Class Is in Session (in the Hospital)
Just because kids are hospitalized for extended periods doesn’t mean they get out of school.
Seven-year-old Ally Coulton should be well-prepared for the start of second grade this month. Nearly every day for about a month and a half this summer, Ally has worked with teacher Jenny Stevens on reading, writing, and math. Class took place in a converted office at Gillette Children’s Specialty Healthcare in St. Paul, where the blonde-haired, blue-eyed Ally, who looks more like she should have been spending her summer at the pool than in the hospital, underwent a selective dorsal rhizotomy in June to alleviate the spasticity associated with her cerebral palsy.
Working from a standing wheelchair, Ally proudly shows how far along she is in her workbook. On her last day of class—the day before she’s scheduled to go home to Texas with her mother, Nicole—she and Stevens are working on adding by 10s, correctly spelling the days of the week and the months of the year, and reading out loud a book about two Chihuahuas.
Summer school isn’t something many physicians or teachers think about for a child who is hospitalized, according to Stevens, who serves as the summer school teacher at Gillette. But Ally’s mom wanted her to keep up with her studies during her nearly six-week hospital stay and enrolled her in classes at Gillette. Minnesota law requires that any school-aged child who is anticipated to be hospitalized for 15 or more school days, has a parent’s permission, and is perceived to be medically able be offered educational services during the school year.
Gillette is somewhat unique in that it has a hospital “school”—two offices that have been converted to classrooms. The rooms are large enough to accommodate standing wheelchairs and other adaptive equipment and stocked with computers, webcams for connecting students to their home classrooms through Skype, a Smartboard, and shelves of books and educational games. Two full-time teachers—both of whom work for the St. Paul Public Schools—work with patients, primarily those who are recovering from traumatic brain or spinal cord injuries or who are undergoing selective dorsal rhizotomy surgery; they also serve school-aged children being treated at neighboring Region’s Hospital’s burn center and Bethesda Hospital’s rehabilitation unit, says Jennifer Monson Gimpl, who has taught at Gillette for seven years. Another teacher from the district works with children in United Hospital’s adolescent behavioral health program and at Children’s Hospitals and Clinics of Minnesota’s St. Paul campus.
In Minneapolis, eight teachers serve children in the behavioral health programs at Fairview Riverside and Abbott Northwestern hospitals; at Children’s Minneapolis facility; at the University of Minnesota Amplatz Children’s Hospital; and at Shriner’s Hospital for Children. Last year, the Minneapolis Public Schools, which employs the teachers, served some 750 hospitalized children at the six facilities, according to Lynn Branham, who facilitates the hospital/agency program for the district.
Other school districts send tutors to the hospital. The Rochester Public Schools, for example, sends them to work with children at Mayo Clinic’s Eugenio Litta Children’s Hospital. In the case of international students, social worker Kelli McManus says Mayo has arranged for private tutors for those whose first language is not English. She says sometimes those tutors are Mayo medical students who are from the patient’s home country.
The Flexible Classroom
The process of enrolling a patient in a hospital “school” is usually initiated by a nurse or social worker, says Branham, who enrolls children in the Minneapolis Public Schools and gathers information about their home school district, their grade, and names of their teachers so the hospital teachers can get the student’s records, textbooks, and assignments. “Often, the parents have done the groundwork before we get there,” says Juli Evers, a teacher at Amplatz, who first learned that educational services were available when her 19-year-old daughter was going through treatment for cancer there in 2002. “We ask teachers to prioritize what they want the student to do while they’re in the hospital, with the understanding that they can’t do everything.” She says most schools are cooperative but notes there have been times when she has had to design a curriculum for a child.
For the most part, hospital schools focus on the basics—math, English, and social studies—for children in kindergarten through 12th grade (those in special ed may be eligible for services until they are 21 years of age). “But if it’s a priority for a high school senior to finish physics, we can help with that, too,” Branham says, explaining that those students might enroll in online classes.
Teachers and administrators interviewed for this article say the school districts they work for bill the students’ home districts for instruction time during the year. Gillette, which enrolls an average of 75 students in school each year, pays the cost of its five-week summer program.
School Is Secondary
In many ways, classes in a hospital setting are far different from those in a school. Most are one-on-one, and teachers often bring class to kids who are unable to travel even to another part of the hospital for instruction. “They’re usually medically fragile or immunosuppressed and unable to leave their room,” says Evers of her patients at Amplatz, many of whom have had bone marrow transplants. She’ll continue to see some kids at the Ronald McDonald House, where those who do not live nearby stay between discharge from the hospital and their 100th day post-transplant, when they are able to go home.
Classes typically last an hour per student per day and often involve more than teaching academics in the traditional way. “Our teachers have to be very versatile,” says Mark Gormley, M.D., a pediatric rehabilitation medicine physician at Gillette. “They’re dealing with a child who may have had a severe brain injury and has severe cognitive changes or they may have a child who has normal cognition but may need minor physical adjustments to the classroom and everyone in between.”
Monson Gimpl says teaching hospitalized children—especially those who’ve had brain tumor resection or head injuries—is about adapting to their needs. “Sometimes their recovery varies, so one day, third-grade math might be appropriate and the next week they might be doing some pre-algebra. We’re constantly modifying and adjusting to meet them where they’re at and pulling them along so they can get as much out of this as they can and keep up with what their classmates are learning,” she says. “I always tell families that this is the only time you’ll hear a teacher say school is secondary to everything else that goes on here,” Evers says. “We know that if a child is sick or sleeping or has other things going on—that takes precedent over school.”
At Gillette, the teachers are part of the child’s rehabilitation team and sit in on meetings with physicians, nurses, and therapists. “They pick up on things that we as physicians, nurses, and therapists might not pick up on,” Gormley says.
For example, a teacher might notice that a child is having difficulty sitting in a wheelchair for a long period of time—something therapists who are focused on getting that child to do an activity may not notice. “The OT works on things like feeding and dressing and writing, the physicians make sure they’re getting the right meds so their body functions as best as it can, the orthotists make sure their wheelchairs and braces are appropriate, the speech therapists work on speech and cognition. All these team members have their little segments that they work on, but the school teacher looks at all of it,” Gormley says. “If we didn’t have them, our ability to rehab a child and get him back to the community would be significantly adversely affected.”
A big benefit for the kids is that attending class in the hospital gives them a chance to get out of their hospital routine. “For the most part, school is their favorite part of the day,” Gormley explains. “It gives them some type of normalcy that they may not get otherwise.”
Although the teachers never see or hear from most of their students after they leave the hospital, they do keep in touch with some or monitor their progress through CaringBridge pages. “They make their way into your heart, and it’s nice to be able to keep track of them that way,” Monson Gimpl says. She and the other teachers at Gillette often see former students when they come back for follow up or another procedure. “They may leave using a walker or wheelchair and the next time we see them, they’ll be using a cane or nothing to help them ambulate,” she says. “If they come down to say hello, it makes our day.”
Evers, who started teaching at Amplatz in 2003, the year after her daughter who had been hospitalized there passed away, says she still gets a Christmas card from her first hospital student, who now is in college. Monson Gimpl says she has been invited to graduation open houses over the years. “You’re dealing with these families when they’re so raw with grief and loss. It’s a privilege and honor to be walking with them even for a short period of time,” she says. “And it’s especially rewarding to see some of these kids into adulthood.”—Kim Kiser