September 22, 2025 • 43 mins
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) -
- School Can’t Australia Facebook Community - https://www.facebook.com/groups/schoolphobiaschoolrefusalaustralia
- Make a donation to School Can’t Australia - https://www.schoolcantaustralia.com.au/get-involved
If you are a parent of carer in Australia and experiencing distress, please call Lifeline on 13 11 14 or contact the Parent Help Line. - https://kidshelpline.com.au/parents/issues/how-parentline-can-help-you
You can contact us to volunteer to share your School Can't story or some feedback via email on schoolcantpodcast@gmail.com
Disclaimer
The content of this podcast is based on personal lived experiences and is shared for informational and storytelling purposes only. It should not be treated as medical, psychological, or professional advice under any circumstances. If you have concerns about your health or well-being, please seek guidance from a doctor, therapist, or other qualified professional.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Leisa Reichelt (00:05):
Hello, and welcome to the School Can't
Experience podcast.
I'm Leisa Reichelt, and thispodcast is brought to you by the
School Can't Australiacommunity.
Caring for a young person who isstruggling to attend school can
be a stressful and isolatingexperience, but you are not
alone.
Thousands of parents acrossAustralia and many more around
the world face similarchallenges and experiences every
(00:26):
day.
Today we are joined by Dr.
Kara Johns, who is a GP in SouthAustralia.
Kara has some lived experiencewith School Can't, which we will
touch on, but I wanted to talkto Kara about the role that a GP
can play in helping to supportfamilies who are experiencing
the stress of School Can't.
And also some tips on what weneed to know to make the
(00:47):
Medicare system work for us asbest we can.
Talking with Kara really made mewish I'd known a lot of this
much earlier in my School Can'tjourney.
I hope you enjoy ourconversation.
All righty.
Shall we get started?
Okay.
Dr.
Kara Johns, thank you so muchfor joining us for our podcast
today.
Dr Kara Johns (01:05):
Pleasure to be here.
Leisa Reichelt (01:08):
Let us get started by hearing a little bit
about you.
Where are you?
What do you do?
Tell us about your familysituation.
Dr Kara Johns (01:16):
Sure.
I'm Kara, I'm a specialistgeneral practitioner based in
South Australia.
I've been in general practicefor 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-ishgeneral practice.
over here There's about 18doctors.
We're all part-time.
We all have a very collegiatework environment.
(01:37):
I spend my other time with my7-year-old son, so it's juggling
the two pretty much.
Leisa Reichelt (01:42):
And you've got a little bit of personal
experience with School Can't.
Dr Kara Johns (01:47):
Yeah, a little bit, and I was trying to think
of the word to use.
Sometimes I say mild, but Idon't know that that really is
the right word.
Maybe brief experience with someSchool Can't.
It has informed me hugely goingthrough that as a parent.
Last year in particular, we hada lot of struggles with my son.
We had a three week period inparticular where getting him to
school was very, verychallenging and the mornings
were really horrendous.
(02:09):
And there was a couple of dayswhere we just didn't and just
let him be at home.
That was a really tough coupleof weeks while we were figuring
all of that out.
But I guess we had the benefitof the context of I'd already
been questioning some thingswith him.
So this was just adding to theinformation that I was
gathering, that helped inform methat there was other things
going on for my son that weneeded to now definitely
(02:30):
address.
We reached a threshold where Iwent, okay, I'm not just
questioning anymore.
I'm quite certain.
And we were able to address it.
and pleasingly this year, it'slike chalk and cheese.
We have a totally differentchild, in many ways, not just
for school attendance, which is.
necessarily always the be alland end all, but we just have a
very different child this year,the School Can't process
informed us.
(02:50):
It was another sign for us thatallowed us to help him.
For a while with my son watchinghim, observing him, particularly
even back for childcare days, wehad some episodes of very
extreme separation distress.
And it was quite fascinating inthat it wasn't all the time.
It was usually episodic, like acouple of weeks where he would
really struggle with drop offand then it would settle.
(03:11):
And we eventually learned thatit was always to do with if
something had shifted in hisworld.
So a friend of his might've leftto go to school, or, a friend
moved into a different room andhe wasn't yet ready to move into
that room.
So something in his worldshifted and then he was
struggling to attend.
We were very fortunate though,in that the childcare center we
were using, the director wasactually a child psychologist.
(03:33):
Which was amazing because itmeant that the strategies that
this childcare center used werevery mentally health protecting
and mentally health safe.
So it was all around shiftinghis emotions, not demonizing
them or making him feel guiltywith them.
It was working with his emotionsand set us up really well with
understanding the emotionalspace and how to work with his
(03:55):
emotions.
So we had this beautifulfoundation and then we'd moved
him to start school and it was avery difficult transition as it
can be for a lot of children.
But he'd gone from this verymentally health protecting
environment to quite an academicenvironment and we saw our child
slowly crumble.
It was fascinating to watchbecause he was still a very
(04:15):
bright, curious, engaged child.
You tell him a piece ofinformation, he doesn't forget
it.
So, to see him then start tocrumble 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 goalong, I was getting this bigger
picture of going, I thinkthere's ADHD here, but I think
it's inattentive ADHD.
(04:36):
Which can be very difficult totease out.
Leisa Reichelt (04:38):
But,
Dr Kara Johns (04:38):
by last year, when the School Can't came into
the picture as well and thelevel of distress that we were
seeing in our child, I just knewthat there was more going on
here.
And there was one particularpivotal weekend that I have very
strong memories with because Iwas very upset and distressed.
I knew that the pressure fromthe school of how we were
handling his drop offs wasescalating into a direction that
(05:00):
I wasn't comfortable with.
And so I, I kind of felt likesomething needs to give or we
need to make some drasticchanges.
And it felt like this verypivotal weekend.
And I spent the weekend talkingto my son a lot about it, and I
was able to get bits ofinformation out.
He ended up sharing with us thatthere were moments in the
classroom where he was lookingaround and going, everyone knew
what they were supposed to beworking on, and I don't know
(05:21):
what I was supposed to do.
I'm so dumb and I'm so stupid.
negative framing of hisexperiences was profound.
And this was a 6-year-old sayingall of this.
He's looking around theclassroom and he didn't know
what he was supposed to beworking on, it was very obvious
to me that he was missing keybits of information in the
instructions.
And so on that Monday morning,I, got an appointment for a
(05:42):
pediatrician and I started theball rolling and we now have a
confirmation of inattentiveADHD.
And so because we now have thatinformation and we're able to
support him, as well asmedication, we have such a
different child this year, sucha different child.
Leisa Reichelt (05:56):
Hmm.
Dr Kara Johns (05:57):
I think the power of teaching him about his
brain has been.
I think we underestimate kidssometimes.
We really underestimate how muchthey process and how much they
can understand.
I talk to him about neurons andsynapses and neurotransmitters.
He now has the language to say,my brain works like this and
this is what I need for my brainto get that information in.
(06:18):
And he is not internalizing itas I'm dumb and I'm stupid.
So we've shifted the narrativein his head.
We now have a kid that skipsinto class.
Leisa Reichelt (06:27):
I think we always love to hear these
stories of where you candiscover something's going on,
get in and do an intervention,and get them back onto a happy
path quickly, rather than havingto live through a lot of trauma.
Dr Kara Johns (06:42):
A happy path is key, I think.
the work I do with young peoplethat I see in my work, it's
interesting sometimes when I usethat language because I don't
think school attendance shouldbe our goal, but on a happy path
should be our goal.
Happy and thriving in their wayshould be the goal.
And working with families torealign their expectations and
goals, it's quite interesting.
The big thing that I take awayfrom it is there's always
(07:03):
something underneath with thesekids.
They don't have the words toexplain it and maybe they don't
understand it, but I haven't meta single child yet where there's
not something going onunderneath.
so it's an exploring journeywith these kids.
Leisa Reichelt (07:17):
Let's pivot into your role as a GP then,
Dr Kara Johns (07:21):
Mm-hmm.
Leisa Reichelt (07:23):
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 nevercrossed my mind at all.
Never crossed my mind that a GPcould help me deal with the
challenges that were going on.
I look back'cause I have a greatGP and I feel some regret that I
didn't give her a chance to helpme on this journey.
(07:45):
she probably would've been a loteasier and done a lot better.
So, really interested to talk toyou today about the role that a
GP can play in a family's lifewhen they're experiencing School
Can't.
Go right back to basics.
How do you think about the jobof a gp?
What is a GP's job?
Dr Kara Johns (08:03):
Aw, that's a loaded question these days.
I can't speak for every GP inAustralia.
I don't speak for anyorganization of GPs.
I can share my experience as aGP a parent.
and a patient The role of ageneral practitioner or a GP in
Australia these days is verydifferent than what it was 30,
40 years ago, even maybe 10years ago.
Like, if you think about theadvances we've had in science
(08:24):
and technology in society,medicine has advanced in just
the same way.
So the breadth of medicine thatwe need to know so wide now and
the depth that we go in eacharea of medicine has changed so
much.
So, General Practice is a reallytough gig these days.
You look at the training processfor a general practitioner,
Several years ago, 20, 30 yearsago, you could finish your med
(08:45):
school training.
Do an internship in hospital,and then you could start working
in the community and you wereconsidered a general
practitioner.
These days it's very different.
You do your medical school, youdo your internship, and then you
have to apply to get onto aspecialist pathway to become a
specialist general practitioner.
And so general practitionersthat are being put out into
society now, we're actuallyspecialists, so we registered
(09:06):
with the Medical Board ofAustralia as specialist doctors.
Like general practitioners arespecialists once they're
qualified and we refer to otherdoctors that have narrowed down
into one field as subspecialistsor partialists.
Leisa Reichelt (09:19):
Hmm.
Dr Kara Johns (09:19):
That language kind of explains the complexity
of it.
Coming back to your questionabout, the role of a general
practitioner, we look afterpeople across the lifespan from
a newborn baby until death.
We're often the first port ofcall for anyone touching base
into the health system inAustralia.
Our role is to differentiatesymptoms and signs from things
that may be part of, and I usethe word normal very carefully.
(09:41):
There could be a normal sign orsymptom, doesn't mean we have to
tolerate it, but it can be anormal sign of symptom versus
what is a sign or symptom of adisease or a process or a
condition that we could besupporting, throughout the
lifespan.
We're also doing a lot ofpreventative healthcare.
As a female GP who specializesin women's health, I see
primarily female patients.
And then I've got a cohort ofkids that I see because I've
(10:03):
looked after them and they'vehad 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 generalpractitioner, is we get to know
the context of a person, notjust the individual person.
So we might look after thegrandmother, the mother, and the
child.
So three generations we lookafter.
And that informs so much of whatwe do because we have a much
broader perspective of what'sgoing on for the individual.
(10:28):
So it's very broad, the generalpractice role, and I'm not at
all surprised to hear you shareyour journey that you didn't
consider the generalpractitioner in your journey.
I think that's common.
And even in my experience withmy son, when the school were
aware that there was somethinggoing on, not once did they say,
touch base with his generalpractitioner.
It was oh, maybe we need an OTor maybe we need a psychologist.
(10:49):
And we're sort of going in thesehorizontal directions.
The general practitioner isoften the coordinator.
So, we are the central person ina person's healthcare that
coordinates between alliedhealth and Partialists.
And we are often the person inthe middle that puts the pieces
of the puzzle together.
Leisa Reichelt (11:04):
yeah.
I grew up with a family who werebasically, don't bother the
doctor.
Only go when you absolutely needto.
Doctor's very busy.
Don't waste their time.
You know, and so you get yourvaccinations and your
antibiotics when you are like,dying.
And that was kind of it.
I know not everybody is likethat.
And, that's great.
But I wonder what's yourperspective on how to develop a
(11:27):
good, productive, usefulpartnership with your GP if
you're fortunate enough to havea great GP?
Dr Kara Johns (11:34):
That's a good question.
I think it comes back down tohaving honest conversations with
them because we are humanourselves, we have our own life
and we all have our own personalpreferences.
So I know the way I practice ingeneral practice is different
than my colleague in the nextroom.
So I guess first of all, it'sfinding a general practitioner
that fits with what you feel youor your child needs are.
(11:54):
That can take time.
And I don't think thatrepresents good or bad GP.
It's just like not the rightfit.
You've gotta find the right fit.
And then I think having openconversations so that you are
actually meeting each other'sexpectations and needs.
I think it's historical.
Like if you looked back to, Ithink before Medicare was
introduced in Australia, it costa lot of money to see a general
practitioner or a doctor, whichyou could argue we're maybe
(12:16):
heading back in that directionthese days.
And so I think that culture ofdon't bother the doctor unless
it's dire was also becausepeople couldn't afford it.
The general practitioner has ahuge role in preventative health
and we try to advocate for that.
The earlier we intervene andaddress things, the less
complications we can sometimesbe dealing with.
So yeah, I think positiverelationship, right fit and then
(12:36):
a dialogue and having aconversation.
Personally as an example ofthat, like, I like patients that
bring in a list of their tasks,because it allows me to see very
early on what are theirexpectations.
So just because they're bringingin a list doesn't mean that they
expect me to cover all of thatin one appointment, which I
think some gps will ofteninterpret and go, oh my God, how
unrealistic.
But having that openconversation, they're like, no,
(12:56):
this is just my list ofthoughts.
I just want these two addressedtoday.
Cool.
Great.
I know what your list is.
I know what we're workingtowards.
That allows us to meet both ofour expectations and both of us
finish feeling fulfilled fromthe consultation.
Don't get me wrong, I get it.
It's hard because we are oftenrunning late, really stressed
and busy.
We might have just sent apatient to hospital that we are
really still worried about andwe are trying to get that out of
(13:18):
our head to focus on you.
And we are human.
We don't always do that verywell.
There are a lot of things goingon for us as well.
So sometimes it might feel toughto have those conversations, but
building to a place where youcan have that and remaining
flexible, really helps thatrelationship.
Leisa Reichelt (13:33):
It's a challenge, isn't it, it's hard
to get an appointment sometimesand then when you get an
appointment it's short.
And then being able to have thattime 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 lengthappointment.
Leisa Reichelt (13:46):
Mm-hmm.
Dr Kara Johns (13:47):
this is something that I see when I
first meet patients oftenthey're unaware of this.
when you call up a generalpractice find out, what length
of time is their standardappointment because every clinic
runs differently.
The clinic I'm at, our standardappointment is 15 minutes, but
what that actually means in realtime is that 15 minutes is
supposed to be from me openingthe file to me closing the file,
not 15 minutes with the patientin front of me.
(14:10):
Patients will often interpretthat as they've got 15 minutes
of my time to sit in front ofme.
So I think book the right lengthof appointment to start with.
Most of my young people that Isee, I request them to book a
double appointment, which ishalf an hour because quite a lot
of young people, need time towarm up.
I'm not gonna be able to getanywhere if they're feeling
nervous or uncomfortable.
Sometimes we need to do somecoloring on the floor first just
(14:31):
to connect again.
Then I can explore what's goingon with them and discuss it.
So book a good lengthappointment and that just have a
conversation with thereceptionist.
what length of appointment isthis?
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 along appointment because like as
a middle-aged woman with complexkids, right.
There's just always so, there'sjust a lot going on and, yeah.
Dr Kara Johns (14:56):
most of my patients are doubles.
Most of my day is doubles, butmy colleagues, it's single,
single, single, single.
And like, that's just thedifference in style, difference
in cohort of patients that seeus, different ways of doing the
job.
It's really hard sometimes towork out what appointment length
you might need.
As a general rule, we say it'sone issue for a standard
appointment, two issues for adouble appointment, but
(15:17):
obviously not all issues needthe same amount of time.
Like I had a patient who bookeda single with me and they wanted
to talk about potentialperimenopause.
That's a massive topic.
To do that, well you can't dothat in 10, 15 minutes.
We can get the ball started.
That's the thing too, It's arolling consult.
It doesn't have to haveeverything in the one consult.
You start it and then when theycome back, you're doing a bit
(15:38):
more on it and you're doing abit more of it.
But I don't think that's whatour society or patients want
anymore.
We are still taught to have therolling consult with our
patients, but patients are busy.
They often take time off work tocome in and have their
appointment.
They wanna get their issuesaddressed in that appointment.
They don't want to come backnext week.
Leisa Reichelt (15:54):
It's a bit of a mindset shift though, isn't it?
Right.
The mindset that we often havenow is transactional.
I'm coming in with a cough and Iwant antibiotics, or I'm coming
in with this pain and I want areferral.
It feels very transactional.
Whereas what you are describingis much more of that
relationship based medicine,which I think lots of people
(16:15):
would want that if they thoughtthat 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 Itotally get it because that is
the way we've been forced towork.
We've been forced into thisspace of going, government wants
us to do six minuteappointments.
If you look at how they fund theMedicare and That's where it has
become transactional.
I don't personally find thatmedicine or way of practicing
medicine satisfying.
(16:42):
So I don't practice that way,but that means to see me is more
expensive than to see a doctorwho does do transactional
medicine.
I can see why it exists, and Ican see why general practice has
become to some sections ofsociety viewed that way, that we
are just a GP.
Because you're just a referraldoctor.
You're just there to refer usonto the actual doctor.
(17:03):
I can see why that's beingformed.
But I think if you have thatview, you're missing out in a
big resource.
We have a huge knowledge basethat we can use and help with,
and can be beneficial with.
Leisa Reichelt (17:14):
Yeah.
I was always fully thetransactional person with my GP
for a long, long time, and Ithought that was me doing the
right thing.
But now I reckon my strategy isbasically I book an appointment
a month.
I, I book a double appointmentevery month because my GP's hard
to get into as well, so I needto book well in advance.
Dr Kara Johns (17:32):
I've got one patient in particular that has a
double appointment booked everyweek with me.
Now whether they use it or notis another thing, but if you get
out and ahead and schedule it.
We don't always use them, butshe's got some serious health
issues.
She knows that things don't goto plan often for her.
She's just highly proactive andhas reserved that spot with me
every week to the end of theyear.
I'm a big one of that.
I often tell my patients tobook, and I sometimes do it in
(17:54):
the room.
When are we gonna touch basenext?
I think booking in advance is avery good strategy as well,
because the worst thing I thinkis if you stockpile issues and
you wait till that month'causethat was on your appointment and
you've come into a doubleappointment, but you've got a
list of 10 things they're all ofequal value to you that you need
to get addressed.
But that's not physically gonnabe possible in a half an hour
appointment.
(18:14):
So yeah, getting out in frontand having pre-booked
appointments, as long as you askin 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 cancelingthe appointment so they can snap
it up.
Dr Kara Johns (18:25):
quickly.
Because I think that's one ofthe complaints I get is it's
really hard to get in to seeyou.
Now my next availableappointment is not till
mid-October.
So, yes it is really hard, butif 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 forus.
Instead of waiting untileverything's desperate and then
going, but I can't see them forhowever many weeks.
Alright.
Let's talk more specificallyabout School Can't now and the
kinds of things that GPS can door that you do in supporting,
families and young people whoare experiencing the stress
(18:59):
associated with School Can't.
What are typical things that youfind 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 youngpeople as much.
They're teaching me a lot aswell.
It's still a growingunderstanding in the general
practice space.
I still hear school refusal termbeing used even amongst my
colleagues.
I don't think it frames what weare dealing with correctly, but
it's still just a label thatthey're using to explain the
(19:28):
situation.
My experience, I guess, has beenvery informed from some of the
work I've done around infantcare.
So before I came to generalpractice, I was very interested
in the women's health space anddid quite a bit of time in
obstetrics and gynecology,delivering babies, doing
postnatal care.
I got very interested in somework being done in Australia by
a GP who's done a lot ofresearch.
(19:49):
It was Pam Douglas and shedeveloped the possums program, I
think it's called somethingdifferent now, Neuroprotective
Developmental Care, I think it'scalled the NDC is the website.
For me, it made a lot of sense.
it was talking about the firsthundred days of life and how we
parent our infants and how itsets them up for positive mental
health moving forward.
It's actually going back totapping into biological drives
(20:11):
and biological needs.
They use a lot of acceptance andcommitment theory in the
program, which also made a lotof sense to me.
I don't consider myself anexpert in acceptance and
commitment theory, but myinterpretation of it was like,
find out what is your genuineself and live that
authentically.
And if we find what thatgenuineness is and can get you
on a path where you can be yourauthentic self.
(20:33):
Often you feel better aboutyourself and about the world
because you're not masking orpretending to be someone you're
not.
There's a freeing that comeswith that.
The work that I did in thatspace has really informed me
moving forward with all of myyoung people, because the most
important bond is that primaryattachment relationship, which
is often the parent and a child.
That's an extraordinarilypowerful relationship in the
(20:56):
brain development of a youngperson.
And we should be protecting andstrengthening that relationship.
When we used to tell mums toleave a baby to cry, we're
actually damaging that childparent attachment relationship,
which is not a healthy thing todo.
So, we now know, respond to yourbaby when they cry because they
are communicating to you.
And that need might be they needa cuddle, but that's still a
(21:17):
need.
And so then if we fast forwardinto primary school age children
who are showing a lot ofdistress, I always start from a
place of strengthening thatprimary caregiver attachment
relationship.
And what I'm finding in theSchool Can't space is that
relationship is often beingripped apart,
Leisa Reichelt (21:36):
Hmm.
Dr Kara Johns (21:36):
and being damaged.
And not strengthened.
So I guess my first journey inthis space was working with a
family where the child wasreally struggling to attend
school and the school weregetting really forceful to the
point of physically restrainingthe child and telling the
parents to leave, I had hugeissues with'cause I was like,
(21:57):
that's assault.
That is absolutely not okay.
Secondly, if that child ishighly distressed and you are
their primary attachment and youare leaving them when they're
highly distressed, that initself is distressing to a child
because you are supposed to betheir safe place to land and you
are now abandoning them.
Like that's not a healthyprocess.
(22:19):
So, navigating and supportingthis family, I came at it from
that lens of just going, we needto support the primary
attachment and the child, andwork with that.
And when I first met this childtoo, because I'd had a heads up
because I knew the mum was mypatient I scheduled it at a time
where I could have time withthis child.
I had an hour with this child.
that appointment too, I was ableto see very clearly that I
thought autism was at play here.
(22:41):
And the school had not seen it.
In actual fact, what they weredoing to get this child to
school was actually damaging theparent child relationship and
causing huge trauma in thischild The way that they were
handling it was not neuroaffirming or neuro safe I don't
consider myself an expert inneurodiversity, so apologies if
I use the wrong terms But I sawso much of what was going on
(23:02):
here was bad.
My role in that place wasstrengthening relationships,
holding space, working out whatwas going on with this child.
You know, we got this child toseveral different psychologists
because there's therapeuticpsychologists and assessing
psychologists.
So you often need to use two orthree sometimes.
We've since had a diagnosisconfirmed.
We've got NDIS in place.
(23:22):
What I think my role was quiteuseful in this place was because
there was a lot of gaslightinggoing onto this mum.
The school had done a lot ofdamage to this mum by framing
her as being weak.
The problem was her, not thechild.
So they'd really broken mum aswell.
So I just contacted theprincipal and I was like, let me
hold that space.
They can blame me, they cancriticise me.
(23:43):
What's going on at this schoolis wrong and not, okay, let me
be the one dealing with this.
I think the GP role in many ofthese cases is to look beneath
the surface of what's going onwith this child.
We can help affirm what isappropriate and safe and we can
help direct families into ahelpful pathway, hopefully, that
won't happen from the firstappointment, but I feel like we
can hold a lot of space here.
(24:04):
Our role is often thecoordinator.
We are sending out, gettingother people's opinions and
bringing it all back together.
And by doing that we can oftenformulate what's actually going
on with this child and whichdirection 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 workout what is the path forward?
Who do you go see?
My journey was that the schoolpicked my son out for not doing
pattern matching in the way thatthey would like him to be doing
pattern matching.
And they were like, you bettergo and see a speech therapist.
We're like, okay.
(24:36):
So we went and saw a speechtherapist and then, you know,
great speech therapist, but weended up on this roundabout
pathway.
In retrospect, it would've beenso 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 themin 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 aheap of assessment stuff, and
then she's like, oh, myexpensive assessments tell me
that you need to go to apediatrician now to get
expensive assessments done.
I'm like, okay, great.
I think the other thing that youpointed out as well is that role
that a GP can play in advocatingto the school.
When communications with theschool are getting very
(25:17):
stressful and very serious, andin 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 ofwhat's actually going on for
this child and the way they needto be handled, which is often
different to what the school isasking for.
Dr Kara Johns (25:36):
Yeah, I agree.
And maybe I'm giving too muchcredit to schools in some cases,
but I think it's nicer to have aviewpoint of thinking that
everyone's actually trying to dotheir best in a very flawed
system.
I often say let me be the badguy.
they can complain about me.
just let the school complainabout me as well.
you don't need to hold all ofthat mental load.
And I see that the burnout inparents is often huge.
(25:57):
Let us hold some of that foryou.
You don't need to hold all ofthat.
Sometimes when I'm talking witha couple of families, I've got a
family with a child that'scurrently not attending school,
and of course that requires awhole 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 verypowerful.
You are carrying some of themental 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 andlike you say, not all schools,
some schools are great and tryreally hard and listen, other
schools are threatening to sendparents 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 issuesright now.
And this is very serious.
And I don't always think thatschools take that seriously in
the way that they do if you havea letter from your GP saying,
this is a situation with thechild, 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 onlyother adult in this child's life
giving them a voice and tellingthem to trust in and be
affirming of themselves.
And I come at it more as a childprotection lens of where we are
trying to raise our childrenthese days to have a lot more
body autonomy, to be moreunderstanding of consent, and
(27:14):
encouraging children to voicewhen they're uncomfortable.
and you know, when you find outthat this child has had to sit
with a lot of uncomfortablefeelings and the school has told
them that's okay, I have a lotof issue with that because
that's, really not keeping thischild safe.
If they're being told that whenthey're uncomfortable, they're
supposed to ignore that to fitin.
I take real issue with that.
(27:35):
We as adults should beencouraging 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 willbe people listening whose
experience has been that theschool has initiated proceedings
with Child Protective Servicesbecause parents were trying to
protect their children's mentalhealth and allowing them to not
attend school all the time.
I wanna circle back, Kara tosomething you said a little
(28:05):
while ago, which was just aboutthe neuroprotective behaviours
and, the damage that can beinflicted when children in
distress see their parents walkaway.
Just to note that there areloads of us who have done that
(28:25):
and who probably carry anenormous amount of guilt because
we thought we didn't have achoice because we thought that
was, you know, that was theadvice that we were given by
people who theoretically knew alot better about these things.
So I just want to reflect backto anybody who's hearing that
and feeling that burden of guiltand self blame that, you know,
(28:47):
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 journeylast year with the school.
I had my son picked up and toldto leave while they physically
held him.
I had a teacher I very muchrespect still'cause I, I do
believe that this teacher wasdoing what she thought was best.
Saying to my son, you're makingyour mum really sad when you
behave like this.
You don't wanna make your mumsad, do you?
(29:13):
And then she's saying, you'remaking 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 dothis to our children'.
So I can see how easy it is asparents because you do assume
that the educators and theteachers know best.
I see it as a knowledge gap inschools and that we need to be
getting our educators to do morecontinuous professional
(29:38):
development in this space.
We need to be gettingpsychologists into these schools
to inform them on how they'rehandling these behaviours.
Because it's not okay.
The way we very quickly turnedthe behaviour response around
with my son had nothing to dowith the school.
the process we had was gettinghim to say, I feel, and then say
the emotion.
I was developing with him sometasks to calm his nervous system
(29:59):
down.
So breathing exercises to dialdown his nervous system to allow
him to make better decisionsthat he was comfortable and
happy with.
So we would do a round ofbreathing 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 nervoussystem down every day, he chose
(30:19):
to stay at school.
Schools need to be validatingand working with emotions.
So we have a lot of work to doas a society on that.
Leisa Reichelt (30:27):
Let's get really practical now and focus
specifically on the Australianhealth system apologies to
international listeners whomight not find this quite so
helpful.
Things that families who haveSchool Can't kids should be
aware of about how theAustralian health system works,
(30:50):
Kara?
I'm thinking about things like,the big thing for me was I
discovered the Medicare safetynet and the fact that my family
wasn't registered and we gotregistered and we had already
passed the safety net by thetime 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 thesafety 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 steppingback, the Australian health
system is complex.
We have a Medicare system inAustralia whereby the patient
can get a rebate throughMedicare, which is a government
set up rebate system to fundhealthcare expenses.
When this first got introduced,the Medicare rebate was very
close to the cost of theservice.
(31:35):
Unfortunately, successivegovernments have not funded
Medicare.
They even froze the Medicarerebate for a number of years.
Every year when CPI rises, forgeneral practitioners accepting
the Medicare rebate, they didn'tget a pay rise for 10 or so
years.
Australian Medical Association,the AMA, sets out guidelines of
fees, every year for differentprofessions.
(31:56):
They're currently saying thestandard general practice
appointment, which is that 10 to15 minute appointment, is valued
at about$105 for theappointment.
Medicare rebate now is$42.
So there is a massive gap.
The Medicare safety net saysthat across a calendar year,
once the gap amount reaches acertain threshold, Medicare will
(32:17):
start paying more about 80%.
I have patients now that see mefor 30 minutes, they're charged
a 30 minute fee, which at ourclinic 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 thegap component.
So if it was a hundred dollarsand 40 from Medicare it's the 60
that goes towards the safety netfor that.
(32:39):
For singles, it's about 2,600.
But then here's the thing, ifyou're a family.
You can tell Medicare you're afamily, and that 2,600 would
apply for your whole familycollectively.
So if it's two teenagers or twochildren and two adults, that's
four people that cancumulatively get the 2,600.
But you often need to tellMedicare that even if you're on
(33:00):
the same Medicare card, theywon'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 stillneed to log in and go confirm my
family.
Otherwise the rebate doesn'tapply.
How ridiculous is this?
But for families that are seeinghealth issues any service that
you are getting a Medicarerebate from that gap can then
(33:21):
apply over to accumulating onyour safety net.
So if you think about it, ifyou've seen your GP and they're
that central person in yourjourney and then they've
referred you to a psychologistand the psychologist, then you
get a Medicare rebate on the gapwith your psychologist goes
towards your safety net.
But if you just went from theschool's recommendations and
(33:41):
went out and saw a psychologistor an OT, you're paying for it
all privately and none of thataccumulates onto your Medicare
safety net.
Then that leads into the nextstep about can you get referrals
from a GP onto Allied Health andto Partialists.
Yes, you can, but there arerules around it.
So first one is a MentalHealthcare Plan.
If your child or yourself meetthe eligibility criteria, which
(34:02):
Medicare stipulates, we cancompile a Mental Healthcare
Plan, which in Australia opensup 10 subsidised sessions with a
psychologist per year.
So it's not much, but it'sbetter than nothing.
So 10 subsidised sessions, it'snot fully funded, it's
subsidised.
So, what I try to explain topatients again is that the
recommended fee for apsychologist is around$300 a
(34:23):
session now, and the Medicarerebate depends on whether it's a
registered or clinicalpsychologist as well, but it can
be around a hundred dollars.
So you're still gonna be out ofpocket a decent chunk.
So it's still a big gap.
And then in terms of otherAllied Health, there are avenues
that we can get Allied Healthinvolved.
Again, it has to be that theeligibility criteria met for
something called a ChronicDisease Care Plan.
(34:46):
So it has to be that you or thechild, depending on who's the
referring patient, they have tomeet the criteria.
And if you meet a criteria youcan get referral to particular
allied health people forsubsidised 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 autoimmunearthritises and you have a
physio that helps you manageyour pain you're gonna use up
probably within two months,three months.
So it's not a huge amount, butit can help, but it also then
adds to your safety net as well.
So all that accumulates up.
Families will find they'll hitthe safety net quite quickly in
the year, and then their healthcosts 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 topsychiatrists 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 thebenefit of using the mental
health and chronic disease plansbecause of the contribution that
would make to the safety net.
I didn't know about that, butthat's very helpful to know.
Dr Kara Johns (35:44):
Yeah, I mean, again, it requires you to have
those appointments with thegeneral practitioner to do up
that paperwork.
At the start of every year, Itry to get all my patients, I
try to remind everyone, have yougot your family safety net set
up Medicare safety net set up?
Leisa Reichelt (35:57):
Definitely.
And I think the other thing thatI learned is if you register
your family for the safety netsort of mid-year, it will still
count all of the stuff thatyou'd done earlier in the year
before you were registered.
So yeah, we registered for thefirst time in June and we were
already well over the safety netlimit.
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 planto 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 fewyears.
My understanding of it is, andhonestly I've probably only ever
done two or three of them.
So this was, I guess thegovernment's or Medicare, being
part of Australian government.
It was their way of addressingthe need to have separate
services for people with eatingdisorders.
However, what I find is that theeligibility criteria are such
(36:45):
that a lot of people won'tqualify.
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 doesis it opens up 20 psychology
appointments.
and dieticians, I might get thiswrong, but I think it's 20
dietician appointments and 20psychology appointments that get
a Medicare subsidy
Leisa Reichelt (37:01):
Hmm.
Dr Kara Johns (37:01):
sessions.
so it's worth discussing becauseI know with a lot of young
children, particularly whenwe're facing certain
neurodiversity aspects, thereare sensory components to eating
and food that can often makefood intake be less than ideal.
My son, particularly justdoesn't like the texture of
meat, which is.
Totally fine.
He doesn't have to eat meat,it's not a problem.
(37:21):
however, we need to make surethat 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 managehis iron because low iron.
often I see in children, it'svery interesting but I often see
in young children, particularlywhen they've been, emotionally
regulated, and then they'regoing through a phase of
emotional dysregulation.
I'll check their iron, and oftenit's low, something's happened.
So low iron can be acontributing thing.
It can be a sign.
So behavioural, emotionaldysregulation, particularly when
(37:45):
it's a change, can sometimes bea sign that their iron has
dropped off.
And we can address that, bothgiving them iron supplements.
And we can often see thesechildren get better emotional
resilience and better cognitivefunctioning, which means they
learn better and engage betterat 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 abeautiful demonstration of the
power of general practice, Whichis that so many of our
specialists would look at thisthrough their lens of expertise
and go, well, it's emotionaldysregulation.
We've got to do some kind oftherapeutic thing.
And like you sitting in thecenter of all of that, you can
go, well, it could be this, orit could be that, or it could be
the other thing.
(38:20):
and here's all of these otherdifferent 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 groupas well, like you said, the
emotional dysregulation of achild and the school's going
down, the OT psychologist andI'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'smultifactorial.
We can't put all our eggs in onebasket, but we should be
thinking about all the differentcontributing factors.
And so my son withinAttentitive, ADHD, and he does
have strong emotions and we knowthat's part of ADHD pathway, but
if his iron's dropped, hisemotions are bigger.
It's very noticeable.
When it happens, you go, oh,right, okay.
(38:56):
We better get back onto that.
it can be multiple factors andwe need to keep our mind broad
to what's going on and how wecan help.
Leisa Reichelt (39:02):
many women will know that life is so much easier
when your iron's at the rightlevel.
Dr Kara Johns (39:07):
a hundred percent.
Leisa Reichelt (39:11):
Amazing.
Kara, I wonder, you've given usso much amazing content and
things to think about in ourconversation so far, but are
there any resources that youthink families who are
experiencing School Can't shouldbe across?
Dr Kara Johns (39:28):
It's a funny question actually, because more
recently, families that I'mmeeting 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 isthat 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 largelydepends on the family situation,
because there are differentresources for different
families, for differentsituations.
there is a podcast that acolleague mentioned to me
recently called Pop CultureParenting.
I've only listened to a fewepisodes I'm always quite
skeptical when I go intolistening to these things, but I
was actually quite impressed bythe conversations going on in
(40:07):
that podcast.
Leisa Reichelt (40:07):
Yeah.
Dr Kara Johns (40:09):
in South Australia there's a lovely
website by some psychologistsIt's a Developing Minds
psychologist group and they'vegot some great stuff on their
website.
there's even a program I thinkthat parents can pay to do.
I believe it's like$20 orsomething.
it's all around emotionalregulation in children.
So I sometimes direct familiesto that website.
They also do great articles thatare all available.
(40:31):
So I think that's a greatresource.
For ADHD stuff, which is, Iguess, because it's my own
journey with my son.
it's an area that I'm doing alot more reading on.
There's a great website, by apsychiatrist 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'screated and she's got it all up
for free.
And she set it up as a buildingSo she's got ground level, floor
(40:53):
one, floor two, floor 3, 4 4,and it is more targeted towards
adults.
But there is some interestingresources in there around
children as well, particularlyteenagers.
And the way she explains ADHD isthe best I've ever seen
explained.
And she gives great analogies.
she talks about what theneurotransmitters are doing in
the synapses and saying thenerves in ADHD have extra vacuum
cleaners that are sucking outthe neurotransmitters.
(41:14):
And that was a concept my soncould get.
So he'll say, I've got extravacuum cleaners in my head.
There are some wonderful, veryextensive resources on Reflect
Health for families that arewanting to understand ADHD
better as well.
Leisa Reichelt (41:26):
That is fantastic.
We will put links to all ofthose in the notes so that folk
can go and explore them forthemselves Alright, well Kara,
thank you so much for taking thetime to come talk to us about
this.
I think building thatrelationship with your GP is
something that I came to verylate in my still ongoing
journey.
(41:46):
And I just wish that I had my GPas an ally alongside the whole
way through here.
I think it can make a hugedifference 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 supportyou and your family on the
School Can't journey, and tomake sure that your family is
registered for the Medicaresafety net as well.
Both of these things made a hugedifference for me once I finally
discovered them.
If you've found our podcasthelpful, please do take a moment
to subscribe or give us a ratingor review.
This really does help us get thepodcast in front of more people
(42:23):
with School Can't kids whohaven't yet found our community
and the information that weshare.
If you have some feedback for usor a suggestion for a future
topic or speaker, or maybe youhave 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 inAustralia and you're feeling
(42:45):
distressed, remember you cancall the Parent Helpline in your
state.
A link with the number to callis in the episode notes.
Sadly, on the 31st of October,the Victorian government will be
shutting down their state ParentLine, which is very
disappointing.
I've put a link to a petitionyou can sign to protest this in
the episode notes if you areinclined to do so.
Thank you again for listening.
(43:06):
We will talk again soon.
Take care.
Hello, and welcome to the School Can't
Experience podcast.
I'm Leisa Reichelt, and thispodcast is brought to you by the
School Can't Australiacommunity.
Caring for a young person who isstruggling to attend school can
be a stressful and isolatingexperience, but you are not
alone.
Thousands of parents acrossAustralia and many more around
the world face similarchallenges and experiences every
(00:26):
day.
Today we are joined by Dr.
Kara Johns, who is a GP in SouthAustralia.
Kara has some lived experiencewith School Can't, which we will
touch on, but I wanted to talkto Kara about the role that a GP
can play in helping to supportfamilies who are experiencing
the stress of School Can't.
And also some tips on what weneed to know to make the
(00:47):
Medicare system work for us asbest we can.
Talking with Kara really made mewish I'd known a lot of this
much earlier in my School Can'tjourney.
I hope you enjoy ourconversation.
All righty.
Shall we get started?
Okay.
Dr.
Kara Johns, thank you so muchfor joining us for our podcast
today.
Dr Kara Johns (01:05):
Pleasure to be here.
Leisa Reichelt (01:08):
Let us get started by hearing a little bit
about you.
Where are you?
What do you do?
Tell us about your familysituation.
Dr Kara Johns (01:16):
Sure.
I'm Kara, I'm a specialistgeneral practitioner based in
South Australia.
I've been in general practicefor 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-ishgeneral practice.
over here There's about 18doctors.
We're all part-time.
We all have a very collegiatework environment.
(01:37):
I spend my other time with my7-year-old son, so it's juggling
the two pretty much.
Leisa Reichelt (01:42):
And you've got a little bit of personal
experience with School Can't.
Dr Kara Johns (01:47):
Yeah, a little bit, and I was trying to think
of the word to use.
Sometimes I say mild, but Idon't know that that really is
the right word.
Maybe brief experience with someSchool Can't.
It has informed me hugely goingthrough that as a parent.
Last year in particular, we hada lot of struggles with my son.
We had a three week period inparticular where getting him to
school was very, verychallenging and the mornings
were really horrendous.
(02:09):
And there was a couple of dayswhere we just didn't and just
let him be at home.
That was a really tough coupleof weeks while we were figuring
all of that out.
But I guess we had the benefitof the context of I'd already
been questioning some thingswith him.
So this was just adding to theinformation that I was
gathering, that helped inform methat there was other things
going on for my son that weneeded to now definitely
(02:30):
address.
We reached a threshold where Iwent, okay, I'm not just
questioning anymore.
I'm quite certain.
And we were able to address it.
and pleasingly this year, it'slike chalk and cheese.
We have a totally differentchild, in many ways, not just
for school attendance, which is.
necessarily always the be alland end all, but we just have a
very different child this year,the School Can't process
informed us.
(02:50):
It was another sign for us thatallowed us to help him.
For a while with my son watchinghim, observing him, particularly
even back for childcare days, wehad some episodes of very
extreme separation distress.
And it was quite fascinating inthat it wasn't all the time.
It was usually episodic, like acouple of weeks where he would
really struggle with drop offand then it would settle.
(03:11):
And we eventually learned thatit was always to do with if
something had shifted in hisworld.
So a friend of his might've leftto go to school, or, a friend
moved into a different room andhe wasn't yet ready to move into
that room.
So something in his worldshifted and then he was
struggling to attend.
We were very fortunate though,in that the childcare center we
were using, the director wasactually a child psychologist.
(03:33):
Which was amazing because itmeant that the strategies that
this childcare center used werevery mentally health protecting
and mentally health safe.
So it was all around shiftinghis emotions, not demonizing
them or making him feel guiltywith them.
It was working with his emotionsand set us up really well with
understanding the emotionalspace and how to work with his
(03:55):
emotions.
So we had this beautifulfoundation and then we'd moved
him to start school and it was avery difficult transition as it
can be for a lot of children.
But he'd gone from this verymentally health protecting
environment to quite an academicenvironment and we saw our child
slowly crumble.
It was fascinating to watchbecause he was still a very
(04:15):
bright, curious, engaged child.
You tell him a piece ofinformation, he doesn't forget
it.
So, to see him then start tocrumble 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 goalong, I was getting this bigger
picture of going, I thinkthere's ADHD here, but I think
it's inattentive ADHD.
(04:36):
Which can be very difficult totease out.
Leisa Reichelt (04:38):
But,
Dr Kara Johns (04:38):
by last year, when the School Can't came into
the picture as well and thelevel of distress that we were
seeing in our child, I just knewthat there was more going on
here.
And there was one particularpivotal weekend that I have very
strong memories with because Iwas very upset and distressed.
I knew that the pressure fromthe school of how we were
handling his drop offs wasescalating into a direction that
(05:00):
I wasn't comfortable with.
And so I, I kind of felt likesomething needs to give or we
need to make some drasticchanges.
And it felt like this verypivotal weekend.
And I spent the weekend talkingto my son a lot about it, and I
was able to get bits ofinformation out.
He ended up sharing with us thatthere were moments in the
classroom where he was lookingaround and going, everyone knew
what they were supposed to beworking on, and I don't know
(05:21):
what I was supposed to do.
I'm so dumb and I'm so stupid.
negative framing of hisexperiences was profound.
And this was a 6-year-old sayingall of this.
He's looking around theclassroom and he didn't know
what he was supposed to beworking on, it was very obvious
to me that he was missing keybits of information in the
instructions.
And so on that Monday morning,I, got an appointment for a
(05:42):
pediatrician and I started theball rolling and we now have a
confirmation of inattentiveADHD.
And so because we now have thatinformation and we're able to
support him, as well asmedication, we have such a
different child this year, sucha different child.
Leisa Reichelt (05:56):
Hmm.
Dr Kara Johns (05:57):
I think the power of teaching him about his
brain has been.
I think we underestimate kidssometimes.
We really underestimate how muchthey process and how much they
can understand.
I talk to him about neurons andsynapses and neurotransmitters.
He now has the language to say,my brain works like this and
this is what I need for my brainto get that information in.
(06:18):
And he is not internalizing itas I'm dumb and I'm stupid.
So we've shifted the narrativein his head.
We now have a kid that skipsinto class.
Leisa Reichelt (06:27):
I think we always love to hear these
stories of where you candiscover something's going on,
get in and do an intervention,and get them back onto a happy
path quickly, rather than havingto live through a lot of trauma.
Dr Kara Johns (06:42):
A happy path is key, I think.
the work I do with young peoplethat I see in my work, it's
interesting sometimes when I usethat language because I don't
think school attendance shouldbe our goal, but on a happy path
should be our goal.
Happy and thriving in their wayshould be the goal.
And working with families torealign their expectations and
goals, it's quite interesting.
The big thing that I take awayfrom it is there's always
(07:03):
something underneath with thesekids.
They don't have the words toexplain it and maybe they don't
understand it, but I haven't meta single child yet where there's
not something going onunderneath.
so it's an exploring journeywith these kids.
Leisa Reichelt (07:17):
Let's pivot into your role as a GP then,
Dr Kara Johns (07:21):
Mm-hmm.
Leisa Reichelt (07:23):
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 nevercrossed my mind at all.
Never crossed my mind that a GPcould help me deal with the
challenges that were going on.
I look back'cause I have a greatGP and I feel some regret that I
didn't give her a chance to helpme on this journey.
(07:45):
she probably would've been a loteasier and done a lot better.
So, really interested to talk toyou today about the role that a
GP can play in a family's lifewhen they're experiencing School
Can't.
Go right back to basics.
How do you think about the jobof a gp?
What is a GP's job?
Dr Kara Johns (08:03):
Aw, that's a loaded question these days.
I can't speak for every GP inAustralia.
I don't speak for anyorganization of GPs.
I can share my experience as aGP a parent.
and a patient The role of ageneral practitioner or a GP in
Australia these days is verydifferent than what it was 30,
40 years ago, even maybe 10years ago.
Like, if you think about theadvances we've had in science
(08:24):
and technology in society,medicine has advanced in just
the same way.
So the breadth of medicine thatwe need to know so wide now and
the depth that we go in eacharea of medicine has changed so
much.
So, General Practice is a reallytough gig these days.
You look at the training processfor a general practitioner,
Several years ago, 20, 30 yearsago, you could finish your med
(08:45):
school training.
Do an internship in hospital,and then you could start working
in the community and you wereconsidered a general
practitioner.
These days it's very different.
You do your medical school, youdo your internship, and then you
have to apply to get onto aspecialist pathway to become a
specialist general practitioner.
And so general practitionersthat are being put out into
society now, we're actuallyspecialists, so we registered
(09:06):
with the Medical Board ofAustralia as specialist doctors.
Like general practitioners arespecialists once they're
qualified and we refer to otherdoctors that have narrowed down
into one field as subspecialistsor partialists.
Leisa Reichelt (09:19):
Hmm.
Dr Kara Johns (09:19):
That language kind of explains the complexity
of it.
Coming back to your questionabout, the role of a general
practitioner, we look afterpeople across the lifespan from
a newborn baby until death.
We're often the first port ofcall for anyone touching base
into the health system inAustralia.
Our role is to differentiatesymptoms and signs from things
that may be part of, and I usethe word normal very carefully.
(09:41):
There could be a normal sign orsymptom, doesn't mean we have to
tolerate it, but it can be anormal sign of symptom versus
what is a sign or symptom of adisease or a process or a
condition that we could besupporting, throughout the
lifespan.
We're also doing a lot ofpreventative healthcare.
As a female GP who specializesin women's health, I see
primarily female patients.
And then I've got a cohort ofkids that I see because I've
(10:03):
looked after them and they'vehad 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 generalpractitioner, is we get to know
the context of a person, notjust the individual person.
So we might look after thegrandmother, the mother, and the
child.
So three generations we lookafter.
And that informs so much of whatwe do because we have a much
broader perspective of what'sgoing on for the individual.
(10:28):
So it's very broad, the generalpractice role, and I'm not at
all surprised to hear you shareyour journey that you didn't
consider the generalpractitioner in your journey.
I think that's common.
And even in my experience withmy son, when the school were
aware that there was somethinggoing on, not once did they say,
touch base with his generalpractitioner.
It was oh, maybe we need an OTor maybe we need a psychologist.
(10:49):
And we're sort of going in thesehorizontal directions.
The general practitioner isoften the coordinator.
So, we are the central person ina person's healthcare that
coordinates between alliedhealth and Partialists.
And we are often the person inthe middle that puts the pieces
of the puzzle together.
Leisa Reichelt (11:04):
yeah.
I grew up with a family who werebasically, don't bother the
doctor.
Only go when you absolutely needto.
Doctor's very busy.
Don't waste their time.
You know, and so you get yourvaccinations and your
antibiotics when you are like,dying.
And that was kind of it.
I know not everybody is likethat.
And, that's great.
But I wonder what's yourperspective on how to develop a
(11:27):
good, productive, usefulpartnership with your GP if
you're fortunate enough to havea great GP?
Dr Kara Johns (11:34):
That's a good question.
I think it comes back down tohaving honest conversations with
them because we are humanourselves, we have our own life
and we all have our own personalpreferences.
So I know the way I practice ingeneral practice is different
than my colleague in the nextroom.
So I guess first of all, it'sfinding a general practitioner
that fits with what you feel youor your child needs are.
(11:54):
That can take time.
And I don't think thatrepresents good or bad GP.
It's just like not the rightfit.
You've gotta find the right fit.
And then I think having openconversations so that you are
actually meeting each other'sexpectations and needs.
I think it's historical.
Like if you looked back to, Ithink before Medicare was
introduced in Australia, it costa lot of money to see a general
practitioner or a doctor, whichyou could argue we're maybe
(12:16):
heading back in that directionthese days.
And so I think that culture ofdon't bother the doctor unless
it's dire was also becausepeople couldn't afford it.
The general practitioner has ahuge role in preventative health
and we try to advocate for that.
The earlier we intervene andaddress things, the less
complications we can sometimesbe dealing with.
So yeah, I think positiverelationship, right fit and then
(12:36):
a dialogue and having aconversation.
Personally as an example ofthat, like, I like patients that
bring in a list of their tasks,because it allows me to see very
early on what are theirexpectations.
So just because they're bringingin a list doesn't mean that they
expect me to cover all of thatin one appointment, which I
think some gps will ofteninterpret and go, oh my God, how
unrealistic.
But having that openconversation, they're like, no,
(12:56):
this is just my list ofthoughts.
I just want these two addressedtoday.
Cool.
Great.
I know what your list is.
I know what we're workingtowards.
That allows us to meet both ofour expectations and both of us
finish feeling fulfilled fromthe consultation.
Don't get me wrong, I get it.
It's hard because we are oftenrunning late, really stressed
and busy.
We might have just sent apatient to hospital that we are
really still worried about andwe are trying to get that out of
(13:18):
our head to focus on you.
And we are human.
We don't always do that verywell.
There are a lot of things goingon for us as well.
So sometimes it might feel toughto have those conversations, but
building to a place where youcan have that and remaining
flexible, really helps thatrelationship.
Leisa Reichelt (13:33):
It's a challenge, isn't it, it's hard
to get an appointment sometimesand then when you get an
appointment it's short.
And then being able to have thattime 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 lengthappointment.
Leisa Reichelt (13:46):
Mm-hmm.
Dr Kara Johns (13:47):
this is something that I see when I
first meet patients oftenthey're unaware of this.
when you call up a generalpractice find out, what length
of time is their standardappointment because every clinic
runs differently.
The clinic I'm at, our standardappointment is 15 minutes, but
what that actually means in realtime is that 15 minutes is
supposed to be from me openingthe file to me closing the file,
not 15 minutes with the patientin front of me.
(14:10):
Patients will often interpretthat as they've got 15 minutes
of my time to sit in front ofme.
So I think book the right lengthof appointment to start with.
Most of my young people that Isee, I request them to book a
double appointment, which ishalf an hour because quite a lot
of young people, need time towarm up.
I'm not gonna be able to getanywhere if they're feeling
nervous or uncomfortable.
Sometimes we need to do somecoloring on the floor first just
(14:31):
to connect again.
Then I can explore what's goingon with them and discuss it.
So book a good lengthappointment and that just have a
conversation with thereceptionist.
what length of appointment isthis?
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 along appointment because like as
a middle-aged woman with complexkids, right.
There's just always so, there'sjust a lot going on and, yeah.
Dr Kara Johns (14:56):
most of my patients are doubles.
Most of my day is doubles, butmy colleagues, it's single,
single, single, single.
And like, that's just thedifference in style, difference
in cohort of patients that seeus, different ways of doing the
job.
It's really hard sometimes towork out what appointment length
you might need.
As a general rule, we say it'sone issue for a standard
appointment, two issues for adouble appointment, but
(15:17):
obviously not all issues needthe same amount of time.
Like I had a patient who bookeda single with me and they wanted
to talk about potentialperimenopause.
That's a massive topic.
To do that, well you can't dothat in 10, 15 minutes.
We can get the ball started.
That's the thing too, It's arolling consult.
It doesn't have to haveeverything in the one consult.
You start it and then when theycome back, you're doing a bit
(15:38):
more on it and you're doing abit more of it.
But I don't think that's whatour society or patients want
anymore.
We are still taught to have therolling consult with our
patients, but patients are busy.
They often take time off work tocome in and have their
appointment.
They wanna get their issuesaddressed in that appointment.
They don't want to come backnext week.
Leisa Reichelt (15:54):
It's a bit of a mindset shift though, isn't it?
Right.
The mindset that we often havenow is transactional.
I'm coming in with a cough and Iwant antibiotics, or I'm coming
in with this pain and I want areferral.
It feels very transactional.
Whereas what you are describingis much more of that
relationship based medicine,which I think lots of people
(16:15):
would want that if they thoughtthat 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 Itotally get it because that is
the way we've been forced towork.
We've been forced into thisspace of going, government wants
us to do six minuteappointments.
If you look at how they fund theMedicare and That's where it has
become transactional.
I don't personally find thatmedicine or way of practicing
medicine satisfying.
(16:42):
So I don't practice that way,but that means to see me is more
expensive than to see a doctorwho does do transactional
medicine.
I can see why it exists, and Ican see why general practice has
become to some sections ofsociety viewed that way, that we
are just a GP.
Because you're just a referraldoctor.
You're just there to refer usonto the actual doctor.
(17:03):
I can see why that's beingformed.
But I think if you have thatview, you're missing out in a
big resource.
We have a huge knowledge basethat we can use and help with,
and can be beneficial with.
Leisa Reichelt (17:14):
Yeah.
I was always fully thetransactional person with my GP
for a long, long time, and Ithought that was me doing the
right thing.
But now I reckon my strategy isbasically I book an appointment
a month.
I, I book a double appointmentevery month because my GP's hard
to get into as well, so I needto book well in advance.
Dr Kara Johns (17:32):
I've got one patient in particular that has a
double appointment booked everyweek with me.
Now whether they use it or notis another thing, but if you get
out and ahead and schedule it.
We don't always use them, butshe's got some serious health
issues.
She knows that things don't goto plan often for her.
She's just highly proactive andhas reserved that spot with me
every week to the end of theyear.
I'm a big one of that.
I often tell my patients tobook, and I sometimes do it in
(17:54):
the room.
When are we gonna touch basenext?
I think booking in advance is avery good strategy as well,
because the worst thing I thinkis if you stockpile issues and
you wait till that month'causethat was on your appointment and
you've come into a doubleappointment, but you've got a
list of 10 things they're all ofequal value to you that you need
to get addressed.
But that's not physically gonnabe possible in a half an hour
appointment.
(18:14):
So yeah, getting out in frontand having pre-booked
appointments, as long as you askin 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 cancelingthe appointment so they can snap
it up.
Dr Kara Johns (18:25):
quickly.
Because I think that's one ofthe complaints I get is it's
really hard to get in to seeyou.
Now my next availableappointment is not till
mid-October.
So, yes it is really hard, butif 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 forus.
Instead of waiting untileverything's desperate and then
going, but I can't see them forhowever many weeks.
Alright.
Let's talk more specificallyabout School Can't now and the
kinds of things that GPS can door that you do in supporting,
families and young people whoare experiencing the stress
(18:59):
associated with School Can't.
What are typical things that youfind 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 youngpeople as much.
They're teaching me a lot aswell.
It's still a growingunderstanding in the general
practice space.
I still hear school refusal termbeing used even amongst my
colleagues.
I don't think it frames what weare dealing with correctly, but
it's still just a label thatthey're using to explain the
(19:28):
situation.
My experience, I guess, has beenvery informed from some of the
work I've done around infantcare.
So before I came to generalpractice, I was very interested
in the women's health space anddid quite a bit of time in
obstetrics and gynecology,delivering babies, doing
postnatal care.
I got very interested in somework being done in Australia by
a GP who's done a lot ofresearch.
(19:49):
It was Pam Douglas and shedeveloped the possums program, I
think it's called somethingdifferent now, Neuroprotective
Developmental Care, I think it'scalled the NDC is the website.
For me, it made a lot of sense.
it was talking about the firsthundred days of life and how we
parent our infants and how itsets them up for positive mental
health moving forward.
It's actually going back totapping into biological drives
(20:11):
and biological needs.
They use a lot of acceptance andcommitment theory in the
program, which also made a lotof sense to me.
I don't consider myself anexpert in acceptance and
commitment theory, but myinterpretation of it was like,
find out what is your genuineself and live that
authentically.
And if we find what thatgenuineness is and can get you
on a path where you can be yourauthentic self.
(20:33):
Often you feel better aboutyourself and about the world
because you're not masking orpretending to be someone you're
not.
There's a freeing that comeswith that.
The work that I did in thatspace has really informed me
moving forward with all of myyoung people, because the most
important bond is that primaryattachment relationship, which
is often the parent and a child.
That's an extraordinarilypowerful relationship in the
(20:56):
brain development of a youngperson.
And we should be protecting andstrengthening that relationship.
When we used to tell mums toleave a baby to cry, we're
actually damaging that childparent attachment relationship,
which is not a healthy thing todo.
So, we now know, respond to yourbaby when they cry because they
are communicating to you.
And that need might be they needa cuddle, but that's still a
(21:17):
need.
And so then if we fast forwardinto primary school age children
who are showing a lot ofdistress, I always start from a
place of strengthening thatprimary caregiver attachment
relationship.
And what I'm finding in theSchool Can't space is that
relationship is often beingripped apart,
Leisa Reichelt (21:36):
Hmm.
Dr Kara Johns (21:36):
and being damaged.
And not strengthened.
So I guess my first journey inthis space was working with a
family where the child wasreally struggling to attend
school and the school weregetting really forceful to the
point of physically restrainingthe child and telling the
parents to leave, I had hugeissues with'cause I was like,
(21:57):
that's assault.
That is absolutely not okay.
Secondly, if that child ishighly distressed and you are
their primary attachment and youare leaving them when they're
highly distressed, that initself is distressing to a child
because you are supposed to betheir safe place to land and you
are now abandoning them.
Like that's not a healthyprocess.
(22:19):
So, navigating and supportingthis family, I came at it from
that lens of just going, we needto support the primary
attachment and the child, andwork with that.
And when I first met this childtoo, because I'd had a heads up
because I knew the mum was mypatient I scheduled it at a time
where I could have time withthis child.
I had an hour with this child.
that appointment too, I was ableto see very clearly that I
thought autism was at play here.
(22:41):
And the school had not seen it.
In actual fact, what they weredoing to get this child to
school was actually damaging theparent child relationship and
causing huge trauma in thischild The way that they were
handling it was not neuroaffirming or neuro safe I don't
consider myself an expert inneurodiversity, so apologies if
I use the wrong terms But I sawso much of what was going on
(23:02):
here was bad.
My role in that place wasstrengthening relationships,
holding space, working out whatwas going on with this child.
You know, we got this child toseveral different psychologists
because there's therapeuticpsychologists and assessing
psychologists.
So you often need to use two orthree sometimes.
We've since had a diagnosisconfirmed.
We've got NDIS in place.
(23:22):
What I think my role was quiteuseful in this place was because
there was a lot of gaslightinggoing onto this mum.
The school had done a lot ofdamage to this mum by framing
her as being weak.
The problem was her, not thechild.
So they'd really broken mum aswell.
So I just contacted theprincipal and I was like, let me
hold that space.
They can blame me, they cancriticise me.
(23:43):
What's going on at this schoolis wrong and not, okay, let me
be the one dealing with this.
I think the GP role in many ofthese cases is to look beneath
the surface of what's going onwith this child.
We can help affirm what isappropriate and safe and we can
help direct families into ahelpful pathway, hopefully, that
won't happen from the firstappointment, but I feel like we
can hold a lot of space here.
(24:04):
Our role is often thecoordinator.
We are sending out, gettingother people's opinions and
bringing it all back together.
And by doing that we can oftenformulate what's actually going
on with this child and whichdirection 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 workout what is the path forward?
Who do you go see?
My journey was that the schoolpicked my son out for not doing
pattern matching in the way thatthey would like him to be doing
pattern matching.
And they were like, you bettergo and see a speech therapist.
We're like, okay.
(24:36):
So we went and saw a speechtherapist and then, you know,
great speech therapist, but weended up on this roundabout
pathway.
In retrospect, it would've beenso 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 themin 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 aheap of assessment stuff, and
then she's like, oh, myexpensive assessments tell me
that you need to go to apediatrician now to get
expensive assessments done.
I'm like, okay, great.
I think the other thing that youpointed out as well is that role
that a GP can play in advocatingto the school.
When communications with theschool are getting very
(25:17):
stressful and very serious, andin 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 ofwhat's actually going on for
this child and the way they needto be handled, which is often
different to what the school isasking for.
Dr Kara Johns (25:36):
Yeah, I agree.
And maybe I'm giving too muchcredit to schools in some cases,
but I think it's nicer to have aviewpoint of thinking that
everyone's actually trying to dotheir best in a very flawed
system.
I often say let me be the badguy.
they can complain about me.
just let the school complainabout me as well.
you don't need to hold all ofthat mental load.
And I see that the burnout inparents is often huge.
(25:57):
Let us hold some of that foryou.
You don't need to hold all ofthat.
Sometimes when I'm talking witha couple of families, I've got a
family with a child that'scurrently not attending school,
and of course that requires awhole 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 verypowerful.
You are carrying some of themental 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 andlike you say, not all schools,
some schools are great and tryreally hard and listen, other
schools are threatening to sendparents 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 issuesright now.
And this is very serious.
And I don't always think thatschools take that seriously in
the way that they do if you havea letter from your GP saying,
this is a situation with thechild, 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 onlyother adult in this child's life
giving them a voice and tellingthem to trust in and be
affirming of themselves.
And I come at it more as a childprotection lens of where we are
trying to raise our childrenthese days to have a lot more
body autonomy, to be moreunderstanding of consent, and
(27:14):
encouraging children to voicewhen they're uncomfortable.
and you know, when you find outthat this child has had to sit
with a lot of uncomfortablefeelings and the school has told
them that's okay, I have a lotof issue with that because
that's, really not keeping thischild safe.
If they're being told that whenthey're uncomfortable, they're
supposed to ignore that to fitin.
I take real issue with that.
(27:35):
We as adults should beencouraging 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 willbe people listening whose
experience has been that theschool has initiated proceedings
with Child Protective Servicesbecause parents were trying to
protect their children's mentalhealth and allowing them to not
attend school all the time.
I wanna circle back, Kara tosomething you said a little
(28:05):
while ago, which was just aboutthe neuroprotective behaviours
and, the damage that can beinflicted when children in
distress see their parents walkaway.
Just to note that there areloads of us who have done that
(28:25):
and who probably carry anenormous amount of guilt because
we thought we didn't have achoice because we thought that
was, you know, that was theadvice that we were given by
people who theoretically knew alot better about these things.
So I just want to reflect backto anybody who's hearing that
and feeling that burden of guiltand self blame that, you know,
(28:47):
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 journeylast year with the school.
I had my son picked up and toldto leave while they physically
held him.
I had a teacher I very muchrespect still'cause I, I do
believe that this teacher wasdoing what she thought was best.
Saying to my son, you're makingyour mum really sad when you
behave like this.
You don't wanna make your mumsad, do you?
(29:13):
And then she's saying, you'remaking 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 dothis to our children'.
So I can see how easy it is asparents because you do assume
that the educators and theteachers know best.
I see it as a knowledge gap inschools and that we need to be
getting our educators to do morecontinuous professional
(29:38):
development in this space.
We need to be gettingpsychologists into these schools
to inform them on how they'rehandling these behaviours.
Because it's not okay.
The way we very quickly turnedthe behaviour response around
with my son had nothing to dowith the school.
the process we had was gettinghim to say, I feel, and then say
the emotion.
I was developing with him sometasks to calm his nervous system
(29:59):
down.
So breathing exercises to dialdown his nervous system to allow
him to make better decisionsthat he was comfortable and
happy with.
So we would do a round ofbreathing 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 nervoussystem down every day, he chose
(30:19):
to stay at school.
Schools need to be validatingand working with emotions.
So we have a lot of work to doas a society on that.
Leisa Reichelt (30:27):
Let's get really practical now and focus
specifically on the Australianhealth system apologies to
international listeners whomight not find this quite so
helpful.
Things that families who haveSchool Can't kids should be
aware of about how theAustralian health system works,
(30:50):
Kara?
I'm thinking about things like,the big thing for me was I
discovered the Medicare safetynet and the fact that my family
wasn't registered and we gotregistered and we had already
passed the safety net by thetime 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 thesafety 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 steppingback, the Australian health
system is complex.
We have a Medicare system inAustralia whereby the patient
can get a rebate throughMedicare, which is a government
set up rebate system to fundhealthcare expenses.
When this first got introduced,the Medicare rebate was very
close to the cost of theservice.
(31:35):
Unfortunately, successivegovernments have not funded
Medicare.
They even froze the Medicarerebate for a number of years.
Every year when CPI rises, forgeneral practitioners accepting
the Medicare rebate, they didn'tget a pay rise for 10 or so
years.
Australian Medical Association,the AMA, sets out guidelines of
fees, every year for differentprofessions.
(31:56):
They're currently saying thestandard general practice
appointment, which is that 10 to15 minute appointment, is valued
at about$105 for theappointment.
Medicare rebate now is$42.
So there is a massive gap.
The Medicare safety net saysthat across a calendar year,
once the gap amount reaches acertain threshold, Medicare will
(32:17):
start paying more about 80%.
I have patients now that see mefor 30 minutes, they're charged
a 30 minute fee, which at ourclinic 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 thegap component.
So if it was a hundred dollarsand 40 from Medicare it's the 60
that goes towards the safety netfor that.
(32:39):
For singles, it's about 2,600.
But then here's the thing, ifyou're a family.
You can tell Medicare you're afamily, and that 2,600 would
apply for your whole familycollectively.
So if it's two teenagers or twochildren and two adults, that's
four people that cancumulatively get the 2,600.
But you often need to tellMedicare that even if you're on
(33:00):
the same Medicare card, theywon'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 stillneed to log in and go confirm my
family.
Otherwise the rebate doesn'tapply.
How ridiculous is this?
But for families that are seeinghealth issues any service that
you are getting a Medicarerebate from that gap can then
(33:21):
apply over to accumulating onyour safety net.
So if you think about it, ifyou've seen your GP and they're
that central person in yourjourney and then they've
referred you to a psychologistand the psychologist, then you
get a Medicare rebate on the gapwith your psychologist goes
towards your safety net.
But if you just went from theschool's recommendations and
(33:41):
went out and saw a psychologistor an OT, you're paying for it
all privately and none of thataccumulates onto your Medicare
safety net.
Then that leads into the nextstep about can you get referrals
from a GP onto Allied Health andto Partialists.
Yes, you can, but there arerules around it.
So first one is a MentalHealthcare Plan.
If your child or yourself meetthe eligibility criteria, which
(34:02):
Medicare stipulates, we cancompile a Mental Healthcare
Plan, which in Australia opensup 10 subsidised sessions with a
psychologist per year.
So it's not much, but it'sbetter than nothing.
So 10 subsidised sessions, it'snot fully funded, it's
subsidised.
So, what I try to explain topatients again is that the
recommended fee for apsychologist is around$300 a
(34:23):
session now, and the Medicarerebate depends on whether it's a
registered or clinicalpsychologist as well, but it can
be around a hundred dollars.
So you're still gonna be out ofpocket a decent chunk.
So it's still a big gap.
And then in terms of otherAllied Health, there are avenues
that we can get Allied Healthinvolved.
Again, it has to be that theeligibility criteria met for
something called a ChronicDisease Care Plan.
(34:46):
So it has to be that you or thechild, depending on who's the
referring patient, they have tomeet the criteria.
And if you meet a criteria youcan get referral to particular
allied health people forsubsidised 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 autoimmunearthritises and you have a
physio that helps you manageyour pain you're gonna use up
probably within two months,three months.
So it's not a huge amount, butit can help, but it also then
adds to your safety net as well.
So all that accumulates up.
Families will find they'll hitthe safety net quite quickly in
the year, and then their healthcosts 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 topsychiatrists 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 thebenefit of using the mental
health and chronic disease plansbecause of the contribution that
would make to the safety net.
I didn't know about that, butthat's very helpful to know.
Dr Kara Johns (35:44):
Yeah, I mean, again, it requires you to have
those appointments with thegeneral practitioner to do up
that paperwork.
At the start of every year, Itry to get all my patients, I
try to remind everyone, have yougot your family safety net set
up Medicare safety net set up?
Leisa Reichelt (35:57):
Definitely.
And I think the other thing thatI learned is if you register
your family for the safety netsort of mid-year, it will still
count all of the stuff thatyou'd done earlier in the year
before you were registered.
So yeah, we registered for thefirst time in June and we were
already well over the safety netlimit.
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 planto 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 fewyears.
My understanding of it is, andhonestly I've probably only ever
done two or three of them.
So this was, I guess thegovernment's or Medicare, being
part of Australian government.
It was their way of addressingthe need to have separate
services for people with eatingdisorders.
However, what I find is that theeligibility criteria are such
(36:45):
that a lot of people won'tqualify.
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 doesis it opens up 20 psychology
appointments.
and dieticians, I might get thiswrong, but I think it's 20
dietician appointments and 20psychology appointments that get
a Medicare subsidy
Leisa Reichelt (37:01):
Hmm.
Dr Kara Johns (37:01):
sessions.
so it's worth discussing becauseI know with a lot of young
children, particularly whenwe're facing certain
neurodiversity aspects, thereare sensory components to eating
and food that can often makefood intake be less than ideal.
My son, particularly justdoesn't like the texture of
meat, which is.
Totally fine.
He doesn't have to eat meat,it's not a problem.
(37:21):
however, we need to make surethat 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 managehis iron because low iron.
often I see in children, it'svery interesting but I often see
in young children, particularlywhen they've been, emotionally
regulated, and then they'regoing through a phase of
emotional dysregulation.
I'll check their iron, and oftenit's low, something's happened.
So low iron can be acontributing thing.
It can be a sign.
So behavioural, emotionaldysregulation, particularly when
(37:45):
it's a change, can sometimes bea sign that their iron has
dropped off.
And we can address that, bothgiving them iron supplements.
And we can often see thesechildren get better emotional
resilience and better cognitivefunctioning, which means they
learn better and engage betterat 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 abeautiful demonstration of the
power of general practice, Whichis that so many of our
specialists would look at thisthrough their lens of expertise
and go, well, it's emotionaldysregulation.
We've got to do some kind oftherapeutic thing.
And like you sitting in thecenter of all of that, you can
go, well, it could be this, orit could be that, or it could be
the other thing.
(38:20):
and here's all of these otherdifferent 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 groupas well, like you said, the
emotional dysregulation of achild and the school's going
down, the OT psychologist andI'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'smultifactorial.
We can't put all our eggs in onebasket, but we should be
thinking about all the differentcontributing factors.
And so my son withinAttentitive, ADHD, and he does
have strong emotions and we knowthat's part of ADHD pathway, but
if his iron's dropped, hisemotions are bigger.
It's very noticeable.
When it happens, you go, oh,right, okay.
(38:56):
We better get back onto that.
it can be multiple factors andwe need to keep our mind broad
to what's going on and how wecan help.
Leisa Reichelt (39:02):
many women will know that life is so much easier
when your iron's at the rightlevel.
Dr Kara Johns (39:07):
a hundred percent.
Leisa Reichelt (39:11):
Amazing.
Kara, I wonder, you've given usso much amazing content and
things to think about in ourconversation so far, but are
there any resources that youthink families who are
experiencing School Can't shouldbe across?
Dr Kara Johns (39:28):
It's a funny question actually, because more
recently, families that I'mmeeting 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 isthat 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 largelydepends on the family situation,
because there are differentresources for different
families, for differentsituations.
there is a podcast that acolleague mentioned to me
recently called Pop CultureParenting.
I've only listened to a fewepisodes I'm always quite
skeptical when I go intolistening to these things, but I
was actually quite impressed bythe conversations going on in
(40:07):
that podcast.
Leisa Reichelt (40:07):
Yeah.
Dr Kara Johns (40:09):
in South Australia there's a lovely
website by some psychologistsIt's a Developing Minds
psychologist group and they'vegot some great stuff on their
website.
there's even a program I thinkthat parents can pay to do.
I believe it's like$20 orsomething.
it's all around emotionalregulation in children.
So I sometimes direct familiesto that website.
They also do great articles thatare all available.
(40:31):
So I think that's a greatresource.
For ADHD stuff, which is, Iguess, because it's my own
journey with my son.
it's an area that I'm doing alot more reading on.
There's a great website, by apsychiatrist 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'screated and she's got it all up
for free.
And she set it up as a buildingSo she's got ground level, floor
(40:53):
one, floor two, floor 3, 4 4,and it is more targeted towards
adults.
But there is some interestingresources in there around
children as well, particularlyteenagers.
And the way she explains ADHD isthe best I've ever seen
explained.
And she gives great analogies.
she talks about what theneurotransmitters are doing in
the synapses and saying thenerves in ADHD have extra vacuum
cleaners that are sucking outthe neurotransmitters.
(41:14):
And that was a concept my soncould get.
So he'll say, I've got extravacuum cleaners in my head.
There are some wonderful, veryextensive resources on Reflect
Health for families that arewanting to understand ADHD
better as well.
Leisa Reichelt (41:26):
That is fantastic.
We will put links to all ofthose in the notes so that folk
can go and explore them forthemselves Alright, well Kara,
thank you so much for taking thetime to come talk to us about
this.
I think building thatrelationship with your GP is
something that I came to verylate in my still ongoing
journey.
(41:46):
And I just wish that I had my GPas an ally alongside the whole
way through here.
I think it can make a hugedifference 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 supportyou and your family on the
School Can't journey, and tomake sure that your family is
registered for the Medicaresafety net as well.
Both of these things made a hugedifference for me once I finally
discovered them.
If you've found our podcasthelpful, please do take a moment
to subscribe or give us a ratingor review.
This really does help us get thepodcast in front of more people
(42:23):
with School Can't kids whohaven't yet found our community
and the information that weshare.
If you have some feedback for usor a suggestion for a future
topic or speaker, or maybe youhave 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 inAustralia and you're feeling
(42:45):
distressed, remember you cancall the Parent Helpline in your
state.
A link with the number to callis in the episode notes.
Sadly, on the 31st of October,the Victorian government will be
shutting down their state ParentLine, which is very
disappointing.
I've put a link to a petitionyou can sign to protest this in
the episode notes if you areinclined to do so.
Thank you again for listening.
(43:06):
We will talk again soon.
Take care.
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.