Intensive School Refusal Treatment Program for Children
North Coast Psychological Services now offers a prescriptive intervention that targets School Refusal Behavior (SRB). SRB refers to a child’s refusal to attend school and refers to emotion-based absenteeism, most commonly anxiety and/or depression (Kearney & Silverman, 1999; Wimmer, 2023).
School refusal is often a result of separation anxiety, social anxiety or performance anxiety (Wimmer, 2023). Unfortunately, this is a difficulty for many students as approximately 16% of all students are chronically absent from school (U.S Department of Education, 2016) and approximately 2-5% of children refuse to come to school due to anxiety or depression (Wimmer, 2010). This school refusal often leads to chronic absenteeism, which can continue a cyclical pattern of stress due to missing assignments and falling behind academically. However, school refusal can also lead to family frustration, lack of socialization opportunities and increased anxiety and/or stress.
An evidence-based treatment for school refusal behaviors include Cognitive Behavior Therapy (CBT) and well as Exposure-Response Therapy (ERP), which focuses on gradual exposures to anxiety-inducing stimuli and situations (i.e., school) (Kawsar, et. al., 2022). The goal of the treatment is to increase the student’s attendance and to decrease their feelings of nervousness around school and school-related stressors (i.e., performance pressures, social pressures etc.). This standard of treatment requires a collaborative, team approach between the therapist, family and school to best support the child (Wimmer, M., 2010). The program that North Coast Psychological offers is based on the work of Kearney and Albano (2018) and is prescriptive in nature that it works to target the WHY of SRB that may be maintaining the school avoidance. This WHY may involve treatment that focuses on the anxious and depressed emotions that youth with SRB may experience or change accommodations in the home environment through consultation with the parents that stops reinforcing the SRB.
The intensive aspect of the treatment model is done to get your child to return to school as quickly as possible. Research has demonstrated that a 3-week CBT intensive program where 88% of students were not attending any school, resulted in 60% of them attending school at a 90% rate at the end of the intervention. The intensive approach typically will involve multiple sessions (1.5 to 2 hours/day) within the first two weeks of SRB and may be in our office as well as in the child's home and community. Students and their parents will learn about SRB, efforts to de-stigmatize the behavior will be presented, and cognitive restructuring, somatic management, and exposure-based work are all integrated into treatment. School-based consultative services are often integrated within the plan and scheduling of booster sessions upon your child's return to school to help maintain success. Interventions are individually designed and you will have regular consultation with your clinician.
Kawsar, M. S. (2022, June 5). School refusal. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK534195/
Kearney, C. A., & Albano, A. M. (2018). When children refuse school: Therapist guide. Oxford University Press.
U.S. Department of Education. (2016). Chronic absenteeism in the nation’s schools. https://www2.ed.gov/datastory/chronicabsenteeism.html#intro
Wimmer, M. (2023). School attendance problems [handout]. National Association of School Psychologists
Wimmer, M. (2010). School Refusal: Information for Educators [handout]. National Association of School Psychologists
For further information, please email Dr. Kathleen Everson ([email protected]) or Dr. Michelle Kirkland ([email protected]) or call (516) 229-1975 ext 8
