THE ROLE OF CHILD AND ADOLESCENT DAY CARE SERVICES FOR SCHOOL-REFUSAL PATIENTS: A RETROSPECTIVE REVIEW

Abstract

Objective: The present study surveyed the status of school-refusal patients attending a child and adolescent day care service, in terms of rate of return to school, Global Assessment of Functioning (GAF) scores, and prognosis as indicated by course after graduation from junior high school, in order to examine the role and significance of such services.

Method: A retrospective investigation was conducted on the medical records of 32 patients (22 boys and 10 girls; 7 elementary and 25 junior high school students; aged 9-15 years) with chief complaints of school refusal, utilizing the child and adolescent day care service of an outpatient child psychiatric clinic.

Results and Discussion: The most prevalent diagnosis among the patients was developmental disorder (n=21 [65.6%]). Mean age at the start of using the service was 13 years 2 months, suggesting association with the transition on to junior high school. Patients were classified into four groups based on course of treatment (course of day service use). The groups who continued with day care had a good prognosis with higher GAF scores, rates of school return, and admission to senior high school. Conversely, the group who discontinued day care had a poor prognosis, possibly linked to subsequent hikikomori. The findings demonstrated that the child and adolescent day care service was functioning as: 1) a temporary refuge from a critical situation; 2) a place offering a sense of safety; and 3) a secure base from which to tackle the outside world. Children appeared to be using the day care service as a temporary refuge from critical situations, and given a place where they could feel safe, were gradually regaining a sense of energy through interaction with peers, enabling them to take on challenges such as returning to school or tackling other aspects of the outside world, and facing their future. While the present findings suggest that child and adolescent day care services are beneficial as a place of support for children refusing to attend school, the issue of support for patients who discontinue attending such services remains unresolved.