While visiting ESD 113, I was reminded that effective school drop out prevention and engagement programs must include efforts towards resolving or mitigating student physical, mental, emotional and behavioral health needs that can impede successful engagement, achievement and school safety. Current research indicates that adverse experiences or unmet physical or mental health conditions in childhood and adolescence may impact school attendance, academic performance and success (Dilley, 2009). In addition, the literature in education, public health, nursing, and medicine point to evidence that children who are frequently absent from school, particularly in early grades, encounter an assortment of negative outcomes which are strong predictors of not completing high school (Chang & Romero, 2008). As an education expert, it seems obvious to me that student educational success and graduation from high school begins by ensuring adequate school attendance.
Given these critical findings and the need to adopt and implement innovative practices that close the achievement gap and increase graduation rates, I learned that in 2010, the Washington State Office of Superintendent of Public Instruction (OSPI), through a partnership between their Institutional Education and Health Services departments, created Washington’s School Nurse Case Management program. This unique program is modeled to align with Title 1, Part D, No Child Left Behind program purposes and outcomes while focusing on students who are at risk for failing academically due to health related concerns. Title 1, Part D funds were granted to pilot this program as an extension of health services in local school districts building upon findings linking health and academic success (Maike & Drevdahl, 2014). The over-reaching goal of this program is to increase student attendance, academic performance and ultimately graduation rates for children with health related concerns.
I learned that school nurse case management services have been implemented in eleven school districts across ESD 171, 123 and 113. Eligible districts must be located within communities with multiple risk factors such as high levels of poverty, unemployment, and a demonstrated need for more school nursing hours. The program serves elementary and middle school youth with a focus on students in 3rd through 9th grades at or below grade level with absences from school due to health concerns such as a life threatening condition, chronic disease or unmet health care need. These grades were selected because at this age, student absenteeism is more likely to impact achievement and ultimately, graduation. About 150 students have been served to date.
School nurse case managers help overcome health related barriers to learning by identifying and managing student health concerns impacting school attendance. Additionally, they promote student health and wellness through communication and collaboration with the student, parent/families, teachers, staff, providers, and others in the community.
Important elements of the program include data driven student selection, holistic nursing assessment, identification of student strengths and barriers and prioritizing nursing interventions. Ongoing evaluation and modification of health plans assure students come to school, remain in class and participate safely in all school activities.
Data and feedback are gathered and analyzed by School Nurse Case Management program administrators from all three ESDs and are considered in the ongoing evaluation of the program. Student attendance and absence data from OSPI’s Comprehensive Education Data and Research System (CEDARS) and the district’s Student Information System is also collected and examined (Maike & Drevdahl, 2014).
As someone who experienced frequent school absences as a child from asthma, it was exciting to hear that first year evaluation results were promising! Absenteeism rates, Northwest Evaluation Association (NWEA) Measure of Academic Progress (MAP) scores for both reading and math, and Washington State Measurement of Student Performance (MSP) for both reading and math all demonstrated statistically significant improvement for students enrolled in the program even though limitations were noted. Results from 2013-14 data noted an increase in student attendance, gaining an average of 3 more school days compared to the prior year. Nine percent more student participants missing 17 days or less met state math proficiency and Reading Student Growth Percentiles for those missing 17 days or less equated to two months’ worth of school gains (Adams, Nelson & Stahlnecker, 2014).
It is well established that academic success and graduation rates can be impacted by poor student health and subsequent absences from school. Washington’s School Nurse Case Management Program has proven to be an innovative, non-traditional and promising use of Title 1, Part D funding.
Chang, H. & Romero, M. (2008). Present, engaged, and accounted for: The critical importance of addressing chronic absence in the early grades. National Center for Children in Poverty, Mailman School of Public Health at Columbia University, New York, NY.
Adams, W., Nelson, L., & Stahlnecker, L. (2014). Title 1 D: School Nurse Case Management Program.