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’.
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 for whom no other education support had been able to meet their needs. Its new role as a Support School for community based young people with severe and complex mental health issues has revealed yet another section of the community for whom service provision has been lacking. What has developed in the last few years at Tennyson is further evidence of the expertise of the education team based there – able to adapt, upskill and mould programs and strategies to meet individual needs within different circumstances and parameters. But it has also illuminated an education gap which cannot be filled by one Brisbane-based school alone.
The information that follows is based on material gathered from the families who have accessed and/or are currently accessing the Barrett School at Tennyson; the P&C Committee of the school; and from advocates in the community (particularly those with professional education backgrounds) who continue to support important and specialised services for those marginalised by severe and complex youth mental health issues in Queensland. Additional sources include the online resources linked to within the content.
The only positive to come from the tragic closure of the Barrett Adolescent Centre at Wacol was the discovery of a group of young people who, due to their mental health issues, had slipped through the cracks of education service provision. Unlike the cohort likely to need extended inpatient care, these previously unacknowledged young people are, in the majority, still engaged in mental health treatment. Most too are not as likely to be affected by the range/depth of additional risk factors that can impact some of those in the cohort needing residential treatment. There are multiple reasons that the Inpatient School within an Adolescent Extended Treatment Facility does not support attendance for day patients other than those transitioning out/in of/from the residential service. Some of those are:
- Those for whom the Support School model evolved are not only in a different situation regarding clinical treatment and other circumstances but require a different approach to that implemented in an Inpatient School e.g. more regularly scheduled engagement in other community-based education/training (see more details under ‘Who It’s For’ and ‘Approach’, following).
- The presence of another cohort within an Inpatient School would create a more variable student composition and therefore a less stable environment, seriously negatively impacting the participation of those undergoing extended residential treatment.
- It would be impossible for teaching staff to manage the dual needs within the classroom or other learning environments let alone combining collaboration with the in-house multidisciplinary team with the necessary individual case management of the home-based cohort (which includes liaison with a range of external clinicians, base school guidance officers and families/carers.)
The needs of these two groups of young people are clearly different. And until 2015, there were adolescents across Queensland who, although accessing some mental health treatment for severe and complex issues, had disappeared from participation in education because there was no service that could respond to their specific needs. It is testament to the dedication of the Barrett School at Tennyson, now operating as a Support School, that they adapted and developed new facets to their service to support these young people who are finally engaging in education after years in isolation from an aspect of life that is a basic human right.
Who it’s for
The Support School for young people with severe and complex mental health issues living in the community provides a range of learning opportunities for a different cohort than those accessing education in the Adolescent Extended Treatment Facility (AETF). Although there are some commonalities, the most important of which is a disengagement from mainstream education, there is likely to be greater variation in acuity and types of challenges across the community-based young people. Although the young people are community-based (within family or other support systems), the environment of a mainstream school is not simply daunting but inappropriate due to the severity of their mental health issues and a range of attempts to facilitate attendance through various modifications, types of support and special education programs will have failed. Many of these young people will have slipped through the cracks to such an extent that the education system may no longer be aware of their existence (e.g. a young person’s existence and lack of attendance can easily not register between the transition from primary to secondary school or junior to senior). As with AETF patients/students, families/carers are likely to be at a stage where the impact of supporting a young person with mental health issues of this severity will have taken a significant toll. However, because these community-based young people are likely to be still engaged in clinical treatment for their mental health issues, it’s more feasible that some be able may have the capacity to view education goals as possible (whereas those requiring AETF inpatient admission will have a significantly diminished capacity for any hope for most aspects of their future).
[Information about how young people are referred to a Support School follows under ‘Approach’.]
Classroom readiness is a key aim of the Support School. In order to enable a young person with severe mental health issues and extended periods of disengagement from schooling (and other social/community environments), young people must develop trust and security (in others, their physical surroundings and themselves) across a range of learning environments to the extent that the acquisition of knowledge and skills can occur on a consistent and ongoing basis. Introducing and sustaining involvement in community learning environments beyond the Support School when initial stability and readiness has been achieved will include options such as:
- their mainstream base school
- Alternative Schooling e.g. QLD Pathways; Flexi-school
- University / University Bridging Course
- Vocational training
Ultimately, though, the goal that drives all that is planned and developed around each individual young person by the Support School is to empower each student to be able to successfully access learning options that will allow them to fully reach their potential and acquire the skills and knowledge that define independence, productivity and personal satisfaction.
How it works/should work
There must be staff members within a Support School team who have extensive, specific experience in teaching young people with severe and complex mental health issues. Not only will this mean that education can be planned to target the needs of this unique group but that other significant issues can also be properly and safely addressed e.g. it is only through experience that staff at the Barrett School have learnt the effects of the overall composition of the student group on the dynamics and environment – vital factors in providing a foundation for positive experiences and outcomes. The comprehensive understanding of both the collective student group within the particular teaching environments and the individual young people whose mental health issues are truly complex is what allows the education team to make the correct assessment as regards a young person’s ‘classroom readiness’ and how an individual’s involvement will fit into the group as a whole. (If there were to be an external individual or panel deciding who would attend without sufficient and valued input from the teaching staff of the Support School, they may not have adequate information to make an appropriate decision based on cohort effect.)
Appropriate staffing levels and expertise will mean that one-on-one or small group activities can be regularly planned for appropriate surroundings and that when reactions, behaviour or challenges that could not be predicted arise (which will happen often within a cohort defined by extreme vulnerability) impromptu adjustments can be made immediately with minimal disruption to other students and staff.
The characteristics of staff and their knowledge of their individual students as well as how their health issues and challenges are likely to reflect those of the education team within the Inpatient School (link to Staff section on Inpatient School page). As with any such environment, teachers need the mindset to understand the pedagogical aspects of the specific learning milieu but since effective online training regarding education for students with mental health issues is easily accessible e.g. Judith Howard’s work on ‘trauma informed practice’ is the basis for a number of such courses, there can be staff employed at the Support School who have not have extensive prior experience in this specific area of special education. Of course, this can only be the case where there are a good proportion of other staff members with a comprehensive background in teaching young people with severe and complex mental health issues and when the collaborative team approach to planning and working with students is embraced by all.
Currently the Barrett School at Tennyson operates as a Support School for this cohort and although other special education environments can have healthcare professionals (nurses, art therapists, occupational therapists etc.) onsite, the Tennyson school does not have access to staff in those additional roles. This intrinsically affects the number of students that can attend as well as the composition of the group, the layout of the physical environment and the roles and duties of the staff. As such, one of the key differences for staff at a Support School without specialised support staff beyond those tasked with general administration is that educators must take on Case Management of individual students to ensure that all needs are met from referral to the optimal outcome of transition to a more diverse/mainstream educational setting. The need for this at Tennyson has actually enhanced the skill set of the education team and given them even greater opportunity to expand their understanding of the needs of the young people within this very unique cohort.
Overall, each member of staff at the Support School is a key player in developing the ‘community of understanding’ – where shared knowledge and collective dedication to each individual young person creates a supportive environment focused on the needs of each student to best facilitate their positive development and learning. There are few educational models as committed to the best outcomes for each young person such that every staff member has such comprehensive knowledge of unique student challenges, interests and abilities as well as the passionate commitment to facilitate achievement at any level for each attending student.
(For more on a collaborative teaching approach, see HUB OF EXPERTISE under The Future of Education in Severe Youth Mental Health.)
Physically, the environment must allow for significant flexibility in the presentation of learning experiences on a needs basis. A peaceful location with natural outdoor spaces along with a building/buildings where rooms of various sizes and levels of resourcing can be easily reconfigured are integral features. There must be withdrawal areas to allow for de-escalation and the development of self-regulation of the challenging episodes that all young people in this cohort suffer but also a classroom set up to encourage the idea and practice of classroom behaviour. There need to be areas for small group learning activities and also individual study areas for those involved in Distance Education.
Small numbers of people whose presence is as consistent as possible and familiar atmospheres and activities will also contribute to providing a setting for traumatised young people to develop trust and hopefully eventually composure and concentration. The acquisition of these characteristics will then ultimately be the basis for opportunities for achievement and the desire to continue to engage in learning.
However, busy classrooms surrounded by corridors continually in use with a range of people coming and going and few areas of calm and space (let alone consistency) can be an assault on the senses for many. But for young people whose fragility has been compounded by multiple issues and incidents, these circumstances can be agonising. So instead of fostering a positive outlook on school and the world beyond their chosen place of prolonged retreat, areas that are not specifically focused on students with severe mental health issues can drive such young people into deeper seclusion. Schools based within major hospitals do excellent work in providing ongoing education and social engagement for children and young people with a range of acute and chronic conditions (as well as their siblings if a family has travelled to access healthcare from remote/regional areas). But major hospitals are located in high density areas surrounded by multiple businesses, forms of transport, large buildings and few areas of genuine tranquility despite innovative designs that make the best of allocated space. For a young person with complex mental health issues, even accessing such a location could be an insurmountable barrier. But even when that can be conquered, the constant and unexpected changes in people, noise, movement, staff etc. will rarely provide an environment conducive to overcoming multiple sources of anxiety or triggers that lead to deterioration in mental health.
One of most vulnerable cohorts of young people requires specialised healthcare and it is no different for devising and utilising a learning environment in which they can overcome past traumatic school/other experiences and impediments that are the manifestation of their mental health issues. There are likely to be few, if any, positive outcomes without such careful attention to the physical arrangement and the atmosphere that will create.
SOME OTHER KEY ELEMENTS
As in the Inpatient School, accessible technology is a key resource for learning opportunities as well as ongoing connections to base schools/Distance Education etc. It’s likely that despite social isolation, these young people will be regular users of devices and online platforms so incorporating familiar tools in which they have proficiency will provide a stability and sense of competence on which to build greater skill and knowledge development. Many will also find communication beyond their familiar and trusted few less daunting to embark upon through the use of technological means of communication initially.
Visiting professionals with expertise in areas within the curriculum not only provide useful information and support new skill development but also facilitate the practice of interpersonal skills and self-management strategies for those with social anxiety. These visiting experts can include:
- Exercise physiologists
- Members of the local indigenous communities
- Art/Craft practitioners etc.
New interests may be developed and variation in daily scheduling adapted to so there are always multiple benefits for young people in a state of readiness to be involved in such activities.
On-site animals and plants to nurture, distract and learn from are extremely useful resources in the Support School. Many traumatised young people find comfort in spending time with uncomplicated creatures who make no demands on them and caring for the growth and maintenance of living things develops an understanding and ability for many aspects of human life – personal responsibility, physical health and patience are the building blocks of maturity and simple activities where the focus is away from the student themselves and on another subject can reduce the stress of undertaking regular task that promote these.
Referrals and Enrolments
At the Barrett School at Tennyson, the students come from a range of initial sources – predominantly from referral from school Guidance Officers but at least 30-40% of opening contact comes from outside the Education Department i.e. Child and Youth Mental Health Services (CYMHS), Evolve, the Child Safety Department, private psychiatrists, Assertive Mobile Youth Outreach Services (AMYOS), parents/carers – who recognise the value that the transition school can provide for a young person who has no other education options. The process, however, requires that:
- each young person must meet the criteria that the Barrett education team devised in consultation with the Region when the school relocated to Tennyson (in 2015) and
- referrals must come from a Senior Guidance Officer as all students must be first enrolled in a base school in order to use the service of the Support School. (It is not uncommon that young people have not attended any school for such an extended period that a Guidance Officer must first facilitate enrolment at a base school that the student has never attended to enable their attendance at the Barrett School.)
- the Support School team has extensive interaction with treating clinicians and with families/carers of potential students for assessment of the suitability of the service for the individual young person as well as the level of risk to both the individual and the cohort (with ongoing collaboration with clinicians a key element of service provision if the attendance at the Support School proceeds)
- liaison with the base school – often by the Barrett School staff to relieve the family of that burden – to make arrangements for an appropriate starting procedure for the young person (who may require gradual exposure to the new environment or other supportive strategies to facilitate positive engagement by the young person) and to determine the most appropriate Barrett School staff member for undertaking ongoing case management for the new student
- after extensive communication with clinicians, base school, families/carers and the young person themselves (including supported visits to the Support School, where relationships can begin to be developed), the method of admission is determined with most requiring a gradual admission rather than immediate
The total number of students accessing the service at any one time varies but there been as many as 27 at the Barrett School when the education team have been able to meet the individual needs of all the young people. While the education team acknowledges that every young person referred needs specialised education support, the mix of students must be assessed particularly carefully before any new student can be accepted. The aim is to provide the best milieu for the whole group in order to best foster progress for individuals so a good balance of genders and ages is optimal. The teaching staff are adept at dealing with students with a wide range of challenges including very complex levels of mental illness (a number have considerable experience having worked at the residential facility at Wacol) but having more than one or two young people who may be self harming or have periods of aggression or dissociation isn’t appropriate without clinical professionals on-site. In addition, too much disruption can also negatively affect other vulnerable students when there is no capacity for an individual to withdraw to receive specialised mental health support or treatment. So the composition of the group must always be carefully considered in order to achieve the best outcomes for every student and it’s only through experience that professional teaching staff have developed the capacity to assess the needs and challenges of potential students as individuals as well as how those will affect the other individuals already enrolled.
This is just one of many indications that this educational environment must not be limited to one Brisbane campus. (See THE FUTURE OF EDUCATION IN SEVERE YOUTH MENTAL HEALTH for more.)
Young people being enrolled will be mindful that the Support School is a ‘bridge’ to a mainstream learning service but time limits can never be imposed as the capacity to develop the skills and confidence required must happen at the pace that meets the unique needs of each student in order for the foundation for learning to be secure and lasting. Gradual, flexible experiences planned and supported by comprehensive case management and collaboration with treating clinicians and families/carers are the only way to achieve true classroom readiness for young people in this cohort.
As with the Inpatient School, a considerable amount of the planning for the initial stages of a young person’s attendance at the Support School will focus on 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 and
- Understand relationships
lays the groundwork for expanded learning and a positive approach to ongoing education. As students develop competence in these capabilities, other aspects of the Australian Curriculum can begin to be explored.
Scheduling to Facilitate Community Engagement / Gradual Integration
Ongoing contact and interaction within the community is an essential element of a school transitioning young people not just to mainstream education options but to living within a community in which they can interrelate and achieve effectively, utilising the skills they have developed to become more independent and productive as they grow to adulthood. For those that have been isolated for and extended periods, this kind of involvement and communication does not happen naturally so must be strategically facilitated by the Support School. As such, the Barrett School at Tennyson has allocated Friday of each week to activities beyond the Tennyson campus e.g.
- Enrolment and attendance in short courses (from cooking at the Jamie Oliver School, jewelry making and other skills to more academic study)
- Independent Learning (e.g. Distance Education)
This not only allows settled students to develop and enhance what the school program has enabled but it allocates a day from those young people beginning their involvement in the Support School to do so through gradual integration experiences when the school is at its most peaceful and least intimidating. Special orientation activities to provide support can be developed for each individual new student in order that their first classroom experience in years will be as specifically paced and resources as each individual requires. Family member/carers can initially be included and then once fear evolves to trepidation/caution, greater challenges can be met and overcome.
As always, severe and complex mental health issues compounded by the negative experiences that have led to debilitating decline requires that each young person’s needs, interests and supports are the framework of every interaction with the school and therefore with all the learning experiences beyond the physical boundaries of the school’s Tennyson campus. So the rigorous case management is augmented by full staff collaboration regarding each student. If there are 16 staff working at the Support School, there are 16 staff every day discussing each student. (This is the equivalent in this setting of the multidisciplinary team collaboration within the Inpatient School.) This ensures that all aspects of each young person’s carefully developed program – both on and off campus – will incorporate the supports that each individual will need and be most likely to stimulate the learning and personal development that will continue the growth of abilities, knowledge and, especially importantly, self-esteem.
Finally … and Importantly
The emergence of the need for the Support School has been a revelation. At this point, the Tennyson campus can only serve Brisbane-based young people whose involvement in the student group as it exists at the time can only occur if their individual circumstances will not be negatively affected by/or negatively impact those within currently attending. So there is likely to be a waiting list. There must be solutions that will meet the needs of similar young people and families in regional areas as well as other facilities in high density metropolitan areas. There is no investment more important than in the education of young people. Except perhaps in education that can also keep young people alive in order to then promote learning and development.