Dialectical Behavior Therapy for School Refusal: Treatment Development and Incorporation of Web-Based Coaching

• School refusal is a complex problem that affects youth. Few effective interventions have addressed these concerns.
• Existing treatment approaches for school refusal may have limitations in both the treatment model and delivery system.
• Dialectical Behavior Therapy for School Refusal (DBT-SR) is a novel intervention addressing mechanisms that maintain school refusal behavior.
• A novel web-based coaching component helps provide “real-time” coaching at the times and in the settings of most need.
• An open pilot trial suggested DBT-SR is potentially feasible and acceptable and deserves further evaluation.

Youth school refusal is a significant societal problem with broad negative long-term consequences, yet few treatments have been developed for this population. This paper reports on the development and implementation of a novel treatment program, Dialectical Behavior Therapy for School Refusal (DBT-SR), that attempts to address limitations in both existing treatment models and current delivery systems. DBT-SR employs a multimodal approach to directly address the severe emotional and behavioral dysregulation mechanisms maintaining school refusal behavior. It also incorporates a web-based coaching component to provide active, real-time skills coaching to youth and parents at the times, and in the context, of greatest need (at home, during morning hours). A pilot trial and illustrative case examples provide “proof of concept” that DBT-SR is reasonably feasible and acceptable to clients and therapists and that web-based coaching provides incremental, unique benefit. Significant development remains, as participant recruitment proved a challenge in this trial. However, results suggest that DBT-SR is a promising, novel intervention that deserves further development.