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
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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
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4
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Sources Consulted
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