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?

I'm a paediatric nurse and we have really struggled in the past to manage teenagers with eating disorders on the ward. It's made staff Ill and others resigned as it was causing them so much stress. Absolutely way beyond your remit as a teacher!

If they are acutely ill, then they will get seen by CAMHS.

If they are not acutely ill, then it's overstepping to supervise meals or do anything else.

It sounds like the parents need to go back to CAMHS/the GP and push to be seen if they are this concerned. If the child is very unwell, parents should take the child to A and E.

Definitely don't get involved.

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!

I teach. I understand your concerns. I am also the parent of a type 1 diabetic. Many type 1s have poor attendance as a result of being hyper/hypo and the impact this has on them. Overall, educational outcomes for type 1s are poor. This is unacceptable for a condition that is largely manageable, particularly with the tech that is now available. Refusing to support a child is appalling and whilst I know we can’t force teachers into training, what do you expect should happen to these children? Are we really saying we’re only prepared to teach children who are healthy? Type 1 is, just so you’re aware, covered by discrimination legislation. The type 1 community is getting better at challenge. Type 1 children, like all children, have a right to an education too. It is beyond me that there are people in the profession who clearly think otherwise.

It's being conflated with diabetes because of the other thread where a parent is trying to sue the school/a teacher over something relating to her child's diabetes.

It's great your child was able to manage their own diabetes, but in primary school especially, often they aren't able, and it does fall on an adult, often a low paid TA, to help them- which again is a huge responsibility.

It's not about making parents feel bad- it's about the situation with funding in schools. Teachers and schools in general are at breaking point, and this leads to mistakes getting made, due to e.g. staff leaving suddenly, high levels of staff absence, staff being unfamiliar with children etc.

What you're asking for is not unreasonable at all in a fully funded system, but I do believe it has reached the point where some schools probably can't safely manage some health conditions- mainly due to high levels of staff turnover etc. And I think it's something parents need to be aware of, rather than piling more and more pressure on individuals.

It takes a village to raise kids. Only these don’t exist anymore. Poor kids. They have no hope. Mental health is on the rise yet those poor teachers just have to carry on like they are all the same. Sad all round.

The poster has clearly said what they think should happen- that people within the school who have the time to do it properly should help the child manage their medical condition. The poster is saying they felt the situation was unsafe for their child.

Would you genuinely rather teachers said "yes, yes, yes" to situations they feel are unsafe (and then take the fall when something goes wrong)?

Obviously all children have a right to an education, but in some cases children need additional support beyond that which a class teacher can provide and that needs to be funded properly.

I was trying to get a sense of the bigger picture here, because quite frankly it doesn’t add up and other posters have noted that too. A teacher would not be asked to take sole medical responsibility for a student with AN. Nor would a teacher be asked to weigh and measure a pupil with an eating disorder - if there really is no specialist provision available then the obvious choice is a GP.

I have no doubt the OP attended the training and felt overwhelmed and unsupported. Perhaps also a bit pissed off with the constant mission creep that teachers are subjected to. But the training was likely more of an overview of the whole care process and here is how you can support, as part of the students’ overall ecosystem, rather than ‘congrats, the job is yours’.

I completely understand why you did this.
Years ago, I had a pupil who was sadly born with intestines outside of the body. The pupil in question was a happy one and had lots of friends etc. No reason why they shouldn't be in mainstream. My problem was the 'training' I had, should a life threatening situation occur. I was told to 'grab something nearby to stem the flow of blood, to stop them bleeding whilst the ambulance came.' It was scary and shocking. As a mother myself, I absolutely would be horrified at this for my child.
We are not qualified to deal with things like this and AN is a very complex issue.

ok, let me just clarify again, the stated aim of the course was keeping diagnosed children safer while on the waiting list for medical support.

There is no "overall ecosystem".

Does your job require and train you to care for someone who is medically very, very unwell?

I think those saying "it doesn't add up" have no idea what things are like in schools right now- in part due to how overstretched CAMHS is.

Do you doubt that schools are asked to supervise students with eating disorders during breaks and ensure they eat?

This isn't related to OP, but would you doubt that schools are asked to provide constant supervision for students at risk of self harm?

But @Nimbostratus100 can you clarify if YOU were told to weigh and measure the student? As this would be hugely detrimental and even dangerous, especially without a wider support system in place.

we were not given specific instructions, the weighing and measuring was on a list of interventions that we were supposed to be using, yes, but only when we judged it to be the right thing to do - no guidance on when it was the right or the wrong thing to do -

also, the withholding of water, etc, when we judged it appropriate, but I wouldn't have the faintest idea when it was a good or a bad thing to let a child with AN have a drink of water, so telling me this is a tool in my tool box, and I should be using it with judgement, is meaningless

ok, let me just clarify again, the stated aim of the course was keeping diagnosed children safer while on the waiting list for medical support.

So the GP has diagnosed this pupil with anorexia and now the responsibility for taking care of that pupil has been passed onto the school/you until she is seen by the ED team, is that right?

This is what I am saying! It was ( past tense - it was last year and I am not currently working) passing the responsibility and care of medical conditions on to teachers, because there was no medical support available, and we were supposed to keep such children "safer" until they reach the top of the waiting list. It wasnt anything like awareness, to raise the alarm, or support, alongside medical interventions, or anything like that.

basically, that was the idea, but I didnt complete the course because I didnt want to be put in that position

Well of course YANBU, but I am really interested to know who is supporting this training? Is it NHS, school? And who is it run by?

That is dreadful, and YANBU at all for refusing the responsibility especially with such vague training!

Yes. I’m a mental health nurse.

I’m surprised you cannot remember the name and that you took absolutely no action. You’ve said the course proposed non medical professionals undertake health care roles which is very dangerous and a safeguarding issue. I am not even going to comment on measuring waists which is dangerous practice even if you were a health professional.
if I’d been on that course, I’d be knocking down doors to ensure it was never delivered again!

It was run by a suicide prevention charity, who had lots of research and case studies etc at their fingertips, they were recommended by NHS. It was put on by a big MAT.

Wow !
I have worked with people with AN
i totally get why you would not wish to take in responsibility for someone who is on the waiting list !!
AN has a high mortality rate sadly, and government needs to address the inappropriate and unsafe wait times into health care, especially CAhms and NOT push psychological and physical monitoring into teachers !!!!
I am Shocked 😮

As a DSL (and former HCP) I would also really like to know this.

I have worked with children with significant mental health issues my whole adult life and have never heard of school staff being asked to weigh, measure, or monitor calorie and fluid intake for a child with AN. It is completely bizarre that any training provider would suggest this.

Any member of school staff who is asked to do anything that they feel falls outside their competence or job description needs to raise it with HR and their union.

Oh god, this is so wrong. I was recently in a paediatric ward with a young girl in the bed opposite who I guessed had an eating disorder.
the nurses were in and out with small snacks all the time and weighed foods. Offering her support and guidance/encouragement.
I cannot as a teacher begin to think you can take on this responsibility.
it is such a complex illness 😞

I dont think this is a particularly unusual situation though, I am just talking about this example, because it is my example, but lots of teachers and TAs have other examples. For instance a friend was recently left in a position where she was responsible for a child in a wheel chair in a situation where she was not strong enough to manage the wheel chair, and they were stranded until rescued ( by other children) . Its the level of responsibility and expectation in general that I am talking about.