Hospital program helps kids face their fears -- of school

Jocelyn Brame was not a fan of sixth grade.

She missed a lot of school because of horrible headaches that lasted for days. When she did go to school, she wanted to be home. She couldn't keep up with the homework assignments she missed, and her friends paired up for class projects without her. She thought other students were whispering about her.

"I was scared all the time," said Jocelyn, who lives in Libertyville. "I was stressed out all the time."

Things didn't get any better in seventh grade. And in eighth grade, Jocelyn missed 48 days of school.

"Her life was taking over our lives," said Judy Brame, Jocelyn's mother. "Every day depended on whether she went to school. Then all day, we worried, did she stay at school all day? Did she come home? This was just not something we could do anymore."

The Brames heard about the school refusal therapy program at Northwest Community Hospital in Arlington Heights - the only one of its kind in the country. It includes inpatient treatment and intensive therapy for both the students and parents.

School refusal behavior is not about a student faking a stomach ache to stay home one day, said Maggie Hahn, the program's clinical coordinator. These students aren't just nervous about school; they're terrified. And the longer they stay home, the harder it is to go back.

"These kids stay home from school one day and then the anxiety builds and builds," Hahn said. "We had one girl who hadn't been to school in two years."

Typically, school refusal behavior strikes kids who are between 12 and 18 years old. It happens to some kids when they face a major transition, such as starting middle school or high school. It affects as many as 25 percent of school kids at some time in their lives - across gender, racial and income groups, Hahn said.

"Parents can't stand to see their child so upset," Hahn said. "Picture it: your child is crying and afraid to go to school. It's pretty darn hard to force them to go to school."

Children with school refusal behavior feel depressed, anxious or fearful about being at school. Some students fear crowded hallways, claustrophobia in the classrooms or bullying. Others lack the necessary social skills, Hahn said.

Since the program started about five years ago, the Northwest Community program has treated between 200 and 300 children from throughout the Chicago area. About half of the 12 beds in the hospital's adolescent mental health unit are for kids with school refusal behavior and there's sometimes a waiting list to enter the program.

After a physical exam, kids with severe school refusal are admitted to a weeklong inpatient program, followed by a week of full-day treatment where the child sleeps at home. The next week, the child spends half of each day at school and the second half day at treatment, while their parents are also in therapy twice a week. Eventually most kids return to school full time - many with the help of anti-depressants or anti-anxiety medication. Still, the chance of relapse is very high, Hahn said.

"You have to stay on top of it," she said. "All of a sudden the child stays home with the flu for three days and then doesn't want to go back to school again."

Kids can call a nurse at the hospital for support if they run into trouble. Hahn has been on the receiving end of many of these calls, which often come on the first day the child is supposed to return to school.

"Once I had to talk a boy out of his house," she said. "I told him, 'I want to hear you brushing your teeth. Good, now I want you to walk out the door,'" Hahn said.

Insurance usually covers much of the program's costs, Hahn said.

Unlike other phobias, kids with school refusal behavior are fine when school is not in session. During the summer, parents often think their kids are cured, Hahn said.

"The longer a child suffers from school refusal behavior and is allowed to stay home, the more difficult it is to return to school," she said. "It's important to seek solutions and get them quickly back on the right track."

Judy Brame agrees with Hahn. Her advice to parents in a similar situation is simple: "Don't wait."

"It's frustrating to admit that a stranger may know your kid better than you, but don't wait another day," she said. "Every new school, we thought it would be different. The teachers are different. The kids are more mature, but don't kid yourself."

Untreated, the behavior gets worse. Kids can become depressed and possibly suicidal. School refusal behavior can affect their college success, relationships and the ability to get a job, Hahn said.

"It's a widespread problem that is often mistreated," Hahn said. "A lot of parents become frustrated and home school the kids, but that should only be a last resort."

Before finding the program at Northwest, Jocelyn's parents tried just about everything. They talked with the school nurse to find a place for Jocelyn to take a break and relax when the headaches started. The had incentives for good attendance, but nothing seemed to help. The nurse's office was too crowded and the headache medicine didn't work. When Jocelyn did return to school she'd find projects already started and all her friends were paired up. Gradually, friends stopped calling her and she couldn't be in the school musical because she missed so many days of school.

The reasons to skip school piled up.

Jocelyn started out with two weeks of full-day treatment at the hospital in the spring of 2007. Then she went to half days, spending the morning at the hospital and the afternoon in her eighth grade classroom. If she started feeling like she wanted to go home, she called the professionals at the hospital instead of her mom.

Today, she actually looks forward to school.

"I love my lit class and seeing my friends," said Jocelyn, 15, and a high school sophomore. "I changed my whole way of thinking. Now everything isn't such a big deal."

She still gets occasional headaches. The difference is now, she knows how to treat them and they don't last for days. Outside of school, Jocelyn is taking tuba, voice and dance lessons. Driver education classes start this week.

After she graduates, Jocelyn wants to attend college and major in music or theater and eventually have a career on Broadway.

"If I can help one kid who is going through what I went through, that would be great," Jocelyn said. "I want to tell them how well I'm doing."

Symptoms of school refusal behavior

• Failing grades

• Frequent physical complaints

• Social problems

• Anxiety or panic attacks

• Depression

• Fatigue

• Dangerous or risk-taking behaviors

• Drug/alcohol use

• Physical aggression or threats

For more information, go to www.nch.org and search "school refusal" or call Northwest Community Hospital Youth Services at (847) 618-4110.