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Each weekday, children and teens hospitalized in the psychiatric unit at the University of North Carolina’s Neurosciences Hospital spend a few hours in a part of the building that doesn’t look like a hospital at all.
They leave their locked unit and head down to UNC’s Hospital School on the second floor, where three classrooms are furnished with desks, smart boards and white boards. A closet in the hallway has been transformed into a makeshift library. For the duration of class, the young patients have only one responsibility: They’re there to learn.
The year-round school is part of Chapel Hill-Carrboro City Schools, but it operates unlike any other campus in the district. The teachers meet daily with students’ treatment teams, prepare lessons and serve as a bridge between the hospital and the student’s regular school. Lessons are important, principal Marny Ruben said, but so is providing a sense of normalcy to students whose lives have been upended by a mental health crisis.
“Oftentimes, things are happening at schools that are contributing to their crisis,” Ruben said, pointing to intense school work, bullying and overwhelming social dynamics. By arranging academic support and a connection back to a student’s regular school, hospital school staff work to alleviate that stress and prepare students for a smooth transition once they leave, she added.
“Kids don’t get better right away, but kids can get better. Schools can play a role in that recovery just by doing what they do.”Marisa E. Marraccini, an associate professor of school psychology at UNC’s School of Education
Now, as the rate of young people experiencing mental health distress climbs, with in-patient mental health hospitalizations rising by more than 120 percent between 2016 and 2022 according to one measure, the need for school support programs has grown. For young people receiving in-patient psychiatric care, hospital school programs like the one at UNC not only keep them on track academically, but can also be helpful to their recovery, said Marisa E. Marraccini, an associate professor of school psychology at UNC’s School of Education.
Past research has shown that children and teens are at a very high risk of attempting suicide after being discharged from psychiatric hospitalization. School connectedness — the way kids feel about their school community and whether they feel cared for by peers and teachers — can help curb the risk, according to research by Marraccini. In one study, her team found that students who said they felt more connected to their teachers were less likely to experience severe or intensive suicidal thoughts after discharge.
“Kids don’t get better right away, but kids can get better,” Marraccini said. “Schools can play a role in that recovery just by doing what they do.”
Her results don’t establish causation, meaning that kids who feel better might report feeling more connected. But the findings do indicate that strong school relationships likely make a difference in a young person’s recovery, Marraccini said.
It’s the kind of support that Grace Richmond, a teacher at UNC’s Hospital School, works to provide for the students she teaches, a small group of fourth through seventh graders from the child psychiatric unit.
“If they haven’t engaged in school while they’ve been in the hospital, if they haven’t had some kind of connection to learning and possibly even to their teachers or their school … then when they do go back to their typical school, it is a much more difficult transition.”Mindy Elliott, secretary of the Hospital Educator and Academic Liaison Association, or HEAL
Each week, Richmond prepares lessons across grade levels and subjects to engage her students, and often spends time supporting them as they complete work from their regular school. Her classes are small — usually no more than five students — and she aims to make each day fun and comfortable. During a recent lesson, students designed food trucks and developed menus; during another, just before Discovery TV’s Shark Week, students created giant Megalodon shark teeth out of plaster.
“Some of them have had really difficult things going on in their lives,” Richmond said. “The fact that they’re able to kind of forget that for a while and come to school and be kids and be silly and be their age again is probably the most important thing to me.”
Later in the afternoons, after class ends, Richmond frequently calls her contacts at her students’ regular schools, often the guidance counselors. She keeps them updated about the student’s academic progress and suggests plans for their return to class. After discussions with the student’s parents and treatment team, she might recommend the returning student start with a shortened school day, or take a lunch break in a low-stress environment, or have a daily five-minute check-in with a guidance counselor.
At UNC’s hospitals, any child admitted to treatment gains access to the school’s supports, no matter what school district they regularly attend or where in the hospital they receive care. School staff also work with children held in the emergency room over a long period, ensuring they, too, have access to academic materials. On average, students stay in the psychiatric unit for roughly two weeks, Richmond said, attending class throughout their stay.
“If there is no process set, then the kids are just kind of dumped back to school. Even when I request for information, the medical team doesn’t really know exactly what to give me, or they don’t respond because they just don’t have time.”Sara Midura, an engagement and behavior specialist with Northwest Education Services, a local state agency in Michigan
But, at other hospitals, the quality of academic programming for students varies greatly, according to Mindy Elliott, secretary of the Hospital Educator and Academic Liaison Association, or HEAL. Though state accreditation rules usually require hospitals to provide some school services to children and teens, there is no standard for the kind of support students receive, she said. HEAL has recently begun tracking hospital school programs across the country. Generally, programs in large, urban hospitals are better equipped to provide wraparound school support for students, Elliott said.
The result is that children and teens hospitalized at less-resourced and rural hospitals often receive minimal school services. Those hospitals may employ limited teaching staff, leaving students with far less support to help them stay on top of class work and reintegrate into their schools after discharge.
“If they haven’t engaged in school while they’ve been in the hospital, if they haven’t had some kind of connection to learning and possibly even to their teachers or their school,” Elliott said, “then when they do go back to their typical school, it is a much more difficult transition.”
Sara Midura, who used to work as a teacher at a hospital school program in Indianapolis, has seen that contrast play out first-hand in recent years. At Riley Hospital for Children, where she taught, Midura regularly communicated with students’ teachers at their regular schools to smooth the transition out of the hospital.
In-patient mental health hospitalizations for young people rose by more than 120 percent between 2016 and 2022.
But in 2020 she moved to northern Michigan to be with her now-husband. There’s no hospital school program in either the 15,000-person city where she now lives or in the surrounding rural area. She now works as an engagement and behavior specialist with Northwest Education Services, a government agency that supports school districts, helping students with emotional needs. Without a program to help schools and hospitals communicate, information falls through the cracks, and young peoples’ care is fragmented, she said.
“If there is no process set, then the kids are just kind of dumped back to school,” Midura said. “Even when I request for information, the medical team doesn’t really know exactly what to give me, or they don’t respond because they just don’t have time.”
That kind of disconnect ultimately fails students, Midura said.
“If we don’t talk to each other, then we’re giving them so much different information,” she said. “We’re basically telling them that your mental health has nothing to do with school and vice versa. Which we just know isn’t true.”
This story about hospital schools was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for the Hechinger newsletter.