Resources needed - School Refusal / School Avoidance / Anxiety

Seeking advice, referrals, experience, etc. in helping our child (15 years old) who will not leave the house, go to school or see a therapist due to what appears to be anxiety. (likely body dysmorphia, depression and sleep disorder issues, as well) Unfortunately, I can't get my child to leave the house to meet with a doctor or therapist.

He is sweet and kind; no oppositional or defiant behavior, no drug or alcohol use, etc. He wants to change but has not been able to do it on his own and neither have we. This has been going on for quite sometime and was exacerbated the pandemic. We'd really like to find a way to help him without resorting to residential treatment.  We would be open to an outpatient setting but we can't get him to leave the house, so we're at a loss of what to do. 

The thought of having outside professionals forcefully dragging my anxious child out of our home against his will and placing him in a residential treatment facility is heart breaking. If that's what we have to do to help him, we will do whatever it takes but it's my hope that he can be treated at home to begin with, then build up to leaving the house but still live at home. We'd we'd like to exhaust all other resources before resorting to residential.

Your resources and advice are deeply appreciated. 

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I wanted to respond that my heart goes out to you. We are in the same exact position, it started earlier this year. Our daughter, who is now 14 and in eighth grade, has a lot of anxiety, which was exacerbated by the pandemic

She attends a private school. At the moment though, she is homeschooling and completing assignments from her school. We also got her assessed through the school district; I suggest you do the same because your child might be able to get accommodations based on anxiety where is school attendance is such a big factor and another option might present itself.  For example, in our school district, they do have an online program for kids year-round (many students elect into it due to various circumstances, including physical and mental health issues issues).

As a parent, I also joined school refusal FB groups that have been helpful.  If you use FB, you can take a look.

You are an amazing parent that you are supporting  your child.  Please feel free to reach out if you have any further questions.

Scott Weber LCSW is amazing. He has tons of experience with teens in need of supports, going to RTC, alternatives to RTC, etc. 

Other resources include 
Facebook page WTRS Wilderness Therapy and Residential Search (run by parents/guardians of teens who have been through it all) They gave great resources and feedback 

Willow in the Winds

support groups for parents/guardians of kids at risk or in RTC or Wilderness Therapy. They are all online now by Zoom but there are meetings around the Bay Area. Contact jrao [at] willowsinthewind.com for more information or visit the webpage

There are short term programs too such as Paradigm 30-45 days which can be very helpful

Disclaimer: I am not an expert, but have some experience with my own son, who is now 21, away at college, and thriving. He had severe anxiety, panic attacks and some difficulty going to school during middle and high school. What really helped him was therapy with Melinda White on Solano Avenue, along with an SSRI. I think that, if your child won’t leave the house, it would be productive to find a psychiatrist who works via video to get him on an SSRI first. After a couple of months, it’s possible that your son will be able to leave the house to go to therapy. Or maybe you can find someone like Melinda who works online in order to truly treat his anxiety.  I was compelled to write because a therapeutic boarding school sounds perhaps like a drastic measure for your anxious child. My son is still on the SSRI, and occasionally still becomes anxious in certain situations, but he calls me on those rare occasions and we talk through what he leaned in therapy (mostly CBT-based). Best of luck. 

I am so sorry you and your child are dealing with this..... he does need help, but it doesn't sound like extreme measure like you describe would be the best idea. I've been in a similar situation with both my teens..... navigating mental health is really rough.

My first question is whether he's working with a psychiatrist? If not, I'd try to get in with someone you feel he could connect with. Same with a therapist. Both can be done from the comfort of home via telehealth (video call) at first. And both should take an extensive history from you the parent, so your kid has less talking to do ;) You may have to set some boundaries and insist he at least be present and as engaged as he's able with them. My son at one point literally did therapy and psychiatrist appointments from under a blanket on the couch, answering questions as briefly as possible in monosyllabic phrases. A good psychiatrist/therapist can work with this situation.

I can honestly say that the combination of good psychiatric care, therapy, and the right school environment truly saved both my kids' lives.

I wish I could recommend a psychiatrist or therapist with an opening, but sadly it is so hard to get in to many practices right now. I recommend looking at the BPN archives for recommendations and just start calling and telling folks about the situation. You could also try getting on the waitlist at Clearwater Counseling in Oakland, which is a DBT therapy center with great therapists and programs. We received some good referrals while working with them. Both my kids also did CBT therapy, which helped immensely with anxiety. Medication enabled them to actually engage more in the therapy.

It is so hard, but there is a way to find a balance of requiring that your kid get some help while also acknowledging and supporting them lovingly in their struggle. I found that getting therapy myself helped me better support my kids.

Parent of anxious teen boy here (although never an issue with not leaving the house, he did love not having to attend school in person). First thing: Is your son diagnosed with anxiety disorder? Have you had him assessed yet for any mental health issues? We had our son diagnosed through the MIND Institute (through UC Davis Medical Center, located in Sacramento). They are excellent; it's possible they can work with you via Zoom. I'd start with them. 

He will likely need to be medically managed. My son works remotely with Dr. Laura Nasatir. My son is on a very high dose of Sertraline (Zoloft) and his anxiety has become incredibly well managed, although not without issue. 

Once you get your son assessed and diagnosed, I highly recommend calling the Anxiety Treatment Center. It is in Rancho Cordova, but they may be able to recommend similar programs in the Bay Area (I think that Stanford maybe has a similar program?). They run an IOP and a PHP: Intensive Outpatient Program, or Partial Hospitalization Program. My son has been attending the IOP for two weeks so far, and it is really amazing what it's done for him. The group is for adolescents in his age range only. (They have various groups for various age ranges.)

I would absolutely NOT turn to a residential treatment center complete with the "child grab" approach unless you were working with an expert and that's the last resort (I can tell you don't want to do that). Those programs are often meant for kids with various types of disorders. For example, our son was enrolled in an IOP through our local hospital, and it was a terrible fit; all the other kids had very different issues (suicide attempts, self-harm) and our son with his anxiety and OCD simply didn't fit in; it wasn't therapeutic for him. So be sure to do your due diligence on PHP and IOP options. 

You may ask the facilitator for my contact info if you'd like to talk any of this through. It's tough, but we have had things really turn around and it's been the first time that we've seen our son's anxiety (and other issues) lessen through all of the other types of therapies that we've tried. 

Many therapists are working online these days, would your son consider talking to someone through a screen? We have a similar child, although body image issues and sleep issues (and mild depression) have not caused anxiety or withdrawal. We've found that therapy and some form of movement are a great help. Maybe your son would agree to taking a walk around the block with you at night when it is dark and no one can see him? Walking and talking are very good therapy too. You don't mention gaming or online schooling. Speaking from experience with anxiety myself, the longer he is away from a 'normal' teen existence the harder it will be for him to reenter society, so I would do whatever you need to get him help, and it sounds like you are willing to do so. I wish I had more advice, but I hope that talking to a therapist online might be an option for him. You might also try to find one who will come to you - hopefully someone has a good referral for you - wishing you the best outcome!

So much empathy here. The pandemic has really created a mental health epidemic for....well, everyone. 

We have been dealing with this since Fall 2019 with my now almost 15 yr old and it has been difficult but there are so many more resources out there than I had ever realized. My kid has anxiety and depression, which presents in self-harm and inability to go out/go to school/leave the bedroom/bed, etc. They do better some days, some days not. We have Kaiser and have made our way through their pediatric behavioral health department. Most of the folks there are really great & knowledgeable but they have few resources.

When it came out that my kid was self-harming, they did the 2-week partial hospitalization program (STEP through Seneca) where they go to the program rather than school for those 2 weeks. It was helpful for learning coping skills and in-person group therapy helped my kid to see that it wasn't just them dealing with all of this. The following year, they spiraled again, & did another stint with STEP, but it was over Zoom (both my kids loathe zoom). 

One thing is that both my kids have ADHD, which exacerbates their anxiety & depression, so we originally had a 504 with the district for their ADHD accommodations but were able to add anxiety and depression to that this year. If you don't have a 504 plan, check with your child's doctor to start this process. We are now moving toward an IEP after having 2 stints of short-term residential.

Last fall, my teen really spiraled and did 2 weeks in a residential program in SF which really helped keep them grounded and not self-harming until about 2 months ago. After spiraling again & being too depressed to go to school for about 3 weeks, they did another 2 weeks at the same program which did help, though maybe a little less than the first time, but they still feel they had a good experience.

My kid was upfront & told us & their therapist from the Kaiser Intensive Outpatient Program that they would not be able to go back to school this year. It would have been too much for them. So, we just set up a "hospital at home" program, where a district teacher communicates with our teachers, finds out what is necessary to be done, and comes to the house twice a week to work with them. There is A LOT of leeway with regard to assignments, credits, and grades, which I was really surprised to find out. I had nightmares of summer school, etc. I am grateful that we can take the stress off of school.

We are still holding our breath and reading about the longer term residentials in case they need it. It is SO painful because I really just want them to be home with us, but I also know that they have a difficult time keeping themselves out of depression at home, and if that means they are unsafe, then I would rather them go into a program that helps them create a solid foundation of healthy skills so they can learn to regulate themselves. Right now we are looking at a few Bay Area places, but have held off on checking for openings, etc. 

The really frustrating thing is that my 2nd grader also has anxiety and his focuses on going to school as well! He is much better able to manage than his sib though & we are getting him the support he needs so hopefully in 7 years we are not in the same boat again. 

I am very sorry for your situation.    I have a son (early 20s) who may have BDD and I was able to convince him to see a counselor for this issue.  (The counselor did not confirm if there is a BDD issue because everything is confidential.) He still struggles, and I hope one day he will return to therapy.  I have noticed that staying home a lot can affect a person’s self confidence to socially interact with others.  I tried to compensate by inviting people over for dinner.

A few years ago when I was searching for answers on anxiety (OCD specifically) I found an organization that has a lot of helpful resources.  It’s called the OCD Foundation. At their Austin, Texas conference I was amazed to hear speaker panels composed of young people who talked about what helped them.  These were young people who suffered from different types of anxiety, including body dysmorphia. There were also numerous helpful Q&A sessions, and support groups targeted for parents and others targeted for younger adults.   

I have attended two of its annual conferences.  I made a California friend that I keep in touch with.  Here is the link to the upcoming Denver conference in June.

https://iocdf.org/programs/conferences/?utm_source=website&utm_medium=ca...

For me it has been very emotionally draining to have a loved one who is ill.  But I try to celebrate the little victories by writing about milestones in my journal.  For example, today he said “the food was good.”   Or today he ate dinner with us for the first time in 6 months.  Or he took the bike out at night for 10 minutes. 

One thing that I found helped me is to listen carefully to what my son says and to respond with concern and questions.  It sounds like you are already doing this. My son and I sometimes have very emotional conversations now.  Something that I have started to think about doing is to model  good responses so that he learns how to respond in a job evaluation.  So instead of arguing with him if he criticizes how I talk, I want to say, “Thank you for telling me, because I want to improve how I communicate.”  Or if he misunderstands something big time, I’ll let hours past and then explain what I meant to ensure that he doesn’t harbor ill will.

Please take care of yourself.  Your health is of paramount importance.  I found by nurturing my own hobbies and getting excited about physical exercises, it gave me something to talk about rather than exuding worry.   And sometimes when I pursue personal interests I am rewarded with new friendships that help me to cope with my situation at home.

I have just spent the last year dealing with the exact same issues with my 13 year old daughter.  I would suggest that you try get a psychiatrist and psychologist to see your son via computer. If he will talk to a Dr via computer that is great.  My daughter refused to talk to hers (we have Kaiser), but I talked and the Dr was willing to prescribe an SSRi which helped my daughter with her depression and her more extreme anxiety symptoms.  She was able to engage more with therapy even though it took MONTHS for her to even talk to her therapist via computer. 

For local out patient therapy, we had a very positive experience with Sandra Concannon of Green Leaf Therapy in Orinda.  She worked with both our daughter and us as a parenting coach.  We saw her exclusively via computer and she is trained in CBT and exposure therapy which are both used to help people who avoid life due to their anxiety. As a parenting coach she helped us set some boundaries at home and be on the same page to help push our daughter because her avoidance due to anxiety was huge.

The psychiatrist also was able to refer us to a PHP program (5 days a week/ 6 hrs a day) at Rogers Behavioral Health in Walnut Creek that specializes in OCD and anxiety and we got on the waiting list (5 months).  PHP programs are the highest level of living at home mental health care. Based on my daughters issues we were able to get an anxiety disorder diagnosis that got her into the Home/Hospital Program in the school district so she had 1 on 1 instruction via computer while we waited for a spot in the PHP program and continued to try to work with her therapist.  I also requested an IEP evaluation which started the long process to get her an IEP for emotional disturbance (ED) which got her a school district social worker/therapist and a non public school (therapeutic) placement.  This is very important if you ultimately need to go to a residential treatment center or a therapeutic boarding school because you can get the district to pay for them (they are incredibly expensive). Unfortunately my daughter was too non functioning anxious to do the PHP program and I hired an Educational Consultant to help me determine what residential programs would be a good fit for her. My daughter started a wilderness therapy program in Idaho last week.  We brought her there ourselves and did not use professional transport.  It was super hard, but ultimately she knew we had exhausted all the options at home.  We told her there was no choice, either they were going to come get her or we would take her, but she was going no matter what.  She chose to go with her dad. I found the FB group:Wilderness Therapy and Residential Treatment Search Support to be an invaluable source of info while we decided our path.

I completely understand wanting to exhaust all other resources before choosing residential, I felt the exact same way. 

Good luck with everything.