Anxiety Based School Avoidance – School Refusal Bristol

Update 15/06/2021Anxiety Based School Avoidance is now much more appropriately known as ‘School Attendance Barriers’.

Anxiety based school avoidance, more commonly known as ‘school refusing’, describes a situation where a child or young people has an extreme reaction to attending school. It’s a thorny issue which is often difficult to resolve and can only be done so when settings and professionals work with families in a non-judgemental way to tackle barriers to school attendance.

School avoidance presents like a phobic reaction. It can include growing physical symptoms, such as a stomach ache, not feeling well or headaches. The child or young person experiencing school avoidance may completely refuse to get ready for school or may do so grudgingly. The school avoidance might build up the closer the child gets to school until they refuse to go in. Or they may refuse to leave the house entirely. The reaction will vary according to each child, but the fear is genuine and usually only subsides once the fear of going into school has been removed and school is avoided.

If a child does make it over the threshold, the parent or carer is often told by school staff later that they were ‘fine in school’. The reality is far different, with the child often holding their anxiety and difficulties in until they leave the premises or arrive home. Being ‘fine is school’ is deeply unhelpful. It doesn’t tackle the difficulties the young person is facing not remove the barriers to attendance. This means the problem will not resolve itself, school attendance becomes an ongoing battle or school attendance stops altogether.

Anxiety based school avoidance is often experienced by children and young people with Special Educational Needs and Disabilities (Send) as well as those with neurodivergence such as autism, ADHD and dyslexia.

In these instances, it is important that pupils are fully supported by an inclusive education designed to meet their needs. This will most likely mean an Education Health Care Plan (EHCP) is necessary.

School attendance, even before the myriad of complexities thrown up by the coronavirus pandemic, has been a long-term issue in Bristol. In fact, by the end of 2019, it became so bad that the city had one of the lowest rates of school attendance in England. The Bristol Learning Partnership had it as a standing agenda item to tackle, eventually recruiting a specialist attendance strategy manager in the summer of 2020.

Whilst researching Bristol statistics and data to write an article about school avoidance in the city, what became abundantly clear is the absence of data to monitor school avoidance.

Who are the pupils with anxiety based school refusal? What causes anxiety based school refusal, is it a lack of school inclusion and Send support or some other Social Emotional Mental Health need? How are they marked on the register? Where are they being educated? How many are in Alternative Provision or Hospital Education due to anxiety based school refusal? How many are being marked as ill? How many are being marked unauthorised absence? How many are being marked as authorised absence? How many are being given Fixed Term Exclusions because of behaviour related to it? How many are being given unlawful exclusions because of it? How many are on part time timetables? How many are pushed into Managed Moves? How many are on inappropriate part time timetables? How many have parents who are being fined for this condition? How many have social care intervention because of it? How do you begin to investigate an issue if you cannot monitor the data around this, especially considering schools mark this condition differently on their register depending on their inclusion approach.

The lack of data surrounding anxiety based school refusal was glaringly obvious when looking at Bristol’s school attendance statistics. What do they actually mean?

Pupils unable to attend their education setting due to anxiety based school avoidance often end up in Alternative Provision or the Bristol Hospital Education Service. With Alternative Provision finally cropping up on the People Scrutiny Commission agenda, I took questions to the meeting on Monday 08 March 2021. In advance of the meeting, I submitted a question:

‘Q1: Pupils who could or should be being educated in their mainstream or specialist schools are ending up in Alternative Provision or Bristol Hospital Education due to anxiety related conditions or anxiety based school avoidance. This can be caused by a lack of mainstream inclusion or schools unable to meet EHCPs. What is being done to challenge and change this?’

The answer given in the public forum response from Bristol City Council: ‘The wider inclusion agenda across schools and settings is a key element of the education transformation priorities as well as the Special Educational Needs and Disabilities (SEND) Written Statement of Action.

‘A recent focus and work-stream on ‘Ordinarily Available Provision’ has been completed and about to be launched. This work focuses on the provision that should ordinarily and routinely be available, in and for mainstream schools and settings, as part of universally available and school-based interventions and support. This includes ‘Quality First Teaching’ and a ‘Graduated Response’ (SEND Code of Practice) to assessment and support for presenting needs, including social, emotional and mental health difficulties (SEMH). In Bristol the culture of removing children from mainstream settings to access specialist help, including alternative learning provision, is being addressed in partnership with the school sector through the City’s ‘Attendance & Belonging Strategy’ and work being coordinated by the Attendance Strategy Manager. Anxiety related conditions or conditions where anxiety can increase in mainstream school setting are often caused or compounded by social communication difficulties (including autism). Coordination with specialist services such as Health, CAMHs, Bristol Autism Team (Family & Education Hubs) and training for schools are key to improving inclusion and inclusion services and all areas that are being addressed.

‘The service is working with working with the Autism Education Trust to provide nationally recognised training to all our educational settings to ensure that all the work force is aware of Autism and anxiety. A current pilot programme is being delivered, which focusses on pupil wellbeing and social, emotional and mental health needs. The pilot uses a screening tool to look at individual and whole school well-being identifying areas, such as anxiety, for the setting to focus on to improve well-being for the school community. In addition to this, a series of seminars are being delivered across the local area by psychologists as part of the return to education wellbeing offer.

‘Priorities such as a SEMH pathway have also been identified as part of the recent review of Alternative Learning Provision (ALP) and will be addressed in the accompanying action plan. Both documents will be published at the end of March.’

In the meeting, broadcast on YouTube, I repeated the question, which Director of Education and Skills Alison Hurley answered:

Hurley said: “With regard to that question that’s obviously a key theme in terms of one of the pillars of the Written Statement of Action and really focused on that inclusion offer in our mainstream schools and settings. So that wider inclusion agenda is already being addressed in a number of different ways through the delivery of the milestones in the Written Statement of Action.

“We’ve had a recent focus as part of that on what’s called Ordinarily Available Provision. So that’s really thinking about how robust and accessible that early intervention and support and resource that is available as needs are identified and to reduce the escalation of those needs and that’s all delivered through what’s called a Graduated Approach.

“So really thinking about what are the needs that are emerging, how do we assess these, so this is as a mainstream school. What are we doing about it, so what provision needs to be put in place. Is it having an impact and that’s a really important part of this and if it’s not, what do we need to do differently.

“And that’s all about the Quality First Teaching, so making sure they’re, that teaching offer and that expertise within schools is of a certain calibre and level and baseline that enables teachers and staff in schools to support a wide range of needs. So again, through our workforce development, we’re finding different ways to support SenCos and our school staff, particularly thinking about some of those pieces of training and workforce development that includes some of our national providers so working very closely with the Autism Education Trust to make sure that we have a really strong foundation and understanding of supporting children and young people with autism in our mainstream schools.

“We’ve expanded the offer for Social Emotional and Mental Health and particularly looking at working with our health colleagues and educational psychology colleagues to make sure there is that workforce development within our schools and settings.

“Obviously, targeting, suppporting and working in an integrated way with our mainstream schools to make sure that understanding of how best to support that child or young person is happening as well.

“Then some of the suggestions and actions that have come out of the recent review of Alternative Learning, talks about really establishing a robust pathway, particularly in relation to areas such as Social Emotional Mental Health.

“So there’s already a lot in place, the review that I’ll be talking to in a moment also offers additional suggestions as how we do that but ultimately, it’s about improving the quality of inclusion in our mainstream schools and settings, which as I say is one of those five key deliveries from the Written Statement of Action.”

Whilst the answer from Hurley explained their approach, I had a further supplementary question regarding the practicalities of this working within the academy system.

I asked: “How do you see these solutions working in things like the academy system which can have a very closed-door approach to the Local Authority?”

Hurley replied: “The way that we’re moving forward with some of those bigger pieces is to actually have everybody signing up to those same shared objectives and ambitions and that’s a piece of work that we’ve done through the Written Statement of Action and through the launch of the Belonging Strategy. So actually, what’s our commitment to our children and young people across the city. How do we sort of live that commitment? What does that look like on a day-to-day basis and really having everybody right the way through the system signing up to and agreeing to a shared set of objectives, a shared set of behaviours that contribute to that inclusive culture. And it is about culture as much as anything else. And you can have your systems and processes in place but unless you fundamentally change the culture of what we you know provide for our children and young people and what we expect our children and young people to be supported with, then we won’t change that.

“So that cultural piece is running alongside that and I see my role in that as absolutely critical in working with our school leaders and making sure we articulate and have that shared ambition. And we call it out when it’s not happening. And that challenge element is a big part of this as well.”

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Chair of People Scrutiny Commission Claire Hiscott, had a question of her own regarding anxiety based school refusal later in the same meeting.

She said: “I’m mindful that it’s often used for school refusers as well as well as children that are actually under hospital services. I was just interested whether you could tell me a little bit about how a child can go from mainstream school to hospital ed then how we get them back to mainstream? And also, just from my own experience there’s a number of schools that one always deals with as a councillor and then you suddenly get a – it might just be a random blip – but you sort of think oh that school tends to, children tend to go into ALP much more quickly. Do we actually look at how schools use those provisions and how some schools can better hold more needy children in their mainstream and perhaps how we’re sharing that good practice throughout the city.

Hurley said: “Certainly with the school referral – and this is again picked up in the review – we only have part sight on this. So we obviously commission places directly from the Local Authority but because we have a sort of framework of providers schools can also purchase support and places directly. So one of the challenges we’ve got is we only see part of that picture. So if a school or setting is commissioning a place directly that wouldn’t necessarily routinely come through, in terms of the process, through the Local Authority. So one of the challenges that we’ve got and one of the pieces of work that we need to look at as part of those actions is how do we have a city-wide view on what that purchasing of provision and the use of provision looks like and how does that then fit in with our culture and ambition around inclusion in our mainstream schools and settings. So you know, that’s a big piece on that.

“And then just in terms of hospital education and school refusers again this isn’t unique to Bristol. The whole role of the hospital education and provision has expanded and developed over a number of years coming away from just those who are currently under the care of the hospital and requiring education through to that whole broader piece around mental health and social emotional need driven need as well. So it’s kind of changed in terms of the cohorts that are accessing hospital education. So one of the recommendations for example in the report is that we have a social emotional mental health pathway across our system, across our education system working really collaboratively with colleagues from health in order to support children and young people much earlier on and start identifying need and have the resources in place much earlier on. So you know that’s a really key piece that will come out of this. There’s already work in that space”

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