In adapting CBT for school refusal, which step is essential?

• A. Rely solely on pharmacotherapy.
• B. Identify the function of the refusal and collaborate with school for gradual reentry.
• C. Avoid involving caregivers to maintain autonomy.
• D. Skip safety planning to speed up return to school.

Answer: (B)

In CBT for school refusal, the key move is to understand why the child is refusing and then coordinate a gradual path back to school that spans home and the school setting. The essential step is to identify the function of the refusal—what the child gains by staying home (for example, escaping anxiety-provoking situations, seeking attention, or avoiding distress)—and use that insight to tailor the intervention. Once you know the function, work with the school to create a stepped reentry plan: begin with brief, supported days or partial attendance, use coping skills you’ve practiced in therapy, and progressively increase exposure to full school participation. This joint approach ensures consistency across environments, makes the intervention concrete and doable, and helps the child apply skills in real-life contexts. Broadly speaking, involving caregivers is important to reinforce strategies and maintain support at home, while safety planning remains a separate, important component to address crises; pharmacotherapy on its own doesn’t address the behavioral pattern at the heart of school refusal.