Where special treatment is just what the doctor ordered

Young people who have to spend relatively long periods in hospital have their education needs well catered for at the Royal Aberdeen Children's Hospital, which has 11 play and teaching staff to ensure their stay is doubly beneficial

Jean McLeish

At first glance, this is like any other toy cupboard packed with board games and brightly-coloured playthings. But look closer and one of the dolls has tubes coming out of its nose and stomach.

It has been five years since the new Royal Aberdeen Children's Hospital opened; a child-friendly place, where play is a priority and colour lifts your spirits.

Heather Beattie is co-ordinator of a team of 11 play specialists and leaders. In the cupboard, she shows a row of dolls used to reassure children about their treatment. She opens the Velcro fastenings on one doll's tummy to see what's inside and lifts out a tiny fabric appendix. "These are anatomically correct teaching dolls and can open up like this. This is very much using play to educate families about the procedures and their illness as well as their bodies," explains Heather, who has worked here for 18 years.

This type of play helps young people when they are facing surgery. "We find if children are well prepared, they cope better - and if families are well prepared, they can support their child better. So you're taking away the fear of the unknown and reducing misconceptions families might have about the treatment of their child's illness," she says.

Play specialists also help prepare children for daunting procedures: "You are just telling them what they want to know, what they are going to hear, what they will see, who they are going to meet and what's going to happen. You can explain what they will come back with - a tube or a plaster on their leg - so you are explaining all that through the medium of play.

There is a birthday party in the ward and parents are chatting together and with the nurses, while children play. Life goes on as normally as possible, despite the challenges they are facing.

Just beyond the ward entrance, normality is key for hospital teacher Rosemary Ross too. She's part of the hospital and home tuition service and helps children from Aberdeen and surrounding areas to keep up with schoolwork during their stay. Some may be in and out of hospital for years and if they need to, they can even sit their exams here.

Ten-year-old Lauren Butler has never been to school in a hospital before and this morning she is having a look around Rosemary's classroom with her mum. Lauren is being treated for a stomach problem: "I'd rather she was at home, but I know she needs it," says her mum. "Her teacher is supposed to be sending work for her, so she's not too far behind when we do get home."

In her sunlit classroom, Rosemary talks about working with children like Lauren. "This is my domain away from the wards," she says, looking round the multi-coloured displays of storybooks and dangling mobiles. there is no medical paraphernalia - children leave that world behind when they are here.

Occasionally, if they are at risk from infection, she teaches at their bedside. "Other people would want to run a mile from a hospital, but that wasn't me - it appealed to me, so I pursued it when I moved here."

Rosemary taught in primary schools before moving from Glasgow and has taught here for more than 15 years. Bright and businesslike, she has an optimistic outlook, which is a crucial quality for hospital teaching. Education and play are vital for children's confidence in hospital, so they can recover without their schooling and self-esteem suffering. There is a holistic approach to care, so teachers and play specialists work closely with medical staff as part of a multi-disciplinary team.

"I enjoy being part of a team. For instance, there's an oncology meeting once a week when each of the therapists are there - so it's joint input and information. That includes occupational therapists, physio, speech and language, the dietician and play staff," she says.

There are usually up to three or four children in class and they are often taught one-to-one, ranging in age from five to 14, but may also include older teens who have opted to continue treatment here rather than transfer to the adult service. "With the older ones, you're more of a co-ordinator, because you can't actually teach every subject, but you can motivate them to do what work needs to be done."

Children come here with a range of problems, from broken legs and burns to cystic fibrosis or cancer. If they are in for more than a few weeks, Rosemary liaises with school and parents to work out an individual education plan.

"In some ways, I often don't see the child as being ill. Obviously in many ways you have to, because you have to be sensitive to their needs. But you can't get sucked into that, you have to see the bigger picture and their re-integration into school.

"As far as I am concerned, nothing bad is going to happen to an ill child - they are going to get better, they're going to get re-integrated. So an optimistic attitude is important."

Not every story has a happy ending, and some children don't recover. "It's sad and it does happen. But when you know that is the outcome, how I teach them is no different. I would still be trying to get the best out of them in terms of education for however long that is.

"Education is normal and for that child and family you want to keep life as normal as possible. But the outcome for the vast majority of these children is now very, very good - but sadly, it isn't always."

Downstairs in the Lowit Unit, Rosemary's four colleagues teach up to 18 children with mental health problems. Moira Fraser is principal teacher for support for learning at St Machar Academy in Aberdeen, seconded here as acting head of the hospital and home tuition service.

"The Lowit Unit is the psychiatric ward of the children's hospital and it's a day unit. They are only in the unit three days a week. The idea is that they are in their normal environment on Thursday and Friday, which includes going to their normal school," says Moira. "When here, they attend classes in the mornings and the rest of the time they are with their nurses doing therapeutic work and assessment."

Older children go to the young people's department at the nearby adult mental health hospital. There is no education provision there, so some are also taught with the younger pupils. "There is an issue around the legislation, the Additional Support for Learning Act 2004, which puts a duty on the local authority to provide appropriate support for pupils up to school-leaving age," explains Moira.

"So there is a population out there of people aged 16 to 18, many of whom have mental health issues and sometimes cannot attend school because of it, but they are getting no real support with their education."

Patients in this unit have a wide range of mental health problems and are looked after by a team of children's psychiatric nurses. "It can be depression, for example: often children who don't fit in for one reason or another, who find school difficult and have opted not to go," she explains. "We have a number requiring a diagnosis of autistic spectrum disorder, attention deficit, hyperactivity order; we have children with obsessive compulsive disorders. Sadly, an increasing number are being referred because of depression, and some with eating disorders."

GPs or educational psychologists initially refer youngsters to the children and adolescent mental health service, where they are seen as outpatients with their parents. If they need further assessment and therapy, they may be admitted to the Lowit Unit. One criterion for admission is that children have found it too difficult to go to school - so an objective is to help them re-integrate. Some may have attempted suicide or parents are concerned for their safety.

"We've had children admitted through Accident and Emergency who have been so distressed and uncontrollable at home that parents have taken them there, and they might be immediately transferred over. That could be things like psychotic symptoms, hearing voices, hallucinating," says Moira.

"As a support for learning teacher, I'm fascinated by what makes children tick, their psychology and their development. So to be working with a consultant psychiatrist in such a close way and finding out about the effect different things have on the brain - for example, with the child and the medication that he prescribes - is fascinating."

Children usually come for two or three months with generally positive results. "By and large they are usually success stories - the children who get such intensive help with life skills - because that's what a lot of them are needing," she adds.

Upstairs, Rosemary describes meeting the parent of a former patient she had helped prepare for Standard grades. "She was really worried but her daughter is now at teacher training college in Glasgow," she smiles.

Former pupils do come back: "If they are here for a six-monthly or yearly check-up, they'll come and see you and it's wonderful to see them well. They're keen to tell you: `I'm doing this' or `I'm about to go to college.' That's the up side of the job."

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Jean McLeish

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