NIH Childrens School 

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NIH CHILDREN’S SCHOOL ORAL HISTORY

On December 8, 2021, teachers at the NIH Children’s School participated in an oral history with Dr. Gordon Margolin of the Office of NIH History. Teacher Anna Davidson and Dr. Gena Mooneyham spoke about the school for children participating in studies at the National Institute of Mental Health (NIMH). William Ring and John Golden represented the school for children participating in studies from one of the other 26 institutes and centers of the NIH. Both schools are located in the NIH Clinical Center, the world’s largest research hospital, which treats people from all over the world as they participate in biomedical research protocols.

MARGOLIN: Today is December 8, 2021. I'm Dr. Gordon Margolin, volunteer in the Office of NIH History and Stetten Museum, about to interview some very important people who have had a great deal to do with the Children's School at NIH. You'll hear all about the history and the involvement of the students and of the teachers particularly. The first portion of this meeting is going to be devoted to the NIMH school where Anna Davidson has been teaching for a number of years.

RING:  To be clear, it's one school with two classrooms. 

MARGOLIN: That's important to know. I was hoping we would get that clarified. So, it's one school with two classrooms and we're going to start with the NIMH classroom and ask Anna Davidson, who's been teaching there for a number of years, to tell us a little bit about the history of the school system and a little bit about her own personal history, how long she's been present. Anna, as a teacher of many years, I will ask you the question:  What do you know about the history of this school?

DAVIDSON:  Back in 1953 NIH formed the contract with Montgomery County Public Schools to provide teachers for the students who are coming in on the various [research] protocols here at NIH. The early directors of the school were Mrs. Gilbert and Mrs. Dowd, and then Helen Mays who was the director for 30 plus years.  She was followed by Julie Fuchs-Margolis and William Ring.

When I came on board, I had been with Home and Hospital Teachers of Montgomery County since 1976.  In 1985, I began teaching here at NIH when the director of Home and Hospital Teachers asked if I would consider teaching at NIH.  Helen Mays had mentioned to the Home and Hospital administrator that she knew me from sharing several students.  When the students were at NIH, Mrs. Mays had them and when the county students were sent home, I would have them.  When I joined the teaching team, the teachers were Beezie Clapper, Chris Liebner, Mary Pat Jones, Nancy Bean, Helen Mays, and then myself.

MARGOLIN:  I want to ask a question. Did the Montgomery County school system set this up? What was their interest?

DAVIDSON:  No, it was NIH who had the interest in providing education for children who were coming here on the various protocols. They wanted to make sure that if a student was here for any amount of time, they were keeping up with their lessons and not falling behind when they would return home.

MARGOLIN:  So, tell me about the role that you play there on a daily basis.

DAVIDSON:  When I became a teacher at NIH, I saw children in the classroom from all the various Institutes.  However, every summer, I would teach the students who were on the Behavioral Mental Health Unit.  Chris Liebner was the teacher at the time and wanted off each summer, so I volunteered.  The Behavioral Mental Health classroom operated on a twelve-month schedule as each discipline was involved in the child’s treatment and evaluation.  The other classroom operated on a nine-month school schedule.

The protocol that was in operation on the Behavioral Mental Health unit in 1985 was addressing children with ADHD. The students entered a “blinded” study [meaning that no one knew if they were on a particular medication or a placebo] and we were blinded—we didn't know whether they were on or off medication. But, we could often tell a difference. As teachers, we were not only assisting the students with their lessons, but we were always writing down what we were observing in each child.

When Dr. Judith Rappaport added additional protocols to the ADHD studies, she was looking at children with Tourette [Syndrome] and obsessive-compulsive disorder and then schizophrenic disorder, she requested an additional teacher because with the additional students, it would require teaching all day to meet the needs of the diverse population.  At that time, I moved to the NIMH classroom full time. We would have maybe seven students in the morning and then in the afternoon, we would have students who needed one-on-one attention. Students in the schizophrenic program, who were higher functioning and less distracted by stimuli attended school in the morning with the other students on the unit, and if they were more involved with their stimuli, we would teach them individually in the afternoon.

Since the protocols under Dr. Judith Rapoport of ADHD, ADHD and Tic Disorder, Obsessive Compulsive Disorder and Schizophrenia, we have had protocols under Dr. Ellen Leibenluft of Mood Dysregulation and Bipolar Disorder and under Dr. Argyis Stringarius depression.  I don’t know the names of principle doctors of research protocols at NIMH before 1985.

MARGOLIN: If you taught them in the morning was it in a classroom that all of them attended at the same time?

DAVIDSON:  Yes. We would have seven or eight desks set up with a lesson plan on each of child’s desk and the material that they would need to work with that day, set beside their desk. Some of the material was sent from their [home] school; otherwise we had many books that we pulled from that we could use to plan their lessons at their functional level.

MARGOLIN:  What were the age ranges and the subject ranges that you had to cover with these students all at the same time?

DAVIDSON: With the ADHD program the children were from first grade through sixth grade and so we taught reading, math, science, social studies, the core curriculum. Children who had schizophrenia or who had obsessive-compulsive disorder, were usually older, but we would still cover the core subjects with them every day. With Dr. Leibenluft’s protocols, the ages varied between children in elementary school to high school, depending upon the study.

MARGOLIN: Each student got all this one-on-one teaching directly from the teachers.

DAVIDSON: Essentially, because, as I said, we would have a lesson plan on their desk and all of the materials that they would be working with beside their desk and then we would go to each student and help them. Some of the students we would have to read with them. We might outline above the words as they read; other times we would share reading. We would say, “I'll read a paragraph, you read a paragraph” or “You write a sentence and I’ll write a sentence” or “You tell me what your thoughts are and I'll put it down.”  With some students they were thinking faster than what they could get down on paper, so we would support them by writing for them. Writing for some was labor intensive and would become frustrating, so we supported the child in whatever way would help them to succeed.

MARGOLIN:  Tell me how the students got selected for this program. How did they end up in the psych[iatric] unit?

DAVIDSON:   Their parents may have looked for [ongoing] studies of their child’s particular disease or disorder and would see NIH was studying their particular disease.  Their pediatrician, doctor or psychiatrist or word of mouth might have been other ways to hear of an NIH study.   They would contact NIH and go through a screening process before they would be admitted to the protocol. 

MARGOLIN:  Where did the students come from basically?

DAVIDSON:  The students with the ADHD program were day students. They came from within a 25-mile radius and NIH sent either a taxi or a van to pick them up every day [and] bring them to NIH where they would have breakfast. They would have school [in the mornings], they would have recreation therapy, art therapy and music therapy in the afternoons, and then they would go home about 3:30 or 4 o'clock. In all the other protocols, children came from all over the United States.

MARGOLIN:   They were all on research protocols, is that correct, under the care of the doctors?

DAVIDSON:  Yes. Then the schizophrenic children were on the Behavioral Mental health Unit [in the NIH Clinical Center] where they each had their own room. The children would come to the classroom or, if need be, we would teach them in their bedrooms.  This held true for all the other protocols following the ADHD protocol.

MARGOLIN: Those were locked rooms. Is that correct?

DAVIDSON:  The rooms were not locked; the unit was for the safety of the students.

MARGOLIN:   So, you got them from all ages, all the way from the first grade through high school and from any community in the country?

DAVIDSON: That's right. We did have one student who came from Israel, and he came back three different times for additional schizophrenic protocols. Just this last year his father sent an email saying his son was getting married, and he wished he could provide transportation for Dr. Tossell, Susan Job,  and myself to attend the wedding.

MARGOLIN:  That's very nice. You formed quite a good relationship with him. He's the only foreign student you had?

DAVIDSON: The only foreign student that we had that I can think of here on the unit. We did have some from Alaska but that's far north in the United States!

MARGOLIN:  Did that Israeli student speak English?

DAVIDSON:  No. It was a process of teaching him English. He was very involved with stimuli when he came, and he liked to pace.  We would walk with him and point out things, have him repeat words of objects we named. It was evident he wanted to learn. Each time he came back his English had improved. I understand that he was doing English teaching as an adult.

MARGOLIN:  Tell me how you assign each student to what he or she was entitled. How did you get their background and knowledge of their level of education?

DAVIDSON:  When a student came in, we would first of all have the parents sign a release of information form that would allow us to contact the school.   We usually asked to speak with the counselor or principal and the teacher.  The information we gathered were his current curriculum, the student’s strengths, weaknesses, behaviors, and how we could best support the child. We would also ask the teachers to send the child’s school books if they chose, but if they chose not to, we wanted to know what concepts the child was to be working on in each subject, and we would supply the books and materials to meet their criteria and plan it from there.  When a child returned home, the teachers would send all the work the child had completed, and we would write out a detailed report, sometimes three or four pages, with what we observed, how we saw them when they came in and as they left.  The teachers also made recommendations [of things] that we saw that worked well, while working with the student. The teachers also had contact with the parents every week to let the parents know how the child was doing. Regardless of the protocol that the child was on, we always contacted parents every week.

MARGOLIN:  And how long did most of the students stay?  What was the average?

DAVIDSON:  It depended upon how many medications the child was on when they first arrived at NIH, because they were observed on their current medication and then they were withdrawn from all of their medications.  Sometimes it would take three weeks or so to gradually withdraw them from their medication so that [the researchers] could get a baseline as to how the child appeared off medication and the doctors could make a correct diagnosis. Children were often here three or four months.

MARGOLIN:  Now how many students at a time have you been responsible for? What's the lowest and what has been the highest?

DAVIDSON:  The highest was eight children; the lowest was four.

MARGOLIN:  So, you were able to teach all of them any of the subjects?

DAVIDSON:  Remember there were two of us. With two teachers in the classroom, each of us would split the load as far as daily lesson plans, talking to the parents and the school, and writing up the final report for each child.  However. both of us would help any of the students that were in the classroom with their lessons at any given time.

MARGOLIN:  But now you're down to one teacher. Does that reflect on the recent pandemic we've gone through?

DAVIDSON:  Yes.

MARGOLIN:  How many students do you currently have?

DAVIDSON:  During the pandemic, the Depression study ended and the teacher that was teaching with me, Errol Rose, left to get a teaching position in a high school, and we have not filled his position yet, as we have not needed the additional teacher

MARGOLIN:  You had told me that you scored students each day regarding their behavior or their activities and then you attended meetings with the whole group of providers every week to discuss each student and what had happened to them during the week.  Is that correct?

DAVIDSON:  That's correct. We daily would observe whether they were having learning deficits, attention deficits, whether they were impulsive or easily frustrated and a variety of other things.  The teacher kept a daily log of everything we observed on various rating forms.  Each week we gathered the daily observations in a report that we shared with the other members of the team and they did likewise.   We would be meeting with the doctors, nurses, recreation therapist, social worker, art therapist, speech therapist, and chaplain. Anyone who worked with the child. We would all share what we were observing in each of these students. For instance, with the schizophrenic child we would be observing are they staring off, looking around, or hallucinating.  Are they repeating everything back that we say? Are they smelling their books? Things like that. Our goal was to keep the child in the real world. We gave them breaks as they needed a break, or we would take them outside for a walk, or we might say, “Okay let's go to the outside and have class outside this afternoon.”  With children in the depression study we took them on field trips to museums in D. C.  In activity outside the classroom, nursing staff would accompany us.

MARGOLIN:  You hold classes five days a week like they would have in regular schooling?

DAVIDSON:  Yes, for three and a half hours in the morning and then if the child was seen in the afternoon, it was usually for two and a half to three hours.

MARGOLIN:  Give me an idea if you learned that a new research subject, a new student, was coming into the unit and he or she was going to be eligible for education. Tell me how you would approach the whole process and what and how you accomplished this and got into their lives, so to speak.

DAVIDSON:  How did I get into their lives? Well, as I said, we would contact the school, find out where they were working before they came onto the unit. One of the first things that we would do in the classroom is have everybody get to know each other, because there were usually three or four students who had been here for a while. The students who had been with us for a while would tell the new student the classroom routine and expectations. Then, we might play a little game to get everybody acquainted. This was followed by the teacher giving the wide-range achievement test to find out the new student’s functional level. This helped us then plan the work that we would be giving them, because sometimes where they were expected to be was not at their functional level. This was very frustrating for them and just added to their stress and with the schizophrenic child an escape into the other world and for other children a time of acting out.  So, we would use the concepts that needed to be taught, but we would teach it at a lower level and at more gradual pace so that they could build up their self-confidence.

MARGOLIN:  You were dealing with mentally ill students, so you had to deal with them differently than I suspect we'll be hearing from the rest of the crew here in a few minutes. I have one more question. How did you grade the students for their work and send the grades back to the schools?

DAVIDSON:  We explained to the school that we did not give grades. The doctors did not feel that it was fair to give grades because of the difficulties and stress children would be under as they were withdrawn from medication and tried of various medications. All daily school work would be corrected before they left the classroom each day and, we would show at the top of the page how many they had gotten correct or assistance needed. It was up to the school whether they wanted to just give a pass or a satisfactory grade, for that period. They could see that the child had done the work. Then over the last several years we would scan back to the school weekly what the student had completed, so that the school each week would see where the student was and send us additional work.  More recently the student might be doing his work on line and the work would go to the school directly.  We supported the child with step by step directions, answered questions, and offered any support to help them succeed.

GM: And the local schools accepted your evaluations and gave them credit for that. The credit led to graduation in a normal way.  Is that correct?

DAVIDSON:  Yeah.

MARGOLIN:  So, you just partnered with the regular school system at a remote site essentially.

DAVIDSON: I guess you could say that.

MARGOLIN: Now, I'm going to talk with Dr. Gena Mooneyham, the Medical Director of the NIMH Autoimmune Brain Disorder Section. She's a pediatrician and a psychiatrist and will tell us about herself. She is one of the mentors or leaders of the group that Anna has been describing.  Dr. Mooneyham, would you tell us about your experience with these same students and how they've done under this rubric that you just heard?

Gena M:  Absolutely. So my name is Gena Mooneyham and I'm the medical director for the NIMH autoimmune brain disorders program here at the Clinical Center. Ms. Davidson's contribution to the NIMH is truly hard to fully capture in words. She has really been a huge part of creating this unit’s infrastructure here where there's quite an enriched environment and a philosophy of care that's really centered on a multi-disciplinary perspective. Essentially Ann has amassed more than 30 years of experience teaching children and adolescents who are having a very wide variety of psychiatric symptoms that they're struggling with, but her level of expertise is simply unmatched. I became aware of her work because my own portfolio of clinical and translational research is really an offshoot of the studies that Judy Rappaport had done looking at childhood-onset schizophrenia.  As I was combing through the papers and trying to understand, really on a listening tour here at the Clinical Center, I was completely awestruck when I realized that Anna had been a part of a 30-plus year portfolio looking at childhood onset schizophrenia. Essentially, she would tailor the curriculum to the developmental level of the child and somehow, with a bit of magic perhaps, she created an environment that really fostered a willingness to learn. Children seem to be quite drawn to her and she carries herself with really a mix of warmth as well as authority, but she allows all of our patients to reconnect with the joy of learning.

A lot of these children frankly are at risk of being excluded in their traditional school environments or classroom environments because of their symptoms. She's quite humble but what she may not have fully stated is that so many of these kids may be experiencing sensory or perceptual disturbances, like auditory or visual hallucinations, and Ms. Davidson would truly be able to ground them back to reality, connect with them in a way that just made them feel safe. It was a non-threatening environment. She looks for their strengths and she's able to articulate those in such a meaningful way that it really highlights the success of each learner that she's interacting with.

Maybe the most impressive part of this is that the children that she has been teaching usually are enrolled in studies here on the unit that require a medication washout period, so she was having to move in a very dynamic fashion. As they had differences in their symptom burden, she would become flexible and move along with them, so her approach philosophically was adapting to the growth of her students in real time. Some of them showed stabilization when they were placed on med[ication] interventions and others showed destabilization when the medication washout window was attempted, but Ms. Davidson just stayed with them and she, along with the other teachers that were here on the unit, really allowed for them to be successful.

DAVIDSON:  Dr. Mooneyham is most kind. Susan Job was my cohort in teaching these students for 25 years and then she retired, so everything that Gena said applied to Susan Job too. We worked on this together.

RING:  It should be added that Anna is not allowed to retire.

MARGOLIN:  That sounds like she's very, very essential to the whole program and it's really remarkable how she's able to meet the needs of each of these very difficult research subjects at their own level. I think it's an outstanding presentation that we've just heard from her.

DAVIDSON:  We learned a lot as we went along. The doctors helped by pointing out things for which we might look for as did other team members. Susan and I always said you can't beat the One Southwest Unit because everybody is so supportive. The nursing staff—everybody—they’re right there at your back at all times.

MARGOLIN:  I am going to take the prerogative of the moderator and move to the other half of the NIH classroom endeavors, where William Ring is the director and a teacher and is joined by John Golden who is his associate. I'd like to hear a little bit first from you, Bill, about your students, where they come from, what their diagnoses are, and what your special problems are.

RING:  Anna's environment is much more controlled than ours and so I envy her structure quite a lot. We don't know what's going to happen on any given day with ours and, again, I think you'll find a lot of overlap between my experience and John's. In fact, maybe you want to hear John first and then I'll just be a footnote to what these two fine teachers have to say.

MARGOLIN:  We'll use you at both ends. Give us your background and your experience and the time and service and then we'll hear from John.

RING:  I was a classroom teacher in Montgomery County public schools for 35 years. I taught everything in Social Studies and English. I've even taught adults in little business colleges; I taught them English, writing, and psychology as well. I taught basically everything I could in what we might call the humanities.

Then they put me out to pasture, and that did not work, and so I started working for the Home and Hospital Program, which has become known as Interim Instructional Services because we do a service. I did that for a semester and then the job as director here opened up and so I applied for it. I didn't think I would get it or anything. Actually, Anna was part of interviewing me—tough questioner, she. In any event, it just kind of fell to me and so I'm now six and a half years into it and, did I ever teach before? I don't know. This is an all-consuming environment. It seems like I've always been here, but of course I've not. Anna's the one with the deep memory. But I‘ve found it to be the best job I've ever had. And also the hardest. I know this month we lost five students here, including one of Anna's, two of John's, and then two that we had worked with. It does add up one way or another. As one of the nurses said, “There's a black cloud over us right now.” I almost lost a four-month-old infant yesterday. I'm sure Anna could amplify on this and John as well. This is not: you meet the kid and you offer lessons and maybe they accept, maybe they aren't too interested or whatever. No, you meet the entire family. Lots of them are here for extended periods of time—more than two years. It's not unusual to have somebody here for a year. But even if they're here for a few weeks or a month, we fill in so they can stay up with things. The older kids especially are very conscious of what their age peers are doing back at their home schools and so they're anxious to stay up. It's a little more give or take with the younger kids. Some of them come here without any support from their home schools. And this is particularly pernicious, I think, but some of the home schools actually remove them from the rolls; it's like, “Oh, ha, you don't exist anymore,” which is not very good for morale. As John will be able to confirm, contact with home schools can be very, very ragged. Some of them are right on top of things, some of them are just, “Okay, well, let’s be fair, do what you can” and then we'll maybe write an evaluation of where they might be as regards what could be expected of their peers.

MARGOLIN: Yes, where do they come from and how do they get in and what are some of the diagnoses?

RING:  They come from everywhere, all over the United States and all over the world. Before covid struck one of the ones I was working with was from Mongolia and that was fascinating because he was always watching videos about Genghis Khan (it is a soft G by the way). His mother was a French interpreter, and she was quickly adding English to her portfolio. You learn all kinds of things from them. But the overall point I was trying to make is that you get close to them, and not just the individual student or patient, but the entire family. We have a lot of ALL [acute lymphoblastic leukemia], a number of aplastic anemia cases and so on. Many of them already know each other before they come, before they're inpatients, or before they ever meet at the Children’s Inn, they've been part of support groups online and so it's a whole community. So when you lose one of them, the entire community crashes. It can be really terrible. But still you like to think that you're doing the best you can for them. I'm thinking now of a four-year-old boy from Mexico I had a few years ago who ultimately died. Until that time, of course, I was teaching him English. He was a very active inquiring four-year-old, what you would expect, and I love to pun so he gave me the chance to make some bilingual puns. For instance, he would do what any four-year-old might do when he was out in the corridor, he grabbed my belt from behind and [I would say] “Oh, where is Santiago? Where is Santiago?” and then he'd laugh and say,  “Aquí, aquí.” Then I would pull out my key and say, “Santiago is not a key. Santiago is a boy, el niño,” and he'd laugh. Find moments like that to teach English. They come from everywhere and the people running the protocols are the ones who funnel them to us.

MARGOLIN:  What's the range in numbers that you deal with?  Numbers at any one time of students.

RING:  That fluctuates wildly. We've had a very consistently low census over here for the last two and a half months, very low. Covid has to be a major factor here. The fact is when it rains, it pours. Sometimes we're jammed, other times these papers are blowing through the hall.

DAVIDSON: Sometimes I go over there and help out if needed because you are overwhelmed with so many students, and then other times you have just a few. That's right.

MARGOLIN:  Where are they housed if they stay such a long time? They don't stay in the hospital all the time. 

RING:  It's worth noting that we do have the inpatient ones and so we either meet them bedside or, if they're able, they can come to our classroom. But we also have outpatients, so there's a day hospital here and so we might meet them there as well. Some of them, if they’re done at the Children’s Inn [on the NIH campus], they’ll just come up on a regular basis to meet with teachers.

DAVIDSON:  Then NIH also has the Woodmont house; I mean they have other places where they house families.

RING: Especially if they have to be in isolation.

DAVIDSON: Right. Or they might be in a hotel nearby.

MARGOLIN:  Are they on the campus at the Children's Inn at all?

DAVIDSON:  Some are at the Children’s Inn.

MARGOLIN:  What subjects do you teach? You go all the way to high school and mostly social sciences you said, Bill. 

RING:  Mostly. Well, I can handle the math, so on up until that point.  I had one girl I taught long division to, a nine-year-old. She said that I made math fun and I figured, well, that's the point for me to walk off into the forest and never be seen again. Yeah, I never expected that one.

MARGOLIN: I think it’s amazing how you teach so many different subjects to so many different ages and you're constantly varying your curricula.

RING: It's very stimulating.

MARGOLIN: It's outstanding. It’s hard to really imagine that it ever happened to any of my teachers in school all the way through.

RING: Did any of them walk off into the forest after they achieved the pinnacle—it’s just an extended metaphor.

MARGOLIN:  It's really an amazing endeavor that you have. Now your classroom is a different classroom than the one Anna has? 

RING:  That's right. She's on One Southwest; we're on One Northwest .

MARGOLIN:  You don't mix the students from the two portions of the school? 

RING:   Occasionally. I've worked with Ann's people sometimes when she's had other things going on or if she was on vacation, something like that. I've done that. But for years we had Susan and then Errol came in and he is a former Air Force officer, and he is very good with the higher math and with chemistry and physics and so on. It's hard to get substitutes in Montgomery County. We're trying to recruit somebody from the retiree list, which would have been me, too, but so far, we haven't filled it.

MARGOLIN:  Tell me about the attitude of your students. They’re coming here and I would think some must think they were playing hooky as they're getting away from school. Do they get involved in the school work, a hundred percent?

RING:  Probably, we don't see them more than one or twice in some cases, two if we're splitting a student at a time. But a lot of them are really eager beavers. I mean last spring I had a student from France. He was 12 and he had studied English for three years. He had read “Old Man and the Sea” in French and then I said, “How would you like to read it in English?” and he was just overjoyed. All the original. It's wonderful. Some of them are really up for that kind of thing; others might be dragging their feet but that's always going to be the case, right, in any population.

MARGOLIN:  That's an important answer. John Golden is your associate here.

RING:   I'll move back, and he can move into the picture.

MARGOLIN:  How do you do? And what variables do you see within your work flow from what's been described?

GOLDEN:   Bill said it very well, but I can tell you that I came to this program in the summer of 2016 via Interim Instructional Services, the old Home and Hospital Service, and so I'm going into my fifth year and I absolutely love it. Like Bill said, it's the hardest job I've had, but the best one. I teach students ranging from age 4 all the way until 18, and I teach across all subjects. My focus is History and English, but I'm capable of teaching math roughly up to algebra 1 and geometry, and science, as long as we don't get into advanced chemistry. I simply don't remember any of that. It's not that I don't “get it”; it’s just not my bailiwick.

We never know when a student may not be feeling well, when they may be scheduled for a procedure, so we have to tailor everything around that. Most days I'm quite busy, but some days I can be fairly free. A student just simply may not be available. You really do become a part of their life and the life of their family. I have somebody that I'm currently working with who is here with his sister. They're from Bolivia and the sister is the legal guardian. I will be with him until he leaves in the summer of 2023, and my goal is to keep him up to speed at his home school in Bolivia. I know enough Spanish that I can read his curriculum and make sure he gets everything done but I am also catching him up on his math and teaching him English so that's quite a bit.

MARGOLIN:   That's outstanding from my outlook. I can't imagine that you can do all that teaching, but all of you rise to the occasion.

GOLDEN:  I try.

MARGOLIN:  Also many of your students are not English speaking.

RING:  For four years I taught a boy who had a rather nasty brain tumor from the Dominican Republic. I taught him English and just before we got to the point where—we were reading Neruda poems, Pablo Neruda, and there's one “We are Everyone” and I found the original side by side with a really wonderful English translation and so the idea was I would memorize it in Spanish, and he'd memorize it in English. That kind of thing. It didn't work out because he died. I still have to memorize it in his honor. I'll do that.

MARGOLIN:  There are many very sick students and I imagine the medications are changing constantly and they're under different protocols, so you have to adapt to that. You have different set of difficulties with dealing with your students than Anna has with hers. Do you have to write up regular reports and sit in on assessment evaluations of the students, too?

GOLDEN:  We do not issue grades. We issue an assessment generally at the end of their study, listing what they've done. A lot of these students are also now on online curriculum, so a lot of it is supporting their online curriculum, helping them complete lessons, so it's incumbent on them to submit the work to their home schools. Oftentimes the school will say, “What have you been working on with this student?” and then I would submit, and Bill would do this too. We would submit reports to the school. We do not issue grades either, but we try to work as closely with the home school as possible to coordinate everything.

MARGOLIN:  It must be difficult.

RING:  One other thing that should be mentioned. Many of the home schools that really are involved seem to expect that the student can keep up the same pace as if they were back home, and sometimes we have to tell them, “No, you're going to have to pare this down; you're going to have to do this in such a way that you don't overwhelm these very ill children.” Because it is possible one-on-one to get a lot more done or to get concepts across that would be much harder in a room of 30, so I think in many ways we're much more efficient that way, but they still want to load on the work, and we have to encourage them to stand back a little bit.

GOLDEN: But it's true and there's a definite disconnect with some schools, not all, with some. They don't seem to fully comprehend what these kids are going through. They think, “Okay, well, they're just at home maybe with a cold and they can do just endless amounts, reams of work.” Some of these kids may not be able to focus the whole day. It may be that they are not able to focus at all. They may be overwhelmed. They [the schools] often fail to take into account the psychological aspect. That's one thing I have to take into account and Bill does as well. We're not just teachers. We're also playing a major role in their lives.

RING: One thing that I've noticed over and over again compared to my time in the classroom—I  was in a classroom, of course. You get 30 kids who are bringing in all of their distractions and you have to somehow turn down the volume of what's going on in their heads so that they can get what you have to give them, but that could take some time. Here, we're actually the distraction. And so all kinds of other things might be going on, but we come in and sometimes it's stand-up comedy, I must admit. But, yes, education is stand-up comedy; we come in and provide relief from the rest of the things that are swirling around them and their medical effects. I thought that was worth mentioning.

MARGOLIN: Do they have all the music therapy and all the other, let's say the word I want, all the other endeavors that are reported from the psych classroom on their units? They have OT [occupational therapy] and PT [physical therapy] and all those things going on all the time.

GOLDEN: They do indeed. And those are also, in a sense, distractions. Having been in the hospital myself for a while at one point in my life—I was quite ill—I know one of the worst things is lying in bed thinking about what's wrong with you. It was hard. I was an adult, and I was able to take it a little bit better than say an 11-year-old, but an 11-year-old in a hospital really needs to be constructively distracted from just the monotony and maybe the fear of being in a hospital setting.

MARGOLIN:  Are there families, parents, around them much of the time while they're hospitalized?

GOLDEN:  Yes, they are, and they often like us to come in because we can give them a bit of a break. The parents need a little bit of time to themselves and this is true with rec[reational] therapy, with occupational therapy, physical therapy, etc. The parents are able to say go for a walk for 45 minutes or an hour and they really do need that time to get away just to take a breather.

RING:   One more thing to add to that, since he's mentioned all these other people that we work with, every week we have interdisciplinary rounds and so everybody who works with these kids gets together and we go through the census and everybody has the ability to contribute to our understanding of how these kids are functioning. It's one of the most useful things I've ever participated in. You get all these different angles on what's happening with these kids and so it’s greater clarity for everyone.

MARGOLIN:  That's great. And so, I think we've pretty well exhausted the whole thing. What I'm hearing from all of your presentations is that we have magnificent teachers who really extend themselves regularly, with love for the different patients and different research studies, working with the students as time allows and as the needs require. You as teachers have been saying that this is something that you really love doing, as hard as it is and as difficult as it's become. You are really an intimate part of this whole cycle of care, not just for medical care that they come to the NIH for, but the entire environmental care and the educational care and everything else that they need in order to continue their normal childhood growth. It's very, very overwhelming to me to hear all this input and all this interest and all these requirements and the records you keep and the value you transmit. I'm sure the responses of the parents and the other observers must be very, very praiseworthy. They must send you lots of very positive notes and I really think the whole story is a very amazing story to me that I knew nothing about before I talked to all of you. I have learned a great deal about what happens in the confines of the NIH. As a newcomer and an outsider, I want to give you credit and praise. As a listener to how much you've done in your interest, in your willingness to participate, in the lives of these very ill students and their families. It's really remarkable. Does anyone else want to add anything before we close?

MOONEYHAM:  Two things. One is just what a joy it is to be able to have the involvement of our school team within the Clinical Center. I think it adds a tremendous value and we learn alongside one another.  The other is just to acknowledge how much of a liaison role that they play in communicating out to the schools what the needs of the students are in a very unique way. So they're the eyes and the ears.  They're caring for some element of normalcy within the general pediatric patient experience and certainly within the psychiatric care experience, so we're incredibly grateful for the involvement of each of our team members from the school program. Thank you all.

Historical Notes from Anna Davidson:

The NIH Children’s School in the old hospital [the original Clinical Center building] was on the 10th floor in the solarium. In 1985, Helen Mays was the director, and the teachers were Beezie Clapper, Mary Pat Jones, Nancy Bein, Anna Davidson, and Chris Leibner on the third floor in Behavior Health classroom. Mays was the director of the school for over 35 years. She followed directors Mrs. Gilbert and Mrs. Dowd. As teachers left, new teachers were hired: Debra Thompson, Phyllis Seigrist, Anne Wasson, Pat Welsh, Anita Fields, Susan Job, Ann Malo, and Julie Fuchs-Margolis.  Other teachers from the Montgomery County Home and Hospital Department were pulled in for brief periods to teach a specific subject before the tightened security following 9/11.

The teachers taught children in the classroom or ran to the 13th floor to teach children at their bedside or in the clinic who were in cancer protocols. On the 12th floor they saw children in the NIAID [National Institute of Allergy and Infectious Diseases] protocols such as AIDs and granulomatous disease. On the 10th floor children in NEI [National Eye Institute] protocols and many children were seen on the 9th floor where NICHD [National Institute of Child Health and Human Development] had protocols such as growth and development, precocious puberty, and osteogenesis imperfecta.  Children were also seen on the NHLBI [National Heart, Lung, and Blood Institute] floor.

The classroom had a Brallier to create work for children who were losing their eyesight. Labels in Braille were placed around the room on objects and doors. One teacher from NIH was sent for a brief amount of time to go with an AIDS student to school.  The doctors felt that by sending the teacher with the child, it would support the teacher in the community who would be having this child, since the disease was relatively new.

In the new hospital [the Clinical Research Center], the school was moved to a classroom across from the playroom on the first floor before it was moved to the Pediatric Unit in 1 NW.

In 2006, the Superintendent of Montgomery County Public Schools recognized Helen Mays, Anne Wasson, Anita Fields, Susan Job, and Anna Davidson with a framed certificate of Appreciation recognizing their teaching at NIH. In 2008, the same teachers were given the NIH Directors Award for teaching, and in 2012, Susan Job and Anna Davidson were given the Directors Award for their work with children in the Behavioral Health classroom.

We all cherished the cures and help that children experienced by coming to NIH. We also enjoyed seeing the growth each child made academically and the letters of appreciation we received from students and parents, as well as the visits many students made to say hello when they were here for follow-up.  It was always fun to hear how they were doing and what they were doing. Teaching at NIH Children’s School had been a treasured experience for all of us.