Exploration of successful intervention with children and young people who show school refusal behaviours, C Nuttall

Tags: research, young person, school refusal, Leah, Support Advisor, SENCO, Amy, case, Attendance, success, Learning mentor, Child Psychology, positive relationship, Educational Psychology, theme, highlighted, Thematic analysis, AO, Gloucestershire Educational Psychology Service, cognitive behavioral therapy, Journal of Health Psychology, Journal of Adolescent Research, Sage Publications, themes, research question, Aspiration Amy, analysing qualitative data, University of Manchester, attendance officers, attendance officer, Amy Leah, interventions, Literature Review, Parent support, Amy Parent, support, Cognitive behaviour therapy, school Strategies
Content: EXPLORATION OF SUCCESSFUL INTERVENTION WITH CHILDREN AND YOUNG PEOPLE WHO SHOW SCHOOL REFUSAL BEHAVIOURS A thesis submitted to The University of Manchester for the degree of Doctorate in Educational and Child Psychology in the Faculty of Humanities 2012 CLARE NUTTALL SCHOOL OF EDUCATION
List of Contents List of Contents ...............................................................................................................1 List of Tables ...................................................................................................................5 List of Figures..................................................................................................................6 List of Abbreviations .......................................................................................................9 Abstract ..........................................................................................................................10 Declaration .....................................................................................................................11 Copyright Statement .....................................................................................................12 Acknowledgements .......................................................................................................13 Chapter 1: Introduction .................................................................................................14 1.1 Context and Rationale for the Research..............................................................14 1.2 Aims of the Research and Research Questions ..................................................15 1.3 Thesis Overview .................................................................................................15 Chapter 2: Literature Review ........................................................................................17 2.1 Overview.............................................................................................................17 2.2 Literature Review Methodology ..........................................................................18 2.2.1 Systematic literature review. .......................................................................18 2.2.2 Hand search and reference harvesting. ......................................................18 2.2.3 Grey literature.............................................................................................19 2.2.4 Included research. ......................................................................................19 2.3 Terminology Relating to School Refusal Behaviour.............................................20 2.4 How is School Refusal Characterised? ...............................................................21 2.5 Prevalence of School Refusal Behaviours...........................................................23 2.6 Why Might Children and Young People Refuse School? .....................................24 2.7 Assessment of School Refusal Behaviours .........................................................29 2.8 What Interventions Are Effective for Children and Young People who are Fearful/Anxious to Attend School? ......................................................................30 2.8.1 Pharmacotherapy. ......................................................................................30 2.8.2 Cognitive behaviour therapy (CBT).............................................................32 2.8.3 Behavioural approaches. ............................................................................36 2.8.4 Parent training/contingency management...................................................37 2.8.5 Hypnosis.....................................................................................................37 2.8.6 Functional Approach...................................................................................38 2.8.7 Systemic approach. ....................................................................................42 2.8.8 Summary of interventions. ..........................................................................43 1
2.9 What Supports Successful Involvement? ............................................................43 2.10 Summary ............................................................................................................47 2.11 Contribution to Knowledge ..................................................................................48 2.12 Aims/ Objectives .................................................................................................48 Chapter 3: Methodology............................................................................................5050 3.1 Overview.............................................................................................................50 3.2 Ontology .............................................................................................................51 3.3 Epistemology ......................................................................................................52 3.4 Axiology ..............................................................................................................54 3.5 Case Study Research .........................................................................................54 3.6 Design.................................................................................................................55 3.6.1 Case study design. .....................................................................................55 3.6.2 Case definition............................................................................................57 3.6.3 Case selection. ...........................................................................................57 3.6.4 Participants.................................................................................................59 3.7 Data Gathering Methods .....................................................................................63 3.7.1 Semi structured interviews..........................................................................64 3.7.1.1 Semi structured interview with practitioners and parent/carers. ........................64 3.7.1.2 Semi structured interview with the young people............................................65 3.7.1.3 Transcription. ............................................................................................66 3.7.2 Existing data...............................................................................................66 3.7.3 Case study database. .................................................................................67 3.8 Data Analysis ......................................................................................................67 3.8.1 Thematic analysis.......................................................................................68 3.8.1.1 Phases of thematic analysis. .......................................................................69 3.8.1.1.1 Phase 1: Familiarisation with the data. ...................................................69 3.8.1.1.2 Phase 2: Generation of initial codes. ......................................................69 3.8.1.1.3 Phase 3: Searching for basic themes. ....................................................72 3.8.1.1.4 Phase 4: Searching for organising themes. .............................................72 3.8.1.1.5 Phase 5: Reviewing the themes.............................................................73 3.8.1.1.6 Phase 6: Producing the report. ..............................................................73 3.8.2 Cross case synthesis..................................................................................76 3.9 Reliability and Validity .........................................................................................76 3.10 Ethical Considerations ........................................................................................77 3.11 Operational Risk Analysis ...................................................................................79 3.12 Critique of Methodology ....................................................................................800 2
3.12.1 Critique of case study research. .................................................................81 3.12.2 Critique of data gathering methods. ............................................................83 3.13 Research Timeline ..............................................................................................83 Chapter 4: Results .........................................................................................................85 4.1 Overview.............................................................................................................85 4.2 Case 1: Amy .......................................................................................................85 4.2.1 Case vignette. ............................................................................................85 4.2.2 What factors were perceived to be effective in supporting Amy, and why? .87 4.2.3 What might have led to more success or earlier success?........................115 4.2.4 Interaction of factors. ................................................................................117 4.3 Case 2: Leah.....................................................................................................118 4.3.1 Case vignette. ..........................................................................................118 4.3.2 What factors were perceived to be effective in supporting Leah, and why 119 4.3.3 What might have led to more success or earlier success?........................142 4.3.4 Interaction of factors. ................................................................................149 4.4 Cross Case Synthesis.......................................................................................149 4.4.1 Comparison of research question 1: .........................................................149 4.4.2 Comparison of research question 2: .........................................................153 Chapter 5: Discussion .................................................................................................155 5.1 Introduction .......................................................................................................155 5.2 Ecological Model of Successful Reintegration ...................................................157 5.2.1 Psychological factors at the level of the child............................................159 5.2.2 Factors supporting the psychological factors at the level of the child. .......160 5.2.3 Factors supporting the family....................................................................162 5.2.4 The role of professionals and systems......................................................163 5.2.5 Context. ....................................................................................................165 5.2.5.1 Socio-legislative context............................................................................166 5.2.5.2 Local authority context..............................................................................167 5.2.5.3 School context. ........................................................................................169 5.2.5.4 Family context. ........................................................................................169 5.2.5.5 Culture....................................................................................................169 5.2.6 Summary. .................................................................................................170 5.3 Implications .......................................................................................................171 5.3.1 Assessment and intervention....................................................................171 5.3.2 Early intervention......................................................................................172 5.3.3 Gathering the views of stakeholders. ........................................................173 3
5.3.4 Availability of a key adult. .........................................................................174 5.3.5 Collaborative working. ..............................................................................174 5.3.6 Time. ........................................................................................................175 5.4 Future Research ...............................................................................................176 5.5 Reflections ........................................................................................................178 5.5.1 The application of counselling skills in research........................................178 5.5.2 Gathering the views of children and young people....................................180 5.5.3 Gathering a range of stakeholder's views. ................................................181 5.5.4 The use of thematic analysis. ...................................................................181 5.6 Conclusion ........................................................................................................182 Chapter 6: References.................................................................................................183 Chapter 7: Appendices................................................................................................193 Appendix A...................................................................................................................193 Appendix B...................................................................................................................197 Appendix C...................................................................................................................199 Appendix D...................................................................................................................200 Appendix E...................................................................................................................203 Appendix F ...................................................................................................................203 Appendix G ..................................................................................................................207 Appendix H...................................................................................................................212 Appendix I ....................................................................................................................213 Appendix J ...................................................................................................................203 Appendix K...................................................................................................................222 Appendix L ...................................................................................................................228 Appendix M ..................................................................................................................265 Word count: 50,150 4
List of Tables Table 1.1. Thesis overview ..............................................................................................16 Table 2.1. Prescriptive interventions based on function of school refusal behaviour (Kearney, 2008, p. 463)...................................................................................41 Table 3.1. Information about the young people in the selected cases ..............................61 Table 3.2. A 15-point checklist of criteria for good thematic analysis (Braun & Clarke, 2006, p.96) ......................................................................................................75 Table 3.3. Measures to ensure reliability and validity .......................................................77 Table 3.4. Research timeline ...........................................................................................84 Table 4.1.Common and different themes which emerged from the two datasets for research question 1.......................................................................................148 5
List of Figures Figure 2.1. Continuum of anxiety and attendance (West Sussex EPS, 2004) ..................23 Figure 2.2. Continuum of school refusal behaviours (Kearney, 2008) ..............................25 Figure 2.3. Bronfenbrenner's (1979) ecological systems theory.....................................425 Figure 2.4. Techniques identified by Kearney and Bates (2005, p.212) as helpful in reducing absenteeism .....................................................................................46 Figure 3.1. Stakeholders involved in the case study ........................................................62 Figure 3.2. A sample of the initial coding process ............................................................70 Figure 4.1. Organising themes in the case of Amy...........................................................88 Figure 4.2. Basic themes to support the organising theme: flexible and individualised approach to ensure young person is prepared and able to access learning.....89 Figure 4.3. Basic themes to support the organising theme: meeting the needs of the family ........................................................................................................................90 Figure 4.4. Basic themes to support the organising theme: taking an interest in young person as a whole ...........................................................................................93 Figure 4.5. Basic themes to support the organising theme: developing feelings of safety, security and belonging.....................................................................................95 Figure 4.6. Basic themes to support the organising theme: personality, skills and experience of staff ...........................................................................................97 Figure 4.7. Basic themes to support the organising theme: make a positive contribution .98 Figure 4.8. Basic themes to support the organising theme: positive nurturing approach 100 Figure 4.9. Basic themes to support the organising theme: positive experiences...........101 Figure 4.10. Basic themes to support the organising theme: increased confidence, self worth and value .............................................................................................102 Figure 4.11. Basic themes to support the organising theme: access to specialist services and effective collaborative working to meet needs.........................................104 Figure 4.12. Basic themes to support the organising theme: early identification and assessment of need to inform intervention ....................................................105 Figure 4.13. Basic themes to support the organising theme: encouragement and positive attention ........................................................................................................106 Figure 4.14. Basic themes to support the organising theme: developing the young person's understanding of thoughts, feelings and behaviour .........................107 6
Figure 4.15. Basic themes to support the organising theme: positive relationships and approach with home ......................................................................................108 Figure 4.16. Basic themes to support the organising theme: whole school approach.....109 Figure 4.17. Basic themes to support the organising theme: flexibility and availability of key adult........................................................................................................110 Figure 4.18. Basic themes to support the organising theme: not focusing on/reinforcing the absence ........................................................................................................111 Figure 4.19. Basic themes to support the organising theme: persistence and resilience of professionals .................................................................................................112 Figure 4.20. Basic themes to support the organising theme: regular monitoring of progress ......................................................................................................................113 Figure 4.21. Basic themes to support the organising theme aspiration and motivation ..113 Figure 4.22. Basic theme to support the organising theme: discussions about the impact of not coming in .............................................................................................114 Figure 4.23. Basic theme to support the organising theme: avoid harsh consequences.114 Figure 4.24. Basic themes to support the organising theme: earlier identification of need and intervention.............................................................................................115 Figure 4.25. Additional ideal organising themes which were supported by a single basic theme ............................................................................................................116 Figure 4.26. Organising themes identified in the case of Leah .......................................120 Figure 4.27. Basic themes to support the organising theme: positive relationships and approach with home ......................................................................................121 Figure 4.28. Basic themes to support the organising theme: developing feelings of safety, security and sense of belonging ....................................................................123 Figure 4.29. Basic themes to support the organising theme: flexible and individualised approach to ensure the young person is prepared and able to access learning ......................................................................................................................125 Figure 4.30. Basic themes to support the organising theme: meeting the needs of the family.............................................................................................................127 Figure 4.31. Basic themes to support the organising theme: aspiration and motivation..129 Figure 4.32. Basic themes to support the organising theme: increased confidence, self worth and value .............................................................................................130 Figure 4.33. Basic themes to support the organising theme: supporting social interaction and communication .......................................................................................132 7
Figure 4.34. Basic themes to support the organising theme: personality, skills and experience of professionals ...........................................................................133 Figure 4.35. Basic themes to support the organising theme: positive experiences.........134 Figure 4.36. Basic themes to support the organising theme: regular monitoring of progress ......................................................................................................................135 Figure 4.37. Basic themes to support the organising theme: discussion about the impact of not coming in and experience of consequences ........................................136 Figure 4.38. Basic themes to support the organising theme: assessment of need .........137 Figure 4.39. Basic themes to support the organising theme: collaborative working between professionals .................................................................................................138 Figure 4.40. Basic themes to support the organising theme: taking an interest in young person as a whole .........................................................................................139 Figure 4.41. Basic themes to support the organising theme: availability of key adult .....140 Figure 4.42. Basic themes to support the organising theme: believing in young person.140 Figure 4.43. Basic themes to support the organising theme: positive nurturing approach ......................................................................................................................141 Figure 4.44. Basic themes to support the organising theme: make a positive contribution ......................................................................................................................142 Figure 4.45. Basic themes to support the organising theme: access to specialist services and effective collaborative working to meet needs.........................................143 Figure 4.46. Basic themes to support the organising theme: additional support to meet the family's needs ...............................................................................................145 Figure 4.47. Basic themes to support the organising theme: earlier identification of need and intervention.............................................................................................146 Figure 4.48. Additional ideal (organising) themes which are supported by a single basic theme ............................................................................................................147 Figure 4.49. Ideal themes which emerged in the two datasets for research question 2..153 Figure 5.1. Ecological model of successful reintegration................................................158 8
Abbreviation
List of Abbreviations Definition
CAF CAMHS CBT EP IPA SENCO SMART SRAS-R-C SRAS-R-P TAMHS
Common Assessment Framework Child and Adolescent Mental Health Service Cognitive Behaviour Therapy Educational Psychologist Interpretative Phenomenological Analysis Special Educational Needs Co-ordinator Specific, Measurable, Achievable, Realistic, Time bound School Refusal Assessment Scale Revised for Children School Refusal Assessment Scale Revised for Parents Targeted Mental Health in Schools Project
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Abstract The University of Manchester Clare Nuttall Doctorate in Educational and Child Psychology Exploration of Successful Intervention with Children and Young People who Show School Refusal Behaviours 2012 A certain degree of anxiety amongst children and young people is common given the pressures that children and young people face but it becomes problematic when it starts to affect children's emotional well being and willingness to go to school. Interventions to support school refusal behaviours have reported success with some individuals, however there are many individuals for whom these interventions are unsuccessful (Lauchlan, 2003). Whilst individualised intervention programmes may be important, the factors associated with successful involvement in cases of school refusal behaviour are unclear. The present study explored factors associated with successful involvement through completing an exploratory case study looking at two successful cases of school refusal behaviour retrospectively. The research sought the perceptions of the young person, their parent, school staff and professionals from health and education to identify what they perceived to be effective, how they understood these factors to be effective and what might have led to more success and why in semi structured interviews. Thematic analysis was completed to identify emerging themes to provide a dynamic and triangulated view about factors which were associated with success. A number of common themes emerged between the two cases and in both cases there were a number of interacting factors which appeared to be associated with successful involvement. These factors have been represented in the ecological model of successful reintegration. This model illustrates the role of psychological factors at the level of the child, factors supporting the psychological factors at the level of the child, factors supporting the family and the role of professionals and systems. In addition, the model recognises the influence of context and how the factors associated with success need to be understood within context. The model is discussed along with the implications of the findings for practice and future research with reflections on the research process made. 10
Declaration No portion of the work referred to in this thesis has been submitted in support of an application for another degree or qualification of this or any other university or other institute of learning. 11
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Acknowledgements Firstly, I would like to thank the young people, attendance officers, practitioners and school staff who participated in this research. Without their enthusiasm and commitment this research would not have been possible. Secondly, I would like to thank my tutor, Professor Kevin Woods for his invaluable advice and support over the three years that I have been on the doctoral training programme. His knowledge and constant support has given me motivation and inspiration throughout this journey and the time that he has given me has been greatly appreciated. Finally, I would like to thank my family and friends for all their support, encouragement and good humour. In particular, I would like to thank colleagues and friends Caroline Murphy, Rebecca Simpson, Lindsay Kay and Richard Skelton, for their words of advice, encouragement and friendship. A special thanks goes to Mum and Dad for their patience, understanding and support. 13
Chapter 1: Introduction 1.1 Context and Rationale for the Research In 2008, the government introduced a three year national programme to provide evidenced based mental health support to children and young people through schools. The Targeted Mental Health in Schools project (TaMHS) was a national project funded by the Department for Children, Schools and Families (DCSF) to support the mental health and wellbeing of children and young people by delivering early intervention and preventative work in schools (DCSF, 2010). This research study was conducted to fulfil the requirements of the Doctorate in Educational and Child Psychology. The researcher was employed as a trainee educational psychologist in Stockshire Borough Council 1, a local authority in the North West of England during their second and third year of the doctoral training programme. Discussions with the TaMHS project manager in the local authority highlighted school refusal behaviour as an area of concern in the local authority's TaMHS schools (the ten schools involved in the local authority's TaMHS project) based on anecdotal reports from the respective Head Teachers. Following the trainee educational psychologist's involvement in casework around school refusal behaviour, the need in the local authority's TaMHS schools and the limited research into factors associated with successful intervention, school refusal behaviour was highlighted as an area for useful research. This area of research was consistent with the local authority's priority to "promote success to ensure that all children and young people have the opportunity for good health and education" as identified in their Children and Young People's Plan for 2009-2011. This was also consistent with the local authority's Inclusion Team Development Plan which targeted, "developing participation and engagement for vulnerable groups" and "transforming learning to improve outcomes". In addition to addressing a gap in the research literature, research into school refusal behaviour also addressed local authority priorities. 1 Pseudonyms used to maintain anonymity and confidentiality. 14
1.2 Aims of the Research and Research Questions A literature review found that a number of interventions have been used with children who show school refusal behaviours. Research has highlighted that some interventions have been successful with some individuals however there any many individuals for whom these interventions were unsuccessful. The factors associated with successful involvement were unclear. Also, the researcher found limited research which explored the perceptions of those involved in cases of school refusal behaviour. This study therefore aimed to explore factors associated with successful involvement through exploring the perceptions of those involved collectively i.e. young people, parents/carers and professionals. Success was defined in terms of an increase in attendance to the point that the children and young people no longer required external involvement from the attendance officer, with an associated decrease in levels of anxiety. The study aimed to answer the following research questions: 1. What factors are perceived to be effective in supporting children and young people who have anxiety/fear which is leading to school refusal behaviours, and why? 2. What might have led to more success or earlier success in the effective support of the school refusal behaviour? 1.3 Thesis Overview An overview of the research is provided in Table 1.1 15
Table 1.1. Thesis overview
Chapter
Contents
2 Literature Review
This chapter provides an overview of the current literature around school refusal behaviours. This examines terminology around school refusal behaviours, the prevalence of the behaviours and why they might be displayed. The chapter also explores how school refusal behaviours are assessed, what interventions are effective in supporting children and young people who show these behaviours and what is associated with successful involvement in these cases.
3 Methodology Two cases of successful involvement with school refusal behaviour were selected to explore the factors associated with successful involvement in a multiple-embedded case study design. This chapter outlines the research design, data collection and data analysis in detail. Reference is made to reliability and validity, ethical considerations, operational risks and a critique of the methodology.
4 Results
Chapter 4 presents the findings from the thematic analysis. Data is presented in three sections: analysis of themes prominent in Case Study 1, Case Study 2 followed by a cross case synthesis.
5 Discussion
The findings are discussed in relation to the ecological model of successful reintegration. Implications for practice and future research are highlighted.
6 References References are presented in Chapter 6.
7 Appendices Appendixes are presented in Chapter 7.
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Chapter 2: Literature Review 2.1 Overview A certain degree of anxiety amongst children and young people is common given the pressures that children and young people face but it becomes problematic when it starts to affect children's emotional well being and willingness to go to school. Children with anxiety about attending school may show signs of fear or panic and may have physical symptoms such as increased heart rate, muscle tension, crying, difficulty breathing, headaches and nausea (Kearney, 2008). These may be present in a morning but may disappear if a child is permitted to stay at home (Elliot, 1999; Kearney, 2002b). School refusal is likely to affect children and young people's social development. It is also likely to affect their educational progress thus likely to impact upon their performance in exams and their subsequent career options (Miller, 2008). Additionally, there is a risk that children who show school refusal behaviours may leave school prematurely (Kearney, 2006) and research has suggested that such children are at a greater risk of mental health difficulties later in life (Flakierska-Praquin, Lindstrom & Gillberg, 1997; King, Heyne, Tonge, Gullone & Ollendick, 2001). Children's ability to cope with their anxieties and attendance at school may serve to strengthen their resilience to cope with life's challenges, pressures and obstacles (Miller, 2008). Effective intervention is therefore essential to promote the educational success, resilience and the subsequent development of such children and young people. This chapter reviews the current literature into school refusal, exploring factors which are associated with successful involvement with children and young people who have shown school refusal behaviours. Initially the methodology for the review is outlined. The literature review that follows begins by examining the terminology and discourse around school refusal behaviours, the prevalence of these behaviours and the reasons why such behaviours may be displayed. The remainder of the literature review explores how school refusal behaviours are assessed, interventions which are effective in supporting children and young people who show school refusal behaviours and factors which are associated with successful involvement with these children and young people. The chapter concludes with a summary of this literature, highlighting the research gap which led to the present study. The aims of the present study are subsequently identified. 17
2.2 Literature Review Methodology Literature was gathered using a systematic literature review which included a hand search, reference harvesting and obtaining grey literature. 2.2.1 Systematic literature review. The following search terms were decided upon and combined using the Boolean operator `AND': · School Refus* · School Phobi* · School Non-attendance · EBSR Research papers were identified through using these search terms in searches across the following databases: ASSIA, British Education Index: Education Literature Datasets, Cinahl, Education: A SAGE Full-Text Collection, ERIC, Pub-Med, Psychinfo, Science Direct, Web of Knowledge and Zetoc. The Faculty Team Librarian for Education was contacted to confirm that this list of databases was comprehensive for the topic area. Papers were limited to those where the search terms appeared in the title and which met the following criteria: · 1990 ­ April 2012 · Peer reviewed journals · Journals written in the English language · Journals where the full text was available electronically 2.2.2 Hand search and reference harvesting. A manual search of Educational Psychology in Practice was also completed to locate further papers. Additionally, a hand search was completed of organisational websites: Ofsted, NICE and the Department for Education (DfE) to search for publications using the search terms listed above. Reference harvesting was completed to locate any additional papers which were not identified as part of the systematic literature search. The reference lists of the papers identified through the search were reviewed and any additional papers which met the search criteria were identified. 18
2.2.3 Grey literature. Grey literature refers to literature within the public domain with information which has not been subjected to a rigorous peer review process (Hart, 2001). Grey literature was sought through searching the University of Manchester's library catalogue systematically for books using the search operators and criteria previously identified. Two books were identified. Once books were selected, the shelf number was searched to ensure that all relevant books had been identified through the library search. Grey literature was also identified through emailing colleagues in the 2009 cohort of the University of Manchester's Doctorate in Educational and Child Psychology programme for any guidance, articles or research on school refusal which they might have obtained from their current/previous local authority. 2.2.4 Included research. The systematic literature search yielded 183 articles with reference harvesting yielding a further 8. Studies were excluded if the full text could not be obtained electronically and where school refusal was a secondary difficulty e.g. where it was associated with a disturbance in sleep such as Delayed Sleep Phase Syndrome (Iwamitsu, Ozeki, Konishi, Murakami, Kimura, & Okawa, 2007) or biological rhythm disturbance (Tomoda, Miike, Uezono, & Kawasaki, 1994). It was hypothesised that the needs of such children and young people may be less representative of children who are anxious about attending school. The systematic literature search is illustrated in Appendix A. The literature review aimed to answer the following research questions: · How is school refusal characterised/defined? · How are school refusal behaviours assessed? · What interventions are effective for children and young people who are fearful/anxious to attend school? · What supports successful involvement? As stated, the literature review considered the definition of school refusal. When considering this definition, papers were specifically reviewed if they contained the following terms in their title: `defin*', `classif*' or `characteristic'. When considering how school refusal behaviours are assessed, papers were specifically reviewed if the titles contained the following: `diagnos*', `assessment', `identif*'. 19
The main body of the literature review focused on intervention. Papers were reviewed if they had the following in the title: `therap*'; `treatment', `intervention', `manage*', `strateg*' or `solution'. Twenty one empirical research papers were identified. These were placed in a table and were reviewed. In addition, studies were reviewed if they had the following in their title: help*; prevent*, effective; support* or suggest* to answer the final research question. Two studies were located. Selected studies are detailed in Appendix A. 2.3 Terminology Relating to School Refusal Behaviour The terminology and discourse used to refer to children and young people who have difficulties in attending school because they have an anxiety/fear response have been heavily debated in the literature (Pellegrini, 2007). As highlighted by Kearney (2003), research has used overlapping and inconsistent terminology. Early literature focused on school phobia (Miller, 2008) and whilst other terminology is starting to dominate more recent papers, school phobia has continued to be used in some recent research (e.g. Chitiyo & Wheeler, 2006). More recently, alternative terminology has been adopted including, "emotionally based school refusal" (e.g. West Sussex County Council EPS, 2004), "chronic non attendance" (e.g. Lauchlan, 2003), "school refusal behaviour" (e.g. Kearney, 2007) and "extended school non attendance" (e.g. Pellegrini, 2007). However, since the 1990s "school refusal" has been the focus of much research, appearing to be the terminology of choice for many researchers. The terminology used within the literature was reviewed and considered, informing the terminology adopted in the present study. Some researchers have criticised the use of terminology such as "school phobia" because according to the DSM-IV criteria (American Psychiatric Association, 1994), a phobia suggests that exposure to a specific phobic stimulus almost invariably provokes a fear response (Kearney & Silverman, 1990). Kearney and Silverman (1990) highlight that this is not always the case with school refusal because behaviours could be reflective of social anxiety or separation anxiety from the caregiver. Similarly, as stated by Lyon and Cotler (2007) and Pellegrini (2007) the terminology "school phobia" implies "psychopathology". This is problematic when not all children and young people who show school refusal behaviours would access services to obtain a diagnosis and when not all children would present with a statistically significant clinical level of anxiety. As stated by Lyon and Cotler (2007), diagnosable anxiety disorders are not representative of the school population as a whole so this questions the usefulness of terminology which carries diagnostic implications. Additionally, terminology such as school phobia or terminology which uses behavioural descriptors as a noun e.g. "emotionally based school refuser" take a within 20
child focus which may present a view that the behaviour is fixed and thus unlikely to change. The researcher therefore prefers to adopt terminology which is more descriptive of the behaviours rather than use diagnostic terminology which could lead to a labelling response. Other terminology cited includes "emotionally based school refusal" (West Sussex County Council EPS, 2004). However, when considering "emotionally based school refusal", Pellegrini (2007) said that this terminology may overlook pupils whose anxiety is not the most visible area of need, for example, children and young people who have medical needs who are anxious about returning to school. In addition, the competing discourses used by different parties to construct different versions of non attendance may affect whether non attendance is characterised as emotionally based (Pellegrini, 2007). For example, local authorities may construct non attendance as a behaviour fostered by low parental interest, legal discourse directs attention to parents, clinical discourse emphasises within child factors whereas parents and children and young people may construct non attendance in relation to school related factors (Pellegrini, 2007). Pellegrini therefore suggested that terminology such as "extended school non attendance" should be used because this is a description of the behaviour which stresses the persistent nature of non attendance. Whilst Pellegrini (2007) recognises that "extended school non attendance" is often persistent, the researcher would argue that this definition may exclude those children who are highly anxious and are just starting to not attend school. The researcher would question at what point the behaviour would be classified as persistent and extended. For example, some children might start with chronic lateness which may lead to missing lessons or single days off school before lengthy absences. This provides evidence for the complexity of school refusal behaviours and the heterogeneity of need. The researcher therefore prefers to adopt the terminology of school refusal behaviour throughout this research because this is a behavioural descriptor which would capture the full range of need and behaviour2. 2.4 How is School Refusal Characterised? Children and young people who show school refusal behaviour with associated anxiety are distinguished from those who are truanting by the severe emotional upset associated with attending school or leaving home; children who are truanting are more likely to miss school because of a desire to engage in alternative activities. Severe emotional upset 2 When making reference to specific research papers the author will adopt the terminology used within the article. 21
would also distinguish such children from those who are encouraged to stay at home by their parent/carer e.g. because of parental mental health needs (Miller, 2008). Berg, Nichols and Pritchard (1969) used the following criteria to distinguish between children and young people who school refuse with associated anxiety from those who are truanting. Children who school refuse: · have severe difficulties in attending school often resulting in prolonged absence · have severe emotional upset which may involve symptoms such as fearfulness, temper tantrums or complaints of feeling ill etc. · stay at home with their parents' knowledge during the school hours · have an absence of anti-social behaviours such as stealing or lying etc. (p.123) However, whilst children and young people who are truanting/ staying at home to support their parents/carers may initially present as having low anxiety, they may become anxious for example, at the thought of returning to school or because of worry about their parent/carers wellbeing. As noted in Lauchlan (2003), it is possible for children and young people to exhibit characteristics of both truancy and school refusal behaviours. This emphasises the complexity of school refusal behaviour further. Just as children and young people's attendance may vary, anxiety levels may change at different points in time. The researcher therefore prefers to consider school refusal behaviour according to a continuum of anxiety and attendance (West Sussex County Council EPS, 2004) as illustrated in Figure 2.1. 22
Low Anxiety
High Attendance
A
B
D
C
High Anxiety
Low Attendance Figure 2.1. Continuum of anxiety and attendance (West Sussex EPS, 2004) Children and young people whose anxiety is impacting on their willingness to attend school would fall somewhere within quadrant C i.e. high levels of anxiety and low levels of attendance whereas children and young people who have low attendance without emotional upset would fall somewhere within quadrant D. This model also suggests that the behaviour is not fixed, which would account for the fact that children and young people's anxiety and attendance may change at different points in time. The researcher also prefers to consider school refusal according to this continuum because, in addition to capturing the heterogeneity of need and representing the fluidity of anxiety and attendance, it suggests that there is capacity for change. 2.5 Prevalence of School Refusal Behaviours When considering the proportion of school age children who may show school refusal behaviours, the complexity of the behaviours and the various definitions of school refusal behaviour used, make it difficult to quantify. Reviews have reported that school refusal behaviours with an element of anxiety affect about 1-2% of school aged children (Elliott, 1999; Kearney, 2008) and have highlighted that behaviours are likely to peak at transition points i.e. between 5-6 years and 11-13 years (Pellegrini, 2007). However, such researchers acknowledged that figures are debatable because of difficulties and differences in conceptualising the behaviours. For example, as previously stated, children and young people's anxiety and attendance may vary at different points in time. Additionally, school refusal behaviours may initially start with pleas for non attendance and attempts to avoid school. This may escalate into missing lessons and days before a 23
complete absence from school for an extended period of time is observed. It is therefore debatable when a child/young person might be described as showing school refusal behaviours. This continuum is illustrated in Figure 2.2. Additionally, the differences in schools and local authorities in how they define, track and report partial absences (Kearney, 2008) will affect the validity and reliability of prevalence figures. Similarly, much research on school refusal behaviour is based on children and young people who would meet diagnostic criteria for mental health needs. However, one of the main difficulties in determining the proportion of young people who show school refusal behaviours who also meet diagnostic criteria for a mental health need is that figures are likely to exclude those who are not accessing services. As highlighted by Egger, Costello and Angold (2003), there is little research with children and young people who show school refusal behaviour in nonclinical settings 2.6 Why Might Children and Young People Refuse School? With regard to aetiology, recent literature has highlighted some of the specific reasons why children might school refuse (Gloucestershire EPS, 2001; Heyne, Rollings, King & Tonge, 2002; Kearney & Beasley, 1994; Lauchlan, 2003; Lyon & Cotler 2007; West Sussex County Council EPS, 2004) for example: · bullying or other threats to safety · lack of monitoring of toilets, corridors and playground areas by staff · difficulty with peer/teacher relationships · authoritarian management styles · difficulties with classroom routine · classroom practices which make performance salient · exam pressure · low academic self concept · separation anxiety · illness of a family member · loss/bereavement · transition · ability to cope 24
Figure 2.2. Continuum of school refusal behaviours (Kearney, 2008) 25
These factors may "push" children away from school or "pull" children towards home (West Sussex County Council EPS, 2004) and are more likely during high risk situations such as periods of transition, moving house and/or area or following major holidays or events (King, Heyne, Tonge, Gullone & Ollendick, 2001). Kearney and Silverman (1990) suggested that the reasons why children and young people school refuse can be categorised by four functions of school refusal, two of which are negatively reinforcing and 2 positively reinforcing: 1/ to avoid specific fearfulness or general anxiety related to attending school 2/ to avoid social situations which cause anxiety 3/ to seek attention and/or to reduce feelings of separation anxiety 4/ tangible reinforcement i.e. to gain a rewarding experience The first two functions describe children and young people who avoid school for negative reinforcement, i.e. to avoid exposure to stimuli that they find aversive. For example, young people may avoid school to avoid specific elements which are causing them anxiety such as a specific teacher, classroom pressure or exams. Young people may however, try to avoid social situations for example, if they have experienced difficulties with peers or if social interaction is something which they find particularly hard. The latter two functions describe children and young people who avoid school to gain positive reinforcement. Young people may seek to reduce feelings of separation anxiety for example, through gaining parental attention. In terms of tangible reinforcement, young people may avoid school to gain a rewarding experience such as staying at home and watching television (Lauchlan, 2003; Pellegrini, 2007) which, as suggested in Kearney and Silverman (1990), may be analogous to truanting behaviours. As highlighted in Miller (2008), Kearney and Silverman's (1990) four function model draws together the early theoretical formulations of school refusal which were influenced by psychodynamic and behaviourist paradigms. Psychodynamic thinking places a focus on the early parental relationship which is congruent with the focus on separation anxiety and the drive to stay near to the caregiver. Similarly, the four function model accounts for behavioural perspectives which focus on classical conditioning and operant conditioning; the theory of classical conditioning focusing on the association of anxiety to particular stimuli and the theory of operant conditioning focusing on either positive or negative reinforcement. 26
Whilst Kearney and Silverman's (1990) four function model has received much attention in the literature, the researcher identifies three limitations in reducing school refusal behaviours to one of these four functions. Firstly, it has been recognised that school refusal behaviours can be multi-causal as behaviours might serve more than one function (Elliot, 1999; Kearney, 2002b). For example, Kearney described a case study of a child who was avoiding school to avoid physical and cognitive symptoms of worry about getting into trouble/making mistakes with his homework. The pleasurable activities the child engaged in when he was at home i.e. spending time with his mother and watching television, subsequently maintained the school refusal by rewarding the child with attention and tangible reinforcement. This therefore suggests that school refusal behaviours may be more complex than explaining them in terms of one of four functions and suggests that the factors initiating the behaviour may be different from those maintaining it. Secondly, this model does not clearly account for the influence of cognition. Whilst cognitive factors have not received as much prominence in school refusal literature (Maric, Heyne, de Heus, van Widenfelt, & Westenberg, 2011), there has been some research which has highlighted the influence of children and young people's thought processes on school refusal behaviour. For example, Heyne et al. (1998) found that children and young people who showed school refusal behaviours had low expectations about their ability to cope with stressful situations associated with school refusal. Additionally, Maric et al. (2011) found that negative automatic thoughts concerning personal failure (e.g. "I cannot do anything right") were found to differentiate between children and young people who showed school refusal behaviours from those who did not. Maric et al. (2011) found thoughts of personal failure and the cognitive error of overgeneralising negative events (e.g. "the last stuff was so hard I just know I'm going to have trouble with this too") predicted the presence of school refusal behaviour. Whilst Maric et al. (2011) highlighted the influence of negative thoughts, they highlighted the need for further research to investigate the role of cognition in the development and maintenance of school refusal behaviour. Thirdly, there may be a range of systemic factors which influence the aetiology and maintenance of school refusal behaviours. Kearney (2008) for example, discussed a range of contextual factors which might have an effect on school absenteeism such as, "homelessness and poverty, teenage pregnancy, school violence and victimization, school climate and connectedness, parental involvement and family variables, among others" (Kearney, 2008, p. 451). Some of these factors are described below. 27
Bullying for example and other threats to safety, as noted above, are specific factors which have been reportedly associated with school refusal behaviour (e.g. Gloucestershire EPS, 2001); this is supported across cultures (Kawabata, 2001; Kearney, 2008). In addition, based on research with youths who engaged in violent behaviour, Kearney (2008) suggested that school climate and connectedness, for example in terms of class size, the extent to which students feel, "safe, accepted, valued and respected at school", (Kearney, 2008, p.459) was associated with school attendance. Kearney (2008) added that school factors such as boredom, students not being able to access learning as a result of poor teaching or work not being tailored to their needs and difficulties with relationships with peers and teachers were associated with students who left school prematurely. Whilst this was related to school absenteeism in general and not specifically school refusal behaviour with associated anxiety, it could be hypothesised that such factors are also associated with school refusal behaviour particularly given the continuum of non attendance and anxiety (West Sussex County Council EPS, 2004). Some of these factors which Kearney (2008) suggests are aspects of the school climate and connectedness are congruent with some of the specific reasons listed at the start of this section about why children and young people might refuse school such as their "ability to cope" (e.g. from Gloucestershire EPS, 2001; Heyne, Rollings, King & Tonge, 2002; Kearney & Beasley, 1994; Lauchlan, 2003; Lyon & Cotler, 2007; West Sussex County Council EPS, 2004). Kearney (2008) highlighted how family variables add an important element to the context and reported that families of young people who show school refusal behaviour are "often marked by poor cohesion and considerable conflict, enmeshment, isolation and detachment" (p. 460). In addition, Lyon and Cotler (2007) and Kearney and Silverman (1995) highlighted the role of the family and the way parents/carers can influence their child's attendance; for example, by the speed in which they address attendance difficulties. This may be influenced by parents'/carers' own perceptions of school and their ability to be supportive of their children which could be affected by the levels of social support and stress experienced outside of the family (Bowen, Bowen & Ware, 2002). Additionally, significant changes in the family dynamic e.g. a new baby, redundancy or separation may trigger school refusal behaviours or may influence parents'/carers' response. Similarly, teacher perceptions and interactions with children and young people might influence school refusal behaviours (Lauchlan, 2003), as might parent-school communication and relationships. This therefore adds another dimension to consider when thinking about the function of the school refusal behaviours and illustrates the complexity of the behaviours. 28
2.7 Assessment of School Refusal Behaviours As previously highlighted, children and young people's behaviour may serve a range of functions and the factors which lead to the onset of the behaviour may be different from those which are maintaining it. There appears to be consensus amongst many researchers (e.g. Kearney, 2002a; Lyon & Cotler, 2007; Miller, 2008) about the importance of gathering information and completing a full case formulation to develop a clear and comprehensive assessment of the behaviour. One could argue that the work of Kearney and Silverman (1990) has influenced recent thinking around assessment and intervention of school refusal behaviours, particularly the emphasis on assessment of the function of behaviour in informing intervention. Kearney and Silverman's (1990) four function model and the associated assessment scales (School Refusal Assessment Scale Revised for Children (SRAS-R-C) and Parents (SRAS-R-P), (Kearney, 2002a; Kearney & Silverman, 1993) have been widely cited in the school refusal literature. These questionnaires assess the function of a child/young person's school refusal and have reported inter-rater and test-retest reliability and construct and concurrent validity (Kearney & Silverman, 1993). Whilst Kearney and Silverman's assessment scales have been used by a number of researchers as part of the assessment process for school refusal behaviours, it is widely agreed that if used, these should be used as part of a multi-method and multi-source approach to the assessment of the child/young person (Elliot, 1999; Kearney, 2002b; Kearney & Albano, 2004; Kearney & Bates, 2005; King, Heyne et al., 2001). Triangulating information is particularly important given that parents and children often differ in their views about the function of the behaviour and that some school refusal behaviours may serve more than one function (Kearney, 2002b). As previously noted, there may be systemic factors which influence the onset and maintenance of school refusal behaviours. Therefore, it is also important that assessment moves away from within child factors to explore how other aspects of the child's system might initiate and maintain the behaviours to provide a comprehensive and useful assessment (Lauchlan, 2003; Lyon & Cotler, 2007). Researchers have suggested that assessment should also include school factors and family factors e.g. familial interaction, structure and relationships, sources of stress and anxiety and possible changes in the family dynamic (Blagg, 1990; Kearney & Silverman, 1995). Assessment tools might include: functional analysis of the behaviour (e.g. SRAS-R), child/parent interviews, self report measures such as self efficacy questionnaires, functional analysis of the behaviour 29
(e.g. SRAS-R), observations at home and at school, attendance data, teacher reports and ratings, current attainment levels, developmental history and information about a child's peer relationships (Elliot, 1999; King, Heyne et al., 2001). Gathering information from different sources about the function of the behaviour in combination with contextual information should enable a comprehensive and complete assessment of the child, family and school. Many researchers would argue that a complete case formulation is essential in informing and ensuring effective intervention (e.g. Kearney, 2008; Lyon & Cotler, 2007; Miller, 2008) 2.8 What Interventions Are Effective for Children and Young People who are Fearful/Anxious to Attend School? A number of articles (Gloucestershire EPS, 2001; Kearney, 2008; Lauchlan, 2003; West Sussex County Council EPS, 2004) have critiqued and/or summarised the interventions used with children and young people who show school refusal. Interventions include Pharmacotherapy (e.g. Bernstein, Garfinkel & Borchardt, 1990), Cognitive Behavioural Therapy (CBT) (King, Tonge, Heyne & Ollendick, 2000), Behavioural approaches e.g. Systematic Desensitisation and Flooding (Gloucestershire EPS, 2001; Kearney & Silverman, 1990), Contingency Management i.e. changing behaviour through rewards (Gloucestershire EPS, 2001) and Parent Training (Kearney & Beasley, 1994). As highlighted, a systematic literature review of empirical research which met the search criteria was completed to explore the effectiveness of interventions in more detail. Studies were reviewed if they had the following in the title: `therap*'; `treatment', `intervention', `manage*', `strateg*' or `solution'. 2.8.1 Pharmacotherapy. Some researchers have discussed the implications of medication in responding to school refusal behaviour (e.g. Bernstein, Garfinkel and Borchardt, 1990; Jainer, 2002). Bernstein et al. (1990) completed two studies; the first compared the treatment of alprazolam (a benzodiazepine) with imipramine (a tricyclic antidepressant) and the second a double blind, placebo controlled study where children and young people were randomly assigned to one of three medication groups: imipramine, alprazolam or placebo in combination with psychotherapy. The researchers found that attendance improved for all those in the medication groups and all but one participant in the control group. They also found that clinician's ratings of anxiety for the medication groups were significantly improved from placebo but there were no other significantly different scores on various children's rating scales for anxiety and depression. 30
Bernstein et al. (2000) later completed a randomised double blind control trial to investigate the effects of imipramine with CBT on attendance and anxiety compared to a placebo with CBT. They found that school attendance increased significantly for the imipramine and CBT group and at a faster rate than the placebo and CBT group. Anxiety and depression rating scales decreased significantly for both groups. The researchers in both studies concluded that the effects of medication show "promising" effects for supporting children who show school refusal and that they may be helpful in treatment. Whilst this may be the case for some children and young people, the researchers recognised that further research is required to substantiate this claim as there are a number of limitations with the studies. Firstly, as highlighted by the Bernstein et al. (1990), attendance improved in both the medication and placebo groups but there was a lack of statistically significant differences between the medication and placebo groups on change in anxiety and depression. Similarly, when participants in Bernstein et al. (2000), were followed up 1 year later there was no significant difference between anxiety and depression levels between the imipramine and CBT and placebo and CBT groups (Bernstein, Hektner, Borchardt & McMillan, 2001). These two findings suggests that whilst medication led to some improvement, it was no more effective than placebo. Given the lack of conclusive evidence and the potential side effects of the drugs (Lauchlan, 2003), the use of medication is therefore questionable. Additionally, the researcher of this study would question whether any positive findings could be generalised to the school refusal population as a whole. In both studies, the inclusion criteria were for children and young people to have a diagnosis of a major depressive disorder or an anxiety disorder. As previously highlighted, many children and young people who show school refusal behaviours would not meet criteria for a clinical diagnosis of anxiety or depression. Also, Layne, Bernstein, Egan, and Kushner (2003) found that treatment response to CBT and imipramine versus placebo was predicted by the absence of separation anxieties but, as Kearney and Silverman (1990) highlighted, separation anxiety may be one function of school refusal behaviour. It is possible that medication may be beneficial for treating children and young people who have diagnoses of anxiety or depression. However, the results are not conclusive and whether this would apply to children and young people who do not have such diagnoses or to those whose behaviour is maintained by separation anxiety is questionable. 31
2.8.2 Cognitive behaviour therapy (CBT). Studies of cognitive behaviour therapy as an approach to school refusal behaviour have employed a multi-dimensional approach incorporating elements such as cognitive restructuring i.e. where pupils are asked to analyse self statements before discussing strategies about how to reduce anxiety (Lauchlan, 2003), graded exposure i.e. a gradual return to school, relaxation, systematic desensitisation, contingency management and changes to the school environment. Researchers have provided evidence for CBT as an effective approach for supporting children who show school refusal behaviour. Tolin et al. (2009) employed a multi-element approach with four children to assess the effectiveness of intensive intervention (15 sessions over 3 weeks). This consisted of graded exposure and contingency management with additional elements based on case conceptualisation such as cognitive restructuring, relaxation training and motivational interviewing. Similarly, King et al. (1998), King et al. (1999) and Doobay (2008) investigated CBT intervention treatments which focus around child therapy coupled with parent and teacher training on contingency management and on providing a positive and welcoming school environment. Additionally, Heyne, Sauter, van Widenfelt, Vermeiren and Westenberg (2011) investigated developmentally sensitive, manualised and modular CBT implemented with adolescents, parents and key members of school staff. Doobay (2008) reported a case example where a counsellor intervened after a child/young person was absent for a period of 2 weeks as a result of separation anxiety. As part of the intervention the counsellor spent time on developing coping skills and relapse prevention to ensure that effects were maintained. Doobay reported improvements in the girl's attendance; this may support the importance of early intervention. Tolin et al. (2009) in their study found that intervention was effective for three out of four young people and concluded that this may provide evidence for intensive intervention; they recognise that further research is required to compare daily versus weekly therapy. This paper raises debate about how success is defined because at follow up, all 3 young people had opted for an alternative education plan. Whilst some may be critical of this because young people were attending an alternative provision rather than returning to mainstream provision, all 3 had engaged in their new education plan and had maintained their attendance. 32
Heyne, Sauter, van Widenfelt, Vermeiren and Westenberg (2011) completed a non randomised control trial to examine the efficacy of a developmentally sensitive CBT intervention to support school refusal behaviours shown by adolescents. They adapted a manualised and modular CBT intervention to support 22 adolescents who were showing school refusal behaviours. The intervention consisted of 10-14 individual sessions with the adolescents, 10-14 joint sessions with their parents and two school based meetings with a school mentor to co-ordinate the implementation of school based strategies. They found that this led to improvements in school attendance, school related fear and anxiety at post-treatment and at 2 month follow up. King et al. (1998) completed a randomised control trial with 34 children who were randomly assigned to a CBT condition plus parent/teacher training or a waiting list control. They found that improvements were made on children and young people's school attendance, self reports of fear, anxiety, depression and coping and caregiver and clinician reports relative to the waiting list control. King et al. (1999) later investigated whether there was a change in the "diagnostic status" of 20 children who received child therapy with parent and teacher training, concluding that this intervention led to an improvement in measures: attendance, fear, anxiety and self efficacy and parent and teacher ratings of child behaviour. They also found that 17 out of the 20 children no longer met criteria for a diagnosis of an anxiety disorder. This provides good evidence to support the use of cognitive behavioural therapy although results from King et al. (1999) should be treated with caution. Diagnoses were based on check lists completed by parents and children and, as King et al. (1999) did not have a control group, one could argue that the validity of a change in diagnosis could be questionable. Interestingly, King, Tonge, et al. (2001) followed up on King et al.'s (1998) original study to see whether the effects were maintained 3-5 years later. King, Tonge, et al. (2001) completed telephone interviews with parents and teachers for 16/17 participants involved in the original study. Attendance increased from 61.5% pre-treatment to 84.4% post treatment with 13/16 having a normal level of attendance3 at follow up compared to 5/17 previously. However, whilst this supports the efficacy of CBT over time, as acknowledge by the researchers, the findings were based on a telephone conversation with no follow up of the original measures. Nevertheless the researchers identified from parental and school reports that many of the children had coped successfully with stressful events without relapse in school or the emergence of new problems. They reported that children were 3 Children had to be at school at least 90% of the 2 week evaluation period to be classified as exhibiting a `normal' level of attendance 33
more confident and more resilient. Based on these findings, it might be hypothesised that the effectiveness of intervention may be related to developing children's ability to cope with stressful situations. It is not clear from the studies of King et al. (1998, 1999) and King, Tonge et al. (2001) which elements were effective or not effective. For example, the intervention took a multielement approach involving child cognitive behavioural therapy and parent/teacher training in behaviour management; were particular elements of the intervention more effective than others or was effectiveness a result of the combination of techniques? Heyne, King et al. (2002) completed a study to investigate this further by completing a randomised block design where children and young people were allocated to groups of child therapy, parent and teacher training or a combination of both child therapy and parent and teacher training. They found that all groups produced statistically significant improvements in attendance, self efficacy and emotional distress post treatment. The hypothesis that combined child therapy and parent/teacher training would produce better outcomes post treatment and at follow up was not supported. Overall the results support the use of CBT strategies but questions whether a combined treatment of CBT and parent/teacher training is cost effective. Last, Hansen and Franco (1998) completed a study to investigate the effects of CBT versus an attention-placebo control "educational support therapy" to control for the effects of non specific therapy i.e. therapist contact and time. The educational support therapy contained no direct instruction to return to school, therapists were not to provide specific instructions for children to confront their feared situations nor to verbally reinforce children for attending school. They found no difference between the two treatments. Both produced statistically significant improvements on a range of measures such as attendance, anxiety and depression. One cannot be sure how far the treatment procedure for educational support therapy was followed given that there was no assessment of treatment integrity as in King et al.'s (1998) study. Nevertheless, the study does question whether there might be other variables which are just as important as therapeutic techniques such as expectancy and the therapeutic relationship (Lambert & Barley, 2001). Moffitt, Chorpita, and Fernadez (2003) acknowledged that there are many children and young people who show school refusal behaviours who would be excluded from many research studies, for example, where systemic factors might influence engagement with treatment or where there were comorbid conditions. They highlighted the difficulty of generalising findings from research to this population. As a result, they described a case 34
study which explored the utility of cognitive behavioural therapy to a 12 year old girl who was experiencing difficulty with school attendance as a result of separation anxiety and social anxiety which they described as a "challenging case". They provided evidence for the utility of CBT to cases where systemic factors influence a child/young person's school refusal behaviours and might subsequently influence engagement in intervention; for example in this case study, the girl's mother was a single parent who was involved in an abusive relationship, there were multiple young children in the family, there were financial difficulties, there was a lack of transportation and school were reluctant to support interventions, applying pressure for the quick resolution of the case. Following cognitive behavioural therapy intervention and a change of school, attendance greatly improved and the girl's fear ratings fell considerably. Cognitive behavioural therapy consisted of psychoeducation, developing a hierarchy of feared situations, parent/school contingency management, identifying and restricting negative thoughts, modelling and role play of feared situations and graduated exposure to feared situations. The therapist however, had to account for obstacles to intervention by changing the location of the treatment when systemic factors led to missed appointments in the clinic. This study, whilst a single case study, highlights support for a full case conceptualisation taking account of the systemic issues which might be influencing their behaviour. Additionally, as highlighted by the researchers, it suggests that flexibility of the therapist and approach may be required to ensure that the approach is effective for a wide range of characteristics. In summary, the available evidence for the use of CBT including findings from a randomised control study, offers positive support for the use of this methodology with children who show school refusal behaviours. However, the findings are not conclusive. There were 3 young people in King, Tonge, et al.'s (2001) follow up who had deteriorated and one young person in Tolin et al. (2009) who made no progress. Whilst Heyne, King et al. (2002) reported significant improvements for all three groups (i.e. child therapy, parent and teacher training or a combination of both) based on the mean scores and attendance of 61 children, it is not clear whether all children and young people improved or whether some deteriorated. This suggests that whilst there is support for CBT to support school refusal behaviours, it may not be effective for everyone. This would be consistent with Miller and Frederickson (2006) who cite Carr, (2000) in explaining that whilst a generalised knowledge of interventions which work for individuals is the "gold standard", "interventions judged the most effective do not work with around 33 percent of young people" (Miller & Frederickson, 2006, p.107). For example, there could be a range of factors influencing the 35
effectiveness of intervention given the complexity of the real-world and the range of contextual factors. As previously highlighted, it is possible that treatment expectation and the therapeutic relationship might account for some improvement (Lambert & Barley, 2001; Moffitt et al., 2003). Additionally, as hypothesised by King, Tonge et al. (2001) there may be other factors which influence the effectiveness of intervention for example, family support and, as highlighted by Moffitt et al. (2003), the range of systemic factors which might be influencing a child's school refusal behaviour may require some flexibility in accounting for obstacles to treatment. 2.8.3 Behavioural approaches. As highlighted, behavioural approaches such as relaxation, graded exposure and systematic desensitisation have been used as part of cognitive behavioural approaches. Behavioural approaches have also been used in isolation, particularly where the function of the behaviour is related to gaining attention from others. For example, Chorpita, Albano, Heimberg and Barlow (1996) used shaping and differential reinforcement with a 10 year old girl who had a history of school refusal behaviour with a function of attention seeking with associated separation anxiety. Family activities were used as a functional substitute and problem behaviours were extinguished using planned ignoring of target behaviours according to a complaints schedule. Additionally, Hargett and Webster (1996) described the use of a graduated re-entry behavioural intervention to support a 7 year old boy in a mainstream classroom. The intervention consisted of graduated exposure to school combined with positive reinforcement for staying in school although this later changed to a rapid exposure to school to minimise the reinforcing effects of home; following the research the researchers emphasised the need to consider home and school factors which may be reinforcing behaviour. The researchers found that by the third week of intervention, the child was attending all classes for five consecutive days; this was maintained at 7 month follow up. Behavioural techniques have also been effective with young people who have learning difficulties. For example, Meyer, Hagopian and Paclawskyj, (1999) found that shaping and fading were effective in reducing school refusal behaviours in an 18 year male who was attending an inpatient unit for behavioural difficulties associated with school refusal. Additionally, in a local authority publication, an educational psychologist described two cases where she had used systematic desensitisation (Gloucestershire EPS, 2001). This was successful in one case but not the other. The case information provided indicated that the child for whom systematic desensitisation was unsuccessful had previously missed two years of schooling. The factors which promoted success were unclear however, one might hypothesise that 36
success was related to early intervention. Whilst these are only single case studies, the reductions in school refusal behaviours suggest that behavioural techniques may be beneficial. 2.8.4 Parent training/contingency management. Research has suggested that supporting parents with behaviour management skills can support a child's attendance (Lauchlan, 2003). As previously highlighted, parent training in contingency management is often used as part of cognitive behavioural interventions (e.g. Doobay, 2008; King et al., 1998, 1999) and has reported success. Kearney (2002b) for example, attributed therapeutic success in his 2002 case study to the involvement of both mother and child in therapy. However, from the studies identified from the systematic search, only Heyne, King et al. (2002) isolated the effects of parent training. Heyne, King et al. (2002) found that all three groups: CBT, parent/teacher training and CBT in combination with parent/teacher training led to significant improvements in attendance, self efficacy and emotional distress. They found that when parents were involved in intervention, children attended school more often than when parents were not involved but, as previously stated, the combination of child therapy with parent/teacher training did not have a greater effect than the interventions in isolation. Whilst the evidence for parent training in contingency management is limited, research suggests that this is a popular intervention with practitioners. Kearney and Beasley (1994) for example, completed a study to find out about practice characteristics when treating children and young people who show school refusal through surveying a sample of 300 practitioners specialising in youth and family practice in America. The survey found that parent training/contingency management was the most popular approach used by practitioners who had worked with cases of school refusal over a period of a year (used by 40.3% of practitioners). Practitioners reported 75% success rate for this intervention. This opens debate about how success is defined by different practitioners because this was a self report measure but nevertheless it suggests that the use of parent/teacher training in contingency management appears to be widely used by practitioners with a relatively high reporting of success. 2.8.5 Hypnosis. Interestingly, hypnosis has recently been cited as an intervention to support children showing school refusal behaviours (Aviv, 2006). Aviv (2006) used hypnotherapy techniques with twelve young people who were provided with mobile telephones so that 37
they could make contact with the therapist during periods of anxiety. Eight out of twelve children maintained full time attendance, three showed partial improvements with one failing to improve attendance. The researchers concluded that this provides evidence for the benefit of hypnosis in supporting children with school refusal. However, one could argue that effectiveness could also be related to the availability of the therapist because, as highlighted by the researchers, this might help to confront the anxiety when it arises. 2.8.6 Functional Approach. Kearney and Silverman (1990, 1993) suggested that the effectiveness of an intervention may depend upon the function of the child/young person's behaviour. Kearney and Silverman (1990) implemented interventions with seven children according to the function of their behaviour: · Four children had high social anxiety so these children received social skills training based on cognitive behaviour therapy and/or modelling procedures (i.e. the prescriptive treatment for the category of avoidant of aversive social situations) · One child was avoidant because of anxiety associated with specific teachers and negative evaluation. He received relaxation training and systematic desensitisation (i.e. the prescriptive treatment for the category of specific fearfulness/general over anxiousness) · Another child was classified as attention seeking/separation anxious so intervention involved shaping and differential reinforcement (i.e. the prescriptive treatment for the category of attention seeking/separation anxious) · The seventh child avoided school to receive tangible rewards so intervention consisted of contingency contracting procedures (i.e. the prescriptive treatment for the category of tangible rewards) Kearney and Silverman (1990) found that when the intervention was related to the function of the behaviour, time out of school reduced. They found that following treatment, 6/7 children had returned to full time school attendance and that this was maintained at the six month follow up. It was reported that these children had not missed any school days except for legitimate physical illness. Also Kearney and Silverman (1990) reported improvements for levels of specific fearfulness, general anxiety and units of discomfort. They suggested that this provided good evidence for a functional approach and the preliminary model to predict the intervention plan. It must be recognised however, that it 38
was not effective for all children and young people because one child did not return to school. Kearney and Silverman (1999) completed a preliminary controlled study following prescriptive treatment based on the function of school refusal behaviour. Eight children participated in the study. Initially four children and young people following full functional analysis were assigned a prescriptive treatment with the other four initially assigned non prescriptive treatments. They found that there was a reduction in time out of school for those who had received the prescriptive treatment with an increase in school absenteeism post treatment for those who had received non prescriptive treatments and an increase in ratings of anxiety and depression. Based on the maintenance of effectiveness at 6 month follow up, the authors concluded that the treatments were considered to have maintained their effectiveness over time and that this added further support for a functional based assessment and intervention. Additionally, Kearney (2002b) reported a case study of a young person who was referred to a specialised university clinic for school refusal behaviours and anxiety disorder. Kearney found that there were multiple functions for the young person's behaviour: to avoid negative affectivity, seeking attention and tangible reinforcement. Intervention consisted of anxiety reduction strategies, gradual re-exposure, parent training in contingency management and restriction of activities during school time. No school refusal behaviours were shown the next month. As highlighted by the researchers themselves it is not clear which elements were most effective. In addition to the techniques used, the flexible availability of the therapist, the extent of their availability and how much the therapist was contacted might also have been pertinent because Kearney (2002b) said that the young person would regularly email/telephone the therapist prior to school. Research by Aviv (2006) would support this hypothesis. He suggested that the availability of the therapist outside of the sessions contributed to the development of a supportive therapeutic alliance. Whilst the specific factors associated with success are unclear, this research does provide evidence for the use of cognitive and behavioural strategies and suggests that intervention might be most effective when intervention links to the function of the behaviour. Kearney (2002b) has demonstrated that a multi-element intervention plan might be particularly important where the behaviour is serving more than one function. 39
Kearney (2008) in his 2008 paper summarised the prescriptive interventions used by Kearney and colleagues to support young people who refuse to attend school for one of the four functions. These are detailed in Table 2.1. 40
Table 2.1. Prescriptive interventions based on function of school refusal behaviour (Kearney, 2008, p. 463)
Function 1 Refusing school to avoid school-based stimuli that avoid negative affectivity (child-based)
Prescriptive intervention - Psychoeducation regarding anxiety and its components - Somatic management techniques such as relaxation training and deep diaphragmatic breathing - Gradual re-exposure to school setting using anxiety and avoidance hierarchy - Self-reinforcement of gains
2 Refusing school to escape aversive social and/or evaluative situations (childbased)
- Psychoeducation regarding anxiety and its components - Somatic management techniques such as relaxation training and deep diaphragmatic breathing - Cognitive restructuring to modify irrational thoughts - Practicing coping skills in real life social and evaluative situations - Gradual re-exposure to school setting using anxiety and avoidance hierarchy - Self reinforcement of gains
3 Refusing school to pursue attention from significant others (parentbased)
- Modify parent commands toward brevity and clarity - Establish a set morning routine prior to school as well as daytime routines as necessary - Establish rewards for attendance and punishments for nonattendance - Forced school attendance in specific cases
4 Refusing school to pursue tangible rewards (family based)
- Contingency contracting that involves increasing incentives for attendance and disincentives for nonattendance - Establish times and places for family members to negotiate problem solutions - Communication skills training - Escorting a youth to school and classes as necessary - Increasing monitoring of attendance - Peer refusal skills training (to refuse offers from others to miss school)
41
2.8.7 Systemic approach. Bronfenbrenner's (1979) ecological systems theory, suggests that behaviour should be seen holistically, viewing it as a system made up of a number of interacting subsystems: · Microsystem; the context in which the child is embedded such as the family, school, peer group · Mesosystem; the interaction between people in the microsystems, for example, schools' relationship with parents · Exosystem; the context of the community for example, extended family, neighbours, services · Macrosystem; the attitudes and ideologies of a particular culture · Chronosystem: changes over time Therefore, a child's behaviour and development is influenced by the interactions with these systems. This is illustrated in Figure 2.3. Figure 2.3. Bronfenbrenner's (1979) ecological systems theory http://jennifershewmaker.com/2011/02/04/systems-of-influence-helping-children-makesense-of-the-world/ [Accessed 31 July 2012]. 42
This ecological perspective highlights the importance of context and views a child and young person's development to be understood within functions of the system as a whole and the subsystems (Ayers, Clarke & Murray, 2000). In terms of intervention, the ecological approach aims to bring about positive changes in specific systems to produce positive changes on behaviour (Ayers et al., 2000). Lauchlan (2003) highlighted the need for a systemic approach to intervention in cases of school refusal behaviour. From reviewing the grey literature obtained from colleagues, it is clear that some local authorities have provided guidance and training for schools and services within the authority (Gloucestershire EPS, 2001; Rose, 2006; West Sussex County Council EPS, 2004). This focuses on developing an understanding and awareness of factors associated with onset and maintenance of school refusal behaviours and encouraging collaborative and multi-agency working in intervention. Additionally, some local authorities have also provided guidance for parents about how they can support their child (The Highland Council, 2006; West Sussex County Council, 2004). Whilst this provides useful information for practitioners and parents, the researcher of the present study is unaware of research evaluating this form of intervention. 2.8.8 Summary of interventions. In summary, as also highlighted by Lauchlan, (2003) research has failed to find any conclusive evidence in favour of a particular approach. Whilst research has suggested that some of these interventions can be successful, some are effective with some children and young people and not others and some lack evaluation studies to substantiate the claims for success (Lauchlan, 2003). The factors associated with success are also unclear. Supportive factors could be hypothesised from the research such as helping children to develop coping strategies, early intervention, availability of the therapist and perceived self efficacy for handling school situations but such factors were not explored in detail as part of the research. Additionally, as highlighted by Phelps, Cox and Bajorek (1992), developmental differences could explain why some interventions are effective for some children and not others. 2.9 What Supports Successful Involvement? Gathering the voice of the child and parents/carers has been advocated from a number of perspectives including legislation and education policy (e.g. Education Act 1981 and SEN Code of Practice (DfES, 2001)) with research also illustrating the potential for a POSITIVE IMPACT of the pupil voice on school improvement and on the young people themselves 43
(e.g. Gersch & Nolan, 1994; Halsey Murfield, Harland & Lord, 2006; Whitty & Wisby, 2007). From a moral perspective, the UN Convention on the Rights of the Child 1989 recognised the human rights of children and posited that children have a right to be heard and be consulted on matters affecting them (Gersch, 2001; Whitty & Wisby, 2007). As highlighted in Whitty and Wisby (2007) the Children's Act 1989, further supported by the Children's Act 2004, was an early development in relation to children and young people's involvement in decision making with legislation making it a legal requirement for children and young people to be consulted and involved in decisions affecting them. As stated in O'Connor (2008) parents and children and young people are affected by the outcomes of interventions so it is important to include them wherever possible. Research has suggested that a lot can be learned through listening to the experiences of others and exploring others' perceptions of success and what they found helpful. For example as stated in Gersch and Nolan (1994), Indeed, if adults are to fully understand the process and experience, if preventive measures are to be effective and appropriate, if plans are to be made to work for pupils, there is no doubt that pupil involvement is critical. (p. 37) The researcher would suggest that we cannot assume what factors support successful involvement without gathering the perceptions of children and young people, parents/carers and practitioners. The researcher would therefore emphasise the value of gathering the views of stakeholders, particularly because what might be viewed as helpful for one individual might not be for another. Therefore, the researcher would suggest that gathering the views of others, particularly the views of young people, could have a positive influence on our understanding of what supports successful involvement in cases of school refusal behaviour. As highlighted in Halsey et al. (2006) this could subsequently influence organisational practices and policy development. However, the researcher whilst recognising the value of gathering pupil views, the researcher recognises the potential risks of gaining pupil views if problematic or unresolved issues are raised. In addition to highlighting the positive influence of the pupil voice on education policy and practice the review by Halsey et al. (2006) also highlighted the potential benefit of the pupil voice on the young people themselves. For example, the review illuminated how pupil participation can have a positive impact on young people's confidence and self esteem, social, personal and emotional competence, sense of responsibility, efficacy and 44
autonomy, communication and collaborative skills and how it can also affect attendance, behaviour, achievement and knowledge and skills. Therefore, in addition to furthering understanding about what supports successful involvement of cases of school refusal behaviour, the researcher recognises the value of gathering the views of the young people because of the potential of this having a positive influence on outcomes for the young people themselves; particularly in terms of their confidence and self esteem and the sense of responsibility, efficacy and autonomy that they may gain from sharing their views. However, there has been little research exploring the perceptions of those involved in relation to school refusal behaviours and limited research exploring factors associated with successful involvement. Parents' perspectives on supporting factors have been reported by Toplis (2004) and practitioner perspectives have been reported by Kearney (2008), Kearney and Bates (2005) and Kearney and Bensaheb (2006). Toplis (2004) completed semi structured interviews to gain parents' views of "emotionally based school refusal". The interviews explored what parents thought were productive and unproductive factors and what parents thought were key factors in the resolution of difficulties. This research highlighted a number of supporting factors including: the importance of a trusting relationship with an adult, an adult in school the child could talk to, support and intervention in the school environment, immediate intervention when difficulties arose, clear information about choices and one key professional managing the case etc. However, whilst this research offers valuable insight, the supporting factors were not explored in any detail due to time constraints, the perceptions of the children and young people and practitioners were not sought and this article contains weaknesses in reporting because data collection and data analysis was unclear. In terms of factors associated with success, peer reviewed papers by Kearney and Bates (2005), Kearney and Bensaheb (2006) and Kearney (2008) offered suggestions based on their experience of success as practitioners. These are reported in review and discussion papers. The researchers acknowledged that these are practical ideas which are not based on empirical research but nevertheless the anecdotal reports provide a useful insight from experienced practitioners in the field. All papers highlighted the importance of a multidisciplinary team to support the assessment and treatment process involving parents, counsellors, educational psychologists, head teachers and regular and specialist teachers. Kearney and Bates (2005) recommended that within this team there should be 45
at least one school based member who was responsible for co-ordinating intervention and to act as a "hub" for liaising between professionals and answering questions. Kearney and Bates (2005) also offered a number of suggestions for school based professionals as detailed in Figure 2.4. Kearney and Bensaheb (2006) emphasised the importance of not reinforcing behaviours by sending children home and suggested that a schedule of classroom attendance that gradually increases each week might be beneficial. They also reiterated many of the suggestions made in Kearney and Bates (2005). Examples of common school-based and frontline techniques that are often helpful in reducing absenteeism include: - increased monitoring of daily attendance - immediate feedback to parents regarding any absenteeism (including missed classes) - required documentation for legitimate absences - assignment of a buddy or special assistant who helps a child attend classes on time and complete assigned work - frequent recognition and reward of school attendance - use of written attendance contracts that outline rewards and penalties for attendance and non attendance - mediation and resolution of problems with teachers and peers - increased participation of the child in extra-curricular or otherwise appropriate social activities - increased participation of the child in appropriate work-study placements - temporary modification or easing of homework More general aims include: - modifying educational expectations and teacher attitudes towards a child - promoting a positive and inviting school atmosphere - frequently reassessing for additional learning needs - providing appropriate and tailored instruction - ensuring a nonoppressive environment for diverse students - developing a strong parent-school relationship - altering classes and schedules as necessary and appropriate Figure 2.4. Techniques identified by Kearney and Bates (2005, p.212) as helpful in reducing absenteeism 46
Additional strategies cited in Kearney (2008) included: providing alternative educational opportunities and individualised instruction, increasing parental involvement and incentives for attendance, assigning adult and peer mentors to youths at risk of leaving school prematurely and employing flexible school based responses. 2.10 Summary In summary, there are a number of reasons why children and young people might show school refusal behaviours. School refusal behaviours are complex with levels of attendance and anxiety varying at different points in time with behaviours potentially serving a number of functions. The research suggests that a multi-method, multi-source assessment is required to provide a complete case conceptualisation which accounts for the range of factors that might influence the onset and maintenance of school refusal behaviour. This will help to ensure that intervention meets the needs of children young people and families (Lyon & Cotler, 2007). A range of interventions has been used with children and young people who show school refusal behaviour. Research has highlighted that some interventions have been successful with some individuals however, there are many individuals for whom these interventions were unsuccessful (Lauchlan, 2003). The evidence for many interventions was based on children and young people in in/outpatient units who met diagnostic criteria for mental health difficulties (Pina, Zerr, Gonzales & Ortiz, 2009). This questions the generalisability of such interventions to those who would not meet criteria for diagnosis. However, as highlighted, estimates of the prevalence of school refusal behaviours and the prevalence of those children and young people who also have diagnosable mental health needs are debatable because of differences in conceptualisation of school refusal behaviour. Whilst individualised intervention programmes may be important, research does not explain why individualised intervention can be effective for most but not all children (e.g. Kearney & Silverman, 1990). The factors associated with effective intervention are unclear and, as many of the interventions are multi-element, it is difficult to determine what contributes to success. The researcher of this study suggests that factors associated with successful involvement require further research. Additionally, there is limited research which has explored the perceptions of those involved. Research has looked at the perceptions of parents and reported practical ideas and suggestions from practitioners. The researcher is unaware of any research which has looked at the perceptions of children and young people, parents and practitioners 47
regarding school refusal, particularly research which has looked at their views collectively around an individual case. The present study aimed to explore factors associated with success through exploring these people's perceptions and reviewing existing documentation using a case study approach. For the purpose of this study, success was characterised by the local authority system: in terms of a pupil's attendance level returning to above 80% with a reduction in their level of anxiety. 2.11 Contribution to Knowledge The present study: · explored why involvement in particular cases was successful · gathered the perceptions of those involved including parents, children and young people, practitioners and school staff · used the range of perspectives to form a triangulated and dynamic view about factors which promoted successful involvement The research replicated part of Toplis (2004) through completing semi structured interviews with parents to gain their views about factors which were associated with success in school refusal. However, the present study also obtained the views of children and young people, practitioners and school staff within the context of the case studies. Information was also sought from existing data sources to provide a dynamic and triangulated view about factors which promoted successful intervention. 2.12 Aims/ Objectives The previous section outlined the need to investigate what factors were effective in supporting children and young people who showed school refusal behaviours and why, and highlighted the limited research into the perspectives of stakeholders who might be involved with children and young people who school refuse. The present study aimed to explore successful cases of children and young people who were showing school refusal but whose anxiety level decreased and attendance increased to the point that they no longer required external involvement. It aimed to identify factors which were perceived to be associated with success and how these were understood to be effective, factors which might have led to greater success and why people perceived these factors to have the potential for more success. This was identified through gaining the perspectives of children and young people, parents, school staff and professionals who worked with the child/young person. It was hoped that this would inform the specialised interventions of 48
educational psychologists and other professionals who work with children and young people who show school refusal behaviour. The study aimed to answer the following research questions 1 What factors are perceived to be effective in supporting children and young people who have anxiety/fear which is leading to school refusal behaviours, and why? 2 What might have led to more success or earlier success in the effective support of the school refusal behaviour? 49
Chapter 3: Methodology 3.1 Overview This chapter outlines the methodology used to explore factors associated with successful involvement in cases of school refusal behaviour to address the research questions outlined in the previous section: 1 What factors are perceived to be effective in supporting children and young people who have anxiety/fear which is leading to school refusal behaviours, and why? 2 What might have led to more success or earlier success in the effective support of the school refusal behaviour? Case study research was selected as the preferred approach to address these research questions because, as stated in Yin (2009), a case study allows an in-depth inquiry into a phenomenon within its real life context. Two successful cases of involvement with cases of school refusal behaviour in Stockshire Borough Council3 were selected to explore the factors associated with success retrospectively in a multiple-embedded case study design. The perspectives of parents, young people and the practitioners involved with the children and young people were gained through completing semi-structured interviews to find out what they perceived to have been effective and why and to identify what they thought might have led to more success and why. Thematic analysis was then completed to identify the key themes in relation to each case. This chapter provides a comprehensive description of the methodology. Initially, the ontological and epistemological position for the research design and axiology are outlined. The research design is then described in detail including description of the case study design, sampling and Participant Selection, case selection, data gathering methods and data analysis methods. Reliability and validity, ethical considerations and operational risks are then discussed with identification of the relevant steps taken to ensure that standards of reliability and validity and ethical principles were maintained. The chapter concludes with a critique of the methodology, including critical discussion about case study 50
methodology and the data gathering techniques. Within each section, explanation and justification for the decisions made throughout the research are presented. 3.2 Ontology The research adopted a critical realist ontological position. This view assumes that reality exists independently of our thinking about it and that science offers an opportunity to obtain knowledge about this reality (Danermark, Erkstrom, Jakobson & Karlsson, 2002). Critical realism developed following critiques of other philosophical approaches such as positivism which were criticised for reducing reality to empirically observable events and assuming that what we observe is all that exists (Danermark et al., 2002). Similarly, it developed following critiques of approaches such as relativism which critical realists criticised for reducing science to a discursive level, placing too much emphasis on experience and how the world is perceived (Danermark et al., 2002). As stated in Robson (2002), if the world was a product or construction of our knowledge, then our knowledge would be "infallible". The critical realist approach suggests that it is possible to acquire knowledge about the external world as it really is. However, the critical realist position argues that knowledge is fallible as our experience of getting things wrong/having expectations confounded suggests that the world exists regardless of what we think about it (Sayer, 2000). Therefore, the critical realist is critical of the ability to know reality with certainty (Reseach Methods Knowledge Base, 2012). The writings of Bhaskar, a key philosopher and influence of the critical realist position, suggest that a distinction can be made between three domains of reality: the real i.e. the mechanisms (or causal powers) which exist (whether they produce an event or not), the actual i.e. when the mechanism produces an event whether we experience them or not, and the empirical i.e. what we experience directly or indirectly i.e. an empirical fact (Danermark et al., 2002; Robson, 2002; Sayer, 2000). Critical realism is based on the assumption that objects in reality possess causal powers i.e. mechanisms, and that outcomes of an action follow from mechanisms acting in different contexts (Danermark et al., 2002; Robson, 2002). As highlighted in Sayer (2000), such powers can produce different effects/events in different contexts. Critical realists therefore would suggest that it is important to understand what produces events and not focus purely on the events themselves (Danermark et al., 2002). In terms of causality, critical realists would suggest that explanation should be explored by examining what causes something to happen through identifying causal mechanisms, how they work, discovering if they have been activated and under what conditions (Sayer, 2000). 51
The critical realist position and view of causality underpinned the present study. The research recognised that there were commonly agreed facts, for example, in relation to educational provision, attendance data and the interventions that the young people received but recognised that there may be differences in how people might understand and perceive the real world. Facts may be perceived differently by different people and in different contexts. Therefore, in accordance with this position, commonly agreed facts were brought into interaction with stakeholders when gathering their perspectives. As stated, the critical realist position suggests that knowledge is fallible. Critical realists, whilst assuming that reality exists independently of our thinking, are critical of the ability to know reality with certainty. Therefore consistent with this view of reality, the present study used of triangulation and multiple sources of evidence to gather a range of stakeholders' perspectives to gain a better understanding of what factors are associated with successful involvement in cases of school refusal behaviour. 3.3 Epistemology The research aimed to gain knowledge about successful involvement with school refusal behaviour and address the gap in the literature identified in Chapter 2. As highlighted, a critical realist view of science underpinned the research which thus influenced the methodology adopted in increasing knowledge. In writings about the critical realist view of science, Sayer (1992) said that, "method suggests a carefully considered way of approaching the world so that we can understand it better" (p. 12), but criticised writings about method in that they often fail to acknowledge knowledge in its context. Sayer (1992) stated four misconceptions about knowledge: · that knowledge is gained purely through contemplation or observation of the world · that what we know can be reduced to what we say · that knowledge can safely be regarded as a thing or product, which can be evaluated independently of any consideration of the production and use in social activity · that science can simply by assumed to be the highest form of knowledge and that other types are dispensable or displaceable by science. (p.13) 52
As stated by Sayer (2000), social events are the products of a range of interacting mechanisms and are thus complex. Therefore in practice, one cannot isolate and manipulate variables to observe cause and effect relationships. School refusal behaviours, as highlighted in the previous chapter, are complex. There are likely to be many interacting structures and mechanisms which could influence the effectiveness of intervention which may be different in different contexts. Therefore, it is not possible to separate factors from context. Congruent with critical realism and the above view about knowledge, this research aimed to gain knowledge through interaction with other people and, rather than focusing on what was observable, it sought to gain knowledge about how and why involvement in these cases of school refusal was successful; consistent with Sayer (1992), it considered the production of knowledge as a social activity. The research gathered the perceptions of key stakeholders through semi structured interviews as part of a multiple embedded case study design. As previously highlighted, the research sought to address the gap in the literature by exploring factors associated with successful involvement with school refusal behaviours by gathering the perceptions of those involved including parents, young people, practitioners and school staff about what they perceived to be successful. The critical realist epistemological position influenced the data gathering methods. In addition to gathering the perspectives of the key stakeholders, the research recognised the importance of context and objective facts. For example, the research sought to determine what was successful and why and sought to produce an explanation of success in relation to the context of the young person, their family and the educational provision. Attendance data was therefore obtained and during the semi structured interviews, the researcher asked questions to gather information about the case background such as what the case was like, who was involved and what involvement consisted of. During the semi structured interviews, reality in terms of attendance, educational provision and prosecution for example were brought to discussion because the researcher recognised the influence of experience and context on perspective. The findings i.e. factors associated with success are described in Chapter 4 in relation to context such as local authority and school systems, the home environment, culture and the socio legislative context. 53
3.4 Axiology When considering the research, it is clear that it was influenced by the researcher's own values and beliefs, for example, a positive psychological approach was adopted, the researcher gained the views of the child/young person and the researcher ensured equality of opportunity for stakeholders in expressing their views. These are values on which the researcher places high importance in their practice as a trainee educational psychologist. The researcher hoped to identify factors associated with success so that this could be used to support practitioners' involvement with cases of school refusal in the future. The research adopted a positive approach by focusing on strengths i.e. what was successful and why and focusing on the ideal rather than focusing on any problems or difficulties which may have been experienced. Additionally, the researcher as a trainee educational psychologist, placed high importance on gaining the views of the child, something which has received attention in educational psychology literature and legislation and policy e.g. SEN Code of Practice (DfES, 2001). The research was also influenced by the researcher's value in ensuring equality of opportunity. All stakeholders were given the opportunity to participate in the research, to express their views and to subsequently inform the understanding of the factors associated with successful involvement with school refusal behaviour. 3.5 Case Study Research Miller and Frederickson (2006) explained the tensions that educational psychologists (EPs) as scientist-practitioners face; for example it has been questioned whether controlled experimental studies which provide an understanding of general psychological processes can be generalised to the complex problems which EPs face in practice. As highlighted in Yin (2009), experimental methodology, "deliberately divorces a phenomenon from its context, attending to only a few variables" (p. 18) and as stated in Miller and Frederickson (2006), for the academic psychologist, science has generated theoretical explanations and understandings by studying multiple cases, each stripped of their messy individual complexities ....in essence these explanations have provided impoverished or incomplete understandings of individuals and yielded little by way of helpful individual strategies or wider policy implications. (p.117) 54
Consequently, Miller and Frederickson (2006) and Yin (2009) explained how alternative methods for complex real-world research are sometimes seen as preferable e. g. understanding singular cases through completing detailed case studies. Yin (2009) for example, explained how case studies can be used to explain the causal links in real life interventions which are too complex for experimental methodology. As stated in Robson (2002), "a case study is a strategy for doing research which involves an empirical investigation of a particular contemporary phenomenon within its real life context using multiple sources of evidence" (p.178). As previously stated, school refusal behaviours are complex so it is difficult to separate the phenomena of successful intervention from the context of the behaviours. A case study was therefore chosen for this study because a case study would allow the researcher to explore successful intervention in the real life context and would enable research to be completed when there was little control over behavioural events. Additionally, a case study would enable detailed exploration of what was successful and why through focusing in detail on a single case or small number of related cases in context (Robson, 2002). Case studies are appropriate to answer "how and why" research questions which are exploratory in nature (Yin, 2009) and with their focus on context and multiple sources of evidence, a case study approach was therefore congruent with the research questions and the critical realist epistemological position. 3.6 Design 3.6.1 Case study design. The research explored factors associated with effective involvement through completing a case study of two successful cases retrospectively in a multiple, embedded case study design to answer the research questions: 1 What factors are perceived to be effective in supporting children and young people who have anxiety/fear which is leading to school refusal behaviours and why? 2 What might have led to more success or earlier success in the effective support of the school refusal behaviour? Yin (2009) discussed four types of case study design: single-holistic, single-embedded, multiple-holistic and multiple-embedded case study designs. A single-case study design 55
provides an in-depth inquiry into a single case with a multiple-case study design providing an in-depth inquiry into more than one case. Yin (2009) recognised that a multiple-case study design can require extensive resources and time so stated that a single-case design may be appropriate if it is not possible to complete a multiple-case design, particularly where there is a single unique case. The evidence provided by multiple-case designs however, is more robust than that provided by a single-case design (Herriott & Firestone, 1983). Yin (2009) stated that when the choice and resources are available, multiple-case designs may be preferred because the chances of doing a "good" case study increase and because multiple-case designs allows analytic conclusions to be made between the cases. Therefore, given the benefits of multiple-case designs and the availability of two successful cases of school refusal behaviour in the local authority, a multiple case design was chosen for the present study. Two cases were identified to ensure data was manageable for the available resources and time. Yin (2009) states that each case study may be embedded or holistic depending upon the research questions; embedded if it involves more than one unit of analysis or holistic if it involves a single unit of analysis. The study consisted of two units of analysis which were explored within each case: · exploration of factors which were perceived to be effective in supporting children and young people who showed school refusal behaviours · exploration of factors which might have led to more success or earlier success in the effective support of the school refusal behaviour Therefore, a multiple-embedded case study design was adopted for the present study as data was gathered for each research question in relation to the individual cases. Multiple sources of information were used to triangulate the information and to increase the construct validity of the emerging themes (Yin, 2009). In accordance with the critical realist approach, the perspectives of stakeholders were gathered in addition to facts and objective information about the context. The perspectives of parents, young people and the practitioners involved with the young people were gained through completing semistructured interviews to find out what they perceived to be effective, how they understood these factors to be effective, what might have led to more success and why. Participants were encouraged to consider these factors at a child, home, school and systemic levels 56
(the propositions). Objective information such as school records and attendance data were obtained to gain background information to provide a context for the findings. 3.6.2 Case definition. Robson (2002) explains how a case can be interpreted widely to include an individual, a group, a setting or an organisation for example. In this research, a case was defined as a child/ young person who had previously shown school refusal behaviours but whose anxiety decreased and attendance increased to the point that they no longer required external involvement from the attendance officer. Literature was reviewed to inform how a successful case was defined. As stated in Lauchlan (2003), school attendance figures are frequently reported in research into school refusal behaviour as a measure of pupil success. Some research papers also include a measure of a child's psychological wellbeing and level of anxiety; for example, a self report measure of emotional distress and anxiety or a clinician's rating of overall psychological well being and school functioning (Lauchlan, 2003). However, because this research investigated successful cases retrospectively, baseline data of psychological wellbeing was not available. Success was therefore based on attendance data and the attendance officer's perception that there had been a reduction in the young person's level of anxiety. Success in terms of attendance was based on the local authority system. For example, discussions with the attendance officer manager identified that the local authority would classify success as attendance returning to above 80% because attendance officers only become involved if attendance drops below 80%. This is consistent with information provided by the DCSF (2009) which states that persistent absentees are defined as pupils who are absent for more than 20% of all possible half days. 3.6.3 Case selection. In terms of the selection of cases, attendance officers were therefore, asked to identify the number of cases that they had been involved in which met the following inclusion criteria: · where a young person's anxiety i.e. some element of fear relating to home/school was the primary cause of school refusal behaviours (this may/may not be linked to family circumstances e.g. a child may be anxious about leaving home because they are concerned about a parent's physical/mental health). These children would meet Berg et al.'s (1969, in King et al., 1998) criteria for school refusal: persistent 57
difficulties in attending school; severe emotional upset; at home with their parents' knowledge when they should be in school; absence of anti-social behaviours such as stealing · where a child/young person's anxiety reduced · where a child/young person's attendance improved to the point that they no longer required external involvement from the attendance officer (i.e. attendance returned to above 80%) · where there were multi-professionals from different disciplines involved (to ensure that this included cases where a range of practitioners were involved with the child/young person to enable full exploration of effective factors. Also the researcher would suggest that there are commonly multi-professionals from different disciplines and families involved in supporting children and young people who show school refusal behaviours) · where involvement was within the last two years (to ensure that participants were more likely to remember key facts about what was effective and why) · where a child/young person's return to school had been maintained at 80% or above for at least 1 term (this was to ensure that the emotional well being and attendance of the children and young people involved were likely to be more stable than those just returning to school thus minimising the risk of the research inducing anxiety and/or causing their progress to deteriorate) Exclusion criteria: · where a child or young person was within two months of public examinations · where there was current family reconstitution or bereavement · where the attendance officer or school was aware of significant stress for the family and/or young person Exclusionary criteria were applied to ensure that additional pressure was not put on a child or family at particularly difficult periods of time, thus ensuring that ethical principles were maintained (HPC, 2008). The selection criteria stated that for those cases which met the inclusion criteria, the two selected for the research would be the two where the pupil's return to school had been maintained for the longest period of time. If these two cases had been led by the same attendance officer, the second case would have been excluded and an additional case selected. This was to ensure that a range of practitioners were involved, thus minimising 58
the confounding variable of individual practitioner characteristics and improving the validity of the findings. The criteria yielded four cases so the selection criteria described was applied. The attendance officers contacted the parents of the young person for the two identified cases to gain their consent for the researcher to make contact and outline the research. These cases were subsequently excluded: one child had started to show school refusal behaviours and one parent chose not to participate in the research. This left two remaining cases, one of which was to be used as a pilot4. Again, the attendance officers made initial contact with the parents to gain consent for the researcher to make contact. The researcher reviewed information of these cases to ensure that they met the inclusion and exclusion criteria to ensure face validity. 3.6.4 Participants. Once initial verbal consent had been gained from the parents, the parents and attendance officers were asked to identify the key stakeholders involved. Participants were referred to as stakeholders because they were recruited because of their status in the cases. The young people, their parent/carer(s), key school staff and professionals involved with the case were then provided with information about the purpose of the research and were provided with information sheets and consent forms (Appendices B, C, D, E, F, G and H). The young people were asked if they would be happy to attend an introductory session with the researcher to find out more about the research and to ask any questions that they had. During the introductory session, the research was discussed and the young person was invited to give full informed assent (Appendix B and C). The researcher however, ensured that signed consent had been obtained from parents prior to discussing the research with the young people or professionals involved. Interviews were not completed until full informed assent/consent had been obtained from the young person, their parent/carer, the attendance officer and at least two other professionals/school staff. If full informed assent/consent were not obtained, an alternative case would have been selected. Table 3.1 provides details of the two selected cases: Case 1 presents information about Amy 5 a Year 9 pupil in a mainstream secondary school and Case 2 information about 4 following no concerns with the research methodology this was subsequently included as part of the sample 59
Leah5, a Year 10 pupil who now attends a vulnerable pupil unit. Whilst provision in the vulnerable pupil unit was part time, it was thought that part time provision should not be part of the exclusionary criteria if a young person was attending the sessions asked of them. This would fit with the information provided by the DCSF (2009) in relation to absenteeism which referred to persistent absenteeism in relation to "possible" half days. Information was drawn from field notes made during discussions with the attendance officer, information presented in the interviews and documentation such as attendance records. 5 Pseudonyms have been used to maintain anonymity and confidentiality 60
Table 3.1. Information about the young people in the selected cases
Variable
Case 1
Case 2
Young Person Pseudonym
Amy
Leah
Sex
F
F
Age at time of research
13
14
Year Group
Year 8
Year 9
Educational Setting
Mainstream Secondary School
Vulnerable Pupil Unit (VPU)
One or Two Parent Family
One (father)
One (mother)
Number of Siblings
3
0
Attendance level at the time of research
80%
100% (sessions in VPU)
Attendance during academic year 2009 ­ 2010 When did the young person first start to show school refusal behaviours?
56% Autumn term of Year 7 (2009)
0% (Leah was out of school for 2 years) Spring term of Year 5 (2007)
When were improvements noticed in attendance?
Autumn term of Year 8 (2010)
Spring term Year 9 (2011)
Diagnosis?
No
Obesity and hypothyroidism;
diagnosed in 2011
External Agencies Involved
Attendance Officer Parent Support Advisor CAMHS Social care
Attendance Officer CAMHS
Individuals identified by the parents and attendance officers as key stakeholders all participated in the research. Stakeholders are detailed in Figure 3.1.
61
Case 1: Amy
Child/young person Amy4
School staff Learning Mentor SENCO Case 2: Leah
Parent/carer Amy's father
Practitioners Attendance Officer Parent Support Advisor Clinical Psychologist (Child and Adolescent Mental Health Service (CAMHS))
Child/young person Leah4
School staff Inclusion Co-ordinator at Primary School Learning Mentor at Secondary School Class Teacher at Vulnerable Pupil Unit
Parent/carer Leah's mother
Figure 3.1.Stakeholders involved in the case study
Practitioners Attendance Officer Senior Nurse Practitioner (Child and Adolescent Mental Health Service (CAMHS))
62
As shown in Figure 3.1, there were seven participants in both Case 1 (Amy) and Case 2 (Leah). This consisted of the young person, parent and attendance officer in each case. In the case of Amy, the parent support advisor who was supporting the family also participated in the research as did the SENCO and learning mentor from her school and Amy's clinical psychologist. In the case of Leah, the senior nurse practitioner (CAMHS) participated in the research as did Leah's teacher from the vulnerable pupil unit. Discussions with the attendance officer and Leah's mother also identified professionals from her previous primary school and previous secondary school as key stakeholders because they were heavily involved in supporting Leah when she attended mainstream settings. Therefore, the inclusion coordinator from the primary school and learning mentor from the secondary school also participated. Given that Leah showed school refusal behaviours in these settings, these stakeholders discussed what was beneficial for Leah when she attended those settings. For the purpose of this research the inclusion co-ordinator will be known as the "learning mentor" in the primary school because she was providing direct support to Leah and it was thought that it would be helpful to have commonality of terms for the research. In the case of Amy, the researcher was also identified as a key stakeholder because of their role as a trainee educational psychologist in offering post reintegration support. However, because this was post-reintegration support, it was thought that the perspective of the trainee educational psychologist was not relevant in understanding the factors which supported reintegration; the views of the trainee educational psychologist were therefore not sought as part of the research. 3.7 Data Gathering Methods Multiple sources of evidence were obtained to triangulate the data and improve the content validity (Yin, 2009). This involved semi structured interviews with the parent, young person, school staff and multi-professionals from different disciplines. Congruent with the critical realist position, semi structured interviews gathered information about the context in addition to gathering the perceptions of those involved. Attendance data was also obtained to provide a context for the research findings. This is described in detail below. The researcher valued the benefit of the semi structured interview for the present study. Semi structured interviews provide an opportunity to gather detailed information about a 63
particular topic and give flexibility to explore particularly interesting avenues of discussion in further detail (Robson, 2002; Smith, 1995). The researcher recognised that this may support a fuller and more comprehensive understanding of the stakeholder's perspective of what led to success, under what conditions and why they perceived this to be effective. Additionally, flexibility was valued because it enables clarification of points made in the interviews and also the flexibility of the method has been reported to be beneficial in facilitating rapport and empathy with participants (Smith, 1995). 3.7.1 Semi structured interviews. Semi structured interviews were completed with the practitioners/school staff identified by the parents and attendance officers as having key involvement, the parent/carer(s) and the young person to ascertain what factors they perceived to be associated with successful involvement and why. This was to ensure the evidence could be examined from a range of perspectives, that the case study did not present a one sided account or was biased in terms of participation selection (Yin, 2009) and to ensure that all stakeholders had the opportunity to be heard. Semi structured interview schedules are presented in Appendix I (for practitioners, school staff, parents/carers and children and young person). Questions were designed to gather information about the case background and context and to gather perceptions in relation to the research questions. Questions were initially open ended but points raised were explored in further detail to support clarification and triangulation of themes. Additionally, prompts were provided to ensure full exploration of the question (i.e. the propositions). The interview schedules were initially piloted with a young person, parent, practitioners and teachers. No concerns were highlighted so adaptations were not made to the schedules; this case was subsequently included as part of the sample. 3.7.1.1 Semi structured interview with practitioners and parent/carers. Interviews with practitioners and parents/carers each took place over one session for approximately one hour in a location of their choice: the school, the practitioner's local office or the home. Interviews were completed individually with participants in a quiet room to minimise disruption. Initially, the researcher engaged in free talk to support the development of a positive relationship with the participant, re-explained the purpose of the research, what was involved, reinforced confidentiality and other ethical principles (see Section 3.10) and ensured consent prior to turning on the Dictaphone. 64
During the interview, the researcher aimed to listen more than they spoke and tried to use minimal probes as recommended by Smith (2007) to encourage the participant to expand on the points made e.g. "can you tell me more about that?" or "can you tell me what that looked like?" Questions such as these supported the researcher's understanding of participants' perspectives and also, when coupled with summarising and reflecting back points made, ensured clarity and encouraged expansion of points. Additionally, the researcher tried to empathise with participants as appropriate, recognising that for some, the interview may have been therapeutic because it may have been the first time that they had talked openly about their thoughts and feelings. The researcher had developed counselling techniques as part of their training to become an educational psychologist so also applied techniques such as active listening, paraphrasing and summarising to support the relationship with the participants for example, in developing a sense of connectedness and enabling participants to feel listened to and understood (Rogers, 1957; Coyle & Wright, 1996; McLeod, 2003). The researcher thought that the development of a positive therapeutic relationship may consequently support a rich gathering of information. As stated in Coyle and Wright (1996), the application of counselling skills when discussing sensitive topics may be beneficial in providing a sensitive environment which also serves a research function because counselling skills, "can foster good rapport, encourage interviewees to elaborate their experiences and help establish potential lines of association and causation in the Research Data," (p.431). At times, the researcher did not want to disrupt the participant's flow, so made notes of key points which needed further exploration so that these were revisited later in the interview. Following the interview, consent was gained for the researcher to make contact if follow up questions and clarification were required. 3.7.1.2 Semi structured interview with the young people. Involvement with the young people took place in school over two sessions. Prior to the interviews with the young people, the researcher met with each young person during an introductory session to provide them with information about the research and to give them an opportunity to ask questions to enable them to make full informed assent. During this meeting, the researcher emphasised ethical principles (Section 3.10) and the participatory aspects of the research by highlighting how the young person's experiences could support other children and young people who find it difficult to attend school. 65
The interviews with the young people aimed to gather their views about the involvement of others in terms of what helped and what could have led to more success. It was thought that gathering this information over two sessions would enable the young person to develop and refine their thoughts which could be argued to improve the coherence and validity of their account. The young people were given the choice of communicating their views through discussion or through drawing/art. This was because research suggests that children and young people often prefer alternative methods of expressing their views than traditional interviews (Parsons, 2010). Young people had access to a range of materials including drawing, painting and craft materials and writing equipment. However, whilst the young people initially explored the art materials, they chose to communicate their thoughts verbally. Questions asked were based on the semi-structured interview schedule detailed in Appendix I. Similar to the semi-structured interviews with practitioners, the researcher encouraged the young people to expand on their responses and the researcher applied counselling techniques to develop rapport and support the therapeutic relationship. The interviews with the child/young person were audio recorded and transcribed. If the young person had communicated their views through art, photos would have been made of the young person's "product" following each session so that the development of their "story" over time would have been apparent. During the art activity the researcher would have commented on what the young person was doing and the way they were doing it to try and open up discussion. Whilst this could be argued to be an element of therapy, therapy/counselling are often defined in relation to goal setting with an intention to support change (McLeod, 2003). These techniques however, would have been used for research and not therapeutic purposes. Whilst these may have been conducive to continued wellbeing, the techniques would not have been used as therapy per se i.e. with an intention to support change. 3.7.1.3 Transcription. Interviews were audio-recorded and transcribed in full by the researcher. See Appendix J, the Statement of Ethical Good Practice, for the considerations and safeguards regarding data security. 3.7.2 Existing data. Existing data was limited to what was available to the researcher. Attendance records were obtained to provide a context for the findings. Also, documents such as the pathway 66
between CAMHS and education and family support meeting minutes were gathered to corroborate information provided in the interviews. 3.7.3 Case study database. Data, including case study documents, annotations and notes etc were organised and documented in a case study database as recommended by Yin (2009). The researcher ensured that a comprehensive chain of evidence was maintained and ensure an audit trail. This was to improve the reliability of the study because independent researchers will not be limited to the final case study report. Therefore, as stated in Yin (2009) they will in principle be able to complete secondary analysis independent of the researcher and draw independent conclusions. 3.8 Data Analysis One of the criticisms of qualitative analysis is that studies have often been critiqued in the literature for the lack of clarity about "how" analysis is completed (Attride-Stirling, 2001; Anastas, 2004). Braun and Clarke (2006) explained how a lack of clarity about the process affects evaluation of the research and comparison with other research studies and, as stated in Anastas (2004), the methodology needs to be described in sufficient detail to permit replication if a qualitative study is to be accepted as "credible". Also, highlighted in Attride-Stirling (2001), "if qualitative research is to yield meaningful and useful results it is imperative that the material under scrutiny is analysed in a methodical manner..." (p.386). Thematic analysis was selected to analyse the data for the present study because it provides a method for identifying key patterns or themes within a large data set and because it enables similarities and differences to be identified across the data set (Braun & Clarke, 2006). The data set refers to all the data which are being used for a particular analysis (Braun & Clarke, 2006) so for the present study a data set referred to the data for each case. Thematic analysis was also deemed to be appropriate for the present study because it is congruent with the critical realist epistemological position and the research questions. Interpretative Phenomenological Analysis (IPA) and Grounded Theory are other analytic methods for analysing qualitative data which were considered. However, IPA is attached to a phenomenological epistemology (Braun & Clarke, 2006) and grounded theory aims to 67
generate a useful theory which is grounded in the data. These approaches would be inconsistent with the research questions of the present study and the epistemological position adopted. For example, the research aimed to gather people's perceptions about what was associated with successful involvement rather than try and examine, interpret and make sense of their experiences, which is a core element of IPA. Additionally, the research aimed to gather a triangulated perspective in order to be well placed to inform practice rather than gain a detailed individual perspective around a young person's experiences. With IPA, a double hermeneutic is involved because the participant is trying to make sense of his or her world and the researcher is trying to make sense of how the participant is trying to make sense of his/ her world (Smith & Eatough, 2007). As stated in Smith and Osborn (2003, p.51) a detailed IPA analysis can involve asking critical questions from the transcripts from participants, such as: `What is the person trying to achieve here? Is something leaking out here that wasn't intended? Do I have a sense of something going on here that maybe the participants themselves are less aware of?' The researcher however, decided that they did not want to make interpretations about participants' experiences, questioning the ethics around making interpretations about something that participants may have limited awareness. Ideally, the researcher wanted to be able to share findings with participants but questioned how far findings could be shared if interpretations had been made about sensitive areas for example, parental mental health. 3.8.1 Thematic analysis. Transcripts were analysed using thematic analysis following a procedure informed by Braun and Clarke (2006) and Attride-Stirling (2001). Given the criticisms surrounding the lack of clarity around qualitative analysis and the subsequent need for a methodical approach to analysis (Attride-Stirling, 2001), the researcher applied a systematic and rigorous process to the data and ensured clarity by making all processes transparent. The thematic analysis methodology is described below with a detailed description and worked example presented in Appendix K. An inductive or "bottom up" thematic analysis was adopted so that themes emerged from the data rather than being driven by theory (Boyatzis, 1998). However, the researcher recognised their "active role" in identifying and reporting themes and how this might be influenced by their prior knowledge (Braun & Clarke, 2006). As highlighted in Braun and Clarke (2006) it was recognised that, "...researchers cannot free themselves of their 68
theoretical and epistemological commitments, and data are not coded in an epistemological vacuum" (p.84). The six phases of the thematic analysis, informed by Braun and Clarke (2006) and AttrideStirling (2001) are detailed below. As stated in Section 3.6, the case study consisted of a multiple embedded case study design. Therefore, consistent with this, separate thematic analyses were completed for each dataset and research question. As previously stated, a worked example for the thematic analysis is provided in Appendix K. 3.8.1.1 Phases of thematic analysis. 3.8.1.1.1 Phase 1: Familiarisation with the data. The researcher completed their own transcription to support immersion in the data because as highlighted in Braun and Clarke (2006), transcription enables the researcher to develop a far more thorough understanding of the data. A verbatim account of the utterances was completed and, following a period away from the data, the researcher relistened to the tapes to check for accuracy and to support immersion further (Braun & Clarke, 2006). During this phase the researcher noted initial thoughts to inform coding. The format of the transcription is evident in Figure 3.2. 3.8.1.1.2 Phase 2: Generation of initial codes. Codes refer to the "most basic segment, or element, of the raw data or information that can be assessed in a meaningful way regarding the phenomenon" (Boyatzis, 1998, p.63). The researcher generated initial codes by working systematically through the transcripts, giving full and equal attention to each data item. Extracts were coded into as many codes as relevant; some extracts were coded once, many times or not at all. Codes were recorded if they provided meaningful information, regardless of the frequency of their occurrence to ensure that data was coded for as many potential patterns as possible. Codes were recorded on the transcript next to each extract as illustrated in Figure 3.2. 69
Figure 3.2. A sample of the initial coding process Interviews primarily focused on research question 1 because this was most significant and apparent for participants: Research question 1: What factors are perceived to be effective in supporting children and young people who have anxiety/fear which is leading to school refusal behaviours and why? However, where discussion focused on research question 2 notes were made on the transcript to inform the researcher that the code related to research question 2: Research question 2: What might have led to more success or earlier success in the effective support of the school refusal behaviour? The generation of initial codes also underwent a constant comparative process (Glaser, 1965; Boeije, 2002) where extracts and codes were reflected upon and compared. This process involved the following: 70
1. Comparisons of codes and extracts within a single transcript (interview) When coding each transcript the researcher was aware of the previous codes generated so reflected upon these codes when coding subsequent extracts. As Glaser (1965) reported there is usually no need to turn back to every previous incident for each comparison. 2. Comparisons of codes and extracts between interviews within the dataset Following analysis of each transcript, previous transcripts were revisited to reflect upon and compare codes. If appropriate, changes were made to the generated codes, for example, "giving the young person choice and control" was not identified in Amy's father's interview until it had been identified in the interview with the parent support advisor. 3. Comparison between the lists of generated codes for the two datasets. This involved comparison between the two lists of initial codes. The researcher read the two lists of generated codes and reflected upon the initial codes in relation to the other dataset. Changes were made to the codes/ code names as appropriate. As stated by Boeije (2002), by comparing different parts of an interview, the consistency of the interview as a whole was examined. In accordance with Boeije, (2002), if similar references were made to the same category more than once, extracts were compared to see whether new information was given or whether the same information was repeated. This constant comparative process enabled the researcher to identify where codes appeared (i.e. in which transcripts) which supported triangulation at the level of initial codes. It also enabled the researcher to ensure that codes were comprehensive and inclusive and it enabled the code name to be reviewed. The researcher also suggests that this process was beneficial in supporting immersion and developing understanding of the data further. The lists of generated codes for the datasets were checked to the initial thoughts noted in phase 1 to ensure that codes were inclusive of the initial thoughts. A complete list of initial codes and supporting extracts for the datasets can be found in Appendices L and M. For each dataset, a list of resulting codes was collated. As part of phase 2, the researcher addressed the reliability and validity at the generating initial codes level by completing inter-rater reliability with another trainee educational 71
psychologist experienced in completing thematic analysis. The trainee educational psychologist independently coded 50% of two interviews for sections which were distinctly populated with initial codes. The resulting codes were compared to highlight commonality and the percentage of omissions. The researcher ensured that 75% inter-rater reliability was maintained i.e. no more than 25% omissions. For example, if the researcher and trainee educational psychologist agree that the content of 8 out of 10 themes matched there would be 80% inter-rater reliability and 20% omissions. For one interview, the omissions totalled 3/95 codes i.e. 3% which provided inter-rater reliability of 97%; 7/95 codes (i.e. 7%) were agreed to be coding errors or not relevant to the research question. For the second interview, the omissions totalled 0/63 which provided inter-rater reliability of 100%; 4/63 codes were agreed to be coding errors or not relevant to the research question. Omissions were discussed and those which were significantly different in meaning were applied to the entire data set. 3.8.1.1.3 Phase 3: Searching for basic themes. For each data set, the list of codes was cut into strips of paper containing the individual codes. These codes were then grouped together and collated into potential "basic" themes. These basic themes i.e. the lowest order theme to be derived from the data, were named and recorded onto post-it notes. Codes which did not appear to answer the research question were recorded as "miscellaneous"/coding errors. In the case of Amy, 2 codes were identified as anomalies and in the case of Leah, 0 anomalies were identified. 3.8.1.1.4 Phase 4: Searching for organising themes. The basic themes were then grouped together into potential organising themes i.e. the main ideas proposed by basic themes; these were named and recorded onto post-it notes. At this stage, the researcher ensured triangulation by ensuring that the organising themes consisted of basic themes which occurred in at least two different interviews and thus supported by more than one participant. Triangulation was viewed to be important because it would minimise the effect of response bias which is often cited as a criticism of interviews. However, triangulation was not viewed to be an important element for research question 2 because the researcher recognised that "ideal factors" are essentially speculative. As part of the constant comparative process, similar labels were given to organising themes in the two datasets if appropriate. 72
3.8.1.1.5 Phase 5: Reviewing the themes. The themes were reviewed to see whether they reflected the list of generated codes and the data set. The transcripts were re-read to see whether the themes also worked in relation to the raw data and to ensure that the analysis provided a story which reflected the data and the research questions (Braun & Clarke, 2006). It was recognised that thematic analysis of the data could be argued to be subjective so a higher level of inter-rater reliability was then completed at this level to support reliability and validity of the themes. Once the basic themes had been grouped into organising themes, a trainee educational psychologist reviewed the theme piles and the labels for the organising themes. Discussions were held and the theme piles were reworked and/or relabelled if appropriate to ensure that the organising themes captured the basic themes and the data accurately. 3.8.1.1.6 Phase 6: Producing the report. As stated in Braun and Clarke (2006), the write up of the analysis involves the final opportunity for analysis. Vivid examples from the transcripts were selected to illustrate the identified themes in relation to the research questions. However, if there was insufficient evidence to support the organising and basic themes, changes were made, for example, one basic theme was deleted and two organising themes were re-worded. The list of generated codes and supporting extracts (Appendices L and M) facilitated this final stage in ensuring that there was sufficient evidence to support the codes, themes and subsequent claims. This was therefore important in supporting the validity of the findings. The analysis written up in Chapter 4 aims to provide a clear explanation and understanding of the data in relation to the research questions i.e. to explain how and why participants perceived factors to be effective and why additional factors might have led to more or earlier success. The researcher aimed to apply a comprehensive and systematic data analysis so the final part of the analysis involved the analysis being checked against the 15 point criteria for good thematic analysis, illustrated in Table 3.2 (Braun & Clarke, 2006). This was to ensure that the coding and analysis was thorough and comprehensive, making sense of the data and providing a coherent story which was related to the research questions. 73
The researcher recognised that some of the criteria detailed in Table 3.2 were more subjective than others. However, the researcher thought that many of the criteria were addressed by ensuring a transparent and thorough methodology by documenting each stage of the analysis and ensuring a clear audit trail from the audio recordings to transcripts, initial codes, basic themes, organising themes and the write up (e.g. point 2, 3, 4, 5, 8, 9, 11, 12, 13, 15). In addition, the researcher thought that it was important to ensure that there was sufficient data to support the codes and themes as illustrated in Appendices L and M. The list of generated codes and supporting extracts in Appendices L and M ensured that themes were checked to the data, that there were sufficient extracts to support the analytic claims and that the analysis told a convincing story about the data (points 5, 8 and 9 of the criteria listed in Table 3.2). Additionally, the researcher thought that by completing inter-rater reliability when generating the initial codes provided evidence to support point 2 (Table 3.2) that each data item was given equal attention in the coding process and that coding was thorough, inclusive and comprehensive (point 3). The researcher would suggest that by completing further inter-rater reliability when reviewing the themes ensured themes were checked against each other, that they were internally consistent and distinctive and that the data was made sense of (points 5, 6, 7). 74
Table 3.2. A 15-point checklist of criteria for good thematic analysis (Braun & Clarke, 2006, p.96)
Process Number Criteria
Transcription
1 The data has been transcribed to an appropriate level of detail and the transcripts have been checked against tapes for accuracy
Coding
2 Each data item has been given equal attention in the coding process
Coding
3 Themes have not been generated from a few vivid examples (an anecdotal approach) but instead the coding process has been thorough, inclusive and comprehensive
Coding
4 All relevant extracts for all each theme have been collated
Coding Coding
5 Themes have been checked against each other and back to the original data set 6 Themes are internally coherent, consistent and distinctive
Analysis Analysis Analysis Analysis Overall Written report Written report Written report Written report
7 Data has been analysed-interpreted, made sense of rather than just paraphrased or described 8 Analysis and data match each other ­ the extracts illustrate the analytic claims 9 Analysis tells a convincing and well-organised story about the data and topic 10 A good balance between analytic narrative and illustrative extracts is provided 11 Enough time has been allocated to complete all phases of The analysis adequately, without rushing a phase or giving it a once-over lightly 12 The assumptions about and specific approach to thematic analysis are clearly explicated 13 There is a good fit between what you claim you do and what you show you have done ­ i.e., described method and reported analysis are consistent. 14 The language and concepts used in the report are consistent with the epistemological position of the analysis 15 The researcher is positioned as active in the research process; themes do not just `emerge'
(Braun & Clarke, 2006, p.96)
75
3.8.2 Cross case synthesis. The degree of commonality and difference between the two datasets was completed by recording the number of common and different themes for the two cases. The results are presented in Section 4.4. 3.9 Reliability and Validity The researcher took a number of steps to increase the reliability and validity of the qualitative study as described throughout Section 3.6, 3.7 and 3.8 because as highlighted by Yin (2009) it is important that reliability and validity is considered throughout the case study. The researcher provided transparency and increased the reliability of the research by clearly demonstrating and documenting the steps involved in data gathering and data analysis and by keeping a case study database with a clear audit trail (Yin, 2009); this will enable other researchers to review evidence and replicate the research if desired. By maintaining a chain of evidence linking the research questions to data and conclusions, Yin argues (2009) that this makes the derivation of conclusions explicit to observers thus increasing the reliability. Yin (2009) explained how four tests are commonly used to establish the quality of empirical social research: construct validity, internal validity, external validity and reliability. The various steps taken throughout the research to ensure reliability and validity are summarised in Table 3.3 in relation to these four tests. 76
Table 3.2. Measures to ensure reliability and validity
Tests of validity/reliability
Measures
Construct Validity
- Ensured cases met the inclusion and exclusionary criteria - Used multiple sources of evidence - Developed positive relationships with participants to make them feel at ease, being clear about the purpose of the research, confidentiality and anonymity to encourage participants to respond freely and honestly - Participants were provided with the researcher's contact details to give them an opportunity to add additional information to enhance the accuracy of their account if required
Internal Validity External Validity Reliability
- Clarified points made by participants to ensure understanding - Ensured there was sufficient evidence to support themes - Ensured that there was a chain of evidence with a clear audit trail - Reviewed themes with an independent researcher (Trainee Educational Psychologist) - Triangulated data sources - Multiple-case study design - Re-listened to audio-recordings for accuracy - Completed inter-rater reliability at the generating code stage - Reviewed themes with an independent researcher (Trainee Educational Psychologist) - Case study database was produced - Transparent methodology and thematic analysis
3.10 Ethical Considerations In accordance with the HPC Standards of Conduct, Performance and Ethics (HPC, 2008) and British Psychological Society's Code of Ethics and Conduct (BPS, 2009), the researcher made a number of considerations to ensure ethical good practice. The Statement of Ethical Good Practice which details the identified risks and safeguards made to ensure the research abided by ethical principles is detailed in Appendix J. Ethical 77
approval for the research was granted on the 25th May 2011 by the Research Ethics Committee at the University of Manchester. As described in Section 3.6.2 and 3.6.3 and explained in Appendix J, full informed consent/assent was gained from all participants prior to the research. As previously highlighted, one case was excluded because parental consent was not obtained; the parent's views were respected and no contact was made by the researcher. Information sheets were provided to all participants to enable them to make full informed consent (Appendices B, C, D, E, F, G, H). The information sheets contained details about the purpose and aims of the research, what would be involved, what would happen to the data, how confidentiality and anonymity would be maintained and what would happen if participants wanted to withdraw. Participants were reminded that their participation was voluntary and that they could withdraw at any point without reason. A letter was also sent to the Head Teacher of the schools to inform them of the research, the potential risks and the safeguards in place (Appendix G). Throughout the research, confidentiality and anonymity and the relevant safeguards were reiterated. Following the interviews, participants were debriefed and were provided with the researcher's contact details should they wish to add any information or should they wish to discuss any concerns that they may have had. Given the vulnerability of children who show school refusal behaviours, the researcher made considerations to ensure that the research would not cause participants distress or anxiety. The researcher hoped that involvement in the research would be a positive experience, encouraging the young people and parents to reflect on the young person's success and helping to reinforce their progress. As previously mentioned, the participatory aspects of the research were emphasised, discussing how the young person's experiences could help other children and young people who have found it hard to attend school. Appendix J explains how the semi structured interview questions were initially piloted to ensure that they did not cause any harm. However, if a participant became uncomfortable as a result of a particular question or topic, the researcher would have moved on to the next question or would have stopped the interview if the participant appeared upset or distressed. As highlighted in Appendix J, the researcher ensured that the research focused on successful cases and factors associated with success rather than going over difficulties which may have been experienced. If however, a participant wanted to discuss their 78
difficulties, the researcher listened and expressed empathy but did not probe. If negative comments were made, for example in relation to the support offered, the researcher tried to respond to this sensitively and tried to maintain a positive focus by discussing the ideal and what would have been helpful. The researcher recognised that discussing previous difficulties might have caused anxiety and could have potentially led to deterioration. Prior to the research, the researcher ascertained with school and parents whether there were any sensitive areas or questions which should be avoided. The researcher ensured that success had been maintained for a minimum period of a term so that involvement in the research was unlikely to lead to an increase in anxiety. As highlighted, a case was excluded from selection when it was reported that the young person had started to show school refusal behaviours again. To help the young person to feel at ease during the session, they were given the choice of methods for communicating their views. It was thought that having the option of communicating their views nonverbally might have facilitated rapport and interaction. Both Amy and Leah explored the art and craft materials but chose to communicate their views verbally. The researcher made consideration over the timings of the interviews to ensure that participation did not cause too much disruption to teaching and learning. At the time of the research, Amy was not attending PE lessons so her interviews were completed during these lessons. Leah's interview was completed at the vulnerable pupil unit; she came to the centre before her session to ensure that she did not miss teaching and learning. In Section 3.6 the researcher identified that they were involved in providing postreintegration support to Amy. The researcher therefore considered whether it was appropriate use this case as part of the research. There were six months between the trainee educational psychologist's involvement as a practitioner and as a researcher. Therefore, it was thought that this would ensure that there was a clear distinction between the trainee educational psychologist's role as a researcher and as a practitioner. This was also emphasised to participants during the research. 3.11 Operational Risk Analysis A number of considerations were made with regard to potential risks prior to the research. Firstly, the researcher acknowledged that there might have been insufficient cases which met the inclusion criteria. The researcher recognised that given the potential vulnerability of such children and young people, there were risks that consent/assent might not have 79
been obtained from parents and/or young people. The researcher also recognised that because of the potential vulnerability, there was a risk that participants may drop out and/or that children and young people might start to show school refusal behaviours. To safeguard against this risk, the researcher ensured that more cases than required were identified prior to contacting parents. In the instance when a parent did not give consent and when a young person started to show school refusal behaviours, additional cases were selected based on the inclusion criteria. If cases were all unsuitable or if consent could not be obtained from those identified the researcher would have explored the possibility of completing the case study in another local authority. Flexibility in terms of the times and location of interviews was offered to practitioners and parents to facilitate their participation. The researcher also acknowledged that young people may have had additional needs which would have made it difficult for them to access the research methodology for example, if a child had speech and language or social communication needs. Information was obtained from parents and school prior to the research to ascertain whether a child/young person had additional needs. If this had been the case, the researcher would have been sensitive to this during the interviews and would have made adjustments accordingly. Finally, the researcher recognised issues surrounding the power dynamic when working in a research capacity with a former client. Prior to working with the young people and families, the researcher made a distinction between their role as a researcher and that as a practitioner and clearly detailed the purpose of the research to all participants in the information sheets (Appendices B, D, F, G) and at the start of the interviews. As highlighted in the statement of ethical good practice (Appendix J) there was an assumption that the young people were coping better at school with a reduced level of anxiety. If however, concerns had arisen about the young person's level of anxiety the researcher would have reiterated the distinction between their role as a researcher and that as a practitioner and would have signposted the parents / school staff to the appropriate personnel or agency. 3.12 Critique of Methodology There are three limitations with the research which were beyond the control of the researcher. These are outlined below before the critique of case study research and semistructured interviews. 80
Firstly, the cases selected for the research were based on inclusion criteria which relied upon on the perception of the attendance officer about whether there was a reduction in anxiety. Pre and post measures of mental health and wellbeing were not available so the improvement in anxiety was subjective. The researcher ensured that the identified cases met the inclusion and exclusion criteria however, because the researcher relied upon the attendance officers' identification of cases, it is possible that those identified were not exhaustive. Secondly, key stakeholders were identified by the attendance officers and the parents. It is possible that there could be other practitioners with a different and valuable perspective who were not identified as key stakeholders. Nevertheless, it was ensured that there were representatives from school, family, the local authority, health services and the children and young people themselves. This is because in cases of school refusal there are likely to be a range of professionals from different disciplines who may be involved at different points in time. Thirdly, the young people who met the selection criteria were both girls. Whilst the researcher is unaware of any research to suggest that there could be gender differences, this will be something to recognise when considering the generalisability of findings. 3.12.1 Critique of case study research. Yin (2009) explained how case studies have been criticised because of concern over the lack of rigour and systematic procedures, over concern that they "provide little basis for scientific generalisation" and because of the renewed emphasis on "randomised control trials". However, Yin (2009) emphasised the benefit of case study research and provided responses to such criticisms. In response to the criticism over the lack of rigour, Yin (2009) acknowledged that some case study researchers have not followed a systematic procedure and that some have influenced the direction of the findings or conclusions. Yin (2009) stated that this can be overcome by following systematic procedures which are made transparent. As highlighted throughout this chapter, this was a goal of the present study. Case studies were recognised by the researcher to be advantageous because they provide an alternative to experiments and enable "how" and "why" questions to be explored, particularly when there are unique or unusual cases. As highlighted earlier in 81
this chapter, this was important for the present study because successful cases of school refusal behaviour in the local authority were limited. Through completing a case study, the researcher could explore in detail why the cases were successful and explore the possible causal factors. However, the researcher recognised that the case study was exploratory and that there could be additional factors which might have led to success because case studies cannot directly address cause and effect relationships. In response to the increased emphasis on "true experiments" or "randomised control trials", Yin (2009, pp.1516) explained that case studies can offer evidence to "complement" experiments and suggests that they should not be "downgraded" because they cannot directly address causal relationships. Generalisability refers to the extent to which the findings are applicable outside the specifics of the situation being studied (Robson, 2002). As highlighted, the case study was viewed to be a beneficial approach for the present study to explain and gain a rich understanding of what was going on in two successful cases of school refusal behaviour. The purpose was not to select a representative sample which would permit statistical generalisation; case studies as stated in Yin (2009) are "generalizable to theoretical propositions and not to populations or universes" (p.15). As reported in Robson (2002), ...this does not preclude some kind of generalisability beyond the specific setting studied. This may be thought of as the development of a theory which helps in understanding other cases or situations, sometimes referred to as analytic or theoretical generalization. (p.177) Yin (2009) explains that the goal of case studies should be to "expand and generalise theories (analytic generalisation)" (p.15) and suggests that the more similar cases with similar findings, the more likely there will be analytic generalisability. A multiple-case study design was chosen for the present study because it was thought that this would make the study more robust, would enable comparison across studies and would thus support analytic generalisability (Yin, 2009). It should be noted therefore that the research findings need to be understood within the context of the individual characteristics of the cases. There could be significant variation in answer to the research questions if there are significant variations in the characteristics of cases. However, as stated the more similar cases with similar findings the more likely there will be analytic generalisability. 82
3.12.2 Critique of data gathering methods. Semi structured interviews were chosen as an appropriate data gathering method because they enable researchers to gain a detailed picture of a participant's perspective (Smith, 1995). As previously highlighted, semi structured interviews give much more flexibility than a structured interview or questionnaire (Smith, 1995) which the researcher thought was beneficial. The flexibility enabled the researcher to probe and clarify responses to further understanding, explore interesting areas of discussion and also it facilitated the development of rapport with participants because responses were adapted to show empathy and understanding. The flexibility of the approach however, has also been noted as a limitation because it reduces the control the researcher has and some researchers have suggested that the lack of standardisation raises questions about reliability (Robson, 2002; Smith, 1995). As stated, semi structured interviews have been criticised because of response bias however, it was thought that the effects of this would be reduced by ensuring triangulation of organising themes. Time planning and completing interviews, transcribing and analysing data have also been recognised as limitations of interviews. Nevertheless semi structured interviews were viewed to be the most appropriate data gathering method to explore stakeholders' perceptions and this was viewed to be feasible in the researcher's available time and resources. 3.13 Research Timeline The research timeline is illustrated in Table 3.4 below. 83
Table 3.3. Research timeline Time- line January 2011 ­ April 2011 May 2011 May 2011 May 2011 June 2011 June- September 2011 August 2011- October 2011 December 2011- March 2012 December 2011 ­ May 2012 May 2012
Activity Planning Ethical approval gained Selection of cases and identification of key stakeholders Attendance data obtained Distributed information sheets and consent forms Consent/assent obtained Semi- structured interviews completed Transcription Thematic Analysis Write up Submit Thesis
84
Chapter 4: Results 4.1 Overview The following chapter presents the findings from the thematic analysis outlined in Chapter 3. Interviews were analysed by case according to the research questions: 1. What factors are perceived to be effective in supporting children and young people who have anxiety/fear which is leading to school refusal behaviours, and why? 2. What might have led to more success or earlier success in the effective support of the school refusal behaviour? Data are presented in three sections: analysis of themes prominent in Case 1 (Amy), analysis of themes prominent in Case 2 (Leah) followed by a cross case synthesis. Discussion about the themes is made in the following chapter. For each case, a case vignette is initially provided to give a context for the research findings; this was drawn from field notes made during discussions with the attendance officer, information presented in the interviews and documentation such as attendance records. The organising themes are then presented under the research questions and are introduced and explained in order of prominence i.e. the number of different codes from which they were derived. The most prominent organising theme is described first with the quantity of description and explanation representative of prominence (see Appendix K, Figure A11). Quotations are used to provide illustrative examples with further examples located in Appendices L and M. For each case, the interaction of factors is also described. The final section presents the cross case synthesis which highlights commonalities and differences between the two cases. 4.2 Case 1: Amy 4.2.1 Case vignette. At the time of the research (June 2011) Amy was a Year 8 pupil in a mainstream secondary school. She lived at home with her father, two sisters (aged 10 and 17) and her brother (aged 19). When Amy was in Year 7, the three eldest children attended the same secondary school with the youngest child attending a local primary school. The family 85
lived out of borough in a neighbouring local authority. It was reported that within a two year period the family had moved house three times. It was reported that when the parents separated, they initially lived with their mother until social care became involved; Amy's father is now the primary carer for the four children. Information reported identified that Amy's mother had a diagnosis of lupus and that she was cared for in the local area by her new husband. Additionally, it was reported that Amy's eldest sister had a diagnosis of bipolar disorder and that she was under the care of a clinical psychologist (Child and Adolescent Mental Health Service, CAMHS). Amy and her siblings saw their mother on a weekly basis. It was reported that the relationship between Amy's mother and father was "strained". At the time of the school refusal behaviours, Amy's father was working shifts. This meant that the children could stay in three different houses during the week for example, if they stayed with their grandparents when their father was working nights. On some days the children were dropped off at their grandparents at 6am by their father on his way to work. It was reported in dataset that Amy found it hard to respond to change. Amy started to show school refusal behaviours in the November/December 2009 when she was in Year 7. It was reported that she started to show school refusal behaviours soon after her youngest sister had started to show similar behaviours. Her sister stopped showing these behaviours after two weeks following a gradual reintegration into school. However, Amy's behaviours persisted and required more long term intervention. Amy's father said that he tried to bring Amy to school but said that she would refuse to get out of the car and said that kicking, shouting and screaming behaviours were observed regularly. When Amy did not respond to school staff or her father it was reported that she was taken home where she spent the day lying on her bed without access to television. This had implications for Amy's father because he was unable to go to work when Amy was not in school. As a result, he had to reduce his hours. During this time it was reported that Amy's father had additional time off work following an operation. The attendance officer and parent support advisor became involved in January 2010. They initially tried to gain an understanding of the family situation by completing home visits and a CAF assessment. A learning mentor was allocated in February 2010 and family support meetings started in March 2010. Family support meetings provided a structure for agencies and parents to come together to identify intervention to meet the 86
needs of children and young people and families. These were held approximately once every half term where Amy, her siblings, her father, SENCO, learning mentor, parent Support advisor and the Head of Year came together to plan support. Other agencies such as social care were invited to the meetings but they did not attend. Amy also received an assessment from clinical psychologist (Child and Adolescent Mental Health Service) and received a series of sessions from the trainee educational psychologist as part of the post reintegration support. 4.2.2 What factors were perceived to be effective in supporting Amy, and why? Twenty one factors emerged as organising themes in response to the research question about what factors were perceived to be effective. These are presented in Figure 4.1. This section describes these organising themes in order of prominence; the most prominent organising themes are described first. The basic themes which make up the organising themes are presented in figures under each organising theme and are presented in the order in which they are described. 87
Flexible and individualised approach to ensure the young person is prepared and able to access learning Meeting the needs of the family Taking an interest in young person as a whole Developing feelings of safety, security and belonging Personality, skills and experience of professionals Make a positive contribution Positive nurturing approach Positive experiences Increased confidence, self worth and value Access to specialist services and effective collaborative working to meet needs Early identification and assessment of need to inform intervention Encouragement and positive attention Developing the young person's understanding of thoughts, feelings and behaviour Positive relationships and approach with home Whole school approach Flexibility and availability of key adult Not focusing on/reinforcing the absence Persistence and resilience of professionals Regular monitoring of progress Aspiration and motivation Discussion about the impact of not coming in Avoid harsh consequences Figure 4.1. Organising themes in the case of Amy 88
Organising theme: flexible and individualised approach to ensure the young person is prepared and able to access learning Reintegration planned according to need Access to a positive working area tailored to need Flexibility in meeting specific need Individual support from teachers Structured plan to catch up missed work/assessments Awareness of and ability to identify barriers to learning Recognition that even when attend school the young person may find it hard Support with journey to and from school Figure 4.2. Basic themes to support the organising theme: flexible and individualised approach to ensure the young person is prepared and able to access learning A flexible and individualised approach to ensure that Amy was prepared and able to access learning was the most prominent organising theme emerging from the dataset. This was supported by the evidence of eight basic themes illustrated in Figure 4.2. A number of participants highlighted the benefit of having reintegration planned according to need. For example, a flexible and reduced timetable was identified as something which was beneficial for Amy, particularly flexibility around subjects which she found hard such as PE. As highlighted by the SENCO, "I think that if we had forced the issue with regard to PE, I don't know, but I suspect it would have made it more difficult". Having access to a positive working area which was tailored to need i.e. Inclusion was suggested by her father to have been beneficial particularly when Amy was not accessing the main timetable. This was supported by the parent support advisor and SENCO. For example, the parent support advisor explained how having a bright and welcoming area with good facilities so that children could study was helpful because this ensured that they were able to access learning in an environment in which they felt safe. Also, the parent support advisor explained how the inclusion area was part of the school culture so said that accessing Inclusion was not viewed as a punishment. She added that work was planned and tailored for pupils and shared that staff were available to support the pupils if required. 89
So I feel that if, if as part of a child's plan they were to spend time in Inclusion, then it was planned for. It wasn't just like well here's a textbook, go and sit in the corner. There was a lot of planning that went into it, you know, sort of work was gathered (Learning Mentor). Flexibility in meeting specific need was another prominent basic theme. The SENCO and Amy's father commented on the importance of Amy being able to access learning and that this was facilitated by the fact that she was "bright". Professionals and Amy herself reported the benefit of having individual support from staff in helping her to make progress and setting a structured plan to help her to catch up on missed work and assessments In addition, professionals talked about the benefit of reviewing and adapting strategies over time to ensure specific needs were met. The attendance officer shared how the school were flexible and made adjustments according to need, for example, in being flexible with the curriculum. In terms of addressing specific areas of need, professionals implemented strategies to support Amy's social development, personal needs and organisation skills to ensure that she was prepared and ready for learning. As highlighted by professionals, this was supported by professionals' awareness of and ability to identify barriers to learning. For example, Before a child went in [to Inclusion] there would be like a round robin done of all their subjects "where is this child in this subject? Have you noticed anything in class? Is there anything we need to be concerned about? um you know do they have particular friends" that sort of thing to encourage them to keep that sort of friendship bond going? (Parent Support Advisor). Also, as highlighted by the learning mentor, parent support advisor and Amy, it was beneficial that staff recognised that Amy may still have difficulty even when she was in school, for example, as stated by the parent support advisor, "yeah but school were also acknowledging that they recognised that she was finding it hard.....but just please be aware that she's still struggling but she's in". Having support with the journey to and from school also emerged as a basic theme supported by interviews with five stakeholders. Amy shared how it was helpful having support with her journey because she did not like being "alone on the bus". It is possible that this was related to difficulties with a group of boys who used to share her bus and the alleged incidents of bullying. For example, Amy explained how it was helpful to have her 90
siblings with her on the bus and how it was beneficial to have her father drive her to the bus stop. Organising theme: meeting the needs of the family Family support Facilitating communication between young person and family Family support plan with SMART targets which were regularly reviewed Increasing effectiveness of parenting skills Firm, honest approach with family Figure 4.3. Basic themes to support the organising theme: meeting the needs of the family Meeting the needs of the family was the second most prominent organising theme emerging from the data supported by the five basic themes listed in Figure 4.3. The data suggested that professionals listening to Amy's father and providing support and encouragement for the whole family were important, given the range of needs within the family. All professionals identified that having a key contact and support for the family was beneficial and that it was important that this was someone they could trust, .....and I think also Parent Support Advisor's role was pretty important as well because she deals with all age groups so she was also dealing with the younger sisters.... which we wouldn't have really had much to do with (Learning Mentor). In terms of facilitating communication between the young person and the family, it was reportedly helpful to have professionals who were advocates for the young person as this enabled Amy's views to be put across e.g. in meetings. Professionals shared the need for the family to have an understanding of Amy's needs and suggested that they had a valuable role in helping the family and extended family to empathise with her needs. As previously mentioned, the local authority operates a family support model where an assessment of a child's needs is identified and a package of family support is implemented to meet the child and family's needs as part of a family support plan. Having a family support plan with specific, measurable, achievable, realistic and time bound (SMART) targets which were regularly reviewed was identified to be helpful particularly because the family was involved in drawing up the plan and because clear, achievable 91
actions were identified. As highlighted by the parent support advisor, "it made it more real for the family" and meant that professionals and the family were clear about who was doing what and by when. The regular reviewing of this plan was suggested by professionals to have been beneficial because it meant that actions were more likely to be completed and also it enabled success to be celebrated and strategies to be adapted if unsuccessful. As illustrated in Figure 4.3, increasing the effectiveness of parenting skills and adopting a firm, honest approach with the family were basic themes which also provided evidence to support the organising theme of meeting the needs of the family. Three professionals and Amy's father provided examples which suggested that developing parenting skills was beneficial. For example, the support provided by professionals reportedly led to an increase in the effectiveness of Amy's father's parenting skills. Also, two professionals reported that being "firm but fair" with Amy's father was helpful in "getting family routines going". The parent support advisor explained how it was helpful to encourage Amy's father to reflect on his own feelings and said that she thought it was helpful to discuss consistency and routine with him, I did more work with Dad to try and get him to parent consistently with her but I also talked to him about the fact that the children seemed to be getting drawn into the grown up side of things because Dad's relationship with Mum was not good (Parent Support Advisor). Linked with increasing the effectiveness of parenting skills was Amy's father starting to take more of a parenting role and taking responsibility for Amy's needs, removing responsibility from her older sister; this was supported by three professionals and Amy's father as beneficial. Amy's father was working shifts at the time of the school refusal behaviours and so the eldest daughter used to take a lot of responsibility for the younger children. However, Amy's father reduced his hours so that he could spend more time with the family. As highlighted by Amy's father and the parent support advisor, the family support meetings provided a context for him to reflect on the home environment and Family Dynamics. Amy's father identified that following such reflections he started to ensure "fairness" at home and started to "stand up" for Amy so that she did not perceive others to be getting at her. He said for example, 92
I think through sitting through the meetings and sitting down and seeing how Amy is. I think more so when you get home and seeing when they're all arguing you sort of like sit back and see what's going on (Amy's father). Organising theme: taking an interest in young person as a whole Regular personalised contact Personalised feedback Noticed in class for positive reasons Reinforced that noticed and missed when not in school Personalised rewards based on interests Taking an interest in young person as a whole Key adult remembers details about young person and follows through promises made Young person aware professionals trying to help, knew what they were trying to do and why Figure 4.4. Basic themes to support the organising theme: taking an interest in young person as a whole Taking an interest in Amy as a whole was a highly prominent organising theme; the dataset suggests that there were eight basic themes which supported this as illustrated in Figure 4.4. Three professionals discussed the importance of regular personalised contact stating that it communicated to Amy that she was "worth more than being forgotten about". The learning mentor explained the importance of regularly contacting Amy whether she was in school or not. She said that she checked up on her every day and when she was not in school she would telephone. She said that sometimes Amy would speak and sometimes she would just listen but the learning mentor emphasised that it was the regularity of the personalised contact which was helpful. The learning mentor also explained how she would ensure that Amy received positive individual, personalised feedback from her teachers and emphasised the importance of doing this in front of Amy. For example, as stated by the learning mentor, "and the positive feedback that she got from the members of staff was a huge part. Huge part." 93
The learning mentor explained that reports/feedback that teachers often gave to students was "generic phraseology". She stressed the power of the individual feedback because it helped to give Amy the feeling that the teacher had "personally noticed" her which was reportedly beneficial particularly because she was very quiet in class. The basic theme of being noticed and reinforcing that she was noticed/not forgotten was prominent in a number of interviews. This ranged from staff, peers to her family noticing her, for example, peers noticing when she was not in school and communicating to her that she was "missed". The learning mentor shared how she made staff "very aware that they had to notice her" and explained how it was important that Amy was noticed for positive reasons such as "her intellect" and not "being the scruffy smelly kid". Personalised rewards based on interests emerged as a basic theme in all interviews. Amy was aware that the learning mentor would give her rewards based on her interests, for example Amy said, "cause I like animals so when I do well she sometimes takes me out to the cats and dogs home," which again was suggested to have communicated to Amy that someone was interested in her. Taking an interest in Amy was a basic theme which emerged in four interviews. For example, Amy talked very positively about teachers who took an interest in students in class and who "start conversations with us". Similarly, talking to Amy was something the learning mentor described as an essential part of her role. She said that asking questions, having a good memory and keeping good notes were important in demonstrating to Amy that the learning mentor was interested in her, I think my memory is really very good and I think that has helped. Oh yeah without a doubt, taking an interest in Amy and that I do remember things that she's said. They know that I've got quite a heavy caseload. They know that I have seen quite a lot of kids over the years but the fact that I can still come up with a fact that she's said (Learning Mentor). This was corroborated by the SENCO who shared that the learning mentor always followed through promises that she had made to a child and never forgot; another basic theme as illustrated in Figure 4.4. The final basic theme to support "taking an interest in the young person as a whole" was Amy's awareness that professionals were trying to help and that she knew what they were 94
doing and why. Amy's attendance at family support meetings emerged in the dataset as a positive factor by some professionals because it was suggested that this communicated to Amy that people were interested in her. It was recognised that her attendance at all the meetings was not always necessary or appropriate and that sometimes staff would have preferred to have had meetings with Amy's father without the children present. However, it was reported by all professionals that Amy's attendance at these meetings developed her awareness that professionals were working collaboratively with home, that they were there to help her and not "chastise her" and, as suggested by the SENCO, that they were concerned enough about her to call a meeting. The attendance officer shared, "I think that she understood that the school were supporting her, although she might not have fully understood that, but she would be able to comprehend the fact that people were not giving up". Organising theme: developing feelings of safety, security and belonging Stability at home Stability, consistency and belonging at school Support at lunchtime where social interaction is (easier) Area she can access which meets basic needs Inclusion area is part of the school culture Figure 4.5. Basic themes to support the organising theme: developing feelings of safety, security and belonging Developing feelings of safety, security and belonging at home and school was a highly prominent organising theme across all interviews, supported by five basic themes as illustrated in Figure 4.5. Developing stability at home was suggested to have been beneficial for the family for example, through professionals working with them to develop family routines. Also, the learning mentor explained that Amy's father had worked a lot of night shifts which meant the children would stay in three houses during the week. The learning mentor explained the positive impact on the family and on stability when he reduced his hours. The learning mentor stated, "so they were home, he was home a lot more with the children and they were in one place .....cause I honestly do think that that three house split each week she didn't quite know where she belonged". 95
In addition, stability, consistency and belonging at school was a basic theme which emerged in the dataset. As highlighted by the attendance officer, "I just think for her it was stability. Somebody in a sense that does actually you know is going to be there for me everyday for me". The importance of a consistent adult in school who could support Amy with routines was highlighted as beneficial for example, in supporting her with organisation and making sure that she had the right equipment each day. A major factor which appeared to support stability, feelings of safety and sense of belonging at school was Amy's access to Inclusion, a "small welcoming space" which she could access where there was "no pressure to talk". This provided evidence to support the basic themes of an area which Amy could access which met her basic needs and provided support at lunchtime where social interaction is easier. In particular, the benefit for Amy of being able to access Inclusion at lunchtime was identified by three participants as essential. It was reported that this provided her with access to a quiet environment where there were reduced social pressures, where she "knows that she's safe". As reported by the learning mentor, "I run a lunchtime club and it's for the vulnerables that that don't like the hurly burly..... I think for Amy that has been absolutely essential". This was supported by Amy who shared, ....that's only because it's quiet up here compared to what it is downstairs and I just if I've had a busy day I'd just rather not have all the loud noise downstairs so I'd rather sit up here with my friends. However, in addition to providing this quiet, safe environment, Inclusion was reportedly an area where Amy felt like she belonged. As illuminated by the learning mentor, "she feels part of the gang when she comes back in" and added, "... when she comes back in they'll [peers] give her a hug and you know pleased to see you so she's felt safe and welcome wherever she is" (Learning Mentor). The basic theme of Inclusion being "part of the school culture" also supports the organising theme of developing feelings of safety, security and belonging. For example, the fact inclusion was viewed positively in school and not viewed as a punishment was identified by the parent support advisor as important in supporting feelings of belonging. The SENCO also reported that the new school building was beneficial, "you know to give 96
her a sense of belonging and also you know a fresh start and so I do think that was probably lucky timing for us". She explained that this was also beneficial in developing feelings of safety because it was easier for pupils to find their way around. Organising theme: personality, skills and experience of staff Key adult with whom the young person can develop a good relationship Key adult who understands how to respond to young person Key adult matched to young person Confidence and experience of professionals Clear boundaries and expectations Appropriateness of praise Figure 4.6. Basic themes to support the organising theme: personality, skills and experience of staff The personality, skills and experience of staff also emerged as a highly prominent theme as evidenced by six basic themes as illustrated in Figure 4.6. It was reportedly beneficial for Amy to have a key adult with whom she could develop a good relationship. In supporting the development of this relationship, it was suggested by four participants that the key adult's understanding of Amy's needs and how she might respond was beneficial. The learning mentor also explained how it was helpful that she, as the key adult, was matched to the young person. For example, she explained how she had worked with Amy's sister which meant that she had a good understanding of the family. The benefit of this was supported by Amy who shared how, "she [Learning Mentor] knows that I've got stuff at home that isn't too good as well cause like she used to like talk to [Sibling 1] as well". Similarly the learning mentor explained how she thought that it was important that she was female because she said that she did not think that Amy "would have connected with a male". This therefore supported the basic themes of a key adult with whom the young person can develop a good relationship, a key adult who knows how to respond to the young person and who is matched to the young person. 97
The SENCO added that the confidence, knowledge and skills of the learning mentor were beneficial in supporting the working relationship with Amy and that it was helpful that the learning mentor felt "comfortable" in her role. The learning mentor was also reported to be skilled, experienced and reflective in knowing how to respond to Amy. For example, ....from my point of view I've learned to go a little bit slower because I'm very much full on and because of time limits the choices are this, this, this or this but with Amy I kind of took a bit of a step back and pause so from my point of view that's a learning thing with Amy, and give her time to think about it and react.... because she's a thinker (Learning Mentor). Similarly, the knowledge and skills of other professionals in being sensitive to Amy's needs were also viewed to be important. For example, as highlighted by the attendance officer, the parent support advisor, "understood enough to know you can't push too far" and recognised the need to give Amy time and space to calm down. Additionally, clear boundaries and expectations were identified as helpful as illustrated in Figure 4.6. Whilst stakeholders recognised the importance of the positive, nurturing approach they highlighted that there were rules which needed to be abided by. The learning mentor also added the importance of "not being over effusive with praise" after Amy started to go back into school. She said that initially both she and the SENCO would say, "oh hi, it's lovely to see you," but said that following improvements it was important to reduce this to demonstrate an acceptance that she was back on track. It could be suggested that the personality, knowledge, skills and experience of staff that allowed them to be sensitive to these needs. Organising theme: make a positive contribution Increased participation at school Young person able to express views and feel listened to Collaboratively developing realistic targets and strategies Give young person some choice and control Encouraging independence Figure 4.7. Basic themes to support the organising theme: make a positive contribution 98
Making a positive contribution emerged from the dataset as an organising theme for example in terms of increased participation, Amy having the opportunity to express her views and for her to be involved in decision making through collaboratively developing realistic targets, giving choice and control and encouraging independence. This is illustrated in Figure 4.7. Amy's father hypothesised the benefit of increased participation at school, sharing, "I think it's because she's getting a bit more involved". The parent support advisor acknowledged how Amy had started to become more involved in school life rather than "isolating herself in the inclusion department" and shared that this was a positive factor. The learning mentor added how she thought it was beneficial to discuss strategies with Amy about how to increase her participation in class. Providing Amy with an opportunity to express her views and feel listened to and collaboratively developing targets with her were also identified as basic themes as shown in Figure 4.7. Giving Amy a voice and enabling her to feel heard was reported by four stakeholders as helpful particularly because it was suggested that Amy had previously had limited opportunities to express her views. As previously highlighted, it was reported how it was important that Amy's views were put across in family support meetings. Giving Amy choice and control and developing her independence were also reported to be important factors, for example, giving Amy responsibility. The learning mentor discussed the importance of encouraging Amy to take responsibility for asking for support rather than, "me saying to her what can I do for you". Also, Amy and the learning mentor described how Amy had been asked to support another young person who had been experiencing similar difficulties. As stated by Amy, "the last meeting I had with her was because [Peer] in my year was also having problems coming into school so she wondered if I could help him". It could be suggested that this was beneficial in supporting Amy's confidence and self worth. 99
Organising theme: positive nurturing approach Positive nurturing school ethos Fresh start Solution focused approach Figure 4.8. Basic themes to support the organising theme: positive nurturing approach The positive nurturing approach adopted with Amy also emerged as a key organising theme. This was evidenced by three basic themes as highlighted in Figure 4.8. The positive, nurturing and caring ethos of the school and the person centred approach adopted with students was something which many professionals identified as essential. For example, it was reported that it was important for her to feel, "cared for and nurtured," and for her, "not to be rejected" by staff. As part of the nurturing and caring approach, the parent support advisor highlighted the importance of recognising the transitions that Amy had gone through with regard to experiences of loss and change, for example, "from Mum not being there, Mum being married to somebody else and then knowing that Mum wasn't well". The SENCO reported the importance of regularly touching base, "it's not a rejection is it you know I'm assuming that there is some, and I am assuming, that there is a feeling of rejection from some of her own mum". In addition, the SENCO in particular reported that staff were welcoming and positive on Amy's return to school and reported that she was, "respected by staff and students alike". This was not only supported by professionals but was supported by Amy and her father. The learning mentor said that she provided strategies for staff to support the positive nurturing approach. For example, she said that she thought it was important to encourage staff not to treat Amy any differently because she had been absent. She said that she emphasised the need to "accept where she is at educationally" and recognise that there will be, "huge gaps". This links to comments made by the SENCO who highlighted the need to treat each day as a "fresh start" and how this supported the non judgemental approach. At the time of the school refusal behaviours, the school moved to a new building; the SENCO reported that the timing of this was beneficial because the new building also communicated a "fresh start" to Amy. Taking a solution focused approach was also a basic theme which was evidenced to be beneficial in four interviews. Rather than focusing on the problem, professionals reported 100
the benefit of focusing on positives and progress made and identifying solutions. In addition to the positive approach adopted by professionals, Amy's father's calm and positive approach in meetings was identified as helpful. Organising theme: positive experiences Positive experience at school Building on interests Spending time together as a family Increased opportunities to see extended family Development of friendships Figure 4.9. Basic themes to support the organising theme: positive experiences Positive experiences was identified as a prominent theme by all participants. As illustrated by the five basic themes in Figure 4.9, this included positive experiences both at home and at school. It was reported that Amy enjoyed school when she was in and that she started looking forward to school, for example to see her friends. Building on interests both at home and school was suggested to have supported positive experiences for example in trying to engage Amy in school life. Spending time together as a family and having positive experiences with family members appeared to be a highly important factor for Amy. The additional opportunities that Amy had with her extended family as a result of her regained contact were suggested to have been a positive. As highlighted by her father, her grandfather "idolised" Amy. It could be suggested that this positive experience with her grandfather made her feel special. ...and when we got to his house, she's always got to sit next to him and he does make a big fuss of her and I think that's helped because she's got [Sibling 3] with my mum and dad and suddenly to get her grandad who, after all this time, is saying you sit next to me (Amy's father). The parent support advisor explained that professionals encouraged Amy's father to start doing things together as a family rather than focusing on daily routines. The additional positive attention that Amy received from her father appeared to be an important factor. 101
For example, Amy's father recognised that he spent less time with Amy than he did with the other children so said that he started to make an effort to spend more time with her; this was facilitated by his reduced hours at work. I then said that I'd start doing more which I have started showing her how to cook. And you know she'll sit with me at nights and we'll go on the Playstation and then I'll play against her. And you know and I'll sit with her and talk to her (Amy's father). Additionally, as highlighted in Figure 4.9, the development of friendships was a basic theme. It was reported that Amy developed friendships and had a group of friends at lunchtime which made school a positive experience. Amy explained how having friendships at school "gave her something to look forward to". As highlighted by Amy, "I've made more friends cause like I know I can look forward to seeing them when I come to school rather than staying at home on my own". Amy's father shared that "Anime" (a Japanese animation) had helped because this had given Amy a common interest amongst her peers which had supported positive experiences at school. He explained how this provided a focus for activities which they completed at "lunch club" and explained how this had also supported her social development out of school as Amy was due to attend an Anime convention with her peers. Whilst this "meant nothing" to her father, he reported that he would talk to her about Anime to get involved in her interests. Organising theme: increased confidence, self worth and value Developing self worth Sense of identity and value Developing confidence of young person Figure 4.10. Basic themes to support the organising theme: increased confidence, self worth and value The development of confidence, self worth and developing a sense of identity emerged throughout the dataset as an organising theme as illustrated by three basic themes in Figure 4.10. In terms of Amy's self worth, Amy shared, "I feel much happier than I did" and, as described by the parent support advisor, Amy had started to take a "pride in herself". The data suggests that Amy developing positive feelings about herself and 102
developing feelings of self worth were facilitative in her success, for example, by making Amy feel special and giving her opportunities to do things that her peers did not; this is illustrated in the quote below in the discussion about personalised rewards: ....because I think they're making her feel a little bit more special and it's something that other children don't do. I take her to the dogs' home...........well again it's going out of school and it's something that I don't do very often with other students so it was for her (Learning Mentor). Linked with this was building on Amy's strengths, letting her take the `lead in something that her peers found fun and fascinating' and using this to develop admiration from her peers. Amy, for example was given the responsibility of leading an origami session with a group of peers during activities week. This was reportedly beneficial because as highlighted by the SENCO, "she knows that she's valuable doesn't she; she knows that it's something that she can do that maybe the other children want to do and find fascinating and useful and fun". The interviews with the learning mentor and parent support advisor highlighted the need for Amy to develop a sense of identity and how it was important that she was treated as an individual. Similarly, one professional reported that she thought that it was important that she had discussions with Amy about the family dynamic and about where she fit in within the family. Amy was one of four children and it was hypothesised by one professional that, "there might be a bit of an identity problem you know in terms of who she is". Strategies which helped to give her more of an identity in school were therefore reportedly helpful. Targeted support to develop Amy's confidence also emerged as a basic theme. For example, Amy reported that she had increased confidence and self efficacy. Amy attended a group intervention which aimed to develop this. The learning mentor described how she discussed strategies with Amy for building her confidence and participation in class, and communicated these to teachers so that they could notice and reinforce these strategies accordingly. She suggested that it was helpful to develop Amy's meta-cognition and to communicate that it is ok to make mistakes. 103
Organising theme: access to specialist services and effective collaborative working to meet needs Multiagency approach with professionals working collaboratively towards a common goal Consistency Information sharing between agencies Lead professional to co-ordinate agencies and involvement Professional who is aware of agencies and support available Clear distinct roles of professionals Figure 4.11. Basic themes to support the organising theme: access to specialist services and effective collaborative working to meet needs Access to specialist services and effective collaborative working to meet needs was an organising theme supported by six basic themes as illustrated in Figure 4.11. The importance of a collaborative multi-agency approach and having professionals working together towards a common goal was recognised by a number of professionals as something which was important in Amy's success. I just think that it's a multi-disciplinary effort as well. Everybody did what was asked of them as best they could. There was no drift. I think people did get on, people did do what they said they would.... I think that multi-disciplinary approach you know of people staying fairly focused as best they can I think that helped (Attendance Officer). The coming together of adults ensured consistency which was reportedly helpful in giving Amy and the family the same messages. The family support model was highlighted as a mechanism for supporting the effective multi-agency approach because meetings were suggested to provide a forum in which professionals could share views, perspectives and information; as highlighted by the learning mentor, the dissemination of information was "absolutely vital". A number of professionals recognised the importance of having a lead professional to chair the meetings, follow up on agreed actions and to co-ordinate agencies and involvement. Also, having the involvement of a professional such as the parent support advisor who was aware of agencies and the support available was 104
recognised to be an important role in signposting and ensuring the family could access appropriate support. Having clear distinct roles of professionals also emerged as a basic theme as shown in Figure 4.11 because everyone had a clear understanding of each other's roles and what this involved. A number of professionals also talked about the benefit of having distinct roles of school staff, for example, the learning mentor talked about how she took a more nurturing role at school, while the SENCO and Head of Year took a more authoritative role with regard to attendance. This was illustrated by the SENCO, "it has been quite valuable then to have me as am um I've taken the more authoritative role, say for example in any meetings.... So you know so the good cop bad cop scenario". Organising theme: early identification and assessment of need to inform intervention Early identification and intervention Try and understand and address the cause of school refusal behaviour Holistic assessment to inform intervention Figure 4.12. Basic themes to support the organising theme: early identification and assessment of need to inform intervention Early identification and assessment of need to inform intervention was also associated with success. This organising theme was supported by three basic themes as highlighted in Figure 4.12. In terms of early identification, effective systems for monitoring attendance was identified as important because this enabled the learning mentor to know instantly when Amy was not in school which meant that she could quickly make contact and follow up. For example, she reported how, "having the information on the screen and at your finger tips is so much better". Additionally, the importance of pre-empting potential difficulties was reported by the SENCO to be an important element of the preventative and early intervention approach. For example, additional support would be considered during periods of transition, school holidays and any other changes. As stated by the SENCO, "I'm jolly sure that she will be top of the list or very near the top of the list for [Learning Mentor] to touch base with in September". 105
Trying to understand and address the cause of the school refusal behaviours was also a basic theme. A number of participants reported that it was important to try and address any difficulties which Amy may have been experiencing, for example, school shared that they investigated potential incidents of bullying. Linked with this is the basic theme of completing a holistic assessment to inform intervention because many professionals recognised the need to address the range of factors at home and school which might have been impacting on Amy. The parent support advisor reported that the CAF was a useful tool in supporting the holistic understanding, I think it's all about that finding out what the family needed and taking a holistic approach to it and trying to meet those needs as best you can really.....I think if I was involved in this sort of situation again I would definitely go down the CAF route (Parent Support Advisor). Organising theme: encouragement and positive attention Encouragement from school, family and peers Positive attention from school, family and peers Figure 4.13. Basic themes to support the organising theme: encouragement and positive attention Encouragement and positive attention was another organising theme which emerged from a number of interviews and was something which Amy herself recognised as helpful in supporting her success. This was evidenced by the basic themes in Figure 4.13 which ranged from encouragement and positive attention from school staff to family members and peers. The learning mentor in particular said how she thought it was particularly important to have the positive attention from peers. She said that she encouraged peers to make contact with Amy when she was out of school to reinforce that she was missed and that they wanted her in school, When she wasn't coming in one of the kids kept asking, `where is she where is she?' So I said, `have you got a text number?', and she said, `yeah', so I said, `text her and find out' (Learning Mentor). 106
The learning mentor added that it was really helpful that peers were pleased to see Amy on her return, "when she comes back in they'll give her a hug and you know, `pleased to see you'" (Learning Mentor). Information suggests that the encouragement and positive attention from her family was also an important factor as identified by many professionals and Amy. Amy for example, reported that her mother had been praising her and that she was proud of Amy for going back to school. This might have been particularly helpful given the family relationships and dynamics. The positive attention that Amy has received from her grandfather, her father and siblings were also reported to have been beneficial. This also supports the fact that she was noticed by the family. um I think um helping Amy, to get Amy back to school was primarily about somebody focusing on her because she's number three of four children and I got the distinct impression that she didn't get listened to much at home; she didn't get heard anyway (Parent Support Advisor). Organising theme: developing the young person's understanding of thoughts, feelings and behaviour Developing the young person's understanding of thoughts and feelings Supporting young person to reframe thoughts and think more positively Providing evidence to challenge negative thoughts Figure 4.14. Basic themes to support the organising theme: developing the young person's understanding of thoughts, feelings and behaviour One of the emerging organising themes was helping Amy to develop an understanding of her thoughts, feelings and behaviour. As highlighted in Figure 4.14 this was based on basic themes of developing her understanding of thoughts and feelings, providing evidence to challenge negative thoughts and helping her to reframe thoughts and think more positively. The learning mentor reportedly completed some work with Amy around her emotions and similarly, Amy discussed the group intervention which focused on thoughts and feelings and thinking more positively. Supporting Amy to think more positively and reframe negative thoughts was a basic theme which emerged in four interviews. This for example, included helping Amy to 107
empathise with her father and to reframe negative thoughts because as highlighted by the learning mentor, her father had "very little life of his own" with working and looking after four children. Similarly, professionals thought that it was helpful to provide Amy with evidence which challenged her negative thoughts and how this might have been beneficial in providing reassurance and reducing anxiety. It was reported that Amy was very anxious about the health of family members and that this may have been a factor which led to some of the school refusal behaviours. I know that one of the break throughs was when [Learning Mentor] printed off the information about lupus which is what mum had because she suspected that Amy had read something somewhere that basically it was a death sentence (Parent Support Advisor). Also it was suggested that it was helpful when the health of her father and sister started to improve because Amy reportedly worried about them too. Organising theme: positive relationships and approach with home Collaborative approach between home and school Regular communication between home and school School has positive relationships with parents Availability of professionals for family Parents' openness to advice, support and change Figure 4.15. Basic themes to support the organising theme: positive relationships and approach with home The positive relationships and approach with home was recognised to be a supportive factor by Amy's father and all professionals evidenced by five basic themes as shown in Figure 4.15. The importance of a collaborative approach was emphasised as was the importance of the regular communication between home and school. As stated by Amy's father, "I think it's the communication. There's a lot of good communication, I mean if there's an issue Learning Mentor will bring it to my attention". School staff perceived that the positive home school relationship that they had with Amy's father was key in ensuring effective collaborative working. 108
Professionals described the availability of professionals for the family as facilitative in supporting this relationship and approach. For example, the parent support advisor and the attendance officer explained that Amy's father/grandparents would ring the school if they had any concerns or issues and said that, "somebody was always there to talk to them". Linked with the positive relationships and approach is the basic theme of Amy's father's openness to advice, support and change which was identified by three professionals as facilitative. The SENCO for example, described Amy's father to have been "fabulous". Professionals shared that Amy's father was "determined" to make things work, he was reported to have listened to and taken on board the school's concerns and it was reported that he was very open to professionals' advice and support. ...and Dad was very, very open to suggestions and it must be very hard. Both [SENCO] and I constantly say how hard it must be as a parent trying to do their best to have somebody from school saying you know what can you do this, can you perhaps try this or try that. But he was at the stage where anything, anything would help so he's been brilliant (Learning Mentor). Organising theme: whole school approach Communication between staff Key adult has support from senior leadership team Supervision for key adult Figure 4.16. Basic themes to support the organising theme: whole school approach A whole school approach to the school refusal behaviours was an organising theme in supporting Amy's success, evidenced by three basic themes as illustrated in Figure 4.16. As shown in Figure 4.16, communication between staff was a basic theme; this ranged from office staff to the senior leadership team. For example, the learning mentor reported the benefit of the office staff informing her about Amy's attendance because, as previously highlighted, this enabled her to follow up on the absences and ensure early intervention. 109
Additionally, it was reported that there was effective communication between the learning mentor and Amy's teachers, for example discussions about Amy's needs, barriers to learning and strategies. As identified by the learning mentor, it's a really hard job to not compromise confidentiality but to give them some information to back off, cut them some slack and back off. and I think at times making staff understand that you know the kids come in and they have huge issues at home that the staff don't know about (Learning Mentor). Also, the learning mentor highlighted the importance of teachers being aware of Amy's targets and strategies because, "the teacher has to notice and acknowledge the fact that actually they're making a choice". The support and trust that the learning mentor had from class teachers and the senior leadership team was reported to have been important in facilitating this approach. The support the key adult had from the senior leadership team was a basic theme as illustrated in Figure 4.16, for example in giving the key adult autonomy. The learning mentor reported the benefits of supervision with the SENCO in discussing and reflecting on her involvement. The SENCO and learning mentor acknowledged the usefulness of meeting regularly for example, to offload, problem solve and receive reassurance from another professional. Organising theme: flexibility and availability of key adult Key adult who is a constant Flexibility of key worker's role to respond to needs Availability of key adult Figure 4.17. Basic themes to support the organising theme: flexibility and availability of key adult The importance of the learning mentor having flexibility and availability to respond to Amy's needs was an organising theme supported by three basic themes which emerged in four interviews. Having someone who was a constant and who was available in school was reportedly a significant factor because it was suggested that this communicated to Amy that someone was available for her. This links back with the theme which talked about the importance of confidence, self worth and value and taking an interest in her. As 110
reported by the attendance officer, "but school was a constant. Alright she wasn't attending but then she knew that they wanted her to attend; they were coming like the cavalry over the horizon you know" (Attendance Officer). The SENCO and learning mentor (key adult) talked about the flexibility of the learning mentor's role in being able to respond to Amy's needs. Also, the SENCO and the learning mentor talked about the benefit of the learning mentor being able to take the lead on the case and having autonomy. As highlighted by the learning mentor, "It makes a huge difference!" In terms of the basic theme availability of the key adult, professionals reported the importance of having an area where Amy could access the learning mentor, where the learning mentor was available to respond to her needs. .....because I'm not on a timetable and they know that they can knock on the door or they know that they can leave a message to say get hold of me and they know that at some point, as soon as I can, I'll be there to see them (Learning Mentor). The "good ratio of staff: students with additional needs" was highlighted by the SENCO as beneficial in supporting the availability of the key adult for Amy. Organising theme: not focusing on/reinforcing the absence Avoid negative attention re absence Not reinforcing time spent at home Figure 4.18. Basic themes to support the organising theme: not focusing on/reinforcing the absence The importance of not focusing on the absence was an organising theme which was highlighted by a number of professionals as valuable, as evidenced by two basic themes shown in Figure 4.18. The learning mentor and SENCO emphasised the importance of avoiding negative attention regarding the absence and said that they provided staff with information to reiterate this. For example, not to comment on the absence, how much work Amy had missed and stressed the need for staff to "quell comments from other students". 111
Learning Mentor does liaise with staff to ensure that they do welcome Amy and other students who have been in similar situations um and you know has requested very specifically that they don't talk about why she hasn't been in (SENCO). The learning mentor said that it was important not to treat Amy any differently explaining that young people who are returning to school after a period of prolonged absence often want their needs to be invisible. The importance of not reinforcing the absence, for example by not allowing Amy to engage in activities at home which she might find enjoyable such as watching television was also highlighted. It was reported that when Amy was not in school, "sanctions" were put in place at home. Organising theme: persistence and resilience of professionals Persistence Resilience of professionals Figure 4.19. Basic themes to support the organising theme: persistence and resilience of professionals The persistence of professionals was something which was another organising theme, emerging from two basic themes as illustrated in Figure 4.19. Professionals' involvement over time and Amy knowing that there was "long term involvement" was suggested to have been beneficial because as suggested by the attendance officer, persistence may have been helpful in communicating that she was valued. Professionals described the importance of persisting with Amy and not "forgetting about her" or "giving up on" her despite the challenge that working with the school refusal behaviour may have presented. As highlighted by the SENCO, "Nobody has given up on this girl. Nobody" (SENCO); and, as stated by the learning mentor, As much as I could I wouldn't let her get away with ignoring me because once they start doing that I find I lose them......so I would just keep on and keep on. and I think, I think having someone here like me in school that doesn't give up and I've made that comment to a lot of the students I see (Learning Mentor). The SENCO explained how persistence ranged from staff within school to external professionals who had involvement with Amy over a number of sessions. 112
She added how building the resilience of staff "not to give up" was important. One professional acknowledged the need to recognise that it takes time and that strategies may not always work first time and/ or that they may need to be adapted. Similarly it was reported that Amy needed time so it was important for professionals to persist and give her a fresh start "no matter how long it took". Organising theme: regular monitoring of progress Regularly reviewing and celebrating progress Regular monitoring of attendance which is communicated to young person Figure 4.20. Basic themes to support the organising theme: regular monitoring of progress Regular monitoring of progress emerged as an organising theme. This was evidenced by the two basic themes in Figure 4.20. Regular monitoring of attendance and regularly providing updates on attendance was something which was reportedly beneficial in providing focus and keeping Amy on track, "but the other thing is that I do keep up, I tell her on a regular basis what her attendance percentage is" (Learning Mentor). As highlighted by Amy, "and um if um like I do something good then she (Learning Mentor) recognises it" (Amy). Making Amy's progress transparent and regularly reviewing and celebrating progress was suggested to have been important, particularly in emphasising progress. Organising theme: aspiration and motivation Recognising aspiration and motivation Positive role models for young person Figure 4.21. Basic themes to support the organising theme aspiration and motivation Aspiration and motivation emerged as an organising theme supported by two basic themes which emerged from three interviews. The basic themes are illustrated in Figure 4.21. Amy's father shared he had discussions with Amy about career options and subject choices and Amy herself talked about her career aspirations and that she needed to get good grades at school to become a private investigator, "probably just that I know I need to do my GCSEs and that I need good GCSEs if I want to do what I want to do" (Amy). 113
Access to positive role models also emerged as a basic theme, for example, the SENCO described the success of Amy's sister, who was described to have "significant mental health needs". The SENCO stated that Amy's sister, "continued coming to school when she could and has achieved extremely well" and, as reported by Amy, had a place accepted at University. Additionally, the SENCO explained that Amy's academic ability had meant that she was placed in high sets so she was amongst peers who strived for high achievement. She suggested that it was beneficial for Amy to be around peers who had a good attitude to learning and high aspirations in modelling the importance of school to her. Organising theme: discussions about the impact of not coming in Discussion about the impact of not coming in Figure 4.22. Basic theme to support the organising theme: discussions about the impact of not coming in An organising theme which emerged from five participants was discussions about the impact of non attendance as shown in Figure 4.22. This included the consequences of non attendance and the impact of this on the family. As highlighted by two professionals, the involvement of the attendance officer and his presence at the family support meetings, communicated to Amy that prosecution was possible. Additionally, the impact of nonattendance on the family was discussed for example, in terms of her father taking time off work. However, it is questionable how far discussions about the impact were helpful when Amy reported that they "didn't really help" and when non attendance persisted. Organising theme: avoid harsh consequences Avoid `harsh' consequences Figure 4.23. Basic theme to support the organising theme: avoid harsh consequences Professionals thought that it was important that the consequences of the school refusal behaviours were not too harsh as illustrated in Figure 4.23. Whilst professionals thought that it was important that Amy was aware of the consequences, the attendance officer recognised the value of avoiding the prosecution route, particularly because a "firm but fair" approach was in place. 114
4.2.3 What might have led to more success or earlier success? This section describes organising themes which might have let to more or earlier success for Amy. Many of the ideal factors may occur in both Section 4.2.2 and 4.2.3 because stakeholders reported that some facilitative factors could be developed further. Organising theme: earlier identification and assessment of need and intervention Earlier involvement with family Earlier access to agencies Earlier involvement to address and support emotions Earlier intervention Figure 4.24. Basic themes to support the organising theme: earlier identification of need and intervention Earlier identification and assessment of need and intervention was an organising theme supported by the four basic themes illustrated in Figure 4.24. Earlier involvement with the family was identified by the parent support advisor as something which might have helped, adding that family work from CAMHS may have been helpful given the family's needs. Similarly, as identified by the clinical psychologist, earlier access to agencies such as CAMHS may have been beneficial. This links in with suggestions made by the parent support advisor and the learning mentor who reported that earlier involvement from someone independent to address Amy's emotions may have been helpful. The learning mentor for example, described how art therapy had been helpful for another young person that she had been working with. Also, earlier intervention was highlighted as something which may have been beneficial. The parent support advisor reported that the first signs of reluctance occurred when Amy attended primary school and said how it would have been beneficial if the school refusal behaviours had been addressed at the first sign of reluctance to attend. 115
Additional ideal organising themes identified which were supported by a single basic theme Better connections with services in different local authorities Further developing parenting skills Additional opportunities to develop self worth Opportunities to meet peers who have experienced similar difficulties Opportunities to join groups and make new friends If not successful investigate alternative provision Figure 4.25. Additional ideal organising themes which were supported by a single basic theme Figure 4.25 displays the additional ideal organising themes that were supported by a single basic theme. Amy's success meant that stakeholders did not discuss ideal factors in detail so therefore these have been grouped together and will be discussed collectively. One of the ideal factors that participants discussed was for the school to have better connections with services in different local authorities. The school which Amy attends borders two neighbouring local authorities so, because Amy lived out of borough, she was not entitled to access some services within the local authority. Stakeholders explained how it would have been helpful to have had better connections with other services to support referrals, for example to agencies such as CAMHS (in terms of knowledge of processes and thresholds). Also, it was suggested that it would have been helpful for school to have more positive and familiar relationships with services out of borough so that they were aware of what was available in other local authorities, and to facilitate multiagency working and earlier intervention. As highlighted by the SENCO, "but that's a, you know, a perennial difficulty for us because some of our families do live across the border and you know finding contacts who will support us across that border is difficult". Further developing parenting skills was also something which emerged as an ideal factor. This has already been described in relation to the factors associated with successful involvement however, it was suggested that it might have been helpful to support Amy's father's emotions and consistent parenting further. The parent support advisor shared how a parenting course may have been beneficial, 116
....under normal circumstances I would have talked to Dad about doing a parenting course and for Amy to go as well, you know something like strengthening families because it would be ideal because there is an element of looking at emotions, who you are and where you fit in the family and who does what (Parent Support Advisor). Also, further opportunities for Amy to meet peers to whom she could relate and to develop additional friendships were discussed as things which may have been helpful. The final ideal factor described was alternative provision and how this could have been explored had there not been success. 4.2.4 Interaction of factors. The data suggests that each organising theme may be one of many components in supporting success. As highlighted by the clinical psychologist, "a number of things got better at the right time." There were factors which were identified as positive and associated with the success but were hypothesised to be insufficient on their own to change the school refusal behaviours. For example, the learning mentor said, "I don't think it [positive contact from peers] necessarily made her come in but I think the fact that she wasn't quite as invisible as she thought she was" (Learning Mentor). Data therefore, suggests that there are a number of factors associated with successful involvement and that it was the synergy and interaction of factors which were beneficial in supporting Amy's success. Some of the interventions such as personalised rewards were in place when Amy was not attending school so how far these facilitated her success is unknown; as highlighted by the learning mentor, "when she did come in and get the rewards she really enjoyed them" but as pointed out by her father, there were days when Amy was due to go to the dog's home as a reward but yet she did not go into school. Additionally, through looking at the organising themes, it could be hypothesised that a number of factors were interacting. The interaction of factors will be discussed further in Chapter 5. 117
4.3 Case 2: Leah 4.3.1 Case vignette. At the time of the research (June 2011) Leah lived at home with her mother; she was an only child. It was reported that Leah came from a traveller background and that historically family members did not attend school. Leah's mother reported that she became the 24 hour carer for her own mother when her father passed away in 2009 and said that there had been a lot of family feuding since. Leah first started to show school refusal behaviours when she was at primary school. It was reported that she showed sporadic attendance throughout primary school and was referred to the attendance officer in 2007 when her attendance dropped below 80%. The attendance officer identified that Leah's attendance was manageable when she was in primary school because she responded well to the interventions put in place at school. However, Leah found it hard to manage the transition to secondary school. It was identified that Leah had a learning mentor when she was in primary school and also had one when she transferred to secondary school. Both supported Leah in school, made home visits and often took her to and from school. However, after Leah's first term at secondary school, the learning mentor's role changed which meant that she was unable to support Leah in the same way; Leah was expected to return to a fulltime timetable. At this point she stopped attending. It was reported that Leah had difficulty interacting with peers and that there had been instances of bullying where Leah was the victim and perpetrator. Leah reportedly attended mainstream secondary school for the first 2-3 months of Year 7 but did not return after this. It was reported that Leah would say that she did not want to get out of bed, said that she did not feel well and she cried when she was at school. Leah's mother explained how she would come home crying and when she took her to school, Leah would send her text messages saying, "you're evil, if you really loved me you wouldn't leave me in this school". Leah's mother added that when Leah came home she self harmed. During Leah's time out of school, a number of attendance officers were involved. It was reported that the family stopped engaging with services for a period of 6-8 months; they stopped answering the door and telephone calls and the attendance officer reported that they could not get any medical evidence why Leah could not go to school. Leah's mother was prosecuted twice and received two fines for Leah's non-attendance. 118
Leah was referred to CAMHS. She missed three appointments before being assessed by the senior nurse practitioner. Involvement consisted of an initial assessment. Attachment and low mood were identified as areas of need by CAMHS as it was reported that Leah wanted to be with her mother all the time, she would sleep with her mother and was fearful if her mother wanted to go out. It was reported that confidence and self worth were also areas of need for Leah's mother. Following the prosecution, a new attendance officer became involved. She took a different approach and managed to put a case for Leah to have a place at the vulnerable pupil unit. At the time of research, Leah was in Year 9 and was attending the vulnerable pupil unit, two sessions a week with 3 or 4 other young people. She started at the vulnerable pupil unit in January 2011 after two years out of education; since then her attendance at her allocated sessions was 100%; it was reported that Leah had asked to increase the number of sessions that she could attend! The attendance officer reported that Leah had sent cards to her and to the staff at the vulnerable pupil unit to thank them for giving her a second chance. In 2011 Leah received a diagnosis of obesity and hypothyroidism. Leah was referred to the Mind Exercise Nutrition Do it (MEND) project for weight management. At the time of the research it was reported that Leah had lost 2 stone 8 pounds in 6 months. 4.3.2 What factors were perceived to be effective in supporting Leah, and why? Eighteen organising themes emerged in the case of Leah. These organising themes which are associated with successful involvement are presented in Figure 4.26. 119
Positive relationships and approach with home Developing feelings of safety, security and belonging Flexible and individualised approach to ensure prepared and able to access learning Meeting the needs of the family Aspiration and motivation Increased confidence, self worth and value Supporting social interaction and communication Personality, skills and experience of professionals Positive experiences Regular monitoring of progress Discussion about the impact of not coming in and experience of consequences Assessment of need Collaborative working between professionals Taking an interest in young person as a whole Availability of key adult Believing in young person Positive nurturing approach Make a positive contribution Figure 4.26. Organising themes identified in the case of Leah As previously highlighted, organising themes are presented in order of prominence. Again the basic themes which make up the organising themes are presented in boxes before being described. As previously highlighted, organising themes are presented in the order of prominence, with the basic themes highlighted in figures under the corresponding organising theme. 120
Organising theme: positive relationships and approach with home Parent more positive about education Parent's readiness to engage with services Professionals developing trust with young person and family Increased confidence of parent to work with professionals Positive relationship with and family support from the attendance officer Positive relationship school and parent Regular communication between home, school and attendance officer Working collaboratively with parents Figure 4.27. Basic themes to support the organising theme: positive relationships and approach with home The most prominent organising theme in the data set was the development of a positive relationship and positive approach with home. This was supported by the eight basic themes listed in Figure 4.27. Professionals described how Leah's mother had a negative view of education and how she had "disengaged" with services, particularly following the two prosecutions for Leah's non attendance. As described by the attendance officer, Leah's success appeared to have coincided with her mother's more positive view of education and her readiness to engage with services. The data also suggest that developing Leah's trust, Leah's mother's trust and their confidence in working with professionals were important. It could be argued that this was facilitated by the positive relationships that the professionals developed with Leah's mother. For example, it was reported that Leah's mother appeared to be comfortable with staff at the vulnerable pupil unit and that she had increased confidence to go to meetings and seek advice and support from professionals as and when she needed it. For example the attendance officer said, I think it's all been about the relationships and the confidence and the fact that Mum wants her to achieve. I think there was something about Mum that actually she didn't want her to go to secondary she wasn't making and she wasn't cooperating (Attendance Officer). 121
Data from five interviews suggests that the positive relationship and the family support from the attendance officer were particularly influential. The family appeared to have had a difficult relationship with their previous attendance officer, especially following prosecution. However, circumstances meant that there was a change in attendance officer which led to the development of a positive relationship with the family; Leah's mother described this attendance officer to be "brilliant". The attendance officer in particular placed heavy emphasis on the importance of this positive relationship, for example, she said, "I do get on well with her and Leah gets on well with me and I do think that makes a massive difference when you're not battling and dreading a visit". The attendance officer explained the importance of the positive relationships in making Leah and her mother feel more comfortable but explained the challenge of this following a prosecution. The support that the attendance officer provided to the family was recognised by a number of professionals as significant. For example, Leah's mother and the attendance officer explained how the positive relationship that had developed meant that Leah's mother would contact the attendance officer if she had a concern or difficulty. Also, the attendance officer was reportedly helpful in providing support to the family in meetings and being a link between the school and the family. The attendance officer explained that she, ... physically collected them, took them to the meeting, had a chat with them afterwards to find out what they thought about it you know because again they were asked in the meeting if they had any questions; neither of them had questions but then asked me about 100 when we got in the car. The teacher from the vulnerable pupil unit described the attendance officer as "instrumental" in supporting Leah's mother's attendance at the meetings and in ensuring Leah's attendance, particularly during her first few days at the vulnerable pupil unit. In addition to the positive relationship that the family had with the Attendance Officer, the positive relationship that the parent had with other professionals was viewed to be important. For example, the learning mentor in the primary and secondary schools suggested that Leah's mother valued having someone with whom she could talk freely. The learning mentor in the secondary school suggested that she thought that respecting the family and empathising with Leah's mother was supportive in fostering the positive relationship. 122
The basic theme of regular communication with the family, highlighted in Figure 4.27, also supported positive relationships and approach with home. For example, the importance of communicating Leah's progress to her mother and emphasising the positives were identified to be helpful, particularly because Leah's mother was used to hearing negative feedback. The teacher in the vulnerable pupil unit and the learning mentor in the primary school also highlighted the importance of working collaboratively with parents. For example, the teacher in the vulnerable pupil unit reported the value of involving Mum in the meetings and listening to her views and opinions so that she was a part of the decision making process. As highlighted by the teacher in the vulnerable pupil unit, the meetings enabled professionals and the family to reflect on what was working well and areas for development so that they could problem solve and move in a direction in which Leah and her mother felt happy. It could be hypothesised that the regular communication and the positive relationship helped to support Leah's mother's "enthusiasm" for Leah to attend the vulnerable pupil unit and support her more positive view about education. Organising theme: developing feelings of safety, security and sense of belonging Stability, consistency and sense of belonging at school Develop feelings of safety and security Introductory visit to the vulnerable pupil unit Stability at home Figure 4.28. Basic themes to support the organising theme: developing feelings of safety, security and sense of belonging Developing feelings of stability, safety and sense of belonging was a highly prominent theme throughout the interviews both at home and at school. The basic themes which make up this organising theme are listed in Figure 4.28. In terms of stability, consistency and sense of belonging at school four stakeholders suggested that small group environments were important. As highlighted by Leah, her placement in the vulnerable pupil unit was successful because she did not have to find her way around the school and arrive on time for lessons. As the attendance officer identified, "she knows that when she's there she's in the same place, she's not walking around, she's not finding rooms, she's not getting lost". It was hypothesised by the learning mentor 123
in the secondary school that the alternative provision and opportunities for small group work in the secondary school were also beneficial because the teacher was consistent. She shared that Leah found it hard to respond to change and suggested that changing classes in the secondary school might have been difficult. In addition to supporting consistency, the small group environment appeared to have supported feelings of safety and security, another basic theme as illustrated in Figure 4.28. The learning mentor in the secondary school said that when Leah was working in the small group she was not as conscious about her weight or about being behind with her work. Leah's attendance at the alternative provision therefore minimised this anxiety; as the teacher at the vulnerable pupil unit shared, I suppose if you spend your time worried that people are name calling you or are being unpleasant or unkind towards you then it is difficult to concentrate whereas obviously there's none of that here so those problems are alleviated. Additionally, a small group environment was suggested to have supported feelings of safety and security when Leah attended the mainstream primary and secondary schools. It was reported that staff were able to provide reassurance and it was suggested that it gave Leah the confidence to ask for help. The attendance officer suggested that Leah found the classroom environment hard, "what she suffers from is being in this big classroom environment she just doesn't feel like she fits in, she doesn't have the confidence to make massive amounts of friends but there she can just go in and learn". A number of participants commented on the benefit of the small group environment and the vulnerable pupil unit in providing a sense of belonging as the children who attended those groups were young people whom Leah could relate to; for example, Leah said, "'cause nearly all of them have gone through the same as what I did". This meant that Leah could relate to them but also, as highlighted by the attendance officer, she did not stand out amongst peers. As illustrated in Figure 4.28, the introductory visit to the vulnerable pupil unit was a basic theme supported by three stakeholders. It was reported that Leah and her mother both liked the provision and got on with staff and pupils during this visit. Information suggests that it was helpful to inform Leah about what she would be doing and how long she would be doing it for. As Leah said, "when I got the offer I just came round and looked and 124
thought it was alright". It could be suggested that this introductory visit supported feelings of safety and a sense of belonging. Stability at home was also an important factor. For example, it was reported that both Leah and her mother were feeling more positive and that this had had a positive impact on their relationship. "I get along with my mum a bit more 'cause I used to just shout at her all the time but now I don't. We get on more" (Leah). The benefit of establishing a routine at home and Leah's mother having more time to herself were also highlighted as factors in supporting stability at home. Organising theme: flexible and individualised approach to ensure the young person is prepared and able to access learning Access to alternative provision Flexibility in meeting specific need Individual support from staff Varied curriculum in the vulnerable pupil unit Developing realistic targets and strategies Reintegration planned according to need Support with journey to and from school Figure 4.29. Basic themes to support the organising theme: flexible and individualised approach to ensure the young person is prepared and able to access learning A highly prominent theme was a flexible and individualised approach to ensure that Leah was prepared and able to access learning. This was based on the seven basic themes detailed in Figure 4.29. As illustrated in Figure 4.29, this included access to an alternative provision which addressed her needs. The opportunity for Leah to attend a provision for vulnerable children and young people was recognised to have been influential in supporting her reengagement with education. The attendance officer stated that it was important to respond to the fact that Leah was not responding to mainstream provision and similarly, as stated by the learning mentor in the secondary school, 125
....you know realising that not all children are the same and realising that you are going to get a group of children that's like this and maybe they won't get on in mainstream and maybe we have to accept that. Additionally, flexibility in meeting specific need was another basic theme as shown in Figure 4.29. For example, supporting access to the curriculum, addressing specific areas of need and as highlighted by three professionals and Leah, being able to adopt a flexible approach when Leah was finding something hard. The teacher in the vulnerable pupil unit explained that through working on a 1:1 in the alternative provision she was easily able to identify specific areas of need and where to target support. Individual support was something that Leah and the teacher from the vulnerable pupil unit identified as helpful. The teacher from the vulnerable pupil unit added that it was helpful to have two teachers in the vulnerable pupil unit who teach core subjects because this has supported Leah's learning in these areas. Leah was particularly positive about the maths teacher at the vulnerable pupil unit in supporting her progress, ..... 'cause there's a teacher and I don't know her name but she does maths with us and like I couldn't do maths in high school because it wasn't just focusing on one person. She had to go round all round the class. But since the other teachers, the maths teacher has been helping me I've been able to understand it a bit more (Leah). Additionally, the 1:1 support reportedly enabled staff to provide reassurance and build confidence which was reported as beneficial in all settings. Another basic theme which emerged was the varied curriculum in the vulnerable pupil unit. The variety of activities was reportedly beneficial because it could be tailored to Leah's needs and as suggested by Leah, a variety of subjects increased her motivation and productivity. Developing realistic targets and strategies was a basic theme emerging from the interviews with the teacher from the vulnerable pupil unit and the learning mentor in the primary school; they talked about the individualised goals and targets developed with Leah. The teacher from the vulnerable pupil unit in particular explained how it was helpful to discuss areas for development with Leah and how she might improve, then reviewing her progress in subsequent pieces of work. The importance of reviewing targets and the timetable, particularly regarding the number of hours, were reported to be important in 126
ensuring her individualised needs were met; it could be hypothesised that this was important in ensuring success. Reintegration planned according to need was also a highly prominent basic theme. A number of participants in the data set reported that a gradual reintegration was important. The teacher in the vulnerable pupil unit for example explained how the part time timetable was essential, "if we bring them in for too much too soon it breaks down" (Teacher from the vulnerable pupil unit). Having the flexibility to support Leah's journey to the provision was reported to be helpful by a number of professionals. The learning mentor in the secondary school said that she recognised that this was an area of need and said that Leah responded well when she collected her and took her home from school. The learning mentor in the secondary school hypothesised that providing Leah with this support added to feelings of safety, for example, "she didn't have to meet any of the kids on the way home from school if there was any confrontation with the neighbours 'cause she was just dropped off at the doorstep so she just felt safe" (Learning mentor in the secondary school). Organising theme: meeting the needs of the family Providing reassurance and relieving parent's anxiety Firm, honest approach with family with clear boundaries and expectations Availability and flexibility of professionals for family Home visits Increasing effectiveness of parenting skills Identifying family needs, targets and strategies to meet needs Figure 4.30. Basic themes to support the organising theme: meeting the needs of the family Meeting the needs of the family was another highly prominent organising theme evidenced by six basic themes as illustrated in Figure 4.30. In particular, providing reassurance and encouragement for Leah's mother and relieving her anxiety was referred to as something which was important. In a number of interviews, Leah's mother explained how she was worried about Leah's mental health and wellbeing. Also she explained that 127
she was worried because she thought that she herself might end up in prison as a result of Leah's non attendance. The attendance officer reported that, I think by me explaining that that [going to prison] wasn't going to happen, Mum started to work with me again because she wasn't avoiding and she wasn't steering away from us to avoid prosecution. I reassured her that that wasn't going to happen again. Leah's mother expressed that the professionals had lifted a lot of "stress" from her and, as highlighted by the teacher at the vulnerable pupil unit, helping Leah's mother to see that Leah was happy in the vulnerable pupil unit was reassuring for her. In addition to reassurance, adopting a firm and honest approach with the family emerged as a basic theme. Whilst professionals recognised the importance of responding in a calm and non confrontational way, they recognised the importance of being firm and honest with the family and giving them clear boundaries. For example, as stated by the attendance officer, she could not, "condone" absences. The availability and flexibility of professionals for the family was suggested to have been invaluable. In particular, the availability of the attendance officer for the family was reported to have been beneficial, for example, in meetings and being at the end of a phone. The attendance officer stated that Mum now has "got that opportunity now where she can ring anybody and ask for advice". Similarly, the flexibility of staff at the vulnerable pupil unit was highlighted as helpful for example, in arranging meetings at a time and location which was convenient for Leah's mother. Home visits when Leah was having difficulty were something which three stakeholders thought was helpful. This was suggested to be helpful in supporting Leah's mother and increasing the effectiveness of parenting skills, for example, the learning mentor in the secondary school shared how she would go to the home in a morning. She said that she provided reassurance to Leah's mother and encouraged her to be firm with Leah. She said that it was helpful in supporting Leah's mother, giving her confidence and supporting her with different strategies, "I think the home visits and that support and giving Leah's mother the confidence to say you know and be strong ....and say you do need to be in" (Learning Mentor in the secondary school). 128
Identifying family needs and setting targets and strategies to support these needs was also a basic theme. As part of the attendance plan, it was suggested that Leah's mother and Leah would benefit from spending time together because as highlighted by the learning mentor in primary school, Leah's mother had "issues herself with not being able to get up". However, additional support to meet the family's needs for example, through a family support plan, was identified as something which might have led to further success (see Section 4.3.3). Organising theme: aspiration and motivation Motivation Goals and aspiration Making learning meaningful and relevant Figure 4.31. Basic themes to support the organising theme: aspiration and motivation Aspiration and motivation was another organising theme which emerged from the data set which was evidenced by three basic themes as shown in Figure 4.31. In terms of the basic theme of motivation, Leah stated how she wanted to get "back on track" with her education and that she would rather be learning at the vulnerable pupil unit than staying at home doing nothing. Additionally, Leah shared that when she was offered the place at the vulnerable pupil unit, she wanted to attend so that she could prove the previous attendance officer wrong, "but that's why I really didn't want to have a day off cause it would have given her more reason to slag us off really" (Leah). As previously noted, the introductory visit to the provision appeared to have been helpful because, as highlighted by the attendance officer and Leah, Leah and her mother instantly liked the provision and wanted Leah to attend. Since attending the vulnerable pupil unit, the teacher at the vulnerable pupil unit reported that Leah had asked to take work home, had independently produced pieces of poetry writing at home, had asked to do more of something if she had enjoyed it and it was reported that Leah had asked to do more sessions. Linked with motivation, was the basic theme of goals and aspiration. Leah stated that one of the reasons she wanted to learn was, "'cause I do want a good job when I'm older". Leah talked about wanting to be a carer. Interviews with three stakeholders identified that 129
there had been discussions with Leah about her career in terms of the options the she might take for her GCSEs and in terms of organising work experience; for example her mother reported that the teacher at the vulnerable pupil unit was organising a work placement for Leah at a local nursery. It is possible that such discussions had given Leah focus and supported her motivation. However, it is also important to note that Leah wanted to be a carer when she was at primary school. The teacher in the vulnerable pupil unit talked about making learning meaningful and relevant for Leah. This was another basic theme as illustrated in Figure 4.31. The teacher shared that Leah enjoyed the cross curricula approach that they adopted and suggested that it was helpful for Leah to see the topic as a whole and see links between different subjects. The teacher in the vulnerable pupil unit highlighted the benefit of supporting Leah to see the direct link between homework, class work and improvements in knowledge and skills, I think definitely making it meaningful for her. Her seeing the point of it um I think in the mainstream school things can be disjointed and you can't always see the way that things link together and certainly not how things have any relevance to yourself whereas working on a 1:1 you can (Teacher vulnerable pupil unit). This could be important in increasing motivation and also in increasing enjoyment. Organising theme: increased confidence, self worth and value Developed self worth Providing opportunities for success Developed confidence Young person able to express their views and feel listened to Figure 4.32. Basic themes to support the organising theme: increased confidence, self worth and value Increasing confidence, self worth and value was a prominent organising theme emerging across the interviews, supported by the evidence of four basic themes shown in Figure 4.32. Improvements in Leah self concept, self worth and attitude towards school were not only reported in the interviews but were supported by Pupil Attitude to Self and School (PASS) data. 130
Have you heard of PASS data?....we did one on entry.....and her attitude towards self and school have improved by 70% which is you know a very significant improvement (Teacher in the vulnerable pupil unit) The basic theme of developing Leah's self worth and value was supported by examples which related to making Leah feel "special", for example personalised rewards. The learning mentor in the primary school reported that Leah was rewarded with things which were "special to her". She suggested that, "she felt worthy you know they were only little things but I suppose they did have a bit of an impact in sort of getting her into school" (Learning Mentor in the primary school). Leah shared that she felt much more positive about herself and said that she was much "happier" since attending the vulnerable pupil unit. This was supported by her mother and professionals. Providing opportunities for success appeared to be something which facilitated this. Leah for example made reference to the benefit of small achievable targets so that "she can actually get something done". As highlighted by a number of participants, helping Leah to make progress in her learning and making this transparent might have led to improvements in her self worth and self perception. Leah also reported that her confidence improved which was another basic theme as shown in Figure 4.32. For example, it was reported that the small group environment helped to develop her confidence in terms of her learning and social interaction. Providing an opportunity for Leah to express her views and feel listened to also emerged as a basic theme within the data. It appeared to be particularly important to value and listen to Leah and respond to what she was saying. For example, the teacher from the vulnerable pupil unit said that she would respond if Leah expressed concern about her learning or if "something was getting a bit much". But definitely her self perception and her perception of her ability has improved dramatically and I would like to hope that because of the positive relationships here and gearing things towards her interest and you know, talking to her, seeing her as a person, all of those things would have helped (Teacher in the vulnerable pupil unit). 131
Organising theme: supporting social interaction and communication Access to calm, relaxing environment with reduced social pressures Support at break/lunch Figure 4.33. Basic themes to support the organising theme: supporting social interaction and communication Supporting social interaction and communication was an organising theme made up of two basic themes as illustrated in Figure 4.33. As illustrated, access to a calm and relaxing environment with reduced social pressures was a basic theme within this organising theme. For example, the learning mentors in the primary and secondary schools reported that opportunities for small group work i.e. the nurture group were beneficial. Similarly, the small group environment of the vulnerable pupil unit was identified by many as influential in facilitating her re-engagement with education. Leah said that she did not like big groups of people and her mother said that Leah, "could not cope with a full class". It was suggested that the small group environment with reduced pressures was not too "overpowering" and was an environment in which she felt most comfortable and able to "cope". She found school very socially difficult and was very anxious about returning. The nature of here sort of eliminates a lot of those problems so you don't always have to look for a specific strategy just the fact that she's in this environment takes away those anxieties (Teacher from vulnerable pupil unit). Similarly, the calm, quiet environment of the nurture group and vulnerable pupil unit was highlighted to have been beneficial. Leah for example said, it's more quiet and there's not um 'cause it's like dead loud and noisy in proper school isn't it but like here it's just calm and people have calmed down....I don't really like loud and shouting and stuff (Leah). The types of activities completed within the small groups were also reported to facilitate a calm and relaxing environment. For example, Leah said that opportunities to do art made her feel relaxed as it was more "calming" than other work. When Leah attended mainstream provision, support at break and lunchtime was identified as helpful by the learning mentors. This supported Leah's social needs, for example, the 132
learning mentor in the secondary school said that she would help Leah to find a friend at break time and would support problem solving with peers if required. Organising theme: personality, skills and experience of professionals Key adult with whom she can develop a positive relationship Key adult who understands child holistically Professionals who understand young person's needs and how to respond Experience of professionals Knowledge and skills of professional to reflect and adapt approach when not effective Figure 4.34. Basic themes to support the organising theme: personality, skills and experience of professionals The organising theme of personality, skills and experience of professionals was evidenced by five basic themes listed in Figure 4.34. As highlighted, a key adult with whom Leah could develop a positive relationship was a basic theme supporting this organising theme. It was highlighted by all stakeholders and was something which was reportedly beneficial in all provisions. In reference to the relationship with the learning mentor in the primary school, the attendance officer said, "in primary school I think that was a very helpful relationship and I think that was very good, it was pitched at the right level" (Attendance Officer). Also emerging from the interviews as a basic theme was professionals' awareness and understanding of Leah's needs and their sensitivity to this. The learning mentor in the secondary school emphasised the role of the key adult and their understanding of the young person's needs holistically. For example, the learning mentor in the secondary said, I can be firm and say come on we need to go to lesson now but at the same time can understand when a child's upset and take on board that maybe they need a bit more time to get back in that lesson. A few minutes chat; just sensitive to their needs really (Learning mentor in the secondary school). Similarly, the attendance officer was reportedly sensitive to Leah's needs and had an understanding about how to respond because as highlighted by Leah's mother, the 133
attendance officer knew that mentioning the possibility of returning to mainstream provision would have had a negative response which could have led to a deterioration in Leah's progress. Associated with professionals' sensitivity to need was the experience or professionals and their personality and skills to know how the young person might respond. This basic theme links with the basic theme of the knowledge and skills of professionals to reflect and adapt the approach when it was not effective. For example, the previous attendance officer prosecuted Leah's mother twice for Leah's non attendance. The current attendance officer however, recognised that prosecution was not helpful, "I decided that actually prosecuting this mum again wasn't going to be a successful way of getting her back into school cause we'd tried that and it had made absolutely no difference" (Attendance Officer). The skills and personality of this attendance officer could be argued to have facilitated the positive relationship. Organising theme: positive experiences Positive experiences at school Build on interests and strengths Development of friendships Figure 4.35. Basic themes to support the organising theme: positive experiences Having positive experiences was another organising theme associated with success, supported by three basic themes illustrated in Figure 4.35. Positive experiences at school for example, was reportedly important so that this reinforced attendance. Building upon interests and strengths and giving Leah the opportunity to do something that she enjoyed emerged as a basic theme from interviews with the professionals working in the different provisions. This appeared to have provided positive experiences at school. For example, in the vulnerable pupil unit the teacher talked about the benefit of working on a 1:1 with Leah in being able to take learning and development in a "direction that she was enjoying going in". Similarly, the opportunity for Leah to do activities which she enjoyed such as art, baking etc. when she attended the nurture group at primary school was also suggested to have facilitated positive experiences. 134
The development of friendships was a basic theme which emerged across a number of interviews, particularly by Leah and her mother. Leah shared that she liked the people in the vulnerable pupil unit and said that, "they're not bullies or judge you for what you look like or things like that". This could have been particularly important for her because throughout the interviews, social communication was highlighted as an area of need and bullying was identified a potential difficulty experienced in mainstream secondary school. During her time at the vulnerable pupil unit, Leah developed friendships and started to socialise with her peers out of school. She herself suggested that the development of friendships improved her confidence and attributed this to, "just finding more and a bigger group of friends and like getting along with them all". Her mother said that previously Leah did not have any friends and said that she would not leave the house. However, she said that, "since she's been at the vulnerable pupil unit everything's just changed, everything's just changed. She's got loads of friends, she's never in" (Leah's mother). Organising theme regular monitoring of progress Regularly reviewing and celebrating progress Regular monitoring of attendance which is communicated to young person Figure 4.36. Basic themes to support the organising theme: regular monitoring of progress Regular monitoring of progress was an organising theme evidenced by two basic themes as illustrated in Figure 4.36. The basic theme, regularly reviewing and celebrating progress emerged across the interviews as a possible factor in supporting success. Helping Leah to recognise improvements in learning and her attendance through making progress transparent was perceived to be beneficial. This was achieved through praise, providing positive feedback and rewards and through the various forms of monitoring which took place. Leah was aware that her attendance was being monitored and tracked. Leah and the learning mentor in the primary school talked about the attendance charts which the learning mentor produced for her attendance group; it could be hypothesised that this visual means of monitoring progress supported transparency. The teacher in the vulnerable pupil unit reflected upon the importance of regularly reviewing Leah's progress to illustrate improvements, ".....with Leah it's being able to identify the areas of weakness, being able to put something in place to improve that and then showing her an improvement and I think that's worked in all areas" (Teacher from vulnerable pupil unit). 135
The subsequent praise and celebration of progress was also highlighted as beneficial, particularly because of the negativity that Leah and her mother previously received. Communicating such progress to Mum was viewed to be important by Leah, her mother and the attendance officer because, as highlighted by Leah, this meant that her mum knew that she was "having good attendance". Also the attendance officer emphasised that it was, "lovely for Mum to hear as well because when she goes to those meetings all she's getting it positive feedback about Leah". Organising theme: discussion about the impact of not coming in and experience of consequences Discussion about the impact of not coming in and the experience of consequences Pressure from local authority Figure 4.37. Basic themes to support the organising theme: discussion about the impact of not coming in and experience of consequences Discussion about the impact of not coming in to school and the experience of consequences was another organising factor which emerged in five interviews; this was evidenced by the two basic themes illustrated in Figure 4.37. In terms of discussions about the impact of not coming in, it was reported that Leah was made aware about the potential consequence of prosecution; Leah also experienced the impact of her mother being prosecuted for her non attendance on two occasions. The attendance officer hypothesised that Leah's readiness to realise that she (Attendance Officer) was not going to go away and that she "legally had to engage in something" was beneficial. Leah stated that she was aware that her mum was worried about her non attendance and said, "I didn't want my mum getting in trouble all the time over me". The pressure from the local authority was another basic theme which supported the organising theme about the impact of non attendance. For example the attendance officer keeping in touch with the family was suggested by the attendance officer and the learning mentor in the primary school as important in keeping the family on track. The learning mentor in the primary school for example hypothesised whether the risk of a fine during Leah's time at primary school helped Leah's mother to "keep on track". However, whilst this was an emerging theme it should be treated with caution because Leah continued to show school refusal behaviours following the first prosecution and also, 136
"avoiding prosecution" was identified as a factor as something which might have led to more success (see Section 4.3.3). Organising theme: assessment of need Try and understand and address the cause of school refusal behaviours Supporting and addressing health needs Figure 4.38. Basic themes to support the organising theme: assessment of need Assessment of need was an organising theme supported by the basic themes listed in Figure 4.38. Trying to understand and address the cause of the school refusal emerged from two interviews as something that professionals viewed as important because this ensured that any problems were identified and addressed quickly. This was suggested by the attendance officer to be something which helped maintain Leah's attendance in primary school when she first started to experience difficulty. The attendance officer stated that it was "manageable" in the small environment of a primary school and that it was "much easier" to sort out, "because a primary school is so much smaller than a high school we could identify things quickly". Identifying and supporting Leah's health needs were identified as factors in supporting her physical and mental health. It was reported that Leah received a diagnosis of obesity and hypothyroidism. She was prescribed medication and attended the MEND programme to support her to manage this condition and to support weight loss. Leah's mother explained how Leah lost 2 stone 8lb in 6 months. She explained how Leah previously used to say that she thought that people were staring at her and said Leah "rarely left the house". She added that Leah would sleep too much in the day and said that she would have panic attacks at least four times a week. As identified by the attendance officer, the diagnosis explained why Leah felt tired all the time. An improvement in Leah's health was reported to coincide with her attendance at the vulnerable pupil unit and improvement in her self worth and confidence. 137
Organising theme: collaborative working between professionals Professionals working collaboratively Communication between staff Figure 4.39. Basic themes to support the organising theme: collaborative working between professionals The collaborative approach with professionals was also an organising theme which emerged from interviews with professionals, supported by the basic themes: professionals working collaboratively and communication between staff as illustrated in Figure 4.39. For example, in terms of working collaboratively, it was recognised that it was helpful having professionals coming together and working as part of a team because this meant that people were working in cohesion and that they were also communicating consistent messages with parent and Leah. Effective communication and collaboration between professionals was also suggested to support effective intervention. The attendance officer and teacher from the vulnerable pupil unit talked about the benefit of the attendance officer communicating with the teacher at the vulnerable pupil unit, informing her about Leah's history and needs to inform support. Also, the collaborative approach with professionals referred to the communication and approach that professionals working with Leah had with other professionals e.g. school staff. The learning mentor in the secondary school for example, explained how she had the respect of staff members and how this was important in communicating with them and helping them to understand Leah's needs. For example, she said, I think it was important for them to see the bigger picture 'cause they were like, `well she needs to be in this lesson now', you know, and if you say, `well look we've had a bit of a bad morning, she needs cajoling along', and they would take on board what I said (Learning Mentor in the secondary school). She explained how it was helpful to communicate areas of need and concerns that Leah had with teachers, for example, if there were any concerns about seating arrangements. 138
Organising theme: taking an interest in the young person as a whole Taking an interest in young person as a whole and treating with respect Personalised rewards based on interests Young person aware professionals trying to help, knew what they were trying to do and why Figure 4.40. Basic themes to support the organising theme: taking an interest in young person as a whole Taking an interest in the young person as a whole was supported by three basic themes as evidenced in Figure 4.40. As illustrated in Figure 4.40, one of the basic themes identified was taking an interest in Leah as a person and treating her with respect. This was something which emerged in the interview with Leah herself and the teacher from the vulnerable pupil unit. The teacher for example, said that she thought that talking to Leah and, "viewing her as a whole person. As somebody who's important as a person not just a subject or a student" (Teacher from vulnerable pupil unit), was important and suggested that this may have been helpful in developing Leah's "self perception". Comments made by Leah suggested that people talking to her and treating her with respect supported the development of positive relationships with her. Personalised rewards based on interests were things which the learning mentor in both the primary and secondary schools thought were helpful in communicating to Leah that they were interested in her, "rewards personal to her. Things that she likes you know. So if she was into flower fairies I would make sure that we found something" (Learning Mentor in the primary school). Similarly, it was suggested that communicating interest was also done through professionals working together and involving Leah in meetings. It was suggested that this communicated to her that it was a "team effort" for her and that people were doing this for her because they were interested in her and wanted to help; this was another basic theme as illustrated in Figure 4.40. 139
Organising theme: availability of key adult Availability of key adult Regular contact with key adult Figure 4.41. Basic themes to support the organising theme: availability of key adult The availability of the key adult was another organising theme made up of two basic themes (Figure 4.41). The availability of the key adult in the primary and secondary school was a factor highlighted to be particularly important in supporting Leah while she attended those provisions. Professionals in those settings explained how it was important for Leah to access support when required and for them to be there when needed. The learning mentor in the primary school for example talked about having someone who Leah could talk to and the 1:1 support which "could be whenever she needed it". In facilitating access, the data suggests that it was important that Leah knew where she could access the key adult. The learning mentor from the secondary school expressed the view that it was important for Leah to know where she could access the key adult throughout the day but particularly at break and lunch times. For example she said, "I think being there at break times and being in that room if she needed to come between lessons if there was something maybe that was going to be an issue". Whilst the availability of the key adult was identified as beneficial as and when required, regular contact was another basic theme which emerged. The regularity of contact and 1:1 support was also described to be helpful for example, as hypothesised by the learning mentor, in developing trust and in building confidence. Organising theme: believing in young person Parent and professionals believed in young person Figure 4.42. Basic themes to support the organising theme: believing in young person Believing the young person was supported by a single basic theme as illustrated in Figure 4.42. Leah placed emphasis on professionals and adults believing in her which was supported by both her mother and two professionals. She talked about how her mother believed that she was able to reengage with education and said how she, "just stuck with me like she never give up on me even when I used to wag the school she never give up on me" (Leah). 140
Leah also spoke about the attendance group that she was part of in primary school and said, "she [Learning Mentor] believed in you that you could do it". Across the interviews, reference was made to Leah's placement in the vulnerable pupil unit and the fact that professionals gave her a chance to attend this provision. Leah associated this opportunity with belief from professionals in her ability to succeed. For example, when talking about the current attendance officer, Leah stated, "she believed in me but [Previous Attendance Officer] didn't. She knew that I could do it so that's why I think she gave me the chance" (Leah). Organising theme: positive nurturing approach Positive nurturing ethos Modelling positive environments and relationships with adults in the vulnerable pupil unit Figure 4.43. Basic themes to support the organising theme: positive nurturing approach A positive nurturing ethos was another organising theme which emerged in the dataset with two supporting basic themes as shown in Figure 4.43. For example, four participants talked about the benefit of the "nurturing" ethos and environment in the vulnerable pupil and the small groups of which Leah was part when she attended primary and secondary school. Linked with this was the role of the key adult in nurturing her. For example, as highlighted by Leah, "if any of us in the school like felt upset or you needed something then she [Learning Mentor] would take us in this little room on our own and speak to us and make people feel better". Additionally, modelling positive environments was a basic theme which also supported the positive nurturing approach as illustrated in Figure 4.43. The teacher from the vulnerable pupil unit talked about the benefit of modelling positive relationships and modelling a calm, relaxing environment. The teacher made reference to the "stressful" environment that existed within the family home and how Leah may have limited experiences of positive relationships with adults. The teacher explained how having an environment which enabled her to see, "that adults you know can be actually quite rational and reasonable people... and see that things can be actually quite calm and normal is probably a really good thing for her" (Teacher in the vulnerable pupil unit). 141
Organising theme: make a positive contribution Give the young person choice and control Increased participation out of school Figure 4.44. Basic themes to support the organising theme: make a positive contribution Enabling Leah to make a positive contribution appeared as an organising theme in the dataset in terms of increased participation out of school and having choice and control as shown in Figure 4.44. Leah for example, attended the youth club where she engaged in activities such as cooking and arts and crafts and going on trips. Giving her choice and control over the types of activities that she completed in the vulnerable pupil unit or in primary school was something which was reported to have been helpful. The teacher from the vulnerable pupil unit for example, explained the benefit of giving young people a sense of control if they are experiencing anxiety for example, ....and I suppose feeling in a position of control as well so that if things are making you feel anxious or that you're really not enjoying them or that you don't understand them that you can take a step back from that and you're not blindly forced to do things (Teacher vulnerable pupil unit). 4.3.3 What might have led to more success or earlier success? This section describes themes which might have led to more or earlier success for Leah. Many of these ideal factors have been identified as factors associated with success and have thus been discussed in section 4.3.2. As explained, factors were discussed in relation to three different provisions. Therefore some of the factors which were reportedly associated with success were evident in some settings and not others; professionals working in settings where such factors were not evident may thus have highlighted these as ideal factors. Additionally, some of the ideal factors are based on developing the factors associated with success further. Again, organising themes in relation to this research question are presented in order of prominence. 142
Organising theme: access to specialist services and effective collaborative working to meet needs Effective working and communication between the vulnerable pupil unit and secondary school Multiagency approach with professionals working collaboratively towards a common goal Regular involvement from professionals Effective links with agencies and information sharing Figure 4.45. Basic themes to support the organising theme: access to specialist services and effective collaborative working to meet needs Access to specialist services and effective collaborative working to meet needs was an organising theme with four basic themes as illustrated in Figure 4.45. As previously stated, professionals recognised that working as part of a team and in cohesion was helpful. However, developing multi-agency working by ensuring access to specialist services and ensuring effective collaborative working were factors identified as something which may have led to more success. In terms of effective working between the vulnerable pupil unit and the secondary school, the teacher at the vulnerable pupil unit and Leah's mother for example discussed how it would have been helpful to have had a "more integrated approach", with more involvement from the secondary school. Discussions identified that Leah was still on roll at the secondary school and that they used to send work to the vulnerable pupil unit for Leah to complete. However, the teacher at the vulnerable pupil unit said that Leah would have benefitted from the secondary school sending a range of work and in ensuring that it was challenging and engaging for Leah to promote her engagement in learning. Leah's mother added that it would have been helpful if the secondary school had sent work home for Leah to complete when she was not attending any provision. The teacher at the vulnerable pupil unit highlighted that she was an English teacher and whilst she covered other subjects in the vulnerable pupil unit she said that knowledge and expertise from subject teachers would also have been helpful; for example, in "levelling work", identifying how it could have been improved and in supporting the vulnerable pupil unit's understanding of expectations and targets in subjects areas, "schools could provide 143
us with more insight into what's expected for different levels and what sort of levels she should be working at in other subjects" (Teacher in the vulnerable pupil unit). Discussions with the senior practitioner nurse (CAMHS) focused around the benefit of a multi-agency approach with professionals working towards a common goal, the second basic theme as illustrated in Figure 4.45. It was suggested that it would have been helpful to have developed a coordinated plan so that professionals were clear about who was doing what and that it would be helpful in ensuring professionals stayed on top of what they were doing and not letting it drift. As stated by the learning mentor in the primary school, I think I would definitely have gone down the family support route with Mum and got agencies involved with .....I just think about all the different agencies out there and I just think now those that would have helped the family... Regular involvement of professionals was the third basic theme as shown in Figure 4.45 which was reported to be important in keeping professionals on top of the case and not letting things drift. In terms of the basic theme of effective links with agencies and information sharing, the senior practitioner nurse added that a multi-agency approach would be helpful in supporting information sharing and supporting understanding of need. The learning mentor in the primary school also highlighted that effective collaborative working would have been beneficial in supporting sign posting. The senior practitioner nurse described how it would have been helpful if there had been pathways between education and CAMHS so that children and young people like Leah with mental health needs could be "picked up sooner". Also, she highlighted how such involvement might have ensured that prosecution was avoided. 144
Organising theme: additional support to meet the family's needs Family support Family support plan with targets which are regularly reviewed Developing parenting skills Support from extended family Figure 4.46. Basic themes to support the organising theme: additional support to meet the family's needs Additional support to meet the family's needs was another organising theme which reportedly would have been beneficial for Leah; the basic themes supporting this are detailed in Figure 4.46. Firstly, all professionals and Leah's mother reported that family support would have been helpful. Leah's mother said that she would have liked a family support worker to support the family's needs and work through the stressors that they were experiencing. Similarly, she said that she would have liked additional support in making contact and liaising with agencies. As highlighted by the attendance officer, it is helpful for families to know who is who, what their roles are and what they can do if there is a difficulty. This links back to the previous themes which have discussed Leah's mother's confidence. It is likely that she would have liked support in making contact with agencies because this was something with which she lacked confidence. As identified by Leah's mother and the attendance officer, recognising and addressing Leah's mother's needs would have been helpful. For example, Leah's mother said, "but what previous attendance officer didn't realise was that I had problems as well..... you know with particularly everything else that was going on at home as well you know and worrying about her being at school" (Parent) and, as stated by the attendance officer, "I think it's about addressing what her needs are because all the time we're constantly looking at what Leah's needs are" (Attendance Officer). Following the family support model and having a family support plan in place to meet the family's needs was another supporting basic theme. For example as stated by the learning mentor in the primary school, I think now looking at school systems now and um the things that are in place, definitely family support, instead of the attendance meetings I think I would 145
definitely have gone down the family support route with Mum and got agencies involved Similar to the case of Amy, developing parenting skills emerged as something which might have been helpful. Practitioners shared that ideally Leah's mother would have benefitted from a parenting course to support her with parenting strategies, developing routines and in providing opportunities to meet with other parents that she could relate to; as highlighted by the learning mentor in the primary school a parenting course would have been helpful for her in, "not feeling like she's on her own you know, lots of people have these problems" (Learning mentor from the primary school). The learning mentor in the primary school however, also talked about how ideally she would have liked to have engaged Leah and her mother in the nurture group provision and how this might have been helpful in problem solving and developing routine. Finally, as highlighted by the attendance officer, having support from the extended family might have been beneficial in supporting the family and in promoting a more positive view of education. Organising theme: earlier identification and assessment of need and intervention Access to alternative provision earlier Earlier identification of needs Holistic assessment to inform intervention Figure 4.47. Basic themes to support the organising theme: earlier identification of need and intervention Earlier identification and assessment of need and intervention was an organising theme evidenced by three supporting basic themes (Figure 4.47). For example, earlier identification and assessment of need was highlighted as something which may have led to Leah re-engaging with education sooner. Leah was out of education for nearly two years and her mother, the attendance officer and the teacher at the vulnerable pupil unit suggested that it would have been helpful to have made the family aware of the alternative provision and made a referral much sooner. However, the attendance officer highlighted that the local authority would need to have had provision which could have met her needs at an earlier age. As highlighted by the attendance officer, "the difficulty 146
we've got is resources in that we weren't able to refer at a younger age 'cause they weren't able to take her at that time" (Attendance Officer). Earlier identification of needs and a holistic assessment to inform intervention were basic themes which supported this organising theme. In particular, the senior practitioner nurse reported that an earlier identification of mental health needs would have been helpful. The attendance officer identified that it would have been useful to have had as much information as possible as to what Leah's and the family's needs were sooner. A holistic assessment such as the CAF was identified by the senior practitioner nurse as something which might have facilitated this understanding, "it's not being treated within isolation...it's looking at the bigger picture" (Senior Practitioner Nurse). Additional ideal (organising) themes which are supported by a single basic theme Parent's engagement and openness to advice, support and change Reintegration planned according to need Nurture group to build on interests and develop self concept and self worth Subject specific support Avoid prosecution route Listen to young person Making learning meaningful and relevant Key adult who is a constant Positive relationship with attendance officer earlier Collaboratively developing realistic targets and strategies and giving young people more choice and control Additional opportunities to spend time with peers who can relate to Avoid comparison to other family members who have refused school Figure 4.48. Additional ideal (organising) themes which are supported by a single basic theme Figure 4.48 shows the additional ideal organising themes, supported by a single basic theme. The factors which might have led to additional success will not be discussed in detail because many of these build on what has already been discussed in Section 4.3.2, 147
for example to do more or less of something. As evident in Figure 4.48, more ideal factors were identified in the case of Leah than were identified in the case of Amy. This could be because Leah's needs were evident in a number of settings, one of which had broken down. Therefore some of the ideal factors identified by some practitioners stemmed from the challenges experienced when Leah attended this provision; many of these ideal factors reportedly occurred in more successful placements. Organising theme: parent engagement and openness to advice and support Leah's mother's engagement and openness to advice and support and change was identified by the attendance officer as something which would have been helpful; for example, engaging with services, attending appointments and being honest with professionals when plans/interventions were not working. Associated with this was Leah's mother's value of education. The teacher at the vulnerable pupil unit reported that it may have been helpful to have supported Leah's mother to recognise the importance of education so that this could have been communicated to Leah. Organising theme: reintegration planned according to need Being more flexible and ensuring sufficient time for reintegration was identified by the attendance officer and learning mentor in the secondary school as something which Leah would have benefitted from. It was suggested that the secondary school staff expected her to return to a full time timetable too soon. The learning mentor in the secondary school for example said, "I just felt as though she needed a bit more time.... to the build up to a full time timetable" (Learning Mentor in the secondary school). Organising theme: key adult who is a constant Linked with reintegration planned according to need was the importance of having a key adult who was a constant. The learning mentor secondary school for example, explained how Leah's reintegration to the full time timetable coincided with when the learning mentor in the secondary school's role changed. The change in role meant that Leah not only had to attend full time, she lost her key adult. Organising theme: avoid prosecution route The attendance officer and the senior practitioner nurse identified that it would have been helpful to have avoided the legal route, "With hindsight it probably would have been better not to have done that" (Attendance Officer). 148
Organising theme: collaboratively developing realistic targets and listening to the young person Leah highlighted that she would have found it helpful to have some control over the hours that she did at secondary school and that if she was finding it hard, for school to listen and respond to what she was saying. She added that she would have liked the school to have listened to her and responded to what she was saying, particularly with regard to timetabling and her hours. Organising theme: additional opportunities to spend time with peers with whom she can relate Organising theme: making learning meaningful and relevant This was highlighted by the learning mentor in the primary as something that Leah would have benefitted from e.g. through the creative curriculum which they now adopt in the primary school and providing her with, "real experiences so that she gets enthused by what she's seen" (Learning Mentor in the primary school). This is something which Leah reportedly accessed in the vulnerable pupil unit. 4.3.4 Interaction of factors. Similarly, as in the case of Amy, there appeared to be an interaction of factors in the case of Leah. For example, as highlighted by the attendance officer, "I think it's all been about the relationships and the confidence" and that this appeared to affect other factors such as meeting the needs of the family, engagement with services and supporting collaborative working for example. Many other interactions could be hypothesised which will be discussed in Chapter 5. 4.4 Cross Case Synthesis Comparison was made between the organising themes identified in Case 1 (Amy) and Case 2 (Leah) in terms of the commonalities and differences. Commonalities and differences are outlined below according to the research question. 4.4.1 Comparison of research question 1: What factors were perceived to be effective in supporting children and young people who have anxiety/fear which is leading to school refusal behaviours and why? 149
Common and different themes which emerged from the two datasets for research question 1 are illustrated in Table 4.1. 150
Table 4.1.Common and different themes which emerged from the two datasets for research question 1
Common Organising Themes Personality, skills and experience of professionals (Flexibility and) availability of key adult Developing feelings of safety, security and sense of belonging
Additional Organising Themes in Case 1 (Amy) Early identification and assessment of need to inform intervention Multi-agency approach
Additional Organising Themes in Case 2 (Leah) Assessment of need Collaborative working between professionals
Encouragement and positive attention
Believing in young person
Flexible and individualised approach to ensure the young person is prepared and able to access learning Discussion about the impact of not going to school (and the experience of consequences)
Whole school approach Not focusing on/reinforcing the absence Avoid harsh consequences
Regular monitoring of progress Positive nurturing approach
Developing the young person's understanding of thoughts, feelings and behaviour
Supporting social interaction and communication
Aspiration and motivation
Persistence and resilience of professionals
Taking an interest in young person as a whole
Increased confidence, self worth and value
Make a positive contribution
Positive experiences
Meeting the needs of the family
Positive relationships and approach with home
151
As illustrated in Table 4.1, there was more commonality than difference in the cases because as shown in Table 4.1 fourteen organising themes were common across cases. An additional commonality between the two cases was the interaction of factors and that some factors did not appear to be successful in isolation. The data in both datasets for example highlighted a number of factors associated with success which appeared to be interacting as described in Sections 4.2.4 and 4.3.4. As previously stated, the interaction of factors will be discussed in Chapter 5. Also, there were more similarities in the differences than might be apparent from looking at Table 4.1. For example, the additional themes which emerged in the case of Leah were very similar to some of the themes in Amy's dataset, however, these were sufficiently distinctly different for them to be considered a common theme. This is discussed below. Assessment of need appeared as a theme in the case of Leah. However, it was recognised that early identification of need and intervention (a theme with Amy) would have been beneficial for Leah, for example, in referring to alternative provision sooner because, as previously noted, Leah was out of education for approximately 2 years. Additionally, the collaborative working between professionals was something which professionals thought was helpful in supporting Leah's needs. However, professionals reported that ideally access to specialist services and a joined up approach would have been beneficial, for example in linking with CAMHS. This could explain why collaborative working was not as prominent in the dataset for Leah as it was for Amy. Believing in Leah was a key factor; again this was similar to but different from the theme of "encouragement and positive attention" in the case of Amy. The benefit of not reinforcing/ focusing on the absence and avoidance of harsh consequences were highlighted as beneficial by those involved with Amy. This did not occur with Leah; as discussed, Leah's mother was prosecuted on two occasions. However, avoiding the prosecution route was identified as something which might have led to more success for Leah. Other factors which emerged from the dataset as reportedly beneficial for Amy were the whole school approach, developing the young person's understanding of thoughts, feelings and behaviour and persistence and the resilience of professionals. These did not emerge out of the dataset for Leah. It is important to recognise that this does not mean that they did not occur or that they were not supportive factors for Leah. 152
4.4.2 Comparison of research question 2: What might have led to more success or earlier success in the effective support of the school refusal behaviour? Themes which emerged from the two datasets for research question 2 are listed in Figure 49. The ideal themes identified in the two datasets have been combined because these are essentially speculative and are therefore not as close to the data as those which were reportedly associated with success. Ideal factors which are common to both datasets are marked with (2) and those which were only evident in one dataset are marked with (1). Organising themes; (2) refers to commonality in the datasets and (1) exceptionality Earlier identification and assessment of need and intervention (2) Access to specialist services and effective collaborative working to meet needs (1) Better connections with services in different local authorities (1) Avoid prosecution route (1) If not successful investigate alternative provision (1) Avoid comparison to other family members (1) Positive relationship with attendance officer earlier (1) Key adult who is a constant (1) Additional support to meet the family's needs and developing parenting skills further (2) Parent's engagement and openness to advice, support and change (1) Additional opportunities to spend time with peers who the young person can relate to (2) Further opportunities to join groups and make new friends (1) Subject specific support (1) Reintegration planned according to need (1) Collaboratively developing realistic targets and strategies and giving young people more choice and control (1) Listen to young person (1) Additional opportunities to develop self worth (2) Making learning meaningful and relevant (1) Figure 4.49. Ideal themes which emerged in the two datasets for research question 2 153
In terms of what might have led to more or earlier success, themes emerging from both interviews focused on earlier identification and assessment of need and intervention. Many of the ideal factors identified in both datasets focused on further developing factors which were already reported to be associated with success. In addition to earlier identification and assessment of need and intervention, other similar factors related to additional opportunities to develop parenting skills; parenting courses for example were identified in both datasets as something which might have been helpful. An additional factor which might have been helpful for Amy was better connections with services in different local authorities. This was not an issue which arose when supporting Leah because Leah, unlike Amy, lived in the borough. Through looking at the ideal factors in Figure 4.49, it is clear that investigating alternative provision for Amy might have been beneficial had there not been such success in reengaging her within the mainstream secondary school. Given the success of the alternative provision for Leah this therefore suggests the value of considering alternative provision. 154
Chapter 5: Discussion 5.1 Introduction The following chapter discusses the organising themes presented in Chapter 4 in response to the research questions which sought to identify factors associated with successful involvement in cases of school refusal behaviour: 1 What factors are perceived to be effective in supporting children and young people who have anxiety/fear which is leading to school refusal behaviours, and why? 2 What might have led to more success or earlier success in the effective support of the school refusal behaviour? Chapter 4 highlighted fourteen common factors (organising themes) in the cases of Amy and Leah to be associated with successful intervention. In addition to the identified common factors, it was also apparent that there were more similarities than differences in the additional organising themes for each case. This suggests that there was a high degree of commonality between the two cases of school refusal behaviour in terms of the factors which were associated with success. In addition, a commonality between the two cases was the interaction of factors because participants acknowledged that factors did not appear to be successful in isolation. It was apparent that both cases were complex and that intervention was not a `quick fix'. Significant time and resources were required to support the young people with a number of strategies implemented at a number of different levels in both cases. Given the degree of commonality between the two cases and the overlap between research question 1 and research question 2, the findings are discussed collectively throughout this Chapter. In trying to synthesise the organising themes for discussion, the researcher noted that factors (themes) could be grouped according to different levels which appeared to interact with each other: · psychological factors at the level of the child · factors supporting the psychological factors at the level of the child · factors supporting the family · role of professionals and systems · context 155
Given the large volume of data and number of identified themes, the researcher thought that grouping factors (themes) into these levels would provide a useful mechanism for structuring the discussion. However, recognising the significance of the interaction between factors and the relation to ecological systems theory, the researcher recognised the need to acknowledge the interaction of factors when discussing the findings. For the researcher, an interaction of factors at a number of different levels related to the multifaceted components of Bronfenbrenner's (1979) ecological systems theory outlined in Section 2.8.7. As stated in Section 2.8.7 the ecological perspective of behaviour looks at behaviour as a system embedded within a specific context (Ayers, Clarke & Murray, 2000). Within an ecological model there are different levels of a system which directly impact upon one another. This perspective suggests that behaviour is a function of the person-environment interactions and therefore behaviour needs to be understood within context. Bronfenbrenner's ecological systems theory has therefore influenced the synthesis of the findings because it relates to the various levels and complexity of practice which were represented in the cases of Amy and Leah. The researcher proposed a synthesis which showed a conceptualisation of successful reintegration, incorporating the five levels listed above and the influence of interacting systems. Given the influence of socio-cultural factors and the interaction between systems the synthesis is titled the "ecological model of successful reintegration". The model recognises the number of systems surrounding a young person which interact and influence their development and illustrates how changes in these systems led to positive outcomes for both young people. This model contains all the organising themes, those which were common and those which were specific to individual cases (illustrated in Table 4.1). Ideal themes which built upon these factors were not included in the model to prevent duplication. However, those which were distinct from the themes identified as facilitative factors were incorporated. In section 5.2 an overview of the model is presented. This is then used to provide a structure for discussing the findings in relation to the previous literature. Discussions about the implications of the research for those working with children and young people who show school refusal behaviours and the implications for future research are then discussed. The chapter concludes with reflections on the research process. 156
5.2 Ecological Model of Successful Reintegration The ecological model of successful reintegration, illustrated in Figure 5.1, includes organising themes common to the two cases and those relevant to a single case. Ideal organising themes were incorporated into the model if these were distinctly different from the identified facilitative factors. As stated in Section 5.1 and illustrated in Figure 5.1, themes were organised into five spheres: · psychological factors at the level of the child · factors supporting the psychological factors at the level of the child · factors supporting the family · role of professionals and systems · context At the core of the model are psychological factors at the level of the child. This forms a triangle at the core because, for the researcher, these psychological factors i.e. developing feelings of safety, security and a sense of belonging, increasing confidence, self worth and value and aspiration and motivation, resonate with Maslow's (1943) Hierarchy of Needs. Also, as highlighted in Section 5.2, in both cases there was an interaction of factors with many of the organising themes related to the development of these psychological factors. Therefore, analogous to Bronfenbrenner's (1979) ecological systems theory, the other factors are organised into four surrounding spheres which can interact and impact upon each other to scaffold and support the child's psychological needs at the inner core. As shown in Figure 5.1, these four spheres consist of factors supporting the psychological needs, factors supporting the family, the role of professionals and systems, with the outer sphere containing the contextual factors which were evident from the research in influencing effective intervention. Congruent with the ecological perspective that behaviour is embedded within context, these contextual factors i.e. family context, school context, local context, socio-legislative context and culture, were included as an outer layer because they reportedly influenced the other systems and effective reintegration. This model will now be used to structure discussions about the research findings and their relation to previous literature as findings will be discussed according to the five spheres. 157
Figure 5.1. Ecological model of successful reintegration 158
5.2.1 Psychological factors at the level of the child. The inner core of the model consists of psychological factors at the level of the child i.e. developing feelings of safety, security and belonging, increased confidence, self worth and value and aspiration and motivation. These factors emerged in both cases and were highly prominent. For the researcher, this resonated with Maslow's (1943) Hierarchy of Needs. In both cases, developing feelings of safety, security and belonging was the most prominent of these psychological factors so this was placed at the bottom of the triangle because it could be argued that feelings of safety, security and belonging would take precedence over the other needs. As stated by a learning mentor, it is important for children and young people to feel safe and secure because as in the case of Leah, young people will not be able to concentrate and learn if they are worried about how they may be perceived by others and what others might say or think. Not feeling safe, not feeling as if they belong and worrying about what others think, may therefore affect young peoples' confidence and self worth for example to participate in class. It could be argued that this might affect young people's subsequent aspiration and motivation. In terms of safety, security and belonging, it appeared to be important for both girls to have an environment that they could access which made them feel safe, for example access to Inclusion for Amy and small group opportunities for Leah. Feelings of belonging at home and school were important too. For example, by being able to interact with peers that they could relate to and feeling part of a group of friends was important for both at home and at school. This therefore supports Kearney (2008) who suggested that the school climate and connectedness for example, class size and the extent to which students feel, "safe, accepted, valued and respected at school" (Kearney, 2008, p. 459) was associated with school attendance. Additionally, the need to develop a sense of self worth and confidence was important. It was reported that both girls had started to have positive feelings about themselves and that they started to develop confidence in their own abilities to learn and achieve. Leah also reported increased confidence in interacting with peers. For both girls, it also appeared to have been important for them to feel valued and to have developed a sense of identity. Aspiration and motivation is at the peak of the triangle and could be regarded as Maslow's (1943) "self actualisation". Both girls developed an interest in obtaining good grades and achieving at school and both talked about future goals and careers. Leah in particular 159
talked about how she wanted to get back into education and how she "helped herself". This therefore, suggests that the girls wanted to achieve their potential and suggests that there may have been a role of cognition. This adds some evidence to support Maric, Heyne de Heus, van Widenfelt and Westenberg (2011) who discussed the role of cognition in school refusal behaviours. For example, as discussed in Chapter 2, they discussed how negative automatic thoughts concerning personal failure are often experienced by children who have these needs. This was previously the case with Amy as she explained how previously she, "did not think she could do very much" but how she now "feels better about myself like I can do more". This therefore highlights the influence of positive thinking and the subsequent confidence and aspiration. 5.2.2 Factors supporting the psychological factors at the level of the child. As illustrated in Figure 5.1 the second sphere consists of factors which appear to support the psychological factors directly. For example, factors identified within this sphere appear to develop feelings of safety, security and a sense of belonging, confidence and self worth and aspiration and motivation. In terms of developing feelings of safety, security and belonging, the positive nurturing approach adopted by the educational provisions was highly prominent in both cases. It was reportedly beneficial that the young people had a key adult who offered a stable relationship and who was a "constant" and that it was beneficial for the young people to feel cared for in a calm and relaxing environment. This supports anecdotal reports from Kearney and Bates (2005) which highlighted the benefit of assigning adult mentors and in promoting a positive and inviting school atmosphere. Factors which were associated with developing self worth, value and confidence included providing young people with a flexible and individualised approach to ensure that they were prepared and able to access learning, having reintegration planned according to need and supporting specific areas of need such as social communication skills. It could be suggested that this provided them with increased opportunities to succeed which may have been beneficial in supporting feelings of competence and mastery and subsequently in improving confidence and self worth. These factors support Kearney and Bensaheb (2006) and Kearney and Bates (2005) who, following anecdotal reports identified the following as beneficial in supporting school refusal behaviour: gradual reintegration where classes are altered as appropriate, frequently reassessing for learning needs, providing appropriate and tailored instruction and offering flexible school based responses. In 160
addition, the encouragement and positive attention emerged in the data as supporting factors. This also supports Kearney and Bates (2005) who noted the importance of frequent recognition and reward for school attendance. Positive attention and encouragement may reinforce progress and success which may subsequently support the development of positive feelings in the young person. In addition, providing positive experiences at home and school and enabling the young person to make a positive contribution were reportedly beneficial in increasing the young people's value of self and self worth. For example, opportunities for choice and control and enabling the voice of the young person to be heard reportedly enabled the young person to make a positive contribution. In addition, positive experiences at home included spending time and doing things together as a family. Positive experiences at school and home included positive interaction with peers through sharing common interests and engaging in activities. This supports Kearney and Bates (2005) who identified participation in extracurricular activities as beneficial in supporting children and young people who show school refusal behaviour. Taking an interest in the young person as a whole was also an emerging theme in both interviews and relates to the development of self worth, confidence and value. For example, factors such as talking to the young people about their interests, valuing and respecting them and treating them as individuals were associated with success. This may have been important in communicating to them that they are valued and in supporting self worth. Similarly, regular personalised feedback, regular contact with the key adult and being personally "noticed for positive reasons" were identified as facilitative factors. This was prominent in both cases and in addition, professionals believing in the young people and providing personalised rewards to make them feel "special" was supported in both cases. This therefore may have led to the development of more positive thoughts about themselves. Another factor which links with the development of self worth and self value was developing the young person's understanding of thoughts, feelings and behaviour. Reframing negative thoughts to think more positively and developing an understanding of thoughts, feelings and behaviour links with the research on cognitive behaviour therapy discussed in Section 2.8.2. Helping the young person to reframe and think more positively may have been beneficial in improving self worth and it may have been beneficial in developing feelings of safety and a sense of belonging in situations where the young person held negative thoughts. For example, providing Amy with information to help her 161
understand that lupus was not "a death sentence" and helping her to reframe her mother's health needs may have led to more positive thoughts and consequently the promotion of stability. A number of factors in this sphere also relate to motivation and aspiration. The organising themes of taking an interest in the young person, enabling the young person to make a positive contribution and providing positive experiences, including providing opportunities for success and making learning relevant and meaningful, are highlighted in the literature as factors which are associated with motivation (e.g. Ames, 1992). 5.2.3 Factors supporting the family. Factors supporting the family were highly prominent in both cases and formed the next sphere of the model. The importance of meeting the needs of the family and providing parenting support supports previous research for example Lyon and Cotler (2007) and Kearney and Silverman (1995) who highlighted how parents/carers can influence their child's attendance and Lauchlan (2003) and King et al. (2001) who reported that family support may influence the effectiveness of intervention. In Case 1 and Case 2 factors supporting the family appeared to be beneficial in supporting collaborative working and in developing feelings of safety, security and a sense of belonging in the young person. In terms of effective collaborative working it appeared to be beneficial to develop a positive relationship and approach with the family, communicating with them regularly, particularly about things that were going well. This supports Kearney and Bates (2005) who identified that providing feedback to parents was a helpful factor in reducing absenteeism. The researcher would suggest that without positive relationships and approach with home and parents' openness and engagement to support change, it is unlikely that they would engage with services and support. This was highly evident in the case of Leah because when the family did not have a positive relationship with the attendance officer they did not engage with services. It was reported for example, that having the positive relationship with the new attendance officer gave Leah's mother the confidence to seek support from professionals and attend meetings. It is also possible that Leah's mother's anxiety and negative feelings about school and the local authority may have transferred to Leah and consequently reinforced Leah's school refusal behaviours. Therefore, the development of positive relationships with Leah's mother may have subsequently helped to break cycles of negativity. 162
In terms of meeting the needs of the family, having the availability and flexibility of professionals for the family and the development of positive trusting relationships were reported to be important in both cases. In the case of Leah, it appeared to be important that her mother had the support of the attendance officer for example, to reassure and relieve her anxieties and to be a key adult whom she could contact if she was experiencing difficulty. Similarly, in both cases identifying and supporting the family's needs and increasing the effectiveness of parenting skills were reported to be beneficial. It could be suggested that supporting the family's needs and the home environment consequently helped to develop feelings of safety, security and stability at home. For example, in the case of Amy, supporting Amy's father with parenting skills coupled with his reflection on the family dynamics, reportedly supported routine and stability at home. It was also reportedly important in the case of Amy to emphasise to the family not to reinforce absences, for example, by not allowing her to engage in positive activities when she was absent; this supports Kearney and Bensaheb (2006) and also Lauchlan (2003) who reported some support for the effectiveness of parent training in contingency management. Whilst, parenting support was identified as beneficial in both cases, additional support to develop parenting skills, for example, through a structured parenting programme was identified as a factor which might have led to more success. 5.2.4 The role of professionals and systems. The next sphere contains the role of professionals and systems in supporting children, young people and families and includes early identification of need and intervention. This sphere surrounds factors supporting the needs of the family and child because it was hypothesised that factors within this sphere supported the factors in the inner spheres. For example, it was suggested that early identification of need and intervention was important in ensuring that children, young people and families' needs were identified and addressed, with the role of professionals and their approach in providing scaffolded support. Early identification of need and intervention was identified in both cases as something that was beneficial supporting Gloucestershire EPS (2001). It was reportedly important, for example, for professionals to gain a full understanding of needs and to use this to inform intervention. This was important in understanding the needs for both the young people and their families. As highlighted in the case of Amy, the parent support advisor thought that the Common Assessment Framework (CAF) was particularly helpful in facilitating a holistic understanding and informing subsequent intervention. Professionals in both cases reported how earlier identification and intervention however, might have led to more or 163
earlier success, particularly in the case of Leah. Professionals reported that it would have been helpful to have made referrals to the Child and Adolescent Mental Health Service (CAMHS) much earlier and to have made a referral to the alternative provision sooner, hypothesising that this might have avoided Leah being out of education for two years. Additionally, as highlighted in Figure 5.1 this sphere contains the role of professionals including the personality, skills and experience of professionals, the flexibility and availability of the key adult and the persistence and resilience of professionals. For example, it was important in both cases for the young people to have access to a key adult as and when required and how it was beneficial that the role of the key adult facilitated their flexibility and availability for the young person. In addition, the persistence and resilience of professionals were also reportedly important in communicating to Amy that she was valued and "worth more than being forgotten about" and also, as highlighted by professionals, this was important given the complexity of school refusal behaviours and that they are not a "quick fix". The researcher suggests that the personality, skills and experience of professionals and their approach scaffolds support to meet the needs of the family and the inner core, "the psychological factors at the level of the child". For example, the skills of professionals could be argued to be helpful in tailoring support to ensure a flexible and individualised approach for the young person so that they are able to access learning. Similarly, their personality, skills and experience could be important in facilitating the positive nurturing approach, taking an interest in the young person as a whole, providing encouragement and positive attention and in providing young people with positive experiences and opportunities for them to make a positive contribution. Many of these factors are congruent with existing literature. For example, Moffitt et al. (2003) following their study, reported that the therapist needed to be flexible in their approach and to adapt to meet the young person's needs. In their studies, Aviv (2006) and Moffitt et al. (2003) for example, reported that the availability of the therapist may be a beneficial factor in supporting reintegration. Additionally, the flexibility and availability of a key adult, the personality, skills and experience of professionals and resilience and persistence of professionals supports the findings of Toplis (2004) who reported how it was helpful for young people to have an adult they could talk to and with whom they could develop a trusting relationship. 164
This sphere also includes regular monitoring of progress, a whole school approach, multiagency working and collaborative working between professionals. This could also be suggested to support the needs of both the young people and families. The whole school approach, whilst only evident with Amy, appeared to be beneficial, because this ensured that professionals had the support from the senior management team to offer a flexible and individualised approach according to need. Also, the whole school approach was reportedly beneficial because the effective communication between staff ensured that teaching staff had an awareness of barriers to learning and consequently they could support access to learning. This approach also supported encouragement and positive reinforcement from a range of school staff members and communicating strategies to staff was reportedly beneficial in ensuring a consistent approach. The importance of the collaborative approach was highlighted in both cases. This included the benefit of multi-agency working in the case of Amy having access to specialist services and effective collaborative working, something that might have led to more success in the case of Leah. In particular, it was reported that access to CAMHS would have been helpful and also, it was reported that it would have been helpful to have had more effective communication and a more integrated approach between the secondary school and the vulnerable pupil unit. The importance of a collaborative approach as stated extended to multi-agency working in the case of Amy. This was not only facilitative in meeting the needs of Amy but also the needs of the family. The importance of collaborative working in supporting assessment of need and intervention was identified in previous literature such as Kearney and Bates (2005), Kearney and Bensaheb (2006) and Lauchlan (2003). Additionally, in the case of Amy it was suggested that it was beneficial to have a key professional managing the case who could be the key point of contact and to liaise with different agencies. This also supports Kearney and Bates (2005), Kearney and Bensaheb (2006) and Toplis (2004). 5.2.5 Context. The findings from both cases suggest that contextual factors might influence school refusal behaviours and intervention, for example: 165
· the socio-legislative context · the local authority context · school context · family situation · culture These factors are detailed in the outer sphere of the ecological model of successful reintegration (Figure 5.1) i.e. the context. However, these are factors which emerged during the interviews when discussing facilitative factors; contextual influences were not explored as part of a research question. Therefore, these factors are not exhaustive; there may be other contextual factors which influenced the school refusal behaviours and successful involvement in the cases of Amy and Leah. Facilitative and ideal themes from a contextual perspective have also been included in this outer sphere as illustrated in the diagram. 5.2.5.1 Socio-legislative context. The socio-legislative context i.e. Section 444 of The Education Act 1996 states that a parent is guilty of an offence if a child registered at a school fails to attend regularly. In Stockshire Borough Council, this means that the attendance officers have a role in enforcing the law. The researcher would question whether this creates tension for intervention and support, particularly because some identified themes contrast, for example, "avoiding harsh consequences and avoiding the prosecution route" with "discussing the impact of not going to school" (this included discussion about the risk of prosecution). In the case of Amy for example, practitioners reported that it was beneficial to avoid the prosecution route and avoid consequences which were too punitive, yet prosecution was discussed regularly in the family support meetings and was reportedly beneficial in highlighting the seriousness of the school refusal behaviours to Amy and her father. In the case of Leah, Leah's mother actually received two prosecutions for Leah's non attendance which the attendance officer said on reflection should ideally have been avoided. As highlighted in Chapter 4, data suggest that the development of positive relationships with the family, meeting the needs of the family and offering a positive nurturing approach were beneficial. However, professionals' role to enforce the law creates challenges and tensions in providing this positive and nurturing approach. Therefore, one could question 166
whether prosecution is too severe for maintaining a supportive intervention role and whether an authoritarian approach is compatible with positive relationships and effective collaborative working. For example, it was evident that the prosecutions made by the previous attendance officer in the case of Leah subsequently affected the working relationships and the family's engagement with services. Developing a balance between a firm and nurturing approach and being able to enforce the law whilst maintaining positive relationships, will therefore require a high level of skill from professionals. Professionals will need to be sensitive to the needs of the family. They will also need to be very sensitive to the interpersonal interactions and recognise that this balance may be different for different children, young people and families. 5.2.5.2 Local authority context. Three factors were identified in relation to the local authority context: the role of the attendance officers, the context of services within the local authority and potential for multi-agency working, and the educational provision available in the local authority. The attendance officer manager and other professionals explained how the attendance officer role had changed from education welfare officer, where there was an emphasis on intervention and support, to attendance officer where there is now a greater focus on prosecution and enforcing the law. This is increasingly becoming the case because, as local authority budgets decrease, there is an increased emphasis on the role of schools in preventative work and supporting early intervention. Changes within the local authority context as a result of the current climate of economic austerity will result in a reduction in the attendance team which will thus limit early intervention and preventative working. Additionally, the context of services within the local authority and the potential for multiagency working influenced the support for Leah and Amy. For example, Section 444 of The Education Act 1996 also states that, The child shall not be taken to have failed to attend regularly at the school by reason of his absence from the school at any time when he was prevented from attending by reasons of sickness or any unavoidable cause (Education Act 1996, Section 444). Therefore, families should not be prosecuted for their child's nonattendance if there are health needs for example. As stated in Chapter 4, having effective links between health 167
and education may have avoided prosecution in the case of Leah and led to more or earlier success if there had been earlier involvement from CAMHS. For example, it was reported that the local authority now has a pathway between CAMHS and Education to ensure that children who have mental health needs receive early intervention and to ensure that prosecution is avoided where appropriate. Such pathways might have ensured that Leah's needs were identified earlier, that she received intervention sooner and that this may have avoided prosecution. Consequently this may have supported the establishment of positive relationships with the family sooner which may have supported effective joined up working. Also, improving systems to facilitate multi-agency working was highlighted in the case of Amy as something which may have led to more success. Amy lived out of borough which meant that access to services was difficult. For example, Amy was required to access health and voluntary aided services in the local authority where she lived; this reportedly presented difficulties in terms of early intervention, multi-agency working and accessing support. It was reported that having similar systems across local authorities or enabling Amy to access agencies within the local authority where she attended school would have been beneficial. This was because professionals were aware of services, knew who to contact and understood services' processes. Being on the border of two neighbouring local authorities was identified as a particular difficulty as it was reported that professionals were less aware of processes and services available in other local authorities. Available provision in the local authority was another element of the context. For example, Leah was able to attend an alternative provision for vulnerable young people. This was reported by a number of participants to have been beneficial for Leah. In the case of Amy, it was reported that access to alternative provision may have been helpful had her return to mainstream education not been effective. As highlighted in Chapter 4, it was suggested by participants that there may need to be an acceptance that not all children can cope with mainstream education and that some may need more individualised support tailored to their needs. However, as stated by the attendance officer, the local authority did not have alternative provision which catered for Leah's needs prior to Year 9; this meant that Leah was out of school for a significant period of time before she could access a place. Therefore the provision available in the local authority had an influence on Leah's reengagement with education. 168
5.2.5.3 School context. Additionally, school structures may or may not facilitate the factors previously discussed. For example, the move to a new school building and the access to the new Inclusion area was described to have, "come at a key time", for Amy because this communicated a "fresh start" and provided her with access to a safe space. Changes in the school structures appeared to have presented a challenge for Leah however. For example, the learning mentor in the secondary school explained how the re-structure in the school presented a significant challenge for Leah when the learning mentor was given a new role in school. This meant that Leah no longer had access to her key adult in school and did not have access to the 1:1 or small group support. At this point Leah was asked to return to a full time timetable. The learning mentor reported that she needed a more gradual reintegration because this transition was too much for her. Consequently, Leah's school refusal behaviours increased. These examples therefore illustrate how school structures can influence successful intervention. 5.2.5.4 Family context. It is important to note that the family context and dynamic is an important element to consider. For example, health needs in the families of both Leah and Amy appeared to influence behaviours. In the case of Leah, her mother's mental health needs reportedly affected their engagement with services and in the case of Amy, her mother's physical needs caused Amy concern and anxiety. Additionally, there was conflict within the families; in the case of Amy, between her father, mother and stepfather and in the case of Leah, between her mother and extended family. These factors therefore may have influenced feelings of safety and security. Also, as highlighted in Chapter 4, Amy was living at home with her three siblings and father but because her father worked nights, the children spent time in three different houses during the week. The learning mentor hypothesised that the children did not know whether they were "coming or going". However, changes to Amy's father's work patterns meant that the children were home more which was suggested to have improved the family routine and increased feelings of stability and security and a sense of belonging at home. 5.2.5.5 Culture. Finally, it is important to recognise the impact of culture and that this might have affected the effectiveness of intervention and influenced school refusal behaviours, particularly in 169
the case of Leah. For example, the attendance officer reported that Leah was from a traveller background. She stated that ideally it would have been helpful to have had support and encouragement from family members but explained the challenge when there were cultural differences in the family with regard to their perception of education, adding that there was a history of non attendance in the family. Her comments supported the DfES (2003) report, "Aiming High: Raising the Achievement of Gypsy Traveller Pupils," which discussed the impact of parental education and aspirations on education. Leah's mother shared that ideally it would have been beneficial for the previous attendance officer not to have made reference to family members who had a history of nonattendance when talking to Leah. In addition to influencing the support from family members, this suggests that culture may have influenced the previous attendance officer's values and interpretations of behaviour and their subsequent approach to Leah. 5.2.6 Summary. This research has explored the perceptions of young people, parents and professionals involved in two cases of school refusal behaviour where there was considered to be professional intervention that was influential in a successful resolution. A range of factors associated with success was identified which are represented in the ecological model of successful reintegration (Figure 5.1). Findings are organised into five spheres with psychological factors at the level of the child at the core of the model, surrounded by factors which support these needs, factors which support the needs of the family, the role of professionals and systems with the outer sphere of the model containing the context. Congruent with an ecological perspective, these facilitative factors can influence each other and need to be understood in context. Kearney and Bates (2005) and Kearney and Bensaheb (2006) identified a number of strategies to support children and young people who show school refusal behaviours based on anecdotal reports as illustrated in Section 2.9. A number of these factors were supported in the present study and have been illuminated throughout this chapter. This research therefore adds empirical evidence to the anecdotal information. 170
5.3 Implications Given the number of factors which were associated with successful involvement, the research has a number of implications for professionals working with children and young people who show school refusal behaviours. To discuss the possible implications of each factor is beyond the scope of this research. The researcher however, will discuss six main implications for involvement with these young people: · assessment and intervention · early intervention · gathering the views of stakeholders · availability of a key adult · collaborative working · time 5.3.1 Assessment and intervention. The researcher suggests that this research has implications for assessment and intervention. As discussed, this research has highlighted the complexity of school refusal behaviours so the researcher would agree with Lyon and Cotler (2007) and Moffitt et al. (2003) that a full case formulation to develop a clear and comprehensive assessment and understanding of behaviour is beneficial in informing intervention. In terms of assessment, in both cases there were a number of factors which might have been influencing the behaviours as discussed. Therefore, the researcher would support the benefit of completing a holistic assessment of need, looking at the systemic and family factors and seeing how they might be initiating and maintaining the behaviours; this is also consistent with Bronfenbrenner's (1979) ecological systems theory. As stated, the parent support advisor suggested that the CAF might provide a useful framework for gaining a holistic understanding of the child; "if [she] was involved in this sort of situation again [she] would definitely go down the CAF route" to gain a full understanding of a child and family's needs. In terms of intervention, the ecological model of successful reintegration (Figure 5.1) illustrates a number of domains where support and intervention may be beneficial. As illustrated in the model, it will be important to think about intervention at a number of levels and recognise the effect of context in effective intervention. Cases of school refusal behaviours as illustrated throughout this research are complex, and what works with one 171
child may not work with another and, as highlighted with the case of Leah, what works with one professional might not work with another. The purpose of this research was not to develop statistically generalisable findings, but nevertheless the research may provide useful information to reflect upon what is working, what is not working and why. The researcher therefore suggests that the ecological model of successful reintegration could be a useful tool to support reflection. For example, this model suggests that successful intervention will be based upon a number of factors at a number of different levels and that there will be an interaction between these factors. Therefore, the researcher suggests that it will be helpful to consider these levels when planning intervention and in particular, to consider whether the child/young person and family needs are being met. When considering the needs of the young person, it might be helpful to consider the psychological factors which are illustrated in the inner core of the model, for example, whether the young person feels safe, secure and like they belong, whether they have confidence, self worth and a positive value of self and whether they have aspiration and motivation. Schools and professionals may then want to think about how they can facilitate the development of these needs by considering factors in the outer spheres. In addition, the research has highlighted the importance of meeting the needs of the family. This was particularly important given the number of familial factors in both cases which were reportedly influencing the behaviours. As stated, meeting the needs of the family appeared to be associated with developing feelings of safety, security and belonging in the child and also appeared to be important in supporting collaborative working. In addition, access to parenting courses was recognised as something which might have led to further success in both cases as it was reported that this might have supported the family's needs further. In summary therefore, meeting the needs of the family could be suggested to be an important in element in effective intervention with children and young people who show school refusal behaviours. However, given current economic austerity measures, the extent to which the local authority can offer parenting support and parenting courses in the future is uncertain. Therefore, based on findings from this research, this could have significant implications for children and young people who show school refusal behaviours, particularly if there are unmet needs in the family. 5.3.2 Early intervention. As highlighted in Figure 2.2 school refusal behaviours could be represented on a continuum ranging from "pleas for non attendance but attends school" to "complete 172
absence from school for an extended period of time" (Kearney, 2008). This research may provide a useful model for reflection to support practitioners working with the range of school refusal behaviours. Such reflections could be beneficial in facilitating effective early intervention. For example, exploring and reflecting upon the ecological model of successful reintegration may be particularly beneficial when working with children and young people who are showing early signs of school refusal behaviour. Interestingly, even though Amy met Berg, Nichols and Pritchard's (1969) criteria for school refusal behaviour and met the inclusion criteria for the research, the clinical psychologist questioned whether Amy was a "true school refuser" because she "got better quickly". The clinical psychologist for example described how she would "normally only get involved with the very chronic" cases. Therefore, if children and young people's needs are supported at the first sign of school refusal behaviour this might limit the number of children whose behaviours could be classified as "chronic". 5.3.3 Gathering the views of stakeholders. The researcher recognised that different stakeholders may have different perspectives which may differ at different points in time, particularly given the range of contextual factors which might influence their values and interpretations of behaviour. The researcher thought that gathering a range of stakeholders' views was helpful in enabling a triangulated view to be formed and in gaining a full understanding of the behaviours. The researcher suggests that this has implications for practice when trying to establish a full conceptualisation of behaviour. For example, in gaining this understanding, the researcher would emphasise the importance of gathering a range of stakeholders' views including the views of young people and families and thinking about the best way to facilitate children young people and parent/carers views. During the research, the researcher thought that participants talked openly and honestly about their experiences and that this enabled a rich understanding of behaviour. It could be suggested that educational psychologists, with their skills in developing rapport, gaining people's views and developing a holistic view of the child could be well placed to gather stakeholders' views and in supporting case conceptualisation to gain a full understanding of behaviour. 173
5.3.4 Availability of a key adult. In addition, access to a key adult was reportedly beneficial for both girls. This has implications for schools, for example, in having professionals who have the time and flexibility to be available for these children and young people. This will be important in ensuring that there is someone who is able to develop positive trusting relationships with the young person and who can be a constant. When thinking about the ecological model of successful reintegration, the key adult could have a valuable role in supporting the child's psychological factors. As highlighted in this research for example, key adults supported the positive nurturing approach which linked with the development of feelings of safety, security and a sense of belonging in the young people. Unfortunately for Leah, as previously stated, changes in the school structures of her mainstream secondary school meant that her learning mentor's role changed which meant that the 1:1 support and "key adult" was no longer available. It was hypothesised by the learning mentor that the loss of the key adult and Leah's subsequent return to the full time timetable led to the long term absence. This therefore highlights the implications of school's processes and systems on the support available but also highlights the valuable role of a key adult in supporting these young people. 5.3.5 Collaborative working. The researcher suggests that the research has implications for collaborative and multiagency working. Working collaboratively and having access to specialist services were highlighted as facilitative and/or ideal factors. Having a whole school approach with professionals and the family working collaboratively were reported to be beneficial. For example, the key adult, in the case of Amy, appeared to have a valuable role in liaising with teachers and other members of staff in terms of areas of need and strategies. It was reported that the whole school approach was beneficial in supporting identification of learning needs, consistency of approaches and in monitoring and celebrating progress. This may therefore be a useful approach in other cases of school refusal behaviour. In addition to collaborative working in school, multi-agency working was reportedly beneficial in ensuring a joined up approach to assessment and intervention. It was suggested that this was beneficial in supporting a holistic understanding of a child's needs and in supporting early intervention. Multi-agency working was reportedly facilitated by having a lead professional who could co-ordinate services. As noted however, different services' different ways of working, for example in terms of time allocation and resources and practitioner's knowledge of available services may influence the effectiveness of 174
multi-agency working. Again, the economic climate may also have some influence on the availability and involvement of services, particularly with more local authority services being disbanded. Therefore, with the increasing economic austerity measures schools and services may want to think about how to ensure effective collaborative and joined up working. 5.3.6 Time. Another implication is professionals' need for time to support these young people and families for example, the investment of time and time in relation to timescales of involvement. Given the importance of gaining a full case conceptualisation and the need to look at needs holistically, professionals will require time to understand both the needs of the young person and the family to develop an individualised approach to meet need. Also, practitioners may need time to develop positive relationships with children, young people and families to facilitate assessment and intervention. It is possible for example, that the first attendance officer in the case of Leah did not have sufficient time to develop positive relationships with Leah and the family or sufficient time to understand their needs. This could for example, have been influenced by pressures such as the socio-legislative context. Also, the investment of time will be beneficial in ensuring a flexible and individualised approach to meet the young person's needs, in providing opportunities for the young person to express their views and feel listened to and in having the availability and flexibility of key adults; factors which were associated with successful intervention. Also as stated, professionals particularly the key adult, will need time to develop a positive trusting relationships with the young people, time to be physically available for them, and will need time to provide an individualised approach to ensure that their needs are met. In terms of timescales, given the nature of school refusal behaviours, this research highlights that involvement will not be a "quick fix" and suggests that a range of strategies will be required to support successful intervention. As stated in Chapter 4, there was a need to recognise that strategies might not work first time. Therefore, professionals will need to reflect upon what is/is not working over time and adapt strategies as appropriate to ensure an individualised approach in order to meet needs; this will therefore require time. Also, as stated in the case of Amy, the persistence and resilience of professionals to 175
continue to offer a positive nurturing environment and provide an individualised approach in the face of challenge was reportedly beneficial. It was suggested that having long term involvement for example, was beneficial in developing the positive relationship, in communicating to Amy that she was valued and in subsequently developing Amy's sense of self. However, again the current climate of economic austerity measures may affect the time that professionals can offer. For example, in this local authority, the parent support advisor role is no longer available and there are current proposals to reduce the attendance service. This therefore suggests that there will be less time available from the local authority to support intervention which thus has implications for support. 5.4 Future Research In Chapter 3, case study research was outlined and the benefits of case study research for researching complex phenomena in context were described. As stated in Chapter 3, the purpose of this research was not to develop statistical generalisability; it was to develop explanation and a rich understanding of what was associated with successful involvement in two cases of school refusal behaviour. The researcher would suggest that future research would be beneficial in developing analytic and theoretical generalisability (Yin, 2009). The researcher has gained a thorough understanding of what was successful and why and has identified a number of factors which were common to both cases. However, as previously discussed, these common factors need to be understood within the context of the individual cases. School refusal behaviours are complex and as stated in Miller and Frederickson (2006), complexity increases with different school systems, the involvement of different school staff with different roles in school, different experience, perceptions, attributions and interpretations of problematic situations. Therefore, what works with one professional might not work with another or what is successful in one school might not be in another. As highlighted in the case of Leah, a different attendance officer, with a different approach led to the development of a positive relationship with the family and their subsequent reengagement with services. The ideographic situation thus depends upon many factors which could explain why research findings and Psychological Theory do not necessarily translate into practice as discussed in Miller and Frederickson (2006). Whilst this research has limited statistical 176
generalisability it provides rich data from two cases about what is associated with successful involvement in cases of school refusal behaviour and why. This, along with further evidence from other similar cases would be beneficial for supporting analytic generalisability. As highlighted by Miller and Frederickson (2006) to "collate, compare and contrast examples of single interventions in complex settings leads to greater and more widely generalizable knowledge of successful interventions" (p.118). Therefore, the more similar cases with similar findings the more promising the evidence of analytic generalisability. In addition, a stronger claim for theoretical generalisability could be made if the factors associated with success are absent in unsuccessful cases. As Yin (2009) describes, contrasting findings would be predicted for unsuccessful cases. Demonstrating that the converse is true would thus add further weight to the research findings, theoretical generalisability and would support the development of the theoretical framework which could be a tool for generalising to new cases i.e. "the conditions under which a particular phenomenon is likely to be found (a literal replication) as well as the conditions when it is not likely to be found (a theoretical replication)" (Yin, 2009, p.54). Completing a theoretical replication i.e. research into unsuccessful cases would therefore be a useful area for further research. The vulnerability of young people who show school refusal behaviours means that constructing an ethically sound design would be difficult and could be argued to be inappropriate, particularly if the researcher has no relationship with the young person. Whilst it was ensured that Leah and Amy had returned to education for a minimum of one term, it is possible that they could start to show school refusal behaviours in the future. If this were the case, further research would be useful in developing the theoretical framework as discussed in Yin (2009). Given the existing positive relationships with the young people and families, future research might receive ethical approval and consent from participants if the design and methodology were treated with a high level of sensitivity. For example, research could explore if there were any changes to factors which were reportedly associated with successful involvement. As highlighted, the more similar cases with similar findings the more likely there will be analytic generalisability. However, this research could also be extended to explore factors associated with successful involvement in cases of non attendance with low anxiety. These children and young people would fall within quadrant D of West Sussex EPS' 177
(2004) continuum of anxiety and attendance (Figure 2.1) which accords with truanting behaviour. As highlighted in Section 2.4 young people may move along the continuum of anxiety and attendance at different points in time. As suggested in Lauchlan (2003) for example, it is possible for children and young people to exhibit characteristics of both truancy and school refusal behaviours, for example if anxiety increases at the thought of returning to school. It could be hypothesised that the factors which support children and young people with high levels of anxiety and low attendance might also be beneficial in supporting those who present with a lower level of anxiety. Researching factors associated with successful involvement in cases of low attendance and low anxiety could therefore be an area for future research. Supporting evidence would also increase theoretical generalisability and would extend the theoretical framework to attendance. 5.5 Reflections As highlighted in Section 2.12, the research aimed to address a gap in the research literature and explore the perceptions of stakeholders in cases of school refusal behaviour and gather their views about factors associated with successful intervention. Following the research, the researcher reflected upon the research process in relation to the gathering stakeholder's views. A summary of four reflections will be presented in this section: reflections on the application of counselling skills in research, on the process of gaining the views of the young people on gathering a range of stakeholder's views and reflections on the use of thematic analysis. 5.5.1 The application of counselling skills in research. As highlighted in Chapter 4, positive relationships emerged as an organising theme in supporting children and young people who show school refusal behaviour. The researcher suggests that the development of positive relationships was also an important element of the research process in facilitating discussion with stakeholders. The researcher would support Coyle and Wright (1996) in recognising the benefit of applying counselling skills in research and would suggest that their application of counselling skills (Rogers, 1957; McLeod, 2003) facilitated the development of a positive relationship with stakeholders and the subsequent gathering of information (described in Section 3.8.1). The researcher thought that counselling skills were beneficial in facilitating rapport and subsequently gaining a thorough understanding of participants' experiences and 178
perception of success. Participants appeared to talk openly and honestly about factors that they thought were successful and the researcher would suggest that the relationship which was quickly established with participants facilitated this. As suggested by Coyle and Wright (1996), developing a sense of connectedness and rapport between the researcher and participant can, "promote open and honest responding" and can be used to, "help the interviewer to obtain detailed information and a clear understanding of the interviewee's experiences and feelings and to check that he or she has understood what has been said" (p.434). In addition, the researcher found that paraphrasing and summarising participants' responses enabled them to check out their understanding which subsequently facilitated elaboration and generation of additional factors from participants. It could be argued that providing summaries gave participants an opportunity for reflection which might have helped to clarify their experience. Similarly, the flexibility of the semi structured interview enabled the researcher to adapt responses and empathise with participants. Empathy was thought to be essential given the difficulties that the young people and the families had experienced. On reflection, the researcher would suggest that the interviews may have been therapeutic, particularly for the parents because at times they both wanted to talk about their own difficulties and "offload". This supports Coyle and Wright (1996) who acknowledged that participants may wish to explore "some of the painful experiences that have been aroused". Both parents for example, wanted to talk in detail about how they had felt when their child was showing school refusal behaviours and wanted to talk about additional stressors that the family were facing. It would have been unethical for the researcher to have ignored or dismissed parents so, as stated in the methodology, the researcher used active listening techniques and empathy i.e. reflecting feelings to help them to construct their story. It is possible that this was the first time that parents had had the time and space with an independent professional to discuss their experiences. Whilst parents may have expressed their views with professionals in meetings about their child's needs, given the implications for the young person and the family and the purpose of involvement, it is questionable how "connected" they might have felt with such professionals to be open and honest about their own experiences. In summary, whilst it was not the purpose of this research, parents (and other stakeholders) may have found that constructing something meaningful and relevant for the first time and having a sense of feeling listened to and understood, was therapeutic. It 179
could be argued that this led to more honest and open discussions. The researcher would therefore suggest that the application of counselling skills in a semi structured interview was beneficial, enabling rich data to be gathered which might not have been obtained with a more standardised approach. 5.5.2 Gathering the views of children and young people. The researcher also made a number of reflections on the process of gathering the young people's views. As highlighted in Chapter 3, the young people were given the choice of how they wanted to express their views, either verbally or through art. Whilst the girls explored the art materials they both continued to express their views verbally rather than use the art materials. There could be a number of reasons for this. Firstly, it could be that the art materials did not lend themselves well to what the girls wanted to say, for example some of the identified factors were quite abstract such as "encouragement", which may have been difficult to express through art. Secondly, the young people might have found it easy to access responses to questions which asked about what helped because these were likely to be in consciousness, particularly given their age. For this reason, children may have preferred to express their views orally. Art materials may have been preferred however, had the young people been of a younger age, had learning needs or if there had been more challenging questions which explored traumatic experiences for example. Thirdly, it was hypothesised that the art materials might have been helpful in engaging the young people. However, it is possible that the positive relationship the researcher quickly established with the young person in the introductory session meant that they felt comfortable to talk openly. Finally, it is possible that a choice of methods was facilitative because it gave the young people some control, particularly given that choice and control emerged as a theme in the data. The researcher held two sessions with the young people because it was hypothesised that over two interviews the relationship with the researcher may have developed further which might have facilitated additional information and enabled the young person to develop and refine their story over time. However, on reflection, minimal additional data emerged from the second interviews. It is possible that because the researcher had developed positive relationships with the young people quickly during the introductory sessions, they talked openly and in detail during the first interview. The researcher had a sense that the young people were conversing freely in conversation and the emergence of positive and negative issues suggested that they were being honest. 180
The young people showed a good insight into factors which supported their success. However, the second research question, investigating what might have led to more success, was hard for the young people to answer. It is likely that this was too abstract for them and on reflection, given their age it is unlikely that they would have had an awareness of other strategies/approaches which may have been beneficial. 5.5.3 Gathering a range of stakeholder's views. The researcher reflected on the process of the research in terms of gathering stakeholder's views because one of the aims of the research was to gather the views of a range of stakeholders to enable a triangulated view to be formed. The researcher thought that this was facilitative in gaining the rich understanding of the factors associated with successful involvement and why those factors were perceived to be successful. The researcher would suggest that an exploratory case study (Yin, 2009) could be useful for future research in investigating factors associated with successful involvement with cases where there are other sensitive areas of need. For example, this approach could be beneficial in researching what supports effective involvement with children and young people who have other mental health needs, such as eating disorders or self harming behaviour. 5.5.4 The use of thematic analysis The researcher also reflected upon the use of thematic analysis as a methodology for analysing qualitative data. The researcher recognised the benefits of using thematic analysis in that it enabled key features of data to be summarised providing results which were accessible to the educated general public; advantages highlighted in Braun and Clarke (2006). This was important for the researcher who wanted findings to be accessible to school staff and other education and health professionals who work with young people who show school refusal behaviour. However, the researcher recognised the challenge of completing thematic analysis when a large volume of data was collected because this meant that transcription and analysis were time consuming. When discussing the limitations of thematic analysis, Braun and Clarke (2006) identified some of the potential pitfalls of thematic analysis such as producing themes which do not appear to work, producing overlapping themes or producing a mismatch between data and claims. The researcher suggests that avoiding these pitfalls becomes more of a challenge as the volume of data increases. The researcher found it a challenge to ensure that the themes captured the data whilst 181
ensuring that the themes did not become too generic that they lost meaning. However, the researcher would suggest that the measures taken to promote validity and reliability in particular the maintenance of a clear audit trail were beneficial in supporting a thorough, inclusive and comprehensive analysis which accurately reflected the data. In addition, the researcher recognised the benefit of completing inter-rater reliability in ensuring the analysis reflected the data particularly at the level of reviewing themes. The researcher suggests that verbalising and discussing the themes with another educational psychologist and the subsequent movement of codes and renaming of themes helped to ensure that the themes captured the data and helped to minimise overlap between themes. 5.6 Conclusion The factors associated with successful involvement in two cases of school refusal behaviour have been understood from an ecological perspective and incorporated into the ecological model of successful reintegration. The implications of this model for practice and future research have been discussed. It is hoped that the ecological model of successful reintegration provides a useful tool to support reflection when working with children and young people who show school refusal behaviours in the future. 182
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Chapter 7: Appendices Appendix A The papers which were identified through the systematic literature search and those identified through reference harvesting were recorded in a table; a sample of this table is illustrated in Figure A1 and A2 below. The researcher reviewed each paper to identify whether they met the inclusion criteria. If excluded, the reason for this was recorded on the table in the `excluded' column as illustrated in Figure A1 and A2. Figure A1. Sample of papers identified in systematic literature search 193
Figure A2. Extract of database of papers identified through reference harvesting As stated in Chapter 2 (page 19) the literature was reviewed to answer the following questions: · How is school refusal characterised? · How are school refusal behaviours assessed? · What interventions are effective for children and young people who are fearful/anxious to attend school? · What supports successful involvement? The main body of the literature review aimed to focus on intervention. In answering the research question, · What interventions are effective for children and young people who are fearful/anxious to attend school? empirical studies which contained the following search times in the title: therap*, treatment, manage*, strateg* and solution, were reviewed. Studies which met these criteria are detailed in Table A1. 194
Table A1. Studies which met the criteria to answer what interventions are effective to support children and young people who show school refusal behaviours
Researcher (s) Bernstein, Garfinkel, Borchardt. Kearney & Silverman
Year 1990
Title Comparative studies of pharmacotherapy for school refusal.
1990
A Preliminary Analysis of a Functional Model of Assessment and Treatment for School Refusal Behavior
Kearney & Beasley
1994
The clinical treatment of school refusal behavior - a survey of referral and practice characteristics
Chorpita, Albano, Heimberg, Barlow
1996
A systematic replication of the prescriptive treatment of school refusal behavior in a single subject.
Hargett, Webster King, Tonge, Heyne, Pritchard, Rollings, Young, Myerson, Ollendick Last, Hansen, Franco .
1996 1998 1998
Treatment integrity and acceptability with families: A case study of a child with school refusal Cognitive-behavioral treatment of school-refusing children: a controlled evaluation. Cognitive-behavioral treatment of school phobia.
King, Tonge, Turner, et al.
1999
Brief cognitive-behavioural treatment for anxiety-disordered children exhibiting school refusal
Meyer, Hagopian, Paclawskyj
1999
A function-based treatment for school refusal behavior using shaping and fading.
Kearney & Silverman Bernstein, Borchardt, Perwien, Crosby, Kushner, Thuras, Last Bernstein, Hektner, Borchardt, McMillan. King, Neville; Tonge, Bruce, Heyne, David, et al.
1999 2000 2001 2001
Functionally Based Prescriptive and Nonprescriptive Treatment for Children and Adolescents With School Refusal Behavior Imipramine plus cognitive-behavioral therapy in the treatment of school refusal. Treatment of school refusal: one-year follow-up. Cognitive-behavioural treatment of school-refusing children: Maintenance of improvement at 3- to 5-year follow-up
Jainer Heyne, King, Tonge, Rollings, Young, Pritchard, Ollendick Kearney
2002 2002 2002
Imipramine plus cognitive-behavioral therapy for school refusal. Evaluation of child therapy and caregiver training in the treatment of school refusal. Case Study of the Assessment and Treatment of a Youth With Multifunction School Refusal Behavior
195
Layne, Bernstein, Egan, Kushner
2003
Predictors of treatment response in anxious-depressed adolescents with school refusal.
Moffitt, Chorpita & Fernandez Aviv
2003 2006
Intensive cognitive-behavioral treatment of school refusal behaviour Tele-hypnosis in the treatment of adolescent school refusal.
Doobay
2008
School refusal behavior associated with separation anxiety disorder:a cognitive-behavioral approach to treatment
Tolin, Whiting, Maltby, et al. Heyne, D., Sauter, F.M., Van Widenfelt, B.M., Vermeiren, R. & Westenberg, P.M.
2009 2011
Intensive (Daily) Behavior Therapy for School Refusal: A Multiple Baseline Case Series School refusal and anxiety in adolescence: Non randomised trial of a developmentally sensitive cognitive behavioral therapy
In addition the research aimed to answer the following research question through reviewing empirical research papers: · What supports successful involvement? Papers were reviewed if they contained the search terms: help*; prevent*; effective; support*; suggest*
Table A2. Studies which met the criteria to answer what supports successful involvement
Author Kearney & Bates
Year 2005
Title Addressing Youths with School Refusal Behavior: Suggestions for Frontline Professionals
Kearney and Bensaheb
2006
School Absenteeism and School Refusal Behavior: A Review and Suggestions for School-Based Health Professionals
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Appendix B Information Sheet for Children and Young People
Dear ____________________,
TEP name C/o Kevin Woods Doctorate in Educational and Child Psychology Ellen Wilkinson Building University of Manchester Oxford Road Manchester M13 9PL TEP email TEP office telephone
I am a Trainee Educational Psychologist. Educational Psychologists try to find out about how children and teenagers learn, behave and get on with others. I work with lots of children and young people to try and help them at school. Some children need help with learning or behaviour or getting along with others, and some need help with their attendance.
I would like to find out more about what helps children and young people who have found it hard to go to school _________________ has told me about how much progress you have made. I would like to invite you to take part in some research because I would be really interested to find out about what you have found helpful. This can be used to help other young people in the future. I would also like to do the same thing with one/ two other young people who have made good progress, to see what they have found helpful too. Please read the information below and talk about it with others e.g. your parents/carers or your teachers if you want to.
· I would like to meet with you to find out your views. I can do this in school. It will be a chat to find out about what has helped you come to school. If you like, we can use art materials/drawing. When I meet with people I often write down what they say to help me remember. Sometimes, I use an audio-recorder so that I don't have to write so much. I might ask you if I can use it but I won't if you don't want me to. · I would also like to speak with the adults who have worked with you and with your parents/carers to find out what they think has helped you too. · I might also want to look at information that other adults have written about you. This might tell me about the work that you have done with other adults.
197
It may tell me about the things that you are good at and about some of the things that you have found hard. I know that this is a private thing so I will be careful to keep the things that you and other people tell me private. I will type up what you say so that no one knows who you are or where you go to school. My supervisor will know about what you say but they will not know your name, your school or anyone who has worked with you. The things that you tell me will be written in a report to help other children and young people and the adults who work with them. Other people who want to find out about children and young people's attendance might want to read this report. They will be able to read about what you have said but they will not know your name, your school or the people who have worked with you. Firstly, I would like to meet with you to tell you more about what I would like you to do. I would also like to answer any questions that you may have so that you can decide whether or not you would like to be involved. It is up to you to decide whether you want to take part or not. If you do decide to take part you will be given this information sheet to keep. You will be asked to sign a consent form. If you decide to take part you are still free to stop taking part at any time without telling me why. I will contact ________insert form tutors name/key contact in school________ to see if I can arrange a time to come and see you in school to explain what I would like you to do and to answer any questions that you may have. If you are happy to meet with me please sign your name on the slip below. If there is anything that you would like to talk about before, during or after the study please contact me using the email address or phone number provided at the top of the letter. I look forward to hearing from you, Best wishes
TEP name Trainee Educational Psychologist ------------------------------------------------------------------------------------------------------I am happy to discuss the study and what I will need to do. I know that I will be able to ask questions before I decide whether I want to take part
_________________________ _________ ________________________
Name (young person)
Date
Signature
198
Appendix C
If you are happy to take part please sign the form below: Please initial box below 1/ I have read the letter and information sheet giving me information about the study. I have had all of my questions (if any) answered and I know what I have to do. 2/ I know that I do not have to take part if I do not want to. I know that if I decide I no longer want to take part I do not have to. I can walk away without giving a reason. 3/ I am happy for quotations and photographs to be used (as long as they do not identify me/my name/school etc) 4/ I am happy for my parents/carers and the adults who have worked with me to talk about the things that they think have helped. 5/ I am happy for reports about me to be looked at 6/ I am happy for other researchers to see and use what I have said (as long as I cannot be identified)
7/ I am happy for the information I provide to be published in a book or research article (as long as I cannot be identified)
I agree to take part in the above project
______________________ _______ ___________________
Name (Participant)
Date
Signature
______________________ _______ ___________________
Name (Researcher)
Date
Signature
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Appendix D Letter and Information Sheet for Parents TEP name C/o Kevin Woods Doctorate in Educational and Child Psychology Ellen Wilkinson Building University of Manchester Oxford Road Manchester M13 9PL TEP email TEP office phone number Date___________ Dear ................................ I am a trainee educational psychologist, employed by Stockshire Borough Council, and I am due to graduate in 2012 from the University of Manchester. As part of my research towards my doctoral thesis, I am looking at how we can best support pupils who are not attending school where pupil anxiety is the primary `cause' of the non attendance. I am interested in finding out more about what helps children and young people who have had difficulty with their attendance. ______Attendance Officer Name___________ has told me about how much good progress your child _________Child's Name__________ has made. You are being invited to take part in some research. I would be really interested to find out about what you think has helped your child, what you have found helpful and what you think might have led to more success and why. This will then be used to help other children and young people in the future. I would also like to gain your child's views, gain the views of those who have worked with your child and review the existing reports/documentation which may be relevant to your child's attendance. I would also like to do the same with one/ two other young people who have made good progress, to see what they have found helpful too. Please read the information enclosed and talk about it with your child. If you have any questions about the project please contact me using the contact details above. If you are happy to participate and you are happy for your child and the people who worked with them to be involved, please complete the attached consent form and return in the stamped addressed envelope. I look forward to hearing from you. Many thanks, Trainee Educational Psychologist University of Manchester 200
Information Sheet Case Study to Explore Factors which Promote Successful Involvement in Work with Children and Young People who Show School Refusal Behaviours What are the aims of the study? The research aims to find out what helps to support children and young people who have not been attending school because of anxiety. I am interested in finding out what you think has helped, how you think these things have helped, what else might have helped your child and why you think this would have helped. This will be researched through completing a study of 2 cases of children who have been successful following a period of school refusal. The views of children and young people, their parents/carers, key school staff and the support staff involved with the case will be gained through completing semistructured interviews. Information such as support staff reports, school records, attendance data and observations will also be obtained. This information will hopefully help to identify some of the factors which may be associated with successful involvement and to identify what else might help children in the future. This may provide useful information for schools and support staff who work with children who school refuse. Why have I been chosen? You are invited to participate because of ...........pupil name's....... success as identified by.........add attendance officer name........ What would the project involve? I would like to complete an interview with you and those who worked with .......pupil name........... You will be asked about: what factors you think helped.......pupil name's........... success, what you have found helpful, what you think might have led to more success, and why. The overall session will last approximately one hour but may be shorter or longer depending upon how much information you have to share. You may also be contacted by telephone if further information or clarification is required. It is possible that a follow up interview may be required. The session(s) will be taped on a Dictaphone to ensure that all the points you make are recorded. Your child will be also asked their views during three sessions at school. The first session will be an introductory session to provide them with information about the project, to give them the chance to ask any questions so that they can decide whether they want to take part. During sessions two and three your child will have the choice as to whether they would like to draw/ make something to show what has helped them or whether they would prefer to tell me. What they tell me will be recorded on a Dictaphone and this audio recording will be transcribed. Photographs will be taken of anything that.....pupil name.... makes. The sessions will be rotated to ensure that ......pupil name......does not miss the same lesson each week. The study will also include interviews with others involved with your child (e.g. school staff, attendance officer, educational psychologist) to find out their views and analysis of their reports and school records. How is confidentiality maintained? The audio file of your and your child's interview (s) will be transcribed by me. The transcripts will remain anonymous. You will be known as Parent 1, 2, or 3 etc and your child known as Child 1 or 2 so that you or your child cannot be identified. All information will be anonymised and will remain confidential with data stored securely away from unauthorised individuals. My supervisor will have access to the information but they will 201
not know you or your child's name, your child's school or anyone who has worked with you. Audio-files will saved onto an encrypted data stick to ensure the security of data. Audio-files will be destroyed 12 months after I have graduated. What happens to the data collected? When the interviews have been completed and transcribed, I will analyse the data by identifying the key points. Will the outcomes of the study be published? The key themes from the interviews and data will be summarised and included within my doctoral thesis. Anonymous quotes may be used to support key points. It is possible that other researchers may use the data in the future for further analysis. At all times, the information that you and others provide will remain anonymous. It is also possible that this research may be published in anonymous form in academic books or journals. A summary of the research will also be produced for those who have participated in the study. What happens if I do not want to take part or if I change my mind? Your participation is entirely voluntary. If you decide to take part, you will be given this information sheet to keep and will be asked to sign a consent form. If you decide to take part you and your child are still free to withdraw at any time without giving a reason. Contact for further information If you would like any further information or have any questions please contact me using the contact details below: Contact details Name of researcher: TEP name Contact telephone number: Office phone number Email: TEP email In the event that you find any aspects of this research unsatisfactory, please contact the researcher using the contact details above. If you have further concerns you can contact: Head of the Research Office, Christie Building, University of Manchester, Oxford Road, Manchester, M13 9PL. I really appreciate your consideration of this project Many thanks 202
Appendix E Consent Form Parents 1. I am happy for my child to participate in this research project
Please initial box
2. I am happy for data/reports documentation about my child to be accessed 3. I am happy for practitioners and school staff to discuss their involvement and to discuss what that they think helped my child's success 4. I confirm that I have read the attached information sheet on the above study and have had the opportunity to consider the information and ask questions and have had my questions answered satisfactorily.
5. I understand that my participation in the study is voluntary and that I am free to withdraw at any time without giving a reason.
6. I understand that the interviews will be audio recorded
7. I agree to the use of anonymous quotes from the interviews
8. I agree that any data collected may be passed to other researchers
9. I agree that any data collected may be published in anonymous form in academic books or journals.
I agree to take part in the above project and I am happy for my child and those who have worked with my child to participate. I am also happy for existing documentation/data to be accessed.
_____________________________ ____________ ___________________________
Name (participant)
Date
Signed
_______________________________ Child's Name
______________________________ ____________ ___________________________
Name (researcher)
Date
Signed
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Appendix F Letter and Information Sheet for Practitioners
Dear ................................
TEP name C/o Kevin Woods Doctorate in Educational and Child Psychology Ellen Wilkinson Building University of Manchester Oxford Road Manchester M13 9PL TEP email TEP office phone number Date___________
I am a Trainee Educational Psychologist, employed by Stockshire Borough Council, and I am due to graduate in 2012 from the University of Manchester. As part of research towards my doctoral thesis, I am looking at how professionals can work best with pupil non attendance where pupil anxiety i.e. some element of fear relating to home/school, is the primary `cause' of the non attendance. This may or may not be linked to family circumstances e.g. a pupil may be anxious about leaving home because they are concerned about a parent's physical/mental health. I want to look at a sample of successful cases retrospectively to ascertain:
1 What factors are perceived to be effective in supporting children and young people who have anxiety/fear which is leading to school refusal behaviours, and why? 2 What might have led to more success or earlier success in the effective support of the school refusal behaviour?
You are invited to participate in a research project which aims to explore these research questions. You have been selected because of your involvement in the success of ..........add pupil name......................... as identified by.........add attendance officer name........ The information sheet enclosed outlines the details of the project. Please consider the information carefully before deciding whether you would like to participate. If you have any questions about the project please contact me using the contact details above. If you are happy to participate please complete the attached consent form and return in the stamped addressed envelope. I look forward to hearing from you. Many thanks
204
Case Study to Explore Factors which Promote Successful Involvement in Work with Children and Young People who Show School Refusal Behaviours What are the aims of the study? The research aims to explore what factors are associated with effective involvement in cases of pupils who have been school refusing. This will be researched through completing a case study of 2 successful cases of school refusal. The perspectives of children and young people, their parents/carers, key school staff and the practitioners involved with the case e.g. attendance officers, educational psychologists etc. will be gained through completing interviews. Objective information such as practitioner reports, school records, attendance data and observations will also be obtained. This is to answer the following research questions: 1 What factors are perceived to be effective in supporting children and young people who have anxiety/fear which is leading to school refusal behaviours, and why? 2 What might have led to more success or earlier success in the effective support of the school refusal behaviour? This information will hopefully help to identify factors which may be associated with successful involvement and to identify additional factors which may have been helpful. This may provide useful information for schools and practitioners who work with children who school refuse. Why have I been chosen? You are invited to participate because of your involvement in the success of ...........pupil name....... as identified by.........add attendance officer name........ What would I be asked to do if I took part? I would like to complete a semi structured interview with you and all practitioners who worked with .......pupil name........... You will be asked about: what your involvement looked like; the factors that you think contributed to the pupil's success; how the case has been different from other cases you have worked on; what might have led to more success or success earlier on and what learning points you have made for future cases. The overall session will last approximately one hour but may be shorter or longer depending upon how much information you have to share. You may also be contacted by telephone if further information or clarification is required. It is possible that a follow up interview may be required. The session(s) will be recorded on a Dictaphone to ensure that all points have been recorded during the session. The study will also include interviews with other stakeholders to find out their perspectives and will include analysis of existing data. This will include: · 1-2 interviews approximately one hour in duration with other practitioners involved · 1-2 interviews approximately one hour in duration with key school staff · 1-2 interviews approximately one hour in duration with the child/young person's parent/carer (s) · 3 sessions (duration of one lesson) with each child/young person completing a semi structured interview/art based activity · existing data including practitioner reports, attendance data, observations 205
Where will the study be conducted? Your interview (s) can be completed in a venue of your choice: in a local school, in your office or at the local authority office. How is confidentiality maintained? The audio file of your interview (s) will be transcribed by me. The transcripts will remain anonymous. Cases will be referred to as Case 1 and Case 2 and practitioners will be known by their job title. All information produced will be anonymous and will remain confidential. Data will be stored securely away from unauthorised individuals. Audio-files will saved onto an encrypted data stick to ensure the security of data and will be destroyed 12 months after I have graduated. What happens to the data collected? When the interviews have been completed and transcribed, I will analyse the data by identifying the key themes in each case. Another researcher who is also training as an educational psychologist will assist with the thematic analysis to improve the reliability. They will only have access to anonymous transcripts. I will contact you regarding the key themes from the research to make sure that I have captured the key facts correctly. Will the outcomes of the study be published? The key themes from the interviews and data will be summarised and included within my doctoral thesis. Anonymous quotes may be used to support key themes. It is possible that other researchers may use the data in the future for further analysis. At all times, the information that you provide will remain anonymous. It is also possible that this research may be published in anonymous form in academic books or journals. A summary of the research will also be produced for those who have participated in the study. What happens if I do not want to take part or if I change my mind? Your participation is entirely voluntary. If you decide to take part, you will be given this information sheet to keep and will be asked to sign a consent form. If you decide to take part you are still free to withdraw at any time without giving a reason. Contact for further information If you would like any further information or have any questions please contact me using the contact details below Contact details Name of researcher: TEP name Contact telephone number: TEP phone number Email: TEP email In the event that you find any aspects of this research unsatisfactory, please contact the researcher using the contact details above. If you have further concerns you can contact: Head of the Research Office, Christie Building, University of Manchester, Oxford Road, Manchester, M13 9PL. I really appreciate your consideration of this project Many thanks 206
Appendix G Letter and Information Sheet for School Staff and Head Teachers TEP name C/o Kevin Woods Doctorate in Educational and Child Psychology Ellen Wilkinson Building University of Manchester Oxford Road Manchester M13 9PL TEP email TEP office phone number Date___________ Dear ................................ I am a Trainee Educational Psychologist, employed by Stockshire Borough Council, and I am due to graduate in 2012 from the University of Manchester. As part of research towards my doctoral thesis, I am looking at how professionals can work best with pupil non attendance where pupil anxiety i.e. some element of fear relating to home/school, is the primary `cause' of the non attendance. This may or may not be linked to family circumstances e.g. a pupil may be anxious about leaving home because they are concerned about a parent's physical/mental health. I want to look at a sample of successful cases retrospectively to ascertain: 1 What factors are perceived to be effective in supporting children and young people who have anxiety/fear which is leading to school refusal behaviours, and why? 2 What might have led to more success or earlier success in the effective support of the school refusal behaviour? You are invited to participate in a research project which aims to explore these research questions. You have been selected because of your involvement in the success of ..........add pupil name......................... as identified by.........add attendance officer name........ This information sheet enclosed outlines the details of the project. Please consider the information carefully before deciding whether you would like to participate. If you have any questions about the project please contact me using the contact details above. If you are happy to participate please complete the attached consent form and return it in the stamped addressed envelope. I look forward to hearing from you. Many thanks 207
Letter to Head Teachers Doctorate in Educational and Child Psychology Ellen Wilkinson Building University of Manchester Oxford Road Manchester TEP email TEP phone number Date___________ Dear ................................ I am a Trainee Educational Psychologist, employed by Stockshire Borough Council, and I am due to graduate in 2012 from the University of Manchester in Educational and Child Psychology. As part of research towards my doctoral thesis, I am looking at how professionals can work best with pupil non attendance where pupil anxiety i.e. some element of fear relating to home/school, is the primary `cause' of the non attendance. This may or may not be linked to family circumstances e.g. a pupil may be anxious about leaving home because they are concerned about a parent's physical/mental health. Further to our telephone conversation, I would like to provide you with some information about the project and the steps I have taken to ensure the research will be a positive experience for the children young people, parents and professionals involved. I want to look at a sample of successful cases retrospectively to ascertain: 1 What factors are perceived to be effective in supporting children and young people who have anxiety/fear which is leading to school refusal behaviours, and why? 2 What might have led to more success or earlier success in the effective support of the school refusal behaviour? I have invited ______pupil name_________, their parent(s)/carer(s) and professionals who have worked with ____pupil name________ to participate in a research project which aims to explore the above research questions. Pupil name has been selected because of their success in returning to school. I have attached the information sheet which will be provided to school staff and the information sheet that will be provided to children/young people, to provide you with details of what will be involved for ----pupil name--- and staff members. The following ethical considerations have been taken into account to try and ensure that this is a positive experience for those involved: 208
· The research aims to focus on positive factors associated with ____pupil name's__ success and will not focus on their difficulties. · Pupil name has been selected because their success has been maintained for at least a term so they are less likely to have a setback. · Discussions will be held with the parent(s)/carer(s) to reiterate that the research is not designed to go over their child's past difficulties. Questions will be asked to ascertain whether there are any sensitive areas/questions which should be avoided. · If a child wants to discuss their difficulties, I will listen but will not probe. I will try to return back to the positive focus of the research. If necessary I will ensure that the child/family is aware of appropriate support mechanisms. · No pressure will be placed on individuals or organisations to participate. If at any point a pupil/parent/carer/practitioner no longer wishes to participate they can withdraw at any time without question. · Interviews will be audio recorded and stored on an encrypted data stick to ensure confidentiality of data. · Participants, the school and the local authority will remain anonymous throughout the research. · Children and practitioners will be provided with sufficient information about the research to enable them to make full informed consent i.e. they will be clear about the purpose of the research and what their involvement will look like. Consent will also be sought from parents. · Discussions will be held with class teachers to ensure that interviews with __pupil name___ do not cause too much disruption to teaching and learning. Prior to contacting the those involved with ---pupil name--- it would be helpful if I could speak with you to determine whether you are aware of any stressors the child may be experiencing e.g. bereavement, current family reconstitution etc.; if you are aware of anything significant, it may not be appropriate for me to work with ----pupil name----. If you have any questions about the project please contact me using the contact details above. Many thanks, 209
Information Sheet Case Study to Explore Factors which Promote Successful Involvement in Work with Children and Young People who Show School Refusal Behaviours What are the aims of the study? The research aims to explore what factors are associated with effective involvement in cases of pupils who have been school refusing. This will be researched through completing a case study of 2 successful cases of school refusal. The perspectives of children and young people, their parents/carers, key school staff and the practitioners involved with the case will be gained through completing semi-structured interviews. Objective information such as practitioner reports, school records, attendance data and observations will also be obtained. This is to answer the following research questions 1 What factors are perceived to be effective in supporting children and young people who have anxiety/fear which is leading to school refusal behaviours, and why? 2 What might have led to more success or earlier success in the effective support of the school refusal behaviour? This information will hopefully help to identify factors which may be associated with successful involvement and to identify potential areas for improvement. This may provide useful information for schools and practitioners who work with children who school refuse. Why have I been chosen? You are invited to participate because of your involvement with...........pupil name....... as identified by.........add attendance officer name........ What would I be asked to do if I took part? I would like to complete a semi structured interview with you and other key members of staff who worked with .......pupil name........... You will be asked about: what factors you think facilitated the pupil's success and why, what might have facilitated more success or success more quickly and the learning points that you have made from working with.....pupil name..... The overall session will last approximately one hour but may be shorter or longer depending upon how much information you have to share. You may also be contacted by telephone if further information or clarification is required. It is possible that a follow up interview may be required. The session(s) will be recorded on a Dictaphone to ensure that all points have been recorded during the session. The study will also include interviews with other stakeholders to find out their perspectives and will include analysis of existing data. This will include: · 1-2 interviews approximately one hour in duration with other key members of school staff · 1-2 interviews approximately one hour in duration with practitioners involved · 1-2 interviews approximately one hour in duration with the child/young person's parent/carer (s) · 3 sessions (duration of one lesson) with each child/young person completing a semi structured interview/art based activity · existing data including practitioner reports, attendance data, observations 210
Where will the study be conducted? Your interview (s) can be completed in a venue of your choice: in your school or at the local authority office. How is confidentiality maintained? The audio file of your interview (s) will be transcribed by the researcher. The transcripts will remain anonymous. Cases will be referred to as Case 1 and Case 2 and you will be known as School Staff 1, 2, or 3 etc. All information will be anonymised and will remain confidential. Data will be stored securely away from unauthorised individuals. Audio-files will saved onto an encrypted data stick to ensure the security of data. Audio files will be destroyed 12 months after I have graduated. What happens to the data collected? When the interviews have been completed and transcribed, I will analyse the data by identifying the key themes in each case. Another researcher who is also training as an educational psychologist will assist with the thematic analysis to improve the reliability. I will contact you regarding the key themes from the research to make sure that I have captured the key facts correctly. Will the outcomes of the study be published? The key themes from the interviews and data will be summarised and included within my doctoral thesis. Anonymous quotes may be used to support key themes. It is possible that other researchers may use the data in the future for further analysis. At all times, the information that you provide will remain anonymous. It is also possible that this research may be published in anonymous form in academic books or journals. A summary of the research will also be produced for those who have participated in the study. What happens if I do not want to take part or if I change my mind? Your participation is entirely voluntary. If you decide to take part, you will be given this information sheet to keep and will be asked to sign a consent form. If you decide to take part you are still free to withdraw at any time without giving a reason. Contact for further information If you would like any further information or have any questions please contact me using the contact details below: Contact details Name of researcher: TEP name Contact telephone number: TEP office number Email: TEP email In the event that you find any aspects of this research unsatisfactory, please contact the researcher using the contact details above. If you have further concerns you can contact: Head of the Research Office, Christie Building, University of Manchester, Oxford Road, Manchester, M13 9PL. I really appreciate your consideration of this project Many thanks 211
Appendix H Consent form practitioners and school staff Consent Form If you are happy to participate please complete and sign the consent form below: Please initial box I confirm that I have read the attached information sheet on the study and have had the opportunity to consider the information and ask questions and have had these answered satisfactorily. I understand that my participation in the study is voluntary and that I am free to withdraw at any time without giving a reason. I understand that the interviews will be audio recorded I agree to the use of anonymous quotes from the interviews I agree that any data collected may be passed to other researchers I agree that any data collected may be published in anonymous form in academic books or journals. I agree to take part in the above project
______________________________ ____________ ___________________________
Name (participant)
Date
Signed
______________________________ ____________ ___________________________
Name (researcher)
Date
Signed
212
Appendix I Semi-structured Interview Schedules Practitioners 1/ When and how did you become involved? 2/ What did your involvement look like? (e.g. any particular strategies/interventions, number of sessions/meetings, over what period of time? etc.) 3/ What was this case like? (Try to get some idea of the communication efficacy, degree of consensus between stakeholders) 4/ What factors do you think facilitated the success of the case? (Explore areas of child, home, school, and environment systematically) Why? 5/ What supported/ made possible those factors in this case? (try to identify personal or material resources; contextual/ more distal factors; to see how their identification of factors relates to their understanding of the problem - it could be that what is distinctive about these cases is less an exhaustive list of do's and don'ts and more a really good understanding of the nature of the child and workers' abilities to link that to the range of possibilities for intervention) 6/ What if you hadn't had those factors? What else might have been possible? (try to identify what else might have been possible given the resources/ contextual/ distal factors) 7/ How has this case been different from other less successful cases? How has your involvement been different? 8/ What might have facilitated more success? Why? 9/ What might have facilitated success more quickly? Why? 10/ What learning points have you made for future cases? Additional questions may be asked regarding attendance data at the end of the interview to triangulate information provided in the interviews e.g. in relation to key change points. If required, an additional interview may be requested to explore attendance patterns and change points in more detail. 213
School staff What factors do you think facilitated pupil name's success? (Explore areas of child, home, school and environment systematically) Why? What might have facilitated more success? Why? What might have facilitated his/her success more quickly? Why? What learning points have you made for working with pupils who have similar difficulties? Additional questions may be asked about attendance data at the end of the interview to triangulate information provided in the interviews e.g. in relation to key change points. If required, an additional interview may be requested to explore attendance patterns and change points in more detail. Parent/Carer When did child's name start to school refuse? When did you first receive involvement from an external agency? What factors do you think facilitated child's name's success? (Explore areas of child, home, school and environment systematically) Why? What have you found helpful? Why? What might have facilitated more success? Why? What might have facilitated his/her success more quickly? Why? Additional questions may be asked regarding attendance data at the end of the interview to triangulate information provided in the interviews e.g. in relation to key change points. If required, an additional interview may be requested to explore attendance patterns and change points in more detail. Work with Child/young person 1st Session: introduction - explain role and project - gain full consent - likes and dislikes (ice breaker activities) 214
2nd/ 3rdSession 1/ make/draw something to represent what's helped to get you back to school? A range of materials will be provided e.g. drawing, painting and craft materials - during the activity, questions will be asked based on what the child/young person has made to promote discussion e.g. tell me about the ............ Comments will be made about features e.g. `I can see that there is lots of purple in here.... X seems close to Y etc'. - Features will be highlighted about the way the child/young person does something e.g. `you smiled when you drew X.' - What else questions will be asked? - Why do you think that? 2/ make/draw something to represent what might have helped you more and/or get you back to school sooner? - during the activity, questions will be asked based on what the child/young person has made to promote discussion e.g. tell me about the ............ Comments will be made about features e.g. `I can see that there is lots of purple in here.... X seems close to Y etc'. - Features will be highlighted about the way the child/young person does something e.g. `you smiled when you drew X.' - What else questions? - Why do you think that? 3/ make/draw something to represent what is different now? - during the activity, questions will be asked based on what the child/young person has made to promote discussion e.g. tell me about the ............ Comments will be made about features e.g. `I can see that there is lots of purple in here.... X seems close to Y etc'. - Features will be highlighted about the way the child/young person does something e.g. `you smiled when you drew X.' - What else questions? - Why do you think that? Opportunities will be provided for the child to revisit what they have made previously to `refine' their story 215
Appendix J Statement of Ethical Good Practice
Ethical Principle
Considerations Made and Identified Risk(s)
Safeguards
1. Respect for human dignity
Practitioners may feel threatened if they perceive the research to be evaluating their practice
The purpose of the research and the proposed outcomes will be made clear. Practitioners will be made aware that the focus of the research is on successful cases to identify what is effective.
Participants will be made aware of confidentiality and anonymity, that their participation is voluntary and of their right to withdraw
2. Ensure integrity and quality
A pupil may feel anxious about having discussions with the researcher. Consequently the information they provide may be limited.
The researcher will complete 3 sessions with the child/young person to enable the researcher to develop a rapport with them. This should lead to more detailed discussions over time and will enable the child/young person to expand on previous points made and refine their `story'.
Children/young people will be provided with a choice of methods for expressing their views to make them feel at ease i.e. semi structured interview or alternative interview techniques incorporating the use of art.
During the introductory session (session 1) the purpose of the research and the required involvement from the young person will be clearly identified. This will provide them with the opportunity to ask questions and enable them to provide full informed consent.
Information provided may be inaccurate
Information will be obtained from a number of sources to triangulate key points.
Having 3 sessions with the child/young person will enable the researcher to clarify information provided and to check the validity of points raised.
Participants may reflect on All participants will be debriefed. Participants will be their responses and want to provided with the researcher's contact details to add additional information make additional comments if required.
3 sessions will be held with the young person to help clarify and refine their story. It is hoped that changes and additional information will enhance the accuracy of the case study and hence increase the construct validity of the study.
Participants' views may be misrepresented/ interpreted incorrectly
The researcher will clarify their understanding during interviews Inter-rater reliability will be completed with
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qualitative data
Participants may not respond honestly because they are concerned about the implications of the research
The purpose of the research will be made clear. The importance of responding honestly will be stressed and participants will be made aware that the information they provide will remain anonymous.
Lack of appropriate cases/ unable to gain consent/ drop out
More cases will be identified than will be required for the researcher i.e. 5 In the event that these cases are all unsuitable or consent is not obtained, the researcher will explore the possibility of completing the case study in another local authority.
The researcher may have difficulty in gaining the participation of all practitioners involved in the case; the views of those who participate may not be reflective of everyone involved
The researcher will contact all participants involved and will be flexible around completing the interviews to ensure that as many practitioners are involved as possible. The potential benefits of the research will be highlighted and participants will be invited to attend the Research Conference at the University of Manchester in the autumn term 2012 free of charge as an incentive.
The case study may not be representative of other school refusal cases
Case selection will ensure that different attendance officers were involved to ensure that success is not purely related to personal characteristics
The researcher will ensure that there will be multiprofessionals from different disciplines involved as this is common in supporting children and young people who show school refusal behaviours
Participants may not be able to remember their involvement/thoughts/ feelings in detail.
Cases where practitioners have been involved within the last two years will be selected to ensure that participants are more likely to remember details of their involvement, what was effective and why.
Methodological limitations A range of methodological techniques will be used
may influence the quality of to triangulate the information and improve the
the research
content validity.
Interview methods will be piloted with young people, practitioners and parents.
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The reliability and validity of the research may be questioned if readers cannot access original data.
A case study database will be completed to increase the reliability of the research. A chain of evidence will be maintained to ensure conclusions are linked clearly to evidence and that there is a clear link back to the research questions (Yin, 2002). This will help to ensure that no data is lost through carelessness/bias.
The case study will present supporting and challenging data as recommended by Yin (2002, p.164) and will provide readers with sufficient evidence to conclude whether a particular interpretation is valid.
3. Respect for free and informed consent
Participants may be unclear about the purpose of the research and their involvement.
Provide all participants with sufficient information for full informed consent, make them aware that participation is voluntary and of their right to withdraw. The purpose of the research and the proposed outcomes will be made clear in a letter to the various professionals and parents (Appendices B,C,D,E,F,G,H)
Pupils may have been informed about the research by a perceived power figure i.e. parent/school. They may be unclear about the purpose of the project but feel pressured to participate.
Pupils will be provided with pupil friendly letter to explain the purpose of the research (Appendix B). The researcher will then hold an introductory session with them to provide opportunity for them to find out further information and opt out if necessary.
Parents may not want the researcher to access existing documentation on their child
Consent will be sort from parents to access pupil data and reports
4. Respect for vulnerable persons
Pupils who have recently returned to school are more likely to be unstable and at a higher risk of being unsettled and their attendance deteriorating.
Inclusion criteria: a pupil must have returned to school for at least a full school term.
Vision/hearing or other impairments.
Identify whether participants have any additional needs prior to the research and ascertain how these can be met.
Pupils may have additional needs which makes it difficult for them to access the research methodology e.g. speech and language difficulties, autistic spectrum disorder
Information will be obtained from parents and school prior to the research to ascertain whether a child/young person has additional needs. The researcher will be sensitive to this during the interviews and will make adjustments accordingly.
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5. Respect for privacy and confidentiality
Practitioners, pupils and parents may be concerned that personal and sensitive information will be disclosed and make them identifiable
Be clear that the school and participants will remain anonymous and that all data and analyses will remain confidential.
Practitioners may feel uncomfortable about discussing pupils/ schools
Ensure that everyone remains anonymous and that all data remains confidential
6. Participation in a voluntary way
There is a risk that laptops and/or memory sticks may be lost or stolen which poses a risk for data security. Participants may feel uncomfortable during the interview/ completing the questionnaire but feel obligated to continue
Data will be saved onto an encrypted memory stick No pressure will be placed on individuals or organisations to participate; participants will be informed of their right to withdraw at any time without question
7. Procedures should avoid harm
Discussing a pupil's past difficulties might make them feel anxious and lead them to go backwards
The research will look at successful cases and will ensure that pupils have returned to school for a minimum period of term. Discussions will be held with the parent/carer to reiterate that the research is not designed to go over their child's past difficulties. Questions will be asked to ascertain whether there are any sensitive areas/questions which should be avoided.
A letter will be sent to the Head Teacher at the school to inform them of the research, the potential risks and the safeguards in place.
A pupil may start to discuss their difficulties. To ignore this could cause harm
If a child wants to discuss their difficulties, the researcher will listen but will not probe. The researcher will try to return back to the positive focus of the research.
This will be communicated to parents.
A pupil who was identified as a successful case may start to school refuse again prior to the research
In this instance an alternative case will be selected for the research based on the selection criteria.
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Pupils may need to miss lessons for participation
Discussions will be held with parents and school to ensure that the research does not cause too much disruption to teaching and learning. The possibility of completing sessions after school or the possibility of alternating the time of interviews will be discussed to ensure that pupils do not miss the same lesson each session. Arrangements for pupils catching up work will be discussed.
Participants may report negative comments about a particular practitioner's involvement.
The research will focus on factors which were successful. Consideration will be made over how to report findings sensitively and objectively. If negative information is provided this will be treated with a high degree of sensitivity to ensure that this does not affect a practitioner's confidence and self worth.
Participants may be concerned about how the information will be reported and used.
Participants will be made aware of how the information will be reported and that the information gathered and reported will be anonymised Confidentiality and anonymity reiterated
Questions could make participants feel anxious or uncomfortable.
The interview questions will be piloted prior to the research and adjusted accordingly. If following the first interview problems arise, questions will also be adjusted to minimise any risk of harm
If a parent/ young person becomes particularly distressed as a result of a question/ topic area, the researcher will move on to the next area or if extremely upset/distressed will stop the session
Risks associated with lone working
Participants will be provided with a choice of where interviews will take place. The researcher will avoid home visits where possible. If a home visit is requested by the parent/carer the researcher will follow the local authority's and University's lone working policy and will ensure that it is safe to enter the home. The researcher will ensure that if a home visit is necessary, the researcher will be accompanied by another council employee
There will be an assumption that the pupils selected for the research will be coping better and will have reduced anxiety. However there is a risk that pupils may still be anxious.
It is hoped that the case study would identify future planning. If concerns arise, the researcher will need to make clear the distinction between their role as a researcher and as a practitioner and signpost the parents/carers to the appropriate personnel/agencies e.g. SENCO. This will enable the appropriate support to be accessed.
Pupils may want to keep the work that they produce during the sessions
Photographs will be taken of the pupils work after each session to allow them to keep the finished product. At the end of each session, pupils' consent to take pictures of their work will be sought.
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Pupils/families may have additional stressors in their lives
Cases will be excluded where a child is within two months of public examinations, where there is current family reconstitution, bereavement or significant stress in the family.
Pupils who have additional needs may find it difficult semi structured interviews difficult
The researcher will try to identify the engagement skills and any potential difficulties that a child/young person may have e.g. social communication difficulties, language difficulties etc. and will make adjustments accordingly.
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Appendix K Worked Example Thematic Analysis Phase 1: Familiarisation with the data. The researcher completed their own transcription to support immersion in the data because as highlighted in Braun and Clarke (2006), transcription enables the researcher to develop a far more thorough understanding of the data. A verbatim account of the utterances was completed and, following a period away from the data, the researcher relistened to the tapes to check for accuracy and to support immersion further (Braun & Clarke, 2006). During this phase the researcher noted initial thoughts to inform coding. A sample of a transcript is illustrated in Figure A3 and sample of initial thoughts illustrated in Figure A4. Figure A3. Sample of a transcript 222
Figure A4. Sample of initial thoughts Phase 2: Generation of initial codes. Codes refer to the "most basic segment, or element, of the raw data or information that can be assessed in a meaningful way regarding the phenomenon" (Boyatzis, 1998, p.63). The researcher generated initial codes by working systematically through the transcripts, giving full and equal attention to each data item as shown in Figure A5. Extracts were coded into as many codes as relevant; some extracts were coded once, many times or not at all. Codes were recorded if they provided meaningful information, regardless of the frequency of their occurrence to ensure that data was coded for as many potential patterns as possible. The codes formed a list of generated codes; this complete list of initial codes and supporting extracts for the datasets can be found in Appendices L and M. 223
Figure A5. A sample of the initial coding process and a sample of the initial codes generated Phase 3: Searching for basic themes. For each data set, the list of codes was cut into strips of paper containing the individual codes. These codes were then grouped together and collated into potential "basic" themes. These basic themes i.e. the lowest order theme to be derived from the data, were named and recorded onto post-it notes as shown in Figure A6. Codes which did not appear to answer the research question were recorded as "miscellaneous"/coding errors. 224
Figure A6. An example of the organisation of initial codes into basic themes As highlighted, each basic theme, the corresponding codes with examples of data extracts are detailed in Appendix L and Appendix M. Phase 4: Searching for organising themes. The basic themes (orange post-it notes) were then grouped together into potential organising themes i.e. the main ideas proposed by basic themes; these organising themes were named and the labels were recorded onto post-it notes (yellow/green) as shown in Figure A7. At this stage, the researcher ensured triangulation by ensuring that the organising themes consisted of basic themes which occurred in at least two different interviews and thus supported by more than one participant. 225
Figure A7. A sample of the resulting organising and basic themes The organising themes (yellow/green post it notes) and the corresponding basic themes (orange post it notes) have been listed in Chapter 4 for both the case of Amy and the case of Leah. Phase 5: Reviewing the themes. The themes were reviewed to see whether they reflected the list of generated codes and the data set. The transcripts were re-read to see whether the themes also worked in relation to the raw data and to ensure that the analysis provided a story which reflected the data and the research questions (Braun & Clarke, 2006). It was recognised that thematic analysis of the data could be argued to be subjective so a higher level of inter-rater reliability was then completed at this level to support reliability and validity of the themes. Once the basic themes had been grouped into organising themes, a trainee educational psychologist reviewed the theme piles and the labels for the organising themes. Discussions were held and the theme piles were reworked and/or relabelled if appropriate to ensure that the organising themes captured the basic themes and the data accurately. A list of organising themes and supporting basic themes was then produced for each case as illustrated in Chapter 4. 226
Phase 6: Producing the report. Vivid examples from the transcripts were selected to illustrate the identified themes in relation to the research questions. However, if there was insufficient evidence to support the organising and basic themes, changes were made, for example, one basic theme was deleted and two organising themes were re-worded. The list of generated codes and supporting extracts (Appendices L and M) facilitated this final stage in ensuring that there was sufficient evidence to support the codes, themes and subsequent claims. This was therefore important in supporting the validity of the findings. The organising themes were presented under the research questions and were introduced and explained in order of prominence i.e. the number of different codes from which they were derived. The most prominent organising theme was described first with the quantity of description and explanation representative of prominence. Prominence was calculated by determining the total number of initial codes which supported each organising theme. The number of codes for each organising theme was then divided by the total number of codes and multiplied by 7500 (i.e. the approximate word count allocated to each case) to determine the approximate word count for each organising theme. The quantity of explanation was thus approximately representative of the number of initial codes as illustrated in Figure A8 below. Figure A8. Sample of the database used to calculate prominence 227
Appendix L Case 1: Amy Basic themes, codes and supporting extracts AO: Attendance Officer LM: Learning mentor PSA: Parent support advisor
Basic theme (bold) and codes
Interview
Quote/Data extract
Stability, consistency and belonging at school
Stability of school
Attendance
Officer
(re key adult) I just think for her it was stability. Somebody in a sense that does actually you know is going to be there for me everyday for me
Lunch club - Feels part of the `gang' at lunch ­ belonging (and A)
Learning mentor
Now as the different sets of children have come up its just a little chatting group and I think for Amy that has been absolutely essential, she's met a couple of good friends there and she feels part of the gang when she comes back in they'll give her a hug and you know pleased to see you so she's felt safe and welcome wherever she is.
New building - sense of belonging
SENCO
I think moving to the new building helped because that all tied in with a time when we were really struggling if I remember correctly....
you know to give her a sense of belonging and also you know a fresh start and so I do think that was probably lucky timing for us
Supporting routine
Learning mentor
it was just preparing her I used to just ask her to try and prepare, making sure that she goes through her planner to know what she's got the next day.
so they can kind of settle into the routine and find her feet again
New building ­ easier to find way round
Amy
it is easier to find your way round
Access to a positive working area tailored to need
Inclusion area work planned for and
Parent
tailored to them
Support
Advisor
(re inclusion) they can work in isolation they can work in groups and stuff can be tailored to them but they also have staff in there who um so they have there is an adult of some form of another in that room at all times
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Inclusion area bright and good facilities
Parent
so can study
Support
Advisor
Well organised inclusion department
Parent
Support
Advisor
Access to inclusion ­ area where can
Parent
work
Support
Advisor
Area can access which meets basic needs
Opportunities to access area which
SENCO
develops feelings of safety
(re inclusion) it's bigger it's brighter it's got um more and better facilities so children can actually study in there I think um that the inclusion department here is particularly well organised and that its part of the school culture now when Amy hasn't gone to PE for example, she's been able to come here and get on with her work yeah and you know she comes up here at lunchtimes (Inclusion). She does spend her lunchtimes here...... she knows that she's safe here, you know she's liked and is respected by staff and students alike you know she's got a nice little friendship group there which actually spans across the different years year 7, 8 and 9 girls
Learning mentor so she's felt safe and welcome wherever she is.
Opportunities to access inclusion where there is a calm, welcoming space Availability of independent space where no pressure to talk Key adult providing hot chocolate and biscuit when access her ­ calming and comforting environment
Dad SENCO Learning mentor Learning mentor
what has helped is being able to go into the BIC (Inclusion) where as this is comfortable and in general it's calm; I believe that we have a really welcoming space (inclusion) was a personal thing, a space, an independent space physically and mentally where they were allowed to just come and be without people questioning them also you know we used to have a kettle and I was known for my hot chocolates and sometimes students would come in like Amy would come in and not speak for 20 minutes. but I'd give her a hot chocolate and a biscuit.....
Inclusion area is part of the school culture
Inclusion area is part of the school
Parent Support
culture
Advisor
(and SENCO)
Inclusion area to access which is not viewed as a punishment
Parent Support Advisor
was a personal thing, a space, an independent space physically and mentally where they were allowed to just come and be without people questioning them perhaps or that I think no I think um that the inclusion department here is particularly well organised and that its part of the school culture now and even though I'm not here now I'm still confident that that work is still going on well first of all it's not seen as a punishment being sent to inclusion like it is in some schools. you know in some schools that department is seen as sort of a sin bin and that's
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Positive nurturing school ethos Strategy for staff: Don't treat differently Not rejecting her Recognition that experienced loss and the transition experienced as a result of this
Learning mentor SENCO (and Learning Mentor) Parent Support Advisor
not how it works which I am very happy with saying do this, do that, don't do this .... things like...don't treat her any differently keep touching base...because it's not a rejection is it you know I'm assuming that there is some, and I am assuming, that there is a feeling of rejection from some of her own mum and recognise the transition that she'd gone through from mum not being there, mum being married to somebody else um then knowing that mum wasn't well but knowing what was wrong with her
Non judgemental approach
SENCO (also AO)
you know you're talking about varying degrees of loss because people accept her and don't judge her
Young person respected by staff and students Staff welcoming and positive Person centred approach
SENCO (and D) (and PSA) SENCO Amy (and AO) Parent Support Advisor
you know she's liked and is respected by staff and students alike you know she's got a nice little friendship group there you know I do feel that as a staff we are generally um welcoming and positive like the teachers are all friendly cause like my brother Sibling 2 sometimes said oh that's a strict teacher they're not very nice so then I was like oh I don't want them but then it turns out I had them I was like oooh I don't want to go in those lessons and then they were really nice (I didn't tell them he was my brother!) yeah I think they did it in a very pupil focused way; very person centred way
Attendance Officer Attendance Officer
(re inclusion) and the ethos is that it is child centred and they will talk to the children as well as teach them (re learning mentor) there was that bond existed between the two of them where she knew that there was some warmth and support from Learning Mentor and I think from other members of staff too to be truthful.
it's that consistent approach you know that warm approach that sort of that non threatening non confrontational approach with a child
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like Amy was needed you know she'd have become more entrenched if people had been more shouty and form you know `you know you do realise' you know
Caring ethos in school
Attendance Officer
all that around that type of support the caring side of things I think that is what she needed at that time
Feeling cared for/nurtured
Clinical
I think they offered various
Psychologist interventions around sort of reward
systems and giving her attention and
care
Attendance
Officer
I mean like I say I mean I shouldn't
say it but I do think schools
(also SENCO) sometimes can be quite cold places
when a child's got a problem ..... you
know um and in this case I don't think
it was you know they sort of
embraced Amy's problems and
wrapped her sort of you know a
cosseting arm around and said you
know we don't know what's going on
but we're here for you and we will
continue to be here for you and we
will be here for your family you know
Strategy for staff: Acceptance of
Learning mentor uh the other one is accept what she's
progress
done in terms of work educationally
because there's huge gaps
Availability of key adult
Area where can access key adult
Learning mentor we needed access to a quiet room
where the children know where to
come
Availability of key adult (learning
Learning mentor because I'm not on a timetable and
mentor) in Inclusion
(also SENCO) they know that they can knock on the
(and PSA)
door or they know that they can leave
a message to say get hold of me and
they know that at some point, as soon
as I can, I'll be there to see them
Support at lunchtime where social interaction is (easier)
Activities to do at lunch time
Dad
at lunch club they'll sit and talk about
Animae and which character should
do what and sit there and try and
write scripts.
Opportunities to access lunch club ­ calm and quiet environment with reduced social pressures
Learning mentor Learning mentor
and this week its production week so um Learning Mentor to uh give Amy something to do she asked Amy to teach the class how to make origami yesterday I run a lunchtime club and it's for the vulnerables that that don't like the hurly burly..... I think for Amy that has been absolutely essential ...I think because it's a smaller group
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Solution focused approach Focus on positives and solutions rather than focusing on the problem Dad being calm and focusing on positives Avoid `harsh' consequences Avoid prosecution route No `harsh' consequences/not too punitive Communication between staff Learning mentor liaising with staff Communication between staff and learning mentor: staff aware of and trying to understand young person's needs, barriers to learning and strategies to use
Amy
of children that could get to know her rather than a whole class that's only because its quiet up here compared to what it is downstairs and I just if I've had a busy day id just rather not have all the loud noise downstairs so I'd rather sit up here with my friends
SENCO Attendance Officer (and PSA) SENCO
and you know everybody's focused on positives add something positive to those meetings and not being punitive and defeatist but certainly dad in his presentations in front of us was always very calm and focusing on the positives.... he knew how to speak positively to Amy
Attendance Officer Learning mentor (and PSA) (and AO)
they adopted the right approach you know firm but fair and keeping the pressure there all the while you know we're not going away, we're here for you you know tell us what the problem is if we can help you we will do this, we'll do that, we'll try this we'll try this but none of this `if you don't do this your dad's going to end up in court'. but there were no harsh consequences so it wasn't as if she was going to go backwards cause she was punished.
Learning mentor SENCO Learning mentor
and it's a really hard job to not compromise confidentiality but to give them some information to back off, cut them some slack and back off. and I think at times making staff understand that you know the kids come in and they have huge issues at home that the staff don't know about as part of her role Learning Mentor does liaise with staff to ensure that they do welcome Amy and other students who have been in similar situations um and you know has requested very specifically that they don't talk about why she hasn't been in staff have been very very understanding, if I say back off they quite often come and talk to me and
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Effective communication between staff members regarding attendance i.e. office staff and learning mentor Communicating personal targets and strategies with teachers Whole school approach
(and PSA) Learning mentor Learning mentor Parent Support Advisor
say is there anything else I should be doing. which I am very happy with saying do this, do that, don't do this and i think the staff here have been instrumental in helping her back in There's a really good contact with me and D who does the attendance so she will phone me and say Amy's not in this morning. I haven't got her in this lesson do you know where she is? and we did have a time you know where she wouldn't put her hand up but we had a plan where it was you put your hand up if if you 100% know the answer put your hand up and after 2 weeks of doing that so you're used answer the question you're used to putting your hand up. after 2 weeks if you're 50% , you might be right you might be wrong, put your hand up and then after another 2 or three weeks if you don't know the answer at all but you could have a good guess put your hand up.....but I'd also say to the teachers if she puts her hand up can you try and choose her to answer the question. because sometimes some kids don't get the chance to answer the question.....because the teacher has to notice and acknowledge the fact that actually they're making a choice so I do use that strategies not all schools would react the same not all schools have the same you know the staff don't work the same you know it may not be as joined up in some places
Supervision for key adult Opportunity for key adult to offload/reflect with / have reassurance/ problem solve with others on a regular basis
Learning mentor
other members of staff knew what was going on so I didn't have a line manager until SENCO arrived. um too offload and to ask them is there anything else you think I should be doing.
SENCO
For me that is a big learning thing so other people have given suggestions. quite often from my point of view they email me back and say no you've done everything uh you couldn't do anymore have talked through any concerns that Learning Mentor has had you know we have discussed the case,
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we meet fortnightly to discuss students
Key adult has support from senior leadership team
Key adult (learning mentor) has
Learning mentor
support and trust from class teachers
and senior management
(also SENCO)
Fresh start Each day seen as a fresh start
SENCO
New building (fresh start)
SENCO (and A)
Individual support from teachers Support from staff
Amy
Individual support from teacher through learning mentor liaising with staff
Learning mentor (and PSA)
Structured plan to catch up missed work/assessments
Structured plan to catch up missed
Parent Support
work/assessments
Advisor
Personalised feedback Positive individual, personalised feedback from staff e.g. on progress Learning mentor taking young person to meet staff for feedback
Learning mentor (also Dad) Learning mentor
Discussion about the impact of not coming in
everyone here in school, from the lowest of the young teachers to the head are really receptive of the things that I do and that is a huge plus for the job no matter how challenging she is you know I think everybody's given her a fresh start the next day the next hour, the next week, however long it's taken (re new building) you know to give her a sense of belonging and also you know a fresh start and so I do think that was probably lucky timing for us well I've had the support from the school staff.... lots of people have helped me (regarding maths teacher) she would come to me and say he's said I've got to do some assessments because I've missed this this and this but he's not given them to me so I'd take her up and say when is she going to do them So I feel that if if as part of a child's plan they were to spend time in inclusion, then it was planned for. it wasn't just like well here's a textbook go and sit in the corner. there was a lot of planning that went into it you know sort of work was gathered and the positive feedback that she got from the members of staff was a huge part. Huge part I made sure that I took her to the members of staff and asked the members of staff in front of her how she was doing,
Discussion about the impact of not coming in; aware of the severity and consequences of not going to school and the impact on the family
Learning mentor Amy Attendance Officer
We did play quite a, we did, SENCO particularly did play quite a lot on the effect that it was having on the rest of the family, especially for dad no I wouldn't let them like fine him or put him in prison cause it's not his fault that I'm staying off she knew deep down that she was
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Presence of AO- know prosecution possible Not reinforcing time spent at home
(also Dad) (also PSA) Learning mentor (also AO)
causing Dad problems by not coming into school uh she certainly was aware she was told that dad could end up going before the magistrates for it (Family support meetings) been helpful in the success as in dad was very conscious of the EWOs (attendance officer's) involved
Sanctions at home No-one encouraging her to stay off Not reinforcing time spent at home e.g. with TV Avoid negative attention re absence
SENCO SENCO Learning mentor
there were occasionally negatives there were sanctions and they were put in place by dad (regarding grandparents) that they would follow through in sanctions as well so she wasn't allowed to just go there and watch the tele or play on the Playstation or whatever... she was certainly not being rewarded when she was off school she would spend the day in bed... no television no radio no books
Strategy for staff: Avoid commenting about absence
Learning mentor (Also SENCO)
so I used to send memos round to school saying do not say `oh you're back in I'm pleased to see you' cause although they think it is a positive it's actually not
Strategy for staff: Avoid negative attention Strategy staff: quell comments from other students
SENCO SENCO
and not only I think it's as much as don't do this as do do this so in terms of do not comment that she's back in again , do not comment she's missed all this. you know there isn't the sarcastic comment on entry to the room and you know she has been greeted and just slotted in Learning Mentor does liaise with staff to ensure that they do welcome Amy and other students who have been in similar situations um and you know has requested very specifically that they don't talk about why she hasn't been in..... or why she hasn't been attending their lessons and also to try to um quell any comments from other students
Positive experience at school Enjoyed school when in
Amy 235
mmm well like when I wasn't coming into school I wasn't doing anything so I was usually miserable and bored so uh when I started coming in and um going to my lessons and seeing all the teachers and seeing my friends
then that made me happier
Something to look forward to at school
Dad (and AO) Amy
Regularly reviewing and celebrating progress
Learning Mentor said when she's in school she's great she gets on well cause like I know I can look forward to seeing them when I come to school rather than staying at home on my own
Emphasising and making progress transparent to young person
Learning mentor Amy (and Dad) (and PSA)
(progress) yeah yeah and it being tangible cause she'd have the rewards for doing it, shed have the certificates for doing it and um if um like I do something good then she (Learning Mentor) recognises it
Regularly reviewing and celebrating progress
SENCO
We are going to have our celebratory meeting with Dad and Amy in the last week of term
Parent Support It's saying this is when we need to
Advisor
review it by, we've reviewed it, that's
been completed, that's been a
success, that's completed
Appropriateness of praise (discuss how links to progress)
Appropriateness of praise: not over effusive
Learning mentor I think I try not be over effusive with the praise
Development of friendships
Made new friends (and learning mentor) Friends in lessons Encouraging her to mix with friends
Amy Amy Attendance Officer
I've made more friends cause like I know I can look forward to seeing them when I come to school rather than staying at home on my own well yeah but I've got a new friend who came and I wouldn't have known about them unless id started coming in again I have friends in my form which I wouldn't be able to see otherwise the one constant at that point I suppose was school trying to get her to come into school and mix with friends
Group of friends particularly at lunchtime
Amy Dad
that's only because its quiet up here compared to what it is downstairs and I just if I've had a busy day id just rather not have all the loud noise downstairs so I'd rather sit up here with my friends. uh and I think this animae's helped I
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Early identification and intervention
Parent Support Advisor (also SENCO and AO)
know it sounds daft cause you know like at break times, there's three or four of them that will sit down at the lunch club. because she was in school she had then started to develop a network of friends which she hadn't had before because she hadn't had time to do that
School system for monitoring attendance enables professionals / key contact to know instantly when she is not in lesson as data readily available­ supports early intervention Early identification and monitoring of pupils at risk ­ information transferred at primary
Learning mentor SENCO (and PSA)
yeah having the information on the screen and at your finger tips is so much better. The new system is also good as well cause the kids cannot get away with not being in class because if they're in the class before and then they're not in this class it automatically goes through to the office to say where are they. if I remember correctly I'll have a look but if I remember correctly we did name Amy as being one of the ones sorry one of the new intake when she joined in year 7 to offer support because Learning Mentor knew of the family
Identifying relevant agencies early Pre-empt potential difficulties/periods of time Flexibility in meeting specific need Young person can access learning Reviewing and adapting strategies/ intervention over time Flexibility/ adjustments made
Attendance Officer SENCO
ok so having knowledge of the family meant that you were able to put intervention in early.. yes I think it's you know identifying what agencies are needed straight off. I don't think that there were any problems with housing so you wouldn't have a housing officer there but it could be that you would have those difficulties in another case yeah yeah and I'm jolly sure that she will be top of the list or very near the top of the list for Learning Mentor to touch base with in September
SENCO (and Dad) Parent Support Advisor SENCO Attendance
and the fact that they can access that learning. you know if you look at other people who are phobics there may be a learning difficulty which is preventing them from achieving once they're in school so why would they want to come anyway whereas it may be made easier because Amy is bright and as we reviewed the plan various things came up as the situation changed so the plan changed slightly. and if we have to rethink strategies then we'll do it (name) you know who's head of the
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according to needs
Officer
Improving subject specific areas of need ­ IT Developing strategies to meet areas of need ( social situations)
Amy Learning mentor
Support with personal needs­ e.g. prepare for lessons and support her organisation, hygiene
Dad (and learning mentor)
School asked if wanted to move form so that can be with friend more
Amy
Awareness of and ability to identify barriers to learning
head of seven. he was there at every meeting, he wasn't there as the bogey man he was there to support and advise and offer to change bits on the curriculum. I think that they did a good job with this kid. but it's ok now cause like I understand how to use the computer I have done it with phrases. Because she doesn't talk to anyone and they don't talk to her and she was off for quite a long time she was quite isolated. phrases that she can use when she comes into school as in `ah its raining again today' `I can't be doing with this', `oh my shoes are hurting today', `oh I've got such and such for lunch' just everyday little things that involved somebody else having a conversation there's a lot of good communication I mean if there's an issue Learning Mentor will bring it to my attention. it's like with her hygiene for a girl she's not the most hygienic so ill say to her go and get a bath and she'll say I can't be bothered. not really I mean in year 7 they asked me if I wanted to move into xxxx's form so that I was in more lessons with her cause I wasn't in any lessons with her but I said that I'd rather stay in my form cause I still get to see XXX but I have friends in my form which I wouldn't be able to see otherwise
Strategy for staff: Acceptance that there will be gaps in learning School have an understanding of her needs and barriers to learning­ e.g. lessons find challenging
Learning mentor Parent Support Advisor (and Learning Mentor)
Flexibility of key worker's role to respond to needs
uh the other one is accept what she's done in terms of work educationally because there's huge gaps before a child went in (to inclusion) there would be like a round robin done of all their subjects where is this child in this subject? have you noticed anything in class? is there anything we need to be concerned about? um you know do they have particular friends that sort of thing to encourage them to keep that sort of friendship bond going?
Flexibility of learning mentor role to respond to needs
Learning mentor (also SENCO)
so timewise not having mine dictated (role) has meant that the children know that I am available and I think the availability of this role for someone like Amy
and SENCO allows me the freedom
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Learning mentor able to take charge of case Good staff: student ratio for students with additional needs
SENCO (and learning mentor) SENCO
to do exactly what I want, when I want and where I want. it makes a huge difference. it's not as regulated we've put Learning Mentor as a learning mentor she's highly experienced and we have allowed her to take charge I do think we're in quite a privileged position actually in that although we do have a cohort of needy students we have got currently a manageable cohort of needy students and you know we are able to put a support system in place.
Confidence and experience of professionals
Confidence of key adult in role
SENCO (and and I think she feels comfortable in
learning mentor) the role
Experience and skills of learning
SENCO
um it would be great if I could have a
mentor
(and learning couple more members of staff with
mentor)
the skills that Learning Mentor has
Experience of parent support advisor
Attendance I know Parent Support Advisor is a
Officer
very experienced woman and she will
speak and tell them well you should
be in school and I think you should be
in school but she wouldn't give them
any of this right you've got 2 minutes
to get your coat on you know she
understood enough to know you can't
push too far
Key adult who understands how to respond to young person
Choose opportunity to talk to young person when calm Learning mentor taking a step back to reflect and think how young person is thinking/feeling and how much of a challenge something is Opportunity to talk about needs and strategies in relation to others ­ depersonalise ­ less threatening?
Parent Support Advisor Learning mentor Learning mentor
we asked her to not shout at her, not to physically manhandle her because it was distressing for everybody that was involved um but to um sit quietly and when she'd calmed down try and talk to her then but not barrack her so from my point of view I've learned to go a little bit slower because I'm very much full on. and because of time limits the choices are this this this or this but with Amy i kind of took a bit of a step back and pause so from my point of view that's a learning thing with Amy. and give her time to think about it and react. and quite often I use my own 3 kids, I tell lies constantly about my own three kids to give them a chance to speak about their own relationships with their own sisters and brothers...... the kids were always I used to have pictures of my kids on my wall and id say this one would do this and that one that, he did that he did that and we got round about it by how about
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doing this what about that. rather than you have to do this. It was, core he drove me mad doing this and I didn't know what to do, but I did this. and it actually worked this time so maybe we could try that this time?
Key adult who understands the young person and what approach they may respond to e.g. time to respond, not heavy handed
Learning mentor (also SENCO) (and PSA) (and AO)
in terms of having more pauses within the time spent with her to think and not to expect an immediate reaction .... because she's a thinker. so different learning methods for me as well I think
SENCO
because I'm very nosy and because I ask huge numbers of questions I will eventually get the twitch of the eye or the smile so I know which route to go down.
but within that we need to consider the personalities of a team and their own personalities and their own capabilities. I mean I'm just lucky that Learning Mentor' way of working has worked incredibly well with Amy and her family
Clear boundaries and expectations Having and keeping to boundaries and expectations
Attendance Officer (also SENCO)
Teachers firm and consistent; clear
Attendance
boundaries
officer
(and Amy)
Key adult with whom can develop good relationship
Good relationship with key adult
Learning mentor
(learning mentor):
Friendly/approachable/ not getting
cross/ can connect with/ open support
Attendance Officer
(also SENCO and Dad
giving them the positive side but at the same time telling them look there are rules and regulations that you've got to abide by but we're willing to sort of be flexible and work around a certain few things but some things are going to be you know one of the things you must come to school but one of the things is that we will make adjustments for you while you're here until you feel better able to cope you know she wasn't being told off but then again they were being firm and fair if you like yeah and I never shout ....my role was the friendly, the friendly face saying fine, if she's in smashing, just tell me why you're not in, you're missing out on this. I just think the consistency you know having someone like Learning Mentor that was listening to what the child had to say, support her as best she could even when she wasn't saying anything there was that bond
Allocated a learning mentor
SENCO
so she was actually allocated a mentor in the February after she started school
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Dad
(also Amy, PSA she's needed a bit of guidance with
and AO)
Learning Mentor
Try and understand and address the cause of school refusal behaviour
Trying to understand and address the cause of school refusal behaviours
Learning mentor (also Amy, Dad, PSA and AO)
everything we'd spoken about was investigated, there was name calling on the bus we investigated that but then we'd find out from one of her siblings that actually it wasn't that at all
Understanding of young person's needs and recognising that there is a reason for behaviour
Learning mentor (also PSA)
Once we'd got to the bottom of one reason why she wasn't in she would come up with another one. we never knew why she did it. but we knew there must have been a reason why she did it.
Reintegration planned according to need
Flexible timetable
Dad
PSA (Also SENCO and AO)
Gradual reintegration into lessons that found hard
SENCO (and PSA)
Carefully planned reintegration
Parent Support Advisor
Breaking challenge down into manageable steps e.g. go in for the first half of the lesson
Learning mentor
Key adult who is a constant Key adult (learning mentor) in school who is a constant ­ someone thinking about her
Attendance Officer
yeah because basically if there's a lesson where Amy's struggling or perhaps she's not keen on. what they've done is for that lesson said that she can go in BIC and um we can sort out getting you the work as homework or we can get you caught up. I think there was there was a reintegration back into classroom and that was done very much on a part time basis I think that if we had forced the issue with regard to PE I don't know but I suspect it would have made it more difficult it was broader it wasn't just in inclusion and sort of you know when the reintegration came back where she was going back into classes there obviously had to be preparation done for that there has to be a good reason and if we can manage to do it you know we can do a compromise we can say well go in for the first half or go in for the second but school was a constant. alright she wasn't attending but then she knew that they wanted her to attend they were coming like the cavalier over the horizon you know
Learning mentor (also SENCO, PSA)
As much as I could I wouldn't let her get away with ignoring me. because once they start doing that I find I lose them. If they think that they can get away with cause it's too challenging
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so I would just keep on and keep on. and I think, I think having someone here like me in school that doesn't give up and I've made that comment to a lot of the students I see.
Key adult matched to young person Matching learning mentor to young person (and learning mentor ­ female role model) Key adult's knowledge of family
Learning mentor (also SENCO) SENCO
as a kind of, as a mentor, as a female that really helped... Because I don't think that she would have connected with a male There's also a huge knowledge of the family Learning Mentor, the learning mentor has got a history of working with particularly Sibling 1 who's well just about to leave us, she's in year 13 so she had quite an intimate knowledge of the family really.... so there was a lot of trust
Regular personalised contact Regular personalised contact­ not forgotten (when attending and not attending) (i.e. daily from LM)
Amy
she knows that I've got stuff at home that isn't too good as well cause like she used to like talk to Sibling 1 as well
Learning mentor
I think certainly I checked up on her every day... yeah and even when she was off school I phoned her every day.
Attendance Officer (also SENCO)
keeping in contact as much as you possibly can....I think that is key ...therefore we think you're worth more than just being forgotten about.
Involvement of agencies over time e.g. EP touching base ­ still thinking of her
SENCO
yes but not someone coming in just for a one off
Persistence Long term involvement Persistence ­ not giving up (family, school, EP (series of sessions))
Learning mentor Learning mentor SENCO
cause Amy's going to be a long term project. She'll be with me til she's finished.... she knows its long term Once they're referred to me I do not give up nobody has given up on this girl. nobody
you as an educational psychologist has given to her and you know the fact that you didn't just have two sessions and then never see her again.... I think it's important that you kept touching base with her
yes but not someone coming in just for a one off... and I think that is the
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you know really really important
and you know an acceptance that it is part of our role to not judge and keep trying
Attendance Officer (and PSA)
um I mean I do think that it is important to not forget if that's correct. not to forget students who are not attending school yeah being there being consistent we're not going to abandon you Amy. we think that you know you're worth more than this. you know we could just walk away and let you sit at home and do nothing and like but you know we're going to keep coming here keep trying to chivvy you along and get you into school cause you you know you know you like school deep down and the child did
Support with journey to and from school
Support from family with journey
Amy(and also
SENCO LM,
Dad, Clinical
Psychol)
home visit from Parent Support
Amy
Advisor to take to school
because he'd usually drive me to the bus because it's 10 minutes from my house. she's come to one of the meetings and she actually came once to my nana's house to take my little sister into school cause she'd also started refusing to go into school.
Personalised rewards based on interests
Personalised rewards based on
Amy(also Clin
interests
Psych, SENCO,
Dad, PSA and
AO)
Taking an interest in young person as a whole
cause I like animals so when I do well she sometimes takes me out to the cats and dogs home
Staff taking an interest in young person e.g. asking questions
Amy (and PSA)
even if sometimes they'll start conversations with us if we're doing our work. If we weren't like they'd obviously be telling them to get on with their work like
Dad take an interest in what she's doing at school
but they'll start conversations with us
and talk to the whole class about
things that they have done in the past
and stuff like that
Dad
and you know and I show an interest
in what she's doing and you know
she told me today she's doing this
history of origami and everything you
know
and then she said we made this tree up um so she's you know so if she says were doing this at school ill
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show enthusiasm you know
Key adult remembers details about young person and follows through promises made
LM follow through with rewards
SENCO
and follows through with a reward no
matter how small and doesn't
forget..... in terms of the child in terms
of the history in terms of what she's
promised
Key adult keeps good notes
Learning mentor I do keep pretty good notes. short
sharp notes on that
Key adult remembers details about
Learning mentor I think my memory is really very good
students and promises made: Taking
(also SENCO) and I think that has helped
an interest and not forgotten
oh yeah without a doubt, taking an
interest in Amy and that I do
remember things that she's said.
They know that I've got quite a heavy
caseload. they know that I have seen
quite a lot of kids over the years but
the fact that I can still come up with a
fact that she's said
Recognition that even when attend the young person may find it hard
Recognition that even when attend
PSA
yeah but school were also
young person may find it hard (ups
(and Amy and acknowledging that they recognise
and downs)
LM)
that she was finding it hard
Give young person some choice and control
Giving young person some
PSA
choice/control
but just please be aware that she's still struggling but she's in ... and um just basically gave her as much information as she could understand and that she needed to know so that she could then ask questions ....so we were sort of giving her a bit more power I suppose.
Dad
Some control over going to lessons she found hard
SENCO (also D)
Positive attention from school, family and peers
I don't treat her like a child I don't say well its 9 o clock you've got to go to bed now I'll say its 9 o clock get ready for bed and she'll still be sat there at quarter to ten but it's getting her to realise look you have got to go to bed cause you've got to be up early in the morning. but giving her that freedom not to go and not to force her to go I think made a difference.
Peers pleased to see her when return Positive attention/praise from family
Learning mentor Amy
when she comes back in they'll give her a hug and you know pleased to see you well like they've been like if I've done something they praise me for it as in like so if I come in they'll be like well done Amy you've gone into school
um she's been praising me as well cause like she knew I was having problems getting into school so she said she was very proud of me when I
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started going back in
Dad
A: Positive attention and encouragement from friends Gaining positive attention
Amy Attendance Officer (and Clinical Psychol, SENCO)
Encouragement from school, family and peers
Reinforcing school is not going to go
Parent Support
away
Advisor (and AO)
Reinforcing want her in school Support and encouragement from family
Attendance Officer (and A) Learning mentor SENCO
Encouragement
SENCO(also Amy, Dad, AO) SENCO
and her granddad that's the father in law does idolise Amy very much. and when we got to his house she's always got to sit next to him and he does make a big fuss of her well they have been supporting me and telling that its best to come into school and like it's easier to talk to them if I'm in school it was looking at all sorts of ways to engage her really when working with people really trying to get her out of her shell........well even if she didn't do it it's the same thing that somebody is showing this child attention and concern you know and I think that's a big factor in any child's life continue to visit the family at home as well to encourage dad to keep going, not give in and to keep saying to Amy, school's still there it's not going to go away but all the while we'd be saying we want you here and reinforcing that. we don't want you outside of school I think having Sibling 1 here helped an awful lot. (grandparents) yeah they were very supportive in that you know if Amy's father needed to go to work and needed to leave a child like Amy they would look after her and they have brought her to school. um full of encouragement for her to come in and there's a lot of encouragement you know
Attendance cause we want you to get the best
Officer
from school
Peers encouraged to make contact
Learning mentor When she wasn't coming in one of
when not in school
the kids kept asking where is she
where is she. so i said have you got a
text number and she said yeah so i
said text her and find out.
Young person able to express views and feel listened to
Giving young person a voice: opportunity to express her views; having someone to talk to
Learning mentor
when we had the FSMs and she wouldn't speak, first of all I was a bit concerned about speaking for her. but I would always say do you remember when we talked about that Amy? do you remember what you said about that? could you perhaps
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Feeling listened to Talking to independent adult Sense of identity and value
Learning mentor (also Amy, PSA and AO) PSA (also SENCO, Dad and AO) Learning mentor
tell us it now? do you want me to say what it was? so id perhaps go back on the notes almost verbatim say that this is what you said is that right Amy? It was a chance for her to say that as a third of 4 she was invisible I think um helping Amy to get Amy back to school was primarily about somebody focusing on her because she's number 3 of 4 children and I got the distinct impression that she didn't get listened to much at home; she didn't get heard anyway..... she was making the noises but I don't think she was being heard and the fact that somebody i.e. Learning Mentor took the time to do 1:1 work with her, I think coming in to talk to you certainly helped because you weren't of the school.
Treating as an individual Discussions with young person about the family dynamic and their role within family Sense of identity Being aware of individual preferences and choices and respecting diversity Encouraging independence Giving her responsibility
Learning mentor (and PSA) Learning mentor Learning mentor Learning mentor
um treat her a bit more as an individual than as a whole class I think for the main we've I have tried to talk about how she fits in with the family and the impact on the family of her not coming into school but um I I just think the bit of identity i think there might be a bit of an identity problem you know in terms of who she is ....it's that I didn't question her honesty .....things like that I think um just gave her a little bit more sense of identity. but that's Amy's choice, she's old enough now to. she might not be that inconsequential chatter person
Learning mentor Amy (also SENCO and Dad)
she would have the responsibility of using my computer to design a certificate the last meeting I had with her was because peer in my year was also having problems coming into school so she wondered if I could help him
Demonstrating trust When in school give young person responsibility to identify needs ­
Learning mentor Learning mentor
and she realised and I would often say things like I know I'm not supposed to leave anyone in my room without me being there but I really do have to just nip there and see so if I leave the door open I know I can trust you is that ok? she's got to draw take responsibility of asking me what she wants rather
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encouraging independence
Developing confidence of young person
Develop confidence e.g. group /
Learning mentor
strategies to put hand up if 100% right,
(also Amy)
then if 50% right
Group: building confidence
Amy
than me saying to her what can I do for you. and for Amy that confidence of getting it right, maybe not getting it right, probably not getting it right and how the other kids are going to react to her. I did this group on a Friday last lesson and it was to help build up my confidence
well when I first went into the group I didn't think I could do anything like I don't like doing sports that often but I did just think well I can't do it so I don't like it but um after that group I've done PE more and I am enjoying it
I didn't think that I could do something but after that group I thought I'd give it a go and found out that I really liked it and thought that I was really good at it well not really I thought I was good at it cause I can do it
Self efficacy Developing self worth Focus on what young person can offer to class Building on strengths and using this to develop admiration from peers Taking a lead in something her peers find fun and fascinating
Amy SENCO SENCO SENCO
cause like um I didn't really think that I can do very much and um from going in that group I feel better about myself like I can do more.... Like skill wise and stuff like that in that she hasn't been made to feel that she's brought the whole class down, she hasn't been made to feel different um and again it is positives. People have focused on what she can offer and what she can bring She knows that she's valuable doesn't she; she knows that it's something that she can do that maybe the other children want to do and find fascinating and useful and fun Learning Mentor just this week has got her involved in some creative and media work you know to a point where she has actually been delivering some workshops in origami
She knows that she's valuable doesn't she; she knows that it's something that she can do that maybe the other children want to do and find fascinating and useful and fun that really has helped this week Dad (re origami) Amy's done that with these children they were doing it and
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she was advising them and telling them how to it.
Making her feel special e.g. doing things other pupils don't do
Learning mentor (also Amy and Dad)
because I think they're making her feel a little bit more special and it's something that other children don't do. I take her to the dogs home
Positive feelings about herself/value of self worth Increased participation at school Strategies to improve visibility in class/ getting noticed ­ supporting participation in lesson
Amy Parent Support Advisor (also SENCO, Amy and AO) Learning mentor
well again it's going out of school and it's something that I don't do very often with other students so it was for her. I feel much happier than what I did. when I first met her in the February she had her school uniform on but she looked quite messy like her hair wasn't very well brushed and that sort of thing and towards the time when I was about to finish with her she'd started to take a pride in herself but I'd also say to the teachers if she puts her hand up can you try and choose her to answer the question. because sometimes some kids don't get the chance to answer the question. you know they'll put their hand up but teachers do definitely do have a
More involved at school
Dad (also SENCO)
strategies...but letting the teacher know I think it's because she's getting a bit more involved I mean Learning Mentor has got a young lad who is very similar to Amy. and she's asked Amy to help this lad and talk to him and try and find things out. so I suppose giving her that responsibility
Parent support advisor
PSA: because she was never in and when she was in she was isolating herself in the inclusion department TEP: right PSA: um whereas gradually she began to move forward TEP: right ok so actually becoming more involved in the school environment PSA: Yeah
Encouragement in leisure activities More active Building on interests Building on interests
Parent Support Advisor Amy
looked at things like the area where she lived and whether or not there was any youth activities that were gentle enough for her to attend I've done PE for the last 6 weeks so I'm sportier and more active
Attendance I didn't meet with him but he was sort
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Officer
of charged with you know she wants to join the science club you know cause she's got an interest in science you know...... it was looking at all sorts of ways to engage her really
Family members and young person doing things together based on interests
Dad (and PSA)
he plays her at resident evil, that's Amy's game so.... yeah and Amy's red hot on that and she's so good on that she's teaching him now to do it and she's getting him all these different weapons and different things and I think having that is good its helped her.
Reinforced that noticed and missed when not in school
Noticed: young person knew
Learning mentor
attendance in each lesson was
monitored
Staff continue to remember her
SENCO
Not invisible ­ noticed
Learning mentor Dad (also Amy)
Reinforce that noticed and missed by peers when not in
Learning mentor Attendance Officer
uh and then Amy's, she was wanting me to teach her to cook which is good... as I say you know if Amy wants to do something you know like I've already told her that ill get the ingredients in this Saturday for her to come home and she can cook either Saturday or Sunday she knew that I was keeping my eye on her. she knew she couldn't get away with it if you like I don't remember forgetting about Amy but it's um it is uh you know maybe because there was some movement with Amy people did continue to remember her she needed to know that the staff noticed her cause she's very quiet in class no not really I think it's just that finding that spot where she realises she's not being pushed back and with that you've got the fact that she's got a bit more family now so a bit more attention so I think that played a big part in it you know people in school saying where are you, we miss you do you realise, I mean she might only have one friend in the class do you realise, she's waiting for you she wants to know where you are. that would be mentioned that type of thing you know I mean its mentioned with lots of children but it's all about you know you've got friends here you know when you're here you seem to have a good you know rapport with people and get along with people.
Noticed in class for positive reasons Personally noticed by staff (particularly Learning mentor they come back with they're a star,
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for positive reasons)
(also Dad)
fab, and I show that to the child I do show them the negative ones but they get the feeling that the teacher has personally noticed
instead of being the scruffy smelly kid she was noticed for her intellect and I think that was quite important to her
she needed to know that the staff noticed her cause she's very quiet in class.....
Encourage teachers to notice her
Learning mentor so the fact that the staff know exactly
where she's at at this time but from
my job point of view I made the staff
very aware that they had to notice her
Consistency
Consistent messages and approach
SENCO(also every adult around her was giving her
Attendance the same message you know about
Officer)
how important her education is and
about the impact it might have if she
didn't attend
Regular monitoring of attendance which is communicated to young person
Regular monitoring of attendance
Learning mentor Parent Support Advisor (and AO)
Regularly provide updates on attendance level
Learning mentor
Positive role models for young person Positive role models ­ success and attitude to learning (sibling ­ mental health needs; academic role models)
SENCO (and Amy)
but the other thing is that I do keep up, I tell her on a regular basis what her attendance percentage is none of us were working in isolation so for instance Learning Mentor, SENCO and xxxx the head of year we kept in touch and the other thing is that part of my role was to monitor whole school attendance and every week um I would meet with the education welfare officer and wed pick out children who were of a concern and Amy was one of them so we always knew where when she'd been in, how long she'd been in for and if she'd made a good, if she'd had a good week so if she'd come in two days but the other thing is that I do keep up, I tell her on a regular basis what her attendance percentage is I think the fact that Sibling 1 has overcome a lot of issues herself, Sibling 1 has had a lot of mental illness but despite that has continued coming to school when she can and has achieved extremely well
she's not in she may be also has good role models when she's here because she's in sets where there are many children who have aspirations and how have a good
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Clear distinct roles of professionals Clear/distinct roles of school staff e.g. learning mentor vs senco vs Head of Year (good cop bad cop)
Learning mentor
attitude to their learning but my view was she was getting the cross and the shouting at home. and if I did that here so I did a definite stance on being the friendly open one
SENCO (and PSA)
but then it has been quite valuable then to have me as am um I've taken the more authoritative role, say for example in any meetings.... So you know so the good cop bad cop scenario
Clear understanding of each other's roles (in multi-agency work)
Attendance officer
Recognising aspiration and motivation
but I've got to understand what happens or have a degree of an understanding what you can do and how I can help you do what you need to do in your job and vice versa
Motivated to come in and succeed Goals and Aspiration
Amy (and Dad) Amy (also SENCO and Dad)
I can't be bothered I'm more like motivated and that's kind of what I was thinking I'm more motivated to come in and that probably just that I know I need to do my GCSEs and that I need good GCSEs if I want to do what I want to do
I wasn't thinking about that before
when I wasn't coming in. I didn't know
what I wanted to be so I didn't know
what lessons id want to do and stuff
so I thought I may as well not bother
with lessons
Careers advice from family
Dad
if that's the route you want to go then
that's what we'll do but you know you
need to look out and see what you
need to do.. what exams you need to
sit, what qualifications.
Collaboratively developing realistic targets and strategies
Subject targets
Amy
so I'm going to try and get higher than
my target. I think I'm just below it. I
think I'm only just getting a level 6 but
I think I'm supposed to be at the top
of level 6 going onto level 7
Collaboratively developing realistic
Parent Support Learning Mentor and I, the learning
targets and strategies with young
Advisor (also mentor, did a lot of work together
person to meet needs
SENCO)
where Learning Mentor worked with
Amy to set her goals and targets she
didn't work in a class for quite some
time. she went into the inclusion
department and did her lessons there
and then gradually she was
reintroduced um back into lessons
the idea was yes she's here to get an
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education but first and foremost we
need to get her through the front door
and then we need to plan with her
because there is no use giving a child
a plan when they've got no ownership
whereas for this she definitely had
ownership for this plan
Professional who is aware of agencies and support available
Parent support advisor ­ knowledge of Learning mentor I think the parent support advisor was
agencies and contacts ­ signposting
(and Parent quite was quite, really very good in
Support Advisor) pulling a lot of the strings together
and she did have a lot of contacts
with different people
Information sharing between agencies
yeah yeah I mean she really did have contacts coming out of her ears, she had fingers in she knew everyone in every department you know she's done a lot of jobs over the years
FSMs: share views and perspectives Communication with agencies/ information sharing
Learning mentor (also SENCO) Learning mentor Parent Support Advisor
we have meetings when we called FSMs here (Family Support Meetings) and sometimes yeah I think it was the head teacher that came here once. and I think the actual class teacher came so we had quite a few meetings with lots of people I think that dissemination of information is absolutely vital none of us were working in isolation so for instance Learning Mentor, SENCO and xxxx the head of year we kept in touch and the other thing is that part of my role was to monitor whole school attendance and every week um I would meet with the education welfare officer and wed pick out children who were of a concern and Amy was one of them so we always knew where when she'd been in, how long she'd been in for and if she'd made a good, if she'd had a good week so if she'd come in two days
Attendance Officer
cause what I would do on a Friday after we'd have a meeting I would circulate an email and say so and so's done this, Amy's had a really good week she's been in, she's done two days, shes done this or she went home at lunch time on such a such a day but she's in
it's just about making use of your colleagues and ideally helping them to do their job properly and helping
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you to do your job properly by sharing
the information and you know
supporting it by going out and doing
the joint visits
Multiagency approach with professionals working collaboratively towards a common goal
Multi-agency approach
Attendance I just think that it's a multi-disciplinary
Officer (also PSA effort as well. Everybody did what
and Amy)
was asked of them as best they could
there was no drift I think people did
get on, people did do what they said
they would.... I think that multi-
disciplinary approach you know of
people staying fairly focused as best
they can I think that helped
Referral to CAMHS
Attendance encouraged dad to make referrals to
Officer (also camhs and things like this to see if
PSA)
there were any underlying mental
health problems which are more
emotional rather than mental health
you know
Professionals working collaboratively Parent Support I think it's that as professionals we all
towards a common goal
Advisor (and AO) work together towards a common
goal
lead professional to co-ordinate agencies and involvement
Lead professional FSM: someone to
Attendance the lead professional to be checking
co-ordinate agencies and involvement
Officer (also up on people did you do what you
SENCO)
said you'd do in the first two weeks
cause obviously we're meeting in 4
weeks but if you didn't then
Family support plan with SMART targets which are regularly reviewed
Family support plan Clear actions in family support plan ­ who by when (and AO) Professionals identifying achievable actions ­ realistic and timely Involving family in the plan Follow up agreed actions
Parent Support Advisor (and AO)
once it was on paper and part of the plan both Amy and her dad did seem to respond to the fact that they had a plan
Parent Support Advisor Attendance Officer Attendance Officer (and PSA) Parent Support Advisor Attendance Officer
I would definitely say that using a family support plan helped the family support meeting was called as a result of what we did at the caf because the first thing we said was that we need a plan. you know of people staying fairly focused as best they can I think that helped I think that when you do any of these assessments let's make a realistic timeframe for when we're going to meet again. If someone's going to do something then how long do they need to do it. and be part of the plan if they haven't done things but you know chivvying people along so you know you said that you were going to do that so do you think you could do it
253
cause we're all busy people and
hopefully they'd do it soon you know
we'd say you said you were going to
do this, have you done it yet?
Family support
Listen to parents and children
Parent Support as well as listening to the parents you
Advisor
must listen to the children's side
Non directive approach with family
Parent Support one of us would try and talk to them
Advisor
and not not tell them what to do but
get them to talk it round so that they
came to their own conclusions but
gave them the odd helpful hint as it
were
Parent support advisor ­ key contact Learning mentor LM: yeah yeah and I think also Parent
and support for family
(also SENCO, Support Advisor' role was pretty
PSA and AO) important as well because she deals
with all age groups so she was also
dealing with the younger sisters....
which we wouldn't have really had
much to do with
TEP: right
LM: but course when her job here
went there was no connection
between the families if you like cause
she was the family support officer
TEP: ok so it was the connection then
and having support for the family
LM: oh yeah definitely
Family trust learning mentor
SENCO
I think the family trust Learning
Mentor you know she knows a lot
about the background, problems in
the past and what's happened with
mum so there was a lot of trust
Identifying how can support Dad
Attendance
talking to dad about what it is he
Officer
needs.
Support and encouragement for family Parent Support Attendance Officer would continue to
Advisor
visit the family at home as well to
encourage dad to keep going, not
give in
Facilitating communication between young person and family
Putting child views to parent
Learning mentor absolutely key in what I do and
sometimes feeding information back
information in a, in a different way to
the parents that the kids can't say
Dad
(also PSA)
she (Amy) has spoke to Learning
Mentor about a few things where
Learning Mentor has been able to
come back to me.
Encouraging family (and extended
Parent Support so we did talk to gran about that so
family) to empathise with YP's needs
Advisor
we said you need to renegotiate and
get her back in because you know
she's gone through enough
Advocate for young person e.g. their Learning mentor to stand up for them um if they
voice in meetings/ staff to back off
haven't done their homework. you
know I send a fair amount of memos
round to staff. and it's a really hard
job to not compromise confidentiality
but to give them some information to
back off, cut them some slack and
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back off.
Firm, honest approach with family
Firm, honest approach with family
Attendance we just tried to say firm but fair and
Officer
try to get family routines going
Discussion with Dad about the
Parent Support I think the other thing is we explained
implications of not coming in
Advisor (and to him on a couple of occasions the
Amy)
implications of her not attending
school um
Developing the young person's understanding of thoughts and feelings
Trying to develop understanding of emotions
Learning mentor
Group: understanding emotions: thoughts and feelings
Parent Support Advisor Amy
Providing evidence to challenge negative thoughts
I used to have a feelings chart on the wall and Amy would be a nodder and a shaker it was just little figures and emotions and my thing is, I used to say every emotion is valid Learning Mentor also um did some 1:1 work with her where she looked at the emotional side Cause like if I know like how my emotions are caused like if it's not a very good emotion I could try and make it better like make it more positive
Providing information and reassurance to reduce anxiety
Parent Support Advisor (and AO)
Learning Mentor also um did some 1:1 work with her where she looked at the emotional side and um talked to Amy about the nature of her mum's illness and um just basically gave her as much information as she could understand and that she needed to know so that she could then ask questions
I know that one of the break throughs
was when um Learning Mentor
printed off the information about lupus
which is what mum had because she
suspected that um Amy had read
something somewhere that basically
it was a death sentence
Improvements in family member's
Clinical
the one big difference is that dad has
health
Psychologist had some health problems which he
(also SENCO) had an operation and I think he was
(and PSA) (and much better so whether some of her
AO)
worries were about her father and
also interestingly her sisters mental
health also improved
Evidence which challenges thoughts
Amy(also Dad) like the teachers are all friendly cause
e.g. when started to come in she
like my brother Sibling 2 sometimes
started to realise that teachers were
said oh that's a strict teacher they're
nice / Dad not being confrontational
not very nice so then I was like oh I
don't want them but then it turns out I
had them I was like oooh I don't want
to go in those lessons and then they
were really nice
Supporting young person to reframe thoughts and think more positively
Helping young person to empathise
Learning mentor he had no life. he still has very little
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with Dad Supporting young person to reframe difficulties and think more positively
Amy
life of his own. so when the kids come in and say he was playing on the xbox last night and I wanted to talk to him, and my argument would be you need to chose your time. so we'd go over how to choose your time to talk to your dad, if he was cooking go in the kitchen with him because that's a time when you can chat. when I get on the bus on my own dad usually says although you're on your own it doesn't matter cause you'll be coming home to us anyway at the end of the day so something to look forward to
Parent Support Advisor
we asked her to um to look at the way she responded to her sister for instance because she was quite volatile where her sister was concerned because she felt like she was bossing her about whereas her sister had assumed this parenting role so what the plan asked her to do was to think about her reactions and to hear when her sister was talking to her that it wasn't that she was bossing her she was trying to help her
`Personal best friend' to help when
Amy
and one of the activities we did we
have difficulties with peers
came up with our own personal best
friend and we had to draw them..... I
know that like if I've got a good best
friend they'd always back me up and
help me to say what I want to say
Young person aware professionals trying to help, knew what they were trying to do and why
Collaborative approach between home and school which young person is aware of Young person aware school trying to make adjustments to make school a more positive experience
SENCO (also Clinical Psych, SENCO, Dad, PSA and AO) Amy
I think probably the main reason is the contact between school and home and the fact that we all sent the same messages um she saw us meeting frequently, she knew that Learning Mentor would be contacting Dad frequently.... i think it was important for Amy to know that we were all working together to get her into school so I thought it was really nice of them to ask but I didn't want to
Young person aware professionals trying to help
Parent Support Advisor (and SENCO and
(re FSM) I think it was important that she heard that yes there were concerns but people weren't there to
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YP aware school trying to help Taken seriously; Family support meetings showed that she was being taken seriously; - official and a context that she understood how serious it was (also involvement of agencies)
Amy) Attendance Officer Learning mentor
chastise her, they were there to help her. I think those sorts of things even if they didn't happen they were offered and I think that she understood that the school were supporting her although she might not of fully understood that but she would be able to comprehend the fact that people were not giving up Family support meetings...yeah I think putting it into place, and putting it into a context that she understood how serious it was
SENCO (also Dad and AO)
yeah I think the fact that firstly she knew that we were taking matters very seriously the fact that we did get somebody
Attendance and participation at FSM: knew what people were doing and why, reflect Resilience of professionals
Parent Support Advisor (also AO)
she actually came to the meetings and she took part in those meetings and as the discussions went on she was included so when the plans were being put together she knew who was doing what but more importantly why
Recognition that takes time and doesn't always work first time
Learning mentor
it's the I'm a drip drip drip person and if it works. and the other one I would always say is that it's not going to work every time.
Resilience of team not to give up Professionals not letting things drift Giving young person time
SENCO AO Dad
I think maybe you know building the resilience of some of our team um to not give up it mustn't drift.... that's when you'd expect somebody to use their, in this case the lead professional to be checking up on people did you do what you said you'd do in the first two weeks I think basically giving her more time
SENCO
Collaborative approach between home and school
Collaborative approach between home
Dad
and school
SENCO (also clinical psych, PSA, AO)
everybody's given her a fresh start the next day the next hour, the next week, however long it's taken she has spoke to Learning Mentor about a few things where Learning Mentor has been able to come back to me. that link with home is has made it so much easier
I think it was important for Amy to know that we were all working
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Regular communication between home and school
Regular communication between
Dad
home and school
(also SENCO
and PSA)
School have positive relationships with parents
School have positive relationship with
SENCO (and
Dad
LM)
Availability of professionals for family
Availability of professionals for family Parent Support
to discuss concerns e.g. PSA
Advisor
(and AO)
Parents' openness to advice, support and change
Dad listened to and took on board
SENCO (also LM
school's concerns
and PSA)
Determination of home to make it work
SENCO
Supportive parent ­ open to advice and support
Learning mentor
together to get her into school I think it's the communication there's a lot of good communication I mean if there's an issue Learning Mentor will bring it to my attention I mean dad has been fabulous because they used to ring um if there was a catastrophe or something they would ring school and get one of us so somebody was always able to talk to them the only negative I could point out with regard to the family is that dad did on a couple of occasions use access to mum as a punishment....but give the man his due he listened and he took it on board who are determined to make it work and tirelessly make it work then it won't work and dad was very very open to suggestions and it must be very hard. Both SENCO and I constantly say how hard it must be as a parent trying to do the best to have somebody from school saying you know what can you do this, can you perhaps try this or try that. But he was at the stage where anything, anything would help so he's been brilliant
Parent Support Advisor (also SENCO)
while I was sat in the office I saw him coming in um or he would phone me or I would phone him or after we'd had a family support meeting he would wait and I would spend some time with him so he would he was very open to suggestion
Increasing effectiveness of parenting skills
Encourage Dad to reflect on feelings
Parent Support
Advisor
I tried to get dad to talk about his feelings
Dad reflect on home environment and family dynamics e.g. as a result of FSM
Dad (also PSA)
When we said things to him like do you talk about your emotions uh how you feel he admitted that he didn't I think through sitting through the meetings and sitting down and seeing how Amy is. I think more so when you get home and seeing when they're all arguing you sort of like sit back and see what's going on.
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Dad trying to ensure fairness at home Dad taking more responsibility for young person's needs rather than older sister Not using access to parent as punishment Standing up for young person at home so she does not feel like people are getting at her Parenting support
Dad Clinical Psychologist(also SENCO, Dad and PSA) SENCO Dad Parent Support Advisor
yeah just taking a step back and making sure you know that if i see that if I see she is a bit down or if for a couple of days I see she's a bit off you know I'll say shall we do this today or shall we do that today as soon as the girls come home I'll say look it's their time now they can watch the tele/ go on the playstation you've got to be fair. you know I won't let him rule it I make sure they all get their fair share the fact of Dad being there all the time meant that he took on that responsibility rather than the older sister that's kind of a learning point for other cases isn't it not using things like that as punishments absolutely absolutely and Amy said something the other day cause he was shouting and raving about summat and he started having a go at her. so i said ay what are you having a go at Amy for? you're ranting and raving we're all trying to sit and watch something on TV and you're having a rant and rave. you're out of order. so like I said i defended Amy cause Amy's right he shouldn't be screaming and balling at Amy. He shouldn't be shouting at her cause he's in the wrong I did more work with dad to try and get him to parent consistently with her but I also talked to him about the fact that the children seemed to be getting drawn into the grown up side of things because dads relationship with mum was not good.
Spending time together as a family Spending time together as a family More time spent with Dad
um so there was an awful lot of messages coming from different people so I encouraged dad to become the main carer....just by boosting his confidence and telling him when he was getting things right and just making gentle suggestions to him
Parent Support Advisor Dad (also Clinical Psychologist, D
he started we encouraged him to start doing things with the children outside the home as well.... and that did seem to work u rather than them getting up going to school coming home, cooking the tea, going to bed So I did 2 days a week now and um which gave me more time at home. so it gave me more time with the kids.
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and PSA)
but I did say the situation at home was that Amy probably got less attention than any of them
I then said that id start doing more which I have started showing her how to cook. and you know she'll sit with me at nights and we'll go on the playstation and then I'll play against her. and you know and I'll sit with her and talk to her
Discussions about strategies to use at home to gain positive attention from Dad
Learning mentor
Holistic assessment to inform intervention
Holistic assessment of family needs:
Attendance
CAF
Officer
So we'd go over how to choose your time to talk to your dad, if he was cooking go in the kitchen with him because that's a time when you can chat. I think it's all about that finding out what the family needed and taking a holistic approach to it and trying to meet those needs as best you can really
Parent Support Advisor
I think if I was involved in this sort of situation again I would definitely go down the CAF route
Assessment to inform intervention Strategies to support the whole family ­ holistic approach
Parent Support Advisor (and AO) Attendance Officer (Also SENCO and PSA)
Now I wouldn't have known any of that if I hadn't have done the CAF so we couldn't have offered her the extra science if we didn't know that that was her favourite subject.... so it then informed what we then did they came out to assess the family as far as they could and see what the family needed. Dad was struggling with money and things like that so they would come in and try and help with those kinds of things. So that was all set up via the support of CAF and the Family Support Meetings that we held
Increased opportunities to see extended family
See mum more often ­ after school
Amy
I get to see my mum more often cause she said if I can if I want to then sometimes off the bus I can get picked up and go to my mum's like so more often than just on Fridays and Saturdays like during the week... but I wouldn't be able to get down if I didn't go to school
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New opportunities to see extended family: bigger support network
Dad (and Amy)
so for 7 years theyve had no contact with their granddad, their great gran, their uncle S which is like my ex wife's brother. and last year I went out me way to talk to the great gran to arrange a meeting. and the granddad come to me and apologised for what had gone on and said basically I've now found out that everything she's said about you has been a lie it was her that's been in the wrong and I said well right you know fair enough but I want you to have a relationship with the kids that's more important so they've now got their granddad back in their life
think that because getting back in touch with them its helped her because she has a relationship with her granddad again and uh her nana again
Stability at home Support family routines Stability at home ­ e.g. knowing where returning each night so gain sense of belonging
Attendance Officer Learning mentor (and Dad) IDEAL
try to get family routines going so they were home, he was home a lot more with the children and they were in one place .....cause I honestly do think that that 3 house split each week she didn't quite know where she belonged.
Additional opportunities to develop self worth
Additional opportunities to develop self
SENCO
worth
Access to groups with peers out of school e.g. to build self worth; make more friends
SENCO (also Amy and PSA)
I say its accessing them, its involvement, being part of a group, building your own self esteem, self worth, her own self worth. but what I wanted was some help with encouraging Amy to join in groups in her area maybe girls group maybe
I think maybe if Amy had some kind of support group out of school that might have led to building her self esteem
Opportunities to join groups and make new friends
Opportunities to join groups and make
Amy
new friends
as I say its accessing them, its involvement, being part of a group, building your own self esteem, self worth, her own self worth. you could like convince them to join groups and stuff so that they make new friends so that they'll want to go in so like you could do groups in
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school and like after school things
Opportunities to meet peers who have experienced similar difficulties
Meeting peer who's gone through
Amy
if they met someone who had gone
similar experience; someone who can
through something similar to them to
relate to
not make them go into school to see
how they've uh gone back into school
again
sometimes you feel like I'm probably the only person who's been through this but if you know that you're not the only person and it's not just you and that there is a way to get through it then it helps
Recognition that they're not the only person like that e.g. meeting peers who have gone through that too
Amy
Earlier intervention Earlier intervention ­ address at first signs of reluctance (primary- flag up at transition)
Parent Support Advisor
Earlier involvement to support and address emotions
Earlier involvement someone
Learning mentor
independent ­ e.g. to address her
emotions (and PSA) e.g. art therapy
Parent Support
Advisor
Additional support to help her to respond to change
Parent Support Advisor
well like there's probably people similar to them in reasons why they wouldn't come to school or if they won't tell you the reasons why they won't come into school get someone else to um didn't want to come into school, it doesn't matter the reason, at least they know they're not the only person refusing to go into school and there is other people like it and there is a way to solve any problem they have there's probably people similar to them in reasons why they wouldn't come to school or if they won't tell you the reasons why they won't come into school get someone else to um didn't want to come into school, it doesn't matter the reason, at least they know they're not the only person refusing to go into school and there is other people like it and there is a way to solve any problem they have I think um it was hinted at that when Amy was at the primary school she had shown some signs of reluctance and I felt that if they had flagged that up at the time that might have been helpful. I think having someone independent earlier on I think if we could have done with that outside input and the other thing is that school bought in for this other child um an art therapist's time. he would come in once a fortnight for an hour and that's how they did the emotion side with her they were putting her in a new building, albeit everybody else didn't know where they were going but I
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think some children just don't cope very well with that sort of change ....school have done some work with the children bringing them in early they'd they'd had um they'd been doing some work with them over the progress of the school, they had come in to look at the building before the school actually opened to pupils. whether or not she took part in those visits, I don't think she did
Earlier involvement with family Early intervention - family work
Parent Support Advisor
who had had you know had house move, mum had left, various other things and I would question the original bond between her and dad because he didn't have her until she was 18 months old and no contact with her until she was 18 months old so I think some sort of family work might have been helpful particularly if camhs could have done that or somewhere similar
Earlier access to agencies
Earlier access to CAMHS
Learning mentor I'm not sure whether we could have
had CAMHS involved a little earlier
on
Multi-agency involvement earlier
Clinical
I suppose you just kind of want multi-
Psychologist agency involvement early on would
be good
Better connections with services in different local authorities
Better connections with and access to services as young person lives in a different local authority ­ earlier involvement e.g. dialogue between CAMHS or referrals going from one to the other
Learning mentor
And it takes so long also because she lives in Local authority 2 our connections in Local authority 2 obviously aren't as good. We have problems with being here in Local Authority 1 borough council for school but living in area 2 and Local Authority 2 borough council so we don't have the connections to get here as fast and take them on as fast.
SENCO
yeah but that's a you know a perennial difficulty for us because some of our families do live across the border and you know finding contacts who will support us across that border is difficult and getting anybody on board in the local authority because some services won't support students who live across the border
because the difficulty is the family live in LA2 and with this being a *LA*
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Better understanding of services in different local authorities Access and support from agencies e.g. attendance at meetings Easier when in same local authority as know what's available and the different thresholds
SENCO (and PSA) SENCO Parent Support Advisor
school they're actually classed as out of area and we couldn't refer to various places where we would normally have used um so we under normal circumstances we probably would have referred her to CAMHS in *LA* where we know how they work um or you know or other local groups, attend the youth club or whatever and I just feel it is difficult because we are that much further away and we don't know what's happening in.... um the only difference might have been something that um something of which we absolutely had no control is that support from other people and it's accessing the thresholds as well because I know when SENCO referred to social care in the south locality team the family didn't meet their thresholds for support so it's knowing where the different thresholds are for the organisations particularly those outside of **LA**
Developing parenting skills Parenting course like strengthening families: looking at emotions, who you are and were fit in family Parent more consistent Parents being more assertive and firm Supporting Dad's emotions
Parent Support Advisor Attendance Officer Attendance Officer Parent Support Advisor
I think so because under normal circumstances I would have talked to dad about doing a parenting course and for Amy to go as well, you know something like strengthening families because it would be ideal because there is an element of looking at emotions, who you are and where you fit in the family and who does what I think had he been more consistent in his approach perhaps and been a little firmer you know without being shouting and balling and screaming I think that dad could have done with some help with his emotions
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Appendix M
Case 2: Leah Basic themes, codes and supporting extracts
VPU: Vulnerable pupil unit
AO: Attendance officer
IC: Inclusion co-ordinator i.e. learning mentor primary
LMS: Learning mentor secondary
SPN: Senior practitioner nurse
Theme and codes Pressure from local authority
Interview
Quote/Data extract
Pressure from AOs
Attendance I think the pressure from our service officer
Risk of fine keeps mum on track Communication between staff Learning mentor liaising with staff
Learning mentor primary
I'm wondering whether it's the fine that helps keep mum on track
Learning mentor secondary
maybe having a quick chat with the teacher and explain if anything was bothering her if such a person she didn't want to sit next to such a person you might have to say well she'd prefer to sit wherever and maybe work with the teachers
Learning mentor has respect of teachers
Learning mentor secondary
Support with journey to and from school
Support with journey to provision (feeling safe?)
Learning mentor secondary
if I had to explain a little bit about the background the teachers seemed to come a bit on board a little bit more and I think it was important for them to see the bigger picture I think it was important for them to see the bigger picture cause they were like well she needs to be in this lesson now you know and if you say well look we've had a bit of a bad morning, she needs cajoling along and they would take on board what I said. I did have the respect from the teachers and they'd take that into the classroom with her taking her on her own she didn't have to meet any of the kids on the way home from school if there was any confrontation with the neighbours cause she was just dropped off at the doorstep so she just felt safe ...... I did feel as though she felt she
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Learning mentor takes to and from school Supporting journey and giving responsibility
Learning mentor secondary (Also AO) Learning mentor primary
was safe you know when she was picked up and dropped off I used to go out and collect her um and take her back home and she did really well um yeah that taking her home and bringing her back in and it's not an ideal thing to be doing it long term but it did work um I remember mum buying her a bike so again that might have made things easier and again it was exercise for Leah so again that was something that mum did
Provision close to home
Leah
Develop feelings of safety and security Small group meant she was not as conscious about her weight/where she was upto with work
Learning mentor secondary
Learning mentor supporting YP to feel safe
Learning mentor secondary
so yeah she used to come on her bike and when she got to year 5, year 6 she came on her own, she actually came on her own on her bike without mum and it wasn't far from my house..... Cause um I could just walk over the bridge near Tesco and then it was right there yeah yeah and it's confidence as well and she was quite conscious of her weight um very often where she lived there were children here who shed have confrontation with outside of school..... i didn't feel as though she gained any more confidence in that small group I just think that because she was closed off she wasn't as conscious of her weight and doing her work cause she was a bit behind with her work. I think it's just the hustle and bustle of the corridors. Someone being there you know taking her to meet a friend, and then she seemed to settle then when she was with a friend. and then she'd make her way back down
very often she would be on her own which she loved she loved that 1:1 attention. There was no threat of anything in the classroom kicking off but again it's not an ideal situation it's not a normal school situation
Feels secure in small group ­ reassurance
Learning mentor primary (Also VPU)
I did feel as though she felt she was safe you know when she was picked up and dropped off She'll have had a lot of small group work. um to help with learning so that will have helped; you know she likes she quite liked that. I mean that um what do I want to say what word do I want to use you know sort of security really you know
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Small group/1:1 gave confidence to ask for help Small group environment reduced distraction worrying about peers and bullying Access to safe environment when upset Feel secure with staff at youth club
Learning mentor secondary (also VPU) Teacher vulnerable pupil unit Leah Learning mentor secondary
I think working 1:1 with Leah initially at the beginning really really helped. i was able to sit with her and talk to her about the work she was doing so if she had any problems she was able to ask straight away rather than in a classroom setting where I think she might have not been confident enough to do that and I could see if she was struggling to be able to prompt her as to what she needed to do I suppose if you spend your time worried that people are name calling you or are being unpleasant or unkind towards you then it is difficult to concentrate whereas obviously there's none of that here so those problems are alleviated (Learning mentor primary) she just used to like, if any of us in the school like felt upset or you needed something then she would take to us in this little room on our own and speak to us and make people feel better and I think they feel secure you know with the same faces every week where they going
Felt safe working in small group (LMS)
Learning she loved art, she loved drawing um
mentor and she loved the baking in the nurture
secondary so I cannot honestly say that she learnt
a lot in that room but she felt safe
Clear boundaries and expectations
Parent
she said but Teacher VPU sat us all
about name calling which were made explicit on 1st day VPU
down and said that we don't tolerate name calling or laughing at the other one, stuff like that and Teacher VPU
just said to her if you've got anything at
all just tell
Access to calm, relaxing environment with reduced social pressures
Balance of relaxing activities and academic activities
Learning mentor secondary
yeah it's about getting the balance right. Settling the child down and then walking them to the classroom you know just feeling safe
Opportunities to do art makes young person feel relaxed
Leah
It's just more calming than other work
(also LMS)
Small group provides a relaxing environment with reduced pressure Small group environment
Learning mentor secondary Leah
I think it was a positive thing for Leah because it was more feeling relaxed in that environment, the pressure wasn't on yeah and I don't like being in big groups of people unless I know them
Parent
I think its smaller groups ....because she's no good with a full class of kids.
267
Access to calm, quiet environment in secondary school Relaxed, calm environment in VPU Reduce social pressure in VPU
she's never like if there were about 6 of us in here she couldn't cope with it
Learning mentor Secondary (also AO and IC) Learning mentor secondary
we'd have just a small group of children who would be in there, upto 4 and possibly Leah maybe just on her own um we'd maybe bring her in a couple of hours at a time and build it up gradually and it really worked well I think because the house is quiet and again the small group I felt was where she belonged, in a calm environment
Leah (also AO, LMS, VPU) Teacher vulnerable pupil unit
It's more quiet and there's not um cause it's like dead loud and noisy in proper school isn't it but like here it's just calm and people have calmed down. TEP: why's that helpful? Leah: um I don't really like loud and shouting and stuff She found school very socially difficult and was very anxious about returning and the nature of here sort of eliminates a lot of those problems so you don't always have to look for a specific strategy just the fact that she's in this environment takes away those anxieties
Quiet environment VPU
Learning mentor secondary
VPU2s again there was very calm, the children that was there were vulnerable children, very similar type of children
Felt comfortable in small group environment
Learning mentor secondary
I think you know when you're in the classroom you get sort of certain kids you get sort of disruption. they've not got that you know it's quiet... they can get on with their work I just think it was too overpowering for her having too many people and I don't think she could cope with situations if somebody said something she would have to shout her mouth off to somebody else.....
very often she would be on her own which she loved she loved that 1:1 attention. There was no threat of anything in the classroom kicking off.....
but that was where she felt more comfortable
Stability, consistency and sense of belonging at school
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Sense of belonging Not having to change classrooms and find way round school
Attendance Officer Leah
yeah so from there being in a unit where there is just 3 or 4 of them what she suffers from is being in this big classroom environment she just doesn't feel like she fits in, she doesn't have the confidence to make massive amounts of friends but there she can just go in and learn no um like getting all around the school on time for your lessons cause it's all full of kids in the thing and then that's when the bullying started really and that's when the bullying started really and then I stopped going
Attendance Officer (Also LMS)
so she knows that when she's there she's in the same place, she's not walking around, she's not finding rooms, she's not getting lost
Small group where same teachers and same children Relate to young people in VPU
Learning mentor secondary Leah
when they're in like the high school they'd go from one class to the other whereas in the younger school they're with the same children, there with the same teacher and I don't think that she could cope with the change of staff Cause like nearly all of them have gone through the same as what I did
Relate to young people in nurture group
Learning mentor secondary (Also AO, VPU) Learning mentor secondary
There are other children in the same boat really that for some reason or another they can't access full time tables in a mainstream we did have a nurture group that Mrs L that was another key thing as well actually, she loved being in nurture. Again small group of vulnerable children, I think that was period one and she loved going in there
VPU: Not standing out amongst peers
Attendance she's with like-minded people as well
Officer
so she's with other children who've not
gone to school who've had anxiety
about going to school so she's not
standing out
Consistency
Learning I think being consistent and being there
mentor when they need you
secondary
Involve in school life
Attendance she was invited to the breakfast club to
Officer
try and involve her in school life and all
the sort of normal everyday things
cause it was only the odd day off here
and there at that time. we did that and it
did have there was some success.
Modelling positive environments and relationships with adults in VPU
Experience of having positive adult
Teacher in you know I think that having a different
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relationships ­ modelling
vulnerable kind of adult relationship, we all know
pupil unit that some family situations are very
stressful and very difficult and some
parents aren't brilliant parents or
particularly good examples of adults
you know so to come to somewhere
and be able to have sort of 1:1
relationship with an adult that's a
positive one
..... and actually see that adults you
know can be actually quite rational and
reasonable people sometimes!
Modelling calm environment
Teacher in in some ways so to see that things can
vulnerable be actually quite calm and normal is
pupil unit probably a really good thing for her.
Professionals developing trust with young person and family
Access to key adults who can trust
Learning mentor secondary
having somebody who she can trust, someone who's not going to shout, someone who will listen to her but be firm as well you know you've got to be in school you know if there's anything that's bothering you we can resolve it
Developing trust with family Positive nurturing ethos
Learning mentor primary Attendance Officer
building up that trust again you know cause um being able to you know go to your TA and you know talk and talk things through if you work with us and we try and work and we try and be honest with each other, you know if you're having a bad day or if there are other issues that you can think of and I think that's sort of helped that mums developed a better trust in our service really
VPU Nurturing environment
Leah
its calmer and it's a bit more homey
(Also AO and
VPU)
Nurturing approach learning mentor primary
Attendance yeah and the member of staff sort of
Officer
she befriended her and took her in
Need key adult to nurture her
Learning yeah she just needed nurturing really
mentor
secondary
Firm, honest approach with family with clear boundaries and expectations
Respond in a calm, non confrontational and firm way
Learning mentor secondary
I have fostered a lot of difficult children so you tend to you don't deal with them in a confrontational way you have to deal with them in calm but firm way
Being honest with family
Attendance Officer (and parent)
I think she felt reassured because I said we're going to give this amount of time X amount of time where we're not going
270
to discuss a prosecution, we're not going to go down that route it hasn't worked. so I think she started to trust but I think at that point if we still haven't managed to reengage anything and if we haven't got a plan that's working I may have to consider it. so she knew that there was a cut off point
Clear boundaries with family with clear expectations
Learning mentor secondary
she was firm you know this is what's going to happen if but she needs to be in school and what can we do to help you?
Attendance Officer
yeah and having boundaries I think that's the thing and if you know where the boundaries are with each other you know what to expect with each other
Learning mentor primary clear couldn't condone absences
Attendance Officer
in primary school I think that was a very helpful relationship and I think that was very good, it was pitched at the right level, you know learning mentor was very clear that she couldn't condone her absences but she was trying to engage her
Taking an interest in young person as a whole and treating with respect
Taking an interest in young person
Teacher in vulnerable pupil unit
(in developing self concept) I would like to hope that because of the positive relationships here and gearing things towards her interest and you know, talking to her, seeing her as a person, all of those things would have helped that
Treating young person with respect Talking to and treating young person as an individual
Leah (Also LMS, VPU) Leah (Also teacher VPU)
... viewing her as a whole person as somebody who's important as a person not just as a subject or a student um well he wasn't like horrible with you. he didn't have an attitude.... he just spoke to me like you're speaking to me like... like in like nice tone of voice but that J just raises her voice at you... yeah more talking rather than shouting yeah its' the way they act around you like cause like teachers think like that they're the boss of you but they're not really are they and like Teacher VPU and TA VPU in there they just treat you normal
Experience of professionals
they treat you how your mum treats you
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Experience of LMS in responding to children with similar needs Increased participation out of school
Learning mentor secondary
to be honest I've fostered 42 children as well and a lot of them have been school refusers so I think you can sort of get a jist of how these children work and how they think and what they respond to things so I think that has probably helped me to deal with her.... ok and um I have fostered a lot of difficult children so you tend to you don't deal with them in a confrontational way you have to deal with them in calm but firm way
Accessing activities out of school Started youth club
Leah (Also parent) Parent (Also LMS)
There's this thing on the park on a Wednesday and I just started going there and like the people that I already knew just started hanging around there and with their friends and that's it really oh yeah she goes to um to the youth club at pavilion it is.
Building on interests out of school
Parent
(re youth club) she just does arts and
(Also LMS) crafts and stuff there and do um
cooking and stuff... yeah she loves it.
and they sometimes go on like trips
Key adult with whom can develop a positive relationship
Positive relationship with and supportive learning mentor (key adult) Positive relationship with teachers e.g.at VPU, primary
Attendance Officer Parent
in primary school I think that was a very helpful relationship and I think that was very good, it was pitched at the right level she absolutely loves Teacher VPU at VPU too
Good relationship with LMS secondary
Vulnerable yeah I would like to think that she has a pupil unit good relationship with us
Young person and mum have positive relationship with teachers at VPU
(Also AO, IC) Attendance Officer
and they're very fond of her because she works so hard and she puts in all this effort
Allocated a learning mentor in primary/secondary Availability of key adult Availability of learning mentor in primary school Availability of learning mentor in
Leah
Mrs W (Learning mentor) she was good
Attendance Officer
well that's well this was when she was in primary school so when she was in primary school um Inclusion Coordinator Primary who was the learning mentor would come out to the house when she was having difficulties
Leah (Also IC) Learning
well she was always on the playground or she was always around the school and again it's just that base being there
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secondary school
mentor to go back to secondary
Access to learning mentor when
Learning having someone to go to and say look
required
mentor I've got a bit of an issue and there was secondary a little bit of bullying but I'm not quite
(Also IC) sure whether sometimes Leah was her
own worst enemy cause shed go
shouting her mouth off sometimes and
then she'd come to me and id be trying
to smooth things over and sort things
out um
Young person knows where can access
Learning I think being there at break time um and
learning mentor
mentor being in that room if they needed to secondary come between lessons if there was
something maybe that there was going
to be an issue in the next lesson can
you come and speak to miss about
whatever
Young person able to express their views and feel listened to
Key adult someone who can talk to and who will listen
Vulnerable pupil unit (Also IC, LMS)
yeah having a relationship with a separate from her separate from her education you know being able to talk to her about ......her interests and things she enjoys and her feeling that she can come and tell us if something's happened at home at the weekend and it wasn't very nice and she needs to talk to someone about it that she has been able to do that
Listening to and responding to young person's concerns
Leah
and you could communicate with and if she had a worry we could talk it through and move it forward um well she used to just give me like English or maths for one whole session but it was taking ages and we never got round to doing any art or things so um I just told her that I could do different things like um like I just said half an hour of one lesson or an hour of another lesson and I still have time for another quick thing.
Vulnerable pupil unit
Positive relationships with youth workers and provide additional support people to talk to
(Also LMS) Parent (Also LMS)
Parent and professionals believed in young person
....equally Leah will say you know I've had this is getting a bit much for me can we do something else and we're able to do that because the youth workers there they tended to like uh take her under her wing really cause they knew how bad she was getting at home with me so they sort of like talked to her and stuff like that. they're alright
Learning mentor at primary believed in
Leah
she listened to what you had to say and
273
her Attendance Officer believed in her Belief from parent Professionals giving her a chance Persistence of parent ­ not giving up Regular contact with key adult YP regular contact with learning mentor primary 1:1 support/attention with key adult Introductory visit to VPU Introductory visit: got on instantly with staff
she believed in you that you could do it
Leah (Also parent, VPU) Leah Attendance Officer
she believed in me but J (previous attendance officer) didn't she um knew that I could do it so that's why I think she give me the chance well me mum has like helped like but that's it really. TEP: how's that? just like believing in me that I will come she sent cards to staff at VPU to thank everybody for giving her a second chance
Leah
She's just stuck with me like she never give up on me even when I used to wag the school she never give up on me
Leah Learning mentor primary (Also VPU)
Because she used to tell us that she knew that we would be able to do it and um like every week she'd do the attendance thing so we knew how well we were doing and she was nice to us and stuff I think having the one : one you know having myself think having the one: one support and that could be whenever she needed i
Attendance Officer
they instantly got on with the people who when we took them to the meeting it was a really positive meeting and they've from then on she's sort of.
Introductory visit to VPU to see provision, meet pupils and teachers, clear understanding of provision and what was expected Introductory visit: VPU aware of needs Access to alternative provision
Leah (Also AO, (VPU)
um cause we had a meeting and I liked the look of it... and there was already kids there anyway so I got to meet some of them as well
it was just really telling me what I'd be doing and how long id be doing it for
Teacher Vulnerable pupil unit
when I got the offer then, I just come round and looked and thought it was alright and then I come and I like it after the end yeah we have an induction before um pupils start for a number of reasons. We have one so school can come in and inform us what the issues are..... and um try and establish what the barriers have been so that we can work a workable way forward um
274
Placement at VPU alternative provision Responded fact mainstream was not suiting young person Recognition that all children are all different and have different needs
Leah (Also AO, LMS, parent) Attendance officer Learning mentor secondary
I think it was just that I got the chance to come here We took the pressure away from her in terms of her prosecution and then we looked at the fact that actually a mainstream school no matter how hard we were going to try or how supportive we were going to be it just wasn't suiting Leah. you know realising that not all children are the same and realising that you are going to get a group of children that's like this and maybe they won't get on in mainstream and maybe we have to accept that
you know and I think there should be more type of provisions for this type of children
Discussion about the impact of not coming in and the experience of consequences
Stopped local authority getting involved
Leah
it's like stopped everyone getting
involved like the education
Aware of impact on Mum and didn't want her getting in trouble
Leah (Also AO)
just like cause I didn't want my mum getting in trouble all the time over me.
Young person made aware about potential consequences e.g. court Young person aware parent worried Readiness to realise that attendance issue and AO not going to go away Positive experiences at school
Learning mentor primary Leah Attendance Officer
basically her understanding that if she didn't come into school mum would get into trouble, mum would get prosecuted, so the severity of it you know that she understood. you know and she was bright to understand that you know. that mum would get a fine, mum can't afford that you know but if you don't come into school that that's what's going to happen so it's putting a bit of responsibility on Leah you know She was bothered that I was wagging school and she did shout at me not shout at me but like what could happen to me if I was in town and I was on my own. like she was worried I wasn't go away and legally she had to engage in something before she was you know for the and it could have been something as simple as that
Positive experience VPU
Leah (Also, parent, AO, VPU)
I just I just like it here and i didn't. cause I didn't think I'd like it but I do and it makes a difference cause I hated proper school
when it was when I come to the meeting then then I thought it was ok and I just started to attend it and then I just ended up liking it.
275
Positive experiences nurture Experience in VPU shown that not everyone bullies
Learning mentor secondary Leah
we did have a nurture group that mrs L that was another key thing as well actually, she loved being in nurture. Again small group of vulnerable children, I think that was period one and she loved going in there It's just that I think it was when I got bullied in school I thought everyone would just do it but obviously they don't
Making learning meaningful and relevant
Creative/topic/thematic based approach
Teacher vulnerable pupil unit
When we were doing um some gothic writing we then did some gothic art as well so a cross curricular approach in things so that we could move things in a direction that she could she the relevance and the links between different subjects um and a topic as a whole I suppose almost in a primary school type of way....
I think as well she was enjoying looking at the topic as a whole as well and seeing the links between them and was using one to inform the other and I think she quite liked doing that
Making things relevant and meaningful
Teacher yeah I think definitely making it
for her
vulnerable meaningful for her. Her seeing the point pupil unit of it um I think in the mainstream school
things can be disjointed and you can't
always see the way that things link
together and certainly not how things
have any relevance to yourself whereas
working on a 1:1
Helping young person recognising the
Teacher um and we've used it as a focus when
benefits and impact of homework
vulnerable I've marked pieces of work to see if
pupil unit she's made an improvement in those
areas so she can see a direct link
between doing the work at home and it
having some affect on her work in
school
Professionals who understand young person's needs and how to respond
Encouragement and persuasion from learning mentor Aware of young person's needs and how will respond
Learning mentor secondary Parent (Also AO, LMS, IC)
when I was there I could cajole it along and say come on Leah's mother you've got to be firm but Leah needs to be in school and then shed respond and she'd get in the car and shed be fine It's like Attendance Officer said to me if she goes back to Secondary 2 we're back to square one Mum I know that she just won't go
Recognition of and sensitivity to needs
Learning mentor
you see some people say I'm far too soft but no I don't think I am I think they
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secondary
need to be treated with respect. I can be firm and say come on we need to go to lesson now but at the same time I can understand when a child's upset and take on board that maybe they need a bit more time to get back in that lesson. A few minutes chat; just sensitive to their needs really
Teacher vulnerable pupil unit Give the young person choice and control
if things are making you feel anxious or that you're really not enjoying them or that you don't understand them that you can take a step back from that and you're not blindly forced to do things.
Choice and control
Leah
well she gives me a choice like RE or history like which one I would prefer to do
Build on interests and strengths
Teacher vulnerable pupil unit Learning mentor primary
and I suppose feeling in a position of control as well so that if things are making you feel anxious or that you're really not enjoying them or that you don't understand them that you can take a step back from that and you're not blindly forced to do things. would happen and she would sort of choose those sorts of activities yeah
Opportunities to do something she enjoys ­ art Building on interests and strengths Support at break/lunch
Learning mentor secondary (Teacher VPU) Vulnerable pupil unit (Also LMS, IC)
(re nurture) I think she enjoyed the activities. there was a lot of art work....baking cakes, more hands on rather than the academic side of things. I remember her making this little tiny Christmas cake and she was really proud you know that she'd done this cake because we work 1:1 not solely 1:1 cause there have been sessions and next year she will be more part of a group but um we were able to take things in a direction that she was enjoying going in
Support at break/lunch
Learning mentor secondary (IC)
at break times I would take her round the corridors, that was one of the things at break time she didn't really like being on her own. so I'd take her round the corridors, meet her friend; leave her for a while with her friends, leave her for a while with her friends and then she'd make her way back down to our room.
Learning mentor support problem solving with peers
Learning mentor
you know you could go and have a chat with that person get their views, let's put this to rest now, let's move forward
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secondary
Reintegration planned according to need
Reduced hours/part time timetable at mainstream school/VPU
Leah (Also LMS,VPU)
and it's only like 4 hours a week so it's not bad but um I am starting on a Wednesday as well
Gradual reintegration 1:1 support initially helped to increase confidence, reassurance Avoid early start Starting later helpful to give mum time to cajole her along Starting at VPU quickly so limited time to think about it Development of friendships Likes young people in VPU Made friends in VPU Not judged by peers
Teacher vulnerable pupil unit (Also LMS, Leah, parent) Learning mentor secondary (Also VPU) Leah Learning mentor secondary Leah
She's only currently got two sessions a week but that will be increasing to 5 after the holidays We're very wary here particularly with attendance issues, if we bring them in for too much too soon it breaks down she loved playing with play dough, making cards. it was more to get them used to the school environment and then I would take her to her lessons and say well right you're in my room for this lesson, period 2 she'd go to English cause if I was at school id have to leave at 8 o clock so you'd have to be up dead early like cause its half an hour walk from my house just things like that and giving mum that time to if she was playing up in a morning to cajole her along, she's had her breakfast she's not fighting with her early in a morning you know um so I started like straight after. so I never went on the Wednesday and then had to wait months later to dya know start like.... it just like cause if it started weeks after it'd just give me like time to moan about it but it went just fast and then by the time id got all my stuff ready it was just time to go here anyway
Leah
cause it's not like a full class or its not
(Also parent) horrible people
Leah
um getting to know other people cause I have got friends here as well
Teacher vulnerable pupil unit Leah (Also VPU)
and you know she has formed friendships with people as well, G particularly who comes in on a Friday afternoon with Leah she's a year older than Leah but still you know they would leave together on a Friday you know and they'd chat about things they'd done in the week and things you know so there was a sort of social relationship as well cause they're not bullies or judge you for what you look like or things like that
278
Developing friendships Socialising with peers out of school Motivation
Leah (Also parent) Parent (Also Leah)
(what improved confidence) just finding more and a bigger group of friends and um like getting along with them all.... I think it's just getting friends really. that's about it but there's a couple of girls up the avenue who she hangs about with well there's nine sisters of them
Motivation to do more sessions
Parent
well she's asked for an extra day so I know that she likes it
Wants to take work home Wanted to prove people wrong
Vulnerable pupil unit Vulnerable pupil unit Leah
you know she's really keen to start her GCSEs and to come for more sessions she straight away asked to take work home and brought work back an so that happened instantly really but that's why I really didn't want to have a day off cause it would just give her a reason to slag us off really
Motivated to come back, learn, get on track with education and succeed (VPU) Rather be at VPU than do nothing at home
Leah (Also AO, VPU) Leah (Also AO)
yeah and it gets my education back to a like to you know to a normal level cause I wanted to change as well like I wanted to learn more and learn more about other subjects and stuff like that cause id rather just be here for these four hours and learn than be at home and not do nothing...
Introductory visit wanting to go to VPU More positive attitude towards school and learning
Attendance officer Teacher vulnerable pupil unit
cause I was always bored at home I think we've just been really very lucky that they instantly liked the look of the vulnerable pupil unit, they instantly got on with the people who when we took them to the meeting it was a really positive meeting and they've from then on she's sort of.. I mean it has changed because we use PASS data. Have you heard of PASS data?.....we did one on entry and we've done.....and her attitude towards self and school have improved by 70% which is you know a very significant improvement.
you know so there was a sort of social relationship as well and I think that probably helped with both her self esteem and her attitude towards her own learning but with her socialising as well you know I think it's important that you coming to a place of education you know otherwise you're not going to want to come
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Will ask to do more if enjoyed something Independently engaging in work at home as well as VPU
Teacher vulnerable pupil unit Teacher vulnerable pupil unit
Developing realistic targets and strategies
Leah will ask you know when she's enjoying something and she wants to do something more but she's actually very enthusiastic about all of them and she's taken a lot of work home off her own back, she's asked to take work home, over the holidays and things and has come in and particularly when we were doing the poetry topic at the beginning she'd come in and she'd bring her own poems that shed written at home
Identifying and informing YP about what she needs to do to improve Individualised goals and targets Regularly reviewing targets Regularly review timetable and subjects Sufficient time given to do homework Realistic target and expectations re hours Providing opportunities for success
Vulnerable pupil unit Vulnerable pupil unit Learning mentor primary Learning mentor primary (Also VPU) Teacher vulnerable pupil unit Leah Teacher vulnerable pupil unit
By identifying in pieces of work what the areas were that she needed to work on and directly linking those to levels as well um national curriculum levels so we'd look at a piece of work and say right ok this is working at a 4a now what you need to do to move it up to a 4b is and it might have been things like better spelling or improved sentence structure she'd have a task to do which could be something as simple as a spelling sheet focusing on a specific spelling rule and then when we next mark the work look at whether she has been able to make an improvement from the previous piece then I'll have done some mini targets with Leah and then perhaps it would have been a reward chart cause you know she has something that we were going through every day you were going through that target and what she had to do you know and if there was a problem well why didn't you come in yesterday? What was the problem? um so that's basically timetabling and what subjects she covers um so yeah those are updated at the reviews as well cause like it's you don't just have to do it overnight, you can take your time with it I think the primary thing is the reduced timetable. Realistically because Leah had been out of school for such a long time and had missed an awful lot of education it wasn't reasonable to expect that she could go back into full time education
Setting small achievable targets
Leah (Also IC)
cause like if I set my target for an hour for one thing and then I know that that's going to be done for that week and then
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Providing plenty of opportunities for success Made progress in learning
Teacher vulnerable pupil unit Leah
I've got an hour to do two more little things and also you know giving her lots of praise. she's done really really well. um she started off with English with a unit of poetry from school and it was something she actually has really good flair for, she's got very good sense of rhyme and rhythm and is quite good with figurative language and things so I think that was a really good starting point cause it was starting off with one of her strengths so I was able to give her lots and lots of positive feedback Leah: um like I've got better at things TEP: you've got better at things? Leah: yeah maths
like I've got more knowledge of things now
Varied curriculum in VPU
Parent (Also Leah's come on leaps and bounds
VPU)
since she's been there with her art and
everything
A variety of subjects completed in session
Leah
they're not really lessons like cause in the 2 hours I could have done 4 different things, like half an hour of maths, half an hour of English, half an hour of art or like an hour of one lesson and then half an hour of 2 different ones
Variety increased productivity
Leah
like coming here I know more things about different subjects and it's got me a bit more clever cause I get more things done
Flexibility in meeting specific need
Identifying and addressing specific areas of need
Teacher vulnerable pupil unit (Also IC and Leah)
Yeah also its quite easy when you're working with someone 1:1 to see what their weaknesses are and we've got things in place to help her a lot with those. I'm talking about her English because I'm an English teacher
Supporting access to curriculum/learning Flexible approach when finding something hard
Learning mentor primary (Also VPU, Leah, IC) Teacher vulnerable pupil unit (Also LMS)
I think she was referred, I'm going back years though, cause her attendance was really low her learning it dipped you know but I'm sure she was referred to the WEST team as it was then (advisory teachers) and she'll have had targets which will have helped her equally Leah will say you know I've had this is getting a bit much for me can we do something else and we're able to do that
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Flexible in work complete Work sent home to support particular areas of need Goals and aspiration
Teacher vulnerable pupil unit Teacher vulnerable pupil unit
.... you know when you last came in and saw her last she wasn't very well ......and that afternoon we set her some work and after a while she said I really just don't feel very well could we do something else? so we just did some art for the afternoon but her sentence structure, use of punctuation wasn't very strong. Her spelling wasn't particularly good either um so we looked specifically at spelling rules and things she's found difficult and I've given her work to take home to help her to improve those things
Goals and aspiration Supporting careers development ­ work experience
Leah Parent
Leah: cause I do want a good job when I'm older TEP: What do you want to do? Leah: Carer Leah: See I've wanted to do that since I was in Primary 2 school yeah but she said that she'll find her a placement at Primary 2 school nursery
Discussion about career and subject choices
Leah
Leah: We've been talking about it but in the TEP: who's we sorry me and Teacher VPU. but in the um I don't know what they're called, in the GCSE things child care is the thing that's the closest I can get
Teacher vulnerable pupil unit Availability and flexibility of professionals for family
we had a list of options that she could take um there was art, child development, media studies, history and RE and she was asked to number them in order of preference and her preference was for child development. she would like to work with children in the future
Availability of attendance officer Availability of professionals for family Flexibility of staff at VPU re meetings to support mum's needs
Attendance officer (Also parent, LSM) Attendance Officer (Also IC) Attendance Officer (Also VPU)
AO: she rang me to see if I was free to give her lift in TEP: ok so your involvement is attending the meetings, being there for mum in terms of being able to pick up the phone? answer her questions AO: yeah yeah she's got that opportunity now where she can ring anybody and ask for advice and there's a meeting this Friday and actually mum can't get to the meeting so they're going to her; so they're taking Leah home and having the
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meeting at her mums house
Home visits
Home visits from AO and key adult
Attendance Primary school um Inclusion
Officer (Also Coordinator Primary who was the
LSM)
learning mentor would come out to the
house when she was having difficulties
Try and understand and address the cause of school refusal behaviours
Responded to problems quickly
Attendance Any little problem that was identified we
Officer
just picked it up quickly and dealt with it
Try to understand and address the cause of school refusal behaviours
Attendance Officer (Also IC)
there was no sort of medical illness we ruled that out right from the beginning but she was saying she didn't want to get out of bed, she was tried, mum didn't know what to do.
....so between us we were doing home visits to try and find out why she wasn't going in
Parent more positive about education
.... we were concerned about her low mood then. we were concerned about her suffering from anxiety and we suggested that we get a medical opinion to find out what was going on and whether we could get camhs involvement as well to address some of the issues that we felt were going on in the house
Mum wanted her to achieve in VPU
Attendance I think it's all been about the
Officer (Also relationships and the confidence and
VPU)
the fact that mum wants her to achieve.
Young person now has support of parent Attendance but now she feels comfortable with the
Officer
people who work at VPU who have
been lovely with her and Leah because
of that feels like she's got the support
from mum again.
Mum enthusiastic and positive about her Vulnerable and mums been very enthusiastic and
going to VPU
pupil unit
positive about her coming..... You know regularly meeting with mum, keeping
mum informed and she's seeing that
Leah's happy and that she's enjoying it
and that she's getting a lot out of it
Increased confidence of parent to work with professionals
Mum feels comfortable with staff at VPU Increase in confidence of parent to make contact with professionals and seek advice and support
Attendance Officer Attendance Officer (Also IC)
mum feels confident and comfortable with the teachers there, they've got a good relationship with mum so mum will make every effort to get her there whether she is ill or not and another positive thing is that mum had a meeting at VPU last Friday and she couldn't get there and in the past she probably just wouldn't turn up. she
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rang me to see if I was free to give her lift in and she's actively seeing out and making sure she conforms to all the meetings to review
Mum confidence to come to meetings
Attendance Officer (Also IC)
it's Leah who needs the education but its mum who's needed the confidence to come to these meetings and to try and sort it out cause I think she's felt a bit intimated by us and by school in the past so she's just avoided it because she's not felt comfortable with it herself
if you're not particularly confident person walking into a room where there are other people its it just wasn't her thing , it just wasn't something that she wanted to do at the time. I think potentially she could do it now but I don't think she could at the time because she just sort of went into a real low view of herself and i think they're both coming out of it now and i think they're both coming out of it together
Mum feels confident and comfortable with teachers
Attendance Officer (Also IC)
Positive relationship school and parent
....and also contacting VPU so if there is a difficulty she's not going to linger on it, she's not going to avoid it, she's got that opportunity now where she can ring anybody and ask for advice
People for mum to talk freely with Learning mentor primary positive relationship with mum VPU staff have good relationship with mum Learning mentor secondary respects family and empathises with needs
Learning mentor primary Learning mentor primary Attendance Officer Learning mentor secondary
just being able to talk freely you know so she might have said I've had a really bad night with her you know uh working closely with the parents is really really valuable really important... I think mum coming in coming into school and working with us um and mum again I had a good relationship with mum. I think she was able to talk you know so she didn't feel afraid They've got a good relationship with mum so mum will make every effort to get her there whether she is ill or not whereas I don't think that relationship ever happened with the mum and Secondary 2 I think with Leah as well and the family they've had police incidents as well and when I've fostered kids I've had to go and sit in R police station and it's not nice for the families and I sort of know i don't condemn because I've been there. I know what it's like trying to get a child to school when they're kicking off
....it might take a little bit longer than we'd like but you know we will get there
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Parent's readiness to engage with services
in the end and I think letting the parents know that you're not there to look down. I do think that saying I know what you're going through, I've been there myself
Mum started to engage with services (AO)
Attendance Officer
think mums been the key to it really because as soon as we got mum on board with ideas about what she could do with her education
Readiness to accept professionals help Attendance Officer Increasing effectiveness of parenting skills
I think we had a period over 2 or 3 months where every time we wrote to mum to say we're going to come and visit, there was no-one at the door or if we invited her to a meeting or to down here and she didn't come. and then she started to It's also their readiness to accept other people's help
Learning mentor support for mum in a morning
Learning mentor secondary
sometimes when she was playing her mum up in a morning I could just say come on, cajole her along really and give her mum support you know you've got to be firm but
Encouraging and supporting Mum to be firm Supporting mum with strategies
Learning mentor secondary Learning mentor secondary
....and I used to say Leah's mother I know she's winding you up. just stay calm you know I'll be there in a bit think the home visits and that support and giving Leah's mother the confidence to say you know and be strong and say you do need to be in there's no handbook is there that comes with a child and if they'd been brought up with you shall go to school then you know they'd sort of copy what they'd been taught and sometimes they just need people to point out well use this strategy, try that strategy and see if this works
Plan together to support Mum and child's needs so spend quality time together Professionals working collaboratively
Learning mentor primary
....and just stay calm with her, don't make excuses for her, be honest mum had issues herself with not being able to sort of get up and stuff and she would sort of be blaming it on Leah and um cause they weren't getting proper sleeps so we sort of put a plan together so mum could spend quality time with Leah and um and worked with mum on that
Attendance officer working with VPU
Vulnerable we don't have a lot of contact from pupil unit school, apart from AO I mean AO's
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been really really good
Everyone working collaboratively (with
Learning working with mum as well cause she
parents)
mentor primary
knew that, we would have a meeting you know with Leah, mum and the
professionals involved.... because mum
because of the relationship between
mum and Leah, I think it helped them
both so they both worked on the same,
they had the same um what do I say
the same um...same expectations
basically
Information sharing with VPU about
Attendance giving the key people the potted history
needs
Officer
about what Leah had been like in the past and how she'd got onto that stage
and that's not just me they were getting
information from the school so they
were getting an assessment about
where Leah was so once we've done
that
Consistent messages
Learning know us working as a team you know
mentor they all mum knows that everybody is
primary saying the same thing you know it's not
the education welfare officer going out
to the home and us saying something
else we're all working in cohesion really
Positive relationship with and family support from the attendance officer
AO support for parent in meetings
Parent
so everytime there's a meeting I go with Attendance Officer
AO Link between family and school
Vulnerable pupil unit Attendance officer Attendance Officer
and of course mum hasn't been able to attend. one i think AO was going to bring her in, that's how supportive AO's been so I physically collected them, took them to the meeting, had a chat with the afterwards to find out what they thought about it you know because again they were asked in the meeting if they had any questions; neither of them had questions but then asked me about 100 when we got in the car so it was just sort of really being that sort of the link I'm just the link now between the school and the family if there needs to be
Support from AO for parent
Parent (Also AO, LMS, VPU)
and then when we looked at alternatives she'd heard of VPU before, we took her round, gave her a look round and since then she's had 100% attendance cause I just didn't know where else to turn cause I was fighting a losing battle all the time. and then um like Attendance Officer said like she'd take Leah on and then she just helped me from day one
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AO fair with family Positive relationship with AO
Learning mentor secondary Vulnerable pupil unit
I think Attendance Officer played a good role as well, the education welfare officer. She was very fair. She was very reluctant to having to take her to court you know. um even at its worst, she was very fair and did as much as she could you know to (re AO) you know she comes to the meetings she's still involved with Leah, she has a good relationship with Leah um she was very positive about her attendance, she brought an attendance certificate in um so her involvement and um you know she was very instrumental in the beginning you know getting mum to meetings, making sure that Leah turned up and on the first couple of days bringing her in and such like so she's been really really good
AO re-building relationships with family
Attendance Officer (Also Leah, parent) Parent
and I do get on well with her and Leah gets on well with me and I do think that makes a massive difference if you're not battling and dreading a visit yeah but I told Attendance Officer straight to her face I will never ever have a meeting with that JC
Keeping in touch with parent
Attendance officer (Also VPU) Attendance Officer
Providing reassurance and relieving parent's anxiety
yeah building the relationship up with mum and making Leah feel more comfortable, I think every time that I went round she just associated me with school so as soon as I would knock on the door she would see me and see that I was going to sit and try to engage her back into school but I keep in touch with this mum because she rang over a letter she'd been sent by the school this week and it had been sent by mistake but she range me and it's nice that she's got that confidence now to say I've got this can you just check it out Attendance Officer
Mum seeing young person is happy Encouragement and reassurance for mum
Teacher vulnerable pupil unit Parent
and she's seeing that Leah's happy and that she's enjoying it and that she's getting a lot out of it well I was thinking that I was going to end up in jail cause some parents do go to prison don't they... and then i was thinking if ended up in prison what would happen to her. all stuff like that... and like Attendance Officer did reassure me and said that it's got to be really really bad for you to be sent to prison um and her we did laugh about it afterwards actually! she just said just
287
make sure you pay your fines then you won't go to prison!
Learning mentor secondary
but let's just take a step back you know I'd say go and have a drink and you know she'll be fine
Supporting Mum's anxieties Reduced stress and pressure for mum Individual support from staff Individualised support Good teaching VPU (Mum)/ subject specific teachers Developed confidence Improved confidence
Attendance officer Attendance Officer Parent (Also LMS)
so I think by me explaining that that wasn't going to happen, mum started to work with me again because she wasn't avoiding and she wasn't steering away from us to avoid prosecution. I reassured her that that wasn't going to happen again. with any of the suggestions and I think that is something to do with mums anxieties about the school environment as well It's just less stress and um she like they did lift a lot of stress with me to be honest with you. I mean I'm constantly with Leah well I was now I get a bit of a break from her. and I suffer from depression as well
Leah (Also VPU)
cause there's a teacher and I don't know her name but she does maths with us and like I couldn't do maths in high school because it wasn't just focusing on one person, she had to go round all round the class but since the other teachers, the maths teacher has been helping me I've been able to understand it a bit more
Teacher vulnerable pupil unit
well normal teachers don't sit there with you for the full lesson and read things through with you and cause they can't obviously but here they do and stuff like that but here they do and I quite like that yeah I'm an English teacher and the teacher that works on other days is a maths teacher and on occasions we've been able to do swap sessions so that she can come in and do some specific maths work with Leah.... we're quite lucky that we've got two teachers who teach core subjects
Leah (Also Parent, VPU)
I'm more confident... oh right before i was dead nervous around people and even sometimes people that i knew.... but now I'm not really that nervous. ....cause I would act like more myself not cause when I was in school I used
288
Supporting, confidence, emotions, development of self worth, problem solving Developed self worth Improved self concept Increase in self worth/value of self/happier
Learning mentor primary
to act shy like not speak to anyone cause I think it helped her to um to work things out for herself, you know to work things out in her own mind yeah it was dealing with feelings that we used. I definitely remember using that programme with her um
Teacher vulnerable pupil unit (Also AO) Leah
to work on and improve areas of difficulty and I think that's really helped Leah with her self esteem. She's been able to see herself making visible progress we needed to get her in and get her reengaged with education as a whole to start with and feeling positive about that and feeling more positive about her abilities ...But definitely her self perception and her perception of her ability has improved dramatically I don't know I just I just feel like myself again whereas at school I didn't.... I'm more happier and I think I don't know I can't really explain it
Parent (Also AO, LMS, VPU)
she never left the house. she was constantly in here. she slept with me. If I went shopping she wouldn't come shopping; she wouldn't go out she used to say people stared at her in town so I'd go to shopping and shed be on the phone. I wouldn't have even got on the bus. Are you there yet mum? When you coming back? I just could not move without her
Make YP feel special (AO)
Attendance Officer (Also IC)
Personalised rewards based on interests
and um like she wouldn't go bed early to give me time on me own. she'd wait for me to go bed or she'd fall asleep on here and she'd say when you go bed mum you wake me up and I'll go bed with you. and since she's been at VPU 2 everything's just changed everything's just changed. she's got loads of friends, she's never in and I always send her one just with 100% attendance on it and we got Director of inclusion services to sign the last one yeah so that was even more special.
Personalised rewards to reward
Learning mentor
in fact she did so well I bought her this dance mat as well as just a little treat
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progress
secondary you know because she'd done that well. (Also IC)
Identifying family needs, targets and strategies to meet needs
Fast track programme
Learning mentor primary
Targets with family
Learning mentor primary (Also AO)
AO identifying what they could do to support family
Learning mentor secondary
Key adult who understands child holistically
once the attendance plan once the attendance plan ceased when her mum had met all the targets, her attendance had come up then after a couple of months attendance dipped again so it just kept them on track really both of them was always if it was about this. ok so with the education welfare officer, they'd have set some targets with mum and then I'll have done some mini targets with Leah AO identifying what they could do to support family
Key adult who knows young person and family well i.e. background and needs Key adult to understand needs holistically Stability at home
Learning mentor secondary Learning mentor secondary
I think again somebody to go to in particular that sort of knows the background, knows her personality, knows her issues and again it's that consistency of somebody working with the family um cause I think you know with chopping and changing, you've got to explain this explain that to somebody else and they don't always see the full picture....... and you maybe get a teacher that thinks she's got that attitude but they don't actually know why and the bigger picture and why the child is acting like she is
Now attending parent has time to herself Establishing routine
Attendance Officer Attendance Officer
....and also the fact that Leah's not there, mum can actually go off and do her own thing now because she wasn't before she just had Leah with her the whole time. I think that's helped because she's in a routine now and she's not just sat at home all the time
Mum and young person both feeling more positive Young person improvements in relationship with mum
Attendance Officer (Also LMS, VPU) Leah
It's not just Leah on her own it's the impact of the family on her and if they're both feeling more positive about things yeah. um and I get along with my mum a bit more cause I used to just shout at her all the time but now I don't we get on more
Parent
well she gets on better with me. She
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(Also LMS, was constantly tearing at me all the
VPU)
time and I just couldn't cope with her
Mum proud
Leah
She's proud
More settled at home
Learning mentor secondary
um I know when I used to bring Leah in Leah's mother was a lot more settled when she knew she was coming in
Supporting and addressing health needs
Health needs addressed and improved
Parent (Also LMS, AO)
in the end he must have got that fed up with me that to shut me up he said go and get her a blood test done. So I took her the hospital, got the blood test done and the lady who took the blood said ring your GP in the next 7-10 days to get the result. I weren't home half an hour and the doctors rang me and said that she's got a thyroid but it's really really bad for her age... so anyway she's on tablets and that now
Motivation and determination to lose weight Support of parent in improving health Young person attending appointments Working collaboratively with parents
Parent Parent Attendance Officer
we went to see the consultant um last Wednesday but it was like you have a group meeting after; it's all like adults that go and he could not get over her. He said I cannot get over her cause these are all adults and they're not doing owt to help themselves. she's only 14 and she's lost 2 stone 8lb and she's done it herself and then she said to me, mum I'm going to go on a diet. so I said if you want to do that don't do it for me or for other people just do it for yourself. anyway she said to me will you help me with what foods to choose so I did and she just changed like the white bread to brown stuff like that mum's making sure she goes to all her medical appointments for her thyroid problem.
Listening to mum's views and involving her in the process Giving mum some control
Teacher vulnerable pupil unit Teacher vulnerable pupil unit
maybe just asking mum's opinion you know making her feel involved rather than making her feel that things are happening to her maybe just asking mum's opinion you know making her feel involved her being involved in the process and helping to make the decisions and her having a bit more control as well
291
Young person aware professionals trying to help, knew what they were trying to do and why
Aware adults working together
Learning mentor primary
I think she knew that we were all working together. It was a team effort for her
Young person involved in meetings
Vulnerable yeah because I think it allows us all to
pupil unit be focused on what Leah wants and
(Also IC) how she wants to move forward with
things
Regular communication between home, school and attendance officer
Communication VPU and home
Teacher vulnerable pupil unit (Also parent)
we have regular reviews as well you know with mum and with like the attendance officer as well from school about Leah's future and where we see this going
we start them and then we do them
every three weeks then we move them
to every 6 weeks and with Leah now
we're probably looking at every term
because she's quite settled
Regular meetings between home, school Parent (Also she tells me exactly what she's done,
and AO, reviewing progress
AO, Leah, um she just lets me know really how VPU, IC) she's doing and stuff like that; they're
always on about her attendance and
how good she is with her attendance.
she says she's helpful, polite stuff like
that
Regular meetings enables to
Teacher because I think it allows us all to be
collaboratively reflect, focus on what young person wants, how to move forward and problem solve
vulnerable pupil unit
focused on what Leah wants and how she wants to move forward with things so if there are things that aren't working we can change those and obviously we
can talk about the things that are
working and build on those as well so
um it gives us a chance to update her
IEP and ILP (individual learning plan)
as well
Regular contact AO with family
Parent
but Attendance Officer she really has
been brilliant because I've had loads of
meetings with her at local authority
offices
Parent attending meetings
Learning I think mum coming in coming into
mentor school and working with us um
primary
(Teacher
AO, VPU)
Regular monitoring of attendance which is communicated to young person
Tracking and monitoring of attendance which young person is aware of Regular monitoring of attendance: attendance group
Learning mentor primary Leah
probably from year 1 year 2 we were tracking her attendance; ....she knew that I was tracking it and getting rewards for it. she used to do an attendance group and we used to go like in her room and we used to get like a sticker or and
292
Regularly reviewing and celebrating progress
these were these attendance charts to see how we was doing
Making progress transparent to young person e.g. attendance, learning
Leah
because then I knew that I was like progressing
Rewards and praise- e.g. charts, stickers
Teacher vulnerable pupil unit (Also LMS) Leah
.....with Leah is being able to identify the areas of weakness, being able to put something in place to improve that and then showing her an improvement and i think that's worked in all areas used to go like in her room and we used to get like a sticker or and these were these attendance charts to see how we was doing
Recognising positives Recognition of progress in attendance ­ certificates Celebrating progress
Learning mentor secondary (Also IC, VPU) Teacher vulnerable pupil unit (Also LMS, AO, parent) Attendance officer (Also IC, VPU) Attendance Officer (Also IC)
yeah I think just being praised as well. I think that's a big thing praising these children um because very often there's a lot of negativity in the neighbourhood as well you know and there's a lot of confrontation and you know coming in and working in a calm environment and being praised for what you're doing, you're doing really well you know I think that um I think that helped We're always very positive about the things that she has achieved. and what I do every half term is send her a certificate so we still send her them and hopefully she'll get another one at the end of next week so she still gets that so we keep with the rewards and it's nice to be able to carry on celebrating what she's doing
Communicating progress to Mum Mum hearing positive feedback
Leah (Also parent, AO) Attendance Officer
because then me mum knew that i was getting good attendance she conforms to all the meetings to review and its lovely for mum to hear as well because when she goes to the meeting all she's getting is positive feedback about Leah
Knowledge and skills of professional to reflect and adapt approach when not effective
Change in attendance officer (did not have good relationship)
Leah
yeah um cause it was Secondary mentor and J but I'm glad that Attendance Officer took over cause she's nice
Attendance I think if you speak to mum she will
officer
probably say it was a clash of
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Adapting strategies and approach when not working Removed pressure of the prosecution route
Attendance Officer Attendance officer (Also LMS) Ideal
personalities because she didn't actually like one of the attendance officers.... speaking with her after the event you know why on earth did you not do this earlier and why did you stop going to the meetings, well I didn't like her, I just didn't like the attendance officer yeah and we got to stage three before I stopped it and thought this is just not achieving anything I decided that actually prosecuting this mum again wasn't going to be a successful way of getting her back into school cause we'd tried that and it had made absolutely no difference
Additional opportunities to spend with peers who can relate to
Ideally additional opportunities to spend time with peers can relate to
Learning mentor primary
Regular involvement from professionals
There's more you know such a body feels exactly the same that I feel. well what do you do you you know they'd be able to you know sort of build that sort of discussion with each other
Ideally: important to stay on top of who's doing what and not to let it drift Listen to young person
Attendance Officer
If it isn't then you're letting it drift again, it's that time wasting isn't it it's that time element of time and its difficult when you're a practitioner and you've got other things to do and other priorities it's difficult to make sure that your key focus is getting that child back into school or working with other agencies to find out who's doing what really
Listen to and respond to what young person is saying
Leah
um just listen to me cause she never used to listen to me well she'd listen but like not take it in
Making learning meaningful and relevant
Ideally creative curriculum with real experiences to support learning
Learning mentor primary
probably the creative curriculum. we have now a creative curriculum and the way Leah learns that may have helped. had more of an impact.... we choose a them topic, and the teacher talks to the children about the things they really like and what things they want to learn about. .... we've put a plan together and it's called hooking the children in so we're going to safari park to give them the real experiences so i think that's what Leah would benefit from. Real experiences so they get enthused by
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what they've seen
Key adult who is a constant
Ideally need regular access to a key adult who can trust Ideally LSM to continue role as key adult, supporting journey, providing small group support
Learning mentor secondary Learning mentor secondary
I think maybe an element of coming into school without that same person .... I mean all staff were very good with her you know if she had an issue but i do think that she needed somebody specific to go to uh and then they changed my role so I wasn't able to go out and collect her, um bring her into that room..... so she was back on full time timetable so i think if that had maybe carried on that might have helped her
Support from extended family
I think probably again with my role changing I think if that had continued if I'm honest I think that would have helped
Ideally: support from extended family members e.g. at meetings, encouragement
Learning mentor secondary (Also AO)
Reintegration planned according to need
I think the extended family as well i think if they'd been more supportive as well with regard to school attendance I think that because the extended family had always had issues I think it had just become a normal way of life to be honest with you... maybe encouraged her into school a bit more
Ideally: More flexible with timetable Ideally giving enough time for reintegration back into fulltime education based on needs; realistic target
Attendance Officer Learning mentor secondary
just being a little bit more flexible with the timetable which Secondary 2 were but I think it's that flexible thing i just felt as though she needed a bit more time TEP: more time what do you mean by that? LMS: to the build up to a full time timetable
Nurture group to build on interests and develop self concept and self worth
Ideally nurture group in primary and building on interests in a small group environment Ideally nurture group to develop additional opportunities to support self image and self belief
Learning mentor primary Learning mentor primary
I think the nurture group would have really benefitted Leah. Again because its small group and because she's not being singled out because she would come within a small group from her class I don't know I was thinking about her own self image and her own self belief because she's not on her own; there's more you know such a body feels exactly the same that I feel.
Subject specific support
Ideally have a qualified teacher
Learning mentor 295
but wasn't enough because I wasn't a qualified teacher ­ we'd just do little
supporting pupil when working in small group in secondary
secondary worksheets
Ideally more sessions with subject specific teachers
Teacher vulnerable pupil unit
um probably more sessions with S probably would have helped.... with her maths
Avoid prosecution route
Ideal: if protocols were in place which would have prevented court action if CAMHS involved Ideally not have gone down the legal route
Senior practitioner Nurse Attendance Officer
protocols in place that would prevent court action being taken if involved in camhs there would be no action from education welfare, well that would be put on hold as long as they were engaging but we didn't have those at the time and I wasn't involved in any of these meetings or invited so couldn't do anything She just felt isolated from her peers at high school, she didn't feel particularly supported by our service probably because we were going down the legal route. With hindsight it probably would have been better not to have done that
Effective working and communication between the vulnerable pupil unit and secondary
Ideal: secondary sending work home
Parent
TEP: so you were talking about having the work being sent home... yeah they wouldn't have none of it we're not sending no work home. but I don't know why not because when Teacher VPU first give Leah the placement, before they had a date for Leah to start when we was on the meeting and Teacher VPU said yeah ill accept you she said I can't give you a date straight away but what I want to do is she said to previous attendance officer I want you to leave here now and get Leah some work set from school for her to do at home until I get her a date and she did it like that!
Ideal: secondary send appropriate, complete and engaging work for young person to complete
Parent
but when they did send the work it was work what a 5 year old could have done... so then Teacher VPU had to send for more work
Teacher vulnerable pupil unit
better quality of work from the school being provided....... it wasn't very inspiring um so hopefully that again will improve because it will be work that we've we'll be administering our own work and we'll be able to do it in more interesting ways than just read through
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Ideal: effective working and communication between VPU and secondary
Parent (Also VPU)
a textbook but it's like Teacher VPU said um I'm asking for her work and they're not sending it time and sometimes they're sending me what she's already done what they've sent me before. they should keep a record of it what they're sending
Ideal: secondary send a variety of work for young person to complete
Parent
so Teacher VPU's said I feel really sorry for her because at first she was only doing maths, constant maths because they weren't sending the right work for her
Ideally VPU aware of expectations and targets in subject areas Ideal support with marking so subject specific areas of improvement/targets can be identified Ideally more involvement and support from secondary Ideally integrated approach between VPU and secondary
Teacher vulnerable pupil unit Teacher vulnerable pupil unit Teacher vulnerable pupil unit Teacher vulnerable pupil unit
....think also school could provide us with more sort of insight into what is expected for different levels and what sort of levels she should be working at and in other subjects because we're not specialists in those other subjects I mean as I'm saying now we're not specialists in certain subjects so if school could then take some of the work back and mark it and level it would be helpful for things like humanities. I think there is an assumption that they can come in and that's and almost like the school wash their hands of them.... you know I'm marking it superficially on subjects I don't know much about um and it would be useful if they could maybe then take the books away and I do feel that as she was only in year 9 that they should have had more involvement and been more keen to try and reintegrate her really and there's sort of been an assumption that she can sort of just stay. I think a more integrated approach between school and here would be more beneficial
Effective links with agencies and information sharing
Ideal: pathways with education and
Senior
I met with the team manager and their
CAMHS
Practitioner team wasn't education welfare, their
nurse
team was an attendance team and their
remit was about looking down the legal
route, fast track prosecution, picking
kiddies up who were long standing not
going to school and when they go out to
visit a lot a lot of girls in year 10 for
example would say I'm not going to
school I'm depressed and there would
be a history in that mums been
depressed in the family or that there
have been other family members that
have been depressed on anti-
depressants and that there was a
history of mental health within the
families but they'd never accessed
camhs services....
297
so there was no diagnosis there was no
intervention but there was big gaps
where these young people weren't
going to school
Ideal: information sharing between
Senior
yeah that would have been ideal in
agencies
practitioner Leah's case we would have picked it up
Nurse
earlier and done that assessment and
had other people's information
Multiagency approach with professionals working collaboratively towards a common goal
Ideal: multi-agency approach Ideal: co-ordinated approach Ideal: team approach working to common goal (IC) Ideal: collaborative approach between professionals, school and parent (AO) (IC)
Practitioner Nurse (Also IC) Senior Practitioner Nurse Learning mentor primary Attendance Officer
and being able to feed into those sort of discussions and sort of all the agencies working together and from what I remember there wasn't really that multiagency approach so a coordinated approach may have been more helpful think you've got a team of people then working for Leah and addressing the needs. There's more people on board who are signed up for having all those people working together helps get a better assessment
Ideally Working collaboratively would have supported signposting (IC) Ideally: a co-ordinated plan where everyone working together with same aim(AO)
Learning mentor primary Attendance officer
I think I would definitely have gone down the family support route with mum and got agencies involved with .....I just think about all the different agencies out there and I just think now those that would have helped the family you know helped her own emotions, you know helped mum herself with her you know things like that you know it's just getting that co-ordinated plan you know so everyone's working
Ideal: multi disciplinary engagement (SPN) Family support
Senior practitioner nurse
multi-disciplinary engagement um get people together, engaging with services
Ideal: family support (SPN) (Mum) (IC) (VPU) (AO)
Parent
but I um want one of them what do they call it is it a support worker? ... yeah one of them cause I don't know how you get one of them. I've been in the council cause I was told you go in the council and they organise one but when I've been in she's took my phone number but never got in contact with me...... It's just because I'm having a lot of stress with me family.
Vulnerable pupil unit
I think probably yeah mum could do with a family support worker or something probably would have helped her um I think I don't know
298
Ideal: aware of the prosecution process and aware of legal support (Mum) Ideal: recognition of Mum's needs (mum) Ideal: family aware of the support available (mum)
Parent Parent Attendance Officer Parent
see I didn't even know when I was taken to court, I didn't even know that I could have had a solicitor I just went and spoke for myself, on me own.... yeah alls I got was a letter through the door saying you're being prosecuted um and you'll get your court date. so week after I got court dates to go magistrates court. I didn't know that I could get my solicitor cause it was all education. I didn't know nothing like that but what previous AO didn't realise was that I had problems as well..... you know with particularly everything else that was going on at home as well you know and worrying about her being at school I think it's about addressing what her needs are because all the time we're constantly looking at what Leah's needs are I just think that they could have advised us a little bit more and told us what help was out there for us
Ideal: supporting family to liaise with agencies (mum) Ideally: families to know who's who from the beginning and who can contact (roles and responsibilities) Ideally ensure families know what to do if there is a difficulty Ideally: supportive environment for mum ensuring her needs are met Developing parenting skills
Parent Attendance Officer
It's like when people say have you been in touch with like ah what's it called St J house they can help well I thought to meself they should arrange that or help me to arrange it but it was just there's the phone number go and phone them when you get home stuff like that. I think the key thing is for families to know who's who from the beginning
Attendance Officer Attendance Officer
....it's just a voice on the other end of the telephone so its building that relationship by bringing the families, making sure the family is aware of what to do if there is a difficulty. I think that some of the families I've worked with over the years have said well we didn't contact the school because we didn't know who we should contact I think it's about addressing what her needs are because all the time we're constantly looking at what Leah's needs are
Ideally nurture group beneficial to develop routine of home life
Learning mentor primary
I think because um the way its setting, you know sitting round a table, having the see if she was, if she'd have been here in ks1 where they come here for 4 days, they come every day, they set the table, having that routine of home life
299
Ideally: parenting course Ideal: Supporting mum with strategies, problem solving together, supporting routines
Attendance officer (Also IC) Learning mentor primary
that you would expect you know so um I think she would have really benefitted from that if she had been younger and I think if mum had possibly linked in with other agencies that had been suggested on the way to help her I think we referred her to the parenting course, (regarding nurture group) I think again they work in small groups don't they and its bringing them both together, working out what the problems are, mum being able to have strategies to deal with Leah's outbursts at home when she used to have angry outbursts at home, getting into routines you know I think they would stop up until really really late
Ideal: parenting course so mum realises she's not on her own; parents she can relate to Earlier identification of needs
Learning mentor primary
and then there's Webster Stratton having that as well not feeling like she's on her own you know lots of people have these problems
Ideally: give as much information as to what the difficulties are Ideal: early intervention
Attendance Officer Practitioner Nurse
yeah I think families who come to meetings who work with us well who listen to advice and give us as much information as to what the difficulties are, we tend to involve them much easier than these sort of families who become like ostridges really who dig their head in the sand and think that it'll go away I think we're just lucky now to have the inclusion officer who gets involved at an earlier stage um and will sort of generate appropriate referrals and appropriate interventions really
Ideal: identify mental health needs earlier
Attendance Officer Attendance Officer (also SPN)
early intervention is always the best the key and if there is a mental health issue is there some work that can be done to address that
Holistic assessment to inform intervention
Ideal: Common Assessment Framework to look at needs holistically Look at needs holistically
Senior practitioner nurse Senior practitioner Nurse (Also IC, AO)
perhaps suggesting that the school do a CAF which is a common assessment framework so if there if you need to look at the whole picture rather than just one element which is like health we'd I'd suggest to go to do a CAF and it's not being treated within isolation it's looking at the bigger picture really
300
Ideally further assessment of needs in primary and where can target support e.g. boxall profile
Learning mentor primary
I mean perhaps if we'd done a boxall profile on her it may have highlighted some other issues. you know of course we didn't do that
Family support plan with targets which are regularly reviewed
Ideally having a good plan to meet needs Ideally family support model Regularly reviewing plan to see whether it's worked
Attendance Officers Learning mentor primary Attendance Officer
just being a little bit more flexible with the timetable which Secondary 2 were but I think it's that flexible thing, recognising where there is a difficulty, finding out sort of much earlier in the time and then having a good plan I think now looking at school systems now and um the things that are in place, definitely family support, instead of the attendance meetings I think I would definitely have gone down the family support route with mum and got agencies involved with but I think the key to having a good plan is then reviewing the plan to see whether it's working or not
Access to alternative provision earlier
Ideal: get into VPU sooner
Parent
I was just going round in circles TEP I can't even answer it because I don't know if anybody else could have helped me or not. I think they could have done it sooner. they were just trying me I think
.....yeah just wish that VPU 2 had been done sooner than it was cause shed missed out on so much work
Ideal: aware of alternative provision sooner Ideal: available provision to meet needs at an earlier age
Vulnerable pupil unit (Also AO) Parent Attendance Officer
I think she should have been referred a lot earlier um I think she'd been out of education for nearly two years I just think that they could have advised us a little bit more and told us what help was out there for us. ....no no it was just that I mentioned it to them. they never ever mentioned VPU 2 to me the difficulty we've got is resources in that we weren't able to refer at a younger age cause they weren't able to take her at that time
Positive relationship with attendance officer earlier
Ideal: effective working with parent earlier (AO)
earlier intervention, more success would have been if mum had cooperated at an earlier stage as well you know. if mum had worked with us in a little bit more supportive way from the
301
beginning we might have been able to allow Leah to have access to other things
Parent's engagement and openness to advice, support and change
Ideal: mum taking responsibility to attend meetings
Teacher vulnerable pupil unit
I think mum could take more responsibility and make sure that she does attend things like reviews
Ideally mum recognise the importance of education Ideally: Mum cooperating with the plans Ideally: where plans/intervention not working be honest about why Ideal: Parent being honest and engaging with services
Teacher vulnerable pupil unit Attendance Officer Attendance officer
don't think mum was that active in trying to get her into school really either really so mum could have perhaps supported her a bit more really and um helped her to appreciate the importance of education think it would have been better if mum had co-operated with the plans not that and if the plans weren't working to be more honest about why the plans weren't working if she'd been a bit more honest with us from the beginning we might have been able to do this earlier for her
Ideal: attending appointments CAMHS
Senior
attending appointments would have
practitioner been helpful
nurse
Ideally: families who listen to advice
Attendance I think families who come to meetings
officer
who work with us well who listen to
advice and give us as much information
as to what the difficulties are
Collaboratively developing realistic targets and strategies and giving young people more
choice and control
Having some control over the hours she does (secondary)
Leah
Ideal: avoid comparison to other family members
like if I told her that I wanted to go home after the hour she wouldn't let me she'd say just do one more lesson and then when that one was over she'd say do another one and then say oh stay for your dinner or you know TEP: right so what would you have found helpful when you were at secondary? Leah: like when I wanted to go home that she would take me home
Ideal: avoid comparison to other family members
Parent
and she'd say to me, cause me niece's names a K, she'd say to Leah oh what you're problem is you want to be K all over again
302

C Nuttall

File: exploration-of-successful-intervention-with-children-and-young.pdf
Author: C Nuttall
Author: Clare
Published: Wed Aug 15 16:16:51 2012
Pages: 303
File size: 1.72 Mb


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