Good medicine

How do you fight chronic absenteeism? Put a nurse in every school.

Almost a fifth of Memphis students are considered chronically absent from school, and too often it’s because of an asthma attack, a toothache or an undiagnosed psychological condition.

Community leaders grappling with the city’s high rate of absenteeism frequently have cited challenges rooted in poverty — from students who struggle to get a ride to school to embarrassment over dirty uniforms. Now they’re zeroing in on a deeper related problem: chronic health conditions.

Last year, a staggering 44,000 Memphis students reported suffering from a chronic health condition, contributing to 18 percent of students missing at least 18 days of class in Shelby County Schools or the state-run Achievement School District.

“It’s clear that having a nurse at every school could greatly reduce the number of students who miss school for preventable health reasons,” said Lora Jobe, executive director of PeopleFirst Partnership, a coalition of business, government, academic and civic leaders. “The health concerns we’re talking about disproportionately affect impoverished children and children of color. In Memphis, addressing this should be a top priority.”

Community leaders came together Wednesday at the University of Memphis for a summit on how health disparities are causing youngsters to miss school. The gathering follows last month’s launch of an attendance campaign by Shelby County Schools, providing supports for 10 schools with the most-absent students.

Students in Memphis are mostly people of color and from low-income families, both groups with higher-than-average rates of asthma and untreated dental cavities.

Last year, in fact, Memphis was named the nation’s worst city to live with asthma, a chronic lung condition that leads to episodes of wheezing, coughing and shortness of breath, among other symptoms.

Panelists talk about chronic absenteeism and health at a summit spearheaded by PeopleFirst Partnership.
PHOTO: Caroline Bauman
Panelists talk about chronic absenteeism and health at a summit spearheaded by PeopleFirst Partnership.

The summit was attended by doctors, dentists, nurses and mental health professionals, as well as education and nonprofit leaders. Discussions gravitated frequently to the importance of having a full-time nurse in each school, not only to treat students but also to educate their families about how to manage medical conditions that might keep their kids home from school.

Tennessee law requires only one nurse for every 3,000 students, and budget cuts have made it impossible for Shelby County Schools to keep a nurse in every school building. Instead, nurses rotate across the district, usually giving each school one day of medical staffing a week.

That’s not enough, said Angela Hargrave, the district’s director of attendance and discipline.

“Parents aren’t comfortable that their children will be properly cared for at school,” Hargrave said. “People at schools aren’t comfortable with that responsibility. We’re not medical professionals. Our front office staff isn’t trained for that.”

A full-time school nurse can provide the medical care or information that makes the difference in coming to school or staying home, said Cindy Hogg, director of health services at Le Bonheur Community Health.

“A nurse in the school building is often the only care provider many children in low-income areas in Memphis see for years,” Hogg said. “Of course, nurses should send students home when they are sick. But so often students are missing way more school than they should because no one in the health world is communicating with them or their parents.”

Jobe pledged that PeopleFirst Partnership, which organized the summit, will lobby local and state officials to enact and fund a policy that lower the school nurse-to-student ratio.

“I hope this time next year, when we see Tennessee require a nurse in every school, you will be able to say, ‘I was in the room when this started,’” Jobe told the group.

Poverty in America

Memphis woman’s tragic death prompts reflection. Could vacant schools help in the fight against homelessness?

PHOTO: Laura Faith Kebede
Graves Elementary School in South Memphis has been boarded up since its closure in 2014. It's one of 10 vacant school buildings in the city.

The death of a Memphis woman sleeping on a bench across from City Hall in frigid temperatures unleashed a furor of frustration this week across social media.

As Memphians speculated how someone could freeze to death in such a public place, some pointed to limited public transportation, one of the nation’s highest poverty rates, and entry fees to homeless shelters. The discussion yielded one intriguing suggestion:

About 650 Memphis students were considered homeless during the 2015-16 school year, meaning their families either were on the streets, living in cars or motels, or doubling up with friends and relatives.

At the same time, Shelby County Schools has an adequate supply of buildings. The district had 10 vacant structures last fall after shuttering more than 20 schools since 2012, with more closures expected in the next few years.

But what would need to happen for schools to become a tool against homelessness? Some cities already have already begun to tap that inventory.

Shelby County Schools has been eager to get out of the real estate business, though it’s not exactly giving away its aging buildings. In 2016, Superintendent Dorsey Hopson said the school system should “repurpose some of these buildings and … anchor some of these communities and rebuild and refurbish these communities instead of tearing stuff down.” The conversation was part of Memphis 3.0, the city’s first strategic plan since 1981 to guide growth for years to come.

District policy allows for “adaptive reuse” to lease vacant buildings for community development including affordable housing, community centers, libraries, community gardens, or businesses. A change requires a community needs assessment and input from neighborhood leaders and organizations before the school board can vote on a recommendation.

But proposals to transform schools into housing haven’t emerged in Memphis.

The Memphis Housing Authority, which oversees federal dollars for housing development, has a two-year exclusive right to purchase two former schools near downtown. But talk has focused on using that space for an early childhood center, not housing, according to High Ground News.

Under state law, districts must give charter schools, which are privately managed but publicly funded, serious consideration to take over a closed building.

That has happened for some Memphis schools, but high maintenance costs for the old buildings are a major deterrent. They also present a significant challenge for any entity looking to convert a structure into a homeless shelter or affordable housing.

Of the district’s 10 empty school buildings, most have a relatively low “facility condition index,” or FCI rate, which measures the maintenance and repair costs against the current replacement cost. The higher the number, the less cost-effective.


*as of October 2017

The idea to turn vacant school buildings into livable space is not new. Across the nation, some communities have found workable solutions to address the excess real estate.

In Philadelphia, a nonprofit organization transformed an empty four-story elementary school that was frequented by trespassers and drug users into housing for 37 homeless veterans and low-income seniors. The $14 million project, led by Help USA, took advantage of federal dollars set aside to house homeless veterans.

Last summer, leaders in Daytona Beach, Florida, pitched in $3.5 million in public funds to help a local nonprofit convert an elementary school into a homeless shelter. Despite pushback from neighborhood residents, the plan secured a unanimous vote from its county council.

In Denver, school officials proposed turning an elementary school into affordable housing for teachers to combat expensive living costs and rapid gentrification. That idea is still up in the air, with some residents lobbying to reopen the building as a school.

Detroit is riddled with empty school buildings. Developers there are buying up properties to repurpose for residential use as they wait to see what the market will bear. The city’s private Catholic schools have seen more success in transforming old buildings into apartments, luxury condominiums, or a boutique office building because they are smaller, easier to renovate, and don’t have the same deed restrictions as public schools.

The same appears to be true in Baltimore, where a nonprofit group converted a 25,000-square-foot Catholic school into housing for women and children. The $6 million project, completed last month, uses federal housing vouchers to subsidize rent.

In Memphis, the community is still assessing what resources need to be tapped in response to this week’s tragic death.

“Simply dismissing this as a tragedy will only allow us to continue to absolve ourselves from the apathy and selfishness that allow people to go unseen,” said the Rev. Lisa Anderson, a Cumberland Presbyterian pastor who is executive director of the city’s Room in the Inn ministry.

academic insurance

Children’s Health Insurance Program is on the brink. Here’s why that matters for education

The fate of the Children’s Health Insurance Program is in Congress’s hands — and children’s education, not just their health, may be at stake.

Congress passed a temporary extension of funding for of CHIP in December, through some states will run out of money shortly. The end of the program would come with obvious potential consequences, as CHIP, which covers approximately 9 million children, gives participants more access to health and dental care.

There may also be a less obvious result: Research has found that access to health insurance helps kids perform better on tests and stay in school longer.

A 2016 study, published in the peer-reviewed Journal of Human Resources, found that expanding Medicaid in the 1980s and 1990s increased students’ likelihood of completing high school and college.

“Our results indicate that the long-run benefits of public health insurance are substantial,” the researchers wrote.

Similarly, an earlier paper shows that broadening access to Medicaid or CHIP led to increases in student achievement.

“We find evidence that test scores in reading, but not math, increased for those children affected at birth by the increase in health insurance eligibility,” researchers Phillip Levine and Diane Whitmore Schanzenbach wrote.

In short, research suggests that when kids are healthier, they do better in school. That’s in line with common sense, as well as studies showing that children benefit academically when their families have access to direct anti-poverty programs like the earned income tax credit or cash benefits.

(Even if CHIP ends, affected children might still have access to subsidized insurance through the Affordable Care Act or other means. The Congressional Budget Office estimates that will be more costly in the long run.)

Congress appears likely to vote on a bill this week that includes a six-year CHIP extension, as as well as a temporary spending measure to avoid a federal government shutdown.