The doctor is in

Big year for school-based health in Colorado

Physician's Assistant Elizabeth Madrid chats with Jade-Marie Burgess and her son Eli at the school-based clinic at Florence Crittenton High School.

Jade-Marie Burgess lifted her two-year old son Eli onto the beige exam table. He was having tummy trouble so she’d gotten a walk-in appointment at the new clinic.

For 18-year-old Burgess, a senior at Denver’s Florence Crittenton High School, the appointment was a cinch. With the clinic just down the hall from her second-hour class and across the courtyard from Eli’s child care room, travel time was about two minutes.

Last year, it was a very different story. When her son was sick, she’d travel with him on two city buses to the clinic at Alameda International High School in Lakewood. The average time away from school was four to five hours.

It was “ridiculously long,” she said.

The clinic—still so new there are no pictures or decorations on its pale green walls—is a major milestone for the school, which enrolls 145 pregnant and parenting teenagers, as well as 109 of their young children.

School leaders believe it will help reduce absences due to illness as well as those associated with long commutes like the ones Burgess experienced.

The clinic, officially called the Alethea D. Morgan, M.D. Health Center, is also part of the reason that school-based health centers are having a red-letter year in Colorado.

Florence Crittenton High School
This new building on the campus of Florence Crittenton High School in Denver’s Valverde neighborhood replaced two cinderblock warehouses and a gravel parking lot.

It’s among five new ones that have opened across the state this fall. That’s an unusually high number for Colorado, which has a total of 61 school-based clinics. The other four new centers are at schools in Aurora, Carbondale, Cortez and Leadville.

The clinic at Florence Crittenton is also the first school-based health center in the state to offer routine obstetric services—everything but ultrasounds and delivery.

Given the population served by the school, it was “a no-brainer to add that component,” said Suzanne Banning, President and CEO of Florence Crittenton Services.

A big lift

Advocates of school clinics in Denver and elsewhere readily admit that establishing such facilities isn’t easy. It takes years of planning and the costs are formidable.

At Florence Crittenton, the clinic is part of a new $8.8 million school building. About two-thirds of that money came from a Denver Public Schools bond issue and one-third from fundraising by Florence Crittenton Services.

Operating costs will run about $200,000 a year, to be covered initially by grant funding and dollars from Denver Health, which operates the clinic.

Currently, the state has a $5.3 million budget line that provides planning, start-up and operations grants for school-based health centers.

“That is enough right now, but as the number of school based health centers grows and that pot is divided among more locations, that won’t be enough,” said Deborah Costin, executive director of the Colorado Association for School-Based Health Care.

Kids in the early childhood education program at Denver's Florence Crittenton High School play on a new playground that was part of a construction project that added a new health clinic, gym and classroom space.
Kids in the early childhood education program at Denver’s Florence Crittenton High School play on a new playground that was part of a construction project that added a new health clinic, gym and classroom space.

Still, there’s evidence that school-based clinics improve health access for kids, particularly those who face the greatest barriers in getting care.

Such barriers are often higher for Florence Crittenton students, who have to manage health care decisions for themselves and their children. Without the same-day appointment Burgess got for her sick toddler at the school clinic, it could have easily turned into emergency room visit, said Banning.

Getting students to make and keep health appointments at off-campus clinics has often been struggle at Florence Crittenton.

“We’ve always seen the challenge the girls had in navigating the health care system,” she said. “We’ve always seen that we set the appointment, but unless we gave them money and a taxicab to get down there, which we often did, they wouldn’t go.”

“Now, they’ve got nirvana,” Banning said as she led a tour of the new brick building that houses the clinic, high school classroom space and a gymnasium.

More clinics on the way

Two more school-based clinics are slated to open in Colorado next year — one on the Boulder Valley district’s Arapahoe Campus and one at a yet-to-be-determined location in the Adams 12 district. The clinics will be the first school-based health centers for both districts.

For many districts, the addition of school-based health centers represents the growing awareness about the link between health and achievement.

The idea is that students with health problems—whether asthma, tooth decay, depression or something else—miss out on learning.

“I think educators are becoming more cognizant of that,” said Costin, even as they work to raise test scores.

“Many of them are saying, ‘Well wait a minute, health is such a big part of this. Even though we’re in the education business, we need to be in the health business too, to move the needle on these measures.’”

 

chronically absent

One in four students are chronically absent in Tennessee’s state-run district. Here’s what educators are doing about it.

PHOTO: (Lance Murphey, Memphis Daily News File Photo)
About 25 percent of students at Humes Preparatory Academy Middle School were chronically absent last year, a drop of 6 percent from 2017.

More than one in four children in Tennessee’s state-run turnaround district were chronically absent from school last year. Until recently, Armani Fleming, an eighth-grader in Memphis, risked being among them.

Armani struggled with attendance until a student support specialist with Communities in Schools, a Memphis nonprofit focused on wrap-around services for children, worked with him to identify and resolve barriers keeping him from class at Humes Middle School, apart of the Frayser Community Schools charter network.

“I realized Mr. B really cared about me, and he’s helped me make sure I come,” Armani said of the support specialist, Cadarius Buckingham. “He’s more of a counselor to me. I come and talk to him about everything, he’s the person I come to when I need help … and me coming to school has gotten a lot better.”

In the Achievement School District, getting kids to show up at school matters. Recent research has shown that when students have more “familiar faces” around them in class, they’re less likely to be chronically absent. Which is why nonprofits like Communities in Schools are sending staff members into local schools to connect with students like Armani.

Tennessee created the Achievement School District in 2012 to fix its lowest-performing schools by turning them over to charter organizations, but it has struggled to move the needle. Last year, 27.4 percent of the district’s students were chronically absent — representing a 2.4 percent drop from the previous year, but still alarmingly high. Now composed of 30 schools, the district faces higher rates of student mobility and poverty, contributing to its challenges with absenteeism.

Statewide, more than 13 percent of students are chronically absent, defined as having missed 10 percent of the school year, which is typically 18 or more days, for any reason (including excused absences and suspensions), but the average rate was significantly higher, 21 percent, for students who live in poverty.

The stakes are high for improving attendance numbers. Chronic absenteeism is now a major part of Tennessee schools are held accountable by the federal government. And research shows that children who are chronically absent from school are often academically below grade-level, more likely to drop out of school, and more frequently involved in the criminal justice system.

Communities in Schools is now in 19 Memphis schools, eight of them state-run. Those schools have seen, on average, a 5 percent reduction in chronic absenteeism, according to Michael Russom, the group’s director of operations and communications.

One school, Cornerstone Prep Denver Elementary, saw even more dramatic results: an 18 percent drop in chronic absenteeism year-over-year. Last year, just 13.7 percent of the school’s students were chronically absent.

What made the difference? Capstone Education Group, the charter school operator that runs Cornerstone schools, has a staff member dedicated to improving attendance and a partnership with Communities in Schools, said Drew Sippel, executive director of Capstone, which runs two state-run schools in addition to Denver that also had low absenteeism numbers.

“Whenever a parent expresses some concern related to regular attendance, [Patricia] Burns works to resolve impediments to consistent attendance,” Sippel said of the school’s Manager of Student Information and Business Systems. “These impediments range from transportation, homelessness, and inability to purchase school uniforms.”

Untreated health issues is sometimes another factor.

Denver Elementary’s principal also worked with Capstone staff to increase the number of meetings with parents, and therefore, to pinpoint the root causes of students’ absences.

Agape, Whitney Elementary, Memphis
PHOTO: Caroline Bauman
Two of Agape’s staff members work with students on reading at Whitney Achievement Elementary School. The staff members, though employed by the Memphis nonprofit, are integrated into school life.

“There’s often an assumption or judgment with parents, ‘Why don’t you just make your kids go to school?’” said David Jordan, CEO of Agape, a Christian nonprofit that has also seen success in reducing chronic absences in Memphis schools. “We keep data on this, and it’s not that parents don’t care. There’s a lot of issues that can prevent students from making it to class.”

The program has grown every year from when it began in 2013 with 113 students. Now, more than 550 students are a part of Agape programs in 16 schools throughout Memphis — and all students they work with are now at school for at least 85 percent of the school year. This is just shy of the group’s goal for Agape students: to attend more than 90 percent of the year.

For its part, Communities in Schools hopes to expand onto additional Memphis campuses, but for now, the focus is the schools they are already serving. And they have added additional staff to some of the highest-needs schools.

One such school is Fairley High School, an Achievement District school run by the charter operator Green Dot Public Schools. There, about 56 percent of students were chronically absent last year, a 19 percent increase from 2017. Russom said they placed two full-time support specialists within Fairley earlier this school year.

Last year, absences spiked at Fairley amid a change of leadership at the school, and it took time for the new principal to gain students’ trust, said Zachary Samson, Green Dot’s area superintendent.

“That’s one huge piece of chronic absenteeism that’s hard to quantify,” Samson said. “It makes such a difference when a student walks in the door, and I as a school leader am able to greet them by name. I know their mom. It’s students feeling seen and appreciated.”

To improve attendance, Samson said his staff is working with Communities in Schools to create an incentive program for students, in which students who meet their attendance goals can attend school parties. He added that they are also focusing on their communication with parents, as many parents may not be aware their children are chronically absent or of the consequences.

Samson said he’s confident attendance can improve at Fairley because he’s seen it happen at another Green Dot school – Wooddale Middle School. About 15 percent of students were chronically absent at Wooddale last year, a drop of 3 percent from the previous school year.

Communities in Schools has a full-time staff member at Wooddale, and that has made an enormous difference, Samson said, noting: “For schools where budgets are very, very tight, having another passionate educator in your school whose big focus is to address attendance and behavior with students – that’s a huge help.”

Update: This story has been updated to clarify that the state defines chronic absenteeism as missing 10 percent of attended school days, which is typically 18 or more days for the school year.

Correction: This story has been corrected to say that one in four students in the Achievement School District were chronically absent last school year, not one in three.

behind the budget

Surprise: Most funding for New York City’s ‘community schools’ going to academics, not social services

PHOTO: Alex Zimmerman/Chalkbeat
Principal Asya Johnson of Longwood Preparatory Academy, a community school, corrals a student between classes.

When Mayor Bill de Blasio promised a new “community schools” program during his 2013 campaign, it was in part a repudiation of his predecessor’s focus on improving academic results.

Rather than punishing schools when students struggle, the theory went, the city should flood schools with services to combat the problems that hold students back from succeeding. The city has included schools with a range of academic performance levels in the program, and officials have said their main goal is to increase equity, not test scores.

So it’s surprising that just a small fraction of this year’s extra spending at the city’s 239 official community schools is going toward physical and mental health services, while about 60 percent of the $198.6 million being spent on the program is going to academic services.

That’s according to a new analysis by the city’s Independent Budget Office, which looked at school-level spending plans produced for the first time this year under a new state transparency law.

The city education department is disputing the budget office’s methodology but not the conclusion that community schools are spending heavily on academic services. Community schools choose which programs and services to offer, based on their students’ needs; the academic services category includes spending on anything beyond traditional classroom instruction, including gifted programs, extra tutoring, and services for students with disabilities.

The spending analysis offers important context for an external evaluation of New York City’s program by the Rand Corporation, which is expected in 2019. It could potentially add to an existing body of research suggesting that efforts to combat poverty by providing “wraparound services” in schools often — though not always — generate improved test scores. The research has so far not answered the question of what makes some programs more successful than others, so knowing that New York City’s results come after spending heavily on academic services will add an important data point.

Early in the program’s development, some advocates pressed the city to tackle academics in addition to social challenges. But how much the community schools model is boosting academic improvement remains an open question locally, and the spending analysis offers important context for an external evaluation of New York City’s program that is expected in 2019.

Education department spokesman Doug Cohen said the state’s fiscal reporting requirements don’t reflect the city’s “holistic” approach to supporting schools. He said the discrete spending categories obscure the reality inside schools, where various programs interact in complex ways.

After-school programs, for example, might offer emotional support for students, Cohen said, adding that the overlap is an important feature of the community schools model.

“If we were only doing mental health alone,” he said, “it wouldn’t really be a community schools strategy.”