1. “I Don’t Want to Go!” School Attendance Problems

2. School Attendance Problems Ongoing attendance issues is linked to: ▫Underachievement/drop-out ▫Social skills and relationship problems ▫Substance use and abuse ▫Mental health problems ▫Violence ▫Accidental injury

3. How Big is the Problem? Unexcused patterns of school absence ▫1-8% have problem ▫28% at one time display school refusal behaviours ▫Peaks at 5-7, 11, and 14 – transition times ▫No gender or socio-economic differences

4. Why do Children Refuse School? Avoid distress/discomfort at school Escape Social/Evaluative Situations Attention from Significant Others More fun when not at school Negative Reinforcement Positive Reinforcement

5. Assessment Tool https://app.schoology.com/resources/public/23 314769/profilehttps://app.schoology.com/resources/public/23 314769/profile School Refusal Assessment Scale ▫Separate questionnaires for child and parent to get a better understanding of the function of school refusal behaviour

6. It can start small but… Snowball into something bigger because the more a child stays away the more he feels he needs to/should/can. The staying away continues because the behaviour is reinforced/rewarded !

7. Staying away leads to more staying away… and in the case of anxiety ▫The fear has time to grow ! ▫student never learns that the bad thing s/he expects will happen may not and/or that s/he can cope even if it did!

9. What does it Look Like? Physical complaints in 26-79%: ▫Headaches ▫Stomachaches ▫Nausea and vomiting ▫Diarrhea ▫Light headedness ▫Heart palpitations ▫Short breathing ▫Body pain ▫Sweating ▫Shakes

10. Behaviours: ▫Verbal protests in the morning or night before ▫Trouble sleeping ▫Tantrums ▫Refusing to move ▫Hiding and/or running away ▫Fears/Worries ▫Intense Dread…even if they do manage to go ▫Noncompliance ▫Aggression ▫Clinging

11. Where Does That Leave School Staff and Parents? Stressed and Worried!

12. So What Can School Staff do? Create a positive school climate that helps students feel connected, get academic and social support  Safe  Accepted  Valued  Respected Encourage parents to:  Send child to school daily unless fever, vomiting, or something more serious.  Come to you with any trouble getting child to school or complaints  Practice good health practices/wellness (sleep and diet)  Practice good night time and morning routines

13. At the first sign of trouble! Communicate regularly with parent even if student not attending (in non-punitive way). Pay close attention to attendance to see if any patterns exist Send work home Think of possible reinforcers to motivate student to attend (positive or negative) Think of in-school experiences that may be enjoyed by student and would help the student feel “needed” Take time to develop a personal interest and relationship with student

14. Make an effort to connect student with positive social interactions and monitor interactions if concerns about bullying Assign an Attendance Mentor/Buddy Check for academic struggles and provide additional support as appropriate Work on developing coping and social skills as appropriate Create safe temporary place to calm…but timed with plan to return Work to get student in the building for at least some part of each day NO SURPRISES! Refer to Mental Health early!!!!

15. Once Mental Health is on Board… Work collaboratively with clinician on the student’s individual treatment plan as appropriate: In the case of anxiety – much planning needed and slow and steady wins the race!  Work hard to prevent “escape” once student is at school (e.g., calling home to get picked up)  Reinforcement for effort to attend will be key as anxious children not naturally motivated to face fears!

17. Treatment for Anxiety-Based School Attendance Problems Child learns: ▫About anxiety and why facing fear is important ▫Coping skills for anxiety, problem solving, social skills ▫To grow more comfortable going to school by taking steps towards the goal of full attendance Parent learns how to: ▫Coach kids in facing their fears ▫Reward efforts to return to school ▫Make school more attractive than home ▫Manage difficult behaviours in the mornings ▫Manage any anxiety they may have about child going to school ▫Develop and carry out effective morning, day, and night time routines Teacher learns: ▫The unique challenges contributing to the child’s school refusal ▫How to support the child’s treatment plan with the goal of returning to school or regular attendance

18. Aldershot Project: Acute only (i.e., new problem that year) Absent and Late Anxious and Non-Anxious students Heavy emphasis on education and prevention: ▫Workshops for parents ▫Information for staff ▫Printed information in Newsletters ▫Attendance Awareness Month and Be on Time Month Attendance records monitored and students are “flagged” Team approach: ▫Outreach position at the school, Guidance/Resource, Administration, Mental Health Clinician, Community Support Worker, Pediatrician (on stand by) In-school interventions put in place to support the student (if attending) If 15% days missed and/or late - contacted by administration. Invitation to a School Attendance FAIS.

19. Of 39 Acute Students we saw through the year….

20. I work in a Middle or High School – What am I to do? By high school the problem is typically more chronic and more complex ▫Anxiety more “engrained” with added positive reinforcers ▫Undiagnosed/Unaddressed learning needs - “too far behind” academically ▫Substances (self medicating) ▫Peer influences ▫Less parental control ▫Less motivated in therapy – avoiding therapy as a way of avoiding returning to school! ▫History of failed attempts gets in the way

21. “Chronic” students can get help too… But…can be a long process even with a motivated youth and parents who are not exacerbated! All the same strategies apply…just look a little different with youth. Increase supervision, “fun” as the reward for going, changes to academic scheduling, negotiation with youth, help with social issues (i.e. refuse offers to skip), written contracts Patience and commitment from all is needed!

22. Why should we Focus on School Attendance Issues? At-risk group! Easier to treat if we catch it early! ▫Most struggle for 1-2 years with 40% struggling for > 2 years before they get help! We all care about the mental health and education of our kids and want to get them on the right path from the start!

23. Resources http://www.attendanceworks.org/ ▫Fantastic tool kits for educators, administrators, and parents! Kearney, C. A. (2008). Helping School Refusing Children and Their Parents: A Guide for School-Based Professionals. Kearney, C. A. & Albano, A.M. (2007). When Children Refuse School: A Cognitive Behavioural Therapy Approach, Parent Workbook, Second Edition ▫School Refusal Assessment Scale to assess four functions of school refusal behaviour Kearney, C. A. & Albano, A.M. (2007). When Children Refuse School: A Cognitive Behavioural Therapy Approach, Therapist Guide, Second Edition Eisen, A. R. & Engler, L. B. (2006). Helping Your Child Overcome Separation Anxiety or School Refusal: A Step-by-Step Guide for Parents.