A relational approach to emotionally based school non-attendance (EBSNA)

Guide for schools

Emotionally based school non-attendance (EBSNA) occurs when stress exceeds support and anxiety builds up to the point that a child or young person (CYP) cannot go to school. Non-attendance tends to arise due to a combination of factors.

Understanding the causes

Underlying causes of EBSNA may include factors related to school, home or the needs of the CYP. Every CYP is different, and analysis of these factors is needed.

School Factors that push the CYP from school	Home Factors that pull the CYP towards home	Child Factors that may affect the child or young person
Avoiding uncomfortable feelings brought on by attending school, such as feelings of anxiety or low mood. Avoiding situations that might be stressful, such as academic demands, social pressures, relationship breakdown and/or aspects of the school environment.	Reducing separation anxiety from significant others, such as parents or carers or other family members. Wanting to be at home in order to, for example, gain attention from parents and carers, feel safe or take part in preferred activities during school time.	Sensitised stress pathways and difficulties with self regulation. Difficulties with trust, forming and maintaining relationships and low feelings of self worth Difficulties coping with change, challenge, accepting help and sensory sensitivities.

What CYP tell us

CYP experiencing anxiety related to school have told us some reasons that they find school hard:

• They don’t have good relationships with the adults in school.
• The behaviour policies are sometimes seen as being overly harsh.
• Some CYP don’t feel known or listened to.
• They find the work too hard.
• They have difficulties with peer relationships. Some CYP told us about how they were being bullied, some were experiencing conflict in relationships, and some felt lonely.
• They find the environment overwhelming.

The anxiety cycle

Whilst avoidance of anxiety provoking situations brings short term relief, in the long-term avoidance leads to increased levels of anxiety. Avoidance also leads to issues such as falling behind with work and losing contact with peers which can also increase anxiety.

Understanding and managing the sources of the anxiety and supporting the CYP to develop alternative coping strategies will help to break the cycle.

Breaking the cycle

It is important that there is good universal provision in place and timely identification of needs followed by intervention. EBSNA is most likely to occur when the needs of the CYP are not being addressed.

Early intervention is vital. CYP who have a history of anxiety should be identified and action taken. Care experienced children may be particularly vulnerable to EBSNA and will need monitoring. Early indicators may include:

• Having experienced separation anxiety as a younger child which has reoccurred at certain times throughout childhood.
• Having found it hard to return to school following a break or weekend.
• Having had poor attendance including regular occasional days off.
• Having found transition to a new year group or school hard. Transition is known to be a significant trigger, particularly transition to secondary school.

EBSNA VST pathway

Prevention (for all CYP known to the VST)

• Needs identified and flexible support provided which includes intervention, adaptations and reasonable adjustments in terms of learning, language, SEMH needs and managing the environment.
• CYP-centred approaches where CYP’s views are heard and valued.
• Trusted relationships with adults including relationships with significant adults as well as class teachers and TAs.
• Strong partnership between parents and carers and school.

Early intervention (when there is a concern or when there is persistent absence (below 90%))

• Identify a team of adults who will form significant relationships with the CYP. Repair relationships where appropriate
• Connect with, listen to and involve the CYP and their parents and carers in planning support. See guide for parents and carers.
• Provide SEMH intervention, particularly in relation to managing anxiety.
• Support the development of peer relationships and help the CYP to manage conflict.
• Co-ordinate support through an EBSNA Relational Support Plan.

Intensive support (when there is severe absence)

• Gather information including CYP and parent or carer views in order to complete a school, home and CYP factors analysis to inform planning.
• Ensure adult and peer relationships are strengthened and/or repaired where appropriate.
• Provide support to manage emotions and develop coping strategies.
• Develop realistic and achievable next steps.
• Plan support using the Re-integration guidance and Re-integration plan.

Guide for parents and carers

Emotionally based school non-attendance occurs when stress exceeds support and anxiety builds up to the point that a child cannot go to school. Non-attendance tends to arise due to a combination of factors.

Understanding the causes

Underlying causes may include factors related to school, home or the needs of your child. Every child is different, and so it is helpful to think about all these factors.

School Factors that push the child from school	Home Factors that pull the child towards home	Child Factors that may affect the child
Avoiding uncomfortable feelings brought on by attending school, such as feelings of anxiety or low mood. Avoiding situations that might be stressful, such as learning, friendships, relationships with teachers and aspects of the school environment.	Reducing separation anxiety from significant people, such as parents and carers or other family members. Wanting to be at home in order to, for example, gain attention from parents and carers, feel safe or take part in preferred activities during school time.	Becoming stressed easily and finding it hard to feel calm. Difficulties with trust, forming and maintaining relationships and low feelings of self worth Difficulties coping with change and challenge. Becoming overwhelmed by the environment.

What children tell us

Children who do not want to go to school have told us some of the reasons why they find school hard:

• They don’t have good relationships with the adults in school.
• The behaviour policies are sometimes seen as being overly harsh.
• Some children don’t feel known or listened to.
• They find the work too hard.
• They have difficulties with friendships. Some children told us about how they were being bullied, some had lots of arguments with friends, and some felt lonely.
• They find the environment overwhelming.

The anxiety cycle

Whilst avoiding situations that cause anxiety brings short term relief, in the long-term avoidance leads to increased levels of anxiety. Avoidance also leads to issues such as falling behind with work and losing contact with friends which can also increase anxiety.

Understanding the anxiety and supporting your child to develop ways of coping will help to break the cycle.

Breaking the cycle

It is important that early signs of anxiety or not wanting to go to school are noticed, as the earlier your child is helped the better.  Early signs of EBSNA may include:

• Becoming anxious when away from significant adults.
• Wanting to take occasional days off due to headache, stomach-ache, nausea.
• Finding it hard to go back to school after a holiday or weekend.
• Overly worrying about homework, assessments, or particular lessons.
• Behaviours which may be linked to stress, such as withdrawal, anger, tearfulness.

Helping your child

Helping your child to talk about the situation and taking care to listen will be helpful. Encourage your child to think and talk about what is going well, how they have coped with things in the past, how they would like things to be and what the next steps might be.

In addition, it would be helpful to:

• Let the school know as soon as possible if your child is overly worrying. Work closely with the school to plan next steps.
• Be curious, ask questions and listen carefully to your child. Encourage them to talk about their worries.
• Notice what your child enjoys doing and provide opportunities for them to do these things.
• Notice when your child is at their best and let them know what you appreciate about them.
• Establish a routine at home with the expectation that your child remains active and occupied throughout the day.
• Support your child to maintain friendships by meeting outside of school and taking part in activities.
• Help your child to manage worries and stress by learning and practising techniques to lower anxiety such as controlled breathing.
• Encourage problem solving and having a go. Join your child in thinking about ways of moving forward and think about next steps
• Take care of yourself. Ask for support when needed and talk to other parents and carers who have the same issues.

Guidance to using the EBSNA VST pathway

Prevention

For all care-experienced CYP, flexible and adaptive provision is required. Children in care (CIC) and previously looked after children (PLAC) should be closely monitored and have access to the following support:

• Identified key adults. Make sure the CYP feels known, accepted, liked, and listened to.
• Mentoring and/or coaching. For example, through the Attachment Based Mentoring Programme.
• Access to safe spaces.
• Support to develop peer relationships including encouragement and support to take part in extra-curricular activities.
• Opportunities to build a sense of belonging through connection with adults in school and contribution both within lessons and the wider school community.
• Strong home-school relationships with clear and regular communication.
• Manage transitions big and small but particularly transition to secondary school. Make sure support is in place on transition, do not wait for difficulties to arise.
• Use restorative approaches to support positive behaviour and mend relationships.
• As transition is a potential trigger for EBSNA all CIC and PLAC should have a relational support plan at these times. This includes all CYP who are new into care and those transitioning between key stages. A guide to developing relational support plans can be found here: devon.cc/relational-learning
• Assessment to identify learning, communication and interaction and SEMH needs and appropriate support, intervention, and reasonable adjustments. Identify specific needs such as literacy, language and sensory needs which might make some situations overwhelming. CIC and PLAC benefit from assessment of their executive functioning skills and from support in this area. Ensure that support includes both access strategies and developmental intervention.

Early intervention: Relational Support Plans with EBSNA in mind

In addition to support provided at the universal level, some CYP will need a more targeted approach. Relational Support Plans provide a useful vehicle for thinking about early intervention.

If the CYP does not yet have a Relational Support Plan you can use the EBSNA RSP template. If the CYP does have a Relational Support Plan you can use the additional EBSNA prompting questions (in the EBSNA RSP template) to update your present plan.

As with all Relational Support Plans it is important to involve the CYP. Guidance as to collecting the CYP’s views can be found in Appendix 3

These plans should be used to co-ordinate support when a CYP’s attendance falls below 90% or when there is concern that there are signs that the CYP is developing emotionally based difficulties with school attendance. The plan needs to be co-ordinated by a member of the team and revisited and adapted.  A template for an EBSNA RSP can be found in Appendix 1

Intensive support: Re-integration guidance and framework

If a CYP’s absence becomes a severe concern the following support should be provided to support reintegration.

Reintegration plans will have several stages, each working towards a realistic and achievable outcome. Planning needs to involve the CYP and the team of adults supporting them. It needs to be flexible and go at a pace that the CYP feels is right for them. A template for a Re-integration Plan can be found in Appendix 2

Following the guidance and process below will support and provide a framework for initial support, assessment and planning reintegration.  Plans should include consideration of the following:

1. Building, maintaining, and restoring relationships

• How to keep in contact with the CYP whilst they are out of school. Emails, postcards, home visits or meeting the CYP outside of the home and school environment. Build upon relationships with significant adults from school. This is likely to need to be done out of school before bringing the relationship back into school.
• How to maintain close contact with the family and establish regular communication. This will include identifying a key adult within school, regular times for catching up and more formal reviewing of plans.
• How to increase a sense of school belonging and maintain access to school activities, even when the CYP is not attending school. Peer relationships will be particularly important. Could the CYP access extracurricular activities or other social activities with peers? Could they connect virtually if the CYP is finding it hard to leave the home? Could friends be encouraged to keep in contact.
• How to use restorative approaches to repair relationships that may have broken down. This should include peer and teacher relationships with the CYP and relationships between parents and the school when appropriate.

2. Understanding the situation

• How to ensure that the CYP is involved. Eliciting the views of the CYP needs to be done by a trusted adult and should be appropriate to the developmental stage and age of the CYP. Consider what the CYP’s views say about their needs. Guidance as to collecting the CYP’s views can be found in Appendix 3
• The factors that are underpinning the CYP’s EBSNA. Complete a School, Home and CYP Factors Analysis, considering the views of all involved, so the needs and strengths of the CYP are fully understood. A template for the analysis can be found in Appendix 4

3. Developing coping strategies and managing emotions

• How to support the CYP to manage their anxiety and enhance their coping skills. The student may also need additional support in specific areas of understanding or managing emotions. The following will be helpful:
  • Support the CYP to understand the anxiety cycle and their own experience of anxiety. Teaching about the brain and the stress response system will be helpful. Support the CYP to gain awareness of their stress, what are their triggers, how does it feel, what helps them? Support the CYP to be able to indicate how they feel to others.
  • Teach the CYP strategies to lower their arousal levels by learning and practising techniques that work for them. For example, controlled breathing and grounding techniques.
  • Explore with the CYP what they are thinking when they feel anxious. Anxious feelings are likely to increase negative self-talk and vice versa. Exploring helpful self-talk such as “I can do this, I have done this before…”, “It is okay to get things wrong, I am going to try again…” “I know what to do, I know what helps me…”.
  • Model, scaffold and teach problem solving. Model problem solving by thinking aloud with the CYP. Move onto asking them questions about things that might help them and what they could do and encourage them to try different things. Avoid overly reassuring and doing it for them, it can be helpful at times to answer a question with a question. For more information on managing anxiety see Anxiety – Devon Schools Wellbeing Partnership
• How to establish a morning routine and manage any difficulties in leaving the house. Is additional support in this area required and is there a need for parent or carer support?
• Establishing a safe base within school that the CYP can return to and continue to utilise as they start to access a more typical school day. It will be helpful to:
• • Allow for regular breaks throughout their time in school in order to manage their arousal levels.
  • Allow the CYP to use an exit card or another signal when things are too difficult so that they can return to their safe base and use their regulation strategies, self-talk and problem solve with an adult as appropriate.

4. Coming back into school; planning next steps. This will need to be separated into stages and completed over a series of meetings taking a plan-do-review approach.

• The next realistic small steps that can be achieved. For example, meeting a trusted adult outside school, attending an after-school club, coming to the school building at a quiet time, completing some schoolwork and bringing it to an adult in school, coming into their safe base for a short time.
• The support needed to achieve each step.
• Ensuring the CYP’s voice is central to the plan and that the pace of change meets the CYP’s needs.

Appendices

Appendices

Appendix 1 – Relational support plan

EBSNA Relational Support Plan (Virtual School)

Appendix 2 – Re-integration plan

EBSNA Re-integration Plan

Appendix 3 – Collecting the CYP’s views

It is important that the CYP is central to the planning process. They need to be involved in developing and reviewing the plan. The more individualised and meaningful the plan is to the CYP the more likely it is to be successful.

When CYP are not attending school, it will be important to ascertain who is the best person to elicit their views. This could be a trusted adult from school, or it might be that the parent or carer is the most appropriate person to talk with the CYP.

The key adult or parent or carer should explain the purpose of this work. It is helpful to explain to the CYP that:

• We want them to feel good about school and that they can attend.
• We need their input to ensure that the adults understand what they are thinking about school, and how they are feeling about school.
• We want to understand how adults can best support them and value their views on how this support should look.

When the CYP’s views have been sought, discuss the best way the views of the CYP should be shared. The CYP may feel able to share their views with adults in a meeting, you could write a letter together that captures the conversation that can be read out at the start of the meeting by either the CYP or the key adult.

Or it might be the case that the key adult advocates for the CYP and represents their views when plans are being discussed. Either way it is important for the CYP to know that the conversation they have had with the key adult will be central to any plans made.

Record the child’s views on the first section of the re-integration plan. Ensure that plans are then shared with the CYP and that the CYP has ongoing involvement in the review process.

Below are some suggestions to ensure that the CYP is involved, and that their views are elicited and utilised in the planning process.

Solution focussed discussion and activities

These discussions and activities can be used by both teachers and parents or carers to gain a joint understanding of the situation and think about shared problem solving.

A solution focused discussion using scaling:

A solution focussed discussion provides a structured and conversational way of exploring a challenging situation without getting bogged down in the problems and difficulties. It is a discussion which supports building a vision of how things could be if a situation was better, exploring the things that are already working well or contributing to enabling things to be better, and identifying what it would be like if things were a little closer to how we would like them to be.

It builds on strengths, is creative and fun and can enable CYP to take genuine ownership of their plan. The process can be adapted for CYP who might find it difficult to access verbally by using drawings, models, collage or acting things out.

As adults supporting the discussion it is helpful to be curious and interested, listen without judgement and be persistent, in a respectful way, as to what the views and opinions of the CYP are. Some CYP might need a little help in getting going at first, and the odd nudge or wondering aloud from the adult can be helpful. However, we must be very cautious of not taking over, or leading the CYP in what we believe they should be thinking or doing. It is of great importance that the CYP is the biggest contributor in the discussion at this stage and that they own the outcomes.

Using a scale can be a good way of structuring the conversation. You can start by asking the CYP to draw a scale from 1 to 10 across a large piece of paper. Both yourself and the CYP can use the piece of paper to write words, draw pictures, add characters with thought bubbles and even just use some colours to help capture the conversation. The following prompts are useful in structuring the solution focused discussion:

Where is the CYP with things at present?

• On your scale of 1 to 10, where 10 is you feel as good as you could possibly be about school and 1 is the furthest from that, how are things at the moment?
• Tell me about some of the things that are happening that are keeping you up at that number.

What helps them to be successful at the moment / has helped in the past?

• What helps you? Who helps you – what do they do that helps?
• What difference does that make to you?
• What do you notice about yourself and others when things are going well?
• What helps when things are tricky?
• How do you cope when things are difficult?
• What helps you to feel safe and calm?

What are their interests / qualities / skills?

• When are you at your best?
• What are you most pleased about – how did you manage to do this?
• What skills did you use?
• What are you proud of?
• What do you like to do for fun?

Encourage the CYP to imagine what things would be like if the problems that contribute to them not going to school were no longer an issue:

• What would a 10 out of 10 look like for you?
• What would I notice about you on a day that was a 10?
• What other differences would there be for you if you were at a 10?
• What would you find yourself being most pleased about?
• What would be most important about this for you?
• What would be giving you the confidence to do that?

Encourage the CYP to consider how things might be if they were just a little further up the scale.

• If in a few weeks’ time you were just a bit further along the scale, what might be different?
• What would be the very first sign that told you things were improving?
• What might I or others notice about you that told us things were a little better?
• What differences might that small step make for you?
• Who might be best placed to help you with that?
• What would doing that tell you about yourself?
• What could you imagine yourself doing that would move you a little further up the scale?

The ideal school activity:

This is good way to elicit a CYP’s views if they find it hard to talk about themselves or their current situation. This activity helps to develop a joint understanding of what the CYP might be finding difficult and what might help.

The CYP and adult work together to represent the CYP’s ideas about their ‘ideal school’ on a big piece of paper. You can use drawings, words and sentences (this can be adapted to suit the CYP). You can suggest areas to think about using the prompts below. You can draw and write for the CYP, alongside them or they can complete their representation independently.

Useful prompts could be:

• What happens in the morning before students get to school?
• How do the students get to school?
• What happens in the morning when students arrive at school – where would they go, who would they meet?
• What would the building be like? Classrooms, social spaces where students can meet, playing fields, dining hall etc?
• What rules would there be?
• What would happen when people break the rules?
• What would the timetable be like?
• What would the lessons be like?
• What would the teachers be like?
• What would the other students be like?
• What would happen at break time and at lunch time?
• What extracurricular activities or trips would there be?
• What help would there be for students who find school difficult? This could be students who:
  • Find the work hard.
  • Find it hard to understand what is being said and to express themselves.
  • Find it hard because they are struggling with their feelings and find it hard to settle to learn.
  • Find it hard to make friends or are being bullied or left out.
• How would students let the teachers know if they were finding things hard, were anxious or unhappy?

It might be best to do this overtime and have a no pressure approach. You don’t need to use all the prompts and can add your own. Adapt it as you wish to make it fun.

Using Cards and Sentence Starters to structure discussion

Cards

Some CYP find it easier to express themselves if they have some prompts to guide and scaffold discussion. There are lots of sets of cards available to purchase which aim to explore CYP’s thoughts and feelings.

• The School Wellbeing Card set was developed specifically to provide a platform for discussion about EBSNA.  Using the cards can provide invaluable insight into how the young person views and makes sense of their experience of school and places the CYP’s voice at the centre of any planning. The cards were developed by Dr Jerricah Holder. More detail can be found here: School Wellbeing Risk and Resilience Card Set (schoolwellbeingcards.co.uk) 
• Karen Treisman has developed a range of resources to support CYP who have experienced trauma. The Therapeutic Treasure Deck of Sentence Completion and Feelings Cards provides a safe, playful way for children to articulate and make sense of their feelings, thoughts, experiences and beliefs. The cards are accompanied by a booklet which explains some of the different ways in which they can be used. The Therapeutic Treasure Deck of Grounding, Soothing, Coping and Regulating Cards provides a playful, non-threatening way to explore feelings, and to explore effective coping, regulating, soothing, and grounding strategies through a range of games and activities which can be used when planning support. More details can be found here: Books, Toys, Cards, & Worksheets | Safe Hands Thinking Minds

Sentence Starters

Sentence starters can be used to scaffold and structure discussion. You can also develop your own. Creating your own sentence starter cards will enable you to adapt the sentences to suit the interests and needs of your child. Cards can be used playfully, for example, the CYP and adult could take it in turns to answer and ask the questions. Below are some examples of sentence starters:

• The things I like best are…
• The things that annoy me are…
• I am at my best when…
• I am happiest when…
• The things I do for fun are…
• The things that are important to me are…
• I feel safe when I am…
• The things I do to keep me safe are…
• When I feel unsafe I…
• When I am (insert feeling) I…
• The people who help me are…
• The things that help me are…
• I am proud of…
• I worry about…
• I think teachers should…
• I need help with…
• My happiest time at school was when…
• If I was in charge of the school, I would…
• The things I would change about school are…
• The things I would change about home are…
• The things I do to cope are…

Person Centred Planning Meetings

If the CYP that you are working with is able to engage with support to help them to think about their future and what they need, they may be able to be part of a person-centred planning meeting. This will be particularly appropriate when it is felt that the CYP needs to feel that they have control over the planning process. It is particularly valuable in supporting the CYP to think about their future aspirations. More details about person centred planning can be found at https://inclusive-solutions.com

Appendix 4 – School, home and CYP factor analysis

School, home and CYP factor analysis