A child is struggling to attend 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.
Explore and reflect upon possible triggers and reasons for a child's inability to cope or thrive in the school environment, Research possible influences such as autistic burnout, PDA, PANS/PANDAS, sensorial difficulties, executive function difficulties, social anxiety, excessive academic pressure, detrimental behaviour policies, bullying, puberty, physical health difficulties or peer pressure. Use resources that aim to explore the child's views and feelings, and consider referring them for assessments, therapy, mentoring or treatment if appropriate.
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. Many Educational Psychology Services now offer an EBSA service or pathway which you can utilise so it is worth checking what is on offer in your area.
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.
THINGS TO CONSIDER:
- Look at a time when the child's attendance was good – what was happening then that helped them attend?
- Have you completed assessments (or referred to someone who can assess the child) to identify any anxiety triggers or unmet needs?
- What are the reported worries/concerns and what can you do to resolve them? (see reasonable adjustments below)
- What is working well - why?
- What is not working well - why?
- Who is monitoring whether the actions/provision/support that is promised is happening/taking place/being provided and do they have the power to intervene?
- Which local authority services can you refer to for assistance? (see the Local Offer)
- Schools have an anticipatory duty to make reasonable adjustments to policies, expectations and practices to address a child's needs related to disability (Equality Act 2010). Some examples of reasonable adjustments suggested by our group members include:
- Letting the child choose when he/she comes in to school
- Being able to choose which lessons she/he does each day
- No forced attendance
- Giving her/him a safe space to go whenever she/he wants
- Letting him/her sit with a friend in every lesson
- Never picking on her/him in class (to read aloud or answer questions)
- Letting her/him drop a subject that causes anxiety i.e. PE
- Paying for/referral to appropriate therapy
- Permission to leave the class at any time
- Dedicated quiet desk outside the class for regular breaks
- Time-out pass to leave lesson early to avoid busy transition between lessons
- Relaxed uniform rules
- Access to sensory aids
- Taking in a small fidget toy/teddy/toy/object from home.
- Regular movement breaks
- Allowed to have a snack at the end of the day before leaving
- Early access into classroom in the morning
- Not going in through a very noisy and busy playground in the morning
- Sending work home if child unable to attend
- Going to lunch early so he/she doesn't have to cope with the crowds
- Allocated quiet area for lunchtimes
- Reserved seat on bus
- A locker in a quieter part of the school
- No pressure about completing homework
- Agreement not to question/pressure the child about absences
- Activities to help child go into school in a happy frame of mind
- No requirement to attend assemblies
- Extra time to complete homework
- No sanctions (ie isolation, detention) for anything SEND related
- Commitment to listen to the child
- To have staff willing to 'think outside the box'
- A safe person at school who builds a trusting relationship - Child goes to their office whenever she/he wants to and can stay as long as she/he wants. They know that this safe person will email teachers about any issues and resolve any problems
- Learning in the learning support base
- Alternative provisions with animal based activities
- Preparation/warning before a change of timetable
- Allowing child to go home or to his/her safe space when overwhelmed
- No spelling tests for a child who's dyslexic
- Child can bring safe foods for lunch even if it's not a healthy food option
- A toilet pass
- Option to stay in at playtimes for sensory or colouring breaks
- Communication cards to help child express their needs
- Child doesn't need to change into PE kit
- A SEND passport
- Use of overlays for dyslexia
- Forest school
- Lego therapy
- Access to a Mentor each week
- Child sits at the front or near the door in all lessons
- Technology to support learning needs (e.g, laptop, text-to-speech pen, Ipad)
- A visual timetable
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
According to the DfE absence due to both physical and mental illness should be recorded as authorised absence. 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.
For many children experiencing anxiety in response to barriers to attendance the significant emotional component might be considered mental ill-health and absence could be authorised on that basis.
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. See Arranging education for children who cannot attend school because of health needs
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 a child's recovery.
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' while 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:
NEW DFE SCHOOL ATTENDANCE GUIDANCE
The Department for Education has published new statutory School Attendance Guidance, 'Working together to improve attendance' to be applied from August 19th 2024
The recommended approach is a focus on building relationships to facilitate access to support.
DfE Guidance
SQUARE PEGS
About this book:
Written by Fran Morgan with Ellie Costello and edited by Ian Gilbert, Square Pegs: Inclusivity, compassion and fitting in – a guide for schools is a book for educators who find themselves torn between a government/Ofsted narrative around behaviour, attendance and attainment, and their own passion for supporting square pegs and their families.
Over the last few years, changes in education have made it increasingly hard for those children who don’t ‘fit’ the system – the square pegs in a rigid system of round holes.
Budget cuts, the loss of support staff, an overly academic curriculum, problems in the special educational needs and disabilities (SEND) system and difficulties accessing mental health support have all compounded pre-existing problems with behaviour and attendance. The ‘attendance = attainment’ and zero-tolerance narrative is often at odds with the way schools want to work with their communities, and many school leaders don’t know which approach to take.
This book will be invaluable in guiding leaders and teaching staff through the most effective ways to address this challenge. It covers a broad spectrum of opportunity, from proven psychological approaches to technological innovations. It tests the boundaries of the current system in terms of curriculum, pedagogy and statutory Department for Education guidance. And it also presents a clear, legalese-free view of education, SEND and human rights law, where leaders have been given responsibility for its implementation but may not always fully understand the legal ramifications of their decisions or may be pressured into unlawful behaviour.
Bringing different perspectives and expertise together in one place, Square Pegs aims to help school leaders and staff support children (and their families) more effectively. The authors cover a wide variety of topics – including school attendance, building relationships, trauma-informed practice, and behaviour management. Featuring contributions from more than 50 individual authors, this is an accessible, dip-in, dip-out book – perfect for busy school leaders.
Suitable for all professionals working in education and the related issues surrounding children and young people’s mental health, as well as policymakers, academics and government ministers.