Teachers’ FAQ

Q1. Why was the child discharged from the program when there are still behavioural issues to work on?

A. Upon discharge, the child and family will have been supported for close to a year by a multidisciplinary team in the Day hospital. Children are discharged when they have made significant gains in treatment and are ready to work towards maintaining these achievements in their home and in their school. While most families work hard to maintain these gains with the program’s support, graduating can require a period of adjustment both for the child and the family. This may explain why there may still be behavioral issues to work on, which is why the school’s support is key to the child’s successful reintegration. By working together with Transitional Care Team educator, the school will be in the best position to address any regression in the child’s behaviour in a timely manner. This collaboration will enable the child and family to get back on track and to continue to practice the skills they worked so hard to achieve.

– Anne Smart, Consultant, Bell Transitional Care Team

Q2. We cannot provide the child with the same resources they benefited from in treatment. How are we supposed to manage?

A. It is true the JGH program affords the child many privileges/resources not available in the school setting. Staff working with the child appreciate this fact and consciously take this matter into consideration. When working with the child towards reintegration, a large part of therapy involves making this point understood by the child. In all interactions with children on the unit, the goal is for them to become more self-aware and take responsibility for their actions. To that end, all the work in treatment is aimed at preparing the child and family to function to the best of their ability within the resources provided by the school and its community.

– Anne Smart, Consultant, Bell Transitional Care Team

Q3. We remember the child from before treatment and are afraid to “set him/her off.” What advice can you give us?

A. Some teachers may be reluctant to place demands on a child after treatment, fearing the child will regress. However, some children may sense when an adult feels uneasy and may act out in order to ensure boundaries are put in place. We often find children with behavioral difficulties thrive within a framework of predictable expectations and firm limits. The problem with allowing too much freedom for children with emotional difficulties is that they have hard time making the switch from unstructured to structured. It is therefore most beneficial to the child to maintain structure in spite of being afraid to “set him or her off”.

– Anne Smart, Consultant, Bell Transitional Care Team

Q4. The child is not completing their homework and the parents are not following up on our notes in the agenda. What should we do?

A. Situations where the home and school are unable to support each other tend to have the greatest implications for the child. In cases like this, the school should meet with the parents and work out a solution together, but a lot of time has usually already been lost at this point. In the Transitional Care Program (TCP), we have found it particularly useful for parents and teachers to continue with the daily communication established while the child was in treatment. For teachers, it is important to maintain an ongoing dialogue, as parents tend to shy away when a problem arises. A key goal for the TCP is to facilitate a working relationship between home an school, if this is not already the case.

– Anne Smart, Consultant, Bell Transitional Care Team

Q5. What do I tell my other students about where the child was when absent from school?

A. Children are very accepting of others’ challenges when presented in a non-judgemental way. While the child’s re-integration is often a non-issue for the other students, the returning child often expresses anxiety about fitting in and having friends. Most classroom teachers speak to their class before the child returns full-time. Successful teachers tend explain it in a very matter-of-fact way and encourage the students to think of how they can welcome the child back.
In one case, an outstanding teacher even brought some students here to the Day Hospital so that they could see from their own eyes how “normal” and even “cool” this environment was. When they went back to class, they spread the word and prevented a lot of the stigma of return.

– Anne Smart, Consultant, Bell Transitional Care Team

Q6. I must continually reprimand the child for their behaviour, and the parents say they feel their child’s actions are unfairly under microscope. What can you suggest?

A. Many parents are very sensitive to any perceived criticism. This is actually one of the concerns most often expressed by the parent(s) as the child re-enters the class. With this in mind, we often encourage the school to call a meeting with the parents and TCT so we can assure the parents we are all on the same side. Often, we have found that ongoing support and communication with the parent can transcend to improved the classroom behaviour of the child.

– Anne Smart, Consultant, Bell Transitional Care Team

Q7. The child has missed out on a lot of academics and is behind in French. Won’t this frustrate them when they return?

A. Yes, it is possible that this will frustrate the child. However, it will be easier to catch up once the child is back in class full-time. Usually, the child is more frustrated by other aspects of reintegration, and academic issues are easier to work on. With their increased ability to function more appropriately in class, lagging behind in a subject or two usually becomes less of an issue and resolves itself with time.

– Anne Smart, Consultant, Bell Transitional Care Team

Q8. What were some of the techniques used, on the unit, when working with the child?

A. All treatment on the unit is aimed at providing constant feedback to the child, to help the child become more self-aware. The Day Hospital staff also help show the child how their actions affect those around him/her. Strategies (specific tools in the child’s “toolbox”) are taught to help the child learn how to manage his/her behavior, the emphasis being the child has control over the way he/she chooses to behave and that this choice in turn affects the way in which he/she is perceived by others.

For example, in the example of a child unable to stay in the classroom and who wanders around the hall during class time, the team would use a variety of techniques. The Educator would help the child understand the personal implications of this behavior, but also bring the discussion into the classroom and discuss the incident with the group. The educator might point out to the group and the child that time was wasted because they had to stop what they were doing to find the child. The educator will then make the link of how the child’s behaviour affects the whole class. in other words, the educator will use the child’s behaviour to point out cause & effect. The dialogue might look like this: “Because you were not in the class room, I had to leave the class to go and look for you,” or “How do you think the rest of the class feels sitting here waiting while I try to find you?” To summarize, The Day Hospital staff use a variety of techniques which enable the child to have a better appreciation of the consequences of his/her behavior.

– Anne Smart, Consultant, Bell Transitional Care Team

Q9. How do we establish a positive relationship with the parent(s) when we have had such a difficult history in dealing with them and with their child?

A. While there may be some hesitation to work with a family who has been resistant in the past, it is important to keep in mind that the family may be feeling the same way. Most children returning to school from treatment at the JGH have a history that precedes them, and their families have often experienced conflict with the school. During treatment and alongside the Transitional Care Team, the family as a whole learned to make better choices and formulate more appropriate responses. Please look at the Transitional Care Manual provided on the website for more detailed advice on establishing a positive relationship with the parents.

– Anne Smart, Consultant, Bell Transitional Care Team

Q10. What if the child returns and they are not “ready,” will you take them back?

A. In most cases, no. This is usually not an option. Children admitted to Day Hospital Program work intensively with its staff for the period they are in program. Discharge is decided based on the family’s progress, and whether the family would be able to benefit from further treatment. Therefore, it is unlikely for children to be taken back into the day program once a discharge decision has been made.

– Anne Smart, Consultant, Bell Transitional Care Team