Ava Towers, 13, is reserved, but has a quiet confidence about her.
In a small class at Wiripaang Public School in Lake Macquarie, New South Wales, she's chatting with teachers and other students, laughing at jokes and engaging in activities in the classroom.
It is a stark difference from six months ago.
"The struggle of getting her to school was massive," Ava's dad Paul Towers said.
In early 2022, Ava started to withdraw from school and by 2023 she had stopped attending completely.
"We would get to school drop-off and she just wouldn't get out of the car," Mr Towers said.
Ava said her anxiety levels were at an all-time high and school became too overwhelming.
"I think it's because there were too many people, I don't like crowds," she said.
"I didn't want to go to school anymore, it was too hard.
"I just stopped going."
Mr Towers said he felt lost and didn't know how to help his daughter, until the team at John Hunter Hospital School reached out.
Outreach class
John Hunter Hospital School runs an outreach class at Wiripaang Public School, helping students with low attendance rates re-engage at school.
Assistant principal Amy Wilson said through her work, she increasingly heard stories from children struggling at mainstream school.
"I have worked at the hospital school for over 15 years now and get the opportunity to connect with a lot of children," she said.
"We would ask how school is going and more and more frequently the stories from students were: 'School is really hard at the moment' or 'I'm not really going much' or even 'I haven't been to school this year,'" she said.
Ms Wilson said she and her colleagues were inspired to create an early intervention program.
"We didn't want to be waiting for kids to get to tertiary-level health care for us to be able to have an intervention. We knew we could do this in the community," she said.
Unlike mainstream school, the outreach class has just a handful of students and flexible school hours.
Teachers are specially trained in mental-health first aid and trauma-informed practice.
The 10-week program targets students from kindergarten to year 12 with an attendance rate of less than 50 per cent due to long-term illness, mental-health conditions or poor engagement with homeschooling.
"We start slowly with an hour of class and build up over the term," teacher Lisa Swanson said.
"And the change in these kids from the beginning to the confidence at the end of our program, it fills our cup."
Ava said the program had helped her immensely.
"It made me a lot more confident in myself. I'm very glad I came here," she said.
Her father has also noticed the change.
"Our relationship is a lot better now because of it. I couldn't be happier," Mr Towers said.
"She's [Ava's] back at mainstream school now, so without the program, I think we'd still be back at square one."
School refusal a wider issue
School refusal is a growing issue across Australia and had been blamed on the COVID-19 pandemic.
But a Senate report into school refusal released in August made clear the problem runs far deeper.
It is defined as different from regular truancy because it is long-term and students do not hide their actions or engage in anti-social behaviour.
The report found the school system was letting down thousands of kids like Ava and asked education ministers to develop a national action plan in the next 12 months.
"We want every kid to have that sense of belonging in an educational setting, because we know how important that connection to education is for them to have the amazing futures," Ms Wilson said.
"And I think the fact that there are more and more of these alternative education environments popping up is really highlighting the need for it as well."