“I Don’t Want to Go!”School Attendance ProblemsDr. Becky Churchill KeatingRegistered PsychologistChild and Youth Mental HealthAnnapolis Valley District Health Authority

You Have to Go!Up. Up. It's time to go to school.

I don't want to go to school. You have to go

I hate that school. The kids are mean and rotten.

You still have to goIt's like jungle. One fight after another.

They threaten me at least 100 times a day!You have to go to school!!

Why must I go?

Because you are the TEACHER!

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

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

Behavioural Psychology 101

Positive (+) ReinforcementMaking a behavior stronger by following the behavior with an added pleasant stimulus.

Negative (-) ReinforcementMaking a behavior stronger by taking away a negative stimulus.

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

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 !

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!

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

• 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

Where Does That Leave Educators and Parents?•Stressed and Worried!

So What Can Educators 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

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

• 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!!!!

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)

Reinforcement for effort to attend will be key as anxious children not naturally motivated to face fears!

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

I’m a High School Teacher – 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

“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!

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!

Aldershot Project (2014/2015)• Acute only• 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

• Attendance records monitored and students are “flagged”• Team approach:

▫ New 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. • Mental Health assessment and intervention is available at the school and in

the home if needed.

Of 39 Acute Students we saw through the year….

LATE ABSENT0

5

10

15

20

25

30

ImprovedWorsenedNo Change

Resources• Becky.Churchillkeating@nshealth.ca

- Feel free to contact me to get specific resources from the current AVRSB program

• 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.

My HOPE is that …

•You leave motivated and empowered to take a proactive and preventative approach to address school attendance problems in your schools!

•Thank you and good luck!