Anna Foxdal Psychotherapist Hemmasittarprogrammet anna.foxdal@magelungen.com Robert Efström Psychologist Robert.elfstrom@magelungen.com

Since 1993. About 400 employees in 9 cities in Sweden Employee owned - Every empolyee is offered to buy an equal share. Treatment assignments usually comes from the social services. School is a growing part of the company.

Magelungen Institutional treatment School with extra resources Outpatient treatment Professional Education School with day-care

What is HSP? Manual based Multimodal Intensive Based on CBT Home visits are required Finding and approaching the school that is appropriate

What characterizes a ”hemmasittare”? School is associated with emotional discomfort The absence is often known by the parents No crime, abuse, or the like The student isolates himself during school hours but may have functional activities after school or during holidays The student have a desire to go to school The student have trouble himself to break his situation Students may experience school as meaningless or difficult to understand the purpose of the lectures / exercises

Our prerequisites Assignment of social services, sometimes childpsychiatry & School We work in teams of two 5 cases/therapist Team Meeting once a week with set agenda Treatment review of all the cases one time every other week – adherence check Emergency phone

To do things in order ASSESSMENT PHASE Treatment Phase 2015-10-05 To do things in order ASSESSMENT PHASE 3-5 WEEKS Treatment Phase 6-12 MONTHS MAINTENANCE PHASE 3 MONTHS En vanlig fälla att gå i är att kasta sig in i åtgärder utan kartläggning.

Causes and maintaining factors 2015-10-05 SCHOOL ABSENTEEISM Specific event, in the family or at school Psychiatric problems Neuro-psychiatry Situation at school Parents functioning Screentime PETERS EXEMPEL MED FOTBOLL/SCHACK PÅ SKÄRMTID?

Hemmasittarprogrammet- HSP Learning theory Student Parent School Cooperation Coordination Assessment Treatment Maintaining Manual based program- individualized action SCHOOLAPPROACHING!

Hemmasittarprogrammet- HSP Learning theory Student Parent School Cooperation Coordination Assessment Treatment Maintaining Manual based program- individualized action

To assess school absenteeism What is the function absence? Are there any clear precipitating cause? What factors perpetuate absence? ?

HOW TO ASSESS? Obtain information from parents, students and school. Draw network map and line of life. Find ways to get information, adapt your way of asking questions. Meetings at home, office or in school. Read previous materials. Make behavior analysis

Behavior analysis Excesses Deficits Overt 2015-10-05 Behavior analysis Excesses Deficits Overt Sits in front of computer, plays computer games Being in school See friends Go by public transportation Social skills Covert Anxiety Stomach ache Negative thoughts Strategies to handle anxiety Kanske i prat säga att beteenden kan vara problematiska för att de förekommer för ofta/för sällan. I fel sammanhang eller för intensivt.. Använda beteenden från slides innan

Function of school absenteeism 2015-10-05 Function of school absenteeism Antecedent Behavior Consequenses Morning, time to go to school. Feels anxiety, stomach ache. Turns at the door, stays at home and sits in front of computer all day. No worrying, chats with friends on internet Handlar mest om att slippa undan obehag, för höga/låga krav, obegripligt sammanhang, kan vara parat med att man också får ngt man uppskattar men troligtvis inte det som styr mest. HÄR KANSKE VI KAN LÄGGA IN EN KORT ÖVNING, DISKUTERA MED GRANNE 3 MIN, VILKA KONEKVENSER STÖTER NI PÅ?

Presentation of the assessment Written documents This is how we understood the problem This is our proposal for action What do you think about that? Shall we try? !

In summary Identify problems before putting into action! Why? 2015-10-05 In summary Identify problems before putting into action! Why? More chance to insert the appropriate action for that particular student you meet It is very effective for creating alliance and a good basis for change Ser också i forskning, t ex Hattie – god effekt

Hemmasittarprogrammet- HSP Learning theory Student Parent School Cooperation Coordination Assessment Treatment Maintaining Manual based program- individualized action

2015-10-05 Fokus för insats är ökad skolnärvaro och för att nå dit krävs regelbunden träning. Det andra då? Måendet? Ökad skolnärvaro leder till förbättrat mående.

The treatment phase: Structure & Content 2015-10-05 The treatment phase: Structure & Content Includes students, parents and school and relate to targets. Should be flexible and intensive care several times / week Planning for the gradual rapprochement of the school. What skills are lacking in students, parents and school? - How do we practice it? - How does school meet the students needs? Enables interaction, e.g. consent to break the secrecy Kanske bättre rubrik här? Generella komponenter typ?

To evaluate and plan the next step "It's so easy that we put into action without thinking about the next step."

2015-10-05 SCHOOL-ATTENDANCE Student Parents School VAD KRÄVS?

The student Home visits – meet the student where he or she is 2015-10-05 The student Home visits – meet the student where he or she is Psychoeducation and rational about difficulties. Working with everyday functions such as circadian rhythm and activation. This is important to start preparing for school approaching behaviours. Starting to plan small steps (exercises) for the student to get back to school. Clarify the purpose of the exercises, how does this help you achieve your goals. Bättre rubrik här också

2015-10-05 Parents Counseling at office 1 day / week, reconciliations on the phone, and if they are present during home visits Increased knowledge of the problem and investigating the difficulties they encounter and how they are affected by these Behavioral changes Procedures / structure, demand level and family climate Promote cooperation with schools Vara bra skolförälder

2015-10-05 School Increased knowledge of the problems and how treatment interventions can be implemented in schools Planning for increased attendance, educational, treatment, information Should be a clear plan when the student returns to school Make adjustments if needed Take responsibility for cooperation with parents (be the bridge). Weekly updates to help with planning ahead. ÅTERRAPPORTERA NÄR DET FUNGERAT BRA

What is helpful for the school? 2015-10-05 What is helpful for the school? A good collaboration where school and treatment meet. The importance of systematic work and well-planned action - taking small steps and be consistent. Solid preparation - preparation of students and parents. Important to have someone to reason with when difficulties arise The feeling that we were a team around the student En skola – ömsesidigt

Hemmasittarprogrammet- HSP Learning theory Student Parent School Cooperation Coordination Assessment Treatment Maintaining Manual based program- individualized action

Maintaining When? How can we make treatment effects last? Highly individualized depending on functioning and resources.

International conference http://www.jobbaktiv.no/arrangementer/international-school-refusal-conference/ http://www.magelungen.com/behandling/oppenvardsprogram/hsp-hemmasittarprogram/

Wanna know more? For more information about Magelungen as a company contact Mia Hubinette mia.hubinette@magelungen.com>; For more info about HSP contact Robert.elfstrom@magelungen.com Anna.foxdal@magelungen.com