During the evaluation, I was able to observe different parts of the hospital. I was able to see the different activities that the children engaged in while they were at the hospital. During the evaluation I was able to speak with different of the children. I was able to read the charts, and see why they are in the hospital. Some of the children had extremely sad stories, and very little support from their families. Some of the children have not been taken out of the hospital because, they have no where to go and are waiting for placement in a permanent housing. I was able to see what the children eat, and the way that their nutrition works (they all have their own meal plan.) Overall, I was able to see the different behaviors that the children showed. I was able to witness, the hospitals response to negative behaviors. I was able to see how the education system worked inside of the school. The classrooms were divided by the mental level that the children have. I was able to see the different functions that different people have in the hospital. There are psychoeducational groups for different children. There are groups for eating disorders, diabetes, brain injury, chronic illness and others. There are also small groups that are held inside of the units by the nurses and the behavior techs. I was also able to see the different roles that the nurses had in the hospital.
Interview and Observations:
During my interviews I was able to gain a lot of insight on the hospitals process. By interviewing the unit coordinator, I was able to get information on safety. At the beginning of the hiring the workers are trained for CPI, which is crisis training. The workers, are able to attend training again if they would like. If they are seen doing something unsafe then they are also taken for another training. The children have physical restraints done on them only when they are being a danger to themselves or others. All the children have a BSP which is a behavioral plan. Depending on their behavior they, will have to go in time out for different times. For example, physical aggression can mean 30 minutes in the time out room. The time out room is maintained open, until they show that they are still having aggression inside (trying to attack the person watching them, or not wanting to stay in the time out room.) The behavior techs are in charge of making sure that the children do the things that they are supposed to do and the nurses are in charge of all the medical that has to do with the children. The children are prompted for medical protocols.
During my interview with the teacher, I was able to learn more about the protocols that the teachers have. The teachers are in charge of making sure that the children do not get behind while they are in the hospital. The teachers report to a principle at the school. The teachers are in charge of teaching and the behavior techs come with the students to make sure that the children are acting safe while they are in the school. The teachers are all specialized in special education. When the kids first come to the hospital they bring their information from their past schools, this way the principal sees this information and is able to place the child in the correct class.
During my interview with a staff member, I was able to see the connection that they feel towards the patients. The staff members are in charge of making sure that the children are safe. They are also in charge of making sure that the children, are doing the things that they are supposed to be doing. Some of the things that they do are making sure that the children shower, follow the rules to their medical protocol, make sure that the children do their laundry, engage the children in activities, they are overall in charge of the well being of all the children. The staff members, also have conversations with the care givers of the children to communicate how their child is doing.
Speaking with different children, they are all different. Some of the children state that they like being there while others state that they do not like being there. Every child states that they have a discharge date, but they do not. They usually state that they have the date, but it is just a target date it is not something that is concrete. Some of the children are open to sharing their stories while others are not. I did notice that overall, the children do exaggerate the truth and say things that are not true (I was able to compare by reading their charts and talking to them.)
My interview with the patient advocate was very interesting. She states that the children are very open into writing her. She states that every time that she receives a complaint she has to do an investigation. Some of the investigations include watching cameras and interviewing other patients and even staff members. The patient advocate states that she has to treat every complaint very serious. The patient advocate states that she is also in charge of getting information together, to see if that one patient needs to move to a different unit. The patient advocate does admit that some of the information that is given to her is true while other information is not true.
In the psychotherapy groups the children are able to talk. They have a choice in the participation that they have inside of the group. They are able to relate to other people that are in the groups, since the groups are divided depending on what the child is going through. The children are very excited to go to group. In group there are interactive activities that are done amongst the groups.
Overall, the children have their preferred staff. Some children only ask for assistance from the staff of their choice. The children have tantrums, and they are sometimes aggressive to each other and the workers that are there. I was able to see how much the behavior techs try to accommodate the children. I was able to see that the children are very upset to be there but some of them do try to make the best of it while they are there.
I was not able to see much from patient records. The hospital does not check on the children. Sometimes, the children contact the hospital to let their favorite workers know how they are doing. Most of the children that are at the hospital do not come back. There are some children that do come back it is about a 10% of the children. The children sometimes leave and then come back due to insurance purposes.
Conclusions from the Evaluation:
My conclusion from the evaluation is that everyone at the hospital gives so much for the children. You are able to see how much the children try on a day by day basis. The children have the support from so many people that are working with them. I was able to see that the hospital provides the children with everything that they need. Even the cafeteria workers are very nice to the children and are able to talk to them in a therapeutic level. I was able to see that the children are there because they need it (the behaviors are easily shown.). By looking at the charts of the children, you can also see the progress that the children are having. In conclusion, I feel that the hospital puts in place a good program for the children. The children have a nutritionist, they have psychotherapist groups, they have a doctor, nurses behavior techs, occupational therapy, recreational therapy, pets, and so much more!
Implications of Findings:
The implications of findings are that the hospital does provide good service to the children. I believe that there should be even more groups for the children. The children should have small groups that they do after school. Sometimes, the children do not have things to do and they watch tv. There can be other things that are done for the children that can assist them. There is free time, and it seems that when they have free time is when they have their negative behaviors. There should also be more behavior techs. The fact that there are not enough workers, can make the safety on the units decrease. It is important that there are the correct number of workers on each unit at all times. Having more staff an also mean more activities.
Findings Impacting the Program:
The findings can assist the program by decreasing negative behaviors. If there are more workers there than more activities can be done. If there are more activities for the children then the children will be more active and less bored. In my observations I was able to see that when the children had nothing to do this is when they started to misbehave. Having groups can also be positive reinforcements for the children. If they have negative behaviors, then they would not be allowed to go to the group of their choice. This can give the children more things to work towards.
Negative or Positive impact:
The lack of workers can have a negative impact on the program. This is because safety is the number one priority. If there is a trend that the children misbehave when they are bored then it needs to be changed. By having more staff than more activities can be done. Children can be taken outside more because there is more coverage. More staff can also mean that during physical interventions, there is coverage on the floor. When one of the children are in time out, it means that the staff member watching them has to be 1:1 ratio, this decreases the coverage that is on the floor.
Recommendations:
My recommendations, is to ask the children for feedback. Ask the children what they would like to add to the hospital. I believe that the children need to have more of a voice than the voice that they have now. As I stated that children need to have more activities. Ask the chidren what kind of groups they would like. Some suggestions would be a Spanish club, art club, soccer team. It would also be a good idea to have the different unit compete against each other on Fridays. This can also give them the option to have more things going on other than their treatment. I think that the most important thing is to have the children’s time occupied. Safety should also be a concern. The biggest safety issue that I see is the lack of workers. Sometimes, the staff members are mandated. This means that they have to work doubles. This is a lot for a person. It is important that the workers have a life and work balance. This is something, that needs to be done to make sure that the workers are refreshed every morning.
Goals and Objectives:
Goal: Have more activities for the children
Objectives: Hire more staff members
Objective: Ask the children what kind of groups would they like
Goal: Increase safety
Objective: Hire more workers
Objective: Have more training sessions for the workers, have the behavior techs complete a longer training on verbal de-escalation.
Broad Goal:
Cumberland Children’s hospital should increase the activities provided for the children in order to, decrease negative behaviors and increase positive reinforcements.
Meeting the Broad Goal:
Increasing staffing can make the goal more attainable. It is important to have the proper training in place, for the children to be safe. The more people that are in place the more that can be done for the children. This is why it is important to increase staffing, and training. With the collaboration of Rec therapy, then more activities can be done for the children.
Research Articles:
Based on my research it is important for children to have recreational activities. This is something that is needed for children in any mental capacity. Children should be able to enjoy their preferred activities, by having the groups the children can do this (Vaisvaser.) Seeing that children with disabilities need a lot of care, it is important that they receive the therapy that they need. With all the health issues that children have at the hospital, they are able to attain everything that they need there. They are able to even receive the nutrition needs that they have (reddy,Azeem, Smiles, and Carrabetta.) There is a lot that children need to be taught. They have to learn small things such as coping skills. The schools need to be patient in teaching the children, the different thing that they need to learn. Patience is probably one of the most important skills that special education teachers have (Unwin, Kroese, Blumson.)
Reference Page:
Gemma L. Unwin, Biza Stenfert Kroese, & Jessica Blumson. (2018). An Evaluation of a Mental Health Promotion Programme to Improve Emotional, Social and Coping Skills in Children and Young People Attending Special Schools. Frontiers in Education, 3, Frontiers in Education, 01 November 2018, Vol.3.
Reddy, B., Azeem, M., Smiles, J., & Carrabetta, L. (2016). Reduction in medication expenditure: Review of strategies at a children’s psychiatric facility. European Psychiatry, 33, S550.
Vaisvaser, S. (2019). Moving Along and Beyond the Spectrum: Creative Group Therapy for Children with Autism. Frontiers in Psychology, 10, 417.
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