Anxiety-Based School Refusal Behavioral Interventions

1
Anxiety-Based School Refusal: Behavioral Interventions and Resources for School
Personnel
Michelle Spencer and Rachel Trainque
Marist College
2
Table of Contents
Part I: Introduction to School Refusal, The Four Functions of School Refusal, & Coach Cards
Chapter 1: Introduction to School Refusal………………………………………………...3
Chapter 2: The Four Functions of School Refusal………………………………………...5
Chapter 3: School Refusal Intervention: Gradual Re-Entry Plan with Rewards………….6
Chapter 4: School Refusal Intervention: Relaxation and Guided Imagery (RGI).............10
Chapter 5: School Refusal Intervention: Cool Kids………………………………..…....13
Part II: Intervention Websites

Chapter 6. Website Resources………….……………………………………...………...18
A. National Social Anxiety Center………………………………………………….19
B. Healthy Children.org……………………………..……………………………....21
C. Attendance Works………………………………………………………………..22
Part III: Mobile Apps

Chapter 7: Mobile Apps………………………………………………………………….24
Part IV: Intervention Kits

Chapter 8: Intervention Kits……………………………………………………………...25
A. Gradual Re-entry Plan with Rewards…………………………………………....26
B. Relaxation and Guided Imagery (RGI).................................................................31
Appendix A: School Re-Entry Plan Checklist………………………....………..…………..…...34

Appendix B: Daily Attendance Sheet with Goals……………………………………………..…38
Appendix C: Daily Home Report Card…………………………………………………..………40
Appendix D: Daily School Report Card………………………………………………..………..41
Appendix E: RGI Scripts…………………………………………………………………..…….42
Appendix F: School Refusal Assessment Scale-Revised (P)........................................................59
Appendix G: Short State-Trait Anxiety Inventory (STAI).……………....……………………...64
Appendix H: Deep Breathing Relaxation Exercise - Homework Assignment…………………..65
Appendix I: Spence Children’s Anxiety Scale (SCAS)……….…....….……………....…….…..66
Appendix J: Spence Children’s Anxiety Scale, Parent Report (SCASp)......................................68
Appendix K: Children’s Automatic Thoughts Scale(CATS)........................................................71
About the Authors………...……………………………………………………………………76

3
Introduction to School Refusal
School refusal behavior is a child-motivated denial to attend school and/or remain in
class for the entire school day, causing excessive inexcusable absences, or absenteeism. School
refusal behavior is characterized by habitual absences, periodic absences or missed classes,
excessive tardiness, and deep dread towards school that causes pleas for future nonattendance.
School refusal may be displayed by any or all of these behaviors, and may vary on a daily basis
(Kearney, 2008).
A student’s onset of school refusal behavior may be sudden or gradual. Frequently, this
behavior is observed after long periods of time away from school, such as an illness or a school
holiday. In other occasions, the student’s absence occurs sporadically, but a pattern of
nonattendance begins to emerge. There are specific features school personnel should use as
criteria for identifying school refusal behaviors:
1. Serious difficulty in attending school which results in a prolonged absence.
2. Severe emotional distraught, which may appear as excessive fearfulness, extreme
tempers, and somatic complaints that appear at thought of attending school.
3. Staying home, even with a parent’s knowledge they should be at school.
4. Extreme antisocial behaviors, such as stealing, destructiveness, lying, etc.
(Thambirajah, Grandison, & De-Hayes, 2008).
Several factors contribute to school refusal behavior. Child factors include and are not
limited to: separation anxiety, anxiety when interacting with peers, fear of failure, poor self-
esteem, worrying about a parent or parents well-being, and an over-dependence on a parent or
parents. School factors include: bullying, transitions, unidentified or specific learning
disabilities, difficulty in an academic subject, and conflicts with peers. Family factors include:
4
recent family transitions, a recent loss in the family, significant event changes in the family,
parents have anxiety or another mental health problem, the father is not as involved in the
students life, parents are easily stressed by their student’s anxiety symptoms, and the parents are
over-involved and/or overprotective (Thambirajah, Grandison, & De-Hayes, 2008).
Without intervention, there are short and long-term adverse consequences to continuous
school refusal behavior. Studies indicate nonattendance adversely affects students learning and
achievement. Additionally, nonattendance increases a student’s risk for early school dropout.
Nonattendance is associated with additional behavior problems, such as social maladjustment
(Maynard, Heyne, Brendel, Bulanda, Thompson, & Pigott, 2018).

5
The Four Functions of School Refusal
School refusal is marked by a variety of different symptoms and behaviors. Therefore,
classifying and addressing school refusal is a challenge. Although many have tried to organize
the behaviors into clinically-derived or statistically-derived groups, there has been no success in
organizing them while also capturing the entire population of students exhibiting school refusal.
For example, using terms such as “school refusal” or “school phobia” only covers students
experiencing absenteeism (Kearney, 2002).
In order to address this issue, a functional model was developed to classify school refusal
behavior based on its function, rather than the symptoms being exhibited. The functional model
revealed children typically refuse school for one or more of the following reasons: 1) to avoid
school-related stimuli that provoke negative affectivity (i.e. tests, school bus); 2) to escape from
various aversive situations at school (i.e. social); 3) to obtain attention from significant others; 4)
to obtain tangible reinforcement outside of the school setting. While the first two functions refer
to youth who are refusing school in pursuit of negative reinforcement, the last two functions refer
to youth who refuse school in pursuit of positive reinforcement. Some students may exhibit
school refusal for just one of these functions, but some youth may display school refusal
behaviors for a combination of these four functions of behavior. An example of the behavior
items presented on the Revised Child-version School Refusal Assessment Scale are offered by
Kearney, which also identifies the corresponding functions of each item (Kearney, 2002).
6
Intervention 1: Gradual Re-entry Plan with Rewards
Description: This plan uses a combination of interventions to address excessive absences and
help students with school refusal to re-enter school in a gradual manner. Parents and teachers
will collaborate and develop the gradual school re-entry plan. The plan will address which steps
should be taken when a child refuses to go to school, or has been absent for a long period of time
and has difficulty returning to school. Forced school attendance may be appropriate for younger
students or those with mild school refusal, so this reentry plan is recommended for older students
or students who are extremely anxious or depressed, but may be used for all populations if forced
school attendance proves unsuccessful (Wimmer, 2010). The re-entry plan will incorporate a
rewards system to add motivation for the student to attend school and achieve the goals on the
reentry plan, with the objective of increasing school attendance. Rewards tend to be central to
effective school interventions, as they serve as the motivational “engine” driving successful
interventions (Intervention Central, n.d.). As an exposure-based plan, it is intended to reduce the
child’s anxiety associated with school attendance, making it easier for them to attend school
(Maynard et.al, 2015). Additionally, the rewards system helps students whose function of school
refusal is to seek tangible rewards. Home-school daily report cards are used as part of the reward
system as well as a way to maintain school to home communication.
Target: Primarily students grades 6-12 displaying school refusal and those with extreme anxiety
or depression leading to school refusal. It may be used for any student who is exhibiting school
refusal if forced attendance proves unsuccessful.
Location: In-school and at home.

7
Materials:
- School Re-Entry Plan Checklist (Appendix A).
- Daily Attendance Sheet with Goals for Progress Monitoring (Appendix B).
- Daily Home Report Card (Appendix C).
- Daily School Report Card (Appendix D).
- Rewards Cards.
- Rewards.
- Re-Entry Plan.
Frequency: Daily until the student is able to arrive, and remain at, school for the entirety of the
day without displaying any hesitancy.
Progress Monitoring: Baseline will be a review of previous attendance records, including early
pick-ups and tardies. Progress will be monitored through daily attendance sheets and daily home
and school report cards.
Directions/Intervention Steps:
Step 1: Parents and teachers will meet with student to collaboratively develop a re-entry plan
and a “safe” staff member will be identified (a teacher or staff member the student reports being
closest with).
Step 2: Re-entry plan checklist is reviewed.
Step 3: Student will identify rewards he/she “likes a lot”, “likes a little”, and “not at all” for
home and school.
Step 4: Identified safe teacher will collaboratively develop a school reward system with the
student.
Step 5: Parent will collaboratively develop a home reward system with the student.
8
Step 6: Re-entry plan will be implemented and goals are tracked on a weekly attendance sheet:
Day 1: Student will arrive at school but not go inside.
Day 2: Student will enter and visit in the front office with school personnel for a chosen
amount of time he/she feels comfortable with.
Day 3: Student will stay for one class of their choice**.
Day 4: Student will stay for two classes of their choice.
Day 5: Student will stay for three classes of their choice.
Day 6: Student will stay for four classes of their choice.
Day 7: Student will stay for entire school day, attending all of their classes.
**Part-time schedules can be modified, such as having the child only go for lunch, go in
at 2pm and leave at 3pm, go in for an hour in the morning, or stay in a room other than
their classroom for an hour of the day (Kearney, p. 82).
Step 7: The home report card will be completed each morning by a parent, filling in whether or
not the child makes it to school that day.
Step 8: Student will check in with identified safe teacher before and after school every day
throughout the intervention.
Step 9: The daily school report card will be filled out by the student’s class teachers throughout
the day.
Step 10: The attendance sheet will be filled out at the end of the day by the student’s “check-
out” teacher.
Step 11: Each day a goal is achieved, the student will choose a reward from their in-school
reward choices.
9
Step 12: Child will present attendance sheet and both report cards to parents after school each
day.
Step 13: Each day a goal is achieved, the child will receive a reward at home as well.
Step 14: Attendance will continue to be tracked on attendance/goal sheet until the student can
consistently arrive and remain at school for the entire day.
Step 15: School/home reward system and report cards will continue as well until the child can
consistently arrive and remain at school for the entire day.

10
Intervention 2: Relaxation and Guided Imagery (RGI) for Anxiety-Based School Refusal
Description: Relaxation combined with Guided Imagery (RGI) is an emerging alternative
intervention to aid in the reduction of anxiety. RGI supports students who are experiencing
anxiety-based school refusal through an avoidance of stimuli (e.i. bathrooms, teachers, cafeteria,
peers, etc.) that provokes a generally negative effect (i.e. crying, distress, nausea, etc.) (Veena &
Alvi, 2016). This intervention is based upon the theoretical approach that the mind and body
interact in determining mental and physical health outcomes. The RGI technique involves
general relaxation exercises to reduce stress with a combination of purposefully and consciously
inducing mental images in order to obtain the desired outcomes. Imagery is a mental process
that draws on the senses and consists of mental representations relative to external events.
Imagery incorporates all five senses. It involves not only visual pictures in the mind, but
hearing, smell, touch, taste and movement. RGI provides a means of alternation and liberation
from distortions that may unconsciously direct a student’s anxious response to a stimulus.
Target: Students grades 6-12, who have been identified by the School Refusal Assessment Scale
(SRAS).
Location: Classroom or quiet location
Materials:
- The 7 RGI scripts (Appendix E).
- School Refusal Assessment Scale (SRAS) [Appendix F].
- Short State-Trait Anxiety Inventory (STAI) [Appendix G].
- Deep Breathing Relaxation Exercise - Homework Assignment (For Progress Monitoring
Purposes and Home Component) [Appendix H].

11
Frequency: The RGI intervention is implemented in seven phases. During Phase III and V, the
RGI intervention includes the 7 RGI intervention sessions. Each session varies in time, but is
approximately fifteen minutes. Sessions are implemented on alternate days (i.e. every other
day). Students will have homework to complete once a week.
Duration: 5 Weeks.
Progress Monitoring: The student’s progress with the RGI intervention will be measured via
the STAI. Specifically, the STAI is administered in Phase I. It is additionally administered after
the last session in Round IV and VII. An additional measure of progress includes the Deep
Breathing Relaxation Exercise. This is a homework assignment and should be completed at
home. This homework assignment is given to the student on the first and fourth session. The
student should complete the assignment and hand it back to the implementer by the next session.
Directions/Intervention Steps: 7 Intervention Phases:
Phase I: Pre-Testing Phase - This phase consists of identifying students exhibiting anxiety-based
school refusal through the administration of the SRAS and the STAI.
Phase II: Final Sample - The final sample was selected by matching anxiety levels of the
participant from the SRAS (obtained in Phase I).
Phase III: (RGI Round I) - RGI intervention implementation for 7 sessions, three times weekly,
on alternate days. This is the first round. Students are given the Deep Breathing Relaxation
Exercise as homework once a week on the first and fourth session. This homework assignment is
completed at home and parents will write a check on the homework if the student has completed
the assignment.
First Session: Beach Visualization Relaxation - This session includes brief relaxation
techniques to start. It then guides the student through imagining spending time on a beach.
12
Second Session: Woodland Walk - The beginning of this session starts with relaxation
techniques and then guides the student though an imaginary walk in the woods.
Third Session: Hot Air Balloon Ride - Within this session, the student is guided through a
hot air balloon ride with relaxation techniques incorporated throughout the script.
Fourth Session: Frosty’s Happy Paintbrush - This session includes brief relaxation
techniques to start. The student is then guided through imagining themselves painting.
Fifth Session: The Magic Shell - A brief relaxation technique begins this session. The
student is then guided along a beach shore in which the student discovers a seashell.
Sixth Session: Still Pond…Ancient Forest - The beginning of this session starts with
relaxation techniques and then, the student is guided through a walk in a quiet forest and a
still pond.
Seventh Session: The Rainforest - This session includes brief relaxation techniques to
start. The student is then guided through a walk along the rainforest floor.
Phase IV: Testing - After 7 sessions of the RGI intervention, the STAI is administered to the
participants again.
Phase V: (RGI Round II) - RGI intervention implementation for another 7 sessions in the same
order, three times weekly, on alternate days. This is the second and last round.
Phase VI: (POST) - After the completion of the two RGI rounds, an assessment of post testing
for state anxiety through the STAI is administered once again.
Phase VII: Follow-Up Testing - After a gap of one month from post-testing, a follow-up
administration of the STAI is completed.

13
Intervention 3: Cool Kids
The Cool Kids program is a program incorporates the education and management of a
child’s anxiety to both the child and the child’s parent(s). This program may be implemented
individually or in group. The program involves the participation of both the child and the child’s
parent(s). The goal is to instruct clear, practical skills to both parties. Cool Kids utilizes
instructional manuals for the sessions and has a variety of manuals for different age groups.
Several manuals incorporate various comorbidities of anxiety and the delivery of the program in
school settings. The Specific goals of the program include: reduce the symptoms and amount of
life interference caused by anxiety, reduce avoidance, reduce family distress, increase
confidence, improve peer relationships, and increase engagement in extra-curricular activities.
The essential components of the program are: psychoeducation, cognitive restructuring,
facilitating the development of parent skills, in-vivo exposure, engaging in appropriate social
skills, and coping strategies. A homework component is included.
Target: Children and adolescents suffering from anxiety disorders. For ages 7-17.
Location: Room space (two group rooms if running in groups).
Materials:
- Whiteboard and markers.
- Program manuals for parents and children.
- 1 group leader (2 if running in groups).
- Spence Children’s Anxiety Scale (SCAS) [Appendix I].
- Spence Children’s Anxiety Scale, Parent Version (SCASp) [Appendix J].
- Children’s Automatic Thought Scale (Appendix K).
- Child Behavior Checklist (CBCL).

14
Frequency:
- Individual format: Eight hour-long weekly sessions followed by two hour-long biweekly
sessions.
- Group format: Eight two-hour long sessions followed by two two-hour long sessions.
- In the school setting, it is recommended interventionists break up these sessions into a
time frame that is feasible for that school.
Duration: 12 weeks.
Progress Monitoring: Spence Children’s Anxiety Scale (SCAS) and Spence Children’s Anxiety
Scale, Parent Version (SCASp). These scales are administered before and after program
implementation.
Directions/Intervention Steps: Before implementation of this program, school personnel can
obtain the necessary training through a training workshop provided through The Reach Institute:
http://www.thereachinstitute.org/. Typically, this is a 1-day workshop, but is occasionally
delivered over 2 days.
Step 1: (Pre-Implementation Stage):
- All children and their parents are interviewed by the group leader using Anxiety
Disorders Interview Schedule (ADIS) from the Diagnostic and Statistical Manual of Mental
Disorders (4th ed. [DSM–IV].
- To measure symptoms of anxiety, children complete the Spence Children’s Anxiety
Scale (SCAS; Spence, 1998).
- Parents complete the parent version of the Spence Children’s Anxiety Scale (SCASp;
Spence, 1998).
- Children complete the Children’s Automatic Thought Scale (CATS).

15
- To assess related and comorbid symptoms, parents also complete the Child Behavior
Checklist (CBCL; Achenbach, 1991).
Step 2: (Intervention Implementation Stage): The Cool Kids program involves 8-10 sessions and
2 hour sessions with children, which is also supplemented by 2 parent information sessions (each
2 hours in length). The program may only be facilitated by a trained psychologist or school
counselor. The program is supplemented by two client workbooks - one for children and one for
parents. The school version of the Cool Kids program comprises the following sessions
(Commonwealth of Australia, n.d.).:
Session 1 - What, Why and How? An Overview of the Program - This session
incorporates the psychoeducation component on the program. Group leaders introduce the link
between feelings and thoughts for the children. Parents are introduced to the causes and nature
of childhood anxiety disorders, such as anxiety-based school refusal.
Session 2 - Learning to Think Realistically: This session encombasses cognitive
restructuring. The concept of cognitive restructuring is introduced underneath the title,
“Detective Thinking”.
Session 3 - Rewards: In this session, parents are taught the strategies to help manage their
child’s anxiety. Such strategies include:
1. Attending to brave behaviors.
2. Reducing reassurance seeking.
3. Increasing child’s independence.
4. Modeling courageous behavior.

16
Session 4 - Fighting Fear by Facing Fear: This session introduces gradual exposure or
response prevention. Parents and children create and carry out relevant hierarchies of the
stimulus evoking anxiety, using step ladders.
Session 5 - Creative Exposure: This session incorporates additional gradual exposure or
response prevention.
Sessions 6-9 - Building Skills While Facing Fears: These sessions involve practice of
detective thinking, child anxiety management, and planning of live exposure homework up the
steps of each hierarchy. Additionally, these sessions encompasses cognitive restructuring and
exposure therapy with an emphasis on addressing obstacles and maintaining treatment.
Session 10 - Maintaining Gains and Coping with Set-Backs: Supplementary training such
as problem-solving skills, responding to bullies, and assertiveness skills are addressed within the
last session. The Parent Information sessions contained within the school version of Cool Kids
are as follows:
Session 1 - Program Overview and Early Skills
Session 2 - Behavior Management and Stepladders
- Both child and parents receive written summaries, worksheets, and guides for home
practice during sessions.
● Cool Kids School Kit: $65
● Cool Kids Parent & Child workbooks: $35 per set
● Cool Kids Parent & Adolescent workbooks: $35 per set
● One-day training: (cost available upon application)
Step 3: (Post-Implementation Stage): All parents are contacted by telephone 3 months after
finishing the program for an informal check on their child’s progress. A further long-term follow
17
up is conducted 12 months after the post-treatment by program facilitators. Children and parents
once again fill out the following questionnaires: SCAS & SCASp.
18
Part II:
Intervention
Websites
19
Website 1: National Social Anxiety Center
Link:
http://nationalsocialanxietycenter.com/2016/09/21/social-anxiety-and-school-refusal-part-1/
Description: This website offers information on various aspects of social anxiety, which is a
common comorbid diagnosis with school refusal behaviors. This particular link is to Part 1 a 2
part web series which discuss the relation of social anxiety to school refusal behaviors. Part 2 is
clickable from the part 1 page. Part 1 offers parents and teachers a general overview of school
refusal, as well as the four functions of school refusal with a short description of each of the
functions. A comparison between school refusal and truancy is also provided through bulleted
points. While school refusal behaviors and truancy may seem similar, they are characterized by
different behaviors and must be addressed as such. Therefore, it is important to be able to
differentiate between the two. Statistics on social anxiety, as well as symptoms exhibited in
school are also offered, with a list of places to receive help concluding Part 1.
Part 2 is accessible by clicking a link in the top right-hand corner of the Part 1 page.
Similar to Part 1, Part 2 is beneficial for the parents of students who are exhibiting school
refusal and school personnel. This page also begins with a brief overview of school refusal, but
provides slightly different information than Part 1. This page addresses the more severe aspects
of school refusal, such as how to determine when school refusal has become a crisis. This page
offers a section for parents titled, “What Can Parents Do?”, which gives two possible actions
parents should take when school refusal has become a crisis. One of the suggested steps parents
should take is seeking a comprehensive evaluation. The following section covers what parents
should do while they are waiting for an evaluation for their child. Lastly, this page offers a
section for school personnel stating what schools can do for school refusal, what they can do
20
while waiting for the evaluation, what they can do after the evaluation, and a list of helpful
resources available for schools. Additionally, a variety of “websites of interest” are listed at the
bottom of this page as well.

21
Website 2: healthychildren.org
Link: https://www.healthychildren.org/english/health-issues/conditions/emotional-
problems/pages/school-avoidance.aspx
Description: This website is specifically designed for parents of students who are exhibiting
school refusal behaviors. The site is designed by the American Academy of Pediatrics and is
stated as being “Powered by pediatricians. Trusted by parents.” The site also has an option on the
top visitors can click if they want to view the website in Spanish instead of English.
Furthermore, the site gives viewers the option to listen to the site, having the English site read to
them in English and the Spanish version of the site read to them in Spanish. The site begins by
giving a definition and brief overview of school avoidance. It then goes on to explain that, when
school avoidance is caused by school-related anxiety, some somatic symptoms being displayed
by the child may be ways to communicate emotional struggles with issues such as fear of failure,
actual physical harm, etc.
The site lists a wide variety of tips for concerned parents on how they can help their child
who is exhibiting school avoidance behaviors. These tips are briefly stated in a bullet point,
followed by a short explanation of how to carry it out and/or why it is helpful for the child’s
school avoidance behaviors. For example, a parent may talk with their child about the reasons
why they do not want to go to school, which is followed further by explaining that parents should
consider all of the possibilities and state them for their child. Following the list of tips is a short
section on when to seek help for your child’s school avoidance, concluded by a list of additional
helpful information and resources. The information and resources list offer resource links related
to many topics, including bullying, friendship, and attendance issues.

22
Website 3: Attendance Works
Link: http://www.attendanceworks.org/
Description: Attendance Work’s mission is to advance student success and reduce equity gaps
by reducing chronic absence. This organization advocates for better federal, state, and local
policies regarding school attendance. It’s vision is for every school district in the country to not
only track chronic absence data beginning in kindergarten— or earlier— but also partner with
families and community agencies to intervene as soon as poor attendance becomes a problem for
children or particular schools. This organization has three objectives:
1) Building public awareness and political will about the need to address chronic absence.
This includes extensive media outreach as well as working with key national
organizations to spread the word about why this issue matters and explore the role federal
government can play. It also includes explaining the critical difference between chronic
absence and truancy.
2) Fostering state campaigns and partnerships by developing coalitions to advance state
and local policies that promote tracking attendance for individual students and reporting
on chronic absence to ensure schools, especially if they are low-performing, will
intervene to improve student attendance.
3) Encouraging local practice by providing technical assistance and tools to help
communities, schools and school districts monitor and work together to address chronic
absence. This includes creating peer-learning networks and using the website to provide
access to a variety of free tools and resources to over 275,000 visitors each year.
Attendance Works offers an introduction to chronic absenteeism, the different ways in
which to address the problem, the policies regarding chronic absenteeism, and several success
23
stories. It offers a variety of ways in which educators, communities, policy makers, and
foundations can take action. The website offers several tools and resources at no cost. This
website offers the following tools and resources:
1) Positive engagement resources
2) Data tracking tools
3) Building capacity resources
4) Videos
5) Toolkits
6) Webinars
7) Teaching attendance curriculum
8) Technical assistance and consultation
9) Research
10) Current news
11) Information on Attendance Awareness Month -
http://awareness.attendanceworks.org/
24
Mobile Apps
Calm HelloMind
Meditation app for beginners Helps change negative thought patterns
Android: Free Android: Free
iOS: Free iOS: Free
Dreamykid Stop, Breathe, Think

Meditation, guided visualization, and Offers fun activities to help children
affirmations for children and teens identify and process their emotions
iOS: Free iOS: Free
Android: Free Android: Free
Relaxation and Mindfulness App Sites for Kids
http://parentingchaos.com/anxiety-apps-kids/
https://www.simplepractice.com/blog/anxiety-relaxation-mindfulness-apps-kids/
25
Part III:
Intervention Kits
26
Gradual Re-Entry Plan with Rewards Intervention Kit
Directions/Intervention Steps:
Step 1: Parents and teachers will meet with student to collaboratively develop a re-entry plan
and a “safe” staff member will be identified (a teacher or staff member the student reports being
closest with).
Step 2: Re-entry plan checklist is reviewed.
Step 3: Student will identify the rewards he/she “likes a lot”, “likes a little”, and “not at all” for
home and school.
Step 4: Identified safe teacher will collaboratively develop a school reward system with the
student.
Step 5: Parent will collaboratively develop a home reward system with the student.
Step 6: Re-entry plan will be implemented and goals will be tracked on weekly attendance sheet
Day 1: Student will arrive at school but not go inside.
Day 2: Student will enter and visit with school personnel in the front office for a chosen
amount of time they feel comfortable with.
Day 3: Student will stay for one class of their choice*.
Day 4: Student will stay for two classes of their choice.
Day 5: Student will stay for three classes of their choice.
Day 6: Student will stay for four classes of their choice.
Day 7: Student will stay for entire school day, attending all of their classes.
*Part-time schedules can be modified, such as having the child only go for lunch, go in at
2pm and leave at 3pm, go in for an hour in the morning, or stay in a room other than their
classroom for an hour of the day (Kearney, p. 82).

27
Step 7: The home report card will be completed each morning by a parent, filling in whether or
not the child makes it to school that day.
Step 8: Student will check in with identified safe teacher before and after school.
Step 9: The daily school report card will be filled out by the student’s class teachers throughout
the day.
Step 10: The attendance sheet will be filled out at the end of the day by the student’s “check-
out” teacher.
Step 11: Each day a goal is achieved, the student will choose a reward from their in-school
reward choices.
Step 12: Child will present attendance sheet and both report cards to parents after school each
day.
Step 13: Each day a goal is achieved, the child will receive a daily reward at home as well.
Step 14: Attendance will continue to be tracked on attendance/goal sheet until the student can
consistently arrive, and remain at, school for the entire day.
Step 15: School/home reward system and report cards will continue as well until the child can
consistently arrive, and remain at, school for the entire day.
28
Materials provided to Implement the Intervention Include:
- School Re-Entry Plan Checklist [Appendix A].
- Daily Attendance Sheet with goals for progress monitoring [Appendix B].
- Home report card [Appendix C].
- School report card [Appendix D].
- Rewards Cards.
- Rewards.
- Re-Entry Plan.
Baseline Measure:
- Review of attendance records (including early pick-ups and tardies).
Progress Monitoring Measures:
- Daily attendance sheet with goals [See Appendix B].
- Daily home report card [see Appendix C].
- Daily school report card [see Appendix D].

29
Integrity Checklist for Implementation of Gradual Re-Entry Plan with Rewards
Intervention Component Completed? (Yes or No) Notes

1) A gradual re-entry plan was
developed collaboratively between
parents, teachers/school personnel,
and the student
2) A “safe” teacher for the student
to check in and out with has been
identified
3) Re-entry plan checklist is
reviewed
4) Student identifies rewards he/she
likes “likes a lot”, “likes a little”,
and “not at all”
5) School reward system is
collaboratively developed between
student and teacher
6) Home reward system is

collaboratively developed between
student and parent
7) Re-entry plan is implemented and
goals are tracked on weekly
attendance sheet
8) Home report card is completed
each morning
9) Student checks in each morning

and afternoon with safe teacher
10) Daily school report card filled

out throughout the day by student’s
teachers
11) Attendance sheet filled out by
“check-out” teacher at the end of the
day
30
12) Student chooses a reward at

home and school each day a goal is
achieved
13) Child will present attendance
sheet and daily school report card to
parents after school each day
15) Child will choose daily reward
each day a goal is achieved
17) Attendance is tracked until child

consistently arrives and remains at
school for full day
18) School/home reward system
continues until child consistently
arrives and remains at school for full
day
31
Relaxation and Guided Imagery (RGI) Kit
Materials provided to Implement the Intervention Include:
- 7 RGI scripts (Appendix E).
- SRAS (Appendix F).
- STAI (Appendix G).
- Deep Breathing Relaxation Exercise - Homework Assignment (Appendix H).
Baseline Measure:
- STAI, administered before implementation.
Progress Monitoring Measures:
- STAI is administered after Round II and 1 month after the last session.
- Deep Breathing Relaxation Exercise - Homework Assignment
Directions/Script for Implementation:

1. Identify students exhibiting anxiety-based school refusal through the administration of
the SRAS. Additionally, administer the STAI.
2. Select students who have matching anxiety levels.
3. Practice reading RGI scripts. Read with a soft, yet clear and audible voice. Read slowly
and steadily.
4. Start Round I. This is the first session and first day of intervention implementation. Read
the first RGI script to the student(s): Beach Visualization Relaxation. Hand out Deep-
Breathing Relaxation Exercise Homework. Tell student(s) it is due by the next session
and ask them to have their parents write a check on the sheet once it is completed.
5. Skip a day before next session. Practice reading RGI scripts, if necessary.
6. Second session: Read the second RGI script to the student(s): Woodland Walk. Collect
homework assignment.
32
8. Third session: Read the third RGI script to the student(s): Hot Air Balloon Ride.
10. Fourth session: Read the fourth RGI script to the student(s): Frosty’s Happy Paintbrush.
Hand out Deep-Breathing Relaxation Exercise Homework, tell students it is due by the
next session, and ask them to have their parents write a check on the sheet once it is
completed.
12. Fifth Session: Read the fifth RGI script to the student(s): The Magic Shell. Collect
homework assignment.
14. Sixth Session: Read the sixth RGI script to the student(s): Still Pond…Ancient Forest.
16. Seventh and last session of Round I. Read the seventh RGI script to the student's): The
Rainforest.
17. Administer the STAI to the participant(s) again.
18. This is Round II. Repeat steps 4-16.
19. Administer the STAI to the participant(s) again.
20. Administer the STAI to the participant(s) again after 1 month.

33
Treatment Integrity Checklist for Intervention Implementation:
Intervention Component Completed? Notes

Yes/No
1)SRAS and STAI were administered before intervention implementation.
2)The implementer practiced all scripts before reading them to the student.
3)Homework assignment was given to the student on the first session.
4)When giving the homework assignment, the student was told to complete
it by the next session.
5)When giving the homework assignment, the student was told to have their
parents put a check on the worksheet when it has been completed.
6)Homework assignment was collection on the second and fifth session.
7)The implementer implemented RGI on alternate days.
8)The implementer read the scripts with the corresponding day/session.
9)The STAI was administered after the last session in Round I.
10)The implementer repeated Round II exactly like Round I.
11)The STAI was administered after the last session in Round II.
12)The STAI was administered after 1 month from the last session.
34
Appendix A: School Re-Entry Plan Checklist

35
36
37
38
Appendix B: Daily Attendance Sheet with Goals
Student Name:
Goal
Day of Week/ In School? Amount of Time in Reached?
Date: (Yes/No) School? Goal (Yes/No)
Monday
Tuesday
Wednesday
Thursday
Friday
WEEK 1 EXAMPLE
Student Name:
Goal
Monday Arrive at school, but don't go in
Enter and visit in the front
Tuesday office
Wednesday Go to one class of choice*
Thursday Go to two classes of choice
Friday Go to three classes of choice
*Part-time schedules can be modified, such as having the student go in only for lunch, go in
at 2pm and leave at 3pm, go in for an hour in the morning, or stay in a room other than
their classroom for an hour of the day (Kearney, p. 82). In this case, modify the goals in the
progress monitoring chart
39
WEEK 2 EXAMPLE
Student Name:
Goal
Monday Go to four classes of choice
Tuesday Go to five classes of choice
Stay for entire school day,
Wednesday attending all classes
Thursday attending all classes
Friday attending all classes
40
Appendix C: Daily Home Report Card

41
Appendix D: Daily School Report Card

42
Appendix E: Relaxation and Guided Imagery (RGI) Scripts
A. Session 1: Beach Visualization Relaxation:
Link: http://www.innerhealthstudio.com/visualization-relaxation.html
Get comfortable. Sit in a supportive chair or lie on your back.
Relax your body by releasing any areas of tension. Allow your arms to go limp... then your
legs....
Feel your arms and legs becoming loose and relaxed...
Now relax your neck and back by relaxing your spine.... release the hold of your muscles all the
way from your head, down your neck....along each vertebra to the tip of your spine...
Breathe deeply into your diaphragm, drawing air fully into your lungs.... and release the air with
a whooshing sound....
Breathe in again, slowly.... pause for a moment.... and breathe out.....
Draw a deep breath in.... and out....
In..... out.....
Become more and more relaxed with each breath....
Feel your body giving up all the tension.... becoming relaxed.... and calm.... peaceful....
Feel a wave of relaxation flow from the soles of your feet, to your ankles, lower legs, hips, pelvic
area, abdomen, chest, back, hands, lower arms, elbows, upper arms, shoulders, neck, back of
your head, face, and the top of your head....
Allow your entire body to rest heavily on the surface where you sit or lie. Now that your body is
fully relaxed, allow the visualization relaxation to begin.
Imagine you are walking toward the ocean.... walking through a beautiful, tropical forest....
You can hear the waves up ahead.... you can smell the ocean spray.... the air is moist and
43
warm.... feel a pleasant, cool breeze blowing through the trees....
You walk along a path....coming closer to the sea....as you come to the edge of the trees, you see
the brilliant aqua color of the ocean ahead....
You walk out of the forest and onto a long stretch of white sand.... the sand is very soft
powder.... imagine taking off your shoes, and walking through the hot, white sand toward the
water....
The beach is wide and long....
Hear the waves crashing to the shore....
Smell the clean salt water and beach....
You gaze again toward the water.... it is a bright blue-green....
See the waves washing up onto the sand..... and receding back toward the ocean.... washing up....
and flowing back down..... enjoy the ever-repeating rhythm of the waves...
Imagine yourself walking toward the water.... over the fine, hot sand.... you are feeling very
hot….
As you approach the water, you can feel the mist from the ocean on your skin. You walk closer
to the waves, and feel the sand becoming wet and firm....
A wave washes over the sand toward you.... and touches your toes before receding...
As you step forward, more waves wash over your feet... feel the cool water provide relief from
the heat....
Walk further into the clear, clean water.... you can see the white sand under the water.... the
water is a pleasant, relaxing temperature.... providing relief from the hot sun... cool but not
cold....
You walk further into the water if you wish.... swim if you want to.... enjoy the ocean for a few
44
minutes..... allow the visualization relaxation to deepen.... more and more relaxed... enjoy the
ocean....
Now you are feeling calm and refreshed...
You walk back out of the water and onto the beach...
Stroll along the beach at the water's edge.... free of worries... no stress... calm..... enjoying this
holiday....
Up ahead is a comfortable lounge chair and towel, just for you...
Sit or lie down in the chair, or spread the towel on the sand.... relax on the chair or towel....
enjoying the sun.... the breeze.... the waves.....
You feel peaceful and relaxed.... allow all your stresses to melt away....
When you are ready to return from your vacation, do so slowly....
Bring yourself back to your usual level of alertness and awareness....
Keep with you the feeling of calm and relaxation.... feeling ready to return to your day....
Open your eyes, stretch your muscles... and become fully alert... refreshed... and filled with
energy.
B. Session 2: Woodland Walk:
Link: https://wholesomeresources.com/3207/woodland-walk-free-guided-imagery-script/
Begin by treating yourself to an enjoyable and satisfying stretch. Go ahead, it’s time to loosen up
and stretch so you can reclaim your energy. That’s right. Stretch all over.
And now, please allow your entire body to settle and relax comfortably . . . if your legs or arms
are crossed, please uncross them and settle yourself into whatever you are sitting or lying on.
Take in a nice big breath …fill your lungs full…and breathe out to let go from deep inside…
And now, simply follow your breath in…and out…allowing each breath to refresh you on many
45
levels.
With your eyes closed or barely open, begin to shift your attention away from the world around
you to your inner world of sensations and into your imagination. It will do you good.
Take a big breath in . . . And breathe it all the way out.
Let your imagination take you out into the woods for an adventure that will help you feel
refreshed and so you can feel like yourself again
These woods are quite special and a place where you can escape and feel safe…it’s your own
private hideaway. Pretend as if you’re there now.
It’s the perfect kind of day to be outside…it’s gorgeous and the temperature feels great…
Overhead, the sky is a brilliant color… the sunlight surrounds you with healing light and warms
you, through and through … the clouds form into all sorts of shapes and drift on by, and as the
clouds come and go, your worries evaporate … your mind clears, like the depth and expanse of
the infinite sky…The trees are magnificent and the woods are brimming with life… it smells
delightful.
(Longer pause)
Imagine yourself walking along a path…take a little time to yourself and notice what it’s
like…how wide is it…what is it made of…how does it feel to be walking on it.
And with each step you take, notice how you feel more and more alive with a bounce in your
step…and it’s hard not to grin. Walking feels effortless and invigorating …like you’re gliding
upon a magic carpet. Walking along, your tiredness melts away, and more and more you notice
46
feeling renewed and revived with boundless energy. There’s a spring in your step and it feels
great to be here.
Looking around, notice your surroundings…there are many types of trees…all different shapes
and sizes, each one is inspiring in its own special way…and perhaps there’s a rainbow of smiling
wildflowers dancing in the light …and the smell of the woods comes alive.
Notice the sounds that come and go…perhaps you hear the sound of a gentle breeze rustling
through the leaves…the songs of the birds…or an occasional bark of a dog, off in the
distance…what other sounds can you notice?
The sunlight streams through beaming a golden light that dapples through the branches above…
casting shadows here and there … and the air tingles and the woods sparkle with life…it feels
radiant and the fresh air renews your energy with each and every breath you take. Take a few
moments to continue down your path, walking along at a comfortable pace, following your
curiosity and losing yourself in the sounds, the smells, and the colors all around.
(Longer pause)
Off in the distance, you start to pick up on the sound of tumbling water and it sparks your
curiosity as to where it’s coming from, it might even be a waterfall … so you take off in a new
direction, not sure what you’ll find … and lo and behold, you discover a beautiful creek that is
gurgling and chuckling by…the water cascades constantly over the rocks like a dance…and the
water’s surface glimmers and glows…being aware of the water as it streams on by… If you
wish, you dip into the refreshing stream of water and it feels exhilarating …and you feel
invigorated with energy…Relishing each and every moment…and you are reminded that this
47
very creek gradually flows into the river that eventually joins the oceans of the earth.
(Longer pause)
Back on your path again, notice how the canopy of trees is protective and comforting and how
the leaves whisper in the soft breeze…. And the sunlight sparkles through, bringing its warmth
and wonder to everything it shines upon, and you drink in its beauty…soaking it’s magic into
your heart of hearts.
And now you become aware that there’s a clearing up ahead and as you enter there is a hushed
silence that is felt…the clearing is carpeted in softness…and it feels magical, and enchanted.
Take some time to explore this special place…how large is it…what do you notice in the
horizon…what is the air like…what sort of plant and animal life are present?
(Longer pause)
And now your attention is captured with watching the squirrels and rabbits darting about …
noticing the birds flying and hopping from place to place, singing their songs … and noticing all
the other wildlife at work and at play.
(Longer pause)
Notice how boundless energy begins surging through you so you feel like joining in all the
activity … feeling the urge to enjoy yourself and play, just like the animals. So, imagine
48
enjoying yourself and having fun, exploring and discovering and playing… perhaps you’d like to
fly like a bird or climb a tree like a raccoon, and be carefree.
And off in the distance, you notice a special place that has a hammock…and a park bench…and
a swing and you seem to glide on over and settle into one or the other for a while…enjoying
yourself completely and allowing yourself to daydream.
(Longer pause)
And now, you notice that an animal is trying to get your attention …what is it… what’s the
animal like…and now it’s coming closer … and you’re getting excited… and sure enough, you
can tell that it has a gift or perhaps a message just for you … and that’s what happens, you are
given a personal gift or a message from this special animal.
(Longer pause)
And now, you’d like to give something back in return.
(Longer pause)
And from this extraordinary space, you begin feeling lighter and more free and easy, feeling the
surge of life pulsing through you … replenishing your energy … and each time you breathe, you
can tell you are being completely restored from deep inside, from an unending and powerful
source of energy and vitality …and you feel your energy and enthusiasm pouring back to you, to
49
continue on with courage, and a willingness to trust, knowing you can more than handle what’s
up ahead with a knowing confidence.
Having come full circle now, it’s time to come back from your woodland walk… noticing how
your energy and resourcefulness has grown and expanded …and knowing you can come back,
again and again…and each time you do, your experience will deepen and grow…
Whenever you’re ready, you can begin to stretch and move… feeling full of life, alert and ready
for whatever comes next.
C. Session 3: Hot Air Balloon Ride:
Link:https://healthunlocked.com/fibromyalgia-action-uk/posts/130267590/hot-air-balloon-ride-
aid-for-relaxation-......................-guided-imagery
Imagine you were on this balloon
Where would you like to be going?
What can you see?
Breathe in deeply and take in that crisp clean air and feel it whisping around you, not making
you cold but making you feel supported and safe.
Focus on the heat of the flame making the balloon fly and imagine it is, slowly, starting at the
feet and then rising up the legs and into your hips and back, warming you and relaxing you.
Breathe in deeply and take in that crisp clean air
You feel comfortable and relaxed as the warmth rises further into your chest and along your arms
and into your hands
it then moves upwards into your neck and your head

50
You are now lovely and warm and relaxed and can enjoy your balloon ride so sit back and let the
balloon take you where you'd like to go, picture the things you see on the journey........
............. for example, the clouds, the lake, fields and trees.
What sounds can you hear when you close your eyes and block out the noise of the balloon's
burner? Is the wind whistling, roaring, gently lapping the sides of the balloon.....?
You are near your destination.
Focus on the heat of the flame making the balloon fly and imagine it is, slowly, starting at the
feet and then rising up the legs and into your hips and back, warming you and relaxing you.
You feel comfortable and relaxed as the warmth rises further into your chest and along your arms
and into your hands
it then moves upwards into your neck and your head
When you open your eyes you will be at your destination.
D. Session 4: Frosty’s Happy Paintbrush
Link: http://kidsrelaxation.com/uncategorized/frostys-happy-paintbrush/
Find a comfortable position.
Talk to your body and give it permission to relax.
Take a breath in, feeling your tummy push out.
Let the breath out, feeling your tummy flatten back down.
Notice any stressful thoughts or tension in your body just melting away like snowflakes in the
sun.
51
Good.
You are now feeling very relaxed and calm.
Now, imagine a blue, blue sky above you.
Notice the cool air. Take another deep breath and breathe some cool air into your lungs.
Pay attention to how the air feels as it touches the back of your throat and inflates your lungs.
Looking down, you see a happy paintbrush at your feet.
This is a paint brush for painting your happiness.
Just like frosty paints the windows in winter, you can paint pretty swirls with this brush.
Pick it up. Begin to swirl it through the air you see wonderful colors flowing behind it.
You are painting the sky!
Maybe you would like to make giant fluffy swirls? Or maybe tiny glittery puffs of paint.
You get to paint whatever swirl feels good to you.
Watch the brush as you swirl and twirl it around. Try some different types of painting.
Chop the air with it. Splatter paint with it. See what colors flow behind it as you swish it this
way and that way.
Watch what pictures appear from your painting. Know that you can paint whatever you would
like.
If you could paint any happy thought in the sky, what would you paint?
This is your happy paintbrush and it will only paint happy thoughts that you think.
52
When you watch your paintings appear, notice the feelings that come along for the ride.
Focus on those feelings or thoughts that help you feel relaxed, calm, content, and safe.
You can hold onto them and keep them with you as long as you would like, even for the whole
day if you choose!
Imagine placing Frosty’s paintbrush back down at your feet. Know that you can close your eyes
and imagine this happy painting paintbrush whenever you’d like.
Begin to bring your attention back to your feet. Take a deep breath and wiggle your toes and
your fingers. You can open your eyes when you are ready.
E. Session 5: The Magic Shell:
Link:https: //www.themindfulword.org/2012/guided-imagery-scripts-children-anxiety-stress/
Place yourself in a comfy, cozy position. Close your eyes and take a long slow deep breath. As
you breathe out relax your body.
Imagine that you are standing on a beach. See the beach in your mind. Think about a beach that
you may have visited, or you could use an imaginary beach if you like.
You can feel the sand beneath your toes and the sun is warm on your face. Look around you. In
front of you is a huge ocean. It looks a silvery-blue color and the sunlight sparkles like tiny stars
dancing on the surface.
You look at the ground and in front of you in the sand is the most glorious shell you have ever
seen. You pick it up. It feels warm. Notice how smooth the shell is. Feel it with your fingers.
53
This is your magic shell. You can tell it your secrets and it will keep them. You can also tell your
shell any worries that you may have. Tell it about any problems that may be troubling you at the
moment. No matter how big or how small they are. The shell wants to hear them.
Whenever you have worried feelings you can tell your shell about them and it will magically
take those horrid feelings and turn them into good ones.
Now see yourself holding the shell close to your mouth. In your mind silently tell it whatever
you wish. No one else will know what you say. Only you and your shell! As you say your words
they go right into the middle of the shell so that it can take them away for you. Tell your shell
your worries right now….
Now you do not have to feel those feelings anymore. The shell has made them disappear. Just
like magic!
They are gone!
As you hold your shell close all you feel is calm and happiness. You feel peaceful all the way
from the tips of your toes, to the tip of your nose. Feel it right now. Notice how it feels.
It is important for you to know that you can imagine your shell whenever you wish to make
yucky thoughts and feelings disappear, whenever you wish to feel calm. Your shell will always
be there waiting in your imagination.
Of course, if you visit the seaside you can always look for your own real magic shell. How will
you know it is magic? Just choose the shell that feels right for you, this will be the magic one.
You can also use a magic stone if you like.
Find one of these in your garden, or in the street.
Here is an idea! Keep your magic shell or stone under your pillow to take away bad dreams and
54
always bring you a peaceful sleep.
F. Session 6: Still Pond…Ancient Forest:
Link: http://kidsrelaxation.com/bedtime-relaxation-activities/still-pond...ancient-forest/
With softness and gentleness, settle into a relaxed position. Allow your body to let go, and sink
into the floor, pillow, bed, or other soft supportive space around you. Close your eyes and take a
deep breath, slowly pushing your tummy out, hold for a moment, and then slowly breathe out,
allowing all the air out of your lungs. Breathe in. Breathe out. Let go of any tension or tight
places that might be within you. Now breathe normally while we take this journey in our
imaginations.
Imagine you are walking on a quiet forest path in the still moonlight. Above you the moon
shines down to light your way as you feel the soft moss covered ground beneath your feet. As
you are walking you know that this is an ancient forest, completely safe and secure from the rest
of the world. Breathing deeply you can smell the pine in the air. Breathing out you feel yourself
relaxing more and more with each step you take.
These trees are all around you and you can feel their wise energy surrounding you as you step
deeper and deeper beneath the canopy of leaves. Soon you come to a still pond. (pause) The
moonlight is illuminating the very thin mist that arises just above the clear pool of water. You
find a mossy soft place to rest while you continue to gaze out on the pond. The glassy water is
crystal clear and undisturbed by wind, rain, or any other thing. Gazing at this still pond in the
ancient forest, you feel the peacefulness within your heart, feeling your body letting go to relax
even more, allowing a sense of deep calmness to ripple out within you. Pause and breathe and
take in that stillness, knowing it is showing you the stillness that is within your own heart, the
stillness within your own mind. You feel held in the calm, stillness of the moonlight, held by the
55
ancient wise trees, supported by the stillness of the water. Breathe in that calm. (pause) Rest.
(pause)
Beautiful. (pause) Rest in this ancient forest sanctuary. (pause several moments here)
Knowing you can return to this serene pond any time you would like, begin to make your way
back through the forest path. Breathe deeply the fragrance of pine as you walk, slowly taking in
your surroundings and feeling the presence of the trees as you walk.
When you reach the edge of the forest, pause and thank the ancient forest for the calm, gentle,
space.
You can open your eyes and begin to return to the room when you are ready.
G. Session 7: The Rainforest:
Link:https://static.squarespace.com/static/510496b2e4b08ef8a15d4105/5104b1e6e4b09d9c98b3
f2d7/5104b1e6e4b09d9c98b3f2f4/1359262185969/?format=1500w
For these first few moments, calm your body by relaxing your toes, your legs, your hips, your
stomach, your chest, your neck, and last your head. Relax your eyes. We are going to take long
deep breaths. Breathe in as I count to 3, and then breath out as I count backwards. We will do
this 5 times.
1,2,3,…3, 2, 1 (5X)
Continue to breath slowly, calmly, and gently.
Imagine yourself walking slowly along the forest floor of your rainforest.
You look down to step over decaying logs and the air feels warm and damp on your skin. Your
eyes adjust to the little bit of light that sneaks in from the understory and canopy layers above.
56
You breathe the steamy, earthy air into your lungs as you take a deep breath.
As your eyes adjust to the darkness, imagine what the ground feels like below your feet. Soft,
wet, leaves and decaying tree bark layer the forest floor and overripe fruit squishes between your
toes. Green ferns and brown mushrooms help create a path for you to walk on. As you look
down, you see tiny frogs and rabbits hopping around the seedlings that are slowly making their
way skyward. Butterflies softly flutter their wings as they fly by you on their way to the flowers.
You breathe in the spicy perfume of the flowers as you bass by their bright pink petals.
As you continue to look down, what do you hear? Insects, the rustling of leaves as animals move
about the rainforest. Does the air feel still at your feet?
As you move up you body to your legs and arms, you feel them brushing against the sapling tree
that are growing to eventually be part of the understory layer. How does the air feel on your
limbs? Are you cool and comfortable or is the air warm and humid?
As you continue to walk and begin to lift your eyes up to look out around you, you notice a tree
has fallen from the understory layer and created a small hole for sunlight to filter in. Leaves start
to appear a bit greener and brighter in this area. Smaller trees are reaching tall to fill the space
and as you are at one particular tree, you see an ocelot sleeping in the crevice fromer where two
branches meet. On another tree you see an anteater sniffing out his lunch. What other animals do
you see resting peacefully in the understory?
As you arrive under the hole made by the fallen tree, you look up into the canopy layer. Drips of
a past rainfall fall down onto your head and cool your body. As your face turns up towards the
sun, what does the air feel like on your cheeks, you nose, and your forehead? Is it cooler from the
rain, or has the sunlight created even more warmth?

57
As you continue to look up, you feel your body being gently lifted until you are sitting on a
branch of a Kapok tree. Now you are surrounded by the canopy layer and all it has to offer. You
slowly breathe in the fragrant scent of orchids as you hold on to a strong vine to stand up on a the
branch.
As you look out at the canopy layer, what animals do you see? Monkeys may jump from tree to
tree above you, or perhaps you see a lizard making its way slowly form one branch to another.
Possibly you see a sloth laxing about on a tree limb or a brightly colored toucan flying over your
head. You cannot see but can hear thousands of insects going about their lives among the trees
and ferns. Are they loud or quiet? Do they sound like they are moving quickly or sting in one
place?
The branch you are on is damp and you imagine it has just rained. The air feels cooler and
lighter, and you deeply breathe in its freshness.
As you continue to look up, you spot an emergent tree reaching high above the rest of the
rainforest. Butterflies and colorful birds soar around its leaves, and it’s bright and green and
seems to reach all the way to the sun. As you continue to stare up at this tree you are again lifted
gently until you rest on a strong branch high above the rainforest.
As you look up at the sun, your body is warmed and you breath in deeply. The world around you
and below you is calm and peaceful. All is right and all is as it should be. You feel a sense of
happiness as you close your eyes and just enjoy being in this exact moment.
With your eyes closed, you slowly feel your body begin to descend back down through the
rainforest. You pass through the canopy, and all its animals, insects and flowers. You take a
moment here to appreciate all the color and beauty around you. You then descend further down
58
into understory where the light becomes dimmer and the sounds of the canopy begin to
disappear. You take a moment here to savor the quietness and green surrounding you. Eventually
you find yourself back on the rainforest floor, with your feet settling into the soft ground. You
take a moment here to embrace the earth and beginnings of life around you.
Now slowly begin to bring your mind back to the present and the room we are in, the people and
noises around you. Slowly bring your body back to the present by wiggling your fingers and
toes. When you are ready, lift your head and body slowly and gently back into a sitting position.
59
Appendix F: School Refusal Assessment Scale-Revised (P)
Name:
Date:
Please select the answer that best fits the following questions:
1. How often does your child have bad feelings about going to school because he/she is afraid
of something related to school (for example, tests, school bus, teacher, fire alarm)?
Half the Almost
Never Seldom Sometimes Time Usually Always Always
2. How often does your child stay away from school because it is hard for him/her to speak with
the other kids at school?
Half the Almost
3. How often does your child feel he/she would rather be with you or your spouse than go to
school?
Half the Almost
4. When your child is not in school during the week (Monday to Friday), how often does he/she
leave the house and do something fun?
Half the Almost
5. How often does your child stay away from school because he/she will feel sad or depressed if
he/she goes?
Half the Almost
6. How often does your child stay away from school because he/she feels embarrassed in front
of other people at school?
60
Half the Almost

7. How often does your child think about you or your spouse or family when
in school?
Half the Almost
8. When your child is not in school during the week (Monday to Friday), how often does he/she
talk to or see other people (other than his/her family)?
Half the Almost
9. How often does your child feel worse at school (for example, scared, nervous, or sad)
compared to how he/she feels at home with friends?
Half the Almost
10. How often does your child stay away from school because he/she does not have many
friends there?
Half the Almost
11. How much would your child rather be with his/her family than
go to school?
Half the Almost
12. When your child is not in school during the week (Monday to Friday), how much does
he/she enjoy doing different things (for example, being with friends, going places)?
Half the Almost
61
13. How often does your child have bad feelings about school (for example, scared, nervous, or
sad) when he/she thinks about school on Saturday and Sunday?
Half the Almost
14. How often does your child stay away from certain places in school (e.g., hallways, places
where certain groups of people are) where he/she would have to talk to someone?
Half the Almost
15. How much would your child rather be taught by you or your spouse at home than by his/her
teacher at school?
Half the Almost
16. How often does your child refuse to go to school because he/she wants to have fun outside of
school?
Half the Almost
17. If your child had less bad feelings (for example, scared, nervous, sad) about school, would it
be easier for him/her to go to school?
Half the Almost
18. If it were easier for your child to make new friends, would it be easier for him/her to go to
school?
Half the Almost
62
19. Would it be easier for your child to go to school if you or your spouse went
with him/her?
Half the Almost
20. Would it be easier for your child to go to school if he/she could do more things he/she likes
to do after school hours (for example, being with friends)?
Half the Almost
21. How much more does your child have bad feelings about school (for example, scared,
nervous, or sad) compared to other kids his/her age?
Half the Almost
22. How often does your child stay away from people at school compared to other kids his/her
age?
Half the Almost
23. Would your child like to be home with you or your spouse more than other kids his/her age
would?
Half the Almost
24. Would your child rather be doing fun things outside of school more than most kids his/her
age?
Half the Almost
63
Do not write below this line
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
Total Score =
Mean Score =
Relative Ranking =
64
Appendix G: Short State-Trait Anxiety Inventory (STAI)
Not at all Somewhat Moderately Very much
(1) I feel calm 1 2 3 4

(2) I am tense 1 2 3 4
(3) I feel upset 1 2 3 4
(4) I am relaxed 1 2 3 4
(5) I feel content 1 2 3 4
(6) I am worried 1 2 3 4
65
Appendix H: Deep Breathing Exercise - Homework Assignment
1. Arms and hands are relaxed downward

2. Body is relaxed
3. Eyes closed
4. Focus on your lower abdomen (belly) and imagine a small balloon in that space
5. Breath in slowly and deeply through nostrils, imagining the balloon inflating (getting
bigger/larger/growing) slowly, hold a few seconds
6. Slowly exhale through your mouth, imagining the balloon gently deflating (getting
smaller/shrinking ); blow out of your mouth as if blowing out a candle
7. Tip: Place a hand over the lower abdomen to feel it go up and down, and make sure you’re not
breathing with your chest
8. Repeat at least 10 times
If child completed this homework assignment, please check here: _________

66
Appendix I: Spence Children’s Anxiety Scale (SCAS)
Your Name: ___________________________________ Date: ____________
PLEASE PUT A CIRCLE AROUND THE WORD THAT SHOWS HOW OFTEN EACH
OF THESE THINGS HAPPEN TO YOU. THERE ARE NO RIGHT OR WRONG
ANSWERS.
1. I worry about things.................................................................................Never Sometimes Often Always
2. I am scared of the dark.............................................................................Never Sometimes Often Always
3. When I have a problem, I get a funny feeling in my stomach………….Never Sometimes Often Always
4. I feel afraid...............................................................................................Never Sometimes Often Always
5. I would feel afraid of being on my own at home.....................................Never Sometimes Often Always
6. I feel scared when I have to take a test.....................................................Never Sometimes Often Always
7. I feel afraid if I have to use public toilets or bathrooms..........................Never Sometimes Often Always
8. I worry about being away from my parents.............................................Never Sometimes Often Always
9. I feel afraid that I will make a fool of myself in front of people………..Never Sometimes Often Always
10. I worry that I will do badly at my school work..................................... Never Sometimes Often Always
11. I am popular amongst other kids my own age....................................... Never Sometimes Often
Always
12. I worry that something awful will happen to someone in my family.....Never Sometimes Often
Always
13. I suddenly feel as if I can’t breathe when there is no reason for this.....Never Sometimes Often Always
14. I have to keep checking that I have done things right (like the switch
is off, or the door is locked).........................................................................Never Sometimes Often Always
15. I feel scared if I have to sleep on my own..............................................Never Sometimes Often Always
16. I have trouble going to school in the mornings because I feel nervous
or afraid....................................................................................................... Never Sometimes Often Always
17. I am good at sports................................................................................ Never Sometimes Often Always
18. I am scared of dogs.................................................................................Never Sometimes Often
Always
19. I can’t seem to get bad or silly thoughts out of my head........................Never Sometimes Often
Always
20. When I have a problem, my heart beats really fast............................... Never Sometimes Often Always
21. I suddenly start to tremble or shake when there is no reason for this... Never Sometimes Often Always
67
22. I worry that something bad will happen to me...................................... Never Sometimes Often Always
23. I am scared of going to the doctors or dentists.......................................Never Sometimes Often Always
24. When I have a problem, I feel shaky..................................................... Never Sometimes Often Always
25. I am scared of being in high places or lifts (elevators)......................... Never Sometimes Often Always
26. I am a good person................................................................................ Never Sometimes Often Always
27. I have to think of special thoughts to stop bad things from happening
(like numbers or words)...............................................................................Never Sometimes Often Always
28 I feel scared if I have to travel in the car, or on a Bus or a train.............Never Sometimes Often Always
29. I worry what other people think of me.................................................. Never Sometimes Often Always
30. I am afraid of being in crowded places (like shopping centres, the
movies, buses, busy playgrounds)............................................................... Never Sometimes Often Always
31. I feel happy............................................................................................ Never Sometimes Often Always
32. All of a sudden I feel really scared for no reason at all......................... Never Sometimes Often Always
33. I am scared of insects or spiders............................................................ Never Sometimes Often
Always
34. I suddenly become dizzy or faint when there is no reason for this........Never Sometimes Often Always
35. I feel afraid if I have to talk in front of my class.................................. .Never Sometimes Often Always
36. My heart suddenly starts to beat too quickly for no reason.................. Never Sometimes Often Always
37. I worry that I will suddenly get a scared feeling when there is nothing
to be afraid of.............................................................................................. Never Sometimes Often Always
38. I like myself........................................................................................... Never Sometimes Often Always
39. I am afraid of being in small closed places, like tunnels or small
rooms……………………………………………………………………... Never Sometimes Often Always
40. I have to do some things over and over again (like washing my hands,
cleaning or putting things in a certain order).............................................. Never Sometimes Often Always
41. I get bothered by bad or silly thoughts or pictures in my mind............ Never Sometimes Often Always
42. I have to do some things in just the right way to stop bad things
happening.................................................................................................... Never Sometimes Often Always
43. I am proud of my school work.............................................................. Never Sometimes Often Always
44. I would feel scared if I had to stay away from home overnight............ Never Sometimes Often Always
45. Is there something else that you are really afraid of?................................................................. YES NO
Please write down what it is______________________________________________________________
How often are you afraid of this thing?....................................................... Never Sometimes Often
68
Always ©2000 Susan H. Spence

Appendix J: Spence Children’s Anxiety Scale (SCASp)
Your Name:____________________________________ Date:___________
Your Child’s Name: _____________________________
BELOW IS A LIST OF ITEMS THAT DESCRIBE CHILDREN. FOR EACH ITEM
PLEASE CIRCLE THE RESPONSE THAT BEST DESCRIBES YOUR CHILD. PLEASE
ANSWER ALL THE ITEMS.
1. My child worries about things................................................................. Never Sometimes Often Always
2. My child is scared of the dark................................................................. Never Sometimes Often Always
3. When my child has a problem, s(he) complains of
having a funny feeling in his / her stomach ............................................... Never Sometimes Often Always
4. My child complains of feeling afraid...................................................... Never Sometimes Often Always
5. My child would feel afraid of being on his/her own at home..................Never Sometimes Often Always
6. My child is scared when s(he) has to take a test..................................... Never Sometimes Often Always
7. My child is afraid when (s)he has to use public toilets or bathrooms..... Never Sometimes Often Always
8. My child worries about being away from us / me....................................Never Sometimes Often Always
9. My child feels afraid that (s)he will make a fool of him/herself
in front of people......................................................................................... Never Sometimes Often Always
10. My child worries that (s)he will do badly at school...............................Never Sometimes Often Always
11. My child worries that something awful will happen to
someone in our family................................................................................. Never Sometimes Often Always
12. My child complains of suddenly feeling as if (s)he can't breathe
when there is no reason for this................................................................... Never Sometimes Often Always
13. My child has to keep checking that (s)he has done things right
(like the switch is off, or the door is locked).. ............................................ Never Sometimes Often Always
14. My child is scared if (s)he has to sleep on his/her own........................ Never Sometimes Often Always
15. My child has trouble going to school in the mornings because
(s)he feels nervous or afraid........................................................................ Never Sometimes Often Always
16. My child is scared of dogs ................................................................... Never Sometimes Often Always
17. My child can't seem to get bad or silly thoughts out of his / her head.. Never Sometimes Often Always
18. When my child has a problem, s(he) complains of his/her heart beating
really fast…................................................................................................ Never Sometimes Often Always
69
19. My child suddenly starts to tremble or shake when there

is no reason for this..................................................................................... Never Sometimes Often Always
20. My child worries that something bad will happen to him/her.............. Never Sometimes Often Always
21. My child is scared of going to the doctor or dentist ............................. Never Sometimes Often Always
22. When my child has a problem, (s)he feels shaky.................................. Never Sometimes Often Always
23. My child is scared of heights (eg. being at the top of a cliff)................ Never Sometimes Often Always
24. My child has to think special thoughts (like numbers or words)
to stop bad things from happening.............................................................. Never Sometimes Often Always
25. My child feels scared if (s)he has to travel in the
car, or on a bus or train ............................................................................... Never Sometimes Often Always
26. My child worries what other people think of him/her........................... Never Sometimes Often Always
27. My child is afraid of being in crowded places (like shopping centres,
the movies, buses, busy playgrounds)......................................................... Never Sometimes Often Always
28 All of a sudden my child feels really scared for no reason at all........... Never Sometimes Often Always
29. My child is scared of insects or spiders................................................ Never Sometimes Often Always
30. My child complains of suddenly becoming dizzy or faint when
there is no reason for this............................................................................ Never Sometimes Often Always
31. My child feels afraid when (s)he has to talk in front of the class......... Never Sometimes Often Always
32. My child’s complains of his / her heart suddenly starting to
beat too quickly for no reason .................................................................... Never Sometimes Often Always
33. My child worries that (s)he will suddenly get a scared feeling
when there is nothing to be afraid of........................................................... Never Sometimes Often Always
34. My child is afraid of being in small closed places,
like tunnels or small rooms......................................................................... Never Sometimes Often Always
35. My child has to do some things over and over again (like washing
his / her hands, cleaning or putting things in a certain order)..................... Never Sometimes Often Always
36. My child gets bothered by bad or silly thoughts or pictures
in his/her head ............................................................................................ Never Sometimes Often Always
37. My child has to do certain things in just the right way to stop
bad things from happening ......................................................................... Never Sometimes Often Always
38. My child would feel scared if (s)he had to stay away from
home overnight............................................................................................ Never Sometimes Often Always
39. Is there anything else that your child is really afraid of? ........................................................... YES NO
70
Please write down what it is, and fill out how often (s)he is afraid of this thing:
__________________________________________________ Never Sometimes Often Always
________________________________________________________ Never Sometimes Often Always
________________________________________________________ Never Sometimes Often Always
©
2000 Susan H. Spence
71
Appendix K: Children’s Automatic Thoughts Scale (CATS)

Name:..................................................... Age:............ Sex: Male / Female Grade:............
Instructions: Listed below are some thoughts that children and adolescents have said pop into
their heads. Please read each thought carefully and decide how often, if at all, each thought
popped into your head over the past week. Circle your answer in the following way:
0 = not at all, 1 = sometimes, 2 = fairly often, 3 = often, 4 = all the time.
Say to yourself “Over the past week I thought...”

1. Kids will think I’m stupid ..................................................................... 0 1 2 3 4
2. I have the right to take revenge on people if they deserve it................. 0 1 2 3 4
3. I can’t do anything right ....................................................................... 0 1 2 3 4
4. I’m going to have an accident .............................................................. 0 1 2 3 4
5. Other kids are stupid ............................................................................ 0 1 2 3 4
6. I’m worried that I’m going to get teased ............................................. 0 1 2 3 4
7. I’m going crazy ................................................................................... 0 1 2 3 4
8. Kids are going to laugh at me ............................................................. 0 1 2 3 4
9. I’m going to die................................................................................... 0 1 2 3 4
10. Most people are against me............................................................... 0 1 2 3 4
11. I am worthless .................................................................................. 0 1 2 3 4
12. My Mum or Dad are going to get hurt ............................................. 0 1 2 3 4
13. Nothing ever works out for me anymore ......................................... 0 1 2 3 4
14. I’m going to look silly ..................................................................... 0 1 2 3 4

72
15. I won’t let anyone get away with picking on me ............................... 0 1 2 3 4
16. I’m scared of losing control ............................................................... 0 1 2 3 4
17. It’s my fault that things have gone wrong ......................................... 0 1 2 3 4
18. People are thinking bad things about me........................................... 0 1 2 3 4
19. If someone hurts me, I have the right to hurt them back................... 0 1 2 3 4
20. I’m going to get hurt ......................................................................... 0 1 2 3 4
21. I’m afraid of what other kids will think of me.................................. 0 1 2 3 4
22. Some people deserve what they get.................................................. 0 1 2 3 4
23. I’ve made such a mess of my life ..................................................... 0 1 2 3 4
24. Something awful is going to happen ................................................ 0 1 2 3 4
25. I look like an idiot ............................................................................ 0 1 2 3 4
26. I’ll never be as good as other people are .......................................... 0 1 2 3 4
27. I always get blamed for things that are not my fault......................... 0 1 2 3 4
28. I am a failure ..................................................................................... 0 1 2 3 4
29. Other kids are making fun of me ...................................................... 0 1 2 3 4
30. Life is not worth living...................................................................... 0 1 2 3 4
31. Everyone is staring at me.................................................................. 0 1 2 3 4
32. I’m afraid I will make a fool of myself ............................................ 0 1 2 3 4

73
33. I’m scared that somebody might die ............................................... 0 1 2 3 4
34. I will never overcome my problems ............................................... 0 1 2 3 4
35. People always try to get me into trouble ........................................ 0 1 2 3 4
36. There is something very wrong with me......................................... 0 1 2 3 4
37. Some people are bad....................................................................... 0 1 2 3 4
38. I hate myself.................................................................................... 0 1 2 3 4
39. Something will happen to someone I care about ........................... 0 1 2 3 4
40. Bad people deserve to get punished................................................ 0 1 2 3 4
© Centre for Emotional Health, Macquarie

University, Sydney
www.ceh.mq.edu.au
74
References
Achenbach, T. M. (1992). Manual for Child Behavior Checklist/ 2-3 and 1992 Profile.
Burlington, VT: University of Vermont, Dept. of Psychiatry.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.).Washington, DC: Author.
Commonwealth of Australia. (n.d.). Cool kids (School version). Retrieved from April 4, 2018
from https://www.kidsmatter.edu.au/primary/programs/cool-kids-school-version.
Intervention Central. (n. d.) Jackpot! Ideas for classroom rewards. Retrieved from
http://www.interventioncentral.org/behavioral-interventions/rewards/jackpot-ideas-
classroom-rewards
Intervention Central. (n. d.). Appropriate school performance. Retrieved from
http://www.interventioncentral.org/behavioral-interventions/rewards/stratagies-for-
teaching/appropriate-school-performance
Kearney, C. A. (2002). Identifying the function of school refusal behavior: A revision of the
school refusal assessment scale. Journal of Psychopathology and Behavioral Assessment,
24(4), 235-245.
Kearney, C. A. (2007). Getting your child to say “yes” to school: A guide for parents of youth
with school refusal behavior. New York: Oxford University Press.
Kearney, C. A. (2008). School absenteeism and school refusal behavior in youth: A
Contemporary review. Clinical Psychology Review, 28, 451-471.
Kearney, C. A. (2014). A response to intervention model to promote school attendance and
Decrease school absenteeism. Child and Youth Care Forum, 43(1), 2-25.
Maynard, B. R., Kendel, K. E., Bulanda, J. J., Heyne, D., Thompson, A. M., & Pigott, T. D.
75
(2015). Psychosocial interventions for school refusal with primary and secondary school
students: A systematic review. Campbell Systematic Reviews, 11(12).
Maynard, B. R., Heyne, D., Brendel, K. E., Bulanda, J. J., Thompson, A. M., & Pigott, T. D.
(2018). Treatment for school refusal among children and adolescents: A systematic
review and meta-analysis. Research on Social Work Practice, 28(1), 56-67.
Schniering, C. A., & Rapee, R. M. (2002). Development and validation of a measure of
children’s automatic thoughts: The Children’s Automatic Thoughts Scale. Behaviour
Research and Therapy, 40, 1091–1109.
Silverman, W. K., & Albano, A. M. (1996). The Anxiety Disorders Interview Schedule for
Children–IV (Child and Parent Versions). San Antonio: TX: Psychological Corporation.
Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and
Therapy, 36, 545–566.
Thambirajah, M. S., Grandison, K. J., & De-Hayes, L. (2008). Understanding school
refusal: A handbook for professionals in education, health and social care.
London;Philadelphia;: Jessica Kingsley Publishers.
Veena, D., & Alvi, S. (2016). Guided imagery intervention for anxiety reduction. Indian Journal
of Health and Wellbeing, 7(2), 198.
Wimmer, M. (2008). Why kids refuse to go to school . . . and what schools can do about it. The
Education Digest, 74(3), 32-37.
Wimmer, M. (2010). School Refusal: Information for educators. Helping Children at Home and
School III: Handouts for Families and Educators (NASP, 2010).

76
About the Authors
Michelle Spencer is currently a third-year candidate in the school psychology graduate

program at Marist College in Poughkeepsie, New York. Prior to the start of her graduate career,
Michelle earned her Bachelor of Science (B.S.) in psychology at The State University of New
York College at Oneonta. Michelle’s interest in school psychology began when she conducted
research alongside a professor at SUNY Oneonta on implicit memory and learning. In addition,
she completed an internship at The Family Services Association in the town of Oneonta where
she worked directly with parents and children who were in need of services in a variety of areas.
Michelle is currently working as an Applied Behavioral Analysis (ABA) Therapist with a student
with autism exhibiting school refusal behaviors. Michelle is additionally completing her school
psychology internship at a high school where several students exhibit school refusal behaviors.
Michelle plans to continue her experience as an ABA therapist as well as pursue a career in
School Psychology in any K-12 setting. Michelle can be contacted at the following email
address: michellespencer027@gmail.com.
Rachel Trainque is a third-year school psychology graduate student at Marist College.
She worked with Dr. Trent as a graduate assistant last year and had the opportunity to present
that research at the 2018 EPA Conference. Her current interests include play therapy, social
psychology, and applied behavior analysis (ABA). Rachel began studying Psychology during
her undergraduate years at the University of New Hampshire. She then started working as an
ABA Therapist in 2014 with a 7-year old boy with Autism, which drove her interest in becoming
a School Psychologist, particularly working with elementary students. She also worked as an
Outreach Specialist and Youth Group Leader for at-risk children and adolescents at Lahey
Health Behavioral Services in Haverhill, MA. Here, she did outreach with parents and the
Department of Mental Health, as well as mentoring at-risk youth in the community. She was
then an ABA Therapist in the Hudson Valley Region of New York, working with a 7-year old
boy with Autism and also with a 16-year old girl with Autism, Depression, and Anxiety. Rachel
is now an ABA therapist in Albany, NY and is completing her internship at an elementary school
in North Colonie with a high population of students with autism. Due to her interests in
behavior, research, and working with youth, Rachel plans to pursue her BCBA credential, as well
as become a School Psychologist in an elementary school setting. Rachel can be contacted at the
following email address: rltrainque@gmail.com.

Anxiety-Based School Refusal Behavioral Interventions

Caricato da

Informazioni sul documento

Titolo originale

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

Anxiety-Based School Refusal Behavioral Interventions

Caricato da

Copyright:

Formati disponibili

1

Anxiety-Based School Refusal: Behavioral Interventions and Resources for School

Michelle Spencer and Rachel Trainque

Part II: Intervention Websites

Part III: Mobile Apps

Part IV: Intervention Kits

Appendix A: School Re-Entry Plan Checklist………………………....………..…………..…...34

About the Authors………...……………………………………………………………………76

Introduction to School Refusal

School refusal behavior is a child-motivated denial to attend school and/or remain in

refusal behavior is characterized by habitual absences, periodic absences or missed classes,

criteria for identifying school refusal behaviors:

1. Serious difficulty in attending school which results in a prolonged absence.

2. Severe emotional distraught, which may appear as excessive fearfulness, extreme

tempers, and somatic complaints that appear at thought of attending school.

3. Staying home, even with a parent’s knowledge they should be at school.

4. Extreme antisocial behaviors, such as stealing, destructiveness, lying, etc.

(Thambirajah, Grandison, & De-Hayes, 2008).

esteem, worrying about a parent or parents well-being, and an over-dependence on a parent or

parents. School factors include: bullying, transitions, unidentified or specific learning

over-involved and/or overprotective (Thambirajah, Grandison, & De-Hayes, 2008).

Nonattendance is associated with additional behavior problems, such as social maladjustment

(Maynard, Heyne, Brendel, Bulanda, Thompson, & Pigott, 2018).

The Four Functions of School Refusal

School refusal is marked by a variety of different symptoms and behaviors. Therefore,

experiencing absenteeism (Kearney, 2002).

Intervention 1: Gradual Re-entry Plan with Rewards

interventions (Intervention Central, n.d.). As an exposure-based plan, it is intended to reduce the

system as well as a way to maintain school to home communication.

refusal if forced attendance proves unsuccessful.

Location: In-school and at home.

- School Re-Entry Plan Checklist (Appendix A).

- Daily Home Report Card (Appendix C).

- Daily School Report Card (Appendix D).

day without displaying any hesitancy.

and school report cards.

Step 2: Re-entry plan checklist is reviewed.

home and school.

Day 1: Student will arrive at school but not go inside.

amount of time he/she feels comfortable with.

Day 3: Student will stay for one class of their choice**.

Day 4: Student will stay for two classes of their choice.

Day 5: Student will stay for three classes of their choice.

Day 6: Student will stay for four classes of their choice.

their classroom for an hour of the day (Kearney, p. 82).

not the child makes it to school that day.

throughout the intervention.

consistently arrive and remain at school for the entire day.

consistently arrive and remain at school for the entire day.

Description: Relaxation combined with Guided Imagery (RGI) is an emerging alternative

Location: Classroom or quiet location

- The 7 RGI scripts (Appendix E).

- School Refusal Assessment Scale (SRAS) [Appendix F].

- Short State-Trait Anxiety Inventory (STAI) [Appendix G].

- Deep Breathing Relaxation Exercise - Homework Assignment (For Progress Monitoring

Purposes and Home Component) [Appendix H].

day). Students will have homework to complete once a week.

Breathing Relaxation Exercise. This is a homework assignment and should be completed at

Directions/Intervention Steps: 7 Intervention Phases:

participant from the SRAS (obtained in Phase I).

for state anxiety through the STAI is administered once again.

administration of the STAI is completed.

Intervention 3: Cool Kids