Developing and Testing a Process to Award High School Credit for Hospital-Based Therapeutic Learning
Bruce Murray1,2,3,4 B.Ed., Andrew Heaton1,2,3 M.A., Rae Miller1,2,3 B.Ed., Laura Rayner1 RN MN, Janice Richardson3 M.A., Nivez Rasic1,5 MD FRCPC.
The Vi Riddell Children’s Pain and Rehabilitation Centre1 & Rehabilitation and Education Program2 (Alberta Children’s Hospital), Calgary Board of Education3, University of Lethbridge M.C. Student (2nd year)4, Department of Anesthesiology, University of Calgary5
Background
Youth who are experiencing complex pain and other health issues often struggle to maintain high school programming and earn credits. The stress of remaining on track in high school often results in heightened anxiety which exacerbates existing challenges1,2,3,4. There is a general lack of knowledge and understanding of pain and mental health education in youth4. The Vi Riddell Intensive Pain Rehabilitation (IPRP) day treatment program at the Alberta Children’s Hospital (ACH) has been shown to be an effective method to restoring function for adolescents with chronic pain3. The average student, due to health concerns, has arrived in the IPRP a half year behind in school. Through the collaboration of the ACH Alberta Health Services (AHS) providers and Calgary Board of Education (CBE) teachers, the program can now offer high school credits for the educational components of therapeutic work.
Methods
Students in the IPRP and Rehabilitation and Education Program (REP) cover a large amount of authentic learning through their interactions with clinicians (see Figure 1). Academic programming has been designed in conjunction with the learning youth acquire while in treatment so that students earn high school credits for their participation and engagement. A consultative process with patients, parents, clinicians, and teachers was incorporated into the design and implementation
Overview of Academics and Therapeutic Programming
As students engage with therapeutic programming, they are evaluated by CBE teachers according to Alberta Education outcomes, and earn up to 4 high school CTS credits.
Supported by the Dr. Gordon Townsend School (DGTS; CBE).
School staff-3 certified teachers, an assistant principal, and a therapy assistant.
Youth focus on 1-2 core subjects from their origin school (e.g. Math, English or Social Studies), for 5 hours in IPRP and variable for REP.
Students are integrated into a classroom consisting of 6 to 10 students.
Figure 1: IPRP Programming Components (average per week)
Figure 1: IPRP Programming Components (average per week)
Interinstitutional Collaboration
Interinstitutional collaboration3 is initiated upon patients’ entry and continues throughout the programs, which involves the following.
Course Development
Learning Leader (LL) position through Classroom Improvement Funding was envisioned by Janice Richardson
LL and rehabilitation programs teacher collaborated with AHS clinical staff in order to understand the learning youth acquire when in treatment. Learning content is reliable and clinicians cover topics ranging from healthy living, wellness, pain management, anxiety and mental health strategies.
Learning outcomes were identified and matched to existing Alberta Education Career and Technology (CTS) courses: Health Services Foundations (HSS1010), Pain and Pain Management (HCS2120), Mental Health and Wellness (HSS3020), and Supporting Positive Behaviour (CCS3050)
LL utilized high school redesign principles, and Alberta Education Competencies to develop courses and assessment
Ongoing feedback from students and clinicians is incorporated
Implementation
Assessment
Nine IPRP youth and six REP youth have completed the therapeutic credit program
Students complete assignments in the IPRP program, such as the “Flare Up Plan” (see Figure 2)
Therapeutic learning is reflected in the assessment tools used: competency evaluations (see Figure 3) self-evaluation and staff evaluation, oral/visual presentation of course content knowledge understanding and strategies, Sleep Diary, Behaviour Pathway, and Transitional Strategy
Figure 2: Flare-Up Plan Example
Figure 2: Flare-Up Plan Example (Student Work Presented with Permission from Student)
Figure 3: Competencies Assessment
Figure 3: Competencies Assessment
Outcomes
Youth demonstrated knowledge and skills acquisition, and retention, and an ability to transfer and apply their learning to their varying daily contexts and activities. During and following the evaluation, the youth exhibited relief, pride, and confidence as a result of earning the credits and sharing the authentic learning acquired.
Student Observations
Students who partake in the learning credit opportunity are proud to share the learning and are relieved and energized by their accomplishment
Students who were unable to participate in regular schoolwork, due to overwhelming personal and program demands, were engaged and earned credits
High School Credits Earned
15 students who have participated in the IPRP and REP have earned a total of 45 additional credits (mean = 3) that were earned for therapeutic work
Interinstitutional Collaboration (CBE & AHS)
Partnership has been strengthened and energized by the collaborative opportunity
Staff are invested in participating in this work as they see real-life benefits such as movement towards high school graduation
All staff are highly motivated in the process of developing mechanisms for further knowledge mobilization of course content to youth and educators
Future Directions
Further evaluation on the effectiveness of interinstitutional collaboration is needed in the area of capitalizing on learning opportunities in therapeutic settings. Offering credits for the educational components of the IPRP and REP has been a synergistic relationship, benefitting the youth, teachers and health care providers. Any students in treatment or in the wider population could benefit from a collaborative education and treatment plan that allows them to earn credits for their efforts.
Future Directions
The partnerships between schools and hospital programs can optimize academic and overall functioning for youth in treatment.
Logan, D. E., & Curran, J. A. (2005). Adolescent chronic pain problems in the school setting: Exploring the experiences and beliefs of selected school personnel through focus group methodology. Journal of Adolescent Health, 37(4), 281-288. doi:10.1016/j.jadohealth.2004.11.134
Logan, D. E., Simons, L. E., Stein, M. J., & Chastain, L. (2008). School impairment in adolescents with chronic pain. Journal of Pain, 9(5), 407-416. doi:10.1016/j.jpain.2007.12.003
Odell, S., & Logan, D. E. (2013). Pediatric pain management: The multidisciplinary approach. Journal of Pain Research, 6, 785-790. doi:10.2147/JPR.S37434
Power, T. J., McGoey, K. E., Heathfield, L. T., & Blum, N. J. (1999). Managing and preventing chronic health problems in children and youth: School psychology's expanded mission. School Psychology Review, 28(2), 251. Retrieved from here
Reid, K., Simmonds, M., Verrier, M., & Dick, B. (2016). Supporting teens with chronic pain to obtain high school credits: Chronic pain 35 in Alberta. Children (Basel, Switzerland), 3(4), 31. doi:10.3390/children3040031
The authors would like to thank the Riddell Family, Dr. Gordon Townsend School, Alberta Children’s Hospital Foundation and the Rehabilitation and Education Program, Calgary Board of Education, Vi Riddell Intensive Pain Rehabilitation Program, Alberta Health Services, and the University of Calgary for their ongoing commitment to the youth and families in these programs.
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