Each year at Upstate Medical University Center for Children's Cancer and Blood Disorders over 70 children are diagnosed with cancer or a blood disorder that will significantly impact their school experience.  For many of the children, the diagnosis and treatment of their disease prevents them from participating in the daily routines of school.  Children will often spend several weeks at a time in the hospital and are removed from both the educational and social experiences that school provides.  These multi-week absences can occur on and off for a period of months to well over a year.  Once discharged from the hospital, many of the children are confined to their homes because of susceptibility for infection or because they do not feel well enough to attend school.  A unique challenge faced by these children and their schools is a lack of predictability about attendance.  There are no practical ways to project attendance patterns and this inconsistency creates frustration for all.  One of the primary benefits of the Staying Connected model is that the interactive technology will follow the child between hospital and home and provide educational continuity regardless of where the child is.

Staying Connected is Good Medicine was developed in 2003 as a trial project. The Center for Cancer and Blood Disorders unit had two children diagnosed with a long term illness that attended the same middle school.  This project was set in motion as a result of the hospitals educational specialist recognizing the need for these children to stay in tuned with their school work and their classmates.  In collaboration with, Tandberg, Oswego County BOCES, Time Warner and Upstate Medical University Telemedicine Program this was made possible.

School is the work of childhood.  When children are aware that adults have continued school expectations for them, they get a strong message that we expect them to get better.  Staying Connected provides the necessary connections for children to stay current with activities, assignments, and classroom instruction that occur in their school.  Further, the program will offer an opportunity for children to maintain social and emotional relationships with their classmates.  These ongoing communications will allow children to return to school whenever they are clinically and emotionally ready.  Because they have been a continual presence in their classroom(s), children will be able to return more comfortably to school without the fear of being academically out of sync or the anxiety of being misunderstood and teased.  The interactive nature of the audio and visual link provides a more sensitive re-entrance because classmates and school staff members are aware of any physical changes the child has experienced.

Staying Connected is Good Medicine was designed to utilize a real-time connection between children who are diagnosed with cancer or blood disorders with their classroom and friends while in the hospital or home.  Tandberg video conference equipment was chosen due to the excellent video and audio quality along with the ease of use, which was very important in the selection of a product.  The Tandberg 1000 model is used at the hospital and at home (Appendix 1), while a larger room system is used in the classrooms (Appendix 3).  The footprint of the 1000 is small enough and not intrusive when the children are in the hospital (Appendix 2).  Often times the unit is transported from hospital to home.  Another factor in using this technology over a broadband connection is that it is not computer based and the school district did not have to worry about anything being stored or saved onto a hard drive. 

Most children's homes have some type of a broadband connection.  In some cases, where there is  not a broad band connection, and they live in the footprint of the Time Warner catchment area, Time Warner puts a broadband connection into the childs home for the duration they are enrolled in this program.

This link can not only drastically improve a child's academic performance once they return to school, but it has proven that the closer the connection between patients and their peers, the more effective the treatment process. 

Children do receive tutoring while in the hospital and most receive tutoring once they are home.  The limitations of existing tutoring programs are a lack in the continuity of instruction and instructional modalities and the difficulty in obtaining assignments in a timely fashion. Older children are unable to receive instruction in specialized or advanced classes, and the loss of interaction with other students.  

The dynamic, interactive nature of the Staying Connected is Good Medicine Program serves as a much needed enhancement to the tutoring relationship not as a replacement.

Yes

Yes

This program provides an opportunity for these children to continue with what they knew as a normal day, part of a routine.  It was developed with the belief that children who maintain close ties with their peers and attend school during most of their illness do better medically, socially, emotionally and academically.  It is also essential for adults who come into contact with the student to keep school as a central focus because this tells the child that they are expected to get better.  The program also allows for an easy transition back to school once the student is better.  A child's return to school signs normalcy and recovery.  For many children, school is a refuge from the world of hospitals and procedures.   
This program gives the children a way to diminish their worry about falling behind in their schoolwork, it keeps them from feeling disconnected or isolated, and gives them a meaningful distraction from long and painful treatment procedures.

Since 2004, we have had several children that have benefitted immensely from this program.  Two children who were in the seventh grade when they started this program, attended school the following fall in the eighth grade without ever stepping a foot in the school the year they participated. Two other children are currently in their second year of this program. While they participate mostly from the home or the hospital, they occassionally attend school.  Both of these children were inducted into the national honor society while participating in this program. This was made possible by them being able to stay on top of their education and work assignments and believing in themselves.

"Her (Naomi) being in class through the Tandberg is wonderful.  She gets to see the entire lesson and the interaction in the classroom, things that she might not get from schoolwork going through a tutor only", said social studies teacher Jonn Stoker.

"At first I was very depressed when I got sick, so I probably would have said, I have no idea how I can make it.  I always had to get things right on, I had to understand things.  Now that I have this system I believe I can make it", Naomi Glenister said.

"Namoi then had a reason to get up, and get dressed, and make herself look pretty, and it was like she was on a school schedule again", said Rose Glenister.

"Probably the most important thing to me is that we are finding out that their attitudes are much better.  If we can do that to help them get better and return to school, then this is well worth it", said Sandy Creek Superintendent of Schools Stewart Amell.

Cancer patient, Lindsey Nelson,"it was weird at first, but its great and it helps kids out a lot like when they're passing notes you can figure out who they're passing them too and whoever gets in trouble.  Especially in science class."

"I dont feel left out", said Lindsey.  "We did a science (review) yesterday and I could zoom in to the packet pretty far..its like youre there".

"It's been wonderful", said Darsie Nelson. "Her grades have been good.  Our goal is for her to return to school in September as an eighth-grader".

Shelly Forrest said, "Math and science involve a lot of discussion, so it's much better to have the classroom experience.  Students that are at home are at a disadvantage when they dont have that."

Mexico math teacher, Suzanne Dunn said, "the program has been good for Lindsey and the other seventh-graders.  I think its given them a new perspective.  They see that being able to come to school is a good thing".

Staying Connected is Good Medicine is just that, it is good medicine for these children.  Children who are absent from school while in treatment for cancer and blood disorders are generally provided a tutor or in-hospital instructor.  While this method does work to address the academic concerns of missing school, it does little to help the child deal with the separation from familiar faces and surroundings.  Traditional methods do not provide the necessary sustained contact with familiar classmates and friends.  It has been shown that contact with friends and peers outside of the hospital can have great benefits in the self-esteem, social development of the child, and their overall attitude about recovery.

Staying Connected is a tool to help solve this problem.  Not only does it directly connect the student with his/her teacher so that they can remain on the same academic track as their friends and peers, but this breaks down the isolation of a hospital room by giving the child a virtual presence in class and a link to friends.  This makes returning to school easier both academically and socially and can help prevent anxiety and intense stress surrounding the return to school.  A childs return to school signs normalcy and recovery.

The biggest obstacle that we face when bringing new children into the program, first is demographics.  Most of the children participating in this program live within the footprint of Time Warner and are provided a broadband connection.  Other students that live in rural areas using other types of connections such as DSL have not had the same consistency in terms of a quality connection for the student to participate in their daily classroom activities. This can have a direct impact on the children if the connection is cutting in and out.  This can easily distract the student and can give them an excuse as to why they don't want to participate. That is why it is important to have quality equipment along with a robust connection to make the children feel as if they are in school.

Another challenge is working with a school district to get the Tandberg communicating with their firewall.  All of the firewall changes at the district level can impact the daily connections.  Oswego County BOCES is very instrumental in this program as they provide all of the technical support and resources for the school districts as well as at the students homes.  

As in most projects, funding is always an issue.  We did not face objections, just reservations in the beginning.   After the first few children were taking part in this program, it spoke for itself.  Once the funding source was ironed out, the process of telecommunication and tutoring can begin. 

For some of our student/patients, homebound instruction using the Tandberg system via telecommunication, allows for the interactivity with the presence of their classmates and teachers that is not possible through just one on one with a tutor. The goal of Staying Connected has been to allow the student to be as up to date with school work as possible.  By doing so, when the child goes back to the classroom, the re-entry process is cohesive and non-threatening.  

Achieved

Staying Connected is Good Medicine will continue to grow with the opening of the Golisano Children's Hospital at University Hospital, which is expanding the number of pediatric beds.  It is viable that this program can offer this service to children of other long term illnesses with proper funding and additional resources throughout the region.  With this technology already in place in the hospital, the children can reach out to other children in other hospitals.  Possibly learning and sharing experiences from each other.  Teachers and school administrators will soon visualize other applications that they can utilize to reach outside of their classroom walls and into the community.

This took a little persuading on the end of School administrators, but once that was established they embraced this with open arms.  They realized the emotional and social importance that this brought to the children, and that the children actually wanted to attend school.  

The children that have been part of this program have totally embraced this technology.  They felt that when they are connected to their classes via video conferencing it is just as good as being there!