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.

Unmet needs

A social worker in every grade? Perhaps for 10 Colorado elementary schools

PHOTO: Ann Schimke/Chalkbeat
Fifth-graders practice mindfulness at Munroe Elementary School in Denver.

Educators, parents, and social workers told of students struggling with depression, younger and younger children attempting suicide, and youths ending up in prison. A bill approved Thursday by a Colorado House committee would pay for a three-year trial to provide social and emotional help for elementary students in the hopes of addressing some of these challenges.

If approved by the full legislature and signed into law, the measure would create a three-year pilot program at 10 high-needs schools. It is estimated to cost about $5 million a year. House Bill 1017 would place social workers, counselors or psychologists in every elementary grade at the test schools starting next year.

In an impassioned presentation, bill sponsor state Rep. Dafna Michaelson Jenet, a Commerce City Democrat, said schools need more social workers “to stop our children from dying by suicide, from ending up incarcerated, from being failed by our system.”

Suicide is a leading cause of death among youth ages 10 to 24 in Colorado, and advocates of the bill said schools are often ill-equipped to deal with children suffering from trauma, bullying and behavioral challenges.

The bill was scaled back from an original version that would have cost $16 million a year. Michaelson Jenet said the nearly $5 million annual cost would be funded in part by $2.5 million from the state’s marijuana cash fund, with the rest from private foundations.

The National Association of Social Workers recommends one social worker for every 250 students, and one for every 50 students at high-needs schools.

Colorado schools don’t come close to those numbers.

About one-third of the state’s 178 school districts employed social workers during the 2016-17 school year, the most recent for which data was available from the Colorado Department of Education. Those districts represented about 89 percent of that year’s 905,000 pre-K through 12th grade students.

The nearly 590 social workers employed worked out to less than one full-time employee per 1,000 students.

Englewood’s Sheridan School District had three social workers for 1,511 students, while Yuma County had 1½ social workers for 807 students.

The two largest districts, Denver and Jefferson County, employed more than one-third of school social workers that year, with more than one social worker for every 1,000 students. Denver voters approved a 2016 tax to help pay for more social workers.

But many districts have no social workers. And most school social workers are stretched thin.

Jessie Caggiano is a social worker who serves more than 3,000 students at four high schools in Weld County.

“I’m not able to meet with students effectively on a one-on-one basis, because I’m trying to implement other services schoolwide,” she said. “I’m only at each of my schools one day a week, so I’m not able to meet their needs by any means.”

Darlene Sampson, president of the Colorado chapter of the Association of Black Social Workers, recalled working at a Denver school when a student was killed in the cafeteria.

“Many kids are carrying their trauma in their backpacks into the school,” Sampson said.

And Cam Short-Camilli, representing the Colorado School Social Work Association, said students are facing increased emotional problems at most schools. The increase in youth suicide and suicide attempts is especially difficult, she said. One Denver incident last fall attracted national attention.

“Every school district, every student is impacted, that’s rural, urban, suburban schools,” Short-Camilli said. “In the past five years, I’ve been at elementary schools, and it’s been extremely shocking. Kids at those schools, there’s an immense ripple effect.”

But state Rep. James Wilson, a Salida Republican, questioned whether the pilot program would be possible to replicate because of the high number of professionals needed.

“I’m sitting here feeling like the Grinch,” Wilson said. “I cannot bring myself to put together an unrealistic pilot. Will it really work in the real world?”

State Rep. Janet Buckner, an Aurora Democrat, also expressed concerns, but voted for the bill.

“I’m concerned how we’re going to fund it,” she sad. “The suicide rate is off the chart and our kids need so much help. I don’t think we can wait. I have a lot of phone calls and emails about this bill, people who really need the help.”

HB-1017 next goes to the Appropriations Committee before being considered by the full House, then the Senate. It is one of several measures aimed at offering help for students and their families beyond academics at public schools.

Story time

This Memphis teacher’s favorite student didn’t stand for the Pledge of Allegiance. She taught him a powerful lesson.

PHOTO: Xzavier Bonds
Daniel Warner teaches at East High School in Memphis.

When one of Daniel Warner’s favorite students refused to stand for the Pledge of Allegiance, he could feel the tension in himself rising.

It was August 2017, the first week of classes, and Warner said he knew how important setting a tone was during the first few days of school.

“Didn’t my teacher prep program teach me that I have to set high expectations in that first week or the year is lost?” asked Warner, a U.S. history teacher at East High School in Memphis. “If I don’t set those, we’re done for.”

But before Warner reacted, he said he took a few moments to reflect on what could be going through her head.

Chalkbeat TN Storytelling Event
PHOTO: Xzavier Bonds
Daniel Warner tells his story to a crowded room.

It was the Monday after a violent white supremacists rally in Charlottesville, Virginia. Stories of former NFL quarterback Colin Kaepernick were again dominating the news, as he remained ostracized for kneeling during the national anthem to protest police brutality.

Instead of punishing her, Warner said, he refocused on what she might be thinking through as a black American high schooler.

“The lesson she taught me that day was that some of the most harmful instances of school discipline happen when we are too focused on ourselves as teachers,” Warner said.

Warner was one of seven educators and students who participated in a February story storytelling night hosted by Chalkbeat Tennessee, Spillit, and The Knowledge Tree. The stories told centered around school discipline practices, a topic Chalkbeat recently dove into in this special report.

Video Credit: Gillian Wenhold, The Social Exchange. The Social Exchange is a pay-as-you can PR & content creation firm for nonprofits and responsible, women/minority owned businesses.

Here’s an edited transcript of Warner’s story. It has been lightly edited for length and clarity:

It’s a week into school in early August. And kids are just trickling into my senior homeroom mostly asleep, sitting quietly in their desk as 18-year-olds do at 7:15 in the morning…And then morning announcements come on. “Please stand for the Pledge of Allegiance.”

So I stand up, and I say, “Alright y’all, go ahead and stand up with me.” I see these seniors throwing their bodies out of their seats, trying to stand up while they are still asleep. And almost everyone stands up but one girl doesn’t…  

So, my eyes meet this girls eyes as she stays in her seat during the pledge. And I can feel the tension in me of my authority being challenged in the room. And I wonder if everyone else is looking at me, my other students. So I give her a teacher look meant to communicate, “Are you going to stand up?” And she looks at me from across the room and shakes her head and mouths, “I can’t.”

So this student was one of my best students the year before in honors U.S. History. She engaged deeply with the material and personally. She asked questions of herself, of her country, of democracy, what this whole thing is about. She processed the double consciousness she feels of being both black and American. And she did so while being kind, thoughtful hardworking. The student you think of that makes you want to cry, you love that kid so much. I wonder what’s going on, what is she thinking about…

This is a Monday and the weekend before had been the white supremacists march in Charlottesville… When she told me, that she couldn’t stand, I went and sat in the desk next to her…I asked, “What’s keeping you from standing up?”

She started by saying, “I hate,” and she stopped herself. She took a breath, calmed herself down and said, “I just can’t.” And so we just sat there for a second. I could see as I got closer to her that she was flooded with emotion and feeling something deeply. And so we let the announcements end and I tell her, “When I say the pledge I say it more as a hope and a prayer…that there would be liberty and justice for all.” She said, “Yeah, I was thinking about that,” like a good U.S. History student, but she said “things don’t’ seem to be headed that way right now…

The lesson she taught me that day was that some of the most harmful instances of school discipline happen when we are too focused on ourselves as teachers. She showed me that I was a little too focused on how I was being perceived by other students in the classroom. And that I wasn’t focused enough on her and what she might be processing. As teachers, we have all of this opportunity to escalate conflict, I’ve done it plenty of times. But we also have an opportunity to be gracious to students who are working out who they are in public…

This girl wasn’t being disengaged by saying no to me, she was being especially engaged with who she is… When we talk about restorative justice, the first step we have to take is for us as educators and adults, and it’s doing your own emotional work. And we have to ask ourselves questions about our identities. You can only lead someone somewhere if you’ve gone there yourself…

What is it about us when it sets us off when a kid says no to us? Why are we that insecure? … When we pay attention to ourselves, our emotional status, the hurt we’ve felt, the pain we’ve lived through, that is when we can begin paying attention to how formative schools are. They are spaces where folks are working out their identities in public, and that’s when you feel the most self conscious and vulnerable and in need of grace offered by someone else.

So, I hope as we talk about this, we think of ways where we can make school a space for people to be figuring out who they are and not just punished into compliance. In high poverty schools, you talk about compliance like it’s the ultimate behavior. I hope we can make schools where students can learn what it is to seek justice, even when and especially when, things just don’t seem to be headed that way right now.