Interventions, strategies and review

Kearney and Silverman (1990) suggest that choice of intervention should be governed by a careful functional analysis of school avoidance behaviour. They describe four types of variable which can maintain school avoidance behaviour, however several of these may be involved and their effects will be interactive. Interventions should be bespoke to the individual and based upon the information which was gathered in the assessment and integration stage.

To avoid something or situations that elicits negative feelings or high levels of stress (e.g. fear of the toilets; the noise in the playground; lots of people moving all together in the corridors between classes, tests/ exams)

Interventions should include learning about anxiety and worrying, how it affects our thinking, feeling and behaviour. How avoidance of the feared situation makes things worse. The child should be taught anxiety management techniques such as relaxation training and deep breathing. Links to resources to support schools in this can be found in the Resource Section.

There should be a gradual re-exposure to school setting using avoidance hierarchy created with the young person from least feared school situations to most feared. School should consider the provision of safe spaces that pupils can go to, such as pastoral zone, and library, these may be less stigmatising for some pupils than learning support area for some pupils.

Anxiety / avoidance hierarchy

To create an anxiety/avoidance hierarchy, the young person can be asked to name situations (or shown cards representing possible fears) and asked to rank them in terms of how they feel about that situation or object from least worried about to most worried about. When thinking about next steps it is important to start with the item that causes the least amount of anxiety, helping them think about how they will cope with this situation and what support they will need. When they have overcome this fear and consolidated this a number of times then they can begin to work his or her way up the hierarchy.

2. To escape difficult social situations (e.g. feeling left out at playtime; reading out loud in class or other public speaking/group task; working as part of a group)

As with the first function intervention should include learning about anxiety and worrying, how it affects our thinking, feeling and behaviour. How avoidance of the feared situation makes things worse. The child should be taught anxiety management techniques such as relaxation training and deep breathing. In addition the child should be taught social skills and given opportunities to practice coping skills in real-life social and evaluative situations, starting small and building up to most challenging. There could be pre teaching of key work missed, buddying, peer mentoring and role playing what they are going to say when peers ask about their absence from school.

3. To get attention from or spend more time with significant others (e.g. change in family dynamic, concerned about the well-being of parent). Intervention would usually include work with care-givers supporting them to develop skills and techniques to:

Manage the school avoidance behaviours such as tantrums or physical/ somatic complaints

Establish morning routines

Use problem solving techniques

Establish positive and individual time to spend with the child outside school hours

Focus on positive behaviours

Limit the attention the child receives when they do not attend school

Establish rewards for when they attend school and where appropriate consequences if they do not.

4. To spend more time out of school as it is more fun or stimulating (watch tv, go shopping, play computer games, hang out with friends).

Intervention would usually include:

Increasing “rewards” for attendance and disincentives for nonattendance i.e. laptop time, access to internet, phone credit, time with friends in town etc.

Limit the attention a child receives during non-attendance

If possible take away the more stimulating activity

Support their travel to and from school

Teach them how to refuse offers from peers

Make school as stimulating as possible, find out the child or young person’s interests and if possible apply this to the work completed in school.

Review

It is essential that any plan is regularly reviewed. There should be set dates for reviewing how any support plan is progressing and key personnel to attend identified. It is essential that the young people and parents are actively involved in the review.

The review should identify and celebrate any progress made, review whether further information has come to light to help inform clear next steps. These next steps can include:

consolidating and maintaining the current support plan,

setting new outcomes and or actions for the young person, school and parents.

Identifying that further consultation with other agencies needs to occur which may, if necessary, lead to a referral to other services.

Cycle
Assess	Gain a full understanding of the various aspects at play (child, school and family)
Plan	Based on information gathered plan for a realistic small reintegration
Do	Ensure resources and support is in place, good communication with school, family and others
Review	Monitor the progress made and adjust the plan for next steps

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Download a PDF version of the Emotionally Based School Avoidance Guidance and other leaflets here.

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