“I Don’t Want to Go!” School Attendance Problems Dr. Becky Churchill Keating Registered Psychologist Child and Youth Mental Health Annapolis 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 go It'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 Most children at some point express an interest in avoiding school but…they still get to school - my 3 year old….just wants to be with Mommy Unexcused patterns of school absence 1-8% of students have problem with school refusal behaviours 28% of students at one time display school refusal behaviours Peaks at ages 5-7, then 11 and 14 Boys and girls All socio-economic statuses

Behavioural Psychology 101 Positive (+) Reinforcement Making a behavior stronger by following the behavior with an added pleasant stimulus. Negative (-) Reinforcement Making a behavior stronger by taking away a negative stimulus. Negative Reinforcement often confused with punishment. Hard time finding good examples on internet as they were all adding a negative stimulus to affect behavior The behavior I mean “avoidance/refusal”

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 Avoid distress/discomfort at school (NR) Entering the building, transitions, being in class, riding on bus, academic trouble (anxiety and/or depression) Escape Social/Evaluative Situations (NR) Peer and/or teacher issues (20% of students report missing school because of bullying at some point), presentations, performances, tests, eating in cafeteria (anxiety) Attention (positive or negative) from Significant Others (PR) Want to stay with parent, may have separation anxiety or behaviour issues More fun when not at school (PR) “better things to do” But sometimes it is family/parent issues: need to see what is reinforcing parents to allow kids to stay home - avoid distress: concern that child not being treated well or programmed for academically - bullying - work schedule and no other time to see child….trouble separating from child - transportation, financial, - mental health/substance - different values - visitation schedules - disorganization/routines/punctuality SRAS - child and Youth (very helpful tool) – can google it!

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!

Describe the “stuck” circuit with example: Up in morning anxiety climbs…getting ready for bus and “bam”! Tantrum, resist going….relief…until tomorrow morning!

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 Legitimate but not always…can learn to falsely claim or exaggerate to stay home.

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! High conflict in the mornings and sometimes the night before Late for work or having to take a leave from work because of childcare issues Confused about how to help Guilty and Embarrassed Pressured and Fearful of consequences (academic failure, legal trouble, financial struggles) Teacher concerns and fears? Student and/or parent doesn’t like me especially when classroom changes requested, I’m doing something wrong, failure worries for child

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!

Notice two things: With practice the peak anxiety lessens in intensity With practice the length of time it takes to habituate and feel less anxiety is reduced

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! Sometimes you may have to press pause on addressing the school attendance – focus on mental health and meeting goals of youth – (i.e., goal of going to public fun activity with friends – to hook them and help them experience some success in overcoming anxiety with the hope that it will generalize). Remember school refusal is not the primary issue – it is a symptom!

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! Children who miss school often are at a higher risk for a number of problems It is much harder to treat after it goes on for a long time than it is if we intervene early! Most students struggle for 1-2 years with 40% struggling for >2 years before they get help! We care about the mental health and education of all children and want children to get 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…. 45 Acute students identified and efforts to support made – 6 moved away DECISION TREE NEXT Late 18 improved 13 worsened 8 No change Absent 27 improved 7 worsened 5 No change Of 39 remaining here is what happened

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!