to refuse to take responsibility for student with anorexia nervosa?

[Nimbostratus100]

Leading on from discussion on another thread, this situation came up in my teaching career recently. I had a year 10 tutor group in a girls school, and was asked to undertake training on AN, to support one of my tutees.

I did attend the training, but did not complete it. It was "in person" in that I attended a central location where a trainer displayed power points and was available for questioning. It took a couple of hours, and I left before it was completed. The reason I left ( as did others) was because we felt that the whole thing was an exercise in passing The Buck to us, under the pretence that we were somehow prepared, able and competent to give medical support in the absence of any other medical support being available.

The training wasn't just AN, it was also other serious conditions, such as suicidal depression, OCD, body dysmorphia, etc

Some of the content was interesting and potentially helpful, but it was quite shocking, the feeling that we were going to be left in the lurch, not with our little bit of knowledge and understanding just improving feelings of welcome and acceptance for our charges, but somehow responsible for them medically.

I think parents have a very limited idea of what teacher training about medical issues consist of. I have over my career trained in more than 60 medical conditions, but nothing like this, in the past I have learnt danger signs like "if a child with asthma cant complete a sentence without drawing breath, call an ambulance". Or "try painting the wall that a child with ASD is facing blank pale pink, it might help" - or " a child with CP may work better on a vertical surface not a horizontal one" etc

not medical management, and not absolutes, just guidelines for safety and things to try only

I did not complete it, and did not allow my name to be recorded as having attended.

I still stand by that - a run through of a few power points does not make me a safely knowledgeable and qualified person for a child with AN to rely on

AIBU?

Blimey. I don't blame you at all.

I'm an 1:1 TA and was stunned when I started the role. I was given an A4 piece of paper listing my named child's needs (not medical) and essentially told, "off you pop. It's entirely your responsibility now."

Anorexia is a hugely dangerous condition and very hard to manage, especially in secondary schools. I think it depends on what you are being asked to do, but if it's eg something like mealtime supervision then no way - not least because that should be your own break, too!

I do think that because CAMHS is so overstretched, schools are being asked to take on more and more mental health support of children and teens, and it is very dangerous because some people get a little bit of training and think they know it all, but there is potential to cause serious harm.

I think you've done the right thing, OP.

The responsibility put on TAs with minimal training and low pay is so unfair in many schools. And many TAs now don't join unions so have really limited protection if something goes wrong.

I moaned to my LA recently as a parent (a bit more formally than moan obviously) that the LA and NHS have come up with an excellent approach to cutting costs... get schools to do more and more. IE speech and language, they want schools to be doing the bulk of the therapy without any SAL therapist input. Schools are expected to take on more safeguarding input to ease the load on SS etc.

I questioned whether when they make these grand plans if they ever actually consult with schools on these grand plans.

It's outrageous and across the board.

This is fairly common. I declined to do an online diabetes course as I was told it would then put me on the list of teachers who could help a student manage their diabetes. This included supervising testing, recording levels, help to give medication and make judgements about the correct course of action. The idea being that this child's subject teachers could do what two TAs who knew him well had previously done. The course would not have made me confident in managing the condition. The child was also an infrequent attender. In order to do this job safely you need to have in person training with the child and someone knowledgeable. You also need ongoing support and help while you build up knowledge and confidence. It would also not be appropriate to be having to leave the rest of the class to their own devices whilst doing this with one student!

Surely supporting a child with asthma presents more acute risks? I know how dangerous AN can be, I sadly had a university friend die from it, but this was the end stage of an illness that had got progressively worse over many years. Is it the fact that it’s mental health that makes it so daunting? Or perhaps the training was too broad and not actionable enough? Or you’re a bit burnt out from all these additional requirements of teachers? No judgement, I’m just trying to gauge why this has left you reeling when you’ve trained in so many other serious things.

If it was me I would probably give negative feedback on the training but double down my efforts to learn in other ways (a more extensive course, briefings from the students’ health professionals, recommendations for books and self learning etc, maybe a visit to a AN facility if they would allow it).

I suppose because managing asthma is different, it is to do with recognising straight away when it has gone beyond what can be done in a school, and passing it on to emergency services. With AN, the idea was not that we pass it on to emergency services, but that we manage the potentially lethal critical stages ourselves, possibly leaving a child on a one way downward spiral if we get it wrong.

I am all for learning to recognise when a child might be in danger to this terrible condition and pass it on for medical intervention. That was not what this was about. This was "This child is already in danger - sign here to take responsibility for her now please"

YANBU
I do think that because CAMHS is so overstretched, schools are being asked to take on more and more mental health support of children and teens,
This is an issue because by doing this training they are effectively passing the buck and assuming the child is being cared for so they move onto the next child on their list. Intervening at all is a disservice to the child and could stand in the way of them getting proper professional help and care.

Anorexia is a long term illness with very complex potential causes and there is no one correct treatment that will help all sufferers. It has one of the highest fatality rates of all the psychiatric diagnoses, and of the (thankfully majority) who don't die, a large percentage never really regain a "normal" relationship with food. Peopl with anorexia also suffer from a host of other psychiatric problems (depression, OCD, PDs, other eating disorders, addictions, etc), either concurrently or subsequently.

In other words, it's a nightmare for all concerned.

You are quite right, OP, to refuse to accept the mantle of the "expert" here.

Teachers are expected to be social workers, nurses, family support, confessors, therapists, aren't they! Not reasonable at all.

OP can you tell us what the course was asking you to do? I completely understand why you're not confident acting in a medical capacity, but I'm not really following what they were asking you to do.

As a recovered anorexic I’m horrified you’re being asked to sign that.

my anorexia went totally unchecked at school. It would have been really useful if the teachers had known to call an ambulance when I blacked out and didn’t come around for several minutes (I don’t even know how long I was out for, my friends thought I was drunk and were debating drawing on my face).

No way should you be expected to take responsibility for medical care - call parents if child is ill, call 999 if it’s an emergency, yes. Support the child emotionally and mentally and try to encourage them - yes.

I left school and went to a college for 6th form because I knew I could hire better there. Ultimately my recovery started when one of my tutors pulled me aside, told me I was incredibly intelligent and talented but that I was throwing it all away, but it wasn’t too late to sort myself out. I scraped through ALevels and went off to uni, now run a successful business. I’ve never thanked him, I really should.

Teachers should never underestimate the power they have to help young people onto the right course.

But no, you should not be medically responsible. You are a teacher not a nurse.

YABU

I get what you are saying as I refuse to be the registered first aid trained person in our ARB as I worry I’d panic in that situation and as we have ex nurses I know they’ll be safer in someone else’s hands - but I still did the training.

It is always good to know the signs and what you should do.

Surely this is no different to safeguard training.

I cannot guarantee that I will 100% spot the signs of abuse and I don’t know if I’ll ever miss a child who is being abused or at risk of being killed under my care.
But I still do the training because I’d rather have some knowledge to try and help, than none.

I don’t like being in a responsible position for illnesses or other things, as I’m not a medical professional like you say but as the person who sees the child almost everyday then I know I have a responsibility to keep them safe and I can spot the signs easier than someone who doesn’t see them as often.

I think it's unreasonable to expect teachers to be experts on AN. My daughter is in year 10 and has AN, I wouldn't expect a teacher to be qualified in dealing with it. My daughters school is excellent and they have put in brilliant support for her at school but the AN side of things is dealt with by the ED clinic, school are more there for her for the emotional side of it

It was things like feeding regimes, calorie intake required, weight monitoring, limiting water drinking as this confuses weight records, supply of chocolate bars regularly throughout the day, etc, checking no vomiting, measuring waist, dental welfare, and also mental health well being, such as not challenging OCD behaviours, giving space for tapping, counting, washing hands, this sort of thing

I both work in a school and have undertaken training in all sorts of conditions and have suffered AN.

I'm not sure I understand in what way you are being asked to medically support this child. The medical management would involve regular blood tests and physical obs such as blood pressure and temperature, managing medication etc. I suspect what you are being asked to offer support in the behavioural and emotional aspects of care.

I think the big thing here is that the management of AN in children and adolescents is a 24/7 thing. What is it you are being asked to do? Meal supervision? Challenging disordered behaviours? Offering emotional support?

This sounds similar to the 'mental health first aider' training I did - it was shockingly inadequate.

no, not challenge disordered behaviour, we were told to accommodate it

It wasn't the "mental health first aider" course, which was also in our council. This one was different, but tbh, I really don't know in what way it was different, it does sound similar from what I have heard

Just want to echo what@CrackersCheeseAndWinePlease said. (Hello again crackers)
My DD is also in yr10 and has AN.
Her teachers are aware in that they are very flexible with homework and her timetable as she’s often exhausted but I absolutely don’t expect them to be involved in her care, that’s not on them.

It seems reasonable to me, sorry! You aren’t being asked (unless I’ve misunderstood) to medically manage the condition, just to be educated enough at lay person level to be able to support in school in a way that prevents you doing anything that may be counterproductive and cause harm, and in doing so support the work of medical professionals managing the condition.
Surely you could have completed the course without signing something to say you’d take sole responsibility for managing the condition (and surely they didn’t actually ask you to sign anything to that effect?)
It seems irresponsible to actively avoid gaining the knowledge that’d support you to do no harm.

Like a previous poster I’m not sure what the course is training you to do. Are there covert expectations that teaching staff will provide pastoral support for those pupils with AN? Or is it about making teachers aware of this condition, in which case why aren’t the course resources available to all teaching staff?

I don't blame you. I work in a school too (TA) and I was shocked when we were brought in for a meeting about how to manage a child's severe diabetes. The child's condition meant that blood tests and medication had to be done multiple times a day at very specific times, all documented and with 2 staff members present. It beggars belief to expect this of staff who aren't medically trained and also who are barely enough to cover the daily running of the school to begin with. As it turned out the child moved back to their home country but we were very worried about it all and it was unfair to have that expectation and responsibility put on us.

I have a child with Anorexia and it has wrecked her education. Mental health is a protected disability. Children and young people have a right to an education so absolutely schools should be supporting those with mental health conditions to attend. In the same way they would with other medical conditions. However this doesn’t sound right. Are you sure you haven’t got the wrong end of the stick?

My child’s Ed team would do all obs. It is crucial they are done properly, certainly not by non medical staff. Nobody has ever measured her waist, in camhs or hospital. 😱 That would be hugely triggering. Why would anybody want to do that?It would also be hugely damaging to have her weighed by anybody other than her team( scales vary, it needs to be properly logged, support provided etc). Why would school need to do any of that? The most school have ever been asked to do is give her a quiet space to eat that is observed without staff being expected to encourage or anything, just feedback on what was eaten.

Maybe you should have stayed until the end. I don’t believe any course would be advising the above. It isn’t the way eds are handled. Are you sure they asked you to do all the above? What was the name of the course?

What exactly were you being asked to do?