School reintegration following hospitalisation for children with medical complexity and chronic disease diagnoses: a scoping review protocol

IntroductionSchools play a significant role in children’s social, emotional and intellectual well-being. For children with medical complexity (CMC) and chronic disease diagnoses (CDD), an absence from school due to prolonged hospitalisation places them at risk for greater social exclusion and poorer academic outcomes than their healthy counterparts. Processes that support the school reintegration of children with complex and chronic medical conditions currently lack consistency and identified evidence-based practices. This scoping review aims to integrate the relevant literature on current reintegration procedures as well as assess stakeholders’ perceived challenges related to children with CMC and CDD’s return to school following hospitalisation. Finally, information will be synthesised regarding parental and child involvement in reintegration strategies.Methods and analysisThe current scoping review follows the five-stage framework proposed by Arksey and O’Malley (2005). The search syntax will be applied in Medline, Web of Science, PsycInfo, Education Resource, ERIC, CINAHL and SocIndex. Peer-reviewed journal articles will be included without the restriction of publication year or language. However, only children and adolescents aged 4–18 with CMC and CDD, who have been out of school for 2 weeks or more and reintegrated into a non-hospital school setting will be included. Articles will be screened by two authors based on the outlined eligibility criteria. Data will be summarised qualitatively and where applicable, visualisation techniques such as tables, graphs and figures will be implemented to address approaches, strategies and outcomes related to reintegration to school following hospitalisation.Ethics and disseminationThe current study comprises available publications and does not collect primary data. For this reason, ethics approval is not necessary. The results of this scoping review will be prepared and submitted for publication in a peer-reviewed journal and presented at future conferences to key stakeholders focusing on educational accessibility and inclusion.

PEDAGOGICAL INTERACTIONS IN PRIMARY SCHOOL REINTEGRATION PROCESSES: A CASE STUDY IN CHILE

In Chile, despite the great coverage achieved, there are still children and adolescents who leave school without being able to complete 12 years of compulsory education (Casen, 2015); moreover, among the countries that make up the OECD, Chile is in the first places of deschooling (TALIS, 2013). This marginalization from the school system is affecting a significant number of children and hindering areas of integration and social development, which accentuates processes of social exclusion and violation of rights in Chile (Casen, 2015; Mide-UC, 2016; Mineduc, 2017). This is reinforced by pedagogical practices that strengthen these probabilities of failure (Román, 2013). The phenomenon of school reintegration has little evidence in relation to the human and technical component in school reintegration processes, either locally (Mide-UC, 2016; UNESCO-UNICEF-Chilean Association of Municipalities, 2012), or internationally (CEPAL, 2010; Contreras et al, 2014; Sucre, 2016), which implies observing and analyzing pedagogical intervention practices in these contexts, in terms of how these dialogical-reflective relational dynamics between teachers and children and adolescents are developed, from the perspective of pedagogical interactions, an area of growing interest in educational sciences, which looks at more than the action itself, at how and what happens in the interaction. (Colomina et al, 2001) This research from a qualitative, transactional approach, oriented from the perspective of descriptive studies (Hernández,et al, 2010) and enriched with the symbolic interactionism of Blumer (1969), whose contributions indicate that the nature of the teaching-learning processes can only be unraveled through direct examination, seeks to understand pedagogical intervention practices from the perspective of pedagogical interactions which are developed between teachers and their students, within the framework of the specialized protection programs in school reintegration implemented in Chile by the National Service for Minors of the Ministry of Justice and Human Rights, in vulnerable sectors of the communes of Talca, Region of Maule and La Pintana, Metropolitan Region. The analysis through the theoretical and empirical contributions provided by the scientific evidence on pedagogical interactions, in terms of how they are configured, deployed and how these pedagogical intervention practices are perceived by the actors involved, added to the findings obtained, provides an opportunity to innovate by allowing the observation of school reintegration as a scenario of human relations and to deepen around this professional action as a critical element, constituting the improvement of teaching and effectiveness in school reintegration processes.

Retrospective Study on the Pathway and the Outcome of Children Victims of Acquired Brain Injury Accompanied By a Mobile Unit of School Reintegration

Objectives: to retrace the care pathways and the academic pathways of brain-damaged children supported a Mobile Unit of School Reintegration (MUSR) and to identify factors associated with their long-term outcome. Patients and methods: Retrospective study from the medical files of 53 children followed by the MUSR, conducted between November 2018 and April 2019. Results: The cerebro-lesions were mainly caused by a craniocerebral trauma (83% of cases), with an average age of onset of 9.8 years. The duration of the initial hospitalization was 39 days on average. The mean length of follow-up was 37 months. Long-term medical outcome was marked by 18.5% of medical complications, 29.6% of behavioral disorders and 9.2% of judiciary complications. The factors associated with long-term behavioral disorders were the age of onset (p = 0.015), the initial Glasgow score (p = 0.025), a head trauma related to a traffic accident (p = 0.046), a poor therapeutic alliance with the parents (p <0.001), the absence of psychological follow-up (p = 0.040) and the existence of legal complications (p = 0.001). The factor associated with long-term legal complications was a poor therapeutic alliance with the parents (p = 0.017). All the children followed were reintegrated into school, after an average of 6.4 months. A school reorientation was necessary in 49.9% of cases, associated with initial complications (p = 0.035), the existence of secondary brain aggressions of systemic origin (p <0.001), the existence of antecedents (p = 0.040), and the autonomy level (p = 0.023). Conclusion: The MUSR offers multidisciplinary, integrative and mobile cares, based on coordination of the care pathway and the academic pathway of children victims of acquired brain injuries.

QOL-34. CAREER FAIR AND RESOURCE EXPO: ADVOCATING FOR THE LONG TERM SUCCESS OF BRAIN TUMOR SURVIVORS

Pediatric cancer survivors have increased unemployment and lower educational attainment rates. This is most significant in brain tumor survivors who show five-fold relative odds increase in unemployment over other pediatric cancer survivors. The long-term effects of brain tumor treatment potentiate the difficulty with work and school reintegration seen in the broader Adolescent and Young Adult (AYA) population. To address this, our team designed an annual job fair for AYA Neuro-Oncology survivors. Vendors were invited representing disability advocacy groups, legal services, scholarship organizations, and employers with strong disability services, several who offered on-site interviews. Additionally, brain tumor survivors served as inspirational speakers for the event. Between thirty to forty survivors have attended each event. Pre- and post-surveys, as well as 3- and 6- month follow up was obtained. Universally, the day was engaging and motivating, both for survivors and staff, and stimulated conversation for pursuing career or academic success within families and the care team. While all the patients took applications, none of the patients completed the on-site interviews, finding them overwhelming. Even at the 3- and 6-month follow-ups following the first event, the survivors continued to be at varying levels of application completion; no one who was previously unemployed attained new employment. This improved after pre-event meetings were held with survivors to participate in resume building and interview preparation. Currently, two survivors obtained employment and are still employed at 1 year and five survivors were able to advocate for their disabilities services in college with help of a non-profit legal assistant.

School Reintegration for Children with Chronic Medical Conditions

School reintegration for the student with a chronic medical condition requires ample preparation and coordination among the student, family, medical providers, and school-based professionals. Changes experienced by the student frequently require that accommodations and interventions are made available to support the return to school. School personnel must clearly understand the challenges experienced by the student in order to appropriately plan for necessary accommodations and interventions. This chapter discusses important factors to consider in support of school reintegration for the student with a chronic medical condition into school. These include medical needs, safety issues, and cognitive, academic, and social-emotional factors. The chapter presents accommodation and intervention strategies that are commonly considered to support school reintegration, such as alternative education settings, modified schedules, and preparation strategies for students, families, peers, and school personnel.

Delivery of Pediatric Cancer Care in Mexico: A National Survey

Purpose Limited data describe the delivery of pediatric cancer care in Mexico. We report a nationwide survey of pediatric cancer units. Methods An electronic survey was distributed to 74 pediatric cancer units in Mexico to describe case volumes; organization of care; and availability of medical/surgical specialists, supportive care, complex therapies, and diagnostic services. Centers were classified as low (< 30 new patients/year), medium (30 to 59/year) and high (≥ 60/year). Results Sixty-two centers completed the survey (response rate, 84%). The median annual new case volume per center was 50 (interquartile range [IQR], 23 to 81). Thirty-four percent (n = 21), 26% (n = 16), and 40% (n = 25) of units were low-, medium-, and high-volume centers, respectively. Treatment units reported a median of two pediatric oncologists (IQR, 2) and one pediatric hematologist (IQR, 1 to 2). Availability of medical and surgical subspecialists varied by center size, with substantially more specialist support at higher-volume centers ( P < .01). Multidisciplinary tumor boards are available at 29% (six of 21), 56% (nine of 16), and 76% (19 of 25) of low- to high-volume centers, respectively ( P = .005). Radiation and palliative care services are available at 42% (n = 26) and 63% (n = 36) of all centers, which did not vary by center volume. Educational support for hospitalized children and school reintegration programs are available at 56% (n = 36) and 58% (n = 36) of centers, respectively. One third (38% [n = 23]) of centers reported that at least one half of patients were lost to follow-up during the transition from pediatric to adult programs. Conclusion A large variation exists in annual case volumes across Mexican pediatric cancer centers. Additional efforts to increase access to multidisciplinary, supportive, and palliative care across all pediatric cancer units in Mexico are required.