#32 - How GPs can support School Can't families with Dr Kara Johns

In this episode host Leisa Reichelt is joined by Dr Kara Johns to discuss the crucial role that General Practitioners (GPs) can play in supporting families struggling with School Can’t.

Dr. Johns, a GP from South Australia, shares her personal and professional insights on handling School Can't situations. They explore the importance of building strong GP-family relationships, navigating the Australian health system, and the Medicare safety net. 

The episode also touches on the impact of emotional health on children's school attendance and provides practical advice for parents dealing with similar challenges.

00:00 Welcome to the School Can't Experience Podcast

00:27 Introducing Dr. Kara Johns

01:42 Kara's Personal Experience with School Can't

07:16 Understanding the Role of a GP

11:22 Building a Productive Partnership with Your GP

13:44 Navigating Appointment Lengths and Expectations

18:45 Supporting Families with School Can't

20:42 The Importance of Primary Attachment in Child Development

21:41 Challenges in the School System and Parental Advocacy

23:48 The Role of GPs in Supporting Families

30:27 Navigating the Australian Health System

39:11 Resources and Support for Families

42:00 Conclusion and Final Thoughts

Recommended Resources

• Possums (Neuroprotective Developmental Care) by Dr Pamela Douglas - https://possumsndc.com/
• Medicare Safety Net - https://www.servicesaustralia.gov.au/medicare-safety-nets
• Medicare Mental Health Plan -  https://www.servicesaustralia.gov.au/mental-health-care-and-medicare
• Pop Culture Parenting podcast - https://www.popcultureparenting.com/
• Developing Minds psychologists - https://developingminds.net.au/
• Reflect Health (ADHD Resources) -

Transcript

Leisa Reichelt: 0:05

Hello, and welcome to the School Can't Experience podcast. I'm Leisa Reichelt, and this podcast is brought to you by the School Can't Australia community. Caring for a young person who is struggling to attend school can be a stressful and isolating experience, but you are not alone. Thousands of parents across Australia and many more around the world face similar challenges and experiences every day. Today we are joined by Dr. Kara Johns, who is a GP in South Australia. Kara has some lived experience with School Can't, which we will touch on, but I wanted to talk to Kara about the role that a GP can play in helping to support families who are experiencing the stress of School Can't. And also some tips on what we need to know to make the Medicare system work for us as best we can. Talking with Kara really made me wish I'd known a lot of this much earlier in my School Can't journey. I hope you enjoy our conversation. All righty. Shall we get started? Okay. Dr. Kara Johns, thank you so much for joining us for our podcast today.

Dr Kara Johns: 1:05

Pleasure to be here.

Leisa Reichelt: 1:08

Let us get started by hearing a little bit about you. Where are you? What do you do? Tell us about your family situation.

Dr Kara Johns: 1:16

Sure. I'm Kara, I'm a specialist general practitioner based in South Australia. I've been in general practice for about six years now. Medicine was my second career, so I came at medicine a bit later. I was doing science beforehand. so I work in a, large-ish general practice. over here There's about 18 doctors. We're all part-time. We all have a very collegiate work environment. I spend my other time with my 7-year-old son, so it's juggling the two pretty much.

Leisa Reichelt: 1:42

And you've got a little bit of personal experience with School Can't.

Dr Kara Johns: 1:47

Yeah, a little bit, and I was trying to think of the word to use. Sometimes I say mild, but I don't know that that really is the right word. Maybe brief experience with some School Can't. It has informed me hugely going through that as a parent. Last year in particular, we had a lot of struggles with my son. We had a three week period in particular where getting him to school was very, very challenging and the mornings were really horrendous. And there was a couple of days where we just didn't and just let him be at home. That was a really tough couple of weeks while we were figuring all of that out. But I guess we had the benefit of the context of I'd already been questioning some things with him. So this was just adding to the information that I was gathering, that helped inform me that there was other things going on for my son that we needed to now definitely address. We reached a threshold where I went, okay, I'm not just questioning anymore. I'm quite certain. And we were able to address it. and pleasingly this year, it's like chalk and cheese. We have a totally different child, in many ways, not just for school attendance, which is. necessarily always the be all and end all, but we just have a very different child this year, the School Can't process informed us. It was another sign for us that allowed us to help him. For a while with my son watching him, observing him, particularly even back for childcare days, we had some episodes of very extreme separation distress. And it was quite fascinating in that it wasn't all the time. It was usually episodic, like a couple of weeks where he would really struggle with drop off and then it would settle. And we eventually learned that it was always to do with if something had shifted in his world. So a friend of his might've left to go to school, or, a friend moved into a different room and he wasn't yet ready to move into that room. So something in his world shifted and then he was struggling to attend. We were very fortunate though, in that the childcare center we were using, the director was actually a child psychologist. Which was amazing because it meant that the strategies that this childcare center used were very mentally health protecting and mentally health safe. So it was all around shifting his emotions, not demonizing them or making him feel guilty with them. It was working with his emotions and set us up really well with understanding the emotional space and how to work with his emotions. So we had this beautiful foundation and then we'd moved him to start school and it was a very difficult transition as it can be for a lot of children. But he'd gone from this very mentally health protecting environment to quite an academic environment and we saw our child slowly crumble. It was fascinating to watch because he was still a very bright, curious, engaged child. You tell him a piece of information, he doesn't forget it. So, to see him then start to crumble in a very academic environment was kind of a clash. It didn't make a lot of sense. And so as we're watching it go along, I was getting this bigger picture of going, I think there's ADHD here, but I think it's inattentive ADHD. Which can be very difficult to tease out.

Leisa Reichelt: 4:38

But,

Dr Kara Johns: 4:38

by last year, when the School Can't came into the picture as well and the level of distress that we were seeing in our child, I just knew that there was more going on here. And there was one particular pivotal weekend that I have very strong memories with because I was very upset and distressed. I knew that the pressure from the school of how we were handling his drop offs was escalating into a direction that I wasn't comfortable with. And so I, I kind of felt like something needs to give or we need to make some drastic changes. And it felt like this very pivotal weekend. And I spent the weekend talking to my son a lot about it, and I was able to get bits of information out. He ended up sharing with us that there were moments in the classroom where he was looking around and going, everyone knew what they were supposed to be working on, and I don't know what I was supposed to do. I'm so dumb and I'm so stupid. negative framing of his experiences was profound. And this was a 6-year-old saying all of this. He's looking around the classroom and he didn't know what he was supposed to be working on, it was very obvious to me that he was missing key bits of information in the instructions. And so on that Monday morning, I, got an appointment for a pediatrician and I started the ball rolling and we now have a confirmation of inattentive ADHD. And so because we now have that information and we're able to support him, as well as medication, we have such a different child this year, such a different child.

Leisa Reichelt: 5:56

Hmm.

Dr Kara Johns: 5:57

I think the power of teaching him about his brain has been. I think we underestimate kids sometimes. We really underestimate how much they process and how much they can understand. I talk to him about neurons and synapses and neurotransmitters. He now has the language to say, my brain works like this and this is what I need for my brain to get that information in. And he is not internalizing it as I'm dumb and I'm stupid. So we've shifted the narrative in his head. We now have a kid that skips into class.

Leisa Reichelt: 6:27

I think we always love to hear these stories of where you can discover something's going on, get in and do an intervention, and get them back onto a happy path quickly, rather than having to live through a lot of trauma.

Dr Kara Johns: 6:42

A happy path is key, I think. the work I do with young people that I see in my work, it's interesting sometimes when I use that language because I don't think school attendance should be our goal, but on a happy path should be our goal. Happy and thriving in their way should be the goal. And working with families to realign their expectations and goals, it's quite interesting. The big thing that I take away from it is there's always something underneath with these kids. They don't have the words to explain it and maybe they don't understand it, but I haven't met a single child yet where there's not something going on underneath. so it's an exploring journey with these kids.

Leisa Reichelt: 7:17

Let's pivot into your role as a GP then,

Dr Kara Johns: 7:21

Mm-hmm.

Leisa Reichelt: 7:23

I'm sure there are plenty of people who hit School Can't with their kids, and the first thing they think is, I'm gonna go and see my GP.. I will hands up say that never crossed my mind at all. Never crossed my mind that a GP could help me deal with the challenges that were going on. I look back'cause I have a great GP and I feel some regret that I didn't give her a chance to help me on this journey. she probably would've been a lot easier and done a lot better. So, really interested to talk to you today about the role that a GP can play in a family's life when they're experiencing School Can't. Go right back to basics. How do you think about the job of a gp? What is a GP's job?

Dr Kara Johns: 8:03

Aw, that's a loaded question these days. I can't speak for every GP in Australia. I don't speak for any organization of GPs. I can share my experience as a GP a parent. and a patient The role of a general practitioner or a GP in Australia these days is very different than what it was 30, 40 years ago, even maybe 10 years ago. Like, if you think about the advances we've had in science and technology in society, medicine has advanced in just the same way. So the breadth of medicine that we need to know so wide now and the depth that we go in each area of medicine has changed so much. So, General Practice is a really tough gig these days. You look at the training process for a general practitioner, Several years ago, 20, 30 years ago, you could finish your med school training. Do an internship in hospital, and then you could start working in the community and you were considered a general practitioner. These days it's very different. You do your medical school, you do your internship, and then you have to apply to get onto a specialist pathway to become a specialist general practitioner. And so general practitioners that are being put out into society now, we're actually specialists, so we registered with the Medical Board of Australia as specialist doctors. Like general practitioners are specialists once they're qualified and we refer to other doctors that have narrowed down into one field as subspecialists or partialists.

Leisa Reichelt: 9:19

Hmm.

Dr Kara Johns: 9:19

That language kind of explains the complexity of it. Coming back to your question about, the role of a general practitioner, we look after people across the lifespan from a newborn baby until death. We're often the first port of call for anyone touching base into the health system in Australia. Our role is to differentiate symptoms and signs from things that may be part of, and I use the word normal very carefully. There could be a normal sign or symptom, doesn't mean we have to tolerate it, but it can be a normal sign of symptom versus what is a sign or symptom of a disease or a process or a condition that we could be supporting, throughout the lifespan. We're also doing a lot of preventative healthcare. As a female GP who specializes in women's health, I see primarily female patients. And then I've got a cohort of kids that I see because I've looked after them and they've had babies, and now I see the babies and look after the

Leisa Reichelt: 10:06

Mm-hmm.

Dr Kara Johns: 10:06

you end up with this beautiful, longevity relationship. The power of a general practitioner, is we get to know the context of a person, not just the individual person. So we might look after the grandmother, the mother, and the child. So three generations we look after. And that informs so much of what we do because we have a much broader perspective of what's going on for the individual. So it's very broad, the general practice role, and I'm not at all surprised to hear you share your journey that you didn't consider the general practitioner in your journey. I think that's common. And even in my experience with my son, when the school were aware that there was something going on, not once did they say, touch base with his general practitioner. It was oh, maybe we need an OT or maybe we need a psychologist. And we're sort of going in these horizontal directions. The general practitioner is often the coordinator. So, we are the central person in a person's healthcare that coordinates between allied health and Partialists. And we are often the person in the middle that puts the pieces of the puzzle together.

Leisa Reichelt: 11:04

yeah. I grew up with a family who were basically, don't bother the doctor. Only go when you absolutely need to. Doctor's very busy. Don't waste their time. You know, and so you get your vaccinations and your antibiotics when you are like, dying. And that was kind of it. I know not everybody is like that. And, that's great. But I wonder what's your perspective on how to develop a good, productive, useful partnership with your GP if you're fortunate enough to have a great GP?

Dr Kara Johns: 11:34

That's a good question. I think it comes back down to having honest conversations with them because we are human ourselves, we have our own life and we all have our own personal preferences. So I know the way I practice in general practice is different than my colleague in the next room. So I guess first of all, it's finding a general practitioner that fits with what you feel you or your child needs are. That can take time. And I don't think that represents good or bad GP. It's just like not the right fit. You've gotta find the right fit. And then I think having open conversations so that you are actually meeting each other's expectations and needs. I think it's historical. Like if you looked back to, I think before Medicare was introduced in Australia, it cost a lot of money to see a general practitioner or a doctor, which you could argue we're maybe heading back in that direction these days. And so I think that culture of don't bother the doctor unless it's dire was also because people couldn't afford it. The general practitioner has a huge role in preventative health and we try to advocate for that. The earlier we intervene and address things, the less complications we can sometimes be dealing with. So yeah, I think positive relationship, right fit and then a dialogue and having a conversation. Personally as an example of that, like, I like patients that bring in a list of their tasks, because it allows me to see very early on what are their expectations. So just because they're bringing in a list doesn't mean that they expect me to cover all of that in one appointment, which I think some gps will often interpret and go, oh my God, how unrealistic. But having that open conversation, they're like, no, this is just my list of thoughts. I just want these two addressed today. Cool. Great. I know what your list is. I know what we're working towards. That allows us to meet both of our expectations and both of us finish feeling fulfilled from the consultation. Don't get me wrong, I get it. It's hard because we are often running late, really stressed and busy. We might have just sent a patient to hospital that we are really still worried about and we are trying to get that out of our head to focus on you. And we are human. We don't always do that very well. There are a lot of things going on for us as well. So sometimes it might feel tough to have those conversations, but building to a place where you can have that and remaining flexible, really helps that relationship.

Leisa Reichelt: 13:33

It's a challenge, isn't it, it's hard to get an appointment sometimes and then when you get an appointment it's short. And then being able to have that time to build that context up. That

Dr Kara Johns: 13:42

really hard

Leisa Reichelt: 13:43

yeah.

Dr Kara Johns: 13:44

I think that's the other thing. Book an appropriate length appointment.

Leisa Reichelt: 13:46

Mm-hmm.

Dr Kara Johns: 13:47

this is something that I see when I first meet patients often they're unaware of this. when you call up a general practice find out, what length of time is their standard appointment because every clinic runs differently. The clinic I'm at, our standard appointment is 15 minutes, but what that actually means in real time is that 15 minutes is supposed to be from me opening the file to me closing the file, not 15 minutes with the patient in front of me. Patients will often interpret that as they've got 15 minutes of my time to sit in front of me. So I think book the right length of appointment to start with. Most of my young people that I see, I request them to book a double appointment, which is half an hour because quite a lot of young people, need time to warm up. I'm not gonna be able to get anywhere if they're feeling nervous or uncomfortable. Sometimes we need to do some coloring on the floor first just to connect again. Then I can explore what's going on with them and discuss it. So book a good length appointment and that just have a conversation with the receptionist. what length of appointment is this? And, and I've got this issue. How long should I book for?

Leisa Reichelt: 14:43

I'm just thinking to myself, my rule of thumb would be always book a long appointment because like as a middle-aged woman with complex kids, right. There's just always so, there's just a lot going on and, yeah.

Dr Kara Johns: 14:56

most of my patients are doubles. Most of my day is doubles, but my colleagues, it's single, single, single, single. And like, that's just the difference in style, difference in cohort of patients that see us, different ways of doing the job. It's really hard sometimes to work out what appointment length you might need. As a general rule, we say it's one issue for a standard appointment, two issues for a double appointment, but obviously not all issues need the same amount of time. Like I had a patient who booked a single with me and they wanted to talk about potential perimenopause. That's a massive topic. To do that, well you can't do that in 10, 15 minutes. We can get the ball started. That's the thing too, It's a rolling consult. It doesn't have to have everything in the one consult. You start it and then when they come back, you're doing a bit more on it and you're doing a bit more of it. But I don't think that's what our society or patients want anymore. We are still taught to have the rolling consult with our patients, but patients are busy. They often take time off work to come in and have their appointment. They wanna get their issues addressed in that appointment. They don't want to come back next week.

Leisa Reichelt: 15:54

It's a bit of a mindset shift though, isn't it? Right. The mindset that we often have now is transactional. I'm coming in with a cough and I want antibiotics, or I'm coming in with this pain and I want a referral. It feels very transactional. Whereas what you are describing is much more of that relationship based medicine, which I think lots of people would want that if they thought that that was a thing that they could do and and plan for.

Dr Kara Johns: 16:21

Yeah, it makes me so sad hearing the transactional stuff, but I totally get it because that is the way we've been forced to work. We've been forced into this space of going, government wants us to do six minute appointments. If you look at how they fund the Medicare and That's where it has become transactional. I don't personally find that medicine or way of practicing medicine satisfying. So I don't practice that way, but that means to see me is more expensive than to see a doctor who does do transactional medicine. I can see why it exists, and I can see why general practice has become to some sections of society viewed that way, that we are just a GP. Because you're just a referral doctor. You're just there to refer us onto the actual doctor. I can see why that's being formed. But I think if you have that view, you're missing out in a big resource. We have a huge knowledge base that we can use and help with, and can be beneficial with.

Leisa Reichelt: 17:14

Yeah. I was always fully the transactional person with my GP for a long, long time, and I thought that was me doing the right thing. But now I reckon my strategy is basically I book an appointment a month. I, I book a double appointment every month because my GP's hard to get into as well, so I need to book well in advance.

Dr Kara Johns: 17:32

I've got one patient in particular that has a double appointment booked every week with me. Now whether they use it or not is another thing, but if you get out and ahead and schedule it. We don't always use them, but she's got some serious health issues. She knows that things don't go to plan often for her. She's just highly proactive and has reserved that spot with me every week to the end of the year. I'm a big one of that. I often tell my patients to book, and I sometimes do it in the room. When are we gonna touch base next? I think booking in advance is a very good strategy as well, because the worst thing I think is if you stockpile issues and you wait till that month'cause that was on your appointment and you've come into a double appointment, but you've got a list of 10 things they're all of equal value to you that you need to get addressed. But that's not physically gonna be possible in a half an hour appointment. So yeah, getting out in front and having pre-booked appointments, as long as you ask in advance what the cancellation policy is at your clinic.

Leisa Reichelt: 18:21

There's probably a ton of people who are very happy for you to be canceling the appointment so they can snap it up.

Dr Kara Johns: 18:25

quickly. Because I think that's one of the complaints I get is it's really hard to get in to see you. Now my next available appointment is not till mid-October. So, yes it is really hard, but if we book in advance and you can cancel if you don't need it, it's actually a better strategy.

Leisa Reichelt: 18:38

Yeah, I agree. That's been a game changer for us. Instead of waiting until everything's desperate and then going, but I can't see them for however many weeks. Alright. Let's talk more specifically about School Can't now and the kinds of things that GPS can do or that you do in supporting, families and young people who are experiencing the stress associated with School Can't. What are typical things that you find yourself doing to support in those situations?

Dr Kara Johns: 19:07

I do not consider myself an expert in this space at all. I'm learning with my young people as much. They're teaching me a lot as well. It's still a growing understanding in the general practice space. I still hear school refusal term being used even amongst my colleagues. I don't think it frames what we are dealing with correctly, but it's still just a label that they're using to explain the situation. My experience, I guess, has been very informed from some of the work I've done around infant care. So before I came to general practice, I was very interested in the women's health space and did quite a bit of time in obstetrics and gynecology, delivering babies, doing postnatal care. I got very interested in some work being done in Australia by a GP who's done a lot of research. It was Pam Douglas and she developed the possums program, I think it's called something different now, Neuroprotective Developmental Care, I think it's called the NDC is the website. For me, it made a lot of sense. it was talking about the first hundred days of life and how we parent our infants and how it sets them up for positive mental health moving forward. It's actually going back to tapping into biological drives and biological needs. They use a lot of acceptance and commitment theory in the program, which also made a lot of sense to me. I don't consider myself an expert in acceptance and commitment theory, but my interpretation of it was like, find out what is your genuine self and live that authentically. And if we find what that genuineness is and can get you on a path where you can be your authentic self. Often you feel better about yourself and about the world because you're not masking or pretending to be someone you're not. There's a freeing that comes with that. The work that I did in that space has really informed me moving forward with all of my young people, because the most important bond is that primary attachment relationship, which is often the parent and a child. That's an extraordinarily powerful relationship in the brain development of a young person. And we should be protecting and strengthening that relationship. When we used to tell mums to leave a baby to cry, we're actually damaging that child parent attachment relationship, which is not a healthy thing to do. So, we now know, respond to your baby when they cry because they are communicating to you. And that need might be they need a cuddle, but that's still a need. And so then if we fast forward into primary school age children who are showing a lot of distress, I always start from a place of strengthening that primary caregiver attachment relationship. And what I'm finding in the School Can't space is that relationship is often being ripped apart,

Leisa Reichelt: 21:36

Hmm.

Dr Kara Johns: 21:36

and being damaged. And not strengthened. So I guess my first journey in this space was working with a family where the child was really struggling to attend school and the school were getting really forceful to the point of physically restraining the child and telling the parents to leave, I had huge issues with'cause I was like, that's assault. That is absolutely not okay. Secondly, if that child is highly distressed and you are their primary attachment and you are leaving them when they're highly distressed, that in itself is distressing to a child because you are supposed to be their safe place to land and you are now abandoning them. Like that's not a healthy process. So, navigating and supporting this family, I came at it from that lens of just going, we need to support the primary attachment and the child, and work with that. And when I first met this child too, because I'd had a heads up because I knew the mum was my patient I scheduled it at a time where I could have time with this child. I had an hour with this child. that appointment too, I was able to see very clearly that I thought autism was at play here. And the school had not seen it. In actual fact, what they were doing to get this child to school was actually damaging the parent child relationship and causing huge trauma in this child The way that they were handling it was not neuro affirming or neuro safe I don't consider myself an expert in neurodiversity, so apologies if I use the wrong terms But I saw so much of what was going on here was bad. My role in that place was strengthening relationships, holding space, working out what was going on with this child. You know, we got this child to several different psychologists because there's therapeutic psychologists and assessing psychologists. So you often need to use two or three sometimes. We've since had a diagnosis confirmed. We've got NDIS in place. What I think my role was quite useful in this place was because there was a lot of gaslighting going onto this mum. The school had done a lot of damage to this mum by framing her as being weak. The problem was her, not the child. So they'd really broken mum as well. So I just contacted the principal and I was like, let me hold that space. They can blame me, they can criticise me. What's going on at this school is wrong and not, okay, let me be the one dealing with this. I think the GP role in many of these cases is to look beneath the surface of what's going on with this child. We can help affirm what is appropriate and safe and we can help direct families into a helpful pathway, hopefully, that won't happen from the first appointment, but I feel like we can hold a lot of space here. Our role is often the coordinator. We are sending out, getting other people's opinions and bringing it all back together. And by doing that we can often formulate what's actually going on with this child and which direction might actually be helpful.

Leisa Reichelt: 24:16

You hit what I think are two or three of the really important things. One which is trying to help work out what is the path forward? Who do you go see? My journey was that the school picked my son out for not doing pattern matching in the way that they would like him to be doing pattern matching. And they were like, you better go and see a speech therapist. We're like, okay. So we went and saw a speech therapist and then, you know, great speech therapist, but we ended up on this roundabout pathway. In retrospect, it would've been so much better to have a GP involved who could say, right, here's how we're gonna approach this. We're gonna do this, this, this.

Dr Kara Johns: 24:49

And OTs and psychologists are fantastic, but I feel like we need to use them in the appropriate space at the appropriate time.

Leisa Reichelt: 24:56

Yeah, We had a lot of duplication where we went to the speech, and she did a heap of assessment stuff, and then she's like, oh, my expensive assessments tell me that you need to go to a pediatrician now to get expensive assessments done. I'm like, okay, great. I think the other thing that you pointed out as well is that role that a GP can play in advocating to the school. When communications with the school are getting very stressful and very serious, and in some cases very threatening.

Dr Kara Johns: 25:21

mm

Leisa Reichelt: 25:21

I think GPS can play a very important role in setting the record straight of what's actually going on for this child and the way they need to be handled, which is often different to what the school is asking for.

Dr Kara Johns: 25:36

Yeah, I agree. And maybe I'm giving too much credit to schools in some cases, but I think it's nicer to have a viewpoint of thinking that everyone's actually trying to do their best in a very flawed system. I often say let me be the bad guy. they can complain about me. just let the school complain about me as well. you don't need to hold all of that mental load. And I see that the burnout in parents is often huge. Let us hold some of that for you. You don't need to hold all of that. Sometimes when I'm talking with a couple of families, I've got a family with a child that's currently not attending school, and of course that requires a whole bunch of paperwork. I was like, that's fine. I'll write another letter.

Leisa Reichelt: 26:11

Hmm.

Dr Kara Johns: 26:12

You're helping hold some of that space for families, which can be very powerful. You are carrying some of the mental load and not letting them carry it on their own.

Leisa Reichelt: 26:19

yeah,

Dr Kara Johns: 26:19

which I think is very powerful.

Leisa Reichelt: 26:21

And I just think it's very legitimizing, like parents can tell schools and like you say, not all schools, some schools are great and try really hard and listen, other schools are threatening to send parents into the legal system.

Dr Kara Johns: 26:34

yeah.

Leisa Reichelt: 26:35

Parents are in there trying to say, my child is having mental health issues right now. And this is very serious. And I don't always think that schools take that seriously in the way that they do if you have a letter from your GP saying, this is a situation with the child, this is how this needs to be handled,

Dr Kara Johns: 26:54

I've seen with some families too a mother say to me once, you are the only other adult in this child's life giving them a voice and telling them to trust in and be affirming of themselves. And I come at it more as a child protection lens of where we are trying to raise our children these days to have a lot more body autonomy, to be more understanding of consent, and encouraging children to voice when they're uncomfortable. and you know, when you find out that this child has had to sit with a lot of uncomfortable feelings and the school has told them that's okay, I have a lot of issue with that because that's, really not keeping this child safe. If they're being told that when they're uncomfortable, they're supposed to ignore that to fit in. I take real issue with that. We as adults should be encouraging our children to recognise their gut instinct of, I'm uncomfortable. This is what keeps them safe. That's huge.

Leisa Reichelt: 27:43

The irony is that, and again, not all schools, but I know there will be people listening whose experience has been that the school has initiated proceedings with Child Protective Services because parents were trying to protect their children's mental health and allowing them to not attend school all the time. I wanna circle back, Kara to something you said a little while ago, which was just about the neuroprotective behaviours and, the damage that can be inflicted when children in distress see their parents walk away. Just to note that there are loads of us who have done that and who probably carry an enormous amount of guilt because we thought we didn't have a choice because we thought that was, you know, that was the advice that we were given by people who theoretically knew a lot better about these things. So I just want to reflect back to anybody who's hearing that and feeling that burden of guilt and self blame that, you know, you're in great company. It's happened to loads of us, and we do the best that we can with what we know.

Dr Kara Johns: 28:52

Oh, absolutely. We had the same with our journey last year with the school. I had my son picked up and told to leave while they physically held him. I had a teacher I very much respect still'cause I, I do believe that this teacher was doing what she thought was best. Saying to my son, you're making your mum really sad when you behave like this. You don't wanna make your mum sad, do you? And then she's saying, you're making me really sad.

Leisa Reichelt: 29:16

Oh my God.

Dr Kara Johns: 29:16

You are trying to make my son feel guilty and responsible for adult emotions. Like this is 101 of'we do not do this to our children'. So I can see how easy it is as parents because you do assume that the educators and the teachers know best. I see it as a knowledge gap in schools and that we need to be getting our educators to do more continuous professional development in this space. We need to be getting psychologists into these schools to inform them on how they're handling these behaviours. Because it's not okay. The way we very quickly turned the behaviour response around with my son had nothing to do with the school. the process we had was getting him to say, I feel, and then say the emotion. I was developing with him some tasks to calm his nervous system down. So breathing exercises to dial down his nervous system to allow him to make better decisions that he was comfortable and happy with. So we would do a round of breathing exercises together and he would then repeat, I feel X, and then say, okay, what do you want to do? And he's a hugely social kid, actually loves to learn. Once we calmed his nervous system down every day, he chose to stay at school. Schools need to be validating and working with emotions. So we have a lot of work to do as a society on that.

Leisa Reichelt: 30:27

Let's get really practical now and focus specifically on the Australian health system apologies to international listeners who might not find this quite so helpful. Things that families who have School Can't kids should be aware of about how the Australian health system works, Kara? I'm thinking about things like, the big thing for me was I discovered the Medicare safety net and the fact that my family wasn't registered and we got registered and we had already passed the safety net by the time I registered. So that was a joy to discover.

Dr Kara Johns: 31:03

Just yesterday I logged in for my family and I can see that we've hit the safety net, but it hasn't been applied.

Leisa Reichelt: 31:10

Can you describe the Safety Net system, how that works and why it's important?

Dr Kara Johns: 31:14

I'll try. look, I think just even stepping back, the Australian health system is complex. We have a Medicare system in Australia whereby the patient can get a rebate through Medicare, which is a government set up rebate system to fund healthcare expenses. When this first got introduced, the Medicare rebate was very close to the cost of the service. Unfortunately, successive governments have not funded Medicare. They even froze the Medicare rebate for a number of years. Every year when CPI rises, for general practitioners accepting the Medicare rebate, they didn't get a pay rise for 10 or so years. Australian Medical Association, the AMA, sets out guidelines of fees, every year for different professions. They're currently saying the standard general practice appointment, which is that 10 to 15 minute appointment, is valued at about$105 for the appointment. Medicare rebate now is$42. So there is a massive gap. The Medicare safety net says that across a calendar year, once the gap amount reaches a certain threshold, Medicare will start paying more about 80%. I have patients now that see me for 30 minutes, they're charged a 30 minute fee, which at our clinic is about$195. And their gap at the moment, because they've reached the safety net, is about$20. There still is a gap. What that threshold is, it's the gap component. So if it was a hundred dollars and 40 from Medicare it's the 60 that goes towards the safety net for that. For singles, it's about 2,600. But then here's the thing, if you're a family. You can tell Medicare you're a family, and that 2,600 would apply for your whole family collectively. So if it's two teenagers or two children and two adults, that's four people that can cumulatively get the 2,600. But you often need to tell Medicare that even if you're on the same Medicare card, they won't consider you a family. You have to go in and tell them. When you're on the safety net, once the threshold has reached throughout the year, you still need to log in and go confirm my family. Otherwise the rebate doesn't apply. How ridiculous is this? But for families that are seeing health issues any service that you are getting a Medicare rebate from that gap can then apply over to accumulating on your safety net. So if you think about it, if you've seen your GP and they're that central person in your journey and then they've referred you to a psychologist and the psychologist, then you get a Medicare rebate on the gap with your psychologist goes towards your safety net. But if you just went from the school's recommendations and went out and saw a psychologist or an OT, you're paying for it all privately and none of that accumulates onto your Medicare safety net. Then that leads into the next step about can you get referrals from a GP onto Allied Health and to Partialists. Yes, you can, but there are rules around it. So first one is a Mental Healthcare Plan. If your child or yourself meet the eligibility criteria, which Medicare stipulates, we can compile a Mental Healthcare Plan, which in Australia opens up 10 subsidised sessions with a psychologist per year. So it's not much, but it's better than nothing. So 10 subsidised sessions, it's not fully funded, it's subsidised. So, what I try to explain to patients again is that the recommended fee for a psychologist is around$300 a session now, and the Medicare rebate depends on whether it's a registered or clinical psychologist as well, but it can be around a hundred dollars. So you're still gonna be out of pocket a decent chunk. So it's still a big gap. And then in terms of other Allied Health, there are avenues that we can get Allied Health involved. Again, it has to be that the eligibility criteria met for something called a Chronic Disease Care Plan. So it has to be that you or the child, depending on who's the referring patient, they have to meet the criteria. And if you meet a criteria you can get referral to particular allied health people for subsidised sessions, and you only get five per year.

Leisa Reichelt: 34:59

Hmm.

Dr Kara Johns: 35:00

again, anyone with chronic health issues you like, if you have autoimmune arthritises and you have a physio that helps you manage your pain you're gonna use up probably within two months, three months. So it's not a huge amount, but it can help, but it also then adds to your safety net as well. So all that accumulates up. Families will find they'll hit the safety net quite quickly in the year, and then their health costs significantly go down.

Leisa Reichelt: 35:23

Massively.

Dr Kara Johns: 35:24

Yeah.

Leisa Reichelt: 35:25

A massive, massive change, especially if you are having to front up to psychiatrists for ADHD and various other things like that. it can really mount up.

Dr Kara Johns: 35:33

It can.

Leisa Reichelt: 35:33

That's really interesting though. I had not thought about the benefit of using the mental health and chronic disease plans because of the contribution that would make to the safety net. I didn't know about that, but that's very helpful to know.

Dr Kara Johns: 35:44

Yeah, I mean, again, it requires you to have those appointments with the general practitioner to do up that paperwork. At the start of every year, I try to get all my patients, I try to remind everyone, have you got your family safety net set up Medicare safety net set up?

Leisa Reichelt: 35:57

Definitely. And I think the other thing that I learned is if you register your family for the safety net sort of mid-year, it will still count all of the stuff that you'd done earlier in the year before you were registered. So yeah, we registered for the first time in June and we were already well over the safety net limit. So that was a pleasant surprise.

Dr Kara Johns: 36:14

yeah,

Leisa Reichelt: 36:14

Kara, when we were talking before, you mentioned another, health plan to support folk with eating disorders.

Dr Kara Johns: 36:20

So

Leisa Reichelt: 36:20

was one I'd not heard of.

Dr Kara Johns: 36:22

Yeah, there's an eating disorder mental health care plan. It's only been around for a few years. My understanding of it is, and honestly I've probably only ever done two or three of them. So this was, I guess the government's or Medicare, being part of Australian government. It was their way of addressing the need to have separate services for people with eating disorders. However, what I find is that the eligibility criteria are such that a lot of people won't qualify. So it can be

Leisa Reichelt: 36:47

Hmm.

Dr Kara Johns: 36:48

it's worth exploring because what the eating disorder care plan does is it opens up 20 psychology appointments. and dieticians, I might get this wrong, but I think it's 20 dietician appointments and 20 psychology appointments that get a Medicare subsidy

Leisa Reichelt: 37:01

Hmm.

Dr Kara Johns: 37:01

sessions. so it's worth discussing because I know with a lot of young children, particularly when we're facing certain neurodiversity aspects, there are sensory components to eating and food that can often make food intake be less than ideal. My son, particularly just doesn't like the texture of meat, which is. Totally fine. He doesn't have to eat meat, it's not a problem. however, we need to make sure that he has adequate iron. And so

Leisa Reichelt: 37:25

Hmm.

Dr Kara Johns: 37:25

often at risk of being low iron. So we have to constantly manage his iron because low iron. often I see in children, it's very interesting but I often see in young children, particularly when they've been, emotionally regulated, and then they're going through a phase of emotional dysregulation. I'll check their iron, and often it's low, something's happened. So low iron can be a contributing thing. It can be a sign. So behavioural, emotional dysregulation, particularly when it's a change, can sometimes be a sign that their iron has dropped off. And we can address that, both giving them iron supplements. And we can often see these children get better emotional resilience and better cognitive functioning, which means they learn better and engage better at school.

Leisa Reichelt: 37:58

Oh.

Dr Kara Johns: 37:58

a key one,

Leisa Reichelt: 38:00

Car. I think you've just done a beautiful demonstration of the power of general practice, Which is that so many of our specialists would look at this through their lens of expertise and go, well, it's emotional dysregulation. We've got to do some kind of therapeutic thing. And like you sitting in the center of all of that, you can go, well, it could be this, or it could be that, or it could be the other thing. and here's all of these other different options. And that's a superpower.

Dr Kara Johns: 38:23

it is, fascinating, to see, and I see that, with my son's peer group as well, like you said, the emotional dysregulation of a child and the school's going down, the OT psychologist and I'm kind of going go to the GP and check their iron.

Leisa Reichelt: 38:34

Mm-hmm.

Dr Kara Johns: 38:35

and it's surprising the number of children that have low iron. for most children it's multifactorial. We can't put all our eggs in one basket, but we should be thinking about all the different contributing factors. And so my son within Attentitive, ADHD, and he does have strong emotions and we know that's part of ADHD pathway, but if his iron's dropped, his emotions are bigger. It's very noticeable. When it happens, you go, oh, right, okay. We better get back onto that. it can be multiple factors and we need to keep our mind broad to what's going on and how we can help.

Leisa Reichelt: 39:02

many women will know that life is so much easier when your iron's at the right level.

Dr Kara Johns: 39:07

a hundred percent.

Leisa Reichelt: 39:11

Amazing. Kara, I wonder, you've given us so much amazing content and things to think about in our conversation so far, but are there any resources that you think families who are experiencing School Can't should be across?

Dr Kara Johns: 39:28

It's a funny question actually, because more recently, families that I'm meeting where their children are having trouble to go to school, I'm actually directing them to your website. The School Can't website. and the feedback I'm getting is that it's a great place to land for these families because

Leisa Reichelt: 39:43

Hmm.

Dr Kara Johns: 39:44

getting key information and the support base.

Leisa Reichelt: 39:46

Hmm.

Dr Kara Johns: 39:46

your website is the first one. but then it really largely depends on the family situation, because there are different resources for different families, for different situations. there is a podcast that a colleague mentioned to me recently called Pop Culture Parenting. I've only listened to a few episodes I'm always quite skeptical when I go into listening to these things, but I was actually quite impressed by the conversations going on in that podcast.

Leisa Reichelt: 40:07

Yeah.

Dr Kara Johns: 40:09

in South Australia there's a lovely website by some psychologists It's a Developing Minds psychologist group and they've got some great stuff on their website. there's even a program I think that parents can pay to do. I believe it's like$20 or something. it's all around emotional regulation in children. So I sometimes direct families to that website. They also do great articles that are all available. So I think that's a great resource. For ADHD stuff, which is, I guess, because it's my own journey with my son. it's an area that I'm doing a lot more reading on. There's a great website, by a psychiatrist in Melbourne and it's Reflect Health. If you go to their ADHD section, they've got a whole bunch of resources there that she's created and she's got it all up for free. And she set it up as a building So she's got ground level, floor one, floor two, floor 3, 4 4, and it is more targeted towards adults. But there is some interesting resources in there around children as well, particularly teenagers. And the way she explains ADHD is the best I've ever seen explained. And she gives great analogies. she talks about what the neurotransmitters are doing in the synapses and saying the nerves in ADHD have extra vacuum cleaners that are sucking out the neurotransmitters. And that was a concept my son could get. So he'll say, I've got extra vacuum cleaners in my head. There are some wonderful, very extensive resources on Reflect Health for families that are wanting to understand ADHD better as well.

Leisa Reichelt: 41:26

That is fantastic. We will put links to all of those in the notes so that folk can go and explore them for themselves Alright, well Kara, thank you so much for taking the time to come talk to us about this. I think building that relationship with your GP is something that I came to very late in my still ongoing journey. And I just wish that I had my GP as an ally alongside the whole way through here. I think it can make a huge difference on this difficult pathway. Alright, thank you so much. Really appreciate it.

Dr Kara Johns: 41:59

Take care.

Leisa Reichelt: 42:00

Well, I hope Kara has inspired you to think about how a great GP can support you and your family on the School Can't journey, and to make sure that your family is registered for the Medicare safety net as well. Both of these things made a huge difference for me once I finally discovered them. If you've found our podcast helpful, please do take a moment to subscribe or give us a rating or review. This really does help us get the podcast in front of more people with School Can't kids who haven't yet found our community and the information that we share. If you have some feedback for us or a suggestion for a future topic or speaker, or maybe you have been inspired to share your own lived experience story, please drop me an email to schoolcantpodcast@gmail.com. I would love to hear from you. If you're a parent or carer in Australia and you're feeling distressed, remember you can call the Parent Helpline in your state. A link with the number to call is in the episode notes. Sadly, on the 31st of October, the Victorian government will be shutting down their state Parent Line, which is very disappointing. I've put a link to a petition you can sign to protest this in the episode notes if you are inclined to do so. Thank you again for listening. We will talk again soon. Take care.