Taking the Scared Ou Out of t of School hool Strategies ies to - - PowerPoint PPT Presentation

Taking the “Scared” Ou Out of t of School hool

Strategies ies to Addres ess Anxiety ety- based d Absent nteeism eeism

Teresa Miller, LLPC Forest Hills Public Schools, Grand Rapids Community College Donna Secor Pennington, LMSW MASSW, Western Michigan University

School hool Socia cial l Work k & & Att ttendanc dance

The “roots” of school social work are closely tied with attendance concerns.

 A 1917 Chicago Truancy Study identified a need for

“school attendance officers” who understood “the social ills of the community, poverty and poor health and their effects on attendance.” By 1918, all states had compulsory attendance laws that contributed to the growth of the early visiting teacher movement. School social workers in Michigan were known as “visiting teachers” until 1966.

Def efining ning School hool Ref efusal sal

 Child-motivated refusal to attend school,

arriving late to school and/or difficulty remaining in school for the entire day.

 May display unusual distress at school  Up to 28% of American school-aged children

refuse school at some time.

 “One of the most frustrating problems faced by

educators and parents.”

 The longer students are out of school, the

poorer the prognosis.

 Since NCLB (2002) – States must report

attendance data to receive federal funding

 Left to states to define truancy and decide

how many days constitute truancy

 Truancy: 3 unexcused absences (NY

, NV)

 Varied Penalties: Fines & jail for parents (MT)

Juvenile detention long term residential care (AL)

Truancy: y: Unexcused cused absence ence from m school

• ol

School hool Attendance endance Polic icy in Mi Michig higan an

 Michigan has not prioritized school attendance.  No state definition  Parent “may” face misdemeanor  Example: One “truant officer” to serve 19 Kent

County school districts.

 10/2012: Truancy tied to state financial

assistance

 10 or more unexcused absences per year

Curren ent t Trua uancy Legis gisla lation ion Sen enate ate Bi Bill lls s 1151 1 – 1154 4 Sen.

• n. Schuitma

huitmaker

SB 1151: Defines “truant” as 10 or more unexcused absences and “chronically absent” as missing 10% of school days for excused, unexcused or discipline. SB 1152: Involve truant officer to contact parent

 Provision for identifying reasons, intervention,

“attendance agreements” SB 1153: Requires increased reporting, including suspensions, truancy, chronic absence & disciplinary absence SB 1154: Possible court proceedings against student*

Emotion

• tionall

ally-based based Scho hool

• l

Ref efusal sal

May include:

 Separation Anxiety  Social Phobia  Performance Anxiety  Specific Phobias  Familial Trauma  Depression

PTSD SD and d Urba ban n St Students dents

 There is a growing concern regarding the need for

differential diagnosis and the role of trauma in the “truancy” seen in poor urban school districts where many students are repeatedly exposed to violence and other trauma.

 Muskegon Heights: Marquis Gresham

http://www.wzzm13.com/story/news/local/muske gon/2014/04/23/hackley-hospital-er-on-lockdown- following-shooting/8069183/ ACES Too High

“Looking out the Window”

School hool Ref efusa usal: l: Student udent Char aract acteristics eristics

 History of anxiety

 May include fear of panic attacks, vomiting in school, being

trapped

 Often have early history of poor attendance  Comorbid depression is also common  History of psychiatric hospitalization  Relatively few friends  May have perfectionist tendencies  Concerns with physical appearance  Feel teased or bullied at school  Sense that they don’t fit in

Parent ent Characte acteristi istics

 May have permissive or “inadequate” parenting

style

 Are dealing with issues of their own

 Divorce, infidelity, illness, psychopathology, family

dysfunction, domestic violence

 Compensating for family difficulties  Separation anxiety  Codependent/enmeshed

Commo mmon n Beh ehaviors iors at Home

 Anxiety, crying, depression, withdrawal,

fatigue

 Physical complaints such as headaches

and stomachaches

 “Intense Morning Misbehaviors”:

 Tantrums, noncompliance, arguing, running away

from home, suicide or other threats and aggression.

School hool History/Beh tory/Behaviors viors

 Youths with lengthy/multiple absences  These can begin with an illness or holiday  Students who skip classes during the day  Students chronically late to school  May be “hiding” in the building, on school

grounds in bathrooms, etc.

 Assessment Scales

Goals als of School hool Refusa usal Behavior ior



To avoid school-related situations that cause substantial distress



To escape painful social and/or evaluative school-related situations,



To pursue attention from significant others, and



To pursue tangible rewards outside of school. (Assessment/Identification of goals is needed)

Is Is it rea eally y anxie iety/emotio ty/emotional? al?

 Does not have as many symptoms when she isn't in

school, including weekends and holidays.

 Does not have a fever, vomiting, or diarrhea.

 Although, these can be fabricated/exaggerated/self-induced…

 Has no obvious physical signs of illness when you visit

your physician. For example, he or she may have joint pain, but no joint swelling or limited movement of the joint.

 Often have other fears, phobias, or symptoms of

anxiety, such as clingy behavior, excessive worrying or nightmares.

Short-term term Conse sequen quences ces

 Child stress  Declining academic status  Social alienation  Family conflict/disruption  Increased risk of legal trouble  Child maltreatment/lack of supervision  Financial expense

Long ng-term erm Conse nsequences quences

 Increasing depression  Being left behind/left out by peer group  Prompt treatment of school refusal is key

to shorten the course of the disorder.

 Without treatment, as many as 40-50%

• f these youths are at risk for not

graduating high school due to the intensity and chronicity of their anxiety.

Adult Outcomes Research

 Twenty Year Longitudinal Study  Depression  Young people with social anxiety were almost 3

times as likely to develop depression later in life

 Psychiatric treatment  Received more psychiatric treatment than the

general population

 Alcohol, drug use  More frequent use of alcohol and marijuana.  Different life choices  Make “fear-fueled choices” with long-term

effects, including electing a less rigorous or challenging career

Current ent Res esea earch ch on Trea eatment tment Effecti ectiven eness ess (Ma Mayn ynar ard d et

• et. al. 2015)

5)

 Meta-analysis of effect of psychsocial

treatment, primarily CBT or CBT plus

• medication. (8 total studies)

 “Robust” finding of positive impact on school

attendance

 No short-term impact on anxiety  Having close friends in school was

associated with improved attendance

Compr mprehens ehensive e Program

Collaborative Team Approach

 Parent/s  Counselor/Social Worker  Teachers  Administrators  Section 504 Plans/IEPs  Outside Mental Health Providers

Provide vide Psych ch-educatio education n to Paren ents ts

 Missing school reinforces and increases

anxiety rather than alleviating it.

 Keep your child in school all day, every day  Do not give in to crying, pleading, threats.  Be firm in your conviction that your child will

be safe in school – that staff will help.

 Encourage your student to use supports

available in school.

Counselor/Social Worker’s Role

 Providing Safety  Escape strategies – a break, to talk, retreat  Media center passes, safe places  Schedule carefully  Teacher characteristics, class make-up, friends,

subject areas of interest

 Get them involved in school

 Sporting events, clubs, theater, helping in media

center.

Coun unse selo lor/ r/ SS SSW Interv erventio entions ns

 CBT techniques  Relaxation training  Desensitization  Kearney treatment plans

 Based on “goals” of school refusal

Kear arne ney: y: Anx nxiety ety Mo Mode del

Anxiety and Avoidance Hierarchy

Feelings lings Thermometer mometer

School hool Refus usal al Suppor port t Group up

Challenges Group Composition* Learn they are not alone Relationships/Sense of Belonging Share experiences/coping

Counselor/Social Worker’s Role

 Social Media

 Social interaction with peers whether home or at school,

friends encouraging attendance (Facebook page)

 Texting

 Encouragement to come to school (staff or other students)

 Coordination with Teachers and Administrators

 Communication and understanding that this is an anxiety

issue, help to coordinate “make-up work conversation,” discipline consequences, etc

 Online Learning – REALLY?

 Ala Carte Learning

Se Sect ctio ion n 504 and d IEPs

 ADA mandates schools to accommodate students with

conditions that interfere with learning

 Use when student is failing or near failing classes  Section 504 Plan

 Provide both flexibility and consistency  Modifications to class schedules, attendance policies,

makeup work, provide positive behavior supports, alternatives for class presentations, P.E.

 Individualized Education Plan

 Adding resource room support, case manager or teacher

consultant

Need for Accommodations

Educat ucate e Tea eacher chers

Empathize with teacher frustration!

 Welcome back – sincerely but quietly  Avoid lectures about attendance  Don’t overwhelm students with missing work  “Forgive” work as much as possible  Give teachers information about school refusal  Help facilitate positive interactions with other

students

 Seating/Lab partners/Small groups  Accommodations  Presentations, not being called on in class

Avoiding lectures

Educat ucate e Ad Administ nistrato ators

 Effective and supportive attendance policies  Punitive consequences/suspensions  REALLY?!  Lecturing (not the student, parents maybe…)  But really, they should be encouraging

parents to get student to school.

 Encourage and support teachers in taking a

flexible approach

Colla llabor borate ate with h Ou Outside tside Me Mental al He Health th Provide iders

 Overall, seldom seem “the answer”  May provide excuses for lengthy absences  They recommend ongoing reduced day

 REALLY?

 Medication: Antidepressants/Anti-anxiety

 Research on results is mixed  May have limited value  Recommended for more severe anxiety

Educate cate Ou Outside side Menta tal l Heal alth th Pr Providers viders

 They “need education about education”  Unaware of the rigidity of the Michigan Merit

Curriculum and pressure on students

 No longer a “Five Year Plan” for high school  Considered a drop-out and likely to be one  Devastating to self-esteem: research on

“graduating with your class”

 Schools lose aid and rarely allow them the

• pportunity to stay within the regular program

In Interv ervention ention Ou Outcomes comes Data

Fall: Spring: K 304 48 D 275 56

2010-11 2011-2012 E 201 129 C 403 206 M. 150 100 A. 300 202 S. 134 71

Help the team understand reality of “remission, not cure” – anxiety as a trait of temperament

Students udents Rea eally y DO Ca O Care e

 They don’t want to be chronically anxious and

fearful, have headaches and nausea

 They don’t want to have temper tantrums, argue,

threaten, and make excuses

 They do want to graduate and with their class!  They do want to belong  They do want to fit in – have friends, go to lunch,

participate in activities and be successful !

 They do want to have a future – go to college

and/or have a good job someday

Ki Kids Do Wel ell if They Can! n!

 One of the most powerful influences on young

people today is their need to belong – to fit in and to be accepted by those they consider their peers

 The greatest emotional need of teenagers is

(after the music, computer, and phone) is a sense

• f belonging

 Is this changing with “friends” on social media?

 They are trying to create an identity, but can’t if

they are not immersed amongst peers for comparison

References nces

1) Bye, Alvarez, Haynes & Sweigart (2010) Truancy prevention and intervention: A practical guide, Oxford University Press, New York 2) Fremont, W . (2003) School refusal in children & adolescents, American Family Physician, 68 (8). 3) Kearney, C. (2008) Helping school refusing children and their parents: A Guide for school-based professionals, Oxford University Press, New York. 4) Kearney, C. (2007) Getting your child to say “Yes” to school: A Guide for parents of youth with school refusal behavior, Oxford University Press, New York. 5) Kearney, C & Albano, A (2007), When children refuse school: A cognitive-behavioral therapy approach: Therapist guide, New York: Oxford University Press.

Refer erenc ences es

7) Kearney, C.A. (2006) Dealing with school refusal behavior: A Primer for family physicians, Journal of Family Practice, 55 (8). 8) Peterson, A., I hate school extreme edition: What school refusal means and how to fix it, The Wall Street Journal, September 21, 2010 9) Bernstein, Bettina, D.O. (August 2014) Separation anxiety and school refusal. Retrieved from: medicine.medscape.com/article/916737-overview#a3 10) Maynard, Brandy, et. al. (August, 2015) Treatment for school refusal among children and adolescents: A Systematic review and meta-analysis. Research on Social Work

• Practice. doi:10.1177/1049731515598619.

11) ACES Too High News (Adverse Childhood Experiences) Retrieved from: www.acestoohigh.com