Effective Practices : Pedagogy
Partnerships with Health Care and Other Professionals
Pedagogy Section 3
1. Does your school have relationships with any healthcare or other professionals? If so, describe the service provider’s area of expertise and the relationship between this individual and the school.
2. Is there a particular person or group who is responsible for maintaining the relationship with these professionals? Describe the nature of that responsibility.
3. Do these individuals provide services on campus, or are they strictly professionals for which a referral is provided? If services are provided on campus, describe the frequency of service and the manner in which students are allowed access to these services.
4. Has your school identified any liability issues connected to its relationship with these professionals? If so, describe the concern and the manner in which it has been resolved.
5. Describe your school’s philosophy with regard to partnering with health care professionals.
6. Is there some aspect of your health care partnering program that is working particularly well? Please describe it.
7. If you had the ability to change some aspect of your school’s partnership with health care providers, what would it be and why?
Does your school have relationships with any healthcare or other professionals? If so, describe the service provider’s area of expertise and the relationship between this individual and the school.
Waldorf schools enjoy relationships with a number of health care and other professionals. Some of these people are employed by the school, while in other cases they are outside contractors. Schools also use the services of a number of other organizations and practices to support the health and development of the students in their schools.
Many schools enjoy the services of a variety of therapeutic personnel. At times these individuals are employees of the school, while in other cases they are hired as outside contractors. These therapeutic personnel include remedial teachers, therapeutic eurythmists, and therapeutic speech teachers.
One school described the work of their therapeutic eurythmist this way:
The school employs a full time teacher to offer therapeutic eurythmy, integrative movement and aspects of the Extra Lesson. She offers, at the request of teachers, services to students with special needs. In addition to this therapeutic work she also teaches eurythmy in the nursery and kindergarten. In the therapeutic work she meets with up to 20 to 25 students per week. The students are taken out for this supportive work during various classes, sometimes in groups and sometimes individually. The school has a dedicated room set aside for this purpose. Sessions are 10 to 25 minutes in length. There is no additional charge to parents for these services, and they are offered to students in kindergarten through high school.
The work in a group is pedagogical integrative movement work, and does not require parent permission. One-on-one therapeutic sessions are carefully worked through with parents. These sessions usually take place over a period of several weeks, and may involve homework in addition to the in-school sessions. The eurythmist keeps records of her work, updates parents as to expectations and progress, and sends out if appropriate written reports to parents after a period of working with a child. The therapeutic eurythmist always provides a written report at year end of her work with each student.
The therapeutic eurythmist also assesses kindergarten children for first grade readiness and does second grade assessments with the class teacher. These assessments look at a variety of skills to see if the children are making appropriate physical developmental changes. Rhythmic activities such as skipping and galloping are assessed as are auditory and visual responses in the classroom. The student’s ability to recognize words and mathematical processes is checked, as are reading skills.
Some schools, most often those with high schools, enjoy the services of a psychologist or counselor. In one school the psychologist has regular office hours at the high school. She sees many of the students who are having personal problems, as well as those who are meeting academic challenges. She is paid a lump sum by the school in exchange for this work. She will see a student a maximum of three times before referring the student and family elsewhere if there is a continuing need. She is also available to the faculty on an on-call basis, even late at night, if a crisis emerges.
Another school employs a counselor on a part time basis. This counselor supports the students in a variety of ways:
- Her primary purpose is to consult with teachers and parents when a child or a family is in crisis. In one case a student was faced with the death of an older sibling. The counselor met with the family and with the young girl and with her class.
- The counselor often works with students with challenging behavior. If this behavior is being exhibited at home then it is often the parents who request the counselor’s assistance; if the behavior is being exhibited at school then the counselor’s help is sought by the teacher. In these situations the counselor will work to create a plan to help the student with impulse control. At times the counselor will identify a need for further outside assessment.
- The counselor also works with bullying and with targeted children, meeting with the children involved and with the class. The counselor conducted an 8 week long Girl’s Circle in which she worked with the 7th and 8th grade girls on what it means to be a friend. She has begun to lead the council process in the 6th and 7th grade to help with social situations that may arise in the classroom. (Editor’s Note: Council is a formalized style of conversation arising from the Native American tradition, and which emphasizes respectful listening and speech.)
- In some cases the counselor will do some preliminary work with children experiencing emotional and psychological difficulties. She will make referrals to appropriate mental health providers, and then offer bridge counseling until an appropriate outside therapist is found.
- At times the counselor is sought out by parents who are divorcing and want some guidance on how to build resilience and support the child through the divorce process.
- The counselor will work with parents and the teacher to help create a circle of support for a child, and coordinate a collective effort and plan for the child.
- The counselor is available to teachers and middle to high school students. She provides counsel and advice and listens to concerns.
- She meets with girls entering puberty and counsels teachers about adolescent challenges.
The counselor will typically see a student up to 3 or 4 times. In cases where a student needs significant support then a referral is provided. She always provides at least 3 referrals, although she may at times include herself as a possible outside referral. She is a licensed social worker and carries her own malpractice insurance. In the referral process there are clear professional guidelines about referrals, and these are helpful when she is trying to determine whether a dual relationship (school and outside) is appropriate in a particular case.
Over time the counselor has developed a list of therapists to whom she refers students to on a regular basis. She has done several two session training courses for therapists in the area on what it means to work with a Waldorf child. She describes the Waldorf life style and view of human development, and addresses the Waldorf perspective on appropriate media exposure by age. There is no one on her referral list who hasn’t been exposed to Waldorf education.
Schools frequently have a relationship with an anthroposophic doctor. At times the doctor practices close to the school, and the doctor is available to be a regular participant in child studies. The doctor is able to view the child in the classroom prior to the faculty discussion, and can make important contributions to the conversation from a medical perspective. In these situations parents will frequently make appointments for regular medical care at the offices of the doctor.
In cases where the anthroposophic doctor is further away, it may be typical for the doctor to visit the school every few months. Parents are given an opportunity to make appointments with the visiting doctor. The doctor will see several students over the course of a day or two, make diagnoses and give prescriptions as needed. Parents pay the doctor directly for these services. In these situations it is important that the doctor be licensed to practice in the state or province in which the school is located, and that his medical insurance cover him in these situations.
Oftentimes schools make arrangements with local ophthalmologists and auditory professionals. These professionals offer low or no cost vision and hearing screening to students on campus.
Some schools have a relationship with an educational therapist. For example, one school has retained the services of a therapist and has her work on campus with several students. The therapist gives reading and English language assessments, and works with individuals and groups of children. These basic services are paid for out of the school’s budget.
Schools also take advantage of organizations such as Planned Parenthood and local drug counseling services such as The Freedom Institute in New York City. Schools also have standing relationships with firms which do drug testing and counseling if students encounter a problem in this area.
Other professional services such as tutoring and instrumental music lessons also take place on campus. In these cases the school acts as a landlord, providing space in which the tutor or instructor will provide services to the student. Parents contract directly with the tutor or instructor for these services. (See: School Operations, Section 4, Facilities Use)
Is there a particular person or group who is responsible for maintaining the relationship with these professionals? Describe the nature of that responsibility.
Most schools have a standing committee, often referred to as a CARE Committee, which manages these relationships. Teachers may come to the committee with concerns about a particular child, and the committee can make recommendations about support that may be helpful to the student. In addition to managing relationships with outside healthcare professionals, it is often the case that the CARE Committee supervises the work of the on-staff professionals such as the therapeutic eurythmist, extra lesson teacher, or school counselor.
In schools with less developed health care networks, the various aspects of the program may be coordinated by one or more individuals on the faculty rather than by a committee. For example, in one school most of the relationships are with organizations that support high school students. The individual responsible for managing these relationships was previously the high school chair. She initiated these programs during her work as the chair, and has continued to manage them since she stepped down from that role.
Do these individuals provide services on campus, or are they strictly professionals for which a referral is provided? If services are provided on campus, describe the frequency of service and the manner in which students are allowed access to these services.
Most of the services described above take place on campus, although there are a few exceptions to this. When students need more extensive counseling than can be provided in one or two on campus sessions then referrals are made to outside psychologists or counselors. Drug and alcohol testing typically takes place off campus.
Has your school identified any liability issues connected to its relationship with these professionals? If so, describe the concern and the manner in which it has been resolved.
In cases where medical professionals (anthroposophic doctors, vision and hearing screenings, psychologists and counselors) see students individually the parent’s permission is received prior to treatment. These practitioners carry their own insurance and must show that the liability coverage includes services provided at a clinical satellite.
Parent permission is also secured prior to a student being involved in therapeutic eurythmy on an individual basis, and for any extra lesson or educational therapy sessions.
Psychologists and counselors have a right and legal necessity to maintain confidentiality. Even when these counselors are employees of the school they must follow the protocols which are generally accepted in that profession. When a counselor observes a child in the classroom or consults with a teacher about a child no parental approval is required. These employees maintain their own liability insurance, even though the school has insurance as well. It is not always the case that the school and the counselor have the same interests and both might need their own legal counsel in a difficult case.
Describe your school’s philosophy with regard to partnering with health care professionals.
Our school is committed to ensuring that a high level of support is available to our students, and works to make sure these services are readily available on campus.
These services, which go beyond those needed by most students, are provided at an extra fee to cover their cost.
We recognize that we are not able to serve some students with severe needs. We have had some discussion about starting a second school that is focused on providing support to students with a need for intensive care and therapy. However, neither these students nor the others in the class are well served when a student’s therapeutic needs exceed our ability to reasonably accommodate them.
The school is required to do a certain amount of health education and we want to present the information in a way that is helpful and supportive to the students. During many of these outside presentations to high school students teachers are not present so that students feel safe about asking questions and getting the information they need.
It is important from the outset to ensure that parents understand what a therapeutic education or support program is, and how it relates to the Waldorf picture of the child and his development pedagogically, emotionally and socially. We communicate with the parents via class meetings and elsewhere to describe what it is that these programs do and how they relate to Waldorf pedagogy. This understanding is important with our in-house therapeutic eurythmist and counselor, as well as with the work of the anthroposophic doctors.
The feedback that parents give if they visit practitioners outside of a school setting is important for the school to hear. Do the parents trust the practitioner, and do they sense a warmth and interest in the child? Did the practitioner communicate in simple terms what could be done for the child? The school should use the parent network to help build up a clear picture of the work and capacities of all therapeutic practitioners.
Once a firm foundation of trust is built up over several years between the school and parents, then the school will be in a position to have a doctor come regularly to the school and for home health care practitioners to be sponsored as well. Counselors and therapeutic professionals such as eurythmists and extra lesson teachers can also be added to the school staff.
The children who are coming to us these days have new issues. It is our hope that our curriculum meets them. This may not always be the case. It is also true that our parents need more advice. We are at a time when there needs to be active collaboration between parents and teachers. The counselor can help with that process. It is time to make things explicit with regard to Steiner’s view of child development.
Is there some aspect of your health care partnering program that is working particularly well? Please describe it.
Schools in our study made the following observations on things that were working particularly well for them:
The eurythmy, counseling and special education work has been very helpful. Many parents feel supported by the anthroposophic doctors as well. They feel a partnership on behalf of their children with these professionals who work in concert with Waldorf approach to education.
The partnership with anthroposophic doctors requires some work on the teacher’s part to share her observations of the child and areas of concern. These communications happen well at our school.
As a counselor it has been great to have a foot in both worlds. We find that counselors and parents often use one language while our teachers use another. Having someone who can aid the translation process helps everyone to work better in support of the child.
Students are very positive about the sex education information provided by Planned Parenthood.
The school is very happy with the in-house counselor. She gives very good advice to the faculty and to the students. She is available in emergencies like threatened suicide, and has been a part of the school community for many years.
We have several people who are on staff or on a contract basis with us that offer a variety of services, including therapeutic eurythmy, therapeutic speech work, and remedial lessons. None of them are full time.
We are happy to have a relationship with an anthroposophic doctor who comes several times a year from 3 hours away.
The speech work receives a grant so that half of that position is covered, which keeps the cost of the program low for parents whose children are using it.
If you had the ability to change some aspect of your school’s partnership with health care providers, what would it be and why?
We would like to find someone who could make appropriate presentations to the students on the issue of rape and date rape. The person who handled this topic in the past has moved away, and we have not yet found another person or group to address this delicate matter appropriately.
Recently we have received feedback from our students that the organization speaking on the topic of addiction and drug abuse is saying the same thing every year. We will be speaking to them about adding to their content or freshening up their presentation so that the students continue to listen to this important message.
We would love to have a nurse in-house. We do not have the space for this, and are fortunate that we have good medical facilities nearby in cases of emergency.
All of this work is done at additional expense to the parent. We try to work on a sliding scale for those people who can’t afford it, but we recognize that this charge can be an added burden for those who are already challenged by their children’s needs.
Only having a few types of therapy -eurythmy, speech and remedial work - is limiting. Not all children are met by what we are able to offer. We wish we could provide more care, and more types of care.
It would be helpful to have the doctors come on a regular basis to the school to visit classes and work more with teachers. This is a time and scheduling challenge both for the doctors and for the school.
The school would like to increase its partnership with the anthroposophic doctors in the area, and works to find more opportunities for the medical team to come to the school to give evening presentations for parents and teachers.
We are considering the creation of a “calm and return room”. This room would be created expressly for situations when a student needs to step out of the classroom and calm herself before she can re-engage with the class.
It was originally thought that the counselor could also act as a mediator when relationships become charged between adults at the school. Although the counselor does hear a fair number of parent complaints, we find that her work as a professional counselor is at odds with her efforts at mediation.
Today the counselor and the therapeutic eurythmist share their office space. Additional room is required so that each is able to do her work and address problems as they arise.
The school’s general release should be amended to note that the school employs a counselor who will be observing children in the classroom and consulting with teachers about those observations. .
We have almost 400 students and the counselor is only on staff 20 hours per week. This staffing level is often inadequate for the need in the community.