Welcome to our podcast: Conversations About Student Mental Health.
I’m Chris Leonard, Clinical Social Worker working with adolescents for over 25 years. In this podcast, I talk with school administrators, educators, clinicians, and parents to open a dialogue that will help the growing number of students struggling with mental illness.
In our last episode, I spoke with Laura, a parent whose daughter spent many years struggling with school avoidance, also known as school refusal. Laura shared that the critical piece to her daughter overcoming school avoidance was the special direct counseling built into her school day.
Chris: Today, I am following up on that conversation with Linda McGovern, a clinician embedded full time in the Randolph, New Jersey public schools, who serves and supports children just like Laura’s daughter.
Welcome, Linda. It’s great to have you.
Linda: Thank you, Chris. Happy to be here.
Chris: So let’s jump right in. So, you’ve been in the school for quite some time. What do you see as the challenges schools face in working with school avoidance?
Linda: I would say probably the biggest challenge is really being able to find, develop, and implement a support team and a plan for these school avoidance students. It can be really difficult to get everybody on the same page.
Chris: Okay, so who’s on that team? What representatives from the school do you pull in?
Linda: Well, I can speak to the district that I’m in, and Randolph has really done a nice job developing a team to work with school avoidance students. They call it the Student Connection Team, and they have administrators, teachers, school psychologists, myself, the nurse, and I believe that’s about it, maybe a guidance counselor as well.
So it’s really all the different roles within the school are involved in the Student Connection Team. They take a close look at attendance, they meet with the students, they do initiatives to try and help improve the students’ attendance and it’s not done in a disciplinary fashion. They do it in a very motivating way, trying to provide help for the student, rather than consequences for not being at school.
Chris: Okay. So it’s really this whole effort by a whole group of professionals.
Chris: That you kind of help coordinate as the embedded clinician, right?
Linda: Yes, I am a part of it. I’m not referred to, as a clinician, in the beginning. They really work initially to do what they can within their already existing program to help the student. If and when the problem continues, they will then be referred for counseling, but initially, that’s provided by the guidance counselor or the child study team.
Chris: So they really try and start with their own team first.
Linda: Mm-hmm (affirmative).
Chris: And then once they’ve really recognized that this issue is really-
Chris: Chronic, the student is really stuck or the family is really stuck, then they’re going to bring you in?
Chris: So you’re really bringing in this level of support that is far beyond what a typical school counselor can bring. Is that correct?
Linda: Yes. Initially, it’s consultation with Sage Thrive, and then, ultimately, we provide that higher level of support where we really get more involved with the student themselves, and the family.
Chris: Can you speak a little bit more about how your work differs from the work that a typical school counselor would do?
Linda: Sure. Basically, school counselors typically provide what I like to call a school/academic check-in. It’s not ongoing consistent counseling, typically. So there’s just not that consistency. I don’t believe that they really get into the root of the anxiety and depression that might be the obstacle for the student getting to school.
So, what I do is try and get in there with the family and the student and try and figure out what are the obstacles, and really help them get through that, and kind of service the whole child, not just the academic child. The school counselors don’t do home visits, they just don’t take it to that next level.
Chris: So there’s really a lot more depth to the work that you do.
Chris: And you can really get to the core of the issue rather than just focusing on the school issues. If a student is having these issues, it goes without saying that there are going to be academic issues, it goes without saying they’re going to be attendance issues. You can talk about the metrics of all that stuff all you want, but you’re not getting to the root cause.
Linda: Correct. And I think probably one of the key components is working with the family. It really is such a factor in seeing an improvement and a change when you’re working collaboratively with the family. When the student sees that you’re on the same team together, that makes all the difference. And typically school counselors don’t get that in-depth.
Chris: Got it. So that family work, how do you begin that work with the family of a school avoidance student?
Linda: It starts with an intake, and just trying and get to know the history of the issues, and the concerns of the parents. And then we look at the family dynamics that might be contributing to the issue. We really start by just developing a plan together to get the student in to the school. But I would say the most important factor is, if it’s possible, to really get both parents involved. We want mom and dad involved. We want them both to be an active participant in the plan. And that’s usually how it starts, by getting them to be on the same page and work together.
Chris: So similar to what you’re trying to build in the school community where you’re bringing in all of those professionals, you really want to engage the family. This is not just a matter of just working with a student, or even with just one parent. If there are two parents involved, you want them both involved in the process.
Chris: They’re both contributing, helping you problem-solve, helping the student problem-solve. That makes a lot of sense. Engaging the entire family, that’s at the core of what you do.
Chris: Can you identify any other key effective strategies?
Linda: I would say coming up with routines, specifically morning routines. Having a plan, whether that be with the student, the family, the other key players, the guidance counselor, the nurse, the security officer, who might need to let them in a side door or manage whatever accommodations we put in place.
Another key strategy is having a lot of flexibility. I think that’s a big part of it: getting the team to all work together to be flexible and come up with accommodations that make sense for that particular student. Those are the key strategies.
Chris: Gosh, that’s really such a great point because one of the things I found in working with students with school avoidance is how rigid they can be in their thinking: “It’s got to be this way or I won’t do it,” or, “It’s got to be this way or I can’t do it.” And so, we emphasize that flexibility. What they really need is to learn how to be flexible, and they also need flexibility modeled for them-
Chris: And they need us to be flexible.
Linda: I think what works for one student is not necessarily going to work for the next student, so we have to take each child and look at them individually and figure out what accommodations make the most sense. And that really has to involve everybody because we all have to be in agreement. So we might say, just for example, this particular student can come in a side door because it makes it easier for them. But then if a teacher or security officer walking by says, “No, you can’t come in here,” that’s already started off the student’s day in a difficult way.
Chris: It can be just that one thing that happens-
Chris: And then the student is running back to the car and it’s over.
Chris: So you must have some great stories. Can you share one with us, one success story that you had?
Linda: I would say probably the best success story that I have, that I do love to share, is a particular student who moved to the US from Italy. She had some school avoidant issues when she was a freshman in Italy, moved to the district as a sophomore, she made it in one day, the guidance counselor handed her her schedule, and she was lost and overwhelmed and she didn’t come back.
The immediate assumption was that she wanted to go back to Italy, and really she was diagnosed agoraphobic. She really struggled. And so the following year, sophomore year, she never came in.
She was referred to Sage Thrive. I started working with her in her junior year, and it started with home visits. So I would go to the home and just meet her and build a rapport with her. And given the diagnosis, we did a little bit of desensitization. We started going out into the community, meeting out for a cup of coffee in the morning. You can’t be real therapeutic then, but we got to talk and get to know each other, until, ultimately, she trusted me a little bit more.
She began coming into the school building just for individual sessions. So she would come in and have an individual session and then leave. And then I developed a group for her, found some other school avoidance students, other students with anxiety. She would come in twice a week then, once for individual, once for group.
Ultimately, she began in a classroom that we had started for chronically avoidant and work refusal students, and she attended every day her junior year. And senior year, she was transitioned out into gen ed classes for most of her day. And she is currently in college and thriving.
Chris: Oh, that’s a great story.
Linda: It was a long process, but it was a beautiful one. She just did phenomenal with the supports that were put in place.
Chris: Well I really think you did a beautiful job in just talking about how slowly you had to work, and it was piece by piece by piece. And really, it started with building that relationship, right?
Chris: And you know, sometimes it was just a cup of coffee-
Chris: And it couldn’t be about anything else. It was just about sitting across from another person and having a cup of coffee and establishing a rapport.
Chris: And all of that was so important to lay that groundwork with someone and establish that kind of relationship before you can even have any kind of working relationship, right?
Linda: Right. I would say, honestly, one of the biggest challenges with working with school avoidant students is setting unattainable goals too fast or having different expectations. Sometimes the school or the parents, they want immediate results, and that’s not always the way it works. Slow and steady sometimes wins the race, and it really worked out very well for the student.
Chris: You’re saying that people want immediate results, it reminds me of a student I was talking about with someone this morning (who was starting a new program). The student went to the new program, and found this new program so overwhelming.
Right away, the family pivoted to, “Well, if this program isn’t working out, we’re going to try this program instead.” And the same issues started to play out because the student was experiencing: “I am overwhelmed by this new thing, so throwing another new thing at me is not going to be the answer.” The answer is going to be discovering what’s hard about the new thing and how do I start. Right?
Linda: Yes. I find that often. Parents will call you saying their child is texting them that they’re having a difficult day and this isn’t working. But that is sometimes said after three days of a new program. And we need to kind of put the brakes on it and allow them to get acclimated, and really let us get to know them and work with them. Expecting too much too soon can be one of the biggest challenges with the school avoiding student.
Chris: So that’s really one of the pitfalls that people easily fall into.
Chris: Because I guess what happens with school avoidance is people get so anxious.
Chris: I’m not sure if you heard our last episode when I was talking to Laura, the mom of a school avoidant student. She was talking about how frightening it was that her daughter wouldn’t go to school. You just don’t know what else to do and you’re kind of at your wit’s end, and that’s got to happen for teachers and administrators as well. There’s a lot of pressure on school administrators, to make sure their attendance is good-
Chris: And everybody just wants results right now.
Linda: Right. And I think that is also what’s different between having a therapist embedded in the school and a typical school counselor. As an embedded counselor, I can take my time and address those fears and concerns. I can call the family in and have a session, and discuss their concerns and why they might feel it necessary to change the program so quickly because one day didn’t work. And have they been through this before and what helped in the past? Did changing it, get you the results you wanted? You can have those conversations and really slow things down a little bit, which can be helpful.
Chris: So one of the biggest benefits of having that embedded clinician in the school is the time that that person has.
Chris: Because having worked in schools for many years, I know that if you’re good in a school environment, there are lots of things to be done, and there are lots of hats to be worn. And if they can hand you another hat and you can take that hat and put it on your head and carry that hat, they’re going to give you the hat.
Chris: So you know, you can easily be somebody who, “Yeah, this is my job title, but there are actually 19 things that I do.”
Chris: And if you can do the 19 things, they’re going to give you a 20th.
Chris: So to be that embedded clinician who’s got one job, who really is there to give the time to the students, that’s got to be so helpful.
Linda: Yes, very much so. I do believe it makes a big difference.
Chris: Does anything else stand out to you that I haven’t asked you about that would be important for people to think about?
Linda: Ultimately it’s really getting everyone on board, getting the family on board. The student seeing that the clinician is working together with the family, working together with the teachers and that we’re really on their side and we want to make it comfortable. We want to be helpful. We want them to succeed. I think that is probably the biggest thing for a school avoidant student to see, that we’re not looking to punish them, to discipline them for having a hard time, we’re looking to help them and have them feel successful.
And that really is a team approach and you have to look at the whole child. You have to look at them in school, out of school, their family dynamics, what things they’re involved in. You have to look at the big picture to really know what you’re working with.
Chris: So it’s both looking globally and it’s probing for that depth. Do you have any other strategies that you would offer to schools? Something that’s worked for you in particular, that other schools could learn from?
Linda: Well, I think Randolph has done an excellent job developing the Student Connection Team. It has been very successful in helping students get back in the building.
Another thing we have done that has been a huge success is starting a classroom for school avoidant students and other students with severe anxiety and work refusal issues, where their day is more flexible. They start the morning in a very comfortable, safe space. We can do the home visits. We have a second chance bus. There is one teacher that’s really committed to that program that they can go to as a mentor, and then the other teachers kind of filter in for their classes.
Building that program around the need has been such a success. For the student that I spoke about earlier, I believe that program made all the difference. It was having that safe space in the school. And everyone wants to help. The teachers want to be a part of it. Administration supports it. The Director of Special Services supports it. So I think developing these programs and really implementing them to meet the needs of these kids can be super helpful.
Chris: Oh, that sounds right. And really, you know, a big part of the success that you’ve had in Randolph is that, as the Sage Thrive clinician, you became part of the culture. You became part of the team, and the team became part of your team. You’re part of their team, they’re part of your team. We’re all on the same page. We’re all pulling in the same direction. You’re an ally for these students. You’re not the truant officer coming to say, you know, “You go to school or else.”
Chris: You’re an ally.
Chris: And this is what helps kids move forward.
Linda: Absolutely. And a lot of consultation with outside programming that’s available, the community supports that are available for these students and families. Having that knowledge, I can share that with the district so that they can help families earlier on and make referrals for what they need. That can be really helpful as well.
Chris: Linda, we’re about out of time, but I really appreciate you coming in today. I want to thank you for your time. It was great.
Linda: Thank you for having me.
Chris: It was a pleasure. I want to thank everybody for listening. We hope you got a clear sense of the strategies that people are using to address school avoidance and get students back to school.
And of course, always, please join us for upcoming episodes of Conversations About Student Mental Health. Have a great rest of the day.
Conversations About Student Mental Health is brought to you by Sage Thrive, partners in school-based mental wellness.
Christopher J. Leonard, MSW, LCSW, M.ED.
Chris Leonard is Director of Operations for Sage Thrive and the Sage Day Schools. He is an experienced teacher, school administrator, social worker and psychotherapist with over 30 years of experience working with children, adolescents, and families. Mr. Leonard is married with two daughters and enjoys distance running, mountain and road biking, hiking, and the outdoors.