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?

re: calorie intake, measuring waist, weight monitoring, dental welfare - what was the hope about what you'd actually do? Not challenging OCD behaviours is not medical management and there may be (maybe I'm wrong?) some scope for a teacher to say 'put our water bottles away now'. I'd not be happy for a teacher to be involved in weighing a child (for example) but perhaps noticing that they appear to have lost a lot of weight or look worryingly slim. Can you give us further details? I can see why you might be worried about this but without more details, it's hard to properly understand.

I’d go nuts if school tried to weigh my child as would Cahms. No way would Cahms be suggesting this and the course sounds horrific if they are.

What on earth was the name of it?

Similarly we had a 45 minutes online, Trauma-informed training at my workplace (FE college) and were expected to take on responsibility for young people's mental health.
Some us complained in the training as it seems teachers are now expected to be everything to young people. (And this is against a backdrop of SMT pushing gender ideology, which is a symptom / cause of MH issues in young people).

SMT cut the amount of trained counsellors in our setting and the. expect teachers to pick up the slack, identify when bad bad behaviour is 'trauma-informed' and act accordingly.

The impact of years of austerity, poverty,,and e.g. in children who have had trauma as refugees etc. is all put onto teachers.

I would expect schools to become more informed re EDs thought particularly a girls’ school. Numbers have risen sharply, AN is the biggest cause of death by mental illness and ime there is a huge amount of ignorance in schools re the condition.

Wow, YANBU at all. What a significant responsibility to place on teaching staff. My 10yo son has OCD. It is very complex and there is no way on earth I would expect a teacher to become familiar with all the in's and out's of his condition. As it is, his teacher is fantastic and keeps an eye on him and will alert me to any significant issues. She knows there are things he struggles with and her strategy is to encourage him with minimal fuss and to leave well alone if he shows any signs of distress. That's as much as I would ever expect from a teacher. Even this likely takes up more time than she has to spare. We are very lucky to have her.

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

Nice try, but they've got to be joking

I'd ask what they had to say about your potential liability if things go wrong, except that would probably be foolish ...

I’ve always had a simple line I do not cross- if I feel the child is at risk I do not agree to manage the condition. If it’s beyond either my capabilities, or if I don’t have the time to safely manage needs.

For example I will offer advice and support to children with type 1 diabetes who only require the confidence boost of an overview or someone to double check. I have refused children with diabetes and eating disorders as I simply can’t keep them safe, I don’t have the time to check up properly for their safety. For younger ones I’ve insisted an adult is timetabled properly at points during the day to support them, I know that when I’m doing a million other tasks as the class teacher I could potentially make a serious error in their care and it’s not safe enough.

Id use this test- if you feel the child is unsafe in your care with the proposed care plan then refuse. It’s about the child. It sounds like this child may need a separate dedicated adult 1:1 at periods to focus on them.

If teachers keep just saying yes more children suffer. Low quality speech support, unmet medical needs. I’ve had things over the years like being asked to manage a tube fed, non verbal non mobile, non weight bearing child in a mainstream class. I honestly believe they would have been in danger in my classroom, especially without the provision of adequate furniture or devices in place. They would have sufffered and been denied an education.

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

Ok so if you’d agreed to complete the training, would you have been running all these checks on a daily basis? Some of these checks would need bathroom supervision so who’s expected to monitor this if you’re busy? Did the course cover referrals? And would you need to liaise regularly with the health teams? And what happens if the pupil dies? Will you be held partly responsible?

I'm shocked by the list of what you are expected to do OP, no wonder you've said no.

I would expect a teacher to be a listening ear where required and to have a list of other resources to signpost the student to go to, but you're not a medical professional or trained psychologist.

This approach sounds like it could do much more harm than good.

100% all this. Totally unfair for the responsibility to lie with you

As someone who suffered eating disorders for over a decade (starting in my teens) this would probably have made mine worse. Certainly wouldn't have helped.

I'm actually shocked at how terribly misinformed this is.

I think this is the context that posters asking 'but what do you actually need to do?' need to understand. It's not that they'll actually SAY we are now handing their mental health over to you- it is almost certainly sold as an 'awareness training course. However, in practice support for students is being stripped and schools (because they care and actually see the young people every day) are the only time many see a professional. I would be using the session to ask how often a qualified medical professional would be coming into school to work with the young person. Surely with a dangerous (and envinronment-sensitive) illness like AN you'd expect weekly visits? And if a form teacher is to meet with them to discuss any observations, they need to be released from teaching to attend that meeting. It's a 'straw that broke the camels back' situation here, which I'm sure if you'd watched interviews with teachers on the strike day you'd be hearing about.

With that I'm trying to figure out when you are expected to fit any teaching in.

I do mental health awareness training and spotting the signs someone needs help, knowing how to approach it, knowing when to escalate, is all part of that training content.
Simply being able to spot the signs can make a lot of difference.
Perhaps that's what the training was about, as opposed to making you a specialist. I'd be very grateful for a teacher who even had basic knowledge.

At one of my last seminars before emerging qualified to teach we were told in no uncertain terms that our job is to teach.

Our job is not to manage mental health problems, administer medicines, monitor medical conditions etc. We should be alert for problems then pass them on.

That's the job of a medical professional and each school should have one. LAs try to save money by foisting it off onto teachers. Too much responsibility. Just say no.

A friend who qualified in first aid had dreadful trouble from an aggressive parent who felt she hadn't done enough to help his child but called an ambulance which meant he had to leave work.

She didn't even get extra money for being a first aider.

It took me ages to work out what you were talking about.

I understand you are a teaching assistant. I have no idea how your employer expects you to manage a child with anorexia after you’ve taken a short course. You don’t have the qualifications or the resources to manage this. What are they expecting you to do? Feed the child?

I know that this is stressing you out. You feel like a huge responsibility has been put on you to manage these conditions.

All you need to do is put in writing that the short course you’ve attended is insufficient to handle complex medical needs and the responsibility is outside your knowledge and abilities and you request a professional such as a school health nurse to attend to medical matters so that you can do your job which is to assist with their educational needs. Send an email every single time you receive a student with complex medical needs which you are expected to manage. It puts the responsibility back on your employers. You also walked out of the training which is a bit strange to me that you did that.

I'm going back 30 years here - but when I was a secondary deputy head a girl in school developed severe epilepsy, was having fits on a daily basis and they were severe enough for an ambulance to be called each time; a member of staff was required to accompany her on each occasion.

The epilepsy support team refused to let us be trained in administering EpiPen valium - but said they'd train some of us to administer it rectally (bear in mind, apart from the obvious considerations, that her fits didn't take place in a private room).

She was 13...

I personally would have completed the training because I’d want to try and keep her safe.
But I understand how that would mean you agreeing to do it and why you wouldn’t want that.

But this is one of the reasons I am leaving my current role in an SEND/SEMH unit.
As I am a full time teacher but I’m also expected to play nurse to at least 20 children a day, as well as dealing with severe MH issues as well as individual needs for ASD students and everyone else’s needs - all whilst being payed less than a NQT.

Teachers and TAs are expected to do more and more and there just aren’t enough hours in the day.

They need to have a role which is solely dealing with ongoing medical issues like this.
TA’s do not get paid enough for this.
And teachers do not have the time to do it.

This doesn’t make sense. Cahms, parents and students wouldn’t expect you to do this and doing it would make things worse. Sufferers have weekly medical checks and weigh ins. If not well enough they are not allowed in school. The only way of knowing if a sufferer is well enough to be in school is with info from the medical checks that need to be done by professionals. ED teams are very much in control and do the monitoring. The only support we’d want is with catch up work, space to eat and better knowledge of what is involved. There is a huge stigma with EDS. We’ve been quite shocked at the ignorance shown by school.

Your op is very vague and you’re not answering questions so I’m suspecting some scaremongering to be going on here and you’re just expected to be more informed which you should be.

I think you sound so stressed and teaching must be such a hard job especially at the moment. Honesty my heart goes out to you.

but I do wonder if you have got the ‘you have to take responsibility’ quite right. This sounds like you were given an overview of what it all entails. I work for CAMHS and with teaching staff and often the teaching staff say they have no idea about common mental health conditions so want some help. This sounds like more of an overview for you to understand. I don’t think they are asking you to be a mental health nurse are they ?

Exactly this.

If the training was more in depth and not a box ticking exercise would you be happy with the extra responsibility?

We have had to help teachers with how they communicate with children with eating disorders as it’s easy to say the wrong thing when trying to be nice.

ie. Don’t say ‘you are looking well today’ you may as well of said ‘you look fat’. So knowledge of the whole process is important.

checking no vomiting, measuring waist- this would tip my child over the edge and I struggle to think they’d ask you to do that?! She has an eating disorder but we’ve managed to get a bit better. I’d love for schools to understand it better - but not that.

ANiceSliceOfCake

Exactly!

Op I don’t understand what responsibility you’re being given. Responsibility for her ED and safety would be with her ED team and parents.