When a child or young person experiences such intense anxiety that attending school becomes overwhelmingly difficult, this is commonly referred to as "school refusal" by different professionals. However, this term can be stigmatizing and misleading for both parents and students alike, because it suggests that the act of avoiding school is a conscious ‘choice’ they are making rather than reflecting the extremity of emotion behind this and the attempts to avoid the school environment being a natural coping strategy. In response to these concerns, alternative terms like "emotionally-based school avoidance" (EBSA),
“Emotionally Based School Non-Attendance” (EBSNA), or "anxiety-related absence" are gaining popularity, as they offer a more accurate description that acknowledges the emotional and psychological factors at play.

Understanding the differences between "school refusal," "truancy," and "persistent absenteeism" is incredibly important for parents, teachers, and healthcare providers alike. More often than not, what we currently see is that when the term "school refusal" is used, this is typically linked to emotional distress or anxiety, while the term "truancy" is used more when there are other reasons to miss school which are not associated with anxiety. On the other hand, "persistent absenteeism" is a broader term that encompasses any frequent absence from school, whether it is excused or unexcused, and may or may not be related to emotional or psychological issues.

If you're interested in learning more about how important terminology can be, see:

https://www.edpsyched.co.uk/blog/ebsa-vs-school-refusal-understanding-the-difference

https://www.edpsyched.co.uk/blog/ebsa-terminology-a-guide-for-school-staff

The EBSA Horizons School Staff course for School Staff (and allied professionals such as Social Workers, Mental Health Support Teams) shifts the narrative away from the language of school refusal to present a model of EBSA in which the child's voice is at the heart of assessment and intervention, and emphasis is placed on understanding EBSA in the context of interacting, child, home and school-based factors.

• EBSA Horizons Training: The EBSA Horizons School Staff course is in eLearning format, broken down into six core chapters to increase knowledge and skills across key areas relating to EBSA and the role of School Staff. Each core chapter encompasses a series of subchapters, containing short animated videos, which you can view at your own pace.
• EBSA Horizons Assessments: There are a range of assessment approaches presented during the course, including a number of child-friendly resources that can be utilised directly with a child in order to access their voice and to provide a functional analysis of the EBSA from their perspective. As well as a comprehensive guide to the EBSA Horizons Risk and Resilience Profiles which enable exploration and analysis of pertinent factors at the level of the child, home and school to identify where interventions and strategies can have the greatest positive impact.
• EBSA Horizons Strategies: A detailed look at a range of evidence-based and practice-based strategies, alongside practical support to consider the requirements of a graduated return to school and the psychological underpinnings of such an approach. Interviews with a Parent and previous EBSA pupil to hear and understand what has helped to make the difference in their lives.

Redefining School Staff Training with a new Tiered Approach

We understand the importance of equipping every member of your school with a solid understanding of Emotional-Based School Avoidance (EBSA). However, we also recognise the capacity and time constraints faced by schools.

Find out more about the new tiered approach to training which enables you to prioritise your staff's CPD according to their role and level of involvement with children and families experiencing EBSA -

Tiered Approach to EBSA Horizons School Training

For staff looking to complete the full course (i.e. Level 3 Practitioner), to get the very most from EBSA Horizons we'd suggest scheduling in at least three half days in your diary, giving the opportunity to reflect and consolidate knowledge as you move through the course.

EBSA Horizons gives you a year's access to all training and content. This gives you the chance to use EBSA Horizons for not just initial CPD development, but to return and use as a reference guide over time. 

EBSA Horizons Contents

Brief Introduction

• Getting Started with EBSA Horizons (how to get the most from this course)

1.   An Introduction To EBSA

1.1 What is EBSA? EBSA as a Spectrum of Need

1.2 Prevalence of EBSA

1.3 EBSA vs. Other Forms of Non-Attendance

1.4 Anxiety as a Defining Feature of EBSA

1.5 Moving Beyond a Within-Child Model of School Refusal

1.6 Pause & Reflect Activity

1.7 CYP Interview: Discussing Experiences of EBSA

2.   Understanding EBSA Over Time

2.1 What is Anxiety?

2.2 The Anxiety Cycle and EBSA

2.3 When Stress Exceeds Support

2.4 EBSA Over Time

2.5 Integration of Models of Anxiety and Profiles of Risk

2.6 Parent Interview Part 1. Discussing Early Warning Signs of EBSA

3.   Understanding and Identifying The Functions Of EBSA

3.1 The Four Functions of EBSA

3.2 Creating a Shared Narrative

3.3 Working with Child and Young People 

3.3.1 Working with Child and Young People (Part 1)

3.3.2 Working with Child and Young People (Part 2)

3.4 The School Wellbeing Cards

3.4.1 The School Wellbeing Cards: Introduction

3.4.2 The School Wellbeing Cards: Cart Sorting Activity

3.4.3 The School Wellbeing Cards: A Model of Active Collaboration

3.4.4 The School Wellbeing Cards: Employing Active Listening Skills

3.5 Working with Parents/Carers

3.5.1 Working with Parents/Carers

3.5.2 Understanding Parent / Carer Anxiety and EBSA

3.5.3 Parent Interview Part 2. The Impact and Consequences of EBSA for the Child and Family

3.6 Creating a Compassionate Team Around the Child

3.7 EBSA Risk and Resilience Profile

3.8 Scaffolding a Meeting with the Family

4.   Functional Analysis and Action Planning

4.1 Action Planning

4.2 Systematic Desensitisation

4.3 Constructing an Avoidance Hierarchy

4.3.1 Constructing an Avoidance Hierarchy with a CYP

4.3.2 The Habituation Cycle

4.3.3 The Ladder of Strength and Courage

4.3.4 Parental Perspective: Building Outwards From Home

5.   Supporting A Return To School and Stabilising School Placements 

5.1 Research on Effective Intervention

5.2 Strategy grids

5.2.1 Introduction to Strategy Grids

5.2.2 Strategy Grid: Child Factors

5.2.3 Strategy Grid: School Factors

5.2.4 Strategy Grid: Home Factors

5.3 Coronavirus and EBSA

5.4 Ecological Systems Model Of EBSA 

6.    The Systemic Change Model of EBSA

6.1 Introduction to the Systematic Change Model and Whole School Audit

6.2 Implementing Systematic Change through use of the Whole School Audit

6.3 Becoming an accredited EBSA Horizons School

7.    Supporting Autistic CYP Experiencing EBSA

7.1 The Ideal School: Exploring the Perceptions of Autistic Students Experiencing EBSA

7.2 The Parent Perspective

7.3 Chapter Summary and Reflections

8.    Entrenched EBSA

8.1 Interview with Red Balloon - Alternative Provision for CYP Experiencing EBSA

8.2 Lived Experiences of Effective Support for Autistic Young People

8.3 Reflecting on the Needs of Children Experiencing Entrenched EBSA

8.4 Chapter Reflections

8.5 Moving From Recovery To Rediscovery

The EBSA Risk and Resilience Profiles is a practical, evidenced-based tool that enables exploration of pertinent risk and resilience factors across the three key areas of: the child, the home, and the school context through a questionnaire format.

The main purpose of the tool is to:

1. Identify pertinent risk factors, that may be contributing to and maintaining the EBSA, and will therefore need to be targeted and reduced
2. Identify resilience factors, that strengthen and protect a child’s wellbeing and school attendance, which will need to be further harnessed

To accompany the EBSA Risk and Resilience Profiles, a fully automated excel scoring and analysis proforma is provided, enabling school staff to convert the questionnaire data into a series of spider diagrams, providing a powerful visual illustration of the inter connection between risk and resilience across the child, home and school domains and to facilitate action planning.

The EBSA Risk and Resilience Profiles are applicable for all children across the spectrum of need, whether this is to provide insight into the risk and resilience profile of a child who is only just beginning to show the early warning signs of EBSA, all the way through to children whose non-attendance is chronic and persistent. There are also significant advantages to using the tool as a risk profiling and screening tool, in order to further facilitate early identification and intervention.

EBSA Horizons Resources

There is an EBSA Horizons Course activity pack, with reflective activities to facilitate learning throughout the course, as well as signposting to key resources. In addition to the EBSA Horizons Risk and Resilience Profiles, there are also a number of additional resources to facilitate support your work with children and young people. For example,

• A visual summary of the Understanding EBSA over time model
• A visual summary of the Integrated Model of EBSA
• Thoughts, Feelings, Bodily Sensations & EBSA – child-friendly model of CBT formulation
• The Ladder of Strength and Courage – a child-friendly version of an avoidance hierarchy
• Action Planning – a visual proforma to record information gathered through assessment
• Case Studies and worked examples
• Resource lists relevant to your work with the child, the family and the school.

Absolutely! Dr Jerricah Holder is an active participant in the EBSA Horizons course community and encourages course participants to ask questions 😊

Although this is an online course, we do still want to promote interaction, collaboration and sharing of practice – so please do look at the descriptive content under each subchapter, where there is also a space to leave comments, share thoughts and reflections and ask questions. We will also signpost and link resources here as well, updating these in response to questions and comments.

The Attendance Action Alliance (AAA) is a government initiative aimed at ‘raising attendance’ within schools. While it is a separate initiative from EBSA Horizons, one of the AAA’s key priorities for the next two years is ‘to help to improve attendance by using supporting systems and services to address underlying drivers of absence, particularly for vulnerable cohorts’.

EBSA Horizons provides schools and other professionals targeted training, resources and strategies to support children and young people who experience difficulties attending school, complementing broader initiatives like the AAA.

It is hoped, that the AAA, by integrating a focus on EBSA, can pave the way for sustainable change by addressing the root causes of attendance difficulties.