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Your Child’s Psychiatric Hospitalization: Working with the School

By  Heather Byrns, LMHC, Operations Director, William James INTERFACE Referral Service and Sarah Rosenthal, LICSW, Clinical Social Worker, Massachusetts General Hospital

Having your child psychiatrically hospitalized can be an incredibly stressful, confusing, and demanding experience for a parent.  You may find yourself trying to balance caring for other children and work commitments with attending treatment meetings and visiting your child.  One question that parents and children who are hospitalized struggle with is “what do we tell the school?”  Children often worry about what their classmates or teachers might say when they return, or if they will be labeled, and parents often worry about the same thing, in addition to how the school will respond.

  • Parents may also wonder “do I need to tell the school about my child’s hospitalization?” It is important to remember that, just like if your child needed to be out of school due to a medical condition, it is helpful to let the school know that your child is out of school for a mental health concern. By involving school personnel (i.e. school nurse, school psychologist, school social worker, or guidance staff) you may be able to access resources, collaborate with the school, and ensure that your child’s return to school is successful.  Below are some things to consider, including ways in which involving the school both during and after your child’s hospitalization could potentially be beneficial for your child and for your family

Frequently Asked Questions (FAQs):

“I am concerned about protecting the privacy of my child and my family.  Who should we tell at the school, and how do I know that what I tell them is being kept confidential?”

Each school system is different, particularly in dealing with children being out due to a psychiatric hospitalization. First, reach out to a school staff person that you trust and feel safe talking to openly.  Depending on your child’s age, this might be his or her primary teacher, guidance counselor, school principal, or a mental health provider within the school, like the school nurse or social worker.  You can begin by letting them know that your child has been psychiatrically hospitalized, and ask if the school has a policy or a protocol for handling this type of absence.  Your school may not have a clear plan, but if they do, the staff person can inform you about what the steps are for supporting your child while he or she is away, as well as planning for the return to school.  In speaking with school staff, share information you feel comfortable providing and know that, medical and mental health providers, like school nurses or social workers, are bound by their professions’ code of ethics, and you can ask them to ensure that your conversation is confidential.

“My child is worried that I will be talking to the school (his or her teacher, etc.) about the hospitalization, and that the information will not be kept confidential.  What should I do?”

Being hospitalized can leave your child feeling overwhelmed and not in control, much as you might feel as a parent, and it will be helpful to include your child in some decision-making.  It may be helpful to ask your child if there is anyone at school that he or she would feel comfortable knowing about the hospitalization.  If there is a clear set of steps that your school follows when a child has been hospitalized or a protocol tell your child about this process. You can also support your child by having a discussion with their clinician at the hospital or psychiatrist about what your child is comfortable having shared, and what he or she would rather the school not know or would like to share personally.  It is important to let your child know if you have talked to the school about his or her hospitalization, and whom you have told. 

“Why should I let the school know about my child’s hospitalization before he or she is ready to return to school?”

While communicating with your child’s school may not feel like a top priority when your child is in the hospital, it is important to consider that by working with the school early in your child’s hospitalization, you allow the school to be part of the team planning and working with your child prior to his or her return to school.  Most hospital programs offer some kind of academic support or tutoring, and they can ask your child’s school to provide them with assignments so your child can have the opportunity to keep up with some assignments if that makes sense, which may decrease your child’s worry about returning to school.   If your child is out of school for 14 school days or more, some schools will provide on-site educational services which may be a tutor or another school staff person who will work with your child, in addition to the educational support in the hospital. There will also be treatment meetings that occur during your child’s hospitalization, and it may be that a staff person from your child’s school will either participate in person or by phone to hear about how your child is doing, and help your child’s team plan for his or her return to school.  At times, schools are able to offer a return to school for partial days, arrange meetings with in-school mental health providers like a social worker or adjustment counselor for extra support, or ask teachers to delay due dates for major assignments or tests to allow your child to catch up. The school can also answer questions you or your child might have about how to discuss his or her absence with peers, and identify trusted school staff that can be available for support if your child is feeling overwhelmed or having trouble coping with the return to school.

“My child is really benefitting from the hospitalization and is learning new skills. However, I’m worried my child will struggle when he or she returns to school.  What do I do?”

All schools are different and have their own policies and rules, so it will be important to collaborate with them, and identify ways they can support your child, which may be easier if you still have the support of the hospital’s clinical team during your child’s hospitalization.  In working with the school either during or immediately after your child’s hospitalization, you can collaborate to identify possible in-school sources of stress that may have contributed to your child’s struggles, like feeling overwhelmed academically or peer conflict.  The school may have ideas about how they can support your child differently or make accommodations during his or her transition back to school.  Also, you and the hospital clinicians may have recommendations about coping skills that your child learned from their hospitalization that he or she would benefit from being able to continue to use in school.  Either you or the clinician working with your child may feel that using these new skills will help your child be more successful at home and at school, and avoid the need to return to a setting like the hospital. It will be useful to work with the school to identify how they can accommodate your child in using these skills. 

“The hospital has told me that my child is going to discharge from the hospital.  How do I prepare him or her to go back to school?”

Below are some general steps that may assist your child in having a successful return to school following hospitalization.

  • Whether or not you have worked with your school during the hospitalization, make a clear plan with your child about his or her return to school, including how to talk to peers and school staff about the absence, and identify in-school or out-of school supports that he or she can use if feeling overwhelmed.
  • If your school has a protocol for the return, make sure you are able to use this protocol and if possible, go with your child on the first day back to make sure that someone is aware that he or she is returning after an absence.
  • Provide a discharge summary if you feel comfortable, or written recommendations from the hospital to a school staff member like your child’s primary teacher, guidance counselor, school nurse, or a mental health staff person who may be seeing your child during school. 
  • If your child participated in testing during his or her hospitalization, discuss with the hospital clinicians, what, if any, of the testing might be valuable to share with school staff, and provide a copy upon your child’s return.
  • Contact the school nurse, especially if your child is going to need to take medicine during school or have snacks.
  • Let school staff, especially the nurse, know if your child was placed on new medications during the hospitalization.  If your child is experiencing side effects, the school staff may be the first ones to notice, and will be able to notify you if they observe anything out of the ordinary.

“While my child has been hospitalized, clinicians recommended that I ask the school for ‘an evaluation’?  What is this evaluation for, and what does it mean for my child?”

A parent may request a special education evaluation for their child to determine if they have any learning, social, or emotional disabilities that may be impacting their ability to make progress in school.  In some situations, children may fail to make academic progress because their social or emotional needs are not being met, they may have a learning disability that has not been diagnosed, or even a combination of these may be causing some academic struggles.  This can be especially true of children who have their academics disrupted by the need to participate in intensive mental health services, like psychiatric hospitalizations.  An evaluation, once requested by a parent in writing, will be initiated which may include testing by a school or outside psychologist, assessments completed by parents or teachers, and reviews of your child’s academic performance.  Within 45 days of the evaluation, a team will convene, to determine your child’s eligibility for services which can include an Individual Education Plan (IEP) or a 504 plan. The team will often include a classroom teacher, mental health providers from inside or outside of school, other school staff and you. There is more information available about this process in the Boston Bar Association’s guide The Parent’s How-To Guide to Children’s Mental Health Services in Massachusetts.  If your child is found to be eligible, he or she can receive a range of services as determined by the team in order to assist him or her in making progress in school.  Aside from the evaluation process, your school may also offer in-school mental health resources like a school social worker, adjustment counselor, school psychologist, or even a school-based health center where your child can access mental health services.  However, without an evaluation and subsequent plan that indicates the need for long-term, school-based mental health services, these services are generally only available for short-term interventions.

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