The Inpatient School: Adolescent Extended Treatment Facility

During the 30 years of operation of the Barrett Adolescent Centre at Wacol, the facility was not only focused on healthcare for young people with severe and complex mental health issues but on their education and rehabilitation. This service was facilitated by an on-site Queensland Education Department school. Information about that school within the context of the BAC’s multidisciplinary approach can be found at ‘Extended Inpatient Service’  with the background of the BAC’s closure and subsequent Commission of Inquiry etc accessible by clicking on any of the topics here.

When the BAC at Wacol was closed, for the 2014 school year the Barrett School moved to a temporary home at Yeronga State High School where it was able to continue to provide education support for some of the former Barrett patients who were able to access the new location. Then in 2015, the Barrett School moved to Tennyson and was able to accept enrolments from new students with severe mental health issues for whom no other education support had been able to meet their needs. (You can read more about its new role as a Support School here.)

There is currently no operational Adolescent Extended Treatment Facility (AETF) in Queensland . However such a service is in development through a co-design process involving a range of stakeholders in response to Recommendation 4 from the Commission of Inquiry:

The progress of the new AETF is updated at the Queensland Health Department’s Youth Mental Health website (click on the Rec 4 text box above to access).

The information that follows on “THE INPATIENT SCHOOL‘ is based on material gathered from the community affected by the closure of the Barrett Adolescent Centre at Wacol and from the evidence and exhibits presented to the Commission of Inquiry into the closure. Additional sources include the online resources linked to within the content.


Who it’s for

The school within the Adolescent Extended Treatment Facility (AETF) is for those young people who are currently inpatients or those transitioning in/out of residential status (day patients). While students will share the fact that they are all dealing with mental health issues at severe and complex levels, the types and combinations of those issues will differ from student to student. This means that their individual needs and abilities will also vary. All the young people accessing the school will have a background of accessing other kinds of mental health treatment that have not achieved progress and many will have experienced considerable trauma. The majority of these young people are likely to have disengaged from mainstream education with many having done so over an extended period. As a result of both of this detachment from their own community and the likelihood of considerable levels of anxiety (which may be an aspect of their mental illness), many will have extreme social anxiety and will find a classroom environment very intimidating.  Their social isolation – which may have extended to years – will also mean that a significant proportion of these students will be experiencing developmental delays in a range of areas having lacked the opportunities to develop socially, emotionally and cognitively during this key stage of life between childhood and adulthood. Many will also lack the literacy/numeracy skills and learning that formal education aims to develop by their chronological age, however some may have acquired other skills, knowledge and interests through their use of technology despite their social isolation. A higher proportion than would be typical in a mainstream school will be physically impacted by their mental health symptoms, their prescribed medication and/or the lifestyle they have endured as a result of their illness. The mental health issues suffered by these young people – the majority of whom are likely to be experiencing the impact of their symptoms at their worst (in order to have been referred to the AETF) and for whom trust and self-esteem will be at the lowest due to the failure of other treatments – may make emotional regulation extremely difficult for many.  This could manifest in episodes of emotional trauma sometimes acted upon physically through attempts to self-harm, physical outbursts, serious dissociation etc. Many will also be experiencing additional challenges as a result of being away from a familiar environment/people and some will have been admitted to the AETF under an Involuntary Treatment Order (due to their resistance to inpatient healthcare).

Fundamental objective

To reintroduce young people whose lives have come to be defined by trauma and isolation into a range of supportive learning environments in such a way as to create the foundation for positive future knowledge and skill development.

How it works/should work

STAFF

The education staff working at the Inpatient School are part of the full multidisciplinary team which includes psychiatrists, psychologists, specialist mental healthcare nurses and ideally also social workers, occupational therapists and any other clinical staff deemed necessary to support young people whose health issues are many and varied. The school’s principal, teachers, teacher aides and administrative staff form a cohesive team but are also a significant component of the larger multidisciplinary collaborative group. It is only when the contribution of each professional is equally valued that the level of information sharing and problem-solving is able to achieve the most effective support, treatment and education for each young person attending the inpatient facility. Delineation solely for bureaucratic purposes will not only inhibit the development of the best strategies and insights for the patients/students but prevent the creation of a positive and productive working and living environment for all at the inpatient centre.

At the foundation of every aspect of the school’s functioning is a motivation to bring young people lost to education back from their isolation. Within the education team, there must be a depth of experience with and knowledge of the impact of a range of mental health issues  – individually and in combination with other issues – on young people’s development and learning capabilities. And from this basis, then, teaching staff must develop as comprehensive an understanding as possible of each individual student – the issues that affect them and how to navigate/utilise these to support learning and development. From this, staff can create and manage an environment and learning experiences most likely to produce positive outcomes. However, when dealing with young people whose issues are complex and severe, education staff must also be able to think, react and plan according to new situations as they arise. This is not only to ensure the stability of each student’s mental health while endeavouring to enable the optimum learning experience wherever possible but to maintain the equilibrium of the setting as a whole so that vulnerable young people can develop some level of assurance in the education milieu. Young people for whom trauma and disruption have been (and may continue to be) frequent and whose histories have meant compromised abilities to learn and to exist without negative impact within any school-related environment require the support that can only come from professionals able to be flexible, patient and calm. Each member of the school staff will have the welfare of individuals and the group as whole at the basis of their decision-making and therefore, compassion and empathy are useful tools as well as the abilities to be proactive, consistent and clear in their expectations. There is no doubt that those who choose to work in this area of education have deep dedication to the progress of these young people in whom they recognise both courage and potential. The unique skill-set of each staff member and of the collective team are a resource from which much can be learnt. And many more young people can be reintroduced to the kind of learning that can change the path of their lives.

(For more, see HUB OF EXPERTISE under The Future of Education in Severe Youth Mental Health.)

ENVIRONMENT

It is essential that the Inpatient School has access to a number of types of environments in order to facilitate the complex needs of each individual patient/student. Most young people in this situation will find new people (staff, fellow students) within a new residential base within a range from daunting to almost impossible to approach (having participated in minimal social interaction beyond that with carers/families for an extended period and negative experiences prior to that). Some students in this cohort can have difficulty with overstimulation or an aversion to particular elements of a school experience. So areas that facilitate de-escalation of stress away from group activities or potential sensory overload are essential. Indoor and outdoor areas not only provide flexibility in the range of activities possible but ensure that there are opportunities for invaluable physical activity – an important factor in learning to manage mental health challenges but also an opportunity for the acquisition of fundamental skills and understanding of a wide range of concepts through the use of the body and active engagement with the real world. Each young person will have individual needs and each young person’s capacity may change abruptly. So a flexible environment with a range of options in surroundings, resources and other people present is a necessity.familyquoteINPATIENTSCHOOL_1

Each Inpatient School will have a different classroom layout – which may change from day to day – due to the unique needs of students. Young people whose mental health issues, trauma and low self-esteem have been debilitating over an extended period (in which multiple treatment methods have failed) must develop the trust and security that could eventually lead to active and ongoing positive approaches to learning. This is only possible in a school with the right blend of consistency and variation, stimulation and simplicity, interactivity and independent pursuits etc. – all within a highly supported environment where observation, engagement and intervention by understanding professionals is always enabled.

In addition to the onsite learning areas, access and planned activities elsewhere are what makes contemporary inpatient care vastly different from the days of institutionalisation. Group outings in the community can include accessing public areas (parks, shops etc.) and attending specialist classes offsite to develop skills in cooking, self-defence, lifeskills etc. These activities will be carefully supervised and will only involve those students who are assessed as being at a level where participation is likely to enhance learning and development and facilitate a positive experience of progress and success. But inevitably, young people within an AETF that has a school with this kind of approach and program will be significantly less socially detached than had they remained unable to leave their home within their own community.

SOME OTHER KEY ELEMENTS

For those who have spent much of their lives feeling minimised, less than, unworthy, it is always valuable to have physical reminders of their value and achievement. A learning environment that displays student work or imagery depicting accomplishment, ability and/or productive collaboration will not only affirm that each student has and can succeed and possesses a unique and valued perspective but will create areas that engender personal ownership of place within a facility that is easily viewed as far from a home environment. The work of others can be viewed and interaction may be stimulated as well as other concepts and abilities e.g. empathy that are assets when living within a community.

Technology is an intrinsic part of the life of everyone and for those who have been socially isolated, it may have become a prominent feature. Utilising media with familiarity that promotes competence and achievement is an indispensable aspect of every modern classroom but especially helpful when needs can range from solitary work at an individual pace to early collaboration with the focus on a familiar tool rather than emphasising social interaction. In addition, for those students who do have connections to schools or other groups in their own communities and for those who develop the capacity and interest to expand their learning through Distance Education, connectivity to those groups and resources must be available.

APPROACH

Ongoing interaction with clinical staff and families/carers are significant in informing the base level of school staff’s understanding of every student’s capabilities, challenges and concerns. Collaboration with the facility’s multidisciplinary team will frame the approach to education with daily meetings with all available professionals facilitating observations and insights from all staff involved in the care/education of the patients/students. These will then inform not just ongoing treatment by clinical staff but the learning experiences provided by the education staff and the interaction with that young person based on an understanding of their current circumstances. Full commitment to this multidisciplinary alliance by all staff is a key element in achieving ongoing and lasting progress for young people for whom other treatment strategies have failed. In addition, an environment in which people positively interact and engage with each other to create a productive micro-community is one in which young people can observe and learn important social skills as well as feeling the security that is so vital in providing a nurturing atmosphere and restoring hope to those who have become hopeless.

Knowledge and experience with young people in this cohort from an educational perspective provides the necessary understanding for teaching staff to develop the right environment and learning experiences across individual, small group and larger group activities as student needs require. Anticipating behaviour and responding appropriately to unpredictable responses will be aspects of daily functioning for the education team. With students likely to experience acute episodes, all staff must be hyper-vigilant for both subtle manifestations of issues like dissociation and for means by which self-harm could be inflicted. (Young people who have reached the need to be admitted to the AETF will have levels of trauma that incite them to find methods that those without this kind of suffering would never contemplate and most will have had a number of admissions to acute wards where they can acquire knowledge about self-harm techniques from fellow patients).

So a flexible approach with multiple options for activities, locations, levels of involvement etc. will always underpin the school’s program and operations. With up-to-date understanding of each student and the issues affecting them and constant observation with an openness to change will allow teaching staff to provide and support the students through experiences that give them to best opportunity to achieve and progress.

Curriculum
Young people admitted to the inpatient facility are likely to be highly traumatised and at a crisis point in their lives. Their health issues and the effects of those will be so severe that they will have become all-encompassing.  So strategic management of the curriculum will be the only way to enable a young person to benefit from any kind of education experience. The initial stages of each young person’s engagement with the school is like to be sporadic (as they deal with new treatment and clinicians and even the concept of school) so the underlying curriculum content staff will aim to address is likely to be within the Personal and Social Capability area of the Australian Curriculum’s General Capabilities tier.

Ensuring that students in this cohort develop knowledge of and the ability to:

  • Recognise emotions
  • Recognise personal qualities and achievements
  • Understand themselves as learners
  • Develop reflective practice
  • Express emotions appropriately
  • Develop self-discipline and set goals
  • Work independently and show initiative
  • Become confident resilient and adaptable
  • Appreciate diverse perspectives
  • Contribute to civil society
  • Understand relationships

will be the basis for building the personal and inter-personal skills that will enable further learning and skill development as well as an openness to ongoing education. As students acquire these capabilities and with them, the capacity to develop their own interests and the tools that will be the foundation of future knowledge and skill acquisition, other aspects of the Australian Curriculum can begin to explored. It is only through this careful structure of curriculum-based learning experiences that there is the best chance of positively developing minds, emotions and lives that have been long overwhelmed by the burden of complex illness.

Finally … and Importantly

The Inpatient School provides a vital service within a facility focused on finding ways to help young people for whom all healthcare and education options have proved ineffective or inaccessible. But it can never be overlooked that the presence of the school – of its classrooms and chill-out rooms and gardens and outdoor activity areas; and of its staff from principal, teachers, teacher aides, admin officers and groundspeople – is particularly significant. The constancy of these teaching locations and people take what could feel like ‘another hospital’, ‘another ward’ and create a micro-community. Young residents are not “patients when they’re learning about the lifecycle of the frog that appeared in the vegetable garden, when they’re editing a video about what Anzac Day means to modern Australia or even when they’re taking time-out with a teacher aide who knows that a long walk is what helps this particular young person to deal with their anxiety. They are “students”, “kids”, “Ben” and “Jasmine” and “Leo”. They are people. And finally people being treated like they’re worth helping, worth listening to. And worth any kind of education that they might want to try in the future.

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