Treatment of School Refusal: Common Components and Unique Perspectives from Three Clinical Directors of School Refusal Treatment Programs

Friday, April 6: 9:00 AM  - 10:00 AM 
Mezzanine Level 
Room: Hoover 
School refusal is a complex phenomenon that affects between 5 and 28% of you and presents with myriad proximal and distal antecedents including child, family, school, and community variables that interact to produce entrenched behavior patterns that are quite difficult to treat effectively and of youth. In addition, school refusal results in short and long-term sequela that often place the affected child on a different developmental trajectory that includes poor academic functioning, impaired social functioning, and lowered self-efficacy, as well as challenges as adults including higher rates of unemployment, marital discord, and the presence of persistent mental disorders. Unfortunately, while effective treatment is essential for these youth and their families, it is tragically and very difficult and often very expensive to obtain.
This roundtable brings together three directors of school refusal treatment programs to discuss shared treatment components such as psychoeducation, exposure therapy, parent training, and school consultation, as well as shared challenges such as treatment avoidance, family noncompliance, and medical comorbidity. The presenters will also discuss unique approaches to the treatment of school refusing youth such as phone coaching of parents, home visits, in-vivo exposure therapy in the school building, and the possible use of law enforcement to compel attendance. In addition, the benefits and limitations of institutional differences between a hospital affiliated Intensive Outpatient Program (IOP), a hospital affiliated outpatient treatment program, and an independent outpatient treatment program will be discussed.
Finally, practical considerations will be addressed such as how to assist a family in finding community resources and funding sources, how to handle a wait list with this acute population, where to refer patients whose clinical need exceed the clinical resources of existing treatment, and how to obtain appropriate clinical training to effectively treat this challenging population.
Jonathan Dalton, Ph.D. is the founder and director of the Center for Anxiety and Behavioral Change, a specialty psychology practice that focuses the treatment of anxiety-based school refusal. Anthony Puliafico, Ph.D. serves serves as director of the Columbia University Clinic for Anxiety Related Disorders (CUCARD) Westchester and directs CUCARD Westchester's School Refusal Program. Patrick McGrath, Ph.D. is the Co-Director of the School Anxiety/School Refusal Program at Amita Health Alexian Brothers Behavioral Health Hospital and President of the Anxiety Centers of Illinois. The target audience are professionals with experience in treating adolescents and children with anxiety disorders and who are looking for more specialized information regarding the treatment of school refusal.

Learning Objectives

1. Participants will be able to identify three essential components of the treatment of school refusal
2. Participants will be able to identify common challenges to the effective treatment of school refusal
3. Participants will be able to demonstrate an understanding of how to obtain additional training to become proficient in the treatment of school refusal 


Jonathan Dalton, PhD, Center for Anxiety & Behavioral Change


Jonathan Dalton, PhD, Center for Anxiety & Behavioral Change
Patrick McGrath, PhD, AMITA Health; Alexian Brothers Behavioral Health Hospital
Anthony Puliafico, PhD, Columbia University Medical Center

Audience Level



Children & Adolescents


Diversity - No


60 minutes


Anxiety Disorders

Treatment Approach