Reengagement With Education: A Multidisciplinary Home-School-Clinic Approach Developed in Australia for School-Refusing Youth

School refusal (SR) can result in decreased academic achievement, impaired social connections, and family stress. Current interventions for SR include behavioral and cognitive-behavioral treatments that are not always effective. Incorporating multidisciplinary work that includes therapeutic and educational interventions may enhance outcomes for youth displaying SR. The In2School program fosters a working partnership between mental health clinicians and teachers. It was designed to meet the needs of young people missing more than 50% of school in the previous 6 weeks due to mental health disorders, including anxiety or depression. This paper reports on an action research study in which the In2School program was piloted. Over a 14-week period, therapeutic and educational interventions were integrated into the learning environment via a transitional classroom to support youths’ return to school. Outcomes of this program are reported for the first cohort of 7 youth. Of these youth, 6 returned to mainstream schooling with attendance levels being maintained for 6 months after completing the intervention. Progress was observed in mental health recovery, quality of life reports, increased social interactions with peers, and positive experiences at school. The preliminary results presented in this paper suggest that a multidisciplinary, home-school-clinic intervention holds promise for helping school-refusing youth to return to school.     

Emerging School Refusal: A School-Based Framework for Identifying Early Signs and Risk Factors

A student’s academic and social-emotional development is increasingly jeopardized with mounting absence from school. School refusal (SR) is one type of school attendance problem (SAP) that is often associated with absence from school. Once established, it can sometimes be difficult to treat. To prevent established SR and associated problems, indicators of emerging SR and risk for SR should be efficiently identified and acted upon. Risk factors are often discussed in relation to SAPs generally rather than considering risk for specific types of attendance problems. Based on literature review, this paper provides an account of the likely signs and risks for emerging SR. A school-based framework is provided to support school personnel and parents in working together to identify these signs and risks. Several challenges associated with the implementation of the framework are discussed.     

Confirmatory Analyses of the School Refusal Assessment Scale-Revised: Replication and Extension to a Truancy Sample

School absenteeism and school refusal behavior are prevalent and serious issues for youth, but few measures have been developed specifically for this population. The School Refusal Assessment Scale-Revised (child and parent versions) provides clinicians with a profile of the relative strength of four functions or maintaining variables regarding school refusal behavior. The scales have been previously tested largely on clinical samples in outpatient treatment settings, however. This study examined 216 youth with primary school refusal behavior and their parent/guardian referred to a community-based truancy court or truancy diversion setting for problematic absenteeism. The four-factor structure of the scales (Kearney Journal of Psychopathology and Behavioral Assessment 24:235–245, 2002a; Journal of Psychopathology and Behavioral Assessment 28:139–144, 2006) was supported via confirmatory factor analysis and specific functions were associated with specific symptom sets as predicted. The results help extend the generalizability of the scales to youths and their families who are more ethnically diverse and referred to a legal process.     

日本拒绝上学概念的演变和原因探讨

拒绝上学指学生不是由于家庭贫困或生病,而是由于某种心理、情绪、身体或社会的原因而不去学校的现象。欧美最早进行研究,日本进行了五十多年的研究。该文介绍日本此现象的称呼从“学校恐怖症”、“拒绝上学”到“不去上学”的演变;日本学者从家庭、学校、社会方面对此现象进行的归因;拒绝上学的行为机制,如分离焦虑、情绪障碍、家庭关系不良;还介绍了日本教育部使用的小泉英二的分类。最后提示该现象在我国发展的可能性     

Reflections on the Field of School Attendance Problems: For the Times They Are a-Changing?

This article presents reflections on the seven articles included in this special series. The classification of school attendance problems (SAPs) based on structured checklists of SAP types (school refusal, truancy, school withdrawal, and school exclusion) together with functional analysis opens the way for establishing norms and social referents. We discuss how authorized nonattendance can also be problematic if it is persistent, and that it is important to take this type of SAP into account if the field is to effectively understand and respond to the complex range of bio-psycho-socio-cultural determinants of absenteeism. We highlight other gaps in the current literature, one of which is the lack of attention to evidence-based prevention and early intervention strategies. Avenues for future research are suggested, with emphasis on the need for pragmatic approaches to address the complexities of SAPs. Promising work is beginning to address the SAPs that are prevalent in special populations such as those with autism spectrum disorder. Overall, our reflections highlight the incremental changes that have characterized the field, exemplified by this series of articles, and the promise of transformational change in tackling the major challenge of SAPs as research in the field continues.     

Differentiation Between School Attendance Problems: Why and How?

School attendance problems (SAPs) are heterogeneous with respect to etiology and presentation. The long history of conceptualizing SAPs has led to a vast array of terms and definitions as well as different perspectives on the most helpful approach to classification. For educators, practitioners, researchers, and policymakers, this presents a challenge in understanding, assessing, and intervening with SAPs. This paper outlines evolution in the conceptualization of SAPs, focusing on two contemporary approaches to differentiating between them. One approach draws on the longstanding differentiation between SAP types labeled school refusal, truancy, and school withdrawal. A fourth type of SAP, labeled school exclusion, is also considered. The other approach focuses on the function of absenteeism, measured via the School Refusal Assessment Scale (SRAS). Anecdotal and scientific support for the SAP typology is presented, along with the benefits and shortcomings of the SRAS approach to differentiation. The paper offers suggestions for how to differentiate between SAPs and introduces the SNACK, a brief screening measure that permits differentiation by SAP type.     

Identifying the Function of School Refusal Behavior: A Revision of the School Refusal Assessment Scale

A revision of the School Refusal Assessment Scale (SRAS-R), a measure designed to help clinicians identify the primary function of a child's school refusal behavior, was examined. Changes in the original version of the scale were made to improve psychometric quality and align the measure in accordance with evolutions in the functional model. Two samples of youth with school refusal behavior, in addition to parents and teachers, were evaluated to determine the test-retest and interrater reliability and construct and concurrent validity of the SRAS-R. The scale was found to have good psychometric strength. Implications of these findings for clinicians who address this population are discussed.     

Modular Treatment for Children and Adolescents With Problematic School Absenteeism: Development and Description of a Program in Germany

Problematic school absenteeism is defined as absence from school occurring with a clinical-level mental disorder. It represents a higher-order term for school refusal, school truancy, and the combination thereof and is associated with an increased risk for school dropout, prolonged mental disorders, and unemployment. This article describes the manualized modular treatment of problematic school absenteeism (MT) by a multiprofessional team. The manual was developed to target a broad spectrum of mental disorders characterized by internalizing but also externalizing behavior. The therapeutic focus is on the reintegration into school and on the cognitive behavioral treatment of the mental disorder. The MT is based on a multilevel model of problematic school absenteeism. The treatment is informed by an extensive case-conceptualization and addresses motivational aspects by offering a low-threshold therapeutic design and motivational interviewing. Core interventions are represented in four modules: cognitive behavioral therapy, family counseling, school counseling, and a psychoeducational physical exercise program. A case vignette provides an illustration of the treatment and the specific graduated approach for school reintegration. The current modular approach is discussed in relation to other cognitive-behavioral manuals targeting a broad spectrum of mental disorders or school refusal.     

Examining School Counseling Students' Multicultural and Sexual Orientation Competencies Through a Cross‐Specialization Comparison

Professional school counselors have an opportunity to directly address the educational, emotional, and social problems facing lesbian, gay, bisexual, transgender, and questioning youth. The purpose of this study was to examine the multicultural and sexual orientation counselor competencies of school counseling students through a cross‐specialization comparison with community agency students. Results indicate that school counseling students had significantly lower self‐reported multicultural and sexual orientation counselor competency scores. The findings and their implications are discussed.     

Antidepressant Medication: Is It a Viable and Valuable Adjunct to Cognitive-Behavioral Therapy for School Refusal?

Cognitive-behavioral therapy (CBT) is an evidence-based treatment for school refusal. However, some youth do not respond to CBT. The serious risks associated with school nonattendance call for novel approaches to help those who do not respond to CBT. Because school refusal is commonly associated with anxiety disorders, and the combination of CBT and antidepressant medication enhances outcomes in the treatment of anxiety disorders, combined treatment may be effective for school refusal. This narrative review evaluates the current evidence base for adding antidepressant treatment to CBT for school refusal. Six randomized controlled trials (RCTs), two open trials, six case studies/series, and one observational study were identified and reviewed. There is support for combined CBT and imipramine, but this medication is not typically used due to the risk of concerning side effects. Two recent RCTs failed to provide evidence for the superiority of combined CBT and fluoxetine. Further research in this area is required because the extant studies have a number of methodological limitations. Recommendations are provided for clinicians who consider prescribing antidepressant medication or referring for adjunctive antidepressant treatment for school refusal.     

Confirmatory Factor Analysis of the School Refusal Assessment Scale-Revised: Child and Parent Versions

The School Refusal Assessment Scale-Revised (SRAS-R) is an instrument designed to evaluate the relative strength of four functional conditions of school refusal behavior in youth. Although previous work has shown the scale's child and parent versions to show good reliability, verification of the SRAS-R factor structure remains necessary. The present study investigated administrations of the child and parent versions of the SRAS-R (SRAS-R-C and SRAS-R-P) using confirmatory factor analysis. For both measures, four-factor models were supported following the removal of two SRAS-R-C and three SRAS-R-P items. Three-factor and two-factor models for each SRAS-R version were not supported. Ramifications of these results for use of the SRAS-R are discussed.     

Developments in Classification,Identification, and Intervention for School Refusal and Other Attendance Problems: Introduction to the Special Series

The literature on school attendance problems (SAPs) is diverse and sometimes confusing, but it is also promising. This special series presents seven articles and a discussion that attest to the diversity, complexity, and exciting developments associated with SAPs. While some articles focus on school refusal in particular, others have relevance for school refusal, truancy, and other types of SAPs. Collectively, the seven articles provide direction in thinking about two key questions: (1) How can SAPs best be classified and identified?; and (2) Which innovative approaches can be applied when a SAP is severe, chronic, and/or complex? In this way the series has direct relevance for Tiers 1 and 3 of the Response to Intervention model for managing school absenteeism (Kearney & Graczyk, 2014). Three innovative treatment programs presented in this series illustrate ways in which mental health interventions and educational interventions can be combined to address Tier 3 SAPs. The discussion article presents thought-provoking reflections on the topics covered in the seven articles and on the gaps in practice and research in the field of SAPs. You are invited to critically and creatively respond to the ideas offered in this series.     

Psychometric Properties and Clinical Utility of the School Refusal Assessment Scale in a Multiethnic Sample

Kearney and Silverman (1993) developed the School Refusal Assessment Scale (SRAS) to assess the function of and to prescribe treatment for school refusal behavior. The present investigation examined the psychometric properties and clinical utility of the SRAS in a multiethnic sample. Participants were 30 children and their mothers who were identified as school refusers after an initial screening. Results indicated that scales measuring negatively reinforced school refusal were intercorrelated, whereas scales measuring positively reinforced school refusal were not. Concurrent validity of dimensional and categorical scoring algorithms was examined. Although parent–child agreement was relatively low, validity analyses suggested that each reporter contributed important information. Clinical implications and areas for future research were discussed.     

Les déterminants du décrochage dans l’enseignement secondaire : une revue de littérature

IntroductionDropping out of school is a research topic with various dimensions: non-graduation, school leaving, absenteeism, school failure and school refusal. It involves processes determined by various factors – individual, social, familial and institutional. Individual determinants have specifically been studied in the recent literature. They involve demographic and academic indicators, behaviors, attitudes and mental health of the student, as well as specific types of school refusal. The aim of our study is to update knowledge in this specific field, and highlight underlying problems and methodological issues raised in the literature.MethodDropping out of school is defined as leaving school without a qualification. It involves a process of specific disengagement, which is non-reducible to the negative counterpart of school commitment. The present article is a review of literature from PsycInfo on the individual determinants of dropping out of school. It is based on 50 articles published between 2010 and 2017, related to the following topics: school dropouts, school leavers, school refusal, and academic failure. Five exclusion criteria were used: studies with single factor analysis, literature review, sample excluding secondary education, sample of less than n = 100, non-general, non-mixed, or composed of a sociodemographic minority.ResultsSchool performance and early risk behaviors (substance use disorders, sexuality) remain the best determinants of dropping out throughout the duration of schooling. Psychopathological factors, anxiety, depression and externalized disorders can play a direct or indirect role in the prediction of dropping out. Lack of psycho-emotional support strongly supports the intention to drop out. Motivation has an unequal predictive value, depending on the type of construct or theoretical model used. Inappropriate beliefs, low self-esteem, pessimism, creativity appear as indirect determinants of dropping out. School burnout, understood as emotional, physical and mental exhaustion due to education, directly causes a break between the student and the school.DiscussionMethodological bias can modify the significance of determinants such as gender, academic achievement and retention. Greater knowledge about the relationships between determinants, the profiles of at-risk students and temporalities should help clarify students’ trajectories and the processes at work in different school contexts. Recommendations to educational staff are put forward regarding the detection of individual indicators of dropping out.     

Treatment Participation among Children with Conduct Problems and the Role of Telephone Reminders

Children with antisocial, aggressive and disruptive behaviour problems are among the most frequent referrals to mental health services. These young people and their families present with a range of adverse contextual factors and can prove challenging to engage. We examined the characteristics of children with conduct problems, treatment participation, and the impact of telephone reminder calls. Consecutive referrals (N=262) to two child and youth mental health services were randomly assigned to either a reminder call condition or service as usual. In comparison to referrals without conduct problems, conduct problem children presented with greater sources of psychosocial adversity, attended fewer initial appointments and were at greater risk of treatment refusal. Importantly, telephone reminder calls significantly increased treatment attendance, though only for participants with elevated conduct problems. Telephone reminder calls, however, had no impact on treatment refusal, regardless of conduct problem status. The findings highlight a straightforward approach for enhancing treatment participation among a group that has been challenging for mental health services.     

Profiles of emotional intelligence and demotivation to attend school in Chilean adolescents

The aim of this study was twofold: to identify different emotional intelligence (EI) profiles and to verify possible statistically significant differences in school refusal factors that result in a demotivation to attend school. Participants were 2362 Chilean adolescents aged from 13 to 17 (M?=?15.25; SD?=?1.33), who completed the Trait Meta-Mood Scale-24 (TMMS-24) and the School Refusal Assessment Scale-Revised (SRAS-R). Cluster analysis identified four EI profiles: high scores in repair and low in attention, high scores in attention and low in clarity and repair, low EI and high EI. Students with high scores in attention and low in repair scored higher in the first three factors of the SRAS-R, whereas in the fourth factor of the SRAS-R, students with high EI had significantly higher scores. Emotional regulation seems to be one of the determinant factors to prevent the appearance of school refusal. Based on these findings, we recommend that EI training be a part of future programs to overcome school attendance demotivation issues.     

Outcomes of children with emotional disturbance in residential treatment for educational purposes

A study was conducted of the outcomes of all children and adolescents (N=114) with serious emotional disturbance who had been placed by school districts in residential treatment facilities for educational purposes over a three-year period. Both cost and outcome analyses were conducted. Cost analyses indicated a total annual expenditure in excess of $5 million, or $80,000 per youth per length of stay. Outcome analyses, consisting of ratings of outcomes and outcome interviews with special education directors, revealed that 63% of the youth had either made no or minimal progress, had been discharged with a negative outcome, or had run away. Positive outcomes were achieved in only 25% of the cases, measured by the students' return to school or placement into a vocational training program. Another 11% of the youth were making substantial progress. Analyses of the relationships between outcomes and cost revealed no relationship. However, positive outcomes were associated with shorter lengths of stay. Further, students in the positive outcome categories had more severe functioning deficits at intake than students in the negative outcome categories. The availability of community-based services for the student and family was the single most likely reason reported by special education directors for positive discharge status.     

Developmentally Sensitive Cognitive Behavioral Therapy for Adolescent School Refusal: Rationale and Case Illustration

School refusal can be difficult to treat and the poorest treatment response is observed among older school refusers. This poor response may be explained, in part, by the impact of developmental transitions and tasks upon the young person, their family, and the treatment process. This paper describes and illustrates the @school program, a cognitive behavioral therapy (CBT) designed to promote developmental sensitivity when planning and delivering treatment for adolescent school refusal. Treatment is modularized and it incorporates progress reviews, fostering a planned yet flexible approach to CBT. The treatment is illustrated in the case of Allison, a 16-year-old female presenting with major depressive disorder and generalized anxiety disorder. A case formulation guided the selection, sequencing, and pacing of modules targeting predisposing, precipitating, perpetuating, and protective factors. Treatment comprised 16 sessions with Allison (interventions addressing depression, anxiety, and school attendance) and 15 concurrent sessions with her mother (strategies to facilitate an adolescent’s school attendance), including two sessions with Allison and mother together (family communication and problem solving to reduce parent–adolescent conflict). Two treatment-related consultations were also conducted with Allison’s homeroom teacher. Allison’s school attendance improved during the course of treatment. By post-treatment, there was a decrease in internalizing behavior, an increase in self-efficacy, and remission of depressive disorder and anxiety disorder. Clinically significant treatment gains were maintained at 2-month follow-up. Factors influencing outcome may include those inherent to the @school program together with less specific factors. Special consideration is given to parents’ use of both authoritative and autonomy-granting approaches when helping an adolescent to attend school.     

Increasing the Parent—Child Communication Through Counselor—Parent Conferences

This study was designed to measure what effect the establishment of a parent-counselor relationship prior to the child's entrance into junior high school would have upon the child's adjustment to school and parent-child communication. Subjects were students and parents from Lealman Junior High School in St. Petersburg, Florida. Parents of the experimental group had a one-hour individual conference with the school counselor prior to the child's entrance into junior high school. Experimental and control groups were followed over a three-year period. The experimental group showed significantly greater (p < .001) parental contact with the school, significantly better student attendance (p < .001), and significantly higher grade point averages (p < .001) than the control group. This was accompanied by a lower dropout rate (p < .05) and fewer disciplinary referrals (p < .001). An overall more effective use of school counselors and other school personnel resulted.     

An Ecological View of School Counselor Ratios and Student Academic Outcomes: A National Investigation

The effect of student‐to‐school‐counselor ratios on academic outcomes has been widely studied, yet few researchers have taken a multilevel approach. Using the nationally representative High School Longitudinal Study: 2009 dataset, the authors found ratios were significantly associated with student grade point average (GPA) and graduation. Attending a Title I school also was associated with students’ GPA, advanced placement/international baccalaureate credits earned, and postsecondary course taking. The authors discuss implications for advocacy and practice, contextualizing their findings within an ecological framework.