A child is struggling to GO TO school - what can we do?
Support Mental Health Issues in Children & Young People
Children suffer with mental health difficulties for a range of complex reasons. The Government recommends that schools develop a mental health policy that creates an environment where young people with anxiety feel supported, understood, and able to seek help, making it more likely they will feel safe and able to attend school.
Assess for SEND, especially if Anxiety is a reason for absence
Many children have an underlying Special Educational Need or Disability that contributes to their anxiety; this can include Autistic Spectrum Conditions, ADHD, Sensory Processing Disorder or Dyslexia.
SEND also include Social, Emotional or Mental Health Difficulties, which could affect a child's ability to establish friendships, cope with a variety of strong emotions, and increase a child's vulnerability to bullying.
High levels of anxiety can be classed as a disability and are a barrier to learning requiring the use of assess-plan-do- review cycles. Children and young people will need a consistent, individual support plan which is shared with all staff. If children struggle to engage, they need patience and an experienced professional to help them access the right support.
Make a Referral for Assessment by an Educational Psychologist
In addition to the support put in place by the SENDCO, an Educational Psychologist can assess an anxious child and recommend appropriate interventions. This input can be useful as inability to attend school is often a symptom of a significant need or problem that requires more specialist knowledge and understanding.
Make or Support a Referral to CAMHS
Where severe problems occur, which are beyond the range of in-school mental health provision, schools should facilitate the child's access to more specialist support. The school nurse, or school directly can support or provide further evidence to expedite a referral. Parents can also ask for referrals to CAMHS, and Paediatricians through their GP. Unfortunately there are often long wait times for referrals , but support from schools goes a long way to ensuring the young people gain access to necessary treatment.
Explore your Local Authority’s Local Offer
Schools can collaborate with other local services and providers to explore how individual needs can be met most effectively. The Local Offer can be an invaluable source of resources, information, advice and relevant support.
Collaborate to Create a Child-Led Support Plan
It is important that all professionals ensure that children and their parents participate as fully as possible in decisions leading to a support plan. Health and SEND professionals can advise schools on developing support plans that are flexible, child-led and sympathetic to the features of anxiety disorders, Autism, ADHD and other medical conditions. Plans must be communicated to all staff, and combined with development of relevant staff training and whole-school awareness. Although this may be harder to achieve in a large secondary school than a small local primary, it is fundamental to success.
Apply for an EHCP Assessment
An EHCP application is crucial if a school does not have the expertise or funding to fully identify a child's needs, or to offer the provision or support a child requires to access an effective education. Parents can also apply to the LA for an ECHP assessment, but a joint approach will be the most beneficial way forward. There have been delays in processing EHCP applications nationally, so support during this process is invaluable.
Medical Conditions
All medical conditions should be identified. Some illnesses are complex, or less common and may take time to diagnose and treat. Underlying physical illness can add to a child's anxiety. School must follow medical advice, and work with parents and children to support their health and wellbeing, and reduce the risk of further deterioration .
The Department for Education has issued Statutory Guidance and Departmental Advice (best practice) on “Supporting pupils at school with medical conditions“. The governing body of a maintained school, proprietor of an academy and management committee of a pupil referral unit must have regard to the Statutory Guidance in this document. This means that they must follow it unless there is a good reason not to.
Schools should have a Policy for Support for Pupils with Medical Needs.
Schools should also consider if an Individual Healthcare Plan is a proportionate response to a child's medical condition
Authorise Absence Due to Illness
Absence due to both physical and mental illness should be accurately recorded. The potential legal implications of unauthorised absences rarely help improve attendance, can add to the child's anxiety and substantially increase the difficulties families face. Attendance cannot take priority over health needs and families need your support rather than fines and prosecution.
Provide Homework & Connections While the Child or Young Person is Unable to Attend
Not supplying learning opportunities during absence means the pupil gets further behind which adds to anxieties around returning to school.
While on roll a school receives funding for a child so you should consider how to use that funding to support their learning in ways that reflect their needs and abilities. Your responsibility to provide an education doesn't cease if they are unable to attend.
You should notify the local authority if absence due to illness lasts for over 15 days (consecutive or cumulative). The LA have a duty to ensure that a child receives alternative educational provision whilst absent.
Recovery can be a very slow process for many children and young people despite everyone’s best efforts; helping them feel connected, significant and welcomed may encourage that big step back into school. Long term recovery needs a focus on support and encouragement for a child to enjoy other activities and friendships (not only those related to school). This will help rebuild their self-esteem, confidence and happiness, all of which are integral aspects of school refusal recover.
Child Law Advice provide information on the duties of schools and local authorities to provide education for children out of school because of exclusion, illness or other reasons.
Safeguarding
Whilst reduced school attendance is a criteria for safeguarding concerns it is important for all professionals involved to gather evidence of the factors which may be impacting on attendance including SEND, health difficulties, and physical and mental health problems, including the impact of high thresholds for referrals, and long waiting times. It is crucial to consider:
- Does this child need reasonable adjustments or plans to be adapted for them to be able to attend school?
- Is this child really fine in school?
Forced Attendance?
There can be many different reasons why a child may start to show signs of school refusal. It can happen gradually, or it can happen overnight. The reason can be obvious, or it can baffle both caregivers and school staff, but when a child is frightened adults must pay attention as their reactions can help or make things a whole lot worse.
The combination of guilt for the child, pressure from schools and heavy-handed threats of fines and prosecution does nothing to ease the strain on these families and is not evidence based practice. Relationships between caregivers and schools can start to break down as their priorities diverge at this point, when instead the focus needs to be on working together in the best interests of the child.
The number one rule of getting a child to go back to school is: