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Welfare Guardian. Welcome Thanks for joining us today! Georgie Troon. Welfare Guardian. Understanding and Managing School Refusal -Georgie Troon -. Introduction. U nderstand what school refusal and school anxiety are, why they might occur and how to manage them - PowerPoint PPT PresentationTRANSCRIPT
Welcome Thanks for joining us
today!Georgie Troon
Welfare Guardian
Understanding and Managing School Refusal
-Georgie Troon-
Welfare Guardian
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.
Introduction
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
Objectives
Long-term management of the problemLiaising with external professionals and knowing when to refer
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
What is School Refusal?
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
High-risk times
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!
Related problems
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
Signs of School Refusal
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
Addressing the Issue
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
Other Considerations
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
Addressing the Issue
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
Case Study: Ella
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
Addressing the Issue
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
Summary
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?
Take Action in your School
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?
Personal Reflection
Question Time