School Experiences Write Up

Running Head: SCHOOL EXPERIENCES OF AN OUTPATIENT CHILD WITH CANCER 1

The School Experiences of Crystal, an Outpatient Child With Cancer

Gabrielle Cypher

Carthage College: Social Work Department

SCHOOL EXPERIENCES OF CRYSTAL: AN OUTPATIENT CHILD WITH CANCER 2

Background Information:

Crystal is a young energetic 8 year old girl. She lives in a small Midwest town attending

2nd grade at a small private school which her Mom also teaches at. Crystal is part of a large

blended family which includes her Mom, Dad, two older half-sisters, and older half-brother.

Crystal enjoys swimming in the pool, hanging out with her neighbors, and playing with

her American Girl Dolls. Crystal is a very active and lively girl who is a great singer and dancer.

Crystal’s favorite time of the year is Christmas and summer (so she can go swimming). She

loves her family and having fun with them at their cabin up north. She likes to watch her brother

and sisters play sports and perform in show choir. Crystal is a loving and caring young girl that

loves to take care of those around her. She is extremely loving and genuinely cares about those

around her. Crystal likes to make her parents proud and often exclaims how brave she is. Crystal

has faced many obstacles in her life but her positive personality is infectious.

Crystal’s birth was very traumatic, “she had a broken collar bone and was not

breathing...in fact she was purple--and we were terrified” said Crystals Mom, Teri, 46. Crystal’s

young life continued to be rot with difficult situations. After her grandpa died, Crystal began

gaining weight and throwing up about 6 times a day. Crystal and her family found out that she

had a very rare, inoperable, slow growing, cancerous brain tumor in the hypothalamus region of

her brain; she was 18 months.

Children’s Hospital then began tests and treatments to try to understand and treat

Crystal’s tumor. The family was also treated poorly by some staff at the Children’s Hospital; the

family was told to “not reward her (Crystal) with a donut” and was told, prematurely, that

Crystal would only live to be 6 years old. After some confrontations with the Hospital staff,

which awarded Crystal’s mother with the term “pushy”, the family was referred to the Mayo


Clinic in Rochester Minnesota; 6 hours away from the family’s home. Crystal began monthly

MRI’s, tests, and treatments at the Mayo Clinic.

Crystal’s tumor grew and she was administered chemotherapy treatment once a week for

a year; she was 5 years old. The tumor had successfully shrunk to a size the doctors were

comfortable with. Crystal’s doctors then put her on new experimental treatments and medicines.

Crystal has been on experimental medications and treatment trials since the discovery of her

condition. She continues these treatments with no success to this day.

Current Research:

Over 10,400 children and adolescents in the United States under the age of 15 will be

diagnosed with cancer this year (Brown, Bolen, Brinkman, Carreira, & Cole, 2001). Of these

children more than 60% are effectively cured by surgery, chemotherapy, radiation, or a

combination of these treatments taking this illness from a once 100% fatal disease to a life-

threatening chronic health condition (Bauman, Dortar, Leventhal, Perrin, & Pless, 1997). With

the improvement of current cancer fighting technologies, many children are spending less time

inpatient or may never be an inpatient cancer patient. In addition, many children are returning to

school during and/or after their treatment (Brown et al., 2011). Aside from the physical effects of

cancer, there is a growing body of research stating that children with cancer face a greater risk of

psychosocial and mental issues. One of the areas includes social issues like bullying and peer

interaction problems. These issues manifest at school (Lahteenmaki, Huostila, Hinkka, & Salmi,

2002).

Reentry Programs:

Crystal was treated on an outpatient basis, meaning that she has not had to miss long

periods of school, therefore never having to reenter school because of her diagnosis. This means


Crystal’s likelihood of receiving services for school support is slim. At Crystal’s hospital in a

Midwest city, school services are available upon request. Information about the existence of

these services is in a binder that is only offered upon request. Usually, the social worker will

suggest these services. Crystal was never an inpatient cancer patient and received treatments as

an outpatient or in the clinic building; receiving experimental medications that did not require a

hospital stay. Because of this, she and her family spent little time in hospital rooms to find out

about school programs. After spending time with the family, it can be seen that the family is very

proactive about Crystal’s care. This means that if additional services were available or known,

the family would have fought for them. In addition, the family had requested to see a social

worker “three times” but has never been referred to one, so finding services this way was not an

option.

One service or program common in the research of the school experience of children with

cancer is Reentry programs. Reentry programs are, broadly, in three different categories all with

different focusses; “1) school personnel, including teachers, guidance counselors, and school

nurses; 2) peers; 3) comprehensive programs that include the patient/student, siblings, and

family” (Cabat & Shafer, 2002). These programs are put in place to foster understanding and

acceptance among peers and to educate teachers on the physical and emotional effects of cancer.

These programs can take the form of activities, lectures, or discussions. Reentry programs are

started by the hospital social worker and worked on by both the hospital staff and school staff of

the child (Cabat & Shafer, 2002). These programs, as can be assumed, are often mostly available

to inpatient cancer patients and not outpatient cancer patients. Since most of the research is

focused on reentry programs, it is also important to note that the experience of outpatient

children with cancer has not been researched.


An exploration into the bullying and teasing that Crystal has had to endure at school is an

excellent way to discover a way to aid outpatient children with cancer at school. In addition, her

story illuminates the need for more research into the outpatient cancer patient experience.

Outpatient children with cancer, as seen through Crystal’s story, experience some of the same

behaviors and experiences as inpatient children with cancer but are not offered the same services.

What are the school experiences of an outpatient child with cancer and what can her story show

us to help others with cancer?

Teasing and Bullying: Physical Appearance:

Strangers:

Crystal’s condition causes her to gain weight and height very rapidly. She is considered

extremely obese; none of this has to do with food intake. Crystal does not whine or want for

more food; she eats like a normal child her age. Crystal has looked “different” than kids her age

for her entire life which has caused stares, comments, and mean remarks from strangers and

friends alike. Crystal’s sister, Jasmine, recounts a time, “we were at Culver’s when Crystal was

younger and a group of older women were staring and talking about Crystal in a mean way. We

tried to ignore but they were loud.” Not only do strangers stare and make loud comments about

Crystals appearance, they sometimes come up to her parents and provide harsh criticism of there

parenting. Crystal’s mother describes that some people will tell them how horrible they are, that

they should be ashamed of themselves and that they can’t believe they let her eat like that. Due

to Crystal’s physical appearance, she is unfairly judged and bullied by strangers.

School Personnel:

While Crystal and her family face scrutiny in public from strangers they also face

bullying and teasing from school professionals. When Crystal was first diagnosed, Crystal’s


family explained to her school teachers and classmates, Crystal’s condition and its ramifications.

Despite this, Crystal has experienced teasing and bullying her entire school career.

Crystal has had many experiences of faculty treating her poorly as a result of her

condition. One event, Crystal’s mother remembers, involved the gym/art teacher. Crystal, being

much heavier, cannot run as fast or as far as her peers. She gets tired and heated and may need to

sit down or rest for a while. Crystal’s mother explains that the old gym teacher made Crystal run

two laps around the gym and, since everyone was already done by the time she almost completed

her first lap, everyone sat and watched. The students even laughed as she pushed herself to

complete her laps. Other instances occurred where Crystal told the teacher she was tired and

hurting but he made her run the laps or other lengths anyways. Her gym teacher even failed her

in gym for not meeting the “requirements.” After Crystal’s mother was aware of these instances

she heatedly confronted the teacher and a 504 plan of care was finally put into place to ensure

Crystal could not be discriminated against for her size in school, especially gym.

Crystal’s gym teacher did not treat her in a way coherent with her condition but coherent

with certain stereotypes. Crystal was pushed to her limits unsafely. Every student is required to

run laps in gym class and participate in all activities. Often times when children complain about

being tired or their bodies hurting they are trying to get out of doing an activity. In addition,

individuals have a tendency to stereotype people who are overweight as lazy. A common sign of

cancer is hair loss or a chemotherapy port. But, since every cancer diagnosis and experience is

different, the way it affects the child’s appearance may be different. In this case, Crystal’s cancer

makes her heavier and taller than her peers making this not an obvious physical sign that she has

cancer. This may have aided in the assumptions that the gym teacher used to discriminate and


bully Crystal. These assumptions by the gym teacher may have caused him to push and over

exert Crystal to an unsafe level.

In addition to making quick assumptions of Crystal, the gym teacher may have not had

enough information about childhood cancer and its physical consequences. Common concerns of

teachers of children with cancer are lack of knowledge about the physical and emotional effects

of cancer and its treatment and uncertainty about realistic expectations (Brown et al., 2011). In

addition to not being well informed about cancer teachers may not or “cannot understand or

accept the frequent absences and changes in the pupil’s physical appearance (Ross & Scarvalone,

1982). In Crystal’s experience, maybe the gym teacher was unaware that her condition and

treatments often give her upset stomachs and “belly aches” which would give reason to her

needing a rest or to sit out in gym class. In all, teachers may judge or bully a child with cancer

because of lack of knowledge about the effects of cancer or inability to accept the changes a

child with cancer must endure.

Although contact with this gym teacher was unavailable, it can be assumed from this

situation that Crystal was treated unfairly and “bullied” because of her size whether the

reasoning was lack of information or unfair and quick assumptions.

Peers:

Crystal is bullied by peers for her physical appearance, due to her cancer diagnosis,

which is congruent with research. In a study by Lahteenmaki, Huostila, Hinkka and Salmi, the

researchers found that, “in most cases, the bullying was due to appearance” (2002). One

explanation for why children would bully a child with cancer based on appearances is that “other

children are often cruel to one who appears different or weak; this is their way of making the


child less like themselves” (2002). In this way, children may unconsciously bully Crystal so they

do not become sick like her.

Teasing and Bullying: Physical Ability:

In addition to being bullied for her physical appearance, Crystal is bullied and left out due

to her physical ability. Her weight makes it difficult to do some activities. In addition, her brain

tumor has caused hurtful foot issues which also inhibit her from certain activities. Crystal is

bullied in and out of school.

Feeling Left Out:

Crystal has had many experiences of being left out or bullied because of her physical

ability. One weekend at her family’s cabin, there was a candy hunt at dark near the pavilion.

Crystal was playing with her friend Lea when Lea’s other friends came and asked “let’s go to the

candy hunt.” They all got on their bikes and rode off without Crystal. Crystal cannot ride a bike

or keep up with them because of her size and physical ability. Crystal was visibly upset and

saddened by being left out of this activity.

In another instance, Crystal and her friends were going to play at the park with her two

older sisters. Crystal’s friends ran up to the park with one of Crystal’s sisters, Tina, while Crystal

walked behind with her oldest sister, Jasmine. While at the park, the friends stayed with Tina

who was playing basketball and other sports which were hard for Crystal to play. Crystal wanted

to play catch because it was something she could easily do but none of her friends wanted to play

that with her.

Being left out may be due to Crystal’s physical ability or, plainly, mean children. In

either circumstance, Crystal becomes very upset and disappointed. In one situation with a peer,

Crystal’s friend asked her to go on a walk and Crystal said that she could not because it was


dinner time. Crystal came back into the house and was very upset and sad. Her father Ricardo

told her it was nice they asked. Based on her reaction and previous reactions, it can be assessed

that although the friends asked and Crystal had a reason for not going on the walk, she was still

afraid her friends would leave her out. Her emotions and previous reactions to similar situations

share that she feels that her friends will leave her if she does not play with them all of the time or

with what they want to do; dropping anything and anyone to play with her “friends”. She is

afraid that her peers will leave her out because of her size and physical ability.

Research shows that Crystal’s fears are legitimate. Researchers Prevatt, Heffer, and Lowe

state that peers who are uncertain about the child with cancer’s physical ability “may reject the ill

child as a friend” (2000). The researchers continue that peer interactions and fears of rejection

are the primary concern of children with cancer at school (Prevatt, Heffer, & Lowe, 2000).

Children with cancer “fear teasing and rejection by their peers” which leads to feeling left out

(Prevatt et al., 2000). It is apparent that Crystal feels isolated from her peers and fears them

teasing or leaving her out. In addition, Crystal’s peers are leaving her out of activities, like

biking, because of her physical ability which is congruent with current research.

Teri, Crystal’s mother, stated that this is something Crystal will have to deal with and that

her peers “leave her out because she can’t do the things that they can.” After analyzing this

statement and Crystal’s situation, important conclusions can be drawn. Although bullying

children with cancer sounds horrible, understanding the thought process or viewpoint of the

“bullies” is essential to help children with cancer. As Crystal’s teacher says, “I don’t think (her

peers) know what cancer truly is and...they just don’t really get it.” Understanding and “getting”

what cancer is involves understanding that there are a plethora of physical consequences that

may accompany a cancer diagnosis. One of Crystals consequences is being heavier and therefore


unable to physically participate in some normal childhood activities. So, Crystal’s peers may not

be intentionally bullying her all of the time by leaving her out. They may want to play certain

activities that are normal for them but extremely hard or impossible for her. And as a child, they

may not fully understand that they are hurting Crystal’s feelings by choosing to do an activity

that she cannot. But, as also displayed in the research, Crystal becomes upset in any case since

she is fearful of being left out by her peers which depicts the need for intervention in this area.

This is not to say that all instances of bullying are due to children not understanding

cancer and its physical consequences. Some children understand cancer but still choose to bully.

One instance, Crystal explains, happened on the playground at recess. The older children were

blocking all of the avenues of getting up to the top of the play gym except one. There were a

rock wall, stairs, and a climbing net. Crystal can use the stairs and climbing net but cannot

support herself on the rock wall. She asked them to “please move” and they said we “don’t have

to move” and then told Crystal to “go climb up the rock wall”, to which Crystal replied “I

can’t...they were being mean”. The children knew she could not climb up the rock wall because

of her size and excluded and embarrassed her because of it. This situation exemplifies the

struggle of having a physical alteration because of cancer. Although, Crystal is bullied because

of her appearance and her physical ability, she is also treated negatively for certain attitudes and

behaviors she exhibits.

Teasing and Bullying: Attitude and Behaviors

During conversations with Crystal, she stated that people are mean to her because they

say that she is mean. This appears to be unorthodox; a happy positive girl, who would do

anything for her friends, is mean. These interactions shed a light into the complex emotions and


behaviors of children with cancer and will help to display possible solutions to help these

children enjoy school.

Follow the Rules: Make Me Proud:

To fully understand Crystal’s behavior that may or may not have something to do with

bullying, an understanding of some of her emotions and behaviors is needed. Crystal is very rule

orientated. Even at a physical therapy appointment, she pointed out that the other boy in the gym

was not following the rules. He was being loud and obnoxious and that was what you were

supposed to do. Children this age see the world as “black and white” good or bad.

Although Crystal is following developmental stages by adhering closely to the rules, she,

because of her past life experiences due to cancer, views following the rules in a different way.

Crystal enjoys making others proud of her. When she does something that another person is

happy or proud of her for she lights up and is genuinely happy. Crystal displays this response and

commitment to making others proud in all aspects of her life. At a physical therapy appointment

for her feet, Crystal completed a series of stretches. When she was finished she looked to the

Physical therapist and her mother who both gave her a thumbs up and praise. Crystal was

beaming from ear to ear; she was very proud of herself. So, although Crystal adheres to the rules

she does so with much more added pressure. She is to follow the rules because they are rules but

also to make others proud of her, like her teacher. Mrs. Groniki, Crystal’s teacher, explained that

Crystal was “very rule oriented, so she wanted to…make me proud of her” when talking about

how Crystal would always follow lunchroom rules. These behaviors, shaped by her experiences

with her diagnosis, are partly to cause for some bullying she endures.

Telling


Crystal’s tendency to follow the rules with extra pressure comes to head when she is

faced with choice of whether or not to tell. One instance that exemplifies this struggle and

pressure was when Crystal was playing foursquare and a rule was to go on your knees and play.

She said “I’m wearing a dress...and I can’t do that” so the other kids made her go to the end of

the line instead of letting her play like everyone else. Crystal explained that she “have to tell but

always I don’t because I don’t want to get in trouble.” Crystal feels like she has to tell because

that is what you do when someone is mean to you, a rule, but, says Crystal, she doesn’t want to

tell because “I don’t want to get yelled at and I don’t want kids to get mad at me.” The other

children, she states, call her mean. She wants others to treat her nice but cannot do much about it

because she feels she cannot or should not tell her teachers.

Although she feels this way, Crystal chooses to keep telling on her peers when they are

mean further making them think she is “mean” and worthy of being bullied. She explained that

“if you hurt my feelings I’m going to be telling. I’m not going to keep doing it (partaking in a

situation that is hurting her feelings) cuz I’m just going to tell cuz otherwise I can’t stop it. I

can’t stop them doing that cuz I don’t control them.” These anecdotes illuminate Crystal’s

concern with the rules. She decides to tell, regardless of what her peers are going to do, because

you are supposed to tell the teacher when someone is being mean.

Sharing:

When asked what would make her peers think or say that she is mean Crystal answered,

“if I don’t let them play and I want to play by myself....but if someone else is playing with me

than I have to let everyone and (Trever, a mean boy)...goes to tell on me and I always get yelled

at for not sharing.” Crystal is allowed to play by herself at recess and enjoys playing “one on one

or the one on just a couple kids” says her teacher. However, like she said, she has to share with


everyone if she is sharing with one person, even if that means children that are mean to her. This

is counter to what her parents tell her to do when someone is being mean, “she says to walk away

and just ignore, just have fun and try to play something by yourself” says Crystal. So, Crystal is

forced to share with children that are mean to her for other reasons but is told she should ignore

them or play by herself. Then these children that Crystal ignores become mad and tell, making

Crystal look like a mean person.

My Way or the Highway:

In addition to telling on others Crystal has also been described as bossy. She is described

by her mother as loving “to get her way” and by her brother as “she really acts like you have to

do what she says”. She is even described as having a “bad attitude” but, her mother continues, “I

think it is all due to her condition and all she has had to endure.” Research does state that

children with cancer “struggle with not being the center of attention, resisted when their

preferences were not indulged”, and exhibit “bossiness” (McLoone, Wakefield, & Cohn, 2013).

The current research states that children often get their way when they have a terminal illness but

does not go into detail as to exactly why children with cancer exhibit these traits but Crystal’s

case provides theories.

Crystal’s teacher, Mrs. GronikI explains how these common behaviors are displayed in

school. She describes “the more comfortable she felt the more...she liked things her way.” She

further explained that “the other kids saw it as her trying to boss them around….tried to be in

charge and I think the other kids didn’t really like that as they got to know her.”

Mrs. Groniki, explained what she did with the class in these instances, “we worked in

small groups...and I could take the second graders and match them with a first grader and they

could work together and the 2nd grade could help the 1st grade and Crystal was one of those real


strong leaders that I could depend on to get the job done.” Mrs. Groniki, instead of seeing

Crystal’s bossy behavior as part of a “bad attitude,” chose to see it as strength and utilize it in a

leadership role. This was beneficial to Crystal, being in a situation where the learned behaviors

from having cancer were celebrated instead of scolded as bad behavior. Mrs. GronikI further

explains that during free time, “the less structured things”, she had to work on how to talk to

each other and play together. But she states passionately that “sharing with Crystal, never an

issue..[she] wanted everyone to be friends.”

In instances at school it can be see that Crystal’s controlling or bossy behavior comes

about when she is comfortable in situations. These behaviors can be off-putting to some students,

but if utilized in the right avenues, can be rewarding skills for Crystal and the rest of the students.

During these times it is important for teachers and other professionals to recognize the strengths

in children with cancer. Although the child comes off as bossy or always wanting her way, these

behaviors can be seen as strengths and utilized in a leadership or teaching role; like in Crystal’s

case. Also, giving a child with cancer an attribute to find pride in, like Crystal, can be extremely

rewarding in the area of psycho-social care.

This is not to say that Crystal is always innocent when being bossy and controlling.

Sometimes she just wants her way, either because of her past experiences growing up with

cancer or just in congruence with child development. In one instance, Crystal was with her

mother and grandmother at a new restaurant. Crystal was hungry for something else and began to

vocally complain about the food and look upset and annoyed. TerI scolded Crystal for this and

then whispered to me that “she gets bucky when she doesn’t get her way.” In addition, in many

of Crystal’s school report cards or other artifacts, working on being “the boss of only herself”,

always using “a nice tone of voice”, and to “not argue” when the teacher or a peer says


something she does not like, were prevalent. In these ways it is clear that Crystal is having

trouble with some of the same behavioral issues described in the research. Although some of

Crystal’s behavior should not be condoned, understanding her experiences that made her develop

these behaviors is needed. In addition, new ways of approaching and correcting these behaviors,

instead of just scolding, is essential to helping children with cancer in the long run.

Another lens in which to look at these controlling behaviors is as a coping mechanism.

To prevent herself from harm or unpleasant emotions, Crystal may try to control situations so

that she is able to participate or not be left out. In this way, she may control her peers to ensure

they are not mean. This was also apparent in Crystal’s response to telling on her peers, “I’m just

going to tell cuz otherwise I can’t stop it. I can’t stop them doing that cuz I don’t control them.”

These anecdotes illuminate Crystals concern with the rules and control as a coping mechanism.

She decides to tell, regardless of what her peers are going to do, because you are supposed to tell

the teacher when someone is being mean. She also realizes she cannot control them or their

behavior and then decides to tell; as somewhat of a last option to protect herself from getting

hurt.

Maturity:

In addition to controlling behaviors, telling on peers, and following the rules causing her

peer interaction issues; Crystal’s maturity level leads to issues as well. Crystal has been

described by various individuals mature. Her entire family agrees that she is mature for her age.

Her respite provider from the county agrees that Crystal is the “most mature.” In addition, her

doctors have noted that “she speaks with good vocabulary for her age.” Crystal’s teacher, Mrs.

Groniki, also stated that “having to go through more than any of us have had to go through has

made her that much more mature...the other kids and Crystal don’t relate. They can’t.” She


points out that not being able to relate to her peers is a great struggle for Crystal at school,

especially in the area of peer interaction and bullying.

Mrs. GronikI explains that Crystal’s maturity level makes it hard for her to relate to her

peers causing her to become upset or feel victimized. Mrs. GronikI goes on to say that “she

wanted everyone to be friends and everyone to be included and I don’t know if everyone was

always real receptive to that.” She explains that kids are “pretty immature at this age and she was

more mature.” Mrs. GronikI sites this as a reason that the kids were not always nice to Crystal or

would leave her out. She also stated that the kids were not “receptive to what she wanted to do or

her ideas.” In all, Crystal’s advanced maturity and life experiences made it hard for her to relate

to her peers. The ideas for fun and playing were not at the level of her peers or were not things

her peers wanted to do so they would choose something else; leaving her out or ignoring her.

Although she has trouble relating to her peers, Mrs. GronikI points out that Crystal

“related more to the older kids and adults.” This is in congruence with current research.

Researchers, McLoone, Wakefield, and Cohn, found that parents in their study stated that their

children with cancer had difficulties forming friendships with children their own age (2013). In

addition, the researchers found that children with cancer, as reported by their parents, “formed

close bonds with their teachers or older school children, in preference to children their own age”

(McLoone et al., 2013). She continues to recount that this “became a challenge for her because

some days she would say nobody wanted to play with me or I tried playing with so and so and

they walked away.”

On the Sunny Side:

Despite Crystal’s rare and uncertain condition, traumatic and constant hospital visits, and

unrelenting teasing and bullying, she is still a positive and energetic 8 year old girl. Crystal


experiences situations and behaviors common of a child cancer patient but also brings to light

new theories of the child cancer experience. Crystal, despite her bad condition and constant

teasing, is overly caring, kind hearted, funny, loving, and extremely self-confident, with an

amazingly positive outlook on her life.

Positivity:

Despite her condition, constant bullying and hardships, Crystal is a very positive and

happy young kid. She doesn’t just experiences bouts of happiness; she truly is a happy child.

Teri, in journals she kept throughout Crystal’s cancer journey, explains that “Crystal is Crystal.

No matter what is going on she is happy...she keeps going and having fun, and loves life!”

Crystal’s doctors agree that she is “a happy, lively girl…” Mrs. GronikI states that Crystal has

such a “positive outlook” and that she is “such a fun spirited kid...she makes the most of what

ever were doing.”

I’m Cute:

In addition to being a genuinely positive person, Crystal is extremely self-confident.

Crystal is often bullied for her size and is aware that she cannot physically do some activities

because of her size. For example, when Crystal was at the park she stated that “I have a big waist

and this is almost too small for me” when she was deciding whether or not to go down the slide.

Despite teasing, Crystal displays a great deal of self-confidence and high self-esteem. During

school, Crystal was assigned a Creative Writing Journal and wrote about herself. She stated, “I

like the swimming pool...I am very good at it. I am very cool,” and “One thing I do really well is

sing and dance.” In addition, in response to the question, What is one thing you like about

yourself, Crystal answered “I’m cute.” Crystal also enjoys taking pictures and videos of herself

on her iPhone. She also has a picture of herself as her screensaver and lock screen. When asked


what made her choose those photos she replied, “because I look good.” It can be seen that

despite the negativity surrounding her health and her size she is still very confident with a high

self-esteem.

How to Make a Change:

Although Crystal experiences turmoil with her health and teasing and bulling she is still a

very positive and self-confident girl. Although she is genuinely happy she still experiences times

were she sad and “just wants to give up” or does not want to go to school. Crystal has not been

offered school reentry services from her hospital or any type of social service for that matter.

TerI explains that they have not met with a social worker and have requested one three times

from the hospital. When I met with the social worker of the hospital it can be seen that she sees a

great deal of patients, inpatient and outpatient, in two different clinics. She cannot possibly see

every patient and some patients must take more of a priority. Since Crystal has a good support

system and has a positive attitude it can be assumed that she would not be in crisis to be seen by

the social worker. So, how do we help children like Crystal experience school in a positive and

rewarding manner?

Possible Solutions:

The case study brings up excellent points and even better possible solutions. One social

worker assigned to so many patients at a hospital will never be able to accurately assist every

patient. As with any agency, a social worker must prioritize crisis clients. The social worker at

the hospital where Crystal is treated is very passionate and hardworking, but simply cannot assist

every patient as much as she wishes. Since the population of children with cancer at school is

significantly less than a hospital, a school social worker or school staff would be better able to

assist children with cancer experience school positivity.


When a child is diagnosed with cancer, the family should alert the school staff who will

then put plans in motion to assist the child at school. Availability of these assistances should be

described in student handouts at the beginning of each year, in the main office, and on the school

website. In addition, hospital staff could ask the family if they would like a note sent or call

made to their school regarding the cancer diagnosis and the school would take the process from

there. This option would be brought to the attention of families by the doctor or the health unit

coordinator that is scheduling the appointments, as part of routine visits for the cancer diagnosis.

In this way, it is more contingent on the doctor or HUC, who sees the family every visit, and not

the social worker who may have too many patients to see. Also, most of the process is carried out

by the school staff, the area in which programs need to be implemented instead of the hospital

staff coming into the school.

Illness Explained:

In Crystal’s experience, she was teased because of her size which is due to her cancer.

For most reentry programs, initiated by the hospital, the child’s class is told of the illness and its

effects to foster understanding of differences. Since children with cancer can experience the

effects of cancer for years after diagnosis, continual explanation is needed to effect change in

teasing. A solution would be to start with an initial physical presentation or talk about the child’s

illness. Every year after, send a note home regarding the child’s condition. Of course, these

solutions will only be initiated if the child’s parents or guardians consent.

Utilize Strengths In Classroom:

In this case study, many solutions to common behaviors of children with cancer that may

cause teasing, emerged. Crystal, as explained by her family and teacher, is sometimes bossy and

controlling but, as Mrs. GronikI points out, she is a great leader. Mrs. GronikI actually utilized


Crystal’s leadership ability by having the older children mentor the younger ones. In this way,

Crystal was able to use her “controlling and bossy” behaviors for something constructive. It is in

this way that children with cancer should be treated or handled in the classroom. Instead of

scolding a child with cancer for behaviors, find strengths and constructively use the behaviors.

Though, Mrs. GronikI was not aware that bossy, controlling behavior was common

amongst children with cancer she unknowingly illuminated how to help children with cancer

excel in the classroom and enjoy school. Mrs. GronikI paired 1st and 2nd graders together and

allowed the 2nd graders to help or mentor the 1st graders in various subjects. This allowed

Crystal to utilize her learned behaviors in a structured and healthy way. To expand on this

solution, teachers should be given a packet of information about children with cancer. It would

include common behaviors, attitudes, feelings, and school tendencies of children with cancer.

The teacher can be aware of these issues in her classroom and employ the following tactics. Just

as mentoring can be a constructive outlet for children displaying bossy behaviors, a big buddy

program can be helpful for children with cancer that relate better to older peers. This program

will give the children with cancer a person to confide in if they feel left out by children their age.

In addition, this big buddy can teach the child play and peer interaction skills.

Learning How to Communicate:

In addition to the suggestions provided above, programs or activities that teach students

how to nicely communicate to other children, especially children who are “different” is

necessary. These programs may include role playing bullying situations or learning how to spot a

bully. In any form, an activity or program teaching young children how to communicate to each

other without being mean will help the school experience of not only children with cancer but

others as well.


All of the suggested tactics can be beneficial to not only children with cancer but all

students. This makes these programs more attractive to school officials.

What’s Next:

Most reentry programs focus on the inpatient child. These programs do not fully help

outpatient children with cancer that have never had to leave school but still face obstacles. In

addition, reentry programs do not aid or have research in effectiveness for the longevity of

success of the programs. It begs the question, are these programs helping the children intended in

the long run? In Crystal’s story, these measures were not helping. Crystal’s mother talked to the

school when she was diagnosed, at 18 months. Now that she is eight, she is still bullied and

teased for reasons relating to her illness. This shows that measures need to be taken to aid

children with lasting effects of cancer throughout their school career.

Future research in this area should focus on the school experience of cancer patients years

after initial diagnosis and children with cancer that continually battle their diagnosis for many

years. Research should also focus on the outpatient experience as the current literature is slim.

Do outpatient and inpatient cancer patients experience the same situations in school? Crystal has

experienced some of the same behaviors but has not been offered services by school or hospital

personnel that would usually be afforded to inpatient cancer patients. Would outpatient children

with cancer also benefit from reentry programs or the suggestions provided?

Children with cancer face a battle that some may never understand. They struggle with

their health as well as at school. These children, like Crystal, should be afforded the same quality

of life as their peers.


References:

Bauman, L., Dortar, D., Leventhal, J., Perrin, E., & Pless, I. (1997). A review of psychosocial

interventions for children with chronic health conditions. Pediatrics, 100(2), 244-244.

Brown, M., Bolen, L., Brinkman, T., Carreira, K., & Cole, S. (2011). A Collaborative Strategy

With Medical Providers to Improve Training for Teachers of Children With Cancer.

Journal of Educational and Psychological Consultation, 21, 149-165.

Cabat, T., & Shafer, K. (2002). Resources for Facilitating Back to School Programs. Cancer

Practice, 10(2), 105-108. Retrieved February 1, 2015.

Lahteenmaki, P., Huostim, T. (2002). Childhood cancer patients at school. European Journal of

Cancer, 38, 1227-1240.

McLoone, J., Wakefield, C., & Cohn, R. (2013). Childhood cancer survivors' school (re)entry:

Australian parents' perceptions. European Journal of Cancer Care, 22, 484-492.

Prevatt, F., Heffer, R., & Lowe, P. (2000). A Review of School Reintegration Programs for

Children with Cancer. Journal of School Psychology, 38(5), 447-467.

Ross, J., & Scarvalone, S. (1982). Facilitating the pediatric cancer patient's return to school.

Social Work, 256-261.

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