Webinar Q&A Recap

If Sage Day already works in a district in the Middle and High School levels, would they be able to help in the elementary school level ? 

Yes, one of our newer in-district programs is currently in talks with us about expanding to the elementary school level, so we would be open to the idea of working with schools at the elementary school level.

Do you recommend SRB students integrate to school full-day from the get-go or try therapeutic interventions first?

It’s important to be flexible and patient in working with SRB students, especially in the beginning. Working incrementally with therapeutic interventions (at school as well as outside of school) can often give the highly anxious SRB student the best chance for success by making the day feel less overwhelming, prior to fully integrating into the full day.

One of the biggest obstacles we are finding is that many families may have outside agencies providing services within the home and they are often working in opposition with the school personnel. We have found this for students who are in district as well as those already in out of district programs. Do you have any suggestions for getting them, as well as the family, on board?

It’s always important to get releases of information to coordinate care regularly with outside providers as a means to get everyone on the same page in addressing SRB (or any therapeutic issue). If your singular efforts to talk with these providers do not seem to be effective, often times, a multi-disciplinary meeting like the one I mentioned in the webinar can be used in these type of situations as well. Additionally, after the initial meeting, it is often a good idea to schedule a follow up meeting a few weeks after the initial meeting to ensure ongoing communication and accountability, as well as to reevaluate the situation/plan if necessary.

Do you travel to schools to present to staff?

Yes. School districts have reached out to us asking us to present to staff on school refusal, our therapeutic approach at Sage Day and our Sage In-District program. If you are looking for some immediate information on SRB, please review the information from this webinar on www.sageday.com.

Is it a good idea to allow a child to pick and choose the subjects they want to go?

In a general sense, I think it can be helpful to ask the child to express their thoughts and feelings about the subjects that they believe will give them an opportunity for emotional and academic success. However, sometimes there can be an unrealistic fantasy by the child that if all of their classes are changed to their liking, then everything will be great at school. As a means to keep some integrity to the schedule as well as to consider the issues related to child’s SRB, the school can begin by changing the first class or two in the morning to accommodate the child’s preferences, which can hopefully make the child’s arrival at school less anxiety provoking.

We have a 2nd year ESL student who is exhibiting behavioral SRB. We have enacted many of the school driven consequences you have mentioned. The student is currently in the I&RS process but I fear another year of education is slipping away. He hasn’t connected with most members of the school community. Because the student hasn’t been in the country or present in the school long enough to establish a baseline of academic skills, I am curious,  at what point should a CST referral and home instruction be implemented? The student is already involved with Family Guidance and Bergen’s Promise.

If this situation continues, particularly with the services already involved and interventions that have already been employed, a CST referral may be an important next step in the near future. I often think of home instruction as one of the last steps in the process, but at times it can be an appropriate interim step in more serious SRB situations, until there is some stabilization and a plan can be determined.

We have had a student who has now been on home instruction for two weeks due to school refusal. The parents have not been cooperative with our recommendation of outside therapy. What should our next steps be?

When parents are not open to school recommendations, it’s often then important to ask them what their plan is to facilitate the child’s return to school and what they see as the school’s responsibility to facilitate this child’s return to school. Ultimately, we all want the child to return to school. Depending on the nature of the SRB and if the student is CST classified, a day/class schedule modification may be helpful, of course I would need more details about the situation. This idea as well as others could also be discussed by holding a meeting at the school with the family and all pertinent school personnel to come up with a plan that is in accordance with the school’s policies and procedures.

How do you determine what is SRB related to anxiety or what is manipulative behavior?

This can be hard to determine, but if a child is feeling the need to frequently manipulate, that should be treated as a significant issue as well. We may also wonder why it’s so important for the child to manipulate and what feelings are being defended against that cause this child to manipulate. That being said, if you begin to employ the consequences and interventions from the webinar, you will hopefully begin to get a better sense of the reality and true nature of the child’s anxiety based on how he/she responds or doesn’t respond to these interventions.

What recommendations do you have for non-psychologist/counselor staff members who work with school refusal, when it is known the student is suffering from anxiety and takes medication. Our biggest challenge is knowing when to push and when to stand back. In the moment, it seems very real to the student at the time.

First, I would get a release of information and consult with the psychiatrist who is prescribing the medication as well as the child’s therapist, if there is one involved. These professionals should have an understanding of this child’s emotional world and should be able to provide appropriate recommendations and interventions for school personnel related to the child’s capacity to handle his/her anxiety.

How would you handle a SRB case which seems to be the result of Munchausen by Proxy?

I would attempt to employ ongoing family therapy/counseling as SRB often has a significant family component to it that often needs to be addressed with the parents as well.

How do you handle parents who do not want more restrictive settings for their child who clearly require a more therapeutic setting (e.g. child is on medication, receiving outside therapy, yet is experiencing panic attacks in school, is often out of class due to anxiety/panic attacks and now social/peer issues, can often spend an hour or more in guidance/CST)?

As a means to get an objective assessment, some school districts will pay for an independent psychiatric evaluation for children in situations where the school district and the parent have differing perspectives about the child’s needs. If the independent psychiatrist then recommends that the child should be placed out-of-district, this can bolster the district’s case to place the child out-of-district and/or in the most appropriate setting.

What about students who have discipline issues and constantly get suspended? What else can we do other than suspend them, because they have no motive to behave better when they prefer to be suspended?

In Bergen County, there is a Suspension Alternative Program (SAP) which provides students with a short-term alternative setting during the school day which can be beneficial and can hopefully facilitate the child’s return to school. Additionally, this child could also be brought up at I&RS to determine other possible interventions. If it is an extreme behavioral SRB, getting truancy involved and pursuing this matter legally can sometimes work as a means to appreciate the seriousness of the issue as well as a form of motivation for the child if all other means have been attempted.

What other partial hospitalization programs (PHP) are there in our area? Parents insurance sometimes does not cover places like High Focus.

St. Clare’s in Boonton is a full service hospital with a PHP, so they may take additional insurances as most full service hospitals do. ICPC is another PHP in Parsipanny and they also may take this family’s insurance.

What interventions might be appropriate for a disaffected student who exhibits depression and anxiety and who might have difficulty engaging in school, outside interests, and does not have peer relationships.

It sounds like this student may have a clinical mood or anxiety disorder and if that is the case, he/she could likely benefit from ongoing work with a therapist as well as possibly a psychiatric evaluation to get further recommendations. This child should also likely be brought up at an I&RS meeting at school or possibly to be evaluated by the CST for classification.