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Welfare Guardian Understanding and Managing School Refusal -Georgie Troon-

Introduction Understand what school refusal and school anxiety are, why they might occur and how to manage them Strategies are provided for both primary school and secondary school staff Accompanying tip sheets, behavioural contracts and handouts can be helpful resources for parents, classroom teachers and can be used in counselling sessions.

Objectives Understanding what school refusal is and related problems Recognising common contributing factors and “high risk” times Identifying the signs of school refusal Implementing strategies at school Helping parents implement strategies

Objectives Long-term management of the problem Liaising with external professionals and knowing when to refer

What is School Refusal? School refusal is when a student consistently refuses to attend school and/or is very reluctant or difficult to persuade The student may display challenging behaviours such as: whingeing, tantruming, crying or complaints of somatic problems (headaches, stomachaches). They may make excuses or employ stalling tactics.

What is School Refusal? • The underlying root of school refusal is anxiety • “Push” factors (those that push the child away from school) – bullying, difficulty with peer relationships, difficulty with teacher relationships, learning issues/exam pressure • “Pull” factors (those that pull the child away from attending school) – separation anxiety, illness of family members, bereavement, marital breakdowns, enjoyable activities at home, secondary gain from parents spending more time with the child

What is School Refusal? Common in children with ASD or Asperger’s Can stem from one specific situation or be an ongoing issue Not to be confused with truancy or “skipping” classes

High-risk times • High-risk times: • After death or illness within the family or someone close • After prolonged absence from school for a legitimate reason (such as illness or holiday) • During difficult ‘transition’ periods in a child’s life – i.e. Beginning of a school year or term, especially in early primary school or early secondary school

Related problems • Long-term problems are: • Family issues & conflict • Missed social opportunities • Missed learning opportunities THE LONGER THE CHILD IS AWAY FROM SCHOOL, THE HARDER IT IS TO GET THEM BACK!

Signs of School Refusal • You may notice the student: • Missing school frequently (but not necessarily on consecutive days) • Crying or becoming difficult at school drop-off • Turning up late and possibly needing a parent to bring them to class • Spending a lot of time in sick bay or the nurse’s office (complaining of aches and pains) • Requesting to call their parents during the day

Signs of School Refusal • Withdrawing from group activities and lunchtime play • Highly emotional • Displaying difficult behaviour

Addressing the Issue • First do no harm… • DON’T: • Jump to conclusions – the student may genuinely be sick or have a legitimate reason for missing school. • Trivialise the problem. In most cases, the student’s anxiety is very real, even though the cause for it may not be well understood. • Create an “us” versus “them” situation between the school and parents. Both parties can work towards a solution together.

Addressing the Issue Phase 1: GATHERING INFORMATION The student and/or their parents can be involved in a frank discussion of the problem Point out what you have noticed. Try to have all the facts on hand (i.e. how many days missed) Ensure that medical/other causes are ruled out Ask them what they believe is going on Voice your concerns

Addressing the Issue • Consider a semi-structured interview with the parents/student (see “Parent Interview” template) • Identify “push” and “pull” factors • Developmental history • Recent stressors • Formal questionnaires can be used if available • Formulate a hypothesis. Include precipitating, maintaining and protective factors (see template “Precipitating and Protective Factors of School Refusal”)

Addressing the Issue Phase 2: PREPARING TO RETURN TO SCHOOL • Discuss how to manage challenges. Include: • challenges at school: arriving at school, facing peers and teachers, difficult times of the day, etc. • challenges outside of school: getting ready in the morning, travelling to school, saying goodbye • Consider: creating a “safe” place at school, what to do if an “emergency” arises • Remind the student/parents that other strategies can be worked on in counselling sessions over time

Addressing the Issue • For secondary school students…. • Consider an adapted attendance plan (how many hours/periods they are expected to attend) • Emphasis should be on attending each day and gradually building up to full attendance (rather than attending for 3 out of 5 days, for example) • Consider getting the child to sign a Behavioural Contract (see template) • ASD children may require a different approach

Addressing the Issue

Addressing the Issue • For primary school students…. • Separation anxiety is often the case for school refusal/reluctance • The emphasis should be on building “brave” and calm behaviours • Consider breaking down the task of going to school (see template: “Stepladder to Success”) • Consider implementing a self-monitoring rating scale and rewards system

Addressing the Issue Phase 3: BACK TO SCHOOL • Implement the attendance plan IMMEDIATELY (i.e. the next day) • Make it clear to the student that everyone is committed to getting them back to school • Anticipate challenges and be prepared • Consider: Seeing the child for counselling at the start of the school day (possibly on a daily basis) until challenges are manageable

Addressing the Issue Phase 4: ADDITIONAL SUPPORT Consult with teachers, other support, and possibly peers (if the student agrees) to gather ideas that may help Consider environmental issues – changing classroom set-up, having a “safe room” set-up if the child needs some time-out, how they get to and from class Consider different teaching methods if learning issues are present

Addressing the Issue Consider relationships with peers - arranging for a “buddy” to accompany the student between classes, reducing exposure to students that might exacerbate the problem (until the child can be taught social problem-solving skills) Ensure that the child is given options about changes to be made so as to help them feel in control

Addressing the Issue Phase 5: COUNSELLING • In most cases, the child will benefit from counselling. This might include: • Relaxation/mindfulness activities • Self-calming statements • Visualising success • Social skills training • CBT (for older children) • Solution-focused discussions (see Counselling worksheets)

Addressing the Issue Phase 6: SUPPORT FOR PARENTS Provide parents/student with a key person at the school with whom they can communicate – House Leader, Vice Principal, Wellbeing Officer etc. Inform parents/student that attendance will be monitored Provide parents with advice about how to manage at home (see tipsheets “School Refusal – Strategies for Home”; “Easing Separation Anxiety”)

Addressing the Issue • Parent counselling is also recommended and can include: • Managing the child’s anxiety at home • Behaviour management if tantrums/outbursts occur • Appropriate rewards and consistent parenting • Addressing any underlying causes for anxiety • Consider whether child and parent counselling is best undertaken at school or externally

Other Considerations Encourage parents to see a GP to rule out real medical causes for somatic complaints If a learning problem is possible, an Educational Assessment is recommended (either in-house or externally) Consider other issues: attentional, social, auditory, etc and whether referral is appropriate

Addressing the Issue Phase 7: LONG-TERM CARE • Regularly review the attendance plan, a gradual reduction of adult support should be the aim • Continue to monitor the child through ongoing counselling/support • Ongoing reviews with parents can identify times of stress in which school refusal may recur – encourage parents to contact the school immediately if they are concerned

Addressing the Issue Phase 8: SEEKING EXTERNAL HELP • In general, external help (private Psychologist, Psychiatrist or other professional) should be sought if you feel the child’s support needs are outside of your expertise or realistic parameters of your job • If counselling/care is provided externally, seek permission for regular updates

Addressing the Issue • External referral is appropriate if: • The school does not have counsellors available every day or school counsellors have a full caseload • The student is threatening self-harm or is otherwise in danger of hurting themselves or others • The student may have experienced abuse or trauma • The student’s school refusal is so severe that parents cannot convince them to come to school, even to attend counselling

Case Study: Ella Background Information & Presentation Year 7 female Parents together, older sister at the school but on a different campus Presented in Term 2 following school camp Multiple missed days, visits to sick bay complaining of a sore stomach Tantrums upon leaving her mother Multiple requests to go home during the day

Case Study: Ella Phase 1: GATHERING INFORMATION • Interview with parents revealed: • History of mental illness in the family (uncle hospitalised with depression) • Recent stressors: death of one grandparent, another grandparent requiring support, mother stressed, new school, difficult time on school camp, unstable friendship group, teasing from popular boy, difficulty keeping up in class (maths) and stern, unsympathetic teacher

Case Study: Ella • Meeting with Ella revealed: • Separation anxiety on school camp • Unable to keep up physically on school camp • Worried she may be “crazy” like her uncle • Feels excluded by friends, “left out” • Feels misunderstood by maths teacher, told to “stop crying” on camp • Teasing by popular boy, worried she might be gay • Complains of stomachaches and stinging when she urinates

Case Study: Ella • Push factors: • Difficulty learning in maths • Unsupportive teacher (maths), also on camp • Anxiety around friendships, poor social skills • Bullying? Teasing from popular boy • Difficulty keeping up physically on school camp/swimming • Pull factors: • Wanting to be home with mum, separation issues • Protective mother and secondary gain from staying home (cuddles, watching TV)

Case Study: Ella • Precipitative factors: family stress & illness/death of grandparent, school camp homesickness & (perceived) exclusion by friends • Maintaining factors: secondary gain from staying home, avoidance of friends and schoolwork • Protective factors: supportive parents & sister, friends willing to help, good relationship with House Leader, healthy, active, no prior history of school refusal or learning issues

Case Study: Ella • Preliminary Action: • Ella’s parents advised to visit GP to rule out UTI or other medical issue • Ella’s parents and Ella introduced to Vice Principal and advised that counsellor/VP would be key people at school

Case Study: Ella Phase 2: PREPARING TO RETURN TO SCHOOL • Amended attendance plan: 4 out of 6 periods per day, attend every day. Ella to choose which periods to miss. • Ella to do homework in room near VP’s office during missed periods. • Ella to attend counselling office first thing every morning (approx 30 minutes before first period) to discuss strategies for the day

Case Study: Ella • Ella to attend VP or counselling office if experiencing a “crisis” throughout the day • Parents and Ella signed Behavioural Contract • Rewards introduced for completing each week

Addressing the Issue Phase 3: BACK TO SCHOOL Ella was required to return to school the next. Her mother brought her straight to the counsellor’s office before first period and then left quickly. Ella became very upset. She was encouraged to calm down – breathing strategies were used. Ella chose which subjects to attend that day. She was encouraged to come up with a plan of what to say to friends.

Addressing the Issue Ella was walked around the (empty) schoolyard a few times before attending her first class She was reminded of the plan She was encouraged to come back to counselling the following day

Addressing the Issue Phase 4: ADDITIONAL SUPPORT Ella’s teachers emailed to advise of the situation and asked to provide homework via email if Ella missed class Teachers asked to manage “bullying” behaviour from boy in question VP consulted with Ella’s maths teacher to discuss amended approach to Ella & support for learning

Addressing the Issue One of Ella’s friends asked to text/call her at home to offer words of support Front office staff advised of the situation and asked to monitor Ella’s attendance closely – to inform counsellor and VP if she is absent completely or missing too many classes

Addressing the Issue Phase 5: COUNSELLING • Ella continued to attend counselling over a matter of weeks – initially daily and then less frequently • Relaxation activities • Psychoeducation about anxiety • Social skills – building confidence and managing conflict with friends • CBT activities – balanced thinking and encouragement of more exercise, regular sleep routine

Addressing the Issue • Discussion of sexuality • Discussion of learning difficulties and how to tackle

Addressing the Issue Phase 6: SUPPORT FOR PARENTS Ella’s parents were encouraged to contact the school counsellor or VP if any concerns Parents pr0vided with advice about how to manage at home As advised, parents took Ella to the GP to rule out medical causes for somatic complaints (stomachaches & pain when urinating)

Addressing the Issue • PHASE 7: LONG-TERM CARE • Ella’s attendance & wellbeing was monitored over time • Regular email contact with parents, counsellor & VP • Gradually attendance expectations were increased to 5 and then 6 periods per day • Ella kept up good attendance & improved greatly in managing her anxiety

Summary The underlying root of school refusal is anxiety Before implementing strategies it is important to understand contributing factors (“push” & “pull” factors) Working with parents is paramount! The approach will be much more effective if all parties are consistent Behavioural strategies as well as counselling support should be introduced

Summary Behavioural strategies can include: school contracts, gradual exposure, self-monitoring and rewards charts Counselling strategies may include: relaxation & visualisation, problem-solving, social skills & assertiveness, self-calming statements and CBT Try to enlist support from teachers, peers & other staff Learning problems and medical problems should be ruled out

Take Action in your School What do you need to do right now with this new information in your school? Can you implement anything preventative? Who needs to know about this?

Personal Reflection • Think about: • Key ideas you learned today • How you can integrate this new information into what you already know • Reflect in your journal... • What do I think? • How do I feel? • What else do I need to do? • What do I need to explore further?

Question Time

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