipeg Children’s Hospital (Winnipeg School Board)
Adaptive Skills Programs: (ages four to 21 years) for students with multiple disabilities, or are medically fragile, and/or have a significant cognitive disability paired with one or more of the following disabilities: communication, physical, behavioural and functional
Child & Adolescent Psychiatry – PsychHealth Centre, Health Sciences Centre: provides schooling for adolescents with eating disorders
Child & Adolescent Psychiatry – PsychHealth Centre, Health Sciences Centre: inpatient services for students with an anticipated lengthy stay Educational Services for Medical Inpatients at Health Sciences Centre: for students (grade 1 to senior 4) expected to be hospitalized for at least one week New Brunswick
Community Mental Health: Child and adolescent team Home-Hospital Tutoring: provides tutoring at home or in the hospital to students who are unable to attend school for short periods of time
None published
Janeway Children’s Health and Rehabilitation Centre (Eastern School Board)
Janeway Hospital School: (kindergarten to grade 12) for hospitalized or treated children at Janeway Children’s Health and Rehabilitation Centre, Health Sciences Centre or the Miller Centre
Rowan Centre Adolescent Addiction Day Treatment Program: (ages 12 to 18 years) for students treated for substance abuse or gambling
Northwest Territories
None published
None published
Adolescent centre for treatment: (ages 13 to 19 years) provides educational services for children in mental health treatment programs IWK: provides school services for students anticipated to miss three weeks because of stay in hospital Choice residence: (ages 13 to 19 years) for students with substance abuse or gambling concerns Child Response Program: (younger than 13 years of age) a residential program for children receiving mental health treatment Brain Injury Response Team: provides schooling and support for transition to a community school
Choice Day program: (ages 13 to 19 years) for students with substance abuse or gambling concerns Choice – Out-Client Services: provides opportunities to work on various educational and vocational projects Adolescent Day Treatment Program: (ages 13 to 19 years) for children with mental health issues
Newfoundland and Labrador
Nova Scotia IWK Grace Health Centre (Halifax Regional School Board)
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Commentary
TABLE 1 – continued Educational services for hospitalized and ill children in Canada Province, hospital
Inpatient
Outpatient
Nunavut
None published
None published
Ontario McMaster Children’s Hospital There are elementary and high school teachers available to help students with at Hamilton Health Sciences schoolwork during long hospital stays (Hamilton School Board, Wenthworth Catholic District School Board)
Cornerstone: (ages one to 18 years) provides academic tutoring
The Hospital for Sick Children (HSC) (Toronto District School Board, Toronto Catholic District School Board). The hospital Web site only mentions that the first school for children in a hospital was established with one teacher on staff in 1892. (Now there are 20 full-time teachers from the Toronto Board of Education on staff.)
HSC Medical Units: for students aged five to 12 years and 13 to 18 years Toronto Rehabilitation Institute: (ages 16 to 21 years) for students with spinal cord injury requiring rehabilitation CAMH: for adolescents with psychiatric disorders, mental health issues, suicidal ideation, etc HSC Eating Disorder Program: severe malnutrition or weight loss requiring admission Youthdale Treatment Centre: (ages 13 to 18 years) inability to function in school due to emotional problems HSC Psychiatric Crisis: (ages six to 19 years) provides schooling and support for transition to a community school
CAMH: adolescents with problematic substance abuse and/or related mental health issues HSC Substance Abuse Day Treatment Program: (ages 13 to 18 years) HSC Eating Disorder Day Hospital Griffin Centre: (ages 12 to 19 years) for students in treatment for eating disorders Sunnybrook Health Sciences Centre: (ages four to 21 years) day treatment program Sickle Cell Anemia Follow-up: for students aged six and seven years
Bloorview Kids Rehab
Has education programs for inpatient children participating in day programs Resource classrooms: (kindergarten to high school) provides schooling and support for transition to a community school Complex Continuing Care, Respite and Recovery Program: provides schooling around individual education programs
None published
Children’s Hospital of Western WD Sutton School Program: provides schoolroom and bedside teaching for Ontario (Thames Valley children hospitalized for extended periods District School Board) Paediatric Cancer School Support Program: supports transition of students from hospital to school and alternative schooling if a child is unable to attend school Regional Mental Health Care: (ages 13 to 18 years) provides elementary and secondary schooling Madame Vanier Children’s Services: is a mental health centre that has a family school team available. Located either on the main campus or WD Sutton School
Eating Disorders Program: (up to 18 years of age) run through WD Suttun School, this program is for children recieving inpatient, day and outpatient treatment Child and Adolescent Centre Day Treatment: (ages 10 to 17 years) for children witn mental health concerns
Kingston General Hospital (Limestone District School Board, Algonquin and Lakeshore Catholic District School Board)
Child and Adolescent Division at Hotel Dieu Hospital: (up to 18 years of age) provides comprehensive psychiatric services for children with severe psychiatric disorders. Services include an in-hospital classroom-based day treatment program
None published
Children’s Hospital of Eastern MF McHugh Education Centre: provides school support for students whose Section 23 day treatment service: for students Ontario (Ottawa-Carleton current needs cannot be met within their home school or range of local school with severe mental health needs District School Board, board services The Dave Smith Centre: is a youth drug and Ottawa Carleton Catholic Royal Ottawa Hospital: offers day treatment classrooms within community alcohol treatment centre for students aged 13 School Board) intermediate and secondary schools, and youth inpatient unit and youth partial to 18 years of age hospitalization unit located at Royal Ottawa Hospital. Also provides an outreach program that helps students transition to their school once discharged Quebec The Shriners Hospital
None published in French The Shriners Hospital uses one teacher privately and hosts one from the Montreal School board
None published
Centre hospitalier universitaire None published in French Sainte-Justine This hospital uses five teachers (three French-speaking, two English-speaking)
None published
Montreal Children’s Hospital
Montreal Children’s In-hospital Teaching Program
Provide schooling for children who go to the hospital for regular treatments
Royal University Hospital (Saskatoon Public Schools)
This hospital provides schooling for children in the hospital for more than three days
None published
Yukon
None published
None published
Saskatchewan
CAMH Centre for Addiction and Mental Health
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of whom are French-speaking while the other two teachers are English-speaking. Although the teachers are employees of the Montreal School Board, they function under the Child Life Department in these hospitals. The Shriners Hospital for Children uses a private teacher and another teacher from the Montreal School Board. In all cases, these teachers cover provincial curriculum from kindergarten to the end of secondary school. There are no other children’s hospitals in the province of Quebec. It seems anecdotal but it is difficult to obtain information about these programs. Neither Web sites nor information centres at these hospitals seem to be aware of the existence of these schoolteachers in their own centres. diScuSSion Although the intensiveness of education services varies, instruction is made available to children anticipating long hospital stays. The actual length of stay, used as a criterion, differs across jurisdictions. In addition, classroom instruction is an integral component of the program for most physical rehabilitation, mental health, substance abuse and eating disorders programs in children’s hospitals, and these programs tend to run for periods of months. Education is a fundamental right of all children including hospitalized children. As paediatricians, we should take responsibility to ensure that children have access to appropriate education, even while they are hospitalized. It seems that schooling hospitalized children is either taken for granted or forgotten, or a low priority in many parts of the country. Even when it does exist, most centres are blissfully unaware of its existence, and the idea of letting the children catch up later seems to prevail. This heightens the idea that being ill is a stalemate situation during which time
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normality drops by the wayside. In many instances, child life services is the only department that is aware of the teachers’ existence. It appears that on many fronts, the fight for education in hospitals is either forgotten or under attack. We did not attempt to contact the hospitals to inquire about the educational services they offer if the information was available at the hospital or school board Web site. The information presented in the present manuscript was gathered and collated by a paediatrician, a high school teacher and a final year medical student. Several hours of individual and combined work was needed to compile this information for the manuscript, highlighting the difficulty time-constrained physicians, ill children or their parents would have in accessing this information. Although several children’s hospitals have school teachers available to educate hospitalized children, the information is not readily available to ill children, their parents or the medical community. referenceS
1. Buerke P. Educational programing for the short term hospitalized child. Except Child 1966;32:559-63. 2. Katz ER, Varni JW, Rubenstein CL, Blew A, Hubert N. Teacher, parent, and child evaluative ratings of a school reintegration intervention for children with newly diagnosed cancer. Child Health Care 1992;21:69-75. 3. Gabbay MB, Cowie V, Kerr B, Purdy B. Too ill to learn: Double jeopardy in education for sick children. J R Soc Med 2000;93:114-7. 4. Arroyos-Jurado E, Paulsen JS, Merrell KW, Lindgren SD, Max JE. Traumatic brain injury in school-age children academic and social outcome. J Sch Psychol 2000;38:571-87. 5. Fels DI, Shrimpton B, Robertson M. Kids in hospital, kids in school. (Version current at April 3, 2009). 6. Fels DI, Samers PJ. Use of the asynchronous Black Berry technology in a large children’s hospital to connect sick kids to school. (Version current at April 3, 2009).
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