Barn som mår psykiskt dåligt och inte går till skolan uppmärksammas allt oftare i media. Både svensk och internationell forskning pekar på att skolfrånvaron ökar världen över.  Här i Sverige riktats kritik mot skolornas hantering av elever med problematisk frånvaro och syftet med denna studie var att undersöka specialpedagoger och kuratorers upplevelse av arbetet med målgruppen. Av intresse var vilka faktorer de upplever underlättar respektive försvårar arbete med målgruppen samt deras upplevelse av både interprofessionell samverkan (inom elevhälsan samt mellan elevhälsa och lärare) samt den intersektoriella samverkan (med socialtjänsten och BUP).  Studien hade en kvalitativ ansats och genomfördes via sju semistrukturerade kvalitativa intervjuer med tre specialpedagoger och fyra kuratorer från sju olika högstadieskolor spridda över landet och med varierande yrkeserfarenhet.  Studiens resultat visar att kuratorer och specialpedagoger upplever en hög grad av frustration kopplat till arbete med målgruppen. Deltagarna kände sig trygga med sina arbetsmetoder men hade sällan möjlighet att arbeta fullt ut i enlighet med dessa på grund av tids- och resursbrist.  Den interprofessionella samverkan inom elevhälsan beskrevs som välfungerande men med ökande svårigheter kopplade till samverkan med lärare. Den intersektoriell samverkan med socialtjänsten och BUP beskrevs fungera dåligt vilket resulterade i tidskrävande arbete utanför det egna yrkesspecifika handlingsutrymmet. Deltagarna uttryckte en stark känsla av ansvar gentemot sina elever samt en frustration utifrån upplevelsen att socialtjänsten och BUP lättvindigt avslutade ärenden vilket medförde betydande hinder för återintegrering av eleverna i skolan. / Media coverage of children with school attendance problems and mental health issues is increasing worldwide. Within a Swedish context, schools are being critiqued for poor handling of these cases. The aim of this thesis was to investigate how school counselors and special pedagogues perceive their work with the respective school’s 7th to 9th grade students. Which obstacles and opportunities do they perceive connected to the methods and strategies they employ in working with these students? How do they feel about the interprofessional collaboration within the school mental health team and in relation to the teachers and how do they perceive the collaboration with the local social services agencies and child psychiatric services?   The study was based within a qualitative research tradition and seven qualitative interviews with three special pedagogues and four school counselors were performed. The participants came from seven different schools from around Sweden and had varying degrees of experience working in schools. The results show that both school counselors and special pedagogues have a high degree of frustration connected to their work with these students. They felt comfortable how they should be working within the bounds of their respective roles but described how limited resources connected to time and staffing prevented them from working in accordance with these methods.   A major area of frustration was connected to poor collaboration with teachers as well as with the local social services agencies and child psychiatric services. The failed collaboration resulted in counselors and special pedagogues working outside the framework of their roles and they described a strong sense of responsibility for the students they worked with. They also described a sense of frustration connected to collaborative partners within the local social services agencies and the child psychiatric services failing to provide adequate support in the cases. This despite the students and families being in need of support to start the process of reintegration into the school environment.

I denna studie undersöks lärares förståelse av fenomenet skolfrånvaro/skolnärvaro utifrån ramsättningarna: roll och ansvar. Då fenomenet är komplext, sammanvävt inom ömsesidiga relationella beroenden mellan elev, lärare, skola, familj, vänner, hälsa, juridik, politik, och så vidare, sker studien genom kvalitativ tematisk analys för att undersöka empirin. Semistrukturerade intervjuer har genomförts med mellan- och högstadielärare i kommunala grundskolor i en mellanstor kommun i Sverige. Intervjumaterialet har analyserats i ljuset av tidigare forskning samt med hjälp av teorier som på olika vis utgår från en systemisk förståelse. Forskningsfrågorna kunde besvaras genom studien och resultatet som följer visar att meningsskapande och förståelse för det sammantagna fenomenet polariseras av respondenterna. Frånvaro betraktas ur ett patogent perspektiv, likt något som behöver botas, och närvaro ur ett salutogent perspektiv, något som kan främjas. Implikationerna som kan följa av detta resultat är de mest intressanta produkterna från studien, vilka kan ge upphov till idéer för möjlig fortsatt forskning. / This study examines teachers' understanding of the phenomenon of school absence/attendance based on the frameworks: role and responsibility. Since the phenomenon is complex, interwoven within mutual relational dependencies between student, teacher, school, family, friends, health, law, politics, and so on, the study uses qualitative thematic analysis to examine the empirical data. Semi-structured interviews have been conducted with middle and high school teachers in municipal primary schools in a medium-sized municipality in Sweden. The interview material has been analyzed in the light of previous research and with the help of theories that in various ways are based on a systemic understanding. The research questions could be answered through the study and the results that follow show that the creation of meaning and understanding of the overall phenomenon is polarized by the respondents. Absence is considered from a pathogenic perspective, as something that needs to be cured, and presence from a salutogenic perspective, something that can be promoted. The implications that can follow from this result are the most interesting products of the study, which can give rise to ideas for possible further research.

In step with the development of society, new social phenomena develop where ”acute social withdrawl” is one of them. Acute social withdrawl is a phenomenon that is about individuals ending up in a social isolation where they withdraw from different relationships and contexts, such as school. Problematic school absenteeism is something that student health works withdaily so students don´t become acute social withdrawn. Based on previous research, we find that early coordinated interventions are significant for the preventive work towards individuals who are at risk for becoming acute social withdrawn. However, we see a knowledge gap in how this type of work should be performed. Through a qualitativ studie in the form of semistructured interviews, we interviewed six people who work actively in a student health team to gain deeper understanding of their work with early interventions. The theories we used to analyze the empirical meterial are Collaboration, Systems theory and Empowerment. Based on our study, we could see several conclusions. For example, we saw that the different interviewees had different functioning processes to draw attention to the students needs, and that collaboration with external organisations worked differently in different municipalities. This is due to the availability, resorurces and willinggness. That it´s not only being meetings and meetings without any results. Based on this, we can se that student health´s work with early coordinated interventions is limited and instead we saw that the interviewees themselves, in their professional role had to find their own 3(64)strategies. In Conclusion, we can see that a group perspective is lacking inte work, as there is a lot of individual focus.

Background: Students with school attendance problems, not only run the risk of failing school, but they also run an increased risk of psychosocial problems in adulthood. Therefore, it is important to pay attention to what can be done early, before the more extensive problems have developed. Through the school social work, it is possible to analyse the entire context around school attendance and school attendance problems. Objectives: To present what has emerged in previous research regarding school counselors’ health promotion and prevention work to increase school attendance and prevent school attendance problems among students in elementary school. Method: Scoping review Eligibility criteria: Publications were selected according to PRISMA ScR guidelines. Sources of evidence: Peer-reviewed articles Charting methods: A qualitative content analysis based on a systems theory approach is presented in both tables and text. The analysis was based on the results and conclusion of the included articles and was described through a categorization against the objectives and different system levels. Results: The school counselors work to strengthen relationships and cooperation between students, parents, school staff and other actors, as well as by offering various types of targeted interventions or prevention programs. Conclusions: School counselors’ work consists largely of remedial actions. It is unfortunate since health promotion and prevention work at different levels in the system is important to reduce school attendance problems. The cooperative role of school counselors and their system-oriented thinking contributes to relationship building, and a holistic view of school attendance and school attendance problems.

Syftet med denna studie var att beräkna graden av behandlingstrohet för en intervention mot problematisk skolfrånvaro och undersöka dess samband med utfallet, med avseende på skolnärvaro och psykisk ohälsa (ångest och depression). Studien genomfördes som en kvantitativ longitudinell studie baserad på befintliga data. Implementeringsteorin och det konceptuella ramverket Evidens tillämpades. Det visade sig att 73.5 % av behandlingen genomfördes som avsett, vilket indikerar hög behandlingstrohet. Resultaten visade förbättringar i både skolnärvaro och minskad psykisk ohälsa. Däremot observerades en negativ korrelation mellan behandlingstrohet och skolnärvaro, i motsats till studiens hypotes. Sambandet mellan behandlingstrohet och psykisk ohälsa överensstämde dock med förväntningarna, då en ökad behandlingstrohet ledde till minskad psykisk ohälsa. Dessa resultat tyder på behovet av ytterligare forskning om sambandet mellan behandlingstrohet och behandlingsresultat i interventioner mot problematisk skolfrånvaro, samt på behovet av att utvärdera metoder för att mäta behandlingstrohet. / This study aimed to measure treatment fidelity for an intervention targeting problematic school absenteeism and examine its correlation with school attendance and mental health outcomes (anxiety and depression). It was conducted as a quantitative longitudinal study using existing data, and applied implementation theory and the Evidence conceptual framework. It found that 73.5% of the treatment was completed as intended, indicating high fidelity. Results showed improvements in both school attendance and reduced mental health issues. However, a negative correlation was observed between treatment fidelity and school attendance, contrary to the hypothesis. The relationship between treatment fidelity and mental health issues, on the other hand, was in line with expectations, as increased treatment fidelity led to reduced mental health issues. These findings highlight the need for further research on the correlation between treatment fidelity and intervention outcomes for problematic school absenteeism, as well as the need to improve methods for measuring treatment fidelity.

De centrala stödteamen som studerats i denna studie är ett komplement till den lagstadgade verksamheten i sina respektive kommuner i arbetet med elever som utmanar i skolan och /eller är i problematisk skolfrånvaro. De studerade teamen arbetar på uppdrag av socialförvaltningen, Barn och ungdomsförvaltningen eller en kombination av de båda. Studien är gjord med den grundade teorin som metod och med ett socialkonstruktionistiskt perspektiv då både metod och teori lyfter informanternas upplevelse av sin verklighet. Syftet med denna studie är att analysera de framgångsfaktorer men även hinder som några studerade centrala stödteam upplever i arbetet med elever i problematisk skolfrånvaro. Det som framkommer i studien är att de studerade stödteamens konstruktion och centrala styrning där genom att verka på alla skolor i en kommun gör det möjligt att använda sig av både de bemötanden och förutsättningar som presenteras i studiens resultat.De framgångsfaktorer som framkommit i studien som också är studiens main concern är uppdelade i två huvudgrupper. Den ena är Framgångsrika Bemötanden där några nyckelkategorier blivit centrala. Dessa nyckelkategorier är; Icke-dömande, Respekterande, Inlyssnande, Förstående, Icke kravsättande, Avlastande, Samarbetande, Samordnande samt Relationsskapande. De studerade teamen menar att det inte går att prioritera dessa kategorier, men att Icke-dömandet är en förutsättning för de övriga. Den andra huvudgruppen är Gynnsamma Förutsättningar. Denna huvudgrupp delas in i: Tid, Kompetens och erfarenhet, Likvärdighet, Upparbetade relationer, Intensivvarande samt organisation. I studien har också framkommit hinder i de studerade teamens verksamhet. Dessa framkommer i olika grad samt på olika sätt för de studerade teamen, men har sammanfattats i några faktorer; Sekretess, Bedömda/dömda pedagoger-ledning, Dömande personal, Komma in i “slutna hem” samt Ekonomi. Dessa hinder menar de studerade teamen kan bromsa upp effektiviteten i både tid och insats i ett ärende de verkar i. Den organisatoriska lösningen där både socialtjänst och skola samverkar är den konstellation som enligt de studerade stödteamen är den bästa och då i kombination med att det i teamet finns både lärare som kan tala skolans språk och även tala med skolan utan att upplevas okunnig eller oförstående. Detsamma gäller anledningen till att socialtjänsten är representerad med en socionom som kan möta socialtjänsten på samma sätt. / The central support team in this study are a complement to the ordinary work with students that is challenging the school or/ and are in problematic school absenteeism. The study uses the grounded theory as method and a social constructive perspective when both method and theory explain the informers experience of their own reality.  Studien är gjord med den grundade teorin som metod och med ett socialkonstruktionistiskt perspektiv då både metod och teori lyfter informanternas upplevelse av sin verklighet. The teams that been studied are initiated by the social department, the school department and some by a mix of them both. The mix are de model that all teams meant was the most successful and best suited constellation with a teacher and a social worker, working together. The reason with this opinion is that the team in the study explains it with the credibility that teacher are better suited to talk with the school and the social worker are better suited to run the communication with the social services. The purpose with this study is to reveal the factors of success in some central support teams work with students in problematic school absenteeism, and also unveil the obstacles that the studied support team could meet in their work with these students. What the study shaws is that how the studied team were constructed with their professions and the fact that they are under a central control and not are tied to one separate school or area were the main factor that allows both the factors of success and the favourable prerequisite that is the two main concerns with this study to work.The factors of success that appeared in the study are represented by two main concerns, the first one is the Personal treatment meeting with people. Some key categories that construct this factor of success are None-judging, Respecting, In-listening, Understanding, Not demanding, to unburden, Cooperating, Coworking and Relation construction. The teams in the study point out that there is impossible to prioritize these categories, but the None-judging behaviour is the prerequisite for the others.The second main concern is the favourable prerequisite for the teams to work. This main consern is divided in; Time, competence and experience, comparability, already done relations, intensity being and organization. The team in the study have an agreement in that it is these categories that divide them from the ordinary work whit students in problematic school absenteeism in their municipalities and that is their strikingness that is the key to make the factors of success to work.In this study there also appeared some obstacles in the work for the teams. These obstacles appear in different grade and different ways for the team in the study, but are concluded in the key categories, Confidentiality, judged/ condemned school personnel, Judgemental personnel, to enter closed homes and economy. These categories the team in the study are factors that can inhibit their work and make it less efficient over time and in effort and also are results presented in the study.

Bakgrund: I Sverige har det rapporterats en ökning bland barn och unga av psykiatriska diagnoser. En ökning av psykiska- samt psykosomatiska besvär hos ungdomar i åldern 13-15 år har konstaterats. Den upplevda skolmiljön ses som en stark koppling till elevernas ohälsa. Elever med långvarig skolfrånvaro riskerar att hamna i svårigheter både på kort och lång sikt. Idag används sociala tjänstehundar som särskilt stöd för elever med långvarig skolfrånvaro dock finns det en brist på kunskap om hur insatsens upplevs av både hundförare och eleven själv. Syfte: Studiens syfte var att undersöka elever och hundförares upplevelse av hundassisterad intervention som särskilt stöd vid långvarig skolfrånvaro. Metod: Två elever och tre hundförare intervjuades genom semistrukturerade intervjuer. Dessa intervjuer genomfördes via videosamtal. Eleverna var i ålder 13-15 år och gick på högstadiet. Hundförarna arbetade på högstadiet på uppdrag av elevhälsan med hundassisterade interventioner som särskilt stöd vid långvarig skolfrånvaro. Resultat: Eleverna och hundförarna upplevde att hunden stöttade eleverna genom sitt bemötande, sin närhet och förmåga till relationsskapade. Detta ledde till att eleverna upplevde en förändring i sitt mående och i sin tillvaro. Eleverna upplevde en känsla av minskad stress och ångest, där elevernas vänskapliga relation till hundarna blev en betydande faktor i sin motivation till att komma till skolan, vara i skolan och utföra sina skolarbeten. Slutsats: Användningen av hundassisterade intervention som särskilt stöd vid långvarig skolfrånvaro upplevdes ge eleverna förändrade förutsättningar att öka sin närvaro i skolan. Elevernas vilja att vara med den sociala tjänstehunden bidrog till en ökad motivation att deltaga i sin skolgång. / Background: Sweden is currently witnessing an increase in diagnosed psychiatric disorders among juveniles of all ages, within which an upsurge in psychological and psychosomatic maladies has been noted in the 13-15 year old demographic. The social environment of a student’s school is seen to have a direct relationship to said student’s potential mental health issues, which can lead to extended absences. Such absences increase the risk of continued problems for the student, even beyond the realm of mental health, in the short and long term. Therapydogs are now used to provide special assistance for students with extended absences from school, however, there is a lack of knowledge how this is experienced by both doghandlers and students. Aim: The aim of this study is to observe students’ and dog handlers’ experience with canine-assisted intervention as a form of special assistance for those with extended school absences. Method: Two students and three dog handlers were interviewed with the “semi-structured interview” technique via videocall. The students were ages 13-15, and study at the middle school. The dog handlers work with student health at the students’ middle school, using canine-assisted intervention as a form of special assistance to those with extended absences from school. Results: The students and the dog handlers felt that canine interaction supported the students in their attempts to create and develop meaningful relationships. This led to positive changes in the students’ temperament and mental health in general. The diminishment of feelings of stress and anxiety can be linked to the friendly relationships built with the dogs, ultimately resulting in an increased motivation attend school and complete schoolwork. Conclusion: The use of canine-assisted intervention as special assistance to those with extended school absences was seen to give students positively changed attitudes towards school attendance, with the students’ desire to build a relationship with the therapydog as a contributing factor towards this change.

Sammanfattning Denna uppsats syftade till att utforska varför skolfrånvaron och därmed hemmasittandet har ökat. Genom att analysera elevhälsoplaner och jämföra dem med tidigare forskning, identifierades en möjlig koppling mellan ändringar i skollagen och ökningen av hemmasittande. Bronfenbrenners systemteori och Beckers avvikarkarriär-teori användes som huvudsakliga teoretiska ramar för analysen. Resultaten pekade på att förändringar i skollagen har manifesterat sig som strikta riktlinjer i elevhälsoplanerna. Dessa riktlinjer, tillsammans med skolornas stödinsatser, kan ha en oavsiktlig stämplande effekt på elever som inte uppfyller förväntningarna. Studien visade att medan dessa stödinsatser syftar till att hjälpa elever, kan de i vissa fall förstärka elevernas avvikelse från den etablerade normen. Tidigare forskning har belyst vissa riskgrupper, såsom de med ADHD eller ASD, och deras potential att undvika skolan på grund av utmaningar relaterade till sociala faktorer och inlärningssvårigheter. Även om dessa specifika diagnoser inte alltid nämndes explicit i elevhälsoplanerna, antyder planernas fokus på sociala faktorer och inlärningssvårigheter att dessa riskgrupper kan vara i åtanke. Metodologiskt använde studien dokumentanalys av elevhälsoplaner, vilket gav en inblick i skolornas officiella ställningstaganden men kunde sakna insikt i verklig implementering. Studiens implikationer pekar på att skolan kan behöva omvärdera sina stödinsatser för att undvika oavsiktlig stigmatisering. Dessutom kan involvering av fler samhällsinstanser, som socialtjänsten, vara en väg framåt för att bättre stödja elever i riskzonen för hemmasittande. / Abstract This study aimed to investigate the reasons behind the rise in school absenteeism and, consequently, the increase in students staying at home. By analyzing student health plans and comparing them with prior research, a potential link between amendments in the Education Act and the surge in students staying at home was identified. Bronfenbrenner's ecological systems theory and Becker's theory of deviant behavior served as the primary theoretical frameworks for the analysis. The findings indicated that changes in the Education Act have manifested as stringent guidelines in student health plans. These guidelines, combined with schools' supportive interventions, may inadvertently label students who do not meet the expectations. While these interventions aim to assist students, they might, in certain instances, amplify students' deviation from established norms. Previous research highlighted specific risk groups, such as those with ADHD or ASD, and their likelihood to avoid school due to challenges related to social factors and learning difficulties. Even if these specific diagnoses were not always explicitly mentioned in the student health plans, the plans' emphasis on social factors and learning difficulties suggests these risk groups might be considered. Methodologically, the study employed document analysis of student health plans, offering insight into schools' official stances but possibly lacking a comprehensive view of their actual implementation. The study's implications suggest that schools might need to re-evaluate their supportive measures to avoid unintentional stigmatization. Moreover, involving more societal entities, such as social services, might present a proactive approach to better support students at risk of staying home.

Problematisk skolfrånvaro är ett omfattande problem som kan få sociala, emotionella och kunskapsmässiga konsekvenser för barn och ungdomar. Forskning visar att multimodala interventioner är effektiva i att öka skolnärvaro, vilka programstrategier inom interventionerna som fungerar i vilka kontexter saknas däremot kunskap om. En realistisk översikt genomfördes därför i syfte att undersöka vilka orsaker till problematisk skolfrånvaro som går att identifiera i tidigare forskning. Vidare var syftet att öka förståelsen för multimodala interventioner genom att specificera vilka programstrategier som leder till ökad skolnärvaro inom vilka kontexter. Efter en systematisk sökprocess inkluderades totalt 124 vetenskapliga artiklar. Resultatet av den realistiska analysen visade att trygghet, attityd, känsloreglering, social kompetens, motivation, föräldraförmåga, föräldrars föreställningar, kommunikation, tillit, familjedynamik, relationen mellan elev och lärare, skolklimat, skolorganisering, normativa föreställningar samt jämlikhet kan generera skolfrånvaro i särskilda kontexter. Inom de multimodala interventionerna identifierades åtta programstrategier som visat sig öka skolnärvaro i vissa kontexter. Mest empiriskt underlag förelåg för de strategier som arbetade med föräldra-förmågan och kommunikationen i elevens omgivning. Resultatet analyserades med hjälp av behavioristisk teori om operant betingning och systemteori. Översiktens slutsatser kan öka förståelsen för orsaker till skolfrånvaro och vägleda yrkesverksamma i vilka programstrategier som bör implementeras under vilka omständigheter. / Problematic school absenteeism is a comprehensive problem associated with social, emotional and cognitive consequences for children and adolescents. Research shows that multimodal interventions are effective in increasing attendance. However, there is a need to refine the contexts in which multimodal interventions are effective. Therefore, a realistic review was carried out in order to identify the causes underlying problematic school absenteeism in previous research. Furthermore, the purpose was to increase the understanding of multimodal interventions by specifying which program strategies lead to increased school attendance in which contexts. Following a systematic search process, a total of 124 articles were included. The results showed that security, attitude, emotion regulation, social skills, motivation, parent self-efficacy, parental beliefs, communication, trust, family dynamics, student-teacher relationship, school climate, school organization, normative ideas and equality can generate school absenteeism in specific contexts. Eight program strategies that generated attendance in different contexts were identified within the multimodal interventions. Most empirical support were found for the strategies related to parent self-efficacy and communication. The result was analyzed using behavioral and systems theory. The conclusions can advance the understanding of causes to absenteeism and guide professionals regarding which program strategies should be implemented under which circumstances.

Problematic school absenteeism is receiving an increasing amount of public attention in today's Sweden due to the impact it has on young people's health and their families. A relatively new profession, School Social Worker (SSW), constitutes a role in the intersection between schools, families, and the social services. The aim of this study is to examine SSWs experiences and how organizational conditions affect their work. The data was collected through nine semi- structured interviews and a thematic analysis was made based on the interviews using organizational theory and domain-conflict theory. Our findings are based on two main themes: The school social workers conditions and approaches and The social services in the pedagogical sphere. The results show that the SSW has a lot of freedom to shape their own professional role. The results also indicate that SSWs had different structures, goals and guidelines depending on the workplace. A common theme was preventive work, with the majority focusing on attendance-related issues. The results suggest a potential change in SSWs tasks if they fail to communicate clear boundaries with other professionals. The assignment's intent and adherence vary, especially regarding the issues SSWs are expected to address, such as handling twice the specified absenteeism rate.