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?

All what you mentioned here is significantly different to weighing a child, measuring their waist and checking their teeth. So what are you actually talking about being first aid trained which every work place has to have first aiders or are you talking about getting children to lift their tops to measure their waists and then putting gloves on getting them to lay down so you can look in their mouths

In schools, the first aider will usually also be the person responsible for day to day care and support of children with medical conditions - storing and taking of medicine, checking temperatures, being a safe place when they cannot stay in class, dealing with emotional distress, monitoring blood sugars, helping calculate doses and carbs, spotting if there are issues/symptoms that are of concern, spotting that there are signs a child isn't eating, being the person that sees them when they feel faint and joins the dots together and reports concerns so that it's picked up by the DSL in the first place, that sort of thing.

IF there was a requirement that a child had to be weighed (never encountered it, but IF there were as part of their health care plan), it would also be their responsibility rather than the teachers. I suspect that the course was designed to cover both HCPs and school staff or that the providers didn't quite understand the differences between their learners and included things that weren't relevant. It's also possible in residential hospital schools that admin also act as HCPs.

Gloves though, you put them on pretty much any time you go near a child.

Yanbu

Managing dental health, feeding regimes, weight and body monitoring is absolutely not within a teacher's remit

I agree with this, as the person monitoring there are two potential issues:
a) What does the teacher do if she has concerns that one of these parameters are deteriorating? What’s the plan? Contact the parents, GP, hospital? What’s the point in doing physical assessments of the results aren’t acted on?

b). Missing a deterioration. Anorexia is dangerous, has a high mortality rate and the anorexic brain is devious. If there’s a weight loss masked by say - weights in the pockets of water loading - is the OP responsible?

Absolutely fine to work with a team of professionals but NOT to be the primary assessor. Add a BP/pulse rate check to the expectations the OP outlined and that would literally be the role of the GP/paediatrician

The op has absolutely not been asked to do any of that. She is just trying to whip up hysteria and it’s frankly shit. Sufferers go through enough, some miss months and months of school, it ruins lives and impacts whole families in so many ways.

My daughter has to wear the same clothes and be weighed on the same scales. The measurements they do are quite specific, are used within the context of historical data and she has an individual weight for height that is calculated. She is weighed blind.Depending on how she is doing she is doing in therapy she may or may not be weighed or have measurements done at all at times and feedback or action would be carefully thought out….Cahms just wouldn’t be giving random members of staff all this personal data or letting somebody not working for the ED team interfere. Prior to being taken on by an ED team a GP wouldn’t either.🤔 So the op being asked to do weighing and medical observations such as blood pressure is completely false.

Then you get to measuring waists. Has never happened in the several years of my daughter suffering with Anorexia for good reason. Waist size gives you no indication of how ill somebody is and would be hugely triggering and is completely inappropriate.

Finally there is the water. However bad restriction has got my daughter has never been told to restrict fluid for good reason as restricting fluid is even more dangerous than restricting food. She has been known to water load.

I strongly suspect the op was given a course to inform her on different mental health conditions and is expected to be aware and log concerns as you would with any safeguarding issue. Entirely reasonable. Students struggling with mental health conditions have a right to education the same as any other student.

Op Yanbu.

When I was a teen, just under fifty years ago, the head of social studies (a lovely, caring man) asked my older sister what was 'wrong' with me. My sister told him, and he decided that he was going to help me.

He had a meeting with a group of my friends and asked them to sit with me at meal times, follow me to the toilet, and to let him or another member of staff know if I made myself sick.

I was a very shy and dutiful child, but when this started to happen, became foul mouthed and aggressive to everyone. My paranoia, that everyone was interfering in my life, was reinforced, and I hated. School had been a little bit of a sanctuary against the suspicion and confrontation at home. Now that was gone, I felt totally trapped.

Not long after that, I collapsed playing rounders, and a few days after that, I began one of my very long stays in a psychiatric hospital.

That was in the early seventies when there was very little understanding of the complexity of the condition. Raising awareness is fine, however direct ED support should be done by professionals.

There seem to be more and more students with complex medical conditions in school and teaching staff are expected to pick up the batten to support them.

I absolutely don't blame you for not wanting to get involved with this.

It's not something you signed up for when you began your teaching career and I personally think it's unreasonable to expect you to do it, your job is stressful enough.

Schools seem to have become another emergency service where it's staff are expected to deal with anything thrown at them.

The more you take on the more they will give you so well done for saying no.

Years ago each school had a school nurse who students would visit for anything remotely medical and they were mild issues compared to the scale they are today.

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

this was what the course for teachers covered, according to the op. The physical measurements, weight monitoring calorie counting, dental checks are a massive overreach.

And I didn’t say the OP was asked to do BP checks, I said that if BP and pulse rate checks were added into the above recommendations, that the OP would be doing the same kind of surveillance check as a GP.

So - either the OP is making it all up, or the education course was a massive overreach and a blurring of roles.

I know at my kids’ school sometimes teachers are involved with supervised eating, but it’s under the guidance of the treating external ED team and managed mainly by the school psychologist

Very sad if OP is not being truthful about what was being asked.
I wonder what point she was trying to make?

I think she had training but I think it was just for awareness and she's either being dramatic or she's misunderstood what was actually being expected of her as there is no way a teacher would be asked to do this. Ed are very specialised areas and aneroxia nervosa has one of the highest mortality rates of any mental illness

I know. I can't fathom the motivation for why the OP would want to lead us to believe she was being asked to take responsibility.

I do think there is a stigma and lack of understanding re Anorexia which clearly the op is an example of. It can go on for a long time with varying levels of health. The struggle is often still there when healthy and equally my daughter has looked awful at times but has been ok physically.What is needed is kindness, understanding and a will to keep sufferers in school as goals and the future can help hugely with recovery.

@AegeanBlue657 I agree with you. I would be very surprised if the Op was asked to monitor these things. ED are rightly on an urgent pathway, treated by specialists, and are not usually the remit of even GPs (except perhaps for 2-3 weeks waiting for referral). Plus a lot of the things here are not part of standard treatment at all, esp the waist, and water restricting (ED sufferers often do overload with water, but the answer isn't for staff to stop them drinking!) I think the OP may well have had these things covered in an awareness training, but it would not have been enough for her to monitor these things whatsoever, my dd has full hospital visits, with bloods, BP and ECGs every one to two weeks, and under no circumstances would even GPs be asked to implement her program, let alone schools- the school are asked to do things like make a room available if they prefer to eat separately, let parents in for food monitoring. Not to actually treat AN patients who are the most vulnerable.

And if the OP was asked to take this on, she needs to refuse, and report. Just refusing isn't enough. No teacher or school staff member can implement the complex regime needed for proper ED treatment, so contacting BEAT to ask their advice would be a good idea (ED charity).

As a parent of a child with seriously risky health problems(now also mentally health difficulties) and a teacher you are showing a scary amount of ignorance.

Your failure to document your completing a course means bugger all in terms of your responsibility to the child.

Your responsibility for the child is in your job description. If you have responsibility for children's welfare in your job description you still have responsibility for that child's welfare. You just have chosen not to complete the paperwork that documents your capability to fulfil that responsibility. That responsibility is inherent to your job.

Any child with a serious health condition will have a medical plan that is agreed with parents, a risky medical condition will also have a risk assessment agreed with parents. They most likely will also have a EHCP. Anyone involved in a child's care must be able to access this information.

The medical plan will outline the responsibilities of the school and potentially you if you are deemed responsible for the child as a nominated/named TA. It will be this combined with your job contract that defines your responsibilities not your arbitratory choice not to admit formally to attending a course.

If the child's condition contains an element of risk as DS's did, there will also be a risk assessment. You should also be able to get sight of this. This will outline the level of risk the school is prepared to assume. In DS' case it also outlined where the level of risk was considered to great for DS to remain in school (at that point they were either to send him home or call an ambulance). All staff pastoral or teaching should have access to this information.

If the child has an EHCP the medical plan will be drawn from the information contained in that. The EHCP will outline the school responsibilities for the child's medical care, and also potentially yours if at any point it says "a nominated/named TA", " all teaching staff" or "all educational or pastoral staff". A child has the right in law to any provision within the EHCP.

If provision is listed with the EHCP You failing to sign to sign documentation to say you complete a course or not makes no difference to a childs right to that legal provision.

If in the EHCP it says "a nominated TA trained in Anorexia Nervosa" and the school fail to evidence the provision of a TA trained in Anorexia Nervosa, that can be grounds for a parent to take a school or LEA to judicial review. You won't get in trouble but the LEA and school will. Actually, as a parent, if the school couldn't evidence your capacity to fulfil the role you were assigned, I'd argue you shouldn't be in the job, especially if it is my child's EHCP funding your job.

Thankfully, when DS was well enough for school, he had a wonderful team of TAs and pastoral care staff all of whom attended the fairly scary information sessions the school provided, actually most of his secondary teachers did too. Not all the information in that session was directly relevant to their responsibilities, but it was included to allow for a 360 understanding of DS' care and experience of life. It wasn't even a definitive diagnosis at that point in time either. DS still had a right to an education with adults able to reasonably support his wellbeing.

If you are still working in schools I suggest you gen up on your responsibilities according to your contract and re read the documentation relating to any child in your care.

@Icedlatteplease so is it likely that the course the op is talking about is true given the info in your post? If the child has an EHCP the medical plan will be drawn from the information contained in that. The EHCP will outline the school responsibilities for the child's medical care, and also potentially yours if at any point it says "a nominated/named TA", " all teaching staff" or "all educational or pastoral staff". A child has the right in law to any provision within the EHCP. So if theECHP says the TA/teacher has to undertake the tasks the OP says they were they have no choice?

Potentially yes although it's hard to say exactly from the information the OP provides (because basically it doesn't comply or show understanding of the legal SN/medical need process)

But to explain fully i can give an example from my own DS's experience which shows parallels to the OPs experience.

DS's EHCP stated that he needed physiotherapy that was to be provided by a named TA. The named TA had responsibility for the delivery of a therapy program provided by a physiotherapist.

DS's EHCP comes with funding from the LEA for this provision. Essentially this provision is a part of the TAs job contract and makes up (part) the funding for the job.

The LEA has a legal responsibilty to ensure that the school is suitable to provide the support within the EHCP and to ensure the support is received. The naned school has a legal responsibility to fulfil the provision in the EHCP. The TA has a legal duty to fulfil the terms of her job contract.

The TA was reluctant to deliver the program due to manual handling concerns, safeguarding concerns over the need for physical contact to deliver the program and concerns that if she did it wrong she could injure either herself or DS.

She didn't just refuse to deliver the program. They would have meant she was failing in her responsibilities according to her job description.

instead she reported her concerns to the SENCO. The SENCO reported the problem to me.

The senco then had the choice. They could decide they couldnt provide the provision on the EHCP and ask for additional support to be written into the EHCP and/or additional funding from the LEA to do this. They could also decide that DS required more support than they were able to provide which would trigger the procedure for change in school placement. They could also ask physiotherapy team for more support. They opted for the last option.

The physiotherapy team initally refused to provide it. I threatened the LEA with judicial review for failure to provide the provision within the EHCP. They took it to the physiotherapy service manager because they contract for medical provision was with them. Further training and joint therapy sessions with me and school was provided. With the additional support The TA felt confident delivering the therapy.

(If she hadn't I would have asked for changes to the EHCP to enable me to bring in my own therapy providers at the LEAs expense. I didn't want to trigger a change in placement)

If the OPs contract states that she has responsibility for students welfare and to attend any training relevant to those welfare needs then yes she wouldn’t have a choice. She really needed to report her concerns to the Senco and contact her union rep to check the terns of her contract.

Just not signing the course completion means bugger all in terms of her job responsibilities.

ok, let me just explain again, for, I dont know, maybe the tenth time!

The stated aim of this course was "Keeping children safer while waiting for medical supervision"

This is not, what do we do in conjunction with a healthcare professional, in communication with a health care professional, with the support of a healthcare professional, or to report to a healthcare professional.

This is what we do because there is NO HEALTHCARE PROFESSIONAL available for the child

It is what we do INSTEAD of an ED team, while in an open ended WAIT for a referral to an ED team, or psychiatrist, or crisis team, or whatever professional the child will eventually come under the remit of!

I have explained this - a lot of posters on this thread dont seem to understand!

And, no, it is not unusual,

and no, of course I am not naming the charity. Ive told you the type of charity it is, (suicide prevention charity),but that is all that need s to be said if you are curious about the set up

I was asked who it was provided by, it is provided by a charity, recommended by NHS. set up by a MAT - that is how these things work

And the reason I posted this ( which was last year, by the way, I am not currently working) was to clarify for the many parents on here who have posted about teachers needing training in their child's medical conditions, with very little understanding of why teachers dont want to do it, or do it, but still dont feel they can act on it.

And again, I did complete the AN section, just not the whole course, And no, no one faces disciplinary measures for not attending unpaid training in their free time!

I have said all this repeatedly, so thank you for reading, and I am not going to come back and say it all all over again!

Incidentally it may also be really important to the child and family even if they don't have a EHCP for the OP to have reported her concerns formally.

Often the LEA will try to skirt their financial responsibilities by providing medical training that is considered "sufficient".

Confirming that a child needs support that the school is realistically unable to provide safely can provide evidence for the need for an EHCP and/or a need for a more specialist placement.

The family may be desperate for that evidence.

The OP really has shafted the child she was supposed to care for in just about every respect.

I think some people have no clue how bad it is in schools right now. Even if we have an EHCP, good luck finding staff to deliver on the EHCP when it’s generally hard work at not much more than minimum wage. And yet schools try because, as people point out, if they don’t then children can’t come to school.

CAMHS do weigh young people with AN. My daughter was refused treatment unless she was weighed. I wouldn’t expect the school to do this however certainly not a TA.

This with bells on !! I left the education sector as the expectation for the job was just becoming too much, unless you work in a school you just don’t see it.

You can say it all you like, it still shows a failure in care for the child at either a school level or an individual level.

School cannot diagnosis.

Therefore school cannot send you on a course if the diagnosis hasn't been confirmed by a medical professional.

Medical diagnosis will trigger the procedure I listed. It is a legal process for every child. School will have a medical plan and a risk assessment. It may not have met the trigger for EHCP assessment.

In the case I suspect it will be the GP diagnosis pending CAMHS involvement (which may well take years). That does not mean there is no medical oversight, the GP will still have responsibilities towards the child.

The course you attended will be considered adequate in the discharge of duty of care at your level. As you stated it is recommended by yhe NHS. If you are uncomfortable delivering that duty of care or that you feel the course is inappropriate then that is a safeguarding concern. You have a responsibility to report that.

Reporting that may be the much needed trigger for EHCP assessment.

Your story smacks of safeguarding failures at every level.

Everyone is responsible for safeguarding.

I don't wanna so I shalt bother is completely unacceptable