School anxiety and school avoidance

Emotionally Based School Avoidance (EBSA) parental guidance

This guidance has been produced by Lancashire Educational Psychology Service. It has been created based on current research/best practice and on what local families and schools have told us about things that are helpful for pupils with Emotionally Based School Avoidance (EBSA).

What is EBSA?

Feelings of worry or anxiety are something that everyone will experience from time to time. They can help to keep us safe from difficult situations. There are times, however, when worry can be so great that it stops an individual from doing daily activities.

It is not uncommon for children and young people to worry about school. For some children, however, that worry can become so great that they may have difficulties in attending school. If your child has high levels of anxiety and is finding it difficult to attend school, they may be experiencing Emotionally Based School Avoidance (EBSA).

Your child is not alone with this issue as it is suggested that 1-5% of the school population experience EBSA. Your child may have worries about their peer relationships, bullying, their teachers or about being away from home.

The impact of world events

In recent years, we have experienced, and received lots of news about global and local events, including the Covid-19 pandemic, wars in other countries, climate change, and more recently the ‘cost-of-living crisis’ within the UK. All of these have had a lasting impact on our country, our economy and our education system. These events will have proven for many to be unsettling and upsetting and may have brought additional pressures to pre-existing personal, familial and school factors.

Prior to school closures during the Covid-19 pandemic, some students were already experiencing difficulties with attendance. When schools closed, most children stayed at home and developed a new routine in which they were told that they were safe at home with their families and did not have to go to school. Some students enjoyed online learning or other activities that they were able to do within their day. During this time, students have had a lack of face-to-face contact with others, they may have lost skills they once had or despite everyone’s best efforts they may have missed learning. EBSA can be exacerbated and maintained through periods of absence with children being isolated from friends, through fear of being behind with schoolwork or an increased anxiety about leaving their safe space at home. Some Lancashire families have talked about children experiencing anxiety around their own or family members’ health, the uncertainty of what school will be like now, anxiety about being separated from caregivers, no longer being motivated to learn in school when they have seen they can learn effectively at home, no longer having friendships or finding the school environment overwhelming.

Signs of EBSA?

Your child may show any of the following signs of EBSA:

• Be fearful, anxious or angry when faced with the prospect of school.
• They may avoid getting ready for school and become upset during their morning routine on a weekday.
• They may complain of physical illness: headache, tummy ache, feeling sick.
• They may share anxiety symptoms such as a racing heart, sweating, fast breathing or pins and needles.

These symptoms may be present mostly during the week or on a Sunday evening when they know they are going to school the day after. They may not show these signs at weekends or during school holidays.

Where a child has been finding attending school difficult for a long period of time, they may no longer be attending school, have difficulty sleeping, have isolated themselves from friends or have a fear of leaving the house at all. This highlights the need for support to be put in place sooner rather than later.

What families told us

What other Lancashire families who have children who experience EBSA told us…

We believe that the lived experiences of children, families and our schools have much to tell us about how we can better respond to this issue. Parents and carers told us that the difficulties their child experiences are made worse when they are blamed for their child’s absence or when the school maintains that the child is ‘fine’ when they are attending in person.

This can lead to conflict between home and school and whilst parents and school are in disagreement, the child continues to struggle and feel isolated. Our children and young people told us that they and their parents often do not feel listened to or believed, which can make them feel worse.

Parents shared that they are often under immense pressure and that an understanding and supportive relationship with school staff is very important and key to moving the situation forwards.

Parents reported that having somebody at school with whom their child could build up a relationship was supportive. Meeting this person when they arrived at school was also important to the child so they did not have to walk into school alone. Some parents also noted that external agency support and mental health support were helpful.

“They are being as flexible as they possibly can be now but if they’d been this flexible right at the beginning how different would the outcomes have been.”

"To acknowledge what we are going through, this is a real issue. The stress and pressures we are already facing as a family is really difficult to then have professionals question our ability of parenting.“

"We had daily communication with the school who were willing to listen and help and it became a totally different experience.”

“No one sent him a card. If he had broken his legs they would have. It didn’t come across as though they want him back.”

“We got a lovely email that was open and honest and not patronising. The person who sent it wasn’t afraid to say he didn’t know and that he would try and find things out. We felt included and respected.”

“’The thought of having to pay a fine the house was a war zone.”

“My child has to know exactly, maybe not just what will be expected but what won’t be expected of her to kind of quell the fears that’s she’s got.”

Other barriers to school attendance

Whilst Lancashire have chosen to use the term Emotionally Based School Avoidance to develop its package of support, there could be many reasons why a child might struggle to attend school. Some of these might include caring for a relative, helping around the house or spending time with peers outside of school. Equally, sometimes a child’s worries about school or home may not be obvious and/or they may not appear to be anxious.

Part of the EBSA strategy involves school staff using the ATTEND framework as part of a discussion with parent, carers and children. The ATTEND framework is a tool designed to identify any barriers to school attendance. In Lancashire, we ask schools to use this framework with any child who has attendance under 90%, regardless of their presentation, so any support that is required can be put into place. The ATTEND framework is purchased by schools as part of the Lancashire EBSA training.

EBSA and the law

The Education Act 1996 places a legal duty on all parents to ensure that their child has an education and is attending school regularly. There are only certain reasons why a child might miss school, e.g., ill health. If it is deemed a parent is not supporting their child to access school it can lead to a variety of actions such as Fixed Penalty Notices (FPNs) and/or court action in a criminal or family court.

For young people experiencing EBSA and struggling to attend school, it is the head teacher’s decision whether to authorise an absence or not. In February 2023, the Department for Education published new guidance: ‘Mental health issues affecting a pupil’s attendance: guidance for schools’ on GOV.UK. It outlines the expectation for schools to build strong relationships with families, to listen to and understand barriers to attendance and work with families to remove them. The guidance shared that medical evidence is not required for schools to make adaptations to support a child and that as long as parents and carers are working with the school to improve attendance they should not be prosecuted.

The Lancashire EBSA strategy is in support of this approach by offering training, a toolkit and resources to support schools to support families. If a school did decide to refer for legal intervention, it would be expected that they have already tried an array of strategies to encourage and support your child’s attendance (see the ‘What can you expect the school to do?’ later on in this guide).

Autism and EBSA

Some parents who attended focus groups to contribute to this guidance have children who are autistic and are also experiencing EBSA. They queried whether the resources within the toolkit are the most appropriate way to support their children.

Autistic children can often face additional challenges in school. Sensory processing differences can make a child’s surroundings unpredictable and overwhelming. School life can include busy corridors, uncomfortable uniform materials and bright lighting which all may be difficult for a child to tolerate. Autistic children may find it difficult to understand their own and other emotions which can make it difficult to process and regulate their emotions.

All of this uncertainty can contribute to autistic children experiencing feelings of anxiety. It is important, however, to remember that anxiety is not simply a part of Autism and it can be supported in its own right.

As with other children experiencing EBSA, it is important that adults supporting the autistic child work to identify what they are finding difficult to tolerate in school and the barriers they are experiencing. Hearing the child’s experiences from their perspective is the most important step. Resources from the Lancashire EBSA toolkit can be really helpful for this, such as the ‘Mapping the Landscape’ activity which explores environmental and sensory experiences. Parents and carers can also be invaluable in sharing their knowledge of how to support a young person with the sensory and social challenges they experience and how this is managed in situations outside of school.

Schools should be well equipped to support autistic children. There is information on whole school approaches and intervention through quality first teaching within the Teaching And Learning Toolkit: Ordinarily Available Provision (PDF 1.49 MB) (pages 54 to 58).

The Autism Education Trust has also created the following video providing insight into how autistic young people experience school and their advice on how schools can support them: Top Tips on How to Support Autistic Young People from the AET Autistic Young Experts on YouTube.

There are also some helpful examples of adaptations to supporting autistic young people created by autistic young people that can be found here: Our key principles on the Autism Barriers to Education website.

How to get support?

We know that it can be really difficult to see your child upset. One of the best things you can do is calmly listen to your child and acknowledge how real their feelings are to them.

It is important that you share your concerns as early as possible with school staff. EBSA can be complex but it is important that everyone is working together to support your child.

A plan should be made between your child, you, and the school to help your child. Your child’s views should be at the centre of that plan. We have found asking your child what the first step they feel they can achieve is can be really helpful. Steps should be small and the plan should be regularly reviewed between you and the school (we recommend at least every 2-4 weeks).

What can you expect the school to do?

• Listen carefully to you and your child. They should acknowledge the challenges faced by your child and you as their parent or carer.
• Maintain regular contact with you and your child, even during extended periods of non-attendance (at least twice weekly).
• You and your child should have a named member of staff as a link person.
• Follow the Lancashire Multi-agency Flowchart in supporting your child. This can be found on page 14 of the Emotionally based school avoidance (EBSA) guidance.
• Work together with you and your child to find out what difficulties your child is experiencing and find ways of making school a happier place and improve their attendance.
• Together you should make a plan that outlines what the next steps will be. It is important that adults take your child’s lead in identifying what is an achievable first step.
• Goal-setting should be done collaboratively with you and your child, ideally using the Target Monitoring Evaluation resource in the Lancashire EBSA Guidance. A date for review should be agreed within a 2-week period.
• Respond to any school-based needs, such as academic support, dealing with bullying or support with social relationships.
• Consider the support your child might require when they arrive at school. This might include meeting with a friend or key adult at a specific place and time, using a quiet space to settle before school starts, engaging in a preferred activity or being given a responsibility such as a monitor role.
• If difficulties persist the school should consider requesting involvement from other professionals including their link educational psychologist.

Lancashire schools told us that they wanted training and resources to be able to support children and their families. This is now available to schools and more information can be found on the Emotionally based school avoidance (EBSA) guidance for professionals.

It is possible that there may be setbacks when following the plan. It is important that these are anticipated and solutions are found. If setbacks happen, whilst this can be difficult, try to keep an optimistic approach. If your child is not able to attend school on one day, start again the next day. At times, steps in the plan may need to be revisited. It is also important to remember it is likely to be more difficult after a school holiday, period of illness or after the weekend. If your child is finding  the current plan too difficult, this may tell us that the next steps were too ambitious and need to be reviewed.

You may feel tempted to change schools, however, research tells us that often difficulties will re-emerge in the new school and whenever possible it is normally better to try to resolve the issue in the current school.

What can you do?

Speaking with your child about why they are not currently able to attend school is likely to make them anxious. It can be helpful to acknowledge this but tell them that you want to know how they think or feel. We have tried to include a range of resources that might support them in sharing their feelings and thoughts about school. 

Sometimes children may find it hard to tell you face to face, perhaps you could ask them to write it down, email or text you. Some children also find it easier to draw how they are feeling.

Your child may benefit from having greater control over the strategies that they use to overcome their EBSA or what their first steps are. Although they will still need your support and guidance they will be more capable of carrying out some of the strategies independently and are likely to want to do them independently.

There are some activities within the EBSA toolkit that you may want to complete with your child or they may want to complete them with someone from school, whom they trust. There is a card sorting activity (pages 21-25) or a mapping the landscape activity (pages 26-31 for the primary version and pages 32-38 for the secondary version), which will help you and the school staff to understand what is ‘pushing’ or ‘pulling’ your child to being at home and at school. There is also a laddering activity (pages 39-43) which young people and parents have told us has helped in ordering their worries and looking at what the young person thinks are the first steps they can achieve in their return to school.

In our experience, a plan is likely to be most successful if the young person has ownership over the next steps they feel able to manage, rather than the adults making assumptions about this. It is also important to remember that these steps will likely need to be very small.

Finally, as a parent it can be really difficult to see your child unhappy. Make sure that you have someone to talk to too. This could be a friend, family member or an organisation such as those listed below or at the end of this guide.

Parents can speak with an educational psychologist from Lancashire Educational Psychology Service through the parent/carer helpline:

• The Educational Psychology Service parent/carer helpline is temporarily closed. We apologise for any inconvenience this may cause.

Lancashire SEND Information, Advice and Support Service (SEND IAS) is a service that provides free, confidential, impartial advice and support to parents with special educational needs and children and young people with SEND.

• Helpline Number: 0300 123 6706 - open 9 – 5, Monday – Friday. You can leave a message outside of these times and we will call you back.
• Email: information.lineteam@lancashire.gov.uk
• Website: Lancashire SEND IAS website
• Facebook: Lancashire SEND IAS Facebook

What we have learnt supports improvements in children experiencing EBSA

Over the last two years we have seen examples of children experiencing EBSA successfully returning to school. Each reintegration has looked different for each child but there have been some common themes that school staff, families, children, and other practitioners have reported have contributed  to the success.

• A gradual plan/stepped approach involving very small steps with staff and parent/carers understanding that it is important to be prepared for setbacks. Small steps might include a staff member building a relationship with the child virtually, in the home or in a local park initially, practicing walking past school, going into school after school, completing learning in a support hub or choosing a favoured lesson to join initially.
• A flexible approach must be taken in relation to the child’s timetable to avoid pressure on a return to school. Parent/carers reported that it was helpful and avoided placing further stress on the situation when school staff worked together with them to find ways forward and avoided attendance procedures for prosecution.
• Allowing the child more ownership and empowerment over next steps and what they felt able to manage; affording them choices around flexible expectations (e.g., choosing their start time). Young people found completing the ‘laddering’ activity where they were able to identify steps they felt were more achievable about returning to school (e.g., initially visiting school after school hours when pupils were not present).
• Regaining trusted relationships for the child with key adults at school was a priority, building up the time they spend together/having daily contact.
• It was essential to make it clear what is not expected of child as well as what will be expected by any visits to school (i.e., they will not be expected to stay longer/attend lessons, etc.).
• Increasing the child’s sense of school belonging (e.g., joining after-school clubs of interest).
• Accessing a student support base as a ‘safe space’ within school.
• Regular home-school communication (by key adult).
• Building first upon areas of a child’s interest and strength as a ‘hook’/motivator.
• Support for developing positive peer relationships by providing safe opportunities. This has included opportunities for social time with peers with a similar interest, having a buddy system and giving the child tools/scripts to use to explain their absence to others.
• Supportive strategies to manage the child’s anxiety regarding academic pressures (e.g., allowing the child to RAG rate lessons and removing subjects they find the most anxiety-provoking from their timetable; providing ‘catch up’ sessions for missed learning, initially focusing on preferred subjects.
• Strategies to support with separation anxiety (e.g., allowing text check ins with family members at certain times).

Examples of targets for EBSA

• Direct communication with the family. Direct written communication with the young person (e.g. through email).
• Between one and three communications per week, including a mix of written and verbal exchanges, with one key person in schools.
• Verbal communication, at least three times a week with two or more people.
• Brief face to face communication, with at least one person, not on the school premises.
• Sustained face to face communication, with at least one person, not on the school premises.
• Brief face to face communication, with at least one person, on the school premises.
• Sustained face to face communication, with at least one person, on the school premises.
• Attending school on a part time basis.
• Attending school full time, within an inclusion base or similar.
• Attending school full time with a mix of mainstream lessons and withdrawal.
• Attending school full time and accessing all mainstream lessons with support.
• Attending school full time and accessing all mainstream lessons independently.

Case study example

Target 1

(Week 1): Daily email contact with key adult at school.

Target 2

(Week 2): Josh will be able to put on his uniform and walk past school during school hours at least once; daily email contact with key adult will continue.

Target 3

(Week 3):

Josh will have at least one contact (possibly via email, phone call or video call, depending on his preference) with at least two trusted members of staff.

Target 4

(Week 4): Josh to visit school at an after-school timing to meet with key adult in Student Support Base. Josh empowered to determine the duration of this.

Target 5

(Week 5): During Easter holidays, Josh to attempt walking past school supported by his mother.

Target 6

(Week 6): In the first week(s) of summer term, Josh to have one after school visit and 1-2 visits during school hours; by the third visit, for Josh to attempt some manageable work with a focus on ‘catching up’ missed/previously learned work.

Target 7

(Week 7): Josh to have after school visits (1-3) as an aim of having more regular visits to school which can then be built up over time to daily.

Target 8

Revisit previous target of Josh accessing after school time visits (1-3) then gradually increase again to afternoon timings during school hours.

Target 9

Josh to consistently access school from 12pm or 11am timings Josh to access lunchtime outside with peers.

Josh to access a PE lesson or maths or science lesson.

Sources of support

When a child is out of school, it can be worrying but also disrupting to family life. We know from families we have worked with that these disruptions can include having to take time off work or stop working completely, it can impact on time spent with other children in the family and the wellbeing of other family members.

Below are some local services that you may find it helpful to get in touch with.

Citizen’s Advice can offer advice on finances and if you are entitled to any support if you are not working. You can search the Citizen’s Advice website for your local Citizens Advice.

Young people, their families or practitioners can refer into Lancashire Young Carers which is ran by Barnardo’s. This service may be able to offer support for siblings of children experiencing EBSA. Find out more on the Barnardo’s Lancashire Young Carers website.

Adult mental health support can be found through Lancashire MIND and supporting services including free wellbeing coaching. For more information visit the Lancashire Mind website.

If you are concerned about your child’s mental health, you can visit your GP and they may be able to make a referral to the child and adolescent mental health team: Children and Young People’s Psychological Services: Lancashire and South Cumbria NHS Foundation Trust website.

If you live in East Lancashire, parent/carers are able to make a referral to ELCAS. Further information can be found here: ELCAS Community Psychiatric Teams: East Lancashire Hospitals NHS Trust website.

If you have immediate concerns about your child’s mental health and feel they are in crisis take them to A&E straight away. You can also telephone the 24/7 mental health helpline: 0800 923 0110

Kooth – Online support for children and young people (where they can remain anonymous) aged 10-18 years, (25 if SEND) available Monday – Friday 2pm-10pm, Saturday – Sunday 6pm-10pm. Kooth website.

Lancashire Parent Carer forum – The forum brings together parents and carers from across Lancashire with an aim to ensure the needs of children and young people are met. Please see the website for further details Lancashire Parent Carer Forum website.

Resources

• Square Peg website
  Square Peg are an organisation working to effect change for children who struggle to attend school and their families.
• Not Fine in School website
  Not Fine in School is a parent support and advice group made up of parents with children who have experienced attendance barriers.
• Parents/ Carers EBSA Guidance | Support Services for Education website
  Somerset Council offer a virtual training video for parents who are interested in learning more about EBSA and how to support your child at home.
• Five Tips for Families | Suffolk County Council website
  Suffolk County Council have provided some helpful fact sheets of the five tips for EBSA. These include noticing EBSA, answering anxious questions, advice for parents, ways to self-regulate for children and young people and planning a return to school.
• The Invisible String by Patrice Karst (Author) and Joanne Lew-Vriethoff (Illustrator)
  The invisible string is a story book that can be helpful for children who experience anxiety around separating from loved ones.
• YoungMinds website and parent helpline
  YoungMinds is a charity championing the wellbeing and mental health of young people. They offer support, advice and guidance to parents and young people. They run a parent helpline, webchat and email.
• Lancashire and Cumbria autism support hub is for autistic people, clinicians and families to share knowledge, ideas and experiences. There is a range of support and advice that has been developed with autistic people, including information about school anxiety.