Facilitating a Positive Healthcare-School Transition for Children Facing Medical Challenges

We hope the new school year is off to a successful start for the children in your life, as well as for you if you are an educator or parent of a school-age child. The first few weeks is certainly a whirlwind of adjustments to new routines, expectations, schedules and activities! So when a child isn’t able to begin the school year transition with their peers it can create additional feelings of anxiety and overwhelm. There can be a variety of reasons that cause children to begin the school year late, including a geographical move, family emergency, or late registration. Missing that initial back-to-school transition with peers can increase anxiety, as students attempt to acclimate after initial expectations and routines have been established, and ice breaker activities have been completed. But children facing medical challenges are already experiencing a high level of physical and emotional distress. Missing extended time in school, and particularly the back-to-school transition, can add to feelings of isolation, disconnection, anxiety and sadness for these kids and their families. Here are some strategies to help facilitate a positive healthcare-school transition for kids and families that could use a little extra support when facing medical challenges.

1. Help Children Process their Emotions and Information. It is natural for children to feel worried, sad, and inquisitive when they learn that someone in their life is facing a medical challenge. Consult with a Child Life Specialist, Pediatric Nurse, Occupational Therapist, Physical Therapist or Social Worker in your school or healthcare organization. They can help to provide a better understanding of the child’s diagnosis, and guide and support the use of child-centered, developmentally-appropriate language and activities to help explain a medical condition, answer inquisitive questions, and ease the anxieties of classmates and siblings. Take confidentiality seriously by always checking and consulting with the child’s parents to request their permission to share basic information about their child’s condition. Some parents may be opposed to any of their child’s medical information being shared, while other parents may view it as a chance to raise awareness and empathy, but almost all families will: 1. Want to be informed beforehand; 2. Want details about how information will be shared and guided by a professional that understands the needs of their child; and 3. Want to have the opportunity to make a choice and have a voice regarding their child’s preferences.
2. Personalize a Class Photo and Make it Fun. If you are a teacher that knows one of your students has not been able to attend school because of medical illness, or you are a parent or healthcare professional caring for a child that has been hospitalized or is homebound, consider coordinating this idea. Take an informal class photo (most official class photos aren’t taken until the spring), print it as an 8 x 10, and use mini Post-it tabs to write the first name and/or nickname of each child in the class. Make a color photocopy so the Post-it tabs are not removable. Or turn it into a fun activity by sending the Post-it tabs separately with a paper that identifies each child’s shirt and hair color for a fun matching game that a child can play to begin to recognize their peers before they arrive back to school. Have a stuffed animal in the photo to represent the child’s presence in the classroom while classmates await the child’s return.
3. Create a Kids Joke Book that can be used as an Icebreaker with their Medical Team. Get Well cards are certainly a nice gesture to communicate to a child and family that you are thinking of them and wishing them a speedy recovery. But try this idea to create a fun tool that is sure to bring smiles, giggles, and be a keepsake that the child can use to lighten the daily interactions they have with numerous medical professionals involved in their care: 1. Start with finding a great kids joke book; 2. Carve out time in class for each classmate (this may take a few days) to pick out 1 joke and re-write it on a piece of paper; 3. Ask the students to add an illustration and/or a get well message; 4. Ask the students to write or sign their name; 5. Assemble and staple the jokes as a small book and mail it to the hospital or child’s home so they can read and retell jokes to ease anxiety and create a lighthearted catalyst for building rapport with their medical team.
4. Track Progress towards “Return to School” with Fun, Child-Centered Visual Tools. Use Get Well Maps as a visual tool with the hospitalized child, as well as in the classroom to visually track a child’s progress through their treatment and anticipated return back to the classroom environment. Parents and healthcare professionals can facilitate this communication by maintaining contact with the teacher, and sharing estimated discharge time frames and basic updates regarding improvements or setbacks in progress.
5. Empower Kids with a Stuffed Animal that can Build an Environment of Inclusion.  Monkey in My Chair is an amazing organization that was developed by Mom of Chloe, a pediatric cancer patient that missed extended school time while undergoing treatments. As a result of Chloe’s experience, her Mom, teachers and community collaborated to develop this program that provides a “monkey kit” which includes a big stuffed monkey that takes their place in school when they are unable to be there. The kits include the monkey with a backpack, a book to help teachers explain to students the situation their classmate is facing and how it affects them, teacher companion guide, along with other items that can be utilized by the child and/or their classmates. All kits are sent out at no cost to the families or hospitals. In addition to each “Monkey Kit,” each child will be given online access to Monkey Message. Monkey Message is an online component that allows the sharing of pictures and documents to ensure the line of communication stays open between the patient and the classroom.
6. Maintain Communication with Video Messaging. With so many technological advancements, video chats, FaceTime and Skype have become more readily accessible in both classrooms and healthcare environments. But it is important to remain sensitive to the needs and wishes of the child. A meet and greet with an entire classroom of peers can feel intimidating to a child experiencing a medical challenge. They may be nervous to let their peers see them ill or injured, and it may spark unnecessary or awkward questions among students in the “live video” moment. Instead, consider creating video messages that can be played and repeated by the child and class as a tool to familiarize themselves with one another, while providing opportunities for adults to help facilitate greater understanding and empathy.
7. Plan Ahead. Patients are often being discharged from healthcare organizations with shorter length of stays and continued medical services that extend into the community. Make sure that dialogue and documentation is being exchanged between the child’s medical team and educational team prior to the child’s return to school, so that everyone involved in the child’s care is well-informed and knowledgeable of the child’s medical considerations, educational needs, and any restrictions ordered by the physician as they complete their recovery in the community. Encourage hospital and school-based therapists to collaborate in order to recommend environmental modifications that might improve accessibility, comfort, and reduce post-traumatic sensory triggers for the child as they prepare to return to the school setting.

^{Christina Connors, OTR/L has over 16 years of experience working as an Occupational Therapist with children and adults throughout Maryland and Delaware. Inspired by her son’s medical journey, and her desire to ease anxiety and improve developmentally-appropriate communication for children and families facing medical challenges, Christina developed Child Inspired in collaboration with artist John Donato. Child Inspired is working to bring a blend of Art, Therapy and Functional Communication to healthcare and education settings in order to bridge the needs of children, families and healthcare & education professionals.}