School Re-entry and Calming Kids’ Anxiety After a Medical Leave
When children return to school after a prolonged absence for medical or mental health care, it's normal to feel anxious, scared, and nervous. Using key strategies and tips, parents can help reduce some of their child’s stress and help them get back to their normal routine more easily.
Notify the school
When a medical or mental health condition requires your child to be away from school for an extended absence, letting the school know what is happening is critical. The school should be made aware of the student’s status and the need for an extended absence, whether that be a hospital admission or a day treatment program.
Often the school might require a note to excuse those absences and serves as a trigger for the school to start preparing at their end. Do they need to start getting schoolwork together? Can they send schoolwork to where the child is? Taking that initial step can be particularly important.
Three areas of concern for school re-entry
Some published research studies on school re-entry indicate there are three main areas on which to focus when children return to school – social worries, academic concerns, and emotional distress.
When a child is returning to school after a medical or mental health leave of absence, anxiety is natural. Kids worry what to tell others about an absence and how much detail to share with friends, classmates, or even teachers and personnel at the schools. Children often don't want people to know that much private information, but they also don't want to lie.
To help children prepare for their return, ask questions that will help develop their response. Determine who your child trusts and how much information your child is comfortable sharing about their experience. For some close friends and teachers, your child may want to share detailed information. For other individuals, your child may be more comfortable not responding directly, perhaps saying, “I was away for a little bit because I wasn't feeling well, but I'm back and I feel great. How are you?" It can be especially helpful to assist your child in developing a response they are comfortable with, and then role playing with your child so they can practice what they will say when they return.
Another common concern is what other people will think. There can be a lot of stigma attached to a child receiving mental health treatment, and unfortunately, rumors often circulate about a student’s prolonged absence which can cause negative social consequences. Sometimes friendships may be negatively impacted due to the absence, the lack of information, or sadly, the rumor mill.
For children who miss school for an extended period, they probably missed some schoolwork. As we know, kids are all different. Some students are very anxious about their grades and catching up on work. Others might be fine with missing all that work. Still other kids may worry about moving on to the next grade or having to repeat a year. There should be an actual plan in place to address how the work can be made up. Having a plan in place can help to reduce their anxiety.
A medical or psychological illness can take an emotional toll on a child. There’s a reason they were out of school, and the re-entry process can sometimes be another stressor. A child may worry about whether they will be treated differently and what people think, and could also fear going back into an environment that may be a significant source of their stress.
Whatever those stressors were when they left school, they may still be there when they come back. Whether they are dealing with depression, substance abuse or something else, children can experience the extra stressors not only of going back to school, but facing what was already there when they left.
What parents and caregivers can do to help children return to school
Schedule a meeting with the school
One of the first steps to re-entry is to set up a meeting with you, your child’s caregiver and clinician, and key people from the school such as a social worker, school psychologist, or guidance counselor. The meeting should address all the needs of the child, the progress they've made to date, and recommendations from the clinician on how they're going to maintain that progress across a variety of settings.
Identify a primary contact at the school
Having someone at the school you and your child can rely on for help or more information is key. That person typically varies from one school to another but ask your school who that contact should be. It may be a guidance counselor, school social worker, school psychologist, or a teacher.
If your child’s treatment plan allows for it, scheduled school visits can be helpful during an extended medical absence. This is especially helpful if a child is entering a new school or a different program. In acute care settings that is not always possible. But for children in day treatment programs or residential settings, attending school part of the day may be possible. This can help make the transition back to school a bit easier.
Develop a plan
Having a plan with the school is vital. It establishes support for the child and helps the student have the best possible transition back to school and potentially avoid a relapse of their condition. When they have been out of school for a while, children often have a lot of anxiety going back. It’s critical to acknowledge the absence, identify the student’s individual needs, and provide appropriate support to avoid a recurrence of the condition. Without a plan, the risk of relapse is greater.
Depending on the school, the plan may address just the transition period, typically just a couple weeks. For other children, it may also include updating or initiating a 504 plan or an IEP to address academic as well as social and emotional support.
Key aspects of a transition plan
There are several things that can be included in a plan to help the child make the transition back to school easier:
- Passes. While this practice goes by different names in each school, it’s important to have an indicator for a child to use to show the teacher when they need a break. Sometimes called a break pass, flash pass, or red card, it is something a child can place on their desk to let the teacher know they need to see an identified person such as a guidance counselor or school social worker, and they can leave the class without drawing attention to themselves.
- A check-in/check-out model. For the first week back at school, it can be especially helpful for a child to have a specific person to meet when they arrive at school, perhaps a school counselor. This can help the child do a debrief on how they are feeling, prepare for what their day looks like, and anticipate any challenges. This individual can also offer a reminder of coping strategies or supportive skills the child may need during the day. Then, they would check out with this person at the end of the day as well to go over the day.
- Outstanding work plan. Develop a specific plan that addresses any outstanding work or core content that the child needs to make up. The plan should prioritize what the student must do, have enough content knowledge, and receive credit to move on to the next grade. Sometimes an abbreviated or a modified schedule is what's going to be best for that child.
- Promote connectedness. Be sure the child has support to access school-based groups or activities and after school activities or school clubs. This helps the student feel connected to the school and more a part of that community, which can have emotional benefits and promote positive social interactions.
- Develop a behavioral plan. There could also be a behavior plan that targets specific behavioral concerns for that child. The child’s clinician can provide information on what type of treatment has worked for the child and address what the school can do when the child returns. Will the child need any risk assessments for ongoing suicidality or self-harm? How can disruptive behaviors be managed effectively?
There are some helpful programs for children returning to school that have some good research behind them. They offer information, resources, and recommended support on how to transition a child from an extended absence back into school.
One especially comprehensive program is called the BIRCh Project, out of University of Massachusetts Boston. While not all schools have the resources to implement it, it is a very thorough plan that outlines the whole process from beginning to end and includes recommended supports.
There are also “bridge programs”, such as the Bridge for Resilient Youth Transition (BRYT). While this model can be known by different names, these school-based programs often have a specific classroom with a dedicated teacher or other personnel to provide individualized support to students transitioning back to school after a long absence, and they provide recommended support, documents, and guidance to facilitate the school re-entry meeting and follow-up that should happen after the student’s return.
About the Author:
Jennifer Hellmuth, PhD
Dr. Jennifer Hellmuth, PhD is clinical director of the Children’s Partial Hospital Program at Bradley Hospital. She is also a clinical assistant professor in the department of psychiatry and human behavior at The Warren Alpert Medical School of Brown University.
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