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The social construction of school refusal

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Title:
The social construction of school refusal an exploratory study of school personnel's perceptions
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English
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Salemi, Anna Marie Torrens
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University of South Florida
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Subjects / Keywords:
school attendance
Absenteeism
Social constructionism
Qualitative methodology
School personnel
Dissertations, Academic -- Public Health -- Doctoral -- USF
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bibliography   ( marcgt )
theses   ( marcgt )
non-fiction   ( marcgt )

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Summary:
ABSTRACT: Despite a multi-disciplinary, international literature, little research has drawn attention to the phenomenon of school refusal within the school. Most research on school refusal follows a positivist paradigm, focusing on the student, instead of examining the role of schools. Using a qualitative design and a social constructionist framework, this study explored how school personnel perceive school refusal, focusing on the social interactions, processes, and perceptions that construct their understanding. The study was conducted in a large school district in the Southeastern United States.Semi-structured in-depth interviews were conducted with school personnel at the middle school (N=42), high school (N=40), and district level (N=10). Interviews at the school level included assistant principals, school psychologists, social workers, health services staff, guidance counselors, teachers, attendance office staff, and school resource officers. The district level interviews incl uded personnel in departments related to guidance, psychology, school health services, and social work. Observational data was collected within the schools selected for interviews (N=10). Thirty-eight out of 68 middle and high school principals in the school district completed the Survey of School Refusal.Findings suggest that school personnel rarely use the terminology set forth by the professional literature to describe the spectrum of school refusal. Further, analysis revealed that personnel delineate students who refuse school according to their own categorizations formed through day-to-day experiences with students. Personnel's constructions of school refusal differed based on legitimacy of the reason for refusal, motivation for refusal, grade level, and barriers, which were physical, mental, emotional, social, and societal in nature. Overarching dynamics of typifications of students included parental control, parental awareness, student locus of control, blame, and victim status. ^These typifications influence how personnel react to students they encounter, particularly in deciding who needs help versus punishment presenting very real implications for students.The findings from this exploratory qualitative study make a significant contribution to this literature. The findings support the use of social constructionism in understanding school personnel's construction of school refusal. Implications for education, public health, and school health practice are presented and include recommendations for policy, training, prevention, early intervention, and future research.
Thesis:
Dissertation (Ph.D.)--University of South Florida, 2006.
Bibliography:
Includes bibliographical references.
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by Ann Marie Torrens Salemi.
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Title from PDF of title page.
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Document formatted into pages; contains 352 pages.
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Includes vita.

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oclc - 132702970
usfldc doi - E14-SFE0001445
usfldc handle - e14.1445
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The Social Construction of School Refusal: An Exploratory Study of School Personnels Perceptions by Anna Marie Torrens Salemi A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Community and Family Health College of Public Health University of South Florida Major Professor: Kelli R. McCormack Brown, Ph.D. George Batsche, Ph.D. Roger Brindley, Ph.D. Jeannine Coreil, Ph.D. Donileen Loseke, Ph.D. Robert J. McDermott, Ph.D. Date of Approval: April 7, 2006 Keywords: school attendance, absenteeism social constructionism, qualitative methodology, school personnel Copyright 2006, Anna M. Torrens Salemi

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i TABLE OF CONTENTS LIST OF TABLES viii LIST OF FIGURES ix ABSTRACT x CHAPTER I: STATEMENT OF THE PROBLEM 1 Introduction 1 School Refusal 2 The Role of Public Health 3 Public Health Significance of School Refusal 4 The Role of School Health 9 Theoretical Perspective 12 Purpose of the Study 14 Research Questions 17 Delimitations 18 Limitations 19 Definitions of Relevant Terminology 21 CHAPTER II: REVIEW OF THE LITERATURE 25 Introduction 26 Overview of Schooling 27 School Refusal as a School Health Issue 28 Various Forms of School Absenteeism 29 School Dropout 30 Dropout, School Refusal, and Labeling 30 The Role of the School 32 The Role of School Personnel 35 Difficulties Within Schools 36 Public Health Implications of School Refusal 38 Identification of School Refusal 39 Occurrence of School Refusal 39 Characteristics of Students with School Refusal 41 Reported Estimates of School Refusal 42 Consequences of School Refusal 44 Short-Term Outcomes 44 Long-Term Outcomes 45

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ii Social and Economic Costs 45 Historical Construction of School Refusal 46 Defining School Refusal and Absenteeism as a Problem 47 Delineation of School Refusal from Other Forms of Absenteeism 47 Development of Clinical Knowledge 51 Ecological Expansion of School Refusal 53 School Refusal as a Complex Issue 54 Barriers to Future Advancement in Research and Practice 55 Theoretical Implications 56 Theoretical Perspective 58 History of Social Constructionism 59 Tenets of Social Constructionism 61 Critique of Social Constructionism 65 Applicability to Public Health 66 Applicability to School Refusal 68 School Refusal as a Cross Cultural Phenomenon 69 Social Construction of School Refusal 69 Discourses on School Refusal 71 The Adult Discourses 71 Psychiatric Discourse 72 Behavioral Discourse 73 Citizens Discourse 74 Socio-medical Discourse 75 Student Discourse 76 The Cultural Context of School Refusal 77 Popular Media and School Refusal 78 Overview of the School District of Shermer County 79 Summary of the Literature Review 81 CHAPTER III: METHODS 84 Introduction 84 Research Questions 85 Study Design 86 Study Population 88 Setting 88 Inclusion Criteria 89 Exclusion Criteria 89 Sampling Design 90 District Level Elite In-Depth Semi-Structured Interviews 90 School Level In-Depth Semi-Structured Interviews 91 Observations 95 Descriptive Self-Administered Survey 95 Data Collection Tools 95 In-Depth Semi-Structured Interviews 96 Elite In-Depth Semi-Structured Interviews 97

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iii Observations 98 Descriptive Self-Administered Survey 100 Data Collection Procedures 101 Levels of Permission, Negotiations, and Entry 101 In-Depth Semi-Structured Interviews 103 District Level Elite Interviews 105 Recruitment for District Level Elite Interviews 106 School Level Interviews 107 Recruitment for School Level Interviews 107 Observations 108 Descriptive Self-Administered Survey 109 Pre-Testing, External Review, and Pilot Testing 110 Levels of Confidentiality 112 Field Notes 113 Tape-Recording 114 Transcription 114 Debriefing 115 Non-Participation 116 Data Analysis 117 Qualitative Data Analysis 117 Analysis of the Survey 122 Interpretation 123 Trustworthiness and Quality in Qualitative Research 124 Credibility 125 Dependability 127 Transferability 128 Strengths and Weaknesses 128 Methodology Definitions 130 CHAPTER IV: RESULTS 133 Introduction 133 Research Questions 133 Final Sample 136 District Level Elite In-Depth Semi-Structured Interviews 136 School Level In-Depth Semi-Structured Interviews 137 Observations 139 Descriptive Self-Administered Survey 140 Description of Study Participants 140 Demographic Characteristics of Interview Participants 140 District Level Participants 140 School Level 141 Individual Participants Within Schools 141 Demographic Characteristics of Survey Participants 142 Section I: Establishing an Understanding of Personnels Attendance Issues Frame of Reference 142

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iv School Personnel and Their Roles 143 Categories of School Personnel 143 Perceptions of Absenteeism 145 Constructing Meaning for Terminology 146 Absenteeism 148 School Refusal 149 School Phobia 150 School Avoidance 152 Separation Anxiety 153 Applied Use of Terminology Within the School Setting 154 Reported Reasons for Absenteeism 154 The Role of the School 157 The Role of the Family 158 Perceived Barriers to Attending School 160 Perceptions of Remaining in School All Day 163 Examples of Perceptions of Bullying 164 Examples of Low Connectedness 164 Section II: Exploring School Personne ls Reported Perceptions of School Refusal 165 Descriptions of School Refusal as a Behavior 166 Descriptive Terms and Words 166 Described Differences in School Refusal by Grade Level 168 Describing School Refusal as School Phobia 170 Parents Role in School Phobia 174 School Refusal as a Symptom 175 Illness as School Refusal 177 Legitimate and Non-Legitimate Illness 178 Mental Illness as School Refusal 183 Schools and Their Environment 184 Cycles and Patterns of School Refusal 187 Describing the Student with School Refusal 188 Constructing the Student Experience of School Refusal 189 Internal versus External Experiences of the Student 190 Family as a Description of the Student 191 Attributes of Students Who Refuse School 192 The Reported Disconnect of Students Perception of Reality 196 Deconstructing Stories of School Refusal 197 Differentiating Students 198 Evaluating Experiences 199 Interacting with Students 199 Other Personnel 201 Perceptions of Parental Influence 202 Typifications of Students 204 The Defiant Student: Theyre not fearful; they just want a good time 206

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v The Adult Student: Theyre the quasi-head of the household 208 The Failing Student: Caught in a vicious cycle 210 The Bored Student: The lazy gifted student 211 The Invisible Student: Just passing through 212 The Physically Refusing Student: Drag em in 213 The Socially Uncomfortable Student: They just dont fit in 214 The Sick Student: What medical condition? 215 The Victim: Bullied and abused 217 Composites of Two Typifications 218 Jose: The Defiant Student 218 Brittany: The Sick Student 219 Influences on School Personnel and their Understanding of School Refusal 220 Internal and External Influences on Personnels Perceptions 221 Frustration as an Influence 223 The Politics of Attendance 225 Section III: Identification and Intervention in the Practical World 227 Identification of Students with School Refusal 227 Deviations from the Intervention Protocol 228 Differentiating Student Referrals 228 Personnel Perceptions of the Process 229 Perceived Outcomes of School Refusal 230 Personnels Concerns for Students Refusing School 230 Programs 232 Alternatives for Students Refusing School 234 Withdrawing Students from School 234 Recommendations for Schools from Schools 236 The School Setting 236 Working with Students Who Refuse School 237 The Role of Parents 239 Results from the Survey of School Refusal 240 School Demographics 241 Student Population 241 Identification and Response to School Refusal 241 System of Identification 241 School Personnel 243 School Refusers 244 Characteristics of School Refusal 244 The School Response to School Refusal 245 Summary of Results 247 CHAPTER V: CONCLUSIONS 250 Introduction 250 Study Summary 250 Study Background 250 Purpose of the Study 251

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vi Methods 252 Key Findings 252 The Language of Attendance Issues and School Refusal 253 General Constructions of School Attendance Issues 257 Descriptions of School Refusal as a Behavior 261 Describing the Student Who Refuses School 265 Deconstructing School Personnels Stories of School Refusal 268 Influences on School Personnel and their Understandings of School Refusal 271 Identification and Intervention in School Refusal 273 Perceived Outcomes of School Refusal 276 Recommendations 277 The Survey of School Refusal 278 Prevalence and Characteristics of School Refusal 279 School Response 281 Summary Conclusions 283 Limitations of the Study 290 Sample 290 Study Design 291 Data Collection Tools 292 Interviews 292 Observations 294 The Survey of School Refusal 294 Strengths of the Study 295 Sample 295 Study Design 295 Data Collection Tools 297 Implications and Recommendations 297 Recommendations for Education, Public Health, and School Health Practice 299 Dissemination of Findings 299 Policy 300 Educational Training 302 Prevention and Early Intervention 303 Recommendations for Research 304 REFERENCES 307 APPENDICES 326 Appendix A: Delineated Terms and Definitions Related to School Refusal 327 Appendix B: Timeline for Data Collection 328 Appendix C: Approval to Use the Survey of School Refusal 329 Appendix D: General Interview Guide 330 Appendix E: Probes for Interviewing 334

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vii Appendix F: Demographic Information Sheet 335 Appendix G: Document Extraction Tool 336 Appendix H: Observation Guide 337 Appendix I: Survey of School Refusal 338 Appendix J: Pre-Testing Protocol 342 Appendix K: Summary of Pre-Testing Findings 343 Appendix L: External Review Panel 344 Appendix M: Summary of Pilot Study Findings 345 Appendix N: Identification and Intervention in School Refusal 348 ABOUT THE AUTHOR End Page

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viii LIST OF TABLES Table 1 Purposeful Sampling Matrix for Elite District Level Interviews 91 Table 2 Purposeful Stratified Random Sampling Matrix for School Level 94 Interviews Table 3 Final Sampling Matrix for School Level Interviews 139 Table 4 Typifications of Students with School Refusal 205 Table 5 School Level and Geographic Location 241 Table 6 Number of Absences Considered as Excessive Absenteeism 242 Table 7 Personnel Responsible for Identifying School Refusers 243 Table 8 School Population and Identified School Refusers 244 Table 9 School Refusers: Complaints & Reasons 245 Table 10 Actions Taken With Students Identified as School Refusers 246 Table 11 Referrals Made for Students Identified as School Refusers 246

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ix LIST OF FIGURES Figure 1 Sample Printout of a Transcript in Ethnograph v.5.08 119 Figure 2 Sample Printout of Inserted Codes 120 Figure 3 Sample Printout of All Responses with the Same Code 121

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x THE SOCIAL CONSTRUCTION OF SCHOOL REFUSAL: AN EXPLORATORY STUDY OF SCHOOL PERSONNELS PERCEPTIONS Anna M. Torrens Salemi ABSTRACT Despite a multi-disciplinary, international literature, little research has drawn attention to the phenomenon of school refusal within the school. Most research on school refusal follows a positivist paradigm, focusing on the student, instead of examining the role of schools. Using a qualitative design and a social constructionist framework, this study explored how school personnel perceive school refusal, focusing on the social interactions, processes, and perceptions that construct their understanding. The study was conducted in a large school district in the Southeastern United States. Semi-structured in-depth interviews were conducted with school personnel at the middle school (N=42), high school (N=40), and district level (N=10). Interviews at the school level included assistant principals, school psychologists, social workers, health services staff, guidance counselors, teachers, attendance office staff, and school resource officers. The district level interviews included personnel in departments related to guidance, psychology, school health services, and social work. Observational data was collected within the schools selected for interviews (N=10). Thirty-eight out of 68 middle and high school principals in the school district completed the Survey of School Refusal. Findings suggest that school personnel rarely use the terminology set forth by the professional literature to describe the spectrum of school refusal. Further, analysis

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xi revealed that personnel delineate students who refuse school according to their own categorizations formed through day-to-day experiences with students. Personnels constructions of school refusal differed based on legitimacy of the reason for refusal, motivation for refusal, grade level, and barriers, which were physical, mental, emotional, social, and societal in nature. Overarching dynamics of typifications of students included parental control, parental awareness, student locus of control, blame, and victim status. These typifications influence how personnel react to students they encounter, particularly in deciding who needs help versus punishment presenting very real implications for students. The findings from this exploratory qualitative study make a significant contribution to this literature. The findings support the use of social constructionism in understanding school personnels construction of school refusal. Implications for education, public health, and school health practice are presented and include recommendations for policy, training, prevention, early intervention, and future research.

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1 CHAPTER I: STATEMENT OF THE PROBLEM Introduction The phenomenon of school refusal occurring in schools falls within the scope of public health and the role of pub lic health in school settings. School refusal, also referred to as separation anxiety, school phobia, or schoo l avoidance, is a term that encompasses an array of reasons and explanations for the avoidance of school attendance by children and youth. Most of the contemporary literature has cited the preference for the term school refusal because it recognizes the hete rogeneity of the problem. School refusal, however it is described, incites much di stress among students, families, and school personnel (King & Bernstein, 2001). The general definition used in this stu dy describes school refusal as student refusal to attend school for various unexplained reasons (Kearney, 2001). In addition, it refers to students who have difficulty in attending school or re maining in school for the entire day (Stickney & Milt enberger, 1998, p.162). More specif ically, this study focused on the phenomenon of school refusal as it occurs within the middle and high school setting which serve as major school tran sitions (King, Ollendick, & Tonge, 1995) (Appendix A Delineated Terms and Defin itions Related to School Refusal). This chapter provides an overview of the literature on school refusal from a public health perspective, explaining the rationale for why it s hould be considered a public

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2 health issue. The significance of school refu sal as a public health issue is addressed, and situated within the sub-field of public health; school health. A descri ption of the role of school health in public health provides furthe r justification for this approach to school refusal. A synopsis of the theoretical framework of social construc tionism is presented, followed by a brief explanation of the study, the research questions addressed, and the limitations and delimitations that guided the st udy. Definitions of terminology used in the study are provided at the e nd of the chapter. School Refusal The literature on school refusal appears in various fields, including psychology, social work, nursing, education, and medici ne (Berg, 1997; Berry, 1993; Freemont, 2003; Harris, 1980; Kearney, 2003; McAnanly, 1986). Th e field of school health, nested within public health, has been slow to acknowledge sc hool refusal as a school health issue, with limited literature originating from this pe rspective (McAnanly, 1986; Torrens Salemi & McCormack Brown, 2003). School psychology as a field has dominated the research on school refusal, directing research attention to the individual student and their family. This has led to the construction of school re fusal as a mental health issue. School refusal is also discu ssed cross-culturally. Claims 1 made related to the definition, cause, and prevalence of school refu sal, as well as its appropriate treatment, appear in literature originating from th e United States, Japan, England, Russia, and Australia (Elliott, 1999; Kearney, 2001; Ki ng et al., 1995; Shilov, 1998; Wataru, 1990; Yamazaki, 1994; Yoneyama, 2000). While the Un ited States primarily addresses this problem on an individual, psycho-social level, other countries such as Japan, claim that 1 Claims refers to any verbal, visual, or behavioral statement that tries to convince people to take a condition seriously (Loseke, 2003).

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3 the construction of school refusal arose from the social and cultural context, which led to the medicalization 2 and demedicalization 3 of school refusal (Yamazaki, 1994). The Role of Public Health The two goals of Healthy People 2010 are 1) improve quality of life and 2) eliminate health disparities (U.S. Department of Health and Human Services [USDHHS], 2000). One indicator of quality of life is s ound physical and mental health (USDHHS, 2000). All aspects of health are affected by sc hool refusal, includi ng the physical, mental, social, and emotional. Ranging from the somatic affects of the refusal on the student to the stress experienced by all pa rties involved, school refusal ca n affect a childs quality of life. Furthermore, if the situa tion is not resolved, the affect s on long-term quality of life could prove devastating. The lack of education, or a poor experience within the students matriculation can reve rberate throughout life. The second goal of Healthy People 2010 seeks to eliminate health disparities, which ma y be partially attributed to issues such as lack of education (USDHHS, 2000). Education is cited as a factor in a lo nger, healthier life (USDHHS, 2000). This is attributed to many factors rela ted to having an education, such as literacy and the ability to attain higher paid, more satisfying em ployment. Higher levels of education increase the possibility of obtaining and interpreti ng health-related information required to develop positive health beha viors (USDHHS, 2000). The unde rlying problems that could arise from an unresolved case of school refusal are discernible. 2 Medicalization describes a process of defining and treating non-medical problems as medical problems, usually illnesses or disorders (Conrad, 1 992; Coreil, Bryant, & Henderson, 2001). 3 Demedicalization refers to a problem that no longer retains its medical definition.

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4 Koplan and Fleming (2000) asserted te n challenges for pub lic health, two of which are pertinent to the issue of school re fusal. The first is that the emotional and intellectual health of children is a need that must be addressed in public health (Koplan & Fleming, 2000). The ability to recognize and addr ess the contributions of mental health to overall health and well-being is the second challenge faci ng public health (Koplan & Fleming, 2000). While mental health and public health function as separate entities in society, within the school setting, mental he alth is a key servic e within the schools continuum of care. The Centers for Disease Control and Prevention sets forth in its research agenda that public health must acknowledge and investigate the multidimensional factors of health includi ng the social ecological environment. Public Health Significance of School Refusal Prevalence rates of school refusal are di fficult to ascertain due to the myriad of conceptualizations of student absenteeism. Rates are further c onfounded by inconsistent and unstandardized reporting systems. Accurate prevalence rates depend upon how absenteeism related to school refusal is defi ned, thus given the lack of consistency and consensus, the reported prevalence rates vary (King et al., 1995). General absenteeism rates range from 5.5 to 20% on an average school day (Bell, Rosen, & Dynlacht, 1994; U.S. Department of Education National Cent er for Education Sta tistics [NCES], 2004). Kearney (2001) provides a best guess base d on various absenteeism data that as many as 28% of school-aged children in Amer ican refuse school at some point during their education. Most studies on school refusa l estimate the prevalence as 1-8% of the school age population in United States (Be rry, 1993; Cerio, 1997; Lee & Miltenberger, 1996).

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5 The issue of student absenteeism, a sym ptom of school refusal, did not become an issue in society until seve ral key points in time. Industria lization led to different labor needs, and children were no longer in demand as members of the wo rkforce (Best, 1994). Furthermore, the nostalgic sentiment attached to children did not emerge in culture until the late 17 th and early 18 th centuries (Best, 1994). Likewise the mandate of compulsory education created social norms related to school attendance. School absenteeism has been constructed as a syndrome within various contexts. School withdrawal refers to a parent enc ouraging nonattendance or deliberately keeping the child out of school (Kahn, Nursten, & Carroll, 1981). School dropout is the permanent withdrawal from school prio r to completion (Kearney, 2001). School resistance, which refers to students reactions to perceive d injustices or excessive demands, can also result in school absent eeism (Fine, 1991; Kearney, 2001). Truancy, also resulting in absenteeism, is often linked with delinquency and willful disobedience (Berg, 1997; Kearney, 2001). The absenteeism associated with school refusal is a major issue given that if a student is not in school, they are not learning (Kearney, 2001). Schooling is a key element to modern society; ther efore, when it is disrupted in any way, prompt attention is necessary (Garcia & Martin ez-Urrutia, 1984). School refu sal and the associated absenteeism can lead to severe short and l ong-term consequences for students, families, education, and society. Short-term consequen ces include distress, lowered self-esteem, problems with school work, decreased academic achievement, social alienation, family conflict, troubled peer rela tionships, and increased risk of legal trouble (Evans, 2000; Kearney, 2001; Last & St rauss, 1990; Want, 1983).

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6 Follow-up studies of school refusal cases document the possible long-term consequences of school refusal. The findings of these studies must be considered in light of sample bias, small sample sizes, and th e conceptual issues already mentioned. How schools perceive and identify such students has not been documented, making it difficult to conduct long-term follow-up with these stude nts. Most schools lack a formal reporting system for school refusal, further compli cating such follow-up (Evans, 2000). Truancy, school dropout, lack of higher education, em ployment troubles, and social problems represent long-term outcomes (Evans, 2000; Kearney, 2001; King & Bernstein, 2001). One potential outcome of school refusal, school dropout, represents an occurrence that reverberates throughout an individuals lifetime. Although school refusal is not definitive as a predictor of school dropout, it is a possibility if school refusal is not identified and resolved in a timely manner. The other factors that may influence school dropout include community, school, parent-fam ily, social, personal, academic success, and various other fact ors (Kearney, 2001). On average, dropouts are more likely to be unemployed, earn less money, and receive public assistance (Allensworth, La wson, Nicholson, & Wyche, 1997; Kaufman, Alt, & Chapman, 2001). The effects of dr opping out are multifactorial, impacting education, literacy, and the ability to attain employment. One of the Healthy People 2010 school health-related objectives includes increasing the high sc hool graduation rate. Attainment of a high school education in creases the possibility of obtaining and interpreting health-re lated information (Allensworth et al., 1997; USDHHS, 2000). The inability to access and understand health inform ation has negative implications for health behaviors in general.

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7 In terms of mental health outcomes, cl aims have shown that school refusal is associated with mental health disorders. Several follow-up studies have demonstrated, based on various factors, that school refusal may serve as a precursor to adult mental health disturbances (King et al., 1995). Ber g, Butler, and Hall (1976) conducted a threeyear follow-up with 100 adolescent students who received in-patient treatment for school refusal. Approximately one-third of the students continued to experience school attendance difficulties, social impairments, and emotional disturbance. Another third, while improved, experienced anxiety and depression. The remaining group resumed regular school attendance and social interactions (Berg et al., 1976). Berg and Jackson (1985) conducted a tenyear follow-up with adolescent school refusers and found over half to be well-adj usted. However, about one-third had required some type of psychiatric follow-up during the ten-year period (Berg & Jackson, 1985). One follow-up study with adults who had sc hool refusal as adolescents revealed increased psychiatric disorders with a significantly higher ra te of outpatient psychiatric treatment than the control group (Flakiersk a-Praquin, Lindstrom, & Gillberg, 1997). They did not find differences between the two gr oups on factors such as school completion, marital status, or criminal offenses (Flakierska-Praquin et al., 1997). One hypothesis that has been proposed is that there is a relationship between adult agoraphobia 4 and school refusal in adolescence (King et al., 1995). This has been explored through retrospectiv e studies focusing on adults with agoraphobia. Tyrer and Tyrer (1974) conducted interviews with 240 adult patients with agoraphobia, chronic anxiety, and depression as well as with a control group. Relatives, hospital records, and 4 Agoraphobia is defined as a f ear of open or public spaces.

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8 physicians confirmed any reports of school refu sal. The adult patients reported a greater incidence of school refusal than did the c ontrol, although there was no association with agoraphobia. The findings did support the no tion of an increased likelihood of adult mental health issues among school refusers. The long-term consequences associated w ith school refusal are related to the burden of mental illness on the health a nd productivity of the population (National Institute of Mental Health [NIMH], 2001). Ov er 15 percent of the burden of disease in market economies like the United States is due to mental illness, including suicide (NIMH, 2001). The prevalence rate of mental illness among children and adolescents is not well documented, but it is estimated that about 20 percent of children have mental disorders with at least mild func tional impairment (USDHHS, 1999). Evans (2000) pointed out that the societ al costs of school refusal may include reduced productivity and increase d educational costs. This is partially supported as some studies have shown that as students miss more days of school, educational institutions lose money and instructional time (Williams, 2002). Additionally, the long-term costs of mental illness are substa ntial (USDHHS, 1999). The direct costs of mental health serv ices in the United States in 1996 totaled $69.0 billion, which is 7.3 percent of tota l health expenditures (USDHHS, 1999). The indirect costs are defined in terms of lost productivity at work, school, and at home due to disability and death (USDHHS, 1999). De veloping a stronger unde rstanding of how school refusal is constructed in the school setting may provide better mechanisms for assurance of the physical, emotional, and inte llectual health so that students may develop into healthy and productive adults.

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9 Education has been associated with mental health status (World Health Organization, 2001). The risks to mental health from educational experience stem from dropout during secondary school (which includes grades beyond the elementary level), therefore the emphasis is to prevent attrition prior to en trance into secondary school (World Health Organization, 2001). The World Health Organization (1948) de fined health as, a state of complete well-being, physical, social, a nd mental, and not merely the absence of disease or infirmity (p.100). Similarly, school health as conceptualized by the Coordinated School Health program, addresses the physical, so cial, and mental well -being of students, through the assurance of a heal thy school environment, health education, and services (Allensworth et al., 1997). The Role of School Health Historically, schools have played a strate gic role in public health, providing a myriad of health and social services for the student population (Alle nsworth et al., 1997). In 2001, Turnock described public health as the collective effort to identify and address the unacceptable realities that result in preventable and avoidable health outcomes and it is the composite of efforts and activities carried out by people committed to these ends (p.19). He suggested the greatest gains in al leviating todays major health problems will come from collective action, especially at the community level. Community is defined not in geographic terms, but as aggregates of individuals who share common characteristics or other bonds and who effec tively use assets to achieve their health goals (Turnock, 2001, p.311).

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10 The mission of school health parallels and relates to the missi on of public health. Whereas public healths mission is to fulfill societys interest in assuring conditions in which people can be healthy, school health s eeks to assure conditions in which children can be healthy (Institute of Medicine [IOM], 1988, p.7). The IOM report (1988) included the need to focus on the main sectors of soci ety that impact the health of the population. This includes the community, of which schools serve as a key component. The concept of healthy people in healthy communities translated in the National Education Goals, which state that schools s hould have students with healthy minds and healthy bodies so that learning may take place (Allensworth et al., 1997). Schools are mini-communities, enmeshed within larger social contexts. Students comprise one component within this complex and dynamic syst em we refer to as school. Composed of multiple parts, schools create a community within existing communities, which mesh to create the individual school climate. The school setting promotes accomplishment of the core public health functions, as well as achievement of th e 10 essential public health functions (Noland, Troxler, & Torrens Salemi, 2004). McGinnis and DeGraw (1991) cited that one-third of the Healthy People 2010 objectives could be met or significantly achieved within th e school setting. Serious health problems faced by children incl uding chronic lifestyle diseases such as obesity, diabetes, high blood pressure, and the social and cultural conditions that breed depression, anxiety, and poor self esteem demand a change in service delivery approach (Peterson, Cooper, & Laird, 2001). School health and public health must focus on more than the physical aspects of stude nt health, such as the emoti onal and social aspects.

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11 Comprehensive school health consists of an organized set of policies, procedures, and activities desi gned to protect and promote th e health and well-being of students and staff which traditionally incl udes health services, a healthful school environment, and health education (Joi nt Committee on Health Education Terminology, 1991) and provides an alternate mechanism fo r the assurance functi on of public health. School environment, education, and services ar e critical areas of school health, providing various avenues for addressing school refusal (Allensworth et al., 1997). The concept of a healthy school environment refers to safe physical surroundings, supportive policy and administration, a nd a healthy psychosocial environment (Allensworth et al., 1997). Health education, within the area of education, is charged with addressing the physical, mental, emotional, and social dimensions of health. Services within schools include the provision of counsel ing, psychological, and so cial services that promote academic success and address the emotional and mental needs of students. Kolbe (2002) proposed that CSHP can assist schools in achieving their educational goals, while simultaneously addre ssing public health concerns. He discussed four types of goals in education. Type I incl udes health attitudes, knowledge, and skills. Type II involves health behaviors and outco mes. Type III represents the main goal of educational outcomes, while Type IV addresse s broad social outcomes. This corresponds with the previous delineation of two perspectives on health edu cation by Lohrman, Gold, and Jubb (1987). They declared that school health education could be viewed as technical, providing the means to increasing the likelihood of a student becoming a good, productive member of society or it can be idealistic, by adding to the holistic nature of learning, enabling them to learn better and become healthy.

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12 These perspectives of school health recognize the potenti al and need to address such issues as school refusal, which is a thre at to health that ar ises from the social environment and behavior, and could be cons idered a social morbidity (Simons-Morton, Greene, & Gottlieb, 1995). School health is con cerned with, the institutions and social conditions that impede or facilitate individuals toward achieving optimal health (Griffiths, 1972). A widening range of behavioral issues in the school institution including school refusal, place youth at an incr eased risk for dropout and, therefore, serve as obstacles to achieving optimal health. This risk status brings school refusal into the purview of school health. Theoretical Perspective It is evident that school refusal, despite its variations in conceptualizations, is an important school and public he alth issue. Traditionally, sc hool refusal research focuses on the individual student from a traditional positivistic approach. The implicit assumption of existing research is that the researchers know and unders tand the social processes and construction of meaning surrounding school refusal within the school setting. This has led much of the research to search for a single truth or reality of school refusal; a truth that is context free (Slife & Williams, 1995). It focuses on the reality of school refusal as understood by the researchers, failing to take into account the subjective experiences of those who are working directly with this popul ation of students the school personnel. The theoretical underpinnings of pa st school refusal research include psychodynamic theory and attachment theor y. Psychodynamic theorys assumption of the unconscious and conscious mind locate the issue of school refusal within the child and, while fruitful, has led to what might be c onsidered victim blaming. Attachment theory

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13 conceptualizes school refusal as the produc t of an overly depende nt caregiver-child relationship, situati ng the issue within the family unit and the child (Last, 1988). School personnel work with large numbers of students on a daily basis; therefore, research aimed at understanding their experien ces with these students could lead to the development of far-reaching prevention and ea rly intervention efforts as opposed to individualistic approaches to school refusal. The literature has posited that there is a tendency for school personnel to place all st udents exhibiting school refusal into one category (Phelps, Cox, & Bajorek, 1992). This is an important point, given the various conceptualizations of school refusal. Labeling a child as such can make intervention difficult (Phelps et al., 1992). This research expands the literature by exploring how school personnel make sense of school refusal. This study uses a social constructionist framework, which proposes that reality and the social phenomen a of life are socially constructed (Berger & Luckmann, 1966). Social constructionism is an epistemological theory that suggests that people socially construct meaning through social processes and inter actions (Burr, 1995; Loseke, 2003). Pilkington and Piersel (1991) cite d the need for school refusal research to focus on the school. There has been a considerab le lack of attenti on on the school setting, in particular on the school personnel in relation to school refusal (Stickney & Miltenberger, 1998). The use of this framew ork represents a shift from the typical approach to understanding school refusal w ithin the context of the school setting. Social constructionism acknowledges that people construct their reality, and that this reality is not concrete and absolute, but is itself a perception of reality. Loseke (2003) indicated that although these cons tructions are perceptions of r eality, they still have real

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14 life implications. Therefore, this theory gui des the exploration of how school personnel construct their perceptions of school refusal. In addition, there is a need to understand how those perceptions affect in teractions with students who portray the signs associated with school refusal. Purpose of the Study The study investigates how school personnel construct th eir perceptions of school refusal within the school setting and how their perceptions affect interactions and social processes with students who experience school refusal. School personnel are cited as being primarily responsible for identifying sc hool refusal, therefore the focus is on this particular sphere (Bernstein, Svingen, & Garfinkel, 1990; Stickney & Miltenberger, 1998). The use of the sociological framework of social constructionism assists in increasing our understanding of how schools a nd school personnel construct the meaning of school refusal. Social constructionism a sserts that knowledge is created and recreated through social interactio ns; therefore, school personnels pe rceptions of school refusal are likely shaped by their interactions with st udents, other personne l in the school, the district, and the larger culture in which they are located (B urr, 1995; Loseke, 2003). It is how we make sense of conditions, experi ences, and people in commonsensical ways. This assumes that perceptions and interac tions reciprocally determine one another through an iterative process. Fi ndings from a preliminary stud y revealed that researchers in the field of school refusal and school personnel conceptualize the terminology and definitions of school refusal differently (Torrens Salemi, 2004).

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15 This preliminary study conducted two separa te Delphi panels; one consisted of national researchers on school refusal, and the second consisted of school personnel from the School District of Shermer County 5 the same school district in which the current study was conducted. The panel of school pers onnel chose to use the term school phobia (focusing on the reason) vi ewing it as the more appropriate term, as opposed to researchers use of the term school refusal (focusing on the behavior). Therefore based on these findings, in the study described here the researcher refrained from using predefined researcher descriptions. This allowed th e participants to play a role in defining the behavior of school refusal in their own terms. The findings from this study will help bri dge the gap that exists in translating research into practice (Glanz, Lewis, & Rimer, 1997; Kearney, 2003). It also expands upon existing research by adding insight into the multiple perspectives of school refusal. Theoretically, this research represents a type of paradigm shift, possibly contributing to the conceptualization of school refusal, as it currently exists Practical implications of this research include possible recommendations for prevention, early in tervention, and staff training. Broader implications include development and implementation of school health and education policies related to school refusal. Additionally, research focusing on school staff may pinpoint potential bias within the identification proce ss, and in turn, shed light on why low prevalence rates of school refusal ex ist. It could assist in the development of specific tools to use in assessing valid prevalence rates. 5 All proper nouns have b een replaced with pseudonyms to protect the identity and anonymity of study participants and locations. Additionally, all references that might identify the location of this study have been removed. The assignment of pseudonyms prevents the reading of this text from becoming monotonous.

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16 This study employs a contextu al (or dualist) so cial constructioni st perspective, acknowledging that the structure of the school and its organization are real in regards to the day-to-day lives of personnel and students. The framework of social constructionism also guides more than the focus of the resear ch questions addressed in this study. Social constructionism proposes that there is no si ngle truth or reality, but rather, multiple, constructed perceptions of reality. Multiple data points were employed to capture the multiple realities of the school personnel and the school district. Social constructionism also calls for reflexivity on the part of the researcher. The framework of social constructionism also guided the methods for this study. Semi-structured interviews with school personnel at the middle school, high school, and district levels in the School District of Shermer County 6 were conducted to gain an understanding of the social cons truction of school refusal. School personnel interviewed at the school level included the assistant prin cipals, school psychologists, social workers, health services staff, gui dance counselors, teachers, attendance office staff, and school resource officers. The dist rict level interviews were conducted with personnel in departments related to guidan ce, psychology, school health services, and social work. Any school personnel in their fi rst year of employment were excluded from the study, as the likelihood of cumulative interacti ons with students with school refusal was limited. The interviews provided qualitative data with the guidance of a semi-structured interview guide. Prior to inte rviews with the district level personnel, a comprehensive review of state and local level statutes and policies related to school attendance was 6 The School District of Shermer County will henceforth be referred to as the district as opposed to abbreviating to the SDSC, which is cumbersome for reading.

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17 conducted. Observational data was collected with in the schools selected to participate in interviews. This provided insight into the climate and culture of the individual school settings. Finally, a descriptive survey was conducted with all middle and high school principals in the district to gain a general understanding of how school refusal information is documented. All interviews were tape-recorded, tran scribed, and entered into Ethnograph for qualitative data analysis (Scolari Qualis Research Associates, 2001). Opening coding was used to create a codebook, which was then used to code the interview data. Research Questions The purpose was to: 1) describe school personnels perceptions of school refusal and 2) identify ways in which these percep tions influence the me thods and strategies utilized by individual schools a nd their district to preven t, identify, and manage youth identified as experiencing school refusal. 1. How do school personnel construct thei r perceptions of school refusal? 1a). How do school personnel think about school refusal? 1b). What influences their understanding of school refusal? 2. What are school personnels re ported perceptions, explanatio ns, and beliefs related to school refusal? 2a). How do school personnel describe school refusal? 2b). What are the different forms of sc hool refusal identified by school personnel? 3. How do school personnel per ceive students they identi fy as experiencing school refusal?

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18 3a). How do school personnel describe st udents identified as experiencing school refusal? 4. What are the consequences of their perceptions for the recognition of school refusal among students? 4a). What is the process by which sc hool personnel identify students refusing school? 4b). How do school personnel evaluate th eir experiences with students with school refusal? Delimitations 1. This study was delimited to the School Dist rict of Shermer County, located in the Southeastern United States. 2. This study was delimited to the district le vel departments, middle schools, and high schools located within the School District of Shermer County. 3. This study was delimited to school and district level personn el working, with at least a year of experience, in the Sc hool District of Shermer County. 4. School personnel, for the purpose of this study, included principals, assistant principals, school psychologists, guidance c ounselors, health serv ices staff, social workers, resource officers, teache rs, and attendance office staff. 5. The interviews conducted with school personnel were delimited to schools that are randomly selected. 6. District level personnel included personnel working within district level departments related to the job f unctions of the aforementioned school personnel, including student

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19 support services (social work, school h ealth, and psychological) and guidance services. 7. Only participants who voluntarily ag reed to participate were included. 8. The results of this study are on the participants perceptions, recall, and interpretation of their experiences. Limitations 1. The school district and the personnel interviewed in this study may not be representative of all school districts in other areas of the county, state, country, or world. 2. Results of the study may not be generalizable to other schools, sc hool districts, or their personnel. 3. The study was based on self-reported data from those included in the study. 4. Schools randomly selected to participate in interviews for this study may be different from those that were not selected. 5. School personnel in the schools selected who agreed to pa rticipate in this study may be different from those who did not agree to participate. 6. District level personnel who agreed to participate in this study may be different from those that did not. 7. Principals who responded to the descriptive survey may be different from those that did not. 8. The results of this study are based on the participants perceptions, recall, and interpretation of their experiences.

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20 9. As a qualitative exploratory study, conclu sions regarding cause and effect or statistical associations can not be made.

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21 Definitions of Relevant Terminology 1. School refusal refers to student refusa l to attend school for various unexplained reasons. Constructs related to school re fusal include separation anxiety, specific phobia of school, and conduct disorder. It has also been defined as a child-motivated refusal to attend school, difficulties remaining in classes for an entire day, or both (Kearney, 2001). Specifically, Kearney (2001) describes school refusal as occurring in youth ages 5-17 who exhibit one or mo re of the following characteristics: completely absent from school, attend school but leave some time during the day, attend class following misbehaviors such as clinging, aggression, refusal to move, or running away, attends school under great duress that may lead to pleas for nonattendance in the future. This defini tion represented the consensus of the professional school psychology literature and reflects some of the insight developed through the Delphi panel with nationa l researchers (Torrens Salemi, 2004). 2. Separation anxiety childhood anxiety disord er that is charac terized by excessive anxiety (fear, worry) concerning separation from a major attachment figure and/or home (Last, 1988). Separation anxiety is lis ted as a disorder in the DSM-IV with specific diagnostic criteria (American Psychi atric Association, 2000). It is sometimes viewed as an explanation of school refusal. 3. School phobia Although not formally accepted as a disorder, school phobia within the DSM-IV can be classified under specifi c or social phobia (A merican Psychiatric Association, 2000). Specific phobia involves a persistent fe ar and avoidance of an object or situation. Social phobia is characterized by the fear or avoidance of social situations. School phobia therefore, may be c onstructed as a reason for school refusal.

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22 Many school personnel have cont inued to use this term, de spite a movement in the professional literature to fi nd more specific ways to address the various forms of school refusal, such as delineating non-problematic versus problematic absenteeism (Kahn et al., 1981; Kearney, 2001, 2003). 4. Compulsory education (compulsory school attendance) State Statutes K-20 Education Code Title XLVIII, Chapter 1003 on Public K-12 Education, Section 21 on school attendance states that all children who have attained the age of 6 years or who will have attained the age of 6 years by Fe bruary 1 of any school year or who are older than 6 years of age but who have not attained the age of 16 years, except otherwise provided, are required to attend school regularly during the entire school term. 5. School absenteeism refers to any absence from school for any legal or illegal reason (Kearney, 2001). The State Statutes mandates school attendance, and directs each school district to adopt an attendance po licy in accordance with the State Education Code. The School District of Shermer C ounty delineates excused from unexcused absences. Excused absences allow the student to complete make-up work, whereas this is not permitted for unexcused absences. Excused absences are limited to the following: 1) a doctors appointment with doc umentation; 2) accidental injury to the student; 3) death of an immediate family member; 4) observance of a religious holiday; 5) preplanned absence with three day approval of school official; 6) a legal subpoena; 7) emergencies related to weather, family crisis, accidents on the way to school, or bus breakdowns; 8) approved visits to colleges; 9) and with school board permission, during suspension. Unexcused refers to absences that are not accepted as

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23 excused, or caused by truancy (see #9 for de scription of truancy) Middle schools are permitted to develop plans to award grades incentive points to encourage attendance, and high schools have exam exemption policies for the same purposes. 6. School withdrawal when a parent activel y encourages a childs nonattendance or deliberately keeps the child home from school (Kahn et al., 1981). 7. School drop out permanent withdrawal fr om school prior to high school graduation (Kearney, 2001). The State defines a dropout as a student who withdraws from school, without transferring to another sc hool, home education program, or adult education program (Bureau of Education Information and Accountability Services, 2003). The State also acknowledges dropout as including students who leave school due to marriage, failure of state assessm ents required for graduation thereby not qualifying for certificate of completion, not meeting attendance requirements and student whereabouts are unknown, and wit hdrawal due to hardship. 8. School resistance involves various student behaviors th at occur in reaction to perceived injustices, inequiti es, or excessive demands at school. It is a conscious nonconformity to the institutional constrai nts of schooling (deMarrais & LeCompte, 1999). 9. Truancy Referred to in the St ate Statutes as a habitual truant in Section 1, Chapter 1003 of the K-20 Education Code Title XLVIII. It is defined as a student who has 15 unexcused absences within 90 calendar days with or without knowledge or consent of the students parent, is subj ect to compulsory school at tendance and is not exempt by meeting the criteria for any other exempti on specified by law or rules of the State Board of Education.

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24 10. Social constructionism Gergen (1985) outlined four key assump tions of the social constructionist perspective. These included 1) a critical stance towards taken for granted knowledge; 2) historical and cultu ral specificity of how we understand the world; 3) knowledge is sustained through social processes between people and through their daily interactions which serve to construct shared ideas and knowledge; and 4) knowledge and action go hand in hand (Burr, 1995; Gergen, 1985).

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25 CHAPTER II: REVIEW OF THE LITERATURE There intention of this liter ature review is two-fold. Firs t, this chapter provides an overview of the published literature on school refusal. Second, this chapter builds the rationale for a social construc tionist approach to understand ing school refusal within the context of the school setting. This chapter provides an overview of the role of schooling in society, to demonstrate the important role it plays in the lives of young people. The rationale for addressing school refusal as a school health is sue is reviewed, providing a general overview of school absenteeism, a discussion of the implications of school refusal and related absenteeism, an explanat ion of the role of the school and school personnel in school refusal, and a review of the difficulties schools face in addressing school refusal as indicated by the literature. The public health implications of school refusal are addressed through a discussion of the identification of school re fusal, a description of its occurrence and reported characteristics of students who experi ence it, a review of reported estimates, and a summary of related health and social cons equences. In the tradition of the social constructionist framework, the historical cons truction of school refusal is outlined, ending with an examination of the theo retical implications of this approach to school refusal. A section providing an overview of the theory of social constructionism provides a review of the major works in social construc tionism, an explanation of the underlying

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26 assumptions and tenets of the perspective, and an identification of studies conducted from this perspective. A critique of the perspective is offered, reviewing the major strengths and weaknesses, followed by an application of social constructionism to school refusal as a cross-cultural phenomenon. The chapter also pres ents an overview of the setting for this study, the School District of Shermer County. The concluding section provides a summary of the literature revi ewed within this chapter. Introduction The term school refusal is used in this literature review as it is the contemporary term used within the professional literat ure. However, the present study used the language of the participants, which included a range of terms and descriptions including but not limited to school phobia. This literatur e review draws on all literature related to school refusal and its various conceptualizations Therefore, in some sections, in order to keep consistent with the referenced authors original intent, some terms (such as school phobia) will be used interchangeably. The outcome of school refusal appears simple, yet, is quite serious; the student refuses to attend school. Given that school is five days a week, school refusal becomes a daily issue. Problems associated with sc hool refusal are considerable, leading to potentially adverse consequences (Hsi a, 1984; Jenni, 1997; King & Bernstein, 2001; Want, 1983). It is important to recognize that legisla tive statutes mandate school attendance. School refusal is an issue that requires quick reso lve to avoid dismal results. Schools represent the key element in school refusal; therefore, a brief overview of schooling in general is warranted.

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27 Overview of Schooling Schools are a unique social institution ch arged with the task of educating and socializing young people. The obvi ous point of school is to provide formal educational instruction to children (Bes t, 1994; deMarrais & LeCompte 1999). Schools represent one of many social spheres that have an influe nce over the lives of young people, providing peer interaction, socializa tion, and the development of normative behavior (U.S. Department of Health and Human Services [USDHHS], 2000). The role of schooling has evolved over time. Schools in the United States began pr imarily because of the demand by the educated elite to provide their children with the educational needs to maintain their social status (deMarrais & LeCompte, 1999). The push for compulsory education for all students, not just the wealthy, began as a form of social control (deMarrais & LeCompte, 1999). Education was a means to ensure a productive and moral workforce. Compulsory attendance laws were enacted between 1880 and 1920 (deMarrais & LeCompte, 1999). Today, legal statutes mandate school atte ndance in the United States and in most Westernized countries. Student s in schools are under the su pervision of someone other than their family; school personnel. School personnel have some form of specialized training, and recognize themselves as expert s in working with students (Best, 1994). They are therefore likely to define students and their problems differently from family members (Best, 1994). Given the amount of time students spend in school, schools and school personnel often act in loco parentis, assuming the obligations and responsibilities of preparing students to become productive members of society.

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28 Approximately 48 million youth attend almost 110,000 elementary and secondary schools for six hours each day in the United States (USDHHS, 2000). Over 95 percent of all youth ages 5-17 are enrolled in sc hool (USDHHS, 2000). Young people spend the majority of their waking hours in school, creatin g a setting in which th ere is the potential for harmful conditions (USDHHS, 2000). School Refusal as a School Health Issue Schools interest in addre ssing the health need s of children stem from the concept that healthier children le arn better (Allensworth, Laws on, Nicholson, & Wyche, 1997; USDHHS, 2000). The inclusion of health and social se rvices dates back to the late 1800s corresponding with the high infl ux of immigrants (deMarrais & LeCompte, 1999). Part of the reason for the inclusion of these services was because the poor conditions among immigrant children impeded their lear ning process, also interrupting the Americanization 5 process encouraged by policymakers (deMarrais & LeCompte, 1999). These health and social se rvices have developed into considerable re sponsibilities for schools, remaining an important func tion of schools today. Although schools do not have the sole responsibility of addressing al l of the health and so cial problems of young people, they do attempt to provide a hea lthy climate, educational curriculum, and appropriate services that can improve thei r health status (Allensworth et al., 1997; USDHHS, 2000). The role of school health has evol ved with public health, mimicking the epidemiological transition from infectious disease to chronic disease. For example, 5 Americanization refers to the process of socia lization that policy makers felt was important for immigrants in order to maintain law and order (deMar rais & LeCompte, 1999). It represents another form of social control.

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29 schools served a major role in ensuring immunizations, but have now transitioned into addressing social morbidities such as depres sion, violence, bullying, and suicide as major health priorities. School health, as an extens ion of public health, r ecognizes the important reciprocal relationship between health a nd education (Noland, Troxler, & Torrens Salemi, 2004). When students have trouble at tending school, there is much cause for concern (Kearney, 2001; King & Bernstein, 2001 ; Torrens Salemi & McCormack Brown, 2003). It is necessary to explor e briefly the various forms of school absenteeism, as this is the first outcome of school refusal that can negatively affect both the health and learning of students. Various Forms of School Absenteeism School absenteeism is referred to as a ny absence from school for any legal or illegal reason (Kearney, 2001). A pproximately 13-14 percent of 8 th and 10 th -graders were absent more than 5 da ys during a four-week period in 2000 (U.S. Department of Education National Center for Education Sta tistics [NCES], 2002a). Absence from school not only affects the student, but her or his classmates, teachers, and schools (NCES, 2002a). It leads to classroom distractions, repetition of sc hool material, remedial work, and increased costs (NCES, 2002a). School withdrawal refers to a pare nt who encourages nonattendance or deliberately keeps the child out of school (Kahn, Nursten, & Carroll, 1981). School resistance, which refers to st udents reactions to perceived inequalities in school, can also result in school absenteeism (Fine, 1991; Kearney, 2001). School dropout is the permanent withdrawal from school prior to completion (Kearney, 2001).

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30 Truancy, also resulting in absenteeis m, is often linked with delinquency and willful disobedience (Berg, 1997; Kearney, 2001). Truancy is said to occur when children are absent from school without the knowle dge of their parent s (Berg, 1997). This behavior is associated with antisocial characteristics, ly ing, stealing, and disruptiveness (Berg, 1997). It has been li nked with conduct disorder 6 and school dropout (Berg, 1997; Kearney, 2001). School Dropout Dropping out of school has been associat ed with multiple social and health problems, such as substance abuse, delinque ncy, intentional and uni ntentional injury, and unintended pregnancy. Th e status dropout rate 7 was 10.7 percent of persons 16-24 years of age in 2001 (NCES, 2002b). Students who exit school prior to gradua tion are more likely to experience poverty, underemployment, and social desp air (Doll & Hess, 2001). Dropout carries societal burdens such as lost tax revenue s and reduced economic productivity (Doll & Hess, 2001). Dropout prior to high school is non-existent, indicating the importance of addressing school difficulties earlier in the educational career of young people (USDHHS, 2000). School attachment and pos itive school experiences enhance the likelihood of school completion (Marcus & Sanders-Reio, 2001). Dropout, school refusal, and labeling. Much of the research on dropping out focuses on, as does the research on school refu sal, the characterist ics of students who drop out of school. This literature has led to common perceptions of students who drop 6 Conduct disorder involves a pattern of repetitive and persistent behavior where the basic rights of others as well as age-appropriate social norms and rules are violated (American Psychiat ric Association, 2000). 7 Status dropout refers to all persons aged 16-24 who dropped out of school regardless of when it occurred.

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31 out of school (Stevenson & Ellsworth, 1993). Various studies have concentrated on the school sphere to explore its contribution to the occurrence of dropping out (J. A. Baker et al., 2001; Doll & Hess, 2001; Egyed, McIntos h, & Bull, 1998; Fine 1991; Gallagher, 2002; Stevenson & Ellsworth, 1993). These studies have focused on the live d experiences of students who dropout, and their perceptions of their expe riences in schools. Similar to research in school refusal, there has been a lack of focus on the pe rceptions of school dropout held by school personnel, and their interactions with the students (Stevenson & Ellsworth, 1993). There is some suggestion that the research bias of focusing on the characteristics of students can lead to labeling and stigmatization of stude nts (Coreil, Bryant, & Henderson, 2001). This is due in part to the manner in which the st udents themselves have been constructed as social problems. Approaches to helping children with school refusal are often different from those for students who are truant, therefore the ab ility to distinguish between the two is paramount (Elliott, 1999). Hsia (1984) re garded school refusal as a continuum progressing from involuntary symptoms to willful refusal (or truancy). Berry (1993) asserted that it is the resp onsibility of both school personne l and parents to identify, understand, and help students with school refu sal, as these student s are often overlooked, misdiagnosed due to similarities to truant s, and other characteristics that are not consistent with the school setting. Furtherm ore, Berry (1993) hypothe sized that many of the behavior problems of secondary students ma y be due to the inability of parents and school professionals to identify and treat the students w ith school refusal during the elementary years.

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32 The tendency for school refusal research to focus on the individual and their family unit can lead to victim blaming and a de-emphasis on the role of the school (Terry, 1998). The impetus to focus on the family unit in school refusal research may be due in part to earlier conceptu alizations that focused on the mo ther-child relationship developed out of psychodynamic theory. This is now fre quently referred to as separation anxiety, although there is still some overlap in the us e of the terms school refusal and separation anxiety. While some research has focused on the home environment, others have pinpointed the school environment, both of which complicate the role of school personnel (Brulle & McIntyre, 1985; Pilkington & Piersel, 1991; Santiago, 1992; Stickney & Miltenberger, 1998). The Role of the School Traditionally, the role of the school in absenteeism is seen in terms of tracking truancy rather than school refusal (Elliott, 1999). According to the literature, school districts do not routinely report school refusal rates, alt hough one study of North Dakota schools found that seventy-five percent (N= 288) of schools responding to a survey had some system for identifying school refusa l (Evans, 2000; Stickney & Miltenberger, 1998). The lack of tracking may be due in pa rt to the continued focus on the individual and family in relation to school refusal, le ading to a failure to recognize the role of schools in addressing school refu sal (Elliott, 1999). The tendency to group all absentee students together fails to acknowledge the he terogeneity of the problem, thus excluding critical information that can inform the so lution to the situati on (Lee & Miltenberger, 1996; Phelps, Cox, & Bajorek, 1992).

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33 The literature emphasizes the role of school personnel in identifying school refusal (Cerio, 1997; King & Bernstein, 2001; Murray, 1997; Phelps et al., 1992; Want, 1983). Also noted is that school s are not always structured to deal with school refusal appropriately (Want, 1983). Many reco mmendations are available as to why and how the school should serve as the center for iden tifying, addressing, and resolving cases of school refusal, emphasizing the key roles for school personnel in ensuring a collaborative effort (Berry, 1993; Brand & O'Connor, 2004; Brulle & McInty re, 1985; Cerio, 1997). The literature recognizes th e importance of early identi fication by school personnel as being crucial to achieve a positive re solution (Brand & O'Connor, 2004; Cooper & Mellors, 1990; Phelps et al., 1992; Want, 1983). While much emphasis is placed on the role of the school, there is a lack of inform ation regarding what ex actly is happening in schools related to early identification and management (King & Bernstein, 2001; Stickney & Miltenberger, 1998). Stickney and Miltenberger (1998) cited that despite adva nces in the knowledge of school refusal, the degree to which school personnel are aware of and use such information is questionable due to the disp arity between research and practice (Kearney, 2003; Kearney & Beasley, 1994). They conducte d a survey to investigate how public schools responded to students exhibiting schoo l refusal behavior in North Dakota. Two hundred and eighty-eight school principals responded. Seventy-five percent of schools reported having some form of a school re fusal identification system, although most schools chose not to describe the nature of the system. Fifty-seven percent of schools reported having a school psychologist. Overall, principals were the most frequently reported person to identify school refusal, especially in elementary grades. They were

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34 less likely to be the person identifying school refusal in schools with grades 9-12 and K8. School counselors were responsible for identi fying school refusal in only 2 percent of schools. Schools confrontation of students with school refusa l occurred in ninety percent of cases, and notifying parent s in eighty-nine percent. Schools reported scheduling conferences with the counselor and student in only sixty-four percen t of cases and with the parent and a school member (either admi nistration or teacher) in only fifty-eight percent. Schools made referrals in sixty pe rcent of the cases, a nd most commonly to a social worker. This is similar to Bernstein, Svingen, and Garfinkel (1990), who indicated that 42 percent of their sample of 76 students were referred by their school for outpatient psychiatric treatment for school refusal. Schools appear to be a likely source for identification of school refusal. Mental health professional referral s were made in 18 percent of cases and juvenile justice referrals in 19 percent. Students were re ferred less frequently to physicians (7%) and psychiatrists (4%). Despite limitations due to the use of a descriptive survey and self-reporting bias, this study re presents the only identified effort in investigating how public sc hools identify and respond to school refusal. The question arises whether the lack of inclusion of parents and students in all identified cases is indicative of a lack of awareness of th e seriousness of school refusal, especially in regards to negative long-ter m consequences associated with unresolved cases. The authors hypothesized that a lack of resources may be an explanation for their findings related to low pare nt involvement and lack of referrals (Stickney & Miltenberger, 1998).

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35 Kearney and Beasley (1994) conducted a study similar to Stickney and Miltenbergers (1998) focu sing on practicing psychologist s specializing in youth and family practice, as opposed to schools. The pr imary goal was to generate information for school psychologists about clinic al prevalence, presenting char acteristics, and treatment practices regarding students with school refu sal. The study was initiated because school psychologists were sometimes unclear in thei r identification and treatment of students with school refusal. The major reason cited was the information gap between practice and research. The response rate was relatively low at twenty-one percent (N=63), yet they reported that out of the 3, 240 youth referred that year, there was a total of 197 school refusal cases. The students described in the study were predominantly male (60.4 percent), over the age of tw elve, and evaluated by both th e parent and psychologist as having moderate to severe school refusal. A dditionally, one of the main reasons cited for refusing school was aversive social situat ions at school. The fi ndings suggested that school personnel, who are most likely to iden tify these students, shoul d first consider the environmental causes of the school refusa l. Overall, the study provided important information for school personnel, but it was no t indicated how this information should be communicated to them. The Role of School Personnel The idea of resolving school refusal from within the school is a core theme in the literature on school refusal (Berry, 1993; King & Bernstein, 2001). School personnel such as teachers, nurses, principals, and guidance counselors are cited repeatedly as those professionals who first identify the existen ce of a school refusal problem (Berry, 1993;

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36 King & Bernstein, 2001; Setzer & Salzhauer, 2001). According to the literature, the principal is often the first to become involved with a school refusal case, especially in the primary school (Stickney & Mi ltenberger, 1998; Terry, 1998). The importance of recognizing school refusa l within the school is that it can be acted on quickly to restore a sense of normalcy in the students life. Skilled identification, assessment, and management of school refusal at an early stage could preclude the need for outside referrals, although it is equally important for schools to be prepared to provide a continuum of care if such is needed (Elliott, 1999). School refusal is considered more difficult to treat the longer it goes unrecognized (Kelly, 1973). One of the major recommendations of all treatments requires th e prompt return of the student to school, whether or not they are actually in a clas s (Berry, 1993; Jenni, 1997; Klein & Last, 1989; Want, 1983). Vigilance and se nsitivity among teachers and support staff such as school nurses and social workers are considered crucial (Elliott, 1999; Terry, 1998). Even the most calm and orga nized approaches can be lost in the stress and confusion brought about by school refusal (Jenni, 1997). Difficulties within schools. Reportedly schools have categ orized students who are absent from school due to school refusal in the same category as truant students, yet it is important to differentiate between the two. Th e signs of school refusal are not difficult to discern, yet, without knowing the profile of vulnerable students, school personnel can easily miss them (Kohn, 1999). Knowledgeable school personnel are key for early identification of youth with school refusal to enable prompt treatment. It cannot be assumed that school refusal will go away on its own or that a parent or pediatrician will identify it (Want, 1983).

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37 Most studies focus on the most severe cases of students with school refusal; those who have been admitted for inpatient and out patient psychiatric treatment (Bernstein, 2001; Kearney, 2001; King et al., 1998; Last & Strauss, 1990). Therefore, the research can be somewhat misleading about the actua l knowledge regarding school refusal and absenteeism in general. Want (1983) cites a key factor that tr aditionally has prevented the prompt action required to resolve school refusal. There ar e tendencies within publ ic schools to ignore children and adolescents who appear to have school refusal, focusing more on students with socially disruptive be havior (Want, 1983). School personnel may sometimes view interventions for students with school refusal with pessimism (Hsia, 1984; Weinberger, Leventhal, & Beckman, 1973). Furthermore, problems occur when school personnel have trouble differentiating between school refusa l and truancy (Harris, 1980; Kahn et al., 1981; Want, 1983). These problems are inherent given that categorization depends on assessing motives, which can be unknowable, complex, and situated. Berry (1993) contrasts the difference be tween the two by suggesting that truant students often have severe anti-social problem s. They willfully hide their absences and appear to have a conduct disorder. A child with school refusal does not have these problems, and in most cases wants nothing more than to be in school (Jenni, 1997). Heightened awareness of certain characteristics can possibly aid in the prevention of school refusal. From the literature, it becomes evident that school personnel could play a central role in resolving school refusal. Unfortunately, problems such as poor identification and lack of emphasis plague the response to school refusal.

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38 Waldfogel, Coolidge, and Hahn (1957) discovered direct c onsultation with the school led to a ten-fold increase of re cognized cases during three months. They hypothesized that school refusal may persis t undetected by common modes of referral leading to unresolved cases (Waldfog el, Coolidge, & Hahn, 1957). Though relatively outdated, the lack of recognizi ng school refusal remains a se rious issue. Findings from studies by Stickney and Miltenberger (1998) and Kearney and Beasley (1994) also demonstrated issues related to referrals. This sentiment was reflected rhetorically by Pilkington and Piersel (1991), who acknowledged that most of the cases represented in the literature are based on referrals, therefor e there may be many more cases that exist but were never referred. Public Health Implications of School Refusal School refusal is a complex phenomenon that occurs throughout the world. Due to its varying conceptualizations, it is difficu lt to assess the accurate impact and outcomes related to school refusal, alt hough the evidence that does exist indicates that if ignored or improperly handled, school refusal can affect the mental, emotional, and physical health of students as well as incur social and economic costs for society. In reviewing the literature for this study, it is important to address the manner in which students with school refusal have been characterized for two reasons. To address the public health consequences, it is important to describe stud ents most likely at risk for school refusal. The second is to document how these students are described in the literature as a point of reference for how th ey are actually perceived within the school setting. Despite the inherent limitations, an overview of the reported prevalence rates of school refusal is provided, along with a review of related outcomes.

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39 Identification of School Refusal While the research on school refusal has not focused on risk factors per se, it has focused on the characteristics of students w ho experience school refusal. While they are not referred to as risk factor s, descriptions and characterist ics of these students provide information to aid in the identification and early intervention, if not prevention, of this phenomenon. Most of the descriptive research has led to diagnostic criteria, although there is no official acceptance of such criteria (American Psychiatric Association, 2000; Kearney, 2001). The author cautions agains t strict adherence to the proceeding descriptions, as they are presented as an example of how school refusal has been conceptualized across diverse disciplines. The overview of these characteristics includes descriptions of the occurrence of school refusal and various reported characteristics of students who typically e xperience school refusal. Occurrence of School Refusal Researchers agree that the general times of onset occur at key transitions in a students life at the beginning of formal education, at the transition to middle school, junior high, or high school, re locating to a new school alt ogether, or at the end of compulsory education (Bernstein, 2001; Berry, 1993; Kearney, 2001; Kearney & Albano, 2000; King, Ollendick, & Tonge, 1995). Referrals for school refusal cases are more likely in the fall semester (Kearney & Albano, 2000) The school grades identified as higher risk include 6 th, 7 th 9 th or 10 th grades, with the most probl ematic cases occurring in the middle-junior high school years (Kearney, 2001). Other characteristic s include frequent changes in schools, emotional adjustment pr oblems, school related fears, and a family history of school refusal (B erry, 1993; Kearney, 2001).

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40 School refusal may begin with a stimulus, followed by a course of events, although each case is unique. Triggers may include a variety of stimuli, such as an embarrassing situation, confront ation with a bully, a disagr eement with a teacher, or some other traumatic event (Kohn, 1996). Afte r the stimulus event occurs, the primary caregiver may hear complaints of stomachach es. The child may have dizziness, nausea, or have a fever (Berry, 1993). The parent su bsequently may permit him or her to stay home. It is believed that by allowing the child to stay home, the parent unknowingly enables the school refusal behavior (Kear ney, 2001). As the starting hour of school passes, the childs symptoms may begin to subside. The symptoms often intensify on Sunday evenings, Monday mornings, or followi ng a vacation (Berry, 1993). This pattern may continue each day depending on the severity of the case. Jenni (1997) carefully described the type of panic experienced by students with severe cases of school refusal: There is a sense of the body being out of ones control. Those afflicted may experience faintness, heart palpitations shortness of breath, dizziness, nausea, loss of control, the desperate need to escape, and a sense of impending doom that includes the belief that one is a bout to die or go insane (p.211). The more severe cases generally seem to occur during adolescence and include the above-described panic attack (Jenni, 1997). One of the hallmark behaviors, according to Pilkington and Piersel (1991), is failure to rema in in school despite pr essure or threats of punishments from parents, teachers, and school administrators. Most professionals who have dealt with cases of school refusal agr ee that if untreated, it can have a permanent and adverse effect on the youths social and emotional development (Kearney, 2001;

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41 King & Bernstein, 2001; Want, 1983). Likewi se, untreated school refusal has the potential to affect school performance, academic achievement, and learning. Characteristics of Students with School Refusal Want (1983) described five common ch aracteristics of students with school refusal: anxiety, willfulness, dependency, de pression, and unrealistic self-image. Anxiety is the most distinguishing feature of a student with school refusal. Willfulness, the manipulation of authority figures, is not as common, while dependency, reliance on a parent for support and protection, is readily seen. Depression is vi ewed as both a cause and effect of school refusal (Bernstein, 2001; Paccione-Dyszlewski & Contessa-Kislus, 1987). An unrealistic self-image is common in adolescents with school refusal (Want, 1983). While these characteristics may be observe d in truant students, they occur more frequently among students with school refusal. There has been some indication that sc hool refusal is indicative of an underlying anxiety or panic disorder, thus serving as a symptom. Three coexisting conditions suggested as central to the ons et of panic disorders related to school refusal include: (a) a genetic predisposition to anxi ety; (b) a threatening loss ev ent; and, (c) an internal, physical experience that appear s catastrophic to the individua l (Jenni, 1997; King et al., 1995; Phelps et al., 1992; Pilk ington & Piersel, 1991). Another theory on the profile of students with school refusal hypothesizes that the student will have at least one parent who is highly anxious (Bernstein et al., 1990; Cerio, 1997). This proposition is consistent with Jennis theory of being predisposed genetically to anxiety (Jenni, 1997).

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42 Lee and Miltenberger (1996) referred to the typical stude nt with school refusal as being male, higher socio-economic backgr ound, and experiencing school refusal postpuberty (Lee & Miltenberger, 1996). This ha s been contested by some researchers who indicate that school refusa l occurs evenly among males and females, although it may appear that more females experience fear or anxiety based school refusal, whereas males are categorized as oppositional school refusa l (Bernstein & Garfi nkel, 1986; Kearney, 2001; Kearney, Eisen, & Silverman, 1995; Kear ney & Silverman, 1996; Last, Francis, Kazdin, & Strauss, 1987; Last & Strauss, 1990). Few studies have examined ethnic or racial characteristics of st udents with school refusal. Of studies conducted based on populations from clinical setti ngs, students were primarily wh ite (Bernstein & Garfinkel, 1986; Kearney, 2001; Last et al., 1987). This must be carefull y considered, as minorities may be underrepresented in clinical settings (Kearney, 2001). It is generally agreed that students with school refusal excel academica lly prior to absenteeism, as they may be achievement-oriented students who set high st andards for themselves, and may pressure themselves and fear imperf ection (Kearney, 2001). Reported Estimates of School Refusal Several researchers cite th at school refusal is on the ri se, although there is a lack of supporting evidence to document this obs ervation (Terry, 1998). The prevalence studies on school refusal are limited in vari ous ways. Few prevalence studies have been conducted, and those that have contain inhere nt flaws due to conceptual and reporting issues. A large portion of the research conduc ted has been based on psychological case studies (Cretekos, 1977; Wei nberger et al., 1973).

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43 The early literature on school refusa l made claims about school refusals seriousness and the severe, but nebulous conseq uences if not resolved. These claims were made without substantial evidence as to how conclusions were derived. The variability of definitions of school refusal does not a llow for a definitive prevalence (Brand & O'Connor, 2004; Kearney, 2001; King et al., 199 5). Most studies on school refusal estimate the proportion of students with school refusal in the Un ited States to be 1-8% of the school age population (Berry, 1993; Ce rio, 1997; Lee & Miltenberger, 1996). Kearney cited that approximately 28% of American students will refuse school at some point in their educational care er (Kearney, 2001). Last and Strauss (1990) referred to school refusal as a relatively widespread disturbance, with a prevalence rate among the general population of school age children at 1% and among clinically referred children between 3 to 8% (Last & Strauss, 1990). Jenni (1997) put the prevalence rate into perspective by estimating th at, if a person were to walk into a middle school, she or he would find between one and five indi viduals with the problem (Jenni, 1997). Conversely, King, Ollendick, and Tonge (1995) described the prevalence rate as relatively low among school-age children. Using a strict definition of school refusal and requiring all informants (parents, teachers, and child) to agree that the child missed school due to extreme fear resulted in 0.4 per cent of the sample bei ng classified as school refusers (King et al., 1995). When they loosened this definitions criteria and included in the sample students with high absenteeism that were judged fearful by any of the informants, the prevalence jumped to 5.4 per cent. This provides furt her evidence that the operationalization of the defin ition influences the prevalence rates (King et al., 1995).

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44 Comparatively, Jenni (1997) poi nted out that school refusal is more prevalent in highly competitive societies such as Japan, wh ere it is estimated to occur in 31% to 52% of middle school students (Jenni, 1997). While in the United States, the numbers are not as high as Japans, even an estimate of 1% is sufficient to demand more attention. From the literature, one can conclude that the prevalence of school refusal may be a reflection of what the larger populations of students are experiencing within their school environment (Tice, 1999). Consequences of School Refusal Most of the literature on school refu sal has concentrated on describing its occurrence, discussing case studies of st udents who experience it, and examining its empirical distinctions. Studies that document the effects of school refusal on long-term outcomes are limited, and those documenting long-term health outcomes are even more limited. Most of these studies are based on sma ll sample sizes of limited generalizability, as they mostly report the outcomes for severe cases that required in-patient treatment. The literature is replete with references to general short and long-term outcomes, despite limited longitudinal follow-up studies. This se ction provides an overview of the short and long-term outcomes of school refusal as indicate d by the literature, as well as a review of the potential social and economic costs. Short-Term Outcomes The short-term outcome of school refusal is primarily the inte rference or loss of education (Berg, 1997). Emotional distress, somatic illness, family disruption, inadequate peer relationships, and poor academic perf ormance with the possibility of failure

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45 characterize some of the immediate outcome s associated with school refusal (Berg, Nichols, & Pritchard, 1969; Last & Strauss, 1990; Rettig & Crawford, 2000). Decreased student academic achievement resulting from chronic absenteeism is a primary concern (Evans, 2000; Williams, 2003). Lower achievement creates a ripple effect of other issues, such as increased risk of retention, lo wer self-esteem, lower grades, or decreased future opportunities (D. Baker & Jansen, 2000; Evans, 2000). Long-Term Outcomes Longer-term outcomes associated with sc hool refusal may include problems of anxiety, depression, and reluctance of students to leave home to set up their own families (Berg, 1997). Increased risk for later psychiatric illness, employment difficulties, and social impairment are also associated with school refusal (Berg et al., 1969; Last & Strauss, 1990; Rettig & Crawford, 2000). Early research on outcomes of in-patient treatment for school phobia revealed that 50 percent of adolescents continued to have serious difficulties with school attendance and 70 percent had continuing evidence of ment al disorder (Berg, Butler, & Hall, 1976). Positive outcomes for treatment of school refu sal seems to be related to how quickly the student returns to school at le ast part-time, participation by both parents in resolution, agreement among all involved parties (incl uding school personnel, other professionals, and parents), decrease in family stress, and contingency plans (Evans, 2000; Paige, 1993). Social and Economic Costs There are significant costs to the individua l, family, and society relating to school refusal. The stress of dealing with school refusal can strain family relationships and

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46 functioning, as parents may have to miss work to go to the school (Evans, 2000). Societal costs are associated with increased educa tional costs, higher probability of high school dropout, the loss of productiv ity, and increased social support (Evans, 2000). Schools also incur various costs related to increased absenteeism. Teachers must provide remediation fo r absentee students, increasing their workload, which interrupts the learning of others (Williams, 2002). The additional time and attention to intervene in cases of school refusal and related problems of absenteeism increases the workload for school personnel (Williams, 2002). Higher rates of absenteeism can affect school funding which is partially based on Full Time Equivalence (FTE) (Williams, 2002). In the Oakland, Califor nia Unified School District, they lost nearly four million dollars per year due to an absenteeism rate of about six percent (Williams, 2002). Also in California, the Los Angeles School District reported a loss of $200,000 due to absenteeism in one year from a single high school. While school refusal is reportedly believed to constitute only a small percentage of absenteeism rates, the reality is complicated by the ambiguities that continue to plague the published literature on school refusal. Ar guments could be made that while school refusal is not the only reason for high absenteeism, it may account for a portion of students with problems of absenteeism and truancy (Williams, 2003). Historical Construction of School Refusal Bolman (1967) cited school refusal as an example of how knowledge about an emotional disorder develops. Due to its short history in the professi onal literature, and its rapid scientific development, there is a unique opportunity to trace its development (Bolman, 1967). Bolman distinguished five step s in the historical construction of school

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47 refusal in the United States: 1) labeling it as a problem; 2) differentiation from truancy; 3) development of clinical knowledge; 4) expansion to the school environment; and 5) recognition of school refusal as a complex syndrome (see Appendix A for a description of terms and definitions related to school refusal). Reviewing the historical shaping of the body of knowledge provides the backdrop necessary to understand the research challenges of today. Defining School Refusal and Absenteeism as a Problem The first step was the labeling of the condition of absenteeism as a disorder. This coincided with the introduction of compulso ry education laws (B olman, 1967; Kearney, 2001, 2003). Mandatory school attendance was introduced in the late 1800s, adopted by most states by 1900, and in the southern states by 1918 (Kotin & Aikman, 1980). The initial conceptualization of absenteeism wa s truancy. Truancy was and continues to be referred to as the unlawful and willful abse nce from school without knowledge or consent of the parents (Broadwin, 1932; Kahn et al., 1981; Kearney, 2003). Delineation of School Refusal from Other Forms of Absenteeism The differentiation of school absenteeis m represents the second phase in the construction of school refusal. Broadwin (1932) began this differentiation when he stated, I wish to describe a form of truancy which may have received little attention. It occurs in a child who is suffering from a deep seated neurosis of the obsessional type of display; a neurotic characteristic of the obsessional type (p.254). Ke arney (2003) indicated that this differentiation created two schools of thought regarding school refusal. The first, the traditionalists, regarded the problem as an illegal and delinquent behavior, and the

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48 second, the contemporaries, viewed the probl em from a medical framework seeing it as a complex neurotic condition. Johnson, Falstein, Szurek, and Svendsen ( 1941) later coined this neurotic truancy as school phobia. They described school phob ia in terms of three main components, including acute child anxiety, oc curring with increased anxiet y in the childs mother, and a history of an over dependent mother-child relationship (Johnson et al., 1941). Later Johnson (1957) clarified that separation anxiety was a more accurate term for what had been earlier defined as school phobia, declaring that adequate scien tific evidence existed to demonstrate the cause of this behavior (Johnson, 1957). Despite the clarification by Johnson, the term school phobia remains popular even today (Kearney, 2003). School phobia has been re-conceptualized throughout the history of its study, from separation anxiety to a more gene ral dread of attending school (Johnson, 1957; Waldfogel et al., 1957). Over time, school phobi a evolved into an umbrella term that covered virtually everything d ealing with school absenteeism School phobia, school refusal, school avoidance, separation anxiet y, and truancy are terms used interchangeably to report on this phenomenon. Yet, the litera ture suggests that each separate term possesses inherent characteristic s that demand differentiation. The construction of school refusal subtypes have focused on various aspects including dysfunctional ch aracteristics of the child or fam ily (Bernstein et al., 1990; Last & Strauss, 1990; Marine, 1968), reason for refusal (Kearney, 2001), and severity (Paccione-Dyszlewski & Contessa-Kislus, 1987). Coolidge, Hahn, and Peck (1957) described two types of school phobia. The firs t was the neurotic type, similar to the

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49 original concept of school phobia, while the second, the char acterological, more closely resembled truancy. Kennedy (1971) approached this same conceptualization but operationalized variations of it. Type 1 school phobia was defined as neurotic crisis which included acute onset, low grades, concerns about death, a nd good parental relations and adjustment. Type 2 school phobia was characterized by onset after multiple episodes of absenteeism, good grades, no concerns about death, and poor parental relations and adjustment. Various researchers expanded upon this dichot omy of school refusal, including Marine (1968) who proposed four categories of school refusal; simple separation anxiety (young children leaving parents for the first time) mild acute school refusal (like Kennedys Type 1), severe chronic school refusal (lik e Kennedys Type 2), and childhood psychosis with school refusal symptoms (fear, depressi on, social withdrawal, somatic complaints, regressive behaviors). There appears to be a general consensu s among researchers that constructs school refusal and truancy as distinct (Berg, 1997; Kearney, 2001; Pilkingt on & Piersel, 1991). Truant students typically spe nd their time out of school away from home, attempting to conceal their absence from thei r parents. They are described as lacking somatic illness, exhibiting poor academic progress, and anti -social behavior (Berg, 1997; Pilkington & Piersel, 1991). The concept of truancy constructs bad kids who should be controlled. Conversely, school refusal constructs good ki ds with problems that should be helped. Students with school refusal are described as exhibiting somatic illness and their parents are aware of their non-attendance. Reportedly, they are also descri bed as having higher

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50 academic achievement, although there are c onflicting views with in the literature (Kearney, 2001; Pilkington & Piersel, 1991). Berg, Nichols, and Pritch ard (1969) postulated criteria for distinguishing school phobia from truancy that have been widely ac cepted within the prof essional literature included the following (Brand & O'Connor, 2004; Brulle & McIntyre, 1985; Elliott, 1999; Kearney, 2001): 1. severe difficulty in atte nding school, often resulti ng in prolonged absence; 2. severe emotional upset, including excessive fearfulness, temper outbursts, or complaints of feeling ill when faced with the prospect of going to school; 3. staying home from school with their parents knowledge; 4. absence of antisocial charact eristics, such as stealing, lying, and destructiveness; and, 5. a self-report of heightened level of negative affect and emotional distress. Berg et al. (1969) also distinguished between acute and ch ronic school phobia, with acute referring to students who prior to the occurrence, had no attendance problems, while all other cases were considered chronic. Kearney and Silverman (1996) proposed a differentiation of school refusal based on duratio n. Self-corrective school refusal refers to students whose initial absentee ism ends within a two-week period. Acute school refusal refers to chronic absenteeism lasting from two weeks to a calendar year. Chronic school refusal refers to students whose absenteei sm lasts longer than one calendar year. The most recent research focuses on s ubtypes of refusal as they relate to maintaining variables or motivating conditions of the problem (Kearney, 2001; Lee & Miltenberger, 1996; Stickney & Miltenberger, 1998). This includes focusing on what

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51 reinforcements or rewards the student receives from refusing school. Kearney (2001) has urged movement away from the symptoms of school refusal to focus on function(s) of school refusal, which he has outlined into four categories. Function refers to what maintains or motivates a childs refusa l of school (Kearney, 2001). The functions, grouped by negative and positive reinforcemen ts, include: 1) avoidance of specific fearfulness or general over-a nxiousness related to the school ; 2) escape from aversive social situations; 3) attention-getting or separation anxious behavior; and 4) rewarding experiences provided out of school (the f unction usually associated with truants) (Kearney, 2001). The first two represent the negative reinforcement, in which aversive conditions lead to school refusal, whereas the latter two represent the positive reinforcement domain, where the student refuses school for rewarding conditions (Kearney, 2001). Development of Clinical Knowledge The development of clinical knowledge, despite Johnsons (1957) declaration that it was not necessary, followed as the next stag e in the construction of school refusal. Most of the research focused on the clarifi cation of intrapersonal characteristics of students refusing school, their family dynami cs, and the development of empirical distinctions. The psychodynamic approach, similar to the psychoanalytic, focuses on the child and the realization of her or his own limitati ons (Berry, 1993). It again traces back to the parents, whose relationship with the child allowed the child to think of herself as invincible, only to find out otherwise in school. The school threatens the childs perception of invincibility and the child reacts by refusing school (Berry, 1993).

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52 In some cases, school refusal has been described as co-occurring with various psychiatric disorders, incl uding separation anxiety, anxiet y, depression, social phobia, specific phobia, and agoraphobia (Berg, 1997). Mo st of the recent research claims school refusal is a manifestation of an emotional disorder. Recent clinical psychology research on school refusal delineated three types of anxious school refusal (Egger, Costello, & Angold, 2003; King & Bernstein, 2001); separa tion anxiety school re fusal (Kearney & Silverman, 1996; Last & Strauss, 1990), simple or social phobia (Last et al., 1987), or anxious and/or depressed school re fusers (Bernstein et al., 1990). Egger, Costello, and Angold (2003) exam ined the association between anxious school refusal, truancy, and psychiatric disorders in a community sample of children and adolescents using descriptive de finitions of school refusal. A secondary objective for the study was to determine if school refusal and tr uancy were mutually exclusive. This study, with a sample of 1,422 non-clinically referre d students, found that school refusal was strongly associated with, but not the same as a psychiat ric disorder. Anxious school refusal was associated with depression a nd separation anxiety disorder. Truancy was associated with oppositional defiant disord er, conduct disorder, and depression. Among mixed school refusers (anxious school refu sal with truancy), 88.2% had a psychiatric disorder. Bernstein, Svingen, and Garfinkel (1990) evaluated seventy-six families of children with school refusal who were outpatient s at a school refusal clinic (Bernstein et al., 1990). The purpose was to investigate fam ily functioning among children with school refusal. Their study separated students with school refusal and anxi ety from those with school refusal combined with depression and anxiety, and school re fusal and depression

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53 only. Family dysfunction was higher among families with students who had school refusal, anxiety, and depression than thos e with school refusal and anxiety only. Attempts to develop empirical definitions of the various constr ucts of problematic absenteeism have been based on the differen tiated sub-types of school refusal. One study employing factor analysis base d on parent ratings identifi ed a truancy component of problematic absenteeism that accounted fo r 20 percent of the va riance, and a school refusal component accounting for 15 percent (Berg & Jackson, 1985). The truancy component relied mainly on lack of parental knowledge, and school refusal on behaviors such as staying home and resisting efforts to resume school atte ndance (Berg & Jackson, 1985). Another attempt to develop empirical de finitions of school refusal used cluster analysis and discerned three groups among se venty-two percent of a sample of youth with attendance problems (L Atkinson, Quarrington, Cyr, & Atkinson, 1989; Kearney, 2003). These groups included separation an xiety and overprotective mothers, perfectionism or fear of failure, and school refusal and psychopathic deviancy (L Atkinson et al., 1989). Another study, also using cluster an alysis, focused on youth with severe nonattendance (Bools, Foster, Brow n, & Berg, 1990). Sixtyeight percent were assigned to a non-clinical group, while the rest were identified with refusal (21%) or truancy (11%) (Bools et al., 1990). Ecological Expansion of School Refusal The fourth stage in the development of knowledge about school refusal focuses on the expansion to the school and other social environments and influences (Bolman, 1967; Kearney, 2001). The concept of school phobia was expanded by Waldfogel, Coolidge,

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54 and Hahn (1957) who defined school phobia as a re luctance to go to sc hool as a result of a morbid dread of some aspect of the school situation (p.754). This is significant as it moved school refusal from the student, initia ting an alternative construction of school refusal as school centered, and not maternal or home centered (Bolman, 1967; Kearney, 2001). Bolman (1967) pointed out that the recognition of the school environment was characterized by public health and prev ention oriented approaches, although documentation of such approaches is not evident within the literature. School Refusal as a Complex Issue The last stage in the c onstruction of school refusal recognizes it as a complex issue, involving factors rangi ng from the intrapersonal to the community. Bolmon (1967) appeared ahead of his time by citing the n eed for public health prevention oriented approaches for addressing school refusal. He discussed the need for attention to the school environment and other social influences and that school re presents a microcosm of the larger community. King and Bernstein (2001) recommended an examination of efforts occurring within schools to identify and manage school refusal. Such research would examine what processes schools engage in when identifying school refusal. This could provide insight into development of successful interventi ons and possibly determine the potential for students to fall through the cracks. The acknow ledgement of school refusal as a complex issue is evidenced through the lack of agreement that continues to pervade the professional literature.

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55 Barriers to Future Advancemen t in Research and Practice Cited as a byproduct of poor interdis ciplinary communicatio n regarding school refusal, disparities over the conceptualization, assessment, and treatment reveal ongoing difficulties (Kearney, 2003). Often, practitioners, researchers, and others are not in-sync with addressing students who experience sc hool refusal, conduc ting research, or classifying absenteeism (Kearne y, 2003; Torrens Salemi, 2004). Kearney (2003) cited the need for a communal definitional system due to such a lack of consensus. He indicated that re search is conducted across disciplines with psychologists studying anxiety-base d school refusal, and educat ors, social workers, and others studying delinquency based refusal, ye t definition remains an issue. Although the research is characterized by a lack of agreem ent, children continue to be diagnosed and subjected to varying types of assessment or treatment. Within the published literature, resear chers rarely mention other forms of problematic absenteeism and there is lik ewise an inconsistent use of existing terminology. One example is an article that discusses what the authors refer to as FVSN or frequent visitors to the sc hool nurse (Sweeney & Sweeney, 2000). They describe a phenomenon similar to school refusa l, yet never make any connection that may be related. Such inconsistencies create problems for readers, who may be uncertain of how to consider the terms, definitions, and research findings. There is also a lack of consensus concerning terminology, definitions, identification, assessment, and treatment (Kearney, 2003). The inconclusiveness regarding school refusal impedes the progress needed to

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56 better understand school refusa l identification, as sessment, and treatment (Kearney, 2003). For the advancement of research on school refusal, it has been suggested that the field must make efforts to move toward s consensus on these issues (Kearney, 2003). Such consensus is significant to the field of bot h school and public hea lth as it is essential information for assuring early intervention of school refusal to provide positive health and educational outcomes. The challenge of coming to an agreemen t regarding school refusal remains in the varying manners in which school district s conceptualize this phenomenon. The recognition of school refusal as a socially constructed problem pr ovides an understanding of why the issue has developed with such complexity. Theoretical Implications School refusal as evidenced is an issue of social and public health importance. School refusal and absenteeism have been th e focus of attention for researchers from various theoretical orientati ons including psychologists, educators, social workers, nurses, physicians, and others. The increasing st udy of absenteeism in general has led to a fractured state of termi nology (Kearney, 2003, p. 9). Hist orically, school refusal has been constructed in divergent ways. Multiple theoretical approaches have been proposed, mostly originating from the fields of psychology and psychiatry. Such theory has been used primarily to inform research on the causes and treatment of school refusal. Berry (1993) outlined the three predominant theoreti cal approaches to school refusal as psychoanalytic, psychodynamic, and behavioral and learning theories. These theories all present the intra-psychic perspe ctive on school refusal, yet the movement in

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57 the literature has suggest ed this does not provide an adequa te explanation for all of school refusal (Kearney, 2001; Pilkington & Pi ersel, 1991; Terry, 1998; Wataru, 1990; Yoneyama, 2000). The positivist paradigm underlies the majority of the research in this field. Positivism makes the assumption that research can access models that describe reality (Slife & Williams, 1995). The theories that frame school refusal research, and their ontological and epistemo logical orientations, have hidden assumptions, which can lead to unknown implications for studen ts, their families, and their futures. Most of the research has focused on findi ngs of experts who attempt to define and explain school refusal in its en tirety. This research has been fruitful, but the results are limited in their utility, as the focus is typically on clinically referred students, which represent the extreme. These students may be easier to identify, whereas the majority of students may not be as extreme and therefore more difficult to discern. Due to a lack of discriminant validity and poor construct validity in school refusal assessment instruments ability to distinguish school refu sal, there can be nega tive implications for large populations of stud ents (Kearney, 2001). Kahn, Nursten and Carroll (1981) discussed the effects of school refusal validity issues in relation to the danger of labeling. Concepts such as stigma 8 labeling, and medicalization are all manners in which devi ance is controlled by socially created constructions or categorizations (Coreil et al ., 2001). In regards to school refusal, this becomes an issue in relation to distin guishing between school refusal and other 8 Stigma refers to the negative perceptions attached to a particular condition or categorization (Link & Phelan, 2002). Assigning labels can lead to stigma. W ith children, the issue of labeling has implications for the issue of becoming the label, in which the childs so cial identity becomes tied to the label. This can be both positive or negative labels, such as a gifte d student, a truant, or a delinquent.

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58 absenteeism problems as well as in how school refusal is perceived by those in power to assign labels. Little information is available on school personnels perceptions of students with school refusal. Despite inferences for the need of such resear ch, this area remains untouched. This limits future research on the co nstruction of school refusal in relation to its health and social consequences for stude nts. There is limited information regarding students who are just beginning to experien ce problems with school refusal and what occurs within the school se tting. The issue of what o ccurs before school refusal progresses to the extent that the student requires a mental health referral remains unknown as well. The continued research from one perspective furt her reinforces the conceptualization and discourse of school refusal as a mental health issue. School refusal is a complex issue, as de monstrated within the literature, which would benefit from an alternate conceptualiza tion. Social constructionism is a theory that can provide a better understanding of how school refusal is con ceived of within the school setting by school personnel. The theory has been used to understand school refusal within Japanese culture, while its use in understanding school refusa l has been sporadic in the United States (Santiago, 1992; Yamazaki, 1994; Yoneyama, 2000). The study presented here is the first to approach school refusal fr om a social constructionist perspective to understand how schools and school personnel perc eive students who refuse school. Theoretical Perspective This section provides an overview of the theory of social constructionism, reviews major works in social constructionism, e xplains the major underlying assumptions and

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59 tenets, and identifies related studies that use the theory. A critique of social constructionism provides the major strengths and weaknesses of this perspective. The application of social constructionism to school refusal is out lined, drawing on the construction of school refusal as a cross-cultural phenomenon. History of Social Constructionism Social constructionism cannot be traced back to one single source, but to various combined influences resulting in a theoreti cal movement that emerged approximately four decades ago (Burr, 1995). The roots of so cial constructionism date back to symbolic interactionism, which arose from George Herbert Meads work Mind, Self, and Society (Mead, 1934). This perspective viewed people as constructing their own and each others identities through everyday encounters w ith each other in social interaction 9 (Burr, 1995; LaRossa & Reitzes, 1993). Social construc tionism emerged as a rejection to the objectivist stan ce (Best, 1995). The paradigmatic milieu for the development of social constructionism was the phenomenological tradition. Phenome nologys foundational questions focus on understanding meaning, structure, and the essence of lived experience of a phenomenon for a person or a group of people (Patton, 2002, p.104). The main focus of this tradition is to explore how people make sense of experi ence and in turn translate that experience into individual and shared consciousne ss and meaning (Patton, 2002). Phenomenology emerged first as a philosophical tradition through the work of Husserl (1967). It was the 9 Social constructionism is concep tually different from constructivism. While social constructionism focuses on meaning as arising from social construction and interaction and being social sustained, constructivism refers to a more internal, meaning making that occurs within the individuals unique experience (Burr, 1995).

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60 work of Alfred Schutz who established phe nomenology as a social science perspective (Schutz, 1977). Constructionism is consistent with th e postmodernist tradition. Postmodernism was a reaction to positivism, which advocated the search for truth or reality through scientific method (Burr, 1995; Slife & W illiams, 1995). Postmodernism rejected this idea, instead assuming that people are not dete rmined by instincts, laws, needs, or other systems, but are actively i nvolved in creating their own lives and meanings (Slife & Williams, 1995). It also suggested that know ledge is created among groups of people who share language and perspec tive, of which there can be multiple perspectives, which are constantly open to revision as boundaries expand (Burr, 1995; Slife & Williams, 1995). A major contribution to soci al constructionist analysis in the United States is considered Berger and Luckmanns text (1966) The Social Construction of Reality They argued that humans create a nd sustain social phenomena th rough social practices (Berger & Luckmann, 1966; Burr, 1995). Since the intr oduction of this in itial groundwork on social constructionism in sociology, it has been used in various research disciplines to study a myriad of topics including: public health (Bartley, Smith, & Blane, 1991; Brown, 1995; Lloyd, 2000); Human Immuno-deficiency Virus (Herek, Capitanio, & Widaman, 2003); teen pregnancy (Phoenix, 1993); domestic violence (Muehlenhard & Kimes, 1999; Stark, Flitcraft, & Frazier, 1979); hea lth communication (Sharf & Vanderford, 2003); sexual health (Harden & Willig, 1998); hea lth education (Shevalier, 2000); education (Kenneth Gergen, 1995; Tuffin, Tuffin, & Watson, 2001); psychology (KJ Gergen, 1985), womens emotions (Cosgrove, 2000; Danforth & Navarro, 2001); eating disorders

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61 (Duran, Cashion, Gerber, & Mendez-Ybanez, 2000); Downs syndrome (Costigan, 2000); social work (Farone, 2002); Attention Defi cit Hyperactivity Disorder (Danforth & Navarro, 2001; Levine, 1997); and anth ropology (Goddard, 1998; Perez, 2002). Tenets of Social Constructionism Social constructionism, according to Berg er and Luckmann (1966), ascertains that reality is socially constructed, thus the sociology of knowledge must focus on social processes by which reality is constructed. Th e main social practices described by Berger and Luckmann included externalization, object ivation, and interna lization (Berger & Luckmann, 1966; Burr, 1995). Externalizing refers to when a person acts on the world, creating some artifact or practic e such as Burrs example of putting an idea into writing (Berger & Luckmann, 1966; Burr, 1995, p.10). An example of externalization might be the creation of social practic es or institutions, such as the concept of schooling. The concept developed from social processes and interactions that le d to schooling becoming an objective reality institutionalized in so ciety. Externalizing thus puts the ideas or constructions into the social realm, where pe ople can re-tell the idea, develop it, and it becomes an objective feature of the life, t hus objectivation occurs. Thus, people regard the objective feature as an extern al reality that has a factual existence. Future generations are thus born into a world where something that was socially constructed exists as a part of the world, and thus they internalize it. Therefore, the world can simultaneously be socially constructed by people, and experienced by them as if it were fixed and stable (Burr, 1995). Gergen (1985) described social constr uctionist inquiry as being concerned with explicating the processes by which people come to describe, explain, or otherwise

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62 account for the world (including themselves) in which they live (p.266). Although there is no one feature that identif ies social constructionism, th ere are key assumptions that guide the theory (Burr, 1995). Gergen (1985) provided several main assumptions that guide the social constructionist orientation. The first is that wh at we take to be the experience of the world does not impose the terms by which the wo rld is understood (KJ Gergen, 1985). This refers to taking a critical stance of the taken-for-grant ed ways of understanding the world (Burr, 1995). Secondly, so cial constructionism assumes the terms in which we understand the world are social artifacts, and that the process of understanding is the result of an active and cooperative endeavor of persons interactio ns. This means that knowledge and meaning is both historically and culturally specific and relative. Included in this is that due to the hi storical and cultural relativity, we cannot assume that one way is better or any more near the truth than another (Burr, 1995). The third point made by Gergen was that the degree to which a given form of understanding prevails or is sustained across ti me is not dependent on the validity of that perspective but instead on the so cial processes that maintain that perspective (Burr, 1995; KJ Gergen, 1985). Burr (1995) explained that social constructionism views our shared versions of knowledge as being constructed th rough the social interact ions that occur in our day-to-day lives. Burr (1995) further delineated these assumptions of social constructionism. She described the theory as anti-essentialist, as it assumes people are not pre-determined by some inherent content within the person, such as personality. Instead, people are themselves a product of social processes. Additionally the theory denies that our

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63 knowledge is a direct perception of reality, therefore it is anti-realist. Social constructionism draws on the idea of langua ge as a pre-requisite for thought. Language itself is both a product of social proc esses and a form of social action. Social constructionism focuses on social interactions, practices, and processes (Burr, 1995). Thus social constructionist research focuses on questions about how certain phenomena or forms of knowledge are achieved by people through interaction. Knowledge is viewed as something that people do together through their interactions and not something that they have or do not have (Burr, 1995) Within sociology, the application of social constructionism to social problems was initiated by the work of Kituse and Sp ector (1973) (Best, 1993). Their work focused on the construction and maintenance of social problems through social processes such as claims-making (Best, 1993; Kituse & Spector 1973). Kituse and Spector (1973) stated, the existence of social problems depends on the continued existence of groups or agencies that define some condition as a pr oblem and attempt to do something about it (p.415). They focused more on how a problem became known as such, as opposed to the actual problem. According to Loseke (2003), a social pr oblem is defined by four criteria. These include that the issue is wide ly evaluated by social actors as one that: 1) is wrong; 2) widespread; 3) is something th at can be fixed or changed; and 4) people believe it should be changed. This approach to social problem s uses social constructionism to focus on social problems, how they come to be c onsidered as such, and how the subjective definitions of social problems change objective characteristics of the world.

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64 The assumptions of social construction ism necessitate the question of whether constructionism should ignore the world outside of the constructions of it (Loseke, 2003, p. 206). This has been addressed through th e creation of strict (or monist) versus contextual (or dualist) constructioni sm (Loseke, 2003; Patton, 2002). Strict constructionism avoids assumptions about objective reality, whereas contextual constructionism references the world as if it exists separately from the constructions of it (Best, 1993; Loseke, 2003). It is evident from the delineation that contextual constructionism is more likely to be of inte rest in the field of public health and school health, as it represents the more practical approach for unde rstanding the constructions of issues of importance. Loseke (2003) pointed ou t that social construc tions of perceptions of reality can in fact have re al implications for people. In summary, social constructionism is based on the assumption that there are multiple realities that are socially and hist orically contextual (Burr, 1995; Loseke, 2003). Social constructionism attempts to access th e constructions of knowledge about perceived reality that arise from social interactions and processes that are rooted in language which is itself socially constructed (Burr, 1995; Loseke, 2003; Slife & Williams, 1995). It is an epistemological theory in that is makes assu mptions about the nature, origins, and limits of knowledge (Slife & Williams, 1995). This study adhered to the premise that school personnels perceptions of school refusal are created through their daily interact ions with students, other school personnel, and the district in which they work. Recogni zing the social constructionist assumption that multiple realities construct the per ceptions of school refusal, a contextual constructionist approach acknowledges the schoo l districts perceptions and constructions

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65 of school refusal as a separate constructed reality from the subj ective experiences of the school personnel. Critique of Social Constructionism Social constructionism has been describe d not so much as a theory, but as a stance, an orientation, a perspective we apply to better understand the world around us (Best, 1995, p.349). There are several critiques of this theory, most of which center around relativism and truth (Burr, 1995). One of the main critiques of social constructionism is its relativism (Slife & Williams, 1995). Social constructionism is ontologica lly relative (Burr, 1995; Patton, 2002). Meaning is constructed within culture, hist ory, and time. There is no standard against which to validate the claims of social c onstructionism, except to continue using the perspective in the analysis of different issu es (Burr, 1995). The issue of relativism calls into question the theory itself, as it too can be considered a social construction (Burr, 1995; Slife & Williams, 1995). Due to the relativity of social cons tructionism, any understandings of social processes generated through this approach are limited in generalizability. This is inherently a function of the a ssumptions of social constructionism, as they assert that knowledge is culturally and hist orically specific and relevant In addition, the social constructionist approach generally calls for qualitative inquiry, which in itself is limited in the quantitative sense of ge neralizability. Instead, the conc ept of transferability takes precedence, which indicates that the consumer of the research findings is left to judge whether the findings are transferable to a similar setting.

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66 Furthermore, the question of whether social constructionism offers any unique way of understanding the world as it exists naturally must be addressed (Slife & Williams, 1995). This theory does not attempt to provide insight into cause and effect or hypotheses such as these, but instead how people understand cause and effect. It moves out of the realm of positivism by focusing on social interchanges and their implications for people, as opposed to seeking the truth or some representation of the truth. Social constructionism offers much in sight into phenomenon as it draws on the lived experiences of the participants, instead of imposing the rhetoric of the expert. In fact it minimizes the expertise of the research er, who assumes a not knowing stance in describing the narrative and interpretations of those unde r study as opposed to making judgments about the issue under study (J ankowski, Clark, & Ivey, 2000). Social constructionism thus captures and honors the multiple perspectives of participants (Patton, 2002). Likewise, it emphasizes reflexivit y on the researchers part, so that they must be critically aware of their presence as a researcher and the implications of that presence (Burr, 1995; Patton, 2002; Sarbin & Kituse, 1994). Applicability to Public Health The use of social constructionism to ex amine public health issues is valuable considering health and social issues are situ ated within social a nd cultural contexts. Social constructionism has been used to st udy diagnosis and illness, in order to examine how social forces influence our understan ding and knowledge of and actions toward health, illness, and healin g (Brown, 1995). That knowle dge in turn produces our assumptions about prevalence, treatment, a nd meaning of illness and disease (Brown, 1995; Herek et al., 2003). In the various sub-fields of public hea lth, such as health

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67 education and promotion, school health, or child health, understanding various issues in relation to knowledge, perceptions, and processes is an increasingly important aspect. Shevalier (2000) used a social constr uctionist approach to examine tobacco education literature used in an alternative high school set ting for at-risk youth. She found that the construction of sm oking from the literature did not match the youths cultural contexts. Recommendations included ways to eliminate the dissonance in order to increase receptivity to the information. In rela tion to the school se tting, researchers have focused on how school personnel and other prof essionals who work with youth construct their understanding of youth and various issu es among youth (Danforth & Navarro, 2001; Davison & Ford, 2001; Ehrens al, 2003; Erchak & Rosenf eld, 1989; Erchul, Raven, & Ray, 2001; Smith, 1997). One study interviewed health teachers to understand how they understand their role as a mental health professional in the school setting and in a ddressing students with possible mental health problems (Tuffin et al ., 2001). Data analysis demonstrated that school health teachers moved from positioning themselves as mental health professionals to health educators with basic knowledge of mental health, cha llenging the idea that people have stable attitudes and knowledge bases (Tuffin et al., 2001). Teachers were also nervous about being in a role to refer stud ents to mental health services (Tuffin et al., 2001). The authors recommended sensitive profe ssional development to prepare teachers for identification and referral to make their e xperiences less stressful (Tuffin et al., 2001). In a similar study, Danforth and Navarro (2001) studied the meanings of Attention Deficit Hyperactivity Disorder (ADHD) as they are socially constructed through everyday language use by lay persons. Thei r conclusions indicated the need to be

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68 careful in adhering to strict terminology for specific situations, such as in ADHD, and instead focus on the moral implications of th e way people as users of language construct problems, solutions, and social identities. Applicability to School Refusal Social constructionism asserts that while there are multiple constructed realities, and that there is no single rea lity, social constructions can in fact have real implications for people (Loseke, 2003). Social construc tionism focuses on social interactions, practices, and processes (Burr, 1995). Thus social constructionist research focuses on questions about how certain phenomena or forms of knowledge are achieved by people through interaction. Knowledge is viewed as something that people do together through their interactions and not something that they have or do not have (Burr, 1995) This study used social constructioni sm as a framework to access school personnels constructions and percepti ons of school refusal to understand how it is constructed within the school setting. This is important given the strong as sertion within the literature that due to c onfusion and disarray within th e field of research regarding school refusal, there is a lack of understand ing, translation, and dissemination of findings between researchers and pr actitioners (Kearney, 2003). School refusal has been constructed within various cultures, adding support for the appropriateness of a soci al constructionist approach to this study. The following review summarizes the crosscultural construction of school refusal, explores existing discourses, and describes the role of the cultural context. Thou gh limited, studies of school refusal in the social constructionist tradition are included within this review.

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69 School Refusal as a Cr oss-Cultural Phenomenon While school refusal has been studied in various forms for the last century, in countries such as Japan, it is a more recent phenomenon. Commonly referred to as tkkyoki, the nation saw a dramatic increase in the 1980s. In Japan, it has risen to the forefront of the nations attention at a rapid pace (Wataru, 1990; Yamazaki, 1994). School refusal has become such an issue that the United Nations Committee on the Rights of the Child stated in its concludi ng observations, Article 43, that the State of Japan should take further steps to combat excessive stress and school phobia (United Nations, 1999). Japan had more than 127,000 reported cases in 1998, although this number was based on statistics reflecting the perception of sc hool officials, of which the authors questioned the accuracy (K ameguchi & Murphy-Shigematsu, 2001). Social Construction of School Refusal Within most of the literature originati ng in the United States, the language used when describing school refusal appears to be influenced by the fields of psychology and medicine. School refusal is often described as a syndrome, symptom, di sturbance, or an emotional disorder (Leslie Atkinson, Quarringt on, Cyr, & Atkinson, 1987) It is identified as a problem, a behavior, or an issue to be addressed clinically. Interestingly, within the literature originating from Japan, school refusal is often referred to as a phenomenon or a social problem (Wataru, 1990; Yoneyama, 2000). Best (1994) stated that the social proble ms of children are constructed within four categories of children. These include the rebe llious child, the deprived child, the sick child, and the child-victim. School refusal has been construc ted as a social problem by various fields who point out its potentially troublesom e outcomes (Best, 1994). The

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70 various conceptualizations of school refusal can fit into any one of these categories, depending upon the manner in which the child is perceived. The construction of school refusal as a social problem originated in Japan (Wataru, 1990; Yamazaki, 1994). The developmen t of family psycho logy and therapy in Japan is thought to have initiated with the social problem of school refusal in the 1980s (Kameguchi & Murphy-Shigematsu, 2001) Although it has been predominantly discussed as a social problem in Japan, ther e has been a struggle over whether it is a social problem or a mental health issue (Wataru, 1990; Yamazaki, 1994). This struggle with competing constructions of school refusal, both within the litera ture in Japan and the United States might be referred to as clai ms competition (Loseke, 2003, p. 41). Claims competition can occur between social problems, such as terrorism or obesity. Claims makers 10 compete to get audiences to believe that a particular issue is a social problem and that it is more important than other social problems. In both Japan and the United States, ther e are claims that school refusal is a mental illness (Wataru, 1990). This situates sc hool refusal as a problem of children who are weak, overly dependent, and have sp ecific personality attr ibutes (Kearney, 2003; Pilkington & Piersel, 1991; Wataru, 1990). Othe r claims construct sc hool refusal as a product of the school system, cons tructing the students as victims 11 of an oppressive atmosphere, with unsympathetic school personnel in an unnatural so cial setting (Terry, 1998; Wataru, 1990). Wataru (1990) echoed ot hers caution of assigning labels to 10 Claims makers are people who say or do things (make claims) to convince audiences that there is a social problem (Loseke, 2003). 11 Loseke states that constructing vi ctims is a prerequisite for convincing an audience that a condition is a problem. In this case, the victim, which refers to wh o and what is harmed by the social problem, is the student with school refusal.

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71 students, especially in light of school refusal as a constructio n of mental illness (Kahn et al., 1981). The theory of social constructionism lo cates the concept of identity formation within the social realm, thereby our identities as persons arise not from inside of us, but from the interactions and discourses that we encounter on a daily basis (Burr, 1995). This perspective adds further insight to the importance of using ca ution in assigning labels to people. Discourses on School Refusal Yoneyama (2000) examined school refu sal by focusing on the various existing discourses 12 that surround it. There are two ove rarching school refusal discourses identified by Yoneyama; the adult discour se and the student discourse. The adult discourse is composed of the psychiatric, behavioral, citizens, and socio-medical discourses (Yoneyama, 2000). The following review of these discourses integrates research from the United States that dem onstrates how these discourses have been constructed across cultures. The Adult Discourses The adult discourses on school refusal grew from the diverse views of adults in various fields, including doctors, psychiatri sts, counselors, psychologists, teachers, administrators, government officials, edu cational critics, journalists, and parents (Yoneyama, 2000). Yoneyama asserted that the views created by these discourses directly effect students, as they influe nce how students are perceived and treated by 12 Discourse refers to a system of st atements which constructs an object (Parker, 1992, p.5). Burr (1995) describes discourse as a set of meanings, metaphors, representations, images, stories, and statement that in some way together produce a particular version of events. She asserts that numerous discourses surround any object and contribute to constructing it a different way (Burr, 1995, p. 49).

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72 people who are in positions of power and auth ority. This discourse is categorized into four types, including the ps ychiatric, behavioral, citi zens, and the socio-medical. Psychiatric discourse. The psychiatric discourse is si milar to the discourse in the United States in that psychiatrists and physicia ns support it and view it as a mental health issue. The resolution for school refusal in cludes medical treatment and in-patient treatment (Yamazaki, 1994; Yoneyama, 2000). This was one of the first conceptualizations of school refusal in Japan, influenced by American and British studies (Yamazaki, 1994). Interestingly, although it serves as the predominant discourse in American and British cultures, it has yet to be adopted as the sole conceptualization in either. This is evidenced by examining the Di agnostic and Statisti cal Manual, fourth edition, text revision (DSM-IV -TR). It does not contain a formal definition for school refusal or school phobia (American Psychiat ric Association, 2000; Brand & O'Connor, 2004). The DSM-IV-TR does make reference to school refusal within diagnostic categories for separation anxi ety, social phobia, specific pho bia, and conduct disorder (American Psychiatric Association, 2 000). This may indicate incomplete medicalization 13 of school refusal. In this case, school refusal has been constructed as a symptom of various psychiatric disorders, thus claims-makers a dvocating for a psychiatric conceptualization have not convinced the American Psychiatri c Association audience of its status as a social problem (Loseke, 2003). Competing views of school refusal and related 13 Incomplete medicalization occurs when competing definitions of a phenomenon vie for legitimation (Coreil et al., 2001, p.156)

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73 problematic absenteeism are rooted in lega l issues as well as the development of a sentimental attachment to children (Best, 1994). Behavioral discourse. Teachers and other school personnel in Japan support the behavioral discourse, construc ting school refusal as laziness, and focusing on discipline and punishment (Yamazaki, 1994; Yoneyama, 2000) This discourse is not as apparent among school personnel in the United States, as little research has focused on their perceptions of school refusal (Cooper & Me llors, 1990; Stickney & Miltenberger, 1998). The only study identified that examined sc hool personnels perceptions of school refusal was conducted in the Great Britain (Cooper & Mellors, 1990). The study focused on teachers perceptions of and differentia tion between school refusers and truants. The authors discussed the impor tance of correct initial identification, as this often leads to the inte rvention plan. Once a child is labeled with one of these classifications, it is di fficult for her or him to lose th at label. The role of teachers perceptions served as a key element in determining the levels of description and explanations of absenteeism caused by sc hool refusal and truancy (Cooper & Mellors, 1990). In this particular study, perceptions among teachers within special teaching units were examined, as they are heavily i nvolved in the management of school refusal and truancy. Thus, their attitudes and actions determined by their perceptions, have an impact on how management of sch ool refusal and truancy occurs. This study also triangulated previous findings from self -reports of school refusers and truants. The findings indi cated that teachers perceived school refusal and truancy differently. Students with school refusal were perceived as more emotionally disturbed

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74 and with lower self-esteem than truants. In contrast, students with school refusal saw themselves as having higher self-esteem. Both teachers and school refusers indicated that they were more self-conscious. Truants, in both the teachers and the truants views, were considered less truthful than the school refusers were. There was some disparity between teachers perceptions and beliefs of sc hool refusers and trua nts. School refusers perceived themselves as well behaved and hard working, while teachers did not. They also viewed school refusers as having poorer peer relationships. The main concern is that the discrepancies between teachers and students perceptions will make successful outcomes more difficult. Citizens discourse. The citizens discourse on sc hool refusal includes some parents and psychiatrists who claim school refusal is a norm al reaction to schooling and that the problem is with the schools and th e educational environm ent (Yamazaki, 1994; Yoneyama, 2000). Although there ar e allusions to this within the U.S. literature, little research has focused on this aspect in rela tion to school refusal (P ilkington & Piersel, 1991; Terry, 1998). There is a growing consensu s suggesting that greater attention should be given to the school environment and pers onnel in relation to school refusal (Bolman, 1967; Elliott, 1999; Pilkington & Piersel, 1991; Stickney & M iltenberger, 1998). The school as the contributing factor in school refusal has been mentioned repeatedly, although not the center of one single study. Pilkington and Piersel (1991) suggested a shift in research to focus atte ntion on the school envi ronment and personnel, in an effort to determine if they are potent ial contributors to the etiology and maintenance of school refusal (Pilkington & Piersel, 1991) This recommendation was based partially

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75 on the notion that the refusal may result fr om something unpleasant occurring within the school. School settings are often the source of bullying, adverse teacher-student relationships, hostile environments, and bore dom (Elliott, 1999). The label of school refusal can prompt a defensive reactio n from school personnel (McAnanly, 1986). McAnanly (1986) cited a defensive response be cause school refusal infers that a person or situation at the school is the stimulus for th e fear (McAnanly, 1986). Long (1971) cited the issue of counter-tra nsference as a potential problem within the school. The manner in which school refusal disrupts the childs school routine becomes a threat to school personnel, which in turn is directed back against the child (Long, 1971; McAnanly, 1986). Unfortunately, it is stated that in order to reduce the threat felt by school personnel, they should be informed that the conditions for school phobia existed within the family unit before the child ever entere d school; the school is not to blame (Long, 1971, p.292). This reveals the propensity to blame the family unit for the problem, and protect the school. Socio-medical discourse. A small number of Japanese physicians support the socio-medical discourse, which constructs school refusal as resulting from chronic fatigue syndrome, suggesting rest as a solu tion (Yoneyama, 2000). This discourse agrees with the citizens discourse in the cause of school refusal st emming from social structure of schools, and not the attributes of the student (Yoneyama, 2000). Miike and Tomodas research (as cited in Yoneyama, 2000) argued that school refusal is similar to burnout, resulting from the repeated exposure to th e anxiety inducing environment of school. The

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76 absence of this discourse may be due to cu ltural specificity and variations in the construction of school re fusal across cultures. Student Discourse In contrast to the adult discourse on school refusal, th e Japanese student discourse is described in various stages which include the following: 1. I just cannot go student is bewilder ed and troubled; goes to school clinic 2. I want to go but cannot stude nt experiences somatic illness 3. The shift from I cannot go to school to I do not go to school student feels self-doubt then accepts school refusal as a choice 4. Discovery of self-hood and critical reappr aisal of school critical voice emerges on school and self-identity These discourses, based on autobiogra phical reports from students, reflect influences from the adult discourses (Yoneya ma, 2000). It represents a process that students report experiencing because of physi cal complaints, perceptions of themselves, and of school. This research, although limite d in transferability due to the cultural context, represents one of the only studies to date that includes th e voice of the student, who is most important and least empowe red in relation to school refusal. Virtually no studies from the U.S. exam ine the perspectives of the student; therefore, it is impossible to compare the student discourse and construction of school refusal. Best (1994) cited the tendencies of researchers to focus largely on adult members of the institutions of importan ce in preadolescents lives, rath er than focus on the children. The consequences of this neglect of school-age youth is that they are left to be studied by

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77 psychologists, who focus on their individual ps ychologies, ignoring their role as social beings (Best, 1994). The Cultural Context of School Refusal What is similar between th e constructions of school re fusal across countries is the acknowledgement that the controversie s over definition, conceptualizations, interpretation, and solutions have not been resolved (Kearney, 2003; King & Bernstein, 2001; Yoneyama, 2000). It is pointed out that although school refusal appears to exist in multiple societies, the sociological cause is not constructed as the same, nor is its significance in the culture (Chiland & Young, 1990; Yamazaki, 1994; Yoneyama, 2000). Yamazaki (1994) examined how the histor ical construction of school refusal in Japan demonstrates that the na tions social structure and cu lture provide the context for viewing school refusal as a social problem. His examination of the competing discourses of the medicalization and deme dicalization of school refusa l reveals the claims-making and claims competitions that have ta ken place in Japan (Yamazaki, 1994). Chiland and Young (1990) suggested that st udents reject or refuse school within the context of the meaning of education for them within their own society (p.4). How a society or culture regards and responds to school refusal is a critical element in understanding the social constr uction of school refusal. Furthermore, to understand how this meaning develops at the school level provi des invaluable insight into future research, potential problems, and further understandi ng. Only one U.S. study was located that approached the study of school refusal from an ecological perspective using qualitative methodology (Santiago, 1992). The data analysis revealed perceptions at the various

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78 ecological levels (micro-, meso -, exo-, and macrosystem leve ls), leading the author to describe school refusal as a socially constructed phenomenon (Santiago, 1992). This research shed light on the importance of considering sc hool refusal within the ecological context of the school and the intera ctions that occur within the school setting. The research also revealed there were negotiations rega rding assignment of diagnostic labels between pare nts, school officials, and sp ecial education committees, and classifications of school refusa l had racial and class impli cations (Santiago, 1992). This particular aspect of the research revealed that educational experiences and outcomes for students classified as school re fusers were similar to student s classified as at risk for dropping out. This provides support for future research to consider the implications of school refusal as a classificatory label. Popular Media and School Refusal The topic of school refusal has become a focus of the popular media, which serves as a reflection and perpetuation of the cultural context. Interestingly, school refusal has been cited as the result of bullying in several cases reported by the BBC News (BBC News, 2002, 2003; CBBC Newsround, 2003). The cases have caught public attention as they all resulted in legal charges being filed against parents for not forcing the student to attend school. In more than one case, the students reported bei ng bullied to the extent that they developed school phobia at the t hought of attending school (BBC News, 2003; CBBC Newsround, 2003). One case cited a studen t who was bullied about her weight, in turn leading to school refusal (CBBC Ne wsround, 2003). Informational websites post information and tips for parents on dealing with the school refusing student and popular magazines feature stories on the issue (CDADC's Project Integrity, 2004; Kohn, 1996).

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79 Such popular media provides insight into the development of school refusal as a social problem of growing concern. Overview of the School District of Shermer County The School District of Shermer County (SDSC), located geographically in the Southeastern United States, served as the setting for this study. Shermer County has a large population estimated to be over 1,000,000 (U .S. Census Bureau, 2000a). According the Census 2000, approximately 27% of th is population is enro lled in school (U.S. Census Bureau, 2000b). The conscientious de cision to provide minimal descriptive information regarding the district was made in order to protect the anonymity and identities of participants and locations in this study. Estimates are provided based on actual numbers; however, all official referenc es have been removed due to identifying information contained within these references. The district is one of the largest school districts in the United States. Secondary education in the district is composed of se parate middle and high schools. There are forty middle schools in the district, which include sc hools with grades 6 through 8, and twentythree high schools, inclusive of grades 9 th rough 12. The student population is ethnically diverse study population, with a large representation of White, Hispanic, and African American students, and minimal represen tation of multicultural, Asian, and Native American students. School refusal data in Shermer County is not readily available through public information channels. There is information th at may include cases of school refusal, although they are not delineated. This incl udes dropout rates and rates of serious emotional disturbance. In 2001-2002, Shermer County had approximately 1,500 students

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80 drop out of school, and an estimated 800 st udents met the criteria for seriously emotionally disturbed. The school system personnel is relatively large with approximately 13,000 personnel. There are approximately 2,000 mi ddle school teachers and 2,500 high school teachers. Support personnel total 1,300. There are an estimated 740 district and school level administrators. Various divisions composed of multiple departments provide the organization at the district level. The de partments that this study focused on included those under student support se rvices, which include guidance, social work, psychology, and school health. The district level employs practitioners with special expertise in providing guidance, social work, psychological and dia gnostic services, and sc hool health services. Guidance services aim to provide developmental and comprehensive programs that support the school districts goa ls. Social work services wo rk to connect students and families with appropriate community resources, address problems that interfere with student success, and assist in attendan ce issues. The psychol ogical and diagnostic services provide educational, emotional, a nd social support to all students, families, school personnel, and the educational commun ity. School health serv ices act to assure public health mandates concerning health requi rements and screenings for education, as well as providing day-to-day monitoring of h ealth procedures, and assessment of health problems. Each of these departments represents to an extent, the personnel at the school level whose subjective e xperiences serve as the primary focus of this study. This includes the following personnel: principals, assistant principals, school psychologists, social

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81 workers, health services staff, guidance couns elors, teachers, attendance office staff, and school resource officers. Summary of Literature Review School refusal has had various concep tualizations within the professional literature, developed by a myriad of disciplines. School refusal involves the institution of schools, thus the role of schooling is important to consider. Schools play a major role in the lives of youth, providing essential skills th at will be used throughout their lives. Legal statutes mandate schooling, hence, when stude nts are absent there are many issues at stake. Schools historically have had a vested interest in the health of students, as health and education have complimentary goals. Additionally, school health has been established as an extension of public health. School refusals association with absent eeism has implications for health and social outcomes. This is especially the case when the cause of absenteeism is associated with negative schools experiences, school refusal, truancy, or dropout. Due to the conceptual issues related to school refusal, differentiation of school refusal from other forms of absenteeism can be problematic. The role of the school is important, as schools serve as the central feature of school refusal. School personn el are identified as playing a key role in the identification of students w ith school refusal. Key personnel are in positions to identify students with school re fusal, although little is known about how this occurs within the schoo l setting. Difficulties arise due to tendencies to ignore students with problematic behaviors, trouble di fferentiating between various forms of absenteeism, and low referrals for services.

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82 School refusal is described as occurring among adolescents during key transitional periods in the sc hool career, such as moving from elementary to middle school. The public health implications involve short and long-term outcomes associated with loss of education and me ntal health, although extrap olation of these must be cautious as the research has issues of internal and external validity. The construction of school refusal began with the recognition of school absenteeism as a problem. This developed into the delineation of school refusal (referred to at this point as neurotic truancy or school phobia) from truancy. Further research added the dimension of the mother child relationship, referring to the issue as separation anxiety. A focus on the development of clinical knowledge developed limited information regarding causes and symptoms for school phobia, also being termed school refusal. These two terms were separated, with school phobia being subsumed as a type of school refusal. The focus moved from the i ndividual to school setting, although this area of research remains unexplored. Much of the research on school refusal follows a traditional positivist paradigm. School refusal has been studied as a problem of the student, focusing on the dynamics of the individual students and th eir families, as opposed to st udying the social or cultural context of the issue. Little research has expl ored the role of schools in school refusal. Social constructionism offers an altern ative to understanding school refusal, and the multiple perspectives that shape its understanding. It provides a framework for exploring how school personnel perceive school refusa l and its construction within the school setting that lead to thos e perceptions. The review of li terature suggests that crossculturally school refusal has been socially c onstructed according to the discourses that

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83 surround it. The social constructionist approa ch to understanding school refusal can help bridge the gap in research and expand the existing boundaries. This study was designed to understand the social interactions, pro cesses, and perceptions that construct the understanding of school refusal within a school setting.

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84 CHAPTER III: METHODS Introduction This study, guided by a social cons tructionist framework and employing qualitative methods, sought to understand the perceptions of school refusal among school personnel in the School District of Shermer County (SDSC). Semi-structured interviews were conducted with school personnel at the middle school, high school, and district levels. School personnel are cited as those pe rsons most likely to refer students with school refusal for treatment outside of the school setting. Specific personnel who were more likely to have experience with student s with school refusal were included. The use of a descriptive survey conducted with middle and high school principals provided detailed insight as to how school refusal in formation is documented at the school level within the district. This study represents a new endeavor in resear ch on school refusal. One element is that unlike previous studi es, this research focused on the school personnels personal experience and subjective de finitions of school refusal in the school setting. The research was grounded in the langu age of the participan ts to reflect their voice and not that of the researcher. This chapter describes the methods used in this study. Included is an overview of the rationale for a qua litative study design, with a descri ption of the study population, the setting, and the inclusion and exclusion criteria that was employed. Sampling strategies

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85 are provided for each method that was used for data collection. The rationale for various data collection tools is outlined, followed by an explanation of the details for the specific procedures. The data analysis is then descri bed. The chapter ends with a review of the criteria for judging qualitative research, in cluding a synopsis of the strengths and weaknesses of the study. Research Questions The purpose was to: 1) describe school personnels perceptions of school refusal and 2) identify ways in which these percep tions influence the me thods and strategies utilized by individual schools a nd their district to preven t, identify, and manage youth identified as experiencing school refusal. 1. How have school personnel constructed their perceptions of school refusal? 1a). How do school personnel think about school refusal? 1b). What influences their understanding of school refusal? 2. What are school personnels re ported perceptions, explanatio ns, and beliefs related to school refusal? 2a). How do school personnel describe school refusal? 2b). What are the different forms of sc hool refusal identified by school personnel? 3. How do school personnel per ceive students they identi fy as experiencing school refusal? 3a). How do school personnel describe st udents identified as experiencing school refusal? 4. What are the consequences of their perceptions for the recognition of school refusal among students?

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86 4a). What is the process by which sc hool personnel identify students refusing school? 4b). How do school personnel evaluate th eir experiences with students with school refusal? Study Design Several factors led to the decision to use a qualitative design, incorporating indepth, semi-structured interviews, observations, and a descriptive su rvey. The theoretical perspective of social constructionism provide s the framework for th e development of the study, which lends itself to qualitativ e methodology (Burr, 1995; Patton, 2002). Qualitative methodology is concerned with exploring how meaning is constructed. Qualitative methods, often used to describe, e xplain, explore, interpret, and build theory, have been defined as: Procedures for investigating human action that allow subjects to describe their own behavior and experience in the langua ge native to thei r experience, and investigators to undertake the analysis of human phenomenon in conversational language rather than numbers (Slife & Williams, 1995, p.234). A qualitative design allowed for the exploration of school personnels construction of school refusal, providing insi ght that is relevant for both the school setting and future public hea lth research. Conducted within the social settings of schools within a district, a qualitative design provi des a real-world perspective, which is lacking in the research on school refusa l. Gergen (1985) refers to negotiated intelligibility, or, what makes sense within a culture is what is intelligible and agreed upon by people within that cultur e (p.272). A qualitative design offers insight into an

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87 understanding of how a negotiated intelligibility of school refusal is constructed within a school district. The qualitative approach allows for depth and detail in developing a contextual understanding of the social setting (Patton, 2002). This is achieved through the triangulation of multiple data collection methods, which provide a wealth of detailed and rich description increasing the depth of understanding of the phenomena (Patton, 2002). This design allows for an in-depth understa nding of how school pe rsonnel define school refusal, the social interacti ons that inform their understand ing, and relationships between understanding and behavior. The role of the researcher in this design is important as well. In a qualitative design, the researcher serves as the in strument for data collection. This is beneficial, as the researcher is flex ible, adaptable, and has the ability to process with immediacy and respond (Lincoln & Guba, 1985; Patton, 2002). Reflexivity emphasizes the importance of self-awareness for the researcher and th eir responsibility to reflect on their role in the research (Burr, 1995; Pa tton, 2002). The researcher must simultaneously be aware of and document their role in the research pr ocess and its effect on the participants. Triangulation of qualitative research methods captures th e multiple layers of how school refusal is conceptualized within the school setting and district. This study employed multiple methods of triangulati on, including data and methods triangulation (Denzin, 1978). Data triangulation uses a va riety of sources of data, while methods triangulation refers to the use of multiple methods to study a single issue (Denzin, 1978; Patton, 2002). Likewise, triangulation supports the social c onstructionist assumption of

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88 multiple realities, as this study sought the multiple perspectives of district level personnel and policies, the school level, and the individual school personnel. Study Population The primary focus of this study was school personnel at the di strict, middle, and high school levels who are employed by the SDSC in the Southeastern United States. At the district level, the focus was on those pe rsonnel employed within specific departments under student support services, which include s guidance, social work, psychology, and school health. At the middle and high school level, the study population consisted of principals, assistant principals, school psychologists, social work ers, health services staff, guidance counselors, teachers, attendance offi ce staff, and school resource officers. The sampling strategy differed based on th e data collection te chnique that was used. This section includes a description of the setting in which the study was carried out, inclusion and exclusion criter ia for all data collection me thods, the sampling strategy for participants in all in-depth semi-structured interviews, starting with elite district level interviews, and for observations and respondents participating in the descriptive survey. Setting School district offices, middle schools, and high schools served as the natural setting for interviews. One main office at the district level provided the setting for the elite interviews (described later) It is located in the downtown area of a large metropolitan area. There are forty middle schools in the SD SC with grades six through eight, and twenty-three high schools that house grades nine through twelve. Middle schools and high schools differ in the number of the i ndicated personnel. The number of specific

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89 personnel differs from school to school, as some of these positions are itinerate, specifically school psychologists, social worker s, and health services staff. Additionally, there are differences due to size of stude nt membership; therefore, high schools have more assistant principals and guidance counselors than middle schools. In middle schools, there are generally two assistant principals, one for curriculum, and the other for administration. The assistant principals in th e high school setting include these, as well as additional positions for student affairs. Likewise, there are typically more guidance counselors in the high school setting than in the middle school setting. All secondary (middle and high) schools in the district are assigned a full-time school resource officer. Based on the schools jurisdiction, the resource officers operational command is from one of the follo wing: the city police Department or the county sheriffs department. Inclusion Criteria School personnel included in the study work ed within the distri ct. For interviews, participants were required to be past their first year of employment with the district. The survey, which was sent to principals to be completed, did not require any length of employment, as principals are able to access information to complete the survey more readily regardless of their tenure. Participants included district level personnel in the specified departments, and school level personnel who work in the designated positions at the selected schools. Exclusion Criteria Personnel at any level (district or sch ool) who were in their first year of employment with the SDSC were excluded from the interviews. For interviews, this was

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90 ascertained via telephone or in person, prior to scheduli ng an interview. Schools included in the sampling frame excluded alternative sc hools, elementary schools, K-8 schools, and new schools opening during the 2004-2005 academic year. Sampling Design The sampling strategies for this study had multiple levels based on each data collection method. Sampling strategies include d stratification, purpos efulness, snowball, population sample, and saturation. Sampling was ba sed on the review of literature and the theoretical framework. Previous literature indicated that specific school personnel are likely to be the first indivi duals to encounter and intera ct with students experiencing school refusal. The theoretical framework of social constructionism is built on the assumptions that knowledge and meaning are socially constructed through social interactions and processes. Likewise, both th e literature on school re fusal and the theory of social constructionism reference the importa nce of the social context in which social processes occur. Therefore, th e first layer of the sampling de sign was at the district and school level, with further levels of samp ling to select the in dividual personnel who engage in the social processes within schools. District Level Elite In-Depth Semi-Structured Interviews The elite in-depth interviews were conducted at the district level. Specific departments under the districts student suppor t services were sele cted using purposeful sampling. Purposeful sampling is especially re levant when the intention is to select information-rich cases who can illumina te the phenomenon under study (Patton, 2002). This may also be considered quota sampling, as this is often used to refer to the selection

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91 of sets of key informants who are particularly knowledgeable about th is topic of interest (Bernard, 2000). In this study, detail beyond what is public ly available in regards to district level perceptions and policies rela ted to school refusal was sought. Within student support services, various departments were selected for participation for inclusion in the elite interviews. These included the department s responsible for guidance, social work, psychology, and school health within the dist rict. The second level of sampling for the elite interviews involved the se lection of participants who work within the division and the departments. Due to the small number of personnel working in these departments, a population sample was attempted. The maximu m sample size possible was twenty-one, based on the number of professional district-level employees at the division level and in the selected departments. Table 1. Purposeful Sampling Matrix for Elite District Level Interviews School District of Shermer County Total Student Support Services Division Level Guidance Services School Social Work Services School Psychological/Diagnostic Services School Health Services Total Professional Staff 3 11 3 2 2 21 *Number in cells represents maximum possible interviews based on number of professional staff in each department. School Level In-Depth Semi-Structured Interviews In-depth interviews were conducted at the school level. Pu rposeful, stratified random sampling without replacement was used to select schools for participation in the

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92 study (McDermott & Sarvela, 1999a). A purposeful random sample helps to reduce potential selection bias, thus increasing credib ility (Patton, 2002). It also adds credibility in the instance of a potential purposeful sample becoming too large to handle (Patton, 2002). It does not however permit generaliza tion, as it is not a representative random sample. Three levels of stratification were us ed in sampling: grade level, geographic location, and category of school personnel. Following dichotomization of schools according to grade level (middle or high), they were stratified according to their geographic location. The Sher mer County Commission divide s the county into four districts. Each district is segmented to represent an equal populat ion size, although one of the districts, which will be referred to as the Center district, is more densely populated with a higher percentage of minorities. An over sample was taken in this particular district (see discus sion below). Schools were mapped by their physical location within these geographic districts. Stratification en sured representations of sub-groups, provides for illustration of characteristic s of these subgroups, and faci litates comparisons (Bernard, 2000; Patton, 2002). Geographic stratificati on allowed for representation of schools across the district. The schools within each geographic st ratum were assigned a random number generated through SAS software, Version 9.1. A progr am was written in SAS to randomly select one middle school and one high school from each geographic stratum, with the exception of the most densely populat ed geographic Center district, in which two middle and high schools were selected. This resulted in a minimum sample of ten schools. It was confirmed that none of the schools selected shared itinerate personnel

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93 (e.g. a school psychologist) of any sort, th erefore no additional sc hools were selected because of that reason. This en sured discrete samples of selected staff. However, two school principals, from both a middle and a hi gh school, declined to allow their school to participate in the study. Both schools were locate d in the Center district, the more densely populated district in which an over sample had been selected. Two additional schools were then selected randomly fr om the district who agreed to participate. Lastly, the criterion for saturation was met within data collection in these ten schools, therefore additional schools were not selected for further data collection (see discussion below for description of saturation) Once the ten schools were randomly select ed, a stratified, purposeful sample of school personnel within each school setting was employed. The number of participants per cell was determined by sa turation or redundancy. Theoreti cal saturation or sampling to the point of redundancy refers to the te rmination of sampling once no new information is emerging from data collection (Lincoln & Guba, 1985). While this represents an ideal of sampling in qualitative rese arch, the practicality of usi ng saturation or redundancy as a sole sampling technique is inappropriate for the proposed study due to time constraints and limited resources (Patton, 2002). For the purposes of this study, saturati on was primarily important for the school level interviews. The concept of minimum samples entailed starting with the minimum number expected for reasonable coverage of the phenomenon (Patton, 2002). As data collection proceeded, more could have been added to the sample, although this proved not necessary (Patton, 2002). Data collection continued until the point in which no new data constituted the creation of new themes in data analysis.

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94 The purpose of this study was to unders tand school personnels perceptions of school refusal; therefore, even when a part icipant indicated that they did not know anything about students who refuse to attend school, they still were considered to have the potential to offer valuable insight into how these students ar e perceived. For all personnel indicated, with the exception of t eachers, interviews were sought based on their availability. Therefore, at each middl e and high school, all assistant principals, school psychologists, social workers, hea lth services staff, guidance counselors, attendance office staff, and school resource o fficers were invited to participate in interviews. Teachers were sel ected using a snowball sample through referrals obtained during interviews with other school personnel. Table 2. Purposeful Stratified Random Samp ling Matrix for School Level Interviews Level One Stratification: Geographic Location Geographic Location District 1 District 2 District 3 District 4 School Level MS HS MS HS MS HS MS HS Total Number of Schools 1 1 1 1 2 2 1 1 N=10 Level Two Stratification: School Grade Level School Personnel within Schools Middle Schools (N=5) High Schools (N=5) Total (N=10) Level Three Stratification: Category of School Personnel Assistant Principals 5* 5 10 School Psychologists 5 5 10 Social Workers 5 5 10 Health Services Staff 5 5 10 Guidance Counselors 5 5 10 Attendance Office Staff 5 5 10 School Resource Officers 5 5 10 Teachers 5 5 10 Total 40 40 80 *Numbers in cells represent minimum samples

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95 Observation The random selection of th e ten schools for in-depth interviews automatically determined the selection of schools for obser vation. Observations we re conducted in all schools selected for interviews (see section on School Level In-Depth Semi-Structured Interviews) Descriptive Self-Administered Survey The sampling strategy for the administrati on of the descriptive survey was simple. A population sample of middle and high school pr incipals was selected. School principals represent the personnel most likely to have acce ss to the information requested within the survey. The desired sample size in cluded sixty-three principals. Data Collection Tools This study employed three main strategies to collect data on school personnels perceptions of school refusal. Various data collection tools were used for data and methods triangulation. The use of these various tools was usef ul to develop an understanding of the multiple perspectives of school personnel. These strategies included: 1) in-depth, semi-structured in terviews of school personnel, w ith elite interviews at the district level; 2) observation at schools selected to participat e in the interviews; and 3) a descriptive, self-administere d survey for all middle and high school principals. This section provides an overview of these various data collection tools, the rationale for their use, and the related strengths and weaknesse s of each. A separate section reviews the detailed procedures that guided the use of these data collection tools.

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96 In-Depth Semi-Structured Interviews Interviews are the appropriate form of data collection when the intention is to understand another persons perspective. It is the only method for finding out things that cannot be directly observed, such as percep tions and thoughts (Patt on, 2002). Interviews are useful in collecting detailed informa tion. This method also reflects the social constructionist assumption of reflexivity and th e role of the research er in the process of social interaction. The researcher is not a neutral objective indivi dual, but is actively involved in the interview process and the creation of data. There are three basic approaches to open-ended interviewing: 1) unstructured interviews; 2) semi-structured interviews; a nd 3) structured interv iews (Bernard, 2000). In-depth, semi-structured interviews were us ed for data collection at the district and school level to understand how school personne l perceive and socially construct school refusal within th e school setting. Semi-structured interviewing is beneficial when there is only one opportunity for the interview (Bernard, 2000). The interview is conversati onal, yet the use of an interview guide provides a sy stematic approach to interv iewing different people (Patton, 2002). The interview guide provides an outline for the interview of topics or issues to be covered, but there is flexibility in the orde r and for probing as the interview progresses (Patton, 2002). The guide also increases the co mprehensiveness of th e data collected, and allows the researcher to antic ipate gaps, and be prepared to account for them (Patton, 2002). Weaknesses of this method include: 1) the potential to ove rlook salient topics, thus producing gaps in the data; and 2) va ried sequencing of questions could produce varied responses that decrease comparability (Patton, 2002).

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97 Elite In-Depth Semi-Structured Interviews At the district level, the style of semi-structured interviewing that was used is referred to as elite interviewing. Elite inte rviewing uses a semi-structured interview format, but is useful as a means of data collection to understand political processes surrounding the topic under study (Johnson & Jo slyn, 1995). Thus, elite interviews are conducted with those persons in elite positions, who may have an in-depth understanding of policies and processes related to a topic (Johnson & Joslyn, 1995). The strength of elite interviewing is that the researcher is able to access the insider perspectives of persons in positions of aut hority. This method allows the researcher to maximize the time with the participant, gi ven they are usually busy people who have limited time. Therefore, consider able preparation is required, as the researcher must not ask questions that can be answered elsewh ere. This preparatio n involves the study of existing documents and other public ly available information rela ted to the topic. This can help the researcher interpret and understand the importance of what is being said during the interview, allowing for probing and re-dir ecting. Additionally, the participant may be impressed with the researchers sincere interest in the issue, increasing rapport (Johnson & Joslyn, 1995). Given the strengths of elite interviewi ng, this method was used when interviewing district level personnel. The re searcher thoroughly prepared for interviews and followed a semi-structured interview guide. District level personnel were more likely to be able to illuminate policies related to school refusal in pl ace at the district le vel. Their perspective on school refusal was important for triangulati on of findings at the school level. These

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98 interviews were instrumental in understanding the social construction of school refusal through interactions between the district and school level. Observations Observations were conducted at the sc hools selected for in terviews (Patton, 2002). Observations refers to observations conduct ed in the field that allow the researcher to describe the setting, the activities that take place, and who participates in those activities (Patton, 2002). Obse rvation exists on a continuum of involvement, with the researcher serving as the inst rument ranging from full partic ipant to spectator (Merriam, 1988; Patton, 2002). Observations in this study were conducted by the researcher as observer as participant or as a spect ator (Merriam, 1988). Although this form of observation does not place the rese archer as an active participant, their presence in the setting is overt and acknowledged by others w ithin the setting. To a certain degree, the observers presence in the setting aff ects those being observed, despite minimal participation (Patton, 2002). The group is aware of the research ers observation activities, and the researchers participation is limited to observation (Merriam, 1988). Observation serves as a key method in qualitative fieldwork. There are several advantages to conducting observations. Observation allows a better understanding of the context within which people in the setting interact (Patton, 2002). Additional strengths of this method include the ability to triangulat e the actual setting and the day to day happenings with what is available in writt en documents and reported verbally, and to move beyond reliance on selective perceptions of others (Merriam, 1988; Patton, 2002). Limitations to observations include the possibi lity of the observer affecting the situation

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99 being observed in unknown ways, limited in its focus on external behaviors, and constraints from observing limited situations (Patton, 2002). This method was useful in observing the da y-to-day occurrences in key locations within each school, to develop the context of the school perso nnels perceptions of school refusal. Observations also served as a me thodological triangulation, allowing insight into interactions and social pro cesses within the school setting, avoiding reliance on verbal data generated from interviews (Patton, 2002). Observations took place prior to the interviews and continued for an ongoing period once they began. The in tention of conducting observati ons was twofold. The first purpose was to gain trust of the various school personnel who might be interviewed. Prolonged engagement and presence in the school setting allowed the researcher to become accustomed to the school setting and vice versa (Lincoln & Guba, 1985; Patton, 2002). Habituation refers to the relaxation of behaviors after th e participants adjust to the new person in the setting, in this instance when school personnel adjust to the researchers presence (Lincoln & Guba, 1985). By conducting the observations prior to interviews and for an ongoing period th roughout data collection, school personnel became familiar with the researcher (described in detail later) In some instances this may have increased the comfort level and rapport during interviews. Development of thick and rich description of th e interactions of students, parents, and school personnel in these various school settings a dds to the transferability of the study, while the prolonged engagement increases credibility.

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100 Descriptive Self-Administered Survey The Survey of School Refusal, originally developed by Stickney and Miltenberger (1998), was used. The survey contains 13 items designed to gather information regarding school size, community setting, presence of a school refusal identification system, person responsible for identifying school refusal, characteristics of school refusal, and steps taken in response to individuals engaging in school refusal (Stic kney & Miltenberger, 1998). The survey contains a combination of opened and closed ended questions designed to generate descrip tive data that describes the middle and high school level response to school refusal and provides a nother point for triangulation of data and methods (McDermott & Sarvela, 1999b). The use of a descriptive self-administered survey relies on written instru ctions that are clear and concise and do not require further clarification. This is an appropriate method for the school principals, as they are a literate population, the survey does not re quire a large time commitment, and it is likely that the response rate will be high (Bernard, 2000). It is also appropriate because the questions do not require a face-to-face format (Bernar d, 2000). The advantages of using a selfadministered survey includes that it can be se nt to a large group, it has relatively low cost, and is based on a standard set of questions thus limiting interviewer bias (McDermott & Sarvela, 1999b). Given that this survey wa s delivered via mail, the major weakness is response rate (McDermott & Sarv ela, 1999b). In an attempt to increase response rates, the Dillman method (2000) guided the survey procedures, as is discussed in the section on data collection procedures.

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101 Data Collection Procedures The following section provides a detaile d plan of how data collection was operationalized. Details regardi ng the levels of permission required to co nduct the study are provided. The section outlines the following: 1) a general overview of procedures for all interviews; 2) a deta iled description of the interviews at the district and school levels, including participant recruitment methods; 3) an explanation of the procedures for observations; and 4) a plan for the descri ptive survey. This section also provides information regarding pre-testi ng, the external revi ew, and pilot testi ng of the interview guides, extraction/review tool observation guide, and desc riptive survey. Additionally, this section reviews tape-r ecording, confidentiality, field notes, transcription, and nonparticipation. The period for data collecti on began at the end of the Spring 2004 school semester and continued through the fo llowing Spring 2005 semester (Appendix B Timeline for Data Collection). Levels of Permission, Negotiations, and Entry Prior to the start of this research, severa l levels of permission were required. In qualitative research, this is often referred to as entry into the fi eld (Patton, 2002). This occurs in two separate but related stages. Th e first is negotiation with gatekeepers, and the second is the actual physical entry into the setting (Patton, 2002). The stages are related as the ini tial negotiation sets the stage for the rules and conditions for entry into the field (Patton, 2002). First, permission to use the survey by Stickney and Miltenberger (1998) was sought and granted via email communication wi th one of the origin al authors (Appendix C Approval to Use The Survey of School Re fusal). This was important to establish

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102 prior to seeking permission to conduct the study. The first le vel was the University of South Floridas (USF) Institutional Review Board (IRB). An IRB application was submitted prior to initiating the study. The second level was the School District of Shermer County. Prior to submitting an application to request permission to c onduct research, meetings were conducted with key gatekeepers at the district level. Tentative verbal appr oval was granted. An official request for research was submitted, and approval was granted. The third level of permission became im portant once access had been granted to conduct the study in the district. This level is represented by the individual schools that were selected for observations and interviews. School principa ls were contacted first by an introduction letter, followed by a phone call to schedule individual meetings. In most cases, a series of phone calls occurred between the researcher and the principals secretary before a meeting was set. Meetings were often scheduled with the principal via the secretary. Only three principals schedul ed meetings from the researchers initial contact. Principals were pr ovided with a brief overview of the study, letters documenting permission to conduct research in the district, and a letter of support from a district level official. Permission to conduct observation and interviews was sought from principals. A signed informed consent documented that the principal of each school granted permission for their school and personnel to participate. Permission and support of the principal is important in any research conducted in a sc hool based setting (Bill ington, Washington, & Trickett, 1981).

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103 The researcher also sought permission to attend a faculty meeting at the beginning of the Fall semester to be introduced to the faculty and staff. This was in an attempt to assist personnel in recognizing the researcher as someone who not only has permission to be in the school setting, but has support from the princi pal as well. One middle school principal agreed that attending the facu lty meeting was important; whereas other principals agreed to communi cate their support of the rese archer to their personnel via intra-office memorandums and email. In a few instances (N=3 high schools), principals requested that the rese archer meet with the assistant principal of the school, as their schedule did not permit enough time, despite most meetings lasting an average of ten minutes. In-Depth Semi-Structured Interviews Individual participants we re contacted to schedule interviews. All participants completed an informed consent agreement. The semi-structured interviews lasted for an hour on average. No interviews were schedul ed with less than an hour between, as the researcher needed time to review tapes and notes. The location and time was scheduled at the convenience of the participant. The location for interviews included participants place of work in a private office, empty m eeting, conference room, or classroom, faculty lounge, or school clinic. All school personnel were provided a ge neral definition, although the term school refusal will not be used. Partic ipants were told that the study is about their perceptions of students who refuse to attend school for various unexplained reasons (Kearney, 2001) and students who have difficulty in attending school or remain ing in school for the entire

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104 day (Stickney & Miltenberger, 1998, p.162) The intention was to understand how school personnel, at all levels, conceptualize this phenomenon. The researcher assumed the stance of knowing nothing. In many cases, participants would make comments to the re searcher indicating th at she probably knew more than they did about what made st udents refuse school. In these cases, the researcher, in order to re-pos ition her power as an expert from the perspective of the participant, would indicate th at she had never worked in a school setting, and considered school personnel the experts and most appr opriate group to speak with to gather information on their opinions. In the beginning of the interview, participants were asked to talk about why students do not come to sc hool. This was intended to get the participant talking and comfortable. They were also asked about what ma kes it difficult for students to come, and what makes it difficult for them to remain in school all day. They were then asked for more and more stories about students who refuse to attend school. All interviews followed an interview guide that provided a flexible structure with key issues to cover during the interview (Appendix D General Interview Guide). The research questions, theory, and literature in formed the development of the guide. Probing was used throughout the intervie w to elicit further details re lated to information provided (Appendix E Probes for Interviewing). A de mographic sheet was completed for each participant at the end of the interview, collec ting information such as official title, years of experience, educational background, ge nder, age, and ethnicity (Appendix F Demographic Information Sheet). Data was collected using two met hods: tape-recording and jottings. All participants were asked for permission to be tape-recorded to assure quality of data

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105 collection. They were made aware prior to sc heduling the interview th at it would be taperecorded. Only in two cases did particip ants decline to be tape-recorded. Both participants verbalized concern that they would not be inclin ed to share fully their views if they knew a tape-recorded record would exis t. In these cases, the researcher agreed to take notes. Notes were taken as close to ve rbatim as possible, and immediately following these interviews, the researcher went to a quiet location, and typed up a transcript based on her notes. Likewise, several times after the end of an interview, a participant would remember something. This was usually after th e researcher had packed up her equipment. In these cases, the researcher would jot down notes, and immediately go to a private location and tape-record these notes onto the interview tape, so the added information would be included in transcription. Jottings, or field notes taken during the interview, were recorded in a small notebook (Bernard, 1994). The purpose was to rela y ideas to paper to transcribe later into field notes. As soon as possible following each interview, the researcher listened to the tape and reviewed field notes to fill in any missing parts. No interviews were scheduled with less than an hour between them, to allow time for reflection and regrouping. District Level Elite Interviews At the district level, a series of elite interviews were c onducted with personnel who are experienced and knowledgeable within the district setting. The intention was to gain an understanding of how school refusal is conceptualized at the district level. The district level personnel have inside informa tion on programs and policies that are related, both directly and indirectly, to schoo l refusal and how it is addressed.

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106 Elite interviews took place prior to the school level interviews and observations in an effort to have advanced knowledge of existing programs that may affect school personnels perceptions of sc hool refusal (i.e., the bullying prevention program). Prior to interviewing, the researcher was informed on various policies and programs of the School District of Shermer Co unty as well as relevant state statutes dealing with school policies re lated to attendance. Examples of information reviewed include the districts we bsite, student handbook, school board policy manual, and the student progression plan. In addition, state statutes rela ted to school attendance and related issues were reviewed. Institutional doc uments served to prepare the researcher for the elite interviews, while at the same time offering insight into a nother aspect of the socially constructed realities that emerge from the social context of schools (Miller, 1997). The use of a review guide/extraction tool was used to ensure systematic review of each document (Appendix G Document Extraction Tool). Recruitment for district level elite interviews. A pre-notice packet of information was mailed to specified district level personnel. This packet contained a le tter introducing the researcher, describing th e study, and indicating that they would receive a telephone call within the next week to schedule an interview. A brightly hued reminder card was included with the researchers contact information in the event that the participant wished to initiate contact. The pack et also included the letter of permission from the school district and the letter of suppor t from the district level offici al. Interviews were scheduled via telephone at the conv enience and desired location of th e participant. On average, it took two attempts to contact particip ants to schedule an interview.

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107 School Level Interviews In-depth semi-structured interviews were conducted with personnel from the randomly selected schools. The school pe rsonnel recruited for interviews included assistant principals, school psychologists, soci al workers, health services staff, guidance counselors, teachers, attendance office staff, and school resource officers. There was an effort to collect data from personnel in si milar positions across schools (i.e., assistant principals) in a shorter time frame to assist in determining theoreti cal saturation, although this was not always possible. Within schools, time between interviews was not less than an hour. Recruitment for school level interviews. The initial contact with school personnel took place during the first two weeks of observations or durin g the initial meeting with the main school contact (principal or assistan t principal). All potenti al participants were provided a packet of information similar to the one sent to school di strict personnel. This packet was placed in the various personnels mailbox at the school or hand-delivered at the beginning of the observation period or wh en introduced by the school contact. The letter explained the observation time being spen t in the school, and i ndicated that during this time, the researcher would contact th em via telephone or in person to schedule a future interview. Many personnel initiated cont act with the researcher via email. This proved to be the most effective method of contacting and scheduling interviews with school personnel. Interviews were scheduled at the convenience and desired location of the participant. A little more than half of personnel scheduled inte rviews upon the initial contact. Remaining interviews were scheduled after an average of two contacts attempts. Once interviews began, recommendations for interviews with teachers were sought.

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108 Teachers were contacted via email, as tele phone access is difficult given the amount of time they spend in a classroom. Participants were asked at the end of their interview if they would refer the researcher to a classroom teacher who might be interested in participating in the study. The researcher then provided teachers with a packet of information and followed-up accordingly. Observations Observations were carried out at each school selected for interviews. Permission was sought to conduct interviews during th e initial meeting w ith principals (see section on Levels of Permission ). A total of 36 hours of observation time was split among the ten schools. Observations commenced two week s prior to interviewing. The observations were intense with the researcher at times observing two different sc hools each day or one school for an entire 1-2 day period. The deci sion to conduct daylong observations within one school setting was intenti onal. It allowed comprehensiv e observations of the full day as opposed to short intervals. Sometimes, when staying for longer periods, the researcher was able to see repeated interactions between the same students and personnel. For example, in one school, the same student re-a ppeared in all three locations throughout the day. Times were alternated, so if observations were taken in the morning at one school in one location, they would be taken in the afte rnoon as well, to captu re variations between these times within th e school setting. Three locations were to be observed in each school for one-hour periods, although it was discovered that some locations have very little student or school personnel traffic flow, therefore time was decreased in these locations (i.e., the guidance office). Locations for observations included the attendance office, school clinic or nurses office, and the

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109 guidance office. These various locations deal w ith the arrival of stude nts at school and at times issues related to attendance. Locations within schools were alte rnated, so that the researcher observed each at least twice. Once interviewing at the schools commenced, each school had been observed for approximately six hours. Field notes were taken to document observa tions. To aid in observations, a guide was developed that assisted the researcher in systematic documentation (Appendix H Observation Guide). This guide included a list of elements and questions that helped the researcher stay focused on the setting (Mer riam, 1988). Elements included the setting, the participants, activities and interactions, fr equency and duration, and subtle factors. Descriptive Self-Administered Survey The Survey of School Refusal was mailed to all middle and hi gh school principals to collect descriptive data on the schools response to school refusal. Participants were asked to provide information regarding school refusal from the previous school year (2003-2004). To increase response rates, th e Dillman method was employed (Dillman, 2000). A response rate of 70% was sought, although 60% would be acceptable. The final response rate was 61% (N=38). School principals were mailed a pre-lette r via first class mail accompanied by the SDSC approval letter to conduct the study and the USF IRB approval (McDermott & Sarvela, 1999b). A waiver of written docum entation of informed consent was obtained for the survey, therefore a conf identiality statement was provi ded within the cover letter. An informed consent was provided, but signa ture was not required. The letter explained the survey and informed the respondent that the survey would be mailed in a week. The survey was sent a week after mailing the pre-letter (Appendix I Survey of School

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110 Refusal). The survey was professional in appearance with a front and back cover (Dillman, 2000). It included a cover letter th at provided a general definition of school refusal, information on confidentiality, and researcher contact information (McDermott & Sarvela, 1999b). The letter also included a st atement that acknowledged that help may be needed in obtaining the data necessary to co mplete the survey, which is okay, but it is preferred that the princi pal be the person to physically complete it. The survey was printed on colored paper with the intention of making it stand out. A self-addressed stamped envelope was in cluded for convenience. All correspondence was sent in large, white envelopes via prio rity mail. A reminder postcard was mailed one week after the survey was sent. Two weeks after the postcard was mailed, another cover letter and survey was sent to participants who had not ye t responded, along with a note explaining that their survey had not been received and stating how important it is for them to participate (Bernard, 2000). Th ese were sent certified mail. A tracking and coding system was used to distinguish who returned surveys, when surveys were returned, who require d follow-up, and who did not respond. Surveys were printed in two different colors, one co lor for middle school principals, and the other for high school principals. A small number code was assigned to each school, and affixed in the inside corner of the last page of each survey to track non-response. Pre-Testing, External Review, and Pilot Testing Pre-testing of the interview guides an d survey was conducted with schoolteachers enrolled in a college level course. All participants completed an informed consent. The interview guide for school personnel and the su rvey was tested with 2-4 participants for each. Pre-testing involved the think-aloud prot ocol for both the survey and the interview

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111 guide (Patton, 2002). This process aims to e licit verbally the cognitive processes that elucidate what someone is thinking when asked a question (Patton, 2002). Participants were asked to think aloud as they read and completed the survey. They were asked questions on comprehension, clarity, and c onciseness of questions (Appendix J Pretesting Protocol). At the end of the interview, de mographic information was collected for each participant. Pre-testing findings ar e summarized briefly in Appendix K. The interview guides were updated based on pre-testing findings prior to pilot testing, external panel review, and data coll ection (Appendix L External Review Panel). Prior to conducting interviews, the guides and instruments were pilot tested with various school personnel and revised as neces sary. Participants for pilot testing were recruited via a snowball sample of school personnel from a middle school, high school, and the district level in Sarasota County P ublic Schools. The total sample size included ten participants. The goal was to obtain representation of each category of school personnel at the school level, and at least one participant from the district level personnel. Pilot testing was conducted with the school and district level in terview guides, the observation tool, and the survey. Interviews were conducted to check the guides for flow, comprehensibility, and appropriateness. Pilot findings are summari zed briefly in Appendix M. Following the pilot, the interview guide, observation guide, and descriptive survey were submitted to the external panel. This panel included a school expert, a school refusal expert, and a qualitative research methodologist. Cha nges were made based on recommendations provided by the panel, although they were not extensive. Given the minimal changes

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112 recommended by the external panel, pilot tes ting was officially concluded and no further interviews were conducted. The document review tool was provided to a volunteer along with a sample of a document. The volunteer and the principal inve stigator both used the instrument and compared the results to determine reliability of the tool. The same process was used with the observation guide. An hour of observation was conducted within one location within a Sarasota school setting; the attendance office, which was locate within the student affairs office. Two principals of Sarasota schools we re asked to complete the survey and provide feedback on clarity of directions, time required to complete, and the resources required to complete it. Only one principa l returned the survey and feedback was minimal. Final content changes to the interview guides, document review tool, observation guide, and survey were submitted to the USF IRB in the form of an IRB modification. Levels of Confidentiality All participants in the study were as ked to sign IRB approved informed consent agreements. No identifying information was recorded on tape or transcripts. Other potentially identifying material, such as the in formed consents, has been kept in a locked filing cabinet in a locked office with access restricted to the principal investigator. Due to the limited boundaries and sampling procedures for this study, the pr incipal investigator is limited in describing certain settings and participants, to protect confidentiality. Therefore, schools selected for the study are not revealed. Additionally, pseudonyms have been used when describing settings and personnel. Pseudonyms do not reflect the

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113 actual gender of the participant, however thei r actual position and level is reported for descriptive and comparative purposes. Field Notes Field notes on data collecti on and analysis were operati onalized using a daily log, jottings, and three forms of field notes. A da ily log consists of what was planned and expected for each day of data collection including things to accomplish versus what actually happened (Bernard, 1994, 2000). Us ing a blank notebook, double pages for each day were dated in advance, with the left page documenting the sche duled events for the day, and the right side documenting the actual occurrences th at day (Bernard, 1994, 2000). Additionally, the researcher carried a small notebook at all times. This was useful for taking quick notes on any informal, unpla nned conversations with personnel. Jottings were also useful to document ideas, thoughts, or information related to the research that arises unexpectedly (Bernard, 2000). Field notes include descriptive, methodol ogical, and analytic al notes (Bernard, 2000). All notes were kept in separate Microsoft Office Word files within separate folders and recorded daily. Each file was titled a ppropriately and dated. During each interview, jottings or field notes were taken in as much detail as possible. Observations were recorded as descriptive field notes, with the use of an observation guide. Methodological field notes included anything that deal s with data collection techniques, such as interviewing methods th at worked well (Berna rd, 2000). Analytical notes were used to document reflections, ideas, and theories that emerge from the data as it is collected and analy zed (Bernard, 2000). In additi on to field notes, a personal journal was maintained to record any persona l reflections that aros e during the research

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114 process. Field notes were reviewed duri ng data analysis to provide reminders, contextual information, and details. Tape-Recording Prior to the start of all interviews, participants were asked for permission to taperecord. A tape-recorder with a small, nondescript microphone was used. Ninety minute tapes were used for each interview. At the be ginning of each interview, the tape recorder was checked to make sure it was proper ly functioning. At the beginning of data collection, this was done by recording a verbal stamp of the date and some additional information with the participant present, as it was thought it might increase their comfort with the tape-recorder. However, after obser ving body language and facial expressions among participants that appeared to indicate some uneasiness, this was done prior to meeting with the participant. Additional tapes were kept on hand in the event the interview exceeds the estimated time. Immediat ely following the interview, the tape was checked to make sure it recorded the in terview. Tapes were labeled and used for transcription. In the event that a participant refused to be tape-recorded, the interview proceeded and the researcher made a concen trated effort to capture most of the conversation in notes. Immediately after the interview, the researcher typed out the details of the interview. Transcription All interviews were tape-recorded and transcribed verbatim with the exception of two interviews in which the participants refused to be tape-recorded. In those two cases, copious notes were taken by the researcher and transcribed immediately after the interview. All other interviews were sent out for transcription into Microsoft Office

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115 Word Upon receipt of transcripts they were co mpared with tapes to check for accuracy. A coding and filing system was used for all field notes, so they were matched with interview transcripts for data analysis. All transcripts were transf erred into Ethnograph v.5.08, which is the qualitative soft ware program that was used in data analysis (Scolari Qualis Research Associates, 2001). Ethnograph is useful for conducting rapid searches of large amounts of text, applying codes to chunks of text, and then sorting text by codes. Debriefing Debriefing was conducted on a regular basi s with a peer to identify any evident biases and clarify interpretations (Tashakkor i & Teddlie, 1998). Debriefing sessions were conducted at three time points during data co llection. The first session took place after ten interviews were completed, the second af ter twenty interviews, and the final when interviews were complete. Debriefing in cluded discussion of the data collection procedures, review of the type s of data that were being ge nerated, and an examination of the experiences of the research er. Towards the end of data co llection, review of emergent themes, data analysis, and interpretati on were included in this process. Prior to each debriefing, the interviewer provided an independent researcher who was familiar with the study a sample of interview tapes to review. The researcher listened to the tapes, focusing on possible researcher bias, leading, participant reactivity, and other possible problems in the data collection. This was done again in the middle of the data collection phase and at the end. The last debriefing session included a sample of interview tapes from various points throughout so that the independe nt researcher could check for consistency as well as the previous ly mentioned issues. Additionally, the last

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116 debriefing included transcript s and the initial data anal ysis codebook, so that the independent researcher could try coding some of the tran scripts. This allowed the researcher to compare the reliability of the coding process. This allowed an outside perspective of the research, served as a credibility and dependability check, and provided an outlet for the researcher to express her ideas and reactions to conducting the study. Non-Participation At the district level, participation was limited within certain departments. This was due in part to gatekeepers who placed parameters on who would and would not be allowed to participate in an interview. Due to confidentiality issues, descriptive details cannot be provided regarding the district level. At the school level, two school principa ls (middle and high school) declined to allow their school to participate in the study. Both schools were located in urban areas. The middle school principal simply declined to participate, whereas the high school principal indicated that the school was too busy assisting other researchers. Neither principal contacted the resear cher directly. Additional schools were selected randomly from the remaining schools. When the researcher was allowed access to a school, most eligible participants within the school were more than willing to participate. Out of the 107 school personnel invited to participate in interviews, 25 we re non-participants. Non-participants were mostly female (N=19) and split between mi ddle school (N=12) and high school (N=13). Non-participants included the following categories of school personnel: secretaries (N=8); resource officers/deputies (N=4); teach ers (N=4); assistant principals (N=3);

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117 health assistants (N=2); school psychologi sts (N=2); and a guidance counselor and a social worker. Reasons for non-participation were attained in only a handful of cases, whereas for the most part non-participation was de termined by non-response following repeated contacts. Some of the reasons offered for non-participation include d, I am not good at these kinds of things [intervi ews], and I really dont have any experience with students that have school refusal. Three non-particip ants actually scheduled interviews, did not make their appointment, and then failed to re spond to follow-up efforts to re-schedule. Non-participation in the Survey of School Refusal was identified by the lack of response following a reminder postcard and a follow-up survey. There were 24 out of 68 schools that did not participate, 15 of which were middle schools. In four cases, the researcher was informed the school would not participate. One school had the follow-up survey returned to sender, while another us ed the postage paid e nvelope provided by the researcher to send back a note indicating they would not participate. Two schools placed telephone calls to indicat e they would not participate, one of which indicated that their principal did not do surveys. Data Analysis Qualitative Data Analysis Based on the exploratory design, the study used a grounded theory approach. Grounded theory is a systematic approach to qualitative data anal ysis, which includes iterative and inductive proce sses requiring the researcher to move from identifying themes and categories to larger concepts a nd patterns (Glaser & St rauss, 1967). Within the grounded theory approach to qualitative data analysis, a constant comparative method

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118 of systematically examining, comparing, a nd refining emerging categories and themes was used (Glaser & Strauss, 1967) This approach to data anal ysis includes several steps: 1. transcription and reading of interviews 2. identification of emergent themes or categories 3. pull together data consistent with themes and compare 4. think about relationships and patterns among themes 5. construct theory comparing it against data 6. present results that exemplif y the theory (Bernard, 2000). Data analysis consisted of several stages, including anal ytical thoughts during data collection, open coding, in-vivo coding (u ses words of the participant), deductive coding, and interpretation (Ber nard, 2000; Glaser & Strauss, 1967). Data analysis began during data collection with th e formation of ideas during da ta collection, which were documented as field notes (Patton, 2002). Th roughout data collection, interviews were reviewed as part of a data analysis. This gui ded the researcher in th e continued process of interviewing as well as in identifying emerging themes within the data. This represents the first level of data analysis. All interviews were tape-recorded, transcribed, and entered into a laptop computer. Transcripts were then loaded into Ethnograph v.5.08, a software package that allows the numbering, coding, and sorting of text. Transcripts for each interview were then printed and read (see Fi gure 1). Transcripts were read in groups stratified by level and category of personnel. For example, all of the district level interviews were read consecutively, and then all middle school le vel guidance counselor interviews, followed

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119 by high school guidance counselor interviews, and so on. This was to allow for within and across group comparisons or patterns to begin to emerge. Figure 1 Sample Printout of a Transcript in Ethnograph v5.08 Interview #079; 3/8/05 1 +020 Teacher 2 Middle School, Female, 3 Location: Her classroom 4 I = Interviewer R = Respondent 6 INTERVIEW BEGINS: 8 I: Can you tell me why you think kids 9 don't come to school? 10 R: I think there are a variety of 12 reasons. It's funny because teachers 13 discuss this I think a lot more than 14 people outside of school would think. 15 Open and in-vivo coding were used during this first reading to begin identifying main categories within the interviews (Berna rd, 2000). This represents the second level of analysis. From this initial review of the data, the researcher developed an initial codebook. This was reviewed with an independe nt researcher during the final debriefing. The third level of analysis involved deductive coding, using the created codebook to code transcripts of individual in Et hnograph (see Figure 2). This was also done according to level and category of pe rsonnel. The codebook was updated as new categories emerged or collapsed into other categories. When the codebook was altered, previously coded transc ripts were re-coded.

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120 Figure 2 Sample Printout of Inserted Codes Interview #079; 3/8/05 1 +020 Teacher 2 Middle School, Female, 3 Location: Her classroom 4 I = Interviewer R = Respondent 6 #-ATTEND $-PROCESS INTERVIEW BEGINS: 8 -#-$ I: Can you tell me why you think kids 9 | | don't come to school? 10 | | | | %-REASONS R: I think there are a variety of 12 | |-% reasons. It's funny because teachers 13 | | | discuss this I think a lot more than 14 | | | people outside of school would think. 15 | | | | | | I: Tell me more. 17 | | | | | | R: We talk about the kids and their 19 | | | attendance regularly, because we 20 | | | notice if a kid is absent like 3 or 21 | | | 4 days in a row that becomes a concern 22 | | | for us, you know? Have you heard from 23 | | | the parents? Do you know if they're 24 | | | sick? Do you know if they're 25 | | | After all codes were entered in to Ethnograph. Coded transcript s were then sorted by code and within each code by level (district, middle, or high school ) and category of personnel (see Figure 3). These codes were then printe d and physical files were created for each category, with folders representing each code within the category. The next level of analysis involved reviewing data and comparing within and across themes.

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121 Figure 3 Sample Printout of All Responses with the Same Code SEARCH RESULTS 9/13/2005 7:08:22 PM Page 23 SEARCH CODE: PROCESS #1 of 201 032SWHS INTERVIEW E: %-EXPERIENCE E: $-FAMILY SEARCH CODE: PROCESS ~-TRANSITION ~-CYCLE ~-LOOKLIKE ~-PROCESS ~-EMOTION ~-SYMPTOM ~-OUTCOMES ~-PARENTS R: I had a young man who was 359 | | | | | | ~ supposed to come to summer school. 360 | | | | | | ~ And he and his mom came in and as long 361 | | | | | | ~ as he was with his mom he was 362 | | | | | | ~ perfectly all right. He was this 363 | | | | | | ~ was at the end of his 8th grade year 364 | | | | | | ~ and for some reason he had a 365 | | | | | | ~ tremendous fear of school. I never 366 | | | | | | ~ found out the reason. But I suggested 367 | | | | | | ~ ---------------------------------------SEARCH CODE: PROCESS #2 of 201 024GC INTERVIEW E: %-DIFFERENT E: $-BORED E: #-LOOKLIKE SEARCH CODE: PROCESS R: There are a lot of students who 1044 | | | | @ are very, very bright, and we know 1045 | | | | @ that if they were in school every day, 1046 | | | | @ they would be making straight A's, and 1047 | | | | @ The analysis of the sorted categories and sub-groups entaile d three levels of analysis. One focused on the first research objective, which is describing school personnels perceptions of school refusal. The second level focu sed on understanding how these perceptions influence the methods and strategies utili zed by individual schools

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122 and their district to prevent, identify, and manage school refusal. The third level of analysis was to examine similarities and di fferences by level and category of personnel. Final analysis involved the use of all data poi nts, including district and school interviews, observations, survey data, and field notes. Memoing was an ongoing process during all phases of analysis. Notes were maintained on observations that occurred durin g reading and coding of transcripts. These notes were divided into three categories: code notes (coding pr ocess), theory notes (ideas about what is appearing), and operational not es (practicalities) (Bernard, 2000). Memos were recorded directly in to Ethnograph, which has a function for attaching memos throughout transcripts during th e coding process. Memos we re used in conducting the analysis, writing the final report, a nd for documenting the process. For reliability purposes, an independent re searcher was provided with a sample of qualitative data to review and code for analysis (Patton, 2002). The principal investigator and independent researcher then met to discus s the sample, reconcile the codes, and reach a consensus. Throughout analysis several appointments to discuss emergent themes were conducted with a colleague to prov ide an external perspective. Analysis of the Survey The Survey of School Refusal provide d mainly descriptive data. Survey responses were recorded in a Microsoft Of fice Excel 2003 spreadsheet. Data were then screened to ensure accurate data entry and valid responses. Existing variables were manipulated to prepare for the analysis. Th is included renaming, creating, and recoding variables as necessary to achieve analytic goals. Univariate and bivariate statistical procedures were implemented using SAS vers ion 9.1.3 to describe survey results. This

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123 data is used to present a broad picture of school refusal in the di strict, the school level response, and processes. Interpretation Interpretation of the data is a process that involve s going beyond description of the data (Patton, 2002). It represents the culmin ating phase of data analysis. Interpretation is to make speculative statements and conclu sions regarding the themes and patterns that emerged from the data (Bernard, 2000). Inte rpretation from a social constructionist perspective involves reflexivity of the rese archer while moving between the data and their interpretation of that data (Patton, 2002) Patton (2002) cites th at the challenge of qualitative inquiry involves portraying a holistic picture of what the phenomenon, setting, program is like and struggling to understand th e fundamental nature of a particular set of activities of people in a sp ecific context (p.480). Interpretation involved a thorough review of patterns and theo ries that emerged from data analysis. Interpretation of data was intertwined with the process of data analysis. The process of inte rpreting results involved writ ing up chunks of results for each developing theme, which then were comp ared against other themes and patterns. Several perspectives informed interpretation of the data including the researcher, the theoretical framework of the study, the research questions, and the previous literature (LeCompte, 2000). The results of interpretation provide a cont extual perspective of the research findings with insight into th e significance of those findings. In addition, speculation about meanings, possible explana tions, and formulations of hypotheses are offered.

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124 To provide credibility of data, member checks with a purposeful sample of 3-5 interview participants were conducted. This involved providing a copy of the interview transcript to the selected participants and asking them whether it wa s representative of the conversation we had during the interview. Four out of five participants responded and all indicated that the transcript s were accurate representations of our interviews. One participant offered comments about some in formation they wished removed from the transcript as they felt it was potentially identifiable. Trustworthiness and Quality in Qualitative Research The major emphasis in qualitative research design is on quality and credibility, as opposed to measurement validity in quantit ative research (Tashakkori & Teddlie, 1998). While quantitative methodology attempts to control threats to internal validity, qualitative perspectives accept that there is potential for th is to occur, and theref ore try to control and prepare for it, and most importantly document it (Patton, 2002). The paradigmatic lens through which research is viewed guides th e methods and techniques for enhancing the quality and credibility of the findings (Merriam, 1995). Th erefore, the theoretical framework of social constructionism plays an important role in determining the criteria for credibility of this study. This study w ill use criteria for judging rigor stemming from the qualitative tradition. Lincoln and Guba (1985) proposed that credibility, dependability, and transferability can be combined to in crease the trustworthines s of a qualitative study. Credibility is the most important factor in establishing the trustworthiness of qualitative findings (Tashakkori & Teddlie, 1998).

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125 Patton (2002) cited three elements th at credibility depends on: 1) rigorous methods; 2) credibility of the researcher; and 3) philosophical belief in the value of qualitative research (p.553). Rigor in qualitati ve research refers to systematic techniques for data collection and analysis (Patton, 2002). Credibility of th e researcher refers to the training, experience, and pres entation of self (Patton, 2002). In addition, the social constructionist perspective would include the reflexivity of the researcher as an aspect of credibility (Burr, 1995). The philosophical belief in qualitative resear ch is demonstrated through the ability to provide the value, rationale, and appropriateness of using qualitative inquiry. Credibility Credibility is considered the analog to the quant itative concept of internal validity. Internal validity refers to whether a researcher is truly measuring what they think they are measuring, whereas credibility focuses on whet her ones findings are congruent with the reality in which the data emerged (Lin coln & Guba, 1985; Merriam, 1995). Various methods were used to increase the credibi lity of this study, including rigorous data collection and analysis, prolonge d engagement, persistent observation, thick description, triangulation, member checks, peer debrie fing, and reflexivity (L incoln & Guba, 1985; Merriam, 1995; Patton, 2002; Tashakkori & Te ddlie, 1998). All data collection methods were systematically conducted and documented. Prolonged engagement over the Fall semester allowed acceptance and trust building within the school settings. Persiste nt observation allowed the development of thick description, to capture the setting within which the data was collected (Patton, 2002). Triangulation of various data sources, the various district school personnel, and

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126 triangulation of the methods, interviews, observa tions, and a survey, sought to capture the multiplicity of perspectives. This also provi ded rigor for the theoretical framework of social constructionism, as it acknowledges a nd accounts for multiple realities that may exist. Verbatim transcription of interviews and the use of the language of the participants were used to capture the partic ipants constructed real ities. Member checks involved taking the data back to the participants to see if the transcripts resonated with them. This was conducted with a sample of the study participants. To triangulate this aspect of credibility, peer debriefing was also used. This was achieved by the use of an independent researcher or colleague reviewing the data analysis and findings and providing comments on their plausibility. Reflexivity is an important aspect of credibility as it is a way to account for the role of the researcher. It re minds the qualitative research er to observe herself, her perspective and voice, and its role in the research. Reflexivity involves acknowledging the biases and limitations of the researcher brought to the study. All biases, limitations, and other personal insights during the study were documented in a reflexive personal journal. Social constructionism calls for reflexivity in the role of the re searcher. It includes taking into consideration the role of power in how meani ng is constructed (Burr, 1995). The triangulation of methods helped in cap turing the multiple voices of personnel in different levels of power. This also takes into consideration the effects the researcher has on the setting and the participants in the se tting. It also refers to the researchers subjective experience in the research. The rese archer was attentive to and documented all

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127 distortions arising from their presence in th e settings, involvement with the participants, biases of the researcher, and from data co llection techniques (Lin coln & Guba, 1985). An example of this was the frequent comment heard from participant, Well, you are the expert. The researcher attempted to reposition her role as a perceived expert by indicating she has no experience in school se ttings, and that she herself considers the school personnel the experts, hence the reas on for the interviews. However, the use of prolonged engagement, trust-building, positive first impressions did help to safeguard against these distortions, while field notes and a reflexive journal was used for documentation (Lincoln & Guba, 1985). Dependability Dependability is similar to reliability, except th at while reliability is concerned with the extent that research findings will be found again, dependability focuses on whether the results found are c onsistent with the data colle cted (Lincoln & Guba, 1985; Merriam, 1995; Patton, 2002). Previously desc ribed methods, such as triangulation and peer examination, can increase the dependability of a study. Goetz and LeCompte (1984) and Lincoln and Guba (1985) refer to the use of an audit trail. The a udit trail c onsists of thorough documentation of everything done with in the study so that another person could replicate the study. This study maintained co mprehensive documentation using various types of field notes, a journal, and memoi ng. Additionally, all files, documents, and all other related materials were maintained w ith an organized system. Tracking forms and protocol sheets were created to document all aspects of da ta collection on an on-going basis.

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128 Transferability Transferability the parallel to external validity, refers to whether findings in one context are applicable in a nother setting, given that ther e is congruence between those contexts (Lincoln & Guba, 1985). While external validity refers to generalizing findings to broad populations, transferability builds on the rich description of the particular and context specific (Merriam, 1995). Strategies suggested for strengthening this aspect of rigor include thick description, sampling with in, and reader or user generalizability (Merriam, 1995; Patton, 2002). Thick descriptio n involved the development of detailed description of all information related to the study, although so me of this description is limited to protect confid entiality of those involved in the study. Field notes were essential to the development of this description. Sampli ng within refers to the inclusion of multiple parts or components within the study (M erriam, 1995). This was accomplished through various data collection methods with delinea ted sampling strategies, and sampling within samples, such as the sampling of school personn el within selected sc hools. Reader or user generalizability refers to the role of the c onsumer of the research findings in deciding whether they apply to another setting. Strengths and Weaknesses A major strength of this study is the use of qualitative methodology, grounded in the constructionist perspectiv e, to understand the social construction of school refusal within the context of a school district. The use of triangulated, qualitative methods including in-depth interviews, observations, and a descriptive survey, allowed insight into the perspectives of school personnel regardi ng school refusal. The sampling strategies used ensure representation of the various pe rsonnel selected. Observations provided the

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129 development of thick contextual description of the school settings. The use of the language of the participants ensured that th e authentic voice of the participants is represented. Both the methods and theory used in this study introduce an innovative approach to research on school refusal, drawing on a paradigm that rarely informs such research. The study represents one of the few studies on school refusal originating from perspectives of both public and school health. This st udy has the potential to make significant contributions to the ex isting knowledge on school refusal. One of the weaknesses of this study is the reliance on predominantly self-reported data. Whereas triangulation accounts for some of this weakness, it re mains a challenge in qualitative research. The social constructionist perspective no t only allows the entrance of subjectivity into research, it is encouraged as it represents part of the social process. Within social constructionism there is no objec tivity. It asserts wh at people believe is real is real; it is real in its consequences. The study draws on an extensive, but simultaneously limited literature and research base. The previous literature on school refusal is limited to select populations, unclear definitions, and studies with poor internal validity. Yet, this lends support that this may represent a phenomenon that is in f act a social construc tion. The study is limited in its transferability, as it focuses on a specifi ed school district. Thus the findings of this study may be applied to a similar setting, but not necessarily to th e larger population of school personnel. Despite the limitations, the findings of this st udy provide insight and direction for future research and training.

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130 Methodology Definitions 1. Qualitative research an additional definition for qualitative research is any type of research that produces findings not arrived at by statistical procedures or other means of quantification (Strauss & Corbin, 1998, p. 10). It is re search where words are not reduced to numerical representations. 2. In-depth, semi-structured interviews Se mi-structured interviews are one-on-one interviews that involve the use of a semi-s tructured interview. The guide is a written list of key questions and topics that need to be covered, usually in a certain order. They are in-depth in that it allows the re searcher to ask quest ions that generate detailed responses. The semi-structured nature of the interview provides flexibility for the researcher to follow leads as they see appropriate. Adhering to the key questions of the guide also allow the development of reliable and consistent qualitative data (Bernard, 2000; Patton, 2002). 3. Observation A strategic method in ethnogr aphic research, observation is a method that puts the researcher in the setting and allows them to collect the data firsthand through the use of their senses Observation exists on a c ontinuum, ranging from the complete participant to the complete obs erver. Bernard (2000) considers complete observation as separate from participant observation, whereas Patton (2002) describes it as part of participant observation, even if the observations involve minimal to no active participation. 4. Exploratory research is c onducted in new fields of study or in areas of study where little work has been done (Patton, 2002). Typica lly little is know about the nature of the phenomenon, and few hypotheses exist (P atton, 2002). It is also a useful

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131 approach in expanding research that has been conducted within the confines of a single paradigm. 5. Triangulation There are various forms of tr iangulation. Data triangulation is the use of a variety of data sources Investigator triangulation re fers to the use of several different researchers. Theory triangulation involves the use of multiple perspectives to interpret a single set of data. Methodological triangulation is the use of multiple methods to study a single problem (Denzin, 1978; Patton, 2002). 6. Stratification a method employed within sampling that involves dividing a sampling frame into sub-frames to ensure represen tation of the populations represented by the sub-frames (Bernard, 2000). 7. Purposeful sampling refers to the selecti on of cases for study that are information rich. Typically, there are criteria deve loped to guide sele ction (Patton, 2002). 8. Snowball sampling locating participants who provide names of people who might be likely participants for the study (Bernard, 2000, p. 179). 9. Theoretical saturation It is referred to as the termination of sampling once no new information is emerging from data colle ction (Lincoln & Guba, 1985). Strauss and Corbin (1998) define theore tical saturation as the point in category development at which no new properties, dimensions, or relationships emerge during analysis (p.143). This is the point where categories are saturated and collecting more data becomes not productive. 10. Random sampling without replacement When conducting random sampling, putting the numbers back into the pool of possible se lections after it has been selected is referred to as random sampling with repla cement. This method maintains an equal

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132 probability of being selected among those in the pool. If it is not replaced, then the odds of being selected go up (McDermott & Sarvela, 1999a). 11. Elite interviews Elite interviews are conducted with those persons in elite positions, who may have an in-depth understa nding of policies and processes related to a topic (Johnson & Joslyn, 1995). The strength of elite interviewing is that it allows access to the insider perspectives of persons in positions of authority. This method allows the researcher to maximize the time w ith the participant, gi ven they are usually busy people who have limited time. Therefore, considerable prepar ation is required so as not to ask questions that can be answered elsewhere. 12. Thick description rich, detailed and c oncrete description of people and places (Patton, 2002). 13. Grounded theory This refers to theory that is derived from data that have been systematically gathered and analyzed through the research process. It starts with an area of study and allows the theory to emer ge from the data (Glaser & Strauss, 1967; Strauss & Corbin, 1998).

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133 CHAPTER IV: RESULTS Introduction This chapter describes the results of the da ta collected from the district and school level in-depth semi-structured interviews with school personnel to answer several research questions. The theoretical framewor k of social constructionism guided the research methodology used to answer these rese arch questions. This chapter also presents the results from the Survey of School Refusa l, which collected descriptive data from middle and high schools. In the init ial section of this chapter, I revisit a description of the original desired sample and provide an explanation and description of the final sample. Secondly, I provide a detailed description of the study participants. The research questions addressed in this study and answered by these data are provided below for the readers convenience. Research Questions The purpose of this study was to: 1) desc ribe school personnel s perceptions of school refusal and 2) identify ways in which these perceptions influence the methods and strategies used by individual schools and their distri ct to prevent, id entify, and manage youth identified as experiencing school refusa l. Specific research questions that guided this inquiry included: 1. How have school personnel constructed their perceptions of school refusal?

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134 1a). How do school personnel think about school refusal? 1b). What influences their understanding of school refusal? 2. What are school personnels re ported perceptions, explanatio ns, and beliefs related to school refusal? 2a). How do school personnel describe school refusal? 2b). What are the different forms of sc hool refusal identified by school personnel? 3. How do school personnel per ceive students they identi fy as experiencing school refusal? 3a). How do school personnel describe st udents identified as experiencing school refusal? 4. What are the consequences of their perceptions for the recognition of school refusal among students? 4a). What is the process by which sc hool personnel identify students refusing school? 4b). How do school personnel evaluate th eir experiences with students with school refusal? The results are presented in three secti ons that address the purposes of the study flowing from the general to the more specifi c results, reflecting the manner in which data emerged within interviews. Throughout these results, I have categorized the types of school refusal using the storie s constructed by the particip ants. I have attempted to capture the practical experiences of the par ticipants in their every day settings. This included analyzing data that drew on ag reements and re-occurring themes, and highlighting disagreements, conflic ting views, and dissenting voices.

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135 The first section, Establishing an Unde rstanding of Pers onnels Attendance Issues Frame of Reference, lays the groundwor k for the results of the study. This section is essential as it provides the participants reported conceptual frame of reference in which their perceptions ar e grounded. To allow reader s to understand personnel perceptions of their own role, the first sub-section is devoted to how they define their roles in relation to attendan ce issues in general. The second sub-section describes participants perceptions of a ttendance issues overall. This section presents the language of the participants as it relate s to attendance in general and sp ecifically to school refusal. Quotation marks are used to di stinguish the language of the participants. Also included is a focus on their perceptions of why students do not attend school, th e perceived barriers to school attendance, and examples of why it is difficult to stay in school on a daily basis. The intention is to ground the remaining results within this umbrella of attendance issues. This section addresses the fi rst purpose of the study, and directly answers the first research question. The second section of results, Explori ng School Personnels Reported Perceptions of School Refusal, is devoted to school personnels first hand accounts and perceptions of school refusal and the students who exhibit th is behavior. The firs t sub-section provides participants perceptions of the actual behavior of refusi ng school and reviews their perceptions of the students who refuse school This section also explores how school personnel construct their experi ences, along with my interpretation of the images they offered of students they encountered. I end th is section with a s ub-section devoted to understanding the perceptions that influence personnels lived realit ies that ultimately influence their practical actions of identifying and intervening in cases of school refusal.

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136 This section addresses the firs t purpose of the study and di rectly answers the second and third research questions. The third section of results, Identification and Intervention in the Practical World, briefly describes the current identification a nd intervention processes for cases of school refusal before providing findings that highlight critical deviations from the reported policies on attendance. A sub-section highlights participants recommendations and ideas about identification and intervention. This se ction directly addre sses the second purpose of the study, and answers th e fourth research question. The results of the Survey of School Refu sal are presented in a separate section following the results of the interview data. Th ese descriptive data pr ovide the context for the identification and intervention efforts that occur within schools dist rict-wide. Lastly, a brief summary that recapitula tes the findings is provided. Final Sample The sampling strategies for this study had multiple levels based on each data collection method. Sampling strategies include d stratification, purpos efulness, snowball, population sample, and saturation. The estimate d total sample size in cluded a total of 100 interviews across ten schools and the district level, and an estimated 62 survey participants. Interviews were conducted with 92 participants overall and the final survey sample totaled 38. District Level Elite In-Depth Semi-Structured Interviews The elite in-depth interviews were conducted at the district level. Specific departments under the districts Division of Student Support Services and Federal Programs were selected using purposeful sa mpling. Within the Department of Student

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137 Support Services, the departments for guida nce, social work, psychology, and school health were selected for inclusion in the el ite interviews. Due to the small number of personnel working in these departments, a population sample was attempted. The maximum sample size possible was twentyone, based on the numb er of professional district-level employees at the division level in the selected departments. Several issues arose in the recruitment process that limite d the population sample. For example, one department would not allow access to certain personnel, indicating they were too busy, while another department indicated they woul d allow only one person to participate in the interview process. The final sample for district level interviews included ten participants representing all departments. Given the le vel of confidentiality that was assured to participants and the small resultant sample size within each department, the final sample cannot provide a detaile d stratification. School Level In-Depth Semi-Structured Interviews In-depth interviews were conducted at the school level. Pu rposeful, stratified random sampling without replacement was used to select schools for participation in the study (McDermott & Sarvela, 1999). Three levels of stratification were used in sampling: grade level, geographic locati on, and category of school pers onnel. This resulted in a minimum sample of ten schools. None of the schools selected shared itinerate personnel (e.g., a school psychologist); therefore no addi tional schools were selected. This ensured discrete samples of selected staff. The criterion for satura tion during data collection was met within the ten schools; th erefore there was no need to select additional schools for further data collection (see discussion below for description of saturation) However, when principals were contacted to obtain permission, two principals, one each from a

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138 middle and a high school, declined to allow thei r school to participate, so two additional schools were randomly selected. With the addi tion of these two schools, again no schools shared itinerate personnel. Once the ten schools were randomly select ed, a stratified, purposeful sample of school personnel within each school setting was employed. The number of participants per cell was determined by saturation or redundancy. For the purposes of this study, saturation was particularly important for the school level interviews. However, this was limited for several reasons. Some department s within the schools would only allow one person to be interviewed (i.e., guidance, h ealth services). Several personnel either declined to participate, typi cally indicating they were too busy, did not know anything about it, or were the wrong person to talk to. The purpose of this study was to unders tand school personnels perceptions of school refusal, therefore, even if a particip ant indicated that they did not know anything about students who refused to attend school, they were info rmed that their opinion and experiences were very important If they declined after being told that their input was valuable, the researcher did not pursue furthe r, as some personnel seemed intimidated by the aspect of being intervie wed for research purposes. Personnel who declined to participate were most often school office secret aries, school resource officers, and health assistants. Teachers were selected using a snowball sample through referrals obtained during interviews with other school pe rsonnel. Principals, who the re searcher met with prior to collecting data in each school, would im mediately recommend a teacher to be interviewed, typically the teacher of the year. Given this and the potential for bias,

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139 referrals were sought from non-instructional pe rsonnel that were interviewed as well as from teachers interviewed. An additional category of personnel was indicated by the principals and assistant principa ls at schools as others that should be interviewed as well. This included the school attend ance clerks and the student in tervention specialists. After conducting a few interviews with personnel in th ese categories it was determined that this went beyond the scope of the study and therefor e no further interviews were added. This category of personnel is represented as Other Personnel in the final sampling matrix. Table 3. Final Sampling Matrix for School Level Interviews Level One Stratification: Geographic Location Geographic Location District 1 District 2 District 3 District 4 School Level MS HS MS HS MS HS MS HS Total Number of Schools 1 1 1 1 2 2 1 1 N=10 Level Two Stratification: School Grade Level School Personnel within Schools Middle Schools (N=5) High Schools (N=5) Total (N=10) Level Three Stratification: Category of School Personnel Assistant Principals 5 5 10 School Psychologists 4 4 8 Social Workers 5 4 9 Health Services Staff 5 7 12 Guidance Counselors 6 5 11 Attendance Office Staff 2 2 4 School Resource Officers 4 2 6 Teachers 10 8 18 Other Personnel 1 3 4 Total 42 40 82 Observations The random selection of th e ten schools for in-depth interviews automatically determined the selection of schools for obser vation. Observation took place in all schools

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140 selected for interviews (see section on School Level In-Dep th Semi-Structured Interviews). Descriptive Self-Administered Survey The sampling strategy for the administrati on of the descriptive survey was simple. A population sample of middle and high school principals was used. School principals represent the personnel most likely to have acce ss to the information requested within the survey. The survey was sent to 68 principals The final response rate was 61% (N=38). Description of Study Participants This section provides a thorough descripti on of district and school level personnel participating in the survey and individual interviews. Given the nature of this study, detailed descriptive information enhances the quality of this study by strengthening the credibility and transferabili ty of the findings. Although mo re thorough field notes were recorded throughout the duration of actual data collection, I uphold the responsibility to protect the anonymity of my re spondents. Therefore, in some cases, descriptive data is limited to do so. Additionally, pseudonyms are used when describing personnel and in quotes. Pseudonyms do not reflect the true gender of the participant, however their actual position and school level is reported for de scriptive purposes as well as to allow comparisons within the results. Demographic Characteristics of Interview Participants District Level Participants District level information related to gender is not provided to protect the anonymity of those participants. Given that this particular group had few participants, providing such information might make them iden tifiable. District level participants had a

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141 combined total of 68 years of experience or an average of 9 years in their current county level positions. All participants had prev ious experience as sc hool level personnel as well. All district level personnel reported gr aduate level college degrees at or beyond the masters level. School Level Schools selected were located in urban, suburban, and rural locations. Student and school level demographics varied acro ss ethnic make-up, economic status, and achievement. This was determined through a re view of school level data from the State Department of Education School Indicators Database. These data were useful in providing contextual information about each sc hool. However, specific indicators are not presented as it could make schools identifiabl e. This also was an issue in reporting specific descriptive data rela ted to the observations conduc ted. Observations informed data analysis; however, these data are only inco rporated into findings when applicable to protect individual schools from being identified. Individual participants within schools. School personnel were mainly female, constituting 70% of all partic ipants. This was paralleled when reviewing the breakdown of the gender of participants by school level. Participants from middle schools were 61% female and in high schools 75%. Overall, school personnel had a combined total of 712 years of experience, with a range of one to 31 years, in their curre nt positions. Years of experience were roughly equal between middl e and high school participants. Occupations of those interviewed at the school level are shown in Table 3. Seven of these participants further identified themselves as department chairs within their school setting. Teacher participants represented the following areas of curriculum

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142 instruction: biology, critical thinking, English, history, mathematics, science, and technology. Slightly more than one-half of all participants had post baccalaureate experiences. All assistant principals, guida nce counselors, psychologists, and social workers reported having graduate degrees, as did nine of the teachers. A little less than one-half of all participants reported being exposed to information related to attendance issues in general. Most indicated they had heard such information through in-service workshops, di strict meetings, staff develo pment, faculty meetings, and masters level courses. Demographic Characteristics of Survey Participants Participants included middle and high school principals and other personnel, as some principals delegated the task of comple ting the survey to othe r personnel within the school. The majority of schools responding de scribed themselves as being located in either a suburban or an urban setting (see Table 5 in the section titled Results of the Survey of School Refusal). Section I: Establishing an Understanding of Personnels Attendance Issues Frame of Reference Attendance issues were described as an umbrella of various reasons for school refusal; therefore, I present this section first to provide a reference point. This section is important as it provides the ge neral contextual framework of attendance issues personnel use in constructing their pe rceptions of school refusal. This section provides the framework for the results by first describing how personnel define their roles in relation to attendance issues in general and describing participants perceptions of absenteeism in

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143 general. Within the descrip tion of participants reported perceptions of absenteeism I review the attendance language of personnel, their per ceptions of why students do not attend school, the perceived ro les of the school and the fa mily, perceived barriers to school attendance, and examples of why it is di fficult to stay in school on a daily basis. This section addresses the fi rst purpose of the study and directly answers the first research question. School Personnel and their Roles The various roles associated with the cat egories of school personnel in this study divide into three main areas; administra tion and discipline, student support, and curriculum instruction. Personnel in the admi nistrative disciplinarian category include assistant principals, office personnel includ ing attendance clerks, and school resource officers. Student support includes guidance counselors, health services staff, psychologists, and social workers. Curriculum instruction consists solely of teachers. Categories of School Personnel Overall, the categories of school personne l are not solely re sponsible for these areas, and often times are responsible for many more areas than what their specific title might imply. This section provides an overview of how school pers onnel describe their role in general and in relation to students who are refusing school. Roles are described in three sections: administration and discipline, student support, and cu rriculum instruction. In Chapter 3, a standard de scription of school personnel s roles was provided, however this section allows a glimpse into th e study participants self-description. The administration and discipline area deals with issues of accountability, assurance, and enforcement of educational rules, regulations and statutes of the school,

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144 the county, and the state. They are involve d with any required reporting of specific educational and school based information. Likewi se, any type of discipline issues that arise among students are routed through this gene ral area, and mainly to what is referred to as the Office of Student Affairs. Assi stant principals mon itor student attendance rates to be aware of any students who are ch ronically absent and over the age of 16, so they may start the process of withdrawal. They are also responsible for student discipline. Office staff and attendance clerks serve as th e regulators of signing in and out of school and bookkeepers of attendance, respectively. School resource officers and deputies serve as security and protec tion of students and faculty, but also serve to enforce law within the school setting. They also work on developi ng positive relationships with students and serving as a role model. Student support generally entails ensuring that the school is safe and comfortable for students. They also work to prevent and intervene when issues that affect these aspects of school arise. They describe them selves as student advocates, parent school liaisons, and the designated safe places in the school where a student can go if they just need to get away. Student support servic es included guidance counselors, health services personnel, psychologi sts, and social workers. Guidance counselors cover a variety of areas but specifically th ey are responsible for talking to students about attendance, bullying, problems at home, and resolving chronic attendance issues. Health services pe rsonnel work to evaluate health with the goal of keeping students in school if it is something that ca n be resolved in the school setting. Psychologists mainly conduct testing, work with students on behavioral issues, and provide counseling if stude nts are having problems at home or school. Social workers

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145 are the only school personnel who are overtly responsible for attendance evaluations. Their role is to work with the school to help identify st udents having difficulty attending, staying in school, or exhibiting emotional or behavioral problems. They work with parents and schools to develop plans to get th e student to school, but are also charged with enforcing the state statutes of compulsory education. Therefore, at some point social workers are responsible for moving chronic abse nteeism cases into the judicial system. Curriculum instruction encompasses the classroom teachers, whose main purpose and goal is to educate the students, although many see their role as more expansive in terms of making a positive connection with students beyond just transmitting knowledge. Often a teacher refers a student to guidance, student affairs, or the social worker, if they notice a pattern of absences or attendance problems. Perceptions of Absenteeism As stated in previous chapters, this study used the definition of school refusal that focuses on the behavior, refusal to attend schoo l. This section begins with a look at the terminology of attendance issues and definitio ns related to school refusal. This is presented first to ground the results of this study in the language of the participants, as well as to orient the reader to the particip ants own definitions for what exists versus what is in the professional literature. Thes e findings document the idiosyncrasies of these terms, but most importantly provide the le ns school personnel use when thinking and talking about attendance issu es. After this, I go on to address personnels reported reasons for absenteeism

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146 Constructing Meaning for Terminology A few important considerations should be mentioned. Participants rarely had a set of terms for describing school refusal. They typically referred to attendance issues, truancy, and absenteeism. Therefore, thr oughout the results, I us e school refusal to describe the general behavior as stated earlier, of stude nts refusing to attend school. When participants described a specific type of school refusal, it is specifically noted. To develop an understanding of how th e terms used among professionals have translated into the applied and practical world of the sc hool personnel, I intentionally asked about these terms at the end of each interview. This was a methodological decision, as participants do not really think about these terms, so to do this at the beginning of the interview may have contaminated the data. The terms asked about included absenteeism, school avoidance, school phobia, school refusal, and separation anxiety. The majority of participan ts did not describe studen ts using the terminology common within professional groups and indicate d that such terms are used infrequently within the school setting. The few who did use terminology were either social workers or school psychologists, and some would specify hearing or using these terms mainly during their professional education. School psychologists were the most specific in their definitions of and delineations between term s. Two categories of school personnel, office personnel and school resource officers, were co mpletely unfamiliar with the majority of terms. Despite rarely using specific terminology within the interv iews, when probed about the familiarity and meanings for the te rms, most school personnel were more than willing to provide definitions. This was particularly the case for district level personnel,

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147 who often provided definitions that mapped onto the defini tions provided within the professional literature. Definitions for the terms centered on the motivating factor for why the student was having an attendance issue (i.e., fear, defiance, safet y, bullying). Personnel also would differentiate between the terms, a lthough such delineations were subtle yet important. For example, a difference between school refusal and school avoidance was that while both meant that the student did not like school, school a voidance indicated the student would do anything to avoid it comple tely. Another type of delineation made was that some terms described phenomena more common among different grade levels. One example was the frequent description of se paration anxiety as o ccurring more commonly in elementary school than in middle or high school. Many of the definitions provided by partic ipants came from examples, stories of students, conversations with parents, and personal knowledge. For some personnel, the process of reflecting on indivi dual terms generated more stor ies or triggered a different type of story about a student who was refu sing school. This happened most often when asked about the term school phobia. The follo wing examples illustrate this process: I: Okay. The next one is sc hool phobia. What about that term? R: Ive heard a little bit about school phobia but I dont think I heard it here. I think I read an article or sa w it on Oprah. Kids not wanting to go to school because they have a stomachache or something. I might have read it in a magazine. But Ive not come acro ss itI take that back. I had a girl last year who didnt want to come to school, because she said she didnt have any friends and it finally wo rked out she went through counseling and she thought everybody here didnt like her and stuff like that (Mr. Frye, middle school teacher). I: I was going to ask you, you smile d when I said school phobia

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148 R: It immediately brought a studentit was my first year in school. He sat right beside the door. He would walk in the door and physically get ill, convulse, shake, and have to leav e. I didnt know what was going on. They told me he had school phobia. He was afraid, literally scared to death, of coming to school (Ms. Ca meron, middle school teacher). In some cases, the partic ipant would actually apply terms retrospectively to categorize the stories of student s they discussed earlier within their interview, but had not used the specific term at that point in time. In the following exampl e, the participant had not mentioned school phobia thr oughout the interview, but when asked about the term at the end of the interview, responded with an example of a student: Yeah. The school phobia. At the middle school level there was a girl where she just really became anxious in class. So we would just keep her in guidance for a while and have her help out in guidance. We ll just sit there at first just to get her have her in the building and then have her help out in guidance for a while and then eventually she started talking with so me of the staff and then eased her back into her classroom (Mr. Sloane, high school social worker). Absenteeism. School personnels definitions of abse nteeism give insight into their basic conceptualization of attendance issues. This provides a point of reference for what they consider problematic or non-problematic when it comes to general school attendance. All school personnel were familiar with absenteeism. The common denominator for all definitions was that a student is missing da ys of school. Some participants added that absenteeism is an actual condition of a student not being where they are supposed to be, wh ether that is in school or in a particular class. One dynamic of absenteeism that emerged was that it is not merely something that defines a one or two day absence, but a chronic, regular pattern that emerges over

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149 time. Specific examples of such a pattern in cluded five or more absences over a nineweek period, or two to thr ee days in a given week. Additionally, absenteeism carri ed a negative connotation with it, despite it being the only term that did not imply a motive. Participants referred to absenteeism as a problem with attendance. It means that I think theyre chronically absent. It seems like a problem to me. It will be a diagnosis. Their problem is absenteeism (Mr. Frye, middle school teacher). Usually its negative. Youre usually not talking about it unle ss its an issue. Thats it (Ms. Stein, district level). Absenteeism to me personally means that youre losing out in school and missing instruction and missing some thing that you might need (Mr. Sloane, high school social worker). We have to look at it as a wholerather than one individual school and one individual child. Its much more a globa l issue for me and looking at the global issue of absenteeismI think of it in terms of okay how can all of us attack the problem and what can all of us do to make a difference in the absenteeism of the students (Mr. Bueller, district level). School refusal. Various categories of school pe rsonnel had never heard of and were not familiar with the term school refu sal, including assistant principals, guidance counselors, health services staff, teachers, office staff, and a few social workers. Participants most familiar with school refu sal were district level personnel, school psychologists, and social workers. Those participants familiar with the term indicated that it wa s not commonly used within the school setting. The most common definition for school refusal was simply refusing to come to school, although most part icipants offered specific dynamics. At the district level, participants emphasized c hoice as a key element of school refusal.

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150 School refusal is more of a conscious act by the student based upon a behavioral choice as opposed to an emotionality issue (Ms. Lim, district level). Other participants echoed this sentimen t of school refusal as motivated by behavioral choice rather than emotional fact ors, further clarifying that it encompassed willfulness and defiance. A few participants provided a delineation of school refusal from school phobia. One middle school social work er, Mr. Hughes, indicated school refusal either was a product of school phobia, or re sulted from academic reasons or social reasons indicating that the latter is more chronic. Another participant, Mr. Ferris, a middle school psychologist, conceptualized scho ol refusal as existing on a spectrum of behavior, which he described as follows: School refusal, yeah. That would be the definitions included in the term, but it would be refusing to come to school, and then I think of two things. I think of either the student whos, you know, ve ry young, afraid to come to school, you know, hasnt, you know, its a new thing, a new scary thing to do. And, again, along with that would be the kid that gets bullied or intimidated and is refusing to come to school. And I think on the other e nd of the spectrum, th e kids that maybe are academically frustrated or just some prefer home over school and theyre not gonna come to school no matter what you say or do. A few participants offered an alternativ e definition of school refusal that had no connection to student behavior. They defined sc hool refusal as the right of the school to refuse to accept a student back into th e school who has been chronically truant. School phobia. School phobia was a term familiar to most school personnel, although many confirmed that it is not a term that is actively used within the school setting. School resource officers, office pers onnel, and approximately half of teachers had never heard of school phobia. The common defi nition of school phobia offered included fear or being afraid of school, attending or coming to school, or being in school. School

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151 personnel described this fear as intense, often resulting in physical rejection of actually going to school. Some personnel described st udents as being una ble to physically function. School personnel reported that school phobia occurs in response to some type of incident or a particular event within the school setting and a few offered specific examples such as bullying, a traumatic event, a teacher, a particular class, or a location within the school. School phobia is familiar to me, and to me that means that we have a child who has been traumatized somewhere, some how, and connects it with school (Mr. Bueller, district level). Ive heard of it and that for some reason the student has a fear of attending the school. Something is generally happeni ng there: being ridiculed by peers, particular teacher the student doesn t like, or actuallysomebody has done something to turn the student away from school. It could be when the child was younger, the student was discouraged, consta ntly told they we re a failure where they developed a phobia against school. Gene rally, its related to some type of traumatic event in the child s life as it relates to the school (Mr. Rooney, high school guidance counselor). The concept of school phobia as an irrati onal or unrealistic f ear of school was infrequent, and such fears were attributed to emotional disturbances, mental conditions, anxiety, and depression. Some specific examples of irra tional fear included fear of crowds, hallways, social environments, and a discomfort associated with school. A few personnel extrapolated school phobi a out to a broader issue, de scribing it as a social or specific phobia. It was pointed out that if a student receives a medical diagnosis of school phobia they can be enrolled in a hospital homebound program. It means there is condition beyond the ch ilds control that means theytheyre afraid of school and its not based on things that you canthat would make sense, or that are real maybe. Its more of a mental condition, a state of mind (Ms. Peterson, middle school guidance counselor).

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152 The idea of school phobia as not real wa s rare; however, a few personnel shared this perception. Delineating between true school phobia a nd school phobia, they described those students who just didnt like sc hool as using this as an excuse to not attend, oftentimes using it to manipulate thei r parents. School phobia in these instances is not viewed as real. Personally I think its a cop outyou know its a fix. Its a quick fix, you know? Kid doesnt want to come so lets label it something. Our society has gotten real big into labeling. ADHD. ADD. So we make exceptions because theyre that way. I think its a cop out. I thi nk maybe there might be I guess one or two cases that it could be, you know, true, but I just thi nk its a label (Mr. Ed, middle school assistant principal). Not very often, because I dont think ther e are anythere arent too many real school phobics. I think theyre few and fa r between, although a lot of kids would like to use that term, just for conveni ence sake (Ms. Grace, high school guidance counselor). School avoidance. School avoidance was a term familiar to slightly more than half of all school personnel. Among those fa miliar with the term, it was not something commonly heard in the school setting. The major ity of teachers had not heard of it, with several offering up task avoidance as what they thought of when they heard the term school avoidance. They define d task avoidance as when a student does anything possible to avoid the task assigned within the classroom. The ge neral definition for school avoidance was avoidance of school for many different reasons. It was pointed out by several participants that this could also apply to students avoiding a specific class, and not just school as a whole. Some participants compared and contrasted this term with others, such as sc hool refusal. One participant described school avoidance as passive-aggressive and intern al, whereas school refusal is blatant and

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153 external. Several participants saw school a voidance and school phobia as different ways to refer to the same behavior. A few indi cated that this was yet another reason for truancy. There was no indication of whether th is was viewed as a positive or negative term. Separation anxiety. Separation anxiety was a term familiar to most participants, but not as a term used within the school se tting. Participants defi ned it in several ways including the anxiety a child experiences when being separated from their parents, their mother, their primary caregiver, or their hom e. Several participants did not associate separation anxiety with atte ndance issues. Two participan ts, both school psychologists, did link separation anxiety to school phobia, as seen in the following examples. I: And then separation anxiety. Is that term familiar? Yeah. Separation anxiety I think is ki nd of linked up with school phobia. You know when you say separation anxiety; the first thing I would think of would be school phobia. If you say school phobia, th e first thing I would think of is separation anxiety. I mean those are kind of hand in hand (Mr. Baker, middle school psychologist). Uh-huh [affirmative]. I dont hear that used unless its used, you know, among guidance counselors or school psychologist s or social workers. The fear of leaving the significant person in the ch ilds life. You know, whether its the mother or the father or something yo u know. The fear of whats gonna happen while that childs away from that signif icant other. And I know its very hard to differentiate in the literat ure, because Ive wanted at one point to doas an undergrad I think I did something or tried to do so mething on school phobia, cause Ive always been interested in that and it is such a conglomeration ofschool refusal, school avoidance, separation anxiety, social anxiety, you know? Itsits a...cause its really hard to know whats going on. And then a lot of times Ive seen kids who once theyv e been out of school so long, maybe it started as a school refusal but then it can slide into the school phobia and then at the same time be an anxiety issue (Ms. Ryan, high school psychologist).

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154 Others related separation anxiety to th eir experiences with their own children when they started school. Most participants described separation anxiety as occurring among younger children, such as kindergarteners, indicating that it is not common in the middle or high school setting. Applied use of terminology within the school setting. The practical use of these terms related to attendance issues is not common among school personnel. While most personnel indicated that they w ould apply specific terms, this was often in a retrospective manner that occurred in real time during an interview. For example, when asked if they would apply any of the terms, many school pe rsonnel would refer back to a particular student they discussed and then proceed to think aloud as th ey applied the various terms they saw most fitting the students story. Absenteeism was the most common term that personnel indicated as being applied within the school setting. Some school personnel would list the terms they thought they might use in a school setting a nd provide reasons for why some terms would be applied to some students ve rsus others. This revealed a fe w of the attributes they use to differentiate students with attendance i ssues, such as young ch ildren typically having separation anxiety, or school avoidance includi ng students who are skippers and have bad grades. Reported Reasons for Absenteeism General perceptions of school refu sal among school personnel reflected conceptualizations of problematic versus non-problematic absenteeism. Most participants cited that there are multiple reasons, factors, and variables to expl ain why students do not come to school. Many participants explai ned further that there are no blanket

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155 explanations for why some students do not come to school, although overall they offered broad themes as the main or most important reasons. Reasons included students not liking school, finding school boring or not challenging e nough, experiencing academic failure, outside activities, working too muc h, peer pressure, laziness, skipping, illness, low motivation, oversleeping, and truancy. Alth ough participants offered these as some of the reasons, these were not emphasized as the main or most important issues affecting school attendance. These perceptions trans cended all categories of school personnel. Very few participants delineated abse nces into excused versus unexcused. Excused refers to parents providing a writ ten note or telephone call excusing the student, while unexcused indicates no parental note, acknowledgement, or permission was provided to the school to excuse the student from their absence. Participants believed absences, regardless of excused or une xcused, were avoidable in most cases, and therefore not acceptable. The majority of participants zoned in on problematic absenteeism, often delineating reasons considered legitimate and thus garnering more empathy as opposed to those that are not. For example, victims of bullying, teasing, or uncomfortable social situations were described more sympathetica lly. It was implied that it is understandable why such students refuse to come to school The following sections highlight the key reasons participants delineated absenteeism in this manner. These key reasons include absenteeism related to school tran sitions, illness, and grade level. Participants empathized with students who are going through transitional periods such as moving from elementary to middle, the middle school str uggle, or middle to high school. This is considered a tenuous pe riod for many students. They would often

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156 link similar personal experiences of their own discomfort in school to demonstrate their awareness of such awkward school transitions A sub-category that is related to the concept of transitions is the general idea th at if during a transiti on the student does not make a social or academic connection w ith the school, it will cau se or exacerbate absenteeism. Participants believed being c onnected to school in some manner was an important part of positive experiences and attendance habits. Grade level emerged as a qualifier between the types of transition a st udent might experience. Personnel believed that in elementary school the transition was often focused on the student leaving home for the first time and resulting in either sc hool phobia or separation anxiety. At the middle or high school level, it was related more to the social aspects of fitting in or finding their social niche. Illness was another way in which sch ool personnel separated reasons into legitimate and non-legitimate. Chronic illnes s was acceptable, when clearly documented by a physician. One participant discussed the process of doctor shopping, which is when parents visit many doctors until they receive a medical diagnosis (typically for mental health) for the child that makes them eligible for district provided hospital homebound education 1 Personnel viewed this negatively. Illness that was not considered legitimate meant that the student faked illne ss, was ill, but could have attended school, was experiencing perceived illness caused by anxiety or fear, or had a parent who was overprotective or doctor shopping. 1 Hospital homebound education occurs when the school district disp atches teachers to the student who has a documented medical reason for their inability to attend school. There is a review process that occurs prior to approving a student for hospital homebound education.

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157 Several participants also br ought up grade level in genera l as a defining factor of whom the blame of poor attendance might fall on. For elementary school students, participants pointed to pare nts as being responsible for ensuring their child attends regularly, whereas once in middle and high school that responsibility shifts to the child. Participants indicated that often, the failure of parents to enfor ce positive attendance behavior in the early years would set the wheels in motion for future attendance issues. The Role of the School Although not considered a main reason, a certain level of responsibility for students refusing school was placed on the school itself. Three major themes emerged including the schools role in promoting connectedness, the social milieu of the school, and the academically focused climate. As one participant explained, In the district we lose almost 7,000 9 th graders a year from quitting school because were not tying them in and theyre not feeling connected (Mr. A ndie, high school assi stant principal). Others alluded to systemic issues within the school district, such as bussing and school choice. Some kids are bussed past seve ral schools close to them to reach a school where they feel out of their environment. One participant indicated that due to the middle to upper class majority in their school if the student does not have the right clothes or personality it is real ly hard for that student to f eel like a part of this school (Ms. Walsh, high school social worker). Severa l participants indica ted that the current environment of academic achievement caters to elite students and leaves students who are not academically advanced more likely to lose interest because they believe they cannot compete.

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158 Academic failure was another main theme that participants described as a major reason for why students do not come to school. Participants believed that students who continually encounter academic failure woul d eventually give up on school. They lose interest and connectedness. They experience em barrassment and rather than continue to deal with it, they would much rather avoi d it. A few participants cited standardized benchmark testing as a reason for some students to avoid school. If the student has failed, they feel like there is no way out and give up. Several participants described some students as experiencing boredom due to a failure of the school to provide appropriate challenges, and thus lose interest as a result. The Role of Family Family was a recurrent theme within diffe rent contexts of the data, therefore throughout the results family and parents will re-appear in various sections. Given that context from which these findings emerged are distinct instead of grouping results related to parents together, th ese findings are reported within the thematic context from which they emerged. The overwhelming majority of pa rticipants indicated that the family plays a major role in attendance issues, with ma ny declaring it the number one reason. Several themes emerged as sub-categories of the role the family plays and it was often discussed in terms of parents rather than the family unit as a whole. These themes included home life, parental educational expe rience, and parenting skills. Participants indicated that home and personal issues make attending school difficult for some students. Home issues included issues such as physical and/or emotional abuse, divorce, and alcohol abuse. Socio-economic status of the family was also mentioned. Participants often cited this in conjunction with reasons for absenteeism

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159 such as the parents keeping th e child home to care for younger si blings or to work to help support the family. A few participants indicated that some parents would just keep their child home to keep them company. Participants indicated the parents own educational experiences as a major issue for why some students do not at tend school. The premise is that the parent transfers their perceptions and opinions (often negative) to their child. We have some parents who never were re ally successful in school, find school to be a threatening place, and kind of perpetuate that with their kids (Mr. Blane, middle school assistant principal). An overwhelming majority of school pers onnel indicated that parents do not value education. Some provided explanations for w hy. A few participants expressed that some of the parents cultures do not value edu cation, or value other things more, such as working and money. Others indi cated that there is often a generational cycle of poor attendance and dropping out. Several particip ants suggested many families lack the structure to support and value education. This includes a failure of parents to motivate and encourage their children to go to school. Many participants indicated that attenda nce problems stem from poor parenting skills, including lack of parent supervisi on, permissive parenting, and loss of parental control. Many parents leave the house before their child has to be at school and expect the child to get up on their own and go. Some parents were described as setting up a historical pattern of non-attendan ce by letting it slide in elementary school, but then when they want them to attend in middle or high school, the student refuses because the nonattendance behavior has been established. This also illustrates the perception of the loss of control the parent experiences that causes them to give up.

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160 A few participants gave students the benefit of the doubt, indicating that regardless of the reason, students truly do not understand the imp act of not attending school. They dont know the ramifications of not coming to school. They think they knowbut I dont think they understand how that daily decision that they make is going to impact them further down the line (Ms. McDonnagh, high school assistant principal). This quote also reveals, as was reiterat ed by many personnel, that in high school, the decision to come to school really is th e responsibility of th e student, although there should be more expectations and involvement from the parents. Perceived Barriers to Attending School Many participants indicated that the issues that make attending school difficult are similar to many of the reasons they mentioned in general as to why kids do not come to school. These reasons included lack of parental support, low educational motivation, academic failure, and boredom. However, th e majority of participants added or emphasized something specific that makes it actually difficult to come to school. Approximately half of participants discusse d the reasons in term s of barriers, which consisted of physical, mental, emotional, social and societal barriers that make coming to school difficult. These barriers we re described as internal and external to the student and their locus of control. Physical barriers included illness and tr ansportation, although transportation was more often mentioned as something that should not make attending school difficult given the busing system in place. However, timing of the school day, especially in middle schools, was indicated as a reason that some students have a difficult time getting to

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161 school. Some middle schools begin at 9:00 a.m. after many parents have already left the home for work, leaving student s to get themselves ready and off to the school bus on their own. Many personnel indicated that th is is too much responsibility for some students. If the student misses the bus they often do not come to school, as either, the parent is already gone, or the family does not have the resources to get them there. Illness was again separated into legitima te and non-legitimate reasons that make attending school difficult. Legitimate reas ons included documented chronic conditions such as asthma, allergies, Attention Defi cit Disorder (ADD), a nd severe menstrual cramps. However, many of these same conditions (asthma, ADD, and menstrual cramps) were also considered non-legitimate reasons. Additionally, vague illnesses such as stomachaches, headaches, colds, and claims of general malaise were often described as reasons students used for not attending sc hool. Despite the verac ity of the illness, personnel still considered these reasons that make attending school difficult. Well, physical issues. Im one of the teachers that really believe that there is such a thing as ADD and ADHD and I think there ar e a lot of kids out there that have similar characteristics and its just difficult for them to work in the classroom and stay focused and theyd rather be bus y doing something else (Mr. Wallace, high school teacher). Many participants described mental and emotional barriers that included issues of embarrassment, school phobia, anxiety, depr ession, ADD, learning disabilities, and feelings of hopelessness. Embarrassment was commonly described as resulting from not having the right cl othes, or not having the social skil ls to fit in with a social group. A few participants cited school phobia as a cause of anxiety in atte nding school. Some participants point to clinical mental health issues as a source of difficulty. Hopelessness

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162 was depicted as resulting from repeated cycles of academic frustration and failure stemming from the students belief that it is too late and they are too far behind to catch up. Social barriers, one of th e most prominent themes that emerged among school personnel, centered mainly on students feel ings of social discomfort in the school setting. Many participants suggested that st udents have a difficult time coming to school if they are not comfortable in their surroundings. There were several dynamics to the perception of what causes student discomfort within the school setting, including peer relations, school climate, and st udent-teacher relationships, as well as some of the issues mentioned above such as physical, me ntal and emotional barriers. Peer relations included issu es related to bullying, soci al groups or cliques, and peer pressure. Bullying was mentioned frequently as a reason that caused some students to have trouble coming to school, especially in middle school. Particip ants indicated that bullying causes fear and concerns of safe ty. Another reason provided was that many students have a difficult time finding their soci al niche for various reasons, and if they cannot fit in, they feel uncom fortable coming to school. Peer pressure related more to the pressure for students to engage in de viant behaviors like sk ipping school. Often, personnel commented on peers outside of the school setting, such as older siblings, boyfriends, and girlfriends who distract the student and serv e as an external force. At the middle school level, it is all peers. Middle school is predominantly socialization. Its all abouttheres such a huge change in a person from 6 th grade to 8 th grade, physically, mentally, and em otionally. Theyre conflictedwith physical change and appearance, peer pre ssure. It makes it hard for em to come to school if they havent found their nich e. And they dont understand the niches to even find their niche, so theyll find the conflict to be so great (Ms. Cameron, middle school teacher).

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163 Peer relations are also a component of school climate, although comments about school climate were related to general safety concerns and a negative school tone. Another part of school climate was the issue of teacher and student relationships. Some personnel indicated that if a st udent perceives a teacher does not like him/her or they have some type of conflict, the student would more likely have difficulty attending. A few personnel raised the issue of the current testing and accountability climate in schools as a reason. They explained that it make s attending school difficult because of the pressure placed on students to perform, as we ll as for those students who fail such testing. Societal barriers include overarching issues that were mentioned as general reasons that serve as barriers to atte nding school. These included poverty, socioeconomic status, basic needs, violence, ne glect, divorce, and drug addiction. A few personnel talked broadly about these issues, i ndicating they affect st udents at home and in society, making school attendance more difficult in light of larger life issues. Sometimes they have to raise children. Sometimes theyre having to find a place to live. And sometimes theyre out th ere trying to make money to ease the pressure onand its usually the grandmot her that theyre living with and trying to help out financially if they possi bly can (Ms. Gary, high school teacher). Perceptions of Remaining in School All Day When I asked school personnel to differentiate between students who have a difficult time coming to school from those who have a difficult time remaining in school for the entire day, they emphasized similar issues, such as emotional difficulties and mental health issues, but also spoke to perceived bullying a nd low connection to school. These two themes are repres ented by the following quotations.

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164 Examples of perceptions of bullying. I guess one of the things maybe could be conflict with a teacher. I think sometimes they look for an out, you know? In their percep tion that maybe theyre being picked on unfairly by the teacher and one of their ways to get out, to leave, you know, just say might be to go to th e guidance counselor, youre gonna go to the nurse, you know, talk to the nurse a few times. Those repeat offenders, I guess we would call them, you know, who always leave class becaus e of the reasons you said. But its a perception that, y ou know, they dont get along with their geography teacher or whoever, you know, t eachers picking on em unfairly. And so I guess that could be a reason why they might it would be their perception of being picked on by the teacher, or conf lict with a teacher, personality conflict (Mr. Baker, middle school psychologist). Weve had some cases of, you know, kids perceiving that people are picking on them, so like we have a kid I dont ac tually have him, but hes on my team. He felt that everyone in this particular cl ass didnt like him, so he would go home on a daily basis, because he didnt want to be in that class (Mr. Henry, middle school teacher). Example of low connectedness. Theres no connection. Theres no connecti on at all. You know, the things that were doing, you know, just in the culture of the school itself, you know, if they dont feel like theyve got fr iends here, if they dont feel like they can connect with anybody, if they don t feel like anybody cares, and if they dont feel like they get the help that they need, what s the point in staying? You know, nobodys gonna miss them in their own opinion (Ms. Donnelly, high school guidance counselor). Issues that keep students from remaining in school the entire day centered again on those issues affecting the comfort level of the student. Exhaus tion and poor nutrition were also included as reasons that make it hard for some students to stay in school all day. Some only thought of s kipping school as the main reason and it was often resulting from peer pressure and outside influences. This was also the first time many particip ants brought up students they refer to as frequent fliers. Although a term predominan tly used by health services staff, other

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165 personnel also discussed these students and thei r frequent visits to the school clinic. Frequent fliers were described as students who come to school, but after the first few hours or even minutes of school, report vague symptoms of illness and request to go to the school clinic. These students visit the clin ic on a regular basis, usually following a pattern, with the same symptoms. R: Well we have a lot of frequent fliers in the clinic. I: Tell me about frequent fliers. R: Theyre kids that come out of the 5 school days, 3 to 5 days a week, at least once a day. We always call the pa rent, especially with the frequent fliers because we want the parent to know how often their child is coming. And 99% of the time, theres no reas on. Every once in a while there will be a medical reason and you find it. We usually encourage a checkup or something if a child comes in, for instance, we have one thats coming in with headaches very frequently (Mr. Wyatt, middle school nurse). Another example of what personnel describe as a frequent flier: Once they come to school, it seems lik e first period theyre fine. They see their friends. They go about and they see their friends and theyre okay. And like usually by third period we star t getting hit with em, they start coming in wanting to go home by th ird period. Id say probably threefourths of them could stay here that go home, but they dont want to be here (Ms. Hilly, high sch ool health assistant). Frequent fliers emerged as a sub-theme within varying contexts of these results. It will be discussed in the next section in relation to the construction of school refusal as illness and as a symptom. Section II: Exploring School Personnels Reported Perceptions of School Refusal This next section represents a shift from the general to the specific. The first section provided the contextual framework of general attendance i ssues as perceived by

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166 school personnel. This section delves into school personnels specific experiences with school refusal and how those experiences info rm their interactions with students and parents. I begin by briefly dec onstructing the specif ic terms personnel choose to use when describing school refusal as a behavior, fo llowed by an examination of their reported understandings of the actual behavior. I th en expand on how school personnel construct their perceptions of actual students who expe rience school refusal, further deconstructing their reported stories and the emergent themes arriving at nine typifications of students. This section addresses the firs t purpose of the study and di rectly answers the second and third research questions. Descriptions of School Refusal as a Behavior This section provides a general overview of the descriptive dimensions school personnel use when thinking about, talking a bout, and describing school refusal. It emphasizes the behavior of school refusal its elf as opposed to the student, although at times these became intertwined. Starting with a brief review of the descriptive terms and words used by personnel when describing the beha vior of school refusal, this section goes on to expound upon emergent themes related to perceptions of differe nces by grade level, cause, and patterns related to school refusal. Descriptive Terms and Words The majority of school personnel indicated that they do not have a predefined or specific terminology that they use to descri be students who are re fusing school or the behavior of refusing school. On ly a handful of participants used the term school refusal, and this was mostly among social workers or school psychologists. However, most participants went on to provide and use va rious terms while providing descriptions of

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167 students and their behavior. The most common term was truant or truancy. Only one participant indicated that this term was old and no longer us ed. Some of the other terms used included school phobic, non-attender, skipper, problem, frequent flyer, and chronic absentee. Some participants descri bed the actual behavior using words like skipping, truancy, habitual non-attendance, excessive absenteeism, and separa tion anxiety. Others, although not the majority, offered some of th e following adjectives: floaters, wanderers, lazy, withdrawn, unmotivated, uninterested, belligerent, underachieving, at-risk, angry, and troublemakers. A few participants used phrases to describe students, including, the kids that got issues, the motivated good versus the motivated bad, kids with attendance problems, and the I dont care kids. One participant, Ms. Johnson, a high school assistant principal, indicated that, It all gets lumped under the attendance issues umbrella. Several participants simply described students as having, an attendance issue, or an attendance problem. A few participants indicated how they see others describe kids who refuse school. Usually I hear them theyre spoken of negatively. I hear a lot of times that theyre lazy. Some of these kids might be frustrated and theyre its coming across as laziness (Mr. Ferris, middle school psychologist). Ive heard other kids call them losers (Mr. Bender, high school teacher). A lot of times what happens is even those kids who are experiencing anxiety and frustration, theyre considered unmotivate d. I think a lot of ad ults dont recognize whats hidden under the surface. They dont a lot of times I dont think they see those kids who feel fearful, who are e xperiencing frustration (Ms. Standish, middle school psychologist).

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168 A few participants indicated that they do not use any specific words because they try to avoid labels or labeli ng of any kind when it comes to students. Mr. Claire, a high school psychologist, was the only participant to express that he hears a lot of positive things used to describe stude nts like, This kids really got a lot of good things going on for him, hes just struggling w ith this part of his life. Described Differences in School Refusal by Grade Level When discussing differences based on grade levels, school personnel went back and forth between discussing specific issues causing absenteeism and addressing general absenteeism. School personnel frequently delin eated differences in the reasons for school refusal and attendance issues according to th e grade level of the students. Only a few personnel indicated that there were not any differences according to grade level. I think its very different for elementary versus secondary studentsI dont think I could give you one. The thing about it is that its complex. Its notthe reasons for it are not just universal and they vary from by age levels, I think. And so if you can look at those issues, I think youve got to understand that its so multifaceted, the reasons for, and the char acteristics of everybody by age level. You know, a 6 year old boy isnt the same as a 16 year old boy in terms of non-school attendance. The reasons for the things be hind it are completely different (Mr. Vernon, district level). Some described school phobia and sepa ration anxiety as more common among younger students in elementary school, but also occurring in middle school. Only a few participants indicate d that they had seen this occur among high school students. Surprisingly, a few participants brought up the issue of Munchausens syndrome as a reason that some elementary school stude nts do not come to school. Defiant school refusal was linked mainly to high school student s. Only one person actually used the term

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169 school refusal while explaini ng it as an issue more comm on among high school students than elementary or middle school. Several participants indicated that in both middle and high school, absences due to one reason, for example illn ess, could spawn a vicious cy cle of absences due to the stress students experience from falling behi nd. However, this was not discussed as an issue among younger students. One participant ci ted a study stating that attendance issues in kindergarten predicted at-ris k status in high school. This particular participant found this disturbing, as she believed most people do not think it is a big deal to miss elementary school. Participants described fifth, sixth, eighth, and ninth graders as more likely to have problems attending due to transitional issues. Th is was described as fear, uncertainty, or general anxiety regarding going to a new school and trying to fit into a new social setting. I see it being most concerni ng with the ninth graders that theres something with that transition between mi ddle school and high school and if we had the magic formula to fix it (Mr. Andie, high school assistant principal). Several participants discussed the main i ssues affecting the a ttendance patterns of secondary level students (middle and hi gh school) as being unsuccessful (either academically or socially), dysfunctional family life, or emotional issues. Emotional issues such as depression, anxiety, and mental health disorders were discus sed as issues also affecting secondary students as well. Participants explained that attendance issues among elementary school students are the parents responsibility, and often are caused by the parents themselves. Some examples included parents who oversleep, are not home in the morning, or leave for work

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170 early. Young students are typically not held accountable for their absence. However, many personnel, at the distri ct, middle, and high school le vels, consider middle and high school students responsibl e for their attendance. This was reflected in how school personne l described the differences in school climate between elementary, middle, and high school. Elementary school is considered warm and nurturing, middle school is less nurturing and high school even more so. Several participants expressed that middle and high school are times when students are extremely vulnerable and could benefit from a nurturing environment, but instead become lost in the crowd of a larger setting, and become harder to engage. Describing School Refusal as School Phobia School phobia and general phobias of school were brought up by various participants, typically social workers, psychologists, hea lth services staff, guidance counselors, and teachers. Participants describe d this type of school refusal as either a phobia in general or school phobia. It generall y denoted any fear rela ted to being in or coming to school. It was often described as an intense fear of school primarily affecting younger students in elementary school, but also students at transiti onal periods in the education. We see more of the problem were ta lking about with school phobia with younger children. It doesnt mean it doe snt exist elsewhere (Ms. Richard, district level). And theres that group of students who begin to develop phobias (Mr. Bueller, district level). Some participants discussed school phobia as occurring among students who have never had problematic school attendance.

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171 There are pretty few truly school phobic kids who really just emotionally cant deal with it. And like I said, a lot of th e time theyre kids who just never had a problem before but something something happened, whether its a combination of factors or whether its ju st one thing that kind of se nt them over the edge (Ms. Reynolds, middle school nurse). Participants often described school phobi a as resulting from real or perceived stimuli. School phobia was thought to result fr om perceived or actual bullying, a negative school climate, anxiety inducing transitions, an unexplained internal fear of school, or an actual fear caused by something else but displaced on school. Personnels idea of a student experiencing a real or perceived stimulus was typically described in connection with two issues: bullying and teacher attitude s towards students. The following examples below illustrate these perceptions. I: How would you describe what student s experience when they have this refusal to go, or this difficulty staying in the school? R: Well it probably falls into, you know a couple of categories: the phobic child whos afraid. The child whos being bullied is afraid, physically afraid. I: Would you break those out? R: Well while theyre two different i ssues, one I think theyre its an internal fear thats, you know, manifested a nd its expanded beyond any reality, thats phobia. And yet where the child whos being bullied, its really physically, or hes afraid what verbally people are doing to him. I mean thats the child that hes rea lly physically afraid to go so, you know, thats just different categories. And I think that theres a lot that theyre discovering about bullying and I think it was, you know, some traditional actions of Ill just ignore it and (Ms. Stein, district level). Some kids feel unsafe. Theyre being bu llied, and they dont want to face their tormentors. They fear that and this could be unfounded or founded, that a major violent event is going to occur at their sc hool. They feel like their teachers have it in for them. The school climate, the over all school climate, could be negative

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172 We go back to the bullying and the fear and their perception of what is going on, even though the reality of th e situation either with the teacher or with what they think is going to happen at school is not va lid, but it is their re ality and so therein we have to deal with that percep tion (Mr. Bueller, district level). Participants often indicated that thes e students would come to school, however, shortly after arrival or upon th e actual arrival to school, begi n to display signs of anguish. It was not described as something that cau sed students to refuse to attend school completely but instead single-minded thoughts that th ey absolutely do not want to be at school. They become very anxious, you know? Its almost like having a panic attack, because theyre confronted with the people, you know, the kids, the teachers, just the whole, you know, school setting is fr ightening to them. They cannot cope, you know. They just cannot cope in a normal way (Ms. Grace, high school guidance counselor). Health services personnel described students with school phobia as often reporting to the school clinic within the first hour of the day either emotionally distraught or with physical symptoms. You know, within 30 minutes or an hour theyre down to the clinic, you know, complaining of symptoms, completely hysteri cal because they just cant deal with it (Ms. Reynolds, middle school nurse). I think theres one particular student who displays a lot of physical complaints, you know, stomach irritability theres al ways some kind of stomach problem. And I believe that this has a lot to do with school phobia you know hes fine at home, but to get up in the morning, that s when the stomach problems and the pain and all these kinds of things (Ms. Walsh, high school social worker). A few described students as noticeable a nd well known by their actual refusal. One participant stated, This is not the qui et child that you pick up indicators on. Several personnel indicated that parents so metimes bring it to th e schools attention

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173 because they are the first to encounter diffi culties bringing their child to school. They then turn to the school for help. Others de scribed the students demeanor as quiet and introverted, and different from more defiant students who they consider truant. I meana truea school phobic I think doesn t have the, you know, the attitude that oh, school is stupid and, you know, its not worth my time kind of thing. Theyre more I think introverted and fo cused on themselves. They dont seem as outgoing and as social, you know, usually as the kids who are in trouble or even dont want to be here because their frie nds are elsewhere (Ms. Grace, high school guidance counselor). Many participants who discussed school phobia emphasized that there are only a handful of true cases of school phobia. Some were more negative referring to school phobia using words like supposedly, cop-out, or another label. A few went further to include that it is something that must be officially diagnosed and that happens in very few cases. It was not clear whether this is due to low utilization of psychiatric care among students. We have had some cases up here that were true school phobias, but I very rarely run across that. Id say I get one, maybe one school phobia every two or three years, maybe (Mr. Burnham, middle school social worker). Weve seen one or two that are true school phobics, but those are few and far between (Mr. Hoeman, middle school assistant principal). When participants used language to desc ribe some cases of school phobia as real or true, I would often ask them to describe the differences between real and not real. Often, real cases were considered true psychol ogical or mental health problems, whereas not real cases were considered students who were just not comforta ble in school, or there was another problem underlying the suppos ed phobia. One participant described differentiating between the two as being difficult.

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174 Parents role in school phobia. When describing examples of school phobia, participants frequently mentioned parents. Pa rents were reported as being very involved with these children, especially when trying to bring them to school. Often, parents were described as having a hard time leaving the child at school because the child was so upset. Personnel indicated that this made the situation worse and the child more emotional. Personnel commented that if they can get the parent to leave, the child typically calms down, although not in every case. A few participants linked this type of re sponse or behavior to separation anxiety expressing that sometimes the parent is more fearful than the child is. It was thought by some that parents enabled the ch ild to continue the behavior. I have never seen in my experience a cas e of school phobia that did not have a parent who was indulging them. Even though th ey say they arent, they really are (Mr. Burnham, middle school social worker). Out of all the comments by personnel about the role of the parent, the mother was discussed most frequently. The mention of fathers was noticeably absent from their comments. Many participants provided resources and suggestions to parents, often including the need to take the child to a therapist, psyc hologist, or psychiatrist. Several participants reported that such students were already work ing with an outside party. A few were said to be on medications of some type. Personnel reported that some student s with school phobia end up on hospital homebound. This requires a doctors diagnos is of school phobia. Many personnel who discussed this believed this was the wors t thing for the student, as they believed it

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175 perpetuated the phobia. Some pa rticipants indicated that some parents pressure doctors for a diagnosis of school phobia so th e child can be placed on homebound. You know, with school phobia, the more you stay home and the more you isolate yourself, usually the worse it gets (Ms. Grace, high school guidance counselor). The school responses advocated by the participants included the use of a team approach. The inclusion of teachers was considered most important. A few participants said that teachers often become frustrated with this issue. Many participants described placing such students on modified school schedules, in attempt to work them back into a full school day. School Refusal as Symptom Several school personnel described refu sing school as a symptom of something else that has occurred in th e students life. These percep tions were found mainly among student support personnel, such as soci al workers, guidance counselors, school psychologists, and health services staff. I just dont see the attendance as the mo st important, the most pressing problem that hes experiencing. I think thats a symptom of some others issues (Ms. Donnelly, high school guidance counselor). Usually for us the lack of school attenda nce for lack of a better phrase is a symptom of a much larger issu e (Ms. Lim, district level). It is a symptom of problems that need atte ntion This is a symptom that needs to be addressed somehow (Ms. Chad, middle school social worker). Participants also described general physical symptoms that appear to be indicative of something larger. Typically, these sympto ms are reported by students who are refusing to attend school, and include non-specific stomachaches, headaches, and nausea.

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176 Many personnel reported that when trying to understand students who are refusing to attend school, they try to get at the real problem. They see attendance issues as an indicator of a larger issue. This wa s especially common among health services staff in their efforts to screen out re al illness from other issues. First of all, like I say, I try to find out what the real problem is and can it be solved, you know? So you can deal with it realistically (Ms. Denton, high school nurse). This also appears to be related to the description of freque nt fliers. Health services staff often described fr equent fliers, or frequent visito rs to the clinic, as students who were not truly ill. Their frequent visi ts to the clinic appear as symptoms of something else, typically a desire not to be in a particular class for some reason. In one high school, where I conducted a daylong set of observations, I watched the same student appear in each office I observed multiple times. She appeared to fit the description of the frequent flier. Her complaint in each location was different. In the clinic, she did not feel well, called home, and cried. In student affairs, she tried to get to call home because she needed different shoes and just wanted to go home instead. In guidance, she walked in and out several tim es asking to speak to a guidance counselor. Later in the day, she came back to the clinic again. At one point the school nurse stepped outside into the student affairs office and said to me, Here is a good case for you to study, referring to the same student I saw all day long. A major concern related to viewing sc hool attendance as a symptom focused on the importance of looking beneath the surface for an underlying cause when a student does have an attendance problem. A few partic ipants indicated that refusal to come to

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177 school might appear like a behavioral problem that should be punished, but it may in fact be due to other factors. A few participants actually described refusing school as a cry for help. What follows is a analogy of a tree with branches that was offered by Mr. Sweeney, a middle school social worker, w ho explained his understandings of how refusing school or what he re fers to as truancy is a symp tom (branch) of deep underlying problems (roots). He began his story while holding up his hand and forearm, with five outstretched fingers: Think of this as a tree with the branches on it. These are all the problems I just said right here. Those are important. A nd when you want to cut down a tree, you dont cut these. Where do you cut? You cut down here at the base, that dries all these up, and the tree goes away. All the problems go away. Now what we tend to do, were not Im not saying we tend to do this. You dont want to be cutting this. Each one of these fingers is a probl em. Heres truancy right here. This kid has a truancy problem. I say no he does not have a truancy problem. He has another problem coming up here, whether theres instability in the family, whether theres violence in the family, wh ether education is no t valued, go to the trunk, and cut it down. Do not go up here because what youll do, youll knock yourself out trying to clear up the truanc y and guess what the branch does after you cut it? It comes right back in another year. These are never the problems. Usually its down here. So you got to get to that problem... I dont think truancy is an issue per say, its something else it s a symptom, but theres something else there, you know what I mean? I dont know if that makes sense. A few participants also described refu sing school as a symptom of school phobia, poor parenting, and drug use, although this was not a commonly reported perception. Illness as School Refusal Overall, most participants considered illness a major reason for why some students do not attend school. Participants who discussed illness mainly included student support personnel (specifically gu idance counselors, health services staff, and social

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178 workers) and teachers. There was a noticeable absence of such themes from discipline and administrative personnel, and school ps ychologists. Some participants would describe common illness, such as colds, as reasons for general absences among students. Many participants indicated that this is rare ly the case, and typically, students are not often sick enough to necessitate absences. For the most part, th ey believed these illnesses are not legitimate excuses. Two major themes related to illness as school refusal emerged including the dichotomization of illness into legitimate or non-legitimate illness, which included sub-themes related to the appropria te and inappropriate use of the hospital homebound program and the notion of claimi ng illness, and mental illness as school refusal. Legitimate and non-legitimate illness. Illness was viewed by participants as a reason, cause, and excuse for school refusal. Many participants delineated between legitimate and non-legitimate forms of illness. Sometimes it is a legitimate health issue and sometimes they need attention (Ms. Chad, middle school social worker). Kids that are legit, legitimately sick or legitimately need to go home, have a tendency to be very specific and make eye contact, and kids that are not are very vague. They look down, you know. So thats probably key (Ms. Fleming, high school health assistant). Within both categories of illness, the bounda ries for what constitutes legitimacy was somewhat flexible. Most school pers onnel considered chronic and medically diagnosed illnesses such as asthma, diabetes, sickle cell anemia, and other specific issues legitimate. Participants seemed more likely to describe a students illness as legitimate if there was a confirmed diagnosis on file, abse nces were documented with a doctors note,

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179 and parents were cooperative with the school. Several personnel highlighted examples of students who were manipulative in the use of their diagnoses to get out of school. Of the participants expressing these perceptions, most related it to students who had some type of chronic illness, like asthma. I think some of them use and I dont te nd to be a very sympathetic person, so I think some of them know that they have these conditions and use them to their advantage, like the ones that have asthma or the ones that have these, you know, allergies or whatever that theyre having. I think some of them tend to play on them (Mr. Duvall, middle school teacher). Ironically, asthma was also one of the condi tions that participants discussed as not being legitimate in all cases. Several participants indicate that parents will claim their child has asthma, but fail to cooperate with the school in providing medications to the nurse, doctors notes, or en rolling them in homebound. We had a boy who his mother said he was home all the time because of his asthma, but we had no medications at th e school and she couldnt get out to the school so the social worker and I went to her home, and talked about it, and picked up the inhaler, got her to sign the consent and everything. He still did not come to school and actually hes been through attendance mediation and he is doing better now but still has more absences than he probably ought to. Meanwhile, never once while hes been at school has he come to use his inhaler. So this is telling me that his asthma really isnt the issu e (Ms. Reynolds, middle school nurse). Interestingly, this same participant observed that students wi th serious chronic illnesses typically have better attendance, as it is more likely their illness is controlled. An interesting example of a legitimate illness becoming a non-legitimate illness emerged within one specific school setting. At a middle school, every single participant I interviewed mentioned the same female stude nt who was, in their opinion, refusing to attend school. It was the consensus of thes e personnel that this student, who had a

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180 doctors diagnosis of a legitimate female rela ted illness, had come to be considered as having a non-legitimate illness. Participants in this setting believed the student was manipulative, her parent uncooperative, and th e doctors proposed therapy unacceptable. All participants indicat ed that this student used her il lness to refuse to attend school. Participants reported that their perceptions of this student were also affected, if not reconfirmed, by comments made by the student to various personnel that she would be famous one day, and did not really need an education. Hospital homebound was often discussed as a solution to helping children with chronic illnesses return to school. Participants did not elaborate on hospital homebound and chronic illness, except to explain that it is usually an option for very ill students (e.g., if a student has a cancer dia gnosis). Several participants in relation to school phobia discussed hospital homebound. School phobia was considered by some participants as a diagnosed illness. While these participants be lieved that such a diagnosis was legitimate, several expressed concerns ove r how children actually receiv ed such a diagnosis. A few participants described what one referred to as doctor-shopping, wh ich was described as when a parent takes the child from doctor to doctor until they get a diagnosis that warrants hospital homebound. Most participants expressed that this usually accompanied a diagnosis related to emotional or mental h ealth. There was concern related specifically to students with diagnoses of school phobia going on homebound, as participants believed it went against the best interest of the student. Many participants used the word clai ming when talking about students and illness as a reason for their attendance problems. They would often discuss students claims of illness as not being a legitimate excuse for absences.

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181 I have, you know, the one child who wants to go to our clinic every other day, you know, she signs out a lot and shes got a sniffle or she has this or, you know, everything just doesnt ring true. Shes as ked me to go to the restroom and the next thing I know shes down at the clinic in my mi nd shes pulled a fast one and I question if shes really sick (Ms. Dean, middle school teacher). Many participants described students who claim they are ill and experience somatic illness, and cannot seem to stay in school all day. These students are described as exhibiting a pattern of leavi ng school early and visiting th e clinic regularly. These students are seen by some school personnel as frequent fliers w ho do not like certain classes or are experiencing stress-induced illness. We call em frequent flyer, the student that comes to the clinic oh a couple or three times a week. Theres not a real heal th issue. Theyre either looking to get out of class or just looking for somebody to talk to for a little bit (Ms. Hayes, high school nurse). Some participants also cited illness resu lting from performance or test anxiety. We have one kid this year who has a tendency every time theres a test, or she perceives every time theres a test, or she perceives somethings going on, she ends up going home sick the mother ki nd of agrees its a stress issue (Mr. Henry, middle school teacher). Participants also referred to examples of students who would manipulate their parents through illness. Some of these exam ples were of students with a chronic diagnosis, while others were of students who faked illness. Part icipants considered students faking illnesses as deviant. It can be a situation that sometimes the child may control whats going on. Maybe the mother trusts that the child may be ill and the child is not really ill (Mr. Lester, district level).

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182 Regardless of whether an illness is legitimate or not, many participants indicated that absences due to illness c ould initiate a cycle of school refusal. It was described as occurring when students fall behind due to absences, and then become overwhelmed at the thought of catching up, lead ing to stress and anxiety at the thought of a return. Refusing school then becomes an easier option. I think some have health conditions and so its just when theyre not feeling well, you know, they get so used to just being out (Ms. Mayo, middle school guidance counselor). A few participants, mainly school nurses and social workers, identified head lice as an issue. They expressed concerns over no-nit policies, which do not allow children to return to school unless they are free of nits. Participants reported that some children would not return for weeks due to head lice. The parents would claim they could not get rid of the nits. A few participants expressed concerns about Munchausens syndrome among the mothers of students who refuse school because of illness related causes, especially when they do not appear legitimate. I had a girl last year who seemed to have a million illnesses to be honest with you it seemed like the mother had like Munchausens Syndrome like where she wanted attention and was transferring it on to the child, because the child did not seem that sick to me, but she was ab sent quite a lot. She was in honors and advanced classes (Ms. Duvall, middle school teacher). Sometimes you see cases where you just dont think the kid is sick but mom sure wants him to be sick, you know, and you kind of get into like the Munchausens kind of situation. At least we see that occasionally. Ive seen that here too, you know? (Ms. Reynolds, mi ddle school nurse).

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183 While this was only brought up by a ha ndful of participants, I believe acknowledgement of issues as serious as Munchausens warr ant attention within these results. Mental illness as school refusal. Many school personnel referred to mental and emotional issues in terms of how they affect and cause students to refuse school. This included references to both diagnosed a nd undiagnosed mental i llnesses, including anxiety and depression. Participants expressing these perceptions were mainly within the category of student support services. Often, participants described mental illness as a reason for why students actually refuse school. Participants reported that some students who have a difficult time attending school often are deal ing with issues that impede their motivation to attend school. Mental health issues we re also indicated as making the school day intolerable or exhausting for students. This was often discus sed in relation to depr ession or anxiety. Many participants indicated that de pression is a concern and should be considered, especially among adolescents. Pe rsonnel described de pressed students as either having trouble coming to school or st aying in school. There were some concerns expressed that these students may not appear depressed, but instead as troubled kids who act out and subsequently are punished. And there is a lot of clinical depression in adolescence I thin k nowadays, a lot of it. And it manifests itself either in complete withdrawal and inactivity, heavy sleeping, which they cant get out of bed and go to school to acting out in which case school personnel will send them home for acting out behavior which only reinforces the whole cycle and so the ne xt day they might not come to school because they were kicked out the day before. So that whole cycle I see goes on and on and on (Mr. Ver non, district level).

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184 There were also concerns about the st udents who slide through school unnoticed, who might also be experiencing depre ssion or anxiety. They tend to know the troublemakers first and then the ones who get all their homework and they answer every question. They know them first, you know, but those quiet students that kind of sit quiet, passing through, those are probably your most at-risk kids, particularly if there are other issu es, you know, maybe theyre depressed or something going on at home ( Ms. Stein, district level). One participant provided a stor y of his own son, who suffered from depression that led to school refusal, but remained unknown to his school. He stated that: My son missed tons of school. I never saw heard even had a phone call from a truancy officer, the resource officer, or the school social worker, who after 16 days of unexcused absences is supposed to come to the house, do all of these things (Mr. Vernon, district level). Anxiety and stress related anxiety was discussed as another reason why students refuse to attend school. High st akes testing was cited as be ing responsible for stressinduced anxiety in some students. Middle school personnel disc ussed anxiety issues more so than high school personnel did. One participant described it as follows: No, its not common, but it happens more than we would think probably and it probably goes undetected a lot. When I wo rked at another [middle] school, at [school name], we there were four or five children at any given time [anxious about coming to school] (Ms. Berkle y, middle school social worker). Schools and their Environment Several district personnel and teachers, along with a few guidance counselors and middle school social workers, described elemen ts and aspects of the school environment that they believe can motivate or exacerbate a students refusal to attend school. Several participants reported that some students w ho refuse school feel unsafe in the school

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185 setting. Several reasons provided for this include d bullying (perceived or real), threat of a major violent attack, negative teacher s, and a negative school climate. The actual structure of the school environm ent and school day was also said to be a motivating factor. This was discussed primarily in relation to the transition that students experience when moving from an elementary to middle or middle to high school. The actual size of schools, incl uding the physical building a nd number of students and teachers can lead some students to feel isol ated. A few participants said that certain elements and expectations of the school da y in secondary school could be overwhelming. Examples offered included changing classes, using a locker, and dressing out for physical education. Participants cited the change in school climate and culture that occurs between primary and secondary school as well. Particip ants referred to elementary school as more nurturing than middle or high school, indicating that this change in the overall climate may deter some students. The climate of schools was apparent to me when conducting observations. Differences were mainly in the student affairs office. Interactions between personnel are business like and abrupt in the high school st udent affairs office. At one high school, I felt uncomfortable and unwelcome. The secretar y stared at me when I introduced myself. When I asked if I could sit in one of the chairs in the fr ont, she simply shrugged. In the middle schools, interactions appeared frie ndlier, with secretaries smiling more and talking longer to students. Likewise, the increasing social milieu of secondary schools can make some students uncomfortable, especially if they feel they cannot find their niche.

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186 If they have a feeling of not belonging with the school structure or within the peer group thats in the school, I find that to be a big one here at this school (Ms. Cameron, middle school teacher). Several participants indicated that sch ools academic environment and emphasis on high stakes testing has create d a climate that makes it difficult for students who do not naturally excel in school. The current edu cational climate in general was described as catering to college bound students. A few participants expresse d that school is designed as a one size fits all approach; therefore, by the very nature of it there will be students who do not fit that mold. I think we lean awfully heavy on academi cs for children who dont fit into those slots very well, yet those children will leav e, theyll go (Ms. St ein, district level). I think that we need to find a way to meet the needs of all of our students. I think the students that have trouble coming to school, as I said ; theyre not coming because were not offering them what th ey need Were kind of unique in this country in that we offer free education to everybody until they graduate from high school, but we only offer... we offer kind of a one size fits all approach (Ms. McMullen, high school teacher). Participants also cited low levels of school connectedness as adding to the reasons for school refusal. School connectedness refers to the feelings of attachment and belonging a student has towards their school This appears to be related to the aforementioned issues of climate and culture. A lot of kids dont make a connectiontheyr e not in an activity of any kind that draws them to school, to c onnect em to school (Mr. Be nder, high school teacher). There are so many children that get lo st and nobody knows them and they dont feel connected(Ms. McMullen, high school teacher). Theres no connection. Theres no connecti on at all. You know, the things that were doing, you know, just in the culture of the school itself, you know, if they dont feel like theyve got fr iends here, if they dont feel like they can connect

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187 with anybody, if they don t feel like anybody cares, and if they dont feel like they get the help they need, whats th e point of staying? (Ms. Donnelly, high school guidance counselor). Personnels perceptions of the school envir onment appear to indicate very real implication for school refusal behavior in the school setting. As indi cated in these results, issues of safety and a sense of belonging are perceived as being associated with school refusal. Cycles and Patterns of School Refusal District level participants and guidance counselors described and referred to cycles or patterns of absenteeism that can be an indicator or trigger of school refusal. General attendance issues were said to follow patterns as well. Patterns were described in terms of the individual student and over all within th e student population. The three themes that were associated with patterns included school transitions, a past history of patterns, or academic difficulty. Several participants indicated that patt erns of attendance will sometimes alert personnel to the presence of an attendance i ssue. Patterns of school refusal were also cited as occurring at transitional periods within schooling. We have seen a pattern of children missing school, perhaps refusing, when children change grades, meaning like from fifth to sixth, theres a change from elementary to middle and then from eight h to ninth, which is looking now towards entering high school (Ms. Richard, district level). Historical patterns also se rve as indicators personnel look for when identifying a student with school refusal. Several participan ts noted a history or pattern of attendance

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188 problems as well as generational or familial cycles of excessive absenteeism as an indicator and reason. You have generations of families that tend to have similar problems. And one of the things that we try to do is break the cycle (Mr. Ipkiss, district level). A few participants also said that lear ning disabilities or academic difficulties could lead to a cycle of absenteeism. Partic ipants emphasized how patterns and cycles of absenteeism affect cumulative learning that occurs in the classroom. Hence, the more a student misses school, the further they fall behind and feel the growing anxiety of catching up with their peers. It becomes a real negative situation for the child because they too get caught up in a cycle of, If I have six classes and I miss three days, three times six, Ive missed 18 assignments and 18 classes that I s hould have been there taking notes; 18 assignments. Can you imagine what its like to have to make up 18 assignments...?And so, you know, there are a lot of kids who, ag ain, that vicious cycle of absenteeism, making it up, abse nteeism, and before you know it theyre so far behind they give up and they stop working. A lot of em just stop functioning altogether in class (M r. Bueller, district level). He just hes kind of gotten into that cycle that, you know, hes not meeting with much success when he is here so its easier to stay home and it feels better to stay home so why go? (Ms. Grace, hi gh school guidance counselor). The issue that concerned personnel was not simply that absenteeism caused a student to fall behind. The concern was the reciprocal relationship they described; absenteeism causes the student to fall behi nd, the students distress increases, and thus miss more school due to stress. Describing the Student with School Refusal This category focuses on school personnels descriptions of the actual students, whereas the last section descri bed reported perceptions related to the behavior of refusing

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189 school. It illustrates the de scriptive dimensions school personnel use when thinking about, talking about, and describing the student s who they identify as experiencing school refusal. This section begins with a description of how school pe rsonnel construct their reported perceptions of students who refuse school, including the perspective from which they arrive at their cons tructions and the descriptive attributes they associate with these students. I then proceed to deconstruct school personnels stories of school refusal, in an effort to examine how they differentiate and evaluate their experiences with students. This section culminates with an ove rview of the nine typifications of students that have emerged schoo l personnels stories. Constructing the Student Experience of School Refusal I asked participants to shar e their thoughts on what they think students who refuse school are experiencing. This was not somethi ng that always emerged within their stories about students, but when asked, most participan ts were more than willing to share their perceptions of what these st udents might be experiencing. Le ss than five participants declined to respond to my questions, offering the explanation that they did not feel comfortable answering such a question, as they had not been in the students place before. Other participants would indicate, wi thin their response, what perspective they were basing their comments on: their prof ession, imagining themselves in students shoes, or thinking about their own experiences as a student or as a parent of a student. Below are a few excerpts that illustrate how participants verbally defined their frame of reference. And Im probably biased in my view point cause Im a psychologist but I think its devastating, and again, I talk from personal experience

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190 It is beyond my comprehension how a thirt een-year-old, how my thirteen year old could tell me Im not going to school? You know its hard for me to say because I try to put myself in their shoes and I try to imagine what I was like at their ag e and I dont have half the issues that some these kids have Its hard for me to say because I loved school. Thats why Im an educator. So for me the concept of not, you knowI did a lot of things in my previous positions with bullying and harassing a nd things like that. Thats definitely a reason that kids dont want to come to school if th eyre being bullied or harassed. They dont feel that theres any conn ection for them here so th at connectedness again, you know, would be a reason. You know, its not important to their familyIts hard for me to say what is going through their minds Internal versus external experiences of the student. Descriptions of student experiences were discussed in terms of two perspectives: what the student experiences internally (i.e., emotionally or mentally) and what external experiences lead to refusal. Many participants based their descriptions of what a student experi ences either through examples they provided of specific students, or different categories of students they had already outlined within the interview. For example, a participant might discuss what Joey with school phobia was experiencing, or what students who were school phobic experienced. Common emotions and feelings of stude nts described by participants included anxiety, depression, embarrassment, failure, f ear, frustration, helplessness, hopelessness, isolation, low self-esteem, peer pressure, stress, safety, a nd uncomfortable. These were considered internal to the student. Fear wa s typically associated as a key emotion for students who experienced school phobia. Failure, frustration, and embarrassment were used in describing students who were refu sing school because they were unsuccessful academically or socially.

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191 Personnel described students as being ove rwhelmed with external expectations and peer pressure. Descriptions of students who refuse school out of defiance focused on participants belief that these students think there are better or more entertaining activities to engage in outside of school. Not... not theyre not fearful. They just want a good time, want to be somewhere where they dont have to be held accountable, you know. And school is not a good time for them, because for whatever reason they feel that being in the classroom is more of a pressure than it is an enjoyable ex perience (Mr. Kane, high school assistan t principal). Several participants discussed parents w ho do not enforce the value of education, which they believe leads students to a cons tant lack of encouragement that enables refusal behavior. Other reasons provided we re physical issues such as illness and emotional issues like depression. Many participants also reiterated the various reasons for school refusal, such as bullying, academic failure fear, and social discomfort, as some of the things that students ar e experiencing externally. Family as a description of the student. Comments provided by participants about parents or families centered on how they potentially influence school refusal by serving as a cause, an enabler, or through their own attitudes on education. In terms of causes, personnel described issues of abuse, divor ce, and other home problems that make the students either fearful of leavi ng the home or the parents. Pa rents were also described as enabling students to stay home through poor parenting practices. A few examples included inconsistent rules, making it easy to stay home or leave school early, and leaving students to get themselves to school on their own. Participants also cited parents ideas and values related to education as being a major influence on school refusal.

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192 Many comments about family actually removed the onus of responsibility for school attendance from the student, as partic ipants described parents who make their child stay home from school. This was often the case in descriptions of students from families that were migrant, poor, or from single parent households, in which the student is relied upon as a translator, wage earner, caregiver, and/or babysitter. Further, several participants said that students with attendance problems often have parents that are not involved or involvement is limited. Typically, if Im dealing with a student with attendance issues, often times the parental involvement is limited (Ms. Lim, district level). Some participants indicated that stude nts who refuse school have parents who have lost control of them, which was consis tent with some participants comments about permissive parents. This theme also seemed more common among descriptions of defiant school refusal. Really, as far as kids who will not come to school, weve had several of those. In most cases, the parents at some point have lost control of their kids. The kids run the house (Mr. Blane, middle school assistant principal). Attributes of students who refuse school. The most common elicited response from school personnel was that students w ho refuse school could look like or be anybody. Several participants stated that there is not just one characteristic of these students, demonstrating their e fforts to avoid stereotypes. They look like everybody else. Theres not theres not any one look that those kids have. They look like everybody else (Mr. Bueller, district level). If you just if you were to see em walking down the hall, thered be nothing about them that would draw your atten tion (Ms. Dean, middle school teacher).

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193 They look like kids. The situation is re gardless of race; regardless of economics Mr. Blane, middle school assistant principal). Despite participants in dicating that students w ho refuse school look like anybody, many went on to provide details about students, ranging from specific individual students to broad commonalities among students. This is one area where participants were contradict ory in their descriptions. Wh ile recounting stories about students who refused to attend sc hool, participants would fre quently include descriptions that highlighted attributes of students, incl uding gender, ethnicity, socio-economic status, demeanor, and physical characte ristics. Comments about su ch attributes were more common among middle school personnel, stud ent support personnel, and middle school teachers. These descriptions often emerged unprompt ed throughout data collection. I would also generally ask participants what stude nts who were refusing school looked like from their perspective. When I would as k this question, many participants would immediately launch into descri ptions or stories, with ma ny thinking aloud about how it brings to mind mental pictures of specific students. Some pa rticipants appeared hesitant to respond, asking, Do you mean physically? The one young lady wheres the same old dirty sweatshirt every single day. And shes always sniffling, always wipi ng her nose on her sweatshirt. The other child I was referring to that sits by himself in the morning at breakfast, he is very tall, very awkward, glasses, pimples, doesnt have the he doesnt have a youthful look to him (Ms. Fleming, high school health assistant). Well, when you say kids who refuse to attend, I get a mental picture of a rebelliousthis is a terrible stereotype, but as you say the ph rase, I think of a rebellious, outspoken, stereotypical, you know, hard rock listening music person, maybe even Goth, whateverthats what I think of (Ms. Dean, middle school teacher).

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194 Participants discussed males and fema les equally within their stories and examples of students. Many participants indicated males and females refused school about the same, often verb ally reflecting upon their knowledge of the professional literature and statisti cs about gender. I think its pretty equally divided be tween males and females, maybe leaning more heavily towards males to some de gree (Ms. Ipkiss, di strict level). When I think of it, I think of boys, but actually I want to think in my own head the statistics, its there doesn t seem to be it seems to be about equal (Mr. Ferris, middle school psychologist). A few participants said that school refusal occurs more with males, while others indicated females. These participants would also express concern regarding whether their own perception of this was biased. Some participants further delineated gender by the motivating factor for refusal. For example, some believed more boys experienced school phobia while others indicated gi rls. One participant explaine d that she notices the girls more and tends to remember their stories and issues more than boys, explaining that girls are just more complicated. As far as gender, I have girls who miss more than boys of my, you know, repeat attendance offenders but I do notice female absences more than males absences just in general I think (Ms. Flick, middle school teacher). Some participants explained that ther e are differences between the genders depending on grade level. Typically, girls we re described as having more attendance issues in elementary school, while boys e xperience them more in secondary school.

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195 While some participants indicated that there are no differences in ethnicity or race, others said that Caucasian students were more likely to refuse school. Students who miss school to serve as caregivers were more often described as female and Hispanic. In my experience, most of my kids ha ve been Caucasian, African American, or Hispanic. I have not had any have not seen any Asians. Typically, these kids have not been necessarily disciplinary issues (Ms. Lim, district level). Some participants indicated that Black st udents were less likely to refuse school. Id say if you want to look at it as a race issue, more white students are absent than black students (Ms. Lis bon, middle school teacher). I seldom see students who are AfricanAmerican who are truants, which is interesting (Mr. Claire, high school psychologist). Participants discussed soci o-economic status as a char acteristic of students who refuse school. Participants who work in sc hools with a higher percen tage of students from lower income households pointed this out more often 2 I was going to say a lot of them are of ten low SES backgrounds. But there might be some real bias in that because a lot of my kids come to me by referral and I do work in a population where half of our students are low SES (Ms. Dawson, high school psychologist). I dont have any research behind I m ean I tend to think of lower socioeconomic kids and kids with achievement problems (Mr. Ver non, district level). Participants described students as ha ving different demeanors depending on the motivating factors for their refusal to attend. Fo r example, participants described students with school phobia or anxiety as introverte d, avoiding eye contact sad, and withdrawn. 2 I reviewed school level indicators for each school in this study to develop an understanding of each school. This allowed me to make interpretations su ch as this. These indicators can be reviewed online through the State Department of Education. Examples of indicators reviewed include percentage of students on free or reduced lunch and percentages of various ethnicities. I have not reported the indicators in these findings to maintain anonymity of the participants.

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196 They described students who defiantly refuse school as having negative attitudes and body language. Some described students in general as being depressed and quiet. Several participants mentioned that students looke d like they had low self-esteem or were passive. Some participants viewed stude nts who refused school as unkempt, not appropriately dressed, and with poor hygiene. Others indicated that such students often do not have the most stylish clothing. Conve rsely, some participants reported that students were nicely dressed and well groome d. A few participants indicated that students who have consistent problems related to attendance appear thinner and ill. The Reported Disconnect of Stud ents Perception of Reality Although this particular theme of students perceptions of reality was not very strong across all categories of personnel, it warranted a small sect ion to present these findings. Discussions of real ity and students perceptions of it and the reported disconnect that personnel perc eive, were unprompted and as well, unexpected. This was often in the form of specul ation about the experience of students who refuse school. Several participants described students percep tion of reality in relation to the following issues: bullying, fear, anxiety, fame and student teacher relations. When describing students who are refusing school due to fear or anxiety resulting from a bullying situation, participants comm ented on the students perception of reality. They indicated that they must be aware th at whether or not bullying is actually occurring, personnel must be cognizant of the students perception of rea lity. Participants reported that students will claim someone is picking on them, but when they monitor the situation, they see nothing happening. Part icipants wondered if they are dealing with

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197 a situation they cannot see, or a situa tion imagined by the student. Teachers who described these types of situations often a dded that they find this to be frustrating. There had been some he had, you know, ta lked with the assistant principal about the bullying and the t easing that he felt and about the whole incident at lunch. They did an investigation like they would do when any other children come and talk and there was no real belief th at things were happe ning. So then you look at well is this perception, you know, is someone saying a word and its becoming misconstrued in his perception or are these children really meaner than they are or are people, you know, are the kids just bei ng sly and so its going under the zone. Whats really happening? But it got to the point that in the morning he would give the mom a hard time about getting in the car. If she would ge t him in the car to come, he would he just cried unmercifu lly when he got here (Ms. Berkley, middle school social worker). A few participants discussed various students who have perceptions of reality that involve impending fame; and in turn, their motiv ation for education is low. Conflict with teachers was also an issue that involved delin eation of student reality versus the actual situation. Deconstructing Stories of School Refusal School personnel had extensive experience s with students who refuse to attend school. I asked participants to tell me storie s of students they had worked with who were refusing to attend, and most were able to pr ovide multiple stories. It appeared that personnel with many years of experience had a di fficult time telling specific stories about students than those with fewer years of experience. Some participants would even explain that they had been working in schools for so long, many of the students faces and names blur together, making it hard to recall spec ific details. Such explanations were often accompanied by long thoughtful pauses as they tried to recall at least one student. Overall, their stories provided insight into th eir perceptions and expe riences with students

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198 who refuse school, as well as the process of identifying and intervening in these situations. This section starts with an examination of how personnel differentiate students, and then proceed to explore how personnel evaluate their experiences with students. Differentiating Students School personnel struggle to differentiate between the various reasons students refuse to attend school. The most obvious di fferentiation, students who are refusing and those who are not, is easy to make due to the obvious lack of attendance associated with school refusal. The manner in which personne l report differentiating between the reasons students refuse was primarily individual contact with the st udent and parent, which was discussed as formal or informal. This could be in the form of a brief conversation with the student, a phone call to the parent, a formal interview with the student, or a parent conference. Emphasis was placed on th e importance of making decisions and differentiating on an individual basis. The way I differentiate between them is to talk to the child to find out whats going on. When you get them one-on-one a nd you get to the point where they understand that youre, you know, spending your time with them because you want to help them, most kids will open up (Mr. Blane, middle school assistant principal). Reviewing student attendance patterns and history was also a factor considered by personnel. If a student does not have a history of attendance problems, it seemed to cause more concern than if a student does have one. Whats the pattern, you know? Was this is this a new pattern, ol d pattern? Whats going on? (Ms. Berkley, middle school social worker).

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199 Personnel differentiate students in vari ous ways that have been described previously, but for convenience ar e provided here briefly: reas ons for refusal (internal or external), grade level, legitimacy of the r eason, and student locus of control. While the majority of personnel differentiated student s similarly, school psyc hologists were the only group to openly consider lear ning disabilities as a possible reason for refusal. Part of their role in the school setting is to conduct tests for such disa bilities, thus it is a logical differentiation. School health services personne l were also different as they delineated students based on the frequency of their visits to the clinic and requests to sign out. Evaluating Experiences Several key factors appear to affect how school personnel think about and evaluate their experiences with students who refuse school. These factors represent perceptions that participants have derived from their experiences with students, and may play a role in how school personnel identify a nd work with students in the future. These factors center on three main themes pers onnels interactions with students, other personnel, and parents. Interacting with students. Within some stories, participants described their actual interactions with students. Likewise, I aske d specifically for participants to reflect on these interactions. The distri ct level personnel reported fe w interactions with students given the nature of their work as administ rators. Many participants working within the school setting believed they have a good rapport with students in general. Interactions with students were considered as being individualized. Personnel have varying types and levels of interaction with students. Those who are in the disciplinarian role described be ing perceived as the b ad guy because they,

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200 especially assistant principa ls, are responsible for assi gning disciplinary action to students. The personnel in charge of offici al documentation of attendance, mainly the attendance clerks, have little if any interacti on with students, except if a parent calls to excuse them. Teachers expressed frustration wi th these students because of the amount of attention needed for one student, given they have an entire class to attend to. Setting the tone of the intera ction also characterized participants interactions with students. Most participants stressed the need to make the student feel comfortable when talking to them about why they are refusi ng school and make it a positive encounter. Participants explained that typi cally they would talk to the st udent privately in their office or in a conference type setting. Teachers re ported that they main ly question students individually about their absences before or after class, so as not to embarrass them in front of the class. I usually haul em out in the hall so they re not in front of the whole class and ask them whats happening, and is it something they want to talk about, because you cant to begin to address the problem unless you know what the problem is (Ms. Metzler, high school teacher). Participants depicted students as bei ng honest and open about what was causing their problems attending school. A few did say that students could be disrespectful, belligerent, and evasive, at least until the students understand they just want to help them. Participants would also delineate their intera ctions by the type of student. For example, one participant indicated they would approach the interaction with the student with an authoritative nature, depending upon the student, or the reason for their refusal. Another told me that if the student has school phobia they have to try to convince them little by little to come to school.

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201 Participants would often re flect and evaluate their ow n actions while discussing their experiences and interactions with stude nts. This mainly included reflection on the manner or tone of their interactions with students who are refusing to attend. A few participants who talked a bout their tendency to joke around or tease students about excessive absences expressed that this might not be the best approach. For example, one participant said: I used to be especially hard on him cause he wouldnt come to school. Id tease him all the time. Hey, you woke up this morning. Glad you could join us. Did you get your breakfast? Hey, I got some he re if you dontI go t an extra doughnut, you know, tease him about iteven though I was joking, I wasnt doing him a bit of good. So, I started congratulating him for coming to school. Hey, did you get that make up work done? (Ms. Cameron, middle school teacher). A few participants described themselves as being hard on students when they did come to school. Additionally, they explained that they do not feel a connection to students who are frequently absent. The kids who are not here I just dont feel like I have as personal of a relationship with them just because the interactions are less. You know, and I guess if I really stopped to think about it then those are the kids that maybe need even more interaction from us because they might feel left out (Ms. Flick, middle school teacher). Although this type of self-evaluation was infrequent, it is important to note as part of participants experiences. Other personnel. Beyond examining their own per ceptions and in teractions, I asked participants to reflect on how other pe rsonnel interact with students. The category of personnel most discussed by participants wa s teachers. Participan ts, including teachers themselves, reported that teachers would rather students who refuse school or have

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202 excessive absenteeism not come to school. This was explained as an attitude resulting from the added effort teachers must put fo rth to catch the student up through make up work and remedial help. Some teachers see it as unfair to the rest of the class. Teachers were reported as saying, out of sight out of mind and we teach the ones that come. Participants discussed the role of pers onnel as it relates to their demeanor in working with students who refuse. Guidance counselors were described as caring and nurturing in their interactions with students If personnel had children of their own, they were described as being more em pathetic than those who do not. Administrators were thought of as more discipline focused and concerned about the school attendance rate. They were said to be more likely to wit hdraw students if they are refusing to attend and are 16 years old, so that it does not a ffect school attendance rates, which can affect school grade de signations. The following quote reveals one participants juxtaposition of teachers and administrators: I think most teachers at some point theyre going to tell you they get frustrated with the non-attenders. Theres a frustrati on level, because if the kid isnt there, the kid is missing whatever important things youre discussing and going over. For administration its a different kind of frustration because theyre looking at FTE money, which is the money the get pa id from the state (Ms. Metzler, high school teacher). Perceptions of parental influence. Parental involvement and awareness were major areas considered to either contribute or hinder the resolution of school refusal. Involving the parent in the problem solving process is considered essential, especially if they are unaware or uninvolved to begin wit h. Parents that are unawa re of their childs refusal to attend are often upset a nd willing to work with the school.

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203 Sometimes its a complete shock for some parents to find out their children have not been attending school (Mr. Bueller, district level). Parents of children who are refusing to attend due to phobia or bullying are often distraught emotionally. Participants described these parents as willing to work with the school, but frustrating because they often give in to the child due to the emotional stress of the situation. Parental support or encouragement for e ducation was also considered important. Parents who are not supportive make it more difficult for personnel to convince a student of the importance of attending. Participants repeatedly emphasized th at if a parent had a negative school experience of their own, it can adversely aff ect their childs experience. Participants explained that parents might fuel their child s refusal to attend, through negative attitudes towards the school or teachers. Parents with their own bad experien ce may distrust the school and teachers, making intervention diffi cult for both the school and the student. The issue of parents passing on negative expe riences was a source of frustration for many participants. A lot of parents that we work with, a nd not all, but many, are mad at the school for whatever reason, they see school as kind of an evil place. They had bad school experiences themselves. They had some misperception that may have been their perception. And maybe they did have a real mean teacher at one time (Ms. Richard, district level). Lastly, several participants shared th eir experiences with a phenomenon they referred to as helicopter parents. Thes e are parents school pe rsonnel consider too protective. They swoop in and save their ki ds from everything. This was seen as negative among school personnel. Parents are ex pected to be involved, but not to the

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204 point of what personnel view as suffocating. Th is type of over-dependence was viewed as unhealthy. This was more commonly described in relation to parents of fearful or phobic students and chronically ill students. Typifications of Students Participants were adamant that stude nts who refuse school could look like anybody or be any student. However, when asked to tell stories and share their experiences, typifications of students did em erge. Although participants expressed that any student could refuse school at some point in their educa tional experience, their stories were limited to specific types of students in specific situations. While not all participants provided identical images, several collective descriptions of students developed within the various stories that were told. In the following section, I provide an overview of my interpretation of these images or types of students who refuse school. Overarching all of the typifications were a few key dynamics that seemed important to how participants defined thes e categories of students. The five main dynamics, as I have termed them, include level of parental control, parental awareness, student locus of control, blame, and victim status. The dynamics of parental control, parental awareness, and student locus of control, appears to represent a continuum of responsibility (parental or st udent), and thus provides th e opportunity for blame. Within their descriptions of the various categories of students, participants would often delineate as to whether or not a parent had control of th eir student and if they were aware that the student was refusing school. Stude nt locus of control re fers to whether or not personnel perceive that th e student is in control of their decision to attend school. Blame refers to who is at fault for the students refusal to attend, and was largely

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205 dependent on who was responsible for the lack of attendance (parent or student). Lastly, victim status, which is related to student lo cus of control, refers to whether or not personnel perceive the student who refuses as a victim or in some way, not responsible for their refusal and in fact is in some way harmed. In this case, the harm is that the student is not in school learni ng. Essentially, if it appears th at a student has less control over a situation that is causing them to refu se school, and there is a legitimate reason, personnel express more sympathy for that st udent. Table 4 provides the dynamics for each typification, demonstrating the relations hips between responsibility, blame, and victim status explained above. Table 4. Typifications 3 of Students with School Refusal Responsibility Typification Parental Control Parental Awareness Student Locus of Control Placement of Blame Victim Status Defiant Student Low Somewhat Aware Internal/ Control Student No Adult Student High Aware External / No Control Parent Yes Failing Student N/A N/A External/No Control School/Student Partial Bored Student N/A Somewhat Aware Internal/Control School/Student Partial Invisible Student N/ A N/A N/A N/A Yes Physically Refusing Student Low Aware External/No Control Partial Blame on Parents N/A Socially Uncomfortable Student N/A Somewhat Aware External/No Control Partial Blame on Parents Yes Sick Student If legitimate illness, high otherwise low Aware If legitimate external otherwise internal If legitimate illness is blamed, otherwise student If legitimate yes otherwise no. Victim Student N/A Somewhat aware External/No Control N/A Yes 3 In some instances, the various dynamics did not emerge within typifications. This may be due to the need for more data, or that for those typifications the dynamics do not apply, or in the instance of the invisible student, the personnel do not know enough about them to articulate these dynamics.

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206 The following sections provide brief overv iews of the various types of students described by personnel. These include the following: the defiant student, the adult student, the failing student, th e bored student, the invisibl e student, the physically refusing student, the socially uncomfortable st udent, the sick student and the victim. As part of developing an image for each type of student, I describe the students as these students are as opposed to re peatedly stating these stude nts are described as. This is to allow an image to form more clearl y. While I caution that these descriptions are representative of my interpreta tion of the participants perspe ctive, it is important to note that the labels I use to characterize these typifications are my own, having emerged from my interpretation of the participants stories; all typifications are gr ounded in the data and in some instances, the labels used are re presentative of the participants language. Throughout the typifications, I also provide quotations of the participants narratives that illustrate examples of each typification. At th e end of all of the descriptions, I provide composites for the typifications of the defian t student and the sick student that offer a more detailed image. The Defiant Student: Theyre not fearful; they just want a good time Participants described these students as willfully disobeying and joy seekers who pursue activities outside of school in search of entertainment. One participant called these students the I dont cares. They are perc eived as being in control of their refusal, although their peers influence them. Sometimes personnel perceive that they are involved in dangerous or illegal activities such as dr ug abuse or gangs. They often refuse school by way of skipping classes, leaving cam pus, or not attending at all.

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207 A lot of what Ive seen is ma ybe peer pressure from othe r students. In particular, I had a student in my Honors class that never showed up the first day and I didnt know if she was she was on my roster, bu t we have a lot of mistakes at the beginning with schedule changes. I didnt know that she wasnt that she was still supposed to be in there. And for 3 to 5 weeks she never showed. And we get new rosters and shes still on my roster. I said shes not here. Shes not coming. Come to find out she had been skipping since day one. And asked why? She was coming to 2 nd period every day. And I could if I was asked to identify her at the time, I would not be able to cause Id never seen her. She just said cause my friends wanted to hang out at lunch. And that was the reason why she didnt want to come to class and it was an Honors class. She will not be she will not returning to me in that Honors class come Thursday. But peer pressure has a lot to with it (Mr. Edmond, high school teacher). Participants often reported that the parent s of these students are usually not aware that their child is not atte nding or skipping school. Some personnel indicated that they think these students are sometimes rebelling agai nst parents, because of parental pressure. Others believed that parents might have simply lost control of their child. Personnel considered this to be deviant behavior on th e students part, but do not appear to place blame on the parents, as they do with other t ypes of students. This appears to be because of the parents general lack of awareness, as they are being duped as well. We had one I think about three years a go, two years ago who she was absent for almost a month straight and were like whats going on? You know, we would ask kids whats going on with this pers on? Apparently she w ould walk to the bus stop and shes skipping school that whole en tire time and the parent was like why why didnt, you know, why didnt I know? And we do have people that call, but the only thing I can guess is that if they called she didnt have an answering machine or maybe the child picked up and things like that. So and we had sent things home and the parent just hadnt got ten it. And the child just decided that they didnt want to come to school, I guess (Ms. Libson, middle school teacher). Participants did consider these students to be at a higher risk for dropping out, especially if they are close to 16 years of ag e. These students are not considered victims, and personnel did not display any sympathy for this type of student.

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208 The Adult Student: They are the quasi-head of the household The adult student is described as a stude nt who takes on a role of responsibility that exceeds the normal expectations of a child in middle or high school. The responsibilities are so demanding that school often becomes a second priority. The reasons that participants provided for why students take on these roles included family pressure, the students decisi on, or there is no choice. I had a young man who had just moved from Puerto Rico with his mom and his sisters. He really was very angry about a lot of things. Number one: he didnt want to be the man of the house, because thats what was expected of him. He was expected to be strong, be the man of the house. He was expected to behave, to make good grades, and do what he had to do to graduate, cause that was his job. And in the eyes of his mother that was the way he needed to behave, and he was very angry with that role. His deal wa s, and he actually said I am not an adult and I shouldnt have to be in this ro le (Mr. Bueller, district level). Parents were often described as not only being aware of their students extended responsibilities, but also ofte n being responsible for placing them on the child. In fact, many participants explained that parents k eep students home to work, provide day care, care for an ill adult, and/or serve as a translator. One participant exclaimed that parents dont see anything wron g with this. Students, for the most part, were considered to lack control of this situation, and therefore were not blamed. Instead, parents were blamed although participants appeared to be understanding to an extent. They described this as an issue that is entrenched in low socio-economic status, and is something that occurs out of necessity. Many participants believed that these families do not place a high value an education. These students, often described as female and Hispanic, are consider ed victims of poverty, society, and of their families values.

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209 This year I have the young man whos running his household. At first I was concerned because his absent rating was so high and he was in my homeroom. First period of the day I never saw him. First 9 weeks I think he must have came to school on time 5 times. So I thought something was seriously wrong and I intervened with social, I intervened w ith guidance. I never really found out I actually stumbled into it because I saw hi m down in the office with his mother and he was handing her money. And I as ked what was going on and mom says well he pays the bills and he hasnt give n me my weekly allowance. And my heart sunk, because heres this, what I perceive as a little boy, who was in fact a young man cause hes responsible not only fo r taking care of younger siblings at the house, but hes paying mom an allowance because mom and dad come from a split family and dad had said son I entrust you with the money and you run your house, and it makes you look at that pers on, that young man as a whole different person. And I cant even imagine a 14-year-o ld having that type of responsibility and that type of torn allegiance. Here he s supposed to be a 14-year-old but he has other obligations. Well why should he co me to school? Why would he want to come to school? Hes got hes got to go pay the cable bill, or mom is in trouble and hes got to go handle his business (Ms. Cameron, midd le school teacher). There were also students within this de scription who actually are raising their own families, working full-time, and trying to continue their education. These students were seen as dedicated, but struggling. Some stude nts were dealing with major life changes, like a death of a pare nt, or a divorce. A few students within the category of th e adult student were conceptualized differently. These students were more likely to be higher SES, and making their own conscious decision to work to meet their ne eds, like paying for car insurance. These students were considered victims in a sense, but victims of modern living. These students parents were described as assuming that students can take care of themselves. One participant believed that schools do not accommodate the working needs of todays students, and should consider this in the school day schedule. None of the students within this category were described as actively refusing school, and in most cases, it is considered completely out of their control.

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210 The Failing Student: Caught in a vicious cycle The failing student is descri bed as caught in a cycle of academic failure. This can lead to school refusal because when the stud ent meets with repeated failure it becomes easier not to attend. Participants commented that some of these students have been retained at least once or are promoted but unable to do the academic work. Likewise, participants indicated that so me of these students are sometimes older than the rest of their classmates, due to retentions. Some participants described these students as struggling with reading and learning issues. These students are frus trated, unmotivated, and feel they have no control over the direction in which they are headed. Participants indicated that as these students are unsu ccessful it affects th eir self-perception. Parents and their level of c ontrol or awareness were not discussed in relation to these students. Participants did discuss whether the parents of these students were themselves unsuccessful in school and how that plays into whether parents motivate their children to do better. Standardized testing a nd benchmarks were discussed as barriers to graduation for these students. Very little was mentioned in terms of blame. The exception was when one participant flat out stated, I blame our schools, the ways the schools runwe dont offer enough alternative choices of educational styles for slow learning students and students that have reading and academic difficulties. In fact, other particip ants lamented that schools are slow to change and only offer a t ype of one size fits all education. There was a higher level of concern expressed about thes e students futures and they were referred to as being at-risk. These students were viewed as victims, and participants appear to be at a loss for how to save them.

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211 There were days that Id go and look fo r her. I remember this one day and the grandmother and I were pretty, no teet h, pretty friendly by then, and, you know, was out there and Im real non-threatening when I go out. Im just like, you know, talking to em and everything. Where is so and so? Shes in the bedroom. So I said okay, do you mind? So I opened the door and Im like what are you doing, you know? Then I asked her, come on, youre going, get dressed and the grandmothers like you can take her. So I brought her and on the way we stopped at McDonalds and I said, you know, are you hungry? Lets just stop at McDonalds. She hardly said 2 words this whole time and I said whats going on, you know, and everything and her family was telling her that was going to be the star of the family, that she hadnt mi ssed going on, and that she would go the furthest, and she was flunking and she was devastated cause she was supposed to be the bright future for her family and she was flunking and she was letting everybody down and she couldnt take it. So we talked for a long time. By the time so she came and she did fairly well for a little well then she, you know, but she would get a little attitude too and everything and but I really felt bad for her. I felt like, you know but like you go out and say whats going on? Well she missed the bus or we had we cant do anything with em or I mean theres always a reason. Homework never got done. Theres never, you know ample opportunity. Wed try to set up meetings and, you know, Id go out to try and get the family involved. Whether or not this li ttle girl was going to be a bright star, she wasnt doing very well. That was real ly devastating to her. She was a sweet kid. I have I mean she was, you know one of the children you just wanted to take home with you or something because she was a good kid. I dont know how she would fare the long haul but she was just she was depressed about it (Ms. Berkley, middle school social worker). The Bored Student: The lazy gifted student Participants characterized the bored student as an individual who is bright and intelligent, but is not being challenged enough within school hence they refuse to attend. Fewer participants described this type of student. Some partic ipants reported that parents are aware of the refusal in some cases. These students were presented as being in control of their decision to refuse school. This was considered frustrating to many participants, as one expressed, Weve got this beautiful mind and its being wasted. Very few personnel associated refusal due to boredom with a lack of academic success. Although many participan ts did not overtly

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212 express blame, a few suggest ed that teachers or schools could be the reason. One participant explained that teac hers, especially those with te nure, do the minimum that is required of them, and do not make lear ning exciting. Another described how the emphasis on accountability has cr eated a teach to the test environment, which has affected the quality of curri culum and instruction. Yeah. I had a student. He was very bright. He was in my gifted class when we had truly gifted classes. But he really did not want to ge t up in the morning. He was very bright, but he didnt feel like school was doing a nything for him. He felt that it was a lot of busy work. And he was actually being very physical with his mother in the morning when she tried to wake him up to come to school. And he had missed many, many days of school. I m ean he was just not seeing a need for it. He thought it was just a lot of busy work (Mr. Bender, high school teacher). The Invisible Student: Just passing through While this barely constitutes a type of student, participants description of the invisible student did evoke an image of a stude nt who is quiet, blends into the crowd, and passes through school unnoticed. There was a sincere concern expressed about kids who go unnoticed, whether they are in school or not. The issue addressed by participants was that if these students refuse school, they might fall through the cracks. You know all the troublemake rs. You know all the high ach ievers. But there are a lot of people that are like invisible. The invisible kid pr obably misses. Nobodys relating to him. Well hopefully the teacher knows them all, but they tend to know the troublemakers first and then the ones that get all their homework and they answer every question. They know them first to, you know, but those other guys that kind of sit quiet, passing through, t hose are probably your most at-risk kids, particularly if there are other issu es, you know, maybe theyre depressed or somethings going on at home, or lots of things. (Ms. Stei n, district level). There was not a lot of data to inform the specific dynamics of these types of students, which correlates with the fact that no one knows these students very well to

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213 begin with. I interpreted the pa rticipants level of concern fo r these students as a sense of responsibility to acknowledge them. The Physically Refusing Student: Drag em in Participants described these students by the physicality of their refusal to come to school. They refuse to get out of bed, into the car, or out of the car. If the parent tries to force her or him, the child will kick, sc ream, cry, convulse, and flail about. Some participants also describe these students as physically af raid to come to school. We have some kids that whose parents will bring them here. We had one kid, a sixth grade girl, whose father would dr ive her to school and she would simply refuse to get out of the car. She just wouldnt do it. And that lasted for about 3 weeks. Its hard on the parent. You k now, you have a daughter whos convulsing, shes crying, shes highly upset, but you dont want to force her out of the car. You dont really want to physically remove her from the car because youre afraid of DFC, you know? Youre more concerned with her emotional state. And we did ask parents to let us know whats going on and the personnel thats involved, cause we can generally do a better job of getting her once you get her to school then thats half the battle. We can help you get her out of the car and into the classroom (Mr. Hughes, middl e school social worker). The image presented of these students is th at they are not able to control this reaction, nor can their parents control them. Th e parents are described as aware, but at their wits end as to how to handle the issue. Some personnel feel like they are placed in an awkward situation with these students, as they want to hel p, but cannot physically force the student. Likewise, parents have a ha rd time doing this as well. One participant told me that if the student having this probl em is 16 years of age then the school could withdraw them at this point. There seems to be no one to blame, although some participants did say that parent s give in too easily and need to take control. Some of the

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214 students who were described as having been bullied or having school phobia might fall within this typification, as they were frequently descri bed as physically refusing. The Socially Uncomfortable Student: They just dont fit in The socially uncomfortable student has such a difficult time fitting into the social schema of school it is more comfortable for him or her to stay ho me. These students are described as not fitting in or unable to find th eir social niche. This student is made even more uncomfortable at transitional periods during their education, such as moving between schools. These students were considered to lack control in most cases. Participants indicated that some kids do not fit in becau se they cannot afford the right clothes, meaning the latest fashion trends. A few participants indicated that parents have not taught their children appropriate social skills, thus reflecti ng some blame on the parents. Likewise, participants highli ghted the tendency for students to be judgmental and mean to their peers, thus making social intera ctions more difficult for these students. We have one story right now; his mother really, really enable s him to stay at home. He doesnt like school. He has a ha rd time has a hard time socially at school. He has a hard time academically at school. So he allows himself to become very angry and then comes down he re and insists on calling mom who is very consistent about coming and picki ng him up and taking him home whenever it is he wants to go home. Thats one of our big ones (Mr. Hoeman, middle school assistant principal). These students were considered victims of their own awkwardness and social exclusion that results from the tendency for defined social groups within schools. Participants expressed unders tanding and appeared empathetic when describing these students, sometimes discussing altern ate options such as online school.

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215 The Sick Student: What medical condition? As there are expectations within soci ety regarding sick behavior, there are expectations within the school setting as well (Coreil, Bryant, & Henderson, 2001). This was evident within the participants image of the sick student. These students are described as refusing school for reasons related to illness, whether it is a legitimate illness or not. Participants clearly indicated that they are more willing to understand attendance issues that are due to legitimate i llness. This particular type of student was not seen as refusing, unless they are using their illness status manipulatively. Students viewed as refusing are those that are abusi ng a diagnosis, have undocumented illness, or non-legitimate illness that results in excessive absences. An interesting example of how something becomes legitimate can be seen in school phobia. One participant indicated that if a student has a medical diagnosis of school phobia, then hospital homebound could be used. Other participants questioned the veracity of school phobia, indicating they really have never s een a true or real school phobic. At one of my schools, Ive got a girl th at has abdominal pain. Well we found out she had she is having discomfort and its very true. Its been going on for a few years now, and recently we even got a note from the doctor that she may be missing 5 to 7 days a month. To me this is really unacceptable. There should be something that can be done. He wrote unt il the therapy theyve started kicks in and helps her. Its been months and she is still doing it. Shell go home on Friday, maybe after calling her mother 2 to 3 times that week, coming into the clinic 2 or 3 times in a day. Shell go home on Frid ay evening and maybe clean the house or fix supper for her mother and then wa nt to go to a football game. And Ive cleaned house, you know? Ive made supper. Saturday she might get up and dust or vacuum, at her mothers every beckon call doing whatever her mother wants and wants to spend the night at a friends. And the mother plays up to this, lets her go to the game, lets her spend the night with a friend. Sundays she fine, shops at the mall. Monday morning sits in the car for an hour crying because shes in such pain she cant get out to come to school. She is one of the most difficult ones

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216 weve had to deal with because of this Shes in such pain throughout the week, and every weekend she runs the entire w eekend (Mr. Wyatt, middle school nurse). The infamous frequent fliers help to illu strate the image of the sick student, but are as well in a class on their own. These stude nts were not considered legitimately ill, however they continually visit the school cl inic for an assortment of reasons. These students are trying to get out of class or school. Some participan ts did reveal that they are concerned that frequent flie rs might have an underlying problem, as sometimes they seem to need to talk. If a student is truly ill, when they return to school, there are particular behaviors personnel expect to see, such as requesti ng make-up work and complying with make-up policies with a positive attitude. For kids who ha ve real illness, they lack control over their situation, parents are typically aware and in contro l of the situati on, and there is little blame. The student just happens to be a victim of their partic ular illness, through no fault of their own. For the other students who are either abusi ng their illness or faking it, the student is viewed as consciously c ontrolling their behaviors. Thes e students are not viewed as victims, unless an underlying problem is disc overed. Parents are partially to blame for being manipulated too easily by their child. Fo r example, parents are considered weak if they pick their child up from school too often. Some participants commented on Munchausens Syndrome as the possible reason for some of the students illness and subsequent absences. For the most part, these students are not viewed as victim, except in the case of Munchausens.

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217 The Victim: Bullied and abused While within each category I have a ddressed whether or not a student is considered a victim in general, there was entire type of student described that evokes the image of a victim. The victim student overl aps with some of the other types of students. The victim is viewed as the stude nt who is bullied, whet her it is real or perceived. Students who are bullied will refu se school, sometimes physically, to avoid the situation. Students are described as claiming that they are being picked on at school. Many personnel reported that they neve r witness any bullying so they are dealing with perceptions. These students refusal to attend is contro lled by their emotions, particularly fear. Participants did not discuss these students parents as much; however, those that did indicated that parents are usually aware, and can be upset at the situation. A few participants stated that th e onus is on the bullied student to step up and report the situation, or nothing can be done about it. These students are viewed as victims of bullying (real or perceived), although personnel do not show as much sympathy for these students, unless the situation can be proven. Some participants, particularly teachers, indicated that this type of student could be frustrating, es pecially if the claims of bullying are unfounded. They may have larger issues in life. Th ere may be substance abuse in the home. There may be physical or emotional abus e that theyve been witness to that supersedes coming to school. And another is kids who feel threatened at school, who may be being bullied or pushed around, who havent got the strength yet to step up and say its not okay and to let us know so we can inte rvene (Mr. Blane, middle school assistant principal).

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218 Also within this type of student, I ha ve included the abused student, who is abused emotionally, physically, or sexually in their home setting. Abused children were described as refusing school to either hide signs of abuse, avoid questions, or out of fear. The control of the refusal to attend is some times internal, unless the abuser is keeping them home. This student is considered a vict im. Participants who discussed this type of student expressed empathy. Composites of Two Typi fications of Students The following two composites were created to provide collective images of two of the nine typifications of st udents. These composites are not representative of one individual student, but inst ead the collective identities of the students personnel described in their stories. The names pr ovided for these students are fictional. Jose: The defiant student. Jose is a tenth grader who regularly leaves school or does not attend. When he is in school, he is rare ly in class all day, and often visits different classrooms or offices. On a typical day, he may visit the school nurse, with a grin and tell her he does not feel well and really needs to go home. She recognizes him from his multiple visits and tells him to take a hike. He then goes over to the student affairs office and complains that he left hi s books at home and he needs to sign out to go get them. The office secretary tells him if he does not have a pass, he needs to go back to his classroom. His classmates view him as a class clow n and he is popular. He will often join other classmates on an afternoon jaunt to the local fast food restaurant, although oftentimes he will skip school on his own. His teachers are concerned about his future, as although they think he is intelligent, he is neve r in class, and rarely completes his work to

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219 get decent grades. Assistant principals in th e school know him well and keep an eye on him, as they worry he may be involved or get involved in illegal activities. Multiple people in the school have met with him, yet he continues to skip. He is from a single parent household and has both older and younger siblings. When the school contacted his mother for a meeting, she had no idea he had been skipping. She works long hours and leaves th e house before Jose goes to school. When she comes in for a meeting with the school social worker, she is shocked at his absenteeism. In the meeting, she asks him, I s this how I raised you? I expect you to do better than this. His reply is a shrug of his shoulders. The mother goes on to express her disappointment, especially given how well his older sister did in high school. She tells him she expects more from him. The social work er explains that if his behavior continues that he and his mother could be taken to court. She also i ndicates that once he turns 16 the school will kick him out. After Jose leaves the meeting, his mother asks for help. The social worker makes some suggestions, like removing his television or telephone. Later, the social worker sets his file aside, realizi ng that if she pursues his case further, it will take too long, Jose will turn 16 soon, and there will no longer be a legal reason to continue the process. Brittany: The sick student. Brittany is a seventh grader and makes frequent visits to the school clinic. She often complains of stomachaches and nausea, and a large number of her visits end in her mother coming to pick her up. She has missed many days of school, particularly Mondays and Fridays, although she is always being excused. Her mother has told the nurse that the doctors have diagnosed her with irritable bowel

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220 syndrome, but despite multiple requests, they have not received any type of written diagnosis or confirmation of this illness. Brittanys teachers are frustrated with her multiple requests to go to the nurse and her absences. Every time she is absent, her mother sends a note or emails them to request her make-up work be prepared, as she indicates she will be picking it up. Sometimes the mother will not pick up the assignments until two days after she has called. The teachers are tired of bending backwards to meet Brittany s needs, when they have a classroom full of students who are there every day. When Britta ny returns from one of her absences, it is common for her classmates to ask where she ha s been. One of her teachers always says, Im glad you decided to join us today. During a team meeting, her teachers talk about her, triangulating the various excuses they have received, and the mounting number of abse nces. One of them decides that since the mother will not respond to re quests for a parent teacher conference, they should get the guidance counselor involved. One of the teachers expresses anger that the mother has let the child take advantage of her illness, while another questions sarcastically, What illness? They end their me eting by writing a referral to the guidance counselor. Influences on School Personnel and thei r Understanding of School Refusal Various experiences appear to influe nce school personnels perceptions and understandings of students who refuse to attend school. These influences affect how personnel identify, relate to, and work with students. While I did ask participants to talk about what influences them, this of ten was discussed without a prompt.

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221 The collectively constructed story am ong personnel reflects what I have interpreted as internal and external influences that appear to affect their perceptions. It became clear that internal and external infl uences were often intertwined. For example, intuition (internal) was often li nked to their training (external) within a certain discipline, like nursing or social work. Fr ustration was a major theme that emerged as an influence on personnels experiences and in teractions. The politics that relate to attendance issues were also reported as a major infl uence and source of frustration. Internal and External Influe nces on Personnels Perceptions Many participants described internal and external influences that affect their perceptions of students who refuse to a ttend school. Internal influences included intuition, communication skills, and knowledge. Several participants reported knowing a student was having difficulty attending sc hool through intuition and perceptiveness. Some participants believed this perceptivene ss was a product of thei r various experiences in their role and years of experience. Its interesting; its been interesting for me over the years you become very intuitive and perceptive about certain students (Mr. Bue ller, district level). The ability to relate to students on an inte rpersonal level was viewed as a skill that influenced a few participants interactions with students. This in cluded the ability to listen, empathize, and connect on an in terpersonal basis with students. My ability to relate [influences me]. Ju st being a regular pe rson. (Ms. Tartak, high school guidance counselor). Only a few participants, mostly psychol ogists, social workers, and guidance counselors, indicated that knowledge was an influence on their perceptions of students

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222 who refuse school. Knowledge included inform ation acquired through their college level training or continuing education. External influences were reported as forces external to the person that impact their perceptions of students who refuse to a ttend. External influen ces included training, teamwork, personal and school based experien ces, district policie s, and information. Training was a major influence mainly among social workers and guidance counselors. They viewed their college level preparation as distinct from other personnels, providing them an alternate perspective of students who refuse school. The social worker perspective is not indi vidual pathology, it is holistic, the kid in their environment. All the f actors that influence the ch ild. I look to see what the system is doing wrong. Its a systems appro ach. You might be able to change one part and affect the whole (Ms. Ch ad, middle school social worker). Participants considered working together with other personnel within the school when addressing issues of school refusal as a process that influences their perceptions of students. Participants own edu cational experiences or experiences as a parent seemed to influence participants, providing a reference point for relating to a student. The most common external influence that was reported was experiences and interactions in the school with students, other personnel, and parents. I think its just drawing on past experiences with those students, becaus e, I myself didnt experience this, you know? (Ms. J ohnson, high school assi stant principal). Some participants reported that having many years of experience influenced their perceptions. Probably 30 years of experience. I th ink you understand more about kids the longer you work in the business. I mean you justyou deal with what youve got at that moment in time, but I guess you reflect on your experience (Ms. Metzler, high school).

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223 Based on experiences with students, many participants indicated that if the students motivation to return and re-engage in school is hi gh, they are more willing to work with and sympathize with them. The more motivated the student is upon return, the more contact I have with the parent that is legitimate and detailed, the more sympathetic Im gonna be (Ms. McAllister, middle school teacher). District policies as an influence were cited by a handful of participants, mostly assistant principals. They often highlighted po licies related to attendance rates, goals, and state laws. A few participants commented on the influence of the increased demand for accountability on schools response to attendance issues. This will be discussed more extensively within another section (see The Politics of Attendance). Frustration as an Influence Frustration was a recurrent theme among pa rticipants, and was discussed as an emotion that influences and affects not onl y school personnel, but parents as well. Overall, this theme emerged unprobed, as if pa rticipants were waiting to express to me their frustrations. I dont know if youre gonna ask me what Im frustrated with, but Im telling you anyway (Ms. Walsh, high school social worker). The main sub-themes of frustration focus on personnel in general, t eachers, parents, and politics. Many personnel expressed frustration with students and parents of students who refuse to attend school. Frustr ations varied among types of personnel. Administrators

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224 were more likely to express frustration related to how students affect the school attendance rate and subsequent funding based on full time equivalency counts. Administrators get concerned because the school district has a goal of 96% [attendance rate], which our school does not have at all (Ms. Mayo, middle school guidance counselor). Assistant principals were viewed as b ecoming frustrated from seeing the same students repeatedly and eventually becoming de-sensitized to the students. Other personnel, such as social workers, are frus trated with administrators who discipline students with attendance problems. Social work ers are also viewed as frustrated with the lengthy process of working with ch ronic cases of school refusal. If you talk with social workers, who esp ecially at this leve l, you may see their frustration. They go through that whole process and take em to court andyou spend a lot of time and youre not getting the results (Ms. Cruz, middle school guidance counselor). Below, an assistant principal reiterates this sentiment about the slow process and low motivation to work on fixing attendance problems. Im very frustrated with a District as larg e as this that we have a lot of resources and trying to focus those resources on a problem, a particular childs absenteeism problem for example is very difficult at ti mes. Its frustrati ng. Its like moving a dinosaur. And I suspect that even in a sm aller school districts its still the same problem. Its not a lack of resources. Its perhaps a lack of will. The system can only work as well as the individuals in it. The highly motivated people will find a way to get to a child like this. The syst em does have cracks (Mr. Purr, middle school assistant principal). One district level participant cautioned that frustration could make personnel blind to the real issue affecting the student. She offered an example of the frequent flier student in the clinic as when a school nurse mi ght become frustrated. She indicated that it

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225 is important to look past the fr ustration of dealing with the same student, and realize that the problem may not be physical. Among personnel, teachers were described as being the most frustrated with students who refuse to attend and with the procedures of intervention. Teachers also acknowledged this frustration a nd the reasons for it. Some teachers did not think so much effort to get one student back to school made sense, while ot hers were frustrated with the repeatedly catching up students who were absent frequently. Sometimes as a teacher, we just get frustrated. You know, youve missed four days. Youre starting you know, Im tired of catching up (Ms. Cameron, middle school teacher). Below a participant describes a middle sc hool boy with school phobia who was moving up to high school and the frustra tion experienced by his teachers: And it was very, very frustrating for the teachers, because he neededhe needed to get over this and the old theory of you know, expose him to more of it and hell get better definitely was not working in his case (Mr. Bueller, district level) Personnel perceive parents as being frustrat ed if they are unawa re of their childs refusal to attend, if their childs refusal is based on a phobia, or if th e parent feels a lack of control. In most of th ese cases, the participants not only acknowledged that these parents can be very frustrated, but they sympathized more with them. Theyll call; my child doesnt want to come. I dont know why. And, you know, the parents are frustrated. They dont r eally know what to do (Ms. Mayo, middle school guidance counselor). The politics of attendance. The political side of atte ndance was reflected within participants frustrations. Many participants discussed the increased pressure placed on schools, administrators, and teachers to meet the standards set forth by the No Child Left

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226 Behind legislation. Pressure is placed on school s to meet district goals for attendance rates. The logic behind meeti ng the attendance rate is reciprocal in nature; students attend, learn, and perform well on standardi zed testing. This not only increases their likelihood of achieving adequate yearly progress but it also factors in to the state assigned school grade. These factors also affect f unding for schools. The consensus is that if students are not in school, they will not perf orm well on the standard ized tests. Schools must also meet set attendance percentages on standardized testing days; therefore, a push is made to have maximum attendance on those days. Similarly, participants expressed concern that pushing students out is being legitimized as a way to decrease the number of students, particularly chr onically absent students who mi ght pull test scores down. The following account from one pa rticipant captures th e how this plays out in the school: Attendance is tied to the FCAT and some times your school grade obviously, if theyre not in school, they dont have the ri ght type credits and that sort of thing, and theyre not going to do good on the FCAT I dont know if theres a word for it, but theres probably a certain amount of culling or whatever, trying to weed out those kids and get em out of your school because theyre going to hurt you with the overall grade for your school as youre rated, you know, through the FCAT A, B, C, D, F. So then its an amount of oh these are kids that we they dont say kick out, okay? Were kind of taught well we need to provide another opportunity for them because theyre currently not successful. And generally the administrators will generally get a printout of, okay, these are the absentees, these are their report cards, after every report card Ill run a its a fairly large stack, Ill run a stack of how many kids received D and Fs in any particular class so I can identify em. Ill go through and circle Gosh, failed everything, okay? If the absences are tied to that, but I would im agine the assistant principals would say lets do a run on how many kids have ove r five absences. Those usually get downloaded, principal lets say would say oh we need to talk to these children because, gosh, theyre hurting us with the FCAT score. Look, they scored a 233. Theyre not going to make an adequate year ly progress so we need to get rid of them and send them to night school, comput er online, one of the career centers or something like that (Mr. Roone y, high school guidance counselor).

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227 Section III: Identification and Inte rvention in the Practical World In this section, I begin brie fly by identifying participants reported descriptions of the protocol and policy for the identificati on of students who refuse to attend school. A full narrative is provided in Appendix N. I th en proceed to use the data to question the authenticity of the reported protocol and po licy due to reported deviations from them. The section then documents personnels re ported concerns for students who refuse school, moving on to their recommendations. Th is section directly addresses the second purpose of the study, and answers the fourth rese arch question Identification of Students with School Refusal Students who are refusing school are id entified by the most obvious means available, which is their atte ndance record. Patterns of non-attendance were also reported as a common way of identifying students. Students who miss five or more days, consecutive days, or patte rned days (i.e., every Monday and Friday) will catch personnels attention. Key personnel in identif ying students include teachers and health personnel, which often involves multiple laye rs with the most common path going from the teacher to the guidance counselor on to th e social worker. The pr ocess of intervening begins at the school level and i nvolves a series of steps that include but are not limited to the following: telephone calls home, letters mailed home after five and ten days of absences, meetings with parents, completion of an intervention form, a Child Study Team meeting, and referral to the social worker. The social worker coordina tes the next level of intervention, which includes interviews, the development of an attendance plan, and monitoring. The district protocol starts once a referral is made to the school social worker and can ultimately lead to legal pros ecution of the parents or the child.

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228 Deviations from the Intervention Protocol Personnel described various scenarios where the protocol for attendance issues is not strictly adhered. Examples of such scenarios were dependent upon whether school personnel are aware of the reasons for excessive absences, regardless of whether they are excused or unexcused. This might include some of the previous described situations such as bullying, illness, students serving as caregivers, lack of parental awareness, and emotional issues. These scenar ios prompt action on the part of the school; however, there is more flexibility in the responses. Various issues appear to impact personnel in their perceptions of different situations, which ultimately influence their response. It is essential to note these deviati ons because of the possibility of unintended consequences. Differentiating student referrals. The participants describe d a key decision in the referral process that detours from the general process. If a student appears to have some emotional, psychological, or behavioral issues related to their absences, the identifying teacher or other personnel will refer the stud ent to a guidance counselor, the psychologist, or the social worker. If there appears to be a more defiant behavioral pattern related to the absences, the teacher will refer the student to the student affairs office, generally the assistant principal. This decision has differential consequen ces for the direction of the intervention process. If a student is refe rred to the support services, it seems that more time is taken to investigate the motivating factors for the students refusal to attend. Generally, they adhere to a problem solving, team oriented approach that is thorough and explorative. Participants described multiple conferences wi th parents, meetings with teachers, and with the student. Various interventions are atte mpted to integrate the student back into the

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229 school day. However, if the student is referred to student affairs, this is generally viewed as a discipline referral. Unless th e assistant principal sees some other indicator, such as an emotional issue, this student could end up with a warning, detention, an out of school suspension, or if over the age of 16, a referral to a genera l equivalency diploma program or withdrawal from school. This decision is not described within any official policies at ei ther the school or the district level. It is an individual decision making process that I heard mainly from teachers. Assistant principals, guidance couns elors, social workers, and psychologists confirmed this process and their respons es to students referred as such. Generally, it depends on who discovers it. If its myself then Im gonna call the kid in. As the counselor, Im gonna fi nd out, why arent you coming to school, and try to provide some resources. I work very closely with the social worker and the psychologist. And, you know, we work as a team a lot so if I feel I need to pull them in on itit just dependsif the kid has some psychological issues Im gonna sayIm gonna go to my school psychologist and say hey, you know, I got this kid. Lets say that the assistant prin cipal discovers it. Well it depends on how many days the kid has been out. If you re talking about somebody thats been gone for 30 days, you know, and we dont have any notification on why that person should be gone, thats probably an automatic withdrawal. If the assistant principal feels hey, this is a kid, they missed a couple of days, you need to try and help em to stay, the assistant principal will bring em here, you know, for us to counsel with em (Ms. Tartak, high school guidance counselor). Personnel perceptions of the process. Some participants have described the process as lengthy, inconsistent, and confusing. Several social workers also reported that despite the set steps of the process, they of ten would get referrals for some students who have missed 40 days of school in a year. A ma jor concern is that there are students who could fall through the cracks and early wa rning signs are missed. The process targets attendance issues and there is no language or steps regarding student motivations or

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230 reasons for the problem, although participants did describe their attempts to determine these issues within the process. Perceived Outcomes of School Refusal Participants, while commenting on the intervention process, often provided insight into the various outcomes that are possible for students who are refusing to attend school. Participants did not delineate these by types of students or reasons for refusal, instead focusing more on overall outcomes. Wh en prompted, they discussed outcomes of students in terms of their concerns for them and the support they perceive to be important for these students. They also provided information about various programs and alternatives that are offered to students who are refusing to attend. Personnels Concerns for Students Refusing School Personnel described a range of outcomes a nd concerns for students when asked about their concerns for students who refuse to attend school. Most concerns were based on whether or not the students were successful in attending school. Overall, most of the reported concerns were not related to a specifi c type of student (with the exception of atrisk students), but instead focused on mo re overarching outcomes. Concerns ranged from immediate outcomes, such as dropping out, to long-term societal outcomes such as increased welfare costs, violence, poverty, ment al health, and crime. These concerns were not only for students themselves, but also for the impact these students have on future generations. If they dont come to school Im wonderi ng what are they going to do? Are they going to end up being on the street? Are they going to end up being in another institution? If its not educa tion, is it gonna be a criminal thing? Are they going to go down that path because if theyre not going into education what are they going into? Are they gonna be a viable member of society or are they going to be, you

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231 know, the problem in society? I dont know My goal is to create as many good citizens as I can and, you know, help students understand that education is the way to do that. It doesnt mean you have to go be a doctor or a lawyer or a Republican. It just means you need to stay in school and have goals (Mr. Frye, middle school teacher). Participants concerns mainly focused on what were described as at-risk students. Outcomes such as dropping out, pregnancy, drug abuse, and violence were discussed. Participants were concerned about cycles of poverty and the fear that some of the students would be caught in the same cycle as their parents. Theyre high risk for poverty. Theyre hi gh risk for being neglected. Theyre high risk for being placed into foster homes Theyre high risk for being beaten by moms various boyfriends. It could go on and on and on. So you have the high risk for pregnancy. You have the high risk for delinquency. While youre sitting here doing this interview kids who are ab sent today are vandalizing your car and mine (Mr. Burnham, middle school social worker). This narrow focus was concerning to me for two reasons. First there is an overwhelming focus on a select segment of st udents who refuse school. The second is the obvious lack of focus on other students w ho might be refusing school, however, not mentioned within participants concerns This can only be highlighted via my interpretation, as the data does not provide direction for interpretation. A few participants did discuss their con cerns for students with phobias or anxiety fueled school refusal. For middle school personnel, their concern wa s how these students would handle the transition to the even less tolerant or nurturing environment of high school. Several participants also used the phrase falling through the cracks when talking about their concerns for students in gene ral. In this sense, the personnel appeared

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232 helpless in making any difference in the outcomes for the student. The proverbial falling through the cracks seemed to be an acknowledg ement that there should be more that is done, but inevitably, there are students w ho will not get the support they need. Well, some of the students are probab ly going to fall through the cracks and where they probably could have met some successes in life, wont, if there maybe wasnt that strong person behind them pushing them. Thats possibly my biggest concern. They dont have the support to help them through (Mr. Wallace, high school teacher). Participants perceptions of support re quired for students who are refusing to attend were considered important. For stude nts to overcome their refusal, personnel indicated there needed to be support from home as well as school. This translated into consistent parental involvement and awareness. This parental support also needed to be cooperative with the school pe rsonnel. As mentioned before with helicopter parents, personnel perceived parents who were not i nvolved or too invo lved negatively. What we try to do is look at it realisti cally as far as what are we expecting our families to do? And theres times where there may be a family who is really trying their best and just cannot get over that hump as far as having their kids attend regularly. Were going to look at that differently than somebody who does not seem to care, or doesnt seem to understand, or is not taking things seriously (Ms. Ipkiss, district level). Participants view of support, specifi cally parental support, affected their perception of whether a student was worth the extra effort. Programs Many participants provided information about programs, both prompted and unprompted. Most programs mentioned seemed to fall into one of two categories: at-risk or incentive based. At-risk programs target stude nts with indicators of being at-risk of dropping out, which typically includes poor or non-attendance. While the notion of at-

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233 risk often includes absenteeism as an indi cator, it rarely is the main reason for considering a student to be at-risk. Incentive programs are based on receiving some type of award for positive attendance behavior s, and can range from tangible awards to acknowledgements. There were no programs th at focused strictly on students with school refusal or any form of school refusal. At-risk programs seek to provide students with some type of connection to school, whether it is the program, a person, or othe r students. These programs can be special classes within school settings, social groups coordinated by school personnel, district wide programs, or mentoring programs (either formal or informal). Incentive based programs are described as rewarding good behavior and enticing continued performance. Incentive programs for attendance are popular. Part of the idea is to promote a positive climate of attendance, and make school a place where students want to be. These programs target the school classroom, and individual level. Many participants conveyed mixed fee lings about incentives. Some believed it targeted students with good attendance, further reinforcing their behavior while doing nothing for students with non-attendance. A few participants beli eved it widened the gap between students in the school. One participant indicated that her school ended attendance awards because they often reflected differences in race and class, and personnel were uneasy with sending the wrong impression. Participants also expres sed frustration with policies like exam exemption, indicating that it is typically the higher performing students without attendance issues who take advantage of this policy.

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234 Alternatives for Students Refusing School Many participants reported on alternative op tions that are offered to students who are refusing to attend school. This was typically offered in cases of students that were not improving, over the age of 16 (sometimes upon be ing withdrawn), or above age for their current grade level. Assistant principals, gui dance counselors, and social workers were the most common personnel who would refer st udents and parents to the various options. Alternatives described as options included ge neral equivalency diploma programs, career centers, adult school, night school, hospita l homebound, and home school. Virtual online high school was an alternative discussed as being appropriate for students who are academically high achieving but are experiencing social problems. This setting allows students to continue rigorous coursework that meets colle ge preparation requirements. One assistant principal explains below the al ternatives for one of her students who is getting closer to 16 and having cont inued problems with school refusal: Ill probably withdraw her to either th e GED the underage GED program or the adult school program. Night school or adul t school is self-m otivating. You know, youre given the work. Youre given the packet. You do it. You pass the test. You move on. Its not like she has it now (Ms. McDonnagh, high school assistant principal). Withdrawing Students from School Participants discussed withdrawing stude nts while commenting on the process of intervention with students who ar e refusing to attend school. This is referred to as taking them off the rolls, withdrawing, or pushi ng out. This was an issue discussed by high school personnel, especially a ssistant principals, who are responsible for this process. Students must be 16 years of age and have anywhere from five or more absences,

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235 although this varied across part icipants. Some participants indicated absences must be unexcused, while others reporte d it did not matter. The proc ess of withdrawing students includes telephone contact, a ce rtified letter, and if no repl y, withdrawal of the student. Some students are reportedly offered options such as GED programs, adult school, or night classes. One participant indicated that wi thdrawals such as this, that are considered automatic, are only to be done in cases referred to as whereabouts unknown. This is when the school is unable to locate a st udent, after phone calls and home visits. The school system is not very sympathe tic toward people who are chronically absent after the age of 16. In other words, if they have five or more absences they are automatically taken off the roles. If you have a student thats having problems or doesnt have a good support system at home then theyre taken off the roles (Mr. Claire, high sc hool psychologist). Participants provided both the positive and negative results related to withdrawing a student. Positive results primarily favored the school, as withdrawal is viewed as a solution for dealing with students who have poor attendance and academic records. High schools in particular just withdraw if youre not going to come, because there are a lot of external pressures, political, from the nature, financial, attendance is a big thing. You know, the le gislature threatens to control how much you get, or cut your money back if you dont have 95 or 96 percent so, you know, the easy answer there: have em withdraw With all the kids, thats not a cure. They got your numbers back in line, but it didnt do anything for the individual children who are missing or not coming. But thats you know, its just like the testing. Teachers want to drill its th e driving force in i gnoring the individuals problems and why hes not coming. Its easie r to withdraw him. And thats a big danger (Ms. Stein, district level). Negative results affected the students Many participants believe withdrawn students will have trouble in the world out side of school. GED pr ograms, adult school, and alternative programs were described as having higher standards and requiring more

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236 discipline on the students behalf. Some pe rsonnel indicated that a GED does not provide the same opportunities for students. A few pa rticipants expressed disapproval over the practice of withdrawing students. One particip ant indicated, I think we owe it to them, even though it is a struggle and even though it affects our attendance and all that B.S. about the testing and stuff, I just dont th ink we can cut them loose (Ms. Hanson, high school teacher). Recommendations for Schools from Schools At the end of each interview, participan ts were provided with the opportunity to highlight, recommend, or emphasize some aspect of attendance issues and school refusal. Often throughout the course of the interview, participants would offer recommendations without prompting. Several key themes em erged from this process representing participants key concerns and recommendati ons. Their comments in general were broad, with few comments specific to school refusal, but overall directed towards problematic attendance issues. Recommendations focused on th e school setting, the ro le of personnel, working with students, and involving parents in the process of intervening. The School Setting Recommendations for the school setting included ensuring the school is a safe haven, and that all students feel welcomed, nurtured, and comfortable in this place. Several participants expressed the need fo r incentives to keep kids coming to school. Others mentioned that there has to be edu cational alternatives such as career or vocational centers. A few participants expre ssed that attendance issues would always a problem and there is no fix or solution.

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237 The role of school personnel was highlighted, especially th e importance of noninstructional personnel, as they often are able to do more investigation in to the reasons why students are refusing school. Recommenda tions included the need for attendance teams to monitor students consistently, as ear ly intervention is vi ewed as the key to making a difference in absenteeism. The fo llowing participant provided an example of why early intervention is so imperative: One more thing I wanted to add, we really need to work to identify kids much earlier than we do with this issue of atte ndance. Ive had some of these cases, or had some of these cases been caught in elementary school we would end of up with different outcomeswhen you look at these kids in high school and you look back at the record, there is some thing happening, that theyre being missed. In elementary school, theyre missing 30 to 40 days a year and falling through the cracks somehow until it shows up as a high school problem or a middle school problem and then the consequences are much different. For example, getting withdrawn from school (Mr. Clar k, high school social worker). Working with Students Who Refuse School Many personnel see absenteeism as the ma in indicator of any type of school refusal. They also consider it the tip of th e iceberg for other issues students might be experiencing. Participants re ported that students who are refusing school are obvious because of their attendance patterns. A few pa rticipants expressed that quiet, uninvolved students are less likely to s how signs, and therefore may go unnoticed. Most participants reported that regardless of the reason for the refusal, working with students was imperative. The two predominant themes that participants emphasized included approaching each student individually and holistically, and to maintain an open mind when interacting with them.

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238 A holistic view of the child was emphasized as the best way to approach attendance issues. Included in this was to ack nowledge that reasons for school refusal are not universal and they often vary by age leve l. One participant, Mr. Hoeman, a middle school assistant principal, stated, We can t stop looking at thes e students as whole beings. We cant just put our focus on them academically. It is essential to investigate the why or the motivation behind the refu sal before making decisions, as Ms. Hanson, a high school teacher described it, I just think we really need to be patient and empathetic and to try to understand whats goi ng on with them in order to help them. I just I would hate to see just because theyre absent a lot or just because theyre having difficulty attending that we just without digging deeper, cut them loose, you know? Participants indicated there is no panacea fo r school refusal, and blanket policies or statements of how to fix such issues should be avoided. When working directly with students who are refusing school, personnel provided tips for interacting with them. A major point made was never judge a student or their situation before listening to them and gath ering the facts. Many of the student support personnel emphasized the need to pay atten tion, be patient, and listen to them. Nurses cited that being perceptive and knowing how to separate students based on their issues was critical. Assistant princi pals stressed consistency in how one treats students and to avoid labels. Th ey also believed that offeri ng options to traditional day school were important, although some did cite a tendency to push students into other nontraditional routes once they turn sixteen. Co mpassion was considered important in the manner in which school personne l communicate with students, especially fo r disciplinary personnel. As one participant, Mr. Blane, a mi ddle school assistant principal, put it, if

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239 you dont come across as being a compassiona te person, youre only, like I said before, youre only pushing em out a door th eyre already halfway through. The Role of Parents The role of parents repeatedly emerged as essential to the intervention process, as it did within various contexts of these re sults. Personnel believed parents must be involved as a part of the soluti on. However, participants indica ted that they must keep an open mind and compassionate stance when working with parents, as many parents themselves have had negative sc hool experiences, and this can affect their perception of school personnel. Participants had the perspective that pa rents of students who refuse school for various reasons do not value education. They related this to parents enabling behaviors like school refusal, because to them it is not a valuable experience. Personnel emphasized that they must be cognizant of this when communicating with parents. School personnel stressed the importance of collaborating with parents on plans to get the student to school so there is both support from home as well as parental responsibility. Only one participant countered views related to sole parental responsibility, stat ing the following: I think that any one that woul d say its all on the parent to get the kid to school is really nave, because the school does have to do their part in wanting the kids to come. And that includes, you know, the teach er and the culture thats developed there and kids feeling safe, wanting to come to school, and knowing theres a nurturing environment, 'cause were all very important. So I think to me the school has a role, has a responsibility, you know, that the people at the school, you know, they have to show they care. Kids know that. They just they perceive whether you care or not. And th en of course you get the parents who definitely have to be involved in being parents, making sure their kids are coming to school. Its the law but also its the ri ght thing to do. So I think that in looking at attendance, both sides, you cant blame one or blame the other. They basically have to work together and cooperate, you know. So that to me and you know Ive done Ive read articles on, you know parent involvement and sometimes

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240 schools, you know, answer questions no one s asked em, you know? You have to get the parents, where theyre at, maki ng it convenient, especially now in 2005, you know, Internet, emails are read r eal frequent, you know, communications with parents more so, voice mail, so ther es things that we can do now that we maybe werent able to do a while back (Ms. Johnson, middle school assistant principal). Results from the Survey of School Refusal This section provides an overview of the results from the Survey of School Refusal. This survey was used to gather de scriptive data regardi ng the approaches taken by schools when responding to students exhibiting school refusal, in addition to providing characteristics of school refusal in Shermer County middle and high schools. Participants included middle and high school principals, who gathered information regarding school refusal based on their da ta from the 2003-2004 academic school year. School refusal, for the purposes of this surv ey, was defined as students who refuse to attend school and have difficulty in attend ing school or remaining in school for the entire day. This definition was provided to respondents on the survey to provide a common definition for their data gathering efforts. Within th e survey questions, the term excessive absences without a justifiable medi cal reason operationa lized the concept of school refusers. Sixty-two surveys were mailed out. The ove rall response rate was 61%. Out of 39 middle schools and 23 high schools, response rates were 67% and 52%, respectively. Five surveys (three middle schools and two high schools) were excluded from the final analysis due to extensive missing data.

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241 School Demographics The majority of schools described themselves as being located in a suburban or urban setting, with all responding high schools and over 90% of middle schools classifying themselves as such (see Table 5). Table 5. School Level and Geographic Location School Level Middle School High School Overall Location Count (%) Count (%) Count (%) Rural 2 (8.7) 0 (0.0) 2 (6.1) Suburban 11 (47.8) 6 (60.0) 17 (51.5) Urban 10 (43.5) 4 (40.0) 14 (42.4) Overall 23 10 33 Student population. Schools reported an averag e student population of 1,359 students, ranging from 615 to 2,727. Res ponding high schools repor ted 2,143 students on average, approximately twice the populati on of middle schools, whose mean student population was 1,019. Identification and Response to School Refusal System of identification. All respondents indicated thei r schools had a system in place for identifying students who have problems with excessive absenteeism. Although all schools indicated the presence of some form of a system, there were inconsistencies in the descriptions that were provided. Descriptions of this system ranged from general references to a school wide attendance plan that is aligne d with the school districts attendance procedures to more detailed pr ocedures that involve attendance reports, telephone calls, and a specific se ries of steps to follow.

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242 The majority of schools referred to a daily attendance bulletin or report that listed students with excessive absences. What varied in their descriptions of the daily absentee report was the person responsible for review ing these reports and the actions taken following review of the report. Personnel re sponsible for reviewi ng the absentee report included principals, assistant pr incipals, social workers, and classroom teachers. Various actions to be taken based on the attendance re ports were described but varied extensively from school to school. Some responses include d calling the parents, referring the student to the social worker, and gene rating letters to send home. Schools also had varying criteria for de fining the excessively absent student, which constitutes the basis for identifying school refusers. The number of absences considered excessive included five, six, ten, and twelve days of absences. Table 6 presents the mean number of annual absences that schools identifie d as being excessive, specifically those for which students lacked a justifiable medical r eason. The definition of an excessively absent student varied cons iderably between middle and high schools. Middle schools, on average, considered a stude nt excessively absent after 12 days, which would be well within the normal limits of the average high school. In these high schools, it was only after 20 absences that a st udent would be deemed excessively absent. Table 6. Number of Absences Considered as Excessive Absenteeism Middle Schools (23) High Schools (10) Overall (33) Mean 12.3 20.4 14.7 Range 8-24 10-40 8-40 Median 10 20 10

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243 School Personnel Information regarding the staff person responsible for identifying school refusers is presented in Table 7. Across all schools, assistant principals were the most frequently reported persons responsible for identifying sc hool refusers. This was largely driven by high schools, where assistant principals were li sted as the person res ponsible in nearly all schools. In contrast, guidance counselors were most frequently reported as identifying school refusal in the middle schools, with a ssistant principals, social workers, and teachers a distant second. Overall, a team approach was the least likely method of identification. Table 7. Personnel Responsible for Identifying School Refusers* School Level Middle School High School Overall Count (%) Count (%) Count (%) Identifier of School Refusers Assistant Principal 5 (21.7) 9 (90.0) 14 (42.4) Guidance Counselor 9 (39.1) 0 (0.0) 9 (27.3) Social Worker 5 (21.7) 1 (10.0) 6 (19.2) Teacher 5 (21.7) 1 (10.0) 6 (18.2) Principal 4 (17.4) 1 (10.0) 5 (15.2) Attendance Clerk 3 (13.0) 0 (0.0) 3 (9.1) Team of Personnel 1 (4.3) 0 (0.0) 1 (3.0) *A school could have listed more than one person responsible for identifying school refusers, thus column numbers will not add up to the total number of responding schools nor will column percentages add up to 100%. All schools reported having a full-time sc hool psychologist on staff. Overall, school psychologists were assigned to two sc hools, and spent approximately two full (8hour) days a week in each school setting. Thes e averages were consistent across school levels, however, psychologists tended to sp end slightly more hours a week at high schools than middle schools.

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244 School refusers. The number of students evidenci ng school refusal as identified by excessive absenteeism in the 2003-2004 scho ol year are presen ted in Table 8. The criterion for determining excessive absenteeis m was discussed earlier (see Table 6). Both rural schools and schools at the high school le vel reported higher percentages of school refusers. Table 8. School Population and Identified School Refusers Total Students School Refusers Count Count (%) School Level Middle School 23,428 1,989 (8.5) High School 21,425 2,893 (13.5) Location Rural 2,020 569 (28.2) Suburban 25,891 3,267 (12.6) Urban 16,942 1,046 (6.2) Overall 44,853 4,882 (10.9) Characteristics of school refusal. Respondents were asked to report the percent of school refusers that presented with somatic co mplaints in the absen ce and presence of a confirmed medical condition. These data are presented in Table 9. Overall, of the identified school refusers, 44% presented with somatic complaints in the absence of a confirmed medical condition, whereas 32% ex hibited somatic complaints with an existing medical condition. Mi ddle schools reported a high er percentage of school refusers exhibiting somatic complaints in th e absence of a medical condition than high schools. For both middle and high schools, the opportu nity to engage in more enjoyable activities was reported as the most frequent reason for school refusal (21.9%). The need

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245 to serve as a caregiver (12.6%) and the presence of depression or emotional problems (12.3%) were also frequently reported r easons for students to refuse school. Table 9. School Refusers: Complaints & Reasons School Level Middle School High School Overall Total Students Refusing School* (1,705) (2,853) (4,558) Somatic Complaints: Absence of medical condition 1,147 (67.3) 865 (30.3) 2,012 (44.1) Presence of medical condition 220 (12.9) 1,253 (43.9) 1,473 (32.3) Total Students Refusing School** (1,989) (2,853) (4,842) Reasons for school refusal: Engaging in more enjoyable activities 429 (21.6) 630 (22.1) 105 (21.9) Serving as caregiver 207 (10.4) 402 (14.1) 609 (12.6) Depression/emotional problem 262 (13.2) 332 (11.6) 594 (12.3) Fear/anxiety of social situations at school 200 (10.1) 142 (5.0) 342 (7.1) Fear/anxiety of specific object/situation at school 91 (4.6) 168 (5.9) 259 (5.3) Evaluative/performance anxiety 63 (3.2) 154 (5.4) 217 (4.5) Gym Class 16 (0.8) 154 (5.4) 170 (3.5) Desire to stay with caregiv er 63 (3.2) 95 (3.3) 158 (3.3) *Complete responses for 22 out of 23 middl e and 8 out of 10 high schools. **Complete responses for all middle schools, but only 8 out of 10 high schools. The School Response to School Refusal Overall, schools reported confronting students in 75.2% of school refusal cases and notifying parents in 93.7% of cases (Tab le 10). Schools reported scheduling meetings most frequently with parents (58.5%) and least frequently between the student and the school psychologist (30.2%). For both middle an d high schools, in nearly every case, the first step taken is either student confrontat ion or parental notifi cation. Meetings between parents, teachers, students, and or guidance counselors are the interm ediary steps, with other actions being taken at a later point in time.

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246 Table 10. Actions Taken With Students Identified as School Refusers* School Level Middle School High School Overall Percent Percent Percent Action: Student is confronted 70.9 84.4 75.2 Parent is notified 90.8 99.9 93.7 Meeting Scheduled: Parent 48.4 80.0 58.5 Parent/Teacher 51.1 45.0 49.1 School Counselor/Student 57.8 45.6 53.9 Psychologist/Student 29.0 32.8 30.2 Complete responses for 17 out of 23 middle and 8 out of 10 high schools Referrals appeared to be an important piece of the schools response to school refusal. Referrals were reported to be made most frequently to the school social worker (19.6%) and least frequently to a psychiatrist (0.7%) (Table 11). In high schools, physicians and mental health counselors were also key points of student referral. Table 11. Referrals Made for Student s Identified as School Refusers School Level Middle School High School Overall Total Students Refusing School (1,989) (2,893) (4,882) Referral Made To: Court referral 134 (6.7) 99 (3.4) 233 (4.8) Mental Health Counselor 72 (3.6) 390 (13.5) 462 (9.5) Physician 132 (6.6) 545 (18.8) 677 (13.9) Psychiatrist 10 (0.5) 23 (0.8) 33 (0.7) Psychologist 22 (1.1) 113 (3.9) 135 (2.8) Social Worker 538 (27.0) 421 (14.6) 959 (19.6) Overall, 31 of 33 responding schools provided descriptions of interventions used in cases of school refusal. The majority of these comments focused on individual counseling for the student, typically with the guidance counselor, social worker, and school psychologist. Student contracts were descri bed as a tool or an agreement that some

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247 personnel use to work with the student. Ofte n these had incentives attached to meeting specified goals in achieving regular attenda nce. A few respondents described school-wide incentive based approaches. Some schools described disciplinary approaches, and th ese were usually assigned to the student by the assistant principal. Th ese mainly included dete ntion or suspension. The process of telephone calls to parents, letters, and parent conferences were described. Summary of Results The findings from this exploratory qual itative study tell the story of school personnel and their construction of school refu sal. The use of a so cial constructionist framework provides insight into school personn els constructions of school refusal, how personnel arrive at them, and their influence on practical experiences with students. This study establishes that school personnel rarely use the terminology set forth by professional literature. School refusal, along with other atte ndance issues is conceptualized within a larg er framework of absenteeis m that provides a frame of reference for school personnel. Personnel deli neate attendance issues into problematic and non-problematic categories, focusing primar ily on problematic issues. The role of the personnel, specifically whether or not they are discipline focused, tends to influence perceptions further. Judgment s about the legitimacy of the reason for absenteeism also influence personnels level of empathy for students. Personnel constructed absenteeism from a social structure diagnostic frame, focusing on school environment and culture, family dynamics, poverty, and culture, and an individual diagnostic frame, focusing on the individual student and their family. Explanatory models for absenteeism centere d on barriers, specifi cally those physical,

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248 mental, emotional, social, and societal in nature. Many participants focused on the motivating factors for refusal, differen tiating various categories of students. Personnel perceived the student experience of refusal as being driven by internal or external forces. Parents were viewed as a cause, enabling factor, or an influence on students refusal behavior. If a student who refused school was from a low-income family, there was an overt perception that th e family does not value education. The major finding that emerged was that despite pers onnels statements that any student could refuse school, their construction revealed sp ecific attributes. Ni ne typifications of students, or collective descri ptions, emerged from school pe rsonnels stories and included the following: the defiant student, the adult st udent, the failing student the bored student, the invisible student, the physica lly refusing student, the soci ally uncomfortable student, the sick student, and the vict im. The overarching dynamics of these typifications included parental control, parental awareness, student locus of control, blame, and victim status. In terms of identifying students who refuse school, the most important indicator was their attendance record. Personnel do not explore reasons in depth until a pattern has formed. The intervention process for any attenda nce issue consists of a series of formal telephone calls, letters, and meetings, all tracked on an intervention form. This represents the formal process of dealing with problematic absenteeism, and there is no other formal process for specific types of absenteeism, su ch as school refusal. The major deviation from this process was the decision of whethe r to refer a student to support services or student affairs. The constructions of the consequences of school refusal included immediate outcomes, such as school failure to long-te rm outcomes, like increased welfare costs.

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249 Programs to target and prevent the negative outcomes personnel associated with school refusal included at-risk programs and incenti ve programs. There was a lack of programs that aim at early earlier interventi on or prevention of school refusal. Survey results revealed that all schools have a system in place for identifying students who have problems w ith excessive absenteeism. Schools also had varying criteria for defining the excessively absent student, which constitutes the basis for identifying school refusers. The most frequently reported reason for refusing school was to engage in more enjoyabl e activities. In high schools, assistant principals were predominantly responsible for identifying school refusal, while at middle schools it was the responsibility of the guidance counselors. Team approaches that were a common method of response according to interviews we re the least frequent method among survey respondents.

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250 CHAPTER V: CONCLUSIONS Introduction This final chapter consists of five s ections. The first section provides a brief summary of the study background, purpose, and methodology. The second section provides a detailed discussion of the key findings. This discussion highlights: (1) the language of attendance issues a nd school refusal; (2) the gene ral constructions of school attendance issues; (3) descrip tions of school refusal as a behavior; (4) deconstructing school personnels stories of school refusal; (5) influences on school personnel and their understanding of school refusal; (6) iden tification and interv ention; (7) school personnels perceived outcomes; (8) recommenda tions; and (9) the findings of the Survey of School Refusal. The third and fourth sectio ns present the limitations and strengths of the study, respectively. The final section examines the impli cations of the findings and provides recommendations for education, public health, sc hool health, and future research. Study Summary Study Background School refusal has long been an issue st udied within a myriad of professional disciplines, but has only recently come under the purview of public health and school health. Likewise, there is conflict within the literature over the language used to describe

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251 school refusal. Most research has studied sc hool refusal as a problem of the student and the dynamics of the students families, rather than studying the social or cultural context in which it occurs. Schools are cited as playing a major role in the identification of students who refuse, however, little is known about how school personnel perceive school refusal and the students who experience it. The social constr uctionist perspective provides a unique alternative for exploring how school personnel perceive school refusal and its construction within the school setting that lead to those perceptions. This study also focused on understanding the social interact ions and processes th at influence school personnel perceptions. Purpose of the Study This study sought to describe school pers onnels perceptions of school refusal. Likewise, this study explores the ways in wh ich these perceptions influence the methods and strategies utilized by individual schools and their district to prevent, identify, and manage youth identified as refusing school spec ifically in the School District of Shermer County. This study has four main questions: 1. How do school personnel construct thei r perceptions of school refusal? 2. What are school personnels re ported perceptions, explanatio ns, and beliefs related to school refusal? 3. How do school personnel per ceive students they identi fy as experiencing school refusal? 4. What are the consequences of their perceptions for the recognition of school refusal among students?

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252 Methods Through a purposeful, random sample of mi ddle and high schools located in the School District of Shermer C ounty, ten schools were invited to participate in this study. Observations were conducted within each se lected school setting. Within each school, personnel within the categories of administ ration, support services and school health were invited to participate in individual interviews. Following informed consent, individual interviews were c onducted with 82 participants. Prior to the school level interviews, ten interviews were conducted with personnel at the district level within the administrati on areas of each of the previously mentioned categories of personnel. A total sample was attempted, but not achieved. All interviews were tape-recorded and transcribed. The data were entered into Ethnograph 5.0 and coded. Analysis of the interview data wa s based on the examination of reoccurring themes that emerged. Finally, a descriptive survey, the Survey of School Refusal, was sent to all middle and high schools within the county. Thirty-e ight out of 68 surveys were returned. Univariate and bivariate stat istical procedures were conduc ted using SAS version 9.1.3 to describe survey results. Key Findings There were many important findings within this study, however it is essential to begin with the overarching outcomes that appear to be crucial to all research related to school attendance. These two major outcomes focus on the language used to describe attendance and general constructions of school attendance issues.

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253 The Language of Attendance Issues and School Refusal The language school personnel used to disc uss attendance did not incorporate an all-encompassing term, specifically not those us ed within the professional literature. The terminology used when referring to students who refuse school or who have attendance issues was inconsistent across categori es of personnel. Terms like absenteeism, attendance issues, truants, and chronic non-a ttenders are used frequently but without reference to the motivating factors for th e behaviors of non-attendance. This study establishes that school personnel do not use a common language when describing students who have attendance issues or refuse to attend school. Despite the use of terms lik e attendance issues, truanc y, or absenteeism, school personnel do not have a lexicon for school re fusal. Participants who used terminology reflective of the professional literature had specialized graduate-level educational training. It is notable that despite knowledge of the language used within research on school refusal, participants ra rely used it in a practical or applied manner in the school. A major area of contention that has plagued school refusal resear ch is the lack of consensus and disarray of the language used to describe this phenomenon (Chiland & Young, 1990; Kahn, Nursten, & Carroll, 1981; Kearney, 2001, 2003). Likewise, there is an obvious lack of understanding of how sc hool refusal research and its set of terminology have translated into the app lied world of the school setting. This study establishes that there is litt le usage of the professional lit erature on school refusal within the school setting. Most participants were not familiar with any of the terms that have been used in school refusal research, incl uding school refusal, school phobia, or other

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254 attendance related terminology. However, partic ipants were willing to provide definitions for these terms when asked about them. Participants were able to differentiate between conceptualiz ations of school refusal, school phobia, and separation anxiety, which are also reflect ive of the research. Such delineations focused on nuances of behavior, grade level, and willfulness of the student. All participants were familiar with general absenteeism. It was often described negatively, and occurring in patterns. School re fusal was less familiar and described as a willful behavior of students. Only a few participants, mainly social workers and psychologists, separated school refusal into further types of attendance problems, like school phobia. School phobia was the most fami liar term to school personnel. It was viewed as a fear of one or many aspects of school. While many participants indicated they try to avoid using terms or predefined labels, many would provide and use various terms while providing descriptions of students and their behavior. The most commonly used term was truant, as well as school phobic, non-attender, frequent flier, skipper, and chronic absentee. Assistant principals were more likely to use truant or skippe r, guidance counselors school phobic, and nurses frequent flier. This is reflective of Losekes (2003) view that our reality is often shaped by our personal experiences. Participants in this study primarily conceptualized school refusal and other attendance issues according to their own real, everyday experiences with students, and not according to any diagnostic criteria or by any predetermined set of rules for identificati on. However, this study does reveal that the practical categorizations of students described by school pe rsonnel are in line with the

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255 research. This is surprising given the apparent gap in the dissemination of research into the applied setting of the school. The term school refusal is increasingly accep ted within the prof essional literature in various disciplines, yet few participants used it in this st udy (Chiland & Young, 1990; Kahn et al., 1981; Kearney, 2003). Those that did were mainly school psychologists or social workers with post-baccalaureate tr aining. School psychologists, similar to researchers on school refusal, were the pers onnel most specific in their definition and delineations of school refusal from other fo rms of attendance issues (Torrens Salemi, 2004). Despite the lack of terminology and limited use of school refusal, the understanding of the term can be examined fr om a social construc tionist perspective. Social constructionism posits that reality is created through our daily interactions with other people as is language created and re-created through these interacti ons (Berger & Luckmann, 1966). Despite schools having some personnel who are aware of the term school refusal and its conceptualization, thes e personnel are limited in their interactions with other school personnel. School psychologist s and social workers are mainly itinerate and spend a few hours each week at multiple sc hools, therefore the limited contact they share with other personnel limits any influence on the language of others. This study suggests the need for appropriate dissemination of research related to school refusal. Additionally, th ere is a tendency for most res earch related to absenteeism to focus on truancy and dropout, although there is an obvious awareness of other forms of absenteeism. The findings in this stu dy underscore the need to develop an

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256 interdisciplinary approach to school refusal that incorporates all areas of research on absenteeism, as opposed to further delineating each type of attendance issue. These findings also raise me thodological issues. In studies of school refusal, depending on the terminology and definitions used, the validity of prevalence measures must be called into question. The most lik ely problem is that such studies have underestimated the prevalence of school refusa l. As Loseke (2003) explains, the number of people harmed by a particular social probl em, in this case school refusal, depend on how the parameters are constructed and how harm caused by it is defined. One example is Foxs (1995) study that examined differe nt school personnels views on student absenteeism due to increased home responsibil ities (such as caregi ving). He concluded that because there was a l ack of a master discourse among personnel on absenteeism related to home responsibilities, that this particular form of absenteeism has not be constructed as a social problem. Given the findi ngs in this study, if school refusal is used, even with a provided de finition, it is limiting. This may indicate the need to expa nd beyond narrowly defined types of absenteeism to examine broader perspective to gain a true understanding of the master discourse of all attendance issu es. It would be beneficial to provide a more inclusive list of behaviors and examples that personnel in schools can identify with, and therefore more accurately assess the students affected. This might be thr ough claims-making strategies, such as piggy-backing or domain expans ion (Loseke, 2003). For example, if school refusal were constructed as a different instance of truancy, this would be considered piggybacking. If truancy, which has long been characterized as a social problem, were expanded conceptually to include school refu sal, this would be domain expansion. This

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257 study fills this gap by developing an array of behaviors, descriptions, and terminology that are conceptualized and used within the sc hool setting that might be helpful in future claims-making strategies. General Constructions of School Attendance Issues First, it is evident that within the school setting, all attendance issues, including school refusal, are couched with in the larger umbr ella of absenteeism. This study clearly establishes that personnel have well-defin ed perceptions and unde rstandings of school attendance problems such as absenteeism and these perceptions form a major part of their frame of reference for all related issues. Inte rpreting this within a social constructionist perspective, this frame of reference might serve as the formula story for the social problem of school refusal (Loseke, 2003, p. 89). Loseke asserts that a formula story is a general type of story that consists of na rratives about types of experiences involving distinct characters. The formula story is de scribed as narrow, only including the elements that construct the condition and the harm caused by it (Loseke, 2003). Within the absenteeism formula story, the condition is problematic absenteeism, which is discussed below. The harm is the negative outcomes a ssociated with problematic absenteeism, which are discussed later. Likewise, the story also contains notions of causes and effects, which are discussed throughout these key findings. School personnel clearly delineate attenda nce issues into problematic and nonproblematic absenteeism. This was the case for the majority of the participants and few differences emerged across categories of pers onnel or grade level. The most apparent difference was between discipline-focused pers onnel, such as assistant principals and school resource officers and those focused on student support. Discipline focused

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258 personnel often viewed absenteeism as a truancy issue, although many also acknowledged other explanations. These view s of absenteeism substantiate Losekes (2003) assertion that while pr actical experiences tend to be shared by members of the same social category, in this instance school personnel, it cannot be assumed that all school personnel draw from this same practical experience (i.e., assi stant principals). While personnel articulated the many reasons for absenteeism, emphasis was placed on problematic absenteeism. Sc hool personnel tolerate non-problematic absenteeism specifically when it is due to reas ons they consider as legitimate. Much of the literature on absenteeism cites legitimate explanations (i.e., chronic illness or regularly occurring illness) for absenteeism that are considered acceptable (Kearney, 2001; Young, Chiland, & Kaplan, 1990). However, some of the same reasons are considered non-legitimate, and are cited as reasons of problematic absenteeism as well. This is congruent with common conceptualizations of school absenteeism. School absenteeism has been constructed and accepted across cultures as a type of problem or syndrome that involves absenteeism as th e primary symptom of a myriad of other problems such as learning problems, truanc y or depression (Kearne y, 2001; Young et al., 1990). Reasons were often delineated by this dynamic of legitimacy, and seemed to affect the level of empathy for students with absent eeism. This was particularly the case for specific explanations for absenteeism such as bullying, school transitions, illness, and grade level. Legitimate reasons were often described as occurring when the situation was out of the students control and how they personally related to the situation. These findings reveal that personnel categorize students in various manners. This supports the

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259 social constructionist assertion that it is natural for humans to categorize as a way of dealing with the complexity of life (Goffman, 1963; Loseke, 2003). The role of the school was cited as pl aying a supporting role in absenteeism. Although this was not a main reason, particip ants did highlight that schools have a responsibility to make school a place where students want to be. Low school connectedness, social climate, and a heavy academic and testing focus were considered aspects of schooling that make attending and remaining in school difficult for some students. Much of the literatu re cites a lack of focus on th e school setting as playing a supporting role in school refusal and problem atic absenteeism, thus the fact that personnel acknowledged the role of the school was a surprising explanation (Brulle & McIntyre, 1985; Elliott, 1999; King & Bernst ein, 2001; Stickney & Miltenberger, 1998). An overwhelming proportion of participants viewed family as having a major influence on attendance issues. Family dynamics have been discussed as having a clear influence on attendance issues and school refusal (Bernstein, Svingen, & Garfinkel, 1990; Kearney & Silverman, 1995). Home life, pare nts own educational experience, and parenting skills were all noted as major aspects of the family that impact absenteeism among students. Socio-economic status and cu lture served as underlying themes within these explanations for absenteeism. Personnel described families that are poor, minority, or lacking a high school education as not valuing education and thus school attendance is not important. This finding suggests that pers onnel may have arrived at this explanation from encountering a larger segment of st udents from lower socio-economic populations; however, it still reveals that assumptions are made regarding family value systems of the absentee student.

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260 The above-mentioned explanations for ab senteeism, from a constructionist perspective, might be interpreted as diagnos tic frames. Diagnostic frames are described by Loseke (2003) when a social condition is constructed in a way that constructs blame and responsibility. Diagnostic frames can be constructed as social causes of a condition, such as social structure (i.e., blaming the va rious aspects of schooling mentioned earlier, family dynamics, or poverty), or social forces (blaming competing ac tivities, differential treatment of students). Diagnos tic frames may also be constructed as a part of the individual, which is seen in participants explanations for absenteeism below (blaming the student or the family). Hoyle (1998) outlined four constructions of absenteeism within the British education system, which ar e reflective of the findi ngs in this study, and included individual pathology, defective parenting, failu re to identify and meet the needs of the student, and factors within the proce ss of schooling. Similarly, these constructions form diagnostic frames for the problem of absenteeism. Participants constructed explanations for absenteeism as barriers, specifically physical, mental, emotional, social, and societal barriers. Barriers to attending school were different in that participants provided these as an explanation for what makes it actually difficult for some students to attend sc hool. Barriers were de scribed as internal and external to the student and their locus of control, and whether or not they are legitimate. Social barriers to attendan ce were the most prominent and focused on students who have a difficult time fitting within the existing social setting. Explanations for why some students have a difficult time remaining in school for the entire day focused mainly on social issues that affect the students comfort level. Participants cited similar issues in terms of barriers; however, they did not focus on

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261 families or parents. Issues such as percei ved bullying and low school connectedness were more common. Descriptions of School Refusal as a Behavior Most of the participants in this study constructed sc hool refusal as a behavior, although these constructions of behavior were often intertwined w ith descriptions of students as well. These constructions provide the dimensions that school personnel think about, talk about, and use when describing sc hool refusal. Often, within their comments, they would delineate between various types of behavior, such as school phobia, defiant school refusal, and separation anxiety. This is contradictory to lit erature that suggests school personnel have a tendency to place all students exhibiting school refusal into one category (Lee & Miltenberger, 1996; Phelps, Cox, & Bajorek, 1992). Participants described that among mi ddle and high school students, school absenteeism could lead to a cycle of school refusal. Additionally students in key transitional periods in their schooling were considered more likely to have problems attending school. Several differe nces between primary and sec ondary school refusal were described. First, secondary stude nts were more likely to experience emotional issues that affect attendance behaviors. Secondly, primary students are less likely to be in control of the decision to come to school and parental re sponsibility was cited as the primary factor, whereas, secondary students are considered old enough to make the right decision (i.e., come to school). These findings suggest that school personne l delineate not only by the explanation for the school refusal, but categorize their explanations by grade level. From a social constructionist perspective, this can be explained as emerging as a product of their

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262 continued interactions with stud ents in certain grade levels. Likewise, it also suggests the need for caution in avoiding preconceived notions according to grade level when identifying students who are refusing. From a constructioni st perspective, this is important because as Loseke (2003) explains, categorizations are im portant because they can influence our behavior. The importance of this is that as practical actors categorize people, they include varying associations, evaluations, and reactio ns (Loseke, 2003). School phobia was constructed as a fear rela ted to being in or coming to school. It was described as a behavior primarily occu rring among primary stude nts or students at transitional periods in schooli ng. School phobia behavior was thought to result from real or imagined stimuli within the school environm ent, such as bullying. Several participants also described the role of parents in sc hool phobia. Parents were described as being involved, if not over-involved, and having a difficult time separating from students who are displaying emotional distress. Participants described sc hool phobia as causing students extreme anguish, emotionality, and soma tic complaints. An interesting aspect of participants construction of school phobia is that many believe that its true occurrence is rare. Further, the idea of a true case is disconcerting as th ere were no consistent criteria among participants for deciding if a case is true or not, except for the diagnosis of school phobia. Some participants described school p hobia as a diagnosable condition, helping delineate true cases from those that are not. Despite the lack of existing diagnostic criteria within the medical field, part icipants described students who have been diagnosed as school phobic thus making them eligible for homebound education. Many participants acknowledged the use of hospital homebound but the majority disapproved. It was

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263 described as only supporting the phobic behavior. This is in agreement with the literature on school refusal and school phobi a that indicates removing th e student from school can be detrimental (Jenni, 1997; Klein & Last, 1989). It is notable that the acceptance of diagnoses of school phobia may suggest that, to an extent, the me dicalization of school phobia has occurred here as it ha s in Japan (Yamazaki, 1994). Participants, mainly student support personnel, described the behavior of refusing school as a symptom of something else in a students life. From th is perspective school refusal was constructed as a type of behavi oral indicator. School nur ses also highlighted this aspect of the frequent flier, or the st udent who continually visits the clinic with vague symptoms. The major finding from th is aspect of school refusal was the importance of identifying the underlying cause of the problem. Only a few participants cautioned that school refusal might appear as a behavioral problem and the student ends up with a punishment, which could inadvert ently encourage the behavior. This is reflective of research findings from a st udy that examined differential punishment among students by race and found that one group of stude nts were punished at greater rates as a consequence of teachers perceptions of st udent behavior, their knowledge of academic performance, and their knowledge of past punishment (McCarthy & Hoge, 1987). This underscores the need for careful identification and appropriate intervention in cases of school refusal of any type (Berry, 1993; Brand & O'Connor, 2004; Cooper & Mellors, 1990). Student support personnel and teachers cons tructed illness as a reason, cause, and excuse for school refusal. Illness among st udents was categorized into legitimate and non-legitimate forms of illness. This finding paralleled the delinea tion of absenteeism

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264 into problematic and non-problematic. There are important implications of this finding that refer back to the need for careful identification, screeni ng, and appropriate intervention in school refusal. It also i ndicates the need for consistency between personnel within the school, especially with those involved in documenting student illness. Student support personnel described mental illnesses and emotional issues as reasons that affect and cause school refusal. In the descript ions, participants generally referred to depression, anxiety, undiagnosed me ntal illness, and stress induced illness. Again, there were concerns that student s who do not appear depressed, but show problem behaviors such as acting out, would be inappropr iately punished. Several participants, particularly distri ct personnel, teachers, guidance counselors and social workers, described elements of the school environment that motivate or exacerbate school refusal behavior. Perceptions of safety, structural environment, school climate and culture, school conne ctedness, and academic pressure were all aspects of the school environment that were thought to influe nce school refusal behavior. This included the transitional periods students experience when moving between schools (i.e., from 5 th grade to 6 th grade, or 8 th to 9 th ). Related to these transitions, participants cited differences between primary and secondary schools that affect students comfort level. Secondary schools were described as being colder, less caring, or nurturing than primary schools, a change that some students are sensitive to. There were also expectations of students to find their social niche on thei r own. If students do not have the social skills to do so, participants explained that they might end up avoiding school. The fact that participants highlighted these elements of the school e nvironment draws attention to the need for

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265 mechanisms to ease the transitions for student s to avoid school refusa l. These findings are consistent with studies on the effect of low levels of school connectedness and the increased risk of dropping out (Marcus & Sanders-Reio, 2001; Resnick et al., 1997). Describing the Student Who Refuses School When offering their description of student s who refuse school, participants would frequently describe the perspective thei r comments were based on, such as their profession, their empathy for students, or th eir own personal life experiences. This was surprising, as it almost appeared as a self-e valuation of how they arrive at their own constructions of students who refuse school. Gergen (1985) described social constructionist inquiry as being concerned with explic ating the processes by which people come to describe, explain, or ot herwise account for th e world (including themselves) in which they live (p. 266). Burr (1995) would describe this as taking a critical stance of the taken -for-granted ways of understanding the everyday lives of school personnel. The processes that unfolded within the interviews allowed insight into what influences school personnels constructions of school refusal, from their own point of view. It suggests that a pers ons role in the school, their empa thy, or ability to relate to a students situation, and their own past pe rsonal experiences infl uence their perception of students who refuse. When describing their perceptions of students who refuse school, participants differentiated students as having internal or external experiences. Internal experiences included various emotions, perceptions, a nd thoughts students might have. Fear was closely associated with school phobia, whereas frustration was linked to refusal due to academic or social failure. External experiences that were used to explain school refusal

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266 included expectations placed on students (or lack of), distractions, and social issues (i.e., bullying, social discomfort). Similar to perceptions of general absenteeism, parents were constructed as a cause, an enabling factor, or an influence (through their attitudes on education) on school refusal. In some descriptions, personnel bl amed parents (and not students) for forcing students to stay home to play the role of tr anslator, caregiver, or wage earner. This was particularly an issue in sc hools with high migrant populations. In most cases, this was viewed as a negative practice. This may be due to cultural themes in Western society about childrens role in society, which indi cates it should primarily consist of attending school, thus keeping them home prevents them from attaining future success, thus does harm (Best, 1994; Young et al., 1990). Likewise this negative view of parents who do not force their children to attend school ma y also be explained by what Loseke (2003) refers to as cultural feeli ng rules which she defines as widely held beliefs about how we should feel about particular types of people. This includes the notion of who deserves sympathy and help and who deserves condemnation and punishment. This is illustrated by the contrasting sympathy for parents who had lost control of the child who was refusing school, and therefore not blamed, as they did not intentionally cause harm. Participants, mainly middle school personne l, frequently highlighted attributes of students who refuse school, but only after in dicating that such students could look like anybody. However, within their stories of students, details often included gender, ethnicity, socio-economic status, and dem eanor. Males and females were discussed equally, although there was often discussion ab out professional opinions, differences by grade level, or what the motivati ng factor for the refusal was.

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267 While some participants indicated et hnicity was not a characteristic, some described more Caucasian students while others specified Hispanic females in instances of students being forced to stay home. Socio-economic status was most often mentioned as a characteristic by participants from school s with a higher percen tage of students from lower income households. Participants often linked socio-economic status to a decreased value placed on education. This may suggest that this particular perception is a product of repeated interactions with this particular segment of students and their families. However, it also implies personnel make assumpti ons based on socio-economic status. An unexpected description of students that emerged regarded their perception of reality. Participants speculated about student s true experience when refusing school and whether it was based on real or perceived issues, for exam ple bullying or anxiety. This reveals participants own evaluation of their interactions with students. This might be interpreted as their way of d eciding what fits their own real ity of what is or is not legitimate as an explanation of refusal. These findings suggest that despite participants statements that any student could refuse school, their construction of stude nts reveal specific attributes. This supports the theoretical perspective of social constructionism, in that their perceptions of the reality of school refusal have developed from their continue d social interactions with students. It also highlights th e potential for personnel to overlook students who do not fit within their accepted descriptions of who re fuses school, which illustrates potential for negative consequences of categorizing students.

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268 Deconstructing School Personnels Stories of School Refusal School personnel shared coun tless stories of their expe riences with students who refuse to attend school. These stories, wh en examined, provided insight into their perceptions and experiences with these students as well as the processes of identification and intervention. A major aspect of the id entification process a ppeared to be how personnel differentiate students. Students who refuse school are mainly identified by a lack of attendance, and whether or not the absences are excused wa s important. Although some participants indicated that excused ab sences, if excessive, would be investigated, such a differentiation has implications. It is re asonable to assume th at it may take longer for a student who is being excused to be id entified as having an actual problem with attending school. School refusal was also diffe rentiated by reasons for refusal and grade level. Several key factors appeared to affect personnels evaluation of their experiences with students who refuse school. These eval uations are important as they may have implications for personnels future interactio ns with students. With students, personnel emphasized individualized intera ctions, especially when trying to identify the reason for their refusal. Most personnel described having a positive rapport with students, although this depended on their role. Disciplinarians often described being viewed negatively by students. Personnel reflected on the role of ot her personnel in the sc hool setting and their interactions with students. Teachers were perceived as highly frustrated. Guidance counselors and females were seen as partic ularly caring, whereas administrators were viewed as discipline focused. This was interesting in that many part icipants described the need for a team approach to intervene in cas es of school refusal; however, the perceptions

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269 described reflect individualized interactio ns between personnel and students. These perceptions should be considered when developing protocols for team interventions. Participants evaluated pare ntal involvement as criti cal to contributing to or hindering the resolution of school refusal. An appropriate balance of parental involvement, communication, and support from the school where the elements most needed, according to personnel, to assist the student in making a return to regular school attendance. Parents who were less involved, di d not appear to value education, or were not willing to work with the school were viewed as impeding the schools intervention. On the contrary, parents who were too involved were viewed as overbearing and personnel considered this unh ealthy for the student. Besides providing insight into identification and in terventions, school personnels stories revealed that their constructions of students went beyond any student. Instead, their stories provided the basis for what be came collective descriptions or images of students who refuse school. Th ese categorizations or typifications are what Loseke (2003) describes as images in our heads of typical kinds of things (p.17). Such typifications and images serve as soci al resources that pract ical actors use to understand things they may not have persona lly experienced (Loseke, 2003). Likewise, these typifications become useful resources for personnels future interactions with students. The overarching dynamics of these typifi cations included level of parental control, parental awareness, student locus of control, blame, and victim status. These are all elements that build the co llective identities of images of students who refuse school. The construction of school refusal within th e formula story of problematic absenteeism

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270 concurrently creates these im ages of students that are v alued or devalued (Loseke, 2003). Again, the notion of cultu ral feeling rules brings up issues of blame and responsibility, specifically the cultural them e of individual respons ibility (Loseke, 2003). This speaks to the dynamics of parental contro l, parental awareness, and student locus of control, which might be viewed as a con tinuum of level of responsibility, and thus introducing the opportunity for blam e. This also applies to the rules of victim status and the emotion of sympathy that people feel for victims (Loseke, 2003). Thus, if these dynamics truly reflect responsibility, it should fo llow that if a parent has low control, low or some awareness of the student refusi ng school, they are not responsible for the behavior and the blame would fall on the st udent. Within the t ypifications, personnel would categorize some students as victims, thus not responsible, and deserving sympathy. Students viewed as responsible for their refu sal were blamed, theref ore not deserving of sympathy. This may reflect the existence of stigma related school refusing behavior, or attributes of this behavior that make it unde sirable (Luiz De Moura, 2002). The issues of blame is a common theme among child problem behaviors (Best, 1994; Luiz De Moura, 2002). Overall, there were nine t ypifications of students includ ing the defiant student, the adult student, the failing stude nt, the bored student, the invi sible student, the physically refusing student, the socially uncomfortable st udent, the sick student and the victim. The descriptions of these students are provided in the results se ction, so a detailed description is not provided here. These typifications paralleled Bests (1994) asse rtion that the social problems of children are constr ucted within four categories including the rebellious child, the deprived child, the sick child, and the child-victim.

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271 The important implication of these typifications is that they represent those categorizations of the practical actors that work in school settings everyday. These categorizations influence how personnel react to students they en counter. Schneider and Ingram (1993) explain that such categoriza tions are normative and evaluative and often portray groups in positive or negative terms, and it is these groups whose behavior and well-being are affected by public policy. Such categorizations help personnel decide who is deserving of help and who of punishment, therefore there are important implications for intervention and policy (Schneider & Ingram, 1993). School personnels categorizations emerged from various influen ces and thus the next section reviews the various influences on school personnel. Influences on School Personnel and thei r Understandings of School Refusal First, it is important to address wh at obviously does not influence school personnel and their understanding of school refu sal. Foremost, existing literature and research on school refusal do not play a role in the understandi ng or perceptions of school personnel. Internal and external influences al ong with frustration fr om experiences were the major influences on personnels percep tions. District poli cies and politics predominantly influenced those personnel responsible for enforcing them, mainly assistant principals. The two major internal influences we re intuition and communication skills. Knowledge obtained from college traini ng and ongoing education was not a major influence, except among personnel with higherlevel training, such as psychologists, social workers, and guidance counselors. This was also interpreted as an external influence that could affect their perception. Teamwork, whic h results in interactions

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272 between school personnel, appeared to influe nce participants per ceptions of students. This is important given inconsistencies in conceptualizations and identification of students by categories of pers onnel. Past experiences rela ted to participants' own educational experience, as a parent, or previous experiences in the school also served as influences on personnels understandings. The latter, previous experiences, was a major influence that participants used to form the basis for future interactions. Participants were eager to share their frustrations with students who refuse and how it influences their actions. Administrators are more likely frus trated by the affect school refusal has on attendance rates, whereas others were frustrated with the process of working with these students. The process, fr om the length of time involved to the amount of work targeting one student, leads to low motivation to work on this issue. This raises concerns about intentional lack of identifica tion or deference to an easier solution (i.e., punishment). Administrators frustration with the affect of school refusal on attendance rates is further exacerbated by the politics of attendance. Given the increased pressures on schools, administrators, and teachers to meet federal and state education standards, attendance is on the radar screen. Due to a relationship between attendance and school funding, many participants expre ssed concern that st udents who refuse to attend school are being systematically remove d from school rolls, specifical ly if they are over the age of 16. This is not by any means a new phe nomenon. Fine (1991) in her study of the politics of dropouts, discussed this process of removing students from rolls, and referred to it as discharge, pushout or coercive discharg e. In her findings, such actions were taken regularly at the high school level due to similar reasons with funding. The issue that

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273 arises in these findings is the current fo cus on accountability, forcing schools to pay attention to attendance for th e wrong reasons. Bowditch (199 3) hypothesized that routine disciplinary procedures such as the use of i ndicators to identify troublemakers are the same indicators that place students at-risk of dropping out but inst ead of intervening, such practices systematically exclude stude nts, thus perpetuating racial and class stratification. Given the identification issues related to school refu sal and the practical categorizations of school personnel, there is the potential for social and economic injustice to result from such practices. Identification and Interven tion in School Refusal There are several important findings rela ted to the identification and intervention of school refusal. This section will start by discussing the findings associated with identification followed by those findi ngs related to intervention. One of the most important findings in term s of identification was that a students attendance record is the primary indicator of a problem with absenteeism of any type. This represents the only measurable attribute of absenteeism and is reflective of the aforementioned conceptualizations of gene ral attendance issues. The most apparent problem with relying on attend ance records is that it reveal s little about the nature or reason for the absence, relying on reliable, valid, and timely bookkeeping and review. Reviews are usually the responsibility of the assistant principal in high schools and guidance counselors in middle schools; however, it is not conducted on a daily basis. Reviews were reported as being conducted every two to three weeks, reviewed for patterns, such as consecutive days of abse nces or repeated absences on Mondays and Fridays. While these reviews are important, it reveals a significant lapse in time between

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274 the development of a pattern to identificati on. This could possibly account for the stories of students falling through the cracks. Additionally, an important finding was the lack of identification systems or processes in place. Only one middle school reported the use of a monitoring system, which relied on teach ers tracking attendance for multiple classes and conducting follow-up on a daily ba sis for each absent student. Part of the attendance record includes the delineation of excused versus unexcused absences. Participants reported th at more emphasis is placed on unexcused absences, which presents the issue of students who might be refusing but go unrecognized if they present evidence for an excused absence. Furthe r exploration of the problem does not occur until after the general identification has occurred, unless there are overt behaviors that are recognized such as crying or physical refusal. Participants expressed concerns related to dependence on such general indicators like attendance, emphasizing the need to explore each student s educational history for patterns. Many personnel are involved formally and informally in the identification of and intervention with students who refuse to attend school. This depended on their role in the school. Teachers were described as those most often to identify a student first and refer them on to other personnel. In this aspect, they serve a critic al role as a gatekeeper to students accessing other personnel who might intervene. This finding underscores the need for teacher support and education on school refusal and identification, especially given the previously described frustrations teachers have with such students. School health personnel are also considered a fron tline of identification, specifically for those students who repeatedly vi sit the school clinic.

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275 It is noteworthy that the general proce ss of intervention, as with identification, revolves around the measurable indicator of attendance. There are two levels of interventions with the first consisting of a school level prot ocol followed by the district level protocol. The main princi pal is that the process of in tervention at the school level should be initiated for all students who are missing excessive days of school, regardless of motivation. Ideally, this protocol would catch all attendance related issues before they progress to chronic issues. The presence of the district le vel protocol appears counterintuitive to this, as it is primarily a pr ocess for chronic or severe attendance issues. Although all of the intervention processes ar e relatively straight forward, they rely on the sole indicator of attendance, and th erefore any exploration of reasons for the absenteeism are informal until it has progres sed to the point of referral. A major finding was the deviations from the formal protocol described by participants. A major deviation occurred when participants indicated they were aware of the reason for absences, specifically bullying, illness, students as caregivers, lack of parental awareness, or emotional issues. Participants indicated they still took action; however, there was more flexibility in their responses. This high lights the impact school personnels perceptions had on their responses to stude nts. Perhaps one of the most important deviations to highlight was a key decision personnel, mainly te achers, make in the referral process that diverts from the general protoc ol. This is the decision to re fer students to student support services or student affairs. Teachers reported sending students with emotional, psychological, or behavioral i ssues related to their absences to student support services, who assume a problem solving position. Students with defiant behaviors related to absences are sent to student affairs, which takes a disciplinary appr oach. The differential

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276 consequences of this decision reveal anothe r manner in which personnels perceptions of students affect the interventi on process. As Loseke (2003) points out, categorizations of practical actors can have very real implicati ons and this finding validates this theoretical point. Lastly, personnel described th e intervention process as lengthy, inconsistent, and confusing. These major concerns center on the problem of overlooking early warning signs, missing students, and l ooking only at attendance. The majority of participants expressed that absenteeism is usually a sign or indicator of something larger, therefore more attention should go towards exploring the reasons behind it. This suggests a need for schools to re-visit their current protocol s and make improvements. In the process of reviewing current identificati on and intervention protocols, it would behoove schools to include those personnel who most frequently identify students. These personnel and their practical experiences must be considered, but not relied upon, in the improvement of such protocols. Further, I emphasize the need to include the voices of students and parents themselves. They represent an unrepresented voice in the construc tion of issues of absenteeism and school refusal. Perceived Outcomes of School Refusal The perceptions of outcomes of school refusal reported by participants are important findings as they reflect the potential harm that results from students refusal to attend school. Loseke (2003) describes harm as the outcome created by the social condition. Likewise, participants claims cons truct the outcomes of school refusal as consequences that should not be tolerated within our society.

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277 Most participants focused on overarc hing themes ranging from immediate individual outcomes like dropping out and schoo l failure to long-term societal outcomes such as increased welfare costs, violence, poverty, mental health, and crime. There was a particularly narrow focus on those students w ho refuse school who were considered by participants as at-risk. Outcomes for at -risk students who have attendance problems focused on poverty, dropout, pregnancy, drug ab use, and violence. This finding is disconcerting for two reasons. First, the te ndency of personnel to focus on a select category of school refusing stude nts highlights the lack of focus on other categories. A possible explanation for this is that the harm has more extreme consequences for the atrisk students than other students. The second reason relates to how the tende ncy to focus on a select group appears to drive programs. Programs to prevent ne gative consequences consisted of at-risk, incentive-based activities, and alternativ e educational options. The most important finding was that programs target the extreme outcomes for students, and few programs target the students in the middle. This is disconcerting, as it seems the options allow problems to progress to the worse case scenario prior to offering some type of program. Early intervention and prevention driven programs can be added to provide a continuum of prevention, early intervention, and intervention programs for school refusal. Recommendations Overall, recommendations provided by participants were directed towards problematic absenteeism in general. They focused on the school setting, the role of personnel, working with student s, and involving parents in th e intervention process. The most important finding in relati on to school setting was ensuri ng that the school is a safe

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278 haven and that all students feel welcom e, nurtured, and comfortable. This finding correlates to studies that ha ve revealed the importance of school connectedness and school climate and their relation to positive educational and health outcomes (Bonny, Britto, Klostermann, Hornung, & Slap, 2000; Park er, 2002; Resnick et al., 1997; Worrell & Hale, 2001). Non-instructional personnel we re considered important in terms of having flexible schedules within the school day that allow them to explore individual students reasons for refusal. Recommendations for improving identification included monitoring systems similar to the one described by one school. If there were a consistent mechanism for following up on student absences, early interv ention is a viable option. The goal is to catch refusal to attend before it progre sses to a chronic or severe pattern. Suggestions offered aimed at improvi ng interventions focused on personnels communication with students. The main theme was to focus on individual students from a holistic perspective. It was recommended that personnel approach students with open minds, consistency, and compassion. Participants also cautioned against the use of labels. Likewise, these same concepts emerged as important in personnel s interactions with parents. Home-school collaboration was cons idered essential but personnel must be cognizant of pre-existing biases against schools that many parents have. The Survey of School Refusal The goal of the survey of school refusa l was to assess the response of school personnel to students who refuse school in addition to gath ering information regarding estimates of prevalence and characteristics of school refusal within the School District of Shermer County, the county in which inte rview data were also collected.

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279 Foremost, several limitations must be highlighted prior to discussing the results. First, the sample size was relatively small; th erefore, there are inherent limitations to the interpretation of these data. For exampl e, only two of the responding schools were located in a rural setting, so any differences between geographic locations may be related to the small sample. Likewise, data are base d on self-reported numbers hence accuracy is questionable. It is also impor tant to point out that while definitions were provided, there was no way to ascertain how respondents inte rpreted questions re lated to excessive absenteeism and school refusal. Prevalence and Characterist ics of School Refusal Overall, 11% of students were identified as refusing school in Shermer County. This is higher than most reported rates, al though still within the re ported estimated rates of excessive absenteeism. Reported rates of absenteeism range from 5.5 to 20% on a typical school day (Bell, Rosen, & Dynlacht, 1994; U.S. Department of Education National Center for Education Statistic s [NCES], 2004). Likewise, Kearney (2001) estimated that as many as 28% of school-age d children refuse school at some point in time, with estimated prevalence rates rangi ng from 1-8% of the school age population (Berry, 1993; Stickney & Miltenberger, 1998). Both high schools and rural schools identif ied higher rates of students refusing school. For high schools, this might be explained by increased autonomy. This corroborates with interview data indicating that high school students are responsible for getting to school each day, maki ng it easier for them to refu se to attend if no one is present to reinforce it. In terms of schools in rural locations, this fi nding may be related to

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280 the finding that students from migrant families are more often pressured into adult roles, hence leading to excessive absenteeism. Somatic complaints in the absence of a medical condition were presented by 44% of identified schools refusers while 32% exhi bited somatic complaints with a confirmed medical condition. Therefore, a large number of students who refuse school seen by school personnel will have some form of a somatic complaint, raising the importance of assessing whether somatic complaints are due to an existing illness. Otherwise, it is important to identify other causes of somatic complaints, such as psychological stress, victimization, or manipulative use of illness. This finding likewise calls attention to the important role of school health personnel in identifying and screen ing students. Middle schools reported a higher per centage of identified school s refusers with somatic complaints without a medical condition. Thus, at the middle school se tting, school health personnel play a particularly important role as well. The most frequently reported reason for sc hool refusal was to engage in activities that are more enjoyable than school (22%). This reflects personne ls categorization of students as defiant or truant students looking to have fun. The second most reported reasons included serving as a caregiver (13%) and the presence of depression or emotional problems (12%). These are both impor tant reasons to consider. The issue of students serving in adult roles, such as caregiver, was a theme that emerged from interview data as well. Schools frown upon this; however, view it as unavoidable for some families. This might be indicative of a need for community level support for families.

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281 The other reason, depression or emotional issu es, is consistent with literature that suggests depression is an key factor to consider when identifying school refusal (Kearney, 2001; Stickney & Miltenberger, 1998). The most frequently reported reasons discussed here are also consistent with Stickey and Miltenbergers (1998) findings, although they did not find servi ng as a caregiver as one of th e secondary reasons as this study did. Specific social related fear and specif ic school related fear accounted for approximately 12% of identified school refuse rs. Likewise, anxiety related to evaluation or performance anxiety or avoiding gym class accounted for approximately 8% of identified students. Overall, the data indi cates that approximately 20% of the students identified as refusing do so because of some fo rm of anxiety. This is an important finding for consideration in the development of identification and intervention plans. Additionally, it implores the question of how schools can work to decrease anxiety among students. These data also suggest that a small percent of students could potentially be identified as experiencing school phobi a (5%), which is important given the importance of delineating motivation for re fusal for appropriate and successful intervention (Elliott, 1999; King, Ollendic k, & Tonge, 1995; Lee & Miltenberger, 1996). School Response All schools reported that a system was in place for identifying students who have problems with excessive absenteeism. This was consistent with state, district, and school level policies that require so me form of an identificati on system for absenteeism. The majority of descriptions provided by responde nts were consistent with interview data. Attendance reports were likewise important in the identification process and descriptions

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282 again were similar to those within the inte rview data. There is typically one person in charge of reviewing the atte ndance report. However, the su rvey results indicated that aside from assistant principals and guidance counselors, teachers, principals, and social workers also reviewed this information regularly. Actions taken for students appearing on the attendance report included telephone calls home, referrals to the social worker, and letters sent home. Based on these results and the results from the interviews, it appears that the use of the attendance report is im portant; however, consiste ncy and regularity of use should be standardized. Surprisingly, the definition of an excessively absent st udent varied greatly between middle and high schools. Middle scho ols, on average considered 12 days as excessive, whereas high schools considered ov er 20 excessive. There might be several explanations to this finding. First, it might be that high sc hools are more tolerant of absenteeism. Likewise, they may have longer intervals between re viewing attendance reports, thus allowing students to accrue hi gher absences. High sc hool personnel reported during interviews that review of attendance reports occurred every two or three weeks sometimes. High schools are also dealing wi th students, who once they turn 16, can legally decide to withdraw from school. Sc hools may allow students, specifically those 16 or older, to accrue high absences without intervention to proceed with withdrawals. This explanation is partially supported by the interview data but is speculative. Additionally this finding might be reflective of interview findings that characterized middle schools as more nurturing than high scho ols, which were considered impersonal. Overall, schools reported confronting st udents in 75% of school refusal cases and notifying parents in 94% of cases. This findi ng was rather surprising, as it would seem

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283 important to explore the reasons for refusal by talking to all students. It may be possible that more often schools contac t parents before confronting students. Further information for why students and parents are not always included is warranted. Schools reported scheduling meetings most frequently with pa rents (59%) and least frequently between the student and school psychologist (30%). The latter, meetings with school psychologists, reflects interview data indicating that the role of the psychologist is to work with students referred during the interven tion process, but not as a primary identifier. Referrals are an important part of the schools response to school refusal. Schools reported making referrals most frequently to the school social worker (20%) and least frequently to a psychiatrist (0.7%). One of the roles of the school social worker, as highlighted in the interview data, is to work with chronic attendance cases, and specifically cases of truancy. There appears to be consistency between the frequency of referrals to social workers (20%) and the fr equency of truancy as the primary reason for refusal (22% i.e., engaging in more en joyable activities). However, court referrals, which are one of the culminating steps in truancy cases, were low (5%). A possible explanation is that many truancy cases e nd once a student turns 16 years of age, as compulsory attendance laws no longer bind them An interesting findi ng was that in high schools, students were frequently referred to physicians and mental health counselors. More data is needed to e xplain this finding further. Summary Conclusions While research has focused on the phenomenon of school refusal for many years, few studies have explored the construction of this problem w ithin the school setting. The findings from this exploratory qualitative study make a significant contribution to this

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284 literature, and expand it in a new directi on. The findings support the use of social constructionism in understanding school pers onnels construction of school refusal. Furthermore, the theory allows for an expl oration of how these c onstructions influence personnels practical experiences. Qualitative analysis highlighted that within the school setting, school refusal, along with all other attendance i ssues are conceptualized with in the larger framework of absenteeism. School personnel have defined pe rceptions and understanding of attendance problems and this study reveals that these percep tions form a major part of their frame of reference for all attendance related issues. Likewise, personnel delineate attendance issues into problematic and non-proble matic categories, focusing primarily on problematic issues. Within personnels tendenc y to delineate, the role of the personnel, specifically whether or not they are discip line focused, tends to influence perceptions further. For example, assistant principals were more likely to view school refusal as issues of truancy. Interviews with participants further revealed that judgments of whether or not the reason for absenteeism was legitimate were im portant and influenced personnels level of empathy for students. Personnel constructed absenteeism as from both a social structure diagnostic frame, focusing on school environment and culture, family dynamics, poverty, and culture, and from an individual diagnos tic frame, focusing on the individual student and their family. This study establishes that school pers onnel rarely use the terminology set forth by professional literature, a nd lack an all-encompassing term for attendance issues or school refusal. Those who did use professi onal terminology had specialized training,

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285 however despite their knowledge of terms such as school refusal, they rarely used it in an applied manner within the schools. An intere sting finding was that despite what seemed to be a lack of awareness for the profe ssional literature relate d to school refusal, personnels constructions of school refusal ar e similar to those de lineated within the research. Many participants focused on the mo tivating factors for refusal, differentiating various categories of students. These categor ies emerged from the stories personnel told about their practical experiences with students, thus substantiating the social constructionist perspective that reality is shaped by personal experiences. These findings related to th e general construction of attendance issues and the language of attendance and school refusal suggests several things. The first is that there is limited dissemination of research on school re fusal. Within the school setting, it only reaches those personnel with mo re specialized training such as psychologists. Given this, the experts in school refusal research should consider making terminology and conceptualizations more inclusive to reach a broader segment of practitioners if they desire a larger impact on th e practical actions of school personnel. Likewise, it is important to note that in no way is school refusal a part of the po licy language of school attendance. This particular in consistency reveals that school refusal is not an officially accepted problem. In attempting to understand perceptions of school refusal, it became evident that most personnel categorize the behavior of school refusal based on motivation or reason, as well as delineate it according to certain elements. The major categorizations included fearful school refusal (school phobia), defiant school refusa l (truancy-like), separation anxiety, illness based refusal, and emoti onality based school refusal (anxiety or

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286 depression). Grade level, transitions in school, legitimacy, and absenteeism patterns emerged as key elements that personnel used to describe and fu rther delineate school refusal behaviors. These findings illustrate how personnel draw on their practical experiences to inform their perception of school refusal. Likewise, these elements revealed that some constructions are consid ered more serious than others are, and likewise draw different forms of attention from personnel. Another area that is of importance was the descriptions of students who refuse school. Personnel explained the student experience of refusal as being driven by internal or external forces. Parents were viewed as a cause, enabling factor, or an influence on students refusal behavior. Likewise, if a student who refused school was from a lowincome family, there was an overt percepti on that the family doe s not value education. Lastly, participants speculated about students perceptions of reality, particularly in cases of bullying. The major issue that emerged was that despite personnels statement that any student could refuse school, th eir construction revealed speci fic attributes. It highlights the potential for personnel to overlook students who do not fit within their accepted working descriptions of who refuses, illustra ting a potential negative consequence of their categories. Nine typifications of students, or coll ective descriptions, emerged from school personnels stories about stude nts who refuse school. The overarching dynamics of these typifications included parental control, parental awareness, student locus of control, blame, and victim status. The implication of th ese typifications is th at they influence how personnel react to students they encounter, assisting personnel in deciding who is deserves help or punishment, thus having im plications for intervention and policy.

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287 While these typifications should be used to inform intervention and policy, there are other influences on personnel as well. Pe rsonnels own experien ces in schools, as parents, and as former students themselves appear to have a heavy influence on their perceptions. Administrators, responsible for accountability and enforcement of policies, are likewise influenced by the politics of atte ndance. The inherent in ference is the impact these influences, paired with th e issues of identifi cation, and could lead to inequalities in school-based intervention efforts. The most important indicator used in id entifying students who refuse school is their attendance record. The most apparent problem is that at tendance alone reveals little about the nature or reason for the absen ce, and relies on reliable, valid, and timely bookkeeping and review. The responsibility for re view and identification is often placed on one person, and are not conducted daily. Un less absences or re fusal to attend is accompanied by overt behaviors like emotional distress or physical refusal, personnel do not explore reasons in depth until a pattern has formed. Teachers, already overwhelmed with class and school duties, are responsible for keeping track of attendance as well, and aler ting others of any patte rns. They serve as gatekeepers to other se rvices that can help students who are refusing. There are both informal and formal mechanisms for this; however, the major problem is that multiple people are identifying students with vary ing consistency. The development of a structured and formal monitoring system w ould help in consistency and accuracy of identification, helping to prevent students from falling through cracks only to be discovered too late. With this in mind, as well as the high level of frustration teachers have for students who refuse, there is a need for teacher support and education on school

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288 refusal and identification. Sc hool health personnel would also benefit from education as they often provide informal screening for school refusal, as in the cas e of frequent fliers. The intervention process for any attendance issue consists of a series of formal telephone calls, letters, and m eetings, all tracked on an intervention form. This is the basis for the formal process of dealing w ith problematic absenteeism, and there is no other formal process for specific types of abse nteeism, such as school refusal. However, several informal deviations were reported as occurring within the formal process, which were related to specific type s of absenteeism. Personnel reported more flexibility in their responses to students who are refusing school such as bullying, illness, or emotional issues. The major deviation was the decision of whether to refer a student to support services (emotional or behavioral students) or student affairs (defiant students). When triangulated with data from personnel who work in thos e areas there are obvious differential consequences for this decision, main ly that students referr ed to student affairs are punished. This finding substantiates that practical categorizations have very real implications, and in this case, affects the stud ent. The key point that must be considered is the timing of the identification and stude nt referral. Has the student had a pattern developing over time and has surfaced as de fiance? Is the student experiencing a new problem with refusing to attend and expressi ng emotional distress? Again, issues of identification are of signifi cance, specifically, accurate and timely identification. The constructions of the consequences of school refusal included immediate outcomes, such as school failure to long-te rm outcomes, like increased welfare costs. There was a tendency to focus on at-risk stude nts who refuse school and this might be due to the perception of more extreme cons equences. Once again, it draws attention the

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289 tendency to focus on a select category of stude nts, which could possibly be at the expense of other students. Programs to target and prevent the nega tive outcomes personnel associated with school refusal represented two ends of a sp ectrum. At-risk programs, with the goal of providing students with a meaningful attachment, and incentive programs that reward school attendance were two main types of pr ograms mentioned. The programs appear to target the extreme outcomes, or reward the students who rarely have a problem. There is an apparent need for programs that target the students in the middle to provide earlier intervention, or possibly prevention of school refusal. Programs that aim at increasing levels of connectedness and social comfort w ithin schools might be a good starting point, given the findings in this study indicati ng increased refusal dur ing transitions in schooling, and related changes in both the school and social climate. Recommendations reflected this sentiment, with personnel suggesting that schools ensure an environment that is welcoming and safe to all students. This nurturing environment should expand beyond the primary school setting. Within this particular school district, efforts are alr eady being made at the high sc hool level via the introduction of a Small Learning Communities pilot, which groups students within a school into small groups or teams. Small Learning Communities, a federal grant program created by the U.S. Department of Education, has shown to have positive implications for student attitudes towards school, beha vior, as well as increasing academic achievements (Cleary & English, 2005; Dryfoos, 2000). Further recommendations emphasized personnel-student-home communication. Suggestions from personnel focused on appro aching students who refuse school from a

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290 holistic perspective w ith an open mind, while cautioning against the use of labels. The view that parents who do not have an edu cation themselves do not value education might represent an inaccurate norm. Given this and some of personnels other negative perceptions of parents, intr oducing some type of relationship building mechanism might be useful. Finally, based on the findings of the Surv ey of School Refusal, future research should examine the reasons as to why not all students identified as refusing school are confronted. Likewise, includi ng parents in all cases was described as paramount in interviews; however, it was not 100% according to survey data, thus the reasons for this should be explored as well. Fi ndings of this study suggest that team approaches are lacking, which is contrary to the recommenda tions within the literature as well as the findings from interviews in this study. It might be useful to educate school administration as well as personnel about identifying and in tervening in school refusal. Continuing education that incorporates school personnels categorizations with the professional literature into existing identification and inte rventions processes might be useful. Limitations of the Study Sample This study used multiple levels of sampling based on each method of data collection. All sampling was non-probabilistic ; therefore, the re sults cannot be generalized to all school districts. Additio nally, two of the data collection methods attempted a total sample, and this was not achieved. At the dist rict level, some departments did not allow all personnel to part icipate in interviews; therefore, there was

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291 not equal representation across departments. The other attempted total sample was for the survey, and despite multiple attempts, it was not achieved. Schools that participated in this study were selected via a purposeful, stratified random sample. Therefore, schools selected ma y be different from schools not selected. From those schools, personnel were sampled using a stratified purposeful sample as well. Personnel were invited to participate, but not required. Consequently, some categories of personnel are underrepresented. Th e final issue is a concern re lated to sample size, which although large for a qualitative study, was dete rmined by saturation. This is a subjective determination that I used to determine that I had enough representation of middle and high school personnel and across categories of school personnel that revealed similar themes across data. Due to the subjective nature there is the potential for researcher bias thus this must be considered. Study Design Given that this study is quali tative and exploratory, the in trinsic limitation is that a cause and effect relationship or statistical a ssociations cannot be de termined. There are a few other issues that should be highlighted as well. School level participants were 70% female, thus, their perspective could be different from their male counterparts. Secondly, all findings are based on se lf-reported data. Although I found it surprising, several incidents made me aware that school refusa l and conversations a bout attendance issues was a sensitive topic. One participant had me stop tape recording to re-confirm the meaning of confidentiality, and two asked that I not tape-record at all. Thus, I cannot be completely certain that participants were honest in their responses.

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292 The nature of conducting interviews requi res rapport building and trust. While I perceived increased trust due to repeated interactions with personnel during my observation period, I cannot conf irm that all participants were comfortable in the interview. However, many participants did share information that I personally considered sensitive, indicating they were comfortable. Likewise, due to the nature of conducting interviews in the school sett ing, there were repeated inte rruptions from school bells ringing, telephone calls, and other personnel barging into the room. While the location of interview was the most convenient for the pa rticipants, it was not always conducive to smooth, uninterrupted interviews. Lastly, while this study adds to the l iterature by focusing on the perceptions of personnel, who are in the likely role of identifying students wh o refuse school, it simultaneously excludes the students and their families. Therefore, only the school personnels side of the story is told. It wa s beyond the means of this study to include students and parents. Further, th e inclusion of students and pa rents raised concerns for the school district regarding issues of confidentia lity. From a theoretical perspective, this is also limiting, as it is common for adults to speak on behalf of child ren specifically in regards to social problems (Loseke, 2003). Fu ture research endeavors should seek out students and parents to tell their stories related to school refusal to develop a full picture. Data Collection Tools Interviews In-depth interviewing is an excellent data collection method for exploratory research especially when there is a need to obtain rich detailed data. Despite the usefulness of this method, there are inherent limitations that must be addressed. First,

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293 some personnel perceived themselves as not knowledgeable enough to do an interview. Often they would agree to participate but onl y after reassurance that I really was not looking for answers, but was truly interest ed in their experiences. Therefore, some participants responses may have been guarde d. Similarly, particular groups of personnel had a harder time articulating responses to questions. I had to engage them more and employ more probing than in other interviews. This was typically the case with health assistants, school resource o fficers, and office personnel. Additionally given th e theoretical framework of so cial constructionism, a major goal was to avoid any instances of leading when possible. This was done by asking for stories instead of probing for specific word s or using a pre-determined language. The questioning all focused on the behavior of students who refuse school. In most interviews, this was not a problem, but for some participants it appear ed to be confusing when I began to ask for stories. For some par ticipants this freedom led to long, protracted stories that did not relate to attendance issues and I had to re direct the participant. This was done carefully to avoid leading. Within interviews, some participants became extremely comfortable, and used the interview as a way to blow off steam. I f ound it necessary to re-direct participants; however, I did allow them to vent frustrations to an extent. Sometimes their frustrations were related school refusal. However, several participants vented about racism, prejudice, and politics within the school. O ccurrences such as these shou ld be expected within indepth interviews; however, this takes time away from the focus of the interview. Lastly, from a subjective researcher pe rspective, an inherent limitation that emerged was a by-product of maintaining th e social constructi onist know-nothing

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294 research stance. As a subjective researcher and someone who never worked in a school setting, I presented myself as someone who knew nothing about the experiences of school personnel. Several times participants tried to move me out of this position and into the role of an expert. This was particularly diffi cult with district level participants, as some were suspicious of my study. Several particip ants asked me what I really was trying to get at in my study, implying deceptivene ss on my part. Although I had a method of handling this, through verbal reinforcement and reaffirmation that I wanted to learn about their experiences with students who refuse school, I have no way of accounting for whether these perceptions a ffected their responses. Observations Limitations to the observations conduc ted in this study were predominantly related to issues of confiden tiality. Descriptive da ta about schools were collected, but due to the potential for schools to be identified from such descriptions, limits were placed on what could be reported. This invariably affects the transferability of these data. However, this element of data collection allowed for tr iangulation of findings during data analysis. The Survey of School Refusal The Survey of School Refusal had several inherent limitations that must be addressed. The survey relied on self-reported da ta and there is no way to determine if the data reported was pulled from actual records or if it consisted of estimates. Additionally there was the potential for misinterpretation of questions. Despite providing definitions for school refusal and operationalizing it as a measurable behavior (excessive absenteeism), definitional issues remain a limitation. Although the response rate was 61%, I cannot determine to what degree schools that did not provide data differ from

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295 schools that did. An additional limitation is the sample of schools. These schools are located in Shermer County, therefore the degree to which these results are transferable to schools in other counties is not known. Overall, aside from these limitations the survey was useful as an exploratory investigation of schools responses to school refusal. Strengths of the Study Sample As a qualitative exploratory study, purpos eful, stratified sampling was used to ensure representation of the various personnel included in the study. At the district level within each of the selected departments, I was able to intervie w at least one person. Although findings cannot reflect individual depart ments, there were sufficient interviews conducted to provide the distri ct perspective. In the random selection of schools for the study, using a design that st ratified schools by geographi c area ensured a broad, representative selecti on of schools. At the school level, I used a sampling matrix to recruit a sufficient number of participants within each category of personnel by middle and high school. In regards to the Survey, a total sample was attempted. Participants received a pre-letter, the survey, and reminde r postcard, and then a second survey. These methods were implemented with the goal of an increased response rate. The final response rate was 61%, which was acceptable. Overall, this study sampling design was unique in that it expands pr evious research by focusing on the perceptions of various categories of school personnel as opposed to individual students. Study Design This study makes a significant contributi on to the research literature on school refusal. While similar studies have been conducted, they have mainly focused on the

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296 cultural context in which school refusal occurs Further, the majority of these studies have been conducted within Japan. No qualita tive studies to date have explored perceptions of school refusa l, particularly those of school personnel in the U.S. Additionally, this study is one of the first to use the theoretical framework of social constructionism to understand and examine school personnels con ceptualizations of school refusal. The manner in which the theo ry informed the study design, data collection methods, and data analysis adds support to the utility of the framework of social constructionism. The design of this study employed multiple methods that provided powerful insight into the complexities of school pe rsonnels perceptions of school refusal. Likewise, the use of multiple methods allowe d for the triangulation of data that was useful in both data collection and analysis. The use of multiple methods and triangulation increases the credibility of these findings Prolonged engagement within each school setting accompanied by persistent observation also adds to the credibility. Rigorous and regular peer de-briefings were used to review data collection methods and emerging themes further ensuring both the credibility and dependability of the data and data analysis. To ensure dependa bility of the research data and findings, an audit trail was maintained that consisted of systematic record keeping, along with field notes, a journal, files, and memos. Lastly, given the social c onstructionist framework for th is study, the language of the participants was used. Th e study confirms that school pe rsonnel conceptualize school refusal differently from that of the expe rts who conduct research on it. This is an important finding, specifically when developi ng identification methods or interventions

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297 for use in the school setting. Likewise, it provides insight that should guide the dissemination of research into schools. Data Collection Tools The use of observations was helpful in establishing a rapport with participants prior to the interview itself. It also provided a glimpse into the social climate of each school setting. The use of semi-structured interviews had several advantages. The most important advantage was the ability to explor e the topic in detail Secondly, the language personnel used within the inte rview was helpful in future interviews, specifically technical language related to the school processes. Other language and terminology related to school refusal was helpful in probing in interviews th roughout data collection. This will also be helpful in future research on school refusal. The flexibility of the semistructured interviewed allowed for explora tion of the complex delineations of school refusal offered by participants. The survey, while fraught with severa l limitations, provided thorough contextual data related to excessive absenteeism a nd school refusal. It likewise allowed for verification of findings from the intervie w data, increasing the credibility and dependability of the research. Implications and Recommendations Despite a multi-disciplinary, internationa l literature, little research has drawn attention to the phenomenon of school refusal within the school. Th e majority of school refusal research has constructed this phenom enon as cases of individual pathology among students. These studies have centered on stude nts who have been referred through various channels to some form of medical care, usuall y psychiatric. However, school refusal still

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298 begins in the same location: school. Several studies have high lighted the need to focus on schools as this is often the first place were students are identified as refusing school (Brulle & McIntyre, 1985; Elliott, 19 99; King & Bernstein, 2001; Stickney & Miltenberger, 1998). In particular the role of school personn el in the identification of such students has remained relatively unexplored. Given the inherent definitional issues that have plagued school refu sal research, prevalence of school refusal is unclear. Without understanding school personnels construction of school refusal within the school, further attempts at measuring prev alence will continue to generate mere estimates. Additionally, without a clear understa nding of the reality of school refusal in the school setting, it is difficult to understa nd the manner in which personnel identify and intervene. This study makes a substantial contributi on to the literature on school refusal. First, it grounds the phenomenon of school refusal within the location of which it occurs, the school setting. Secondly, it captures school personnels construction of school refusal. Regardless of the research conducted in th e expert world of school refusal, school personnel play a central role in constructi ng the problem of school refusal. This is especially important given the finding that personnel are not influe nced by the expert literature. This study authentic ates school personnels practic al constructions as having real implications for students who are refu sing school, how they are identified, and what is done to intervene. This study presents contri butions to three major areas in the research on school refusal: education pr actice and policy, public and sc hool health practice, and policy, and research.

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299 Recommendations for Education, Public Health, and School Health Practice Dissemination of Findings The findings from this study will be disse minated in various ar enas. In terms of education, providing findings to the school district in whic h the study was conducted, as well as practitioner-oriented organizations will help to raise awareness of school refusal as a part of problematic absenteeism as we ll as highlight some of the issues within schools that hinder the identif ication of this problem. School officials may use these findings to build support for programs that incr ease sensitivity to attendance issues, and to correct the misuse of curre nt policies such as withdrawing students. Likewise, on an individual school basis, thes e findings can help guide the revision of current practices related to school absenteeism. School advocates may use thes e findings to draw attention to support the movement to decrease ine qualities in educational outcomes. The findings will also be disseminated to public health and school health organizations and professional publications. A lthough previous research has attempted to construct school refusal as an issue of importance in public he alth and school health, this has not been particularly successful as in other countries (Chiland & Young, 1990). This research will help in build ing the case for school refusa l as an important public and school health problem that can affect the he alth and well-being of students in both their present and future outcomes. Specifically, it will be important to provide findings to outlets that reach school health practitioners such as school nurses and health assistants, given their role in screeni ng students who might be refusi ng school. These data can be used to influence policy that addresses issues of school health, speci fically mental, social, and emotional health.

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300 These findings can also be used to support recent recommendations for the development of a research network of indivi duals who study school attendance problems (Kearney, 2003). Whether in the form of a conference or a consortium, these findings confirm the need for a formal network of re searchers and practitioners to provide an outlet for communication, colla boration, and research. Lastly, dissemination of this research within social constructionist literat ure will contribute to expanded use of this theoretical framework. Policy Public policy efforts related to school refu sal are most likely to occur at either the state or local level, however past reports ha ve indicated national a nd international action given the occurrence of school refusal across cultural contexts (Committee for Economic Development, 1987; United Nations, 1999). Education policy must focus on several issues related to school refusal. One woul d be the expansion of current attendance policies to include accurate conceptualizations of problematic absenteeism. Current state policy focuses on truancy, but the findings of this study reveal the complex, multi-faceted nature of school absenteeism. Given that fi ndings indicated a lack of consistency in understanding attendance problems, the implicati ons are that this consistency can lead to inaccurate or low identification and responses. Policy should not only expand beyond the umbrella of truancy, but also take into considerati on school personnels practical categorizations of student attendance issues, as otherwise there is no internal consistency between policy and action. Educational leaders must review the imp act of current policies on what I have referred to in this study as the politics of attendance. It appears that unspoken processes

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301 in schools such as withdrawing students, or clearing the ro lls are accepted as unavoidable regardless of the acknowledged consequences. Schools are doing what is necessary with the resources they have to meet the state and federal standards for accountability, while contradicting the inten tion of policies such as No Child Left Behind. Educational reform policy also needs to c onsider the social and ecological effects of school. The findings in this study point to the importance of the school social environment and its influence on school re fusal. With the increased awareness of bullying and school violence, the importance of the school social setting should be considered within future reform efforts. Bullying was a common theme within this study and often cited as a cause of school refusal. Findings also suggested that primary school is more nurturing than secondary, thus contri buting to an uncomfort able, negative school experience. A policy that assures all schools promote and maintain a safe, nurturing environment for all students is critical to addressi ng and preventing school refusal. Public and school health policy currently does not fo cus on school attendance as an issue. However, given that one of the HP 2010 objectives is to increase the high school graduation rate, policies that advocate for decreasing high rates of absenteeism are needed. Such policy initiatives should target pr imary school levels, as the findings in this study suggest that attendance patterns can be established at very young ages. Further, participants in this study s uggested making and enforcing stri ngent parental responsibility laws. The effectiveness of su ch actions is uncertain, however, should be evaluated. At the school health level, advocacy for policy that increases the presence of school nurses is imperative. School nurses play a pivotal role in both screening for school

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302 refusal as well as keeping students in school. Th ere is a constant struggle to keep school health services a priori ty in education, thus these findings can be used to bolster advocacy efforts. Educational Training Findings in this study indicate that school personnel are inco nsistent in their understanding of attendance issu es in general. The practical experiences inform their actions, and there is a lack of awareness of the professional li terature. Given that attendance issues are relatively widespread, educational training on a variety of school attendance issues for all school personnel is warranted. It is specifically important for those personnel who are considered primary in the role of identification or might find themselves in that role. The content of su ch training should use the language of school personnel, as opposed to expert terminol ogy. Training should also be extended to decision-makers within the school district, such as school board members, district level administrators, and school level administrators. Content for higher level personnel, such as administrators and school board members, might include information about the global occurrence of school refusal and other attendance issues, school personnels perceptions of these issues and the consequences (both documented and perceive d) of these issues if not resolved. Additionally, the content of e ducational training should include personnels constructions of students who refuse school, while incorpora ting new conceptualizations to build onto their existing realities. Tr aining must also address pr evention, early intervention, identification, and responses, while incorpora ting strategies for working with students and parents.

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303 The need for educational training on school refusal also extends to public health professionals who work in areas related to sc hool health, child and a dolescent health, or given the findings of this study, in areas of research focusing on bullying, school connectedness, or delinquency. With the in creased awareness and acknowledgement in the field of public health of issues aff ecting child and adolescent populations, it is imperative to translate research on school refusa l into appropriate educ ational training for this specific audience of public health pr ofessionals. This may include educational training targeting professionals who work with in schools, communities, or other areas of public health, as often these professionals work both with and in sc hools, or separately with child and adolescent populations (N oland, Troxler, & Torrens Salemi, 2004). Content of such training may include general awareness of school refusal, the relationship of school refusal to other issues such as bullying, sc hool connectedness, and longer-term outcomes (i.e., mental h ealth or educational outcomes). Prevention and Early Intervention Education efforts for personnel must also be accompanied by prevention and early intervention initiatives. Prevention for school refusal and attendance related issues should draw on the findings from this study, previous studies, and additional research on attendance problems. From the findings in th is study, prevention efforts might start by targeting the school setting to increase leve ls of school connecte dness. Mentoring and peer facilitator programs could assist in pr oviding students with a meaningful connection to school. Such programs might be particular ly helpful at transitional periods within schooling, such as moving from elementary to middle school. Additionally prevention efforts should focus on nurturing positive hom e-school connections. The effects of

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304 bullying prevention programs on attendance ra tes should also be e xplored, given that bullying may instigate school refusal. Early intervention efforts should be inco rporated into educational training for staff. Efforts should focus on identifying students before the development or at the onset of a pattern of non-attendance. The development of a screening protocol that can be used by various personnel would assist in identifying students base d on behavioral indicators as opposed to strict adherence to attendance data. This might assist in identifying the situation that could lead to sc hool refusal, such as bullying. Screening mechanisms such as a monitoring system could help increase the regularity of reviewing attenda nce records. This could help decrease the number of students who fall through the cracks. An attendance team composed of key personnel who meet regularly to review school attendance procedures and data could help increase proactive responses. Likewise, such a team could develop a structured communication and referral protocol for attendance issues that is more inclusive of student support services as opposed to di sciplinary action. Recommendations for Research The findings in this study raise importan t issues about past research on school refusal. Future research must frame school refusal within the language of those working with students, such as school personnel, as opposed to the expert terminology used by a select group of people who work with a sma ll percentage of students. To expand on the outcomes of this study, I propose the recommenda tions below be taken into consideration for future research.

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305 1. Using the language and categorizations sc hool personnel used to describe students who refuse school, develop a screening a pproach. This screening approach would need to be tested in various se ttings to determine its utility. 2. Using the research undertaken in this study, develop sepa rate studies that focus on parents and students percep tions and experiences with refusing school, from a social constructionist framework, to develop the full story of students who refuse school. 3. To understand constructions of school refusa l as well as were it fits within school attendance issues in general, this study c ould be replicated with modifications in different cultural settings with varying social contexts. This would assist in developing an understanding of how the social contexts of different cultures influence conceptualizations of school attendan ce issues. Aside from developing a crosscultural perspective of these phenomena, it would provide data to inform identification, prevention, and early intervention efforts in different settings. 4. Research on possible links between bullying and school re fusal should be explored given the findings in this study using national data sets such as the National Longitudinal Study of Adolescent Health or the Youth Risk Behavior Surveillance 5. The development of a survey instrument th at incorporates a broader definition of attendance problems would assist in devel oping accurate prevalence rates. Such an instrument would be helpful to supp ort future research efforts. 6. The findings in this study, as well as previous studies, call attention to inherent problems in how attendance records are docum ented within schools. Future research efforts should investigate improved methods for tracking attendance.

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306 7. Given that responses to school refusal appear to be depe ndent on the perception of the personnel who identify the student (i.e., assistant principals appear more likely to discipline) future research might look further into the differential outcomes of students based on who identifies them.

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321 Rettig, M., & Crawford, J. (2000). Getti ng past the fear of going to school. The Education Digest, 65(9), 54-58. Santiago, E. (1992). An ecological inquiry into school phobia: observations of a high school program (dropout prevention). Dissertation Abstracts International, 53(11A), 3871. Sarbin, T. R., & Kituse, J. I. (1994). A prologue to constructing the social. In T. R. Sarbin & J. I. Kituse (Eds.), Constructing the social (pp. 1-18). Schneider, A., & Ingram, H. (1993). Soci al construction of target populations: Implications for politics and policy. American Political Science Review, 87 (2), 334-347. Schutz, A. (1977). Concepts and theory formati on in the social scien ces. In F. Pallmayr & T. McCarthy (Eds.), Understanding and social inquiry Notre Dame, IN: University of Notre Dame Press. Scolari Qualis Research Associates. (2001). Ethnograph (Version v.5.08). Thousand Oaks, CA: SAGE Publications Software. Setzer, N., & Salzhauer, A. (2001). Understanding school refusal Retrieved March 3, 2003, from http://www.aboutourkids.org/ articles/refusal.html Sharf, B., & Vanderford, M. (2003). Illness na rratives and the social construction of health. In T. L. Thompson, A. M. Dorse y, K. I. Miller & R. Parrott (Eds.), Handbook of health communication (pp. 9-34). Mahwah, NJ: Lawrence Erlbaum Associates. Shevalier, R. (2000). Context dissonan ce in tobacco educ ation literature. Journal of Drug Issues, 30 (2), 407-434. Shilov, D. S. (1998). On organizing the system of rehabilitation of children and adolescents suffering from school disadaptation. Russian Education and Society, 40(4), 22-32. Simons-Morton, B. G., Greene, W. H., & Gottlieb, N. H. (1995). Introduction to health education and health promotion (2nd ed.). Prospect He ights: Waveland Press.

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322 Slife, B. D., & Williams, R. N. (1995). What's behind the research: Discovering hidden assumptions in the behavioral sciences Thousand Oaks, CA: Sage. Smith, T. J. (1997). Storying moral dimensions of disord ering: Teacher inquiry into the social construction of severe emotional disturbance. Paper presented at the Annual meeting of the American Educatio nal Research Association, Chicago, IL. (ERIC Document Reproduction Service No. ED409507). Stark, E., Flitcraft, A., & Frazier, W. (1979). Medicine and patriarchal violence: The social construction of a private event. International Journal of Health Services, 9(3), 461-493. Stevenson, R. S., & Ellsworth, J. (1993). Dropout s and the silencing of critical voices. In L. Weiss & M. Fine (Eds.), Beyond silenced voices: cl ass, race, and gender in United States schools. New York: Albany State University of New York Press. Stickney, M., & Miltenberger, R. G. (1998). School refusal behavior: Prevalence, characteristics, and the schools' response. Education and Treatment of Children, 21(2), 160-170. Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory Thousand Oaks, CA: Sage. Sweeney, J. F., & Sweeney, D. D. (2000). Frequent visitors to th e school nurse at two middle schools. Journal of School Health, 70 (9), 387-389. Tashakkori, A., & Teddlie, C. (1998). Mixed methodology: Combining qualitative and quantitative approaches (Vol. 46). Thousand Oaks, CA: Sage. Terry, P. M. (1998). Do schools ma ke students fearful and phobic? Journal for a Just and Caring Education, 4 (2), 193-211. Tice, T. N. (1999). Schools affect phobias. Education Digest, 64 (8), 49-50. Torrens Salemi, A. (2004). School refusal: Engaging rese archers and school personnel in the Delphi process. Unpublished manuscript.

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325 Yamazaki, A. (1994). The medicalization and demedicalization of school refusal: Constructing an educational prob lem in Japan. In J. Best (Ed.), Troubling children: Studies of chil dren and social problems (pp. 201-217). New York: Aldine de Gruyter. Yoneyama, S. (2000). Student discourse on t okokyohi (school phobia/re fusal) in Japan: Burnout or empowerment? British Journal of Sociology of Education, 21 (1), 7794. Young, J. G., Chiland, C., & Kaplan, D. (1990) Children rejecting school and society rejecting children. In C. Chiland & J. G. Young (Eds.), Why children reject school: Views from seven countries (Vol. 10). New Haven: Yale University Press.

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326 APPENDICES

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327 Appendix A: Delineated Terms and Definitions Related to School Refusal Terms Definitions School Refusal Students who refuse to attend school for various unexplained reasons (Kearney, 2001). Refers to students who have difficulty in attending school or remaining in school for the entire day (Stickney & Miltenberger, 1998). School Refusal Behavior (Kearney, 2001) Generally, a child-motivated refusal to attend school, difficulties remaining in class for an entire day, or both (Kearney & Silverman, 1996). Refers to children aged 5-17 who refuse to attend school and/or have trouble remaining in class for an entire day (Kearney & Albano, 2000). School Phobia Differentiated from Truancy 1. Severe difficulty attending school, often resulting in prolonged absence 2. Severe emotional upset, including excessive fearfulness, temper outbursts, or complaints of feeling ill when faced with the prospect of going to school 3. Staying home with the parents knowledge when the youngster should be at school 4. Absence of antisocial characteristics such as stealing, lying, and destructiveness (Berg, Nichols, and Pritchard, 1969). School Phobia anxiety and irrational fear related to bein g in school, and explicitly focusing on the ages of early to middle adolescence (Contessa & Paccione-Dyszlewski, 1981). A set of behaviors characterized by persistent absenteeism not due to truancy or actual illness. An exaggerated or irrational fear of attending school (Paige, 1993). Also referred to as specific phobia of school indicated by intense fear of some school-related stimulus. Specific phobia is the marked and persistent fear of clearly discernible, circum scribed objects or situations (American Psychiatric Association, 2000, p. 405). Separation Anxiety childhood anxiety disorder th at is characterized by excessive anxiety (fear, worry) concerning separation from a major attachment figure and/or home (Last, 1988). Separation anxiety is listed as a disorder in the DSM-IV with specific diagnostic criteria (American Psychiat ric Association, 2000).

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328 Appendix B: Timeline for Data Collection ACTIVITY Spring 2004 Summer 2004 Fall 2004 Spring 2005 F M A M J J A S O N D J F M A M J J Approvals X X X X X X X Contact Stickney & Miltenberger SDHC X X X USF IRB X X X External Panel X X Pilot Testing X X Recruitment X X X X X X District Level Elite Personnel X X X X X Randomly Select Schools X X Contact Pilot Schools X X X Contact Principals of Schools X X X X School Level Personnel X X X X X X X X X Data Collection X X X X X X X X X X X Elite Interviews X X X X Descriptive Survey X X X X X Observations X X X X Individual Interviews X X X X X X Transcription X X X X X X Data Analysis X X X X X X X X X X X X X Final Reports X X X Dissertation Reports Publications

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329 Appendix C: Approval to Use the Survey of School Refusal From: Ray Miltenberger [Ray.Miltenberger@ndsu.nodak.edu] Sent: Friday, February 27, 2004 4:15 PM To: Anna Torrens Salemi Subject: Re: Permission to use survey Hi Anna, You are certainly welcome to use the survey we reported in our paper. Best of luck in your research. I would be interested in hearing about your findings once you complete the study. Regards, Ray Miltenberger Raymond G. Miltenberger, Ph.D. Professor Department of Psychology ray.miltenberger@ndsu.nodak.edu North Dakota State University Fargo, ND 58105 Phone: (701) 231 8623 Fax: (701) 231 8426 http://www.ndsu.nodak.edu/ndsu/psychology/facstaf/MILTENBE/index.html At 02:20 PM 2/27/2004 -0500, you wrote: Good Afternoon Dr. Miltenberger, My name is Anna Torrens Salemi and I am a doctoral candidate in Public Health at the University of South Florida. I am in the process of writing my dissertation proposal of which the purpose is to investigate how school personnel construct their perceptions of school refusal within the school setting and how their perceptions affects interactions and social processes with students who experience school refusal. I have read the paper published in Education and Treatment of Children by Stickney & yourself (School refusal behavior: prevalence, characteristics, and the schools' response., 1998) and would like to ask permission to use the survey that was conducted in North Dakota. I have been unable to locate contact information for Dr. Stickney, but found your information online. I appreciate the consideration of my request, and look forward to your response. If you would like for me to contact Dr. Stickney, if you have her information, I would be more than happy to send her an email as well. Sincerely, Anna Torrens Salemi, MPH, CHES Doctoral Candidate Department of Community & Family Health University of South Florida, College of Public Health 13201 Bruce B. Downs Blvd. MDC 56 Tampa, FL 33612 tel. 813.974.6687 email. asalemi@hsc.usf.edu

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330 Appendix D: General Interview Guide Reminders to Researcher 1. I know nothing I as the researcher am here to learn from this persons experiences. 2. Do not think about the literature. 3. I am asking about the behavior refuse to attend school or have difficulty attending or remaining in school the entire day. 4. Do no probe until necessary! Let them exhaust everything. 5. Do not lead nor provide terminology. Introduction I am conducting a study to learn and understand your experiences, thoughts, ideas, and perceptions regarding students who refuse to attend school or who have difficulty in attending school or remaining in school for the entire day. I am conducting interviews w ith various district leve l personnel and throughout various schools as well. I want to lear n about how you understand these students, your perceptions of students who have these di fficulties attending sc hool, and your thoughts on why it happens. I am also in terested in how you identify these students and what your experiences have been. Appreciation Know you are busy thank you for taking the time to meet and talk with me Your participation is voluntary if at a nytime you feel uncomfortable and would like to stop, just let me know Tape-Recording As I mentioned when I contacted you, I w ould like to tape record our discussion Focus on our conversation rather than worrying about taking notes This information will not be accessible to anyone but me, and your name will not be recorded or used anywhere with in the transcript of the tape May I turn it on now and ask you to confirm that it is okay to record this? [Start Tape]. This discussion is about you, your thoughts, experiences, ideas, and concerns. The information that we learn during our time together will be reported in a confidential manner. No individual or school information will be identified. Before we start, do you have any questions? Warm-Up Question (optional) Tell me about your role/position. Opening Questions Tell me why you think kids dont come to school. [VARIOUS VERSIONS OF SAME QUESTION ] What makes it hard for kids to come to school? What makes coming to school difficult for some kids? What makes attending school difficult for some kids? What makes it hard for some kids to stay in school during the day?

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331 Appendix D (Continued) Have you ever known a student like this? Tell me about your experience. Tell me a story. Do not differentiate students for them. Let them talk about one type of student or however they categorize them. Ask for a stor y about each student they discuss. Then, ask them to talk about some more students Continue to probe about more students Tell me about some more students until participant appears to have exhausted everything they can discuss without being prompted. Reminders: Note the order in which the participan t discusses different types of students. Note any terminology, or th e absence of terminology. Document unprompted versus prompted responses (no probe versus probe). Key Questions/Areas to Cover: _____Description (general) _____Specific descriptio ns of students _____Experiences with students _____Identification of students _____Programs _____Perceptions _____Influences on Understanding Below are all probes for each area as I ask people to talk about more and more students, I am listening for these various areas to be covered. Only when they are not covered, should I probe. It is important to note when and where probes are used. Description Tell me what you think of these students. How do you describe what they are experiencing? How would you define/descr ibe these students? Are there any specific words you would use? How do you differentiate between these students and others? If you were training a new teacher/counselor what would you tell them are ways to identify these students? Description of students (more specific) How would you describe a student that is dealing with these issues? What does a student like this look like to you? Only if this does not come out ask for specifics such as grades, age, maturity level, family structure, behavior, ment al health, and potential causes. Experiences with students Tell me about your experiences with these students.

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332 Appendix D (Continued) What caught your attention? Were there any signs that alerted you? What happened? Tell me about your interactions with these students. [Only looking for this to be discussed do not probe]. What has happened if you thought a student had this issue but they didnt? Identification How are these students identified? What happens when a student is identified? What do you do if you are confronted with a student who appears to be dealing with this issue? Probe: Who would you talk to? [Note who is not mentioned]. What administrators, teachers, pe rsonnel, etc. would be involved? What happens? How do these other personnel interact when working with students? Probe: How often do you communicate with these other personnel? If communication does occur, how is it stru ctured? Daily? Weekly ? Monthly? Meetings? Teams? Unstructured? Are parents involved? Tell me about the level of parental involvement. Probe: Interactions with parents? [District Level Section Programs] Tell me about programs related to this i ssue (repeat for each student described). What programs or policies would you identify th at specifically relate to these students? Probe: Student Progression Plan School Board Policy Manual Bullying Prevention Program Florida Statutes Student Handbook Manual School level policies Other school or dist rict level programs Perceptions Tell me about some of your opi nions regarding these students? What is your level of concern for thes e students? District level concerns? Why does it happen? Causes? Outcomes? How do you think it happens? What are the differences in the importance of this issue now as compared to the past? How has No Child Left Behind influenced your perceptions of these students? Influences on Understanding How have you learned about these students? What influences your unders tanding of th ese students? Describe any policies or pro cedures that you know of that relate to these students.

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333 Appendix D (Continued) Where do you turn for information on these students? What kind of information have you seen that is related to these students? Closing Of everything we have talked about, what is the most important th ing you would like me to take away from this? Only do this at the very end OR in th e event that participant exhausts their stories early, use this. As I mentioned before, this study is about your perceptions of students who refuse to attend school and who have difficulty in attending school or remaining in school for the entire day. When I provide you with this description, what does this mean to you? When I say the following terms, are any of them familiar to you? What do they mean to you? Terms: Absenteeism, School Refusal, School Phobia, School A voidance, Separation Anxiety Are there any you would apply to the categ ories of students you have described? If the participant has not been able to talk very much, go through and probe with previous questions. Appreciation. Thank you for your time. This information will be very helpful.

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334 Appendix E: Probes for Interviewing Redirecting Lets move on: to the next question. to a different topic. Probing [Use ambiguous words] I see Thats interesting Silent probe 5 seconds while maintaining eye contact Paralanguage Ummm, Uh-huh Tone of voice Elaborating Could you tell me more about that? Could you tell me more about your thinking on that? You started to say something about? Is there anything else? Specifying What specifically about _________ makes you feel that way? What else do you think about _____? What other reasons do you have for feeling that way? What else do you think about that? Laddering [ask a series of questions to get more specific comments and uncover root causes] In what way is it good? What about it do you like? What does it mean to you? How does that make you feel? BUT be careful not to lead! Specific examples I see, can you give me an example of that? How might someone do that? Would you give me an example of what you mean? Clarifying I dont understand I am not sure I understand how you are using the word ________? Im a bit confused, could you try again to explain what ________? Could you explain what you mean by _______? Repeating [If confused you can repeat the question or their answer.] Let me repeat the question So, the message you wanted me to get from that story is.

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Appendix F: Demographic Information Sheet Demographic Information Sheet Thank you for participating in this study This information is for descriptive purposes only. All potentially identifiable information will remain strictly confidential. GENDER (circle one): MALE FEMALE GRADE LEVELS YOUR WORK WITH: SCHOOL: ___________________________ _____________________________ POSITION AT SCHOOL: _______________________ _____________________ YEARS IN CURRENT POSITION: ________________________ _____________ HIGHEST LEVEL OF EDUCATION: ____________________ _______________ UNDERGRADUATE MAJOR: _______ _______MINOR:___________________ IF GRADUATE DEGREE, MA JOR:________________ ____________________ ADDITIONAL TRAINING?:_____ __________________________ ____________ AT ANY TIME DURING YOUR EDUCATION TO SERVE IN YOUR CURRENT ROLE, WERE YOU EXPOSED TO INFORMATION RELATED TO WHAT WE HAVE DISCUSSED TODAY? (Circle one) YES (if yes, please describe below) NO PREVIOUS EMPLOYMENT IN EDUCATION: (Describe grade levels you worked with and position held) Grade Level Position Description Thank you for your time! 335

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336 Appendix G: Document Extraction Tool Bibliographic Information Title of document: Author: Date of creation: Revision dates: When was this document released?: Number of pages in document?: Reviewer Information Who is reviewing this document?: Date and Time: Document Retrieval Information Website? (include full path): Publication? (include accession number): Other: Document Information: What type of document is this? (legal, academic, article, etc.) Who is the intended audience? Document Information Relevan t to School Attendance Issues Does this document contain inform ation related to school attendance? If yes, document pages numbers:_____________________________ Yes No Does this document mention proble ms related to school attendance? If yes, document pages numbers:_____________________________ Yes No Does this document refer to programs that deal with attendance issues? If yes, document pages numbers:_______________________ Yes No Does this document refer to proced ures related to school attendance? If yes, document pages numbers:_____________________________ Yes No

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337 Appendix H: Observation Guide Consider the following during participant observation: SETTING What is the physical environment? What is the context? What kind of behavior does the setting en courage, permit, discourage, or prevent? PARTICIPANTS Who is in the scene? How many people are there? What are the roles of the people present? What brings these people together? Who is allowed here? ACTIVITIES & INTERACTIONS What is going on? Is there a definable sequence of activities? How do the people interact with the activities an d one another? How are people and activities connected or interrelated? FREQUENCY & DURATION When did the situation begin? How long does it last? Is it a recurring type of situation or unique? If the situation reoccurs, how frequently? What are the occasions that led to it? How typical does this situation appear to be? SUBTLE FACTORS Informal activities Unplanned activities Nonverbal communication (dress, physical space, facial expressions) What does not happen? (Especially if it was expected).

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338 Appendix I: Survey of School Refusal This survey has 13 questions regarding school refusal at your school during the 2003-2004 school year (last school year). Some of the questions may require you to obtain input from some of your sc hool faculty (i.e., the school psychologist, nurse, or guidance counselor). Additiona lly, some questions will require you to make estimates of data. A general definition of school refusal is provided for your reference. School refusal, for the purposes of this survey, is defined as students who refuse to attend school and have di fficulty in attending school or remaining in school for the entire day. 1. Which of the following best describes your school? Please circle appropriate letter. a. High school b. Middle School What grades are included in your school? ____________ 2. Which of the following best describes the area your school in located in? a. Rural b. Suburban c. Urban d. Other (please specify): 3. What number of students attends your school? ____________ 4. Please indicate the title of the person responsible for determining which students have a problem with excessive absences. 5. Does the school have a system in pl ace for identifying a student who has a problem with excessive absences? a. Yes (if yes, please describe in the space below.) b. No

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339 Appendix I (Continued) 6. What number of absences (for stu dents who do not have a medical condition that would justify their absences) is considered excessive (cause for concern)? ____________ 7. What number of students have been identified as evidencing excessive school absenteeism since the beginning of the 2003-2004 school year? ____________ a. What number exhibited ph ysical complaints with no confirmed medical problem?: # b. What number exhibited ph ysical complaints with a confirmed medical condition?: # 8. How many of the identified students ( from question 7) have been referred to court for truancy? ____________ 9. How many of the identifi ed students were referred to: a. Mental health counselor # b. Physician (family doctor, pediatrician) # c. Psychiatrist # d. Psychologist # e. Social worker # f. Other (please specify below) # # #

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340 Appendix I (Continued) 10. Below are a number of reasons for school absenteeism. Please indicate the number of students refusing school for which each of the following was the primary reason for the school absenteeism. Anxiety associated with evaluative sit uations such as tests or oral presentations Serving as a caregiver for parents and/or siblings Depression or other emotional problem Desire to be with caregiver(s) Fear or anxiety related to social situations at school Fear or anxiety related to a spec ific object or situation in school Gym class (e.g. showering, dressing out) Opportunity to engage in more enjoyable ac tivities (e.g., free time, tv, games) Other (Please specify): __________________ ________________ 11. When a student engaging in excessive school absenteeism is identified, which of the following steps are taken? (Please identify the order in which they occur and then approximate percentage of cases for whom the action is taken). Order % Steps Taken Student is confronted. Parent(s) are notified of absences. Meeting with parents scheduled. Conference between teachers and parent(s). Meeting between student and school counselor. Meeting between st udent and school psychologist. Referral to juvenile court system. Other (please spec ify):_______________ ______________

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341 Appendix I (Continued) 12. Is there a school psychologist av ailable to your school? (circle one) a. Yes (if yes, see 12 a-c below). b. No (if no, skip to question 13). 12a. How many schools does the psychologist serve? 12b. How many days are they present in your school? 12c. How many hours are they available to your school? 13. What interventions (if any) does the school counselor implement with students evidencing excessive school absenteeism (e.g. detention, contracting, tangible rewards for school attendance, etc.)? Please describe in the space provided below: If you would like to make additional comments, please feel fr ee to write on the remaining section of this page, or the inside of the back cover. Thank you for your cooperation in comp leting this survey. Your time is appreciated greatly!

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342 Appendix J: Pre-Te sting Protocol Survey pre-testing (2-4 Participants) Provide participant with informed cons ent if consent is granted, continue. Offer survey pre-letter to participant and as k them to read it, providing instructions to think aloud as they read it Probe regarding comprehension, clarity, and conciseness of the letter Offer survey cover letter to participant and ask them to read it, providing instructions to think aloud as they read it. Probe regarding comprehension, clarity, and conciseness of the letter Are return directions clear? If you received this letter, would you be interested in completing the survey? o Provide survey ask them to read th e instructions and think aloud as they do Are directions clear & concise? Is survey visually appealing? Easy to navigate? Are questions comprehensib le, clear, and concise? Are all options availabl e (where appropriate)? Interview guide pre-testing (2-4 Participants) Provide participant with informed cons ent if consent is granted, continue. Offer interview cover letter to participant and ask them to read it, providing instructions to think aloud as they read it Probe regarding comprehension, clarity, and conciseness of the letter Are return directions clear? If you received this letter, would you be interested in participating in an interview? Provide instructions to participant as ou tlined in semi-structured interview guide. Additional instruction is to tell the participan t that after they hear a question, they will be asked additional questions (to engage them in thinking aloud): o What is the first thing that comes to your mind when you hear this question? o What does this question mean to you? o How would you respond to this question? o What is not clear a bout this question? o What would make this question make more sense?

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343 Appendix K: Summary of Pre-Testing Findings Survey Overall, participants felt the survey was well written. Suggestions for minor changes in wording in order to simplify the language were offered. Interview Guide The first question tell me your views on a ttendance was too general one participant suggested I ask Tell me why you th ink kids dont come to school. One participant felt the questions should flow from specific to general, as opposed to general to specific (current). It was also sugge sted that transitional statements be added, i.e., Now I am going to ask you questions. The opening of the interview was particularly troublesome. It seemed that I could not move past this section, as I was not getting any read on a particular term or phrase that is used to describe these students. When I pr ompted for terms (by offering terms, asking which were familiar, which would they apply to what we are using), it led to a term that was not expected (i.e., at risk). When I followed through with questions in this particular case, I fe lt that the interview was about something not related (but then ag ain, if that is what the teacher thought of, then wouldnt it be against social constructionism to lead her away?) Participants would clearly diffe rentiate between different t ypes of students, but did not apply any of the terms I suggested to any of the students they described. One participant suggested that I provide litt le descriptions of di fferent categories of students and then ask what they might call these students. I worry that this too would be leading, as I would be offering a pre-existing construction of school refusal as opposed to finding out what it is from them. Everyone was able to distinguish that some students regardless of everything, will miss school and enjoy doing so (truant). Then there are other students who hate to miss school but cant stand being there (socially). A few things I must consider: 1. The population I tested with was not a strong group. Not all were actual teachers (substitutes). 2. Teachers might think about these things different than the other categories of school personnel (i.e., specific to the general, not using terms).

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344 Appendix L: External Review Panel School Panelist: H. Roy Kaplan, Ph.D. H. Roy Kaplan is the former Executive Di rector of the National Conference of Community and Justice (NCCJ), Tampa Bay Chap ter, where he has served for fourteen years. He received his Ph.D. in sociology from the University of Massachusetts, Amherst, with a minor in public health. He served as a professor for nearly fifteen years, and currently serves as a visiting professor at the University of South Florida. He worked intensely within the school di stricts during his tenure as th e executive director of NCCJ. He has provided diversity training and conflic t resolution for personnel and students. He has served as a consultant to various school districts as well. He is skilled in both qualitative and quantitative research methodology. Dr. Kaplan possesses a unique perspective on schools as he has worked closel y with them on issues such as violence prevention, racism, and other issu es that relate to the social interactions within a school setting. His most recent work has been doc umented in his text, Failing Grades: How Schools Breed Frustration, Anger and Violen ce and How to Prevent It (2004). School Refusal: Christopher Kearney, Ph.D. Christopher Kearney is an a ssociate professor of clini cal child psychology at the University of Nevada, Las Vegas (UNLV). He also serves as the director of the UNLV Child School Refusal Clinic and Anxiety Disord ers Clinic. He received his Ph.D. at the State University of New York, Albany. His research focuses on classification, assessment, and treatment of school refusal in children and adoles cents. He has made significant contributions to the study of school refusal, thr ough his research, numerous articles, and several texts. He is a proponent of bridging the gap that exists currently in this field of study. Qualitative Methods: Maria Cabrera, MPH Maria Cabrera is the research director for Best Start Social Marketing. She received her Masters in public health from the University of South Florida, College of Public Health. She has vast experience in designing, coordi nating, and conducting large-scale qualitative research projects. Many of the projects she oversees are for federal agencies and involve multi-site designs with multiple methods. She has much experience in a variety of qualitative methods, including interviews, el ite interviews, focus groups, observations, and document reviews.

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345 Appendix M: Summary of Pilot Study Findings The pilot study was conducted in an alternate school di strict that the one that will be used in the main study. One of the reasons for doing th is was to have a separate school district setting in the event that the district or the geographic location seems to affect school culture. Sarasota County served as the study site. Sarasota as a county is characterized by a large gap in the distribution of wealth. This was elucidated in the pilot study as an issue that can causes attendance problems among students, particularly in the high school setting. Although it cannot be stat ed that school districts vary in their culture the data would indicate this is a possibility but further study would be required. This will be useful however once the main study is initiate d as a comparative point of reference. Pilot testing closely mirrored the data coll ection for the main study. Interviews were conducted with the following school personne l: a school resource officer, a guidance counselor, a school nurse, an assistant principal, two attenda nce workers, and a district level social worker, head of dropout preven tion program, and a dist rict level guidance counselor. Interviews lasted approximately one hour. The interviews with the attendance workers were not part of the protocol, but because it was requested by the schools that these persons be interviewed, they were conducted as a courtesy. Based on the pilot, the flow of the interview guide will vary, therefore there is no specific order of the questions in the guide. Specific in structions and reminders to the researcher will be embedded within the guide. Most of the questions were used as probes as participants described various examples of their experiences with students. In general, it would be best to have more than an hour betw een interviews, but this will remain flexible due to scheduling constraints. Some of the findings from the pilot interviews included the following: All school personnel differentiated a variet y of reasons for why students refuse school, including family dynamics, bullying, derisive teachers, students as caregivers, social niche issues, and speci fic to Florida, a tr ansient population. When asked to describe the students w ho have these difficulties, school personnel responded in one of two ways these students could be any student or they represent the gap in wealt h, either very poor and minority students or very wealthy students, but rarely middle class. Most participants readily shared what they thought thes e students look like. Some described, with some hesitance, lower income minority students, ugly students, or students who phys ically do not fit in with the popular students. There seemed to be a natural divergence between the responses of some of the school personnel. For example the school resource officer and one of the attendance workers (both with law enforcement backgrounds) shared very similar views which were quite diffe rent from the views of the guidance counselor and

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346 Appendix M (Continued) the other attendance worker (who had twenty years of guidance experience). For example, both delineated students as ha ving difficulty attending school due to various similar reasons such as pleasure -seeking behaviors (fishing, theme parks, malls), left to own free will to attend school, outcast academically. They also both expressed opinions driven by the legal st atutes of school attendance and truancy. Everyone interviewed at some point referre d to students who have a difficult time with a particular teacher. They often de scribed teachers who are in the system or have tenure and dont really care a bout what offends students. Some personnel indicated this could be resolved simply with a schedule change for the student. Professional and educational experience appe ared to influence their perceptions of the students. Likewise, personal experiences such as their own as a student informed the manner in which they construct their experiences with these students. Some participants felt that more concer n was placed on students who previously had no history of academic or attendance problems, than on students who had some type of history of school related issues. (This finding was confirmed during the observation of a student study team meeting where a similar scenario was played out. This particular meeting wa s not in the protocol, but the school principal insisted that I observe this meeting). Terminology that school personnel used varied and no one brought up the term school refusal. There was however a distri ct level person who used the term, but it was because of her contact with someone who had more information on my study. I am going to make sure that no letters mention the term school refusal. It will only include a description of the student behavior. Some other interesting terms used to describe the students included: retrievable, social niche issues, truants, disenfranchised, ESOL, unsuccessful in academics, illness, chronics, and frequent flyers, just to name a few. School pers onnel appear to create working terms to describe groups of students, although th ere was little overlap in the actual terminology used. District level interviews were quite different from the school level interviews. They described students in terms that are more general and had fewer examples to share than the school leve l personnel had. These interviews may take less time overall. Some of the findings from the pilot observations included the following: After an hour, things start to look th e same. Based on two raters conducting observations for 1 hours, findings were almost identical. For the main study, observation time will be reduced by 50%. If there appears to be more data that will be useful, this time will be increased. Some of the findings from the pilot survey included the following: Only one survey was returned and that was after a follow-up survey was sent.

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347 Appendix M (Continued) Survey took approximately 30 minutes to complete. One question was not answered as responde nt indicated they did not track that particular information. It was apparent (and expected) that respons es in some cases will be estimates or approximations, therefore there is the pot ential for either underreporting or over reporting. Personnel who assisted in completing this survey included attendance staff and guidance counselors.

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348 Appendix N: Identification and Intervention in School Refusal Students who are refusing school are id entified by the most obvious means available, which is their attendance reco rd. Nowhere in the process of primary identification of students are there delineations made, with most students grouped under a general umbrella of patterns of non-a ttendance. Schools are required to track attendance; therefore, they are able to identify excessive absences. They also are required to delineate between excused and unexcused absences. Excused absences are noted when parents provide a legitimate excuse, by calling the school or sending a doctors note. Unexcused absences have penalties attached after a student accrues a certain amount. Likewise a formal, district-wide process of intervention is initiated after five and ten da ys of unexcused absences. More emphasis is placed on the identification of unexcused absenc es. This is important to note, as there may be students sliding through unidentifie d because their absences are excused. Personnel emphasized that when and how a student is identified must be done carefully as the most obvious i ndicator of excessive absences is so vague. Participants described attendance records, patterns, and educational history as s ources of information to assist in identification of school refusal. Student or parent confer ences also add further insight and detail into the pro cess. In rare cases, participants said parents would actually call the school to identify that their child was refusing to attend, mostly in cases where the student was physically refusing, defiant, or fearful, and the parent was looking for help. Attendance Records The most apparent issue with relying on attendance record s is that it reveals little about the nature or reason for the absence. The actual differentiation of students does not seem to occur until after they have been identified as having a general attendance problem, unless there are overt behaviors such as crying or ph ysical refusal to come to school. Additionally attendance records rely heavily on reliable, valid, and timely bookkeeping and review of records, which is not always possible or feasible. Overall, all personnel cited the use of an attendance bulletin. Some described this as a list that contains the name of all abse nt students (both excused and unexcused), or in some cases only the excused students. Cert ain personnel are responsible for reviewing such bulletins at varying inte rvals, such as every two week s although this did not appear to be a standard. This is a common responsibility for assistant principals. R: Basically whatll happen isI mean I run a printout where what Ill do is Ill run a printout every couple of days of students with excessive absences. I: And what do you mean when you say excessive? R: Well what Ill do is Ill put in a da te from like 3 weeks ago through today and then I want a printout of it for consecutive absences meaning two or more. And then what Ill do is Ill go through the list with myself and the

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349 Appendix N (Continued) other AP. And what well do is try to identify ones that are chronically absent. And what you look for like youre looking at one with 10 absences. That needs to be addressed (Mr. Sanders, high school assistant principal). Other personnel who reported using the at tendance bulletin to check for patterns included guidance counselors, social work ers, and school psychologists. Teachers, although aware of the attendance bulletin, more often cited their ow n daily attendance records for recognition of patterns of absences among their students. Identifying Patterns of Non-Attendance Patterns of non-attendance were also reported as a common way of identifying students. Students who miss five or more days consecutive days, or patterned days (i.e., every Monday and Friday) will catch personnels attention. One school reported the use of a monito r system, in which one teacher is responsible for monitoring the attendance for se veral classes. This teacher places daily calls to the homes of all absent students within their designate d group. The idea is to catch issues before they deve lop into serious problems. Few schools reported any type of identification system or protocol. One social worker indicated that, Some schools dont identify much. Some schools are very diligen t about identifying them and other schools could care less. Key School Personnel and thei r Role in Identification Teachers are most commonly thought of as being the first person to identify students, bearing the responsib ility of identifying and refe rring students when an issue arises. In this aspect, teachers play a critical role as gate keeper to students access to other personnel and their services. Sometimes the identi fication referrals go through multiple layers or sources, with the most common path going from the teacher to the guidance counselor on to the social worker. A teacher will notify through the school guidance counselor that this student has missed 10 unexcused daysthe guidance counselor will notify me (Mr. Hughes, middle school social worker). Health assistants and nurses were consider ed front line in sc reening out students who are having difficulty attendi ng or remaining in classes and refer them on to either the school psychologist or assistant principal. Social workers, guidance counselors, and school psychologists, were neither responsible nor able to conduct primary identification of students. These personnel often float betw een several schools, with the exception of the guidance counselors, and do not have daily contact with all students. Social workers are known as the person in charge of serious attendance issues; howev er, it is only after a student has been referred after multiple attemp ts to solve the problem. At some point, the school psychologist may be asked to evaluate or assist in what was described mostly as a

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350 Appendix N (Continued) team approach. Sometimes it takes place in a more formalized process involving the use of the Child Study Team (see The General Process of Intervention). Personnels level and manner of involvement in the process of identification and intervention varied depending upon their role in the school. It was also dependent upon other personnel getting others involved. In a school setting, youre gonna make your plan as part of a team, like I mentioned, you might get the nurse i nvolved, you might have the guidance counselor so youre never working in a school as just on your own (Ms. Richard, district level). Most participants described key personnel working together as a team to solve a problem, although some personnel have individua l involvement and responsibility. At the high school level, an assistant principal usua lly had the role of reviewing the attendance bulletin and working with students, where as in middle school this responsibility was commonly assigned to a guidance counselor. Personnel such as career specialists, resource officers, student affairs office secretaries, and student inte rvention specialists are less involved as key personnel. Sometimes a career specialist or a student in tervention specialist might be asked to work with a particular student who is refusing to a ttempt to re-engage the student or help with goal setting. School resource officers are infreq uently involved, and if so, it is by the request of the social worker. Social worker s will ask the resource officer to accompany them on home visits or take students to th e local truancy center. A few participants mentioned the student affairs secretaries, as they sometimes have a good idea of which students are refusing school because they see the student signing out repeatedly. One participant discussed the impor tance of personnel like custodian s, bus drivers, and other non-instructional staff. These are considered personnel who interact with students in a less formal setting, and might see other indicators that other personnel miss. The Process of Intervening The identification of students who are re fusing school or are de veloping a pattern of non-attendance is the first step in the pr ocess of intervention. A general protocol is used by all schools for interveni ng in cases of excessive absent eeism, or the cases that are considered chronic. The distri ct protocol starts once a referral is made to the school social worker. This occurs after the sc hool level protocol has been exhausted. School Level Intervention What happens prior to a student progressi ng to chronic is left somewhat to the schools discretion, although there are general steps provided by the district and state statutes that must be include d. Schools submit a protocol to the district and are required to adhere to the implementation and conduction of it. Typically, this process is to be initiated with all students who are missing excessive days of school regardless of motivations or reasons for the absences. This process is important, as it should ideally

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351 Appendix N (Continued) catch students who are having difficulty a ttending school, for whatever reason, before it progresses to a severe problem. The General Process of Intervention Overall, there is a general process of early interventi on, but it varies from school to school by the order step s are taken, the consistency between personnel, and the assigned responsibilities. Theref ore, the following description has been gleaned from the data as a generic process that unfolds w ithin individual schools. Personnel described exceptions to the rule; therefore, deviations from this protocol are expected and are described later. At the most basic level, all schools repor tedly have a call system in place that makes daily telephone calls to the homes of students who are absent to alert parents. Although the district level pa rticipants described the telephone calling system, few schools indicated they had such a system. The first step in most descriptions of the process of interventi on includes a teacher not icing a pattern of ab sences and alerting another person within the school, such as a guidance counselor. Some participants indicated that teachers are responsible for calling the homes of students who are absent on a daily basis, although many acknowledged that this become s difficult with the class load most teachers have. Other participants expl ained that the student affairs office or the attendance clerk is responsible for this type of daily follow-up. This effort of making daily calls is mandated by both state educat ion law and district level procedures. After a student has five ab sences (unexcused or excu sed), a letter is generated automatically and mailed to the home. School attendance records are used to determine this. Most participants reported that the attendance clerks are responsible for the consistency and accuracy of the attendance records; however, it is reliant on teacher records. Attendance is often taken in all clas ses, but there is usua lly a designated class during the day for attendance records (i.e., homeroom or second period). Once it is determined that a student ha s missed five days, the student affairs office, the attendance clerk, or the social worker mails the letter. After the five-day letter, attempts are supposed to be made to c ontact the parent and schedule a meeting. Additionally, an interventi on form should also be initiated. After doing over 60 interviews, an assistant principal at a high sc hool pulled out a form to show me. I had not heard of nor seen this form until this point in the study. The form is in triplicate form, and is used to document all actions taken within th e process from the first letter that is mailed, the dates of all accrued absences, meetings, fo llow-up letters, referrals to the Child Study Team, interventions, and any outcomes. Due to the infrequent mention of this form, I am uncertain as to the consistency of its use. Howe ver, the form is from the district level and intended to be used for such documentation. Some of these kids arent even going to get identified unless somebody does the paperwork to identify those children, okay, first off. If a teacher doesnt write a referral, the assistant principals never goi ng to know that theyre absent in the

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352 Appendix N (Continued) classroom 32 times okay. So theres a cer tain amount of likethe teacher would have to be proactive (Mr. Rooney, high school guidance counselor). A second letter is sent after 10 unexcused absences. Once absences progress past a minimum of 10 unexcused, a date is set for a Child Study Team meeting. At this meeting, a team of school personnel meets. Prio r to the meeting, the students cumulative record as well as the students attendance reco rd is reviewed. At this meeting, the team considers referring the child to the social worker If they agree to refer the student, a form is completed (which does not require parental signature or consent), and a copy is mailed to the parent. The social worker then ha s the main responsibility for the case. Social work interventions. Social workers constitute the main pe rsonnel from student support services who are responsible for chronic cases of non-attendan ce. The social worker has a set series of steps that they follow as well. Once receiving the attendance referral from the Child Study Team, they may consult with other person nel within the school. Given the role as a social worker, they also interview the stude nt, sometimes the parent, or caregiver, and conduct a home visit. This is done to a ssess the home environment and the family dynamics to help determine if they play in the attendance problem. Social workers develop an attendance plan for the student, an d monitor adherence to that plan. Depending upon the success of this plan, the social worker will write a final report, and determine whether further intervention is needed. If the problem does not improve, the social worker can refer to the student and their family on to the Attendance Review Board process, which is for the elemen tary level, or Case Staffing process, which is for the secondary level. At each of th ese levels, the process can lead to legal prosecution of the parents or th e child. This is the most seri ous stage of the process, but according to most participants, it is rarely pursued, as it is lengthy and once a student is 16, it is no longer necessary.

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ABOUT THE AUTHOR Anna Torrens Salemi received a Bachelors Degree in International Studies with a minor in Political Science in 1998 from the Univ ersity of Tampa, Florida, while working at the National Conference for Community and Justice. She received her M.P.H. with a concentration in Health Educa tion in 2001 from the University of South Florida, College of Public Health. Entering the Ph.D. program at the Univ ersity of South Florida in 2001, Ms. Torrens Salemi was active in several resear ch projects, including an evaluation of the Florida Coordinated School Health pilot pr ogram, and Sarasota Countys Demonstration Grant Counseling for Today for Learni ng Tomorrow. She has coauthored two publications, one in the American Journal of Health Educatio n, and another in the Florida Public Health Review. She currently serv es on the Health Counc il of West Central Florida, the local School Health Advisory Committee, and the Flor ida School Health and Education Consortium.


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Salemi, Anna Marie Torrens.
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The social construction of school refusal :
b an exploratory study of school personnel's perceptions
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ABSTRACT: Despite a multi-disciplinary, international literature, little research has drawn attention to the phenomenon of school refusal within the school. Most research on school refusal follows a positivist paradigm, focusing on the student, instead of examining the role of schools. Using a qualitative design and a social constructionist framework, this study explored how school personnel perceive school refusal, focusing on the social interactions, processes, and perceptions that construct their understanding. The study was conducted in a large school district in the Southeastern United States.Semi-structured in-depth interviews were conducted with school personnel at the middle school (N=42), high school (N=40), and district level (N=10). Interviews at the school level included assistant principals, school psychologists, social workers, health services staff, guidance counselors, teachers, attendance office staff, and school resource officers. The district level interviews incl uded personnel in departments related to guidance, psychology, school health services, and social work. Observational data was collected within the schools selected for interviews (N=10). Thirty-eight out of 68 middle and high school principals in the school district completed the Survey of School Refusal.Findings suggest that school personnel rarely use the terminology set forth by the professional literature to describe the spectrum of school refusal. Further, analysis revealed that personnel delineate students who refuse school according to their own categorizations formed through day-to-day experiences with students. Personnel's constructions of school refusal differed based on legitimacy of the reason for refusal, motivation for refusal, grade level, and barriers, which were physical, mental, emotional, social, and societal in nature. Overarching dynamics of typifications of students included parental control, parental awareness, student locus of control, blame, and victim status. ^These typifications influence how personnel react to students they encounter, particularly in deciding who needs help versus punishment presenting very real implications for students.The findings from this exploratory qualitative study make a significant contribution to this literature. The findings support the use of social constructionism in understanding school personnel's construction of school refusal. Implications for education, public health, and school health practice are presented and include recommendations for policy, training, prevention, early intervention, and future research.
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school attendance.
Absenteeism.
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School personnel.
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