Systematic Review of Interventions with Some School Involvement for School Refusal in High School-Age Adolescents

Chronic absenteeism is a public health concern. School refusal due to emotional distress is one reason students exhibit chronic absenteeism. The objective of this systematic review was to determine potential aspects of interventions, in school settings or involving a school-based component, that are successful in addressing school refusal among high school-age adolescents. After duplicated records were excluded, 1,864 studies were identified from searches. The abstracts and full text articles were independently reviewed and received two votes from each of the five reviewers using the eligibility criteria. Two reviewers independently evaluated the remaining articles and met to discuss findings with a third reviewer. The 10 articles included eight studies that noted techniques in cognitive-behavioral therapy (CBT) as promising and two studies that considered CBT as effective as other approaches. The study design for three studies were randomized controlled trials. The remaining seven studies were quasiexperimental. Only three of the 10 studies received a high rating using the Quality Appraisal Tool. There was a limited number of quality studies that used rigorous scientific methods and variation in how each study engaged schools. Further exploration and development of interventions with an integral school-based component are needed.