Portal de Periódicos da CAPES

PROTOCOL: Interventions Intended to Increase School Attendance in Elementary and Secondary School Students

2009; The Campbell Collaboration; Volume: 5; Issue: 1 Linguagem: Inglês

10.1002/cl2.52

1891-1803

Brandy R. Maynard, Katherine Tyson‐McCrea, Terri Pigott, Michael S. Kelly,

Educational and Psychological Assessments

School absenteeism, also referred to in the literature as school refusal and truancy, has been of concern to schools, courts, communities and social and behavioral scientists since compulsory education laws were first put into effect in the 19th century. Today, school absenteeism remains a serious problem that continues to plague this country and negatively impact our youth and their futures. There is a substantial body of literature related to school absenteeism; however, there is a lack of consensus and "considerable disparity about fundamental concepts of definition and meaning, assessment, and treatment" (Kearney, 2003, p. 57). Terminology utilized in this body of literature includes truancy, school absenteeism, school refusal behavior, school phobia, anxious school refusal, problematic absenteeism, and school non-attendance. There is no universally agreed upon definition for any of the terms used in the literature. Many terms are used interchangeably, are used differently by different authors and have evolved over the years. However, I will attempt to provide an overview of the terms and definitions frequently utilized in the literature to provide some understanding of how the terminology is utilized and in what contexts. Truancy Truancy is applied as an overall descriptive term for students who are absent from school for one reason or another, as well as used as a legal term referring to absences that are illegal as defined by statute. Broadwin (1932) broadly defined truancy as "absence from school without proper leave" (p. 253), citing various reasons why one might be absent from school. Reid (1999) more specifically defined truancy as "miss[ing] school illegally, with or without the consent of their parent" (p. xi). Some authors distinguish truancy from other forms of absenteeism as an absence which is unexcused, is done without the knowledge of the parent and is not due to anxiety or fear (Kahn, Nursten, & Carroll, 1981; Lauchlan, 2003). Truancy has also been used to refer to students whose parents keep their child home to work, take care of siblings, etc. (Kahn et al., 1981). Kearney (2008b) defined truancy as "unexcused, illegal, surreptitious absences, non-anxiety-based absenteeism, absenteeism linked to lack of parental knowledge about the behavior, absenteeism linked to delinquency or academic problems, or absenteeism linked to social conditions such as homelessness or poverty" (p. 452). In addition to the various ways in which truancy is used in the scholarly literature, the term truancy also carries local meaning (Reid, 1999). Different states have different compulsory education laws, thus making the definition of the term dependent upon state statues. School districts, and even different schools within the same school district, have different definitions of truancy and different standards for when they consider a child 'truant' (Garcia-Gracia, 2008). This makes it difficult, perhaps impossible, to find consensus regarding the meaning of the term truancy or to compare rates of truancy from one state or school district to another. School Refusal Behavior The conceptualization and definition of school refusal behavior has evolved over the years and has been employed differently by various authors/researchers. Kahn et al. (1981) defined school refusal as "cases where there is a psychosocial component" (p. 3). King and Bernstein (2001) define school refusal as "difficulty attending school associated with emotional distress, especially anxiety and depression" (p. 197). Kearney and Bates (2005) define school refusal behavior as "any refusal to attend school for an entire day by a child" (p. 207) and include youth who "miss long periods of school time; miss sporadic periods of school time, skip classes, or arrive tardy to school; or attend school with great dread and somatic complaints that precipitate pleas for future non-attendance" (p. 207). Kearney (2007) defined school refusal behavior as an "umbrella term that covers many hypothesized subtypes of youths with problematic absenteeism, including truancy, school phobia and anxiety-based school refusal" (p. 53). King & Bernstein (2001) defined school refusal as "difficulty attending school associated with emotional distress, especially anxiety and depression" (p. 197). School refusal behavior is often distinguished from truancy by 1) an absence of antisocial behavior/characteristics; 2) parental awareness of the problem and knowledge of the absence from school; and 3) presence of emotional distress, separation anxiety, anxiety and/or depression (Elliot, 1999; King, Tonge, Heyne, Pritchard, Rollings, Young, et al., 1998; Heyne, King, Tonge, & Cooper, 2001). There is considerable debate in the literature as to whether school refusal behavior should be more broadly used to encompass truancy as Kearney (2007) suggests or whether school refusal behavior should be distinguished from truancy as a different type of school attendance problem as Heyne et al. (2001) recommends. School Phobia The term school phobia is applied to describe students who are not attending school due to the fear of going to school and who meet DSM criteria for specific phobia (Fremont, 2003). Although the definition of school phobia is probably the most concrete of all the terminologies used in this body of literature, school phobia is often used interchangeably with school refusal behavior or gets subsumed under this more broad term (King & Bernstein, 2001). Kearney (2008) noted that the prevalence of students being phobic of school is rare and thus the term has been deemphasized in the literature. School Absenteeism and School Non-Attendance School absenteeism and school non-attendance are broad terms used interchangeably to describe an occasion when a student misses school, regardless of reason. Kearney (2008) defines absenteeism as "excusable or inexcusable absences from elementary or secondary (middle/high) school" (p. 452). School absenteeism and school non-attendance are more neutral terms than truancy, school refusal behavior and school phobia, as the former do not carry the emotive connotations associated with the latter (Reid & Kendall, 1982). Truancy, school refusal behavior and school phobia are all based on a pathological model, with non-attenders either being viewed as 'mad' or 'bad' (Carlen, Gleason, & Wardhaugh, 1992). Authors who utilize the terms school absenteeism and school non-attendance argue that these terms provide a non-pathological conceptualization of the problem and advocate the use of these terms over truancy and school refusal (Lauchlan, 2003; Lyon & Cotler, 2007; Pellegrini, 2007). Discussion of Terminology This brief overview of the terminology utilized in this body of literature highlights the lack of shared definition and conceptualization of the problem of school non-attendance. Although the literature often differentiates school refusal from truancy based on the reasons students are not attending school and whether or not the absence was known by the parents, some authors have argued that the distinction between the two terms and whether or not the absence was excused is unnecessary, counterproductive and logistically difficult (Lauchlan, 2003; Kearney, 2008; Lyon & Cotler, 2007; Pellegrini, 2007). In addition, the differences between students who are classified as truant and those classified as school refusers are not clear cut. There is considerable diagnostic heterogeneity in both groups and substantial overlap in symptoms (Egger, Costello, & Angold, 2003; Kearny, 2008). There is also evidence that some students can exhibit both truant behavior as well as school refusal behavior either concurrently or sequentially (Berg, Butler, Franklin, Hayes, Lucas, & Sims, 1993; Bools, Foster, Brown, & Berg, 1990). The utility of classifying students as excused or unexcused has come under debate. Some argue that the outcomes for students, schools and communities are the same regardless of the reasons for students missing school or if the absences were known by the parent (National Center for School Engagement, 2007). Eaton, Brener, & Kann (2008) found that absentee students, regardless of whether they had permission or not to miss school, are more likely to engage in risk behaviors than those with no absences. Malcolm et al., (2003) also argue that distinguishing between authorized an unauthorized absences in unhelpful. Schools apply the terms differently and accept a range of evidence for authorizations, thus making the distinction invalid, or at least inaccurate. Also, parents, or clever students posing as a parent, may provide an excuse for an absence after the fact, thus validating an absence as excused when it really was not. Malcom et al. (2003) argued that classifying absences in this way only masks the scale of the problem, thus reducing the imperative to seek solutions to the problem. Lauchlan (2003) and others argue that the problem of school non-attendance is heterogeneous and we should not be bogged down in making invalid and unnecessary distinctions when addressing the problem. Because of the conflicting, confusing and changing constructs and definitions used for school refusal behavior, truancy and other terminology, the categorical distinctions perpetuated in the literature have not necessarily been useful when responding to the problem (Kearney, 2003; Lauchlan, 2003). For the purposes of this systematic review, the term school absenteeism will be utilized throughout the review. School absenteeism will encompass the subcategories of research related to truancy, school refusal or other research examining the problem of students missing school for whatever reason, except when citing a specific study or body of literature that utilizes a different term/definition, to allow for a broad range of studies to be included. Accurately reporting the prevalence of absenteeism is challenging because of inconsistent reporting requirements and the use of multiple definitions and constructs of truancy, school refusal and school absenteeism (Kearney, 2003; Lyon & Cotler, 2007; Pellegrini, 2007). It is estimated that hundreds of thousands of youth are not attending school on a regular basis, many without an excuse (Baker, Sigmon, & Nugent, 2001). Several large inner-city schools systems report thousands of unexcused absences each day with some reporting absentee rates as high as 30% (Garry, 1996). According to the National Center for Education Statistics (2006), 19% of students in 4th grade and 20% of students in 8th grade reported missing three or more days of school in the preceding month. The study also noted that the patterns of absenteeism have remained relatively stable between 1994 and 2005. According to recent statistics available from the U.S. Department of Justice, the number of truancy cases petitioned and handled in juvenile courts increased 69% between 1995 and 2004, and accounted for the largest proportion (35%) of status offense petitions handled by the juvenile courts (Stahl, 2008). The problem of school absenteeism has several implications for the youth who do not attend school regularly as well has his/her family, school and community. The negative outcomes for the truant/absentee youth include delinquency, poor school performance, school expulsion and dropout, substance use and other risky and problematic behaviors (National Center for School Engagement, 2007; Petrides, Chamorro-Premuzic, Frederickson & Furnham, 2005; Reid, 1999). The economic implications for students are also significant. Students who are chronically absent are more likely to perform poorly in school and more likely to drop out, which negatively impacts their earning potential over their lifetime (Attwood & Croll, 2006; Garry, 1996). The implications for schools whose students are not attending at a high rate include loss of funds and failure to meet performance requirements (Goldstein, Little, & Akin-Little, 2003). Significant costs to communities associated with truancy/absenteeism include higher rates of criminal activity, citizens not productively contributing to the community and higher government spending for social services (Baker et al., 2001). Due to the seriousness and prevalence of the problem of absenteeism, researchers from several different fields, including social work, education, psychology, nursing and criminal justice, have attempted to understand and address the problem. A large body of literature has been accumulating over the past several decades related to the causes, correlates, outcomes and interventions with this population. The causes of school absenteeism have been given extensive attention in the empirical research in the field. Research indicates a number of factors that have demonstrated some causal or correlational relationship to school absenteeism. These include individual, family, school, and community/contextual factors. Individual risk factors associated with absentee youth include lower academic self-concepts, lower self esteem, less competent social relations, phobia, anxiety, personality traits, race/ethnicity and learning disabilities (Corville-Smith, Ryan, Adams & Dalicandro, 1998; Lounsbury, Steel, Loveland & Gibson, 2004; Malcolm, Wilson, Davidson & Kirk, 2003; Romero & Lee, 2008; Sheppard, 2005; Southwell, 2006). School factors identified as causal or correlational to absenteeism include school culture, curriculum, poor teaching, negative school environment, interpersonal conflict or poor relationships with teachers, dissatisfaction with school, school disciplinary practices, and threats to physical safety such as bullying (Corville-Smith et al., 1998; Enomoto, 1994; Malcolm et al., 2003; Reid & Kendall, 1982). Family factors, such as family conflict, poor/unhealthy family relationships, parental attitudes and values toward education, lack of cohesion, inconsistent and ineffective discipline, sanctioning/colluding of school absences by parents, parent-child interactions, parental involvement in school, family poverty and family structure have been implicated as causal/correlational factors in absenteeism research (Corville-Smith et al., 1998; Malcolm et al., 2003; McNeal, 1999; Romero & Lee, 2008). Community/contextual factors have also been found to have effects on school absenteeism. These factors include race/ethnicity, socio-economic status, employment and other opportunities in the community, neighborhood characteristics and level of organization, levels of social support, community norms, and community violence (Bowen, Bowen, & Ware, 2002; Lyon & Cotler, 2007; MacDonald & Marsh, 2007). School absenteeism is increasingly being recognized as a complex and heterogeneous problem that can be influenced by a number of factors (Kearney, 2008; Kim & Streeter, 2006; Lauchlan, 2003). Researchers and practitioners have developed various strategies targeting a number of risk factors that have been associated with absenteeism resulting in diverse intervention strategies being implemented in various settings. The number of interventions designed to increase student attendance have been growing substantially. In the United States, several federal and community initiatives have been established to reduce absenteeism. The Office of Juvenile Justice and Delinquency Prevention (OJJDP) established a database of programs that have shown some effectiveness in reducing truancy. Included in this database, the Model Programs Guide, are 16 model programs. The National Center for School Engagement lists 171 truancy programs registered in their database, of which 69 have had external evaluations and 30 have final evaluations completed. In addition to national initiatives to improve attendance, several national initiatives have also been implemented to reduce high school dropout. Although this review is concerned with absenteeism rather than the problem of school dropout, absenteeism is strongly associated with, and has been identified as a significant risk factor for, school dropout (Baker, 2001; Garry, 1996). As a result, many strategies utilized in dropout prevention programs focus on increasing student attendance, thus there is some overlap between absenteeism and dropout interventions. The National Dropout Prevention Center, for example, lists 60 model programs for truancy reduction in their database. This review will focus on interventions intended to increase student attendance, thus will likely include some studies of interventions that are identified as "dropout prevention" programs. Not all dropout prevention programs have an identified goal of increasing student attendance and do not measure attendance, thus many studies of dropout prevention programs will not meet criteria for this study. Because school absenteeism is a recognized problem among various disciplines, including education, psychology, social work, nursing, criminal justice, sociology and others, the conceptualizations of the problem as well as the approaches used to intervene with school absenteeism are diverse. Interventions targeting school attendance fall into several different categories, target a variety of different risk factors and levels, are implemented in different settings and are delivered through a variety of modalities. Interventions generally target individual risk factors, such as anxiety/phobia, low self-esteem, social skills and medical conditions; family factors, such as communication and parental support, discipline/contingency management, parental involvement and communication with the school; and school factors, such as school climate, attendance policies, relationships between teachers and students and bullying. Several interventions target multiple risk factors across all three levels. In addition to the variety of risk factors targeted, interventions also differ in terms of the settings in which the interventions are implemented. Interventions have been implemented in clinical and community agency settings, schools, courts and police agencies. Interventions may be conducted as part of a collaborative effort between community agencies, schools, courts and/or police agencies or by a single entity. Depending on the risk factor(s), the level being targeted and the setting(s) in which the intervention is being carried out, programs intended to increase student attendance are delivered in a variety of modalities. These include, but are not limited to individual therapy, parent training, family therapy, group therapy, monitoring/supervision, case management, incentives/rewards, fines/sanctions, prosecution, social service referrals, tutoring, teacher training/development, and school improvement strategies. Despite the widespread attention to this problem and the increase in interventions designed to reduce absenteeism, the issue remains a significant problem. The lack of consensus about definitions and conceptualizations of the problem as well as intervention strategies for youths with problematic absenteeism has contributed to the disconnection between sets of professionals studying absenteeism. While examining a problem from various perspectives can be productive, the study of absenteeism has remained disparate. Several authors in various fields studying the problems of student non-attendance have concluded that the problem of non-attendance is heterogeneous and lies along a continuum, thus maintaining a distinction between truancy and school refusal is unnecessary and can be counterproductive (Kearney, 2008; Lauchlan, 2003; Lyon & Cotler, 2007). They have called for a more inclusive and integrated conceptualization of absenteeism and a need to include all students exhibiting problems with absenteeism in research, assessment and treatment. Thus, this review will utilize a broad conceptualization of absenteeism. A search for previous reviews and meta-analysis of interventions related to the problems of school absenteeism, school refusal, school attendance, school non-attendance and truancy was undertaken. Six databases (ERIC, PsychInfo, Academic Search Premier, Dissertation Abstracts, Criminal Justice Periodicals and Pegasus (Loyola's book search), were searched and twenty-two reviews were identified. A summary of the findings of the search will be discussed below. Twenty-two reviews were identified (see Appendix A). There were no meta-analysis identified. Of the twenty-two reviews identified, 17 were traditional narrative reviews of the literature. Because these 17 reviews were very similar in their nature and content, the individual reviews will not be discussed in great detail. These literature reviews focused on literature regarding causes, correlates, diagnostic features, etc. as well as highlighted various treatment modalities, citing published intervention studies to provide evidence of effectiveness of the treatments included in the report. Much of the discussion of intervention in these reviews covered a range of programs and settings, providing discussion and descriptions of different types of interventions available. These reviews cited relatively few studies of interventions. In addition, none of these 17 reviews were systematic. They did not specify their search strategy or inclusion/exclusion criteria and they included only published studies. The outcome studies that were cited in the reviews used various methodologies including case studies, open clinical trials, randomized and non-randomized studies (see Appendix B). The reported findings primarily favored the intervention discussed. Many of these reviews also focused on the same literature base, yielding considerable repetition. This is especially the case as it relates to the reviews related to the subgroup of school refusal, which tends to cite the same studies on cognitive behavioral treatment and pharmacology. A narrative review of strategies to encourage attendance conducted by Railsback (2004) was more comprehensive and inclusive than the above traditional narrative reviews. Railsback "surveyed the last decade of research that discusses strategies or experiments to increase student attendance" (p. iii). The author did not describe her search strategy, but did include unpublished studies. The author's stated intent was to include only "scientifically based" research, but broadened her inclusion criteria to include a range of research designs as well as surveys and expert opinions because "it was quickly determined that little research of that kind [scientifically based] exists" (p. iii). The reviewer concluded that "we found no research that definitively answers the question: Do some strategies [to encourage attendance] work better than others?" (Railsback, 2004, p. 11). The author then summarized the literature and strategies found during the search and provided guidelines to readers interested in implementing policies and programs to increase student attendance. Three of the 22 reviews used narrative synthesis approaches and were narrow in focus. Two were of cognitive-behavioral interventions dealing with the treatment of school refusal (King, Tonge, Heyne & Ollendick, 2000; King, Heyne & Ollendick, 2005) and one was a review of welfare-school attendance programs (Cambpell & Wright, 2005). The 2000 review by King and colleagues included eight studies. The authors' search strategy was not specified; however, all studies in the review were published. Their inclusion/exclusion criteria entailed including only cognitive-behavioral interventions and all methods. The report concluded that "At first glance, our review of research suggests empirical support for cognitive-behavioral therapy in the treatment of school refusal …" (p. 501). "However, since very few controlled studies have been reported at this stage in treatment research, it would be premature to extol the clinical virtues of cognitive-behavior therapy" (King et al., 2000, p. 506). The 2005 review by King and colleagues focused on a broader topic of anxiety and phobic disorders, but did review seven studies on school refusal behavior. They limited the studies included to those studying behavioral or cognitive-behavioral treatments. The search strategy for this review included searching literature in peer-reviewed journals from 1980, but did not specify the year they used for the cutoff. The authors did not specify which journals or databases they searched, but provided some examples of specific journals they included. Of the seven studies included in this review, five of them were used in the previous review. One of the additional studies was a follow-up study of a randomized control trial included in the previous review and the other was a randomized trial with a comparison group which received an alternative treatment (which showed no significant difference between CBT and the alternative treatment). Although the authors used substantially the same studies in both reviews, they came to a different conclusion. The authors concluded that "overall, school refusal has responded to CBT programs as demonstrated in a number of controlled studies, with general maintenance of gains" (King et al., 2005, p. 249). The final review identified was a narrative listing of 23 model, promising and emerging truancy programs published by the National Dropout Prevention Council (Reimer & Dimock, 2005). The programs chosen for this publication were based on the author's familiarity with the program and if the program "demonstrated success and practicality of implementation in a variety of environmental realities and programmatic contexts" (Reimer & Dimock, 2005, p. 7). The authors did not specify the criteria they used to establish a program as a "success" and did not provide outcome data or method of evaluation in their narrative descriptions of the programs. Reviews and meta-analyses have also been conducted of interventions to target other related school problems, such as problem behaviors, school performance, and anxiety and phobic disorders, with school attendance being one of the measures used (King, Heyne, Ollendick, 2005; Little & Harris, 2003; Maughan, 2003; Mattison, 2000; Wilson, Gottfredson, and Najaka, 2001). However, not all studies included in these reviews and meta-analyses measured attendance as attendance was not the primary problem being reviewed. Thus there is limited information in these reviews related to interventions intended to increase attendance per se. In addition to published reviews of interventions targeting school attendance, lists of "model" truancy reduction programs have been developed by the OJJDP, the National Center for School Engagement (NCSE) and the National Dropout Prevention Center (NDPC). Only the OJJDP database of model programs specifies criteria for inclusion of programs in the database. They rate programs as exemplary, effective or promising dependent upon the rating criteria. Programs classified as exemplary must have demonstrated effectiveness using an experimental design; programs classified as effective must have demonstrated effectiveness with a quasi-experimental design; and programs classified as promising have demonstrated effectiveness using limited evaluation designs such as single group pre-post test designs. The rating and classification system is also based on four dimensions of program effectiveness: 1) conceptual framework of the program; 2) program fidelity; 3) evaluation design; 4) empirical evidence demonstrating the prevention of problem behavior; the reduction of risk factors related to the problem behavior; or the enhancement of protective factors related to problem behavior (OJJDP Model Programs Guide). The National Center for School Engagement's database is a self-registry of programs, requiring no minimum criteria to be met in order to be registered in the database. Thus programs that are ineffective could be listed amongst those that have demonstrated effectiveness. The National Dropout Prevention Center's list of model programs does not specify criteria by which the programs have been determined to be "model" programs. Although having lists of programs in various databases may be helpful at some level, merely listing programs with varying levels of evaluation and evidence of effectiveness can be misleading to those who are looking for programs to implement. A review and synthesis of these outcomes of interventions, using what is likely unpublished evaluations of the programs, is needed to summarize the extant research in this area, estimate the magnitude of the program impacts (effect size) and establish the evidence base for programs being disseminated through these guides and registries. The knowledge being gained about interventions to increase student attendance is growing substantially. From the literature reviews and lists of "model" programs, there seems to be a number of diverse programs that have been evaluated, both published and unpublished, providing a substantial body of research available for assessing the efficacy of interventions to increase student attendance. Unfortunately this knowledge is disparate, confusing, and much is possibly unpublished, making it difficult for policy makers and practitioners to use evidence of effectiveness to guide policy and practice. To date, we have not been able to locate a meta-analysis or systematic review of interventions intended to increase school attendance in primary or secondary school students. It is important to synthesize the intervention research to provide a comprehensive picture of interventions that are being utilized, to identify interventions that are effective and identify areas in which more research needs to be conducted to better inform practice and policy. This review will fill this gap in the literature with the ultimate goal of providing evidence-based guidelines to help guide policy makers and practitioners in helping students attend school regularly. The proposed systematic review will improve upon prior work in