The miscommunication between Schools and Hospitals Why by zhangyun


									The miscommunication between Schools
and Hospitals: Why students with Mental
Health Disorders and other disabilities are
inadequately and inappropriately served.

            By Ignacio IV Lopez
       National-Louis University 2006
       Students with Mental Health
          Disorders in America
• According to the Epidemiologic Catchments Area Survey
  (ECA), the National Comorbidity Survey (NCS), and the
  Methods for the Epidemiology of Child and Adolescent Mental
  Disorders survey (MECA) each year mental health disorders
  affect about one in five Americans.
• The percentage of students having mental health disorders
  increases with age and is highest in the high school (Jans,
  Stoddard, & Kraus, 2004).
• From 1988 to 2001, the total number of people receiving
  services for mental health disorders rose more than two and one-
  half times, from about 1.7 million to 4.3 million (Jans, Stoddard,
  & Kraus, 2004).
Mental Health Disorders in America
• The drop-out rate for students with mental health
  disorders or emotional disturbances age 14 and up was
  50.6% (Jans, Stoddard, & Kraus, 2004).
• The total economic cost of mental health disorders in
  1990 was almost $150 million (Jans, Stoddard, & Kraus,
• If the economic cost in 1990 was $150 million and the
  total number of individuals with mental health
  disorders has nearly doubled that would mean that
  today the total economic cost for individuals with
  mental health disorders would be around $300 million.
  More Students with Mental Health
   Disorders = More Clinical Visits
• I argue that if there are a growing number of students
  with mental health disorders, and those students are
  seeing physicians, then proper, effective correspondence
  between agencies must begin to exist.
• Once proper and effective communication is created
  between agencies we will start to see a decline in the
  mental health student drop-out rate, which in turn
  could lessen the economic cost of mental health
  disorders in the United States.
          What does Hospital to School
           communication look like?
• The majority of the information that is sent from a
  hospital to inner city high schools and elementary
  schools alike is sent by fax in the form of a discharge
  summary listing treatments based on the DSM-IV by a
• “I have rarely found a discharge summary to come in a
  timely manner. It could take weeks even months
  before I receive a discharge summary that could be
  effective to the students needs [and be added to the
  students IEP].” - School Social Worker
       Who communicates with who?

• Which school personnel is supposed to receive
  transmissions from the hospital?
  School social workers argue that they should be receiving
  the transmissions from the hospitals pertaining to a
  students treatment and diagnosis.
• Who gets the information from the hospitals the
  majority of the time?
  The attendance office
   Why don’t Doctors communicate
           with Schools?
• Some Doctors don’t communicate because they feel
  schools are unorganized and they do not have a point
  person established to receive transmission.
  Coincidentally, schools feel the same way.
• Some Doctors do not perceive teachers as their
  partners in caring for children.
• Some Doctors feel it is the parents responsibility to
  communicate any diagnosis or treatment information to
  the school themselves.
What should be communicated: The first
look at closing the communication gap
    between schools and hospitals.
    Communication between Schools and Hospitals – Information both agencies should request
Table 1 – What schools should request from hospitals in                               Table 2 – What hospitals should request from schools in
order to adequately serve students with mental health                                 order to adequately serve students with mental health
disorders.                                                                            disorders.
•      A written hospital and program description that are available as public        •      Special education definitions and diagnostic criteria.
       information.                                                                   •      Availability of special education continuum of services (i.e., self-
•      The primary focus of the hospital/treatment unit.
                                                                                      •      Available alternative schools and programs and their entrance
•      A typical, daily activity schedule.                                                   requirements.
•      About level of involvement endorsed and allowable according to                 •      Support services and resources available (e.g. student assistance
       hospital policy (participation in staffing, discharge staffing, visitation,           program, at-risk programs, development guidance services).
       calling, or writing patients).                                                 •      Established track system for monitoring difficulty level of course work.
                                                                                      •      Established track system for monitoring student’s progress and
•      Planned dates for discharge and return to school.                                     behavior.
•      Written reports that are applicable, including psychiatric summary,            •      Disciplinary school policies (e.g. detention, suspension, expulsion).
       psychological evaluation, psychosocial history, educational evaluation         •      A description of the school program, including school hours, number of
       school report and transcript, and a neuropsychological evaluation.                    teachers, instructional content, and employed delivery systems.
•      Summary of academic hospital school accomplishments specific to skill          •      Who is identified as the contact person at the school?
       development, course of study, and study of skills.                             •      Present educational placement (regular, special, alternative).
                                                                                      •      Academic functioning and grades.
•      Who is identified as the contact person at the hospital?
                                                                                      •      General responses and attitude toward school and learning.
•      Diagnosis, course of treatment, specific outcomes, and prognosis.              •      General school involvement including extracurricular activities.
•      General placement and specific recommendations for home, school, and           •      Specific student interests.
       community functioning.                                                         •      Response to different teachers and subject.
•      Description of effective treatment intervention that with modification         •      Level of work productivity.
       can be implemented in the school.                                              •      Organizational and study skill abilities.
•      recommended methods for approaching ongoing clinical issues within             •      Response to homework.
       the school environment.                                                        •      Social skills abilities and general peer relations.
                                                                                      •      Behavior problems and the schools response to them (i.e. prevention
•      assessment of present feeling and attitude towards school and learning.               and intervention strategies implemented).
•      Possible recommendations for academic reintegration.                           •      Behavioral response to intervention
•      recommended methods for supporting positive social reintegration.
•      The level of parental commitment and involvement and involvement
       that can be expected
Note: Date on this table was derived from:
• American Psychiatric Association. (2000). DSM-IV Diagnostic and statistical manual of mental disorders. (4th ed., text rev.).
   Washington, DC: Author.
• Goldfarb, P. (1993). The Psychiatric Hospital Adolescent Experience: Toward Greater School/Hospital Understanding and Communication.
   Preventing School Failure, 36(3), 37-42.                                                                                            By Ignacio IV Lopez
Interventions that have been developed to help
    close the communication gap between
             Hospital and Schools
• System-of-care models
      -Hospital Treatment Teams
      -Requiring the use and understanding of
        the DSM-IV by school personnel (i.e. nurses,
        social workers, school psychologist, and
• School-based Health Centers
      -Health Centers in schools
      -120 sites in 1988 to 1,500 sites today
      -Incorporation of mental health services (2002)
       Are these systems working?
• The plans or systems in place to help close the
  communication gap between schools and hospitals still
  do not reveal effective means of communication.
  Although, there is a clear effort being made in
  addressing the lack of commutation between physicians
  and schools, we are still far away from establishing
  communication and correspondence across a national
  level so that every and all students with mental health
  or emotional disorders receives an equal and fair
 Why today's systems don’t work
• Third-party communicators. It’s like playing the
  telephone game.
• Organizational structures are bureaucratic and
• Fragmented or miscommunication amongst
       Communication Transmission Strength:
An assumed model of agency-to-agency communication

  • What does communication look like when a third-party
    (system-of-care models) acts as a conduit of
    information between Hospitals and schools? Table 3
  • What does communication look like when a third-party
    communicator is removed and Hospitals and Schools
    are allowed to exchange and interchange
    communication about a student freely. Table 4
Table 3 - The strength of the communication transmission between Hospitals, Parents,
     Third Party Agencies, and Schools. A model of transmission strength today.


                                                                               Notice that the
                                                                              to the parents is
                                                                             Weaker when the
                           Third Party
                                          Student      Parents              Information comes
                                                                              From the school

                                          School         Model Key:

                                                                The solid arrows represent strong
                                                         Transmittance of communication between the
                                                         groups at hand.

                                                                 The dotted arrows represent weak
                                                         transmittance, which can be caused by many
                                                         variables (e.g. language barriers, lack of
   - By Ignacio IV Lopez
                                                         parental figure, etc…)
 Table 4 - The strength of communication transmission between Hospitals, Parents, and Schools.
An assumed model of transmission strength with the removal of a third-party information transmitter.

Notice the reciprocated                      Treatment
communication                                  Team
                                                                             Notice the difference
occurring between both                                                       in the Communication
agencies when the                                                            Transmittance Strengths
Third Party Agency                                                           from the parent to the
is removed.                                                                  student.


                                  School                      Parents

Model Key:

       The solid arrows represent strong
Transmittance of communication between the
groups at hand.
                                                           Notice the strength in transmittance
        The dotted arrows represent weak                   from the hospital to both the
transmittance, which can be caused by many                 parents and student.
variables (e.g. language barriers, lack of
parental figure, etc…)                                                                      - By Ignacio IV Lopez
Closing the communication gap between
     Hospitals and Schools involves

• Eliminating third-party communicators
• Establishing needs for both agencies
• Creating pre-service classes for both
  professional organizations detailing agency-to-
  agency communication (Hospitals and School

To top