Synopsis
Assess persistent school non-attendance as a functional and safeguarding presentation, identify anxiety, depression, neurodevelopmental, learning, physical-health, bullying, family and access drivers, respond urgently to danger, and coordinate a supportive graded return with education, health and family services.
- Use neutral language such as emotionally based school avoidance or persistent absence while identifying the function; 'school refusal' should not imply wilful defiance or a diagnosis.
- Speak with the young person privately and obtain family and school perspectives, reconstructing when absence began, daily pattern, safe lessons or people, bullying, online events and what happens at home.
- Assess suicide, self-harm, abuse, exploitation, violence, substance use, eating, sleep, homelessness and physical red flags before planning a gradual return.
- Review anxiety, depression, trauma, autism, ADHD, learning need, sensory load, pain and chronic disease; symptoms commonly interact rather than fitting one explanation.
- Physical complaints are real clinical data even when anxiety contributes; examine and investigate proportionately while avoiding repeated tests that reinforce uncertainty and absence.
- Ask the school for attendance pattern, academic and special-educational information, observed peer interactions, bullying reports, adjustments tried and a named safe adult.
- Build a graded, time-limited return that starts with achievable attendance, reliable arrival support, a safe base, planned responses to distress, reasonable adjustments and frequent review.
- Treat the identified anxiety, depression, neurodevelopmental or physical condition and act directly on bullying or unsafe environments; exposure to an unchanged threat is not therapy.
- Coordinate health, school, local authority, family and safeguarding services with one plan and active follow-up; punitive attendance action alone can worsen distress and conceal unmet need.
Key red flags
Suicidal thoughts, self-harm, severe hopelessness, psychosis, intoxication or inability to remain safe requires direct same-day mental-health assessment.
Injuries, sexual symptoms, missing episodes, unexplained gifts or travel, online threats or fear of particular adults or peers may indicate abuse or exploitation.
Marked weight loss, dehydration, fainting, persistent vomiting, severe sleep reversal or uncontrolled chronic disease suggests a medical consequence or alternative cause of absence.
A child who disappears from education or moves repeatedly between settings without confirmed enrolment may be missing education and requires local-authority safeguarding processes.
Sudden attendance decline with headache, neurological signs, fever, inflammatory symptoms, pain waking from sleep or growth change should not be attributed automatically to anxiety.
Investigation priorities
Identify when absence occurs, what precedes it and what consequence maintains it.
Management branches
Assessment identifies suicide, abuse, exploitation, homelessness, serious assault or medical instability.
- Use emergency physical or mental-health care and establish safe supervision and accommodation where required.
- Share information with safeguarding, social care, police or education proportionately and avoid alerting a suspected perpetrator unsafely.
- Record who will see the child, by when, and how a failed contact or missing episode will be escalated.
- Return to education planning only when the immediate environment and crisis response are sufficiently safe.