Anna Foxdal Psychotherapist Hemmasittarprogrammet anna foxdalmagelungen com Robert

Anna Foxdal Psychotherapist Hemmasittarprogrammet anna. foxdal@magelungen. com Robert Efström Psychologist Hemmasittarprogrammet Robert. elfstrom@magelungen. com

• Since 1993. • About 400 employees in 9 cities in Sweden • Employee owned - Every empolyee is offered to buy an equal share. • Treatment assignments usually comes from the social services. • School is a growing part of the company.

Institutional treatment School with day-care Magelungen Professional Education School with extra resources Outpatient treatment

What is HSP? • • • Manual based Multimodal Intensive Based on CBT Home visits are required Finding and approaching the school that is appropriate

What characterizes a ”hemmasittare”? • School is associated with emotional discomfort • The absence is often known by the parents • No crime, abuse, or the like • The student isolates himself during school hours but may have functional activities after school or during holidays • The student have a desire to go to school • The student have trouble himself to break his situation • Students may experience school as meaningless or difficult to understand the purpose of the lectures / exercises

Our prerequisites • Assignment of social services, sometimes childpsychiatry & School • We work in teams of two • 5 cases/therapist • Team Meeting once a week with set agenda • Treatment review of all the cases one time every other week – adherence check • Emergency phone

To do things in order ASSESSMENT PHASE 3 -5 WEEKS TREATMENT PHASE 6 -12 MONTHS MAINTENANCE PHASE 3 MONTHS

Causes and maintaining factors Specific event, in the family or at school Psychiatric problems Screentime SCHOOL ABSENTEEISM Neuropsychiatry Parents functioning Situation at school

Hemmasittarprogrammet- HSP Learning theory Student Parent School Assessment Treatment Maintaining Cooperation Coordination Manual based programindividualized action SCHOOLAPPROACHING!

Hemmasittarprogrammet- HSP Learning theory Assessment Treatment Maintaining Student Parent School Cooperation Coordination Manual based programindividualized action

To assess school absenteeism • What is the function absence? • Are there any clear precipitating cause? • What factors perpetuate absence? ?

HOW TO ASSESS? • Obtain information from parents, students and school. • Draw network map and line of life. • Find ways to get information, adapt your way of asking questions. • Meetings at home, office or in school. • Read previous materials. • Make behavior analysis

Behavior analysis Excesses Deficits Overt Sits in front of computer, plays computer games Being in school See friends Go by public transportation Social skills Covert Anxiety Stomach ache Negative thoughts Strategies to handle anxiety

Function of school absenteeism Antecedent Morning, time to go to school. Feels anxiety, stomach ache. Behavior Turns at the door, stays at home and sits in front of computer all day. Consequenses No worrying, chats with friends on internet

Presentation of the assessment • Written documents • This is how we understood the problem • This is our proposal for action What do you think about that? Shall we try? !

In summary Identify problems before putting into action! Why? • More chance to insert the appropriate action for that particular student you meet • It is very effective for creating alliance and a good basis for change

Hemmasittarprogrammet- HSP Learning theory Assessment Treatment Maintaining Student Parent School Cooperation Coordination Manual based programindividualized action

The treatment phase: Structure & Content • Includes students, parents and school and relate to targets. • Should be flexible and intensive care several times / week • Planning for the gradual rapprochement of the school. What skills are lacking in students, parents and school? - How do we practice it? - How does school meet the students needs? • Enables interaction, e. g. consent to break the secrecy

To evaluate and plan the next step "It's so easy that we put into action without thinking about the next step. "

Student SCHOOLATTENDANCE School Parents

The student • Home visits – meet the student where he or she is • Psychoeducation and rational about difficulties. • Working with everyday functions such as circadian rhythm and activation. This is important to start preparing for school approaching behaviours. • Starting to plan small steps (exercises) for the student to get back to school. • Clarify the purpose of the exercises, how does this help you achieve your goals.

Parents • Counseling at office 1 day / week, reconciliations on the phone, and if they are present during home visits • Increased knowledge of the problem and investigating the difficulties they encounter and how they are affected by these • Behavioral changes • Procedures / structure, demand level and family climate • Promote cooperation with schools

School • Increased knowledge of the problems and how treatment interventions can be implemented in schools • Planning for increased attendance, educational, treatment, information • Should be a clear plan when the student returns to school • Make adjustments if needed • Take responsibility for cooperation with parents (be the bridge). • Weekly updates to help with planning ahead.

What is helpful for the school? A good collaboration where school and treatment meet. The importance of systematic work and well-planned action taking small steps and be consistent. Solid preparation - preparation of students and parents. Important to have someone to reason with when difficulties arise The feeling that we were a team around the student

Hemmasittarprogrammet- HSP Learning theory Assessment Treatment Maintaining Student Parent School Cooperation Coordination Manual based programindividualized action

Maintaining When? How can we make treatment effects last? Highly individualized depending on functioning and resources.

International conference http: //www. jobbaktiv. no/arrangementer/intern ational-school-refusal-conference/ http: //www. magelungen. com/behandling/oppe nvardsprogram/hsp-hemmasittarprogram/

Wanna know more? • For more information about Magelungen as a company contact Mia Hubinette mia. hubinette@magelungen. com>; • For more info about HSP contact Robert. elfstrom@magelungen. com Anna. foxdal@magelungen. com