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?

But you being asked to use common sense and god forbid some compassion? How has that so mightily offended you?

But that is not what was being asked of her. So why bring this up?

You are not being unreasonable. In fact it was the only professionally responsible course of action.

It is one thing for teachers to have a general understanding of what children with different challenges are going through so they can accommodate them in their lesson planning. It is quite another for the NHS / CAHMS and school SMT to pass the buck to classroom teachers in this way. You cannot be expected to take on such a responsibility. It is a serious safeguarding failure to put someone who teaches hundreds of children a week and has attended a powerpoint presentation in charge of monitoring the wellbeing of a child with a serious and complex medical condition.

A child on a waiting list os not being treated yet. Broadly speaking untreated anorexia has approximately a 1/3 recovery rate, 1/3 managed but not recovered rate and 1/3 fatality rate. It has the highest mortality rate of all psychiatric illnesses. Teachers who see a child for maybe a 15 minute tutor period a day and teach them three times a week in classes with other children cannot and never will be able to provide adequate oversight of their mental and physical health.

There is no way I would take on any kind of formal responsibility for such a child and that is not because I am being difficult. The percentage of children at our school with EHCPs, on the EHCP diagnosis pathway, with diagnosed SEN and with non-specific SEN that require consideration is vast. We have a 2 hour meeting after school every fortnight to go through these children's progress and goals to help the SEN department update their learner profiles and the paperwork they submit to CAHMS every year to justify funding for additional support etc. That is 38 hours of meeting time a year just for that element of SEN provision. We also have other paperwork that we have to complete for each child and inset sessions dedicated to differentiating for them and evidencing that differentiation to cover our backs. We are not an SEN schools.

I'm on the 'parents of teens/young people with an ED' thread and don't recall anyone's school getting involved in weigh-in's or measuring waists - it would be highly inappropriate whether or not CAMHS are involved. Please can you link to the training course provider as I'd like to flag it up with ED charities - thank you

OP why are you not answering the question you've been asked several times here? Were you told in the course that YOU should be weighing and measuring, doing meal plans and restricting water?

All of which are highly likely to exacerbate the situation?

My DD was seriously ill with anorexia and it's not something that can be managed in school.
I do think teachers should have an awareness, ie my DDs school had several calorie count posters in the canteen , not helpful in a girls grammar d
School!
I also think teachers should raise concerns if they notice a pupil routinely not eating, stressed around food, losing a lot of weight etc.
But with anorexia you need to have a non negotiable high calorie meals, watch them eat, and ensure they arent sick,/exercising it off afterwards. Getting them to eat lunch can take a couple of hours of tears meltdowns and stress, it's not something a teacher or teaching assistant can do tbh.
I had to give up work to care for my DD ,who was too ill to attend school. We did try and manage it school but unless someone can watch them eat it doesn't work. I used to go in every lunchtime.
But raising awareness so staff are aware of warning signs , so they can raise concerns, make reasonable adjustments etc should definitely be encouraged.
CAMHS are very under resourced and often staff dont have the right expertise/ training. , they repeatedly told me it was their job to train me to be my daughters eating disorder nurse. I didnt want to be her nurse her wanted to be her mum.
But it's too much responsibility to take on as a teacher beyond safeguarding, awareness, adjustments etc

I agree this is beyond your expertise. Heck, it's beyond my expertise as a parent, but am continually called on to do this even though I have started to suspect that home treatment is not a good idea at all for many students, and ends up with the parents incredibly stressed as they are not able to manage the AN patient.

There is definitely education that would be helpful in a school setting, but it is not at this depth and should not require you to 'do' anything, more to accommodate parents/child in the school setting (e.g. going home for lunch, understanding attendance issues). Also, this is why they had school nurses- my dd's college has a college nurse and she is responsible for calling the ambulance or assessing health, because, well, she's a nurse!

I don't know if you were being asked to measure weight or monitor vomiting though. I don't think they would ask a staff member to do that. It may have been for information about how AN is currently treated.

I think you are totally right. You are a teacher and not a psychologist or psychiatrist. A general understanding is useful for everyone but this could be very dangerous for the children. These children with these conditions are very ill and need medical help.
you could not be expected to treat a physical condition.

Read the thread, she hasn’t been asked to treat the condition.

@Highdaysandholidays1 Safeguarding and SEN courses I have been on are often given by people who are only qualified to deliver the powerpoint and cannot answer these sorts of questions. They talk about how certain provisions are important, but they know nothing about the roles of the various course participants and why they have been sent on the course, other than that they work in a school setting. When asked they will say things like 'well it would be desirable' or use the word 'should' or tell you it can change a child's prognosis so it 'could' be seen to form part of your duty of care. They don't actually provide training on implementation.

Odd advice re OCD - the treatment is to challenge the compulsions. If you let people - patients!! Not pupils - do all their compulsions the condition becomes worse and worse as you are reinforcing their thinking.

i have not read the whole thread but I think you are totally right. Noticing worrying things and reporting to the right medical authorities/social services etc is presumably something you already would do.

we would not be happy with amateurs treating a physical illness.

You are right. I only read the original post. Was not clear what exactly they were being asked to do.
i have some experience of mental illness and passing the buck in this way frightened me.
anyway think I have given my opinion

The lines between Health and Education are frequently blurred. As a Head, I'm often asked to sit on the Autism diagnosis panel, which I'm not qualified to do and have had no proper training in. Give me an autistic child and I'll teach him or her effectively, likewise help with social skills and interactions in school. Am I trained to diagnose? Absolutely not! I'm not an Ed Psych, a GP or a Mental Health practitioner. I'm trained to teach and look out for possible signs of a health problem, in order to pass this information onto health professionals. That is it! All I can give is my professional opinion, which is exactly that. This could be life-changing for a child. Whilst most children need to be in relatively good health in order to access education, education professionals are not health professionals and shouldn't be regarded as such. It's counter-productive and needs to stop.

The OP is right to be concerned about attempts to make teachers undertake mental health interventions with children.Awareness training for schools is important as a number of posters have testified upthread and creating a sympathetic supportive environment critical. But adults in schools need boundaries about what they are qualified to do. Unqualified adults making psychological interventions around anorexia, self harm, suicidal ideation, socially transitioning children etc is dangerous - for the child and for the career of the adult.
Pastoral care requires training and boundaries - knowing what you don't know, when you're out of your depth, when professional support must be found. Just as we do in safeguarding, so schools must do with mental health issues. It's not up to schools to replace underfunded qualified mental health support.

I have heard of TAs being told to change catheters, so I am not surprised that other medical processes are being pushed onto teachers and TAs.

Clearly the course being a short 2 hrs, and also lumping anorexia in with a load of other conditions, was a blatantly ridiculous attempt at educating anyone in how to manage it, that's why! Anorexia is an unbelievably complex condition.

Asthma also requires sound knowledge but it's a far more cut and dry set of knowledge and medical data that you'd need to know.

Nothing to do with being burnt out, everything to do with OP being great at her job and rejecting the lazy buck passing, if you ask me.

I’m sorry, but this is ridiculous. I’m en ex teacher and have been a designated safeguarding lead. I have worked in both primary and secondary schools and currently work in student wellbeing at a university.

A teacher would never be asked to take on the medical management of a child while they are on the waiting list for an ED referral. The medical management of that child would remain under their GP. Referrals would be made to CAMHS with yes, a shockingly long waiting list. Possible to in house school counselling if available.

Teachers who work closely with the child may be given more in depth training on signs to look out for but in a SAFEGUARDING capacity only. Any concerns would be passed on to the designated safeguarding lead at the school. A DSL at a school where a child is on an ED waiting list would in all likelihood be in regular communication with the child’s parents/carer anyway.

A teaching member of staff would never, ever be responsible for weighing a child, checking calorie intake etc. regardless of training. To even to suggest that is simply ludicrous. The only time this might happen within a school setting would be with a medical professional eg school nurse and it would be in agreement with their ED treatment and with parental consent.

Said teacher might report to the DSL if they notice visible weight loss, concerning comments being made about food, another child reports that they overhear the child vomiting in the loos etc etc. The teacher would then report these concerns to the DSL for them to follow up on. Information is then shared with parents, GP, CAMHs professional.

The only role a teacher would have is safeguarding or providing first aid if you are trained.

Your role might be slightly different if you are in a different pastoral role in the school eg head of year/house, deputy head. But you’re still not going to be weighing a child at school .

Sorry to derail but quite a few posters have conflated offering diabetes support with what this poster has been asked to do. They're not the same at all.

Support for T1 children requires some knowledge of the condition, the technologies and tools used to manage, but that's a few hours of your life in terms of training. And, in our experience, it's the child who does the managing. My child administers their own insulin, for example, treats their own hypos, and their glucose data is constantly transmitted via their phone to me, their dad and the hospital. If they're hyper or hypo, we know about it before you do and often manage it remotely.

So, it's primarily about awareness. You would not be in 'trouble' if a child had a hypo. You would be if you were unable to recognise it (decided their symptoms were bad behaviour, for example), and prevented the child sorting their own treatment for it. Or, your would be if you prevented them from using their phone in class - this happened to my child. They tried to take his phone off him, a disaster for a T1 who uses it for monitoring.

This is not at all the same as being asked to provide medical care to a child diagnosed with AN, who has no medical support, no treatment plan and is, presumably, at high risk.

Please don't make children like mine, and parents like me, feel bad for asking for some basic care for a specific condition that's contained within the Disability Discrimination Act. It's shit for you having to learn something new, sure, but much worse for my child, living with an incurable disease for the rest of their lives, which we as a family can't manage ourselves while they're in school. This surely is the definition of in loco parentis.

In return we're very grateful, we keep our child's care plan updated, offer training and support ourselves, risk assess activities and encourage our child to be proactive in managing their own condition. We also remind them to work hard, be well behaved.

So, this bears no relation whatsoever to what the OP stated she had been asked to do in relation to a child with AN.

Wait. You were gobsmacked the school didn't contact you about your daughter's weight loss, which you knew the reasons for and were on it. But you didn't feel it necessary to head off any concerns yourself by letting them know what was going on in the first place?

FFS.

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

What weight records? Are these given to the school by the pupil's GP while they await assessment from the ED team? Who are you meant to give the results to? I don't think waist measurement is part of any ED management, is it?
Feeding regimes and calories intake are carefully calculated and monitored. A pupil needing such monitoring should not be in school.

Is the parent insisting the child attend school?

I think the school needs to state they cannot support this pupil. Who asked you to take the course?

It is right that teachers know basic first aid, but anorexia requires specialist psychiatric support - not even a GP can fully help an anorexia sufferer. It's a horrid condition and you should not be made to feel responsible for this poor child.

Sorry to derail but quite a few posters have conflated offering diabetes support with what this poster has been asked to do. They're not the same at all.

It an easy thing to do, doesn't it.
Just drop in a poor comparison which muddies the waters and derails the discussion.

*isn't it.

I think that's very sensible of the your school.

You do have a choice. You can refuse, and all the major unions will back you on this.

The school may then say they have no other role for you, but honestly this is rare.