Chapter 9 discusses Tier 3 cases, youths who have severe, chronic, and complicated absenteeism. Such students have often exceeded the legal limit for truancy, attend class sporadically when they do go to school, and/or frequently leave school prematurely. Attendance problems have lasted for months or years. Youths with Tier 3 problems have failing grades, few credits, and little knowledge of their current coursework. They are often socially detached and may display anxiety and oppositional behavior about the prospect of returning to school. Tier 3 attendance problems often involve deteriorating relationships between parents and school officials. Interventions include addressing comorbid problems and contextual variables, enhancing academic remediation and integration, establishing school attendance, and increasing parent and family involvement in school attendance. Intervention strategies may involve an expansion of the procedures described in this therapist guide, alternative educational schools and programs, specialized programs, and second-chance programs.