model educational visits policy

Educational visits policy: model and examples

An educational visits policy provides support for staff in the effective and safe planning and operation of school trips. this policy isn't statutory, but it's best practice to have one. download our model policy with practical templates in the appendices, and see examples from other schools., download our model policy, examples of school policies.

Our model policy is approved by Forbes Solicitors , and has instructions for you to adapt and make it your own.

Model policy: educational visits

It includes:

• A proposed visit planning information template for staff to use when seeking approval for educational visits
• A risk assessment template
• Volunteer behaviour guidance and code of conduct, for volunteers to sign

Primary schools

• Benedict Biscop Church of England Academy, Sunderland
• Highgate Primary School, Haringey

Secondary schools

• St Angela's Ursuline School, London
• Lord Williams's School, Oxfordshire

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School visits: guidance, policy and planning tools

Use our guidance and templates to ensure monitoring visits are well planned and have a positive impact

Visiting the school is an essential part of the governor/trustee role. Feedback and learning from visits allow the governing board to monitor how their strategy is being implemented, how their policies are working and to identify strengths and areas for development.

School visits also raise the profile of the governing board and provide governors/trustees with valuable insight into school life and culture.

Visits are usually focused on a specific area or priority and carried out by the link governor/trustee  who has been given responsibility for monitoring that area and reporting back to the board.

Our school visits guide is designed to help governing boards to ensure visits are well planned and have a positive impact. A model school visits policy, schedule and report accompany the guide.

The guide covers:

• the focus for school visits
• scheduling and planning visits
• school visits policy
• virtual visits
• during and after a visit
• reporting back to the board

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Governor school visits policy: model and examples

Adapt our model policy to help make sure your governors stay on track during visits, and so school staff know what to expect when they're visited. plus, see examples from other schools., download our model policy, see examples from schools, get more help by reading our other articles.

Download: governor school visits policy

Our model is:

• Designed for you to adapt to suit your school's context
• In line with good practice – for more articles on this topic see the final section of this article
• Approved by Forbes Solicitors

Voluntary aided primary school in Windsor and Maidenhead

Clewer Green Church of England (CofE) First School's governor visits policy  includes guidelines for meetings with staff and for visits to classrooms, as well as how to report on each formal visit.

The school encourages governors to attend ad-hoc events such as assemblies, church services, sports days and fundraising events.  

Community secondary school in Hillingdon

The governor school visits policy from Barnhill Community High School sets out:

• The rationale for school visits
• Protocols for arranging visits
• Areas of focus, along with some possible discussion topics

The school includes its preferred record template for governors to use, as well as some suggested questions to ask during the visit.

Community special school in Wigan

Oakfield High School and College is part of a federation of 2 special schools. Its governor visits policy  includes:

• What governors can get out of visiting the school
• What governors should do before, during and after their visit
• What's classed as an 'informal visit'
• Governor visit objectives and responsibilities
• A template visit record for governors to use

Find out everything you need to know, including questions to ask and visit templates, in our how-to guide on school visits for governors . For a quick read, try our 1-page summary about governor school visits .

If you're the chair, share the how-to guide linked above with your board and read our:

• Guide for chairs , which includes a template schedule 
• Top tips  to help you encourage your governors to go on visits

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Educational Visits Policy

It should be noted that the Headteacher, Deputy Headteacher and Assistant Headteacher (EVC) completed updates and training respectively in Autumn 2023 and Spring 2024.

LA Model Adopted

Introduction

Educational visits are activities arranged by or on behalf of the school, and which take place outside the school grounds. The governors and teaching staff believe that off-site activities supplement and enrich the curriculum of the school by providing experiences which would otherwise be impossible. All off-site activities must serve an educational purpose, enhancing and enriching our children’s learning experiences.

In this policy we seek to establish a clear and coherent structure for the planning and evaluation of our off-site visits, and to ensure that any risks are managed and kept to a minimum, for the safety and health of all pupils at all times. Within these limits we seek to make our visits available to all pupils, and wherever possible to make them accessible to those with disabilities. The visits usually take place within the school day, but on occasions, take place after school. Our school adopts the LA guidance and uses their proforma when planning Educational Visits.

The aims of our off-site visits are to:

• Enhance curricular and recreational opportunities for our pupils;
• Provide a wider range of experiences for our pupils than could be provided on the school site alone;
• Promote the independence of our children as learners, and enable them to grow and develop in new learning environments;
• Increased levels of trust and opportunities to examine the concept of trust (us in them, them in us, them in themselves, them in each other);
• Enhanced opportunities for ‘real world’ ‘learning in context’ and the development of the social and emotional aspects of intelligence;
• Greater sense of personal responsibility;
• Improved environmental appreciation, knowledge, awareness and understanding of a variety of environments.

Curriculum links

For each subject in the curriculum, there is a corresponding programme of activities (which includes visits to the school by specialists). All these activities are in line with guidance published by the LA:

Literacy – theatre visits, visits by authors, poets and theatre groups, visits to the local library;

Science – use of the school grounds, visits to botanical gardens, visit to the Sea Life Centre, visit to Twycross Zoo, external visitors;

Mathematics – use of shape and number trails in the local environment;

History – castle visits, study of local housing patterns, local and national museums;

Geography – use of the locality for fieldwork, visit to a beach, village trails;

Art and design – art gallery visits, use of the locality, external visitors;

PE – a range of sporting fixtures, extra-curricular activities, visits by specialist coaches;

Music – a variety of specialist music teaching, extra-curricular activities, local schools’ orchestra, concerts for parents to hear, Morning of Music;

Design and Technology – visits to local factories, design centres and a local secondary school;

ICT – its use in local shops/libraries/secondary schools etc;

RE – visits to local centres of worship, visits by local clergy;

PSHE and citizenship – visit to the fire station or an old people's residential home, visits by local police officers and health workers.

Residential Activities

Children in Upper Key Stage 2 have the opportunity to take part in a residential visit to Dol y Moch. The residential visit enables children to take part in outdoor and adventure activities as part of their PE work, as well as having links with PSHE, Science and Geography. We undertake this visit only with the written agreement of the LA. The centre provides qualified instructors for all specialist activities that we undertake.

Children in Lower Key Stage 2 have the opportunity to take part in an overnight camping trip within the local area. The experience enables children to experience the outdoors, and increase their independence and confidence. 

How Visits may be Authorised

The EVC will appoint a party leader to be responsible for running the activity. This will normally be a teacher employed at the school.

The school’s educational visits coordinator, who may be the headteacher, will be involved in the planning and management of off-site visits. S/he will:

• Ensure that risk assessments are completed;
• Support the headteacher and governing body in their decisions on approval;
• Assign competent staff to lead and help with trips;
• Organise related staff training;
• Verify that all accompanying adults, including private car drivers, have had satisfactory DBS checks, and that the letter from our coach company assures us their drivers too have had DBS checks;
• Make sure that all necessary permissions and medical forms are obtained;
• Keep records of visits, and ensure there are regular generic assessments of the risks (for example road-crossing) where there are frequent visits to local venues (for example a swimming facility).

Staff arranging or otherwise involved in off-site activities must familiarise themselves with the regulations, advice and procedures published by the LA (and available from the school office). All off-site activities must take place in accordance with the LA’s instructions.

Where staff are proposing to arrange an off-site activity, they must seek and obtain the approval of the EVC before any commitment is made on behalf of the school. A comprehensive visit plan should be provided by the member of staff to allow for an informed decision to be made. The EV pack is available from the staff handbook, school office, or EVC. Paperwork is also available on the School Server.

Where the activity involves a period of more than 24 hours, an overnight stay, or a journey by sea or air, the headteacher will seek the approval of the governing body and the Local Education Authority before permitting the activity to take place.

It is our policy that all children should be able to participate in educational visits. Where a child with a disability is eligible for a trip, we will make every effort to ensure that s/he is included. We may seek guidance from parents to help us adapt our programme, and we will make any reasonable adjustments to our itinerary to include a child with disabilities. Any such adjustments will be included in the risk assessment.

Risk Assessment

A comprehensive risk assessment is carried out by the group leader before the proposed visit. It will assess the risks which might be encountered on the visit, and will indicate measures to prevent or reduce them. The risk assessment should be based on the following considerations:

• What are the hazards?
• Who might be affected by them?
• What safety measures are needed to reduce risks to an acceptable level?
• Can the group leader put the safety measures in place?
• What steps will be taken in an emergency?

Staff planning an off-site activity should make a preliminary visit to the venue, in order to carry out an on-site risk assessment. It is important to take into account the probable weather conditions at the time of year proposed for the trip, and the party leader should take careful account of the facilities available, with due regard to the proposed size of the group. They should also assess the site’s suitability with regard to the age and any particular needs of the children. They will also consider the venue’s own approach to security and to health and safety. Venues providing instructor-led activities will have their own risk assessments for particular sessions, and these assessments may be adopted if it is impractical for the group leader to experience the activity beforehand, or if s/he lacks the skills required to make informed judgements about the risks it may involve. The LA will not have given its approval for the visit unless it is satisfied with the venue, its instructors and their risk assessment procedures.

It is important to assess and record any health, safety or security issues that are identified during the preliminary visit. Any such issues will be taken into account when the final decision is taken on whether the visit should proceed, and the Visit Plan must state both the extent of any risks involved, and the measures that will be taken to reduce or eliminate them. The cost of these preliminary visits will be borne by the school, and should be built into the overall financial arrangements for the visit itself.

An activity will have sufficient adults taking part to provide the correct ratios (see Appendix 1). Any trip will require a minimum of two adults per class.

The risk assessment must also cover transport to and from the venue. The coach company we use on a regular basis has provided us with a letter detailing all the health and safety measures it routinely takes, including:

• The provision and required use of seat belts and booster seats (if required);
• Proper vetting of the driver by the police;
• Proper insurance for the driver;
• Details of first aid and emergency equipment;
• Breakdown procedures.

The group leader will double-check that all adults helping to supervise the trip have been subject to DBS checks.

A copy of the completed risk assessment will be uploaded to Evolve to be approved by the EVC. A copy of the risk assessment will also be shared with all adults supervising the trip.

The costing of off-site activities should include any of the following that apply:

• entrance fees;
• provision of any special resources or equipment;
• costs related to adult helpers;
• any refreshments the school has opted to pay for.

Transport arrangements will allow a seat for each member of the party. It is our policy only to use coaches fitted with seat or lap belts, and to insist that they be worn by all those participating in the visit.

Where private cars are used for transport, the group leader is responsible for checking that the insurance of each driver covers such journeys, and double-checking that each driver has been subject to the normal DBS checks.

Our minibus meets LA guidelines, and each seat has a belt. We instruct all children, whether travelling by car, minibus or coach, to attach their seat belts.

Communication with Parents

The parents of children taking part in an off-site activity should be provided with all appropriate information about the intended visit. Parents must give their permission in writing before a child can be involved in any off-site activities.

Funding for off-site activities is provided mainly by parental contributions (voluntary except in the case of residential visits). This is made clear to parents in all correspondence about an educational visit at the planning stage and is currently charged at £30 to cover all trips for the year (excluding residential trips).

No child may be excluded from an activity because of the unwillingness or inability of the parent to make a contribution. Parents will be informed of this principle through the school prospectus and letters sent home about intended visits.

Further Health and Safety Considerations

All adults accompanying a party must be made aware, by the party leader, of the emergency procedures which will apply. Each adult should be provided with an emergency telephone number. This will normally be the school number, but where an activity extends beyond the normal school day the home telephone number of a designated emergency contact should be provided.

Before a party leaves school, the school office should be provided with a list of everyone, children and adults, travelling with the party, together with a programme and timetable for the activity.

The safety of the party, and especially the children, is of paramount importance. During the activity the party leader must take whatever steps are necessary to ensure that safety. This involves taking note of any information provided by medical questionnaire returns, and ensuring that children are both safe and well looked after at all times.

Prior to an activity, if it is felt that the behaviour of an individual child is likely to compromise the safety of others or the good name of the school, the party leader should discuss with the headteacher the possibility of making additional arrangements for that child.

Group Leaders’ Planning

Group Leaders must read thoroughly the appropriate guidance for off-site activities:

They must consult the LA’s documentation detailing procedures and requirements, including guidance on Emergency Planning and Crisis Line organisation, and must draw up a Visit Plan which records in writing (including standard forms where appropriate) the arrangements that have been made.

The visit plan for intended educational visits must include the following:

• risk assessment;
• report on preliminary visit;
• applications for approval of visit;
• general information;
• names, ages, contact details, permission forms, medical records and other relevant details of all those going on the visit;
• travel schedule;
• accommodation plan (if applicable);
• full plan of activities;
• fire precautions and evacuation procedures;
• intended arrangements for supervision;
• insurance arrangements for all members of the group;
• emergency contacts and procedures;
• general communications information;
• guidance for party leaders;
• guidance for the emergency contact and headteacher;
• medical questionnaire returns;
• first-aid boxes.

Monitoring and Review

Visit leaders are encouraged to review visits, taking into account the successful and less successful parts of the visit, and considering ways in which the visit could have been improved. Informal conversations might take place between the visit leader(s) and the EVC or Headteacher regarding the outcome of the visit.

This policy is monitored by the governing body and will be reviewed every two years, or before if necessary.

Appendix 1:                                                                                                  

STAFFING  AND STAFF  RATIOS

*Note : for KS2 local visits to AT7, or similar, 1:15 ratio is appropriate.

• Stoke Primary School
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• West Midlands
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• Education, training and skills
• Pupil wellbeing, behaviour and attendance
• Health, safety and wellbeing in schools

Health and safety on educational visits

• Department for Education

Published 26 November 2018

Applies to England

© Crown copyright 2018

This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: [email protected] .

Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.

This publication is available at https://www.gov.uk/government/publications/health-and-safety-on-educational-visits/health-and-safety-on-educational-visits

Types of trip

The 2 main types of trip are:

• routine visits
• trips that need a risk assessment and extra planning

Routine visits

These involve no more than an everyday level of risk, such as for slips and trips, and are covered by a school’s current policies and procedures. They only need a little extra planning beyond the educational aspect of the trip and can be considered as a lesson in a different classroom.

Trips that need a risk assessment and extra planning

These are trips not covered by a school’s current policies. This could be due to considerations such as the:

• distance from the school
• type of activity
• need for staff with specialist skills

Sometimes a school may simply need to review its current plans or arrangements that were successful on previous trips. However, some trips will need a risk assessment, detailed planning and the informed approval of the headteacher or governing board. The person given the job of managing this should:

• have the skills, status and competence needed for the job
• understand the risks involved
• be familiar with the activity

Plans should be proportionate and sensible, focusing on how to manage genuine risks.

When to seek consent from parents or carers

A school must always get written consent for nursery-age children.

For children over nursery age, written consent is not needed for most trips, as they’re part of the curriculum. However, it’s good practice to tell parents or carers about them.

Written consent is usually only needed for trips that:

• need a higher level of risk assessment
• are outside normal school hours

The school can ask parents to sign a consent form when their child enrols. This will cover them for their whole time at the school. Advice on consent forms is available on the Outdoor Education Advisers’ Panel ( OEAP ) website.

A school should still tell parents or carers about such trips and give them the opportunity to withdraw their child.

Using outside organisations

Schools using an outside organisation to provide an activity must check the organisation has appropriate safety standards and public liability insurance.

The Council for Learning Outside the Classroom ( LOtC ) awards the Learning Outside the Classroom Quality Badge to organisations that meet nationally recognised standards.

Schools can check if an organisation holds the LOtC Quality Badge .

If an organisation does not hold the badge, the school must ensure that they’re an appropriate organisation to use. This could include checking:

• their insurance
• that they meet legal requirements
• their health and safety and emergency policies
• their risk assessments
• control measures
• their use of vehicles
• staff competence
• safeguarding
• accommodation
• any sub-contracting arrangements they have
• that they have a licence, where needed

The school should have an agreement with the organisation that makes it clear what everyone is responsible for. This is especially important if they will be taking over supervision of the children.

Adventure activities: caving, climbing, trekking and watersports

These kinds of activities should be identified and risk assessed as part of the visit beforehand. Staff managing or leading visits must not decide to add such activities during the trip. They should always consider the abilities of the children when assessing risk.

Organisations need a licence to provide some adventure activities. Organisations that hold the LOtC Quality Badge should hold a licence for the activity they provide.

Information about licensing is available on the Health and Safety Executive ( HSE ) website.

Watersports

When planning watersports, schools should consider the need for:

• instructors

A school should take particular care when using hotel swimming pools and other water-based leisure facilities that may not have a trained lifeguard on duty. Although there are no swimming-pool-specific health and safety laws, the OEAP provides useful advice about undertaking adventure specialist activities, including swimming.

Trips abroad

Trips abroad can present extra risks and need a higher level of risk assessment.

Schools should make sure that any organisation providing activities holds the LOtC Quality Badge or similar local accreditation.

The HSE does not cover incidents overseas. However, it can investigate work carried out in Britain to support the trip, such as a risk assessment. School staff could be liable under civil law for any injuries to the children due to negligence.

If the trip includes significant risks, such as challenging terrain, a remote location or an extreme climate, a school should follow the guide to the British Standard for adventurous activities outside the United Kingdom as the basis for its planning and risk assessment. Organisations employed by the school should follow this, too. If they have a LOtC Quality Badge, they follow this standard.

Schools should consider the Foreign and Commonwealth Office’s detailed guidance on safer adventure travel and volunteering overseas and foreign travel advice when organising a visit abroad.

Knowing what to do in an emergency

Schools should have an emergency response plan that covers what to do if there is an incident away from school. They should also have a communications plan that covers how routine communications should be handled, including regular check-ins and calls to reassure people. Trip leaders should be familiar with the plan.

Schools can get advice on creating a communications plan from their outdoor activity adviser or the OEAP website .

Evaluating trips

A school should set up a clear process for evaluating all visits once they have been concluded, from the planning through to the visit itself. It should keep a record of any incidents, accidents and near-misses.

This will help it:

• evaluate whether its planning has worked
• learn from any incidents which took place

Educational visits coordinators

Schools should appoint an educational visits coordinator and make sure they have the training they need. The headteacher assumes this duty if there is no coordinator. Local authorities or academy trust outdoor education advisers can advise on appointing and training coordinators.

The coordinator works with the outdoor education adviser to help their colleagues in school to assess and manage risks.

The coordinator should:

• be an experienced visits leader
• have the status to be able to guide the working practices of other staff
• be confident in assessing the ability of other staff to lead visits
• be confident in assessing outside activity providers
• be able to advise headteachers and governors when they’re approving trips
• have access to training, advice and guidance

Guidance is also available on the OEAP website .

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CEPEO Annual Lecture 2024: Educational inequality - patterns, causes, and potential solutions

04 July 2024, 6:00 pm–8:00 pm

Join this event to hear Sean Reardon discuss patterns in educational inequality and its potential solutions at the Centre for Education Policy and Equalising Opportunities (CEPEO)'s third annual lecture.

This event is free.

Event Information

Availability.

Professor Sean Reardon is a professor of poverty and inequality and will discuss his research into educational inequality, including his work as the developer of the Stanford Education Data Archive (SEDA), a database of roughly 450 million 3-8th grade standardised test scores that provides measures of educational opportunity for nearly every public school, district, county, and state in the United States.

His work develops methods of measuring social and educational inequality (including the measurement of segregation and achievement gaps) and methods of causal inference in educational and social science research.

This in-person event will be particularly useful for researchers, policymakers, academics and teachers.

Related links

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About the Speaker

Professor sean reardon.

Professor of Poverty and Inequality in education; Professor (by courtesy) of Sociology at Stanford University

He is also a Senior Fellow at the Stanford Institute for Economic Policy Research (SIEPR), the director of the Educational Opportunity Project (EOP) and the developer of the Stanford Education Data Archive (SEDA).

His research focuses on the causes, patterns, trends, and consequences of social and educational inequality, the effects of educational policy on educational and social inequality, and in applied statistical methods for educational research.

He particularly studies issues of residential and school segregation, and of racial/ethnic and socioeconomic disparities in academic achievement and educational success.

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AMPATH Kenya: IU and partners create visionary global health model

Indiana University formed a partnership with a new medical school in Kenya nearly 35 years ago and created a model of global health collaboration that was visionary in its emphasis on equitable partnerships and long-term sustainability.

The results of the Academic Model Providing Access to Healthcare, or AMPATH , partnership that “leads with care” include the creation of one of Africa’s first, largest and most comprehensive HIV care and control programs supported by the United States Agency for International Development; sub-Saharan Africa’s first transitional home for people with mental health challenges ; and Kenya’s first medical fellowships in pediatric oncology and maternal-fetal medicine .

“When the IU School of Medicine formed a partnership with Moi University School of Medicine in Kenya in 1989, the trajectory of both institutions changed for the better,” IU School of Medicine Dean Jay L. Hess said. “The AMPATH partnership has provided care for more than 250,000 people living with HIV and has hosted thousands of trainees and conducted research that has changed lives, not just in Kenya and Indiana, but around the world.”

AMPATH now includes a global network of 15 academic health centers led by IU working in partnership with Moi University and Moi Teaching and Referral Hospital in western Kenya. The success of the innovative global health model in Kenya has led to recent partnerships with additional academic health centers in Ghana, Nepal and Mexico.

“Together we have improved access to quality health services for people in western Kenya, and in doing so have saved many, many lives,” said Dr. Adrian Gardner , director of the IU Center for Global Health Equity and executive director of the AMPATH Consortium. “Together we have taught, mentored and inspired the next generation of healers from multiple continents. And together we have produced impactful research that informs Kenyan and global health policy.

“But this partnership has allowed us to do so much more. We have laughed, celebrated and dreamed together; learned from each other; struggled together; and, at times, bickered with each other, cried together, mourned together and supported each other through good and challenging times.”

A foundation of educational exchange

The four IU physicians who initiated the partnership in Kenya were looking in 1988 for an academic partner in a low- or middle-income country that would provide IU School of Medicine students with the same life-changing and career-inspiring experience they each had earlier in their careers. They insisted that the partnership provide bidirectional opportunities for Kenyan medical students and residents to train at IU, and that each IU faculty member living in Kenya work in partnership with a Kenyan colleague to provide care and build a health care system that was responsive to the community’s needs.

The vision that doctors Joe Mamlin , Robert Einterz , Charles Kelley and Dave Van Reken shared with leadership at Moi University was pioneering for the time and has become a premier model for equitable global health partnerships. More than 1,200 IU learners have had health care experiences in Kenya, and more than 425 Moi University students and residents have trained at IU and other AMPATH Consortium schools. Students and faculty members from IU schools of nursing, public health, liberal arts, law, dentistry and others have participated in various aspects of the partnership throughout the years. These medical exchanges are possible because of donor generosity.

“The IU Center for Global Health Equity prepares learners for their experience, ensures a safe and comfortable living and working environment in Kenya and Indiana, and provides mentorship and support during and after their trip,” said Dr. Debra Litzelman , director of education for the center.

Research on AMPATH’s global health experience shows that the partnership provides medical students and health professional trainees with “a highly impactful, transformative learning experience that fosters the development of global mindedness and community involvements, whether local or global, long after the experience.”

“AMPATH’s 360-degree care model has become a critical aspect of my education,” said Dr. Victoria Sanchez, who received the Brater Scholarship as an IU School of Medicine student and is now a surgery resident at Stanford University. “A goal of mine was to learn about how a global partnership should be structured to optimize ethical operations. I think IU School of Medicine models an excellent bidirectional and sustainable partnership with Moi University through AMPATH.”

Faculty committed to sustainable care system

Several IU School of Medicine departments support full-time faculty in Kenya who teach and mentor Kenyan and IU trainees and provide clinical care at Moi Teaching and Referral Hospital and several local facilities throughout western Kenya.

“It’s simple: We ‘lead with care,’” said professor Sylvester Kimaiyo , chief of party for USAID AMPATH Uzima and AMPATH executive director of care. “Notably this is what sets us apart from other health institutions doing similar work, because it is the needs of the patient that draw us closer. We respond to their needs by setting up sustainable interventions to combat realistic challenges they face every day.”

AMPATH’s partners provide care for a population of more than 24 million people in western Kenya including oncology, child health, adolescent care, women’s health, surgery, anesthesia, antimicrobial resistance, non-communicable diseases including cardiovascular disease and mental illness, and economic empowerment and agriculture.

“With support from the faculty at the IU Simon Comprehensive Cancer Center , the AMPATH oncology program is a leading comprehensive cancer care program in Africa seeing over 1,500 cancer patients per month and providing radiotherapy for over 60 patients per day,” said Distinguished Professor Dr. Pat Loehrer , director of the cancer center’s Center for Global Oncology and Health Equity.

Dr. Brenda Chepkoech was one of six Kenyan registrars, which are equivalent to residents, who traveled to Indianapolis in 2023 as part of the two-way exchange , working at Riley Hospital for Children at IU Health. She hopes to be part of the team setting up a pediatric intensive care unit in Eldoret, Kenya, in the near future.

“I want to be a part of the bridge that connects where we are back home with where Riley is,” she said. “The gap is so big, literally ages apart! I want to contribute to providing options for the children back home who would have survived had they been cared for at Riley.”

In addition to the pediatric intensive care unit, a pediatric cancer center, burn hospital and neurodevelopmental clinic are all under development with support from IU faculty and the AMPATH partnership. Individual donors, corporate and foundation supporters, and grants from the U.S. President’s Emergency Plan for AIDS Relief through USA ID, the National Institutes of Health and other agencies have contributed more than $900 million to AMPATH care, training and research efforts over the past three decades.

Research that informs policy

Since the first research collaboration in 1992, AMPATH has invested heavily in infrastructure and training to conduct research to strengthen care systems, quickly respond to health challenges and push for new breakthroughs in health, policy and justice worldwide.

“AMPATH is known for leading with care, but research has informed a lot of the work we do in care, so it’s a very complementary relationship,” said professor Winstone Nyandiko , AMPATH co-director of research and a pediatrician at Moi Teaching and Referral Hospital.

The AMPATH research program includes more than 20 collaborating institutions and has received $247 million in total research funding since 1998.

“The resulting 1,400 publications in peer-reviewed journals stay true to AMPATH’s ideals by including investigators from Kenya, North America and Europe,” said Dr. Kara Wools-Kaloustian , AMPATH co-director of research, director of research for the IU Center for Global Health Equity and recipient of IU’s John W. Ryan Award for Distinguished Contributions to International Programs and Studies.

Improving Hoosier health

Reciprocal innovation describes the process of high- and low- and middle-income countries working together to continuously innovate solutions to shared health challenges. In Indiana, programs to improve infant and maternal mortality , identify counterfeit medication and improve care for immigrant and refugee communities rely on lessons learned from IU’s longstanding partnership in Kenya.

“Our global health community in Indiana has a deep knowledge base and has worked with talented colleagues around the world to improve health outcomes in communities with incredible challenges,” said Dr. Laura Ruhl , director of reciprocal innovation for the IU Center for Global Health Equity. “When these global health experts join in partnership with people from communities in Indiana facing some of the same challenges, we have the collective power to make real progress toward improved health outcomes.”

Debbie Ungar

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The doctor is in.... but what's behind them?

Americans have gotten used to seeing their doctors and other health care providers using telehealth video visits in the past four years. But a new study reveals that what a doctor has behind them during a telehealth visit can make a difference in how the patient feels about them and their care.

Even if the doctor is miles away from their usual in-person clinic or exam room, they should make it look like they're there, the study suggests.

Even better: sitting in an office with their diplomas hanging behind them -- or perhaps having a virtual background that's a photo of such an office. This is especially true if they haven't seen the patient before, the study shows.

A home office with a bookshelf or a plain solid-color background are both acceptable to patients, too.

But providers should use blurred or virtual backgrounds if they carry out the visit in a home environment with a kitchen or a bed in the background, the study shows.

The findings come from a survey that asked patients to react to seven different backgrounds behind a model physician, and to rate how knowledgeable, trustworthy, caring, approachable and professional the physician appeared in each, and how comfortable the patient would feel with that provider. It also asked them to consider each background for a first or returning appointment with a primary care or specialty provider.

The study is published in JAMA Network Open by a team from the University of Michigan's academic medical center, Michigan Medicine, and the VA Ann Arbor Healthcare System. More than 1,200 patients who had seen providers at one of the two health systems completed the study surveys, and the researchers compiled their responses.

Lead researcher Nathan Houchens, M.D., is an associate professor of internal medicine at U-M and associate chief of medicine at VAAAHS. His past work on how interpersonal communications affects the patient-provider relationship -- including non-verbal factors like attire and posture -- led to the new telehealth study.

"The transition to virtual care was rapid and came without specific guidance during the start of the COVID-19 pandemic, but telehealth appears to be here to stay so it's important to understand what patients prefer when it comes to the setting their provider is in," says Houchens, a hospitalist who worked with U-M and VA general internist Jennifer Meddings, M.D., M.Sc. and others on the study.

He notes that during the first year of the pandemic, providers were urged to conduct telehealth visits outside of clinics if they didn't need to go in, to reduce the chance of COVID-19 transmission.

But now, some clinics have created dedicated spaces for providers to sit in if they have telehealth appointments on days when they're also seeing patients in person. Some of those might be spaces shared with other clinicians, so a virtual background would also serve to reduce visual distractions.

Houchens notes that as telehealth increased in use and became a standard way to receive care, some guidance on "webside manner" has been suggested to guide providers in the ways in which they interact verbally over a virtual connection. But very little guidance is available about the background for their video visits.

He and his colleagues were surprised at the level of dislike that patients had for kitchen and bedroom settings, with only 2% and 3.5% saying they preferred these backgrounds respectively, compared with 35% for an office with displayed diplomas, 18% for a physician office, 14% for a plain color background, and around the same for a home office with bookshelf or an exam room.

There were also significant differences in the composite scores for how patients rated the way each background would make them feel about receiving care from the provider. The bedroom and kitchen backgrounds received far lower composite scores than any of the other five backgrounds.

Houchens and colleagues including co-author Sanjay Saint, M.D., M.P.H., have previously published work on patients' preferences for what physicians wear during clinical encounters. Just like with video visit background, these seemingly superficial factors can actually make a difference in the patient experience, he says.

"Patients have expectations of what physicians' attire and workspaces should look like. This study showed that patients prefer what have been previously termed traditional or professional attire and settings," he said. "Diplomas and credentials remind patients of the expertise they expect a physician to have, and conversely, something is lost when the background conveys a relaxed, informal home environment."

The team is currently analyzing more data from the same study, to assess other factors that affect patients' telehealth experiences -- including their access to high-speed internet and their ability to use necessary technologies.

But for now, they suggest that providers can take immediate steps to conduct virtual visits from an office or exam room. Clinics may want to make unused clinical rooms available for use by providers conducting virtual visits during in-person clinic days.

Another option is to create virtual backgrounds that will evoke these types of professional settings.

Houchens also notes that while they haven't yet studied what physicians think of the backgrounds behind patients during video visits, these may provide helpful information.

The rise of "Hospital at Home" and home-based primary care means that patients with more acute conditions may be able to see their providers virtually, and that their setting can give clues to the way physical and social factors play a role in their health. Discussing visible elements from both a provider's and a patient's virtual background -- art and other hobby-related items, for example -- can also help build rapport, Houchens notes.

"This is a reminder that patients often do care about some of the details that providers and health systems may not have emphasized," he said. "It's important to remember that our words and our nonverbal behaviors are taken to heart by those we care for, and it behooves us to care about them as well."

Meddings and Saint are members of the VA Center for Clinical Management Research and the U-M Institute for Healthcare Policy and Innovation.

In addition to Houchens, Meddings and Saint, the study's authors are Latoya Kuhn MPH, David Ratz MS, Jason M. Engle MPH of VA CCMR.

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Story Source:

Materials provided by Michigan Medicine - University of Michigan . Original written by Kara Gavin. Note: Content may be edited for style and length.

Journal Reference :

• Nathan Houchens, Sanjay Saint, Latoya Kuhn, David Ratz, Jason M. Engle, Jennifer Meddings. Patient Preferences for Telemedicine Video Backgrounds . JAMA Network Open , 2024; 7 (5): e2411512 DOI: 10.1001/jamanetworkopen.2024.11512

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Client Service Agreement Update – 5/20/24

We are committed to providing transparent and understandable financial policies to ensure clients can focus on the care of their animal without surprises. Here’s a brief overview of our financial policies.

Read the Full Client Service Agreement

Payments and Outstanding Balances

Upon discharge, all current charges must be paid in full. Should there be any additional charges after that point, clients will be notified within 30 days. Clients must settle any outstanding past-due balances in full before scheduling new appointments or receiving additional services.

Emergency Visits

For small animal emergencies, an initial fee of $167 is collected at check-in. If emergency stabilization is required, this fee will increase to $500.

For large animal emergencies, a flat fee of $500 is collected at check-in.

Treatment Plans

Before proceeding with services, we will provide a written treatment plan including potential risks and a low-end to high-end cost estimate to help make informed decisions about an animal's care. Documented acceptance of this plan from the client or the financially responsible party will be required prior to the patient receiving services beyond emergency stabilization.

Evaluation Appointment Deposit : An initial deposit will be collected for all scheduled Evaluation Appointments. This deposit will be forfitted if the Evaluation Appointment is not canceled within 72 hours. This deposit will be applied to the final bill on the day of the appointment.

Admitted Paitent Deposit : Before any services are provided to an admitted patient, a deposit of either 100% of the low-end estimate or 50% of the high-end estimate, whichever is greater, will be required. This deposit ensures we can proceed with necessary treatments promptly and will be applied to the final bill on the day of appointment.

Payment Options

We offer a variety of payment options including cash, checks, all major credit cards, and Care Credit. Payments can be made in person or over the phone.

Accounts Receivable and No Service Policy

Accounts that remain unpaid 30 days after notification of balance will be subject to a late fee. Accounts that remain unpaid 90 days after notification of balance will be transferred to Purdue University Accounts Receivable and will be placed on a "No Service" status until the balance is paid in full. T his status ensures that all financial obligations are met before any further services are provided.

Refunds are processed based on the results of billing audits and are usually completed within 10 business days.