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Published in: Trials 1/2019

Open Access 01-12-2019 | Anxiety | Study protocol

The Back2School modular cognitive behavioral intervention for youths with problematic school absenteeism: study protocol for a randomized controlled trial

Authors: Mikael Thastum, Daniel Bach Johnsen, Wendy K. Silverman, Pia Jeppesen, David A. Heyne, Johanne Jeppesen Lomholt

Published in: Trials | Issue 1/2019

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Abstract

Background

School absenteeism (SA) is associated with anxiety, depression, and disruptive behavior. It is a risk factor for academic difficulties and school dropout, which predict problems in adulthood such as social, work-related, and health problems. The main goal of this study is to examine the initial effectiveness of a modular transdiagnostic cognitive behavioral therapy (CBT) intervention (Back2School) for increasing school attendance and decreasing psychological problems, relative to a comparator control arm (treatment as usual [TAU]).

Methods/design

One hundred sixty children, aged 7 to 16 years, will be randomly assigned to either Back2School or TAU. The design is a two (Back2School and TAU) by four (preassessment [T1], postassessment [T2], and 3-month [T3] and 1-year [T4] assessments) mixed between-within design. The primary outcome is school attendance based on daily registration. Secondary outcomes pertain to youth psychosocial functioning, quality of life, bullying, self-efficacy, and teacher-parent collaboration. These secondary outcomes are measured via youth, parent, and teacher reports.

Discussion

This study will provide critically needed empirical evidence on the initial effectiveness of a manualized treatment program for youth with SA. If the intervention is found to be effective, the program can be further implemented and tested in a larger school health effectiveness trial.

Trial registration

ClinicalTrials.gov, NCT03459677. Retrospectively registered on 9 March 2018.
Appendix
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Literature
2.
go back to reference Egger HL, Costello EJ, Angold A. School refusal and psychiatric disorders: a community study. J Am Acad Child Adolesc Psychiatry. 2003;42(7):797–807.PubMedCrossRef Egger HL, Costello EJ, Angold A. School refusal and psychiatric disorders: a community study. J Am Acad Child Adolesc Psychiatry. 2003;42(7):797–807.PubMedCrossRef
3.
go back to reference Kearney CA. School absenteeism and school refusal behavior in youth: a contemporary review. Clin Psychol Rev. 2008;28(3):451–71.PubMedCrossRef Kearney CA. School absenteeism and school refusal behavior in youth: a contemporary review. Clin Psychol Rev. 2008;28(3):451–71.PubMedCrossRef
4.
go back to reference McShane G, Walter G, Rey JM. Characteristics of adolescents with school refusal. Aust N Z J Psychiatry. 2001;35(6):822–6.PubMedCrossRef McShane G, Walter G, Rey JM. Characteristics of adolescents with school refusal. Aust N Z J Psychiatry. 2001;35(6):822–6.PubMedCrossRef
5.
go back to reference Baxter SD, Royer JA, Hardin JW, Guinn CH, Devlin CM. The relationship of school absenteeism with body mass index, academic achievement, and socioeconomic status among fourth-grade children. J Sch Health. 2011;81(7):417–23.PubMedPubMedCentralCrossRef Baxter SD, Royer JA, Hardin JW, Guinn CH, Devlin CM. The relationship of school absenteeism with body mass index, academic achievement, and socioeconomic status among fourth-grade children. J Sch Health. 2011;81(7):417–23.PubMedPubMedCentralCrossRef
6.
go back to reference Carroll HCM. The effect of pupil absenteeism on literacy and numeracy in the primary school. Sch Psychol Int. 2010;31(2):115–30.CrossRef Carroll HCM. The effect of pupil absenteeism on literacy and numeracy in the primary school. Sch Psychol Int. 2010;31(2):115–30.CrossRef
7.
go back to reference Evans LD. Functional school refusal subtypes: anxiety, avoidance, and malingering. Psychol Schools. 2000;37(2):183–91.CrossRef Evans LD. Functional school refusal subtypes: anxiety, avoidance, and malingering. Psychol Schools. 2000;37(2):183–91.CrossRef
8.
go back to reference Hancock KJ, Shepherd CCJ, Lawrence D, Zubrick SR. Student attendance and educational outcomes: every day counts. Canberra: Department of Education, Employment and Workplace Relations; 2013. Hancock KJ, Shepherd CCJ, Lawrence D, Zubrick SR. Student attendance and educational outcomes: every day counts. Canberra: Department of Education, Employment and Workplace Relations; 2013.
10.
go back to reference Maynard BR, Mccrea KT, Pigott TD, Kelly MS. Indicated truancy interventions for chronic truant students: a Campbell systematic review. Res Soc Work Pract. 2013;23(1):5–21.CrossRef Maynard BR, Mccrea KT, Pigott TD, Kelly MS. Indicated truancy interventions for chronic truant students: a Campbell systematic review. Res Soc Work Pract. 2013;23(1):5–21.CrossRef
11.
go back to reference Maynard BR, Heyne D, Brendel KE, Bulanda JJ, Thompson AM, Pigott TD. Treatment for school refusal among children and adolescents: a systematic review and meta-analysis. Res Soc Work Pract. 2018;28(1):56–67.CrossRef Maynard BR, Heyne D, Brendel KE, Bulanda JJ, Thompson AM, Pigott TD. Treatment for school refusal among children and adolescents: a systematic review and meta-analysis. Res Soc Work Pract. 2018;28(1):56–67.CrossRef
12.
go back to reference Chorpita BF, Weisz JR, Daleiden EL, Schoenwald SK, Palinkas LA, Miranda J, et al. Long-term outcomes for the Child STEPs randomized effectiveness trial: a comparison of modular and standard treatment designs with usual care. J Consult Clin Psychol. 2013;81(6):999–1009.PubMedCrossRef Chorpita BF, Weisz JR, Daleiden EL, Schoenwald SK, Palinkas LA, Miranda J, et al. Long-term outcomes for the Child STEPs randomized effectiveness trial: a comparison of modular and standard treatment designs with usual care. J Consult Clin Psychol. 2013;81(6):999–1009.PubMedCrossRef
13.
go back to reference Kearney CA, Graczyk P. A response to intervention model to promote school attendance and decrease school absenteeism. Child Youth Care Forum. 2014;43(1):1–25.CrossRef Kearney CA, Graczyk P. A response to intervention model to promote school attendance and decrease school absenteeism. Child Youth Care Forum. 2014;43(1):1–25.CrossRef
14.
go back to reference Lyon AR, Cotler S. Multi-systemic intervention for school refusal behavior: integrating approaches across disciplines. Adv School Ment Health Promot. 2009;2(1):20–34.CrossRef Lyon AR, Cotler S. Multi-systemic intervention for school refusal behavior: integrating approaches across disciplines. Adv School Ment Health Promot. 2009;2(1):20–34.CrossRef
15.
go back to reference Weisz JR, Chorpita BF, Palinkas LA, Schoenwald SK, Miranda J, Bearman SK, et al. Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: a randomized effectiveness trial. Arch Gen Psychiatry. 2012;69(3):274–82.PubMedCrossRef Weisz JR, Chorpita BF, Palinkas LA, Schoenwald SK, Miranda J, Bearman SK, et al. Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: a randomized effectiveness trial. Arch Gen Psychiatry. 2012;69(3):274–82.PubMedCrossRef
16.
go back to reference Chu BC, Crocco ST, Esseling P, Areizaga MJ, Lindner AM, Skriner LC. Transdiagnostic group behavioral activation and exposure therapy for youth anxiety and depression: initial randomized controlled trial. Behav Res Ther. 2016;76:65–75.PubMedCrossRef Chu BC, Crocco ST, Esseling P, Areizaga MJ, Lindner AM, Skriner LC. Transdiagnostic group behavioral activation and exposure therapy for youth anxiety and depression: initial randomized controlled trial. Behav Res Ther. 2016;76:65–75.PubMedCrossRef
17.
go back to reference Arendt K, Kjerholt C, Jeppesen P, Jørgensen L. Mind My Mind Manual – træning af tanker, følelser og adfærd for skolebørn [Mind My Mind treatment Manual – training of thoughts, feelings and behaviour for schoolchildren]. 2nd ed. Copenhagen: Danish Mental Health Foundation; 2016. Arendt K, Kjerholt C, Jeppesen P, Jørgensen L. Mind My Mind Manual – træning af tanker, følelser og adfærd for skolebørn [Mind My Mind treatment Manual – training of thoughts, feelings and behaviour for schoolchildren]. 2nd ed. Copenhagen: Danish Mental Health Foundation; 2016.
18.
go back to reference Heyne D, King N, Tonge B, Rollings S, Pritchard M, Young D, et al. The self-efficacy questionnaire for school situations: development and psychometric evaluation. Behav Chang. 1998;15(1):31–40.CrossRef Heyne D, King N, Tonge B, Rollings S, Pritchard M, Young D, et al. The self-efficacy questionnaire for school situations: development and psychometric evaluation. Behav Chang. 1998;15(1):31–40.CrossRef
19.
go back to reference Maric M, Heyne DA, de Heus P, van Widenfelt BM, Westenberg PM. The role of cognition in school refusal: an investigation of automatic thoughts and cognitive errors. Behav Cogn Psychother. 2012;40(3):255–69.PubMedCrossRef Maric M, Heyne DA, de Heus P, van Widenfelt BM, Westenberg PM. The role of cognition in school refusal: an investigation of automatic thoughts and cognitive errors. Behav Cogn Psychother. 2012;40(3):255–69.PubMedCrossRef
20.
go back to reference Heyne DA, Sauter FM, Maynard BR. Moderators and mediators of treatments for youth with school refusal or truancy. In: Maric M, Prins PJM, Ollendick TH, editors. Moderators and mediators of youth treatment outcomes. Oxford: Oxford University Press; 2015. p. 230–66.CrossRef Heyne DA, Sauter FM, Maynard BR. Moderators and mediators of treatments for youth with school refusal or truancy. In: Maric M, Prins PJM, Ollendick TH, editors. Moderators and mediators of youth treatment outcomes. Oxford: Oxford University Press; 2015. p. 230–66.CrossRef
21.
go back to reference Thastum M, Arendt K. Back2School. Manual til behandling af børn med bekymrende skolefravær [Back2School. Manual for treatment of youth with problematic school absenteeism]. Aarhus: Department of Psychology and Behavioral Sciences, Aarhus University; 2017. Thastum M, Arendt K. Back2School. Manual til behandling af børn med bekymrende skolefravær [Back2School. Manual for treatment of youth with problematic school absenteeism]. Aarhus: Department of Psychology and Behavioral Sciences, Aarhus University; 2017.
22.
go back to reference Lyon AR, Cotler S. Toward reduced bias and increased utility in the assessment of school refusal behavior: the case for diverse samples and evaluations of context. Psychol Sch. 2007;44(6):551–65.CrossRef Lyon AR, Cotler S. Toward reduced bias and increased utility in the assessment of school refusal behavior: the case for diverse samples and evaluations of context. Psychol Sch. 2007;44(6):551–65.CrossRef
24.
go back to reference Kearney CA, Silverman WK. Measuring the function of school refusal behavior - the School Refusal Assessment Scale. J Clin Child Psychol. 1993;22(1):85–96.CrossRef Kearney CA, Silverman WK. Measuring the function of school refusal behavior - the School Refusal Assessment Scale. J Clin Child Psychol. 1993;22(1):85–96.CrossRef
25.
go back to reference Kearney CA, Albano AM. When children refuse school: a cognitive-behavioral therapy approach: therapist guide. 2nd ed. Oxford: Oxford University Press; 2007.CrossRef Kearney CA, Albano AM. When children refuse school: a cognitive-behavioral therapy approach: therapist guide. 2nd ed. Oxford: Oxford University Press; 2007.CrossRef
26.
go back to reference Kearney CA, Silverman WK. The evolution and reconciliation of taxonomic strategies for school refusal behavior. Clin Psychol Sci Pract. 1996;3(4):339–54.CrossRef Kearney CA, Silverman WK. The evolution and reconciliation of taxonomic strategies for school refusal behavior. Clin Psychol Sci Pract. 1996;3(4):339–54.CrossRef
27.
go back to reference Heyne D, Sauter FM, Ollendick TH, Van Widenfelt BM, Westenberg PM. Developmentally sensitive cognitive behavioral therapy for adolescent school refusal: rationale and case illustration. Clin Child Fam Psychol Rev. 2014;17(2):191–215.PubMed Heyne D, Sauter FM, Ollendick TH, Van Widenfelt BM, Westenberg PM. Developmentally sensitive cognitive behavioral therapy for adolescent school refusal: rationale and case illustration. Clin Child Fam Psychol Rev. 2014;17(2):191–215.PubMed
28.
go back to reference Kearney CA, Albano AM. When children refuse school: a cognitive-behavioral therapy approach: parent workbook. 2nd ed. Oxford: Oxford University Press; 2007.CrossRef Kearney CA, Albano AM. When children refuse school: a cognitive-behavioral therapy approach: parent workbook. 2nd ed. Oxford: Oxford University Press; 2007.CrossRef
29.
go back to reference Goodman R. Psychometric properties of the Strengths and Difficulties Questionnaire. J Am Acad Child Adolesc Psychiatry. 2001;40(11):1337–45.PubMedCrossRef Goodman R. Psychometric properties of the Strengths and Difficulties Questionnaire. J Am Acad Child Adolesc Psychiatry. 2001;40(11):1337–45.PubMedCrossRef
30.
go back to reference Niclasen J, Teasdale TW, Andersen AM, Skovgaard AM, Elberling H, Obel C. Psychometric properties of the Danish Strength and Difficulties Questionnaire: the SDQ assessed for more than 70,000 raters in four different cohorts. PLoS One. 2012;7(2):e32025.PubMedPubMedCentralCrossRef Niclasen J, Teasdale TW, Andersen AM, Skovgaard AM, Elberling H, Obel C. Psychometric properties of the Danish Strength and Difficulties Questionnaire: the SDQ assessed for more than 70,000 raters in four different cohorts. PLoS One. 2012;7(2):e32025.PubMedPubMedCentralCrossRef
31.
32.
go back to reference Nauta MH, Scholing A, Rapee RM, Abbott M, Spence SH, Waters A. A parent-report measure of children’s anxiety: psychometric properties and comparison with child-report in a clinic and normal sample. Behav Res Ther. 2004;42(7):813–39.PubMedCrossRef Nauta MH, Scholing A, Rapee RM, Abbott M, Spence SH, Waters A. A parent-report measure of children’s anxiety: psychometric properties and comparison with child-report in a clinic and normal sample. Behav Res Ther. 2004;42(7):813–39.PubMedCrossRef
33.
go back to reference Arendt K, Hougaard E, Thastum M. Psychometric properties of the child and parent versions of Spence Children’s Anxiety Scale in a Danish community and clinical sample. J Anxiety Disord. 2014;28(8):947–56.PubMedCrossRef Arendt K, Hougaard E, Thastum M. Psychometric properties of the child and parent versions of Spence Children’s Anxiety Scale in a Danish community and clinical sample. J Anxiety Disord. 2014;28(8):947–56.PubMedCrossRef
34.
go back to reference Daviss WB, Birmaher B, Melhem NA, Axelson DA, Michaels SM, Brent DA. Criterion validity of the Mood and Feelings Questionnaire for depressive episodes in clinic and non-clinic subjects. J Child Psychol Psychiatry. 2006;47(9):927–34.PubMedCrossRef Daviss WB, Birmaher B, Melhem NA, Axelson DA, Michaels SM, Brent DA. Criterion validity of the Mood and Feelings Questionnaire for depressive episodes in clinic and non-clinic subjects. J Child Psychol Psychiatry. 2006;47(9):927–34.PubMedCrossRef
35.
go back to reference Eg J, Bilenberg N, Costello EJ, Wesselhoeft R. Self- and parent-reported depressive symptoms rated by the Mood and Feelings Questionnaire. Psychiatry Res. 2018;268:419–25.PubMedCrossRef Eg J, Bilenberg N, Costello EJ, Wesselhoeft R. Self- and parent-reported depressive symptoms rated by the Mood and Feelings Questionnaire. Psychiatry Res. 2018;268:419–25.PubMedCrossRef
36.
go back to reference Hunt C, Peters L, Rapee RM. Development of a measure of the experience of being bullied in youth. Psychol Assess. 2012;24(1):156–65.PubMedCrossRef Hunt C, Peters L, Rapee RM. Development of a measure of the experience of being bullied in youth. Psychol Assess. 2012;24(1):156–65.PubMedCrossRef
37.
go back to reference Epstein NB, Bishop DS, Levin S. The McMaster Model of Family Functioning. J Marriage Fam Couns. 1978;4:19–39.CrossRef Epstein NB, Bishop DS, Levin S. The McMaster Model of Family Functioning. J Marriage Fam Couns. 1978;4:19–39.CrossRef
38.
go back to reference Miller IW, Ryan CE, Keitner GI, Bishop DS, Epstein NB. The McMaster Approach to Families: theory, assessment, treatment and research. J Fam Ther. 2000;22(2):168–89.CrossRef Miller IW, Ryan CE, Keitner GI, Bishop DS, Epstein NB. The McMaster Approach to Families: theory, assessment, treatment and research. J Fam Ther. 2000;22(2):168–89.CrossRef
39.
go back to reference Kearney CA. Confirmatory factor analysis of the School Refusal Assessment Scale–Revised: child and parent versions. J Psychopathol Behav Assess. 2006;28(3):139–44.CrossRef Kearney CA. Confirmatory factor analysis of the School Refusal Assessment Scale–Revised: child and parent versions. J Psychopathol Behav Assess. 2006;28(3):139–44.CrossRef
40.
41.
go back to reference Canaway AG, Frew EJ. Measuring preference-based quality of life in children aged 6–7 years: a comparison of the performance of the CHU-9D and EQ-5D-Y—the WAVES pilot study. Qual Life Res. 2013;22(1):173–83.PubMedCrossRef Canaway AG, Frew EJ. Measuring preference-based quality of life in children aged 6–7 years: a comparison of the performance of the CHU-9D and EQ-5D-Y—the WAVES pilot study. Qual Life Res. 2013;22(1):173–83.PubMedCrossRef
42.
go back to reference Furber G, Segal L. The validity of the Child Health Utility instrument (CHU9D) as a routine outcome measure for use in child and adolescent mental health services. Health Qual Life Outcomes. 2015;13:22.PubMedPubMedCentralCrossRef Furber G, Segal L. The validity of the Child Health Utility instrument (CHU9D) as a routine outcome measure for use in child and adolescent mental health services. Health Qual Life Outcomes. 2015;13:22.PubMedPubMedCentralCrossRef
44.
go back to reference Heyne D, King NJ, Tonge BJ, Rollings S, Young D, Pritchard M, et al. Evaluation of child therapy and caregiver training in the treatment of school refusal. J Am Acad Child Adolesc Psychiatry. 2002;41(6):687–95.PubMedCrossRef Heyne D, King NJ, Tonge BJ, Rollings S, Young D, Pritchard M, et al. Evaluation of child therapy and caregiver training in the treatment of school refusal. J Am Acad Child Adolesc Psychiatry. 2002;41(6):687–95.PubMedCrossRef
45.
go back to reference King NJ, Tonge BJ, Heyne D, Pritchard M, Rollings S, Young D, et al. Cognitive-behavioral treatment of school-refusing children: a controlled evaluation. J Am Acad Child Adolesc Psychiatry. 1998;37(4):395–403.PubMedCrossRef King NJ, Tonge BJ, Heyne D, Pritchard M, Rollings S, Young D, et al. Cognitive-behavioral treatment of school-refusing children: a controlled evaluation. J Am Acad Child Adolesc Psychiatry. 1998;37(4):395–403.PubMedCrossRef
46.
go back to reference Last CG, Hansen C, Franco N. Cognitive-behavioral treatment of school phobia. J Am Acad Child Adolesc Psychiatry. 1998;37(4):404–11.PubMedCrossRef Last CG, Hansen C, Franco N. Cognitive-behavioral treatment of school phobia. J Am Acad Child Adolesc Psychiatry. 1998;37(4):404–11.PubMedCrossRef
47.
go back to reference Wu X, Liu F, Cai H, Huang L, Li Y, Mo ZJ, et al. Cognitive behaviour therapy combined fluoxetine treatment superior to cognitive behaviour therapy alone for school refusal. Int J Pharmacol. 2013;9(3):197–203.CrossRef Wu X, Liu F, Cai H, Huang L, Li Y, Mo ZJ, et al. Cognitive behaviour therapy combined fluoxetine treatment superior to cognitive behaviour therapy alone for school refusal. Int J Pharmacol. 2013;9(3):197–203.CrossRef
48.
go back to reference Twisk J, de Boer M, de Vente W, Heymans M. Multiple imputation of missing values was not necessary before performing a longitudinal mixed-model analysis. J Clin Epidemiol. 2013;66(9):1022–8.PubMedCrossRef Twisk J, de Boer M, de Vente W, Heymans M. Multiple imputation of missing values was not necessary before performing a longitudinal mixed-model analysis. J Clin Epidemiol. 2013;66(9):1022–8.PubMedCrossRef
49.
go back to reference Heck RH, Thomas S, Tabata L. Multilevel modeling of categorical outcomes using IBM SPSS. New York: Routledge; 2013.CrossRef Heck RH, Thomas S, Tabata L. Multilevel modeling of categorical outcomes using IBM SPSS. New York: Routledge; 2013.CrossRef
50.
go back to reference MacKinnon DP, Lockwood CM, Hoffman JM, West SG, Sheets V. A comparison of methods to test mediation and other intervening variable effects. Psychol Methods. 2002;7(1):83–104.PubMedPubMedCentralCrossRef MacKinnon DP, Lockwood CM, Hoffman JM, West SG, Sheets V. A comparison of methods to test mediation and other intervening variable effects. Psychol Methods. 2002;7(1):83–104.PubMedPubMedCentralCrossRef
Metadata
Title
The Back2School modular cognitive behavioral intervention for youths with problematic school absenteeism: study protocol for a randomized controlled trial
Authors
Mikael Thastum
Daniel Bach Johnsen
Wendy K. Silverman
Pia Jeppesen
David A. Heyne
Johanne Jeppesen Lomholt
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Anxiety
Published in
Trials / Issue 1/2019
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-018-3124-3

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