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Children’s Hospitals and Education
Policy Description
When beginning the research for this project, I didn’t find any specific policy relating to
children’s hospitals and their education standards. Most of the research I found states that each
child has a home school coordinator that works with them while they are in the hospital. For this
project, I would like to propose a new policy that combines aspects of the “No Child Left
Behind” policy and the “Family Medical Leave Act” to create education for children in hospitals
that care for their social, cognitive, developmental and spiritual needs.
Children in hospitals are faced with many stressors that other children their ages are not
aware of. Procedures, extended stays in hospitals and the feeling of isolation from others are just
a few things that contribute to this stress. According to the journal of Pediatric Nursing “When a
child is hospitalized, the nature of the crisis at hand takes precedence, and caregivers may set
aside the child's school and academic needs (Eaton, 2012).” When looking at a child’s
development, it is important that it be understood by those educating that a child learns through
their environment (Rodd, 1996). Experiences the child has and expectations put on the child are
determined by those in their family and their community (Rodd, 1996). When a child is
hospitalized and taken away from the classroom and their peers, they are missing a lot of
interactions necessary for normal development of the child in social settings. Children are often
times very worried about missing what is going on at school and falling behind in their school
work (Eaton, 2012). School is something that is very normal for children and they are socialized
to expect to be in school for approximately 18 years. “For youngsters, going to school is their
job… When we deprive sick children of school… we slow their progression to adulthood
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(Cassman, 2008).” In one study that I found conducted by Eaton, a large number of hospitalized
students were upset about missing school and “it became apparent that hospital staff had not
been addressing these needs (Eaton, 2012).”
What is Available Now?
Child Life Specialists work in a number of different places including schools, doctor’s
offices and hospitals. They are not limited within the health-care realm of where they can work
as long as it is a place where a child is going through a medical or traumatic crisis; either
themselves or a family member (Child Life Council, 2012). What this person does is help a child
manage the crises in a way that they can understand and to help them cope through “play,
preparation, education, and self-expression activities” (Child Life Council, 2012). This involves
allowing the children to see the medical equipment up close and witness fake procedures being
done in order to understand what they will soon have to go through. Their play interactions
mostly consist of the child, a family member if they can be around, and the child life specialist.
Parents are often very limited in the amount of time that they are able to spend with their child
when there is need for an extended stay in the hospital (United States Government, 1993). Child
life specialists do provide many benefits and have become standard in most child health care
fields, however, the educational value they can provide is limited as they do not have a teaching
degree1. Even Cassman, a teacher in a pediatric dialysis unit, admits that children on dialysis are
often only able to attend a full day of class on Tuesdays and Thursdays; this leave the student to
try to make up the rest of the time through second hand communication with parents or medical
staff, e-mails, and faxes (Cassman, 2008). Students that are unable to attend regular classes at all
1 I am a firmadvocate for child lifespecialists;I believethat they do provideexcellent valuefor children.However,
I believe they should be in addition to teachers on staff at hospitals.
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have a “home teacher” visit them to go over class work; even with this situation, students still
fall behind (Cassman, 2008). As it stands now, a lot of hospitals are not even able to get access to
their patients’ records and transcripts; this in itself is a hindrance to the progression of the
students (Cassman, 2008). Cassman goes on to mention that some students over the age of 18
that are unable to work on their GED spend their time improving their education by working on
solving puzzles (2008). This is not the way that the government, who is the voice of the people
of the United States, wants education for children to be. As stated in the No Child Left Behind
Act under Section 101: Improving the Academic Achievement of the Disadvantaged, “The
purpose of this title is to ensure that all children have a fair, equal, and significant opportunity to
obtain a high-quality education and reach, at a minimum, proficiency on challenging State
academic achievement standards and state academic assessments (United States Government,
2004).”
Perspectives and Positions
The perspective that I have is shared by Rodd, “More than ever, those responsible for
planning and developing young children’s education programs must be responsive to the
children’s diverse needs (Rodd, 1996).” Education is a huge factor for a child having a since of
normalcy in their lives and in propelling their understanding of the world (Boonen & Petry,
2011). Boonen and Petry report that parents of students with long-term illnesses say their
student’s homebound instruction was a positive attribute the school re-entry process (2011). It is
of the popular opinion that children with chronic illnesses need to be educated on their
similarities to others as well as their differences from others (Rodd, 1996). Especially with older
students (i.e. junior high or high school), there is less time spent one on one with teachers and
more time intermingled with their peers in order to create self-worth (Eaton, 2012). Eaton states
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that a large amount of students with medical concerns had lost communication with their school
as well as access to resources their peers received (2012). “Attempting to locate assistance for
these children through school districts became time-consuming and often un-successful (Eaton,
2012).” School districts are unprepared to help students who are hospitalized and do not know
how to connect to them via proper procedures (Eaton, 2012). A lot of times, hospitals have to
reach out by request of parents to get a teacher to come meet with them and even then it is only
part-time (Rabetoy, 2008).
Family members are unprepared to help their child in the way that they need to receive a
structured education. If the family member works, the Family Medical Leave Act only grants
them 12 unpaid work weeks within 12 months to tend to their sick child2 (United States
Government, 1993). In a survey conducted with two large out-patient facilities, it was found that,
“Although 81% of parents missed work for child illness, 41% reported not always missing work
when their child needed them, and 40% of leave-takers reported returning to work too soon
(Carey, et al., 2007).” “…Parents who were eligible for Family and Medical Leave Act benefits
and aware of their eligibility had 3.0 times greater odds of missing work for child illness than
ineligible parents. Parents with >4 weeks of employer-provided leave benefits had 4.7 times
greater odds of missing >4 weeks than parents without benefits. Parents with paid leave benefits
had 2.8 times greater odds than other parents of missing work whenever their child needed them
(Carey, et al., 2007).”
Impact of Current Policies and Procedures on Families
2 This is if the family is non-military.Eligiblemilitary servicemembers and their families may receive26 unpaid
work weeks in one year.
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What I am consistently finding is that most researchers have a general idea of how
families are impacted but they do not have enough research to improve programs for school re-
entry or schooling while in care for students who missed a lot of time at school due to illnesses
(Boonen & Petry, 2011). There are a lot of conflicts for families with sick children as they try to
balance caring for the child, their work, as well as all their other responsibilities in the home and
in their life in general. Many of these families are eligible for FMLA time off, however, they are
unable to utilize it due to a lack of knowledge or “unmet needs for leave” or in other words
financial struggles from not having paid time off or not having enough time off available to them
for them to provide all the needs of their children (Carey, et al., 2007). “Young children's overall
development can greatly benefit from participation in quality, structured, early education
environments (Archard, 1993).” When the education quality is lacking, a child can easily fall
through the cracks (Eaton, 2012). Eaton states that parents and hospital staff do not know how to
adequately help these children; this allows for children to easily get behind and stay behind in
their educational careers (2012). “Although children have always missed school due to
hospitalization and medical treatment, little is clear about the requirements for continued
education of these children. From the hospital perspective, The Joint Commission (2008)
requires that "the hospital arrange for a child or youth to receive academic education based on
his or her length of stay and condition in accordance with law and regulation" (p. 136). This
raises many questions with respect to what specifically is meant by "law and regulation. There is
also little regulation pertaining to the services schools must provide in regard to a hospitalized
student (Eaton, 2012)." Parents were most satisfied with the care they (as a family) received from
health care establishments when the environment of the hospitals were accommodating, the child
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received services from a CCLS, and the doctors spoke to them frequently and in ways that they
understood (Strittmatter & Jessee, 1999).
Recommendations for Future Policy
“If hospitals were required to "provide" rather than "arrange for" academic education,
additional requirements and a definition of academic education would be expected (Eaton,
2012).” My recommendation for future policy is to implement a structured school in children’s
hospitals for patients who will be hospitalized for an extended period of time where they can be
with other students, interact of a more “normal” childhood level with peers, learn for certified
teachers and use resources for learning such as textbooks. A classroom in a hospital would be
more like a classroom in any normal school than a hospital, however, it would still allow for the
students to be patients. In addition to getting an education, the hospital staff would be on site so
if something were to happen or need to happen then hospital staff can step in. Certified child life
specialists would be a big part of the integration of schools into hospitals because they are the
link in between the two services. Any time spent away from school and away from learning
should be cause for concern for the school, administrators, hospital staff and the parents. As soon
as the child is pulled away from school multiple times or for an extended period of time due to
illness, someone should step in and consider non-school-based instruction (Eaton, 2012). An
ideal team involved in caring holistically for the hospitalized child is: child life assistant or
specialist, parents of the child, educational consultant or teacher, pediatric doctors and health
care staff and the administrator of the hospital (Eaton, 2012).
In order for the parents to be more involved in the child’s road to recovery, I believe the
Family Medical Leave Act should be extended to provide parents with more job security and
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paid time off. Women report that the policies surrounding the FMLA helps them to manage
balancing their work and their family responsibilities; yet women, more often than men, are not
covered by this policy through their place of employment (Waldfogel, 1999). “The [other]
frequently suggested reform of the FMLA is to extend coverage to the roughly 50 percent of
American workers in the private sector who are not currently covered by the law (those who
work in smaller firms and those who work part time). The results in this article suggest that the
net negative employment and wage effects of extending coverage to the remainder of the
workforce are likely to be minimal, while the benefits in terms of new coverage and expanded
usage could be substantial. Moreover, family leave legislation may provide other benefits, such
as improved health outcomes for mothers and children. The effect of the FMLA on these
outcomes is a promising area for further research (Waldfogel, 1999).” To me, the evidence and
research is over whelming in the fact that there is not research out there speaking to an
educational facility in a hospital setting. It is my opinion based off of the research in my paper
that the idea of establishing a school in a hospital needs to be visited and studied. When looking
at the effects on the family when a parent gets time off to be with their child: “Most parents
reported positive effects of leave on their child's physical (81%) and emotional (85%) health;
57% reported a positive effect on their own emotional health, although 24% reported a negative
effect (Schuster, Chung, Elliott, Garfield, & Vestal, 2009).”
Summary
It is always hard to see someone in pain, especially if it is a person close to you. Parents
of children in hospitals are, in addition to not being prepared to help their child, not prepared
emotionally and financially for the long-term hospital stays and extensive medical care. Most
parents would do anything to help their sick child. It is important that families have a large
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support group when facing issues of hospital stays and sick children. Child life specialists along
with teachers and other health care physicians should encourage the child to speak out and talk
about their illness, concerns, questions and feelings. However, for a lot of questions, parents
won’t know the answers. This is where a teacher could help dramatically. “Music, drawing or
writing can often help kids living with a life-threatening disease express their emotions and
escape through a fantasy world of their own design (Kid's Health From Nemours, 2012).”
Teachers have a way of connecting with children on a level that they cognitively can understand
and know how to take a child psychologically away from their current situation and allow them
to escape their realities. Children are naturally inquisitive. Having questions about their condition
is normal, what is also normal is the child having questions about cowboys and Indians or kings
and queens in Europe. Depending on the child’s maturity level and educational background, it is
natural for them to be curious about the world that they live in and for them to want to know
more about topics they left off in while at school. Teachers can help fill a need that doctors or
parents may not have time or knowledge for.
When all is said and done, the most important thing for a child with an illness is that they
know they are loved and cared for and that they have a support system. In order to better provide
children with this sense of security, it is important for us as family life educators to understand
the effects of children being isolated in a hospital environment for extended periods of time. We
need to apply the knowledge we have of child development and really be the advocates for the
child’s development: psychosocially, cognitively and biologically. In collaboration with parents,
doctors, physicians, and child life specialists; the child can live a life that is as fulfilling as
children who get to go to school. An illness should not prevent a child from getting the best care,
holistically, as they can. “Children will continue to require medical treatment that will cause
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them to miss school. Distance learning and online educational opportunities are likely to grow,
but they will not replace the school experience or need for teacher involvement. Without teachers
to provide a liaison between health and educational institutions, more students will fall through
the cracks. An opportunity exists for these entities to work together, along with our communities,
on behalf of the future of children with medical needs (Eaton, 2012).”
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