Emotionally Based School Non-Attendance (EBSNA)

What is EBSNA?

Emotionally Based School Non-Attendance (EBSNA) is a term used to describe the difficulty children and young people experience in attending school due to emotional reasons, such as stress, anxiety and/ or feeling overwhelmed. This can result in prolonged periods of absence from school.

Other terms EBSNA is known by include:

Emotionally Based School Refusal (EBSR)
Anxiety Related Non-Attendance (ARNA)
Emotional Based School Avoidance (EBSA)
School refusal

In Surrey we use the term Emotionally Based School Non-Attendance (EBSNA) to include children who are unable to attend school, rather than choosing not to attend, because of increased feelings of fear and anxiety that may make school feel unsafe.

If you are looking for support for your child or for someone you care for or support, please know that you are not on your own. We hope this webpage will provide you with the information you need.

What are the signs of EBSNA?

Spotting the signs of EBSNA and taking action quickly can enable a child or young person to remain in education and achieve their aspirations.

Children and young people can display a range of behaviours, which on their own may not be a sign of EBSNA. However, Parents/ Carers of children and young people with EBSNA have reported the following behaviours:

Frequently feeling unwell
Separation anxiety
Frequent minor absences
Tearfulness and general irritability
Sleep difficulties
Emotional volatility
Lack of appetite
Friendship issues
Changes in personality
Poor academic attainment

Autistic young people are also described as experiencing 'Autistic Burnout'.

What is the impact of EBSNA on children?

The impact of EBSNA on children is far reaching and can include:

poor academic attainment
reduced social opportunities
limited employment opportunities
an association with poor mental health in adulthood

EBSNA absence can often lead to long periods of time away from school. EBSNA is different from absence for physical illness and truancy. Most young people experiencing EBSNA can be highly anxious and show significant distress about attending school. In many instances, they remain engaged with education and want to return to school even though they feel unable to do so. Often, the young person's anxiety will reduce during weekends or school holidays.

EBSNA is complex and the issues are specific to each individual so there is not one way to resolve the situation for all children and young people. It is likely to be a gradual process to support a child to return to school particularly when it may feel that the EBSNA is well established, but there are many avenues of support available. This webpage offers information, advice, and a range of strategies gained from Surrey families' lived experiences.

How can EBSNA impact families?

Supporting your child with EBSNA can impact on families in different ways, we've listed some of these below, along with potential sources of support.

Parent Carer mental health and wellbeing

Caring for a child with EBSNA might impact on your mental health and wellbeing. You may feel lonely or isolated, but please know that you are not to blame, and you are not on your own. Family Voice Surrey have created a School Anxiety group for parents and carers.

It is important to look after yourself. If you find that your mental health and emotional wellbeing is poor, there are services that can offer advice or emotional support:

The Child Mind Institute offer information on why Self-Care is essential to parenting on their website
Mindworks Surrey information for Parents/Carers - Every child or young person is different and may require different services. Mindworks Surrey will guide you through each step you need to take as a parent or carer, from your initial concerns to being introduced to the Mindworks service
Healthy Surrey Wheel of Well-being - The Wheel of Well-being is a handy way to think about things you can do to help improve your mood, reduce the risk of depression, strengthen your relationships, and even add up to seven years to your life
Relate - services include relationship counselling, family counselling, mediation and children's and young people's counselling
Parent and Carers Group – The Hope Service - The Hope Service is a multi-agency service for young people aged 11-18 who are experiencing complex mental health, emotional, social and behavioural needs.
Barnardo's Parent Wellbeing Service - The Parent Wellbeing Service offers support to parents or carers whose children are experiencing poor mental health and wellbeing such as anxiety, depression, stress, self-harm and eating disorders. The service will enable parents and carers to be a protective factor for their child/young person in their wellbeing recovery. Increasing their confidence to support their child/young person

This shortlist of Helplines and online support services for parents has the details of further services who may be helpful to refer to.

Parenting support and advice:

For more general parenting support and advice, the following may be helpful.

Family Lives - provides targeted early intervention and crisis support to families who are struggling. The issues they support families with include family breakdown, challenging relationships and behaviour, debt, and emotional and mental wellbeing
Surrey Family Information Service's parenting courses and advice web page
Surrey Family Learning offer a wide range of free courses which are offered online, from parenting and wellbeing to Maths and English for parents who speak English as an additional language
The Free online parenting guides which are available to all Surrey residents that include top tips from childcare, education and NHS health experts.

Finances:

Supporting a child experiencing EBSNA can also have a financial impact on families if for instance, parents have given up work or reduced their working hours to support their child or have paid privately for education provision, counselling, therapy and assessments. There is a range of financial assistance that may be available to you.

Family Information Service- Family Finance pages If you're responsible for a child there is a range of financial assistance available depending on your family's circumstance
Turn2us - Get support web page there is a range of support including a Benefits Calculator; Grants Search; details about Turn2us' direct grant-giving funds; and links to other sources of information and help.

Siblings:

EBSNA may also have an impact on siblings, if for instance they are often late for school or mirror their sibling's behaviour. The Local Offer Support for sibling and young carers web page, provides details of activities that siblings can do together, help for young carers and financial assistance.

Ways you can support your child

Unfortunately, there are many children and young people across the UK struggling with school-based anxiety and other difficulties that can impact on school attendance.

Such difficulties should not be viewed as a behavioural or parenting problem. There are many different things that can trigger anxiety and attendance difficulties including bullying, academic pressure and sensory issues in the school environment.

It is common for children to pretend or hold in their distress until they get home from school - this is called "masking". This can lead to misunderstandings and differences in opinion between home and school. It is important that professionals work in partnership with parents and listen to the voices of children and young people.

What you can do if your child is struggling to go to their education setting?

Believe your child's distress is real, listen to what they say and trust your instincts as a parent

One of the most important ways you can support your child is to calmly listen to them and acknowledge that their fears are real to them. Remind them how important it is to access education and reassure them that you and the education setting will try and make it a happier place for them.

Listen to and talk with your child

Consider when and where you will talk. Think about what communication method might be easiest for your child e.g. text messaging, letters, brainstorming key words and feelings. You may find 'mapping the landscape visuals', to be a useful method of communication for your young person. Your young person can 'drag and drop' their thoughts.

Agree an appropriate time and place with your child, e.g., this could be in the time after school and before dinner if your child is attending school. For children who are not attending, agree with them the best time to talk for instance, in the middle part of the day or after they have had breakfast. Try to avoid first thing in the morning before they are fully awake or just before bed as they may be tired or it might disrupt sleep.

When you speak to your child, try to remove any distractions (such as family members, TV or electronic devices) and also set a limit on how long you speak to them for.

You may like to refer to the NHS Talking to your child about feelings web page for support in approaching this conversation.

Focus on listening

If your child has opened up to you, it is because they trust you and feel a need to share their difficulties. Let them talk and try to ask open questions that encourage a fuller response than 'yes' or 'no'.

Examples of open conversation starters:

What is going well for you at the moment?
What would you be doing differently if it wasn't for these difficulties?
What is going well in school?
If things get better, how would that look?
How are things with friends?
If you woke up tomorrow and knew it was better, what would have changed?
What do you want to change?
When things where better than they are now, what was happening then to make it better?
When did this start?
What ideas do you have about what you need to feel better at the moment?
How does it affect you?
What kind of support would help you?
What is this stopping you doing......?
Are there things or people that help?

Let them know if you do not understand or need clarity

Answers can get muddled as children try to explain feelings they may not understand, asking clarifying questions shows you are listening and trying to understand.

Examples of ways of clarifying might include:

"Did I understand you when you said?"
"Did I hear you correctly when you said?"
"Let me check [...] you feel angry/ frustrated/ sad because [...]"

At the end of your conversation validate their feelings, acknowledge their strength and clarify priorities.

Examples of how to do so:

"I can see that things are difficult at the moment. However, you managed to share/ talk about a lot of things today. So, let us recap/ see where we've got to…"

Empathise and acknowledge how hard it is

It is important to let your child know that overcoming anxiety is hard, and that you are proud of their efforts. Let them know you are trying to understand their experience, are listening to what they have to say and want to help. Try not to validate their fears. The message you want to send is, "I know you're scared, and that's okay, and I'm here, and I'm going to help you get through this."

Make yourself available to talk again if needed

It can be a relief to talk, but ongoing anxiety is not solved with just one conversation. Let them know they can speak to you again. Explain that you will look at how you can help them. Never leave this kind of conversation without agreeing next steps, this will help the child to realise that you are working with them to move things forward.

A support plan can be used to support your child/young person think through how support can be individualised to support their own needs. This can be completed independently, with a parent/carer, trusted adult or with friends. This plan can be shared with school/college to help create a package of ongoing support.

It is crucial that all adults, at home and in school, work together to understand the reasons for EBSNA and find solutions together. As soon as signs are spotted parent/carers should tell the school there is a problem and request a meeting.

If you have a younger child who is experiencing anxiety with accessing a pre-school environment you may find the NHS Learning to talk resources following resource helpful to support the development of language.

Parent/carer EBSNA resource bank

The EBSNA Resource Bank, has detailed information about EBSNA, approaches to try at home and tools you can use to help your child open up about school and what they are finding difficult.

Activities outside of an education setting

You may like to look at encouraging participation in activities outside of an education setting to support social interaction and reduce isolation. Some suggestions of how to do so include:

The Local Offer Directory contains details of both one off and ongoing leisure and social activities.
Club 4 holiday activities run during the longer school holidays and offer healthy food and fun activities for eligible children aged 5 to 16. The Club 4 website also includes a number of holiday ideas for children.

The video below aims to support parents and carers to develop plans to manage the anxiety of getting into school.

Who can you contact for support?

There are a number of services who can offer support if and when you feel you need it.

Support from School or education setting

It is important to communicate any concerns regarding EBSNA with your child's school/setting. They can help to find out what's worrying your child and what you and they can do to help. A support plan can be created that could include:

Home-school meeting to understand the reasons for the non-attendance.
An allocated named key adult who can maintain daily communication, to include a wellbeing check and ensure work is set, if not in class
Meeting with the pupil to gain their views around the non-attendance or participation
Jointly creating a support plan with you, your child and the school/setting.
Making reasonable adjustments according to your child's needs and the reasons for their non-attendance/participation.

Schools in Surrey can take a Surrey Healthy Schools approach to wellbeing and health and can access a range of resources and services to support your child. Support can include mental health support, counselling, and access to a School Nurse, they can also ask Specialist Teachers for Inclusive Practice (STIPs) to assess your child's difficulties.

Children and Young People with Additional Needs

An underlying Additional Need or Disability can contribute to anxiety levels; this can include Autistic Spectrum Conditions, ADHD, Sensory Processing Disorder or Dyslexia. These can make school feel like a difficult place to be for a child, even if they do want to attend school. It is worth noting that additional needs includes Social, Emotional or Mental Health Difficulties. These can affect a child's ability to make friendships and cope with strong emotion.

You may therefore also wish to discuss with the school if they feel an assessment of your child for any relevant additional needs is required.

If you need a bit more help

There are times when the challenges of family life become more difficult, and families may need some personalised support for a period of time. Targeted help focuses on the specific needs of the family to help them make positive changes. Requests for support (we used to call these referrals) can be made by all health, education and social care practitioners. Parent/carers can also request support via the Children's Single Point of Access (CSPA).

Helpful resources and services

You may also find the information and support offered by these services is helpful to you. The details of further services can be found on our Local Offer Directory.

Service	Description
Define Fine	A small UK parent led organisation that support families affected by EBSNA.
Not Fine In School	A UK based organisation set up to support parents, young people and professionals impacted by EBSNA: They also have a family support group on Facebook.
Young Minds	Have a parent's guide to School Anxiety and Refusal.
Every Mind Matters- Children's Mental Health	This is important for children of all ages, but in particular if the child is transitioning from one school to another, or to another class, which may make them more anxious about school.
SEND Advice Surrey	Offer impartial, confidential, free advice and support to parents/carers of children and young people with special educational needs and/or disabilities.
Family Voice Surrey	Champions the needs and rights of SEND families in Surrey: families with children or young adults up to the age of 25 who have special educational needs, chronic illnesses, including mental health conditions, or disabilities.
The National Autistic Society Surrey Branch	Is a volunteer-run support group founded by parents to support other parents. Volunteers offer a variety of local support group meetings, talks, parent programmes and activities for families that include autistic children or adults.
CYP Haven	Are safe spaces for young people to drop into to talk about worries and mental health confidentially. There is also a phone service and virtual workshops operating alongside the face-to-face sessions. The opening times and phone number are listed on their website. They also offer two daytime projects for young people who aren't in school called 'Slow Grow' and 'Forests Skills'.
Children and Family Health Surrey	Have a number of sensory video workshops, on their website.
BBC Bitesize	Have a section on School refusal.

Your Child's GP can offer support which might include a referral to a Paediatrician or Mindworks who provide advice, help and support to children, young people and their families through a wide range of emotional wellbeing and mental health service,

You can also speak to your child's school nurse. The video below describes what a school nurse does and how they can help.

EBSNA information for young people

Everyone feels anxious or worried about school or college sometimes. This is normal, Anxieties are part of life and learning to deal with them is part of growing up However, sometimes anxiety or constant worrying can become a problem especially when it stops us doing what we want or need to do. If you have high levels of anxiety and worry about attending school, you may be experiencing Emotionally Based School Non-Attendance (EBSNA).

You most definitely are not alone and there is lots of useful information which can help you to find the best ways to help support yourself with this.

Some signs of EBSNA

Getting head or stomach aches
Feeling unsure
Feeling bad tempered
Worrying about relationships
Struggling to sleep
Feeling scared
Feeling depressed
'Autistic Burnout'

Remember you are not alone many children and young people feel this way.

We understand that it can be hard to start a conversation about how you are feeling sometimes as you may be worried about the reaction you will get. You may be surprised to know that your parent/carer or teacher may already have an idea that you are finding things difficult and it may be an easy conversation to have. It's important to tell your family and school how you feel so they can support you. There is no wrong way to do so and you might like to write a letter or send a text to say how you are feeling.

You may wish to complete a support plan which can be used to support you think through how support can be individualised to support your needs. This can be completed independently, with a parent/carer, trusted adult or with friends. This plan can be shared with school/college to help create a package of ongoing support.

You can also let them know about this webpage so they can come and look at the resources for parent/carers and schools.

Some of these services might also be able to help you:

Name	Description	Age ranges covered
Surrey Libraries- Reading well	Self help books can be very effective when read on their own. Reading Well is designed to give practical information and advice while encouraging self-awareness and understanding of individual health issues including anxiety.	All
Mindworks Surrey	Help and support for children and young people in Surrey who are feeling very sad, worried, angry or upset. They also help parents or carers so that they can help their children.	0 to 18
The Mindworks 24/7 mental health crisis line	Available for children and young people who are worried about themself, a friend, or for parents worried about their child or young person. It can be contacted on 0800 915 4644, is open all day and all night, seven days a week.	0 to 18
CYP Haven	Safe spaces for young people to drop into to talk about worries and mental health confidentially. There is also a phone service and virtual workshops operating alongside the face-to-face sessions. The opening times and phone number are listed on their website.	0 to 18
Kooth	A free, anonymous, confidential, safe, online wellbeing service, offering counselling, information, and forums for children and young people aged 11 to 18.	11 to 18
Childline	A free, private, and confidential service for children and young people where you can talk about anything. The phone service 0800 1111 operates between 9am and midnight.	0 to 18
SHOUT	A 24/7 text service, for anyone in crisis anytime, anywhere. It is a place to go if you are struggling to cope and you need immediate help. Text 85258 (24/7)	All
Papyrus	A service providing confidential support and advice to young people struggling with thoughts of suicide.	0 to 18
The Mix	Provides information, support and listening for people under 25. They can be contacted by phone 0808 808 4994 (24 hours)	0 to 24
Extended Hope	The service is available for young people over the age of 11, who are facing an emotional or mental health crisis. It operates between 5-11pm, 7 days a week and can be accessed through the Emergency Duty Team on 01483 517898.	11 to 18

Please remember, in the case of an emergency, call 999 or 112 from a mobile.

How can you support a child with EBSNA you are working with?

EBSNA is a complex issue, staying curious, feeling confident to try a different approach, remembering that no one is to blame for the situation, along with a culture that promotes staff and student well-being, can all support a successful reintegration.

It is important to remember most school-anxiety/ school refusing children do WANT to attend school however their difficulties and anxiety are overwhelming. They care about their education and want to succeed; however, they need understanding and support at home and at school to do so. They may need adjustments to their daily routines, timetables, or their school environment. Pressures to focus on attendance rather than the child's needs can make things even harder to 'fix'. As soon as concerns are raised, a designated member of school staff should reach out and connect with the parents/ carers. Preferably staff with a trusting relationship.

Many of the factors associated with positive outcomes will already be present within your education settings existing good practice and include:

Developing a Surrey Healthy Schools approach to wellbeing, health, inclusion and achievement
Early Intervention
Working with parents and staff as well as the child or young person
Working flexibly with a focus on understanding the function of the child or young person's avoidance behaviour
A focus on a rapid return to an education setting alongside intervention, support and adaptations within the school and home environment (be mindful that a focus on rapid return will not be appropriate for all children and young people).
Implementation of the 'Assess, Plan, Do, Review' Four part cycle:

Stage of the cycle	Description
Assess	As part of the 'Assess' phase you can identify EBSNA signs and risk factors, education setting push and pull factors to gather information to build a rich picture of the situation. You can use Surrey's Early Help Assessment form and Early Help Assessment practitioner guidance.
Plan	As part of the 'Plan' you can bring together all the information gathered and use it to inform a co-authored action and support plan.
Do	The 'Do' strand should describe strategies and interventions that have been effective in supporting the reintegration of a child or young person who is experiencing difficulties coming to an education setting. Carry out additional High Quality Teaching strategies and note differences made. Refine delivery of strategies to maximise the effect they have. Ensure that additional provision is delivered as it is meant to be. Think about what you need to adjust considering initial observations and feedback.
Review	Using assessment measures to monitor the progress of an intervention and adjust the plan for next steps will be part of your 'Review.'

Where can I receive advice or support with EBSNA?

Training and Webinars

Surrey Educational Psychologist Service and Mindworks School Based Needs Services are continually delivering training. The training is underpinned by research and provides extensive resources. Training for schools/settings can be booked on the training section of the Surrey Education Services. Third sector and wider partner EBSNA webinars have been uploaded to the Surrey Youth Focus webpage.

There is a progressive programme of training and support for schools to assist in the development and maintenance of a supportive and inclusive school culture. For more information visit Surrey Healthy Schools

Effective Family Resilience incorporating Early Help Assessment training is bookable through the Surrey Children's Services Academy: Training covers how to use the Family Resilience Windscreen and identify the range of services available to support families.

Resources

Individual support for children and young people

A Profile of Risk of EBSNA has been developed that looks at 5 key risk areas for EBSNA. The checklist is for use alongside the usual attendance monitoring systems in education settings, e.g., SIMS and consideration of patterns of attendance, to screen for possible EBSNA in relation to non-attendance. If the resultant profile suggests to you that the pupil is at risk of emotionally based school non-attendance, the next step is to obtain the views of the pupil, parent/carers and other staff within a setting. A support plan should be co-produced with the pupil, parent/carers and education setting using the EBSNA support guide for settings and the EBSNA Support Plan template provided by Surrey County Council and partners.

If the family need resources to be made accessible e.g., no access to technology or are not confident using it, are visually impaired or have English as an additional language you must ensure the resources available to families can be made accessible and families are supported to use them.

As part of any plan to support the child to attend well, education settings should facilitate relevant pastoral support. This should be done with the clear aim of improving attendance as much as possible while supporting the underlying EBSNA issue. The Department for Education have published examples of effective reasonable adjustments.

You may also like to refer to the Department for Education's summary of responsibilities where a mental health issue is affecting attendance.

Additional Support Services

The Inclusion Service provides support to schools, parents and young people in providing services on behalf of the Local Education Authority and deals with non-attendance, child Protection and making enquiries about children missing education.
Surrey's Education Psychology Service offer a weekly helpline for education settings that operates in every quadrant every Wednesday from 1-4pm (including school holidays).

Surrey County Council are developing a new support pathway for EBSNA via our Learners Single Point of Access (L-SPA), this will allow referrals for support to be made direct to our multi-professional team. More information COMING SOON

Whole School best practice

By asking "can we create an environment where EBSNA doesn't exists?" schools are already employing many strategies that support CYP who may experience school related anxiety. We suggest that schools develop a Surrey Healthy Schools approach to wellbeing, health, inclusion and achievement and use the Self-Evaluation Tool and training to assist the leadership and management of these areas. This can help to foster a compassionate, respectful and anxiety friendly environment.

Surrey Healthy Schools presents an opportunity for schools to actively promote physical, emotional and mental health and wellbeing. It is a commitment to encouraging personal, social and health development and supports the links between health, behaviour and achievement. It is not aimed merely at pupils' health or school curriculum development but centres around the whole school environment and all aspects of school life.

By looking at the systems already in place and creating opportunity for open discussion, you will develop a solid foundation that works for your school.

Where can you find support and advice?

This EBSNA Padlet website has an EBSNA resource bank designed for professionals.
Surrey Educational Psychology Service EBSNA Whole School Initial Audit Tool for Schools is a useful tool to gain a whole school understanding of EBSNA awareness and will help to identify areas of development.
Graduated Response Early Years information and documents to help special educational needs coordinators (SENCOs), early years practitioners, home-based childcarers and playworkers support children with Special Educational Needs and Disabilities (SEND) and their families.
Surrey Inclusion & Additional Needs service schools a document designed to schools and settings understand Surrey County Council service offers available to support schools to meet pupils needs as they emerge.
Ordinarily available provision (schools) this guidance aims to support settings, practitioners, families, and carers to work together to ensure that children's additional needs are met at the earliest opportunity.
Surrey Wellbeing Partnership (SWP) is a formal joint venture of local and national charities of various sizes with a common goal: to work with children and young people in the community to improve wellbeing and mental health so that they can live full, fun and confident lives.
Mindworks School Based Needs Team: offers advice and signposting for children, young people, parents and school staff, 1-1 support and group work for children, young people and parents (both within school and out of school settings).
Mindworks - Complex Mental Health Needs Teams (Community Teams)- work across Surrey and are made up of health and social care professionals. These multi-disciplinary teams promote good mental health and provide assessment and treatment to children and young people up to the age of 18 with a mental health condition. The teams assess and treat children and young people who are struggling with difficulties associated with neurodevelopment conditions where these are having a significant impact on the child's development and quality of life and causing them and/or their carers distress.
Mindworks - Mental Health Support Team for Specialist Schools in Surrey - a school-based service, which supports the mental health of children and young people in specialist schools across Surrey. The team offer support and advice to key people (teacher and or parent/ carer) around the child or young person to enable them to identify any concerns, understand what has happened for that child or young person and support any developing mental health needs.
The Mindworks 24/7 mental health crisis line, is available for children and young people who are worried about themself, a friend, or for parents worried about their child or young person. It can be contacted on 0800 915 4644, is open all day and all night, seven days a week.
Transitioning from primary to secondary school or changing schools in-year is a particularly significant change for children. Learning about change and how to cope with it will help them with transition and prepare them for many other changes and challenges they will face in life. Young Minds have a section of resources related to supporting school transitions.
Youth Engagement Scheme (YES) - is an early intervention for young people, between the ages of 13 and 16, who are struggling with one or more of: school attendance, low self-esteem, lack of self-confidence and/or are at risk of becoming involved in anti-social behaviour and the criminal justice system.YES is an early intervention for young people, between the ages of 13 and 16, who are struggling with one or more of: school attendance, low self-esteem, lack of self-confidence and/or are at risk of becoming involved in anti-social behaviour and the criminal justice system. You can email yes@surreycc.gov.uk for more information.

You may also find the details of further services who offer information and support on our Local Offer Directory.