It is essential that intervention is not generic. It must be based on a thorough assessment of individual needs. Once you have developed a formulation of needs you should begin to think about the following to address over time:

• adjustments
• support
• intervention

You may want to refer to the SEN Support Toolkit when producing an intervention plan. If you feel unclear about underpinning needs or interventions then you can seek support from:

• Local authority professionals via the EBSNA pathway
• TEAM UP or the Educational Psychology Service

There are some universal strategies and support systems that are likely to help all children who are experiencing EBSNA. The frequency and intensity may be different as a function of how severe their avoidance is. You should apply the following principles in the majority of cases when designing intervention plans.

The following pages outline the key principles to a good intervention plan.

For some children and young people (CYP), small adaptations may be enough to increase attendance. These adaptations could be to:

• environment,
• expectations,
• and learning.

For others, significant adaptation and adjustment will need to be made as part of a small steps return. Some children will need adaptations to be permanently factored into planning. When developing plans ensure that you have considered any adaptations relevant to all areas of need identified.

It is important that the child or young person is aware of what has been agreed. This is so they feel heard and are clear about the expectations of them. Some simple adaptations could include the following:

Predictable environments

Some pupils struggle with sensory overload. This could be due to hypersensitivity (over-sensitivity) or hyposensitivity (under-sensitivity) to various stimuli. To reduce anxiety, schools can:

• Minimize Uncertainty: Make the school environment as predictable as possible. Provide visual timetables and use social stories for infrequent occurrences.
• Reduce Sensory Overload: This could include adjusting the lighting, minimizing loud noises or creating a calm space where pupils can retreat if needed. Allow different arrangements for situations that produce high sensory load or are socially challenging. For example, lunchtime or PE. Some lessons or situations may need to be removed either short or long term. 
• Individualized Approaches: Recognize that each pupil’s sensory needs may differ. Some may benefit from sensory breaks, while others may need quiet spaces.

Flexible timings and routines

• Allow pupils to arrive at school at different times. This helps to avoid crowded hallways and overwhelming situations.
• Consider alternatives to the school bell, which can be distressing for some.
• Relax uniform regulations on an individual basis to accommodate sensory preferences.
• Provide movement breaks/time-out cards and other systems that allow for regulation during lessons.

Classroom expectations

• Consider buddying and seating arrangements. This allows access to supportive peers and reduces social anxiety.
• Reduce the unknown by agreeing when or that a child will not have to answer questions in front of the class.
• Consider expectations around positive behaviour are too rigid. For example, giving eye contact, remaining still or on a chair.
• Provide alternative spaces in the classroom/school for children to work in when feeling overwhelmed.
• Ensure that work is differentiated. Not only for learning needs but also in recognition that anxiety reduces cognitive functioning.
• Do not impose time limits where not necessary or without adequate practice/support.

Some children and young people may be able to increase their engagement with little adjustment or intervention. However, the process of re-engaging for many is a long one. It is important for everyone, especially the child or young person, to understand this.

Every small step should be celebrated. There should be reassurance when things do not go as expected. School attendance is the end of the journey and the focus should remain on engagement along the way. The road to re-engagement is rarely straight up.

It is likely that progress happens in bursts and includes plateaus and regressions. Preparing children, young people and their families for this will stop disappointment from feeding into the anxiety-avoidance cycle.

It is sensible to expect regressions to occur around key transitions such as:

• weekends
• holidays
• new academic year.

Allowing for ‘planned regression’ can allow for more sustained progress. For example, a slightly decreased timetable. It can reduce the burnout that sometimes comes from exertion through the anxiety that these transitions elicit.

Children and young people need strong relationships with adults in school to feel safe. Most early years settings use a key adult model to:

1. help children and young people (CYP) separate from their parents,
2. integrate into an unfamiliar or scary setting,
3. ensure continuity of support when children find it hard to understand/communicate their needs.

Using this model for older children provides the same support as those who are struggling to attend. Older children may be experiencing similar challenges in separation, feeling safe and being able to understand and communicate what is happening to them.

Definition and purpose

• A Key Adult is an individual within the school who has the responsibility of being a consistent/supportive presence for a specific child.
• Their primary purpose is to nurture and advocate for the child. They will provide emotional support and stability.

Key Adult responsibilities

• They are a consistent presence. The Key Adult ensures they are available to the child throughout the school day. They check in with the child during transitions between places or adults. They will check in at agreed intervals or when they recognise arising emotional needs.
•  Emotional Support: They model the role of a trusting adult, offering comfort and understanding. 
• Emotion coaching and co-regulation. These help the CYP to develop their emotional regulation skills. They do this by acknowledging, validating, listening and modelling problem-solving and regulation strategies. This helps children cope with their emotions in the moment.
• The Key Adult advocates for the child’s needs, ensuring they feel heard and understood.

Qualities of an Ideal Key Adult

• Empathy: Understanding and connecting with the child’s emotions.
• Resilience: Remaining steadfast even in challenging situations.
• Imagination: Creatively engaging with the child’s needs.
• Resourcefulness: Finding effective solutions.
• Calmness: Providing a stable presence.
• Acceptance: Embracing the child as they are.

Providing support as a key adult

• You should consider the following when providing support to children and young people in your school:
• Allocate two or three “key adults” to each CYP. These adults serve as points of contact for the child. For most, a group of adults is better so you can plan for continuity of support if a key person is absent. In some extreme cases, a child may need a single key adult.
• Involve the CYP in choosing their key adults where possible. Capitalise on existing relationships.
• Spend time building relationships through enjoyable activities before pushing on more structured activities. See the toolkit section on 'Establishing a rapport' to support your developing relationship.
• If the CYP is not attending school you will need to consider the following to try and establish trust:
  • home visits
  • letters
  • emails
  • phone/video calls
• Focus on active listening and understanding the CYP’s needs.
• Invest in training for staff. Focus on key topics that will help adults understand how to support EBSNA children. These could include:
  • Attachment
  • Trauma
  • Emotion coaching

Routines must be clear, communicated and adhered to by all 

It is important to ensure that a child or young person (CYP) feels:

1. welcomed to school each morning,
2. they know what is expected of them,
3. things will not change unexpectedly.

Ensure that routines, expectations and plans when things go wrong are communicated to everyone. Use visual aids to support the child or young person.

Morning routines

• Provide a soft landing for CYPs transitioning from home to school. This might mean transitioning into a preferred activity before going into class.
• Ensure positive verbal and non-verbal communication upon arrival to make CYPs feel welcomed. You may want to rehearse what people say and how the child or young person might respond.
• Create a welcoming environment with displays, lighting, seating, and audio cues which meet sensory needs and help children to feel safe. Relaxing or familiar music can help some children.
• Consider offering a drink or snack upon arrival. If you have provided a breakfast club, consider whether the CYP person may find it easier to arrive for this.
• Communicate drop-off procedures and involve CYPs in decision-making.
• Adapt drop-offs to reduce anxiety. For example, later starts, alternative entrances or the use of transitional objects.

Daily routines and unstructured times

• Explain the day’s routine using a visual timetable after welcoming the CYP.
• Address unstructured times (breaks and lunch) that may be challenging. Establish structure during these times. Identify where CYPs can go and what they can do.
• Ensure that all staff are aware of action plans.
• Plan for continuity of support if a key person is absent.

Anxiety management plans 

• Involve the CYP in devising a plan for heightened anxiety. Include the individual signs and supportive strategies.
• Agree on arrangements for monitoring anxiety levels and offer support early.
• Use co-regulation strategies to help CYP to understand what they are experiencing. Promote regulation techniques.
• Provide visual prompts for communication. For example, 5-point scale, emotion wheel and pictograms.
• Designate safe places for breaks like a 'calm corner'.
• Consider a “calm box” with soothing activities.
• Agree how to ‘step down’ when things continue to be too much. Do this instead of completely avoiding by sending the child home. For example, can transitional objects such as a text message or call to parents reduce their need to go home?

Anxiety management is key but co-regulation comes first

Over time, we hope that children and young people with ESBNA will improve their ability to:

• manage uncomfortable thoughts and feelings
• Manage these across various situations.

Learning self-regulation is a gradual process, and co-regulation serves as its fundamental basis.

Co-regulation is where one individual supports another in managing their emotions and behaviours. It helps individuals soothe and manage powerful emotions, especially during challenging situations. As adults, we’ve learned how to:

• separate ourselves from a stressful situation,
• adapt to the situations,
• and overcome intense feelings.

CYP need support to separate from stressful situations and regulate their emotions. They may not understand triggers or be aware of effective calming mechanisms. Co-regulation involves a connected adult interpreting situations for a child. The adult would use strategies, tools, and guidance to help the CYP to soothe themselves.

Teaching anxiety management strategies to CYP is an important intervention that promotes sustained change. This should include traditional anxiety management techniques as covered later in the toolkit. Take a look at the ‘Planning a small steps return’ section.

When supporting CYP experiencing anxiety the aim is not to eradicate anxiety. Anxiety is a functional emotion, so the goal is to teach them to learn to live it and change their responses to it. Teaching CYP the following is essential:

• Noticing their emotions
• Understanding why they arise
• Thinking flexibly about how they respond to them

Co-regulation strategies should focus on physical regulation as well as these higher-order processes.

Continue to Part 3: Returning to school