SCN0679
Written evidence from Not Fine in School (NFIS)
Authors
1.1. ‘School Attendance Difficulties’ (May 2018) completed by 1,661 parents
1.2. ‘Skipping School: Our Reality’ (February 2019) Completed by 473 parents, in response to the Children’s Commissioner’s report and Channel 4 Dispatches programme entitled ‘Skipping School: Invisible Children’.
1.3. ‘Medical Evidence’ (January 2019) completed by 253 parents
1.4. ‘Accountability survey’ (May 2019) completed by 122 parents
1.5. Where appropriate, samples of parent comments have been included. Statistics from the survey are shown in bold; parent comments are shown in blue italics.
2.1. This evidence relates primarily to the ‘assessment of and support for children and young people with SEND’ and is intended to raise awareness of the particular problems of anxiety-based school refusal in connection with SEND. Where we have evidence about the impact of the current EHCP process, this has been included.
3.1. School refusal, also known as school phobia or emotionally-based school avoidance, is triggered by excessive anxiety. It cuts across the whole of SEND and the majority of school refusers have a diagnosed or suspected SEND.
3.2. There is no data to monitor the incidence or trends of school refusal, or the impact on the school refusers and their families; school refusal figures are usually hidden within attendance code ‘I’ if authorised and ‘O’ if unauthorised.
3.3. The response to school refusal and the evidence required to authorise absence is entirely at the discretion individual schools. This has created huge local (and national) inconsistencies and is a particular problem where the ethos of the school is not inclusive.
3.4. Even when absence is authorised, there is precious little educational support offered, as local authorities and schools are not set up to provide education to children who can’t attend school
3.5. Unauthorised absence leaves parents open to prosecution (under truancy laws), off-rolling and non-elective home education
3.6. The problem has been compounded by a lack of understanding of school refusal, the absence of any national guidelines, problems within the EHCP process, high thresholds and long waiting lists for CAMHS, lack of expertise around the assessment and treatment of trauma, a lack of expertise and long waiting lists around other aspects of SEND assessment (e.g. dyslexia), and cuts in school SEN budgets and staff
3.7. Early identification of potential of school refusal problems relies heavily on the pre-EHCP SEN support systems in schools, which have been compromised as a result of SEN resources being redirected towards the EHCP process
3.8. Children with SEND or high anxiety may act out (often resulting in exclusions) or withdraw and shut down (often resulting in school refusal and problems engaging with support services). There is a lot of scrutiny of the former; very little on the latter
3.9. Professionals in the system who should be supporting school refusers and their families are not found to be supportive by parents
3.10. The response to school refusal from schools and local authorities demonstrates a culture of parental blame, a worrying increase in accusations of Fabricating or Influencing Illness, also known as Munchausen’s By Proxy, and an ‘us’ and ‘them’ culture which often results in appeal and tribunal
3.11. We have submitted 12 recommendations:
3.11.1. School reporting on all EHCP requests
3.11.2. More detail on the timeliness of EHCP supporting evidence, highlighting problem areas
3.11.3. More rigorous reporting on annual reviews
3.11.4. A campaign to raise awareness of EHCPs
3.11.5. A new attendance/absence ‘holding’ code for school refusal
3.11.6. An independent complaints body for schools and local authorities
3.11.7. An optional basic support package for parents who choose to home educate
3.11.8. A cultural shift in the relationship between schools and parents of SEND children
3.11.9. A focus on ‘trigger’ points for school refusal, eg. Transition
3.11.10. In-built SEND training for school staff
3.11.11. Improved services for child and adolescent trauma
3.11.12. A national research programme for school refusal
4.1. The lack of appropriate support for children with SEND is an overriding factor in school refusal. 92% of parents tell us that their child’s school attendance difficulties are related to SEND that is inadequately supported or recognised in school. 64.1% of parents have a child with a SEND diagnosis and a further 26.6% suspect a diagnosis is needed[3].
4.2. This relationship between SEND and absence is corroborated by the Department for Education’s latest report on pupil absence, which find that pupils with SEND are twice as likely to be persistent absentees than those without SEND[4].
4.3. Whilst school refusal is a specific issue, it crosses all of SEND. Parents cite diagnoses of Autistic Spectrum Disorders and Tourette’s (40%), various learning difficulties, anxiety disorders, mental health difficulties (such as depression, PTSD and anorexia) and physical illnesses such as hypermobility, epilepsy and diabetes[5].
5.1. There is currently no means of collecting data on school refusal. This has been confirmed by a statistician at the House of Commons library[6] and by the FFT Education Datalab[7].
5.2. Current attendance codes do not allow for school refusal to be measured, or for the relationship between school refusal and SEND to be defined. If absence is authorised with a ‘proven’ medical reason, it will be recorded as ‘authorised absence’, usually under ‘I’ for illness. If unauthorised, it will be recorded as ‘O’ and pooled together with unauthorised holidays and truancy. No further detail is available.
5.3. Not Fine In School was only launched 15 months ago (November 2017) but already has a membership of 5,160[8] with an average of 600 members per month joining the group in January and February 2019. This is indicative of the scale of the problem.
5.4. Related statistics – the rise in home education, prosecutions, permanent absences and exclusions – may well be linked to school refusal, but there is currently no means of assessing this.
5.5. School refusal can become entrenched if not properly supported with early intervention and an appropriate response. 44% of parents tell us that their child has been off school for more than 6 months[9].
6.1. 20.4% of parents have been told by schools or CAMHS either not to bother applying for an EHCP, or that they are unlikely to get one[10]. One parent said, “About to begin - but told to expect to be turned down.” Another had secured an EHCP “after being told not to bother, being refused to assess, then granted.”
6.2. A further 20% of parents do not know what an EHCP is, suggesting that professionals are either not offering or deliberately obstructing the opportunity for an EHCP assessment[11].
6.3. Nearly four years on, there remain significant delays in the process of securing an EHCP. One parent says, “it took 53 weeks to finalise, causing Social Emotional and Mental Health issues for my child”. Another says, “Applied twice, both applications ‘lost’”. A third says, “Assessment agreed and undertaken. 2.5 yrs later, still without an issued Plan that meets need and is properly quantified, specified and funded.”
6.4. Delays are caused by a lack of the necessary expertise to carry out assessments and long waiting lists. One parent says, “when [the school] rang (Nov 17) to get an Ed Psychology appointment they were told that because there was a backlog of assessments that no appointments would be given, and to ring back in April 18 to be given an assessment date. School have now rang back as advised (April 18), and are still unable to get a date for an assessment”
6.5. There are challenges reaching agreement on the need for, and content of, an EHCP (often resulting in tribunals which either go to court or are conceded by the local authority just before the court date). One parent tells us, “Applied for statement [EHCP], went to tribunal for part 4, lost the tribunal they named a school that it was impossible for him to attend and he has been out of school. He’s not attended for 3 years.” Another says, “Refused, successfully appealed, but by then too ill to attend.” Another says, “Turned down, failed at appeal due to insufficient evidence - CAMHS let us down.”
6.6. The legally-binding support outlined in an EHCP is often not consistently provided, if at all, with cuts to the SEN teams and the lack of ring-fenced SEN budgets compromising SEND support. Often the 1:1 support in a child’s EHCP cannot be provided within the school’s SEN resources – 1:1 does not mean 1:2, 1:3 or even 1:4. One parent says, “SEN provision within statement not provided by school. Should have had full time 1:1 support but found out too late this was shared out between other children. By the time we realised the root of the problem, school anxiety was beyond reconciliation. Totally traumatised & unable to return.”
7.1. There is a widespread lack of recognition that school refusal is real and a result of extreme anxiety, whatever the underlying cause and difficulties such as excessive anxiety are still not being seen as an ‘illness’. One parent said “Social worker claims that mental illness is not classed as a disability! Social Worker is clear that my son is to return to the same mainstream school although the consensus from other professionals (inc. CAMHs) is that this is unlikely for some time if at all.”
7.2. Where a child has mental health difficulties, the ever-higher thresholds for CAMHS often mean assessments are refused. There are also long waiting lists
7.3. Children with high anxiety or SEND who struggle to cope with school will either act out (often resulting in exclusion) or shut down and ‘mask’. The latter group are our biggest challenge as they can struggle to engage (making assessment/ diagnosis difficult) and can appear ‘fine’ in school, when they are in fact under intense stress
7.4. Where there may be issues of trauma (a growing problem[12]), there is a huge national shortage of trauma-trained consultants and therapists which makes assessment and therapy almost impossible in many parts of the country
7.5. There is a lack of expertise and/or lengthy assessment/diagnoses waiting times across other areas of SEND (eg. for dyslexia)
7.6. There are key ‘trigger points’ for school refusal, around transition (years 6/7) and exams (years 10/11)
8.1. 55.5% of parents say that school refusal has been blamed on their poor parenting and 60.8% on their child’s negative attitude towards school. 26.3% of parents report that they have been threatened with a fine as a penalty for unauthorised attendance (this figure was 45% in our NFIS ‘Medical Evidence’ survey). 24.9% reported that they had been referred to Social Services because their child had a difficulty with school attendance[13].
8.2. Related to this, there is a worrying increase in accusations of Fabricating or Inducing Illness (FII), also known as Munchausen’s By Proxy, with almost a fifth of the parents in our survey (18.4%) reporting that they had been accused of FII in relation to their child’s difficulty with school attendance[14]. One parent says, “School claimed I taught [my daughter] to be autistic”, another said “Although not accused of FII it’s been hinted at…. No help available anywhere only threats and blame. Very traumatic and inflicted long term damage.”
8.3. The legal tension between a local authority’s duty to provide an education that a child can access, and the parents’ duty to ensure their child receives an education, has led to an ‘us’ and ‘them’ culture
8.4. Off-rolling has increased. 24% of our parents have been pressured to de-register their child and 13 children have been illegally de-registered without parental permission[15]
8.5. School refusal is in part responsible for the rise in home education. Primary reasons for home educating are: child’s mental health deteriorating, undiagnosed/unsupported SEND, or a broken relationship with school. 61% say they would not be home educating if the right support was available in mainstream[16]
8.6. There is a misconception that ‘facing the fear’ is the appropriate response for school refusal. 45.5% of parents have forced their child to attend school, as they felt under pressure to do so; in addition, 21.2% felt under this pressure but refused to force attendance. When asked if the use of force was helpful in resolving their child’s anxiety, 36% said no, and 59.1% said it has made things much worse. Only 0.4% of parents thought force helped and 4.5% thought it might have helped[17].
8.7. The lack of national guidance means that individual schools can choose how to respond to school refusal. Most will only authorise absence if endorsed by a medical professional; some will accept a GP report that a child is unfit for school, but many insist that a consultant commits to this in writing, ideally naming a fixed time period. Our parents say that 27.1% of school refusal absence is authorised, 25.2% is unauthorised, 25% didn’t know and for 5.2% it varied day to day and week to week[18]
8.8. If the school is satisfied that a child is unable to attend, there is precious little educational support available. Only 12.8% of parents received suitable educational provision once medical evidence had been accepted, 58.7% did not, and 13.4% were still waiting to find out[19]. One parent says, “Even though signed off as unfit for school for last year, we have had very little official support with education: nothing for first 6 months, then 1 hr per week for 5 months, only just increased to 2 hours per week.”
8.9. Absence is more often unauthorised, meaning that parents are liable to prosecution. Many schools will then refuse to send work home, claiming it endorses an unauthorised absence. One parent said “For six months we were in a strange position where [the school] acknowledged [our daughter’s] diagnosis of chronic anxiety by a consultant psychiatrist, so agreed to a reduced timetable yet simultaneously marked all absences as unauthorised. The result was that this prevented her being referred to the LA for the support she needed and as her attendance worsened we found ourselves threatened with legal action.”
8.10. There is a lack of understanding that children experiencing high anxiety will either act out (leading to exclusions) or ‘mask’ and shut down (leading to school refusal). There is generally far more focus on exclusion than on school refusal
8.11. Professionals are not supporting parents adequately. Our parents rated professionals offering positive support as follows: Education Welfare Officers 5.4%, local authorities 13.7%, social workers 10.2%, school nurses 7.5%, school counsellors/therapists 12.7%, SENCOs 33.1% and teachers 33.3%. The most supportive source was peer-related, with social media support groups rated by 66.7% of parents, and online websites rated by 46.5%[20].
8.12. The internal school complaints process is by default not impartial and often fails parents. Dissatisfaction with the outcome of school complaints (to teacher, SENCO or Head) was over 90% whilst 81% thought the complaints policy hadn’t been followed and 92% thought that Government guidance hadn’t been followed[21]. One parent says, “complained to governors, school reported to Social Services, Social Services threatened child protection unless we stopped asking the school to put him on SEN support - specialist family support workers sent into school to investigate our 'child abuse' - suddenly dropped without a word and the local authority issued an EHCP (no mention of social care needs !!!!)”
9.1. Schools should be legally bound to record all requests for an EHCP with their response, and forward this to their local authority so that national data can be collated. This would highlight where schools are obstructing parental requests for an EHCP assessment
9.2. More detail about the timeliness of the supporting evidence for an EHCP should be reported, in order to identify gaps and delays in acquiring the necessary evidence including where there are shortages in professional expertise, eg. educational pyschologists
9.3. Local authorities should report more rigorously on annual reviews, within a consistent national framework, to monitor whether the provision legally awarded in an EHCP is actually being provided. This means that where EHCPs are not being implemented it will not be left to individual families to fight for the support to which their child is legally entitled
9.4. A national campaign should be launched, to ensure that all families of SEND children are aware of their opportunity to apply for an EHCP, either through their school or as an individual
9.5. A new attendance/absence code should be created for school refusal, in part to recognise that only 65% of EHCPs are completed within the legal 20-week timeframe[22] and to recognise the difficulties accessing other SEND assessments, diagnoses and support
9.6. There must be a new independent complaints and monitoring body for schools and local authorities. This must include issues around the EHCP process but also other SEND-related issues about assessments, diagnoses and support
9.7. There should be a basic package of educational support for parents who have chosen to home educate, should they request it. This is particularly relevant to families who have chosen to home educate solely because there is no suitable educational provision elsewhere which supports their child’s needs
9.8. There must be closer working between school and parents regarding children with SEND. The ‘us’ and ‘them’ divisions need to be mended if children are going to be put at the heart of any improvements to SEND
9.9. There needs to be a focus on ‘trigger’ points for children with SEND, particularly at transition (years 6 -7) and pre-GCSE exams (years 10-11) as this is where many reach crisis point
9.10. There must be better SEND-related professional training for school staff, to bolster pre-EHCP SEN support and help early identification of SEND or school refusal
9.11. Trauma is a specific and growing SEND issue with significant national gaps in expertise that need to be addressed
9.12. A national research programme is needed to identify examples of good practice relating to school refusal, create consistent national guidelines and identify the scale of the problem
March 2019
[1] Data on membership at 5 March 2019
[2] Figures for January and February 2019
[3] NFIS ‘School Attendance Difficulties’ survey (May 2018)
[4] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/749352/Absence_2term_201718-Text.pdf
[5] NFIS ‘School Attendance Difficulties’ survey (May 2018)
[6] Email response to further questions submitted by Peter Kyle’s office following parliamentary questions regarding the national data on school refusal, 11 January 2019
[7] Email from Philip Nye, External affairs manager; research lead for inspection and academies, FFT Education Datalab, 16 November 2018
[8] Data on membership at 5 March 2019
[9] NFIS ‘Medical Evidence’ survey (January 2019)
[10] NFIS ‘School Attendance Difficulties’ survey (May 2018)
[11] NFIS ‘School Attendance Difficulties’ survey (May 2018)
[12] https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30037-9/fulltext
[13] NFIS ‘School Attendance Difficulties’ survey (May 2018)
[14] NFIS ‘School Attendance Difficulties’ survey (May 2018)
[15] NFIS ‘Skipping school: our reality’ survey (February 2019)
[16] NFIS ‘Skipping school: our reality’ survey (February 2019)
[17] NFIS ‘School Attendance Difficulties’ survey (May 2018)
[18] NFIS ‘medical evidence’ survey (January 2019)
[19] NFIS ‘medical evidence’ survey (January 2019)
[20] NFIS ‘School Attendance Difficulties’ survey (May 2018)
[21] NFIS ‘Accountability’ survey (May 2018)
[22] https://www.gov.uk/government/statistics/statements-of-sen-and-ehc-plans-england-2018