Support Strategies For Pupils With Emotionally Based School Avoidance (EBSA) With Jerricah Holder

Support Strategies For Pupils With Emotionally Based School Avoidance (EBSA) With Jerricah Holder

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In the past, we've described children who have difficulty coming into school as 'school refusers,' as if their behaviour is down to wilfulness. But is it time to flip the script - and start looking at other causes for that behaviour?

In today's show, Jerricah Holder explains how thinking in terms of Emotionally Based School Avoidance can be much more powerful, what really drives children to avoid attending school, and what we can do to support them.

Important links

Jerricah's School Based Well-being Cards

Get Jerricah's EBSA training.

For more details about Jerricah's EBSA training for EPs and teachers, see the EdPsychEd website.

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Join our Inner Circle membership programme:

Download other FREE behaviour resources for use in school:

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Show notes / transcription

Jerricah Holder  0:00  

One of the biggest misconceptions around EBSA is that people think because the child is finding it difficult to attend school and they might be communicating that distress around attending school in various different ways. One way might be some very kind of overt challenging behaviours is that the opposite behaviours are misinterpreted to mean that the child doesn't want to attend school. But actually, if you speak to their child, they really do want to attend school and they really want other people to know that they want to attend school. But at that moment in time, the anxiety is very overwhelming and they lack the skills and strategies to be engaged with school at that moment.

Simon Currigan  0:32  

Hi there and welcome to another episode of school of behaviour secrets. My name is Simon Currigan and Gustavo Flaubert, In his seminal classic Madame Bovary once wrote "language is like a cracked kettle on which we beat out tunes for bears to dance to" Yeah, we're like that, but for educational podcasts. I'm joined today by my co host, Emma Shackleton. Hi, Emma. 

Emma Shackleton  1:32  

Hi, Simon. 

Simon Currigan  1:33  

Emma, I'd like to start the show by asking you a quick question. Are there any jobs or activities that you procrastinate over that you consistently put off or avoid?

Emma Shackleton  1:43  

Oh, yes, lots actually. But the one that springs to mind straightaway is I absolutely hate taking the rubbish out. So I always leave it and leave it and leave it until it's a real pain and all the rubbish is spilling over, when actually what I should have done is just done it straight away. And then it wouldn't be half as difficult by the time I get around to doing it. Is that the sort of thing that you mean?

Simon Currigan  2:07  

Absolutely. We have the same thing in our house, we leave it until the bag is splitting and the juice is kind of pouring out across the kitchen floor. When if we'd done it two days ago, it would have been an easy job,

Emma Shackleton  2:16  

Hmm, bin juice! Anyway, why do you ask this question?

Simon Currigan  2:21  

It's because today our guest on the podcast is Jerricah Holder who is an expert in EBSA, or emotionally based school avoidance and how our thinking on what used to be called school refusal is changing. So as whereas in the past, the word refusal channelled us towards thinking about a child being willful or making choices. The latest thinking in school avoidance is actually focused on pupil anxiety. And it's the anxiety and worry that we need to deal with the avoidance is a symptom of that anxiety. And Jerricah shares her knowledge about EBSA in more detail and gives us strategies for supporting children who are presenting EBSA in school.

Emma Shackleton  3:00  

Oh, brilliant. And just before we press play on that interview, I've got a quick favour to ask if you've got friends or colleagues who you think would find this information useful, or are even part of a Facebook group or Twitter community where this is being discussed. Don't forget to share this episode. You can do it directly from inside your podcast app, just open it up and you'll see a Share button where you can share this episode directly. And now here's Simon's interview with Jerricah.

Simon Currigan  3:31  

I'm very excited to welcome our guest Jerricah Holder to the show. Jerricah is an experienced educational psychologist who has a specialist interest in children who experienced difficulty in attending school due to emotional factors and who may be at risk of emotionally based school avoidance or EBSA. She has contributed to local authority guidance on the needs of children who experience EBSA and regularly delivers training sessions to school staff and social care colleagues. Jerrich, welcome to the show.

Jerricah Holder  4:01  

Thank you very much for having me. I'm very excited to be here.

Simon Currigan  4:04  

Emotionally based school avoidance is actually a topic I've been really keen to cover on the show for some time. So it's really great to have you on the podcast. In recent years, we've moved away from using the terminology of school refusal, the meaning of which is fairly clear to emotionally based school avoidance or EBSA. For short, can you tell us about why this change has been made and what it means for schools and teachers?

Jerricah Holder  4:26  

Yes, of course. So emotionally based school avoidance shortened into EBSA,  as you said is very much is trying to promote a more compassionate and child centred approach to school attendance issues. So if we kind of break the term down a little bit the first part emotionally based, we're using that in order to hopefully capture and reflect the emotional complexity of school avoidance behaviours. This is more than just an child and young person not wanting to attend school or refusing school as the previous term implies the difficulties in attending school are rooted in that emotional and physical anguish and they can escalate to such an extent that a child no longer feels able to attend school at all. And then if we look at the latter part of the new term school avoidance, this refers to a psychological process involved in anxiety in the sense that avoidance is a very natural and understandable reaction to stressful situations. So avoidance is a strategy that we all employ in different aspects of our lives. It's a self protective strategy. And it's a very effective strategy for keeping us safe from things that make us feel anxious. But the term avoidance also invites us to be curious about the aspects of the child's world that could be triggering that stress response, and leading to those feelings of needing to escape needing to avoid so the term EBSA also concerns itself with those environmental factors that are likely to be feeding into or perpetuating the child's difficulties at school. So we're really trying to kind of encourage that shift away from the within child model of school refusal, which has you alluded to a number of very unhelpful and negative connotations around choice and control. But it also detracts from those important environmental factors that we know could be feeding into the EBSA, and as well as the environmental factors that could be instrumental in supporting a child to return to school. So emotionally based school avoidance, the new terminology, and the new framework is very much a holistic approach to understanding children's needs around school attendance and school attendance difficulties and their individual context within that. 

Simon Currigan  6:22  

When you say environmental factors. What do you mean by that? Because I can understand a child's say, having anxiety about going into school. Where do environmental factors come in? What sort of factors do you mean? 

Jerricah Holder  6:32  

So traditionally, school refusal very much placed blame within the child. So it's very much a kind of within child experience of anxiety or kind of refusal, or a choice of not wanting to attend school, whereas now we're very much broadening our understanding around the framework of emotion based school avoidance in terms of environmental factors. And really, I think environmental factors can occur across you know, three key areas, we're looking at the things that are happening at the child level, but also at the home level, and the school base level. And environmental factors can also exist across the cultural and societal level as well, in terms of how we conceptualise attendance and how we respond to incidents of non attendance. I talk a lot about environmental factors and the aspects of a child's emotionally based school avoidance. So the causes and the things that are happening within the environment that are also feeding into and perpetuating the emotion based school avoidance.

When you work with young people, what sort of common causes Do you see driving EBSA? 

Yeah, so this is a tricky question is there's so much to unpack when trying to decipher the causes of EBSA. And like, in many situations, there's no single cause or simple one size fits all solution. And more often than not absolutes, that really complex interplay of a number of different factors that interact over time. And there's a lot of multi layered barriers to a child's attendance which can exist at the individual child level, but also across the home and school context and within the environment. However, having said that, there are common experiences and patterns that we can pull out from the literature. And this can be really useful when wanting to adopt more of a proactive approach to EBSA. So if we have an awareness of some of those environmental risk factors, so these are the risk factors that may be predisposed or make a child vulnerable to experiencing EBSA, then we put ourselves in a position where we can potentially identify these children during those earliest stages. So in terms of some of these common causes, we know that an individual child level that anxiety often plays a really significant role in emotionally based school avoidance and anxiety is one of the defining features of episode that distinguishes it from other forms nonattendance, such as truancy or ill health. And we know that when a child has limited strategies to cope with those high levels of anxiety, or perhaps a school environment isn't conducive to supporting their needs, at this time, maybe there's unmet Sen needs, or there's things happening within their school environment that are extremely distressing. So experiences of bullying, lack of friendships, lack of belonging, then actually what happens is the child enters that cycle of anxiety avoidance. And we know that this is a vicious cycle as avoidance brings that instant comfort and relief from the things that are difficult and that are happening. But actually what happens in the longer term is that anxiety grows. And then the next time the child encounters that stressful, anxiety provoking situation, ie the school environment, it gets bigger. But we also know in terms of some of those environmental factors that we get peaks in EBSA across key transition points. So the literature shows that we get peaks in EBSA, across that primary to secondary transition, as well as in those first two years of secondary school. And I think there's a lot that probably happens in those first two years of secondary school that plays into that sort of peaking up so that we see in terms of developing friendships, establishing yourself within a friendship group as well as coping with the increasing demands of a secondary school environment. So the larger class sizes having to relate to multiple teachers who might have different teaching styles, but we also see different risk factors across the family environment. So a risk factor in the literature is around an older sibling for example, who might have experienced EBSA and the child's kind of seen and witnessed school avoidance strategy model previously to deal with that distress, or even parents own educational journeys, and the anxieties that the parent might hold around their experiences at school and the projection of that onto their child, and of course, there's lots of environmental risk factors at the school level as well, which I've alluded to. And often a key one is around friendship, difficulties, bullying, feelings of isolation. So there's so much that feeds into emotion based school avoidance too much to cover in this one podcast. And actually, within my course, the EBSA Horizons course, we have what's called the EBSA risk and resilience profiles. And the first part of that profiling tool is looking at all of those kinds of predisposing risk factors of which there's actually 48. In total, not every child will have all 48 of course, but these are common themes from the research literature that feed into and perpetuate EBSA. So it enables you to kind of really analyse what the common causes for that child and in their individual context could be.

Simon Currigan  10:54  

We already said that all these children are in individuals that they all have their own reasons and profiles that sort of drives their EBSA. But in general, when you're working with children, when you speak to them, how do they feel about their anxieties in school avoidance? Do they want to be at school, but just find it difficult to be there? Do they want to push the problem away and pretend like it's not happening or everything will be okay, if they don't go to school? What kind of conversations do you have?

Jerricah Holder  11:18  

One of the biggest misconceptions around EBSA is that people think because the child is finding it difficult to attend school, and they might be communicating that distress around attending school in various different ways. One way might be some very kind of overt challenging behaviours is it that the observed behaviours are misinterpreted to mean that the child doesn't want to attend school, but actually, if you speak to the child, they really do want to attend school, and they really want other people to know that they want to attend school. But at that moment in time, the anxiety is very overwhelming, and they lack the skills and strategies to kind of engage your school at that moment. But I think most definitely, there's a real misconception around the child's you know, perceptions of school and the extent to which they want to attend school, I would say most children that I work with really want to attend school, and they want other people to know that I think some of our older students, so our maybe our secondary school aged students who have a greater breadth of vocabulary, but more insight into their emotions, they might be able to specifically pinpoint and anxiety or worry at school, share that with a parent carer or an adult. And you can kind of work within that framework of that worry quite concretely. However, what I find in my work as an educational psychologist, is that for most children who experience EBSA, they actually don't have that conscious, well informed understanding around anxiety or of their kind of thoughts and feelings around school. And actually, it's much more felt at that psychosomatic sort of experience of anxiety, the tummy aches, the headaches, the feelings of dread the signs and symptoms of anxiety, without more conscious awareness of the thoughts and feelings. And actually, when I work with children in that sort of position, they're very overwhelmed by their experience of anxiety at school, and a lot of the work is around supporting them to have a framework to make sense of that. And to do some of that understanding around those psychosomatic experiences and what that means for them and what's triggering them in school and why they're feeling the way they're feeling

Simon Currigan  13:07  

That must have a significant impact on parents as well. Actually, when you see your child having stomach aches, and as a parent, you've probably guessed, it's not a stomach ache. That's like a psychosomatic experience of that pain has been driven by their anxiety. When you speak to parents, out of curiosity, what did they say? What was the impact on them? 

Jerricah Holder  13:23  

Yeah and I think there's several impacts in this respect. I think sometimes, because it comes out as tummy aches, feelings of sick feelings of nausea, it leads to parents, even professionals, sometimes questioning the legitimacy of the episode because when the parent agrees to keep your child at home, the tummy ache disappears, or they get them into school, and suddenly, they seem fine. And everyone says, Oh, they're here, and they're fine. There's not a problem here. So sometimes it's about supporting families and schools to kind of unpick those observable behaviours and look at what lies beneath. For families who may be come to that discovery themselves. They've noticed that pattern of the tummy ache quickly disappearing, I think it's really empowering for them to have that conversation around how they can scaffold the child's understanding of their anxiety and move beyond that psychosomatic experience and actually move into more of an in depth conversation around what aspects of school the child is finding anxiety provoking, and I think that gives parents something to work with, doesn't it? It's hard to respond to those tummy aches. But actually, if you can empower your child to share with you the aspect of school that they're worrying about, then you can offer some support and validation around that.

Simon Currigan  14:25  

From your experience. How's the pandemic fed into the number of kids presenting with school avoidance?

Jerricah Holder  14:31  

Yes, so the pandemic presents us with a lot of additional barriers to attendance. We've experienced unprecedented disruptions to children's schooling and I think this has impacted EBSA in a number of ways, including for children who experienced EBSA prior to the pandemic, so children were already aware of and very worried. You know, some of them may have already been out of school for several months, and now this has been exacerbated by the school closures and now having been out of school for several years, all the way through to children who weren't really on our radar before for whom these anxieties around school are completely new. And for these children this might have been because during the pandemic, they had events or experiences that led to some very legitimate fears for them. So they might have experienced a bereavement in relation to COVID, they might have had family members in the shielding group, or they might have parent carers that were on the front line working within the pandemic. For these children, we need to work in a slightly different way because we need to really validate those legitimate fears and their bases, whilst also supporting that more hopeful narrative of safety that we're beginning to work towards. And I think something that I really grappled with as an educational psychologist through the pandemic, something I've noticed with children is for children with sensory needs. So lots of children who are on the autistic spectrum, and how actually they've thrived in the context of online learning and more flexible approaches to learning. And there's both strengths and challenges of this as we come out of the pandemic. One challenge is how do we reintegrate children with high levels of sensory needs to how we support them to increase their tolerance for the sensory demands of the school day when actually they found their time at home to be much more comfortable, and they've been able to engage in learning without those distractions or those discomforts. But also thinking in terms of the strengths of that situation, what we take away from those more flexible arrangements around the pandemic and the fluency that we've achieved in these online learning modules and how we can utilise this moving forward to support children who experience EBSA

Simon Currigan  16:26  

it's interesting, we're working with a number of children at the moment who are saying I was able to learn perfectly well during the lockdown online without having to go into this environment I find incredibly anxiety provoking. So why have I got to start now, in your experience, what's the best way to support children with EBSA?

Jerricah Holder  16:43  

So in my opinion, the best way to help a child who's experiencing emotion based school avoidance is to talk to them and to find activities that enable them to open up and share their experiences about school. And I very much advocate that often the solutions and answers that we're searching for around EBSA, or within this person centred work with a child, this is the most powerful thing that we can do for the child. And the best way to get our answers is to have those conversations.

Simon Currigan  17:10  

How do you open those conversations if the child's reluctant to have them?

Jerricah Holder  17:14  

So I think we have to be mindful that at the moment when a child is experiencing EBSA their current strategy to deal with those anxieties around school is to avoid school. So any talk around returning to school or going back to school or engage in activities that is anxiety provoking or distressing for them is also going to raise anxiety. So I think the first thing is to always reassure a child that that one conversation doesn't mean you're suddenly going to expect them to come to school returned to school or engage in things that difficult is that reassurance. It's that validation of the things that they find stressful in the research literature, children report over and over again, that in regard to EBSA, so they don't always feel listened to heard or believed. So I think that's always the first point of call is to let them know that you're listening, you're hearing and you're believing them. And then I'm a big believer in using creative activities, get your colouring pencils out, and a big pen and paper to support children to use those projective techniques. So to project their worries on to whether it's a character in a book or a drawing that you're doing together to reduce the demands of that face to face conversation and eye contact and give them a creative output to explore some of those thoughts and feelings. So that could be as simple as you know, spend a couple of minutes thinking about your thoughts and feelings about school and see if you can just begin to draw that for me and wait out some of those awkward silences while the child you know thinks about it, and then begins to draw. And often once a child starts drawing, you can start weaving in some of those questions around how they feel about school. Or there's more structured assessment tools, like one of my resources, which is the school wellbeing cards, which gives you more of a structured format to having those conversations around experiences at school.

Simon Currigan  18:50  

I've seen the cards and they are excellent. You want to quickly describe what they are and how they work.

Jerricah Holder  18:54  

Yes, so the school wellbeing cards were designed exactly for this purpose. It's a deck of 40 picture cards that provides a platform for children to explore any anxieties or worries around school and it uses those projective techniques. So there's a series of illustrated characters and statement cards onto which children can kind of project their worries and use that as a vehicle to discuss some of those worries. So there's 20 risk cards, which include things like I feel unwell when I think about school, I feel worried about the schoolwork, I feel worried when I'm away from my parent carers, so you can start to uncover some of those personal risk factors, of course, you're going to want to reduce when improving well being and school attendance. But there's also those strength from protective factors. So I enjoy learning I feel included at school, there's an adult I can share my worries with so you're looking at risk and then you're also trying to balance it with strength from protective factors and an aspect of the school well being cards but in any work that you do have a child who is experiencing so it's also that opportunity to collaborate around your action plan and your reintegration plans. And it's providing a platform in which you can kind of look at those risk factors and look at those strength factors and come up with a plan with the child about how we can make school better for them and how we can support them to either return to school or to attend school more consistently.

Simon Currigan  20:06  

So it sounds like what you're describing is a very kind of bespoke response to individual children's needs and worries and anxieties. It's not like there's a book of six EPSA or lesson plans that we can roll out in the hope that is going to address the underlying causes.

Jerricah Holder  20:20  

No, most definitely not. So although we have like commonalities in the research literature, it is very individual and unique. So our approach needs to be completely bespoke.

Simon Currigan  20:30  

When you help to get a child back into school. What's the impact for them and their family?

Jerricah Holder  20:34  

I think the immediate impact is one of relief across the whole network. These are often messy, complex cases. And especially when we were operating within a school refusal framework, they were very contentious cases as well, with schools and families often becoming very polarised. So I think when we get an EBSA case, and we make effective change, and we bring schools and families together, I think there's just immense relief across the whole network. I think for the parents it's and the carers, it's that, you know, not having to deal with that daily morning battle and struggle to get child into school every day. It's the reduction in feelings of isolation of being at home with your child who's, you know, experiencing extreme distress around school and at a child level, it's about I think the biggest impact is around reconnecting them with those strengths and protective factors that their school placement affords them. So it's about empowering that child to engage in their learning, find joy, rebuild those friendships and that sense of belonging at school and supporting them to flourish both academically and socially. And that certainly what we do see within the practice is that when we do successfully reintegrate child get the child back into school, usually things begin to fall in place,

Simon Currigan  21:39  

How likely is a child to, once you've got them back into school, and you've done that programme of work in the long term? How likely is EBSA to recur in a child's life?

Jerricah Holder  21:49  

Yes, I think that's a really valid and good point to raise because one of the risk factors is previous experiences of emotional high school avoidance. So for example, in primary school, also previous experiences of separation anxiety, even dating back to the preschool years, so difficulty separating at preschool. And that's why in my approach to emotionally based school avoidance, we very much see attendance as a continuum, and not using non attendance as our criteria to understanding EBSA. If we use non attendance as our criteria, so waiting till the child stops at any school or showing excessive non attendance, you know, the child's got very far down the line of their distress at school, and we want to be intervening much earlier. So it's really important that we acknowledge that a child even though they apparently got over there emotionally based school avoidance that we still consider their needs in their framework, as there's always that possibility that the absence could reemerge following a change in the child's circumstances, or just, you know, a change in the support that's available to them. And that could just be the transition to secondary school, we know that children who experienced EBSA in primary school, we got a really good support package in place, it seemed to resolve itself and were three, four years on, and then we get that transition to secondary school, everybody's kind of forgotten about the episode because it felt historical. And then all of a sudden, we get a reemergence of the EBSA in secondary school, because those strengthening protective factors that we worked so hard to harness and improve, haven't been thought about during that transition. So I think it's really important to kind of think of EBSA as a continuum of need, and look at kind of attendance across the child's educational journey. 

Simon Currigan  23:20  

If youre a teacher, or a parent listening to this podcast, what's the first step you can take today to start helping your pupils or child with emotionally based school avoidance?

Jerricah Holder  23:31  

Yeah, so what I would love schools and families to take away from this podcast is to just get out there and talk to children find a way to access and shine a light on their voice, supporting them to share their experiences of school and how we can support them. And to really commit to changing that narrative moving away from the language of school refusal, that's something that we can do really quickly and easily. Language is really powerful. And the language that we use often determines how we respond to a child and their family and the frameworks that we use. So really embracing the kind of language of emotion based school avoidance, and that more compassionate and child centred approach to EBSA.

Simon Currigan  24:07  

And how can our listeners find out more about the school wellbeing cards you were describing and your courses?

Jerricah Holder  24:12  

So the school wellbeing cards can be found on my website, and we'll link a direct link to that. And on my website, there's also links to my EBSA Horizons courses. So I have one for educational psychologists and one also for specifically for school staff. And so Horizons is an online CPD package, which is great because you can take it at a time that is convenient for you. But I also really encourage school staff to take it as you progress through your work for child in the family. So it's absolutely packed full with lots of tools and resources, like the risk and resilience profiles that I was talking about earlier that you can use whilst you're working with the child and their family to kind of support them to overcome but also prevent EBSA into the future in terms of that more systemic and proactive approach. And with the school well being cards. I will just mention that I also have video tutorials on my website about how you would do it. School wellbeing cards and how you would scaffold some of those conversations with children around their attendance difficulties.

Simon Currigan  25:05  

And last of all, we ask this of all our guests. Who's the key figure that's influenced you? Or what's the key book that you've read that's had the biggest impact on your approach to working with children? It doesn't have to be just EBSA children in general.

Jerricah Holder  25:18  

So it has to be the dynamic duo that is Colin and Derek from Inclusive Solutions, who are incredible psychologists who really champion creative person centred approaches to working with children in particular, they developed the path approach, which stands for planning alternative tomorrow's with hope, as I think really, in terms of EBSA, sometimes we need to just park school attendance and spend some time with the child and their network really exploring their hopes and dreams for the future. What does this child need to lead a meaningful and fulfilling life and taking those small steps every day to get the child there?

Simon Currigan  25:53  

Jerricah Thank you very much. You've shared so much practical, valuable advice on the podcast today. Thanks for Thanks for being on the show. 

Jerricah Holder  26:00  

Thank you

Emma Shackleton  26:01  

Jerrica shared so much good information and insight there.

Simon Currigan  26:05  

Yeah, I know. And as we said in the interview, if you want to find out more about Jerricah's school wellbeing cards, or EBSA training, check out the links in the episode description.

Emma Shackleton  26:14  

And if you work with children with challenging behaviour, and you're not sure why they're acting in that way, we've got a download that can help. It's called the SEND handbook, and it will help you to link behaviours that you're seeing in the classroom with possible causes such as autism, ADHD, and trauma.

Simon Currigan  26:33  

The idea here isn't for teachers to try and make a diagnosis because we're not qualified to do that. But if we can link behaviours to possible causes quickly, it means we can get the right help get the right professionals involved and get early intervention strategies in place.

Emma Shackleton  26:48  

And by the way, we've completely revamped the handbook in the last month or so. So now it contains fact sheets on conditions such as PDA, ODD, DLD, foetal alcohol syndrome, and more. It's a free download. So go over to our website, click on Free Resources near the top, and we'll also put a link in the episode description.

Simon Currigan  27:13  

Now finally, if you've liked what you've heard today, then make sure you don't miss next week's episode, all you have to do is open your podcast app and press the subscribe button or follow as it's now called on Apple podcasts. And your app will automatically download every new episode as it's released. So you don't miss a thing. And to celebrate, why not order a deck of cards in a way that might cause surprise or amuse to guests to your home. Really let your imagination go. 

Emma Shackleton  27:42  

And how would you do that? 

Simon Currigan  27:44  

You know, just use your imagination. The possibilities are infinite. 

Emma Shackleton  27:47  

And with that nonsense. We're going to end the show. I hope you have a really great week and we look forward to seeing you next time on school behaviour secrets.

(This automated transcript may not be 100% accurate.)