Clinics bring together the people involved in a child’s care to make shared decisions around strategies for addressing specific issues in a holistic manner. Most importantly, the child and their family are placed at the heart and centre of all decisions made. Together the group endeavours to deal effectively with complex issues, and improve the quality of life for the child and their family.
As an alternative way of working, SchoolKit Clinics have proven invaluable for resolving specific issues and problems, and for helping a child through periods of change and transition. They improve professional practices, they improve outcomes, and they change lives for the better.
This successful school clinic model has developed and evolved over a period of around thirty years. It began because of frustration with the old ways of working – medical disability models – where communication was limited and the management approach did not place the child and family at its centre. A fragmented approach often meant that families were left feeling the needs of their child weren’t being properly met and their voice wasn’t being heard.
Traditionally, a child would have been referred from a general practitioner or paediatrician to a specialist developmental paediatrician for a thorough review and health screen at perhaps three or four years of age. They would be diagnosed with, for example, global developmental delay or autism and a series of recommendations would be made, including advice about options for schooling.
While this model worked well in many ways, follow-up was more difficult. The focus was on assessment rather than ongoing care. There might be just occasional follow-up with the developmental paediatrician when health problems were interfering with school or behaviour. But children with disability often have multiple health and behavioural problems that are difficult if not impossible for families to manage alone.
When more people became involved with the child as they started school the difficulties of communicating between services became apparent. Issues of confidentiality, and hierarchies and formality in both health and education systems, impeded open discussions. Plans were made independently by different parties but there was no cohesion; information was not shared in a timely manner, and families were not at the centre of the process.
This was far from ideal. A new way of working was needed.
At Cairnsfoot Public School, a school for specific purposes (SSP) in Arncliffe (Sydney), it was felt that bringing a child’s developmental paediatrician into the school would be beneficial. Initially, this experience was a shock for both doctor and teachers – it was a new concept for the very different health and education systems to work together. It was soon clear that the family should be involved – they were key – and then disability services needed to be brought in too. Meetings were organised – clinics – that brought everyone together in one place for the first time.
Very quickly it was clear to everyone that this approach had widespread benefits. Families were keen, feeling it would help to give everyone involved greater insight into what it means to care for a child with a disability. This in turn made families feel increasingly comfortable about sharing issues openly. Children were considered in both their school and home environments and families gained a clearer understanding of the roles of the professionals involved with their child. The aims of the clinics were discussed, confidentiality issues addressed, and an understanding grew that the clinics could expand the knowledge and skills of everyone involved.
Meanwhile, from many discussions and meetings a comfortable rapport developed between health and education professionals, increasing their confidence in the process. The various participants discovered that the clinics provided an opportunity for up-skilling and professional development. For example, disability service workers and teachers gained an understanding of how medications may or may not help students and how to trial them, and health professionals gained insight into different behavioural strategies. Everyone was prompted to rethink and improve their work practices.
With all participants learning a great deal and an ever-growing confidence in the process the clinics became more and more successful and effective.
The key aims and values of the SchoolKit Clinic model developed over time. It came to be understood that everyone in a clinic needed to be treated as equals. Everyone’s opinions were valued and respected and everyone was given the opportunity to participate. The child’s and family’s needs and priorities were at the core of the process – they had to have confidence in everyone at the clinic and feel supported by them. The importance of where the clinics were held became apparent; they were trialled in many spaces before moving to a large, private room in the school. This safe setting helped facilitate open discussion. Ongoing communication was critical too. Follow-up after the clinic via emails or phone calls helped ensure issues were addressed.
The SchoolKit Clinic development process was not entirely smooth, but a commitment to the core aims – working holistically and in partnership – and the shared belief that this approach would reap benefits for a group of vulnerable children, provided the incentive to deal with issues as they arose. For example, it was found that having too many people present in a clinic can be overwhelming for families – the balance needs to be right. There needs to be flexibility – different participants may contribute more or less in a clinic depending on the particular needs of the child at that time. Inevitably, very sensitive or contentious issues arise and these need to be dealt with appropriately. Different professionals may push their own agenda too strongly, making a family uncomfortable. This needs to be recognised openly and alternative approaches considered.
Also, it often becomes apparent that issues are not going to be ‘solved’ outright, but within the group a better way of dealing with things can often be found. By identifying a problem and bringing together everyone’s knowledge and perspectives openly in the one place, often the appropriate strategy to use or approach to take will become clear. Sometimes it can be small pieces of information that had not been considered important that are actually critical to finding the best solutions. A relaxed approach and maintaining a sense of humour throughout are critical to the success of the clinics.
At Cairnsfoot SSP, a particularly committed school principal saw the value of what became the SchoolKit Clinic model in helping students and families and in improving education practices. Over time the clinics developed a life of their own and have become a part of school culture. The concept is now introduced to families at school enrolment and clinics occur on a regular basis. As Cairnsfoot has students from all over Sydney, other developmental paediatricians conduct clinics to see their clients from their local health districts.
“I don’t just enrol the child, I enrol the whole family. It’s about the support processes around the child so that they can have improved quality of life and be as independent in the community as possible.”
– Lesley Bruce, School Principal, Cairnsfoot SSP
The respectful relationship between education and health professionals has stayed strong and continues to grow. Junior doctors who have been involved with the process have used the skills and knowledge gained to help develop similar partnerships as senior clinicians.
The SchoolKit Clinic model, was expanded and used as the basis for a Metro-Regional Intellectual Disability Network pilot in other schools for specific purposes extending into the Illawarra Shoalhaven Local Health District and beyond. This successful pilot aimed to provide improved specialist multidisciplinary services for young people with intellectual disability and their carers in regional and rural New South Wales.
A successful process has been created with the child and family at the centre, supported by a range of services, all working in partnership.
Experience has shown it is a model that works well.