A Guide for Parents Navigating School Refusal: Understanding Levels of Care
The transition back to school brings with it many emotions – from excitement to anxiety and everything in between. For some students, the excitement of seeing friends and starting a new school year is overshadowed by big feelings of worry or fear, leading to school refusal. If you’ve ever dealt with school refusal in your home or family, then you know it's a challenging experience for both parents and students alike. When kids refuse to attend school, it can be frustrating and stressful - and it's important to remember that they are not being difficult on purpose. They are struggling with something deeper that needs understanding, support, and appropriate intervention.
Knowing the right steps and options available often feels overwhelming. Let’s dive into the ins and outs of school refusal, explore the levels of care available for mental health support and identify a few strategies for helping your child navigate school refusal.
Defining School Refusal
School refusal can be unfamiliar or misunderstood for many families. School refusal is a term used to describe when a child experiences intense anxiety or emotional distress about attending school, making it difficult or even impossible for them to go. Unlike skipping school for other reasons, children who struggle with school refusal often want to be in school but feel overwhelmed by fear, worry, or other strong emotions that hold them back. The root causes of school refusal can vary for each student:
- Anxiety: Fear of social situations, academic failure, or separation from parents
- Depression: Lack of motivation, feelings of hopelessness, or low energy
- Bullying: Fear of being targeted or ridiculed by peers
- Learning Differences: Frustration with academic challenges
- Family Issues: Changes at home, such as divorce or illness
Recognizing the Signs
Recognizing the signs of school refusal early is a crucial first step in seeking the right level of care. Some common signs to be aware of include:
- Frequent complaints of physical symptoms such as headaches or stomachaches, especially on school days
- Excessive worry or panic attacks about going to school
- Tantrums or emotional outbursts when it’s time to leave for school
- Difficulty sleeping, nightmares, or fatigue
- Declining academic performance due to frequent absences
Levels of Care for Mental Health & School Refusal
Early intervention is a key indicator for healing and growth for kids experiencing school refusal. Understanding the levels of care available can help you make informed decisions about the best course of action. The various levels of care are not always familiar – let’s break each down!
Outpatient Therapy
Outpatient therapy is often the first line of defense against school refusal. It involves regularly scheduled therapy sessions (typically weekly or bi-weekly) with a mental health professional. This level of care is suitable for children/adolescents with mild to moderate symptoms of anxiety or depression. Outpatient therapy may include Cognitive Behavioral Therapy (CBT), which helps adolescents challenge negative thoughts about school, and Family Therapy, which can address the family dynamics impacted by school refusal.
When to consider: If your student’s school refusal is mild to moderate and they are still attending school most of the time.
Intensive Outpatient Programs (IOP)
If outpatient therapy is not enough, an Intensive Outpatient Program (IOP) may be the next step. IOPs provide more structured and frequent therapy sessions while allowing your student to continue living at home and attending school part-time. IOPs often include group therapy for peer support and skill-building sessions focused on social and coping skills and emotional regulation.
When to consider: If your child’s school refusal is moderate to severe, and they have missed several days of school but are still capable of attending part-time.
Partial Hospitalization Programs (PHP)
A Partial Hospitalization Program (PHP) is a step up from IOP and provides an even more intensive support. In PHP, a student attends a structured program during the day, like a school day, and returns home in the evening. PHPs offer a therapeutic environment where students can receive individual therapy, group therapy, family therapy, crisis intervention and a psychiatric evaluation all in one place.
When to consider: If your child’s school refusal is severe, and they are unable to attend school at all. PHPs are also appropriate if there are concerns about safety or if outpatient and/or intensive outpatient treatment has not been effective.
*Learn more about Simply Bee’s adolescent IOP/PHP School Refusal Programs here!
Residential Treatment Centers (RTC)
Residential Treatment Centers (RTCs) are for students who need 24/7 care. In these centers, children live on-site and receive round-the-clock support from mental health professionals. RTCs provide a highly structured environment with individualized treatment plans and a combination of individual, group, and family therapy. They also include educational support to help the child keep up with their studies.
When to consider: If your child’s school refusal is chronic and has not improved with other levels of care, or if they are a danger to themselves or others. RTCs are typically a long-term solution for severe cases of school refusal, often lasting several months.
Inpatient Psychiatric Care
Inpatient psychiatric care is the most intensive level of care and is used in crisis situations. It involves hospitalization in a psychiatric unit where the child can be closely monitored and stabilized. Crisis stabilization, discharge planning, psychiatric evaluation and medication management are often key components of inpatient care.
When to consider: If your child is in immediate danger due to severe anxiety, depression, or suicidal thoughts.
To learn more from Simply Bee CEO Audrey Grunst, LCSW on different levels of care, check out this video!
Strategies for Supporting Your Child Through School Refusal
While seeking professional help is crucial, there are also ways you can support your child at home. Be sure to check out our resource linked at the bottom for more!
- Create a Morning Routine: A consistent morning routine can help reduce anxiety. Include calming activities like deep breathing or mindfulness exercises
- Gradual Exposure: Work with your school to create a plan for gradual re-entry. Start with a few hours a day and gradually increase attendance
- Collaborate with the School: Stay in close contact with your child’s teachers and school counselors. They can provide support and accommodations, such as allowing your child to take breaks or visit the school counselor during the day
Embracing Support on the Road to Healing
School refusal is a difficult experience for families, but with a thoughtful and compassionate approach, you can make a real difference in your child's life. If you begin noticing signs, don’t wait – reach out for support from mental health professionals. Remember, you're not alone—there are many resources and support systems ready to help you and your child find the path towards confidence at school.
Additional Resources:
- Free PDF Download to help you create a plan and practice mindfulness and breathing techniques for anxiety
- Understanding Higher Levels Of Care with Simply Bee CEO Audrey Grunst, LCSW
- School Refusal Online Course with Simply Bee Therapist Eric Stevenson, LPC
