Lester Kathryn J, McDonald Brontë, Tunks Alice, Michelson Daniel
School of Psychology, University of Sussex, Brighton, UK.
Primary Care and Public Health Department, Brighton and Sussex Medical School, Brighton, UK.
Child Psychiatry Hum Dev. 2024 Sep 19. doi: 10.1007/s10578-024-01755-6.
The aftermath of the Covid-19 pandemic has seen an increase in persistent school absenteeism and Emotionally-Based School Avoidance (EBSA). However, suitable evidence-based psychological interventions are often unavailable. We aimed to assess the feasibility and acceptability of a new parent-focused online program, Intervention for School Anxiety and Absenteeism in Children (ISAAC), which has been co-designed with parents and practitioners. This exploratory mixed-method study recruited participants from three schools in southern England, enrolling N = 9 parents for whom a child, aged 5-11 years, was experiencing signs of EBSA. The intervention consisted of three web-based psychoeducational modules respectively addressing parental stress, accommodating parenting behaviors, and communication with school staff. Module completion was assisted by weekly calls with a non-specialist "coach." Feasibility was measured using indicators of retention, module participation, overall program completion and coaching fidelity. Acceptability was assessed using semi-structured interviews, module ratings and written qualitative feedback. We also explored baseline-post change in parent-reported measures of children's school avoidance, absences, anxiety, parental stress, accommodating parenting behaviors, and quality of parent-school communication. Overall, the intervention was feasible to deliver to parents with six (67%) participants completing the full intervention. Participants found the intervention acceptable across thematic domains of affective attitude, burden, coherence, self-efficacy and perceived effectiveness. Participants particularly appreciated the coach's support. We observed small to moderate reductions in school avoidance behaviours (d with Hedges correction = 0.36), child anxiety (d with Hedges correction = 0.33) and accommodating behaviours (d with Hedges correction = 0.44) at the post timepoint compared to baseline. In conclusion, ISAAC shows early promise with the potential to deliver scalable online support for families affected by emerging EBSA. Future research should move toward establishing effectiveness in a randomized controlled trial.
新冠疫情之后，持续的学校缺勤和基于情感的学校回避行为（EBSA）有所增加。然而，合适的循证心理干预措施往往难以获得。我们旨在评估一项新的以家长为重点的在线项目——儿童学校焦虑与缺勤干预项目（ISAAC）的可行性和可接受性，该项目是与家长和从业者共同设计的。这项探索性混合方法研究从英格兰南部的三所学校招募了参与者，招募了N = 9位家长，他们5至11岁的孩子出现了EBSA的迹象。干预包括三个基于网络的心理教育模块，分别针对家长压力、适应性养育行为以及与学校工作人员的沟通。通过与非专业“教练”的每周通话来协助完成模块学习。可行性通过留存率、模块参与度、总体项目完成情况和教练忠诚度指标来衡量。可接受性通过半结构化访谈、模块评分和书面定性反馈来评估。我们还探讨了家长报告的孩子学校回避、缺勤、焦虑、家长压力、适应性养育行为以及家校沟通质量等指标在基线至干预后的变化。总体而言，该干预对家长来说是可行的，有6名（67%）参与者完成了全部干预。参与者认为该干预在情感态度、负担、连贯性、自我效能感和感知有效性等主题领域是可接受的。参与者特别感谢教练的支持。与基线相比，我们观察到在干预后时间点，学校回避行为（经Hedges校正的d值 = 0.36）、儿童焦虑（经Hedges校正的d值 = 0.33）和适应性行为（经Hedges校正的d值 = 0.44）有小到中度的减少。总之，ISAAC显示出早期的前景，有可能为受新出现的EBSA影响的家庭提供可扩展的在线支持。未来的研究应朝着在随机对照试验中确定有效性的方向发展。
