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Illness and hospitalization lead to loss of school days and education for some children. This issue has been addressed in published literature for more than three decades (1). Regular school attendance and swift school re-entry are considered to be important mechanisms for helping children cope with hospitalization and the management of their illness (2,3). Helping children stay connected with regular academic and social activities has been shown to reduce difficulties during school re-entry (4). Access to a teacher and being able to continue school within the hospital provides children with a sense of normalcy during the hospital stay. However, evaluating these educational services for children in Canadian hospitals seems less obvious compared with our counterparts in other countries, some of whom use Canadian educational researchers to assess hospital-based educational services (5,6).
In an attempt to accommodate the educational needs of children and young people in hospitals, many paediatric hospitals have teachers who provide one-on-one teaching either in a hospital classroom or at the bedside of children who are hospitalized for extended periods. The involvement of a teacher in a patient’s total care enhances the student’s learning potential while ill, and facilitates a smoother return to school. Sometimes, the teacher’s responsibility may include course selection or rearranging timetables, work completion, test or examination proctoring, and/or initiating an Identification, Placement, and Review Committee if the illness has affected the patient’s learning abilities. By providing this liaison work, the hospital teacher can facilitate the school program at a time when the parents are possibly very preoccupied with workplace demands and other children at home, in addition to caring for a sick hospitalized child. We hypothesized that the information on educational services available to hospitalized children was not uniform across Canada, and that the information on these services was not easily accessible. We wanted to assess educational service information available to inpatient or outpatient children in Canadian paediatric hospitals that are accessible on the Internet.
A list of children’s hospitals was obtained as identified by the Canadian Paediatric Society Web site <www.caringforkids.cps.ca/resources>. The hospital Web sites were searched using key terms: school, inpatient education, schoolroom, classroom, teacher, class, tutor, day programs and child life. The regional public and Catholic school board for the area of the hospital location was determined by Internet search. Each school board Web site was searched using key terms: hospital name, hospital, special education and alternative program.
A Google search was conducted in English and French using search terms such as inpatient education, day programs, and more specifically, eating disorders, substance abuse and other medical programs. The searches were conducted over two weeks in January 2008 and again in the last week of March 2008 to identify any new information. The hospitals were contacted directly if there was no published information available to validate unposted services. All the information obtained on inpatient education and day programs in each hospital was summarized and tabulated (Table 1).
Alberta, British Columbia, Newfoundland and Labrador, Nova Scotia and Saskatchewan had this information published on the hospital and school board Web sites. Manitoba presented the information on the school board Web site but the hospital Web site was under construction. Hospital Web site information varied in Ontario, although most hospitals and school boards had the information.
New Brunswick, Northwest Territories, Nunavut, Prince Edward Island and Yukon had no information.
Telephone interviews were conducted for hospitals in New Brunswick, Northwest Territories, Nunavut, Prince Edward Island and Yukon. There were no official school programs in New Brunswick or Prince Edward Island. Volunteers, most of whom were retired teachers, served the needs of children admitted to the Queen Elizabeth Hospital in Charlottetown, Prince Edward Island. The Northwest Territories and Nunavut have no educational services for hospitalized children.
Quebec had information on teaching programs in the Montreal Children’s Hospital but no information on teaching programs in the French-speaking hospitals. Quebec had information on teaching programs in three Montreal facilities when the hospitals were telephoned directly. The Montreal Children’s Hospital and the Centre hospitalier universitaire Sainte-Justine are under the McGill University Health Centre umbrella and they share five teachers, three of whom are French-speaking while the other two teachers are English-speaking. Although the teachers are employees of the Montreal School Board, they function under the Child Life Department in these hospitals. The Shriners Hospital for Children uses a private teacher and another teacher from the Montreal School Board. In all cases, these teachers cover provincial curriculum from kindergarten to the end of secondary school. There are no other children’s hospitals in the province of Quebec. It seems anecdotal but it is difficult to obtain information about these programs. Neither Web sites nor information centres at these hospitals seem to be aware of the existence of these schoolteachers in their own centres.
Although the intensiveness of education services varies, instruction is made available to children anticipating long hospital stays. The actual length of stay, used as a criterion, differs across jurisdictions. In addition, classroom instruction is an integral component of the program for most physical rehabilitation, mental health, substance abuse and eating disorders programs in children’s hospitals, and these programs tend to run for periods of months.
Education is a fundamental right of all children including hospitalized children. As paediatricians, we should take responsibility to ensure that children have access to appropriate education, even while they are hospitalized. It seems that schooling hospitalized children is either taken for granted or forgotten, or a low priority in many parts of the country. Even when it does exist, most centres are blissfully unaware of its existence, and the idea of letting the children catch up later seems to prevail. This heightens the idea that being ill is a stalemate situation during which time normality drops by the wayside. In many instances, child life services is the only department that is aware of the teachers’ existence. It appears that on many fronts, the fight for education in hospitals is either forgotten or under attack.
We did not attempt to contact the hospitals to inquire about the educational services they offer if the information was available at the hospital or school board Web site. The information presented in the present manuscript was gathered and collated by a paediatrician, a high school teacher and a final year medical student. Several hours of individual and combined work was needed to compile this information for the manuscript, highlighting the difficulty time-constrained physicians, ill children or their parents would have in accessing this information. Although several children’s hospitals have school teachers available to educate hospitalized children, the information is not readily available to ill children, their parents or the medical community.