1. Anna Foxdal
Psychotherapist
Hemmasittarprogrammet
Robert Efström
Psychologist

2. 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.

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

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

5. 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

6. 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

7. To do things in order ASSESSMENT PHASE Treatment Phase
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.

8. Causes and maintaining factors
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?

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

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

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

12. 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

13. Behavior analysis Excesses Deficits Overt
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

14. Function of school absenteeism
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?

15. 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? !

16. In summary Identify problems before putting into action! Why?
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

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

18.
Fokus för insats är ökad skolnärvaro och för att nå dit krävs regelbunden träning. Det andra då? Måendet? Ökad skolnärvaro leder till förbättrat mående.

19. The treatment phase: Structure & Content
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?

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

21.
SCHOOL-ATTENDANCE
Student
Parents
School
VAD KRÄVS?

22. The student Home visits – meet the student where he or she is
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

23.
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

24.
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

25. What is helpful for the school?
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

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

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

28. International conference

29. Wanna know more?
For more information about Magelungen as a company contact Mia Hubinette
For more info about HSP contact