Psychosocial Interventions for School Refusal with Primary and Secondary Students: A Systematic Review. Campbell Systematic Reviews 2015:12 (original) (raw)
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Treatment for School Refusal Among Children and Adolescents
Research on Social Work Practice, 2015
Objective: School refusal is a psychosocial problem associated with adverse short-and long-term consequences for children and adolescents. The authors conducted a systematic review and meta-analysis to examine the effects of psychosocial treatments for children and adolescents with school refusal. Method: A comprehensive search process was used to find eligible randomized controlled trials and quasi-experimental studies assessing the effects of psychosocial treatments on anxiety or attendance outcomes. Data were quantitatively synthesized using meta-analytic methods. Results: Eight studies including 435 children and adolescents with school refusal were included in this review. Significant effects were found for attendance but not for anxiety. Conclusions: Evidence indicates that improvements in school attendance occur for children and adolescents with school refusal who receive psychosocial treatment. The lack of evidence of short-term effects on anxiety points to the need for long-term follow-up studies to determine whether increased attendance ultimately leads to reduced anxiety.
Psychosocial Interventions for School Refusal Behavior in Children and Adolescents
Child Development Perspectives, 2009
This article reviews empirical evidence for the efficacy of psychosocial interventions for school refusal behavior. Data corresponding to 8 experimental singlecase and 7 group-design studies are presented. Across studies, behavioral and cognitive-behavioral treatments emerged as promising lines of intervention. These interventions produced improvements in school attendance and youths' symptom levels (e.g., anxiety, fear, depression, anger) based on this study's examination of effect sizes. The article concludes with suggestions for interventionists, researchers, and policy makers attempting to deal with the problem of school refusal.
Campbell Systematic Reviews, 2015
This article reviews empirical evidence for the efficacy of psychosocial interventions for school refusal behavior. Data corresponding to eight experimental single-case and seven group-design studies are presented. Across studies, behavioral and cognitive-behavioral treatments emerged as promising lines of intervention. These interventions produced improvements in school attendance and youths'symptom levels (e.g., anxiety, fear, depression, anger) based on this study's examination of effect sizes. The article concludes with suggestions for interventionists, researchers, and policymakers attempting to deal with the problem of school refusal. While research on school refusal behavior in children and adolescents has a long history (e.g., Berg, Nichols, & Pritchard, 1969; Broadwin, 1932), this area has received increased attention in recent years (e.g.
Behavior Therapy, 1999
The management of school refusal behavior in children and adolescents has long been a nettlesome process for clinicians. However, a functional analytic model of school refusal behavior has been proposed to assist clinicians in organizing, assessing, and treating this heterogeneous population. The present study examined, on a preliminary controlled basis, the treatment utility of this functional model and the School Refusal Assessment Scale (SRAS). Specifically, participants with acute school refusal behavior were initially assigned prescriptive (n = 4) or nonprescriptive (n = 4) treatment from child and parent SRAS ratings. Those receiving nonprescriptive treatment did so in a lagged design prior to prescriptive treatment. Results indicated that nonprescriptive treatment led to worsened percentage of time out of school and daily ratings of anxiety and depression. However, prescriptive treatment substantially ameliorated these problems. In addition, improvements were seen across child self-report measures and parent and/or teacher ratings of internalizing and externalizing behavior. Using a functional model, treatment may thus be assigned efficiently and effectively for this population.
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.
Cognitive and Behavioral Practice, 2018
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 issue 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. S CHOOL absenteeism is a universal phenomenon that can lead to short-and long-term problems for youth, 1 their families, schools, and the broader community. People not familiar with the field of school attendance problems (SAPs) are sometimes surprised to learn that there are school-aged youth who attend school irregularly or not at all. Their responses include: "But don't all kids have to attend school until a certain age?" and "Surely, the school makes them attend." In contrast, educators and practitioners are very familiar with the problem of school absenteeism. What is often perplexing for educators and practitioners is how to efficiently and effectively support youth displaying a SAP and those at risk of developing a SAP. Increasingly, educators, practitioners, researchers, and policymakers are searching for answers to important questions like these. The articles in this special series are part of the rolling discovery of answers to 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? Classification, the focus of the first article, is a basis for identification, which is taken up in the second and third articles. The timely identification of SAPs within the school setting facilitates early intervention and a greater likelihood of return to full school attendance. Too often, youth with SAPs are not identified in a timely fashion or not provided with effective early intervention. SAPs become severe and chronic, presenting a substantial challenge to schools and practitioners. In these cases, intensive intervention is warranted, which is the focus of the fourth, fifth, sixth, and seventh articles. Classification Currently, there is little indication of an emerging consensus on the conceptualization and classification of SAPs. The first article (Heyne, Gren-Landell, Melvin, & Gentle-Genitty, 2019, this issue) addresses this fundamental issue of consensus. It reviews the decades-long discussion and dissent about the best ways to conceptualize and classify SAPs, concluding with practical suggestions for the field. Classification encompasses the operationalization of problematic absenteeism (e.g., when to intervene) and differentiation between youth with different SAPs (e.g., how to intervene), both of which are described next. Agreed-upon criteria for operationalizing problematic absenteeism are still lacking (Skedgell & Kearney, 2018), despite Pellegrini's (2007) suggestion a decade ago that "researchers and practitioners could increase understanding of school nonattendance by working towards a shared definition of this behaviour" (p. 75). Definitions of 1 The term 'youth' is used to refer to children and adolescents.
Cognitive‐Behavioral Treatment of School‐Refusing Children: A Controlled Evaluation
Journal of the American Academy of Child and Adolescent Psychiatry, 1998
ObJective: To evaluate the efficacy of a 4-week cognitive-behavioral treatment program for children who refuse to go to school. Method: Thirty-four school-refusing children (aged 5 to 15 years) were randomly assigned to a cognitivebehavioral treatment condition or a waiting-list control condition. Treatment consisted of indiv idual child cognitivebehavioral therapy plus parent/teacher training in child behavior management skills. Measures taken before and after treatment included school attendance , child self-report of emotional distress and coping, caregiver reports on emotional and behavioral problems, and clinician ratings of global functioning. Results: Relative to waiting-list controls , children who received cognitive-behavioral therapy exhibited a significant improvement in school attendance. These children also improved on self-reports of fear, anxiety, depression, and coping. Significant improvements also occurred in relation to caregiver reports and clinician ratings. Maintenance of therapeutic gains was demonstrated at a 3-month follow-up assessment. Conclusions: Cognitive-behavioral treatment of school refusal was efficacious and acceptable.The relative contributions of child therapy and parent/teacher training require further study.
Empirically Based School Interventions Targeted at Academic and Mental Health Functioning
Journal of Emotional and Behavioral Disorders, 2007
T his review examines empirically based studies of school-based mental health interventions. The review identified 64 out of more than 2,000 articles published between 1990 and 2006 that met methodologically rigorous criteria for inclusion.Of these 64 articles,only 24 examined both mental health and educational outcomes.The majority of school-based mental health intervention studies failed to include even rudimentary measures of school-related outcomes. Analysis of the 24 studies yielded several key findings:The types of mental health outcomes most frequently assessed included self-, peer-, teacher-, or parent-reported measures of social competence, aggression, or problem behaviors. Academic scores and school attendance were the types of educational outcomes most frequently assessed.The majority of interventions focused on elementary students, had a preventive focus, and targeted prosocial, aggressive, and antisocial behaviors. Only 15 of the 24 studies demonstrated a positive impact on both educational and mental health outcomes, 11 of which included intensive interventions targeting both parents and teachers. The studies that had an impact only on mental health outcomes tended to be less intensive with more limited family involvement.This review discusses the implications of these findings for schoolbased mental health services and identifies directions for future research.