Lisa O’Toole and Nalani Wineman: MESD Teachers Embrace a Tough Assignment with Grace and Humor

Willamette Falls Medical Center (WFMC) sits on a high bluff in a quiet residential neighborhood in Oregon City. Like other hospitals in the Providence Health and Services system, people come to Willamette Falls to receive critical medical treatment, emergency care, undergo surgery or give birth.
 
For a small population of children and youth, however, WFMC becomes a temporary home while they receive therapy for serious mental health problems. Currently, 22 children, up to age 17, live at the facility while an array of psychiatrists, nurses and social workers try to discover, and dispel, the demons that may propel them into their next mental health crisis.
 
Into this mix have stepped MESD teachers Lisa O’Toole and Nalani Wineman. The team provides an educational program that inserts a bit of normalcy into an otherwise therapeutic and highly structured daily environment.
 
Through a contract with the Oregon Department of Education, Lisa and Nalani make sure the children in the Child and Adolescent Psychiatry Unit continue receiving their education while living at WFMC.
 
With infectious laughter and positive outlook, their patience and expertise replaces dismay, dejection and depression with optimism and opportunity, if only for a few hours each day.

Separate strategies for the “smalls” and the adolescents
 
For teaching purposes, Lisa and Nalani have divided the students into age-based groups that require different strategies and approaches. The younger children, ages 5-12, are referred to as the “smalls” by Lisa and Nalani. Though less physically imposing than the older students, they can be more challenging and complex.
 
“We teach the smalls one-on-one,” said Lisa. “They are more intense in their behavior and less regulated. It is mostly boys who are a bit more aggressive. We've had only one girl in that group.”
 
The lessons with the younger children last just half an hour, as that is all they can absorb at one time, said Nalani.
 
The cohort of adolescents, ages 13-17 are taught in a group setting. “We have a table full of big high school kids sitting here waiting for us,” said Lisa. “Some are very outgoing and go off subject a lot.” That dynamic requires lesson plans that must be adaptable to whatever behaviors, or new students, are present on a particular day.
 
Laughter and spontaneity are a major component of their successful approach. “We have a balance of being a little humorous in here, a little silly and then teaching something,” said Lisa.
 
“Our days are half management, half teaching, and half normalizing in here,” added Nalani.
 
As transplants to Oregon, Nalani grew up in Hawaii and Lisa is a Canadian by birth but now holds dual citizenship. They have each worked in a variety of schools and have experience in regular and special education.

Before starting at Willamette Falls, they knew each other from working at Doernbecher, Shriners and Randall Children's Hospital as part of MESD’s Hospital Program. They juggle work life with raising teenagers – Lisa and Nalani both have a high schooler and a middle schooler at home.
 
Curiously, both Lisa and Nalani suffered traumatic brain injuries when they were young children - an ironic coincidence which is not lost on them or their students.
 
They live fairly close to each other so they carpool to and from work. This gives them time to debrief the day’s triumphs and failures, what panned out and what fell flat. Some days they go home and admit “that did not work.”
 
That extra time together in the car is is also an opportunity to decompress. “We don’t have time to process here – we are going from the minute we get here,” said Nalani. “We are very sensitive people and sometimes we need self care because we see these terrible situations.”
 
After the first three months at WFMC, they finally feel confident and secure in their roles, but it wasn’t always so smooth, they said. As with other programs MESD operates in detention facilities and hospitals, the population of students can change daily.

Starting a new program with students who are transient – they may stay up to 45 days or just for a week or so – is challenging.
 
“There is so much involved in this job. You are a teacher and there is the therapeutic component and then you have EPIC (the medical records system) and you work with the doctors,” said Lisa.
 
“It is such a multi-disciplinary field – I know teaching in regular schools is too, but this is a different beast,” she said.

“We have seen growth with the smalls and it’s a beautiful thing, especially from the special ed perspective because their emotional problems have affected their ability to act in an appropriate way in school and that is why they are here,” said Lisa.

The adolescents are a totally different challenge.
 
“When I first came here, the adolescents scared the living daylights out of me. I was used to the smalls,” observed Lisa. “But Nalani was unfazed as she drew on her experience in a resource room in a Portland Public high school.”
 
Now they have reached a comfort level that allows them to interact seamlessly with children of ages as they laugh, tease and teach.
 
Returning to a supportive home is rarely an option
 
Sadly, they know the reality for some students is not full of promise and rehabilitation.
 
Most children in the unit face an indeterminate future of foster care or a return to dysfunctional family life. At times, the doctors and nurses will speculate that a particular student is sure to be re-admitted to the unit somewhere down the line. Some of the children have experienced verbal, physical and sexual abuse. It’s like a horror movie, they said, listening to stories about police coming in the
middle of the night to take away their parents or siblings.
 
“Our students might be homeless, living in a car, coming from juvenile detention,” said Nalani. “We have kids who have been taking care of their families at a young age.”
 
Patrick McArthur is the supervisor of the program and speaks highly of Lisa and Nalani.  "I am very impressed with how well the Willamette Falls staff work together to plan, evaluate the effectiveness of their lessons, and ensure their students are able to relax in the positive and supportive classroom they have developed. The students in their classes have very significant mental health needs and need highly motivated and skilled teachers," he said.
 
"Since the first week of school, they have worked to learn and improve every facet of their program. I couldn't be anything but pleased with their accomplishments this year."
 
Their classroom – a work in progress
 
Because the unit recently moved to WFMC, the physical environment in which they teach is not yet optimal – they need bookshelves, a classroom phone, a separate office and access to the medical records system – but they are making the best of the situation.
 
As the medical staff of WFMC have adjusted to their daily presence, a real sense of teamwork is emerging. They start each day taking part in the medical rounds where there is in-depth discussion about the children and input is gathered from a variety of perspectives.
 
“We feel like we do a good job here…we connect with these kids. We’ve had a nurse say the amount of restraints and lock-downs have gone down,” they commented. “It’s all about success in here for me - that students are successful and spent the hour at least feeling a little bit normal, doing something to keep the brain going,” said Lisa.

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