Dr. Liza Hopkins - Incoporating Education into the holistic Care of paediatric Patients: the CL@RCH Project


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A presentation given by Dr. Liza Hopkins at the CHA Conference October 2012, The Journey, in the 'Service Redesgin & Innovation' stream

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  • Paper reports on the CL@RCH project which took place in 2011-2012 at the RCH in Melbourne
  • The project came about because dynamic and visionary educational leaders at the hospital decided to move away from the traditional model of the hospital school – which is usually a special school, although most of the students do not have special education needs, but rather are regular learners, learning in an irregular setting
  • The Education Institute at the RCH is not a registered school, but rather is a company limited by guarantee, funded by DEECD and based at the RCH. Ed Inst staff work with patients, siblings and families at the hospital to provide ed support for school-aged children and young people (approx half of all inpatients). Ed Inst also has a small research team who focus on the generation of evidence at the health-education interface to improve outcomes for children and to influence policy and procedures strategically in the provision of world-best education support to children and young people with acute and chronic health conditions. The CL@RCH project came about specifically in the context on the development of a new children’s hospital and the move from the old building, which took place in Nov 2011, into the bright, new, spacious, flexible, child-centred building which houses the new RCH. We wanted to focus on the ways in which education, which is not traditionally understood as belonging in a health-care space, could be incorporated much more holistically into the child-centred model of care and well-being.
  • We had five main research questions:
  • We had a number of outputs from the project. Today I’m going to touch very briefly on the relevant findings from the literature review and then I’m going to focus on the findings of our research with our young patients, their parents and the teachers of the Education Institute who deliver education support in the hospital. I’ll finish with a mention of three of the recommendations which we came up with for incorporating education more holistically and effectively into the hospital environment.
  • A lot of work has been done on the effects of physical spaces on children’s learning. These are some of the key findings which support the evidence we found by talking to people in the hospital
  • We talked to all these people.
  • What did we find?
  • Perception that move to new hospital (single rooms) would increase privacy, but decrease socialisation and group learning opportunities
  • Parents views were different.
  • How do the teaching staff see their roles?
  • We’re thinking big!
  • Dr. Liza Hopkins - Incoporating Education into the holistic Care of paediatric Patients: the CL@RCH Project

    1. 1. Incorporating education into theholistic care of pediatric patients:The CL@RCH (Children’s Learning at The RCH) projectLiza HopkinsTsharni ZazrynSue WilksKira MacleodRoyal Children’s Hospital Education Institute
    2. 2. CL@RCH: Overall premise• To strengthen the capacity of a children’s hospital to keep children engaged with learning in a dynamic and flexible environment.
    3. 3. CL@RCH: context• Development of a new children’s hospital
    4. 4. CL@RCH: Our questions1. What do children and young people value about learning during hospitalisation?2. In what ways do they and their families use the hospital environment to stay engaged in learning related activities while in the hospital?3. How can physical spaces where children and young people spend time across the hospital be used to strengthen the promotion of children’s learning?
    5. 5. CL@RCH: Our questions (2)4. What partnerships could or should be developed to enhance learning opportunities at the RCH and how should these partnerships be fostered?5. What are the critical components for children’s learning applicable to a hospital environment?
    6. 6. CL@RCH products• Learning spaces literature review• Learning spaces issues and needs framework• Consultation report• Snapshot booklet• Key messages framework• Set of principles for teaching and learning• RCH procedure for education support
    7. 7. Literature review findings• Effective spaces connect with best practice teaching and learning• Learners need ownership of the learning space• Technology connects learners wherever they are• The importance of the outdoor environment• Connecting spaces with people – a holistic learning environment• Arts based pedagogy contributes to education, well- being and health
    8. 8. Consultation methodology• Consultations with: • 57children & young people (3-19 years) • 29 parents • 10 external education professionals • 23 RCH Education Institute staff • 4 junior medical doctors
    9. 9. Example: Children & young people• Across all areas of hospital • except ED & ICU • purposive & convenience sampling• Stimulus – photographic slide show• Semi-structured interview questions• A3 design activity
    10. 10. Photographic stimuli
    11. 11. Children & young people questionsDomain Examples of guiding questionsChildren as learners • Which activities in the photos would you like to do? Why? • What sort of activities/things have you done today while here in the hospital? What was your favourite? Why? • How do you know when you have learnt something? • Can you tell me about something you have learnt whilst here in the hospital?Learning communities • Do you like working/playing with other children/people? Why? • Do you sometimes like working/playing on your own? Why?Continuity of learning • Have you worked with a teacher/play therapist here? What was that like? • Do you keep in touch with your friends from school while you are in the hospital? How? Why?Physical spaces • What is your favourite place to learn? What makes it your favourite place? • What areas of the hospital do you spend time in? What do you do while you are there? Are there things you wish you could do there?
    12. 12. A3 design activity
    13. 13. Children and young people• Children and young people have a deep and broad understanding of what ‘learning’ is• Fun/games/interactivity are the key to engagement in learning opportunities in a hospital setting• Children and young people are social beings and learning opportunities should reflect this
    14. 14. Children and young people (2)• Children and young people want to access activity rooms and outdoor spaces for social interactions• Children and young people want more appropriate fit outs for furniture/activities in activity rooms and are capable of being included in decision making in this regard
    15. 15. Children and young people:Perceptions of learning“... I like working in groups more. Because ... everyone has different ideas, and so ... you can learn different things off different people, and, if your answer’s wrong or something, they can be up there to help you learn different ways that they’ve learnt how to learn it.”“It feels good. Before you didn’t know what it is. You now know how to do it.” “It’s easier to learn when working with others. You learn more... it’s sometimes better [to work alone] if you need to concentrate.” “If you work with other people, they might get something wrong.” “You can teach it to someone else.” “I know something else.”
    16. 16. Parents• Parents value and expect the inclusion of education and learning support as part of the holistic care of their children• Many parents have limited knowledge of the education support that is available in hospital• Parents of hospitalised children undervalue the early years of education• “Um, cause she’s only at Kinder I don’t think it’s ... much of an issue. The Kinder stuff they do is all play to learn, it’s not sit down and write ... it’s all blocks and play dough ... and things like that.”
    17. 17. Parents (2)• Parents of hospitalised children view learning and education as formal schooling only“There’s nothing you guys can do that is actually gunna get me over the thorough dislike I have of the fact that he’s not at school.”“He doesn’t bring his work from school, his homework in here – he conveniently forgets a lot! And um, that’s actually a concern for me now”“I hate it when she misses school. I really hate it.”“And ... during the school term we’ve organised work from school and he’s had to do some schoolwork. So you can’t just take games all the time.”
    18. 18. Parents (3)• Parents highlighted a need to reduce social and educational barriers for their hospitalised children and were unaware of the opportunities available for better connections to be established• Families want to be able to utilise the outside spaces more• Communication between school and hospital is critical
    19. 19. Parent comments• “... I’m trying to explain to her that she needs her education to further her um expenditure on – going forth in her life ...”• “[Education] - it’s very important for her to be all she can be.”• “... just to maximise all opportunities he’s got. To give him opportunities to do whatever he wants to do really. And um, cause I know that education can give you access to things ... and education allows you to achieve things that other people don’t think you can.”• “And even if he makes it up to 20 [years old] you know, he’s still going to need to think ahead ... So if he does, then he’s going to need to be able to go forward and have a job.”• “I want her to be able to think well, you know she can do anything in life if she wants to. But she also needs to be, we have to try and keep her normal, too. So school and her health are very… on my top of the list.”
    20. 20. Education Institute staff• Integration of education into a health dominated environment is challenging and takes a considerable time to be achieved• There is an increasing understanding from ward teams about the role of the Education Institute and the teachers• Communication and consultation are key to teachers being successful in their role
    21. 21. Education Institute staff (2)• There are vast differences (both positive and negative) between teaching and learning in a school setting and teaching and learning in a hospital setting• There is the potential to better involve parents in the education and learning opportunities in this setting, but in some instances it is better to allow parents ‘time out’
    22. 22. Education Institute staff comments “... what I’ve seen in the play and learning spaces [in the hospital] are safe spaces. So they’re one of the very few places in the hospital where there’s no procedures undertaken. No medical staff can come in, unless it’s to engage in learning or play activities. And that’s a really important thing for children in a hospital to have. A space that they know if someone comes in with a lanyard on, they’re not going to be doing something to them that they don’t want.” “I always think a space in which students are comfortable to take risks I think is one of the most important things.”
    23. 23. What we hope to achieve• Outputs – procedure incorporated into the RCH & an evidence-based framework to guide teaching & learning in a paediatric setting• Embed notion of ‘children as learners’ into the core business of the new hospital• See evidence of this in: • budgets • key messages • infrastructure • decision making processes
    24. 24. Recommendations• The RCH Education Institute and RCH Executive should continue to advocate and provide opportunities for patients as learners• Government and non-government education organisations, and the RCH Education Institute, need to provide opportunities to build parent knowledge and skills• The education support available in the hospital needs to be publicised to staff, patients and visitors
    25. 25. Acknowledgements• Thanks to the children, families, hospital & non-hospital-based professionals who have generously given their time and voice to this research• The work of the Royal Children’s Hospital Education Institute is made possible by funding provided by the Victorian Government Department of Education and Early Childhood Development
    26. 26. More infohttp://www.oecd.org/edu/ceri/inventorycas es.htm