Rapid Return for School Refusal: A School-Based Approach Applied With Japanese Adolescents

Abstract

Cognitive behavioral therapy (CBT) is often effective in the treatment of school refusal (SR). Its usefulness is limited, however, if youth displaying SR also refuse to attend treatment sessions. In these cases parents and school staff may consider using school-based interventions that do not rely on face-to-face assessment and treatment with the young person. The current study examined the effectiveness of a school-based intervention applied in Japan to achieve rapid return to school among adolescents displaying SR. Between 2009 and 2015, the parents of 62 adolescents displaying SR were invited to implement a school-based rapid return approach. Thirty-nine parents agreed to implement the approach and 23 decided to wait until their child spontaneously attended school. Of the 39 cases in which the approach was implemented, 28 adolescents (72%) resumed attendance at their original school, 2 (5%) transferred to another school, and 9 (23%) did not resume attendance. In contrast, all 23 non-intervention cases continued to refuse to attend school for 3 months or longer, and none of these adolescents returned to regular school attendance within 9 months. This study tentatively suggests that the rapid return approach may be an effective form of intervention for adolescents displaying SR and simultaneously refusing to attend individual therapy. Because this approach is ethically complex, involving forced school attendance in adolescence, it should only be employed under specific circumstances. These circumstances are discussed.

An Approach for School Counselors: Behavioral Consultation with Parents of Youth with School Attendance Problems

“…School counselors provide basic behavioral theory, outline the formation process of SAPs, highlight the negative effects of long-lasting SAPs (e.g., academic underachievement, employment difficulties, and increased risk of psychiatric illness), and propose behavioral management strategies that aim to improve school attendance (e.g., the process of flooding and coping skills for addressing resistive behaviors; Maeda, 2016;. In accordance with these consultations, Maeda and Heyne (2019) implemented the rapid school return approach, which is school-based, to 39 cases of SAPs (SR type) in Japan and reported that 28 cases (72%) resumed their normal school attendance at their original schools. However, because this study was an uncontrolled case series, further research requires case studies to evaluate the success of this type of school-based approach (Maeda & Heyne, 2019).…”

“…In accordance with these consultations, Maeda and Heyne (2019) implemented the rapid school return approach, which is school-based, to 39 cases of SAPs (SR type) in Japan and reported that 28 cases (72%) resumed their normal school attendance at their original schools. However, because this study was an uncontrolled case series, further research requires case studies to evaluate the success of this type of school-based approach (Maeda & Heyne, 2019).…”

“…These results indicated that a considerable number of SAPs among Japanese students in recent years are significantly associated with parental factors. Against this background, SAPs based on parental attitudes and the home environment have been notable in the Japanese context in the past few years (e.g., Ishikawa, 2002;Maeda & Hatada, 2019;Maeda & Heyne, 2019). Heyne et al (2019) classified SAPs into four types-school refusal (SR), truancy (TR), school withdrawal (SW), and school exclusion (SE)-through their School Nonattendance ChecKlist (SNACK), which was the first comprehensive classification tool for screening SAPs.…”

“…When supporting students with SAPs at the school level, school counselors frequently confront their inability to undertake individual counseling sessions, as students with SAPs are reluctant to come to the counseling office at school (Maeda, Hatada, Sonoda, & Takayama, 2012). Under such circumstances, only parents (mainly mothers) or school staff visit school counselors, who may then inevitably discuss specific school-based approaches without interviewing students and directly evaluating them (Maeda & Heyne, 2019). In other words, school counselors should acquire specific knowledge and techniques for SAPs under the assumption that they cannot hold individual counseling sessions with students suffering with SAPs.…”

“…Several case studies have demonstrated the effectiveness of school-based behavioral approaches for SAPs provided by school counselors on students who refuse individual counseling sessions (e.g., Maeda & Heyne, 2019;Maeda, 2016;. In these approaches, conducting behavioral consultations with parents and the school staff is crucial for addressing SAPs.…”