Behavioral changes take shape at University's award-winning Circle of Courage School

	Recreational therapist Robyn Eisenbach leads a group session in the UI Circle of Courage School in the John Pappajohn Pavilion of UI Hospitals and Clinics. Photo by Tim Schoon.

Accolades are nice, as the educators in University of Iowa Hospitals and Clinics’ Circle of Courage School can tell you. Last fall, they received an award from the Iowa City Human Rights Commission for their work with children dealing with mental or behavioral issues.

But the teachers and staff at the school find similar reward in their everyday jobs, such as when they see their students respond to therapeutic techniques and stay on track in their educational lives.

“When a student discovers that he or she can make a change in behavior—when the lights go on—that’s a wonderful thing,” says Nancy Millice, an expert in treating eating disorders and one of the Circle School’s four senior educators.

The school serves all the inpatients in the Child and Adolescent Psychiatry Unit in the John Pappajohn Pavilion, as well as children referred to the school when local academic programs can’t meet the children’s needs. Circle of Courage bases its model on four universal growth needs of all children: belonging, mastery, independence, and generosity. The school combines a strong academic program with a therapeutic approach to provide special-needs students the tools to modify their behavioral issues.

“Children struggle with all kinds of problems, from serious thought disorders to problems that are more behavioral in nature,” says Mary Eileen Hogan, another of the school’s senior educators. “We make recommendations for teachers in the home schools to address the specific strengths and deficits of each child.”

The school’s staff consists of the four senior educators, a half-time principal, a full-time paraeducator, two secretaries, five to six part-time student aides, and twenty-six volunteers. They see on average about 500 students per year. The long-term patients are taught using materials provided by their local school districts; the Circle School provides appropriate remedial school materials for the short-term students. The senior educators are certified in special education and behavioral disorders, and many of the volunteers bring much needed experience in specific areas of education.

“Many of our patients are high school students and are in advanced classes or language areas,” Hogan says. “Volunteers providing that specialty, that is a wonderful part of the program.”

But the academic side is only part of the service the school provides. When a student arrives, a wide range of evaluations occurs—medical and behavioral in addition to an academic assessment. From there, the staff develop cognitive behavioral therapy for the patient. “How we proceed often depends on the patient’s age,” Hogan says. “Younger children receive a great deal of behavior shaping, while the classes with older students deal more with cognition.”

“We teach our adolescents the tools and strategies for changing troubling behaviors, but only they can choose to use the tools to gain their independence and to reclaim their futures,” Millice adds.

The program is intensive in nature. Throughout the day, students are in a therapeutic, structured environment, which allows them to internalize new behavioral habits. A multidisciplinary approach allows for work in music therapy and recreational therapy, and unit nursing staff and doctors see the students every day.

“The whole day is built around the therapeutic component of getting the students on the road to recovery from whatever’s causing them problems in school,” Hogan says. “The children receive constant coaching all day long to address the issues of their issues.”

The school stays open year-round; the only days the school doesn’t operate are University holidays. “The inpatients don’t have ‘snow days,’” says Millice. “They need to have structure. They need the daily cognitive work. The doctors need to see if the medicines prescribed are having an effect.”

This approach can facilitate change fairly quickly. “We see day students who make progress, go back to their old schools, and do better,” Hogan says. “The same is true for the inpatients: some of them just need the tools to negotiate their lives, whether in school or at home, and we can provide them.”

Beverly Witwer, a member of the Iowa City Human Rights Commission and a former teacher at Iowa City High School, has volunteered at the Circle school. Each visit moved her in such a way that she was inspired to nominate the school for the human rights award in the community category. As she wrote in her nomination papers, “Despite this very sensitive, difficult, and challenging work, many of these teachers have been on staff for a long time and are truly gifted in the field. They receive a salary for their work, but their commitment to each student and to the school as a whole goes far beyond the basic requirements of the job.”

The excellence found at the school comes in part from the camaraderie of the staff. “We love that there’s a team here,” Millice says. “When you’re in this line of work out in the school systems, you’re often down at the end of the hall without much support. Here, the multidisciplinary team approach provides that support.”

Teacher Deb Rudish conducts an assessment in one of the Circle of Courage classrooms. Photo by Tim Schoon.

The staff members face challenges in their everyday work. Not all students are initially receptive to attending the school; more often than not, a parent or a school official has made a decision that the child needs to be there. The risk of defiance is illustrated through a button on a classroom wall—a last-resort option that summons security members to help quell a disturbance.

“But the truth is that these children want to do better,” Hogan says. “Sometimes they don’t know how to achieve that—they haven’t learned the necessary skills, or the techniques they’ve used aren’t working for them anymore.

“School is a pretty complicated social place to be,” Hogan adds. “Children need a lot of support to negotiate that maze. It can be tough at any age, especially when compounded with learning disability, chaotic family situation, or organic brain trauma. What is encouraging is this: our students discover a lot about themselves during their time here, things that allow them to be successful back in their home schools.”

by Christopher Clair