For some children and young people, a robust assessment of needs and appropriate changes to provision/setting may be enough for a return to school. However, for some children and young people, this is not enough. Residual anxiety and loss of trust in adults or their school may mean they need a high level of support. In those cases, investing time in creating a small-step plan for school return is essential. In some cases, this may be put in place over a short period of time. In others, a small-step plan may need to be in place for months or even years.

Before considering a return to school you should have worked through the other sections in this toolkit. This is so you can:

1. Create a shared narrative with the child’s parents
2. Establish a rapport with the child
3. Map out their preferred future and their aspirations
4. Establish the risk and protective factors for the child
5. Understand the factors underpinning their individual EBSNA 

Designing a successful plan is dependent on us having a good understanding of what underpins an individual child’s EBSNA. A good small steps plan:

• Is child-led and reinforced by parents/carers and school
• Is based on what the child finds difficult, not necessarily by timetables or other contextual restrictions
• Progresses methodically from what the child finds the least to the most difficult
• Has small enough steps for the child to be comfortable before progressing
• Is supplemented by direct teaching and practice of anxiety management techniques (see next page)

The next sections will outline underpinning psychological theories and ideas. These should inform small-step planning and offer tools for their design and implementation.

Re-engaging in small steps

Gradually re-engaging an individual with the situations that cause them distress can diminish their emotional, physical and sensory responses.

In some cases, they may fade entirely. In other cases, they may diminish to a level that an individual can self-regulate at least some of the time.

Small steps and regulation

The aim of all small steps plans is to stop the ‘fight or flight’ responses. These can occur when children experience particular tasks or situations in school. Our brain is designed to react to things in our environment when it first encounters them. It then reduces emotional, physical and sensory responses over time. In everyday terms, you might think of it as ‘becoming accustomed’ to a situation or a stimulus.

Consider the following examples:

• You jump into a swimming pool and it feels freezing at first. After a couple of minutes, you stop noticing.
• You put perfume on in the morning and it smells really strong. After a few minutes, you then can't smell it. .
• You are working in a room full of people. At first, you can hear everything others are saying but over time you manage to ‘tune it out’.

When designing a small steps plan we are aiming for the initial fear/emotional response to diminish in a similar way. We want the child or young person to experience the relief of their intense feelings diminishing over time. We want them to be able to regulate them if they still appear at low levels.

How do we make sure regulation can occur?

It is important to be both gradual and methodical in the re-introduction of activities/situations that a child avoids. In doing so we are aiming for the child or young person’s response to be either:

• less than they feared,
• or for it to quickly reduce to a manageable level.

It is important to know that some of the following factors impact on the likelihood of this occurring. 

Changing the stimulus

If the duration or intensity of the stimulus/situation changes you may get a recurrence of the original response. For example, where there has been some initial success, we might ask the child to stay longer than the agreed 10 minutes. This may leave the child in a heightened state of anxiety at the end of the agreed time. It is important not to change the agreed-upon step. 

Duration

If a stimulus/situation has not happened for a long time, you may see a full-strength reaction when it occurs again. For example, we may have successfully got to the point where a child or young person can ‘talk in front of the class’. This does not occur for several weeks so the next time they are asked they experience a spike in anxiety. It is important to continuously work on target situations.

We should be mindful that small steps plans which have been successful may need to be repeated following extended absences. For example, after the school holidays.

Frequency

The more frequently a task or situation is experienced, the quicker the child or young person will learn that it is ok. This is important when planning your reintegration. Working daily on a smaller target is most likely to affect rapid change.

Intensity

If a stimulus is very intense and leads to an extreme emotional response, it is possible that the child will always have a strong response. For example, an alarm. We don’t become accustomed to noises like that. This is because they are intense, uncomfortable and frightening.

Understanding the situations or contexts a child experiences the most anxiety is key to building a plan. Start with the tasks and situations that elicit less fear, anxiety and discomfort. Then tackle situations that need more active management for regulation to occur or that might need continued avoidance in the short term.

Planning for psychological safety

It is important to understand that any reintegration plan is asking a child to:

1. step outside their comfort zone
2. do something they find scary or hard

Their avoidance behaviours are protecting them from unpleasant, even scary, emotions and feelings. We must be mindful of this and ensure that we are asking for something that we believe is manageable.

Parents and advocates for SEN often raise concerns that a planned return might mean asking a child to abandon their psychological defences. It is asking them to learn to accept situations that carry unreasonable expectations. This concern needs to be addressed and thought about throughout in your planning. Consider the following examples:

1. A young person is being bullied by children in their maths class.
2. An autistic child experiences high levels of discomfort in response to the noise in the school hall.

In both situations, we must ensure that we have addressed the needs before considering exposing them to the child.

In the first case, we would need to ensure that you have addressed the bullying. You'll need some reparation work undertaken before working towards attending maths lessons.

In the second case, there would need to be a discussion around having the following in place:

• short-term reasonable adjustments
• equipment
• management techniques in place.

There should be a discussion about the longer-term benefits of going into the hall. Then you can decide whether to include it within the small steps plan. For example:

• Is it likely that the level of discomfort will reduce over time?
• Is it reasonable to take away the requirement of being in the hall?
• Will this be forever?
• Does this have any negative consequences for the child?

We must only ask children and young people to do what we believe to be safe. They must be supported for their own safety and well-being. It is important to know that exposure to a very intense stimulus will not lead to a diminished response. It would in fact undermine the success of a small-steps plan. 

Uncovering situations that lead to avoidance

A good small-steps plan should work systematically. It should go from situations or contexts that are lower intensity to higher intensity. This maximises the likelihood that negative responses diminish. An avoidance hierarchy is an emotion-based ranking of situations, contexts or places that a child or young person finds challenging. It should be the basis for any plan. 

It may be possible to build a hierarchy through simple discussion and mind-mapping with the child or young person. For example, by asking them about the things that they find hard in school. Some children and young people may not be able to articulate and identify their feelings. The toolkit details activities to do with the child/young person and their family to explore the situations, places and contexts that cause them anxiety.

Please refer to the Exploring Individual EBSNA section of the toolkit if you haven't already.

Choosing your steps

Once you have a list of situations or places, you can begin to work with the child or young person to rank them. You may find it helpful to use visual tools to do this such as a ladder, thermometer or pyramid. 

Encourage the child or young person to give a fear or anxiety rating to each level. Keep adjusting the hierarchy until they feel it reflects what they experience. 

Remember you may need several hierarchies to capture the situations that the child or young person avoids. For example, the simple act of putting on a uniform in the morning. If this is very anxiety-provoking, there may be many steps from there to being in a classroom.

It is also possible that some steps within the hierarchy will need sub-hierarchies. For example, ‘going into my Drama class’. This could be one step on the ladder, so you may need another ladder that breaks down that situation further. This could include:

• being in the empty drama studio
• walking into the room when the class are already there
• finding a place to sit 
• the time before the teacher starts when my classmates are chatting
• warm-up exercises and games
• writing down ideas
• working in pairs
• working in small groups
• acting in front of the whole class
• answering the teacher’s questions 

Understanding their experience

It is important to help children and young people understand:

• the functions of anxiety,
• how it is maintained,
• and how to manage it.

By doing so it can help reduce the feeling of hopelessness so many young people experience. The following resources can be useful to show them. It may help them to understand their EBSNA and how you will address it.

• Video: School is not my enemy 
• Video: The Happiness Trap - Evolution of the Human Mind 
• CAMHS: Resources to understand anxiety and anxiety management 

Using anxiety management tools to facilitate regulation 

In some situations, the response to a situation may be too large for a diminished response to occur quickly. Teaching techniques that can help to dissipate the thoughts and feelings linked with anxiety is helpful. Such techniques can increase the likelihood that habituation occurs. It can also help the child or young person feel that they have some control over their responses. In your small-steps planning you should allocate time to teaching anxiety management techniques. Once the child or young person is ready to engage with more challenging situations, they will have strategies to use. It is important to consider developmental levels as well as the capacity to put such strategies in place. As part of the small-steps plan the child or young person may be joined by an adult who can co-regulate. This adult should be able to step them through the strategies to increase the likelihood of habituation.

Information about potential strategies for anxiety management is available on the websites below. You may also find other suggested activities online.

• Anna Freud self-care ideas and resources 
• Videos: Guided meditation exercises (older children and adults)
• Videos: Mindfulness and yoga for younger children