Thursday, August 8, 2013

Education Triage

I've started my fourth year teaching at the hospital (14th year of teaching) and after a month of summer I feel refreshed and ready to take on the challenges that come with teaching in the hospital.

Teaching in a children's psychiatric assessment unit has forever changed my perspective on what matters most.

For the last three years, I have worked with children who are in some kind of crisis. None of these children come to the hospital to get caught up on their homework. If homework was their priority, they could stay at home, complete their homework and go to school -- but because these children are experiencing such difficulties, their regularly scheduled homework and curriculum can not meet their needs.

When people ask me about my job, I tell them that I do educational triage. My job is to figure out what a child's immediate needs are and help them to start meeting those needs. Children might stay for 72 hours or as long as 5 weeks. Often their stay is somewhere in between. 

When a child enters my classroom in the hospital, I explain that no one comes to the hospital to get caught up on their homework, and I ask them to write down some of the reasons why they are in the hospital. Essentially, I ask them to write a list of things that are causing them problems in their life that they would like to make better. I explain that some children write down things like anger, depression, suicide, cutting, sadness, eating disorders, relationship problems, trust issues, violent mood swings, lack of sleep, anxiety, stress, poor concentration, poor communication, self-harm, abuse, neglect... It's important to note that while there are a wide range of reasons for why children come to the hospital, every single one of them has a low self-esteem. Almost every single child I have worked with in the last three years thinks very little of themselves.

After I read their responses, I provide them with resources to read, write, view, represent, play, think and talk about. In a very real sense, I am tailoring a personal curriculum for each and every child based on their personal needs. Without at least some input from the child, I would have a very difficult time providing them with something relevant to their lives. I know this because I've tried to give kids resources and learning opportunities without asking them about their lives and their needs and it did not go well.

Every day is different from the last. Children come and go quickly, so I have to be prepared to listen to their needs and have a timely and informative plan. 

First, I provide every student with a journal. I buy a variety of journals from discount or dollar stores and tell the children that it is their own private journal and that no one will read it unless they invite someone to do so. Their journal is a place where they can curate all of their thoughts and feelings that arise from all of the things they learn.

It's important to note that I subscribe to Dr. Ross Greene's approach, so I believe that children will be successful if they can. Doing well is always more desirable than not doing well, so when a child is not doing well, it is likely because their environment is demanding skills that they are lagging. I use the Assessment for Lagging Skills and Unsolved Problems to frame my conversations with students, parents, and colleagues.

I continue to collect and curate a number of engaging activities that address some of the problems that are plaguing children. Here are some examples of the resources I provide students depending on their needs:

Eating Disorders. For children who have an eating disorder, I provide them with a copy of Life Without Ed by Jenni Schaefer. It is a reader friendly book that is accessible and appropriate for even reluctant or struggling readers. Schaefer encourages people to identify their eating disorder as a separate identity by naming it Ed or Edie; her book is made up of bite size (pun intended) chapters that detail how eating disorders are about constant self-criticism, loss of self-esteem, and unrelenting perfectionism. I also provide students with Shaefer's second book Goodby Ed, Hello me. We also do projects like this that focus on the effects media and technology have on self image, self-esteem and self-worth.

Depression. For children who are profoundly sad and/or depressed, I focus on having them learn about how they can alter their lifestyle in order to move their mood. I provide them with a copy of Brain Rules by John Medina. Some of the most popular chapters include exercise, sleep and stress. I also provide them with a copy of John Ratey's book Spark where we read chapter 4 on anxiety and chapter 5 on depression where Ratey shows that exercise is as effective as certain medications for treating anxiety and depression. I also use the video Twenty Three and Half Hours by Dr. Mike Evans. We also discuss I had a black dog, it's name is depression.

Anger. For children who have difficulty with their anger, I provide them with a little book called 30-Minute Therapy for Anger. Anger is an emotion that is managed not cured, because it is entirely appropriate for us to become outraged by the outrageous. The difference between successful people and unsuccessful people is not that one gets angry and the other doesn't. We all get angry. Successful people manage their anger adaptively and productively, while unsuccessful people have difficulty managing emotional response to frustration so as to think rationally.

IsolationWhen things are at their worst, do you turn to people or things? When we turn to things to solve our problems, we look really bad, so we isolate ourselves because we don't want others to see us doing things that make us look bad. Meanwhile, we become consumed with shame and guilt. Isolation begets isolation and over time we develop an acute fear of being judged which keeps us from turning to people, so we isolate more and continue to turn to things.  I often provide children with a copy of Brene Brown's book The Gifts of Imperfection where we learn that the best things in life are not things; because things can only ever take from us, they can't give us what we need. What we really need is a connection with people through healthy relationships. Things are impostors for connection, and when we substitute people for things, we are corrupting our connections and sabotaging ourselves. Children who isolate often have difficulty considering a range of solutions to a problem, starting conversations, entering groups, connecting with people, and attending to or accurately interpreting social cues and nuances.

Hate school. For too many children, school is a place they go to be told they are not good at anything. For too many children, school is a daily exercise in being forced to passively sit through out-of-context and purposeless lectures, worksheets and quizzes that hold no relevance to their life. For these kids, I ask them about what greases their gears, blows their hair back and floats their boat. By far the most disheartening answer I can hear from a child is "nothing". We are all born with a love for learning, and when I meet a child who has lost that loving feeling, I know that something very bad has happened to them. Too many children experience school as a place where they are told they are stupid. For these kids, I try and rekindle their love for learning by empowering them to rethink school.

Adults tend to cause the most trouble for children when we assume they already have the necessary emotional, behavioural and intellectual skills to navigate successfully through their day. Trying to understand a child who has an eating disorder or who is profoundly depressed might be impossible for someone who has never experienced an eating disorder or depression. But that might be okay, because when children are experiencing these difficulties sometimes what they need most is for us to just believe that what they are experiencing is their reality. I'll put it another way -- these children are not giving the adults in their life a hard time; they are having a hard time.

The gross majority of the children I see in the hospital have nothing wrong with their DNA. They are not retarded or psychotic. These children suffer from something much worse and that is abuse and neglect.

The difference between the children I spend my day with and you and me is not that these kids are experiencing a challenging childhood. Everyone has to some extent a challenging childhood.

The difference between the children I spend my day with and you and me is not that we were resilient in the face of frustration and refused to quit when quitting would have been easier than persisting. These children are remarkably persistant and resilient.

So what's the difference?

If I asked you to make a list of people who went out of their way to support you and help you and accept and love you unconditionally, I bet you could name names. The difference is that too many of the children I work either mistakenly place inappropriate candidates on their list or they have no list at all.

If real estate is about location, location, location -- then education is about relationships, relationships, relationships.

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