Future of Schools

State law and school outreach both levers for boosting immunization rates

This vial contains the DTaP vaccine, which prevents whooping cough.

Kathy Hill is a health clerk at Central Elementary School in Longmont. With a few clicks of her mouse, she can find out which of the school’s 340 kindergarten through fifth-grade students are up to date on their immunizations and which ones have “personal belief exemptions” because their parents have opted them out of some or all of their shots.

On a recent day, she did just that using the Infinite Campus data system. Her search revealed that 14 students, or about 4.1 percent, have no immunizations due to personal belief exemptions and 27 students have exemptions for certain immunizations, often Hepatitis B or chicken pox, but are up to date on others.

Hill’s data queries, which she efficiently sandwiched between helping a student with an itchy patch of skin and another who came in with a headache, provide exactly the sort of data that schools will be required to disclose by law beginning next year with the passage of House Bill 14-1288 last Friday. Originally, the bill also contained a provision to make it harder for parents to obtain personal belief exemptions, but a Senate committee stripped the bill of that measure last month.

In addition to requiring schools to disclose vaccination and exemption rates upon request, the bill requires the Colorado Department of Public Health and Environment to create a website with immunization information and to help schools analyze student immunization data. Also, it requires the State Board of Health to establish rules on the frequency with which parents have to submit exemption forms to schools or child care centers.

While some public health advocates are disappointed that a parent’s signature will continue to be all that’s required to get a personal belief exemption, they hope that requiring schools to disclose vaccination and exemption rates will bring more transparency to a historically murky area.

They say such information will arm parents, especially those with children who can’t get vaccinated for medical reasons, with valuable information that could figure into school choice decisions. In addition, the information might also nudge schools to improve their rates.

“We think it could be almost like a consumer-driven force rather than a mandate,” said Stephanie Wasserman, executive director of the Colorado Children’s Immunization Coalition.

The idea is that parents with concerns about vaccine-preventable illness–perhaps those with infants or immunosuppressed children or family members–will actively seek out school immunization information and could send their child to the local school where rates are highest and therefore herd immunity strongest. In turn, schools with low immunization rates might make extra efforts to push their rates up so they are on par with the competition.

“Schools are playing such an important role in enforcing immunization policy,” said Wasserman.

Mary Beth Rensberger, director of health services in Aurora Public Schools, said her staff can pull up vaccination data within five minutes, but she’s never heard of a parent request for such information.

“Once that hits the headlines that might be happening more.”

Unimpressive immunization rates

Colorado, which is one of 18 states to offer parents the option of a personal belief exemption, lags behind most other states when it comes to childhood immunization rates. While many have rates in the 90-95 percent range for three common kindergarten vaccinations, Colorado and Arkansas bring up the rear with rates in the low to mid-80s.

These low rates are a concern for public health experts, particularly because of outbreaks of whooping cough in recent years. The highly contagious disease, also known as pertussis, can be deadly for babies and young children.

The problem is most people don’t know whether the vaccination rates in their schools and communities are high enough to offer herd immunity, which usually requires immunization rates of 90-95 percent. Statewide  immunization numbers don’t help much because they are based on surveys with relatively small sample sizes so they don’t reveal much about risk in individual communities. That’s where school immunization data may help.

“Theoretically, every school is supposed to have this information on hand,” said Wasserman. “It’s just that it’s not collected in a uniform way.”

State officials say district’s like St. Vrain Valley, where Hill works, are exemplars when it comes to immunization policy, but many districts lag behind. Part of the problem is that schools vary widely in how they collect, confirm and store immunization information. Results can depend on a health clerk’s or nurse’s hours, the type of student data system used, whether districts are signed up to access the state’s immunization registry, and how deeply principals care about the issue.

Other immunization levers

School staff members like Hill are on the front lines when it comes to improving immunization rates. Not only are they charged with tracking down missing or incomplete immunization records, they’re often the ones to remind and encourage parents to get their children up to date on shots. Sometimes, they also help families address financial or logistical barriers.

It may not be glamorous work, but there is evidence it makes a difference. The Boulder County Public Health department worked with the St. Vrain Valley and Boulder Valley school districts to study the impact of school outreach to families during the 2012-13 school year. At the time, there were a number of whooping cough cases among school-aged children and Boulder health officials secured a state grant to look DTaP vaccination, which protects children from the disease.

Specifically, the project examined changes in DTaP vaccination rates after school staff contacted parents whose kindergarteners had received most but not all of the shots in the five-dose series. In the Boulder Valley district, 289 kindergarteners started school that year with four of the five shots and in St. Vrain, it was 137.

Soon, health clerks, nurses and sometimes even principals were e-mailing, calling and sending out letters to remind parents to get their children up to date on shots. In some cases, staff gave out vouchers for free immunizations or helped working parents figure out which providers had evening clinics. While such outreach efforts are routine in the two districts as well as many others, the DTaP project marked one of the rare occasions the results have been measured.

At the end of the project, the proportion of Boulder Valley kindergartners fully immunized against whooping cough rose from 75.4 percent to 86.2 percent, and in St. Vrain Valley, the numbers rose from 86.9 to 88.4 percent. In addition, both districts saw increases in the number of schools with DTaP vaccination rates of at least 90 percent, a guideline for herd immunity. In Boulder Valley, where there are 34 elementary schools, the number rose from 2 to 14. In St. Vrain Valley, where there 32 elementary schools, the number rose from 11 to 18.

Sophia Yager, immunization program coordinator at Boulder County Public Health, said, “The bottom line is we did see improvement.”

Plus, she added, “We were able to stomp the myth out that Boulder people don’t vaccinate.”

Hurdles for parents and schools

For harried parents, getting their kids up to date on shots can mean inconvenient appointments, confusing insurance coverage, and the hassle of submitting one more school form. And although students are required by Colorado law to have vaccinations or signed exemptions to attend school, those without the required documentation are rarely turned away.

“There’s not really any sanction or teeth in that law,” said Rensberger. “Sometimes, it just really, really tedious to have parents see the need to get their healthy kids in there.”

For that reason, some parents will simply sign a personal belief exemption even if they’ve already gotten their child partially vaccinated and have no philosophical objection to vaccines.

Hill said, “Unfortunately, when they sign their exemption, they’re like, ‘Oh well.'”

She said the timing of kindergarten registration is also a factor in parent follow-through. With some registration events now held in December, it’s easy for parents to forget about immunization forms over the next eight months.

“It’s much more difficult for some families to keep it together,” she said.

In Aurora, district staff try to make it easy for parents to get their kids vaccinated on-site. The district’s school-based health clinics vaccinate elementary children with parental consent and the district’s annual “Welcome Back” event in August often features a walk-in vaccination clinic operated in conjunction with the local health department. In previous years, up to 400 students have gotten shots at the clinic.

While a certain percentage of parents don’t follow through with vaccinations no matter how many reminders they get, others are amenable to getting their kids caught up. The problem is that over-taxed school staff don’t always have the time to contact those parents until the school year is almost over.

In Aurora, Rensberger said some schools weren’t reaching out to “non-compliant” families—those without required vaccinations or signed exemptions– until March. This year, she set an early November deadline for that work.

Susan Rowley, director of health services for the Boulder Valley district, said in schools where health clerks work a full day, the job gets done during the first semester. In schools where they’re on duty for just three or four hours a day, it takes longer.

“This is what the unfortunate economic downturn did,” she said.


hurdle cleared

Indiana’s federally required education plan wins approval

PHOTO: Courtesy of the Indiana Department of Education
State Superintendent Jennifer McCormick greets elementary school students in Decatur Township.

U.S. Education Secretary Betsy DeVos has signed off on Indiana’s federally required education plan, ushering in another era of changes — although not exactly major ones — to the state’s public school system.

The U.S Department of Education announced the plan’s approval on Friday. Like other states, Indiana went through an extensive process to craft a blueprint to comply with the Every Student Succeeds Act, or ESSA, which was signed into law in 2015.

“Today is a great day for Indiana,” state Superintendent Jennifer McCormick said in a statement. “Our ESSA plan reflects the input and perspective of many stakeholders in communities across our state. From the beginning, we set out to build a plan that responded to the needs of Hoosier students. From our clear accountability system to our innovative, locally-driven approach to school improvement, our ESSA plan was designed to support student success.”

The federal government highlighted two aspects of Indiana’s plan. One is a pledge to close achievement gaps separating certain groups of students, such as racial and ethnic groups, from their peers by 50 percent by 2023.

Another is a staple of other states’ plans, as well: adding new ways for measuring how ready students are for attending college or starting their careers. Indiana education officials and lawmakers have made this a priority over the past several years, culminating in a new set of graduation requirements the Indiana State Board of Education approved late last year.

Under Indiana’s plan, high schoolers’ readiness will be measured not just by tests but also by performance in advanced courses and earning dual credits or industry certifications. Elementary school students will be measured in part by student attendance and growth in student attendance over time. Test scores and test score improvement still play a major role in how all schools are rated using state A-F letter grades.

In all, 35 states’ ESSA plans have won federal approval.

Advocates hope the law will bring more attention to the country’s neediest children and those most likely to be overlooked — including English-learners and students with disabilities.

Indiana officials struggled to bring some state measures in line with federal laws, such as graduation requirements and diplomas.

Under the state’s ESSA plan, A-F grades would include these measures (see weights here):

  • Academic achievement in the form of state test scores.
  • Test score improvement.
  • Graduation rate and a measure of “college and career readiness” for high schools.
  • Academic progress of English-language learners, measured by the WIDA test.
  • At least one aspect of school quality. For now, that will be chronic absenteeism, but the state hopes to pursue student and teacher surveys.

The last two are new to Indiana, but represent ESSA’s goal of being more inclusive and, in the case of chronic absenteeism, attempting to value other measures that aren’t test scores.

Because the Indiana State Board of Education passed its own draft A-F rules earlier this month — rules that deviate from the state ESSA plan — it’s possible Hoosier schools could get two sets of letter grades going forward, muddying the initial intent of the simple A-F grade concept parents and community members are familiar with.

The state board’s A-F changes include other measures, such as a “well-rounded” measure for elementary schools that is calculated based on science and social studies tests and an “on-track” measure for high schools that is calculated based on credits and freshman-year grades. Neither component is part of  the state’s federal plan. The state board plan also gets rid of the test score improvement measure for high-schoolers.

While that A-F proposal is preliminary, if approved it would go into effect for schools in 2018-19.

The state can still make changes to its ESSA plan, and the state board’s A-F draft is also expected to see revisions after public comment. But the fact that they conflict now could create difficulties moving forward, and it has led to tension during state board meetings. Already, the state expected schools would see two years of A-F grades in 2018. If both plans move forward as is, that could continue beyond next year.

Read: Will Indiana go through with a ‘confusing’ plan that could mean every school winds up with two A-F grades?

Find more of our coverage of the Every Student Succeeds Act here.


Aurora recommends interventions in one elementary school, while another gets more time

Students during PE class at Lyn Knoll Elementary School in 2016 in Aurora, Colorado. (Photo by Helen H. Richardson/The Denver Post)

Aurora school district officials on Tuesday will recommend turning over management of some operations at one of their elementary schools to an outside management company.

The school, Lyn Knoll Elementary, is located in northwest Aurora near 2nd Avenue and Peoria Street and serves a high number of students from low-income families, with 4 percent of students identified as homeless. The school was one of three Aurora schools that earned the lowest rating from the state in 2017.

That rating automatically flags the school under a district process for school interventions. The process directs district officials to consider a number of possible improvement plans, including closure or turning the school over to a charter school.

Lyn Knoll has had good rankings in recent years before slipping dramatically in the past year, a change that put it on the turnaround list. The district did not recommend intervening at Paris Elementary, even though that school has been in priority improvement for years and will face state sanctions if it has one more year without improvement.

Annual ratings for Lyn Knoll Elementary

  • 2010: Improvement
  • 2011: Improvement
  • 2012: Performance
  • 2013: Improvement
  • 2014: Priority Improvement
  • 2016: Performance
  • 2017: Turnaround
Colorado Department of Education

The board will discuss the recommendation on Tuesday and vote on the school’s fate next month. In November, four union-backed board members who have been critical of charter schools won a majority role on the district’s school board. This will be their first major decision since taking a seat on the board.

In September, Superintendent Rico Munn had told the school board that among January’s school improvement recommendations, the one for Paris would be “the most high-profile.” A month later the district put out a request for information, seeking ideas to improve Aurora schools.

But in a board presentation released Friday, district officials didn’t give much attention to Paris. Instead, they will let Paris continue its rollout of an innovation plan approved two years ago. Officials have said they are hopeful the school will show improvements.

The recommendation for Lyn Knoll represents more drastic change, and it’s the only one that would require a board vote.

The district recommendation calls for replacing the current principal, drafting a contract for an outside company to help staff with training and instruction, and creating a plan to help recruit more students to the school.

Documents show district officials considered closing Lyn Knoll because it already has low and decreasing enrollment with just 238 current students. Those same documents note that while officials are concerned about the school’s trends, it has not had a long history of low ratings to warrant a closure.

In considering a charter school conversion, documents state that there is already a saturation of charter schools in that part of the city, and the community is interested in “the existence of a neighborhood school.” Two charter networks, however, did indicate interest in managing the school, the documents state.
The district recommendation would also include stripping the school’s current status as a pilot school.

Lyn Knoll and other schools labeled pilot schools in Aurora get some internal district autonomy under a program created more than 10 years ago by district and union officials.

Because Lyn Knoll is a pilot school, a committee that oversees that program also reviewed the school and made its own recommendation, which is different from the district’s.

In their report, committee members explained that while they gave the school low marks, they want the school to maintain pilot status for another year as long as it follows guidance on how to improve.

Among the observations in the committee’s report: The school doesn’t have an intervention program in place for students who need extra help in math, families are not engaged, and there has not been enough training for teachers on the new state standards.

The report also highlights the school’s daily physical education for students and noted that the school’s strength was in the school’s governance model that allowed teachers to feel involved in decision making.

Read the full committee report below.