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- I do wanna take a second and introduce our presenter today.

Dr. Christopher Kearney is distinguished professor and chair of psychology at the University of Nevada, Las Vegas.

He's also the director of the UNLV Child School Refusal and Anxiety Disorders Clinic.

Dr. Kearney received his BA in Psychology and Sociology from the State University of New York at Binghamton and his MA and PhD in Psychology from the State University of New York at Albany.

He completed his internship at the University of Mississippi Medical Center before moving to Las Vegas.

And as I'm sure you noted in the information on the bio that we posted on our website, Dr. Kearney's range of research interest spans a wide variety of areas and topics, and he's published a number of books and book chapters and journal articles.

And today, we're thrilled that Dr. Kearney is with us to share his experience and his expertise in the area of school refusal behavior, and to provide us some strategies to support learners who are experiencing school refusal.

So Dr. Kearney, welcome.

We're glad to have you with us, and I will turn the webinar over to you.

- All right, thank you.

Thank you, everyone, for coming today, and thank you, especially to Shelley McLean for putting this together.

I've done enough of these over the years to know that there's a lot of logistical effort and work that goes into getting this set up, so I really appreciate all the work and effort that she's put into this as well.

I was in Halifax to give a talk on school refusal behavior in 2008 at the IWK center, which I think is across the street from APSEA and really enjoyed my time there, beautiful area.

So hopefully, I'll get to go back one day in person.

Virtual is the next best thing, especially in the current environment, but I always enjoy going to the provinces.

Having grown up in Upstate New York, it's always a treat for me.

So really a pleasure for me to be able to speak with you today.

A lot has changed since 2008.

So I'm gonna share my screen and we'll get started with the slides.

And I know it's doing a little bit of a funky thing and that it shows the main slide, and then it also sort of shows the next slide.

Shelley and I were trying to work through that a little bit, but couldn't quite figure it out.

So you're gonna get kind of the main slide, and then you're gonna get a sneak peek of what's coming.

Hopefully, that's not too distracting as we go along.

Also after the talk, I'll send Shelley a copy of the slide deck.

So if anybody wants to get a copy of that, feel free.

So again, my name is Christopher Kearney, I'm from the University of Nevada, Las Vegas.

My email is on the, front slide there is the webpages and you can always go there if you're looking for a lot more information and detail on some of the things we're gonna be talking about today.

If there's particular resources that you feel might be helpful, let me know.

Obviously, there's a lot to cover in a very short period of time.

And really, what I'm gonna do today is just try to give you an overall blueprint of some of the things that we work on in this area and how we've adapted these things to the pandemic era, and hopefully, now, the post-pandemic era, and some of the questions that it's raised.

But really, we can only sort of talk about sort of a broad scope of things in a limited amount of time.

So if you do have follow-up questions about resources and a lot more detail about the things we'll be talking about today, feel free to go on the webpage and the book list of a lot of different journal articles and things like that that that might be helpful.

So as I mentioned, a lot certainly has changed in the last 20 months or so.

We're certainly at a point where we've seen a lot of major shifts in the world and especially in the educational process.

The pandemic has really forced us, I think, to ask a lot of fundamental questions about things that we used to sort of take for granted.

And one of those questions is, well, what is school attendance, right?

We used to be able to think about, school attendance is a very straightforward, basic kind of thing.

You looked at NC class time, and you'd kind of measure that, and whether kids were in school for a certain amount of hours per day.

But now, we've got a situation where there's all different kinds of teaching and learning formats.

We've got hybrid learning and distance learning, remote learning, home-based learning.

I'm the chair of the Psychology Department here, I've had to get even into more of the nuances of remote learning, like synchronous and asynchronous learning and it gets pretty mind boggling at times, but it means that, I think that's, in our new normal, we're probably gonna have to really think about, well, what is school attendance been in those kinds of environments?

A lot of the cases that we saw in our clinic last year really had a lot to do with kids, just not wanting to participate in the online educational process.

So it was a largely a compliance issue, not necessarily an attendance issue.

And some of that has built into the cases that we're seeing this year.

What if some children never come back to school then?

In Clark County here in Nevada, we're the fifth largest school district in the United States, which always shocks people, you know, given that we're in Las Vegas, but it's a very large school district, 330,000 students, and thousands of those kids are missing.

The school district can't locate them.

Did they move out of state?

Did they stay home?

What happened to them?

We really don't know.

And so the school district is still tracking those kids down.

I think that's a fairly universal phenomenon.

What if, what do we do with those kids that just never come back to school?

What kind of supports and instructional spectra will be needed in the new normal?

Will some kids be back in school with other kids, be reluctant to come back for a long period of time?

Will some kids engage in a hybrid kind of teaching and instructional practice model?

A lot of these fundamental questions and some of these questions I'll come back to near the end of the talk, but I just kinda wanted to foreshadow some of the things that we've thought about in our own work as we're sort of moving forward in this area.

And obviously too, there's been a renewed focus on social justice issues.

I know less so in Canada, but especially in the United States, there's really key disparities and different geographical areas and student groups with respect to school funding, enclosures, exclusionary discipline, access to care, a lot of residential mobility, and so housing and food insecurity, a lot of systemic barriers to attendance.

My background is in clinical child psychology, and so when we originally developed therapeutic models for this population, it was very much focused on children and families and psychopathology kind of issues.

But as I've talked more to school districts and got more involved in the policy aspects, it's clear that there's a lot of systemic broader factor that are related to attendance as well that we have to pay close attention to.

And of course, we were faced with a lot of, kind of loss of faith in the educational process.

Parents, at least the United States are less satisfied with K-12 education.

Millennials are sort of shooing the traditional educational process, including college.

A lot of males, especially in the United States, are not going on to college.

So there's really been a fracturing, I think, of the educational process, and this is all something that sort of looms over the whole absenteeism kind of area.

When we talk about how we sort of arrange interventions for absenteeism, we have gravitated toward a multi-system, multi-tiered system of support model over the last few years to sort of arrange the different kind of myriad interventions that are available for absenteeism, score refusal behavior, school attendance problems, whatever it is that you wanna call it.

And so this is the model that we sort of developed a few years ago to sort of arrange these kinds of things.

So I'm sure many of you are familiar with MTSS models or more traditionally, response to intervention models where there's a tier level of support.

Of course, at the universal bottom level, ideally, the larger level you'd have a set of interventions that are designed to be utilized for everybody.

So all students, so at a particular school.

So if you had a reading curriculum, for example, everybody would get the reading curriculum.

And then you would assume that there'd be a certain percentage of students that would struggle with that reading curriculum and they would need more targeted kind of support, more in-depth tutoring, for example, and reading.

And then at that level, you would expect that some kids are still gonna have some difficulty and they would move into tier three or more intensive kind of support.

So maybe special education or more intensive kind of intervention in terms of word decoding or comprehension or whatever the specific skill deficit might be.

So we try to apply that model as well to absenteeism, and it works fairly well in terms of arranging the different kind of interventions.

There is one sort of flaw in the system, which I'll talk about.

But at the universal level, we're talking about things that all students would get.

So there's a variety of school climate interventions that are out there, programs that focus on increasing safety or health based strategies, which is especially important in the post-pandemic era, school-based health and mental health programs, social emotional learning programs, which I'll talk a little bit more in a bit, parent involvement initiatives, district-wide policy reviews, orientation, summer bridge, school dropout prevention programs.

All these kind of things would be sort of at the universal level to gradually increase attendance or at least decrease absenteeism.

But we would expect that a certain amount of kids are gonna have difficulty going to school, staying in school.

And so those kids and those families might benefit from more of a tier two or targeted approach.

And of course, there've been a lot of psychological approaches for anxiety and non anxiety-based absenteeism.

Our group has been involved in developing a lot of that over the years using a functional model of school attendance problems by focusing pretty much on why kids, what sort of the reinforcement value is sort of attached to different school attendance problems.

But of course, there's also engagement approaches.

We know that kids in middle school start to, often start to disengage from school and they become more at risk for dropout, and teacher and peer mentoring programs.

So these are all sort of tier two.

And then of course, there are gonna be some kids and we expect to see a lot of these in the post-pandemic era who are not able to go to school, they're having a lot of difficulty, maybe a lot of mental and physical health problems, and so they're gonna require a much more intensive kind of support and that could involve things like alternative educational programs or schools or intensive case study and case management, wraparound programs, second chance programs, extended periods of time.

The new model in a lot of districts across the United States, for example, is to sort of start blurring the line between the end of adolescence and the beginning of adulthood, that instead of seeing high school graduation, for example, as a specific point in time, seeing a more of a process where kids have, take a longer time graduating from high school.

But while they're doing that, also getting ready for young adulthood, whether it's eligibility for community college or a certification or vocational training or military service, getting them sort of blurring that line between the end of high school and the beginning of adulthood.

The flaw in this system is that if you look at the percentages, emerging absenteeism and severe absenteeism, that's way too many kids.

So it kind of floods the system.

And a lot of school-based health professionals are just, it's just too overwhelming to see a lot of these kinds of cases.

So to utilize this system more effectively, it really is gonna mean that a lot of districts are gonna have to pour more efforts into universal kinds of intervention, more preventative kinds of things.

So what we've tried to do in the last year or so, given the pandemic and given the fact that a lot of kids are gonna be coming back to school after maybe having been out of school for a long period of time, engaged in more home-based or remote learning, is to sort of extend this MTSS model to sort of the post-pandemic era where, especially to this sort of semester or this academic year where kids are coming back to school.

And we know that there's a variety of different kind of areas that are probably gonna need a lot of focus as kids come back, and so we've chosen four main domains that we recommend that educational agencies and school districts focus on as kids are coming back to school to try to ease that transition back into a regular learning environment.

So we're focused on adjustment, traumatic stress, academic status, and health and safety.

I'm gonna go through each of these in a little bit more in depth.

So this is just sort of an initial foreshadowing of what we're gonna be talking about.

This would be sort of in addition to the model that I just described.

But again, it's a little bit more tailored to the current situation that we're in where kids are starting to come back to school and maybe need an extended period of adjustment or readjustment as they're coming back.

So on a tier one level, we would expect that if we talk about things like adjustment, you know, given the fact that kids have been out of school maybe up to 20 months or so, that they're probably gonna need a lot of extended support as they come back to a classroom for the first time in quite a long time.

My wife was a third grade teacher during the pandemic, and it was very challenging.

I mean, she had a group of eight-year-olds online and half of them would participate and half would log off, some of them were in their pajamas all day, some would log on part of the day and not other times.

So obviously, there's gonna be a lot of transition between that kind of learning environment and a more traditional learning environment where kids come back to school, they're physically in a classroom for several hours at a time.

We also know that for a lot of these kids, their academic skills did not develop as well during the pandemic months as might've happened if they were in school on a full-time basis.

There've been some modeling studies that have shown that in terms of reading, for example, that kids only got about two thirds of the progress in reading during the pandemic era that they would have gotten if they were in school full-time in a regular basis, and that math skills are only about 30 to, 37 to 50% of development as opposed to what would have happened in a regular learning environment.

So clearly, there's a lot of sort of readjustment to do, not just in general, but academically as well.

So again, what I'm gonna do here is just sort of talk a little bit about some of the broad strokes of what we've been recommending.

Obviously, a lot of the nuts and bolts of this are in conversations that happen after this talk at individual schools and individual classrooms and with parents and so forth.

But again, the purpose of this talk is just kind of give an overall blueprint of some of the things that we've been recommending.

So at the adjustment level at tier one, when we talk about tier one, we're sort of focused on at least a four to eight weeks sort of re-integration period.

And the reason for that is that we wanna sort of allow for sufficient time and space for everybody to sort of get back to a regular routine.

And that's not just the kids, but also the families and the teachers and the school-based staff, the health staff, the administrative staff.

It's going to take a bit of time to sort of readjust to classroom routines, to separation kinds of points, to getting used to a new school.

Kids that I really feel badly for are those kids that were sort of in remote learning for the last year of a particular building, and now, when they come back to school, they're actually going into a new building for the first time and those are the kids that are, in particular, that I have a lot of concern about, especially those kids that are moving from elementary school into middle school for the first time.

Those are the kids that are gonna need, probably even more of a longer readjustment kind of period.

So there's several things that we've generally recommended in this regard at the adjustment level for tier one and that the first thing is to sort of focus again on the morning school preparation routine, as well as separation points.

So we would expect that for a lot of kids, a lot of families, the morning routine got pretty messy or maybe a little chaotic or unstructured during the pandemic months.

And so as they come back, there's probably gonna have to be a lot of focus on shifting to a more structured morning routine with specific parent commands and expectations.

And that actually falls in line with things that we've recommended in general for kids and families with school attendance problems.

We think it's even more pertinent now in the current environment.

And so that would be things like getting up at a regular time, making sure that there's a fairly structured morning routine with enough time built in for different kinds of tasks and making sure that the morning routine ideally ends about 30 minutes before everybody has to leave home.

So that if there's any kind of dawdling or noncompliance or problems, that there's enough of a buffer time so that if there is difficulty, it's not going to interfere too much with everybody's ability to get out of the house.

We're trying to focus apparent commands on being very specific, very brief.

And in terms of separation points, this sort of also intersects with things that we generally recommend for this population which is that families should do all of their affection at home, not at the point of separation at school.

If families are driving their kids to school, to try to make the separation point as brief as possible, and to allow school officials to bring a child into school.

If the child has any concerns about school, to make it clear that those should be discussed in the evening and not in the morning before school.

And really, there shouldn't be any reason to go back home to get anything.

You want to make, encourage parents to have the separation point to be as clean and crisp as possible.

We would also expect that a lot of these kids, again, are gonna need to be reoriented to school.

So especially those kids that are coming into a new school building, making sure they know things about the lockers, the cafeteria, the classrooms, the main offices, the bus depots, all the major areas of school.

Now, the reason I bring this up too is because we would expect that a tier one process is going to have to occur on a rolling basis.

So not just at the beginning of the school year, but as kids are starting to roll in during the course of the academic year.

We're expecting that a good chunk of kids of course showed up on day one and they've been there, but there's gonna be a lot of kids that maybe show up in October.

They're gonna show up in December.

They're gonna show up even in spring.

We have a lot of cases in our clinic now where kids have been out of school for, since the beginning of the year.

We're only transitioning them back into school now.

I know I'm gonna get calls in the spring from parents who say that their kids missed the entire fall semester.

So the, what we're encouraging agencies to do, districts to do, is to kinda consider these things on a rolling basis.

So if a child is coming back to school and they have announced school for awhile, having that sort of reorientation process we think would be helpful.

We also would expect that for a lot of these kids, their social and academic skills have probably eroded over the last 20 months or so.

And so the literature base that we can sort of rely on to sort of help reinvigorate a lot of these skills is sort of a social-emotional learning approach.

So a lot of what we're recommending here is actually based on evidence-based practices.

We're just sort of applying them in a new kind of way in a post-pandemic era.

And so if we look at sort of SEL learning practices, a lot of the components, the major components that go into those kinds of things are here on the list.

So identifying personal and others' emotions and perspectives, sort of understanding the connection between thoughts, emotions, and behaviors, behavioral and cognitive coping with relaxation and self-talk skills, so that kind of emotional regulation kind of strategy, setting goals, mindfulness, yeah, older kids and valuing diversity and social and assertiveness skills.

So we expect that for a lot of these kids, they are probably going to have to sort of relearn, kind of basic interaction skills.

They've been on Zoom for 20 months or working through social media, but haven't necessarily had a lot of direct conversations or direct interactions with teachers and quite a long period of time.

But even for the teachers, we would expect that there's probably gonna have to be an extended period of adjustment so that they're conveying very clear academic and behavioral expectations.

So this is sort of based on the main components of school-wide positive behavior support model, that there'd be positive group contingencies.

So if the class cleans up, for example, everybody gets some kind of incentive, very focused more on affirmative and constructive feedback as opposed to critical feedback, differential reinforcement of appropriate behavior, and especially reduced use of exclusionary discipline in the post-pandemic era.

So as much as possible, trying to minimize suspensions, expulsions, even detentions, things like that, really more of a focus on trying to keep kids in school, even if it's not necessarily in the classroom, physically in the school building as much as possible.

We would also expect that there's a variety of developmental tasks that kids have probably struggled a little bit with over the last 20 months or so that maybe if they were in school on a regular basis, they would have probably advanced a little bit more.

But we would expect that some of these developmental tasks are skills that probably been stagnated or maybe eroded a little bit over time.

And so what we're generally recommending is just to sort of be on the lookout for different kinds of developmental tasks.

These are, on the next few slides, are sort of arranged according to our functional model.

If you're familiar with that, we have a functional model of school attendance problems that really focuses on the reinforcement system or why a certain child would have difficulty going to school, sort of what they're getting out of the situation, whether it's avoidance of anxiety-based situations or attention-seeking behavior or tangible reinforcement outside of school.

So these tasks in the next few slides, if you're familiar with that model, are generally linked to those function conditions, but they do apply to kids in general.

So we'd expect, especially if those kids who maybe have a history of more general distress about school, that maybe these are some of the developmental task that might need a little bit more focus going forward.

So things like handing in homework without it being reviewed or handling ambiguous situations or unknown or unpredictable circumstances, they haven't had a lot of experience with that necessarily over the last 20 months or so.

Handling negative feedback or rejection, handling not knowing what's gonna happen in the future or making mistakes, receiving bad news, solving problems independently.

A lot of these kids have relied on their parents pretty heavily for homework and other kinds of problem solutions.

So doing things more independently and succeeding despite being given sort of a limited amount of information in a given situation.

And then for those kids that, maybe have a history more of social or evaluative kinds of concerns or anxieties, things like assertiveness skills.

So things like asking authority figures for help or saying no, going to parties, breaking into conversations, actually, live conversations with people, inviting people to things, oral reports and tests in class, improvising different social situations, managing their own emotional problems that maybe have developed over time, and how that juxtaposes with social situations, managing interactions and conflicts with family members, safe and appropriate peer interactions, ordering one's own food.

We actually have a lot of kids in our clinic now who are really upset about eating lunch in the school cafeteria.

They just haven't had to do it in a long period of time and the noise and the chaos and the just sort of the general, you know, discombobulation of the whole scene is very upsetting for them.

And so we're, really, in the hallways as well.

They're not used to walking in crowded hallways, and so just really things that we sort of take for granted, but these kids, a lot of them just haven't done it for a long period of time.

And so transitioning back is gonna take some time for them.

Seeking opportunities to meet others and talking with authority figures.

A lot of these kids have not talked to teachers directly or principals or administrative staff directly for quite a long period of time.

For those kids that maybe struggle with attention-seeking issues or more independent kind of things, some of the developmental tasks might be like going away on field trips or school trips.

I mean, they haven't had to do that for a long period of time or sleepovers, not contacting their parents during the course of the school day, trying to seek more afterschool or more independent activities, sleeping alone.

We have a lot of kids that sort of got used to sleeping with their parents at home during the pandemic months.

Now, everybody's trying to kind of go back to normal and that's taken some transition.

Traveling short distances independently, including riding the school bus.

A lot of kids haven't had to do that for awhile.

So just a lot of these or more independent, not with parent kinds of activities.

And then the other one would be maybe for older kids.

And I really feel bad for the kids that, including my own daughter who kind of lost their senior year in high school to the pandemic.

My daughter had to take online classes, so she got deprived of a lot of the things you get to do as a high school senior.

She's in college now.

But high school is also a time to sort of get kids ready for adulthood in a lot of different ways.

And so some of those developmental tasks may have been eroded as well.

And they're, some of those are on this list.

So just things like maybe developing long-term plans or managing academic requirements, or just sort of learning the skills for emerging adulthood.

A lot of high school classes, for example, do focus on things to get you ready for adulthood, whether it's managing a budget or planning meals or planning your own living circumstances or doing things more independently.

So it's possible that for a lot of these kids, they're gonna need some extra support and those kind of things.

Another main domain that we've focused on is traumatic stress.

So we would expect that a lot of kids coming back to school in the post-pandemic era have gone through a lot of significant traumas.

We know domestic violence went up, maltreatment.

Obviously, the pandemic itself created a lot of health problems for people, a lot of kids who lost relatives and couldn't go to the funeral, a lot of food and housing insecurity, there's a lot of residential mobility, and a lot of trauma-focused kinds of events that these kids have had to go through.

And so what we're recommending is that schools be cognizant of that and perhaps focus on school-based trauma-focused practices.

And there's a strong literature base on this as well, and we think that these kinds of practices are gonna be especially pertinent to those kids that are coming back to school, but are gonna have kind of a lot of difficult time with sort of trauma-related symptoms.

So things like hypervigilance or difficulty managing emotions, acting out kinds of behaviors, having difficulty trusting authority figures at school, these are all kind of common signs of trauma-based reactions.

So making sure that teachers and other school officials are kind of aware of those effects and signs, making sure that the teacher-student interactions are sort of built on, trust-based and collaborative kind of interactions.

So things that involve empathy, active listening, positive affirmations, different forms of communication, not just verbal, providing real clear rationales for expected behavior, a lot of transparency attached to that, sort of extending the compliance times for different kinds of things.

Making sure that the classroom routine is quite predictable, very consistent, very supportive, that there's calming strategies available.

So whether there's special cooldown areas or flexible seating or kids need to leave the classroom temporarily to go to a counselor's office, really sort of focusing on developing the competencies that the child does have as opposed to a punitive approach, just sort of enhancing a general sense of safety in the classroom environment.

And then of course, we would expect that for a lot of non-offending parents, they've gone through their own trauma.

And so taking that into consideration as well is gonna be important as these kids come back.

At the academic level, what we're generally recommending is that, especially at a tier one level, and again, especially as kids are kind of coming back to school, this semester in particular, sort of the fall, is that they're generally be a focus more on low-stakes academic assignments and requirements as opposed to high-stakes academic requirements.

So when we're talking about high stakes, we're talking about those kinds of academic requirements that contribute a lot of variants or a lot of decision-making potential for things like whether a child's going to get a certain grade or whether they're gonna get promoted to the next grade.

So that could be things like standardized testing or midterm exams or final exam, really impactful kinds of circumscribed events that have a lot of value in terms of whether a child's gonna pass a certain course or get promoted to the next grade.

So in lieu of that, there's, what we've recommended is that there'll be more of a focus on sort of low-stakes academic assignments and requirements, at least initially, as kids are kind of coming back into school.

And so those would be things like short quizzes, brief essays, reading journals, in-class problem-solving, dissecting larger projects into smaller components.

So for example, if you have, one of the course requirements is a large paper, sort of dividing that up into different components, so maybe an outline, and then a draft, and maybe peer feedback, and then a teacher feedback, and then the final draft, making sure that there's rubrics, very clear expectations for different kind of academic requirements.

And then in terms of how children meet the benchmarks, how their grades are determined to, flexible about that as well.

So instead of things like NC class time and multiple choice test, maybe a focus more on broader based kind of competencies that could involve experiential or service work, volunteerism, internships, group and video projects, portfolio kind of work, presentations, discussions, debates, reflections, things that are a little bit more outside the box, more creative and flexible in terms of determining grades, but still allow students to demonstrate that they've met certain different kind of academic benchmarks or competencies, but to do it in kind of a broader way, at least in a short-term period as these kids are coming back to school.

And then we would expect that a lot of schools of course, have engaged in health and safety protocols.

So here in the United States, it's quite the patchwork, depending on where you live.

Here in Las Vegas, we do have a mask mandate for the kids that are coming back to school.

At UNLV, the undergraduate students now are under a vaccine mandate.

So they have to be vaccinated by November 1st in order to register for spring classes, but the vaccine mandate hasn't been extended to children at the K-12 level yet, although the teachers and administrative staff are under a vaccine mandate.

So you gotta get this.

And that's in Las Vegas.

Obviously, different states in the country, there's different politics and different practices in terms of what's gonna happen.

So my point is that every district seems to have its own sort of policy.

So making sure that parents and families are made well aware of what those health-based protocols are, so that when they come back to school, even on a rolling basis, they have a pretty good expectation of what they need to adhere to.

But on top of that, what we're also recommending is that school officials, to the extent that's possible, sort of have discussions regarding health and safety with kids at different developmental levels to try to process the months that they were away, but at the same time, maybe sort of give information about the current health and safety protocols and some of the rationale behind that.

But to do that, it's important to make those things kind of developmentally appropriate 'cause obviously, adolescents have a better understanding of disease, transmission, and illness than preschoolers do.

But the purpose here is maybe just to imbue these things, maybe in everyday curricula or health-based classes or assemblies, but just to sort of have a general mechanism at school that sort of allows for kids to sort of express what happened during the pandemic months and what their current worries are and what their current health and safety protocols are.

So at the preschool level that could involve things like using creative visual effects.

So for example, using soap bubbles to sort of illustrate how the virus floats through the air, if you will, and lands on other people, you know, very basic kind of way, or drawing, making drawings of the virus, doing play experiences, telling stories about family activities that they did during the pandemic months, videos on illness and things like that.

Elementary school kids have a little bit better idea about disease transmission.

It's not as sophisticated as older kids and adults, but they get a better idea that if you're close to someone that's sick, you're probably gonna get sick.

So really, the focus for elementary school kids can sort of be more on sort of processing their current worries and anxieties about the virus, about getting sick.

What are some creative kinds of ways that they can sort of cope with some of the emotional regulation issues that they might have as they come back.

And then at the middle and high school level, doing things that are more sophisticated related to self-care strategies, so appropriate sleep and stress management and diet, exercise, interacting, making sure there's good social support, as well as talking about any kind of traumatic stressors that they may be experiencing.

So we do expect of course, that a lot of kids are gonna move to the tier two level where they're gonna require even more additional or more intensive kinds or more targeted kinds of supports.

I should be clear too that it's not necessarily a linear process where all kids come in and it's tier one, and then you identify those kids that need tier two interventions.

There are gonna be certainly kids that as they come back to school, they can move immediately into tier two or immediately into tier three.

It's clear maybe that they're having a lot of difficulty academically or socially or behaviorally, adjusting as they come back, and maybe they need a tier two or their family needs tier two support right off the bat.

And so at tier two, if we're talking about adjustment, so those kids that maybe need a little bit more support as they're coming back, probably a good idea to have sort of a daily check-in, afternoon check-out process with a mentor, and a mentor can work with key skills that are related to academics or social skills, conflict resolution, self-regulation and coping, problem-solving skills, just sort of general life skills as they're checking in with the child in the morning and the afternoon, making sure that for these kids, there's a lot of frequent contact between teachers and parents.

So that could be a daily report card about academics and behavior, it could be text or Skype session or something that's pretty frequent, especially for these kids that require a lot more support.

It's gonna be important for parents and teachers to have pretty frequent feedback during the week about the child's academic status and their behavioral issues, if any, making sure that there are school-based incentives.

You know, for a lot of kids, school was the main place that they got support.

A lot of non-academic support, like maybe food or meals, medical care, mentoring, you know, kids were really connected to teachers and coaches, and then the pandemic hit, they were home and they lost a lot of that support.

So taking advantage of school-based incentives to draw certain kids back to school, they might have access to things at school that they don't have access to very well at home.

Maybe it's technology, maybe it's special time with a teacher or a coach.

We've had kids on our clinic where they love to come to school just to work with the custodian on fixing different things at school or working with school librarian to help out in that way.

So just sort of being creative to sort of draw these kids back into school, but also to sort of to understand what are some of the barriers to school attendance.

You know, we know that for a lot of underserved students, especially in the United States, they didn't have access to the proper technology and equipment for quite a long period of time and so their school progress got delayed.

I mean, a student like my daughter could just, you know, she stopped going to school because they shut down school, but she just logged onto the computer the next day and picked up right where she left off.

But for a lot of kids, they had to wait for the school district to actually park a bus in their neighborhood that was equipped with wifi, and that took several weeks.

And finally, they were logged into their classes.

So providing a lot of these external services and resources, especially for underserved youth is gonna need to be a priority, especially at a tier two kind of level.

We also know that for a lot of these kids, they went through some pretty serious kinds of things and as a result, they're gonna be, at a point where maybe they have a formal diagnosis or mental challenge, maybe PTSD or acute stress disorder, for example.

And so not only are there sort of specialized trauma-focused practices that can occur in school that might need maybe an accommodation plan, but it might also require some linkage to a community-based mental health provider that would provide some additional care whether cognitive-behavioral intervention or wraparound care.

And certainly, again, attention to a lot of the parent-caregiver trauma that happened as well.

In terms of academic status, I mentioned accommodation plans, and I know I should know this, I've given enough talks in Canada to know what the accommodation plans there, but I'm sort of blanking on it, but I'm sure there's a mechanism.

In here, in the United States, we have what's known as a 504 Plan or IEPs, Individualized Education Plans.

But basically, we're talking about some kind of formal administrative mechanism that allows for extra accommodations that can be given to kids that are struggling with conditions that interfere with learning.

So in this case, it could be the fact that they were out of school for a long period of time, and now have a lot of anxiety about coming back, or it could be something trauma-based, or it could be academic in nature.

But what we're strongly recommending is that there'll be an expanded use of accommodation plans during this time to sort of account for the kids that are coming back and having a lot of difficulty readjusting school, especially academically.

So what I have listed here are some of the things that we commonly build into our accommodation plans.

It's not necessarily an exhaustive list, but it gives you a little bit of a sense of idea of what we have tried to do in the past and currently to try to ease the child's transition back to school.

So sometimes, changing class schedules.

Sometimes what we'll do is put more favorite classes in the morning as sort of an incentive to come in.

Part-time schedule is very important.

So a lot of the kids that we work with, if they've been out of school for a long period of time, we'll start with, maybe an hour or a class in the morning, and then kind of gradually build the time during the course of the day.

Sometimes we start at the end of the day and work backwards or work from the middle.

For other kids, they prefer to start with a favorite class first, and then go to the second favorite class, and so forth.

We try to add in maybe an hour or two per week until they can get up to a full-time schedule.

Modifying academic work requirements, a lot of these kids sort of get overwhelmed by just tons of make up work that they have to do.

Providing space at school for therapists to come in and work with them directly, scheduling regular meeting times with a school counselor, but also sort of instructional timeline.

So auditing courses or extending it with summer work.

Again, looking at sort of alternative criteria for grade promotion.

Is there a way that a student can show that they've demonstrated a particular competency without it being a formal test, for example, looking at different credit requirements for different kind of kids, really sort of thinking outside the box.

For a lot of these kids academically, it's really gonna have to be an eye toward sort of looking at how flexible and creative and innovative the academic progression process can be.

And of course, that could intersect a lot with tier three kinds of things like specialized academic programs or separate kinds of schools or alternative educational avenues.

And then of course, health and safety.

We know that there are gonna be problems that happen as kids come in.

We've had this happen in Las Vegas already where you have outbreaks of the virus at specific schools, for example.

And of course, I'm sure there's procedures that are in place for that, obviously.

And I know this is where there's a little bit of a disconnect because I know not a lot of provinces in Canada have school nurses, but if there is a wellness mechanism at a particular school to sort of expand that, sort of account for the health and safety protocols that might be available, that might be important.

I think there's probably gonna have to be more of an emphasis in general on telehealth kinds of practices in the current environment.

I think that's sort of the new normal for a lot of families and educational agencies as we move forward.

And then of course the tier three, we're talking about those kids that maybe are completely out of school, maybe they're not coming back to school.

And a lot of the recommendations at tier three for that population now also intersect with things that we've talked about before the pandemic for those kids that have a lot of difficulty going to school.

So again, alternative educational pathways, full service community schools, things that would allow for, again, sort of a broader array of avenues so that the child is able to sort of complete high school, whatever that looks like, and then move on to adulthood.

There's a pretty large literature base that shows that students that graduate from high school have much greater earning potential and many fewer occupational and psychological, and even marital kinds of problems in adulthood compared to students that don't finish high school.

So getting those kids across the finish line in a very creative kind of ways is really gonna have to be a, I think a major, not just educational point, but a public health kind of point moving forward.

And again, of course, we can draw from at tier three the school-based crisis intervention literature.

Unfortunately, of course, in the United States, we have a lot of school violence issues, and so there's pretty well developed crisis intervention protocols that are adapted to those situations, but they also have good applicability to the current situation because we would expect that a lot of kids coming back or having gone through pretty significant trauma-based kind of circumstances.

You know, at a broad level sort of looking at district policies on attendance, you know, are there things that could sort of be set aside or that can sort of be reconfigured in some way to sort of account for the fact that a lot of these kids have been out of school for a long period of time?

I think that's gonna be important.

And of course, health and safety there's, you know, here in the United States, we have a CDC guidelines.

I'm sure there's specific guidelines in Canada as well.

The one point I did wanna make with respect to that is to be aware that many students with disabilities have trouble adhering to the health and safety protocols.

So for example, you have a lot of kids that are very sensitive to disinfect them, or they have trouble with the social distancing element, or they have trouble wearing masks, for example.

Some kids have service animals and you have to worry about the animals getting COVID.

So just to kind of keep in mind that there might be a lot of special considerations for kids with disabilities.

And of course, we know that those kids are very high risk for absenteeism anyway.

So special care with that population is especially important.

So we talked a little bit before about sort of tier one and sort of what to look for, and I wanna spend the next few slides, just sort of talking a little bit about assessment and sort of things to look for and questions to ask as kids are coming back to school, and maybe they're having difficulty coming back just to sort of give you a sense of what to look for and to sort of give you sort of high value targets, given the limited amount of time and resources in a lot of school in terms of staff.

So these are common early warning signs for attendance problems.

It doesn't necessarily mean that if a child has something on this list, they're gonna start having difficulty going to school, but it does mean that it's something that might bear additional assessment or evaluation.

So if you have kids that are having difficulty going to specialized classes, especially a visit, difficulty eating in the cafeteria as I mentioned or entering school building in the morning, moving from class to class.

A lot of these kids are having difficulty with the hallways, but also if there's changes in the routine.

If they're always asking to go to the main office or the counselor's office, or go to the restroom, if there's persistent distress in the morning or in the classroom during the course of the day, and really, I mean, what I'm talking about are kids that are so distressed that maybe they're crying the entire day in the classroom or they're withdrawn with their head down, they're not participating, they're not able to really interact with the educational process, or they're always asking to sort of contact their parents, or if you notice a sudden decline in their academic work or their personality or behavior, these are other sort of common warning signs.

It's always a good idea for school officials just to kind of keep an eye on these things collectively.

So teachers, administrative staff, pretty much anybody that works at the school just to sort of keep an eye on 'cause they kind of look for these kinds of things, and then report any kind of concerns to an attendance team at school would be helpful.

If you are working with a specific case of school attendance problems, these are the interview questions that we generally ask.

Again, focus more on trying to get a lot of information in a short period of time.

You know, what is the child's current attendance status?

Are they actually still enrolled in school?

I mean, a lot of kids in the pandemic, they actually got disenrolled from school, and now, they're coming back and the school has no idea who they are.

Why are you here?

And so just the whole bureaucracy related to that is sometimes an issue.

What's their academic status?

How do their forms of absenteeism change daily?

That helps you sort of target an intervention.

We have a child in our clinic now who misses every single Monday of the week.

Now, actually, goes to school fine Tuesday through Friday, but misses every single Monday.

So we poured a lot of our treatment resources into what the family is gonna do on Sunday evening, Monday morning, and Monday evening.

And that's really helped the situation quite a bit.

Really focus on arousal management on Sunday evening, a very focused routine in the morning, making sure there's an incentive on Monday evening if the child did go to school, and that had sort of eased the process.

How did their attendance problems develop over time?

So they might look at what was done at an earlier time to sort of address the problem and maybe try to rework that into the situation.

Is the child's difficulty going to school legitimate or justified in some way?

is there a school-based threat?

Has there been some kind of recent trauma involved?

It's so important to look at that.

The questions that are in green are particularly important and I'm gonna follow them up on the next slide and that is what problems does the child actually have going to school in the morning?

Usually, if it's a morning based issue, it's gonna come down to anxiety, separation, oppositionality, or an ineffective morning routine.

And then just as important, how do other people respond to the child's attendance problems?

And so let's talk a little bit about those in a little bit more in depth.

So how can you tell that the child is anxious in the morning and more importantly, is the child more anxious about school than most kids his or her age?

Now, that's an important question to ask in a post-pandemic era because a lot of kids are coming back to school pretty anxious about it.

They haven't been in school, and so there's a lot of nervousness as they come back.

So really, what we're focusing on here is, is the child much more anxious compared to most kids their age?

Is their anxiety more intense at home, on the way to school, on the playground, like before they go to school or actually in the school building?

And it's also a good idea to sort of look at how the anxiety level changes during the course of the day.

Some kids, it spikes in the morning and then kind of eases through the day.

For other kids, it's fine in the morning, but it actually exacerbates during the course of the day.

Same with attention-seeking behavior.

Do they show attention-seeking behavior, especially from their caregivers, much more so than most kids their age?

Very important, what does a typical morning routine look like at all?

Or does it even look like a routine?

You know, is it so chaotic that nothing's really getting done?

And how does the child get to school in the morning?

Is there anybody that's available to sort of help with the morning routine and transportation to school?

A big problem we have in Las Vegas is shift work where parents have to leave for work very early in the morning, maybe it's seven in the morning before a child has to get themselves to school.

So is there a way to mobilize the family social support network to bring other people in who can help in the morning routine and help transport the child to school?

Sleep habits, I mean, that's a big one too.

A lot of these kids got used to staying up all hours of the night, and then just kind of rolling out of bed in the morning and logging on to class.

But now, they have to come back to school in a physical building, and so their sleep habits require a little bit more of fine tuning.

But equally important, how are other people responding to the difficulties in the morning?

So a lot of parents are engaging or do engage in sort of ineffective responses that I have listed here.

So they acquiesce to the bear.

For example, they'll say, "Well, you can stay home for a few days, and then we'll see how it goes."

Well, we know how it's gonna go.

It's gonna be even more difficult.

Are they rescuing their kids from anxiety-provoking situations?

Are the parents lingering at school or leaving a child at home to attend school on their own?

Is there a lot of arguing, negotiating, bribing, enticing, threatening?

These are all, of course, more ineffective kind of responses.

So getting a handle on what's exactly happening in the morning is gonna be important.

Is there something at school that provokes a lot of distress while they're there?

I mean, a lot of times for younger kids, they don't really know.

They just know that they're upset.

Older kids, middle schoolers, high schoolers, usually, if they're upset about something, it has to do with more social and evaluative situations.

So getting a handle on that would be important.

Are the symptoms evident on weekends and holidays?

If so, if the child's anxious all the time, not just at school, it means that the breadth of intervention probably has to be a little bit larger.

If the child's not in school, what are they actually doing during school hours?

Are they home, playing video games?

Are they out with their friends?

And that's gonna help you form intervention as well.

All of these questions are kind of important.

I do wanna spend a little bit more time on the next slide though, and that is the second one, and that is how much school attendance can the child tolerate right now?

So if you're working with a family and a child is having a lot of difficulty coming back, maybe they've been out of school for several weeks, it's always important to sort of ask right off the bat, how much school attendance could the child actually do?

And you wanna always start with even a small amount because if they're physically in school for a short period of time, it will set the stage for a more effective treatment plan later on.

So right now, we're seeing a case in our clinic where the child has been out of school for a long period of time, pretty much the whole academic year in addition to the pandemic year, and the best that we can do right now, we're still in the early stages, is to have the child stay in the main office for 30 minutes.

And then the parent has to take them home because the behavior problems get pretty intense.

But that's a good start because it means that the child has to get out of bed, they have to get ready for school, they have to go to school, they have to be physically in school, they're getting exposed to all the social and academic cues that are associated with school attendance.

And we can build on that.

It's much better to build on those kind of cases than a child that's just completely missing the entire day.

So even if you've got a fairly intransigent case, if there's just some way that you can get some school attendance, even a small amount right off the bat, that will enhance the prognosis for that particular case.

It's also important to sort of look at what the family's obstacles are for reintegrating a child to school.

I mean, a lot of families, of course, pretty substantial food and housing insecurity and other kinds of things that are sort of, transportation vulnerability that are sort of preventing them from being able to reintegrate a child back in the school.

So making sure that there's a full consideration of those broader contextual factors is gonna be important as well.

So I mentioned earlier that the pandemic is really sort of focused, forced us to sort of focus on real fundamental kinds of questions.

And one of those is, well, what is school attendance and what our school attendance problems?

And I was writing this article that I have cited here last summer, summer of '20, and so that was right in the middle of the shutdowns and I was coming into work, but I was pretty much the only one that did on the campus.

I was in charge of a ghost town essentially, and my daughter was home on the computer, attending her classes and I was thinking about this and my wife was at home as well, teaching her third grade class, and I was like, "Well, what is school attendance in the contemporary era?"

You know, it's not necessarily NC class time.

It's a broader array of kinds of things.

And so as I've thought about this more, I sort of settled on the definition of school attendance as involvement in teaching and learning practices that either augments or subverts the prospect of graduation or completion.

And more importantly, it's, I think it's useful to sort of think about school attendance and school absences as impairment in different kinds of domains.

So certainly, when we're talking about school attendance problems or school absenteeism, physical NC class time is important.

But we also know that not all absences are exactly the same.

So for example, I keep going back to my daughter, if she had missed 10 school days last year, there probably wouldn't have been too many negative consequences of that.

She still had a lot of opportunity to make up work, the teachers were offering a lot of support, the classes were, you know, fairly loosely governed, and so even if she missed 10 days and she was sort of in her senior year, so she was gonna end up graduating anyway.

There wasn't really necessarily a lot of impairment for those kinds of absences, but you contrast that maybe with a middle schooler who misses 10 days at school, but does it during study and finals week, fails a variety of classes and has difficulty progressing to the next grade.

Now, for that child, 10 days of school being missed creates a lot of impairments in different domains.

So it's just kind of important to understand that not all absences are the same.

We sort of need to understand the context of it.

So if we're talking about school-based impairment, that would be things like, "Well, are the absences actually interfering with the child's academic performance?" You know, looking at sort of the timing of the absences as well, and then any kind of administrative or legal action that might prevent attendance.

So is the child being suspended from school or expelled from school, for example.

And we also wanna sort of look at the social domain.

So are the child's absences to the point where it interferes with their social competence, their ability to interact with other people, their interpersonal relationships?

And at the family level, does, do the absences interfere with daily functioning?

Are parents having to miss work to stay home with a child, for example.

Are there significant maladaptive changes in the family dynamics?

Are they fighting a lot more than they used to?

Is it creating a significant cost for family members?

Do they have to pursue health-based or mental health-based services or even legal services in some cases?

So just sort of understanding the context of the absences, I think, is gonna be important as we move into the new era.

Another article, Patrick and Chambers, they talked about school attendance as defined is time on a task, including engagement on the task, participation.

So actually, evidence of student-work and competency-based attainment.

So as opposed to formal grades, again, more of an innovative creative demonstration of building skills and knowledge.

I think moving forward too, we're probably gonna also have to rethink how we sort of implement our interventions, you know, given sort of a new normal.

I think there's gonna need to be a lot of multi-agency collaboration to track students with, just like I said earlier, just lost track of so many students.

But a lot of these students, especially underrepresented students, do interact with a variety of systems of care, whether it's the developmental system, the legal system, the educational system, the primary mental health care system, housing system.

And so having that kind of multi-agency collaboration so we understand where these families are, is gonna be important.

It's also important, I think, to avoid a deficit approach.

And I fall into this trap myself.

As a clinical child psychologist, we tend to put a lot of burden and blame on students and families for school attendance problems, but it's important to understand as well that there's a lot of systemic barriers to education for underrepresented students and their families as well.

And so to sort of understand the full context of those absences is gonna be important.

And that's true too when we use cutoffs.

So in the United States, a common definition of chronic absenteeism is 10%.

So if a school has 90% attendance overall, usually, their mark is good.

I mean, 90% attendance sounds good, but if you look at it a little bit more deeply, you might notice that certain student groups are far below that 90%.

So overall, the school might be at 90%, but then certain student groups might be at 60 or 70%.

So sometimes, cutoffs sort of mask those problems.

In the United States, a lot of times absenteeism data is actually used to sort of exclude kids for other kinds of problems, whether it's low test scores or behavioral issues, and so attending to that is gonna be important.

Also looking at sort of, what are the real key salient drivers of absenteeism?

Not just looking at sort of aggregated data, but really disaggregated data or intersectionality.

So for example, we know that impoverished students with disabilities are sort of at the highest risk for absenteeism.

A lot of districts now have very large datasets.

So being able to sort of parse those real key drivers of absenteeism out, I think, is gonna be important.

And the other thing is to really change the mindset of a lot of educational agencies, not just moving from absenteeism and punishing absenteeism, but really looking at attendance data.

How can we build more positive policies to draw kids in rather than being reactively punitive toward those kids that are missing school?

Even in our own statistical models, we've found that it's much easier to predict kids who come to school, than it is to predict kids who don't come to school.

And so just sort of changing the mindset in that respect might be helpful.

And then at an even more basic sort of fundamental level, unlearning learning.

You know, what does the future of education look like in the new era?

What does school attendance look like?

How do we adjust to that?

Are we're gonna be at a point where, you know, most kids are gonna be sort of engaged in distance learning.

Schools without walls, you know, schools without physical capabilities.

Maybe that is the sort of the new normal.

What does the future of graduation look like?

Again, is it maybe more of a process than a singular event moving forward?

Should we focus more on continuance into young adulthood as opposed to this artificial distinction between adolescence and adulthood at the age 18?

How do we look at these real key fundamental drivers of school absence?

You know, how do we identify those geographical areas, those zip codes, those key intersection points that really drive high levels of school absence, and how do we prepare our interventions for that?

And then we're gonna have another cataclysmic event at some point in the future.

I don't know what it's gonna be.

Another pandemic, a cyber attack, something, right?

But it's gonna disrupt the educational process in a major kind of way like the pandemic has, and it's gonna expose a lot of disparities among different student groups.

And so how do we prepare for that?

How do we sort of reconfigure our interventions and our approaches, not just educationally, but clinically for those kinds of events?

'Cause unfortunately, at some level, they're coming.

So as always, we're sort of in an ongoing crossroads.

I always say this when I give talks on school attendance, even before the pandemic, we always seem to be at these crossroads.

We're always sort wondering what's next?

But the pandemic has obviously put a new layer of complexity on that.

So what I've tried to do today is sort of, again, just sort of give an overall blueprint, a framework if you will for sort of how we approach these different kinds of problems.

Obviously, they're very complex and messy.

And y'all that are on the front lines, like I have tremendous amount of respect and admiration for those people who work directly with these kids, especially in educational agencies.

I know that these cases are extremely complex and difficult and messy, so the important work that you're doing is greatly appreciated.

I know that in this country, for example, about two thirds to three fourths of all kids who have a mental health problem, the only person that they're ever gonna see for that mental health problem is someone at school.

So the counselors, the school-based social workers, school psychologists, even administrative staff doing extremely important work, special education advocates.

So thank you very much for participating today.

I know it's late there in the afternoon.

Thank you for coming to the workshop today.

Again, follow, feel free to follow-up with me with any kind of need.

For questions or resources, I'd be happy to talk to you.

And we have some time for the questions here as well.

So again, thank you.

- [Woman] And thank you so much.

Serving Children & Youth Who are Deaf, Hard of Hearing/Blind or Visually Impaired