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Working with children: Exploring individual EBSNA

Working with children: Exploring individual EBSNA

By now you should have established a rapport with the child/young person and their family. You are ready to begin exploring their specific avoidance patterns and the needs that underpin their behaviour. There are lots of different activities and tools that you may already be familiar with which would suit this purpose.

Consider activities which encourage the child to make a connection between their thoughts, feelings and behaviours. Or an activity that explores how they feel about themself and their experiences. It is important to remember that some children find this level of reflective thinking and introspection to be a challenge.

Some children and young people may not know why they avoid certain situations. It may be that using a variety of tools and questions over time is required before we can begin to understand the individual EBSNA presentation.

Below is a list of activities, tools and resources that you may find helpful in understanding a child’s individual barriers to attendance.

Anxiety scaling

You can use visual representations of a scale to help you in exploring a child’s avoidance hierarchy. The aim is to determine the variables that lead to anxiety. You then rank them according to the level of anxiety or likely avoidance a child experiences. Examples you could use include:

  • Ladders
  • thermometers (see example thermometer below).
  • icebergs
  • mountains
  • smiley/sad faces

You may need to scaffold the activity by listing different situations in case the child/young person finds it hard to suggest some, for example:

  1. When the teacher asks a question or for hands up 
  2. Talking to my teacher 
  3. Specific lessons
  4. Being in the lunch hall 
  5. Playtime 
  6. Sitting next to another child in my class 
  7. Getting out of bed 
  8. Putting my uniform on 
  9. Being in an empty classroom

 

You may want to write situations on a piece of paper and cut them up so that you can sequence them together. You may need several scales, for example:

  • one about interacting with teachers
  • one about different parts of the school
  • one about friendships

The incredible 5-point scale

The Incredible 5-point Scale is a resource to structure conversations and strategies relating to a child’s emotional world. You can explore a range of emotions and help children think about emotions that they may struggle to name by using numerical scales. The scale is available in the book referenced below. Some downloadable resources are also available on the author’s website.

The Incredible 5-Point Scale: Assisting Students in Understanding Social Interactions and Managing their Emotional Responses Paperback. 16 Dec. 2021 by Kari Dunn Buron (Author), Mitzi Curtis (Author).

The Blob People

The Blob People were created by Pip Wilson as a way of exploring the emotional world of children as young as 4 years of age. The Blobs are representations of people. They display a range of emotions and behaviours across different contexts. The Blobs are:

  • genderless
  • colourless
  • culture-non-specific

They can be used to start conversations with a child which might open up their inner world. They can help to reduce the pressure on them to answer more direct questions.

The Blob Tree is a classic resource which can be used as a starting point. Present the child with the picture and ask open, curious questions such as:

  • which blob is most like you?
  • which blob do other people (your mum/teacher) think is like you?
  • which would you like to be?

Explore further using exploratory questions like ‘why’ and ‘what would need to happen before that could be true’. You may also want to ask them to think about other people in their lives and which Blobs are most like them. You can then build up to using more targeted Blob pictures to deepen understanding of their emotional experiences in different contexts. For example, those in the Blob school or parts of the community.

School mosaics and anxiety landscapes

It is important to consider the physical environment as well as the social interactional environment as a factor in a child’s EBSNA. Simple activities to explore how the child feels in different places can help you understand how sensory experiences underpin anxiety.

For some children, a negative sensory experience may be enough to lead to avoidance outright. For example, not being able to go into the lunch hall as the noise causes them extreme discomfort. For other children, a specific environment may lead to lower-level physiological arousal. This might reduce their capacity to manage other stressors in the environment. For example, the smell in the science lab may cause them discomfort. It is distracting and may mean they find the stress of learning a challenging subject unmanageable.

A child or young person may find it difficult to articulate whether it is the social or physical environment that they find difficult. Mapping and mosaic activities are a starting point for identifying ‘triggers’ or ‘hot spots’ and can be used to experiment further. For example, being in the environment with and without other people present to determine the level of stress elicited in each scenario.

Instructions for a mosaic approach are available in Appendix 5.

Drawing the Ideal School

The Drawing the Ideal School technique has been adapted from an approach developed by Moran (2001). It enables children to become involved in understanding themselves and expressing their views. This approach explores children’s important/core views about themselves and how they view the world. Children (and adults) behave in a way that makes sense to them according to their own view of the world. We are likely to understand children (and the sort of provision that is most likely to help them) more if they can express these core constructs to us.

The technique itself is simple to use once the child understands what is expected. This resource is available in Appendix 7 and provides:

  1. guidelines for the adult completing the technique to follow
  2. a list of how to complete the technique 

School well-being cards

The School Well-being cards were created by Educational Psychologist Dr Jerricah Holder. They help to understand the reasons why a child is struggling to attend school.

The cards are divided into two:

  1. risk factors that have been shown to increase the likelihood of EBSNA
  2. protective resilience factors which make school attendance more likely.

Risk factors are identified by asking the child to sort the yellow risk cards into piles that are true and not true. They then choose the top 5 that are true about them.

Resilience factors are identified by sorting the blue cards in the same way before choosing the top 5 they would most like to change.

These can then feed into action planning with the child and their support network. This can help support adults to make changes that should reduce EBSNA behaviours, increase attendance and improve wellbeing.

'RAG' rating systems 

RAG (Red-Amber-Green) ratings, also known as ‘traffic lighting’, are often used to summarise indicator values.

  • Green represents a ‘favourable’ value
  • Amber is a 'neutral' value 
  • Red is an 'unfavourable' value

This can be applied to children’s timetables as a method of supporting the child to increase their school attendance.

To do this, a key adult who supports the child should work with them to identify any days of the school week or lessons on their timetable that they feel more comfortable attending. This could be a lesson with a particular teacher or peer. These can be coloured as ‘green’ days or lessons in which the child agrees to attend. The other days/lessons can be ‘amber’ which signifies that they may be able to attend them with support. Finally 'red’ means they do not feel able to attend at the moment and will need more time and support to attend.

This can help provide goals for the child and a sense of progress in being able to attend some school or lessons. It also helps the staff supporting the child to understand when to encourage them to attend and when to provide other forms of support.

The RAG ratings can be reviewed on a regular basis. The aim is that over time more days or lessons will become ‘green’. The child should then be able to increase their attendance and maintain an element of choice and control over their anxiety.

Functions of school avoidance - card sort

This card sort activity has been devised by Sheffield EPS and shared by Lancashire EPS in their EBSNA guidance. It's a tool to support staff to develop a greater understanding of a young person’s school avoidance. It is based on the School Refusal Assessment Scale developed by Kearney (2002).

The statements are colour-coded to indicate the function of the school avoidance behaviour, as identified by Kearney and Silverman (1990).

These cards may be a useful tool in a 1:1 session with the child or young person and a trusted adult. By asking the child to sort the statements it can aid conversations around what function EBSNA behaviour has for them. It may then be easier to identify strategies to support them in overcoming barriers to attending school full-time.

The card sort is available to download in Appendix 8

Continue to Part 3: Planning reintegration 

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