Sponsors

Chair: Christopher Kearney

Professionals in the field of school absenteeism agree that assessing and analyzing attendance data is the crucial first step to an early identification of students at risk for problematic school absenteeism. The most acknowledged comprehensive model for the use of this data for prevention and intervention at different levels of absenteeism intensity is the response to intervention (RTI) model for school absenteeism (Kearney & Graczyk, 2014), which will be presented by Patricia Graczyk, one of its authors, at the beginning of this symposium. A special focus will be put on the work of school attendance teams as the core component of this model and how they can use attendance data strategically. In line with this, the second presentation by Robin Ulriksen will demonstrate attendance data-based strategies against the development of school absenteeism for secondary school students in Norway. Using an RCT-design with follow-up-assessment, interventions aiming at the successful transition of at-risk-students to upper secondary education will be evaluated. How interactive and visualization methods can be applied by schools to analyze both school attendance data and other relevant information in order to derive specific actions to foster regular school attendance and prevent school absenteeism will be presented by Catherine Munro and her colleagues from the Catholic Education Diocese of Parramatta (Sydney, Australia).

Presentation 1

Title: School attendance teams in action: Strategic use of data within an RTI / Multi-Tiered System of Supports framework.

(Patricia Graczyk, University of Illinois at Chicago, USA)

Abstract: School Attendance Teams (SATs) often focus their work at the individual student level, i.e., on those students who are displaying school attendance problems. Although this level of analysis is an important component of the work of SATs, strategic use of data to improve school attendance warrants a broader approach, one that focuses on the use of multiple levels of data to guide the selection of effective interventions. In this presentation my overarching aim is to show how an RTI/Multi-Tiered System of Supports (MTSS) framework can be especially helpful in guiding the strategic use of data. Through discussion and the use of ‘real world’ examples, participants will learn the multiple levels of data analysis to be used by SATs (e.g., school, tier, individual) to determine at which level(s) they need to focus their efforts to be strategic and maximize student outcomes. They will learn a four-step problem-solving process that is applicable at all levels and of other types of relevant data (e.g., early warning systems, parent & teacher report, fidelity) to inform their work and maximize their effectiveness. To conduct this work successfully SATs will need professional development and coaching support related to effective team functioning, how to take a leadership role in the implementation of an RTI/MTSS framework for attendance, effective problem-solving, data-based decision-making, and ways to ensure implementation fidelity.

Presentation 2

Title: Targeting students at high risk for non-attendance: A school-based model to prevent absence and increase school completion among upper secondary school students.

(Robin Ulriksen, Statped - National Service for Special Needs Education, NORWAY)

Abstract: School absenteeism, also referred to as school refusal and truancy, has been of concern to schools, courts, communities and social and behavioral scientists. Today, school absenteeism remains a serious problem that have a negative impact on youth and their futures. This study investigate the effect of a school based monitoring program aimed at students with high risk of developing school absenteeism. Utilizing information from primary school The absent reduction model (AR-model) are developed to promote early follow up in the transition to upper secondary education for student with high risk of developing high absenteeism, and counsellor focus on promoting students’ engagement and autonomy in the process. Students having 12 % absence or above in 10th grade (gathered from official school registered data) will receive specific follow up from the intervention schools. When starting school student will be followed up by school counsel, using information from primary school and in dialog with the student, they will mutely agree on appropriate interventions defined to the students needs. School consular will monitor the progress through registered school absence and course status. The present study is a quasi-cluster randomized controlled trial. A total of 35 upper secondary school in the municipalities of North-Norway was included in the study and follows first year students age 15-16 years in the school year 2018 – 2019. Schools were randomized into treatment and control groups based on stratification (school size, demographic factors (counties), educational programs and prior non-attendance) and through regular conversation with the students the first year in upper secondary education. The AR-model objectives are to examine if early identification and follow up of attendance in transition to upper secondary education reduces non-school attendance first year in upper secondary education and improve school completion. The findings will help schools in promoting better support for students with high risk of developing high absence and dropping out of upper secondary education.

Presentation 3

Title: An essential companion: Leveraging system wide data to transform approaches to school attendance.

(Catherine Munro, R. Gorbach, & D. Walker, Catholic Education Diocese of Parramatta, AUSTRALIA)

Abstract: In 2015 the Catholic Education Diocese of Parramatta (Sydney Australia) found that although most students attended school regularly, on average one in five did not. The challenge to support all students to be present and engaged in learning could not be ignored. This paper examines how: (a) access to real-time attendance data supported a paradigm shift in thinking about attendance; (b) data analytics and visualisation tools mobilised a system to transform attendance. In this paper we discuss the context of the data analytics strategy employed by Catholic Education Diocese of Parramatta and how democratising data informed changes in processes and mindsets. We will walk through a number of visualisations and interactive dashboards that examine the relationship between attendance (and absence) with school, student and community characteristics. We will discuss findings from an analysis of student survey data on a range of student engagement and wellbeing measures and its relationship with attendance. Students’ sense of belonging and attendance in CEDP schools will be explored and the actionable insights shared. Attendance as a measure of school performance, student performance and wellbeing is a dynamic landscape where we are developing more knowledge and understanding of the multi layered factors at play. Attendance data and the use of analytics tools asks more questions than it answers. However we know data can be a powerful lever for change if it is accessible, used to highlight points of inquiry and to inform change.

Chair: Kirsten Hancock

This symposium draws attention to moderate to severe cases of school refusal. These students often suffer from mental health problems such as depressive or anxiety disorders and have been away from school for a relatively long time, making more intensive interventions necessary to support re-engagement with school. These are often referred to as tier 3 interventions (cf. Kearney & Graczyk, 2014). From a systemic family therapy perspective, Heather Dalby and her colleagues from the Catholic Education Diocese of Parramatta (Sydney, Australia) introduce the adaption of one-way mirrors and reflective teams as classic techniques of systemic therapy for the treatment of school absent youths. Case examples highlight how teams composed of school counsellors, specialist teachers, social workers, and family therapists can effectively help students on their way back to school. In a similar way, Gino Ameye and his colleagues from Belgium argue for a multidisciplinary approach to school refusal based on their qualitative research project with school refusing youths. They also present a psychoeducational animation film about school refusal which was created during the project. Finally, Johanna Sergejeff will introduce Tuuve, a tool developed for teaching and supporting students who refuse to go to school and suffer from severe and complex health issues online. In cooperation with the students’ local school, it enables teachers to stay in contact with their absent students, and first results indicate that students supported by Tuuve were able to continue their educational career.

Presentation 1

Title: Unlikely companions: Introducing one way mirrors and reflective teams into school systems for work with vulnerable students and families.

(Heather Dalby, R. Gorbach, C. Munro, & D. Walker, Catholic Education Diocese of Parramatta, AUSTRALIA)

Abstract: Students and families who have disengaged from the school system, and who have chronic absenteeism often come with a complexity that schools struggle to manage. The aim of this paper is to outline the process of bringing systemic family therapy, complete with a reflective team, into an educational setting as part of a suite of interventions to address non attendance. The Wellbeing Team is part of the Catholic Education Diocese of Parramatta (Sydney, Australia). The team includes school counsellors, specialist teachers, social workers, and family therapists. As therapists in an education system we understand both educational and therapeutic contexts. We have drawn on our understanding of both disciplines to develop a family therapy ‘model’ that allows us to work with vulnerable families and students, to support improved family functioning and student wellbeing, along with increased school attendance. We will present examples of this work with a range of students and families, and share stories about the powerful and positive impact of the reflective team. We discuss how we have attempted to manage the competing agendas of the school, the family, the student, and the team. Finally we reflect on the groundwork that has been necessary to slowly build the resources required to offer family therapy as an integrated element in the suite of responses for students, schools and families.

Presentation 2

Title: Scared of the school gate? What schools can do against school refusal.

(Gino Ameye, Centre for Child & Youth Mental Health Karus Melle / HOGENT, BELGIUM; G. De Nys, F. Van Drongelen, & N. De Stercke, University College Ghent, BELGIUM)

Abstract: School refusal, a type of school attendance problem (SAP), is difficult to explain to parents, youngsters, peers, teachers and many others. It is a multi-faceted issue with significant personal and social consequences, which requires a multidisciplinary approach. In this presentation we will argue that a better understanding, communication and connection (attunement) are needed between the various parties that are involved. Our main purpose of this project is to provide answers to the question of which steps a school can take in situation of school refusal together with young people and their family. This presentation is based on a multidisciplinary qualitative research project, which started in 2017 and will end in December 2019. Six researchers are involved from different disciplines, namely social work, education and psychology. The results of this research are based on a literature review and on interviews conducted with twenty school refusal cases between 11-25 years old. In those cases in which the child is still expected to go to primary school or secondary school, we also interviewed other involved parties, such as parents, friends, teachers and doctors. School has an essential role to play in preventing and dealing with school refusal. Therefore, staff within the school require a better understanding of what school refusal is precisely. In order to also take on a coordinating role in managing school refusal, the school needs tools: for understanding, for screening, and for helping the youngsters and their families. To this end, we will present an animation film that was made as part of this project. The film shows the complexity of school refusal with a hopeful perspective.

Presentation 3

Title: Tuuve: Supported online teaching for students who refuse to go to school.

(Johanna Sergejeff, Valteri Center for Learning and Consulting, FINLAND)

Abstract: In Tuuve, pedagogical and social support is provided via video conferencing system and the students are using online time-place independent study materials based on their individual learning plan. The connection between a student’s neighborhood school is retained and the teachers monitor student’s learning. The results of the pilot are promising: most of the students that are engaged in the program receive their final diplomas and continue their education in secondary level. A study about these students profiles (questions about anxiety level, friend at school etc. which might have connection with their school refusal behavior) has been started together with the University of Jyväskylä in the autumn of 2018. A questionnaire has been sent to all students attending the programme. The purpose of the study is to compaire the results from the Tuuve students with the mainstream students who attended Tuomo Virtanen’s dissitation study in 2016. First results will be available in spring 2019.

Chair: Malin Gren Landell

Mechanisms of promoting school attendance include for example student engagement, parental support and support from friends and also interventions addressing special needs issues. In this symposium we look into these factors from two studies on Norwegian adolescents and their parents and one school-based study on prevention. Firstly, we report on creating and maintaining engagement through the school system. One of the studies of the symposium presents data on how the quality of classroom interactions was associated with engagement in school. The second study describes a multitier intervention for upper secondary schools including a universal program and a mental health support team. Results on perception of teachers’ support, class belonging and mental health wellbeing are discussed. Thirdly, a study on parental monitoring and involvement is presented. The results show that school absence in Norwegian adolescents was significantly associated with risk of receiving less parental monitoring and involvement. The last presentation reports the preventive work of school attendance teams in Bergen, Norway. The authors demonstrate how school attendance teams can prevent school absenteeism by fostering safe and attractive learning environments and by reacting fast to early warning signs for the development of school attendance problems. What are the implications for prevention within a whole society context? The results from the three studies are discussed and elaborated.

Presentation 1

Title: The first years in upper secondary school are often challenging: Can a good psychosocial environment mitigate the challenge?

(Torill Bogsnes Larsen, University of Bergen, NORWAY)

Abstract: Dropout in upper secondary education has been relatively stable over recent decades, and is a pronounced concern for Norwegian authorities (Lillejord et al, 2016). Previous research shows that a good psychosocial learning environment helps to promote health, well-being and good social development (Durlak et al., 2011, Samdal & Rowling, 2011; 2014). In addition, the transition from lower secondary to upper secondary school is considered a critical period (Eccles & Roeser, 2009, Eccles & Roeser 2011). In an already vulnerable development period, changing from an environment where one knows most people, to a whole new environment where few or no-one knows each other, entails an additional burden for some students. It is therefore particularly important that one facilitates a good transition process (Eccles & Roeser, 2009, Eccles & Roeser 2011). To address the psychosocial conditions in schools a multitier intervention was developed, and implemented in 12 upper secondary schools. The intervention is combining a universal program with a mental health support team. The universal program is a whole school peer-mentoring program addressing all new students in the schools while the mental health support team is an indicative and selective measure identifying and addressing students with special needs. The aim of this presentation is to show results from the second wave of the intervention. More concretely, the presentation will address ‘if and how’ the intervention effected the students’ perception of teachers’ support, class belonging, mental health wellbeing, as well as ‘if and how’ the implementation (measured as program fidelity) influenced the effects. Results suggest that systematic work with the psychosocial environment effected student’s perception of teacher support and class belonging in a positive way.

Presentation 2

Title: What do ‘parental monitoring of adolescents’ and ‘parental involvement with adolescents’ have to do with school absence?

(Kristin Gärtner Askeland, NORCE - Norwegian Research Centre, NORWAY)

Abstract: School attendance is an important functional marker in adolescents. Continued absence from school is associated with social, psychological and health problems, and is the most important predictor of school dropout. The current study examined whether the parenting practices parental monitoring and involvement was associated with school absence in a sample of Norwegian adolescents. Data was collected from the [email protected], conducted by the Regional Centre for Child and Youth Mental Health and Child Welfare, RKBU Vest in 2012. The current study was based on 1257 parent responses linked to official registry data on adolescents’ school absence. The instruments measuring parental monitoring and involvement relied on self-reports. Socioeconomic status and parental warmth were included as control variables. When studied continuously, school absence was significantly associated with risk of receiving less parental monitoring and involvement. When investigated categorically, parental monitoring was found to be significantly lower for adolescents with normal levels of school absence (3-15% absent), whereas adolescents with high levels (>15% absent) of school absence were at risk of receiving less parental involvement compared to adolescents with low levels of school absence (<3% absent). This could not be explained by levels of socioeconomic status nor warmth in the youth-parent relationship. These findings highlight the importance of including parental factors when investigating the causes of and factors influencing school absence, as well as when developing interventions targeting absence. The findings further suggest that collaboration between schools and parents can be important in reducing school absence also in late adolescence.

Presentation 3

Title: Preventing absence by providing caring and safe schools for all students.

(Trude Havik, University of Stavanger, NORWAY)

Abstract: Imagine your workplace to be a place where you feel unsafe, have few people to talk to, have colleagues who talk behind your back, a leader who hardly notices you, no possibility to influence the tasks you do, and a lack of clarity about your tasks and their importance. It would probably be enough to make you dislike being at work, preferring to stay at home. For many years, schools and classrooms are students’ “workplace”. For some students, the daily experience of school is a lot like the imaginary scenario just sketched. This is despite the fact that students have a right to a safe and suitable learning environment, as regulated by section 9A-2 of the Education Act in Norway. About five percent of students are regularly being bullied, and some students do not attend school at all. We also know that students’ perceptions of teacher support decrease with age, at the same time as these young people are developing physically, socially, emotionally, and cognitively. This presentation highlights preventive work in schools to ensure that students are willing and able to attend. Emphasis is placed on addressing students’ right to experience a caring and safe school and classroom environment. School factors important to the creation of a safe learning environment are presented, such as the need for predictability, classroom management, relations between teacher-student and student-student, mastery-orientation, and home-school cooperation. All of these factors can reduce stress-provoking situations at school, helping to reduce the likelihood of school absenteeism.

Presentation 4

Title: School attendance team in Bergen: A project to prevent school non-attendance.

(Marion Stava Bjørgan & Annett Lyngtu, Educational-Psychological Service [PTT] Bergen, NORWAY)

Abstract: The presentation will give an introduction to our project about how to increase school attendance. The background for the present project is that while working with school non-attendance, interventions often appears to be given at a too late stage in the process in order to keep the child in school. The present project aims to provide tailored early intervention, while the child is absent from school to a degree that may be of concern. This is a preventive approach at lowest level (tier 1); what to do when the child is still in school. The project emphasizes building knowledge and competence for school-workers, providing information to parents, creating new procedures for reporting non-attendance, developing a manual for collaboration-meetings and the implementation of those meetings. Furthermore, the project focuses on the effective and tailored interventions, as well as their continuous evaluation. Collaborators are the child, the child’s parents, school-employees, educational-psychologic service and low threshold health services. Our experiences so far is, that when the child receives early and tailored intervention, while problems have not grown too big and complex, more children stays in school. We believe it is essential that the child’s voice is to be heard to be able to give the right type of interventions.

Chair: Martin Knollmann

Albeit not being a diagnostic entity itself in DSM-5 or ICD-10, school absenteeism has been widely recognized as a condition that complicates the treatment of mental health problems such as depressive or anxiety disorders. This symposium focusses on interventions that have been developed especially for youths with severe school attendance problems and associated mental disorders. The first paper reports strategies for a central point during the inpatient treatment of school refusal: When faced with their imminent return to their regular school, school-refusing patients have to cope with their most feared situation and are at a high risk of falling back on their long-learned avoidance behavior. Thus, a thorough preparation and planning of the reintegration into school is crucial for treatment success. The second paper summarizes the available literature on medication for school refusal. In light of both the sparse empirical evidence and the developmental risks associated with persisting school absenteeism, the authors discuss the role of psychopharmacological medication as one possible treatment component for school refusal. The last presentation deals with treatment options for school absent youths with an intellectual disability. Since regular CBT treatment for school refusal exceeds their cognitive capabilities, Floor Sauter and her colleagues present a specialized CBT treatment protocol for this subgroup of school absentees.

Presentation 1

Title: Planning for school re-entry following psychiatric hospitalization.

(Patricia Graczyk, University of Illinois at Chicago, USA)

Abstract: Students with significant psychiatric issues such as anxiety and depression often exhibit school attendance problems. These students also are at increased risk of additional absences due to psychiatric hospitalization. Successful and sustained re-entry into school for these students requires an ecological framework that involves careful planning and collaboration among key individuals such as the family, hospital staff, the outpatient therapist, and school personnel. This session will provide such a framework and will discuss barriers to successful school re-entry as well as practices that promote successful re-entry and should be included in a written re-entry plan. Participants will have the opportunity to reflect on a checklist designed to guide school personnel in developing such a plan. The checklist provides a breakdown of steps school teams should take during the student’s hospital stay and after the student has returned to school. Participants also will have the opportunity to discuss strategies they have used successfully to facilitate their own students’ successful re-entry and “lessons learned” in their efforts to promote student success and prevent relapse. A careful planning and implementation process for students returning to school following psychiatric hospitalization is an essential component of Tier 3 supports within an RTI/Multi-Tiered System of Supports that promote school attendance and address problem absenteeism.

Presentation 2

Title: Medication for school refusal: What role does it play?

(Michael Gordon, Monash Health, AUSTRALIA; Glenn Melvin, Deakin University, AUSTRALIA)

Abstract: Introduction: School refusal can be a challenging presentation for mental health professionals. Current best practice interventions such as cognitive behavioural therapy lead to increases in attendance for the majority but not all adolescents. The rationale for considering antidepressant medication arises when both the evidence that supports the use of antidepressants for anxiety disorders is considered along with the high frequency of anxiety disorders among young people who refuse to attend school. Methods: A narrative review of the literature on psychopharmacological treatments for school refusal was undertaken. The review included case studies and series, open, controlled and naturalistic trials. Most trials evaluated a medication combined with a psychosocial intervention. Results: Few studies have addressed the efficacy of antidepressants for school refusal and methodological limitations were evident in the available research. Newer antidepressants (e.g., selective serotonin reuptake inhibitors) offered little advantage over psychosocial treatment for school refusal. Some studies demonstrated that older antidepressants (e.g., tricyclic antidepressants) boosted attendance beyond psychosocial treatment alone. Implications: A small body of research suggests that newer antidepressants did not appear to add to the effect of psychosocial treatment alone in the treatment of school refusal. However, antidepressant medications may be cautiously considered for school refusal under certain circumstances, given the gravity of long-term school non-attendance and if other psychosocial treatment options have failed. Guidance will be provided on the circumstances under which antidepressant treatment might be considered.

Presentation 3

Title: Supporting school-refusing adolescents with (mild) intellectual disability via a research-based treatment protocol.

(Floor Sauter, De Banjaard/Youz, THE NETHERLANDS; David Heyne, Leiden University, THE NETHERLANDS; C.L.M. van Vliet, De Banjaard/Youz, THE NETHERLANDS)

Abstract: Young people with (mild) intellectual disability ([M]ID) are particularly vulnerable to problems affecting participation in education. These are young people with significant deficits in cognitive abilities (defined by APA as a total IQ at least 2 standard deviations below the average, in combination with problems in adaptive functioning). Young people with M(ID) additionally have an increased risk of developing psychiatric problems. As a result, they may develop school attendance problems such as school refusal. Given the negative short- and long term effects of school refusal, it is essential that interventions provided are based upon a sound evidence-base. Until now, however, most research into school refusal and its treatment has focused on youth with average cognitive functioning. Two factors may explain this. Firstly, evidence-based cognitive behavioural therapies (CBT) are often recommended as the first line treatment for school refusal in young people, but CBT contains techniques that may be beyond the developmental capacities of children with (M)ID. Secondly, there are many methodological and practical barriers to conducting clinical trials with (M)ID populations (Mulhall, Taggart, Coates, McAloon, & Hassiotis, 2018). Practice-based research (Boone & Higgins, 2019) involves collaboration between practitioners from a ‘real-world setting’ and researchers, and may help overcome these barriers. In this presentation, the process of tailoring a promising evidence-based treatment (@school protocol; Heyne & Sauter, 2013) for use in a ‘real-world setting’ with school-refusing adolescents with M(ID) will be described. We provide case material to illustrate ways in which the content and delivery of treatment can be adjusted to better meet the needs of young people with (M)ID and their families. In addition, options for practice-based research into the adapted protocol are discussed. Knowledge gained from the process of adapting and evaluating the @school protocol for young people with M(ID) can facilitate further development of interventions to meet the needs of these youth.

Chair: Carolyn Gentle-Genitty

While child and adolescent psychiatrists and psychologists have traditionally focused on delivering therapies for youths with school refusal in association with anxiety or depressive disorders, educational professionals and social workers mainly developed interventions for truants with school aversion. Approaches combining psychotherapeutic techniques and educational interventions to tackle both truancy and school refusal are scarce. Even in professional contexts such as clinics for child and adolescent psychiatry, in which both professions work and both truants and school refusers are treated, educational and mental health professionals do not necessarily mingle, but rather continue to go separate ways. We describe the moment when this changed and both professions truly fell in love with each other: the cooperation of educational and mental health professionals working in a multi-professional team for school absenteeism. Using case examples, we document the development and the result of this intense relationship. At the end, this collaboration gave birth to a multimodal, multi-professional manual for the counselling and treatment of both truant and school refusing youths. Rather than distributing tasks or delegating clients according to the traditional roles (i.e., school refusers: psychiatrists; truants: pedagogues), both educational and psychiatric professionals work together in each individual case. Since this was not a marriage of convenience, but rather a very romantic and sometimes stressful relationship, there are many moments to remember: Benefits such as mutual learning and enrichment as well as challenges like developing a “common language” during the development and implementation of the manual are highlighted. The case examples demonstrate how manualized techniques for joint interventions of educational and mental health professionals can successfully resolve even severe cases of truancy and school refusal and how this keeps their relationship alive. To maximize the profits of a collaboration of mental health and education, multi-professional teams treating school absent youths should go beyond just adding proven techniques from both professions. The highly specialized knowledge and skills of educational and mental health professionals should be seen as a chance for the corporate creation and exploration of novel solutions, especially for youths with severe or complex forms of school absenteeism. To keep the love alive, both professions need to find a common language and a communication on eye level, in good times as in bad.

Presentation 1

Title: Love at first sight? The Essener Manual as a multi-professional approach to intervention for school absenteeism.

(Volker Reissner & Martin Knollmann, LVR-Clinic Essen / University of Duisburg-Essen, GERMANY)

Abstract: While child and adolescent psychiatrists and psychologists have traditionally focused on delivering therapies for youths with school refusal in association with anxiety or depressive disorders, educational professionals and social workers mainly developed interventions for truants with school aversion. Approaches combining psychotherapeutic techniques and educational interventions to tackle both truancy and school refusal are scarce. Even in professional contexts such as clinics for child and adolescent psychiatry, in which both professions work and both truants and school refusers are treated, educational and mental health professionals do not necessarily mingle, but rather continue to go separate ways. We describe the moment when this changed and both professions truly fell inlove with each other: the cooperation of educational and mental health professionals working in a multi-professional team for school absenteeism. Using case examples, we document the development and the result of this intense relationship. At the end, this collaboration gave birth to a multimodal, multi-professional manual for the counselling and treatment of both truant and school refusing youths. Rather than distributing tasks or delegating clients according to the traditional roles (i.e., school refusers: psychiatrists; truants: pedagogues), both educational and psychiatric professionals work together in each individual case. Since this was not a marriage of convenience, but rather a very romantic and sometimes stressful relationship, there are many moments to remember: Benefits such as mutual learning and enrichment as well as challenges like developing a “common language” during the development and implementation of the manual are highlighted. The case examples demonstrate how manualized techniques for joint interventions of educational and mental health professionals can successfully resolve even severe cases of truancy and school refusal and how this keeps their relationship alive. To maximize the profits of a collaboration of mental health and education, multi-professional teams treating school absent youths should go beyond just adding proven techniques from both professions. The highly specialized knowledge and skills of educational and mental health professionals should be seen as a chance for the corporate creation and exploration of novel solutions, especially for youths with severe or complex forms of school absenteeism. To keep the love alive, both professions need to find a common language and a communication on eye level, in good times as in bad.

Presentation 2

Title: In2School: A shared response to school refusal.

(Lisa McKay-Brown, University of Melbourne, AUSTRALIA; J. Ring & R. McGrath, Travancore School, AUSTRALIA; C. Mitchell, Royal Children’s Hospital, AUSTRALIA)

Abstract: Current interventions for school refusal in Victorian education and health settings having limited rates of success. Something new was needed. In2School is an intensive wraparound intervention for school refusal delivered through a robust team partnership that includes mental health and education specialists. This presentation will describe the development of the intervention through a unique partnership model and explore how the team members work both within and across their professional specialties to drive successful outcomes. In2School is a 6-month intervention that targets 11-14 year olds diagnosed with a primary mood disorder. The team conduct mental health and educational assessments in home and clinic environments; bring participants into a transitional classroom incorporating educational and therapeutic interventions; provide psychoeducation to school staff and parents; and deliver structured outreach support upon participants’ return to the regular school. Outcome measures investigated school attendance, mental health recovery, quality of life, academic learning, and social functioning. Results show ongoing return to school and improvements in mental health, social functioning, academic re-engagement and quality of life for young people. Partnership findings indicate that the wraparound model encouraged the multidisciplinary team to share their knowledge, expectations, and collaborative skills to strengthen the intervention. The young people benefitted from a consistent approach to implementing individual and family-based routines and strategies in the clinic and the transitional classroom. This education/mental health marriage drives an innovative model that promotes a holistic approach where individual student needs are anticipated, shared and built into return to school interventions.

Presentation 3

Title: The Link Program for school refusal: An educational facility and its mental health care spouse(s).

(Marije Brouwer, De Link, SWV Regio Almelo, THE NETHERLANDS)

Abstract: The Link is an alternative educational program for Dutch adolescents with school refusal (SR). These adolescents often display chronic and severe SR, meet criteria for anxiety or depressive disorders, and are diagnosed with an autism spectrum disorder. Collaboration between various parties is typical in alternative educational programs and it is inherent to the Link program. The adolescent, parents, Link staff, staff from the original school, therapist, and regional student attendance officer work together on the goal of reengaging the adolescent with schooling. This requires considerable coordination, which is managed by the Link. When possible, the Link expertise team arranges mental health care via a treatment facility with an established alliance with the Link. Link is not monogamous, in that it does not exclusively work together with this treatment facility. However, there is a close and adaptive relationship between Link and this particular facility. During this presentation, the relationship between the Link and the mental health care service is described in terms of its courtship (e.g., how we started working together; why we liked each other), the ups and downs (e.g., successes and challenges in working together; the impact of finances on the relationship), and plans for the future together (e.g., growing towards a more exclusive relationship). The presentation concludes with relationship advice for a ‘happy marriage’ between education and mental health care. As a case in point, both partners need to be available for each other.

Chair: Glenn Melvin

This symposium brings together modern cognitive-behavioral therapy approaches for school absenteeism. Addressing the heterogeneous problems associated with school absenteeism, the first presentation reports the implementation of a multi-modular, transdiagnostic treatment program in Denmark, including modules for anxiety, depression, behavior problems, parent and teacher training, and self-efficacy. The second paper summarizes the results of the evaluation of an intensive outpatient program for school absenteeism in France: Most of the patients who received a comprehensive CBT treatment 4 times per week while visiting their regular school managed to continue to go school regularly after the end of the program. The third presentation uses case examples to illustrate how schema therapy can be adapted for the treatment of school absenteeism in a psychiatric inpatient unit in Germany. As school refusers often are “therapy refusers”, too, a special emphasis is put on schema therapeutic techniques for fostering therapy motivation and compliance. The closing presentation examines the potential of dialectical behavior therapy as another prominent third-wave CBT-approach for the treatment of school refusal. Besides components such as skills training with both the patients and their families, web-based coaching is presented as an opportunity to deliver “real-time” skills coaching to school absent patients in particularly demanding situations such as in the morning hours prior to school.

Presentation 1

Title: Back2School: A feasibility study of a modular cognitive behavioural intervention for youth with school attendance problems.

(Johanne Jeppesen Lomholt & Daniel Bach Johnsen, Aarhus University, DENMARK; Wendy Silverman, Yale University Child Study Center, USA; David Heyne, Leiden University, THE NETHERLANDS; Pia Jeppesen, Mental Health Services in the Capital Region of Denmark, DENMARK; Mikael Thastum, Aarhus University, DENMARK)

Abstract: There is a diversity in the etiology of school attendance problems (SAP) among youths. This results in a heterogeneous group of youths with problems attending school, necessitating flexible interventions. Back2School is a newly developed manual-based modular transdiagnostic cognitive behavioral intervention aimed at increasing school attendance. Back2School includes evidence-based interventions for anxiety, depression, behavior problems, parent and teacher training, and a focus on improving self-efficacy. A feasibility study was conducted as a preparation for a randomized controlled trial (RCT) investigating the effectiveness of the Back2School program. This presentation will focus on the feasibility and preliminary clinical outcome of the Back2School program. In 2017, twenty-four youths with SAP (more than 10% absence during the last three months) from primary and lower secondary schools in Aarhus Municipality, Denmark, were included together with their parents. Twenty-two families completed all sessions of the Back2School program, and rated the satisfaction of participating as high. On average, the youths were 67% absent from school at baseline, which was reduced to 25% post-treatment and 20% one year after treatment. A year after the intervention 71% of the youth had less than 10% school absence. The participants reported on average a significant and large reduction in the youths’ psychological symptoms, as well as significant and large improvements in self-efficacy after intervention. Back2School is feasible and shows promise in terms of its positive effects on school attendance, psychological symptoms, and self-efficacy. However, conclusions of the strength of the efficacy require further research in a RCT, which are in the making.

Presentation 2

Title: School refusal in adolescence: Effectiveness of a cognitive behavioural outpatient treatment program in France.

(Hélène Denis, University Hospital, Montpellier, FRANCE)

Abstract: A specific ambulatory therapeutic cognitive and behavioral (CBT) program for anxious school refusal was established to gradually reintegrate children back into the school environment. Method: The program consists of a part-time day hospitalization, 4 times per week, with normal school education, individual and group CBT (manualized program with anxiety psychoeducation, stress management, cognitive restructuration, problem solving techniques, progressive exposure, assertiveness exercises and self-esteem work). Medical practitioners accompany the children (11 to 16 year olds who have completely dropped out of school) to school for gradual exposure. The parents also undergo a CBT program (guidance, psychoeducation and stress management). We evaluated the effectiveness of this program in a group of 36 patients treated between September 2014 and December 2018. School reintegration period assessment, overall functioning (CGAS), clinical improvement (CGI) and anxiety (FSSC-R, RC-MAS, MASC,ECAP) were quantified. Results: 33 patients have returned to school partially after 15 (SD: 6) weeks of treatment on average. For all the adolescents, overall functioning assessment and anxiety level (in all anxiety scales) showed a significant improvement. 30 patients have returned to school full time in September after the beginning of the program. Conclusion: This CBT program for anxious school refusal performed in an outpatient treatment setting is effective and allows partial attendance in school within a year, and to fully return to school the year after, for the majority of patients.

Presentation 3

Title: Implementation of schema therapy in an inpatient unit for adolescents with absenteeism and mental health problems.

(Ursula Neumann, LVR-Clinic Essen / University of Duisburg-Essen, GERMANY)

Abstract: Introduction: Schema therapy is one of the so-called "third-wave therapies" of cognitive behavioral therapy and has been developed for non-respondent patients. Since many students with severe school absenteeism and associated mental disorders show low therapy motivation and compliance as well as chronic avoidance behavior, schema therapeutic techniques should be useful for the treatment of these youths. Method: The implementation of schema therapy at a psychiatric and psychotherapeutic inpatient unit for adolescents with school absenteeism and associated mental disorders is presented. Case examples demonstrate how schema therapeutic techniques can be adapted to the specific needs of school avoiding patients with both internalizing and externalizing symptoms. Multiprofessional Interventions that target chronic avoidance tendencies and that can be integrated in daily routines during inpatient treatment are highlighted. Results: School absent patients showed a high acceptance of schema therapeutic approaches to their problems. Working with different modes of the patient’s especially seemed to be useful in those with low therapy compliance and generalized avoidance behavior. Furthermore, all involved professions reported that techniques such as modus feedback were rather easy to apply, even in difficult therapy situations. Conclusion: In severe cases of school absenteeism, avoidance or refusal behavior not only occurs with regard to school attendance, but also extends to efforts of parents, teachers, and mental health professionals to help the affected youths. Novel therapy approaches developed for difficult-to-treat-patients such as the schema therapeutic one presented here offer new ways of building and sustaining a therapeutic alliance and enable therapists to resolve both school refusal and "therapy refusal".

Presentation 4

Title: Re-thinking interventions for school attendance problems: Implementing Dialectical Behaviour Therapy and web-based coaching.

(Brian Chu & L. Rizvi, Rutgers University, USA; E. A. Zendegui, Icahn School of Medicine at Mount Sinai, L. Bonavitacola, Cognitive Behavioral Consultants, USA)

Abstract: Youth school refusal is a significant societal problem with broad negative long-term consequences yet existing evidence-based treatments continue to struggle with incomplete treatment response and limited impact on the whole family context in which school attendance problems occur. Dialectical Behavior Therapy for School Refusal (DBT-SR) was developed to address limitations in both existing treatment models and current delivery systems. DBT-SR employs a multi-modal approach to directly address the severe emotional and behavioral dysregulation mechanisms maintaining school refusal behavior. All youth and caregivers participate in multi-family skills training groups and youth receive individual therapy reinforcing DBT skills. DBT-SR also incorporates a web-based coaching component to provide active, “real-time” skills coaching to youth and parents at the times, and in the context of greatest need (at home, during morning hours). The current presentation will report results and lessons learned from a pilot trial illustrating the development and implementation of this model in two families who sought outpatient care for school refusal. DBT-SR showed promising feasibility and acceptability, but significant implementation challenges remain, including technology requirements for providers and families, provider burnout from providing web coaching at early hours, and poor attendance at individual and multi-family groups. Discussion will focus on the unique incremental value of applying a DBT framework to the treatment of SR and will discuss implementation challenges both unique to DBT-SR and common to all behavioral treatments of SR.

Chair: Brian Chu

In this symposium different educational and psychiatric concepts and interventions for school absenteeism in the Netherlands and Germany are presented. This includes inpatient and outpatient treatment in child and adolescent psychiatry clinics as well as the implementation of a treatment protocol for school refusing students in a school setting and educational projects for students who can be classified as truants. The symposium will highlight similarities and differences between these approaches. Furthermore, some pitfalls in the field of school absenteeism research and practice will be discussed: How can research-based intervention concepts be implemented in a way that fits the needs of practitioners “at the coalface”? How can the continuity of the treatment process be ensured during the transition from outpatient- to inpatient treatment and back again? How can different educational and psychiatric concepts for school absenteeism be combined in a sound, mutually enriching way? Multidisciplinary questions awaiting multi-professional answers….

Presentation 1

Title: Inpatient and outpatient treatment for youth with school absenteeism and mental disorder.

(Daniel Walter, University Hospital Cologne, GERMANY; Eva Möhler, University of Heidelberg, GERMANY; M. Döpfner, GERMANY; F. Resch, GERMANY)

Abstract: Introduction: School absenteeism is a common problem throughout the countries of Europe and results a major developmental impediment of the affected children and adolescents as it endangers further development. School absenteeism integrates a variety of different diagnoses and multifactorial causes and the duration of school absence varies from a few sessions to several years. Therefore, different in- and outpatient treatment approaches have been developed at multiple sides throughout Germany. Methods: The Universities of Heidelberg and Cologne offer specific in- and outpatient treatment programs for youth with school absenteeism. Different clinically referred samples as well as conceptual issues will be presented. Results: The different samples considerably vary in terms of mental disorders and school absence rates. Within samples that underwent in- and outpatient therapy based on a cognitive-behavioural treatment approach (CBT), statistically significant reductions of school absence rates and mental symptoms were found. Conclusion: Different treatment approaches seem to be needed that have to be individually tailored depending on psychopathology and the functional conditions of the affected youth. Results strengthen previous findings on outpatient CBT of youth with school absenteeism and mostly anxiety disorders.

Presentation 2

Title: Bridging the gap: Fostering transitions between outpatient and inpatient treatment for youth with severe absenteeism.

(Volker Reissner, Martin Knollmann, & Johannes Hebebrand, LVR-Clinic Essen / University of Duisburg-Essen, GERMANY)

Abstract: Introduction: Treatment of youths with severe school absenteeism is challenged by diverse obstacles such as low therapy motivation and compliance, anxiety with regard to inpatient treatment, and relapse of school absenteeism because of chronic anxiety and avoidance tendencies. For a sustained treatment success, flexible intervention strategies and contexts are needed to address the changing needs of school absent youths during the course of the treatment. Methods: The LVR-clinic for child and adolescent psychiatry in Essen, Germany, developed a standardized and modularized treatment concept for the outpatient- and inpatient treatment of school absenteeism as well as for transitions between these different treatment contexts. The development, the modules, and the structure of this concept as well as results of the evaluation of some of its parts are presented by drawing on both quantitative data and clinical case examples. Results: Results of the evaluation of the treatment modules indicate their usefulness for treating school absent patients with severe and mixed (both internalizing and externalizing) symptoms. Clinical case examples highlight the necessity of special interventions for hard-to-reach school absentees and their families and for designing transitional structures to keep them in contact with social and mental health services. Conclusion: Comprehensive treatment approaches are needed to successfully treat patients with severe school absenteeism. These interventions need to be adaptable to changes in the course or the severity of school absences, to the different symptoms associated with school absenteeism, and to changes in the treatment motivation of school absent youths and their parents.

Presentation 3

Title: Educational concepts and interventions for school absenteeism in Germany.

(Heinrich Ricking, Karsten Speck, & Gislea Schulze, University of Oldenburg, GERMANY)

Abstract: Introduction: Regular school attendance is essential for school success – frequent absences often lead to school problems. School absenteeism includes all behavioral patterns of students staying away from school without acceptable permission. Absenteeism often leads to third-graders not reading correctly, sixth graders not passing subjects and ninth graders dropping out of school completely. Consequences of school absenteeism are not limited to educational attainment, but also show considerable long-term effects such as a high risk for delinquency. Students who not attend school regularly are at risk and endangered to miss their way to a contented life. Absenteeism is not only a problem of the school the student is not willing to attend. Method: We present an overview of German concepts of the different forms school absenteeism; an overview of the person-environment analysis (based on Kurt Lewin's field theory) and its usefullness for understanding school absenteeism; an overview of empirically based educational prevention and intervention concepts in Germany; results of selected educational research studies on school absenteeism. Results: Concepts for a better understanding of the processes behind school absenteeism as well as the results of empirical educational studies foster the creation of supportive learning environments, which in turn strenghten the participation in school life, especially for socially disadvantaged students. Conclusion: From an educational perspective, the development of school absenteeism can be seen as a result of imbalanced relations between child, family, school, and community level. Compehensive measures on all levels involved are necessary to prevent and resolve school absenteeism.

Presentation 4

Title: The highs and lows of translating a research-based treatment protocol for school refusal to a real-world setting.

(Cynthia Defourny, Evelyne Karel, & Hilde Hermes, De Berkenschutse Centre of Expertise for Special Education, THE NETHERLANDS; David Heyne, Leiden University, THE NETHERLANDS)

Abstract: The value of research conducted in the ‘ivory tower’ – that is, in ideal research settings such as University clinics – is ultimately determined, in part, by its successful application in real-world practice. However, translating research protocols and outcomes to effective interventions in real-world settings is not straightforward (Boone & Higgins, 2019). LANS (an acronym which translates to ‘All Students To School’) is a Dutch initiative in a special school setting in which education, mental health, and research are integrated in the delivery of a comprehensive intervention for young people with school refusal. Practitioners translate the research-based @school treatment protocol (Heyne & Sauter, 2013) into practice, at the same time as they collect data to evaluate the protocol’s effectiveness in their school setting. In this presentation, practitioners working in the project share some of the lessons they have learned about translating research to practice. They reflect upon the ‘highs and lows’ that flow from: (1) setting up an effectiveness study of a research-based protocol for school refusal; and (2) implementing the protocol in this setting. For example, working within the framework offered by a modularized treatment manual has enabled these school-based practitioners to conduct their work in a more systematic and integrated manner. At the same time, flexibility remains important, to respond to the everyday challenges of clinical practice. The need to be flexible raises difficult questions about adherence to the treatment protocol. Case material is used to exemplify the highs and lows associated with translating research to real-world practice. Overall, it is the impression of the LANS practitioners that research and practice not only benefit from each other, but the whole is greater than the sum of the parts. That is, science informs practice, and the experiences from practice are highly valuable in further research, but more than that, the relationship between researchers and practitioners can lead to ‘use-inspired research’ (Boone & Higgins, 1997) to better meet the needs of school-refusing youth and their families and teachers.

Chair: Johanna Sergejeff

The growing number of students with school absenteeism has led to increased awareness of policy-makers in many countries in Europe. This symposium starts with an analysis of the situation in the Netherlands, where recent data indicate that more preventive measures are necessary to reduce the number of students with long periods of school absence. The authors stress the need for close cooperation between both national and local government and the educational, youth welfare, and health care systems. The second and third presentation deal with the legal framework for school attendance in England. Both its history and its impact on the work of schools and school attendance teams will be reflected. The authors highlight recent legal and policy changes and the challenges they pose for professionals working in the field of school absenteeism.

Presentation 1

Title: Does government policy impact grassroots work? Dutch examples of dilemmas and progress.

(Fatima Tatahi-Post, Dutch Ministry of Education, Culture, and Science, THE NETHERLANDS)

Abstract: This presentation begins with an introduction to Dutch law and policy around school attendance and absence. Thereafter, there is discussion of certain dilemmas experienced in trying to make policy that has an impact on reducing absenteeism, and how to respond to these dilemmas from the perspective of policy-making. For example, recent data on school attendance and absence (October 2017 – October 2018) present a discouraging result. On one hand we see that more pupils are going back to school after a period of school absence, but on the other hand the number of pupils that are absent from school for more than three months is growing. In the meantime policy-makers of the national government, schools, local governments, and other local partners are working together to implement methods to reduce school absence and increase school attendance. School attendance is a local and national responsibility and therefore schools and local government have a lot of influence on the national policy. At the same time, all the hard work is not paying off in terms of preventing school absence. This is one of the dilemmas I will discuss in the presentation, together with recent plans to address this dilemma and other dilemmas. I will also talk about the importance of the collaboration between the local domains of education, health, and youth-well-being, and the obstacles we meet in building bridges between the domains. The outcomes of the presentation for participants include new insights and learning from each other’s experience on this topic. Maybe we can derive an answer to the question: ‘How can government policy better impact grass-roots work?’

Presentation 2

Title: Legal frameworks for school attendance: What would the ideal framework for England look like?

(Victoria Franklin & S. Griffiths, National Association of Support Workers in Education, UK; Ian Norman-Bruce, Association of Education Welfare Managers, UK)

Abstract: Abstract: This presentation will look at the legal framework in England regarding school attendance. We will examine the history and philosophy behind the legal framework and how this works in practice across the country. We will consider whether the legal framework is fit for purpose in the current education climate and scrutinise the success or otherwise of this system using research in the field. The aim of the presentation is to share knowledge and create debate about a framework that is the backbone of all school attendance work and has changed little in one hundred and fifty years, despite vast political and economic change during this time. Would we replace this current framework and if so, what would that look like? What other framework models work well elsewhere?

Presentation 3

Title: Adaptive school attendance teams: Changing models of service delivery in England.

(Victoria Franklin & S. Griffiths, National Association of Support Workers in Education, UK; Ian Norman-Bruce, Association of Education Welfare Managers, UK)

Abstract: This second presentation will examine the different models of service delivery across England today in relation to supporting schools and families to address issues of school attendance. Practice in this area of work has undergone unprecedented transformation over the last ten years with schools seeking increasing autonomy, encouraged to do so as part of Government policy in education provision. The role of the Local Authority and the evolution of private service providers will be explained and related to the challenges this poses to schools and school attendance teams. We will examine some of the practice issues this has raised and how these have been addressed. Consideration will be given to the benefits as well as looking at areas of concern these changes have brought. A key factor is managing the risk for families and children that fall through the net in this changing landscape of provision. An increasing area of work has been in systems, procedure and data analysis linked to a targeted approach rather than a universal one. The aim of the presentation is to explain how school attendance teams have had to adapt as a result of both education and financial policy implemented by Government and the impact this has had on service delivery and families.

Chair: Floor Sauter

School students with a disability have been found to have poorer attendance rates than those without a disability. These elevated rates combined with the range of negative outcomes associated with school non-attendance, justify efforts to develop an understanding of why students with a disability are missing out on school. This symposium brings together for papers on autism spectrum disorder, other neurodevelopmental disorders, and intellectual disability from three countries. First, results of a qualitative research project in Norway are presented. The authors conducted interviews with school absent students diagnosed with ADHD, Tourette-Syndrome or autism. The second paper explores the role of sensory difficulties in school refusal in a sample of Norwegian students with autism spectrum disorder. The third paper, focuses on intellectual disability and presents data on the reasons why students miss school using a new measure of non-attendance, the School Non-Attendance ChecKlist (SNACK). The fourth study also uses the SNACK to classify reasons for non-attendance but in a sample of students with Autism Spectrum Disorder from the UK. The latter two papers present implications of improved knowledge about non-attendance for schools and families.

Presentation 1

Title: Hear our stories: Voices of students with neurodevelopmental disorders that have been school non-attendees.

(Elisabeth Øverland, Maren-Johanne Nordby, & Espen Langbråten Wilberg, Statped - National Service for Special Needs Education, NORWAY)

Abstract: Aim: The aim of this study is to view school non-attendance (school refusal) through the personal stories of students with diagnosed neurodevelopmental disorders. The study is conducted by Statped; the national service for special needs education in Norway. Our research group wants to put an emphasis on a group of students that have gotten little attention in the research field of school non-attendance: Students with neurodevelopmental disorders. A recent study in Norway (Munkhaugen et al, 2017) investigated school refusal behaviour within a group of students with autism spectrum disorder, compared to a group of neurotypical students. The students with autism spectrum disorder had significantly higher school refusal behaviour than the neurotypical students. The research and treatment of school non-attendance has focused primarily on the refusal and anxiety behaviour, with little focus on how non-attending students function in specific teaching situations. We want to emphasise how students with neurodevelopmental disorders function in the classroom, using their own stories. We believe there is a need for more knowledge among teachers and supportive school staff, on how to adjust classroom activities according to these students’ needs. Method: We have recruited 6 students in the age-range of 11-18 years old, with diagnosed neurodevelopmental disorders. They were recruited through the national and regional interest organisations for ADHD, Tourettes syndrome and Autism. The informants are all enrolled in the special education support system in their municipality. They have all answered a set of questions regarding school experiences and school non-attendance. They have told their personal stories. Results: The stories have been recorded and will be analysed and presented in a paper that will be submitted in august, 2019. The informants have all had long-term school non-attendance, but most of them are now back in school, following individualised teaching programmes. Some of the stories have been made into a short film that we wish to share with the participants at the INSA conference in Oslo, October 2019 (English subtitles). Key implications: Our initial findings suggest that school non-attendance for students with neurodevelopmental disorders is closely linked to the school/teacher’s knowledge and understanding of how these students experience their surroundings. The informants describe a diversity of experiences in the classroom, that contribute to identify some causes of school refusal behaviour and non-attendance.

Presentation 2

Title: Sensory Difficulties in the School Environment – Conversations with Students with Neurodevelopmental Disorders.

(Hedda Gjesti Tjäde, Statped – National Service for Special Needs Education, NORWAY)

Abstract: Sensory difficulties are common in persons with NDs such as Autism Spectrum Disorder (ASD), ADHD and Tourette’s Syndrome. Studies have shown that sensory processing difficulties influence school attendance in students with ASD (Fernández-Andrés et al., 2015; Munkhaugen, 2018), something often experienced as senior advisers in the National service for special needs education (Statped) in Norway. Statped is able to share from our experience concerning children and adolescents with school non-attendance and different NDs, and how these individuals give feedback about their sensory experiences in the school environment.

Presentation 3

Title: School attendance in Australian school students with an intellectual disability.

(Kylie Gray, Monash University, AUSTRALIA; Richard Hastings, University of Warwick, UK; David Heyne, Leiden University, THE NETHERLANDS; Vaso Totsika, University College London, UK; Bruce Tonge, Monash University, AUSTRALIA; Glenn Melvin, Deakin University, AUSTRALIA)

Abstract: Introduction: School attendance problems have been flagged as being more prevalent in children and adolescents with an intellectual disability than typically developing children. However, the reasons for non-attendance and the factors that influence non-attendance in these students are largely unknown. The aim of the Kids and Teens at School study was to address this gap and determine the reasons for non-attendance and improve understanding of risk factors for non-attendance. Methods: Parents of children with an intellectual disability who were attending primary or secondary school in Victoria Australia and their teachers were invited to participate in a cross-sectional survey. Parents from specialist and mainstream and schools participated (N=636) along with their child’s teacher (N=376). Parents and teachers reported on reasons for any absence from school using the School Non-Attendance ChecKlist and completed questionnaires about a range of factors purported to increase risk of non-attendance. Results: According to school records, on average students missed 1.6 days in the last 20 days of school with 28% missing more than two days of school. According to parents, the three most common reasons for absence were illness, appointment and parent withdrawal of the child from school. Students who attended a mainstream school missed more school than those who attended a special school. Implications: Characterisation of the amount and reasons for school non-attendance will allow schools and services to target supports for families in an effort to improve attendance rates.

Presentation 4

Title: School non-attendance among UK children and adolescents with autism spectrum disorders.

(Vaso Totsika, University College London, UK; Richard Hastings & Yoko Dutton, University of Warwick, UK; Alison Worsley & Glenn Melvin, Deakin University, AUSTRALIA; Kylie Gray, University of Warwick, UK; Bruce Tonge, Monash University, AUSTRALIA; David Heyne, Leiden University, THE NETHERLANDS)

Abstract: Introduction: School non-attendance has been linked to adverse outcomes for children. School attendance can be further complicated in children with developmental disorders. Despite recognition of non-attendance as a problem for children with autism spectrum disorders, very little research is available. The study aimed to measure school non-attendance among children with autism using a newly developed parent-report tool (SNACK; Heyne et al., 2019). Method: Data on 486 school-aged children with autism were collected through an online survey, where parents reported how many days during March 2017 their child was absent from school. Children were aged 10.8 years (range 2 to 18), mostly male (69%), and 21% had an intellectual disability; over 80% attended a mainstream school. Results: Of the 23 school days, participants missed on average 5 (SD:7), with 36% of students not missing any days, 64% missing at least 1 day, and 7% missing all 23 days. Over 43% of children presented persistent school absence as defined by the UK Department for Education. Implications: School non-attendance and school non-attendance problems are highly prevalent in autism spectrum disorders, suggesting intervention is urgently needed. For effective intervention, we need to understand better the type and correlates of non-attendance; these will be further discussed at the symposium.

Chair: Martin Karlberg

Efforts to classify school attendance problems and to analyze different reasons behind school absenteeism have a long history. Nevertheless, the knowledge about profiles of school absent youths and the factors relevant for the development and maintenance of school absenteeism remains scarce. In this symposium, the results of empirical studies focusing on both individual and social variables associated with school absenteeism as well as their interplay will be presented. First, Daniel Bach Johnsen and his colleagues report the results of a cluster analysis of a Danish sample of students with school absenteeism. Variables available for analysis include sociodemographic information, mental disorders, self-efficacy, and bullying. In the next presentation, empirical evidence for an elevated risk of migrant students for chronic school absenteeism will be demonstrated by Joshua Childs using a large dataset from the US. Similarly, Martin Karlberg and colleagues show how a multilevel analysis of 3300 students from 101 schools in Sweden can reveal insights into the importance of the school climate for school absenteeism in the third presentation of the symposium. Finally, drawing on the results of another large multilevel analysis study in the Netherlands, Rene Halberstadt will integrate information on peer relationships, parenting styles and school attendance policy to explore their interplay with regard to both authorized and unauthorized school nonattendance from a sociological perspective.

Presentation 1

Title: Who are we missing? Characteristics and different profiles of youths with school attendance problems.

(Daniel Bach Johnsen, Johanne Jeppesen Lomholt, & Mikael Thastum, Aarhus University, DENMARK)

Abstract: Introduction: School is an important arena for youths’ development, and absence from this arena may disturb and have a negative impact on this development. School attendance problems (SAP) is a collective term, encompassing different types of attendance problems. Youths with SAP are a complex and heterogeneous who differ in their development and presentation their problems. The primary goal of this study is, to descriptively present the characteristics of a sample of youths presenting SAP. Based on these characteristics the study aims to investigate different profiles of SAP, and build on previous knowledge regarding the different types of SAP. Method: Data collection is currently ongoing. The sample will consist of approximately 180 youths with SAP and their parents, from Aarhus municipality, Denmark. They are all self-referred clients seeking psychological treatment for SAP between 2017 and 2019. The municipality will provide school attendance data. Data regarding sociodemographic, background information, mental disorders, self-efficacy, and bullying will be collected from the youth and parents. Cluster analysis will be used to identify possible profiles of SAP in the sample. Results: Characteristics of the sample of youths with SAP, and their families will be presented, as well as a description of the different profiles of SAP. Implications: The results from the current study may provide valuable knowledge regarding youths with SAP. Furthermore, it may help school leaders, educators, social workers and therapists, better understand and help this complex population of youths.

Presentation 2

Title: Who else is missing from our classrooms? Migrant students, chronic absenteeism, and implications for school leaders.

(Joshua Childs, University of Texas at Austin, USA)

Abstract: There are about 350,000 migrant students in the US, and about 40,000 migrant students in Texas. The U.S. Department of Education defines a migrant student as someone under 22 years of age, who is an agricultural worker or fisher or who has a parent, spouse, or guardian who is a migratory agricultural worker, and who has moved across school district boundaries within the previous 36 months to obtain temporary or seasonal employment. These students are among the most educationally disadvantaged population, facing extreme poverty and limited access to quality health care. Using student level data from the PEIMS at the Texas Education Agency and the Higher Education Coordinating Board from 2003-2015, we measure chronic absenteeism for migrant students, a matched sample of non-migrant students, and the general student population. Using panel data, we compare longitudinal migrant student outcomes as well as the general population and a matched population using logistic regression, poisson regression, and PSM matching. Preliminary findings show that migrant students have 47% higher odds of being chronically absent compared to the general student population. When we consider total days absent, migrant students have a 16% higher incidence rate of absenteeism than non-migrant students, but they miss only 1/5th more of a day than a matched sample. Our findings suggest that additional resources and expertise towards addressing chronic absenteeism as it relates to migrant students would be beneficial. We discuss the need for further research on migrant populations as it relates to school attendance and dropout prevention strategies.

Presentation 3

Title: The relationship between pedagogical climate, social climate, and absenteeism: A multilevel study of 101 Swedish schools.

(Martin Karlberg, Uppsala University, SWEDEN; Kirsten Hancock, University of Western Australia, AUSTRALIA; Filip Andersson & Melody Almroth, The Karolinska Institute, SWEDEN; Nina Klang, Uppsala University, SWEDEN, Christopher Kearney, University of Nevada, Las Vegas, USA; Maria Rosaria Galanti, The Karolinska Institute, SWEDEN)

Abstract: Attending school is important for children’s academic, social and personal development. Numerous studies have documented the factors that are related to absenteeism. Whileindividual and family factors behind absenteeism have been well investigated, fewer studies have specifically investigated how the quality of school climate is related to absenteeism. School climate refers to how s chool personnel, students and parents experience school life, academically, socially, ethically and emotionally. The aim of this presentation is to describe a study investigating how the school climate is associated with school absenteeism, and to what extent a potential association is confounded by factors such as age, gender, school management, parental education, parental occupation and country of origin. The study is a longitudinal, multi-informant, multi-method study including two cohorts of students in middle school in central Sweden. 3300 students (aged 13-16) in 101 school participated in the study. Total scores and three subscales in Teacher PESOC and Student PESOC respectively (aggregated to school level) were used as predictors, registered absenteeism was used as a dependent variable, and confounders were taken into account. Preliminary results show that poor pedagogical and social climate in the schools, rated by the teachers, predicted an increase in absenteeism. The results based on student ratings were not as consistent. The key implication of this study is that focus on certain aspects of the educational and social climate in the school can prevent absence.

Presentation 4

Title: Parents, adolescents, peers, and school policy: A multi-level analysis on the effect of their interplay on authorized and unauthorized absenteeism.

(Rene Halberstadt, Ingrado / Erasmus University, THE NETHERLANDS)

Abstract: This paper and presentation deals with authorized and unauthorized absenteeism of all pupils, not the extreme absenteeism of some. School absenteeism is the outcome of a complex interplay between four relatively independent actors: the school, the parents, their children and the peers of these youngsters. Understanding this interplay contributes to the explanation of differences in individual absenteeism and is the central focus of this paper. To study this interplay, surveys amongst parents, their youngsters and school personnel, were held in twelve secondary schools in The Hague. The distinction between the two kinds of absenteeism is based on Dutch law. This brings forward the interplay between the four actors in its purest form. The central concepts: parenting styles, school adaptations modes, peer influence and school absenteeism policies lead to a quantitative multi-level analysis of absenteeism. Baumrind’s theory was used to define types of parenting styles. Merton’s strain theory was used to define types of school adaptation modes. This theory assumes a friction between cultural dominant goals (e.g. educational and economic achievement) and institutional means (e.g. school results) resulting in forms of deviant behavior, typified by school adaptation modes. The presentation will contain the results of this analysis. Ethnicity proved to be an important indicator for all parenting styles and adaptation modes. One parenting style was found to be an indicator for all adaptation modes. Peer group influence proved to be the most important predictor for both sorts absenteeism. The presentation will be designed to inform researchers, policy makers and school personal.

Chair: Jo Magne Ingul

Screening and assessment instruments are essential to our work in education, mental health, and research. They allow us to efficiently and systematically gather information about the youth and families we come in contact with. Ideally, the instruments we use are valid and reliable measures that help us achieve the task before us, such as selecting youth most likely to benefit from an intervention, learning about the needs of youth presenting with school refusal, and evaluating the effectiveness of interventions used to help school-refusing youth and their families. This symposium comprises six presentations which highlight new developments in screening and assessment of school attendance problems. In the first presentation, colleagues from Australia and the Netherlands outline the reasons for developing the ’SNACK’ (School Non-Attendance ChecKlist), an instrument to help distinguish between different types of absenteeism (school refusal, truancy, school withdrawal, and school exclusion). They report on the first evaluation of the SNACK, based on an Australian study of 600 youth with intellectual disability. In the second presentation, a colleague from France describes the development, evaluation, and potential use of the SCREEN (SChool REfusal EvaluatioN). This is a self-report instrument used with school-refusing adolescents, using a cut-off score to screen for school refusal among clinical and community samples. The next two presentations summarize the latest developments regarding the School Refusal Assessment Scale (SRAS-R), the most established questionnaire for school absenteeism. The authors report its validation in three Spanish speaking countries as well as how profiles or different types of school absenteeism can be derived from SRAS-scores. After that, the Inventory of School attendance Problems (ISAP), an newly developed tool for assessing the presence of a wide range symptoms prior to or at school as well as their functional impact on school attendance, is introduced. The last presentation provides a timely framework for evaluating the outcome of treatment for school refusal. This framework is based upon the first systematic review of instruments used to measure outcome of school refusal treatment. The review was conducted by colleagues in Sweden, Norway, Finland, and the Netherlands. It is the intention of the presenters that participants at this symposium will have a broader and more informed understanding of ways to screen and assess school attendance problems.

Presentation 1

Title: The School Non-Attendance ChecKlist (SNACK): A screening for non-attendance type.

(Glenn Melvin, Deakin University, AUSTRALIA; Kylie Gray & Richard Hastings, University of Warwick, UK; Vaso Totsika, University College London, UK; Bruce Tonge,Monash University, AUSTRALIA; David Heyne, Leiden University, THE NETHERLANDS)

Abstract: Determining the type(s) of school absenteeism operative in a given case can provide useful information to guide intervention and support for youth, families, and schools. It was recognized that a brief instrument to assess various types of non-attendance is missing. In this context, the authors developed the School Non-Attendance ChecKlist (SNACK). The SNACK aims to assess recognized school attendance problems - including school refusal, truancy, school withdrawal, and school exclusion - as well as common and potentially unproblematic types such as illness, cultural observances, and additional vacation during school term. In this presentation we will describe our motivation for developing the SNACK and demonstrate its use. To achieve this we will present data from an Australian survey which identified types of non-attendance among youth with intellectual disability. Data was gathered from their parents (N=636) and their teachers (N=376). We will discuss the advantages and pitfalls of using instruments like the SNACK to help classify type of non-attendance, and sketch some future directions for educational, clinical, and research settings. It is hoped that the SNACK can be utilized within these settings as a brief yet broadly applicable tool to classify non-attendance. The SNACK is currently available in English, Dutch, Danish, German, and French languages.

Presentation 2

Title: The School Refusal Evaluation Scale (SCREEN) for Adolescents: Construction, validation, and feedback from the field.

(Marie Gallé-Tessonneau & K. Gana, University of Bordeaux, FRANCE)

Abstract: The SChool REfusal EvaluatioN (SCREEN) is a new and innovative self-report measure of school refusal for use with adolescents. This presentation aims to describe: 1. The construction and the psychometric aspects of the SCREEN; 2. Feedback from its utilization in the field; and 3. The potential of this instrument. Two studies were performed to develop the SCREEN. Study 1 used content analysis on semi-directed interviews to identify and organize the indicators of school refusal and to generate items. The item pool was then reviewed by experts to construct a pilot-scale. Study 2 examined the psychometric properties of this pilot-scale of the SCREEN in a community sample of 649 French adolescents (aged 10-16 years) and a clinical sample of 31 adolescents. The initial SCREEN structure was identified via exploratory factor analysis and the resultant model was validated using confirmatory factor analysis. In its final version (an 18-item, 4-factor measurement model), the SCREEN reliably measures four interrelated aspects of school refusal (anxious anticipation, difficult transition, interpersonal discomfort, and school avoidance). Data suggests good reliability and validity of scores. Results of the receiver operating characteristic (ROC) curve analysis indicated good accuracy of the SCREEN (sensitivity = .94 and specificity = .88). Feedback from its utilization in the field comes from clinicians (psychologists and doctors) and via an ongoing study with a systematic utilization of the SCREEN with every first year pupil in a French secondary school (current N=121). The presentation will end with a discussion about the feedback from different users (schools and practitioners) and the benefits and limits of the SCREEN in school and clinical practice.

Presentation 3

Title: The School Refusal Assessment Scale-Revised: Psychometric studies carried out in three Spanish speaking countries.

(Carolina Gonzálvez Maciá & Ricardo Sanmartín López, University of Alicante, SPAIN)

Abstract: The School Refusal Assessment Scale-Revised (SRAS-R) is an instrument designed to identify the primary function of four functional conditions of school refusal behavior in children and adolescents. In the last years this scale, originally written in English, has been validated in other languages such as Turkish, Dutch, German, French, Japanese or Spanish. The aim of this communication is to present the main findings of the SRAS-R’s validations carried out in three Spanish-speaking countries: Spain, Chile and Ecuador. The results of these investigations revealed that in Spain and Chile the 3-factor model obtained the best adjustment. However, if we consider tetra factorial models, in Spain the own model composed of 18 items distributed in 4 factors was better adjusted. On the one hand, this model was successfully replicated in Ecuador adding correlations between some of the items. On the other hand, in Chile, although the 3-factor model was the one that obtained the best adjustment, the model of the Chilean version composed of the 24 original items and with a correlation between items 3 and 11 obtained the best adjustment for the four-factor models. These models remained invariant across gender and age and adequate levels of internal consistency were obtained for the four factors in all cases. These findings provide support for the use of the SRAS-R as a measure to assess school refusal behavior despite of the discrepancies found about the 3 or 4 factors model structure.

Presentation 4

Title: Identification of profiles derived from the School Refusal Assessment Scale-Revised.

(Ricardo Sanmartín López & Gonzálvez Maciá, University of Alicante, SPAIN)

Abstract: There are many causes that can justify the problems of school attendance, so there is no a single profile that characterizes these students. The aim of this communication is to present the profiles of Spanish and Ecuadorian students who refuse going to school. In these studies, 1113 Spanish children participated (M = 9.53, SD = 1.10) and 1582 Ecuadorian adolescents (M = 14.83, SD = 1.86). To identify the school refusal profiles, a non-hierarchical method quick cluster analysis was conducted based on standardized scores of the four functional conditions obtained from the School Refusal Assessment Scale-Revised. In Spain, the results revealed the identification of four profiles: Non-school refusers (44.8%), School refusers by positive reinforcement (28.6%), School refusers by negative reinforcement (13.8%) and School refusers by mixed reinforcement (12.8%). On the other hand, in Ecuador three profiles were identified: Non-school refusers (44.82%), School refusers by tangible reinforcement (42.98%) and School refusers by mixed reinforcement (12.20%). In both countries the group of mixed reinforcement was the most maladaptive profile and revealed the highest mean scores on school anxiety, anxiety, depression and stress. In contrast, the Non- School Refusers groups scored the lowest mean scores in all cases. Based on these findings, an approach is offered to the characteristics that describe the groups of students who reject school in order to be able of offering more specific attention measures according to their needs.

Presentation 5

Title: Assessing forms and functions of school absenteeism: The Inventory of School Attendance Problems.

(Martin Knollmann, Volker Reissner, & Johannes Hebebrand, LVR-Clinic Essen / University of Duisburg-Essen, GERMANY)

Abstract: Introduction: School attendance problems (SAPs) have a heterogeneous phenomenology and are associated with a wide range of risk factors. Therefore, comprehensive assessment instruments are needed in order to adjust treatment strategies according to the individual needs of the affected students. Methods: The Inventory of School Attendance Problems (ISAP) assesses both the quality and the function of a wide range of SAPs by first asking students to rate the intensity of symptoms prior to or at school and then to rate their impact on school attendance. We report its development in a clinical sample of N = 245 students with SAPs (53.5% male; Mage: 14.4). Reports regarding its validity will draw on both the construction sample (correlations with YSR, SRAS, extent of school absenteeism) and the ongoing cross-validation in convienience samples (mental health, youth welfare, public health departments etc.). Results: The 13 scales assess symptoms related to SAPs (depression, social-/performance-/separation anxiety, agoraphobia/panic, somatic complaints, aggression, school aversion), including emotional distress due to problems in the school or family context (problems with teachers/peers, dislike of the specific school, problems within the family/with parents). All scales showed good internal consistencies (α >.74). Their correlations with the YSR, the SRAS and the extent of school absenteeism indicated constructvalidity. Convergent and discriminant results regarding the cross-validation will be discussed. Conclusion: The results support the usefulness of the ISAP for a comprehensive assessment of SAPs in clinical and settings. First results of the cross-validation indicate that it might also be useful in educational and youth welfare-related settings. Further research will focus on the ability of the ISAP to screen for emerging SAPs in regular school settings.

Presentation 6

Title: Assessing the outcome of treatment for school refusal: Are we measuring up?

(David Heyne, Leiden University, THE NETHERLANDS; Johan Strömbeck, Magelungen Utveckling AB, SWEDEN; Martin Bergström, Lund University, SWEDEN; Katarina Alanko, Åbo Akademi University, FINLAND; Robin Ulriksen, Statped - National Service for Special Needs Education, NORWAY; Martin Karlberg, Uppsala University, SWEDEN)

Abstract: To date, there is no consensus on the way in which the outcome of treatment for school refusal is measured. Most people would agree school attendance is an important outcome but there has been little discussion of other primary outcomes that ought to be measured. A group of researchers from the Netherlands, Sweden, Norway, and Finland conducted a systematic review of constructs, instruments, and procedures reported in the literature on treatment for school refusal. All studies reported in English, Dutch, Norwegian, Swedish, Finnish, or Danish since 1980 were included, irrespective of study design. This presentation focuses on the results of the review and implications for research and practice. Results include the frequency with which constructs are studied, the frequency with which specific instruments are used, and research procedures such as the time-frames for measurement. The presenters will reflect upon the breadth of constructs included (e.g., are quality of life and school engagement often omitted), the characteristics of commonly used measures of outcome (e.g., reliability and validity; availability in different languages), and variability in research procedures. A framework for the assessment of outcomes following treatment for school refusal is being prepared. It will include recommendations for core and additional constructs to be measured depending on researchers’ aims and resources. Such a framework can contribute to greater consistency across studies, with benefits for future meta-analytic research and international comparisons. The framework also provides guidance for practitioners contemplating routine evaluation of their clinical work.

Chair: Joshua Childs

Professionals working in schools, youth welfare, or in health care institutions are often faced with uncertainty when they want to prevent students from being absent in school or to help those already affected by problematic absenteeism: How high must absence rates be to signal serious psychosocial problems? Is being absent in school a red flag for the presence of a mental disorder? Or is being absent in school so common nowadays that it must be viewed as a sign of the ever-changing times? This symposium will help to answer these questions by presenting empirical evidence from five European countries that is directly linked to grassroots work in the field of school absenteeism. The first paper by Gil Keppens from Belgium analyzes how the extent of unauthorized school absences is linked to academic achievement outcomes. The next two contributions by Kristin Gärtner Askeland and Katie Finning and colleagues present data from two large population-based surveys in Norway and the UK on the association between school absenteeism and mental health problems in adolescence. The fourth presentation by Laelia Benoit and colleagues is based on the first online health survey on school refusal in France, which not only assessed the youths’ mental health status and their school attendance, but also their use of educational and mental health services and the impact of their school absenteeism on their parents. The last presentation by Katarina Alanko and Åbo Akademi focuses on the change vs. stability of absence rates in Finland during the last 22 years, using data 8th and 9th graders from a large national annual survey.

Presentation 1

Title: Differentiating between nonproblematic & problematic school absenteeism: How much absence is too much absence?

(Gil Keppens, Vrije Universiteit Brussel, BELGIUM)

Abstract: School absenteeism is known to hamper academic achievement and predict a range of school-related problems. In addition, school absenteeism tends to increase over time: what starts out as occasional absenteeism easily evolves into regular absenteeism which results in early school leaving. To counteract this process of disengagement, strategies aimed at fast detection and early intervention are paramount. In this regard, the question of 'how much absence is too much absence' is a principal question that requires close investigation. Indeed, what constitutes as problematic absenteeism seems to vary from country to country and from school to school. Additionally, empirical research investigating differentiation between problematic and non-problematic absenteeism remains scarce. Against this background, this paper uses official registration data on school absences from 2014-2015 among pupils of secondary education in Flanders (N= 291968) to examine the relationship between the number of days unauthorized absent from school and (a) the sum of absences in one school year and (b) the academic achievement at the end of the school year. Our results indicate that there is no 'safe threshold' for what amounts to harmful or problematic school absenteeism. In the discussion we elaborate on the implications of our findings for conceptualizing school absenteeism and for the development of truancy interventions.

Presentation 2

Title: Is school absence related to milder mental health problems in adolescence?

(Kristin Gärtner Askeland, NORCE - Norwegian Research Centre, NORWAY)

Abstract: Continued school absence in adolescence can lead to a range of negative educational and health related consequences. Mental health problems, especially anxiety and conduct problems, have been consistently related to higher absence from school. Still, the majority of studies have focused on diagnosable metal disorders or students with high levels of absence, and less is known about the associations between all levels of absence and milder mental health problems in community samples. Data stem from the population-based [email protected], conducted in Hordaland County, Norway, in 2012. The current study included 8222 adolescents between 16 and 19 years old who consented to linkage to official registry data on school absence. Symptoms of depression, inattention, hyperactivity/impulsivity, conduct problems and anxiety were measured by self-reports. Investigating the association between the individual mental health problems and school absence continuously, the number of days and hours absent were predicted by higher symptom scores of depression, inattention, hyperactivity/impulsivity, conduct problems and anxiety. Including the mental health problems in the same analysis to investigate their independent contributions, only symptoms of depression, inattention and conduct problems were significantly associated with school absence. The same pattern was found when categorizing total absence into quintiles and when investigating the associations with more serious mental health problems (indicated by symptom scores above the 90th percentile). The present findings confirm the role of mental health problems in explaining school absence at different levels, and suggest the importance of symptoms of depression and inattention as contributors to absence in late adolescence.

Presentation 3

Title: Relationships between emotional disorder and absence from school in the British Child and Adolescent Mental Health Surveys Surveys.

(Katie Finning, O. Ukoumunne, D.A. Moore, & T. Ford, University of Exeter, UK)

Abstract: Emotional ill health may be associated with poor school attendance, but a recent systematic review identified substantial weaknesses with the current evidence-base and a lack of longitudinal research. We undertook a secondary analysis of the 2004 British Child and Adolescent Mental Health Survey and its 2007 follow-up to explore relationships between emotional disorder/difficulties and total, authorised and unauthorised absence. Emotional disorders (anxiety and depression) were assessed using the Development and Wellbeing Assessment, and emotional difficulties using the Strengths and Difficulties Questionnaire. Teachers reported the number of total and unauthorised absences in the previous term, and authorised absences were derived by subtracting unauthorised from total absences. Multivariable regression was used to examine cross-sectional and bi-directional relationships between emotional disorder/difficulties and absence. In cross-sectional analyses anxiety, depression and emotional difficulties were associated with higher rates of all types of absence. The strongest association was observed for depression in relation to unauthorised absence. Baseline depression and emotional difficulties, but not anxiety, were associated with higher rates of unauthorised absence in 2007, and depression was also associated with higher rates of total absence. Baseline total and authorised absences were associated with higher levels of emotional difficulties at follow-up. We detected strong cross-sectional associations and some evidence for bi-directional relationships between emotional disorder/difficulties and school absence. Our findings question the commonly-held belief that unauthorised absences are associated with behavioural but not emotional disorders. Health and educational professionals should be aware that poor attendance may indicate emotional ill health regardless of the absence “type”.

Presentation 4

Title: An overview of school refusal in France: The first national health survey, and how we made it possible.

(E. Chan Sock Peng, University of Paris-Saclay, FRANCE; C. Barry, French National Institute of Health and Medical Research [Inserm], FRANCE; P. Nadin, University of Paris Descartes, FRANCE; M.R. Moro, French National Institute of Health and Medical Research [Inserm], FRANCE; B. Falissard, University of Paris-Saclay, FRANCE; L. Benoit, French National Institute of Health and Medical Research [Inserm], FRANCE)

Abstract: Background: School refusal is an increasingly common motive for consultation in child psychiatry. However, to date little is known about school refusal epidemiology in France. In 2018, the French National Institute of Health and Medical Research (Inserm) co-designed the first national survey on school refusal, together with a family support group and the Ministry of National Education. Methods: An online survey was designed for parents of children and teenagers with school refusal in France. Participants were contacted via online family support groups, medias (newspapers, TV, radio), and via health professionals and educators. Questions addressed the children demographical characteristics, mental health comorbidities, educational pathways, access to mental health care and access to educational support. Questions ranged from the diverse therapeutic methods being used, to parents’ feeling of being supported by both school professionals and health professionals. The impact of school refusal on parents’ professional lives was addressed, as well as the one of health costs on the family budget. Results: The survey received more than 1850 complete responses and the statistical analysis is currently ongoing. Statistical biographical methods will allow exploring factors that may impact the individual pathways to care and the duration of school refusal. During this presentation we will discuss the results of this study and provide recommendations to improve public health and educational policies.

Presentation 5

Title: Is the rate of school absence changing as society changes? A study based on Finnish national data.

(Katarina Alanko, Åbo Akademi University, FINLAND)

Abstract: Do rates of school absence fluctuate as a function of societal changes? Can we see an increase in school absence rates after internet and smart technology was introduced in the 1990ties? Is it possible to see the influence of e.g. large scale efforts to diminish bullying and school absenteeism in prevalence rates in Finnish national data? In the US, truancy rates have remained the same from 2002 to 2014 (Maynard et al., 2014), despite efforts to diminish truancy. The purpose of the present study is to study changes in rates of school absence from 1996 to 2018. Data from a large national annual survey, Health in Schools, will be used. Responses from 8th and 9th graders will be used. Preliminary data from the comparisons of absence rates over time will be presented at the conference.