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.