The hospital-to-school transition Erin Stroud, MD Pediatric resident, St. Louis Children’s Hospital

Learn goals of transition from hospital to home and school Understand the people involved during a student's transition from hospital to school. Discuss how school nurses and healthcare providers can better collaborate and communicate to improve care of recently hospitalized students. Learning objectives

Outline Case discussion Discuss the providers involved in the transition from hospital to school Parent and provider goals for hospital-to-home transition AAP/NASN recommendations School Reintegration Programs Discussion Outline

A 5 yo boy recently discharged from the hospital after being admitted with a new diagnosis of asthma Case 1

A 15 yo girl with a complex medical history who was recently discharged from the hospital for gastrostomy placement Case 2

Goals of Transition Planning For the student For peers and staff Goals of Transition Planning Maximize health Maximize academic experience Reduce isolation/improve social reintegration Increase knowledge about disorder Decrease negative emotions surrounding return of child to school

Family priorities during hospital to home transition Pain and symptom control Respect for families’ discharge readiness Effective engagement with healthcare providers Care coordination Timely and efficient discharge processes Normalization and routine Self-efficacy to support recovery and ongoing child development Family priorities during hospital to home transition

Medically complex children: care map Kuo DZ, Houtrow AJ, AAP COUNCIL ON CHILDRENWITH DISABILITIES. Recognition and Management of Medical Complexity. Pediatrics. 2016;138(6):e20163021

Communicate with health care teams and families regarding care plans Maintain the clinical skills to provide necessary services in school Implement care plans and supervise care Maintain awareness of local, state, and federal laws Maintain awareness of local resources NASN Recommendations

Pediatricians should discuss school-related health problems at visits and provider relevant information directly to the school Pediatricians and school nurses should work together to establish an agreed-upon method of communication Standardized forms Pediatricians and school nurses should collaborate on the development of Individualized Health Care Plans Written or electronic Integrate subspecialty care, dental care, emergency care, home- nursing services, physical therapy, community mental health, and school-based services AAP recommendations

Plan of Care Two components: The Medical Summary Care providers and roles Diagnoses/problem list Goals with “Negotiated Actions” Patient, family, and provider goals Contingency plans Available in real-time and across care settings Fluid document

School re-entry interventions Workshops with school staff Education with students At age 5, children are capable of understanding new facts about illnesses Address concerns, brainstorm future interactions Contact with peers during recovery Pre-return meetings with schools and family School re-entry interventions

School Reintegration Programs Royal Manchester Children’s Hospital Burn service School reintegration team: psychologists, OT, PT, nurses, play specialists Results: mean length of time from discharge to return to school dropped from 53 days to 20 days Increased student/staff awareness Decreased anxiety Teachers, students, parents felt supported School Reintegration Programs Arshad et al. “Measuring the impact of a burns school reintegration programme on the time taken to return to school: A multi-disciplinary team intervention for children returning to school after a significant burn injury. Burns 2015; 41, 727-734.

Communication between hospital and community providers should be initiated early in the hospitalization Care plans should be created, implemented, and adapted by all members of the care team Teachers and fellow students should receive education on the child’s illness Efforts should be made to maintain contact between the child and his/her peers during the hospitalization Summary

What changes has your program made to improve children’s transition from hospital to school? How should a child receive extra attention following return to school? Discussion

Email: stroud_e@kids.wustl.edu Questions?

References Kuo DZ, Houtrow AJ, AAP COUNCIL ON CHILDREN WITH DISABILITIES. Recognition and Management of Medical Complexity. Pediatrics. 2016;138(6):e20163021 Leyenaar JK, O’Brien ER, Leslie LK, et al. Families’ Priorities Regarding Hospital-to- Home Transitions for Children with Medical Complexity. Pediatrics. 2017; 139(1):e20161581 AAP COUNCIL ON SCHOOL HEALTH. Role of the School Nurse in Providing School Health Services. Pediatrics. 2016; 137(6)e:20160852 National Association of School Nurses. Transition Planning for Students with Chronic Health Conditions. January 2014. https://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNPositionSt atementsFullView/tabid/462/ArticleId/644/Transition-Planning-for-Students-with- Chronic-Health-Conditions-Adopted-January-2014 Arshad et al. “Measuring the impact of a burns school reintegration programme on the time taken to return to school: A multi-disciplinary team intervention for children returning to school after a significant burn injury. Burns 2015; 41, 727-734. Canter KS and Roberts MC. “A Systematic and Quantitative Review of Interventions to Facilitate School Reentry for Children with Chronic Health Conditions.” J Pediatr Psychol. 2012. McAllister, JW. “Achieving a Shared Plan of Care with Children and Youth with Special Health Care Needs: An Implementation Guide.” Lucille Packard Foundation for Children’s Health. http://www.lpfch.org/sites/default/files/field/publications/achieving_a_shared_plan _of_care_implementation.pdf