School's Guide to Emotionally Based School Avoidance.

Definition

Emotionally Based School Avoidance is a broad umbrella term used to describe children and young people who have difficulty in attending school due to emotional factors, often resulting in absences from school. It is different to children and young people who are absent because of truanting and it can be extremely distressing for the child or young person.

Cause

There is no single cause for EBSA, it is often underpinned by a number of factors including the young person, the family and the school environment. There tends to be four main reasons for school avoidance:

Prevalence 

The onset of EBSA may be sudden or gradual, often with peaks in EBSA corresponding to transition between school phases.  Frequent factors are listed below:

Prevalence in Conwy County

As part of the development phase of Conwy’s EBSA pathway, Conwy Educational Psychology and Education Social Work Service carried out research to investigate the reasons some children and young people find it difficult to attend school in Conwy.

Pupil Wellbeing Questionnaire

Electronic wellbeing questionnaires were  conducted with 52 pupils across Conwy schools from Year 3-Year 11. These pupils represented a cross section of young people receiving support from both the Youth Service and the Education Social Work Service, and who were struggling to attend school.

From this research, 3 key themes were identified as being important to children and young people who find it difficult attending school in Conwy;

The School Health Research Network (SHRN) Student Health and Wellbeing Survey (2019)

Findings from the most recent School Health Research Network (SHRN) Student Health and Wellbeing Survey Report for Conwy have been reviewed in light of the EBSA research in order to identify any common and re-occurring themes. All students from Year 7 to 11 in secondary schools across Conwy were asked to complete the survey during the period from September to December 2019. Some cross-cutting themes included feelings of pressure around school work, not feeling a strong connection to school and difficulties with peer relationships. The following data from the SHRN report highlights some of these themes.

Conwy Professionals Questionnaire

A questionnaire was also sent to Conwy schools and a range of services across Conwy County Council to gather a snapshot of the number of EBSA cases currently receiving support from Conwy services. It also aimed to find out what works currently and what support schools and services think would be helpful going forward.

The majority of services and schools that responded reported an increase in the number of EBSA cases over the last 12 months. Schools and services also noted that often parents’ own anxieties and difficulties within the home have a significant impact upon pupils presenting with EBSA. Pupils also presented with additional barriers such as having Additional Learning Needs and being Young Carers.

EBSA cases typically presented with the following indicators of EBSA;

Focus Groups

In order to gain a better understanding of the experiences of children and young people in Conwy and to further explore the 3 key themes that emerged from EBSA research, follow-up focus groups and individual semi-structured interviews were conducted with pupils from a sample of Conwy schools.

These focus groups re-emphasised the importance of the 3 key themes that were identified through the Pupil Wellbeing Questionnaires and also highlighted some other key factors for consideration in developing Conwy’s EBSA approach. Further exploration of these findings can be seen below:

The importance of supporting pupils’ to develop their resilience and coping skills to enable them to manage their feelings of stress and worry on a day to day basis.

What would help?

Lastly, pupils and Conwy schools and services were asked what they think would be helpful to include in any approach to supporting pupils experiencing EBSA. Strategies and resources that would be helpful include:

Different children will be hesitant to attend school for different reasons. It is usually a unique combination of various factors and their interaction rather than a single cause that leads to EBSA.

RISK: Just as with general mental health there have been factors identified that place children at greater risk of EBSA. It is usually a combination of predisposing factors interacting with a change in circumstances which leads to the pattern of behaviour described as EBSA. The predisposing factors may present in the nature of the school, the child’s family or the child themselves.

RESILIENCE: When working with individuals it is really important to also identify and build areas of strength or resilience of the child, family and school which may help to ‘protect’ the child and promote school attendance.

This may include:

·         Developing ambition, aspiration and motivation

·         Increasing confidence, self-esteem, self-efficacy and value in themselves

·         Developing feelings of safety, security and a sense of belonging

·         Having positive experiences where they can succeed

·         Holding positive relationships with peers or staff

·         Feeling listened to and understood

·         Understanding the relationship between thoughts, feelings and behaviour

·         Willingness to work in partnership between school, family and external professionals

·         Developing parenting skills and understanding

·         Flexibility of approaches within school

The contributory factors of ‘risk’ and ‘resilience’ can also be divided, and understood, in terms of ‘push’ and ‘pull’ factors.

·         ‘PUSH’ factors (i.e. those that push the child towards attending school)

·         ‘PULL’ factors (i.e. those that pull the child away from attending school)

Emotionally Based School Avoidance is most likely to occur when the risks are greater than resilience, when stress and anxiety exceeds support, and when the ‘pull’ factors that promote school avoidance overwhelm the ‘push’ factors that encourage school attendance.

Example of possible ‘Push’ and ‘Pull’ factors

Identification, Information Gathering and Planning 

School plays a key role in the identification of children and young people who are currently experiencing, or at risk of EBSA. It is important for schools to;

·         Develop effective whole school systems to support young people,

·         Be vigilant to early risk factors and attendance patterns.

·         Employ a thorough assess, plan, do and review cycle placing the young person at the heart of interventions.

Potential indicators

It is very important to be proactive with EBSA. The longer the problems remain unaddressed the poorer the outcome, as the difficulties and behaviours become entrenched. Schools need to be vigilant in monitoring attendance of young people noticing any patterns in non-attendance or changes to behaviours. 

A Profile of Risk of EBSA can be found on the resources page. This can help practitioners identify areas of risk. The Profile of Risk schedule looks at 5 key risk areas for EBSA. The checklist is for use alongside usual attendance monitoring systems in school to screen for possible EBSA in relation to non-attendance.

Information gathering and analysis

Once a difficulty has been identified it is essential to gain an understanding of the various aspects causing and maintaining the EBSA behaviours.

The main aim of this analysis is to:

·         To confirm that the child is displaying EBSA as opposed to truancy or parentally condoned absence

·         To assess the extent and severity of (a) a school absence, (b) anxiety and (c) ascertain the types of anxiety

·         To gather information regarding the various child, family and school factors that may be contributing to the EBSA in a given child

·         To integrate the available information to arrive at a practical working hypothesis as a prelude to planning effective interventions

It is often tempting to try to locate a simple reason and simple solution for the behaviour. However, as identified earlier it is often an interaction of a number of factors and trying to find simple causation often encourages blaming and individuals can then become anxious and defensive. Parents may feel blamed for the absences, feel that their parenting skills are being criticised and they may be fearful that they will get into trouble or even prosecuted for non-attendance. Children may feel guilty or scared that they will be forced to attend school. 

Each person may have a different perspective on EBSA and have a different story to tell. It is essential that different people’s views are respected and differences in views are acknowledged. When there is a difference of views it is often more helpful to focus on how the behaviour is occurring rather than why.

Due to the complex nature of EBSA no fixed ‘assessment process’ can be followed. However, in all cases it is essential that the views of the young person, the family and key school personnel are gathered and listened to.

Working with the child

Any child currently avoiding school is likely to become anxious when asked to discuss returning. They currently manage feelings of anxiety by employing the avoidant behaviour of not going to school, so any talk about going back to school is probably going to raise their anxiety as you are proposing to take away their way of coping with their fears. A good place to start any assessment with a young person is to acknowledge it may be difficult but you would like to know what they think and feel. It is important that the adult does not dismiss anxieties or worries the child has, empathises with the young person but does not collude or promote the EBSA.

The approaches taken will depend on the child’s age, level of understanding and language. Even if they are able, often children find it difficult to verbalise what they are thinking and feeling and they may prefer to draw what they are feeling or have visual prompts.

Some example activities or questions could include:

• Think about your thoughts and feelings about school and what these would look like if they could be drawn?

•  It also helps to externalise the anxiety:

    o  What name would you give the feeling that you experience when you think about going to school?

o   If it was a thing, what would it look like? What would it say?

o   How does the ____ get in the way of you attending school? When is ____ in charge and when are you in charge?

• Ask them to draw how their body feels when they are worried.

• Use an anxiety thermometer or a scale to ask the child what aspects of school they find difficult, some areas to consider include:

o   The physical environment e.g. toilets, corridors, assembly hall

o   Times of the day or social interactions e.g. arriving at school, play and break times, lining up to go into school or classroom, lunch times, going home, changing for PE

o   Particular lessons or activities within lessons e.g. writing, working as part of a group, reading aloud, verbally answering a question

•  A life graph or path can help them tell you their ‘story so far’ and what they would want in the future

Working with parents/carers

As mentioned previously, parents/carers may find it difficult to talk about the concerns they have and the difficulties they experience in trying to get their child into school. It is important that school take time to build a collaborative partnership working together in the best interest of the child. Sometimes parents/carers may have had similar experiences to their child and may experience their own anxiety making it especially difficult for them.

Working with parents/carers is essential to successful outcomes. While the focus is on the child it is also important to remember that parents/carers may need their own support and consideration should be made to referrals to services such as Conwy Family Support. Further details can be found by following this link:  Conwy Family Life

During the initial meeting, it is important to gather background information, establish the current situation and the parent’s views. Questions should be sensitive and the person asking should employ active listening skills. Examples of questions can be found in the table below. It is advised that regular contact is made with parents and school staff should identify who will be the key person to communicate with parents and agree how they will do this.

Working with school staff

It is essential that representatives from schools seek information from members of staff who work most closely with the child or young person. We all respond differently according to the environment, situations or task and with different people. Each member of staff may have valuable information to help identify triggers for anxiety and strategies the young person responds positively to. In particular it is important to seek out the views of any members of staff the young person speaks positively about and any member of staff where relationships may be more difficult.

Key information to gather includes:

·         What is the young person’s strengths?

·         What is going well?

·         Any difficulties they have noticed?

·         Peer relationships

·         Relationship with adults

·         Response to academic tasks

·         If they have witnessed emotional distress, what did this look like and what caused it?

·         What support or differentiation is put in place and how the young person responds to this

·         Any ideas for further support

It is also essential to consider whether the child has unidentified Additional Learning Needs, medical needs or a disability. If they are not already involved school staff should consult with the school’s Additional Learning Needs Co-ordinator (ALNCo).

An example of an ‘information gathering’ form can be found in downloads

Interpreting the information and planning

Following the gathering of information from the child, family, school and any other professional it is essential that this information is gathered together and ‘sense’ made of it. That an overview of the whole picture and various factors involved are obtained and potential hypothesis are formed. These should then inform the return to school support plan.

The form below is designed to help you integrate the information gathered from the young person, school and family. It is not designed to be a questionnaire but a tool to be completed after the information gathering to help you collate, integrate and analyse the information gathered from a variety of sources.  A blank copy can be found in the Downloads page.

At the Formulation and Integration Stage schools can access support by following the Conwy EBSA pathway to assist in the identification of function of the EBSA behaviour and inform the subsequent action planning and intervention.

Interventions and strategies

Research suggests that choice of intervention should be governed by a careful functional analysis of school avoidance behaviour. There are four types of functions which can maintain school avoidance behaviour. Interventions are based upon the information which was gathered in the assessment and integration stage.

1. 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 can be found in the Resource Section.

There should be a gradual re-exposure to school setting using an 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 a pastoral zone, and library, these may be less stigmatising for some pupils than learning support areas.

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 their way up the hierarchy.

An example of an anxiety hierarchy is included below:

2. To escape difficult social situations (e.g. feeling left out at playtime; reading out loud in class or other public speaking/group tasks; 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 wellbeing of parent)

Intervention would usually include work with caregivers 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 (e.g. 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.

Any successful work with an individual needs to be embedded in whole school systems. General good practice for promoting emotional wellbeing and positive mental health also applies to EBSA. The figure below outlines the culture, structures, resources and practice within a school than can promote wellbeing of staff and young people, with particular reference to EBSA. A whole school good practice checklist can be found in Downloads

Literature has shown that peaks in the number of young people with EBSA correspond with transition in educational phases. This is not surprising as young people face significant changes.

Successful transition involves the young person being supported to be able to make adjustments to fit in with their new environment.

Most children adjust to these changes over time. However young people who experience higher levels of anxiety or who have experienced loss and separation may be vulnerable to developing or experience an exacerbation of EBSA behaviours. It is important that schools and parents provide appropriate support and any vulnerable young people are flagged up early by the feeder school and an individual approach is taken.

Good transition practice involves effective exchange of information both pastoral and academic from primary to secondary school. It is really important if feeder schools flag up any early separation difficulties and past EBSA even if the issues were mild and attendance is now fine. We advise that secondary schools should specifically ask this information on any transition gathering forms.

Good transition also involves good communication with the young person and their parents. Key to this is giving the young people and their parent’s practical information.

Familiar school staff should discuss with young people and their parents what they are looking forward to and what they are worried about and this should be individually addressed. An example of support for this are ‘What if cards…’