School Nurse Needs Help!

[nurse alex]

I am an elementary school nurse and a child in my school has recently been diagnosed with ODD. She has not yet been diagnosed with any other disorders and is not on medications. Her therapist and mother do not have any suggestions on how we can help this first grader through her difficult mood swings. I happen to work in a small rural school where most of the staff think this child just needs an "old fashion whipping." We all know that will solve nothing and probably make things worse. She has become a danger to herself and others. She has run out of the school building and becomes physically and verbally aggressive when we try to bring her back in or block the exits to prevent her from leaving the building. Talking with her in a calm manner does not seem to help. I try to get her to tell me how she is feeling and what she would like to do. Most of the time she wants to sit in my office or in the hallway all day. While it may keep her calm, this does not provide an education for her. We can not monitor her in the hallway to ensure her safety and there are privacy issues with keeping her in the school clinic. I desperately want to help this child succeed!!! I have been unable to find any info online geared towards school personnel. I think as parents who have been dealing with school systems, you may be able to help. What would you like to see happen with your own children? Does anyone have a positive experience dealing with a school? Please keep in mind any solutions also have to take the other children in the classroom into account. Thanks for your feed back. Sorry this was so long!!! This same message is also posted on the education form.

 

[Anna1345]

Hi there and Welcome! I am sorry she is dealing with this. It must be really tough on her. I would ask first, what, if any, steps are the parents taking to help her? They have gotten her diagnosis, but now what?

I would say she needs to learn some coping mechanisms, and perhaps medications are in order. Can you get a consult with the school therapist in your district? Other then that I am no help except to say always remember no matter how bad it gets, she is still a little girl. Patients and consistency are a must. Compassion needs to be included in the mix as well.

Hang in there!

 

[houseofcards]

I am impressed with your concern. My son was an emotional child from preschool on, he would hide under the desks/toys when anyone was scolded, the teachers suspected he was abused!! Please support the parents as best you can, that may be the biggest thing you can do along with trying to educate the teachers in general on the conditions children can have that show up as behavioral problems. When my son is stressed too much he loses it and there isn't much anyone can do except give him his space, he will talk about it but not right away, he needs a safe place to unwind at...maybe your office is that for this child.
If the teachers are willing to educate themselves, they could learn what tends to upset the child and take steps to prevent it...but they will just keep upseting the child if they see it as just "bad behavior" and then you are right, the child can't live in your office. Good luck

 

[busywend]

Well, hopefully, the teacher has requested an evaluation and started the child on the process to an IEP. The IEP should provide the child with a safe place to go cool off.

It might help to post on the Special Education 101 forum here on the site, there are some real great parents with a ton of knowledge on the IEP process and supports for kids at school.

 

[BusynMember]

Your concern is commendable, however this child needs more help than you can give her. If her parents want more help, they'd push for it. She needs in my opinion a thorough neuropsychologist evaluation to find out what is going on besides ODD...and, unfortunately, you are not in a position to do anything. As much as you want to help her, she probably can't do much better than she is until she gets more help...hopefully her parents will take this further. Hate to be a pessimist, but if she's that out of control, she probably has a serious disorder that may needs medication and/or interventions/counseling. You may want to gently suggest that the child get another evaluation. Good luck :smile:

 

[klmno]

The only thing I can add to the good suggestions above is that sometimes the parent isn't aware of the specifics going on in school as much as the people in school think. Some or all of this might have been done already, but 1) notifying parents of specific things that concern you (I had several calls telling me my difficult child was disruptive in class and being punished for it- no one told me that he was staring off into space consistently, picking at sores until they bled, and other things that indicated he had "shut down" and was probaly depressed) until months later when I pressed them to know specifically what he was doing- if I had known these things earlier, I would have taken more action earlier; If you are seeing a side of this child that others in the sschool have not informed the parents about, that could be (not neccessarily IS) but could be the glitch 2) suggesting testing, as others have said, 3) suggesting the IEP evaluation (I can't remember the correct term for this), 4) notifying someone else in or out of the school that intervention is called for if the parents aren't responsive in some way. I don't mean CPS, but maybe a Special Education director or someone who might be able to meet with the parent(s) and hear their side of things and help them understand more about what they might be able to do.

The child and the school and the parents of the students are very lucky to have someone like you there. You might be the only person this child feels safe going to right now as it sounds like she's not getting the supports she needs to feel understood and function appropriately.

 

[nvts]

Has anyone figured out what triggers her outbursts? If she's sensory, it could be loud noises, a crowded room, a particular sound, etc.

If it's transition, it could be moving from one task to another.

If it's nerves it could be something that happened at home, on the way to school, the night before, a month ago, etc.

I think you'd have a lot more luck helping if there was a Functional Behavioral Analysis done through the school and then a Behavior Intervention Plan put in place. (These are done via the school based assessment team).

I admire your dedication to this poor little one!

Beth

 

[bzymomto4]

I haven't had those type of behavioral problems with my own kids, but I always wish that the school would put objective descriptions of the problem in writing so that I can take it in to the doctor to represent my child's problem from a 1st person perspective when my child is away from me. I believe it would help the doctor have a more complete understanding of the child.

As for dealing with behavior that is completely disruptive and providing an education, our previous school district provided a 1:1 aide 5 days a week to support kids in class. While I'm sure there are adjustments at first, the kids in our school were able to be part of the class and have their own support always available to help them cope and focus. It's expensive, as we had many 1:1's in our school, but as I understand things the districts other choice would be to provide private school education. I hope you find a way to help.

 

[looking4hope]

Thank goodness for people like you in education!

I am also a teacher, and even with that background, I had a hard time navigating the procedures necessary to get help for my difficult child, who sounds a lot like this child.

First, tell her parents that they need to initiate the IEP process by writing a letter to the principal of the school. The letter should outline the behavioral problems she exhibits at home and at school, and include information from you, her teacher and her medical/ psychological diagnosis. It should include a phrase such as "based on this behavior, our daughter is not able to be academically successful", because she is out of the classroom so much. Then state that you want the child tested for possible learning disorders, including a full psychological profile.

Per the federal IDEA law, the school district has 30 days to reply and arrange for testing. Based on what you have said, this child definitely qualifies for an IEP, and get some specialized services that will help her at school. This may include an aide, a special day class, or other interventions. The IEP team will determine what are the best interventions, and if something isn't working, anyone on the IEP team (parents, teacher, case worker, you) can reconvene and tweak the document at any time. Believe me, we've rewritten my son's IEP at least six times in the last year!

The IEP team has also pointed me toward some resources that are available outside of the school district, which has been helpful for me. But under federal education law, this child has help available to her. What no one will tell you is how to ask for it.

Please share this information with the parents. It must start with them, but some gentle nudging couldn't hurt. Also, you can ask to be a part of the evaluation and IEP team if the parents approve. If you've forged a bond with this child, I would highly suggest it. These kids have a difficult time bonding with anyone, let alone someone they view in a position of authority. Good luck!

 

[Lostparent]

I can not say how amazed I am that a school official is on a forum looking to help a student.It is a shame that it should shock us to such a degree! I applude your effort to help this child and hope that you can be a part of changing the way that the school system views and handles or chidren!

WAY TO GO!!!!!

 

[Big Bad Kitty]

I echo Lost Parent's sentiments. I am amazed and deeply moved!

OK, generally ODD is not a disorder that stands by itself. It usually accompanies something else. You mentioned that the chil'd therapist and mother came in to talk to you. I wonder if it was a counselor or a doctor. A child with that many problems probably needs further evaluation, as was stated. The very best you could do for her, since you came here for help (bless you), is pass this along to mom. Recommend a multi-disciplinary evaluation or a neuropsychologist. Very thorough and in-depth. She very well may not have known to do that, or even known they exist. I sure didn't until I came here!

Good luck. The girl has one cool nurse.

 

[nurse alex]

Thanks to all who have responded. I have spoken to the child's mother and grandfather (no dad involved). The mother and therapist have all received copies of the documentation I have made for every instance the child has been in my office. I have also found some resources outside the school district and am working with her therapist to refer the child and encourage the mom to seek help through this avenue also. There are many complex family issues that also play a role in the situation at hand. Hopefully these first steps will result in long term treatment and recovery for this bright child. Thanks again for all your help. I will let you all know if I discover any new avenues that may be of help to you also. Good luck!

 

[klmno]

Thank you! As said before- they are lucky you are there and hopefully, your concerns and efforts and attitudes will spread to others at the school (and at other schools) who haven't reached that level of care and initiative yet! Keep us updated!

 

[Shari]

I hope this child's mother will come to realize what a huge asset she has in her corner...and that asset is YOU.

Thank you from another difficult child's mother.