School Refusal: Parents
So let's get real for a second. Every school morning you wake up hoping "this is going to be a good day." Your morning is wrecked when your kid wakes up and doesn't want to go to school. These are the mornings you fear. Parents of school refusal kids know what I am talking about. Your day depends on how your kid wakes up. If your kid is good, you're good. If your kid is bad, you're stuck. What do you do? Do you try forcing your kid in the car, take away his/her iPad "forever," go to work and leave him/her at home..... School Refusal parents, you need help!
In this four week class, we help you step back, determine the reasons for your child's school refusal behaviors, and develop a step-by-step parenting plan to encourage your child to stay in school all day, everyday.
Randy Floyd, LSCSW, Founder, Clinical Level Therapist
Randy is the founder of Midwest Anxiety. He is a Licensed Specialist Clinical Social Worker who is an optimist and passionate about helping people focus on what they can do rather than what they can't do. Randy believes that building a strong therapeutic relationship and tapping into a person's strengths are the most essential components of the therapeutic experience. Randy is passionate about changing the way we do mental health. He is focused on making mental health normal, a positive experience. He is also adamant about doing mental health differently. Randy believes the "old ways" suggest mental health is for the "broken" or "mentally ill." Randy believes that "Everyone Struggles." Sure. Some people struggle more than others, but everyone struggles with something. With this belief, Randy is focused on providing a wide range of programs and services to help people be mentally well ;) Go give Randy a fist bump on Instagram, Twitter, and Facebook.
4 WEEK CLASS
August 6, 2018, 7:00pm-8:00pm: "School makes me feel bad."
At times, kids demonstrate school refusal behaviors because school gives them a bad feeling such as a stomachache, headache, or nausea. While your kid may not be able to identify the trigger, these negative feelings are generally triggered by a specific school situation. We will help you develop a parenting plan when your kid doesn't want to go to school when feeling bad.
August 13, 2018, 7:00pm-8:00pm: “I am nervous about what other people think of me at school.”
There are many opportunities to feel judged at school such as raising your hand in class, sitting by unfamiliar peers, socializing at lunch, etc. While it is real to them, school refusal kids tend to exaggerate the frequency and intensity of these situations. It becomes much easier for anxious kids to refuse school rather than face the potential judgment of others. We will help you develop a parenting plan when your kid doesn't want to go to school because of social fears.
August 20, 2018, 7:00pm-8:00pm: “I don’t like being away from my parents.”
Some kids demonstrate school refusal behaviors because they are anxious about separating from parents. Also, kids may refuse school as a way to get attention from others. We will help you develop a parenting plan to help your kid learn how to get their emotional and physical needs met without refusing school.
August 27, 2018, 7:00pm-8:00pm: “Being at home is more fun than going to school.”
Simply, some kids like the comforts of being home rather than working through the school day. The conveniences of home make it very rewarding to refuse school. We will help you develop a parenting plan when your kid doesn't want to go to school because being home is easier than go to school.
week 1: "School makes me feel bad."
Caleb is a 7-year-old boy who gets up in the morning and immediately starts to cry and say, "I don't want to go to school." Although his parents can get Caleb ready for school, their son sulks during the car ride, complains of having a stomachache, and sobs when he sees the school playground. Caleb's mother says she has a hard time getting her son to go into the school building and that she sometimes drives him home when he seems so distraught. Caleb seems fine once home but sulks as well during the evening before school.
This week we will be talking about:
- Your child having trouble going to school in the morning because of distress about school or trouble riding the school bus.
- Your child seems quite distressed in the mornings or evenings before school.
But First Lets Get some of the School Refusal Basics Out of the Way.....
What are SCHOOL REFUSAL BEHAVIORS?
- Negotiations about school attendance the night before, morning of, or during school.
- Tardy or absentee from school.
- Pattern of physical complaints (headaches, stomachaches, nausea, etc) prior to or during school.
What are the Reasons for School Refusal behaviors?
- To stay away from objects or situations at school that makes your child feel unpleasant physical symptoms.
- To stay away from social or evaluative situations at school that are painful to your child (Social Anxiety Disorder).
- To receive attention from a parent or a significant other (Separation Anxiety Disorder).
- To obtain tangible rewards outside of school that make skipping school more fun than staying in school. Home is more fun!
Okay lets get Back to This Weeks Topic "School Makes Me Feel Bad."
Like Caleb, one reason why children show school refusal behaviors is to get away from the distress they feel when at school. This distress may be due to specific things such as the school bus or walking from one part of the school to another. In some cases, children cannot say what is bothering them. Children just indicate that are distressed and they don't like it. We may not know WHAT is causing the distress. The goal is to find ways to reduce the stress not find what is causing the distress.
This week we will focus on:
- Understanding what distress is: the "thinking," "feeling," and "doing" parts of distress
- Lowering physical "feelings" of distress through correct breathing and relaxation
- Dealing with the "thinking" part of distress or what to do when your child says he/she doesn't want to go to school.
- Managing the "doing" part of distress by gradually reintroducing a child to school and increasing his/her time in the classroom.
What is distress?
Distress is generally characterized by the anxiety, worry, uneasiness, apprehensiveness or dread about school. It is shown in different ways in children including crying cling, tantrums, withdrawal, verbal statements asking to stay home.......
Distress is made up of three parts: thoughts, feelings, and behaviors.
Thoughts: Worries about bad things happening, sometimes just general thought of "I don't like school" (especially in younger children). When distressed, your child does not have clear thoughts.
Feelings: Uncomfortable physical feelings such as aches, trembling, "butterflies," shortness of breath. The focus is on how your child "feels." I "feel" bad. Don't always know what is causing the feelings, just that the child is feeling bad. The goal is we have to teach your child to ways to control uncomfortable feelings and despite the feelings move forward with full time school attendance.
Behaviors: Avoiding places that cause distress, asking for reassurance, seeking accomodations.
"I feel bad."
Parents and teachers will ask a child a lot questions about what is bothering the child about school but come away with little information. Part of the reason for this is that the child is focusing a lot on how he FEELS inside. For whatever reason, school has become associated with uncomfortable physical feelings, and your child may be upset mostly with those feelings.
Changing the "feeling" part of distress
Three main approaches to lowering your child's distress and increase relation: breathing, muscle relaxation, and general relaxation.
Breathing: The first method for lowering physical "feelings" of distress is to help your child breathe correctly. Shortness of breath or breathing too quickly can lead to alot of distress or can be the result of feeling upset. Ask your child to sit in a comfortable to breathe in through nose (mouth closed) and breathe out slowly through mouth. The idea is to focus on breathe and controlled breathing. Ask your child to practice breathing outside of distressed times so that your child will be familiar and "good"during distressed times.
Muscle Relaxation: The second method for lower physical "feelings" of distress is muscle relaxation. When children are distressed about school, they often feel very tense in their muscles, especially in the hands, face, jaw, and stomach. One way of helping your child ease muscle tension is to tense and then release different muscle groups.
Try this: Take your hand and ball it into a fist. Squeeze as hard as possible. Hold your tense fist in place for about 10 seconds. Then quickly release. Repeat. Do for different muscle groups.
General Relaxation: The third method involves breathing and relaxation tapes. Many breathing, relaxation, and yoga tapes are available online. Another important piece of relaxation is feedback from you. Whenever you notice that your child is particularly tense, gently encourage him/her to practice one or more of the relaxation methods.
Do's and Dont's!
- Help your child understand the different parts of distress: the physical "feelings," "thinking," and "doing" parts of distress.
- Think about how these different parts of distress occur in your child.
- Teach your child breathing, relaxation in muscles, and generally to relax.
- Speak to your child in a calm, matter-of-fact tone.
- Ignore your child's distress.
- Fight, yell, lecture, criticize, negotiate, beg, or bribe your child to go to school.
continue reading Chapter 3 of Getting Your Child to Say "Yes" to School
- Changing the "Thinking" Part of Distress
- Home Schooling
- Changing the "Doing" Part of Distress
- What Should I Keep My Child Home from School
- Coming in Late in the Morning
- Missing Most of the School Day
- My Child Won't Ride the School Bus!
- Those Sunday Evening Blues
Basecamp discussions this week
Keep Track of your Child's Level of Distress each day.
- What does my child "feel" when distressed?
- What does my child "think" (or say) when distressed?
- What does my child "do" when distressed?
Getting Your Child to Say "Yes" to School, Chpt. 3, Christopher Kearney.
Week 2: “I am nervous about what other people think of me at school."
Raven is a 13-year old girl who has problems attending school because she is nervous in different social and performance situations at school. Raven has skipped several classes already this year and has three full-day absences. She says she is shy, feels uncomfortable talking to other kids at school, and does not like speaking before others or going to gym class. In particular, she has been skipping classes where she has to take tests or give oral presentations, and her teachers complain that Raven will not answer questions in class.
This week we will be talking about:
- Your child is having trouble going to school or classes because of distress about social or performance situations at school.
- Your child is missing certain classes such as gym, choir, band, reading, English, or other classes where performing before others is expected.
GOALs THIS WEEk:
- Continuing to understand what distress is: the "feeling," "thinking," and "doing" parts of distress.
- Lowering or "pushing through" physical "feelings" of distress
- Dealing with the "thinking" part of distress, or how to help your child think more realistically in social or performance situations. Focus on the "thinking" part with older children.
- Managing the "doing" part of distress by monitoring your child's school attendance and increasing his/her time in the classroom.
Lets Review the parts of Distress:
Thinking: Uncomfortable thoughts or worries about bad things happening, such as worrying that everyone will laugh as a child changes clothes in the locker room or that the child will stutter badly during and oral presentation at school.
We sometimes think about the worst case scenarios or all the terrible things that could happen. Sometimes the thoughts are so bad that we avoid situations. Anxious children become hypersensitive/hyper focused to situations that resemble the worst case scenarios.
Anxious children think alot about:
- Being embarrassed or humiliated in front of others
- Being laughed at or ridiculed in some way
- Blushing or appearing very nervous before others
- Being excluded from social group such as a clique of friends
- Being ignored by others when speaking or asking for help.
Feelings: Uncomfortable physical problems such as trembling, shaking, "butterflies in the stomach," and shortness of breath or hyperventilation.
Doing: Moving away from something that causes distress, such as avoiding school or withdrawing from people or a social gathering. Avoiding school might seem like a good short-term thing to do, because distressed is lowered, but eventually your child has to go to school.
Anxious Thoughts + Anxious Feelings = Anxious Behaviors (School Refusal)
Changing the Pattern of Distress
Children that are distressed about social and performance situations at school seem most bothered by their thoughts that something bad will happen at school. The goal is to help you child think more "realistically" in social and performance situations. Notice I didn't say more think more "positively." Have your child take a step back and distiquish between possibility and probability of something "bad" happening. When we think more realistically, we understand that the chance of bad things happening is actually small and we often feel less distressed.
Changing the "thinking" part of distress is something that you, your child, and the school have to work on together.
Examples of Negative Thoughts
- They assume something bad is happening when actually it is not.
- They assume terrible things will happen when terrible things are not likely to happen.
- They assume what other people are thinking about them even though they cannot know. This is called "mind reading."
- They jump to conclusions from just one event or make "mountains out of molehills" by assuming that the consequences of their acts will be extremely terrible.
- They assume they will be embarrassed and that the embarrassment will be horrible.
- They see situations as only perfect or terrible and not somewhere in between.
- They focus much more on the negative than the positive side of things.
- They blame themselves for things that are not within their control.
Encourage your child to use the STOP method to change the thoughts
- S: Am I SCARED or nervous about a certain social or performance situation?
- T: What THOUGHTS am I having in this situation?
- O: What OTHER, more realistic thoughts can I have?
- P: PRAISE myself for thinking more realistic thoughts.
Questions to Ask to Have "Other" More Realistic Thoughts
- Am I 100% sure this will happen (or is happening)?
- Can I really know what that person thinks of me?
- What's the worst thing that can really happen?
- Have I ever been in this situation before, and was it really that bad?
- How many times has this terrible thing actually happened?
- Am I the only person that has ever had to deal with this situation?
- So what if I'm not perfect in this situation?
- Is this really my fault?
Everyone feels uncomfortable from time to time- that's part of being human! Talk with your child about this. The goal is to control the distress and move forward by going to school regardless of the feelings. Encourage your child to use the relaxation methods discussed last week of: breathing, muscle relaxation, and general relaxation. I find that children aren't too motivated to "relax" when they are in physical distress. At this point, your goal is to normalize the feelings and name them as "anxiety." "For anxiety not to win, YOU (not we) have to push through the feelings and they will get better the more you do it."
Your child may be missing some or most of the school day because of social and performance situations at school. The most important part at the beginning is to get your child in the school building for part or all of the school day.
- Find out what classes (times of the day) your child doesn't want to go to school and then build your plan around that. Then you can gradually increase the amount of time spent in school.
- If you are not capable of transporting your child for only parts of the school day, set up plan that your child will go to "safe" area (defined by your child) during the missed classes.
It is important to have your child practice the feared social or performance situations outside of the school day. Then as your child becomes comfortable, the classes missed due to social or performance anxiety should be added back in gradually.
Getting Your Child to Say "Yes" to School, Chpt. 4, Christopher Kearney.
Week 3: “I don’t like being away from my parents.”
Sam is an 8-year-old boy who has problems attending school because he would much rather be with his mother at home. Sam often refuses to go to school in the morning, although his mom (Emily) can sometimes get him to go into the school building. Sam says he likes school but often misses his mother. Whenever he is at school, Sam tries to call Emily and has even run out of the school building twice to try to go home. Lately, Emily has been eating lunch with Sam in the school cafeteria to get him to go to school with less fuss.
This week we will be talking about:
- Your child is refusing school only to get attention from you or significant others.
- Your child wants to attend school with him.
- Your family's morning routine is chaotic.
- Your child is having trouble attending school mostly in the mornings.
- Your child is exaggerating physical complaints (stomachaches, headaches) to try to stay out of school.
- Your child has trouble separating from you or significant others.
Refusing School for Attention
Some children seek alot of attention from one or both parents and are defiant about going to school because they would rather stay home. Many of these children are NOT distressed about school.
To change your child's attention-seeking behavior and help improve his school attendance, focus on:
- Setting up a regular morning routine.
- Pay attention to appropriate behaviors and ignoring inappropriate behaviors.
- Setting up formal rewards for going to school without a fuss.
- Setting up consequences for going to school without a fuss.
- Dealing with excessive telephone calls and texts.
behavioral modification SYSTEM
Consequences: Your child will “owe” you time. Owing you time can include anything from chores to writing you a letter how your child will handle the situation differently next time. Your child does not do anything “fun” (watch TV, video games, play with toys, etc) until ALL the time is owed back. The goal of this is for your child to determine that he/she is giving self consequence and he/she does not have consequence if makes good choice. It is very important to keep track of time in minutes and seconds and consequence be for exactly that amount of time.
Rewards: Give "Random Rewards." A “Random Reward” is any reward you give your child when he/she doesn’t expect it. Give Random Rewards to reinforce positive behaviors (i.e. putting shoes on without your help, smiling, etc.) The main point of a Random Reward is to reward them randomly when they least expect it. For example, “Wow you did such an awesome job this morning, lets celebrate and go get ice cream.” Rewards are not to be given on a schedule of “you do this, you get this.”
SETTING UP A REGULAR MORNING ROUTINE
Morning routines are generally a disaster for school refusal children. The school refusal child may be "calling the shots," and everyone else in the family is reacting to what he/she does in the morning. You may be "giving in,"working with," yelling, negotiating, bribing, or constantly bugging your child to go to school. In the meantime he/she is still resisting to going to school. You are reacting to what your child is doing and, in doing so, giving him/her a lot of attention that reinforces the school refusal behaviors. We have to change this. We have to set up the morning so that your child is responding to your rules and to what you say, and not the other way around. We have to set up a clear and predictable morning routine that your child is expect to follow each day.
- Simple commands. Tell your child exactly what you want him/her to do. The goal is not to let the all content make it complicated on moving through the morning.
- Set boundaries. You have to get good at which behaviors/statements to ignore and which ones to attend to.
- Direct eye contact. When speaking to your child or giving a command.
Separation Anxiety Disorder is a psychological condition in which an individual has excessive anxiety regarding separation from home or from people to whom the individual has a strong emotional attachment (like a mother). Separation anxiety is often characterized by some of the following symptoms: persistent, excessive worrying about losing the subject of attachment, persistent, excessive worrying that some event will lead to separation from a major attachment, excessive fear about being alone without subject of attachment, persistent reluctance or refusal to go to sleep without being near a major attachment figure (like a mother), recurrent nightmares about separation, difficulties with drop off at activities (school, birthday parties, sporting events).
Note: It is highly encouraged the child, parents, and school agree to the specifics of this protocol prior to initiation. It is important that child separate from parent by choice rather than a teacher, counselor, principal, etc. intervening by pulling, carrying, distracting child.
1. Determine how long you will allow for complete separation (typical drop-off) from child (at least 2 weeks).
2. Discuss with your child in confident (non-negotiating) voice that complete separation will occur within established time. It is important for child to see that parent is calm, confident, and in control.
3. Give child choice to determine gradual plan for separation such that child chooses specific places in school to separate. Always begin separating at classroom and then move backwards from classroom. For example:
Aug. 23 - 26: Drop off at classroom
Aug. 27 - 31: Drop off at school office
Sept. 1 – 4: Drop off at front door
Sept. 5: Drop off at curb
The important part is to establish that you will determine when complete separation will occur and the child can choose how it happens. It is very important for the child to understand that once you drop off at a certain point from the classroom that you will not move closer to the classroom again.
4. At drop off point you will say one (only one) good bye. You will then become non-negotiating and not talk to your child, no eye contact again. If you need balance, stand against a wall. You will wait for the child to separate from you. This is very important, as you want the child to begin learning and have confidence that he/she can separate from you. You have to be prepared that the first several times that it may take an extended period of time for your child to separate. It is important that you not give in early if you want child to learn that you are not going to give in. If you stay strong, separation will occur but you have to wait it out.
5. Establish for every second your child is late to class, your child will have to stay after school or have to “owe” you at home for the amount of time your child is late to class. It works best if the school will allow your child to stay after school for the time he/she is late. If staying after school is not an option, then when your child gets home they have “owe” you for every second they were late. Owing you time can include anything from chores to writing you a letter how separation will be different the next drop off. The child does not do anything “fun” (watch TV, video games, play with toys, etc) until ALL the time is owed back. The goal of this is for your child to determine that he/she is giving self consequence and he/she does not have consequence if not late. It is very important to keep track of time in minutes and seconds and consequence be for exactly that amount of time.
6.) Give “Random Rewards” when your child is being brave, separating from you. A “Random Reward” is any reward you give your child when he/she doesn’t expect it. Pick out all the things that you want your child to do on his/her own (i.e. walking into school without holding your hand, smiling, etc.) The main point of a Random Reward is to reward them randomly when they least expect it. Maybe randomly reward when you pick up your child from school, “Wow you did such an awesome job this morning, lets celebrate and go get an ice cream.” Rewards are not to be given on a schedule of “you do this, you get this.”
Phone calls/texts During the School Day
There are several different ways to handle phone calls/texts during the school day. Your child needs to know your expectation.
- No phone calls/texts during the school day. Encourage your child to connect with his/her teachers, counselor, etc.
- Limit phone calls/texts to a specific number. Once your child reaches that number you will not answer. Gradually reduce number of phone calls/texts over time.
- Allow your child to call/text you when needed. Your child will "owe" you the time after school for the time spent on phone calls/texts during the school day.
Do's and Dont's
- Set up a regular morning routine.
- Reward your child for properly getting reading in the morning.
- Punish your child for not completing the morning routine.
- Praise good behavior and ignore poor behavior.
- Expect your child to go to school each day.
- Work closely with school officials when developing your morning plan.
- Speak to your child in a calm, matter-of-fact tone and give brief commands.
- Be consistent and persistent
- Fight, yell, lecture, criticize, negotiate, beg, or bribe your child to go to school.
- Let your child dictate the morning vibe.
- Stay with your child at school.
- Allow your child to come home.
Getting Your Child to Say "Yes" to School, Chpt. 5, Christopher Kearney.
Week 4: “Being at home is more fun than going to school.”
Maya is a 16-year-old girl who has been skipping afternoon classes to hang out with her friends outside of school. Although Maya does go to school in the morning, she often meets up with her friends Callie and Nita in the middle of the day for lunch. Many times the teens eat lunch off the school campus and then "ditch" the rest of the day to go to a local mall or spend time at Callie's house. Maya is not distressed about school but complains sometimes that school is boring. She tried to hide her absences from her parents., but the principal recently informed Maya's mother that her daughter has now missed at least seven afternoons of school.
This week we will be talking about:
- You child is refusing school only to get to do more fun things outside of school.
- Your child is skipping class to be with friends or to do other fun things.
- Your child prefers to sleep in during the morning instead of going to school.
Refusing to have Fun or Dangerous Things Instead of School
- Hang out with friends
- Enjoy sleeping late
- Watch television
- Riding bicycle
- Destroy Property
Many of these children are not particularly distressed about school.
Things to change
- Must make sure that you and school staff know exactly where your child is at all times of the day. This will require you working closely with the school.
- Have to change all the fun things your child gets to do when she/he is out of school. Change to your child is getting reward for going to school and is receiving consequence for not going to school.
- Have your child check in at various times of day with school officials to maintain school attendance rather than ditching school.
- Require your child keep an attendance log to be assigned by each teacher.
- Get in the habit of your child checking in with you more during non school hours.
- Have regular meetings with your child to school preparation and attendance.
School Refusal Expectations
- Parents will give clear expectation to child that he is to participate in school activities with his assigned class allday, every day. There will not be any pulling, tugging, carrying child to car, classroom, etc.
- Randomly Reward positive behaviors.
- For every second that child is not in his seat in class, he/she will owe that time prior to getting any privileges (T.V.,video games, sports practices, sports games, eating dinner out, etc)
- Child will owe missed time by completing missed schoolwork and other academic work assigned by parents or school.
- If child refuses to go to school, he will follow same schedule at home as he would in class (only eat during eatingtimes at school, sitting at kitchen table to complete school work, only restroom breaks when restroom breaks at school)
- Parents will call school and report child as unexcused if refuses to go to school.
- If child refuses to go to school, he will pick up his schoolwork in his classroom or office after school. School work will not be forwarded to parents.
- Child is to self-advocate if he is not able to manage expectations.
- Parents and school will provide minimal negotiating or accommodations without child self-advocating.
Getting Your Child to Say "Yes" to School, Chpt. 6, Christopher Kearney.
- Nothing. Just let it ride and see how it goes ;)
- Take some more LIVE or Recorded classes. This class pairs well with Anxious Kids = Anxious Parents and Growth Mindset for Parents.
- Need more help than just a class? Try the Monthly Club or Individual Therapy.
- Stay connected with us on Facebook, Twitter, Instagram, and YouTube.
LIVE STUDENTS ONLY: You should have received an invite to join Basecamp. This is where we will communicate about the class ;) Your classmates are also in Basecamp so feel free to connect with them. Our hope is that Basecamp is the place you can go between classes to get info, support, talk about how you are doing with the skills you're learning.
We highly encourage you download the Basecamp 3 app to your phone and computer. The App will help you stay up to date with the class. If you didn't receive a Basecamp invite or having trouble signing in, contact us below.
School Refusal Parent Group
This is a supportive group for parents whose school aged children are emotionally struggling with going to school. We hope you will join our group to connect with other parents who are going through similar struggles. We will also discuss interventions that work and don't work for managing school refusal behaviors.
EVERYONE STRUGGLES FACEBOOK GROUP
We believe Everyone Struggles. Some struggle more than others, but everyone struggles socially and emotionally. It is part of being human! Regardless of your struggle with procrastination, obsession or compulsion, fear or phobia, problematic relationships or communication skills, depression or anxiety, we still believe you have more strengths than struggles. We encourage you to live a purpose driven life by focusing on what you can become rather than what you cannot become.
This group is for anyone interested in gaining useful resources to assist with social and emotional struggles, while also connecting with others who may be going through similar struggles.
We believe social and emotional wellness can happen in many different ways. We offer a variety of services for children, teens, and adults to help improve self-awareness and better manage social and emotional struggles.
We've designed our services to build off each other. So what you learn in the classes will help you in the Monthly Club and the Monthly Club will put you that much further ahead in Individual Therapy. You don't necessarily have to go in that order. Just know, whatever level you begin, we'll help you build a good foundation of Cognitive Behavioral skills and cheer you on until you are rockin' it ;)
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Limits and Restrictions:
The materials distributed are provided with the understanding that the author and presenters are not engaged in rendering professional services. This is a psychoeducational class and information in the presentations or group discussions by the presenters, facilitators, or participants should not be considered to be medical, psychological, legal, financial, or spiritual counsel. The presentations and written materials are not intended to provide medical, psychological, legal, financial, or spiritual services or counseling. If expert assistance or counseling is needed, the services of a competent professional should be sought. Any opinions, finding, recommendations or conclusions expressed by the author(s) or speaker(s) do not necessarily reflect the views of Midwest Anxiety, LLC.