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Introduction

The model of delivery of the Walker Unit Learning Centre is the result of an evolution of a collaboration between NSW Health and the NSW Department of Education. Hospital Schools had been established in NSW since 1976 when a schoolroom, in partnership with the Department of Education was provided in the new Prince of Wales Children’s Hospital (Department of Education, 2021). The model of having a classroom within an inpatient unit developed later and started to take shape after it was strongly advocated by health and education experts to ensure that students in inpatient units had access to education in line with Article 28 of the United Nations Convention on the Rights of the Child (UNICEF, 2021).

Prior to Admission

Education is a core component that is considered prior to the young person’s admission to the Walker Unit. When the Walker team go out to assess the young person (see Chap. 4), they gather information about the young person’s educational history. As most young people have a long and relapsing illness, their educational pathway has been disrupted and it is not unusual that they have been absent from school and learning for months or years. As school is an essential part of their recovery process, the Walker Program supports all students, independent of their capacity and level to regain an educational pathway. The process of transitioning the young person from the hospital-based learning centre to a school in the community is referred to as integration.

First Week

On admission, the young person is introduced to the Learning Centre using principles of graded exposure to support anxiety and adjust to the environment and new people. How a young person copes with this transition at the start of admission provides an indication as to how integration into a community educational facility towards discharge should be managed. The patient is assessed to determine their level of educational functioning. The education team, together with the health team decide early in the admission what the optimal discharge educational destination could be. Many young people would have difficulty reintegrating into the mainstream school system and an application or Access Request may be submitted in order to access a placement in a School for Specific Purposes (SSP).

When a young person commences attending the Learning Centre, the Walker education team focuses on engagement, information gathering and academic assessment. There is liaison with the patient’s previous educational placements to assist the teachers in developing the young person’s academic programme. Previous school history can also be helpful in informing psychiatric diagnosis, and assessment of function.

Formulation and Care Planning

In the third or fourth week of admission, the mini team assigned to work with the patient undertake a Formulation and Care Planning meeting (see Chap. 5). Teachers attend the first of these meetings in order to gather information that is necessary to support the young person in the Learning Centre, and also to feedback to the health team regarding any information gathered around schooling. The discharge pathway is considered, including the educational pathway. Once the school pathway has been determined, the team supports the young person’s family in order to achieve a successful outcome regarding schooling. The health team may request the Walker teachers to attend family meetings in order to assist parents with acceptance around educational planning.

Learning Centre

Within the Walker Unit, there are two classrooms called Learning Centres. All students are required to attend school to the best of their capacity every morning from Monday to Friday. The Learning Centre schedule comprises two 1.5 hour periods each week day during term time and is part of the therapeutic treatment programme. During school holidays, the same periods in the day are filled with diversionary activities facilitated by educationally trained staff. Whilst young people are attending the Learning Centre, there is always a member of nursing staff present to observe and support the young people to focus on and attempt school tasks. Some young people can avoid schooling tasks through a variety of challenging behaviours. Nursing staff are there to support young people who may escalate in their behaviour, move them out of the environment, de-escalate and resolve before re-engaging in learning.

The Walker education team is staffed by two teachers and two school learning support officers (SLSOs) with support provided by the principal and school counsellor from the adjacent Rivendell School. The Walker education team are also closely involved in the Rivendell School community and engage in whole school activities including professional learning and workshops on a weekly basis.

Teachers

Teachers work with the young person and all stakeholders in order to develop an academic programme, including teaching and learning activities and individual plans to support the young person. Teachers liaise with various stakeholders in support of the young person. They attend weekly Case Review meetings and provide feedback to the multidisciplinary team about student progress in the Learning Centre and during integration. They maintain regular contact with the home school and their future educational setting. Teachers may also attend family meetings to discuss educational matters.

Teachers also manage the processes that involve the continuity of the young person’s education, such as ensuring they have evidence to achieve their Record of School Achievement (RoSA) at the end of year 10, and assisting in the application for special provisions for those in year 12 undertaking their exit examinations. Teachers may also assist students with pursuing alternative vocational settings and coordinating the Access Request process between schools when it is decided by the treating team that an alternate school placement is needed.

School Learning Support Officers (SLSOs)

SLSOs fulfil a number of administrative roles including recording attendance, preparing resources and organising the equipment in the Learning Centre to ensure that the environment is well equipped and safe. Another key role of the SLSOs is to support student engagement and achievement in the Learning Centre. They work 1:1 with students to support them in their learning and contribute to all key Learning Centre activities.

School Reintegration

Once a young person’s mental illness has stabilised, the treating team will support the young person by facilitating a slow and progressive integration from hospital to school. Once a school has been confirmed for the young person, the Walker teachers arrange an integration meeting that usually occurs at the receiving school. The meeting is attended by the treating team, the Walker teacher and the key contacts at the school. The integration meeting helps inform the school integration plan and care plan. Close communication is maintained between the Walker Unit teachers and the receiving setting throughout the whole integration process until discharge.

School integration plans are staged, starting with shorter time periods and in favoured subject lessons or with support staff available. The aim is to gradually increase their exposure to the environment, to other students and staff and for longer periods in the day. The frequency of integration days gradually increases up to a maximum of three days. Walker teachers gather timely feedback from schools during the integration and communicate this to the health team to ensure all parties are up to date with progress. Typically, the integration process is spread over five weeks.

Ahead of school integration, a care plan is developed jointly by education and health staff that includes strategies for recognising and managing the early warning signs that the young person is struggling. The care plan will have self-help strategies for the young person, and guidance for staff on what to do if the situation escalates. Interventions may include sensory modulation activities, time out periods, meeting a mentor or staff member, contact with the Walker Unit or parents and use of PRN (pro re nata or “as needed”) medication. Contact details of key support people are highlighted in the care plan Figs. 7.1 and 7.2.

Fig. 7.1
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Example of a school integration care plan (p. 1)

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Fig. 7.2
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Example of a school integration care plan (p. 2)

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Transport to and from integration is ideally undertaken by parents or carers of the young person, but if the school is within reasonable proximity to the Walker Unit nursing staff may support the initial stages of integration. An ongoing need for a clinician to support the integration is an indicator that the young person is not yet ready for discharge.

Discharge

In preparation for discharge from hospital, the Walker education team communicate the details of a young person’s mental health treating team in the community to the school to assist with continuity of care. Sometimes it will be agreed with a school that the young person will continue a negotiated partial attendance plan beyond discharge, or they may return to school full time. Prior to discharge, a farewell is organised for the young person by the Walker team. As a part of the farewell, Walker education staff present the young person with their academic report, a scroll that is co-written by the education staff and the young person’s peers and any other certificates they have earned during their time at the Walker Unit.