Strategies & Interventions for School Refusal/School Anxiety

The School Refusal/School Anxiety Treatment Team suggest some strategies and interventions for parents and school personnel to use with children and adolescents who are struggling with these issues.

For Parents

• Make school attendance mandatory unless your child has a fever or contagious illness. Avoid calling your child out of school unless absolutely necessary. Children cannot deal with their school issues unless they are present at school. A child’s anxiety will increase the more school is avoided. 
• If a child refuses to attend school, contact school personnel and report the child’s refusal to attend school, even if it results in a unexcused absence. Allow the child to have consequences from school for unexcused absence.
• Establish and maintain open communication with school personnel regarding your child’s feelings about school, difficulties with school, etc. 
• Create an environment at home that fosters structure and consistency. Expectations should include rules, chores, privileges and limits. This will allow children to learn to structure themselves, as well as understand rewards and consequences. Likewise, expectations should be clear regarding school attendance and homework, as well as privileges and consequences given for not meeting expectations. Based on research, structure, routine and consistency are effective in alleviating anxiety in children. 
• Routine is essential for children with school anxiety/avoidance issues. A daily schedule that is followed consistently through the year both when the child is in school as well as out of school is beneficial. 
• Encourage children to enroll in school extracurricular activities to feel more connected to school. Have child choose at least one activity per school term. 
• Provide positive feedback for successes made at school. 
• Seek support from school and/or external resources when your child first starts displaying symptoms of school anxiety/avoidance. 
• If patterns of academic failure are present, psychological and/or neuro-cognitive assessment and/or intervention may be needed due to possible learning disabilities or neuro-cognitive deficit issues that may be present.
• Negative peer relations may result in school avoidance/anxiety issues. Contact the school social worker if your child is struggling with peer relations, i.e. bullying, difficulty getting along with peers, etc. Therapeutic intervention on the school level may be needed. 

For School Personnel

• School personnel should keep track of both excused and unexcused absences; allowing excessive absences without consequences may foster the refusal, anxiety and avoidance behaviors. Once a pattern of excessive school absences has been identified, it may be helpful to schedule a meeting with the school personnel, parents and student to discuss absences and implement a plan for educational success as well as require a medical note on re-entry for all upcoming absences.
• It is important to initiate and maintain communication between school personnel and parents on the student’s progress and expectations. Sending a written weekly report home to parents provides consistent dialogue between home and school of the student’s progress. 
• Expectations for attendance, homework, assignments, and tests need to be clearly defined for the student and parents.
• The student may benefit from a designated school personnel, such as the school social worker to check in with the student and help the student to feel more connected to the school. 
• School assimilation is essential for the students with anxiety and avoidance behaviors. Encouragement of extracurricular activities and student participation can decrease anxiety, foster independence and increase connections in the school setting. Students can work in the office, be a classroom helper or teachers assistant to increase integration in the school environment.
• Negative peer relationships need to be addressed in the school environment, such as bullying, teasing, etc. Social skill development may be necessary to promote change. School social workers, counselors, psychologists, teachers and peer groups are resources for intervention. Peer mediation may also be necessary.
• A psychological/neuro-cognitive assessment and/or intervention may be determined necessary if patterns of academic failure are present. Identifying and implementing emotional/behavioral/academic accommodations for students may be needed.
• Academic accommodations may be necessary through the development of a 504 plan and/or case study evaluation. Outside therapeutic resources may also need to be recommended. 

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