Preventing anxiety-based school refusal: a guide to working with children and families

Contents

Foreword

  1. What is school-based anxiety?
  2. The purpose of this advice
  3. Identifying the cohort at risk
  4. Guidance for pastoral leads
  5. Guidance for parents/carers
  6. Guidance for children and young people

Foreword

This guidance draws heavily on comprehensive advice from Babcock EP service which you can read in full here. It doesn’t attempt to cover in any explicit way school-based anxiety that might be rooted in SEND, though many of the strategies suggested will certainly help children and young people who find school more difficult because of SEND. Equally, strategies from the SEND field can help all children cope with anxiety and this comprehensive resource from the National Autistic Society may well support planning.

The guidance assumes that pastoral leaders will prioritise individual needs over systems when the school day in its undifferentiated form is more than a vulnerable pupil can manage. It strongly recommends that personalised, written plans are devised and shared so that there is reassuring clarity for all involved in supporting pupils at risk of school refusal.

1. What is school-based anxiety?

To friends, family and school staff, the reasons for anxiety and avoidance can be baffling and it is not always easy to know how to help. For those who struggle, the experience can be overwhelming: children and young people can become trapped in a cycle of avoidance, feeling like they simply cannot cope with school life.

Anxiety affects different people in different ways. Some may find it harder to sleep, eat or concentrate whilst others may find that they just can’t stop themselves thinking and worrying about the situation they fear, which can then get in the way of everyday life.

It is of course normal to feel anxious – about an exam, a rollercoaster ride, a presentation, a whole range of  situations that people may find stressful  – and there are bodily changes associated with this feeling: an increased heart rate or butterflies in the stomach, for example. This is the body’s ancient way of preparing physically for perceived threat or fear. Anxiety occurs when the level of threat is over-estimated and experienced as pervasive.

Screenshot 2020-06-23 at 18.05.08

2. The purpose of this advice

Within every school, there is a small minority of children and young people who experience high levels of anxiety, some masking it better than others. Whilst this cohort will have experienced lockdown in a range of ways, it is unlikely that the extended period away from school will have ameliorated their difficulties, even though it might have afforded a period of respite. We can anticipate that some will find the return to school very challenging indeed, and anxieties will be increasing as the return date looms closer. Some may return initially, but then attendance may become sporadic whilst other pupils may not return at all, fears associated with the virus only intensifying their anxiety about school.

Sensitive transition planning will of course mitigate some of these risks – the more familiar that all pupils are with the school environment and new arrangements for September 2020, the less worried they will be about it. The more opportunities there are for them to connect with the school community online, to re-establish supportive relationships before they return, to know who to share worries with, the more reassured they will feel. Visual information – faces and places – will of course be especially helpful.

However, there will be some children and young people who will need more support than this to make a successful return to school. Universal transitional arrangements will help, of course, but to overcome any pre-existing school-related anxiety which has escalated during lockdown – or which may have developed since lockdown, perhaps because of the experience of trauma – a personalised plan of support, the PSP or equivalent, will be essential. The pupil and family should be invited into school to co-produce this in advance of the start date, if possible – or it may be necessary to meet at the family home if anxiety is acute.

The purpose of this guide is to define good practice around what helps children and young people overcome school-based anxiety, as a reference for effective PSP planning. To inform the discussion with families and the agreements made, relevant sections should be shared in advance of the initial meeting: there is an invitation to the pupil to practice relaxation activities and to complete a wellbeing plan at home and this could usefully be brought along (Section 6). There are also prompts for parents/carers about how they can reduce school-based anxiety at home (Section 5) and the meeting will provide an opportunity for them to feed back on what has helped.

3. Identifying the cohort at risk

Pastoral leaders will want to identify which pupils are at risk of anxiety-based school avoidance in advance of this becoming a problem they are grappling with reactively; what we can predict, we can prevent. Simple scaling surveys can be shared virtually with pupils or parents/carers for this purpose. For example, on a scale of 1 (extremely anxious) and 10 (extremely confident), how do you feel about your return to school? Please give a reason if your score is low.

Pastoral staff can then use this information as the basis for initial conversations over the telephone or online with pupils and parents/carers. Where concerns are confirmed, then arrangements should be made for the initial PSP planning meeting.

4. Guidance for pastoral leads

Babcock LDP identified “factors associated with the successful inclusion of young people who display anxiety-based school avoidance” through a series of case-studies. Whilst each case was different, there were clear message for pastoral leaders about what enabled pupils to overcome their difficulties, as follows:

a) Key worker/adult support 

Feelings of safety, security and belonging were strong in pupils and all reported that they had developed a good relationship with at least one member of staff who they could rely on for support. Some of the pupils had a ‘key worker’ who would meet them in the morning to discuss any concerns or talk about the day. Adult support promoted feelings of security and there were lots of examples of adults supporting pupils flexibly, including in the classroom or transitioning between lessons.

Outline within the plan:

  • an adult the pupil can trust
  • arrangements for checking in
  • how to find during a crisis, or to prevent one

b) A culture of kindness and flexibility

 Another important factor to note is that the pupils to a large extent felt that all staff were ‘understanding’ and ‘kind’ and this was not isolated to the support staff or those more involved with them. They felt that on the whole, communication was good between all staff and teachers were very understanding of anxiety and responded appropriately, e.g. letting students leave the room when needed.

Outline within the plan:

  • how all staff will be made aware of the issues
  • how they should support in lessons, e.g. seating arrangements, time out
  • reasonable adjustments to mitigate any identified stressors, such as changing for PE

c) Personalised timetables

Another strong factor was the level of personalisation and planning that had gone into developing the pupil’s timetable. There was clear evidence of listening and valuing the pupil’s perspective and prioritising individual need over system processes at times. One important factor raised by pupils, staff and the parents was understanding the need to be realistic and build success slowly over time, rather than setting up a high expectation of reintegration, for example. Each pupil’s timetable was personalised.

Outline within the plan:

  • which subject learning will continue virtually, either at home or within the safe base
  • how such work will be set and marked
  • whether some subjects will be dropped to reduce demand that exceeds personal capacity to cope
  • whether there needs to be support for homework, or a reduction in homework (for example, just reading) 

d) Access to a safe base

 Having a safe base within the school was extremely important to the pupils when they talked about their experiences. They talked about the ‘safe’ area as being ‘welcoming’, ‘quiet’ and ‘accepting’ and some pupils reported that without this area, they would not be in school at all. This was partly about the staff in the centre, but also the nature of this area was described as ‘relaxing’ and ‘less pressured’ than other aspects of the school, which allowed pupils to develop their confidence at their own pace.

Outline within the plan:

  • where the pupil can go that feels safe
  • who will supervise the space
  • how it can be accessed at times that are stress-inducing, such as lunchtime

 e) Communication with parents and carers

 All parents involved in the study spoke very strongly of the relationships and communication they had with school staff. For some parents, staff had been a ‘lifeline for both me and [pupil]’ and daily communication with a familiar member of staff was common, which would have been hugely supportive in supporting the pupil.

Outline within the plan:

  • who will be the single point of contact for home
  • how they will communicate – email, text, phone call
  • how often and at what time during the day

5. Guidance for parents/carers

Parents and carers play an essential role in helping their child to manage anxiety and there is research to suggest that the right parental support can have a big positive impact. Although every situation is unique, the following are some key ideas that might help when supporting your anxious child.

a) empathise and encourage

It is important to let your child know that overcoming anxiety is hard, and that you are proud of their efforts.  The message you want to send is, “I know you’re scared, and that’s okay, and I’m here, and I’m going to help you get through this.” Help the child to understand that worry, fear and anxiety are all normal emotions and that they can learn to manage and cope with these normal responses to difficult or scary situations. Every time a fear is confronted, that is a success, and the more successes the child accrues in dealing with their worries the greater their confidence and eventually their resilience will be.

b) don’t avoid everything that causes anxiety

Avoiding things that make your child upset is a natural parental response, but in the long run this only serves to reinforce that anxiety. By taking a child out of a situation that makes them anxious they are learning this as a coping mechanism, and this can become a repeating cycle. An alternative method is to try an exposure ladder. This is a process where the child breaks down their anxiety into manageable steps, and gradually increases these steps to overcome their anxiety. The PSP process will enable school to formulate this exposure ladder with you: ten minutes in reception for the first week might be the best starting point. (Going into school every day is important in relation to establishing a routine).

c) don’t ask leading questions

Whilst it is important to encourage your child to talk about their anxiety, asking leading questions should be avoided as this can reinforce their worry and validate their anxiety. For example, try asking “How are you feeling about the school trip?” rather than “Are you worried about the school trip?”

d) calm parent, calm child

Children model their parents’ behaviours, and so it is important to also consider how your own anxiety might be affecting your child. If you are anxious, your child will pick up on it and experience an increase in their own anxiety. So when you want to reduce your child’s anxiety, you must manage your own anxiety first. Parents can do this by modelling how they successfully manage anxiety; let your child know when you are using a coping skill (e.g. “I’m feeling a little bit nervous about that, I’m going to take a few deep breaths before I respond”). By modelling appropriate behaviour and positive thinking, when you look for the positive in situations, so will your child.

e) reduce the amount of time the child has to anticipate the event

Often the hardest part for children who are anxious is the run up to the anxious event or act. Therefore, parents should attempt to eliminate this anticipatory period, or keep it to a minimum.

f) discuss with your child their reluctance and anxiety about going to school

Try to explore their concerns (often easier said than done) and try to establish if there are specific worries about specific aspects of school. If successful in picking apart the reasons for avoidance, work with the child and the school to find ways of minimising the worries so that the anxiety can be better managed. This might involve reasonable adjustments, such as leaving lessons early, or having a time-out card and access to a safe-base. Consider:

  • Are there any friendship issues?
  • Could there be any social media related issues or bullying?
  • Are they under any extra stress at school? (examples, transition from primary, exams, staff or class changes)
  • Could there be any other school related issues? (subject or teacher issues)

Also explore whether experiences outside of school are at the root of the problem:

  • How and what does the child benefit from not going to school? (what are they doing at home? xbox, tv, laptop etc – is the home environment too enticing?)
  • Have there been any recent stressful or traumatic events?
  • Is there a history of worry, anxiety or stress within the family?
  • Bereavement or loss in family and/or friends
  • Long term Illness in family or friends
  • Any traumatic events or loss
  • Could the child be reluctant to leave the parent for fear of something happening to the parent whilst they are at school?

g) support your child in confronting fears (where possible)

It is through this that they will learn the coping skills that they will need throughout life. Ensure that you are consistent in encouraging your child to go to (and remain at) school. Avoiding worries and fears is less painful (in the short term) for the child than confronting them. Some children learn how to ‘stay off’ school and they can soon learn the ‘buttons’ to press with parents that will allow them to stay away from school (and avoid their anxieties). This can lead to the habit of avoidance that can be a very tricky habit to break later on. Confront rather than avoid.

h) encourage your child to keep in touch with friends and go to clubs

This will strengthen friendship bonds and could improve their support network within school. This can help them in dealing with their worries.

i) prepare for return and introduce routine

Have the child get everything prepared for school the night before so that there is no added rush (or opportunities for excuses and delays) in the morning. Establish and maintain good routines (eating, sleep and exercise). Sleep patterns are particularly important, sleeping and catching up on sleep during the day must be vigilantly managed. Poor sleep patterns feed anxiety and sleeping during the day will just make it a harder to break a cycle of avoidance.

6. Guidance for pupils

This guidance aims to provide some information about ways that can help you to better manage anxiety. Don’t try and do all of these at the same time, but maybe pick two or three that you think sound helpful for you. Try and do this with someone if possible and let the supporters at your PSP meeting know which ones you have chosen to try.

a) Talk to someone you trust. Talking to someone about how you are feeling can be really important and this could be a family member or someone at school. By doing this, you may realise you are not the only one experiencing these feelings and adults are able to help in different ways when they know how you are feeling.

b) Try out different relaxation techniques by looking at the 30-3-30 approach. Once you have a sense of what’s helpful, complete ‘My Wellbeing Plan’ and consider bringing this to your PSP meeting. There might be opportunities during the school day to use some of the techniques and this can form part of your plan.

c) Try doing something physical. Some people benefit from using stress balls or fiddle toys and they find this can reduce anxiety through distraction (if the mind is occupied, it is distracted from focusing on the anxiety). Exercise is recognised as being particularly beneficial for anxiety and low mood.

d) Keep a diary. Notice and record how you are feeling on a daily basis and identify what triggers the feelings, what helps and how long the feelings last. Remember to record times where you feel good too and record successes and achievements.

e) Distraction techniques. If you notice yourself worrying a lot about something and are finding it hard to stop yourself, try out some distraction techniques, e.g. doing difficult sums in your head, looking around you and thinking in detail about your environment.

f) Understand the feeling won’t last forever. This could involve thinking about times before when you have felt as bad but later felt better. This is about accepting and understanding how you feel but also knowing the feeling will change.

g) Move forward in small manageable steps. Talk to someone about how you could gradually face your fears in small steps and use coping techniques to help you manage, e.g. use the step-ladder approach.

h) Try and eat a healthy and balanced diet.

i) It is very important to have a good sleep routine and to get enough sleep. If you feel you would benefit from more sleep, talk to someone about what could help.

j) Stay away from recreational drugs, alcohol, late nights and excessive screen time. These do not help you.

Screenshot 2020-06-23 at 20.42.31

 

 

Published by Mary Meredith

Working in schools for over 20 years, I've been a Head of English, a SENCO and a deputy headteacher. I'm currently Head of Inclusion at Lincolnshire County Council. I am a sucker for the underdog. Always have been, always will be.

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