Table 1 Description of the Dutch intervention ‘Medical Advice for Sick-reported Students’, abbreviated as MASS

The MASS intervention consists of an integrated approach in a public health setting. MASS provides a clear framework in which schools, in direct collaboration with youth health care physicians (YHCPs), are able to reach students and their parents, discuss aspects of the student’s medical absence, and design and monitor a management plan that aims to optimise students’ health and maximise students’ participation in school activities. In summary, the aim of the MASS intervention is to limit the absenteeism by arranging appropriate care, educational adjustments and adequate support for students and parents. A systematic routine is followed.

Step 1 School’s policy:

The school communicates with students and parents about the new policy in case of absenteeism because of medical reasons.

Step 2 Referral to the YHCP:

Students with extensive medical absence are identified by school by using well-defined threshold criteria: reported sick four times in 12 school weeks or more than six consecutive school days (MASS-criteria). Meeting the criteria always leads to a referral to the YHCP for student and parents.

Step 3 Consultation of student and parents with the YHCP:

During the interview and medical assessment YHCPs look for biological, psychological and social factors that contribute to the students’ medical absenteeism. The YHCP identifies whether there is a specific somatic or psychiatric diagnosis to account for the absence. If the diagnosis is clear the focus will be on optimising the (adherence to) treatment. In cases of frequent physical complaints and psychosocial problems with no clear medical diagnosis, the YHCP considers diagnostics, and looks for family and school related factors, as well as health risk behaviours and lifestyle aspects that contribute to the physical complaints and psychosocial problems. If needed, the YHCP refers to a medical specialist or a psychosocial support network. A management plan is then designed together with student, parents and school, and with curative professionals, if applicable. This plan includes agreements on cure, care and school attendance.

Step 4 Monitoring the management plan:

School and YHCP monitor the execution of the management plan.