Including Students with Chronic Health Conditions c. 1990 Ellie Goldberg, M.Ed.
Children
with chronic health conditions often have a tough time staying healthy
at school and keeping up with their peers, but in Brookline,
Massachusetts, a Transition-to-Kindergarten (TK) program shows how two
students with special health needs can stay healthy and fit right in.
All
it takes are a resourceful staff committed to building parent-teacher
partnerships, the effective use of community resources, and a
student-centered integrated whole-child curriculum.
When school
started in September, 1989, TK teacher Judy Orlandi discovered that two
of her 18 students had severe asthma and potentially life-threatening
food allergies. Judy and her co-teacher, Harriet Kaplan, were nervous
but undaunted. In keeping with the Brookline schools' early childhood
education philosophy that every child's needs provide opportunities for
teachers, children and parents to learn and grow together, they decided
"the more you know, the less you worry."
They spent an afternoon
consulting Lisa Gray, RN, at Pediatric Asthma and Allergy Associates.
They read numerous articles as well as Children with Asthma, A Manual
for Parents, by Tom Plaut, MD, a book they found "extremely helpful.”
Brookline's school physician met with Brookline's entire early childhood
education staff to discuss what they needed to do to make sure that
student's needs were met and staff members' questions answered.
Using
classroom activities to teach students about basic health issues is
nothing new to Judy and Harriet. The year before, in response to
student's interest in four pregnant moms, the class had turned the
dramatic play area into a maternity/neonatal ward.
Now, Judy and
her class decided to transform the play area into what they called the
"TK Asthma/Allergy Hospital.” They began the project by brainstorming
the supplies they would need. (Shots, stethoscope, specimen bottles,
ambulance driver hats.) The children had many discussions about their
own doctor visits, injuries and illnesses. They read books together for
more ideas.
Combining classroom materials and parent donations,
they assembled a variety of supplies including empty medicine
containers, lab coats, surgical gloves, X-rays, and folders for medical
records, a basketful of InspirEase (the collapsible holding chamber that
Patricia and Josh used to help deliver aerosol medicine to their lungs)
and disposable mouth pieces. Allen and Hanburys, Inc., a
pharmaceutical company, provided coloring books and an array of posters
and charts to decorate the room. The students made a variety of signs.
The
TK "medical library" included So You Have Asthma, Too, and I'm a Meter
Reader by Nancy Sander and Winning Over Asthma, by Eileen Dolan Savage,
three books about asthma especially for young children.
The
DeVilbiss Company, a nebulizer manufacturer, donated a Pulmo-Aide
nebulizer, a small air compressor designed to make liquid medicine into a
mist for inhaling into the lungs.
Before long, the play area was
bustling with busy four and five-year old doctors in blue face masks
answering the phone, listening to each other's hearts, and tending to an
examining table full of baby patients getting shots, X-rays, band-aids,
or breathing treatments. Each child had a personalized facemask. "So
we don't catch germs from each other," explains five-year-old Jackson.
"Getting
a chance to play with the medical equipment is very important for
reducing children’s fears,” says Lisa. "Medical testing, needles, IV
tubing, and surgical procedures are so scary for them."
She came
to talk to the students about their lungs, the mechanics of breathing,
and how everyone could take good care of themselves. Lisa also
explained asthma, comparing the inflammation in the airways to the way
scrapes or cuts in the skin become red, sore and swollen. Every child
got to try his or her own InspirEase. As they breathed in, they
listened for a wheeze-like whistle (a signal that the person is inhaling
too fast).
"Everyone got to see what using the device feels
like, to ask questions," Lisa emphasizes. "It is important to convey to
kids that it is okay to ask questions about your body and your health,
to be informed about your medical care."
Diane Limbo, RN, MS, a
health educator at Boston Children's Hospital, visited to talk to the
students about the people who work in the hospital, especially the
emergency room. She arrived dressed in her regular clothes and
introduced herself first as "a mommy," and then put on her hospital coat
to become "TK's Nurse-in-Residence."
While she was there, she
saw a lot of dramatic play illustrating the theme of getting hurt and
being taken care of. "Children in this age group need this kind of
play. It helps them cope with the things that worry them. Injuries,
accidents, violence, and bad people are big worries for them."
"There
was also a remarkable degree of mutual support among the students who
brought their `babies' to the hospital," Diane noted. "Their waiting
room talk involved a lot of consoling words and sympathy for each
other."
This kind of dramatic play offers students many
opportunities to express consideration for each other. It is an example
of the varied ways that Judy and Harriet encourage curiosity and
empathy in all areas of the TK program. Their goal is to enhance
everyone's sense of belonging while working on cognitive skills and
language development.
During one circle time, Judy asked all the
children to make a statement or ask a question about asthma. "What is
it like to have asthma?" she modeled a question for the group.
"Good and terrible," said Patricia.
"I throw up," said Josh.
"You cough," added someone.
"You can't eat stuff." contributed another.
Later, Judy pointed out that if Patricia or Josh need to stay indoors on cold days, a friend usually stays with them.
To
help the class understand asthma, Judy asked the students to describe
what it felt like when they have a cold and can't breathe well. The
conversation was remarkably free of any social discomfort so typical of
people who grew up when someone with a disability was rarely encountered
as a friend.
In contrast to some schools that would expect
Patricia to stay home during asthma flares or shunt her off to an
isolated area to use her nebulizer, Judy enabled five-year-old Patricia
to stay in class with her friends even on days when she needed extra
medication.
"Judy and I would discuss the best time to fit in a
breathing treatment," said Melita Malley, Patricia's mother. "The goal
was to find a time that didn't interfere with Patricia's activities.
Best of all, Patricia learned that asthma doesn't have to be a reason
for her to miss out on anything."
Judy's efforts extended beyond
the classroom. Her newsletter informed parents that "Patricia's
breathing treatments at school have enabled the children to get a
firsthand look at asthma and what having it sometimes involves. It does
my heart good to see her sitting in the reading corner using her
nebulizer with all her friends around listening to a story with her."
Because
children are constantly bombarded with antidrug messages, TK students
got needed reassurance about the benefits of medicine when they watch
their classmates take it. "Medicine can keep you healthy and make you
better when you are sick." explained 5-year-old Charlotte to a visitor
during a tour of the play area.
Normalizing daily life for Josh
and Patricia was good health education for everyone. When another child
had to have his tonsils out, his mother reported that the class had
prepared him to cope with his operation without unnecessary anxiety and
apprehension.
Patricia's mother is extremely grateful for Judy's
consistent efforts to ensure that students were safe in such a
practical positive way. Like many other parents of severely allergic
children, Melita finds that friends and family tend to underestimate the
risks and frequently don't believe that small amounts of certain foods
could be lethal. In TK, allergies were taken seriously and respected.
To
reduce the risk of Patricia or Josh having a serious allergic reaction,
Judy and Harriet explained to the class that they could not share food
because it could make these two friends very sick. The program
newsletter explained the new rules to parents: "We have two children
with serious, potentially life-threatening food allergies, thus snack
may not be a shared event. We remind everyone each day. Please reinforce
this at home."
Anticipating upcoming birthdays, another
newsletter added, "In the past we've often had birthday food treats from
the birthday girl or boy to share with the class. Considering the fact
that this year we have two children with severe food allergies we need
to be a bit more thoughtful. If you want to send a food treat, you must
let me know ahead of time so the parents of the allergic children can
plan to send their own special snack on that day."
Judy also had
alternatives available -- animal or ballerina stickers, for example.
Instead of sending in food, families were encouraged to donate a book or
puzzle to the program in honor of a child's birthday.
Even at
home, students reflected the program's dedication to social inclusion
and creative problem solving. One mother reported that when Patricia
couldn't visit a classmate who has a cat, the resourceful friend was
quick to suggest an alternative, "Can we go out with Patricia instead?"
To
ensure that their approach to meeting students’ individual needs worked
for everyone, two part-time social workers meet with teachers and
parents on a regular basis. Barbara Murphy, early childhood/primary
specialist, explains, "We build on our experiences with each child and
each family. We keep working at it so we get better and better at doing
it."
"We meet each child as an individual," says Judy,
describing the strengths of Brookline’s curricular guidelines. "That is
part of what we are doing with all the children--if the child happens to
have asthma, food allergies, or whatever, it is part of the picture.
You can't leave out a piece of the child. It's all important. Our
program is designed to provide students and their parents with
strategies and skills that empower them. We plan for the future, with
his or her whole life in mind."
Barbara adds, "We not only deal
with the needs of the individual child but with the impact on other
children. When a child in one of the classes was placed in foster care,
it had an impact on the other children that needed attention. In another
group, a child with a significant developmental delay behaves very
aggressively and scares the other children. In parent meetings we
discuss how we are dealing with it and how teachers are supporting all
the children. We help parents decide what to say to the children at
home. It is never a question of one child's needs being met at the
expense of anyone else."
Brookline's early childhood program's
philosophy is based on the legacy of the Brookline Early Education
Project, a ten-year comprehensive birth to kindergarten study funded by
the Carnegie Corporation and The Robert Wood Johnson Foundation that
showed the benefits of school-based early childhood education. Parents
and teachers work as partners. They help each other because they have
the same goals -- reducing risk and finding out what works best for each
child. (Early Education in the Public Schools: Lessons from a
Comprehensive Birth to Kindergarten Program, 1991. Hauser-Cram,
Pierson, Walker and Tivnen, Jossey Bass Publishers, San Francisco.)
Indeed,
TK staff members are selected especially for their dedication to the
concept of parent-teacher partnerships. Throughout the year there are
regular opportunities for parent-teacher communication including guided
classroom observations, conferences, frequent newsletters, and a weekly
Friday morning coffee time in the play area.
What would other
teachers need to translate Judy's success to their classrooms? All the
materials and resources are readily available to any classroom, Judy
insists. Every community, large or small, has health professionals,
social workers, and other specialists eager to collaborate with schools.
One of the most important requirements is "taking the time to
communicate."
Lisa agrees with parents that what Judy does in
her classroom is "wonderful." Medical advances have enabled more
children to lead active normal lives. Brookline's TK program shows how
"wonderfully normal" it can get.
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