Doctors and health professionals often have many pressures on their time and are highly in demand. It is important, even so, that they make every effort to arrive at the school in good time for a SchoolKit Clinic.
Arriving in advance may allow for the school principal and paediatrician to meet together to share what they know of the child and the family situation, and to agree how they will work together to lead the clinic. It might also be an opportunity for the school principal to take the health team into the classroom or school playground where they can observe the child together ahead of the clinic.
The child and their parent or carer (and indeed some school staff) may feel intimidated by doctors or other authority figures and may associate them with previous bad experiences (for example, the diagnosis of their child with a disability). An introductory chat, perhaps as food and drink are served before the clinic gets underway, may help break the ice and set the tone. A non-judgmental and friendly approach are very important throughout.
The composition of the health team attending a SchoolKit Clinic will depend on the particular issues to be discussed. Often a developmental paediatrician and paediatric registrar or fellow (trainee paediatricians) will be present. Depending on the needs of the clinic other specialist doctors may also attend or be referred to, for example psychiatrists, gastroenterologists or rehabilitation physicians. Various allied health professionals and other specialists may also participate on the day.
Irrespective of who attends a SchoolKit Clinic, open communication is encouraged to invite and foster broad discussion of presenting issues from everyone’s different perspectives. The direct invitation of opinion from participants may be required.
It is important that health professionals do not ‘lapse’ into technical medical language and jargon during the course of the clinic, particularly when talking between themselves; simple, plain-English language should be used throughout.
During clinic discussions the health team will participate and contribute in a number of ways:
- After the family have had the chance to share their main issues or concerns, the paediatrician will ask questions – primarily of the family – to clarify their understanding of what they’ve heard and gather any details required. The school will likely also have useful input during this time.
- The paediatrician will review any medical reports the family have brought with them, again asking any questions necessary to clarify the information presented.
- As discussion progresses different members of the health team will be asked to contribute what they know about the medical or other considerations being described and the ways they may be impacting on the child’s health, behaviour and general wellbeing.
- At all times, the health team must be very conscious of the fact that they are talking about people who are in the room – the child and their family. Sensitivity and respect are essential. Asking the parent or carer for their permission to ask about delicate and private matters is important, for example, ‘Do you mind if I ask you about…?’.
- The paediatrician will ask lots of questions. Often this will mean asking open questions of the family, such as, ‘What one thing could we help your son with that would make the biggest difference in his life?’ or ‘Tell us about what happens at mealtimes at home’. Sometimes this might mean gently probing around something that a parent or carer may be uncomfortable about saying, for example, ‘Are you always able to get your child to take her medication?’.
- Everyone in the health team will do lots of active listening. Listening closely is when the health team will learn a great deal about the experience of day-to-day life for a child and their family. Listening closely – with an open mind – is when the health team have the opportunity to gain some critical insight into what medical or health strategies they might be able to change or put in place to better support the child.
- One of the key benefits of a SchoolKit Clinic is that a child can be observed in an environment they know well, meaning the health team are more likely to see a typical behaviour pattern.
- Sometimes observation is enough, at other times physical examination may be necessary. This may be possible in the clinic, or occasionally may need to be done elsewhere. The paediatrician should take a medical kit to the clinic to aid examination, containing written screening tools, and prescription pads so these can be provided on the day. If further investigations in other settings are required the best way of achieving these should be discussed.
- The paediatrician and other members of the health team, may offer suggestions and contribute ideas throughout the clinic about what existing strategies might be modified, or what new strategies might be put in place, to help and support the family and care for their child.
- A representative from the health team will take notes about whatever information might be useful to them in supporting the child and the family and meeting their needs, and for a clinic report.
Concluding With Clear Agreement
One of the most important parts of any SchoolKit Clinic is the management plan that comes out of it. It is important, for all participants to be involved in discussing this plan at the conclusion of the clinic meeting so that everyone has a clear understanding of shared goals and intended outcomes, and their role in achieving them.
This may include arranging additional appointments for the family to further investigate medical issues, or referrals to new health clinicians, for example, speech pathologists. It may involve recommending a family pursue access to resources they hadn’t been aware of, or make new requests from disability service providers.
At the conclusion of a SchoolKit Clinic the health team will be very clear about what medical interventions or health treatment plans need to be put in place for the child and family, what actions others in the partnership will be taking, and what actions and follow-up will be required by them specifically.