The MSS survey is administered to students across the state, with students and parents having the choice to ‘opt out’ if they desire. Students had the opportunity to skip questions within the survey. 10 questions from the survey were chosen to represent the prevalence of ACEs, 3 questions were chosen linked to the identified education outcomes outlined above and 7 questions were used to measure school connectedness. The survey is used by the state as a planning tool to inform future resourcing.  

Hardcastle et al suggest education may play a critical role in moderating the impact of adversity and addressing the associated inequalities. One factor related to improving education related outcomes is fostering an environment based on school connectedness. School connectedness is defined as ‘the belief held by students that adults and peers in school care about their learning as well as about them as an individual.’ (US Center for Disease Control and Prevention).  

Survey results 

• 5% of the respondents to the survey reported having >4 ACEs (females 6.4%, males 3.7%). Report of having >4 ACEs was associated with having more than 4 times the likelihood of having on of the 3 education-related outcomes which were measured. 
• Among males who reported sexual abuse or food insecurity there was strong association with responding that they had no plan to graduate.  
• Among males and females who reported sexual abuse there was a strong association with responding that they had cut school for more than 3 days in the past month.  
• Experience of any ACEs was associated with males being 1.5 times more likely to have below average grades.  
• Marginal effects were reduced by school connection. These effected differed between male and female students.  

The study did not conclude that school connection can improve on the impact of ACEs and education –related outcomes, however the author does suggest that there would be scope to explore these relationships further with younger students within the 6th – 8th grades. The author concludes that while the results of the study did not show a link between school connectedness and mitigating the impact of ACEs that school contextual factors may still promote youth wellbeing, a sense of belonging and resilience to challenge adversity.  

Are staff aware of pupils within their setting who have >3 ACEs?  

Do we have effective tools for screening pupils for ACEs and to gather data based on planning for future outcomes?  

What knowledge do senior leadership teams and pastoral care staff have on school connectedness?  

What role do EP colleagues have to play in gathering data on ACEs and future education outcomes?  

experiences and educational and employment success in England and Wales: findings from a retrospective study. Public Health. 2018;165:106-116. 

US Centers for Disease Control and Prevention. School connectedness: strategies for increasing protective factors among youth. 

1. Positive influence on social development and mental and physical health 

1. Prepares youth for transition into adulthood  

1. Aids economic and social participation in society  

1. Provides access to academic, practical and social-emotional learning.  

INSA’s mission: to reduce absenteeism and promote attendance by researching and disseminating information, assessment and intervention strategies.  

INSA’s objectives: 1) to ensure all stakeholders have access to current scientific and practical developments in the field, 2) to share data and best practice, 3) to connect and mentor junior researchers and practitioners, 4) to convene annually at different international locations, 5) to document deliberations in the field.  

The paper outlines 3 key challenges, identified by INSA’s members, that hamper progress in promoting attendance and reducing absenteeism:  

Lack of consensus  

No universally agreed upon classification or definition exists. Kearney et al’s functional model of absenteeism provides meaningful classification and Heyne et al’s model suggests 4 categories of SAP (school refusal, truancy, withdrawal, exclusion) and that interventions should be differentiated in response to the type of absenteeism.  

The field lacks clarity around the attendance rate thresholds for when is best to begin initial interventions and intensive interventions and how often to measure attendance. Research recommends frequent monitoring.  

There is a lack of a shared, interdisciplinary research agenda. New interdisciplinary models for SAP research have emerged but these require efficient and effective dissemination and implementation in order to inform the creation of multi-level assessments and intervention strategies.  

Inadequate attention to the voices of all stakeholders  

In order to fully understand and address the causes of SAPs, the first-hand views of all stakeholders should be obtained to form a fully interdisciplinary approach. The extent of qualitative research required to effectively obtain these views is limited and often unreliable. The paper summarises and references examples of qualitative studies but acknowledges the limitations of the findings due to the small size and narrowed selection criteria of the samples used. The voice of parents and professionals is under-represented across studies.  

Sub-standard dissemination and implementation  

Inadequate dissemination of information and data across disciplines (i.e. education and psychology) and across countries, has resulted in inconsistent use of definitions and classifications, making it difficult to analyse attendance trends, ultimately hampering our ability to identify areas of greatest need and hindering our understanding of socio-cultural influences on attendance and root causes of SAPs. The paper acknowledges the potential of a multi-tiered implementation approach, namely the Response to Intervention Model (RtI). The paper also recommends the use of specific implementation science strategies to best support the adoption and use of complex models such as the RtI.  

The papers concludes with a statement from INSA outlining current and intended future developments. It also invites professionals involved in the field of attendance to become members of their network.  

Can we use INSA’s operational structure and improvement strategy to enhance our own strategic plan?  

How can we best make leaders at all levels aware of the three key challenges that hinder progress in promoting attendance and reducing absenteeism?  

Bellis et al. BMC Public Health (2018) 18:792 

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5699-8 

 adult available, given opportunities, treated fairly, culturally engaged, supportive friends and having a role model) showed protective relationships with each child health condition, overall health status and school attendance. This was a comparative, retrospective study where those with reported ACES were measured for a level of benefit with respect to the amount of access they had to the seven mitigating factors. This research study wanted to determine if community factors that provide support, friendship and opportunities for development could build children’s resilience whilst safeguarding against some of the damaging impacts of ACEs. There were no interventions offered by this group.   

The method of study involved a national (Wales) cross-sectional retrospective survey of 2452 individuals using a stratified random probability sampling methodology. That being, the overall group studied were split into smaller groups, these groupings being decided by their common characteristics or attributes.  

Outcome measures were self-reported poor childhood health, specific conditions (asthma, allergies, headaches, digestive disorders) and school absenteeism.  

The conclusion of the study outlined that, better prevention of ACEs through the combined actions of public services may reduce levels of common childhood conditions, improve school attendance and help alleviate pressures on public services. Whilst the eradication of ACEs remains unlikely, actions to strengthen community resilience assets may partially offset their immediate harms. 

How might an educational setting be a partner in ensuring effective exposure to the maximum amount of community resilience assets?  

How can we ensure that the researched wellbeing strategies are supported universally or indeed with a more targeted approach when childhood adversity is prevalent? 

ACEs- Educational Interventions 

Socioeconomic Disparities in School Absenteeism after the First Wave of COVID-19 School Closures in Scotland — University of Strathclyde  

The report also compares school absenteeism rates pre and post COVID, using biennial yearly attendance rates from 2006/07 – 2018/19. Attendance rates categorised by SIMD are only available from 2012/13.   

In addition, the report strives to determine if socioeconomic inequalities exist in both COVID-19 related and non-COVID related school absenteeism, and if so, to what extent. Socioeconomic information was measured using the Scottish Index of Multiple Deprivation (SIMD). It is important to note that this analysis includes data for both primary and secondary pupils, as SIMD information is only available for primary and secondary combined. Therefore, the report is unable to present findings that demonstrate socioeconomic disparities in school attendance separately for primary and secondary.   

In comparison to absence rates from previous years, the study indicates that overall absence was 2.7% higher. This increase was mainly due to COVID-19 related absences, with non-COVID 19 absence rates similar to that of previous years. However, findings show a rise in socioeconomic inequality in non-covid related absenteeism, with data showing higher absence rates among pupils from the most deprive backgrounds and lower absence rates among pupils from the least deprived backgrounds. The disproportionate impact of COVID-19 on the health (Lone et al., 2020), wellbeing and learning (Andrew et al. 2020) during lockdown for those from disadvantaged backgrounds, is acknowledged by the report for the rise in socioeconomic inequality, and this extends to the inequality in attendance rates after the first school closures.   

Based on previous research, the report takes the stance that school absenteeism has a detrimental effect on academic achievement (e.g. Gottfried, 2010). After analysing the absenteeism data to identify trends, the report goes on to conclude that the education of children from more deprived socioeconomic backgrounds did not only suffer during the first bout of school closures, but it was also adversely affected through more frequent school closures after the lockdown. Therefore, the report advises that addressing the disproportionate short-term and long-term impact of the pandemic on the most vulnerable children needs to be made paramount and placed at the forefront of the educational policy agenda, in order to mitigate the consequences of COVID-19 on achievement gaps.  

How can we delve deeper into the socioeconomic factors which negatively affect attendance?  

How can schools best address the disproportionate impact of COVID-19 on the health, wellbeing and learning on pupils from disadvantaged backgrounds?  

Klein, M., Goodfellow, C., Dare, S., & Sosu, E. (2020). Socioeconomic Inequalities in School Attendance in Scotland: Research Brief. University of Strathclyde. 

To investigate how students’ perceptions of relationships with peers at school and teachers’ classroom management are associated with school refusal and truancy.  

Supports viewing school refusal (non-attendance due to expectation of experiencing strong negative emotions while at school) and truancy (related to anti-school sentiments and antisocial characteristics – such as school is boring and activities outside school are more rewarding) This difference is needed to implement effective preventative measures 

Poor relationships with peers = important risk factor for school refusal and moderate risk factor for truancy.  

Teachers’ classroom management may indirectly lead to school refusal when not preventing bullying or social isolation by peers.  

Secondary teachers’ classroom management directly impacted on school refusal and truancy through perceived poor support. Good teacher-student relationships could directly influence the prevalence of school refusal and truancy  

Efforts to prevent bullying is important in reducing school refusal more so in primary than secondary.  

Social isolation at school affected secondary school refusers more.  

Impact of absence -on personal, emotional, social ad academic development.  

Prolonged absence effects – school dropout, impaired social functioning, unemployment, mental health problems, needs for welfare services 

Impact of truancy – delinquent behaviour, juvenile crime. 

Difficult peer relationships – Studies suggest that having good friends who provide social support may prevent school refusal as school refusers can be shy and socially withdrawn so problematic peer relationships and bullying have an impact.  

Teachers’ classroom management – includes structuring social interactions, supporting individuals. Lack of classroom order/structure/organisation may have a role to play as difficult to prevent bullying, unpleasant or threatening experiences. Structured classrooms promote predictability which supports attendance.  

Individual and family factors – Emotional instability can lead to anger, anxiety, depression and vulnerable to stress and more at risk of school refusal. Parental support of school can lower truancy.  

classroom management associated with SR-related and truancy-related reasons 

for school non-attendance if controls are included for emotional stability, parental 

interest in schoolwork and parental monitoring of reasons for absence? 

2. Do these associations differ between students in primary and secondary school? 

The survey questions could provide the basis for your own survey.  

To investigate how students’ perceptions of relationships with peers at school and teachers’ classroom management are associated with school refusal and truancy.  

Supports viewing school refusal (non-attendance due to expectation of experiencing strong negative emotions while at school) and truancy (related to anti-school sentiments and antisocial characteristics – such as school is boring and activities outside school are more rewarding) This difference is needed to implement effective preventative measures 

Poor relationships with peers = important risk factor for school refusal and moderate risk factor for truancy.  

Teachers’ classroom management may indirectly lead to school refusal when not preventing bullying or social isolation by peers.  

Secondary teachers’ classroom management directly impacted on school refusal and truancy through perceived poor support. Good teacher-student relationships could directly influence the prevalence of school refusal and truancy  

Efforts to prevent bullying is important in reducing school refusal more so in primary than secondary.  

Social isolation at school affected secondary school refusers more.  

Impact of absence -on personal, emotional, social ad academic development.  

Prolonged absence effects – school dropout, impaired social functioning, unemployment, mental health problems, needs for welfare services 

Impact of truancy – delinquent behaviour, juvenile crime. 

Difficult peer relationships – Studies suggest that having good friends who provide social support may prevent school refusal as school refusers can be shy and socially withdrawn so problematic peer relationships and bullying have an impact.  

Teachers’ classroom management – includes structuring social interactions, supporting individuals. Lack of classroom order/structure/organisation may have a role to play as difficult to prevent bullying, unpleasant or threatening experiences. Structured classrooms promote predictability which supports attendance.  

Individual and family factors – Emotional instability can lead to anger, anxiety, depression and vulnerable to stress and more at risk of school refusal. Parental support of school can lower truancy.  

classroom management associated with SR-related and truancy-related reasons 

for school non-attendance if controls are included for emotional stability, parental 

interest in schoolwork and parental monitoring of reasons for absence? 

2. Do these associations differ between students in primary and secondary school? 

The survey questions could provide the basis for your own survey.  

March 2007 

The author’s review of written texts on the subject of extended non-school attendance identifies a dominant clinical discourse with use of language such as ‘treatment’, ‘symptoms’, ‘disorder’ and ‘diagnosis’. Other discourses focus on the legal elements of school non-attendance, directing the focus on parents as the problem rather than examining systemic factors which may influence non-attendance.  

Referencing a study by Malcolm et al (2003) of parents, children and education staff on factors influencing non-attendance there were varying factors identified by each of these groups. For pupils factors included problems with lessons or teachers, the complexity of secondary schools, peer pressure, social isolation and bullying. Parents of both children with and without attendance problems believed that bullying and problems with teachers were the principal reasons for non-school attendance while school staff believed that low parental interest and low belief in the value of education were contributing factors. Pellegrini suggests that all parties need to be supported in understanding each other’s discourses and to devise interventions which address the factors influencing attendance at individual (child), group (peer/family) and systemic (school) level.  

The article discusses the importance of considering characteristics of the child and family as factors contributing to non-attendance but also highlights the need to consider school risk factors. One suggested way of doing this is using the ‘School Refusal Assessment Scale’ developed by Kearney and Silverman (1990). This assessment helps identify the needs of individual children through 4 functions of non-attendance * and is completed by the child and their parents. The limited evidence presented in the text suggests that using the SRAS assessment scale could be beneficial in improving measures of non-attendance, however it recommends being used alongside other assessments.  

Early identification of pupils at risk of non-attendance should take place, using a multi-agency approach to identifying factors which could be a cause.  

Interventions to support returning to school at individual level should not exacerbate any underlying issues, such as anxiety, by forcing a child to spend time within a school setting. Unless environmental factors which have led to the non-attendance are addressed such interventions are likely to be unsuccessful. Effective interventions at systemic level include awareness raising through staff training, ensuring a member of staff has responsibility for attendance, flexible part-time timetables, peer-mentoring, effective anti-bullying policies, identified ‘safe havens’ and whole school emotional literacy programmes. Parental interventions such as training in positive behaviour management are also cited.  

Educational Psychologists have a key role to play in supporting work with non-attending pupils, this can include assessment, intervention, parental training, social skills and behavioural support.  

* 4 functions of non-school attendance (Kearney et al 1990):  

1. avoidance of specific fear and anxiety-provoking stimuli/ settings    2. Escape from social situations which are unpleasant and/ or an element of evaluation is present       3. Attention seeking     4. Positive reinforcement (e.g opportunity to spend time with peers or parents by non-attending). 

How quickly do we take a multi-agency approach to addressing non-attendance? 

How involved are EP staff in the early stages of identifying ‘at risk’ pupils and risk factors?  

How does each setting promote and model emotional literacy across the whole school context?  

Kearney, C. A., & Albano, A. M. (2004). The functional profiles of school, refusal behaviour: Diagnostic aspects. Behavior Modification, 28(1), 147–161. 

Kearney, C.A. & Silverman, W.K. (1990). A preliminary analysis of a functional model of assessment 

and treatment for school refusal behaviour. Behavior Modification, 14(3), 340–366. 

Yoneyama, S. (2000). Student Discourse on ‘Tôkôkyohi’ (school phobia/refusal) in Japan: burnout 

or empowerment? British Journal of Sociology of Education, 21(1), 77–94. 

Current Psychiatry. 2006 December;5(12):67-83 

https://www.mdedge.com/psychiatry/article/62456/solutions-school-refusal-parents-and-kids/page/0/1 

Common long-term problems include delinquent behaviours, economic deprivation, social isolation, marital problems, and difficulty maintaining employment. Approximately 52% of adolescents with school refusal behaviour meet criteria for an anxiety, depressive, conduct-personality, or other psychiatric disorder later in life. 

The most common age of onset is 10 to 13 years. It is Imperative to ascertain the form and function of school refusal behaviour. (Click the link for an example of a School Refusal Assessment Tool https://schoolavoidance.org/school-avoidance-101/ ) 

Aside from medication psychological techniques can be applied. Once the primary reinforcers for the behaviour have been established then a tailored technique can be applied, such as-child-based interventions to manage anxiety (cognitive therapy, breath work) parent-based techniques to manage refusals such as incentives and disincentives for attendance/non-attendance and help in establishing effective parenting skills. In severe cases a multidisciplinary approach is required including psychotherapy and or medication. A multi-agency/parental inclusion approach is most often a crucial element in resolving school refusal behaviour. 

What policies and procedures are in place (both at LA and school level) to support children and families dealing with school refusal issues? 

How effectively do we identify and assess the underlying causes of absence including home, educational setting, and community factors? – Are we ascertaining the primary reinforcers and tailoring our interventions to specific needs? 

How do you effectively support those learners returning after extended absence? 

How could you facilitate an effective multi-agency approach? 

In what ways are we effectively addressing barriers to attendance? 

https://education.gov.scot/improvement/Documents/sac82-edinburgh-research.pdf 

Emotionally Based School Refusal Manual 

https://www.schoolavoidance.com/schools 

Can Informing Parents Help High School Students Show Up for School?  

This intervention used text messaging to send daily absence updates and weekly attendance summaries to guardians of students in New York City High Schools. Students were assigned randomly to receive the messages and guardians were automatically opted in to the study with the opportunity to ‘opt out’ if they chose to. The system did not replace the existing automated robo voicemails that were already being sent to guardians. Both the control group and the text message groups still received these.  

The intervention took place during the second semester of the 2015 – 16 school year. 

Text messages were sent between 6pm and 10pm on the day of absence and did not frame the information in a positive or negative way or prompt guardians to take any further action. Each message was sent in the student’s first language, to any guardian whose phone number was associated with them. The school contact information was also included within the messages.  

The evaluation found that there was no change in attendance for those students who received the text message information. Both groups had second semester attendance of about 86%. There was a pattern of attendance noted for both groups across the semester; attendance declined across the course of the semester, after a holiday and after the weekend. Attendance for both groups declined in the second semester compared to the first.  

There were no statistical differences in attendance for different sub groups e.g by grade level, those with only 1 guardian receiving messages compared to 2, or those with English as an additional language.  

Explanations for the lack of meaningful effects of the study concluded that:  

1. The study may have been too broad as it targeted all students, not specifically those with chronic absences.  

1. The intervention gave parents no further informational support to prompt them to take action on absences.  

1. The intervention may have needed to have taken place at a different time or for a longer period of time.  

1. The continued use of the original voicemail system for the text message group may have been overload for the parents receiving both types of alert.  

The report recommendations are: 

1. Target attendance interventions on students in the first year of high school.  

1. Build relationships with parents so they regard information on absence as being non-punitive.  

1. Engage parents and students together to address barriers to attendance.  

How can we best engage with parents without overloading them?  

How do we engage parents and students together to address barriers to attendance?  

What referrals and services are available to support parents in promoting attendance? How do we inform parents about these?  

Balfanz, Robert, and Vaughan Byrnes. 2014. A Report on the New York City Mayor’s Interagency Task Force on Truancy, Chronic Absenteeism, and School Engagement. Baltimore: Everyone Graduates Center, Johns Hopkins University. 

https://educationendowmentfoundation.org.uk/projects-and-evaluation/projects/developing-healthy-minds-in-teenagers 

This evaluation focused on health outcomes as measured by the Child Health Questionnaire-CF87 (CHQ-CF87) (Schmidt, Garrett and Fitzpatrick, 2002). The primary outcome measure was the single scale of self-assessed general health drawn from the CHQ-CF87. Twelve other scales were evaluated as part of this study as secondary outcomes, alongside other validated scales (the Short Mood and Feelings Questionnaire, the life satisfaction 0-10 ladder and the Child Anxiety Related Disorders (SCARED)). Outcomes were measured after both two years and four years of the programme. A second evaluation conducted by a team at NIESR includes both an impact evaluation looking at academic outcomes and an Implementation and Process Evaluation. This was published in 2020. Overall, Healthy Minds has had some positive impact on health-related outcomes without compromising academic attainment and possibly supporting reducing absenteeism and exclusions. 

The evaluation also measured pupils’ self-assessed general health after two years of the programme and found a similar impact (0.23 standard deviation difference).  

Secondary outcomes associated with physical health, behaviour and external relations were generally positive.  

Measures of internalised emotions (Emotional Difficulties, Self-Esteem, and Mental Health) were mainly close to zero and positive after four years of the programme, but in some cases were negative when collected after two years of the programme.  

Further research is ongoing to ascertain whether the optimum time for implementation is two or four years.  

The approximate cost of implementation was £23.50 per pupil per year. The programme requires 7 days of teacher training.  

It is possible to change the ‘Health Related Quality of Life’ of the treated regardless of their starting point. 

How would you implement this across your specific setting- what would the model of operation look like, who would staff it and what would the accommodation look like for this? How and to whom would you report impact? What would your criteria be for selecting the participants? 

How would you measure and demonstrate this intervention’s impact on attendance? 

Bonell, C., Fletcher, A. & McCambridge, J., (2007), Improving school ethos may reduce substance misuse and teenage pregnancy, British Medical Journal, 334:614–16.