SchoolKit Clinics offer a model for developing new strategies for the care and support of a child or young person with disability and complex health issues in a setting which is most convenient for the child and their family. It has been shown to be valuable in metro settings and may be particularly useful for those struggling to access the expert advice and assistance they need in regional and remote areas.
Involving a health team from a metro setting in a day of clinics at a regional school, for example, can be enormously valuable in providing families in those areas with access to specialist advice that may otherwise be unavailable to them.
While this possibility opens up a number of opportunities, establishing SchoolKit Clinics and running them on an ongoing basis in regional and remote areas may create a number of challenges for both school and health teams. This is especially the case where the key participants are based in different localities (for example, where a paediatrician and other specialists need to travel to visit a school, or where a consulting teacher from a school for specific purposes is brought in).
Visiting participants being unfamiliar with local service provision, such as educational, medical or disability-specific services available in a particular area, their organisational structures and lines of communication, may impact on the way a clinic is run and its effectiveness.
Adopting a consultative approach with the aim of building local capacity and providing educational support to key participants, rather than coming in and taking over, has proven a successful strategy for managing this situation most productively.
Lessons Learned – Two Case Studies
In the course of developing the SchoolKit Clinic model in partnership with Cairnsfoot School for Specific Purposes, and then piloting it further afield in the Illawarra district, the Metro-Regional Intellectual Disability Network has gained some experience about what works and what doesn’t in this regard.
Two examples are presented here as case studies which highlight some of the challenges that have emerged and the strategies used to address them.
At a school for specific purposes in regional New South Wales, school clinics were established to address the issue of improving the care of young people with significant health, behavioural and psychosocial needs. Coordinating transition to adult health services was also a priority.
Multiple meetings involving representatives from health, Ageing, Disability and Home Care (ADHC) and the school were held to discuss the reasons for holding clinics, processes and how the partnership was going to work. Clear identification of the responsibilities of all participants was made and clinics began.
Clinics in this school were based on a unique collaboration between New South Wales Health, Ageing Disability and Home Care (ADHC) and the Department of Education and Communities (DEC). The intention was to build local capacity by providing consultation and support. The responsibility for case coordination and follow up was shared between all three agencies according to the age of the child or young person involved.
Following changes to disability services, participation by ADHC in the clinic coordination and follow-up ceased after two years. Subsequently, the agreed protocols and processes proved more difficult to maintain.
This resulted in occasions where, unknown to the school, multiple clinicians (including other paediatricians and psychiatrists) became involved with the young person’s care, resulting in duplication of services.
This situation was managed by making changes to the intake process (i.e. communication with the family) to more clearly identify what clinicians might be involved in their child’s care. This was followed by much closer liaison with the family and their established specialists and clarification of clinic goals. These measures resulted in:
- Enhanced communication between the school and local clinician and clarity about management (with no school-based clinic required)
- The local clinician requesting involvement in a review at a school-based clinic (and providing past information, letters etc.)
As a direct result of this experience, a template letter was developed to explain the role of school-based clinics to local clinicians and to request what information they may have that would be relevant for consideration within the clinic context.
Despite these brief hiccups in the effectiveness of their delivery, and changes to staffing and local disability services, clinics have continued successfully in this school ever since.
Following a request to the MRID’s Sydney-based health team from the school principal at another school for specific purposes in a regional area an information session on mental health and intellectual disability was held for teachers and parents or carers connected to the school. Feedback from the session identified interest from all those attending in setting up regular clinics at the school.
A meeting was organised with representatives from the teaching staff and the health team. This meeting did not include the school principal, who was unavailable, or the director of the health team.
Clinics were organised and it immediately became apparent that the understanding of the process, including who would participate and the purpose of the clinic, were unclear to school staff and families, and differed from that of the health team. Health staff had assumed that the school, particularly the principal, were aware of the foundation principles and the clinic processes. It was also assumed that parents and carers and school staff understood the collaboration required to achieve best outcomes and that school staff had an understanding of the family dynamics and psychosocial backgrounds in each case.
The health team recognised that the required preparation, including securing the school’s commitment and particularly the principal’s acceptance of ‘ownership’ of the clinic, had been inadequate. The foundation principle of interagency and multidisciplinary collaboration had been poorly explained, which in turn impacted on the ability of the clinic to achieve the desired outcomes.
Despite this issue, the power of collaboration and shared commitment to working as a team were amply illustrated in the successful outcomes achieved for a child and family who were referred to this school clinic.
This child had been exhibiting distinct behavioural change and had been seen by a local paediatrician and admitted for physical and dental examination and blood tests under general anaesthetic to exclude physical causes. No cause was found.
During the clinic, it became clear that the child was not sleeping well, and that his behavioural change had caused significant strain on his already stressed family. Medications to aid his sleep and mood were commenced. An ADHC representative involved in the clinic referred the family for case management and intensive behavioural support was begun. On-going medical support was provided by the health team after the clinic, via phone and email, to both the family and involved clinicians.
The result was significant improvements in the child’s behaviour.