Medical Day Treatment: One-of-a-Kind School for Children
from The Children's Hospital (TCH) News, November 2006
Arletta Cockrell, nurse practitioner and
clinical manager of Medical Day Treatment,
has worked in the department for about
12 years. “I love what I do,” she said.
Each weekday morning 16 children arrive at The Children’s Hospital’s Medical Day Treatment Program. Although they have a variety of ages and medical conditions, they share one thing: they are here to continue their schooling in an environment that supports their often complex medical needs.
Arletta Cockrell, nurse practitioner and clinical manager of Medical Day Treatment, tells each child in the program, “everybody here is working on something medical, so you are in very like company.” Cockrell says that while the program offers a very individualized service to each child, it provides one shared experience that they have been unable to find in a typical school setting: the opportunity to feel “normal.”
Medical Day Treatment was started in 1992 by David Kaplan, MD, and David Rainey, MD, for medially fragile children with chronic or acute medical problems that necessitate high medical nursing care during the day. The program is run in cooperation with Denver Public Schools (DPS), and is staffed by four DPS educators, including full-time teacher Paulette McGill, and five Children’s staff. The program serves 16 children, ages 7 to 21, who attend Medical Day Treatment for anywhere from one month to several years or more. Since its beginning, more than 300 children have been served by the program.
Lesley Lauro, patient services coordinator
in Medical Day Treatment, is a part the nine
person team staffed by four DPS educators
and five Children’s staff, who care for the
medically complex children. Since its
beginning, more than 300 children have
been served by the program.
Medical Day Treatment consists of three components: nursing, educational and psychosocial. It is an accredited school program, held Monday through Friday, from 8 a.m. to 2:30 p.m., with regularly scheduled academic days. In addition to standard academics, patients participate in music therapy, art therapy, movement therapy, yoga, speech therapy, OT and PT. Medical treatments are conducted throughout the day, and Diane Reichmuth, Medical Day Treatment psychologist, works with patients one-on-one or in small groups throughout the day. It is a year-round program, with one month of summer school.
During the winter months Medical Day Treatment nurse Kay Troxell, RN, coordinates a ski program with Vail. The patients go skiing four or five times a year; Vail provides transportation, ski instruction, clothing and lunch.
Patients in Medical Day Treatment have a wide range of medical conditions, but according to Cockrell, often there are patients in the program who have asthma, diabetes, endocrine disorder and sickle cell anemia, as well as patients who have had an organ transplant.
These kids would get lost in the regular school system and end up at home,” McGill said. “These are kids who just cannot go to school – it might be medical, it might be psychological on top of the medical. It’s very complicated.
A child’s admittance to Medical Day Treatment must be approved by insurance; a physician, specialist or PCP needs to support and admit them to program; and the child’s school district must support their admission. If the child is a DPS student, Medical Day Treatment is a DPS center program. If the child is from another school district, then that district pays DPS for the child. Transportation is then arranged; DPS students can ride a DPS bus. Children out of the DPS district use Logisticare, a Medicaid transportation system that’s set up through the state that regulates transportation for patients with medical needs. In some cases the parents transport their children.
“I always think kids’ work is to go to school, to make friends, to try to be as normal as they can,” Cockrell said. “Our kids here don’t do that because they look funny, they smell funny, they’re gone a lot, they’re not able to participate in a lot of things, they don’t have normal friendships. There’s a need for this program because these kids need to be as normal as they can. We can provide this kind of environment for them where they don’t have to worry about being ostracized or criticized, and families don’t have to worry about them being very sick. They know that there’s a nurse here and there are doctors across the street.”
The program is very individualized depending on each child’s academic, social and medical needs.
“The goal is to transition kids back to their home school,” she said. “Lots of times because of medical needs, the progression of the illness, the increased nursing needs, they’re not able to transition back.”
“We’ve had kids whose parents didn’t expect them to live, and now look what they’re doing,” Cockrell said. “We become very attached because we see them everyday. It’s very rewarding to see them be able to go through some normal things. Some children have passed away while in this program, but I truly believe we served a need for them, provided them with a quality of life they would not have had if they had not been in our program. I love what I do.”
