Social Work Intervention
School refusal is a “staid emotional issue that is connected with considerable short- and long-term consequences. (Finch, 2012) In the early 1940s the apprehension of going to school was actually termed as school phobia. School refusal, as an alternative term, was utilized especially in Great Britain and the United States to define similar issues in kids who essentially did not go to school because they were distressed emotionally. In general, children with school refusal differ in some ways from kids who are truant, even though the behaviors are not mutually exclusive. This paper will explore a group or family social work intervention for a school refusal issue. Nature of the disorder/problem
Anthony, a twelve year old male, has missed nearly two weeks of school since beginning of the seventh grade approximately three months prior. When home from school he spends most his time playing video games or just browsing the internet. In most cases when he goes to school, he is usually late, something that makes it hard for him to interact with his classmates before classes begin. In addition, in class he prefers sitting at the back and is never interested in raising his hand and also has problems working on any group projects. His teachers have identified his behaviors, especially of being absent and lacking enthusiasm for class work. His parents have punished him for performing poorly at school and have also started wondering if they should arrange home tutoring or actually change his school placement. In terms of prevalence, at some point, as much as twenty eight percent of school aged children in the United States refuse school during their schooling process. The behavior of school refusal is as common among boys as it is girls (Sturmey, 2008). While any child aged between five and seventeen may decline to attend school, a number of young people who refuse are between ten and thirteen years old. Furthermore, peaks in school refusal process are also seen in times of transition such as five and six, and fourteen and fifteen years as kids enter new schools. Even though the problem is significantly more prevalent in some major metropolitan areas, it is observed equally across socioeconomic levels.
There are varying aspects of school refusal behaviors. Initial school refusal behavior just for a short period may actually resolve without any intervention. There is also substantial school refusal behavior which takes place for not less than two weeks. Thirdly, acute school refusal behavior entails cases lasting more than two weeks and even at times it goes to about one year, being a problem that is consistent for the greater part of that time. Lastly, chronic school refusal behavior affects or interferes with a least two or even more academic years. This is because it refers to cases that last more than one academic year. Young people who miss school due to chronic physical diseases, withdrawal from school which is actually motivated by societal or parental conditions like homelessness, or even running away in order to avoid mistreatment should not actually be incorporated in the above definition of school refusal activity as some of these factors are actually not child-initiated. “While some of the children who refuse school display a presentation that is more heterogeneous, typically some of these youths can actually be grouped into two key types of troublesome behavior – externalizing or internalizing challenges” (Mufson, 2004). In fact, the rifest internalizing challenges are generalized worrying, social isolation or anxiety, fatigue, physical complaints and depression (such as nausea, stomachaches, headaches and tremors). The most common externalizing challenges are tantrums (like screaming and crying), physical and verbal aggression, as well as oppositional behavior. Empirical Evidence
Psycho-education and multifamily groups make the best alternative. This treatment methodology views people or individuals as “trapped within a network of interconnected systems that incorporate family, individual, plus extra familial factors such as school, peer, and neighborhood. The focus of treatment is on changing the process of dysfunction that took place in these other systems. In general, MST is recognized as a treatment methodology that is effective specifically for conduct disorder and also has been disseminated widely. The most effective approach to the problem of school refusal is parent-teacher interventions. Basically, caregiver training and parental involvement are vital factors in reinforcing the efficiency of behavior treatment. Generally, interventions in behavior seem to be equally efficient with or without involvement of the child directly. Child adjustment and school attendance particularly at post-treatment follow-up are usually the same for kids who are solely treated with child therapy and for kids whose teachers and parents are involved in the treatment process. Teacher-parent interventions incorporate clinical sessions with not only parents, but also consultation with school workforce. Parents are actually given behavior-management approaches like offering constructive reinforcement for school attendance, escorting the kid to school, and lastly curtailing positive reinforcement specifically for staying at home (such as watching television whilst home from school). Also, parents benefit from cognitive training in order to help decrease their own anxiety as well as understand their responsibility in helping their kids make changes that are effective. In this case, school consultation encompasses specific recommendations to school personnel to prepare well for the return of the child, making use of positive reinforcement, as well as emotional, social, and academic accommodations. Approach
Approaches and treatment components specifically for each element of school refusal behavior Function or Reason
Escaping the negative impact
(Sadness, , fears, the blues, generalized anxiety and worry, various phobias, separation anxiety) Somatic management skills like breathing retraining and progressive muscle relaxation training. In addition, gradual reintroduction to school should be used and finally, self-reinforcement plus building self efficacy
Escaping from evaluative and aversive social situations
(Social phobia, test anxiety, public speaking fears, shyness, social skills deficits) Here it involves role play practice, cognitive restructuring of unconstructive self-talk, and graded exposure tasks entailing real-life situations. Also, social skills training in addition to problem-solving skills training.
Attention-seeking behavior (crying, Tantrums, clinging, separation anxiety)
Here approaches like parent training especially in contingency management, establishment of routines, changing parent commands, employment of punishers and rewards for both school refusal and school attendance. If necessary, forced attendance under special situations
Positive tangible reinforcement (Lack of structure or respect for house rules and responsibilities, free access to reinforcement, disregard for limits) At this point, contracting with parents in order to increase incentive specifically for school attendance, curtail social as well as other activities due to nonattendance. In addition, providing the family with alternative approaches for problem-solving to reduce conflict. Lastly, communication skills as well as peer refusal skills are as well at times added to this intervention process.
At treatment stage, normally, even when providing treatment to the same children with the same challenges, therapists in this field typically focus on targets that are different. For instance, if a child who has been missing school comes with his or her parents to a treatment program, responsible parties will basically identify the issue as the presenting problem. Initially, at least, group therapists will see the key goal as first arresting the habit of missing school (Sturmey, 2008). On the other hand, a family therapist will see the system of family—which could actually be the parents—as a key component of the school refusal problem. Usually, the key goals of the family intervention group will be much broader compared to the school refusal counselor’s, emphasizing improvement of relational patterns across the family system. Since, families change their interaction patterns over the recovery course; they are actually believed to need assistance that is continuous in order to avoid developing another pattern that is dysfunctional. Measure of Effectiveness
To answer the effectiveness of the approaches used, it is prudent to consider the case of Anthony as previously mentioned. Basing on the Anthony case, cautious assessment revealed that school refusal behavior of Anthony was initially as a result of anxiety separation which was positively strengthened by having the attention of his parents as well as play time during school times. This actually forced his therapist to develop a treatment plan encompassing somatic management skills. Also, practice in being far away from or just being out of his parent’s sight and also parent training specifically in contingency management. The measure is valid and reliable and is also appropriate for diverse demographic, as it has been applied by therapists for many years now (Kearney, 2007). Following the evaluation of Anthony, he was actually prescribed a treatment that would deal with his social anxiety that specifically was behind his school refusal.
The behavior of Anthony was reinforced negatively by avoiding evaluative and social affairs. Therefore, his treatment program entailed role plays, cognitive restructuring, problem-solving skills and social skills, and lastly steady reintroduction to school. Apart from the use of the above model, a strong working connection between the school personnel and the therapist is an integral part of an efficient treatment plan specifically for school refusal behaviors. For instance, via a structured plan of treatment with very clear goals as well as a definitive time limit, any supportive school personnel might facilitate the return of Anthony to school. Conclusion
When children such as Anthony refuse school, urgent intervention is essential not only because attending school is mandatory in most cases, but to address psychological, academic and negative social consequences both to the family and the individual youth as well. If not identified in advance and treated effectively, school refusal behavior has consequences both in the short- as well as long-term basis. Some of the consequences of this issue in the short-term include considerable deteriorating school performance, child stress, social isolation, as well as family conflict and tension. Consequences in the long term include impaired social functioning affecting professional and personal goals, decreased likelihood of attending college, and increased risk of drug abuse, depression and anxiety in adulthood.
This is premised on the fact that the longer the child refuses to go to school, the higher the possibility of these problems enhancing. In terms of additional research, it is critical that parents, kids, school personnel, and mental health professionals act as a group to understand school refusal further. In terms of this research informing evidence-based practice, it helps unravel this issue of school refusal behavior as it still remains both a prevalent and potentially severe issue that is under-investigated specifically empirically-based treatment and evaluations.
Finch, J. (2012). Specialty competencies in adolescent psychology and clinical child. New York: Oxford University Press. Kearney, C. (2007). Functions and Forms of school refusal behavior in young people: an empirical study of the severity of absenteeism. Journal of Child Psychiatry and Psychology, 48 (1), pp 53–61. Mufson, L. (2004). Interpersonal psychotherapy for depressed adolescents. New York: Guilford Press. Sturmey, P. (2008). Behavioral case intervention an formulation: a functional analytic approach. Hoboken, NJ: Wiley-Blackwell,.