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School refusal (SR) impacts on youths’ engagement with education due to an inability to attend school. Young people do not live in isolation, rather they are part family, school and wider community systems and this systemic positioning suggests that the development of school refusal interventions would benefit from including the experiences of young people. This study examines the responses of 18 young people identified as school refusing and attending outpatient programs. Results show that barriers and facilitators to school refusal include a need to belong, have positive peer and teacher relationships, flexibility in learning programs and an organised, positive school climate. Using this information when developing school refusal interventions may increase their effectiveness and return to school outcomes.