Kartini Clinic for Children and Families

Pediatric Eating Disorder Treatment Program

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School During Eating Disorder Treatment? Not To Worry

October 13, 2022 by Morgan O'Toole-Smith

During the school year, families are sometimes hesitant to have their child enter treatment in the Partial Hospitalization Program (PHP) because they are worried about time away from school. The teachers at Kartini School understand your concern. 

Often, our patients are super-conscientious students who have done very well in school. They take advanced classes, and they get good grades. What will happen if they are not at their school, parents wonder?

Kartini teachers help students stay on track in their classes by working closely with their school during treatment. Kartini School, as an Oregon Alternative School, is partnered with many school districts around the state. As a result, students stay enrolled.

Our goal is to help students understand the concepts they are studying and enable them to fit in smoothly with their classmates, without missing a beat, when they return to school. These high achieving students almost always do just that!

Sometimes, we see kids who have not been doing well in school because of their health and/or COVID-related, less-than-perfect online school experiences.

Again, please don’t worry. When a student needs to catch up, we take that seriously. Many students missed key concepts over the past few years. We work with these students, one-on-one, to fill in the gaps.

So, do not delay critical medical treatment because of concerns about school. Whether your child is at the top of their class, or wondering if they can graduate, we will work with them and provide the support they need to be the best student they can be.

Filed Under: Kartini School Tagged With: eating disorders

Kartini School: A Success Story

February 9, 2022 by Morgan O'Toole-Smith

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Kartini School: A Success Story 2

[Ed. note: This is one in a series of guest blogs by our Kartini School administrator, Mary Gunesch. With schools returning to at least partial in-person instruction we thought it a good time to focus on this subject.] 

When a student begins treatment at Kartini Clinic, we reach out to their school.  We find out what they should work on in their classes – what the learning objectives are – and we support them as they work to achieve these objectives.  Some teachers tell us to look at Google Classroom where they post assignments; some teachers stay in regular contact and provide extensive information; some teachers provide very little.

We support students, whatever their school’s response (or lack of response) may be.

We had a student who began with us at the end of January.  She was a senior in high school; she had two required classes to graduate.  We told the school that we could contract with them and partner with them to provide this student (who was very sick) with the support she needed to complete these classes.

The girl’s parents were afraid that she might give up and drop out.  They asked for our help.

The patient was in a dark place.  She was eating nothing.  The doctors were worried about her cognition.  They put in an NG tube.

In school, the girl told us she couldn’t concentrate. We gave her a graphic novel to read. She was able to do that.  

When we talked to her district, they said they didn’t need to contract with us; they would provide a tutor.  I told them that the girl was in treatment all day, each day of the week. They said, “No problem, we can get a tutor who will meet with her in the evening or on weekends.” They said the tutor would call me.  When the tutor called, she said, “I can do any day, Monday through Friday.” I asked about evenings or weekends and she said she couldn’t do that.

When I told the school district what I’d heard they said, “Oh, then the student can just wait until she is better, and we’ll give her a tutor then.”  I told them that the student did not want to wait, she wanted to finish what she needed to do and be done.  The student said she would do the district’s online program.  I asked the district about that and they said that program was full so she couldn’t do that.  They said, “But if you create a learning plan for her, we will be happy to accept the work she does with you.” 

So, that’s what we did. We designed an Economics class and a Senior English class.  She read Fahrenheit 451 and wrote an in-depth response.  She talked about how it was interesting that it was written over 50 years ago, but it is relevant today, with us spending so much time on our screens.  She also studied and discussed what was happening to the stock market in response to COVID-19, and she created a plan for economic recovery following the pandemic.

All along, she was recovering physically, slowly but surely. After 11 weeks, she was well enough to go home.  

The Governor had just announced that all seniors who were “on track in their classes and passing” would be done with school and ready to graduate.

Fortunately, we were able to report to her school that she was “on track and passing” in her classes.  They were happy to get our report.

Our student graduated this spring.

Filed Under: Family-based Treatment, Kartini School

Tips for Motivating Kids in School

January 19, 2021 by Morgan O'Toole-Smith

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Tips for Motivating Kids in School 4
[Ed. note: This is one in a series of guest blogs by our Kartini School administrator, Mary Gunesch. With schools returning to at least partial in-person instruction we thought it a good time to focus on this subject.]

At Kartini Clinic for Children and Families we take the second part of our title, “for Children and Families,” seriously.  We treat children suffering from a wide range of eating disorders – from anorexia nervosa to high body weight – and in this work we know that the family (whatever that may be: Traditional, nontraditional, foster family, or something else) plays a key role in recovery.  The founding doctor of the clinic, Dr. Julie O’Toole, with 25 years of experience says, “Getting support from the family is critical to success.”

In our current situation, with schools either closed or limited to partial in-person instruction for the rest of another academic year, the same thing could be said about education.

Schools are working hard to provide learning materials. Many activities are accessible online; other resources are available on paper. There’s no shortage of what to learn.

But kids need more than the “what” of learning right now.  They need the “why.” 

Many children and teens rely on their relationships with teachers and friends to get them out of bed and headed to school every morning.  Now, “off to school” means 10 steps to the folding table recently set up as a temporary desk at home.

What can families do to give kids the motivation to learn in this topsy-turvy time? Here are some tips:

1. Do schoolwork with your child.  Whether your child is 6, 12, or 20, you can learn together. Your first grader’s work is cute – read the assigned book with them and ask them to act out their favorite character. Your seventh grader’s work may have you re-learning things you’ve forgotten (like phases of the moon); after they finish the unit, let them refresh your memory, and be sure to show genuine interest. Your 20-year-old’s college work may be something you never learned, but have them explain it to you; the ability to summarize is a fabulous way to understand better what they are learning.

2. This unprecedented time is an opportunity to focus on the content of what your kids are learning rather than how they are doing. Learning management systems adopted by schools in recent years, like ParentVUE and Schoology, tell parents how their kids are doing (they got a 78% on the test, for example) but they don’t tell parents about what kids are learning.

3. As it was with Goldilocks, the learning level needs to be “just right,” i.e., not too hard and not too easy. If the work is just ahead of their current level of proficiency, a little bit ahead of where they are, that is best. If the work provided by school is definitely too hard, communicate with your school. Ask about alternatives. (“My child still doesn’t understand how to add fractions with common denominators yet. Can we work on that before we do the problems with unlike denominators?”) A good teacher will work with you and be thrilled that you noticed. On the other hand, if the work is too easy, that’s boring for kids. Again, ask about something different. If fractions are easy for your child, maybe they can triple a recipe or change the scale of the directions to build a birdhouse.

4. Talk with your kids about what they will get when they complete the learning goal. Some children may need something material to aim for, like a new bike helmet they’ve been wanting.  Other kids will be happiest to get your time. Tell them that when they complete the assignment, you will play a game with them.

5. Speaking of games, there are many great ones for learning: Scrabble, Catan, Code Names, and many others. You can also modify a game to make it an educational game: At Kartini School we play Scattergories revised to have categories like: U.S. Presidents, State Capitals, and famous authors and artists.

6. Foster a growth mindset.  From the work of Carol Dweck, we know that kids do better when they think that effort is more important than innate ability. Try not to let your child believe they don’t have what it takes to do something.  There are many stories of hard work winning out over innate ability (e.g. the story of Rudy). Try to help your child use phrases like “I’m almost there” or “I’m getting it.”

7. Finally, don’t be afraid to ask for help. One school district recently posted a notice that they had been inundated with offers from people who wanted to volunteer. Reach out.

At Kartini Clinic we have a school, Kartini School, where we support students for weeks and sometimes months while they are out of their regular schools for medical treatment. We help kids understand concepts and achieve learning goals. What parents are doing now is the same: supporting kids who can’t be in their regular classrooms. This is challenging for sure, but the rewards are great. So tally-ho, temporary teachers, and remember to model a CAN DO attitude for your children and teens.

Filed Under: Family-based Treatment, Kartini School

The Importance of School in Holistic Recovery from an Eating Disorder

June 20, 2019 by Julie O'Toole

A peaceful, happy and healthy childhood with completion of developmental goals can be severely disrupted by illness, especially by chronic illness.  

The developmental tasks of childhood and adolescence are roughly:

  1. to develop a physical body that will carry one through life  
  2. to develop an autonomous sexual identity
  3. to develop the capacity for critical thinking
  4. to develop the ability to communicate with the written word (be literate)  
  5. to make friends and sustain friendships and 6. to find an individual way to be a productive (and producing!) member of society.

 

In the case of an eating disorder, many of these tasks will be thrown off course. A child or teen who suffers from an eating disorder may miss a lot of school, causing a cascade of academic problems ranging from inability to read or write well or achieve math literacy to delayed admission to the college of one’s choice and, ultimately, to interference with job and income later on. Height (and brain!) growth can be stunted and compromised; social isolation due to delayed maturity is common and treatment itself may disrupt family life.

 

Despite the severity of illness and its possible consequences, when we are faced with admitting a child to the hospital or partial hospital (day treatment), parents are often chiefly concerned about the impact of treatment on school. At first glance this may seem a strange priority when a child is ill, but over the years I have come to think that parents are actually looking out for their child’s welfare in a way that is hard to articulate: they are not focused on the eating disorder, they are focused on the child. Their approach to their own child is therefore holistic and that is the kind of treatment they want to find.

 

What does it mean to say “holistic treatment”? It means you treat the whole person, not just the disease or condition. To treat a child holistically you need to take their social, family and academic life into consideration, serious consideration. It is not enough to just weight-restore a child, it will be necessary to see them as an individual, to make them feel loved, accepted and validated. It will be necessary to help them return to full social functioning and to return to school in better shape than when they left.

 

At Kartini Clinic we have always had access to schooling for hospitalized children as well as our own school in our Day Treatment (Partial Hospital) Program. And over the years, as the diversity of patients and diagnoses has increased, I have come to see school during treatment as part of holistic treatment, in some ways as critical as the therapy that helps them cope with their feelings and the weight-restoration which is the cornerstone of recovery.

 

I think we see roughly three categories of students in treatment. The first is the highly perfectionistic child with (typically) anorexia nervosa who gets straight A’s and is terrified treatment will disrupt this. The second is the average to very good student for whom the disruption in their social/sports life is often the most devastating. The third is the child who is struggling in school and may not make it to graduation as they fall  further and further behind. Adult investment in their academic life may be low.

 

For the first group, the real challenge is to help, in so far as help is possible, with the tormenting trait of perfectionism. They almost always have school materials with them and need little guidance in this regard. Our school teachers, art teachers and therapists may be the first important adults they have ever met who try to make them feel good about who they are apart from their GPA, and who help them to enjoy learning and relax some about “success” — all while continuing to move forward academically.

 

A classic example of this would be a young Chinese American boy I remember whose parents were engineers and who attended a competitive private high school where he got “all A’s all the time”. He struggled to make and keep friends, because he invested so little in them, being focused day and night on his grades and his admission to an Ivy League school later. His parents were proud of his success, but assured him to no avail that he could also relax a little and have fun with other kids. He was terrified he would miss his admission to the “best” college if he did. Despite all of his “success” this boy was deeply unhappy and terribly insecure.

 

For a kid like this, it is not right to dismiss their hyper-focus as “neurotic” but rather to validate what they have achieved and help them continue to do so, even while “perfectionism and its negative effects on the whole person” needs to be a therapeutic conversation in their treatment milieu. Missing school is very hard on these kids and attendance at our alternative school while in treatment, where they can have exams proctored and are given time, and support, to do assignments, is comforting. Our school teacher works with their hometown school to help them stay up to date with their class work. Kids in this category typically have a lot of adult support at home and will likely do well academically no matter what.

 

The second category of children with average to excellent grades and a more rounded focus on social as well as academic requirements, also suffer when required to miss school for treatment. Parents are often convinced their chief concern is the missed schoolwork, but the kids tell me their chief concern is missing their friends. After all, when we are teens and pre-teens our friends are the focus of our lives, even when we love our parents and siblings and care about schoolwork. Attendance at Kartini School during the long weeks of treatment helps with their anxiety about keeping up, but does little to console them for the loss of their sports and social life. And in some ways this is good, as they experience the effect of an untreated eating disorder on life, the “disadvantage”, if you will, to engaging in eating disordered behaviors (calorie restricting, purging and over-exercise). Only when they themselves see where an under-treated eating disorder leads, are they willing to do the hard work of treatment. The schedule of the partial hospital (day treatment) program will allow them to see their friends in the afternoon or on weekends. As for their sports, they are now “injured athletes” and need to be treated as such. In the same way that a young high school soccer star can be sidelined by a broken leg, they can be benched by an eating disorder. Once they heal, they can return. But not before.

 

The third category of children give me the most worry, and have taught me the most about their challenges. As our population of children with various kinds of Oregon Health Plan insurance coverage has grown, so has the diversity of our families increased. These kids’ lives are challenged and academics are only a part of it. Yet school failure and non-graduation from high school will arguably do more to wound their future than any other single thing except drug (including alcohol) abuse.  

 

I remember a young man in this category. His parents were born in Mexico, his father lived there still and had no contact with him. His mother had suffered domestic violence in her family of origin and had never had an education. She worked as a domestic and received state help where she could. They had no car and he arrived at Kartini Clinic every day via Med Transport after an hour’s ride. Mother was gone most of the day and left before her son got up in the morning for the breakfast he never ate. He had been born in this country and, of course, spoke native English but he often skipped school because no one got him up in the morning to go and the further behind he got, the less likely he was to attend. He had all D’s and F’s. He mostly stayed home and played video games because it was “easier”. His hometown school suggested he try some online options, which resulted in him doing nothing except having more time to engage in his eating disordered behaviors. He was nominally “working on getting his GED” but had no real adult guidance to do so. He was quite starved, de-motivated and felt a failure.

 

It is here, in this third group, where school is most critical to treatment. Academic rescue will save this child’s future if not his life. This problem is worth throwing everything we have at it. Our team prefers a return to brick and mortar schools in nearly every case, not only for the social/developmental advantages, but because “online” is neither structured nor supervised enough. Getting a GED works when it works for a motivated child and parent, but a high school diploma is better. Focusing on literacy, critical thinking and math skills will be game-changing for a child who views themselves as “not smart” and an “outsider”. Helping challenged families understand how they can support their child and advocate for them in their hometown school may make the difference between perpetuating poverty and chronic illness and rising out of it.

This is the meaning of holistic.

Filed Under: Eating Disorder Treatment, Family-based Treatment, Kartini School

Kartini School: The Difference between Learning and Doing

August 7, 2018 by Julie O'Toole

Kartini School
 
[Ed. note: This week’s guest blog has been written by Mary Gunesch, a licensed Oregon teacher and administrator, who recently joined Kartini’s clinical team. Mary has been instrumental in securing official recognition of Kartini School by the Oregon Department of Education.]
 
What if we told you that your child—during his/her time at Kartini Clinic—will not only learn to eat in healthier ways but will also learn better ways to think about learning and school?
 
Most patients we see have high expectation of themselves, and they are very responsible students.  While this seems desirable, and can help kids get good grades, it is worth looking at carefully.  Sometimes what looks like being “responsible” could be more accurately defined as “dutiful.”
 
When kids complete assignments, when their work is legible and turned in on time, they often get positive feedback (e.g., high grades, gold stars).  However, as kids get older, schoolwork gets harder.  In advanced classes in high school, as well as college courses, the expectations go far beyond neatness and timeliness.
 
At Kartini School we have time with students one-on-one.  We can help them decide if they are learning from an assignment (a worksheet, for example) or if they are simply doing it because it is expected.  We can alleviate stress for kids by helping them focus on the activities that facilitate  understanding.
 
Sometimes kids get bogged down by “all the work” they “have to do.”  By reducing the volume, we can reduce stress.  And when they feel less stressed, they get better sooner.
 
There is a difference between learning and doing.  Learning is like remodeling; you have to get in there and see what you know and then you have to get rid of the old incorrect concepts and build the new ones.
 
You can test this out by thinking about the earth, the sun, and the moon.  How do the rotations, the revolutions, and the tip of earth’s axis determine the seasons?  You learned it in school.  At least you did worksheets about it.  But did you learn it?  Can you explain it now?
 
While they are in the PHP, our kids won’t spend all day in school.  They have other activities to help them get well.  We’ll work with them during their time in Kartini School to enable them to learn the concepts their teachers are teaching.  But they may not do all the activities their classes are doing. That’s okay!  We’ll teach them to determine priorities in their schoolwork and help them learn to decide which activities are most helpful for them.
 
This is a good thing.  When they go on in education, they will face increasingly greater challenges, and they will have to know how to manage what often feels like too little time to complete all their work.
 
Educator and author Susan Weinbrenner asserts the importance of students knowing how to handle this.  She asks parents to think about when and where they want their kids to be when they struggle for the first time: “Surely not alone in a freshman dorm far from home.”

Filed Under: Kartini School

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