school phobia and school refusal - National Foundation for ... · school phobia and school refusal: research into causes and remedies LGAresearch• Report 46 by Tamsin Archer, Caroline

school phobia and school refusal: research into causes and remedies

LGAresearch • Report 46

by Tamsin Archer, Caroline Filmer-Sankey and Felicity Fletcher-CampbellNational Foundation for Educational Research

LGA educational research programme

school phobia and school refusal: research into causes and remedies

Tamsin ArcherCaroline Filmer-Sankey

Felicity Fletcher-Campbell

Published in October 2003by the National Foundation for Educational Research,

The Mere, Upton Park, Slough, Berkshire SL1 2DQ

© National Foundation for Educational Research 2003Registered Charity No. 313392

ISBN 1 903880 59 9

school phobia and school refusal iii

Acknowledgements iv

Executive summary v

11 IInnttrroodduuccttiioonn 11

1.1 Background 1

1.2 Aims of research 1

1.3 Methodology 2

1.4 The report 3

2 Identification and assessment 4

2.1 LEA survey 4

2.2 School survey 6

2.3 Interview data 8

3 Factors that precipitate school refusal or school phobia 11

3.1 LEA survey 11

3.2 School survey 11


4 Provision for school refusal or school phobia 16

4.1 LEA survey 16



5 Training issues and monitoring structures 24

5.1 LEA survey 24



6 Conclusions 26

6.1 Key findings 26

6.2 Key questions for consideration 27

References 29

Contents

iv school phobia and school refusal

Acknowledgements

The research reported here was sponsoredby the Local Government Association. We aremost grateful to them for making thispossible. We would like to thank the localeducation authorities (LEAs) and schools whoparticipated in this study. Particular thanksshould go to the schools and staff involved inthe case studies, who gave their time toshare their perceptions and experiences ofworking with pupils regarded as schoolrefusers or phobics.

The following National Foundation forEducational Research (NFER) colleagues arealso due thanks: David Teeman for hisassistance with the fieldwork; Mary Atkinsonfor her helpful and insightful comments onthe report; Emma Scott for the statisticalanalysis of the questionnaire data; ChristineWebster for her assistance with thequestionnaire surveys; Alison Lawson foreditorial input and Alison Bannerman for hersecretarial support.

school phobia and school refusal v

Executive summary

Introduction

The publication of school attendance figureshas led to schools being increasingly awareof the reasons for pupils’ non-attendance,particularly for unauthorised absences.Within the category of non-attenders, theremay be pupils labelled as school refusers orschool phobics who display a range ofprofiles. They include those who may simplynot want to attend school, as well as thosewho may show signs of anxiety if schoolattendance is suggested. Owing to theindividual nature of pupils’ problems it isdifficult to establish a firm definition ofschool phobia and school refusal, and thus toidentify and assess the pupils affected.Highly complex collaboration betweenschools and other agencies is necessary toaddress the needs of individual pupils and toput appropriate support in place.

There has been little educational literatureon the causes of school refusal or phobia andalso little research into the strategies thatcan be adopted by LEAs and schools tosupport pupils affected by the problem. Theaim of this research, commissioned by theLocal Government Association, was toincrease knowledge about, andunderstanding of, pupils identified as schoolrefusers or school phobics, in order toenhance professionals’ approaches tosupport them. The specific areas ofinvestigation were: identification andassessment, causes of school refusal andphobia, provision for pupils affected, andtraining and monitoring structures.

Methodology

The research was undertaken in threestrands. The first strand involved aquestionnaire survey to all LEAs in England.A total of 60 LEAs returned thequestionnaire. The second strand involved aquestionnaire survey to 600 schools in

England, including primary, secondary,special schools and pupil referral units(PRUs). A total of 280 schools returnedquestionnaires, but only 48 schoolsdistinguished school refusers or phobics fromother non-attenders. These schools werealso asked whether they would be willing totake part in further case study work. Thethird strand involved case studies in 16schools where school refusers or schoolphobics had been identified. Interviewswere conducted with a range of school staff,LEA representatives, professionals fromother agencies, and with some of the pupilsidentified as school refusers or phobics, andtheir parents or carers.

Key findings

DDeeffiinniittiioonn ooff tthhee ccoohhoorrtt((ss))

◆ The research revealed no cleardefinitions among practitioners in LEAsand schools distinguishing betweenschool phobics and school refusers.Common descriptions were of the broadgroup of pupils to whom practitionersapplied the terms ‘phobic’ and ‘refuser’.These descriptions included pupils withacute anxiety about attending school,pupils who cannot face school, andpupils who persistently refuse to attend.

◆ Generally, school phobics were seen as asubset of school refusers, and there wasa distinction in the descriptions of schoolphobics and school refusers, in thatschool phobics were perceived as thosewith anxieties (either rational orirrational) about attending school, andschool refusers were perceived as thosewho chose not to attend for whateverreason. There was a degree of overlapfor those pupils who chose not to attendbecause they had an anxiety – forexample, they were anxious about notmeeting curriculum challenges or aboutbeing bullied.

vi school phobia and school refusal

IInniittiiaall rreessppoonnssee ttoo iiddeennttiiffiieedd ddiiffffiiccuullttiieess

◆ What was significant in terms ofresponse to these pupils was that therewere common strategies which wereapplied regardless of the particularcategory in which they might nominallybe put.

◆ A common response was that a genericproblem of attendance would beidentified from analysis of attendanceregisters. Investigation of reasons forpoor patterns of attendance, eitherinternally by the school’s pastoral staffor externally by the attached educationwelfare officer (EWO), would thenidentify specific problems of refusal orphobia. In the schools participating inthe research, school pastoral staffworked closely with the relevant LEAsupport services – usually the educationwelfare service (EWS).

TThhee pprrooffiillee ooff iiddeennttiiffiieedd ppuuppiillss

◆ As definitions were so indecisive, therewas no possibility of quantifying cohortsof refusers and phobics. However, theredid seem to be evidence that morepupils were identified with attendanceproblems in the higher key stages (in thesecondary phase of education). Thereseemed to be a higher degree ofidentification in those schools wherethere was specific provision to supportthem – for example, where there was aseparate unit or a member of staff withspecific responsibility or interest. Thequestion remains as to whether this levelof identification was because theseschools were more sensitive to needswhich might not have been identified inother situations, or because theprovision was taken up merely becauseit was available.

◆ The main causes of the problem atschool appeared to be social anxiety,change of pupil groupings and fear ofthe school environment. However, itwas generally felt that, while schoolfactors could trigger school refusal orphobia, the origins of the problemusually lay in the home.

PPrroovviissiioonn ffoorr sscchhooooll rreeffuussaall oorr pphhoobbiiaa

◆ Strategies centred around preventionand addressing needs once they wereidentified. Preventative measuresincluded early action on non-attendance, extensive pastoralconsultation within the school, supportat school from another pupil (throughpeer mentoring schemes) or adult,provision of a safe environment inschool, and whole school behaviour andanti-bullying policies (though therewere no specific policies on schoolrefusal or phobia).

◆ The strategies considered effective insupporting pupils once the problem hadarisen were similar to those forprevention. Gradual reintegration wasfavoured. This might entail a part-timetimetable, provision of a place otherthan the classroom where the pupilwould feel safe, or extra support in class.In addition to this it was important thatpupils knew what was expected ofthem, and that a trusting relationshipwith staff was established andmaintained.

◆ The application of specific strategies wasdetermined, ideally, by analysis ofindividual need, usually undertaken bydiscussion amongst all those involved inthe school, and discussion with externalagencies as appropriate. While a multi-agency approach was favoured, theroute of prosecution was not consideredto be effective. In some cases, responseto a pupil’s difficulties was determinedby the provision that was availablewithin and outside school. Thesequence of support was fairly uniformacross schools.

◆ For strategies to be effective long-term,support (pastoral and academic) neededto be maintained.

TTrraaiinniinngg iissssuueess aanndd mmoonniittoorriinngg ssttrruuccttuurreess

◆ Approaches to refusal and phobia wereunsystematic across local authorities andschools participating in the research.Schools had received very little trainingon issues related to school refusal and

school phobia and school refusal vii

phobia. Any training which wasmentioned, was generally within theframework of school attendance.

◆ While attendance was routinelymonitored through statutory attendanceregisters, closer monitoring and action asa result of scrutiny of data depended onthe size of the school, the availability andinterest of staff, and the way in whichpastoral structures operated in theschool. In smaller schools and schoolswith a separate unit, it was possible tomonitor the progress of school refusersand phobics more closely.

◆ Schools did not routinely monitor theacademic progress of school refusers andphobics as a separate cohort. However,when these pupils were in a separateunit, the relevant pupils were monitoredmore closely. Staff were able to talk tothe pupils daily about their perceptionsof the school.

◆ Separate support units, and schools witha designated member of staffresponsible for school refusal andphobia, considered that their focusedsupport was effective in encouragingreintegration.

1.1 Background

The statutory requirement to publishattendance figures, and to record non-authorised absence, has made schoolsincreasingly aware of the range of reasonswhy pupils attend school irregularly or not atall. If schools are to reduce non-attendanceand reach government targets, it isparticularly important that they understandthe reasons for non-attendance so that theappropriate remedial strategies can be putinto operation. The reasons include schoolfactors such as bullying, inability to cope withschool work or peer group pressure, andhome factors such as family break-up, illnessin the family or outside employment (Kinderet al., 1995; O’Keeffe and Stoll, 1995;Atkinson and Hornby, 2002). Among thepupils who do not attend school, there maybe pupils labelled as school refusers or schoolphobics who exhibit a wide range of profiles.Some may simply not want to come to school,and others may not attend because theycannot face the prospect of school and willexhibit symptoms of stress if attendance issuggested. The problems these pupilsexperience and their personal circumstancesare so individual that it is difficult to arrive ata firm definition of school phobia and schoolrefusal. This means that not only isidentification and assessment of such pupilschallenging, but also a range of supportservices may be required to address the needsof different pupils, and support for them mayentail highly complex interdisciplinarycollaboration between schools and otheragencies. Arguably, any label such as schoolphobia or school refusal ought to bemeaningful and attract a commoninterpretation so that it indicates anappropriate and helpful response. There is nopoint in labelling if the label merely generatesuntested assumptions and/or does notindicate the sort of action that would addressthe problem.

Traditionally, the problem of school refusaland school phobia has been located in thechild or in family circumstances, but there isnow increasing awareness that the problemcan affect any pupil regardless ofbackground, and that factors at school playan important part (Atkinson and Hornby,2002). There is, however, very littleeducational (rather than psychological)literature on the causes of the problem, andalso very little research into the strategies andinterventions that can be adopted by schoolsand other agencies to support pupils who areanxious about attending school.

1.2 Aims of research

The Local Government Associationcommissioned the NFER to undertake aresearch project. The broad aim of the projectwas to increase knowledge and understandingof pupils identified as school phobics or schoolrefusers in order to enhance professionals’approaches to these pupils. Its specific aimswere as follows:

● to explore different perceptions ofschool refusal and school phobia andthe effect that these have onidentification and assessment

● to describe the range of profiles whichrepresent pupils identified as schoolrefusers or phobics

● to describe the approaches and actiontaken by LEAs and schools to supportschool refusing pupils and their families

● to identify training and staffdevelopment needs with respect tomeeting the needs of school refusersand school phobics

● to identify preventative measures andgood practice in this area.

school phobia and school refusal 1

1 Introduction

1.3 Methodology

There were three strands to the research - asurvey of LEAs, a survey of schools, and casestudies in a sample of schools.

1.3.1 LEA survey methodology andresponse

An eight-page questionnaire, directed to theprincipal educational psychologists, was sentto all 150 LEAs in England during the autumnterm 2002. The questionnaire soughtinformation on the following:

● LEAs’ definition of school refusal andschool phobia

● policies relating to the issue

● numbers of pupils regarded as schoolrefusers or phobics within the authority

● evidence of the causes of the schoolrefusal or phobia within the school

● school-based strategies to support pupilswith school refusal or phobia

● support available to pupils, families andschools

● collaborative activity with outsideagencies to support these pupils.

The LEAs were also asked to nominate schoolsthat they felt had been effective in addressingthe problem of school refusal or phobia, andin encouraging pupils to return to school.

A total of 60 questionnaires were returned(40 per cent response rate). Data from theLEA survey are displayed as frequencies andnot as percentages, owing to the smallnumber of cases. It should also be noted that,although the questionnaire was directed tothe principal educational psychologist withinthe LEA, it was often passed on to anothercolleague who worked specifically in this area,such as an EWO or a home tuition manager.

1.3.2 School survey methodology andresponse

A nine-page questionnaire was sent to asample of 600 schools in England during theautumn term 2002. The random sample

consisted of 175 primary schools, 175 secondaryschools, and 250 special schools and PRUs. Thequestionnaire sought information on:

● whether schools had a definition ofschool refusal and/or school phobia

● the numbers of pupils identified asschool refusers or phobics

● schools’ experiences of the causes ofschool refusal or phobia

● approaches to dealing with the problemwithin and outside of school

● the schools’ collaboration with outsideagencies to support individual pupils.

The schools were also asked whether theywould be willing to participate in furtherstudy, as part of the case study sample ofschools.

The questionnaire asked schools to provideinformation on attendance and then askedwhether they identified school refusers orschool phobics as a separate category of non-attenders. Only those who did distinguishschool refusers or phobics were required tocomplete the remainder of the questionnaire.A total of 280 questionnaires were returned(47 per cent response rate) of which only 48 (17per cent of the achieved sample, and eight percent of the total sample) completed the wholequestionnaire. This response rate can beviewed as a finding in itself. This finding mightsuggest that the problems of school refusal orphobia do not affect all schools or only affect asmall number of pupils at any one time.However, it may be that other schools simplydo not label pupils in this way. Secondly, thefinding also suggests that it is necessary toinvolve a large sample of schools to achieve asmall response, when the issues in questionmay not be at the top of schools’ agendas.

Table 1 Number of returned questionnaires

Breakdown by school type Frequency %

Mainstream primary schools 101 36

Mainstream secondary schools 84 30

Special schools and PRUs 95 34

N = 280

A single response item

2 school phobia and school refusal

Only 48 of the 280 responding schools (17per cent) noted that they distinguishedschool refusers or phobics from other non-attenders. Therefore the majority of thequestionnaire analysis is based on theresponses from 48 schools. For this reasonthe data in the subsequent chapters aredisplayed as frequencies and not aspercentages.

1.3.3 Interview methodology

Schools which completed the schools’questionnaire were asked if they would beprepared, in principle, to take part in furthercase study work. Of those who respondedpositively, approximately 20 schools werecontacted. These were schools with a rangeof pupils identified as school refusers orphobics and with a variety of differentapproaches to the problem. After initialnegotiation, a final sample of 16 schools wasidentified. These included seven secondaryschools, two middle schools, two primaryschools, three special schools and two PRUs.There was a geographical spread across thecountry and a wide variety in size. The largestschool had 1,700 pupils, and the smallest wasa PRU with six pupils. Five secondary schoolsin the case study sample had separate unitswholly or partly dedicated to supportingschool refusers and phobics.

In initial telephone calls with the schools,researchers identified which professionalswere most concerned with school refusers orphobics in each school and arrangementswere made to interview them. Thoseinterviewed included in-school staff, such asclassroom teachers, special educational needscoordinators (SENCOs) and learning support

assistants, LEA staff such as EWOs, andrepresentatives from other outside agenciessuch as social services, the health authority orvoluntary organisations. Headteachers and/orrelevant senior staff were interviewed aboutwhole school approaches to school refusal,including pastoral and curriculum support,whole school behaviour policies andattendance policies. Finally, interviews weresought with parents and carers and, wherepossible, with the children themselves.

The interviews were carried out in an eight-week period in the spring term 2003 andfocused on four main areas:

● identification and assessment

● factors that precipitate school refusal orphobia

● provision for school refusal or phobia

● monitoring and evaluation structures.

1.4 The report

The report is arranged around the four mainareas of research listed above. Chapter 2discusses issues of identification andassessment, including the varying definitionsof school phobia and refusal and the differentmeans by which pupils are identified.Chapter 3 focuses on the factors thatprecipitate school phobia and refusal atschool and at home. Chapter 4 describesprovision for pupils identified as schoolphobics and refusers, and Chapter 5 examinesstructures in place for monitoring andevaluating their progress. Finally, Chapter 6discusses the conclusions from the researchand poses key questions for consideration byLEAs and schools.


A series of questions were asked at localauthority and school level, by questionnaireand in interview, in order to find out aboutdifferent definitions of school refusal andphobia and means of identification. Inaddition, respondents were asked if there wasanyone with specific responsibility for pupilsregarded as school refusers or phobics andwhether they could give numbers of pupilsaffected by the problem within their school orLEA.

2.1 LEA survey

2.1.1 Definitions of school refusal andphobia

LEAs in England were asked how they definedschool refusal and phobia and whether theyidentified pupils with school refusal or phobiaas a separate category within the broadergroup of non-attenders.

Table 2 Identifying school refusers or phobics

Are school refusers or phobics identified as a separate category of non-attenders? Frequency

Yes 34

No 26

N = 60


Just over half of the LEAs which respondedindicated that they did distinguish schoolrefusers and phobics from other non-attenders. The most common phrases used intheir definitions tended to allude to thereasons why a pupil was not attending school.They included:

● pupils with a psychiatric diagnosis

● pupils with acute anxiety aboutattending school

● pupils who do not attend for emotionalrather than behavioural reasons

● pupils who do not attend forpsychological reasons.

It should be pointed out that these wererespondents’ perceptions of the characteristicsof pupils displaying the particular non-attendance problem. It is not clear that theseare, indeed, separate categories. Forexample, the acute anxiety may be perfectlyrational and explicable given certainenvironmental features (and disappear oncethese features have been amended) or it maybe deep-seated, and the observed behaviourresulting from a psychiatric condition.Equally, the ‘emotional reasons’ could be theresult of a child's stressful domestic situation(a parent with a medical condition, forexample) and disappear once the parent’shealth had improved or when day care forthat parent was guaranteed. Or the reasoncould be because the child had experiencedsignificant abuse, when very much more thana change of environment would be needed tohelp that child return to mental health.

Just under a third of LEAs which respondedalso said that they had specific writtenguidance for school staff or parents on schoolrefusal or phobia. It covered areas such as thesymptoms and causes of school refusal orphobia, and information on strategies thatmight be employed to support pupils.

2.1.2 Responsibility for school refusersand phobics

Over half of the LEAs which responded to thesurvey indicated that there was someonewithin the authority who had a specificresponsibility for pupils regarded as schoolrefusers or phobics, however, there was noconsistency as to who this was. In some LEAsit was the EWS that was responsible, in othersit was the educational psychology service(EPS). In some cases, the responsibility at LEAlevel lay with a particular member of staff, for


2 Identification and assessment


example, the head of the PRU or a designatedteacher within the education other than atschool team (EOTAS).

2.1.3 Numbers of pupils identified asschool refusers or phobics

The LEAs were also asked whether theyroutinely collected information on thenumbers of pupils within the authority whowere identified as school refusers or phobics.Just over one-quarter indicated that they did.In these cases, the data collection task seemedto be performed by the service with theresponsibility for school refusers or phobics,that is, the EWS or the EPS. A small numberof LEAs stated that information on the causesof the refusal or phobia was held on adatabase that was centrally retained.

The LEAs which did keep data on the numberof pupils within the authority regarded asschool refusers or phobics were asked toprovide numbers of pupils within each keystage, according to the most recent datacollected. Only 14 authorities provided thisinformation.

Table 3 shows that there were greaternumbers of pupils identified in key stages 3and 4.

Table 3 Number of pupils identified as school

refusers or phobics

Minimum Maximum Median Within each LEA number number number

Key stage 1 0 2 0

Key stage 2 1 10 2

Key stage 3 1 71 4

Key stage 4 1 154 12

N = 14

The numbers also varied considerably acrosslocal authorities. This is likely to relate to thedefinition of school refusal or phobia thateach LEA adopted as well as the means ofidentification. Some LEAs pointed out thatthey were not clear whether school refusaland school phobia were the same. Others

commented that there seemed to be widefluctuation in both the diagnosis andtreatment of school refusal or phobia. Ifthere is a lack of clarity at the level of the LEA,it is not surprising that there was confusionwithin schools – as is reported below.

2.1.4 Means of identification

LEAs were presented with a list and wereasked to indicate how schools in theirauthority identified pupils with school refusalor phobia by ticking ‘often’, ‘sometimes’, or‘never’ next to each means of identification.Table 4 illustrates the most common means ofidentification.

Table 4 How schools identify pupils with

school refusal or phobia

Frequency

Means of Often Sometimes Never Noidentification Response

Assessment by EWO 27 24 2 7

Attendance registers 27 17 6 10

Psychological assessment 17 33 6 4

Teacher nomination 12 30 5 13

Parental nomination 11 32 7 10

Other in-school identification 9 29 6 16

Assessment by Special Educational Needs (SEN) services 3 25 19 13

Pupil self-nomination 3 21 21 15

N = 60

A series of single response items

The most common methods of identifyingpupils as school refusers or phobics werethrough school attendance registers andassessment by the EWS. Other means ofidentification mentioned were referrals to thehealth service, and specifically to child andadolescent mental health service (CAMHS).Only 12 authorities referred to CAMHS, whichmay suggest difficulties in accessing theservice.

2.2 School survey

The survey for schools asked for similarinformation as the survey for the LEAs.

2.2.1 Definitions of school refusal andphobia

The schools were asked whether they usedthe attendance registers to identify reasonsfor poor attendance and whether theyviewed pupils with school refusal or phobia asa separate group within non-attenders ingeneral.

Table 5 Use of attendance registers by schools

Do you use attendance registers to identify the reasons for poor attendance? %

Yes 83

No 15

No response 2

N = 280


The majority of schools, including mainstreamprimary, mainstream secondary, specialschools and PRUs, did use the attendanceregisters to examine the reasons for poorattendance. However, only 17 per cent (48schools) stated that they identified schoolrefusers or phobics as a separate category ofnon-attenders, as is shown in Table 6.


Do you identify school refusers or phobics as a separate category of non-attenders? %

Yes 17

No 74

No response 9

N = 280


The remainder of the school survey analysis isbased upon data from these 48 schools.

Although survey response rates were verysimilar from each category of school (as

shown in Table 1), the number indicating thatthey identified school refusers or phobics as aseparate group was higher in some types ofschools than others. Nearly two-thirds (30schools) of those who did identify schoolrefusers or phobics as a separate categorywere secondary schools, just over one-quarter(13 schools) were special schools or PRUs, andthere were only five primary schools, asshown in Table 7. The fact that school refusalor phobia appeared to be more of an issue atsecondary level is shown by evidence fromthis questionnaire survey to schools and fromthe interview data reported later in thischapter.


Breakdown of school types Frequency

Mainstream primary schools 5

Mainstream secondary schools 30

Special schools and PRUs 13

N = 48


There were common phrases used by theseschools to define the pupils regarded asschool refusers or phobics. Many of theschools noted that they did not have a formaldefinition, but would describe the individualsas ‘persistently refusing to attend school’.Some schools used phrases such as ‘pupils whocan’t face school’, or with ‘acute anxietyabout attending school’. On the whole, theschools recognised that the definition ofschool refusal or school phobia was vague.Furthermore, there was no consensus over theterms school refusal and school phobia. Someschools noted that they did not use the termschool phobia, some used the termssynonymously, and others distinguishedbetween school refusal and school phobia.The issue of definitions regarding schoolrefusal or phobia is also discussed in the casestudy section of this chapter.

Out of the 48 schools, only one indicated thatit had written guidance on school refusal orphobia. The purpose of this guidance was toprovide information on actions to take.



The 48 schools were asked to provide thenumber of pupils within each key stage oftheir school that they regarded as schoolrefusers or phobics.

Table 8 Number of pupils identified as schoolrefusers or phobics

Across all 48 schools Number of pupils

Key stage 1 2

Key stage 2 28

Key stage 3 114

Key stage 4 149

N = 48 Total = 293

In any one of the schools, the number ofpupils identified as school refusers or phobicsranged from none (in a primary school) to 47(in a secondary school). It may be that thelatter was using a broader definition of schoolrefusal or phobia, or that they interpretedschool refusal or phobia purely in terms ofpupils who had attendance problems.

Obviously the size of the participating schoolsalso varied considerably. It should also benoted that there were also fewer key stage 1and key stage 2 schools in this sample of 48.

2.2.3 Responsibility for school refusersand phobics

The schools were asked who was primarilyresponsible for supporting pupils with schoolrefusal or phobia within their school. Schoolscould list as many personnel as applicable.

Table 9 People primarily responsible forsupporting school refusers or phobics

Within schools Frequency

EWO 38

Head of year or head of key stage 30

SENCO 23

Headteacher or deputy headteacher 22

N = 48

A multiple response item

Most schools noted that the EWO attached tothe school had a responsibility for pupilsregarded as school refusers or phobics.However, there was a slight difference acrossschool phases in other personnel withresponsibility. In primary schools and specialschools it was usually the headteacher or thedeputy headteacher who took responsibility,whereas in the secondary schools it was morecommonly the head of year or head of keystage.


Similarly to the LEAs, schools were presentedwith a list of different means of identifyingschool refusers or phobics and were asked totick ‘often’, ‘sometimes’ or ‘never’ dependingon how frequently they used each methodwithin their school.

Table 10 How schools identify pupils with

school refusal or phobia

Frequency

Means of Often Sometimes Never Noidentification Response

Attendance registers 41 4 0 3

Assessment by EWO 23 12 2 11

Teacher nomination 22 16 3 7

Parental nomination 14 17 8 9

Other in-school identification 13 17 6 12

Psychological assessment 6 22 7 13

Assessment by SEN services 6 20 9 13

Pupil self-nomination 2 20 12 14

N = 48


Most of the 48 schools noted that they usedattendance registers as a means of identifyingpupils as school refusers or phobics. They alsoreferred to the EWO for assessment and tothe teaching staff for comments.


Approximately one-third of the 48 schoolsnoted that they collected information on thecauses of the school refusal or phobia. On thewhole the information was supplied by theparents, the pupils and the EWS. Theirobservations on the possible causes of theproblem are examined in detail in Chapter 3.

2.3 Interview data

2.3.1 Definitions of school refusal andschool phobia

The school interviews gave further evidencethat there was little common understandingamongst practitioners about the phenomenaassociated with the terms school refusal andschool phobia. The majority of the staffinterviewed did perceive school refusersdifferently from school phobics, although theschools did not tend to have writtendefinitions. There were a few intervieweeswho did not distinguish between schoolrefusers and school phobics, and who saidthat they treated each case individually. Onemiddle school teacher was not sure what aschool phobic was, another did not thinkschool phobia existed. On the whole, thosewho did distinguish the two terms viewedschool phobics as:

● pupils with anxieties about school ingeneral (not specific to a particularschool)

● pupils with psychological problemsregarding school

● pupils who want to learn and want toattend school but cannot.

Definitions of school refusers tended to bebroader. In some schools definitions suggestedthat school phobia would fall under theumbrella term of school refusal, whereas inothers school refusers were viewed as adifferent cohort. School refusers weredescribed in a range of ways including:

● pupils who refuse to access education,including those who are disaffected – thiscould include condoned absences fromparents who do not value education

● pupils who choose not to attend schoolfor a particular reason – for example,because of bullying issues

● pupils who genuinely do not like schooland the way it operates

● pupils who are afraid of leaving aparent alone at home, for fear of whathe/she might do, or what might happento him/her.

Some of the above descriptions allow foroverlap in the terms – for example, a pupilwho has suffered prolonged bullying maychoose to refuse school for this reason, butmay also develop anxieties about attendingschool because of these experiences. Whilethey were not presented as such in theinterview, it seemed that definitions of thephenomena could be placed on a continuum,the axes of which are, broadly, ‘rational fear’and ‘irrational fear’. Placement on thiscontinuum is important for the informationthis provides about appropriate responsestrategies and which services the pupil shouldbe involved in. For example, arguably those atthe ‘irrational fear’ end need referral toCAMHS staff or the EPS, while the needs ofthose at the ‘rational’ end may be met by afunctional adjustment to the environment –though this may only be effected by a multi-agency approach. Some reported characteristicscould clearly lie on various places on thecontinuum (for example, ‘pupils with anxieties’).

One teacher who was head of key stage 3 ina mainstream secondary school explainedhow she viewed the differences in groups ofnon-attenders:

There are a number of children who aren’tcoming to school, which includes truants,school refusers and school phobics. Thereare different reasons for each. I think schoolrefusers are those who don’t come in forsocial reasons and school phobics are thosewho have panic attacks if they come in.

Although the majority of schools noted thedifferences between school refusers andschool phobics, this was not so evident in


practice. The pupils seemed to be viewed ashaving problems attending school and werethen treated individually. This becameapparent when different staff memberswithin a school were asked how many schoolrefusers and phobics there were in theirschool, because the numbers given did notoften match. The specific labels did notappear to be frequently used within theschools although staff members had similarconceptions of the terms. There was ageneral consensus, however, that there werevery few genuine school phobics.


As mentioned above, interviewees wereasked whether they knew how many schoolrefusers and phobics there were in theirschools at that time, how many boys and girlsthere were, which year groups they were inand whether numbers varied from year toyear. Their responses indicated that exactnumbers were not always known and thateven within schools there was no consensus asto how many there were. This appeared to bebecause schools did not necessarily have aclear-cut definition of the phenomenon andso were unable to label pupils as schoolrefusers or phobics. Schools viewed pupilsindividually and saw school refusal or phobiaas just one of the problems with which pupilshad to contend. It is important to note herethat schools perceived the response as moreimportant than the label. In such schools,where individual pupils’ difficulties wereprofiled, the label of refusal or phobia waslargely unnecessary. These schools alsoregarded the behaviour of refusal as part of acluster of characteristics around thatparticular pupil, as opposed to the principalphenomenon. The second reason that thenumbers varied was related to the size of theschool and the nature of provision for schoolrefusers and phobics within it. For example,in schools with a special unit, staff were moreaware of how many refusers or phobics therewere because they were dealing with themevery day. At the same time, as this secondaryteacher explained, the very existence of a

special unit, possibly caused more referrals tobe made:

We have approximately ten, a mixture ofboys and girls right across all the yeargroups. The number is fairly constant overthe years but since we’ve had the LSU[learning support unit] we’ve probablyfound out about more. Maybe in the pastthey were just hidden. Since the unit’sbeen set up, the staff know they can referkids to us.

This comment is interesting insofar as it raisesquestions as to whether the specific problemof refusal or phobia was identified becausethe provision was available and the label wasavailable to be applied, or because staff weremore sensitive to the pupils’ particular needs.In another secondary school, the EWO hadbeen allocated time and resources to workwith five pupils in each year group and so amaximum of five pupils per year group wereidentified. In this case, there are questions asto whether cases were created in order to fitthe resources available. The two specialschools in the sample, which had a system oftaking pupils to and from school by bus,tended to define school refusers and phobicsas those who did not attend at all. This casealso shows that definitions shifted accordingto environmental features – pupils at specialschools tend to have less opportunity for non-attendance unless this is condoned at home.In this case the school refusers or phobicswere those with no attendance rather thanthose with poor or eccentric attendance, asmight be identified in mainstream schools.


School refusers were normally first identifiedfrom the attendance registers. Once apattern of non-attendance had beendetected, the matter would be investigatedfurther by form tutors, heads of year ordedicated attendance workers. Usually itwould be the school that identified the non-attendance and then the matter would bediscussed with the EWO. In all cases the EWOwould do regular register checks and consultwith teachers. In the primary schools in the


sample, where numbers of pupils weresmaller, teachers would notice immediatelywhen a pupil was not there. In general, thespeed with which pupils would be identifiedand action taken was related to the work loadof the EWO, the frequency of their visits andthe number of staff in the school involved.

This chapter has examined the varyingperceptions of school refusal and phobia acrossthe LEAs and schools in the survey, and theensuing difficulties in identifying and assessingpupils affected. Chapter 3 examines the factorsat home and at school perceived to causeproblems of school refusal or school phobia.


This chapter focuses on the factors that thoseparticipating in the research felt precipitatedschool refusal or phobia, both within andoutside school. It also includes informationcollected on the reasons why pupils wereafraid to attend school, and on the groups ofpupils felt to be particularly susceptible to theproblems of school refusal or phobia.Sections 3.1 and 3.2 provide an overall pictureof the views from LEAs and from schools,based on the questionnaire data. Section 3.3focuses on these issues in more detail, usingthe interview material.

3.1 LEA survey

3.1.1 Factors precipitating school refusalor phobia

LEAs were asked to indicate from a list, thefactors at school they felt precipitated schoolrefusal or phobia by specifying ‘often’,‘sometimes’ or ‘never’. They were also giventhe opportunity to specify other factors. Theresponses are shown in Table 11.

More than half of the LEA respondents feltthat social anxiety often seemed to triggerschool refusal or phobia, and approximatelyone-third felt that a change of school wasoften a factor. In their additional commentsto this question, some noted that thetransition to key stage 3 and to key stage 4could cause problems. Other factorsmentioned by the responding LEAs weremainly home-related factors includingseparation anxiety, bereavement, and otherfamily issues. Some LEAs stated that factorsoutside school were more important thanthose in school.

Table 11 School-related factors thatprecipitate school refusal or phobia

Frequency

Often Sometimes Never NoFactors Response

Social anxiety 36 21 0 3

Change of school 18 37 0 5

Fear of failure in class work or tests 13 38 2 7

Fear of specific places 10 38 2 10

Anxiety about the journey to school or travel sickness 10 38 2 10

Reaction to a specific incident or lesson 8 40 3 9

Fear of lesson time 7 39 3 11

Changes in pupil groupings 5 43 3 9

Fear or dislike of a specific adult 5 40 5 10

Fear or dislike of a specific subject 5 38 7 10

N = 60


3.2 School survey


As in the LEA survey, schools were asked tonote the factors that they felt precipitatedschool refusal or phobia. They were askedabout school-related factors first and thenabout factors outside school. Their responsesare shown in Tables 12 and 13.


3 Factors that precipitate school refusal orschool phobia

Table 12 School-related factors thatprecipitate school refusal or phobia

Frequency


Social anxiety 27 19 0 2

Reaction to a specific incident or lesson 8 26 3 11

Fear of specific places 8 20 9 11

Fear of lesson time 7 26 6 9

Fear of failure in class work or tests 7 25 7 9

Fear or dislike of a specific adult 7 24 8 9

Anxiety about the journey to school or travel sickness 7 20 13 8

Change of school 5 33 3 7

Fear or dislike of a specific subject 4 29 6 9

Change in pupil groupings 3 27 7 11

N = 48


The majority of participating schools felt thatsocial anxiety was often or sometimes aprecipitating factor. This was very similar to theviews of the LEAs. However, the schools andLEAs views differed slightly with regard to theeffect of changing schools. The schools were lessinclined than the LEAs to note this as a factor.

Table 13 Home-related factors that precipitateschool refusal or phobia

Frequency


Family conflict 24 18 0 6

Traumatic event at home 17 26 1 4

Pupil illness (physical or mental) 15 28 0 5

Violence or abuse 9 30 2 7

Special educational needs 6 31 4 7

Illness or death in the family 5 35 2 6

Birth of a sibling 0 27 11 10

N = 48


A conflict within the family, a traumatic eventat home or pupil illness were the three mainexternal factors that schools felt triggeredschool refusal or phobia. Some schools alsonoted that parenting issues and parents’mental health were other factors.

3.3 Interview data

Data gathered in interviews withheadteachers, in-school support staff, EWOsand outside professionals providedinformation on:

● how information was collected on thereasons why pupils were afraid toattend school

● the groups of pupils who were thoughtto be susceptible to the problem ofschool refusal or phobia

● the factors perceived to precipitateschool refusal or phobia.

3.3.1 Collection of information onreasons for school refusal andphobia

In most cases, detailed information on thereasons why pupils were refusing school wasgathered once the attendance problem wasidentified in the registers. Once a pattern ofnon-attendance had been noted, either theschool would telephone home to investigatethe reasons for the non-attendance or theEWO would contact the family and possiblymake a home visit. Information would also besought from class teachers and learningmentors. In one large secondary schoolwhere there was a unit specifically for schoolrefusers and phobics, the teacher in charge,together with a clinical psychologist, haddevised a questionnaire that would give herinformation to use when devising strategiesand targets to reintegrate the pupils. Inanother case the EWO would ask identifiedpupils a set of questions from a ‘life events’questionnaire on a home visit to see if therewere factors in the past which might havecontributed to the problem. In just one of theschools, (a special school), detailed


computerised records were kept on thereasons for non-attendance.

3.3.2 Profiles of school refusers andphobics

Staff were asked whether the problem ofschool refusal or phobia was more prevalentin any one group of pupils and, though therewas some variation from school to school,their responses indicated on the whole thatboys and girls were equally affected by theproblem and that there was a spread of ageranges. In the secondary schools it was feltthat the problem was more acute in key stage4. Pupils had more exciting things to do outof school and were less able to cope withpressures of course work and examinations ifthey had been absent for periods of time.This illustrates how a vicious circle of non-attendance may emerge, because poorattendance leads to problems in school (forexample, uncompleted course work), and thiscould lead to further attendance problemsand fear or dislike of school because of thisfailure.

A number of teachers felt that school refusersand phobics were more likely to come fromdisadvantaged or dysfunctional backgroundswhere school was not valued. As one seniorteacher in a large school explained:

Social outcasts. Without a shadow of adoubt, it’s always about children (thoughthere are always exceptions) who comefrom deprived backgrounds, whose parentsdon’t really understand the process ofeducation, children who don’t look thesame, who haven’t got the money to wearthe same, who haven’t succeededthroughout life, who don’t succeed withintheir own family, and I’m not talking aboutacademic pressures here.

Children with psychological problemsthemselves, or from families in which therewere psychological problems, were also felt tobe more susceptible to the problem. OneEWO in a middle school felt that the child’sproblems could be reinforced by the family:

I find that the families in some ways, notconsciously, actually feed the young person’sanxiety. So they might be overprotective,they might be reinforcing the anxiety everytime the child comes home.


When teachers and other professionals werequestioned further about specific factors thatcontribute to the problem of school refusal orphobia, their comments reinforced the datafrom the schools’ questionnaire. Both schooland home factors were seen as important incontributing to the problem. The schoolfactors mentioned included:

● The size and layout of the school. Pupilswere anxious about moving around theschool, coping with long crowded corridorsand going into specific places such as thecanteen or classrooms.

● The structure of the school day. Pupilswere anxious about unstructured oruncontrolled time, the journey to and fromschool, break times and lunch times.

● Conflicts with teachers. Pupils mightdislike a particular teacher or teaching styleor there may have been a particular incidentwith a teacher.

● Transition periods, for example, whenpupils move from primary to middle orsecondary school, or at the options stage insecondary school. Pupils could be anxiouswhen unfamiliar with new pupil groupings.

● Fear of specific subjects, particularly PE,where pupils might have a low body imageand inhibitions about getting changed infront of others.

● Academic pressures. Pupils might bestruggling with the work, particularly withend of key stage tests in years 6 and 9.

● Bullying or perceived bullying.

● Friendship problems, particularly inadolescence and with girls.

● Inappropriate provision – ‘the wrong childin the wrong school’.


● The knock-on effect of repeatedabsence. The fact that a pupil wasfrequently absent would make it moredifficult to come back to school. Atsecondary level a pupil who had missed a lotof school would find it hard to catch up withthe work. At primary level a pupil might find it hard to maintain friendship groups, asone primary headteacher explained:

They have a difficulty with relationshipsbecause they are absent so often andtheir friends get used to playing withother sets of children and they come backand it’s difficult for them to feelcomfortable with their friends again.

This is how one teacher summed up theproblems for school refusers in a largesecondary school:

Size of school. The way the buildings are setup. The corridors in this school can be quiteintimidating at the end of a break time.Lots of big bodies moving down very smallcorridors. Class sizes are significant withschool refusers. They do need moreindividual attention and sometimes this isnot possible. Lack of knowledge on thepart of the teachers on how to deal withpupils who don’t want to come to school.Sometimes it’s seen as being somethingwrong or something’s wrong with the child.

Many of those interviewed felt that factors atschool could trigger a period of school refusalor phobia but that factors at home were morelikely to be the root cause of the problem.Where a child was refusing to come to schoolbecause of something that had ostensiblyarisen at school, it was generally the case thatthere were already issues within the family. Anumber of home factors were mentioned:

● problems in the child such as low self-esteem, anxieties about physicalappearance, lack of social skills andspecial educational needs

● psychological problems in the parentaffecting the child (such as depression)and anxieties which the parent mightcommunicate inappropriately to the child

● family breakdown, separation anddivorce, and single parent families

● traumatic events at home such asbereavement

● violence and abuse in the home

● separation anxiety experienced by thechild. In some cases the child might actas a young carer and have fears for theparent’s health. One EWO in a middleschool felt that:

if there are problems at home,children don’t want to come to school,because they’re frightened of leavingtheir parents at home by themselves

● separation anxiety experienced by theparent. A number of school refusers inthe sample were the youngest child inthe family and it was felt that parentswere unwilling to let them leave thehome

● situations where the child was requiredto look after a younger sibling

● inadequate parenting, lack oforganisation and of sustained support.In some cases the school refuser mighthave siblings who were also schoolrefusers. One EWO explained:

With all my cases home factors aremore important. If they’re notencouraged to come to school or todo their homework or to get in ontime. It’s a pattern that’s set at homeand it is something that runs in thefamily. I think it’s all family – a lotdon’t have the attitude that school’simportant. They take the childshopping or out of school on holiday.

● poverty, for example, where the familywas not able to afford school meals orthe uniform.

To conclude, data from the LEA and schoolquestionnaires were corroborated by datafrom the interviews. What emerged indiscussions with teachers and support staffwas that any number of factors at school or athome could contribute to problems of school


refusal or phobia, and that for any individualchild it would most likely be a complexcombination of internal and external factors.Most interviewees felt, however, that whileschool factors could trigger or exacerbate theproblem of school refusal, the origins of theproblem usually lay in the home. This

suggests that the phenomenon is probably asymptom of other factors and signals extremevulnerability in those children. Furthermore,it indicates that schools should seek supportfor these families from external agencies (forexample, CAMHS), as well as addressing theschool-related factors.


This chapter focuses on the provision forpupils regarded as school refusers or phobics,particularly the strategies for preventingproblems of school refusal or phobia and thestrategies for supporting pupils with theseproblems, including reintegration strategies.It also includes information on the outsideagencies that LEAs and schools use to supportschool refusers or phobics. Sections 4.1 and4.2 are based on the questionnaire responsesfrom the LEAs and from schools. Section 4.3addresses the issues in more detail using datafrom the interviews.

4.1 LEA survey

4.1.1 Strategies for dealing with schoolrefusal or phobia

The LEAs were presented with a list of school-based strategies and were asked which theyfelt to be effective in preventing the problemof school refusal or phobia and in addressingthe needs of the pupils affected. Table 14shows the strategies that were considered tohelp with prevention.

Table 14 Strategies for preventing refusal orphobia

Frequency

Effective Not sure Not Strategies effective

Early action onnon-attendance 55 5 0

Support from other pupils 48 11 1

Creation of a less threatening environment 47 12 1

Support from an adult 46 14 0

Behaviour and anti-bullying policies 44 15 1

Alternative curricular/extra-curricular provision 32 24 4

Extra support in literacy and numeracy 29 27 4

Change of class/tutor group 23 33 4

N = 60


Nearly all responding LEAs felt that takingearly action on non-attendance was effective.In addition to this, providing support to theindividual from other pupils or from an adult,for example a classroom assistant orcounsellor, was also considered effective aswell as creating a less threateningenvironment or a safe place in school for thepupil. Whole-school strategies such asbehaviour and anti-bullying policies were alsothought to help in preventing the problem.

The strategies considered effective inprevention were similar to those consideredeffective in addressing the needs of pupilswith school refusal or phobia, that is, supportfrom an adult or other pupils, the creation ofa less threatening environment, and takingearly action on non-attendance, as shown inTable 15.

Table 15 Strategies for addressing the needsof school refusers or phobics

Frequency

Effective Not sure Not Strategies effective

Support from an adult 50 10 0

Creation of a less threatening environment 50 9 1

Early action on non-attendance 47 12 1

Support from other pupils 43 15 2

Alternative curricular/extra-curricular provision 41 16 3

Change of class/tutor group 25 32 3

Extra support in literacy and numeracy 25 29 6

Behaviour and anti-bullying policies 20 27 13

N = 60


Another strategy that was noted by someLEAs was a gradual reintegration programme.Some LEAs also felt that the emotional orpsychological issues needed to be addressedfirst, before such strategies were adopted.


4 Provision for school refusal or school phobia

4.1.2 Educational provision for pupilsregarded as school refusers orphobics

The type of provision offered by LEAs isshown in Table 16.

Table 16 LEAs with specific educationalprovision for school refusers or phobics

Type of provision Frequency

Home tuition service 50

Alternative curricular provision 45

PRU 34

N = 60

A series of single response itemsFrequencies reflect LEAs with the provision

The majority of the participating LEAs offereda home tuition service that pupils who wereidentified as school refusers or phobics couldaccess. However, there were no data on theextent of the provision, for example, on thenumber of hours of support available. Three-quarters of the LEAs offered alternativecurricular provision for these pupils and overhalf offered provision at a PRU. Some LEAsreferred to other specific provision, forexample, hospital schools, and some notedthat the individual schools were expected toprovide appropriate support, for example,through learning support units (LSUs) orinclusion units.

4.1.3 External support

The LEAs were also asked to indicate whichother services within the region were used tosupport pupils regarded as school refusers orphobics (see Table 17).

The majority of the LEAs noted that theyoften used the EWS to address pupils’ needs.Services such as the CAMHS and the EPS wereused at least sometimes by the participatingLEAs to support pupils with school refusal orphobia. However, some LEAs noted that theyhad found it difficult to access CAMHSprovision for these pupils, as suggested inSection 2.1.4. A few LEAs also noted that theyreferred to the Connexions service forsupport. On the whole, a multi-agencyapproach was recognised as an effective

means to support pupils regarded as schoolrefusers or phobics because of the complexnature of the problems.

Table 17 Services used to support pupils withschool refusal or phobia

Frequency

Services Often Sometimes Never

EWS 50 10 0

CAMHS 29 31 0

EPS 27 33 0

Learning and behaviour support service 11 37 6

Health service 8 38 5

Counselling service 5 27 14

Voluntary organisations 2 27 17

Social services 1 38 12

Youth service 1 36 14

N = 60

A series of single response itemsMissing data not included

4.2 School survey

4.2.1 Strategies for supporting pupilsregarded as school refusers orphobics

In order to compare the strategies consideredeffective by the LEAs with the strategies usedby schools, the schools were asked whichstrategies they actually used to support thepupils.

Table 18 Strategies used by schools forsupporting school refusal or phobia

Strategies Frequency

Early action on non-attendance 48

Support from an adult 46

Behaviour and anti-bullying policies 41

Creation of a less threatening environment or safe place in school 36

Extra support in literacy or numeracy 36

Change of class or tutor group 36

Alternative curricular or extra curricular provision 33

Support from other pupils 30

N = 48

A multiple response item


All schools stated that they took early actionon non-attendance, which was alsoconsidered one of the effective strategies bythe LEAs. On the whole, most schools used avariety of strategies for supporting pupilsregarded as school refusers or phobics.

As a variety of strategies were used, schoolswere asked how they decided on appropriatestrategies for individual cases. Their responsesshowed that the main procedures involvedwere:

● discussions with the pupil concerned

● considering each case individually

● discussions with parents

● discussions with all school staff

● involving the EWS

● consultation with outside agencies.

Most participating schools which hadexperience of dealing with pupils regarded asschool refusers or phobics felt that there werestrategies that they considered to be effectivein the reintegration of pupils after a period ofabsence from school. These included:

● devising a part-time timetable

● providing one-to-one support from anidentified adult

● devising a specific reintegrationprogramme for the individual

● liaising with the parents involved.


The schools were also asked to list the outsideagencies with which they collaborated tosupport pupils regarded as school refusers orphobics. As Table 19 shows, the outsideagencies involved were in line with thoseused by the LEAs. As before, the EWS was theone used most often to support schoolrefusers and phobics.

Table 19 Services used to support pupils withschool refusal or phobia

Frequency

Services Often Sometimes Never

EWS 42 6 0

Learning and behaviour support service 16 20 4

EPS 15 27 2

Health service 14 27 4

CAMHS 9 21 7

Social services 8 28 4

Counselling service 7 26 6

Youth service 2 13 18

Voluntary organisations 2 10 19

N = 48

A series of single response itemsMissing data not included

4.3 Interview data

4.3.1 Internal school support

When schools were questioned about theplace of school refusal or phobia in theiroverall pastoral structures, it became clearthat this varied immensely according to thesize and phase of the school and to whetherthere was separate provision for schoolrefusers or phobics in the form of a specialsupport unit in school. Some general trends,however, could be identified. In most casesthe issue would be discussed along withbehavioural and non-attendance issues atregular (weekly or fortnightly) seniormanagement team meetings attended byheads of year and key stage coordinators. Insome cases there was a pastoral coordinatorwhose responsibility was to liaise with headsof year, and through them to appoint tutors,attendance officers and EWOs. Pastoralcoordinators also had specific responsibilityfor liaison with the families and outsideagencies as appropriate. In some schools itwas the deputy headteacher or a seniorteacher who assumed this role, and in othersit was the SENCO. In the five schools wherethere was a separate support unit, the


manager of the unit would be the one toliaise with the mainstream school, familiesand outside agencies. One manager’s view,however, was that while pastoral staff borethe main responsibility, all staff in the schoolwere responsible, and there should be flexiblearrangements for consultation andcommunication at all levels.

We need to avoid contrived structures.When things need reviewing, we should beaware of it and review it, not necessarilywait for some appointed time. We need tobe more responsive than that. I think wehave a collective responsibility and it shouldbe based less on old ideas of demarcation.

On an administrative level, several schoolshad staff specifically responsible formonitoring attendance on a daily basis. Theywould trawl through registers, telephonehome on the first day of absence and chase upwith letters and telephone calls if there wasno satisfactory explanation for non-attendance.


All schools in the sample worked with LEAstaff to support school refusers and phobics.Those most involved were the EWOs, whosestatutory role was to monitor attendance, butschools also worked with educationalpsychologists, school nurses, specialeducational needs support services and thetuition service. In many cases, central LEAstaff were based in the same building and thisfacilitated liaison between different services.In addition to this, schools in the sampleliaised with outside agencies as and when theneed arose. These included CAMHS, socialservices, the health service, child prostitutionagencies, counsellors, clinical psychologists,EOTAS, Connexions and social inclusionofficers. In special schools, speech andlanguage therapists, occupational therapistsand physiotherapists were also involved.

None of the schools in the sample had specificpolicies on school refusal or phobia, though

several stressed that they adopted a positiveapproach to school refusers and phobics bywelcoming them back on their return. All,however, had positive behaviour andattendance policies and anti-bullying policiesin place.

4.3.3 Support processes and strategies

In order to decide what kind of support toprovide in individual cases, schools said theyspent a lot of time with pupils and found outas much as possible from the parents aboutthe causes of the problem. They would thentailor their support to the individual need andinvolve outside professionals as appropriate.Some pupils would need emotional support,and others would need extra support withwork.

The strategies that were considered to beeffective were varied and many, but the mostimportant approach was to establish a closecontact with the pupil and with their home.Schools would attempt to gain the trust ofthe students by listening to what they had tosay and by being prepared to listen to thesituation from their perspective. It wasimportant not to be figures of authority andto work with the pupil – a role which staff feltwas easier for learning support assistants thanfor teachers. As one home-school supportworker in a PRU explained:

I think listening and accepting wherethey’re at. Taking what they say at face-value, until the point when they manipulateor over-simplify something. Then I willpoint out what we need to do together. Itis very effective to point out that you’re notthe teacher – you’re concerned about theireducation as well as them as whole people.

It was important that pupils knew whatwould be expected of them and that it waswithin their limits. It was also considered vitalthat the support and trust was maintained,even when the pupil was back at school andattending normally.


Most schools in the sample felt it waspreferable to get the child back into schoolfull-time if possible, because it established aroutine and a basis on which to build up thesupport. This suggests that provision such asthe home tuition service should only beconsidered as a temporary measure. In someschools a restricted timetable was offered andpotential sources of anxiety removed. As onepastoral coordinator explained:

If you keep them in school you can initiallywithdraw the problem and you get theminto a routine where they are in school andmixing and their confidence is increasing.For example, if I have a kid whose problemis PE then we can remove PE for a while butmake it very clear to the child that this is nota long-term solution, it’s support.

In other schools, pupils were allowed to comeinto school slightly later, or through adifferent entrance, to register separately, andto leave earlier to avoid the rush. This mightmake all the difference to pupils who wereanxious in crowded areas or the classroom. Asone fifteen-year old explained:

The unit is a wonderful way of gettingsomeone back into school. It got me rightback into school anyway. It’s so good - thetiming – you go in there at half nine in themorning, you leave at three so there’s noregistration.

In one school, school refusers and phobicsattended every morning and were collectedby a parent at lunchtime. Part-timeattendance was not always an option though,as one rural school explained, becausetransport in country areas was either difficultor non-existent during the day, and not allparents could drive or were available todeliver or collect their child.

Large schools, in particular, provided a ‘safeplace’ in school for pupils who could not facegoing into classes. This could be a particularroom that they could go to or even an adultthat they knew would always be availableshould they need support. In the schools witha separate support unit for school refusers or

phobics, pupils would be based in the unitand attend mainstream lessons if they feltthey could cope. While in the unit, theywould be taught in smaller groups andsupported by learning mentors who wouldescort them to lessons if needed.

Another strategy mentioned by several of theschools was to provide extra support in class.This might be through learning mentors, whowould talk to pupils about any problems theymight have, or through classroom assistants,who would provide support with the work. Asone EWO explained:

[You need to give] as much support in theclass as you can because that’s the bit wehave to be concerned with. We may not beable to change what is happening at home,although I’d like to if I could, but if the workis too difficult and they need someonesitting with them to differentiate theactivities, that might just hold them.

This illustrates that schools acknowledgedthat they could only support children atschool. Other agencies would need to beinvolved if there were problems at home.

Some schools operated a buddy system,pairing up pupils with another child whocould support them.

Despite the fact that recent research(Kendall, White and Kinder, 2003) showededucation welfare staff to be generallysupportive of prosecution in cases of non-attendance, this study revealed thatprosecution was not thought to be effectivefor school refusers or phobics. The EWOsoften noted that they had a statutory role toenforce school attendance. They wouldwork to get non-attenders back into school,but when this was unsuccessful they wouldbe required to take legal action. Thisbecame problematic when dealing withschool phobics. As one EWO explained:

With this case of a school phobic I wasseriously considering going to court withit, but I’ve now put my hand up and said Ican’t, because I think he is a genuineschool phobic.


Box 1 explains how one school organised itsprovision for school refusers and phobics.

Box 1 11 – 16 secondary school

In this large secondary school a separateunit for school refusers and phobics hadbeen set up on the suggestion of an EWOwho was now seconded to the school andcoordinator of the unit. The unit wasknown as the Vulnerable Pupils Unit butthe pupils referred to it as the VeryImportant Pupils (VIP) room. It functionedalongside a separate learning supportunit for pupils with learning difficultiesand was housed in a spare classroom.There was a staff of two, the coordinatorherself and one full-time learning mentor.Once pupils with identified attendanceproblems were referred to the unit,usually by a head of year, the coordinatorwould give them a questionnaire abouttheir anxieties and discuss their problemswith them. This would enable her todevise targets for individual pupils andstrategies for reintegration. Thesequence of support was entirely tailoredto the individual and there was nopressure on pupils to return to theclassroom.

Pupils would be based in the unit andcould remain there until they could facereturning to normal lessons. They wouldregister in the unit and the staff wouldarrange work for them to do there. Theeventual aim was to get the children backinto normal lessons by providing a saferoute and at a pace with which they feltcomfortable. They would try to build upattendance across the timetable, byasking the children which lessons they feltcomfortable with, escorting them tolessons if necessary and, once the childrenwas back in class, by finding another pupilin the same class who could supporthim/her during the lesson. If necessarythe learning mentor could accompanypupils during the lessons as well. It was

important to give support but not createdependency. There were approximately18 pupils in the unit at the time of theinterview, most of them full-time, and itwas possible to monitor their progressclosely because the numbers were sosmall. If a pupil did not attend, the staffof the unit would telephone homeimmediately and, if necessary, make ahome visit.

This is how the learning mentor describedthe strategies they employed:

Our strategies are different for everycase. To get them back in we do itreally slowly. We’ll discuss theproblems, we’ll ask them what themain problems are, what they feelcomfortable doing while they are inschool, and which lessons they feelcomfortable with. Generally we startout going to these lessons with them.We’ll look to see if there are any peoplein the lessons that they know and we’llmanipulate the timetable around that.We’ll take them out of difficult classesand put them in easier groups. We’lldo that in conjunction with the headsof year so we have to have quite stronglinks with them. We make them feellike they can come back to the unit andit’s like they’re on hallowed ground,they’re safe there.

Both members of staff in the VulnerablePupils Unit felt that the support they wereproviding was successful in encouragingpupils to return to school, but they alsofelt that attendance was liable to slip backonce pupils left the unit. The success ofthe unit was such, however, that theywere hoping to expand to providesupport for new referrals as well as forpupils in years 10 and 11 who neededmore specific curricular support. The mixof ages in the unit was felt, however, tohave positive benefits because the olderchildren supported and helped theyounger ones to overcome their anxieties.


Box 2 PRU for key stage 3 pupils

This unit was set up to cater for up to sixkey stage 3 pupils identified as havinganxiety problems and who were failing toget to school because of this. Thisincluded pupils regarded as schoolphobics and refusers. The unit wasoriginally set up as a project by the healthservice but was now operating as part ofthe PRUs. It was funded jointly by theeducation service, which paid the teachingstaff salaries and the running costs, andthe health service, which housed the unitin a hospital and paid for interventions.Children all had a psychiatric diagnosis,and could be referred to the unit fromtwo LEAs via their GPs and the child andfamily guidance clinic. In addition to theteachers, the multi-disciplinary team inthe unit included a consultant psychiatrist,a trainee registrar, two nurses, anoccupational therapist, a psychologist anda psychotherapist. The main aim of theunit was to reintegrate pupils into full-time school. This might be a differentschool from that attended previously or aspecial school, but it was made clear toparents and pupils in the unit that theywould lose their place there if theyrefused to try to reintegrate. The pupilshad to remain on a school roll whilstattending the unit and the staff were veryclear that it was not an alternative toschool, but a package to helpreintegration.

The teacher in charge described the fourstages of the reintegration process. In thefirst stage they would try to let the pupilsestablish themselves within the smallgroup in a safe setting, so they feltcomfortable doing educational activities,going out and about and interacting withtheir peers. This would help to raise theirself-esteem because they were always

Though strategies to support school refusersand phobics were very much designed aroundindividual pupils, the sequence of support wasfairly uniform across schools in the sample.Attendance patterns was identified fromregisters and if there were cause for concern,schools would contact the parents and speakto the pupil to establish reasons for non-attendance. On the whole, schools wouldliaise with the family first. As one EWOexplained:

School attendance is a school issue andthere is an expectation that the school hasactually tried to resolve the issuesthemselves first, because that’s where therelationship is, between school and home. Icome in to mediate. The school will do firstday response. It’s a good way to bringabout change. It could be a letter, it couldbe a meeting or a home visit. They do a lotof liaison themselves.

If the problem stemmed from home it wouldbe the EWS which would liaise with thefamily. All schools would aim to get the pupilto attend, even if they did not go to lessons.This might entail offering a partial timetableor extra pastoral support in and out oflessons. Once the child was back in schoolthey would encourage them to go to lessonsthey felt comfortable with and find themactivities for the remaining time. Theemphasis, however, was to build upconfidence by regular attendance rather thanput pressure on work. Once back in schoolthe pupil would be supported by learningsupport assistants or mentors.

The interview data have provided manyinsights into the ways in which school refusersand phobics were supported in mainstream orspecial units within the school. Two of theestablishments in the sample, however, werePRUs outside schools which had been set upspecifically for school refusers and phobics.The strategies to support pupils in one ofthese are described in Box 2.


with the same people. Pupils would beexpected to attend regularly but withoutother school pressures like the bellringing, changing classrooms and schooluniform. Pupils were also taxied to schoolto remove the pressure on them. At thebeginning of the week sessions wouldstart at lunchtime but by the end of theweek they would start at 9.30am. Thepupils would follow the key stage 3curriculum and have specific lessons.However, the timetable was flexibleenough to allow time to deal with thepupils’ anxieties and work throughreintegration strategies. During thesecond stage of the reintegration process,staff would talk to the pupils individuallyabout going to the school gates with oneof the school nurses. Once they feltcomfortable enough, and this was veryindividual, staff would select a lesson thatthey felt the pupil might be able to copewith. The classroom assistant from theunit would go with him/her and would sitin the background, or with him/her, asnecessary. When the pupils were ready,time in school would be extended andtheir timetable would be filled withperiods in the unit and periods in school.By stage three they would be attendingalmost 100 per cent and managing to

take themselves to and from school. Inthe final stage, management would behanded over to the school. The staff inthe unit would meet the pupilsoccasionally or telephone them to findout how they were, until the pupils saidthey no longer needed that support. Theywould also keep in close contact with thepupils’ teachers and work with theeducational psychologist.

The length of time the reintegrationprocess lasted varied from two schoolterms to as long as two years. The unit didnot cater for key stage 4 pupils so it aimedto reintegrate the pupils prior to the startof key stage 4. On the whole, the teacherin charge felt that their support waseffective. They could only cater for a fewpupils but getting a child with apsychiatric diagnosis back into school wasa tremendous achievement.

This chapter has documented generalstrategies employed by schools to supportschool refusers and phobics and the sequenceof support in two of the sample schools hasbeen described in more detail. In Chapter 5training issues related to school refusal andphobia are briefly examined, as well asstructures for monitoring the progress ofpupils affected.


Within the questionnaire surveys, both LEAsand schools were asked about whether therehad been any training relating to schoolrefusal or phobia. This issue was alsofollowed up in the interviews at school level.These also explored the mechanisms formonitoring and evaluating the progress andattendance of pupils regarded as schoolrefusers or phobics, which is described inSection 5.3.2.

5.1 LEA survey

The LEAs were asked whether they regularlyorganised any in-service training (INSET) onissues relating to school refusal or phobia.

Table 20 Training on issues relating to schoolrefusal or phobia

Focus of INSET Frequency

Awareness raising on school refusal or phobia 14

The causes of school refusal or phobia 11

Strategies to support pupils with school refusal or phobia 11

N = 60

A series of single response itemsFrequencies reflect LEAs that had organised specific training

Some LEAs indicated that there had beentraining on the issues surrounding schoolrefusal or phobia but this had not been thecase across the board. Some LEAs also notedthat training was available for specific services,such as the hospital outreach service or theEPS. Some LEAs stated that INSET was plannedor that there had been INSET on school refusalor phobia for schools which had requested it.

5.2 School survey

Only a small number of the schools whoidentified school refusers or phobics as aseparate category of non-attenders statedthat they had received INSET on the issuessurrounding school refusal or phobia.

5.3 Interview data

5.3.1 Training issues

Schools in the case study sample were askedwhether they had had any INSET on thesubject of school refusal or phobia but noneof those interviewed had taken part orprovided any training specifically on thistheme. Several teachers, however, stated thatthey had participated in courses where theissue of school refusal or phobia had beenmentioned within the wider framework ofschool attendance.

5.3.2 Monitoring and evaluationstructures

Interviewees were also asked whether theymonitored and evaluated the progress ofschool refusers or phobics. On an everydaybasis, schools monitored pupils’ attendanceand non-attenders were identified from theregisters either by attendance workers in theschool or by EWOs. In all cases, meetingswere held between pastoral staff in theschools and EWOs to discuss attendance ingeneral and the progress of individual pupils.The frequency of these meetings wasdependent on EWOs’ caseloads and theavailability of staff. Closer monitoring wasdependent on the size of the school and theprovision in place. In schools with separate


5 Training issues and monitoring structures

units staff would have daily contact withpupils. They would be able to observeprogress at first hand and there would beample opportunity to talk to pupils abouttheir perceptions of the school and theirprogress. In the two primary schools in thesample each pupil was known individually.On the whole, the academic progress ofpupils remained the preserve of subjectteachers and it was not monitored bypastoral staff. In schools with separate units,however, where learning mentors supportedpupils in and out of lessons, staff were able tosee how pupils were progressing with theirwork.

Schools with separate units, in particular, feltthat the support they gave was very effectivein encouraging pupils to reintegrate. This wasdue to factors such as the favourableadult:pupil ratio, the more relaxedatmosphere and the ‘semi-family’ setting. Inone of the units, staff commented on thepositive effects of having vulnerable pupilstogether because they supported each other.In one of the PRUs, where staff had set upparent support groups, it was felt thatindividual attention to pupils and families wassuccessful in understanding school refusersbetter, even if they did not manage to getthem back to school.


This chapter presents the key findings fromthe study and suggests a number of questionsfor LEAs and schools to consider in relation tothe support they provide for pupils regardedas school refusers or phobics.

6.1 Key findings

6.1.1 Definition of the cohort(s)

◆ The research revealed no clear definitionsamong practitioners in LEAs and schoolsthat distinguished between schoolphobics and school refusers. Commondescriptions were of the broad group ofpupils to whom practitioners applied theterms ‘phobic’ and ‘refuser’. Thesedescriptions included pupils with acuteanxiety about attending school, pupilswho cannot face school and pupils whopersistently refuse to attend.

◆ Generally, school phobics were seen as asubset of school refusers, and there was adistinction in the descriptions of schoolphobics and school refusers. The schoolphobics were perceived as those withanxieties (either rational or irrational)about attending school, and school refuserswere perceived as those who chose not toattend for whatever reason. There was adegree of overlap for those pupils whochose not to attend because they had ananxiety – for example, they were anxiousabout not meeting curriculum challengesor about being bullied.

6.1.2 Initial response to identifieddifficulties

◆ What was significant in terms of responseto these pupils was that there werecommon strategies which were appliedregardless of the particular category inwhich a child might nominally be put.

◆ A common response was that a genericproblem of attendance would beidentified from analysis of attendanceregisters. Investigation of reasons forpoor patterns of attendance, eitherinternally, by the school’s pastoral staff,or externally, by the attached educationwelfare officer (EWO), would thenidentify specific problems of refusal orphobia. In the schools participating inthe research, school pastoral staff workedclosely with the relevant LEA supportservices – usually the EWS.

6.1.3 The profile of identified pupils

◆ As definitions were so indecisive, therewas no possibility of quantifying cohortsof refusers and phobics. However, theredid seem to be evidence that more pupilswere identified with attendanceproblems in the higher key stages (in thesecondary phase of education). Thereseemed to be a higher degree ofidentification in those schools wherethere was specific provision to supportthem – for example, where there was aseparate unit or a member of staff withspecific responsibility or interest. Thequestion remains as to whether this levelof identification was because theseschools were more sensitive to needwhich might not have been identified inother situations, or because the provisionwas taken up merely because it wasavailable.

◆ The main causes of the problems atschool were reported to be social anxiety,change of pupil groupings and fear ofthe school environment. However, it wasgenerally felt that, while school factorscould trigger school refusal or phobia,the origins of the problem usually lay inthe home.


6 Conclusions

6.1.4 Provision for school refusal orphobia

◆ Strategies centred around preventionand addressing needs once they wereidentified. Preventative measuresincluded early action on non-attendance,extensive pastoral consultation withinthe school, support at school fromanother pupil (through peer mentoringschemes) or adult, provision of a safeenvironment in school, and whole schoolbehaviour and anti-bullying policies(though there were no specific policieson school refusal or phobia).

◆ The strategies considered effective insupporting pupils once the problem hadarisen were similar to those forprevention. Gradual reintegration wasfavoured. This might entail a part-timetimetable, provision of a place other thanthe classroom where the pupil would feelsafe, or extra support in class. In additionto this it was important that pupils knewwhat was expected of them and that atrusting relationship with staff wasestablished and maintained.

◆ The application of specific strategies wasdetermined, ideally, by analysis ofindividual need, usually undertaken bydiscussion among all those involved in theschool and with external agencies asappropriate. While a multi-agencyapproach was favoured, the route ofprosecution was not considered to beeffective. In some cases, response to apupil’s difficulties was determined by theprovision that was available within andoutside school. The sequence of supportwas fairly uniform across schools.

◆ For strategies to be effective in the longterm, support (pastoral and academic)needed to be maintained.

6.1.5 Training issues and monitoringstructures

◆ Approaches to refusal and phobia wereunsystematic across local authorities andschools participating in the research.

Schools had received very little trainingon issues related to school refusal andphobia, and any training which wasmentioned was within the generalframework of school attendance.

◆ While attendance was routinelymonitored through statutory attendanceregisters, closer monitoring and action asa result of scrutiny of data depended onthe size of school, the availability andinterest of staff, and the way in whichpastoral structures operated in theschool. In smaller schools and schoolswith a separate unit, it was possible tomonitor the progress of school refusersand phobics more closely.

◆ Schools did not routinely monitor theacademic progress of school refusers andphobics as a separate cohort. However,where these pupils were in a separateunit, the relevant pupils were monitoredmore closely. Staff were able to talk tothe pupils daily about their perceptionsof school.

◆ Separate support units and schools with adesignated member of staff responsiblefor school refusal and phobia consideredthat their focused support was effectivein encouraging reintegration.

6.2 Key questions forconsideration

On the basis of the research evidence, wesuggest that the following questions mightbe useful to practitioners.

6.2.1 Questions for LEAs

◆ Is there any LEA guidance to schools orparents about issues of attendancegenerally and, within these, on anydistinctive characteristics of school refusaland school phobia? Are there any goodschool policy documents or guidancewhich could be shared within theauthority?


◆ What part is currently played by the EWSin cases of school refusal and phobia?

◆ What part is currently played by the EPSto support schools’ approaches to schoolrefusal and phobia? Could this bedeveloped?

◆ What input do other agencies (forexample, CAMHS, social services) make insupporting pupils with school refusal andphobia? Could a stronger multi-agencyapproach be usefully developed?

6.2.2 Questions for schools

◆ Is there any school policy or guidanceregarding issues of school refusal andphobia? Is this located within otherbroader documentation or within aspecific document?

◆ Who is responsible for the analysis ofregistration data? Is there an effectivemeans for collating, and taking actionon, the results of any such analysis?

◆ Has there been any recent training forthe whole school or individual membersof staff with regard to pupils withproblems of refusal or phobia?

◆ Is there a clear line of responsibility forthese pupils? Are all staff aware of this?

◆ What strategies are in place to supportschool phobics and refusers in school? Isthere, for example, a peer mentoringsystem?

◆ What ongoing support is there for pupilsonce they have been reintegrated, after aperiod of absence? Are pupils clearabout what is expected of them?

◆ How are parents involved in attendancedifficulties?

◆ To what extent are pupils involved inaddressing issues of school refusal andphobia, both for themselves, and inrelation to difficulties which theirpeers might have? Is there a systemfor accessing pupils’ perceptions ofschool?

◆ Is there evidence that school systems arereformed if a pupil’s non-attendance isthe result of a ‘rational’ fear? This mightbe due to bullying or particularlyunpleasant places or situations in school,such as unruly corridor behaviour, breaktimes in confined spaces, or disorder indinner queues.

◆ Which LEA support services or outsideagencies can be accessed to supportpupils regarded as school refusers orphobics?


ATKINSON, M. and HORNBY, G. (2002).Mental Health Handbook for Schools.London: RoutledgeFalmer.

KENDALL, S., WHITE, R. and KINDER, K. (2003).School Attendance and the Prosecution ofParents: Perspectives from Education WelfareService Management. First Report (LGAResearch Report 43). Slough: NFER.

KINDER, K., HARLAND, J., WILKIN, A. andWAKEFIELD, A. (1995). Three to Remember:Strategies for Disaffected Pupils. Slough:NFER.

O’KEEFFE, D. and STOLL, P. (Eds) (1995). SchoolAttendance and Truancy: Understanding andManaging the Problem. London: PitmanPublishing.


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