|Author||Christopher A. Kearney|
Managing School Absenteeism
at Multiple Tiers
Absenteeism at Multiple Tiers
An Evidence-Based and Practical
Guide for Professionals
CHRISTOPHER A. KEARNEY
Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education
by publishing worldwide. Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America.
© Oxford University Press 2016
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by license, or under terms agreed with the appropriate reproduction
rights organization. Inquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
You must not circulate this work in any other form
and you must impose this same condition on any acquirer.
Library of Congress Cataloging-in-Publication Data
Names: Kearney, Christopher A.
Title: Managing school absenteeism at multiple tiers : an evidence-based and practical guide
for professionals / Christopher A. Kearney.
Description: New York : Oxford University Press, 2016. | Includes bibliographical references
Identifiers: LCCN 2016005545 (print) | LCCN 2016006470 (ebook) |
ISBN 9780199985296 (paperback) | ISBN 9780199985302 (ebook) | ISBN 9780199985319 (ebook)
Subjects: LCSH: School attendance. | Children with disabilities—Education. |
BISAC: PSYCHOLOGY / Clinical Psychology. | PSYCHOLOGY / Education & Training.
Classification: LCC LB3081 .K37 2016 (print) | LCC LB3081 (ebook) | DDC
LC record available at http://lccn.loc.gov/2016005545
9 8 7 6 5 4 3 2 1
Printed by Webcom, Canada
1. Introduction to Key Definitions and Concepts 1
2. Tier 1 Strategies to Enhance Attendance and Prevent Absenteeism 18
3. Assessment Procedures for Tier 1 37
4. Tier 2 Interventions for Emerging School Absenteeism 55
5. Assessment Procedures for Tier 2 74
6. Tier 3 Interventions for Severe School Absenteeism 95
7. Beyond Tier 3 and Into the Future 114
About the Author 149
I worked in graduate school at a well-k nown anxiety disorders clinic where many
families referred their children for various emotional conditions. My colleagues
at the time were interested in developing protocols for specific anxiety disorders
such as panic disorder or social phobia. Many of the children who were referred
to the clinic, however, presented with problems going to school, a situation that
the parents wanted to address immediately. My colleagues, who were wary of
introducing such muddled issues into their research projects, were more than
happy when I said that I would see these cases!
As I saw more and more of these students, I became fascinated by the fact that
so many different clinical profiles were evident. Some of these kids were anxious,
and some were depressed, but some simply did not want to go to school. I relied
on my behavioral background to develop a functional model of what I labeled
school refusal behavior. I found some basic reasons why many of these children
were refusing school, and I was able to develop assessment and treatment procedures based on those reasons that (mostly) worked.
The assessment and treatment procedures I developed for this population fit
well in a clinic setting and seemed to be effective for this difficult population.
I began to publish data as well as descriptions of the assessment and treatment
procedures, and then the requests for workshops began to arrive. In talking with
many of the school officials at districts I visited, I found that the kinds of cases
I was seeing in my clinic were quite different than the kinds they were seeing in
their schools. It was time for bigger thinking.
Over the years, I have tried to broaden my horizon by considering the many different variables and circumstances that apply to these students. This process has
evolved to different models and conceptualizations that more fully accounted for
the intricacies of this population. The overarching model presented in this book,
a multitier approach based on a Response to Intervention prototype, arranges
nicely the various strategies from different disciplines to boost school attendance
and to prevent and treat school absenteeism. The organizational model is not
perfect—too many kids are missing school and thus flooding Tiers 2 and 3, and
too often the lines between the tiers are blurred. The severity and complexity of
school absenteeism and its intervention may eventually warrant a more nuanced
organizational model. Toward that end, I invite comments and suggestions.
Managing School Absenteeism
at Multiple Tiers
Introduction to Key Definitions
School attendance is a key foundational competency for children and adolescents. Children who attend school regularly and adolescents who complete high
school are more likely to experience better quality of life and to achieve greater
success in social, academic, occupational, and other aspects of functioning during their lifespan than youth who receive little to no education. Conversely,
children who do not attend school on a regular basis, or who prematurely leave
school before graduation, are at risk for various economic and related drawbacks
in adulthood (Rumberger, 2011; US Census Bureau, 2012).
Because school attendance is such an important factor in a person’s life, children have been deemed to have a right to an education as delineated by Article
26 of the United Nations Declaration of Human Rights:
(1) Everyone has the right to education. Education shall be free, at least
in the elementary and fundamental stages. Elementary education
shall be compulsory. Technical and professional education shall
be made generally available and higher education shall be equally
accessible to all on the basis of merit.
(2) Education shall be directed to the full development of the human
personality and to the strengthening of respect for human rights
and fundamental freedoms. It shall promote understanding, tolerance and friendship among all nations, racial or religious groups,
and shall further the activities of the United Nations for the maintenance of peace.
(3) Parents have a prior right to choose the kind of education that shall
be given to their children.
M anaging S chool A bsenteeism
D EFI N I N G SC H O O L A B S EN T EEI S M
School attendance is a key foundational competency, and education is a basic
human right, so political leaders, policymakers, educators, and researchers in
various disciplines have explored legal and other methods to enhance attendance and reduce absenteeism over many decades (for historical summaries, see
Kearney, 2001, and Rosenheim, Zimring, Tanenhaus, & Dohrn, 2002). School
absenteeism refers simply to a child’s absence from school, which can come in
many forms. A child may be completely absent from school for a short or a long
period of time. Or, a child could miss part of a school day in the form of tardiness, a skipped or otherwise missed class, or premature departure from a school
School absences are often classified by school districts as excused or unexcused (Gottfried, 2009). Excused absences typically refer to those that are legally
justified and often due to illness, hazardous weather conditions, family emergency or travel, or other sanctioned release. Unexcused absences typically refer
to those that are not legally justified; the child should be at school but is not.
However, a distinction between excused and unexcused absences can be detrimental. A child may accumulate a large number of absences that are technically
excused (e.g., a medical note secured by parents) but mask serious mental health,
family, or other problems. Or, a child may miss many school days due to family
travel or other “justified” reason but then experience lowered grades and test
scores and difficulty reintegrating socially into class. A child with a large number
of excused absences may also fail to qualify for needed assessment and intervention services. Even a small number of absences, whether excused or unexcused,
are linked to many psychiatric, learning, and other problems (see the later section on effects of absenteeism).
School absenteeism has been studied historically by professionals in many
disciplines, including education, psychology, social work, medicine, nursing, sociology, and criminal justice, among others. As such, many different
terms have been developed over the past century to define youth with various
types of school absenteeism (Box 1.1). One effect of this process is that professionals in certain disciplines tend to examine certain types of youth with
problematic absenteeism. Psychologists, for example, often study absentee
youth with fear-and anxiety-based problems, whereas educators and criminal justice experts often study absentee youth with delinquency problems
The term school refusal behavior was developed to encompass all youth with
problematic absenteeism regardless of type or symptomatology (Kearney &
Silverman, 1990). The terms problematic absenteeism and school refusal behavior
are used interchangeably in this book. School refusal behavior refers to child-
motivated school absenteeism that can involve refusal to attend school and/or
difficulty attending classes. The term thus excludes parent-motivated school
absenteeism, or school withdrawal (Box 1.1), though parents and other family members often contribute to a child’s absenteeism (see the later section on
Key Terms Related to Problematic School Absenteeism
breaking behaviors and status offenses, such as stealing, physical and verbal aggression, property destruction, underage alcohol or
tobacco use, and violations of curfew and expectations for school attendance
(akin to conduct disorder).
School dropout: permanent departure from school before graduation.
School phobia: fear-based absenteeism, as when a child refuses school due to
fear of some specific stimulus, such as a classroom animal or fire alarm.
School refusal: anxiety-based absenteeism, including general and social anxiety, and general emotional distress, sadness, or worry while in school (also
referred to as psychoneurotic truancy).
School refusal behavior: child-motivated refusal to attend school or difficulty
remaining in classes for an entire day, whether fear/anxiety-related or not.
School resistance: student behaviors such as missing school that occur in reaction to perceived injustices or excessive demands at school.
School withdrawal: parent-motivated absenteeism, or deliberately keeping a
child home from school to secure economic support, sit with younger children
or elderly adults, protect the child from kidnapping by an estranged spouse or
from victimization at school, punish the child for some infraction, reduce parental separation anxiety or other psychological symptoms, extend the length of the
absentee problem, sabotage efforts to reintegrate the child into school, or some
Separation anxiety: excessive worry about detachment from primary caregivers and reluctance to attend school (or, in parents, excessive worry about detachment from the child).
Truancy: illegal, unexcused absence from school; the term is sometimes applied
to youth absenteeism marked by surreptitiousness, lack of parental knowledge or
child anxiety, criminal behavior and academic problems, intense family conflict
or disorganization, or social conditions such as poverty.
Adapted from Kearney, C. A. (2001). School refusal behavior in youth: A functional approach
to assessment and treatment. Washington, DC: American Psychological Association; and
Kearney, C. A. (2008a). School absenteeism and school refusal behavior in youth: A contemporary review. Clinical Psychology Review, 28, 451–471.
causes). School refusal behavior refers to absentee-related problems that occur
along a spectrum (Figure 1.1).
School refusal behavior can thus appear in various forms that may not even
involve actual school absence but rather behaviors designed to try to miss school
(e.g., morning tantrums and pleadings for future nonattendance). Children with
school refusal behavior often display variable patterns of attendance problems.
A child could skip school on Monday, be tardy on Tuesday, attend school fully
M anaging S chool A bsenteeism
X --------------------X --------------------X -----------------X -------------------X ------------------X ---------------------X
and pleas for
period of time
period of time
Figure 1.1 Spectrum of school refusal behavior.
Adapted with permission from Kearney, C. A. (2001). School refusal behavior in
youth: A functional approach to assessment and treatment. Washington, DC: American
on Wednesday, miss one class on Thursday, and depart from campus after lunch
on Friday. School refusal behavior may also be described as self-corrective (dissipating on its own within 2 weeks, such as soon after the start of the school year),
acute (lasting 2–52 weeks), or chronic (lasting more than one calendar year or
across multiple academic years).
The definition of problematic school absenteeism also varies across school
districts and researchers in different disciplines. Many definitions of nonproblematic school absenteeism generally surround the theme that a formal school
absence is agreed on by parents and school officials as legitimate and not involving detriment to the child. The key phrases in this definition are that parents
and school officials must concur and that the absence must not be causing any
harm. Parents may keep a child out of school for what they believe to be a legitimate reason, but the child may still experience social and academic problems
as a result. In contrast, many definitions of problematic absenteeism generally
surround the theme of missing most school time for a set period of time, such
as 2 weeks or 10 days, or displaying behavior that significantly interferes with
academic progress or other aspects of daily functioning.
A practical and concrete definition of problematic absenteeism has been proposed based on a review of treatment outcome studies in this area as well as common standards adopted by many school districts (Kearney, 2008b). Problematic
school absenteeism could thus refer to school-aged youth who:
• Have missed at least 25% of total school time for at least 2 weeks, and/or:
• Experience severe difficulty attending classes for at least 2 weeks with
significant interference in a child’s or family’s daily routine, and/or:
• Are absent for at least 10 days of school during any 15-week period while
school is in session (i.e., a minimum of 15% days absent from school
for any reason, with an absence defined as missing at least 25% of the
A 25% criterion was chosen based on the median used by treatment outcome
researchers and on the rationale that 25% represents a substantial portion of a
school day, or 2.5 missed days in a 10-day (2-school-week) span. This definition
of problematic absenteeism also accounts for the spectrum of attendance problems noted earlier as well as for acute and chronic forms of nonattendance. The
definition also eschews the traditional distinction made between excused and
EPI D EM I O LO GY O F SC H O O L A B S EN T EEI S M
WO R L DW I D E
Free, compulsory, and high-quality primary education remains out of reach for
many of the world’s youth despite its designation as a basic human right. The
number of out-of-school youth of primary school age is currently 61 million;
about 47% of these youth (57% in low-income countries) will never enroll in
school. Only 55 countries have a school enrollment rate above 97%, and 29 countries have a school enrollment rate below 85%. School dropout, or permanent
departure from school before graduation, is particularly problematic in low-
income countries, with a rate of 41%. These figures are made worse by the fact
that very poor performing countries are omitted from official statistics, either
because of a lack of data or because conflict and other disasters prevent children
from attending school. Countries in sub-Saharan Africa are among the worst
performers (UNESCO, 2012).
Late entry into school, or lack of education altogether, is most prominent
among the world’s poor. Poverty and delayed entry into school are closely connected because of schooling costs, transportation problems and long distances to
school, parental concerns about safety (especially for girls), less parental awareness about the importance of school enrollment, less parental education, and
poor nutritional and health status that prevents school attendance. Furthermore,
late entry into school increases the chances for eventual school dropout due to
social and academic alienation, need to work outside of school, and intersection
with a young average age of marriage (UNESCO, 2012).
EPID EMIO LO GY O F SCH O O L A B SEN T EEISM IN
T H E U N I T ED STAT ES
School enrollment is less problematic for a country such as the United States, but
rates of chronic school absenteeism and eventual school dropout remain high.
A systemic analysis of chronic absenteeism rates, defined as missing at least 10%
(or 18 school days) per year, revealed a national rate of 14% to 15%. This translates to about 5.0 to 7.5 million American children who are not attending school
on a regular basis. In addition, about half of students who are chronically absent
from school may be so for multiple years. About 25% of these youth are considered to be severely chronically absent, defined as missing at least 2 months of
school during the academic year (Balfanz & Byrnes, 2012).
Chronic absenteeism decreases in elementary school grades but rises in middle school grades, especially grades 6 to 8. Rates then increase steadily into high
school and peak at 12th grade. Rates of chronic absenteeism are similar across
M anaging S chool A bsenteeism
gender and ethnic groups and geographic locations but are consistently elevated
in youth from low socioeconomic backgrounds and those in special education
classes (Balfanz & Byrnes, 2012).
Not all cases of school absenteeism are chronic, but the prevalence of acute
absenteeism is substantial as well. Data from the National Assessment of
Educational Progress (Ginsburg & Chudowsky, 2012) reveal that the percentage
of students missing at least 3 days of school in a given year has remained similar
in past decades. In particular:
• Students in grade 4 missed zero (51%), 1–2 (30%), 3–4 (12%), or 5+ (7%)
days of school in the past month.
• Students in grade 8 missed zero (45%), 1–2 (35%), 3–4 (13%), or 5+ (6%)
days of school in the past month.
• Students in grade 12 missed zero (38%), 1–2 (39%), 3–4 (15%), or 5+ (8%)
days of school in the past month.
Approximately one-fifth of students miss at least 3 days of school in a given
month. Absenteeism rates are generally higher for youth with lower reading achievement levels (25%–29% missing at least 3 days of school in the past
month). Absenteeism rates differ little across public and private schools, though
private schools tend to have slightly higher rates of perfect attendance in the
past month (50%–54%) than public schools (45%–50%). Absenteeism rates based
on missing at least 3 days of school in the past month are generally elevated for
youth eligible for reduced-price lunch (23%–25%) compared to youth ineligible
for reduced-price lunch (16%–22%). Illness accounts for substantial absenteeism
as well. Youths aged 5–17 years miss 6–10 days (10.9%), 11 or more days (5.1%),
or all days (1.0%) of school due to illness or injury in a given year (Centers for
Disease Control and Prevention, 2006).
Absenteeism rates based on missing at least 3 days of school in the past month
also differ somewhat by ethnicity:
African American (22%–23%).
Asian/Pacific Islander (11%-16%).
Native American/A laska Native (29%–34%).
These epidemiological figures focus on actual absences from school and do not
reflect the wider problems associated with the school refusal behavior spectrum
noted earlier (e.g., tardiness, skipped classes, and anxious and other behaviors
designed to induce school nonattendance). The prevalence of wider-spectrum
school refusal behavior has been speculated to be about 28% to 35% (Kearney,
2001; Pina, Zerr, Gonzales, & Ortiz, 2009). Many students in middle and high
school, for example, sometimes (54.6%) or often (13.1%) skip classes (Guare &
Cooper, 2003). Tardiness has been reported as problematic by 32% of principals
(National Center for Education Statistics [NCES], 1999–2000). Anxiety related to
school attendance is common as well and contributes to the spectrum of school
refusal behavior prevalence (Egger, Costello, & Angold, 2003).
Related to absenteeism figures are statistics for school dropout. Status dropout
rates are defined as the percentage of persons aged 16 to 24 years who are not
enrolled in school and who have not graduated from high school or achieved
an equivalency credential (NCES, 2012). The status dropout rate of 7% is an
improvement over the status dropout rate of 12% in 1990. Status dropout rates
are more elevated for males (7%) than females (6%). In addition, status dropout rates are more elevated for Hispanics and Native Americans/A laska Natives
(13% each) than Pacific Islanders (9%), African Americans (8%), Whites (4%),
and Asian Americans (3%).
Status dropout rates are also more elevated for family groups with low income
(12%) than for family groups with middle low (9%), middle high (4%), and high
(2%) income. Approximately 18% of dropouts had less than 9 years of schooling;
50% of dropouts had completed 11 to 12 years of schooling. The status dropout rate for those living in institutional settings, such as prisons or residential
health facilities, is 35% (NCES, 2012). The overall graduation rate for American
youth may be 68% to 71%, though this is considerably lower for minority youth
(50%) (Bridgeland, Dilulio, & Morison, 2006). Others claim that the national
high school graduation rate is 81.4% but that a particular focus is needed on
graduation rates for low-income, minority, English language learner, and special
education students in several key states (DePaoli et al., 2015).
EFFECTS O F A B S EN T EEI S M
Chronic absenteeism and school dropout are serious risk factors for economic
and other problems over time. Chronic absenteeism poses a high societal cost in
the form of billions of dollars in lost revenues, welfare and unemployment programs, underemployment, and crime prevention and prosecution (Christenson
& Thurlow, 2004). Chronic absenteeism has been linked as well to lower academic
performance and achievement, lower reading and mathematics test scores, fewer
literacy skills, grade retention, involvement with the juvenile justice system, and
eventual dropout. With respect to the latter, only 64% of youth with 10 or more
absences in 10th grade eventually graduate from high school, and only 53% of
these youth enroll in postsecondary education (Balfanz & Byrnes, 2012; Claes,
Hooghe, & Reeskens, 2009). Chronic absenteeism also leads to a greater likelihood of psychiatric, occupational, and marital problems in adulthood (Kearney &
Even small amounts of absenteeism can have serious consequences. Egger
and colleagues (2003) examined hundreds of absentee youth classified as anxious school refusers, truants, or mixed school refusers. Students needed to have
missed only one-half day in addition to symptoms such as worry, anxiety, or
leaving school without permission. Anxious school refusers missed an average
M anaging S chool A bsenteeism
of 4.2 half-days, and truant students missed an average of 6.6 half-days in a 3-
month period. The absentee groups displayed significantly more internalizing
and externalizing diagnoses than students without absenteeism. Other problems
generally more common among absentee students included school-related fears
and worries, sleep difficulties, and somatic complaints. Henry (2007), who studied youth in 8th and 10th grades who missed at least 1 day of school in a 4-week
period, also found that a relatively limited number of absences can have deleterious effects. The most robust predictors of absenteeism were substance use, poor
grades, and low educational aspirations. Calderon and colleagues (2009) found
that missing more than 7 days of school in 2 years predicted school dropout.
Schwartz and colleagues (2009) found that youth who missed 12% of school time
in an academic year had ill health, impaired self-efficacy, negative thinking, and
poor developmental competence. These studies indicate that even acute absenteeism is associated with myriad negative effects.
School dropouts are more likely than graduating peers to be unemployed,
impoverished, on public assistance, in prison or on death row, unhealthy,
divorced, and single parents whose children also drop out of school. High school
dropouts are estimated to earn $1 million less than college graduates in their
lifetime (Bridgeland et al., 2006). Average salaries for those who do not graduate
high school tend to be more depressed for females and for African Americans
and Hispanics. Average salaries for those who do not graduate high school are
66.1% that of those who do graduate high school and only 35.7% that of those
who have a bachelor’s degree (U.S. Census Bureau, 2012). Employment rates for
those aged 20 to 24 years who do not graduate high school are substantially lower
(48%) than for those who do graduate high school (64%) or who have a bachelor’s
degree (87%) (U.S. Department of Labor, 2012).
CAU S ES O F A B S EN T EEI S M
The causes of absenteeism are highly varied and can be aggravated by many contextual factors (Box 1.2). Primary contextual factors associated with a higher risk
for school absenteeism are briefly summarized here. Child-based factors related
to school absenteeism include a wide array of psychiatric disorders. These problems most commonly include anxiety and mood disorders (especially depression)
as well as disruptive behavior disorders, such as oppositional defiant and conduct
disorders (Kearney & Albano, 2004; McShane, Walter, & Rey, 2001). Externalizing
behavior problems are an excellent predictor of school absenteeism (Ingul,
Klockner, Silverman, & Nordahl, 2012). A growing amount of data has also linked
learning disorders to higher risk for absenteeism, though this risk does not seem
to be as elevated as that for emotional problems, such as anxiety and depression
(Chen, Culhane, Metraux, Park, & Venable, 2015; Lane, Carter, Pierson, & Glaeser,
2006; Redmond & Hosp, 2008). Other child-based factors are more specific to
older age. Many school dropouts leave school to get a job (32%), become a parent
(26%), or care for a family member (22%) (Bridgeland et al., 2006).
Key Contextual Factors Related to Problematic School
Extensive work hours outside
History of absenteeism
Learning-based reinforcers of
Low self-esteem and school
Personality traits and
Poor health or academic proficiency
Problematic relationships with
Race and age
Underdeveloped social and
Inadequate parenting skills
Low expectations of school
Problematic parenting styles
Poor communication with school
Poor involvement and supervision
School dropout in parents and among
Ethnic differences from school
Intense conflict and chaos
Large family size
Poor access to educational aids
Poor cohesion and expressiveness
Resistance to acculturation
Stressful family transitions
(e.g., divorce, illness,
Participation in gangs and gangrelated activity
Poor participation in extracurricular
Pressure to conform to group
demands for absenteeism or other
Proximity to deviant peers
Support for alluring activities outside
of school (e.g., drug use)
Victimization from bullies
Author Christopher A. Kearney Isbn 9780199985296 File size 1.79MB Year 2016 Pages 168 Language English File format PDF Category Psychology Book Description: FacebookTwitterGoogle+TumblrDiggMySpaceShare School absenteeism is a pervasive and difficult problem faced by mental health and school-based professionals. Even in mild forms, school absenteeism has been shown to be a significant risk factor for social, behavioral, and academic problems in middle childhood and adolescence, as well as psychiatric, economic, and occupational difficulties in adulthood. Problematic absenteeism has been examined for decades by professionals of many different disciplines, leading to a considerably fractured literature. Managing School Absenteeism at Multiple Tiers provides an integrative strategy for preventing, assessing, and addressing cases of youth with school absenteeism at multiple levels of severity and complexity. Dr. Christopher Kearney presents a multi-tiered framework based on prevention (Tier 1), early intervention for emerging cases (Tier 2), and more extensive intervention and systemic strategies for severe cases (Tier 3). Each tier is based on empirically supported strategies from the literature, and emphasis is placed on specific, implementable recommendations. This approach is based on a Response to Intervention model that has emerged as a powerful guide to prevention, assessment, and treatment of social and academic problems in schools. Response to Intervention is based upon tenets that parallel developments in the school absenteeism literature: (1) a proactive focus on early identification of learning and behavior problems and immediate, effective intervention, (2) universal, targeted, and intensive interventions, (3) frequent progress monitoring, (4) functional behavioral assessment, (5) empirically supported treatment procedures and protocols to reduce obstacles to academic achievement (including absenteeism), and (6) a team-based approach for implementation. This user-friendly, practical guide will be useful to mental health professionals, school administrators, guidance counselors, social workers and psychologists, as well as others who address kids with problematic absenteeism such as pediatricians and probation officers. Download (1.79MB) A Case-Based Approach to Emergency Psychiatry Psychosocial Approaches to Deeply Disturbed Persons Violent Attachments, 2n Edition Strengthening the DSM: Incorporating Resilience and Cultural Competence, 2nd edition Psychiatry of Intellectual Disability: A Practical Manual Load more posts