August 2014 Behavioral Health Partners e-Newsletter
School Refusal vs. School Truancy and How to Help Teens
School Refusal vs. School Truancy and How to Help Teens
by Laura Koehler, PsyD and Megan Moller Schmitz, PsyD
The number one, most important fact that individuals should take away from reading this article is that avoidance is the most harmful, unhealthy coping strategy an individual can employ. As an individual opts to avoid discomfort, they systematically reduce their ability to tolerate distress in a healthy manner; thereby making the world seem more and more uncomfortable, overtime things that were once slightly stressful are now perceived as overwhelming and completely unapproachable. As an individual’s tolerance level decreases, their urge to avoid intensifies, resulting in an unhealthy self-sustaining pattern that ultimately reduces an individual’s ability to function over time and results in emotional dysregulation (unpredictable and intense shifts in mood).
School refusal and school truancy differ mainly in the intention of the individual’s avoidance of attending school. An individual refusing to attend school is typically not demonstrating oppositional behaviors, but is rather struggling with intense emotional difficulty and often has been avoiding aspects of school (e.g., particular classes, homework, hallways) long before they start torefuse to attend an entire school day. As discussed above regarding the consequence of avoidance, these individuals also tend to have a low tolerance level for distress and are emotionally dysregulated. As a result, most individuals who refuse to attend school also isolate in their homes during school hours and often complete the missed schoolwork. These individuals are very open about their heightened level of distress regarding attending school and request that their parents call them in “sick.” Consequently, this may result in family arguments or overaccomodation from parents who truly believe they are acting in their child’s best interest. With the latter, parents are often truly unaware that when they facilitate avoidance, they are depriving their child of the opportunity to learn how to manage difficult situations, which is a skill they will require in adulthood.
On the other end of the spectrum, individuals who are truant from school often are oppositional in nature and likely display inappropriate behaviors in other areas of their life (e.g., lying, stealing, breaking curfew, and fighting). As these individuals do not experience heightened distress related to attending school, they often hide their truancy from their parents- maybe even pretending to go to school. They do not stay at home during school hours, and are uninterested in completing missed schoolwork or meeting academic expectations.
Recommendations to support individuals, demonstrating school refusal include the following: First, individuals always should be strongly encouraged to attend school on a daily basis and both applied (e.g. loss of electronics) and natural consequences (e.g., inability to make up schoolwork from the missed day) for refusal should be allocated if they ultimately chose not to go to school. Second, individuals should be encouraged to manage their emotional experiences while remaining in their classes. However, if individuals go down to the guidance office for support, do not send them home unless physically ill (i.e., fever over 100 degrees and excessive vomiting and/or diarrhea , as emotional distress can manifest itself physically), allow them space to practice a coping skill for a maximum of 10-15 minutes before prompting them to return to class. Third, if individuals need to talk, allow a brief summary of the problem and validate their distress, but DO NOT allow them to dwell on the issue. Instead, empathically shift the conversation to any topic except for their emotional discomfort (e.g., hobbies, friends), which is a distraction coping skill.
For more information on school refusal or truancy issues, contact firstname.lastname@example.org.
Ciarrochi, J. V., Hayes, L., Bailey, A. (2012) Get Out of Your Mind and Into Your Life for Teen. New Harbinger Publications: California.
Fremont, W. P. (2003) School Refusal in Children and Adolescents. American Family Physician, 68(8), 1555-1561
Pederson, L. & Pederson, C. S. (2012) The Expanded Dialectical Behavior Therapy Skills Training Manual. Premier Publishing & Media: Wisconsin.
Laura Koehler, PsyD, Licensed Clinical Psychologist
Laura graduated from the American School of Professional Psychology with a doctoral degree in Clinical Psychology. She has been working in the mental health field for over 10 years in a variety of settings, including community mental health, private practice, and residential treatment centers. Her work has mainly focused on working with adolescents and their families. Laura’s approach to treatment integrates Dialectical Behavioral Therapy (DBT) and Acceptance and Commitment Therapy (ACT), along with exposure therapy to provide patients with the skills they need to increase their ability to regulate emotions, as well as tolerate overwhelming emotions.
Megan Moller Schmitz, PsyD, Licensed Clinical Psychologist
Megan Moller graduated with a doctoral degree in Clinical Psychology from the American School of Professional Psychology – Argosy University. She has gained experience in the mental health field for approximately 10 years in a variety of settings, including private practice and providing in-home intensive treatment. She has primarily concentrated on working with adolescents and their families, with a variety of presenting problems including but not limited to ADHD, Autism Spectrum Disorders, Anxiety Disorders, and Disruptive Behavior Disorders. Megan’s approach to treatment integrates Dialectical Behavioral Therapy (DBT) and Acceptance and Commitment Therapy (ACT) alond with exposure therapy to provide patients with concrete skills to increase personal accountability for behavioral choices and to improve their daily functioning.
Prescription to Treat the Psychiatrist Shortage: Are Psychologists the Solution?
In June, the state of Illinois signed into law a bill that allows psychologists the ability to prescribe common medications such as anti-depressants. However, the bill does place stipulations on psychologists and their prescription abilities. For example, psychologists are prohibited from prescribing certain medications, such as stimulants, and are restricted from prescribing to minors. The bill also requires psychologists to acquire advanced training prior to dispensing medication.
To be considered, the prescribing psychologist must undergo specialized training, pass an examination and enter into a written collaborative oversight agreement with a licensed physician. Although the training required will mean an additional two and a half years of school, analysts predict a large demand, particularly with new and incoming students. The training requirements for prescribing psychologists under the new law mirror those of advanced practice nurses and physician assistants, both licensures which have flourished in recent years. However, some behavioral health specialists allege that despite the advanced training, psychologists don't have enough medical training to safely dispense medication.
While there's a general consensus of a mental health crisis in the United States, there's intense debate on how best to fix the growing need for mental health services. According to the Illinois State Medical Society, in 2013 Illinois had only 1,462 psychiatrists statewide, while dozens of counties had no psychiatrists at all. This leads to long appointment wait times for patients and delays in treatment. While this new bill may provide some systematic relief for patients with medication needs, it remains to be seen whether the change will have a positive effect on the current mental health crisis.
Addiction Awareness and Recovery 5K Run/Walk
The Addiction Awareness and Recovery 5K Run/Walk at St. James Farm and Forest Preserve is Sunday, September 14, 2014 at 10:00 am. The Addiction Awareness and Recovery 5K Run/Walk was born out of the desire to celebrate and support individuals who are recovery and their families while raising awareness for addiction services and recovery efforts in the community.
The 5K Run/Walk is open to the public and the course is trail style through the scenic woodlands, meadows, and fields of the St. James Forest Preserve. Pre-registration for the Addiction Awareness and Recovery 5K Run/Walk is online at www.tandhtiming.com. Day of registration will be 8:30-9:30 am and the 5K begins at 10:00 am.
The 5K will be immediately followed by a post-race party at the St. James Farm pavilion. The party will include music, refreshments, and a celebration to promote awareness for addiction and recovery services.
Registration is $35 and includes a 5K tee-shirt and timed chip run. Kids are invited to join in the fun and participate in a Kids Fun Run. The Kids Fun Run is $15 and registration includes funnel cake & slushie coupon.
The presenting sponsors of the 5K Run/Walk are JUST of DuPage, West Suburban Fellowship Club, and Linden Oaks at Edward. These local organizations are dedicated to the treatment and recovery of individuals from substance and drug abuse. All of the proceeds from the event will benefit recovery services for addicts.
The Addiction Awareness and Recovery 5K Run/Walk coincides with National Recovery Month which promotes the benefits of treatment, prevention and recovery from substance abuse.
For more information or to register for the Addiction Awareness and Recovery 5K Run/Walk, visit www.lindenoaks.org/events-and-training.