New student

[ana010]

Hello all!

I could use advise on new student in self contained class. Student is not new to me, but is to teacher and her 2 aides. She comes from a facility after hip surgery. TBI, blind, nonverbal 16 year old functioning at about 18 month level. Her first 2 days were the week before Thanksgiving break. She was lovely, giggling, playing tickle games with me as I went over training with staff.

Now after break, parents are weaning clonidine. She is self injurious and is hitting, pinching, biting staff. Also, she makes a noise that is akin to sobbing without tears, seems anxiety related to me. I have mentioned twice to parents I did not thing coming off this med was beneficial to the child. They insist she needs to come off of it.

I will, of course, have another conversation with parents about how it is affecting their child. I do not want the staff I work with injured, but I certainly do not want this child injured. My heart breaks for her, watching her struggle through activities that were pleasant a mere 2 weeks ago. What else can I share or illuminate so her parents see the benefit of this medicine. They are barely at 5th grade education level, btw.

[ohiobobcat]

Why are they weaning her off the clonidine? Are they planning on replacing the clonidine with another medication? Do you have permission to speak with the student's physician or prescribing provider? It might help to know some of this information. And if the parents aren't responsive, speaking to the physician (with permission) can be helpful to a. tell him/her the behaviors you are observing with this student after the clonidine was decreased and b. to find out what the plan is- why the clonidine is being weaned, any plan to try another medication etc.

[MHDNURSE]

Who decided she needs to come off the clonidine? Can you contact her physician and speak with him/her about it? I had a student that was newly diagnosed with seizures and there was some confusion about the meds. I called and spoke with the NP in the office who was lovely and made sure we were all on the same page. Might be worth a shot.

[Flare, ASN, BSN]

Did the family give a reason for weaning the clonidine?

I have found that the most successful means for showing that a student needs a certain intervention is massive amounts of documentation. Document each and every time she hurts herself, hurts staff, has a behavioral outburst, etc. If the injuries to staff require you to file a report with workers comp, then so be it. Don't let your staff avoid reporting injuries, no matter how minor that she has caused simply because they don't want to fill out some paperwork or make a call. It's a paper trail. It shows that there is an issue. Don't lead the teacher to believe that it's her lack of management either. To go off the medication is huge.

Once the documentation starts piling up- and from the way it sounds it probably won't take long - you and your admins should have the teeth to go back to the family to say that there needs to be some sort of intervention, return to the neuro to address the behaviors, etc. The admins DO have the authority to keep the child from attending school if she is creating an unsafe work environment until the behaviors are addressed. Granted, this is usually done as a last resort after behavior mods have been put in place or even a behaviorist has gotten their 2 cents in. But given that this is a step back due to the family weaning the med it make take a different course.

Another thought though - Keep up the documentation but a meeting is in order - what types of behaviors is the family seeing at home? Self injurious? Aggressions towards family members? If so (and will the family even be forthcoming with that info?) will it be enough for the family to start the medication and interventions back up?

[ana010]

Thank you so much!

To answer the why, dad doesn't like her on it. He was angry she began in facility. Said it was just for the staff and didn't make any difference in her behavior. It's not accurate from my vantage point, but I don't live with her and do not spend more than an hour, if that with the child.

Flare, the paper trail will begin. Her teacher is excellent with 15+years of teaching experience, so she knows it not her management.

Let the additional documentation begin!

[MrNurse(x2), ADN]

There are a lot of parents who do not want to use meds, and what may not be an issue for the parents is for others. Sounds like the girl was away from school for a protracted time and is responding to the change. Perhaps request a period of time (a month?) before weaning so she can reacclimate?