Working with parents

Working with parents: Creating a shared narrative of EBSNA

Understanding parental experiences

Parents of children experiencing EBSNA may have had a long and challenging journey to get support. They may:

  • have faced daily battles in getting their child to school
  • worry that they are causing trauma to their child by insisting on attendance
  • feel let down by professionals who have failed to acknowledge the level of stress in the child and the family system

It is important that we recognise this as professionals. Close partnership working and consistency in approach are fundamental to being able to make changes. Parents must be involved and in agreement with support and reintegration plans for their children.

Family stress and parental anxiety are understandably high when a child does not attend school. This can undermine even the best plans for reintegration. If a parent does not trust plans in place to meet their child’s needs then a child is likely to have the same or similar anxieties. To support parents/carers we should:

  • Listen to them.
  • Acknowledge that they are important in supporting their child's return to school.
  • Empower them to see a way forward with their child. 
  • Educate them about anxiety and EBSNA. 
  • Ensure they feel supported. Put them in touch with other parents to gain support. 

Individual EBSNA formulation

The first step to developing a successful intervention is to build a picture of the individual child’s EBSNA. You should be inquisitive about their school history and the picture of needs in settings other than in school. This information should be used as a foundation for building an EBSNA formulation. This should set out the individual presentation and needs which underpin it for each child. (A tool to aid your formulation is in Appendix 6).

Over time you will of course need to ensure that the pupil voice is part of your formulation. The next section of the toolkit focuses on engaging children in understanding their EBSNA. It is often sensible to start this discussion with parents and carers as they may be more willing to engage. They may be able to help us understand how their needs have developed over time.

Beginning the EBSNA formulation

EBSNA history

The first section of the EBSNA formulation begins with a history. Invite parents or carers to a discussion. Ask them to talk about how their child has experienced school over time, since their early years. Be open and curious. Ask questions that will help you to understand the functions of the avoidance. See the 4 functions of EBSNA.

Try and ask questions which explore the child’s world beyond the doors of the school as well as within it. Here are some example questions that you might use to help you explore the history:

  • Tell me about when your child first started school. 
  • How does your child feel about school? When did you first notice any concerns? 
  • How does your child cope with the expectations of school? For example, how to behave, homework and exams? How has this changed over time? 
  • Does your child have friends in school? Are there ever any difficulties in their friendships? Have their friendships been stable across the school years? 
  • Does your child happily separate from you? Has this always been the same? Is this true in other contexts? When is it easier/harder? 
  • Are there other places/activities/environments that your child struggles with?
  • Are there any contexts/activities/places where your child is comfortable and confident? 
  • What does your child do when they are home? How is their behaviour/are their emotions different? Where and when are they most relaxed? Has this always been the case?

Use the formulation document to record your initial consultation. Begin to map out any underlying needs which are already apparent. Don’t forget to return to history over time though. It may be that your understanding develops the more you work with the child and the family.

Triggering events and maintaining factors

During your discussion with parents look out for triggering events and maintaining factors. These are things which might not have ‘caused the EBSNA’ in isolation but may have led to an increase in avoidance behaviours or which are a barrier to the child returning. For example:

1. John has always found going to school difficult but things got really difficult in year 3. His teacher told him off in front of the class for ‘messing around’ and he still worries about that today.

2. Jainab has always been a high achiever. Now she worries about how far behind she is and worries that people will think she is stupid.

Tools for working with parents

You may find it helpful either before or after this initial discussion to use tools which can help you further explore the individual needs underpinning a child’s EBSNA. There are various tools available online and below.

The School Refusal Scale

The School Refusal Scale is a self-report scale that parents fill out to identify factors that may be contributing to EBSNA. It is a 24-item measure with 6 items devoted to each function. You may want to manage the language used before sharing this resource with parents and acknowledge that we no longer advocate use of the term ‘refusal’.

Worry time and worry diaries

Ask parents to sit down with their child once a day for a week. They should talk about what worries them when they think about school. This information may help to identify fears that need attention and needs that underpin them.

In Appendix 4 you will find a handout about worries and how to talk to children about them.

Risk and resilience

Psychology research tells us that some children and young people are more likely to experience mental health needs. This includes the anxiety that is common in EBSNA. Examining the risks in a child or young person’s life can help us understand where support might be needed. Examining potential protective factors also helps us to understand the child or young person’s resilience. Protective factors can provide a buffering experience to the negative ones in a child’s life. It is also thought you can teach skills which might promote resilience.

The Science of Resilience video explains more about risk and resilience. 

Use the chart below to talk to parents about the risks to their child’s mental health. You can help everyone understand the protective factors that are present or could be explored further in your action planning. 

Risk factors

  • Family history of mental health needs
  • Learning difficulties
  • Communication difficulties 
  • Physical illness 
  • Low attainment 
  • Low self-esteem  
  • Family breakdown and/or stress
  • Parental substance misuse 
  • Abuse 
  • Parental criminality 
  • Death/loss in the family


  • Bullying 
  • Discrimination 
  • Friendship issues 
  • Poor relationships with teachers 
  • Deviant peer influences 


Resilience factors

  • Secure attachments 
  • Good communication skills 
  • Experiences of success in school or elsewhere 
  • Capacity to reflect 
  • Sense of control 


  • Family stability/harmony
  • Supportive parents 
  • Strong family values 
  • Consistent discipline 
  • Support for education 
  • Support from extended family/friend network  


  • School environments which embrace belonging/connectedness 
  • Clear policies on behaviour and bullying 
  • A whole-school approach to promoting good mental health 
  • Having friends in school and/or at home 


Continue to Working with children: Establishing and rapport

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