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?

Oh I see. I think I misunderstood the gist of your post.

It’s ok. I think OP is very over stretched which is totally understandable and this was just one course too many. We all know that OP hasn’t been asked to be ‘responsible’ for any kids. Just to go on a course for awareness.

The main issue is that kids are now so complex. I see it every day like never before.
we all need to take a part in kids mental health. It takes that ONE adult to make the difference. They can be the dinner lady, the PE teacher or a coach from a sports club.

having just a little insight into mental illness goes a long way. Years ago it was hidden away.

now mental health is everyone’s business.
We all need to be the village 💙

YABU - if I had that attitude towards training that my employer was paying me to do and allowing me to take time out of my working day for, I would be given short shrift.

I honestly don’t think you were being expected to manage your tutee’s medication, feeding regimen etc, it was just to understand more about what her and other students may be going through and to help keep her safe while she’s at school. I think you can cope with that.

Yet another example of teachers thinking they work harder than anyone else, if you don’t want to do the job then find something else.

Obviously mental health services for children desperately need to be improved through the provision of specialist medical services. However, I totally fail to understand why you couldn’t have attended the course and informed yourself. It doesn’t make you responsible if something goes wrong, it simple puts you in a position where you might be empowered to help/ at least avoid causing harm. If anything you have made yourself responsible for refusing to attend in full, since despite being offered training, you have chosen to remain (at least partially) ignorant.

I read a memoir by a (now thankfully recovered) young British woman about her near fatal AN and in it she recounts how she was excluded from school because her physical condition was so near death that the school quite properly in my view felt they could no longer take responsibility for her being there and them being in loco parentis. AN is an incredibly complex disease and manipulation, secrecy and deceit are some of the main hallmarks, as is a HUGE resistance to treatment (in this respect it is quite unlike most other health conditions). No way should non-specialist professionals have to do any of this. If you accidentally trigger her into getting worse, or god forbid she has a medical emergency in front of you, then that's on you.

ok let me just explain again, it was in my free time, voluntary, and I went along thinking yes, it will help me to learn more about this...

however, it wasnt anything like what we thought, it was managing the medical conditions for an open ended length of time until the top of the waiting list was reached, and so |I decided ( as did others) that I very definitely did not want to be listed as a person who had completed this training, as I was going to be dumped with far more responsibility than I was competent to take on.

And there was no other medical or psychological team around the child at all, just the school. It wasnt "understand what the child is going through out side of school" it was "manage this medical condition as an open ended stop gap"

And this happens, and the reason I started this thread, is due to the misunderstandings that some parents have about this sort of situation

This is an AN trick called waterloading and the fact that she knows how to do it suggests her condition is chronic and she is 'experienced' in the deceit and manipulation that stems from the disease. You'll spend hours being sucked into her mind games. Plus, ANs can become dangerously dehydrated or too hydrated shockingly quickly. Don't do it OP. You're setting yourself up for being sued and the kid in question should be in hospital.

It wasn't a clear set of instructions as such, it was more "Here is a list of what you should be considering - use your judgement"

Ok. So they were priming you to do some or all of the monitoring of this pupil with no clear idea of when she would be eligible for professional assessment and treatment. And It’s left to you how much monitoring/measuring you do with the pupil…I think you dodged a massive bullet, OP. Psych services struggle with ED so how they expect a teacher to do this, heaven knows? And all this is wrapped around your everyday work ‘cos it won’t take long 🙄 It sets up so many potential areas of harm for both you and the pupil.

Sorry - I haven't seen the other thread, so can't comment on that. I was commenting on what has been written in this post, i.e. the attitude that my child with an incurable but treatable autoimmune condition - covered by the DDA - should be treated as a PITA because of it. I find it heartbreaking. We've sadly seen that attitude in my child's school and it has (somewhat ironically) led to him developing some mental health issues as a result. Which we are also now managing solo.

Imagine getting a life-changing diagnosis at 13 and then your teachers, who had until then loved you as you're an academically strong and very well behaved kid, basically wash their hands of you. Because they don't think it's their job to read a care plan and occasionally check in with you.

There IS a duty of care. I'm talking about a child who is registered disabled. I wouldn't sue, very clearly, but it breaks my heart to read what people are writing here. And I am 100% aware of teacher workloads and I fully support teacher strikes, and do all I can to mitigate rather than "pile on the pressure". But at the end of the day my child is newly disabled, and if a teacher can't take 10 mins to read a care plan, and makes an example of them for using their phone in class, when their phone is now a medical device for which they have permission to use ... and they're already struggling with their diagnosis making them "different" to their peers ... then yeah, that's not OK.

I just wanted to point that out, really, as diabetes gets lumped in with so many other things for some reason. It is not what the OP was talking about; it's a different conversation.

(For the teachers managing primary school-aged T1s, I agree that will be harder. But, again, it's a disability. Saying they shouldn't have care in school is active discrimination.)

I’m a TA and looked after a very unstable diabetic. I had no choice . Operating the app, rounding up and down dosages of insulin, the dexcom, prick testing, ketone testing, injecting measured doses and dealing with non safety needles. Dealing with hypos and hypers

Are you a trained specialist in this area as well as being a TA JT69?
Because if not I think you'll find you had every choice and that any union would back you on this

After all there's every difference between supporting someone to get the help they need and actually delivering it, especially when it comes to medical interventions

This training scheme is very odd

for example, people don’t often understand why my ASD child who we are very worried about developing AN is encouraged by her doctors to eat certain foods as part of her “healthy diet”. Not having teachers question her lunchbox would be very useful. That kind of training would be helpful.

I would be absolutely furious if a teacher decided to weigh or measure her. The potential damage from something like that is huge.

Hello again 👋

I think you are being more responsible by making the point that a Teacher is not in a position to take on the work of a Health Care Provider.

Having been a Teacher and served the Special Needs Role, and then swapped profession to be a Psychologist with professional experience in Psychiatric and Neurological conditions, I can say that the two professions cannot be merged.

It's good to have Teachers who can recognise some of the early warning signs of conditions in children so that they may be sent for investigation in the early stage. But only the psychiatric professionals have the time and training to take responsibility for delivering care for the conditions they diagnose and treat.

Teaching is a demanding profession. It takes up all a Teacher's time to do her own job adequately let alone well. It's time to stop giving Teachers roles and responsibilities that belong to other professions and expect them to learn them on a part time out of hours course online when the true health professionals take about seven years to get there and still work in a team.

It's another sign of the demolition of the health 'service' and the abuse of Teachers.

I said this upthread but you didn't respond @Nimbostratus100 - please can you dig through emails etc to find the training provider and the name of this course. I am very worried about the implications of such poorly framed advice and would be keen for an ED charity to take up the reins on this

I think people are spectacularly missing the OP's point.

Eva Musby who is regularly cited as one of the go to resources about ED's is explicit in her 'practical guide for schools' anorexiafamily.com/meals-anxiety-school-eating-disorder/

No weighing

The school should not do any weight checks (unless by agreement with the care team, who will advise on how to do it and what to say and what to not say). And as mentioned earlier, when a pupil is in treatment, do not comment on their weight gain.

I absolutely think you did the right thing in to agreeing to act in this way but imo - the poor advice needs to be removed in case others don't feel able to step away.

I don't believe anyone has said children like yours shouldn't have care in school. The issue is that teachers and teaching assistants (on minimum wage) already have full on jobs in school and classrooms full of children with all kinds of educational and special educational and behavioural needs. Adding yet another job, being a well informed, alert, capable medical care provider who needs to carve at significant time to ensure all is well medically at this level, is not appropriate in many cases. Proper support needs to be brought in to ensure the appropriate care is provided, such as a school nurse or proper health professional.

@amonsteronthehill I don't disagree, you're right that schools and teachers should have the support they need. But my child needs support from all of his teachers; having a school nurse wouldn't, for example, help him in a classroom context. As in, having a teacher informed about his condition, so that they can recognise the symptoms and help him manage his condition without disruption to either him or the class. If he was sent to a nurse, he couldn't go alone (due to risk of collapse if it's a hypo), and it'd take far longer to reverse (as his blood glucose would be through the floor by the time he got there). Plus, he'd be far less likely to pipe up that he needed to deal with it - he'd be mortified about being sent out, as it'd mark him out as "different".

This is diabetes specific, and this is what I am banging on about. I want to gently correct people specifically on diabetes as my son has experienced discrimination already.

I'm not actually disagreeing with the general point, i.e. that here it is entirely unfair to expect a teacher to medically manage, in a very invasive way, the needs of a child with AN.

I'm honestly not trying to be clever - we just get lazy discrimination all the time, sadly, and so I can't help but want to gently correct it when I see it.

Teachers are generally amazing. They have enough to do, I know, I really really do know.

That is absolutely ridiculous. I am a teacher and there is no way I would take responsibility for this level of monitoring

Are you a trained specialist in this area as well as being a TA JT69? Because if not I think you'll find you had every choice and that any union would back you on this. After all there's every difference between supporting someone to get the help they need and actually delivering it, especially when it comes to medical intervention

So if TAs, and teachers refuse to support children with medical needs, where exactly dies that leave them?

Isn't it more a case of not being qualified or within their job description rather than refusal?

It would be down right dangerous to support a child with complex medical needs w/o the appropriate training and support.

So if TAs, and teachers refuse to support children with medical needs, where exactly dies that leave them?

I'm honestly not trying to be evasive, but that would depend on the medical need. Obviously many consider things like giving a paracetamol, antihistamine, plaster and even prescription meds okay, but the PP I was responding to is going vastly beyond that and very possibly putting herself at risk too

I freely admit I don't have an easy answer to "where it leaves them", short of requiring parents to come in and do the things described which is hardly ideal either, but a slippery slope of putting them onto classroom staff doesn't seem to me like any answer at all

Sorry, Changechangechanging, I should have added that some of this is surely where school nurses come into the picture

Clearly it'll depend on the training of any particular nurse, but by the very nature of the job they're a lot more familiar with medical interventions than most, and equally to the point they have the relevant professional back-up

The answer for “where does that leave them?” Is not for teachers and TAs to act as the back stop for increasingly complex health needs. Especially as it is increasingly common for a class of 30 to have several children with complex health (physical or mental) needs.

I feel for the poster’s son with T1 diabetes, but teachers being responsible for keeping an eye on that condition, whilst also managing a class of 30 others, including the violent children, the disruptive children and so on, let alone actually teaching, it’s not fair on the class, the teacher or the pupil.

What people arent getting is that this would be another thing on the list that a teacher has to deal with. Yes we are talking about a child but if something was to go wrong then @Nimbostratus100 would be in the firing line.

There will be a plethora of other children with other needs that the teacher comes across during the school days with additional needs associated with learning or behaviour management or other medical needs. Teaching is like spinning plates - and when you are teaching five different year groups, potentially 150 kids a week, time allocation for anything is spread thin.