United Psychological Services has developed a program essential to helping students who are experiencing extreme difficulty in attending school; a refusal or reluctance to attend school for two weeks or more. Our program is targeting students who have become phobic and/or highly anxious specific to going to school. This extreme anxiety can cause the student to become physically ill and literally, unable to go to the school building, the classroom or even get out of bed on school mornings. This program is for children and adolescents in middle or junior high school and high school and is the only such program available in Michigan.

This disabling emotional crisis is increasing at alarming rates; particularly in the middle/junior high and high school years. There are many statistics citing the long term impact of absenteeism posing a high societal cost (welfare, unemployment, crime) linked to lower academic performance and achievement, substance abuse, lowered educational aspirations and greater likelihood of psychiatric problems in adulthood[1]. Children absent often from school tend to develop a pattern of absenteeism that worsens over time as opposed to abating, resulting in a significant long-term impact. Peer pressure and social media influences leading to bullying and low self-esteem are huge contributing factors adding stress to already difficult years for many students.

School refusal begins with frequent claims of illness; physical symptoms that arise due to anxiety, resulting in being late to school and eventually leading to daily confrontations with parents and school professionals that result in a refusal to attend school at all.  This is not an intentional avoidance of school; it is a fear based deeply rooted phobia.  The student is frantic to avoid confronting the issues and or people causing their emotional distress.  The lost classroom instruction time and increasing amount of homework to make up ultimately creates an extreme emotional downward spiral for these students from which they cannot escape on their own.

The consequences surrounding the refusal to attend school can be devastating and far reaching including academic decline, disruption in the daily function of the family, potential legal involvement and further along, a decreased potential for advanced education, occupational and marital success all leading to poor psychosocial functioning, anxiety and depression.

Our clinic has responded to the specific need for intervention for these students in developing our School Refusal Program.  This is an intensive; highly individualized program for students and their families with the goal of returning the student to school in the shortest time possible to provide the greatest potential for success.

In brief, the program includes:

• Four week intensive involvement in treatment, individual and group
• Neuropsychological and psychological testing to rule out any disorders that are contributing to school avoidance (ADD/ADHD, psychiatric disorders, sleep disorders, memory and reading deficits).
• Group therapy for the student once per week: There are two groups separating middle school/junior high and high school. Groups will target anxiety education, emotional reactions from a brain/behavior point of view, developing various methods to cope with anxiety including relaxation, mindfulness and self-hypnosis as well as cognitive re-structuring targeting the concept that change is possible. Sleep issues will be addressed. The goal will be to share experiences and learning that involves an understanding of the emotional and physical symptoms of anxiety.
• Individual therapy, twice per week addressing avoidance and specific anxiety situations (using an anxiety and avoidance hierarchy,) including ongoing systematic desensitization (at the school), cognitive restructuring, self-reinforcement, modeling, mindfulness and role play, contingency management and communication skills training.
• Group parenting skills program once per week to provide education about anxiety and depression, the impact of the brain, impact of ongoing stress, coping skills and strategies for anxiety and nurturing parenting methods. Parents will learn mindfulness and nurturing techniques for themselves.
• The child and his or her parents will meet our nurse practitioner once per week to address conflictual issues, medication management (if appropriate) and specific child needs
• Setting up a communication bridge with all involved professionals in the academic setting including teachers, school social workers, psychologists
• Ongoing connection with primary care physician and/or pediatrician.
• 504 Plan implemented by program therapist in conjunction with designated school liaison for follow up
• Community outreach for tutoring and academic coaching
• Follow up sessions available at school breaks and prior to the beginning of a new school year

This program is extremely detailed and finely tuned to meet each student’s specific needs.  Our goal is to provide the tools and intensive support to break through the anxiety preventing students from attending school.

[1] Kearney, Christopher, Managing School Absenteeism at Multiple Tiers, Oxford University Press, 2016