Outcome of a Multi-modal CBT-based Treatment Program for Chronic School Refusal

Abstract

School refusal (SR) can have several negative consequences, but effective treatments are available. When chronic, school absence requires comprehensive treatment. This study evaluates an intervention for SR based on a Cognitive Behavioral Therapy (CBT) model, Hemmasittarprogrammet (HSP). Attendance, anxiety, depression, quality of life, and emotional and behavioral symptoms were measured at pre-treatment, post-treatment, and follow-up. The participants (n = 84; 69% male) were SR students between 10 and 17 years old and their parents. School attendance increased after treatment and at follow-up. The proportion of students totally absent from school decreased and the number of students with an acceptable level of school attendance increased. Levels of anxiety and depression were lower both post-treatment and at follow-up for the youths and their parents. HSP, a promising treatment program for school refusal, builds on the literature of CBT-based programs, which has been shown to be effective for SR treatment. However, more research about the effectiveness of the program is needed. Future studies should have a stronger research design, include a measure of fidelity, and be evaluated independent of the founders of the program under investigation.

School refusal: mapping the literature by bibliometric analysis

“…The review study conducted by Kearney (2008) stated that similar studies on school attendance problems and school refusal were undertaken primarily in the United States, the United Kingdom, Canada, and Australia. However, when the current studies on school refusal are examined, Spain ( Inglés et al, 2015 ; García-Fernández et al, 2016 ; Gonzálvez et al, 2016 ; Sanmartín et al, 2018 ; Gonzálvez et al, 2020 ), Norway ( Havik et al, 2014 ; Munkhaugen et al, 2019 ; Havik and Ingul, 2021 ; Høiseth et al, 2021 ), Finland ( Strömbeck et al, 2021 ), Belgium, ( Al-Husni Al-Keilani and Delvenne, 2021 ), and Turkey ( Bahali et al, 2009 ; Oner et al, 2014 ; Secer, 2014 ; Seçer and Ulaş, 2020 ) countries seem to be gaining momentum. As expected, this situation is similar in terms of the universities where school refusal studies are carried out, and University of Alicante, Central University of Ecuador, University Illinois, University Bristol, Leiden University, and University College London, Monash University, and University Paris universities are at the forefront of current studies.…”

School Refusal Behavior: A Narrative Review

“…42 However, some studies suggest standard CBT manuals developed for treating anxiety or depressive disorders may not be appropriate for managing school refusal, given its highly heterogeneous nature. 43 As a result, authors from various countries have tried to modulate CBT according to their social and cultural structures. For example, in Sweden, Strömbeck et al studied a multimodal CBT intervention for chronic school refusal among adolescents, called hemmasittarprogrammet (HSP).…”