title: Frequent fliers, school phobias, and the sick student: school health personnel's perceptions of students who refuse school.
abstract: BACKGROUND
  This study explored school personnel's perceptions of school refusal, as it has been described as a "common educational and public health problem" that is less tolerated due to increasing awareness of the potential socioeconomic consequences of this phenomenon.
  
  
  METHODS
  In-depth interviews were conducted with school personnel at the middle school (N = 42), high school (N = 40), and district levels (N = 10). The findings focus on emergent themes from interviews with school health personnel (N = 12), particularly those themes related to their perceptions of and role in working with school-refusing students.
  
  
  RESULTS
  Personnel, especially school health services staff, constructed a typification of the school-refusing student as "the sick student," which conceptualized student refusal due to reasons related to illness. Personnel further delineated sick students by whether they considered the illness legitimate. School health personnel referenced the infamous "frequent fliers" and "school phobics" within this categorization of students. Overarching dynamics of this typification included parental control, parental awareness, student locus of control, blame, and victim status. These typifications influenced how personnel reacted to students they encountered, particularly in deciding which students need "help" versus "discipline," thus presenting implications for students and screening of students.
  
  
  CONCLUSIONS
  Overall, findings suggest school health personnel play a pivotal role in screening students who are refusing school as well as keeping students in school, underscoring policy that supports an increased presence of school health personnel. Recommendations for school health, prevention, and early intervention include the development of screening protocols and staff training.
authors.affiliation: Navarre, FL 32566, USA. bandaarmstrong@gmail.com
authors.forename: Anna M
authors.initials: AM
authors.lastname: Torrens Armstrong
authors.forename: Kelli R
authors.initials: KR
authors.lastname: McCormack Brown
authors.forename: Roger
authors.initials: R
authors.lastname: Brindley
authors.forename: Jeannine
authors.initials: J
authors.lastname: Coreil
authors.forename: Robert J
authors.initials: RJ
authors.lastname: McDermott
mesh_terms: D000041:Absenteeism; D058445:Bullying / Q000523:psychology*; D002648:Child; D002669:Child Welfare; D005260:Female; D005431:Florida / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D055809:Illness Behavior; D007406:Interview, Psychological; D008297:Male; D008306:Malingering / Q000453:epidemiology / Q000451:nursing / Q000523:psychology*; D010698:Phobic Disorders / Q000453:epidemiology / Q000451:nursing / Q000523:psychology*; D011594:Psychometrics; D012572:School Health Services; D012573:School Nursing; D013334:Students / Q000523:psychology*; D013637:Tape Recording