Supporting ākonga with high health needs

Issue: Volume 102, Number 12

Posted: 13 September 2023
Reference #: 1HAc0K

At any one time, throughout Aotearoa, the education of around 2,000 ākonga with high health needs is being provided by around 400 teachers working out of three regional Health Schools.

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Health School teacher Sherril Palmer has supported Sophia since she became unwell in 2020.

The Health Schools – Northern, Central Regional and Southern – offer support and a variety of options to students with physical or mental health needs throughout Aotearoa. They were established in 2000 when they mainly operated out of hospitals.

“Each school has grown organically since then and does things a bit differently, but the brief is the same – we are here to cater for students who are unable to attend mainstream schooling because of their health conditions.

“When the schools were established, that was approximately due to 80 percent physical conditions, or illness, whereas that has pretty much flipped and it’s now around 80 percent mental health,” says Jason White, Tumuaki | Principal of the Central Regional Health School.

Grueling journey

In 2020, when she was in Year 9, Sophia (now 16) became sick, resulting in an eight-week stay in Hutt Hospital. She was diagnosed with POTS (Postural Orthostatic Tachycardia Syndrome) – a disorder of the autonomic nervous system which regulates functions the body doesn’t consciously control such as heart rate, blood pressure and body temperature.

“She loved school, was bright, very sporty, had lots of friends and was involved with a lot of activities, so it was devastating really,” says Sophia’s mother, Debbie Turner.

Debbie says that without the support of the Central Regional Health School, she doesn’t believe that Sophia would have been able to return to school and achieve 50 NCEA Level 1 credits in 2022 and aim to pass NCEA Level 2 this year.

Sophia also developed a chronic pain condition, became bed-ridden and lost the ability to walk and to eat. The condition resulted in multiple visits to Starship Hospital and the Wilson Centre, a North Shore rehabilitation centre – totaling about 17 weeks away from home in Auckland.

Invaluable support

Debbie, can’t speak highly enough of Health School teacher, Sherril Palmer.

“We first met her in Hutt Hospital where she came to see if Sophia was well enough to do a little bit of schoolwork. At that point, she wasn’t well enough to do schoolwork, but even just talking about school and alleviating the concerns around it helped. We were thinking, we’re missing so much school, what happens here?

“Being able to allay those concerns and reprioritise and refocus where the learning needs to be was really invaluable in those first few weeks,” says Debbie.

Sophia has been supported by Sherril since then, with the Northern Health School providing support during stays in Auckland.

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Sophia’s mother Debbie (right) says support from the Health School has helped the family to cope.

Support and advocacy

Debbie says that Sherril’s support continues to be invaluable.

“Sophia got back to school part-time last year. The amazing thing was working with Sherril and just realigning our goals. Our goal last year was not to achieve Level 1 as that’s a very big goal and we need to attack things in bite-sized pieces; our aim was to try to get back to school 80 percent by the end of the year.

“The big thing was our review meetings with Sherril and the deans at Sophia’s school: just realigning expectations and reminding them that just because she got to school for one week, doesn’t mean she will get to school the next week. Also understanding that stress is a big factor and making sure that teachers communicate with her in the right way and don’t forget that she’s sick and put the pressure on, because then we become derailed,” says Debbie.

With Debbie’s energy going into supporting Sophia and her family, she was grateful when Sherril ensured that Sophia’s wellbeing was provided for at school. This has included asking the school to provide a space where Sophia can rest when she becomes exhausted and explaining that she needs to wear additional non-uniform clothes at times as her body doesn’t regulate its temperature.

“Sherril has helped us explain to school that she will need to wear non-regulation clothes to try and keep warm. She has advocated for us, and it means I’m not coming across as a precious parent.

“Without the Health School support, I don’t know that I would have got her back to school last year. I don’t think I had enough in my tank to drive that. Without their support, it might have been in the too hard basket. But it was invaluable to have someone there to navigate and guide, be our voice and advocate, and also to work at a pace that was accessible and doable for her,” says Debbie.

Future goals

While POTS still dominates Sophia’s life, things are getting back to normal.

“She is determined to get Level 2 NCEA and she’s working with Sherril on that. The timetable didn’t work for the subjects she wanted to do, so Sherril managed to organise one paper through Te Kura, which means she only has to do four subjects at school. She might start school later, finish earlier, or work with Sherril for a couple of hours. It just means there’s not the pressure to do five subjects at school every week.

“She wants to be a paediatric nurse. She wants to travel. She wants to get back to as normal a life as possible: have a career, have a family. She has normal aspirations, it just takes us longer,” says Debbie.

“Without the tremendous help of Sherril and the CRHS I have no idea where I would be now. Health School advocated for me when I couldn’t and has now given me the tools to advocate for myself. I will forever be eternally grateful for their help not only in my transition back to school and my recovery but for building my self-confidence and making me believe in myself,” adds Sophia.

Transition-focused kaupapa

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Support from the Central Regional Health School has helped Sophia to continue her education.

The Health Schools are focused on transition back to school, unless a student is over 16 and has no plans to return to school. Each student has between two and three hours each week with a Health School teacher. The schools work alongside a team which can include a student’s school, whānau, health professionals and agencies such as Child Adolescent Mental Health Service (CAMHS).

“For students to be admitted to our school, there needs to be a referral from a specialist and an active treatment plan in place that we work alongside with the idea that when they’re back on their feet, we transition them back, either into the school they came from, or whatever their next step is whether it’s going to tertiary study, or work. We’re not intended to be a permanent solution for a student,” explains Jason White, Tumuaki | Principal of the Central Regional Health School.

Problem-solving and relationships

Flexibility and problem-solving are important skills for the teachers, who generally have around 10 students they are responsible for, which may include cancer patients, students with significant medical concerns and students with mental health issues.

“A student going through chemotherapy, for example, may have a period when their immune system is impacted, they can’t go back to school and that’s where our teachers can really help with maintaining education at home. The treatment plan they are going through is the medical process to become physically well again – that’s a simple one. Supporting students in the mental health space is more complex because there are no timeframes that we can predict, and the treatment plans themselves need to be quite agile.

“The waiting lists are heartbreaking. A student is being told to put their mental health crisis on hold for eight months until they can see a specialist. Unfortunately, we’ll get a situation where a referral will come through and the student hasn’t been involved in education for over a year. Just getting alongside them, building the relationship and getting them engaged is a significant first step,” says Jason.

Challenging and satisfying

While the work is different and challenging, it can be an appealing career option and many Health School teachers have been on the job for a long time. A typical week includes travel, attending multi-agency meetings and teaching and supporting students with complex needs.

“We’ve got nine units around the [central] region that cater for students in the community health strand of the school. Our ideal is that we work with students at their own school where possible. If that’s not possible, then we work with students at one of our sites and if that’s not possible, we go to the home. For some of our students with mental health conditions, in particular, actually getting them out of the house and into our site is a great step towards transition back to school, so we don’t like to teach in the home unless we have to.

“Each of our sites are quite different, but in general, there’s a nice open classroom space where each of the students comes in and works one on one with their teacher. Some of our sites have study programmes and activities that students can opt into and access. But in general, they get their two hours face to face contact time with their teacher, as well as work done independently outside of that, which the teacher manages,” says Jason.

Jason says it’s important that Health School staff have access to a network of supervisors and counsellors and while there’s a limit of six sessions per year, he will approve more if it’s required.

“There’s a risk of secondary trauma. Given the work our staff do, I think it’s really important they can access this. Our teachers work through quite a lot with students and sometimes they are still working with students as they are going through palliative care – that is the unfortunate reality of this job as well.”

Nationwide service

Central Regional Health School covers Wellington through to Hawke’s Bay and Whanganui; Northern Health School covers the top half of the North Island and Southern Health School provides a service for the South Island.

A week in the life: a health school kaiako

Ann MacGregor has had a four-decade career as an English teacher, RTLB and head of student support. She’s been teaching at the Central Regional Health School for six years.

“I loved teaching English but I came to a realisation that I felt that I was teaching English, but not necessarily the students,” she says of her decision to train as an RTLB.

“Our programme is tailored to what the student needs. Typically, with a secondary student, we might start with an admission meeting with Child Adolescent Mental Health Service, the whānau, the school if they are involved. From that we develop an individual plan for each student and make the decisions about who provides the teaching.

“Fortunately, within our team we have people that have come from other curriculum strands and they are a good resource. The teachers from Te Kura are wonderful too.”

Typical week

When asked to describe a typical week, Ann said:

“The last week of term was a monitoring time, so there are review meetings to see how things are going, to monitor what is happening and to set new goals where appropriate.

“Last week involved a trip out to [a high school] where I’m working with a Year 13 girl who has a brain tumour. My role is largely monitoring that she’s on track and liaising with the staff if necessary, but she is very strong on managing herself.

“Another student has endometriosis which is pretty crippling and that has led to quite a lot of social anxiety. She’s a very high-functioning student with a pretty amazing future, I suspect. She’s going to university next year, but for health reasons, school was not meeting her needs.

“There was no continuity for her in a school environment and that was leading to real anxiety. She’s still involved in a class at school and attending that when she can, but the rest of the curriculum is being delivered through Health School and Te Kura.”

With the majority of students being mental health referrals, Ann says that flexibility and building relationships with the student and whānau are very important.

“It’s very relationship based. Not just with the student, but with family as well. Because family have often had extremely unfortunate waiting times to access the service and they’ve become very disillusioned and frustrated to get that far. There’s always an element of grief with a parent when things aren’t working smoothly for their young person.

“That pastoral care is pivotal. And most of us have come in from a background as heads of department, or deans – managing the pastoral care of students.”

Rewarding job

Problem-solving and being an advocate is an important part of the role.

“I’m often advocating for deadlines, renegotiating when things are due, what kind of framework the school can use to support access to resources within the school.

“Rationalisation of their timetables is quite a big one: some students can’t manage a full day at school. We might look at some Te Kura work if they can’t attend classes regularly. I have quite a few students where I’m in charge of a curriculum area for them and they can manage the rest at school.”

Ann says health school is important as otherwise students with high health needs wouldn’t be able to realise their vast potential.

“Most of these students would have fallen by the wayside otherwise. That’s the joy of the job – keeping opportunities open for young people.

“It’s a really, really rewarding job. The main part of that is being able to have a real knowledge of the student and what will support them in a very focused way. It’s also wonderful working with a group of people who are dedicated to being on the same page. The primary focus is supporting students to be able to access the curriculum,” concludes Ann.

BY Education Gazette editors
Education Gazette | Tukutuku Kōrero,

Posted: 3:00 pm, 13 September 2023

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