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.
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.