Which statement best describes the role of caregivers and school staff in a CBT-based plan for school refusal?

• A. Exclude school staff to prevent escalation.
• B. Involve caregivers and school staff to support exposure and gradual reentry.
• C. Rely only on therapist.
• D. Delay involving caregivers.

Answer: (B)

In CBT for school refusal, the key is to support exposure to the feared situation in a gradual, well-coordinated way. Involving caregivers and school staff provides the concrete, real-world framework that makes exposure workable and sustainable. Caregivers reinforce coping strategies at home, help with predictable routines, and monitor progress, which reduces overall anxiety and increases the child’s sense of control. School staff collaborate on a stepped reentry plan—starting with shorter days or partial attendance and gradually extending time at school—while keeping communication with the therapist to adjust the plan as needed. This teamwork helps the child practice skills in multiple settings, learn that going to school is manageable, and generalize gains beyond therapy sessions.

Excluding school staff removes the essential environmental support the child needs in the school setting and makes exposure harder to implement consistently. Relying only on the therapist bypasses real-world practice and generalization, which CBT relies on to transfer skills outside the therapy room. Delaying involvement of caregivers deprives the plan of the reliable reinforcement and structure that support progress.