interview – Rose and David Bloomfield Family Transitional Care Program

Carol-Anne and Anne support the child’s transition back to his/her community school. Their goal is to help the school help the student. They do this by asking the school, “what is it we can do for you?”

Carol-Anne and Anne first get to know the children before they leave the Child Psychiatry Day Hospital program, by observing the children on the unit. As discharge approaches, the Child Psychiatry team identifies which children and families could benefit most from follow up care. If the family agrees, they are assigned to either Carol-Anne or Anne, who divide the cases based on the geographical location of the school. This isn’t just for convenience when doing school visits: each school functions differently and it takes times to learn the ways each school works and how the Transitional Care Team can best help.

Carol Anne Photo — Carol-Ann Blanshay, MA, BA

The team works with school administrators and teachers to develop a child-specific plan for the student’s transition back to class. Carol-Anne’s message to the teachers and school administrators is they “keep the lines of communication open.” She encourages school staff to reach out frequently rather than wait until small problems escalate into big ones. She explains to the teachers, “you are our eyes, you are the most valuable part of our team. No matter how good it is or how bad it is… we’re here to see how we can support you.” The Transitional Care Team provides teachers with a “toolbox” of strategies and information that are specific to each child. They regularly visit the schools and observe the child in his/her classroom, checking up on how the child is managing now that they are attending school full-time, and trying to identify how the child responds to different situations. They keep an eye out for early signs that a child may be regressing. Carol-Anne and Anne represent continuity for the child. Carol-Anne elaborates that children recognize “someone from there [the child psychiatry unit at the Jewish Hospital] still knows what I’m doing and knows how I’m behaving… I have to be accountable… It creates the link, the kids feel that they’re still connected and supported and maintaining whatever they did learn [on the unit].”

In addressing the needs of both the children and the school personnel, Anne and Carol-Anne work to devise plans with small manageable steps that the child feels confident he or she can complete. For example, one senior elementary student was asked by his teacher to recall the difficulties he had over the course of a week. Sensing that this task was overwhelming for the student, Anne created a daily chart of each subject and throughout the day the child wrote down issues as they arose. At the end of the week, the team could easily identify and address difficulties the student was having.

It can also be difficult for children and parents to make the transition back to school as it is often the case that the family has a history of negative experiences with the school. Anne explains the student’s job is “to go back and show the teachers and students, that’s not who you are, you worked really hard to get to where you are now.” Children are often excited but nervous to return to their school. “They have been able to see themselves in a positive light for the first time in many years. Their family sees them differently. They don’t want to lose that,” explains Anne, and she tries to help them bring the new success they achieved in the Child Psychiatry program back to their school. When problems arise, Carol-Anne explains “we put a mirror up to the child” and remind him or her of the behaviors they are working to improve. Anne mentions a situation where a mother was going to remove her child from the school because she was upset with the administration. Anne was able to mediate in a meeting between the parent and school personnel, so that the child was able to stay in the school. “I think if we hadn’t been there, the outcome would have been very different.”

Ultimately, Anne and Carol-Anne witness many success stories. School administrators frequently comment on the positive changes in the child’s behavior as a result of treatment in the Jewish General Day Hospital Program. The Transitional Care Team is able to see children transfer what they have learned to their schools. “Success is maintaining behavioral gains. There are varying degrees of success depending on what their needs are,” Carol-Anne explains. She recalls one student who was having a very difficult time, yet “even though things were not perfect, she gained a certain amount of self-actualization. She started to appreciate herself,” and that was a milestone for her.

Together Anne and Carol-Anne make a flexible team and a creative resource – a combination that they think contributes to their success.

I sat down with Jane Bourke, social worker and coordinator of the Transitional Care Team. Jane has been part of the team since 2006 and works with families whose children have been discharged from the child psychiatry units, while other members of the team work closely with the schools.

She says, “The goal of the team is to maintain the gains” children made in psychiatric treatment, after they have been discharged. Her team helps to achieve this with a flexible approach, which she describes as one of the strongest parts of the program. She explains, “We’ve structured the team so that we are available just about any hour. I’ve had families that have called me late in the evening… We aren’t an emergency service, but access to support in a more… practical way is necessary.”

This transition process is not without challenges. “Regression is often a normal experience,” Jane explains, “our role is to support that regression, whether it is minimal and needs just a little boost, or whether it’s actually a full regression.” Part of the way the Transitional Care Team can provide this support is by easy access to the psychiatric team at the Jewish General Hospital.

*Jane Bourke MSW, MFT. Coordinator of the Transitional Care Program*

The biggest challenge for children are the changes that arise during the transition back to school. These may include social expectations and learning difficulties that surface when kids return to school. Another example is class size, “coming from a program here where the classroom is at most eight children [at the Day Hospital] going back to a classroom that is on average, 25 children” can be challenging. Part of this difficulty, is that “a teacher cannot be expected to see the cues in terms of early regression… Those little behaviors that will accelerate if not addressed.” These cues are what the childcare workers on the team look for when they observe in the schools.

Despite these challenges, the Transitional Care Team witnesses many successes. In particular, Jane recalls one boy with aggressive behavior who had serious difficulties at school and home. The team surpassed the usual 6 month contract and worked with this family for two years. Jane guesses the child “probably would have been suspended from school permanently had we not been there” and “he’s still in school. That is a success, because that is ultimately our goal, to make sure these children can graduate. And then, hopefully not accessing the [mental health care] system as often as maybe would have been needed had they not had earlier treatment.”

How can parents help with this transition? “Stay in touch” Jane says, “Our intention is to build a team around the child.”

Tag: interview

“We’re your link” Carol-Anne Blanshay and Anne Smart on the school component of the Transitional Care Program

Maintaining Gains: Insights from Jane Bourke, Coordinator of the Transitional Care Program