School refusal treatment – Understanding school refusal podcast

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Transcript

Deborah Howell (Host): Hello. I’m Deborah Howell the host of School Refusal, a special podcast series from Rogers Behavioral Health. This is episode four of our four part series where we will look at treatments and solutions that help with the issue of school refusal. I’d like to welcome Dr. David Jacobi, a licensed clinical psychologist who specializes in using cognitive behavioral therapy for the treatment of OCD and anxiety disorders. Dr. Jacobi serves as the lead psychologist of child and adolescent CBT services for Rogers Behavioral Health. Welcome Dr. Jacobi.

David Jacobi PhD (Guest): Hi Deborah. Thanks for having me.

Host: A true pleasure. Let’s dive right in. When a child is refusing school, how can educators and parents work together to find a solution?

Dr. Jacobi: It’s certainly an important piece of this is how as teachers, school counselors, and then certainly as parents, do we kind of coordinate our efforts to help a child who is refusing school. Oftentimes, with school refusal, as we’ve talked about previously, it can get to the point where we are dealing with a diagnosable mental health disorder such as anxiety or even depression. So, it becomes even more important that for example, parents are involved in that process of their child getting well. What I mean by that is that parents will for example, engage in things that are called accommodations, so it certainly sounds like a really nice word and it certainly the behaviors on the part of parents and even teachers are well-intended. They are designed to alleviate the child’s distress. They are designed to improve functioning so the child for example, doesn’t fall behind. But accommodations are things like doing the child’s homework for them, because the child is unable to because of them feeling down and blue or because their anxiety disorder interferes with their ability to do that.

It may be that the parent helps the child in terms of getting ready in the morning, going through different rituals for example that are part of obsessive compulsive disorder. Again, they are intended to help the child be less distressed, more functional, but ultimately, they work sort of against what we are trying to accomplish with the treatments for these particular disorders.

So, what we want to make sure that parents are able to do during the course of treatment is to begin to gradually withdraw those accommodations so the child can take on a more independent role in getting well. And the same thing would apply with teachers. We really want teachers, even though it’s their general nature to be as helpful as they possibly can; we want them also to withdraw some of those accommodations in a way that allows the child to work through and problem solve different situations that allow them to be successful.

So, sort of in our world in dealing with these anxiety and mood disorders, we really want to partner with both the parents and school counselors and teachers to come up with a plan that allows that child to transition back into school and then also be successful when they are back in school. So, we have to include the parents. We have to include educators, school personnel to really make this a successful outcome.

Host: Let’s talk a little bit about that partnership. What is the role of educators?

Dr. Jacobi: So, it’s going to be just by nature of how much we are really asking of school counselors and educators is; it can really be a few different things. One is through podcasts such as this and other information; we really want them to be able to identify and understand when a child might be struggling with an anxiety or depressive disorder. So, there are a whole variety of different symptoms that we look out for in the school setting so, for example a child checking for mistakes, incomplete assignments, seeking lots of reassurance, maybe isolating more than they are used to, not being involved in class discussions or participation, truancy or chronic lateness. All of these things are sort of symptoms that an educator might notice and then be able to identify what it is that might be going on with this child.

From there, again, based on sort of that assessment, it might be an opportunity for the teacher or the school counselor to talk with the parents to share kind of what they’re observing and seeing how it’s playing out in the school setting. And then from there, it sort of depends. In some instances, where there is maybe some mild issues related to something like social anxiety; the teacher or school counselor may feel comfortable coming up with some different goals or exposures for that child to work on that might really improve their function in school to make it more likely that they are going to continue to go to school. But in many cases, if it’s to the point where the child is refusing school quite frequently, it’s probably something that’s a little bit more significant. So, an anxiety disorder, a mood disorder that really needs professional help.

In that case, then the educator can begin to make that referral to an outside resource such as someone who specializes in the treatment of anxiety or mood disorders to kind of work on that mental health issue.

Host: Got it. Okay, so that’s the role of educators. What about the role of parents?

Dr. Jacobi: The parents – it’s hard to understate or overstate I should say, the role of parents. They are an integral part of our treatment programs here at Rogers. We incorporate them. We want them to be involved because we want them to understand through psychoeducation what are the symptoms and issues that their child is dealing with. How is it that this generalized anxiety or OCD is interfering with their child’s ability to function?

We want them to learn how to do the treatment. We want parents to be involved in doing for example, exposure work or behavioral activation as it relates to depression. We also want as I mentioned earlier, for them to withdraw those accommodations, those well-intended behaviors designed to help their child be more functional to reduce their distress because we really want the child again, to take on more of their own sort of independent role in not only confronting their fears but feeling like they have that sense of self-efficacy like I can impact my environment, I have the skills and the knowledge to change my environment in a way that allows me to be more functional. The other thing that’s important I think as well Deborah, is this idea of parents getting their own help should they find that it’s difficult to withdraw those accommodations or support their child in the way that they need to.

Host: I have a final question for you today. What are some indicators that a child may need professional help to address the school refusal behaviors?

Dr. Jacobi: Sort of chronic, when the child experiences more distress, when they are not able to function in a way that we would expect them to across multiple situations, so school, home, socially; that’s when it becomes an issue that we need to kind of look a little bit further to address kind of what is the underlying reason for this.

So, even in the situation with schools, oftentimes, they will initiate a 504 plan which is designed to provide accommodations for kids who are struggling and even in those instances, those accommodations may not be enough. And the child may need again, additional support through mental health treatment and so forth. So, it tends to be a matter of degree certainly to some extent and also just really the inability to function in a way that we would expect our child to be able to function.

Host: Absolutely. Well thank you so much for joining us Dr. Jacobi. It’s really been a pleasure having you with us and thank you so much for the crucial work that you do.

Dr. Jacobi: Thank you Deborah.

Host: Rogers Behavioral Health is working each day to ensure those with mental health challenges have access to the highest quality of care and most effective treatment available today. To learn more about the many ways Rogers can help children, teens, families and schools please visit www.rogersbh.org today. That’s www.rogersbh.org. I’m Deborah Howell. Thanks for tuning in. We’ll see you next time. Have a wonderful day.