The Other 60 Percent

Q&A: Investing in student health reaps academic gains

Dr. Charles Basch, professor of health and education at Columbia University’s Teachers College, addressed the connection between student health and school success during his keynote address at the Colorado Association of School Nurses conference in Loveland on Nov. 2. In particular, he addressed seven key health factors that research shows are closely associated with students’ academic performance, but are often not addressed in a cohesive, coordinated way by schools.

Dr. Charles Basch
Dr. Charles Basch (photo courtesy of Charles Basch)

Dr. Basch’s address covered many of the findings from his 2010 report, “Healthier Students Are Better Learners: A Missing Link in School Reforms to Close the Achievement Gap.”

What are the seven health factors that you’ve found to be most relevant to students’ school performance?

Vision, asthma, teen pregnancy, aggression/violence, physical activity, breakfast and ADHD. Kind of an underlying theme of all those is physical and emotional health. That’s because physical and emotional health is either affected by or affects all of the seven problems…But it’s important to say that I’m not really advocating that every school system in every part of the country needs to focus on these seven things. But rather these are things that are highly prevalent and we know they can have powerful effects on educational outcomes.

What about dental health?

I think oral health is a huge issue…When I was reviewing the literature I used three criteria to select these factors and one was high prevalence and extent of disparities, and oral health problems clearly satisfy that one. The second one was evidence that these problems had causal effects on education outcomes and at that time I didn’t really find the evidence that oral health problems had effects…That doesn’t mean that they don’t. That just means that the research hadn’t been done.

There are other problems as well that might be deemed as priorities in given locations. It’s not a one-size-fits-all model. Clearly, the intent of the work is to show how and why…a set of health problems can have powerful effects on academic achievement.

And, in turn, are partially responsible for achievement gaps?

Absolutely, yes. The same children who experience disparities in academic achievement are the ones most likely to experience these health disparities. And both academic achievement disparities and health disparities are generally concentrated in areas of high poverty. So, there’s reciprocal relationships between these economic and health and educational factors, but unfortunately in too many cases we tend to deal with them in a siloed way.

Until recently, the public health community has not really been that interested in educational outcomes as a public health goal. That’s now changed. High school graduation and academic achievement are seen as a really important way to promote the health of the population.

And unfortunately,…schools have not really fully engaged health as a fundamental part of the school mission. There’s always been school programs, whether it be feeding programs or physical education program or screening programs…but it’s never really been embraced as a really basic part of the mission of schools. Therefore, the… benefits for children from those efforts have not been as great as they might be.

How well have school district leaders recognized the impact of the seven factors you talk about?

I think it’s quite variable from one place to another… I think it probably depends on the administrator and how closely they’ve been in touch with students, whether they’ve come up through the ranks as teachers and seen these things first hand… It seems that there’s definitely increasing recognition among school leaders about the importance of these issues and the need to address them in order to achieve the academic agenda.

Are there states or districts that are exemplars in the area of coordinated, strategic health efforts?

I think there are different kinds of activities going on in different locations…I know the Denver Public Schools, in fact, is doing some really interesting work related to their data systems, related to the asthma program, related to a variety of these issues.

There are pockets of exemplary programs all around the country and there are examples of states doing very innovative things, like the state of Tennessee requiring a school health coordinator in every district.

At this point, from my perspective…there’s not really a coherent effort nationally to get this issue on the education agenda.

What’s the role of state and national policies to demand that schools take a coordinated approach to school health?

Ultimately, it’s probably going to take such policies and the accountability that goes with those policies to really bring about meaningful changes. I think at the same time, there’s a need for increasing awareness and interest at the grassroots level, among parents, among school board members, among teachers and school leaders to recognize the importance of these issues and the value they can bring not only to academic achievement but to the overall development of children.

But policies and accountability measures are really important. Are there health goals in the school improvement plans? Are there healthy foods served in the school breakfast and lunch programs and on school grounds? Is there an effort to promote breakfast consumption by allowing children to eat breakfast in the classroom?

There is vision screening in most schools throughout the country, but is there the follow-up?….Is there an effort to provide good case management for children with asthma to help ensure they don’t miss a lot of school because of poorly controlled asthma?

One of the most important things: Is there a direct effort to promote a positive school climate where students feel connected to schools? … Is there a good physical education program, not just catered to the most athletic kids but really tries to engage all the kids in physical activity?

What kinds of things do you see happening in your hometown of New York City? Do you feel encouraged?

I do…New York City’s kind of a unique situation because it’s the largest school district in the nation…There’s a lot of different kinds of activities underway… to address the school breakfast issues and school lunch issues, which really need to be addressed.

We’re piloting a vision program to actually conduct optometric exams and provide glasses on-site immediately following. There’s efforts underway to provide children with physical activity breaks in the morning and afternoon each day to improve their ability to pay attention.

There’s many people in the city, and in the country, who really recognize the importance of this work, who really passionately care about children and see them as the next generation … and see the schools as probably the single most important social institution, after the family, to really help kids have a good chance to succeed in life.

Of all the groups you’ve delivered your message to, where has the biggest push for coordinated school health come from?

I wouldn’t say that there’s any one group. I think there’s a lot of interest from different groups. There’s increasing interest from state education departments and school districts,…from those providing primary care to children through school-based clinics,…pediatricians, school nurses,….school administrators and those professional association, like the Association for Supervision and Curriculum Development,…agencies of the U.S. Public Health Service and the Centers for Disease Control.

I’m very optimistic but at the same time there’s still so much work that remains to be done. One of the biggest challenges is that most of the funding agencies and most of the policies and most of the programs are very categorically oriented. So there’s a group that’s interested in violence prevention and there’s a group that’s interested in school breakfast and there’s a group that’s interested in vision…There’s all these disparate groups and in some ways they may be competing for attention and funding.

What’s really the most challenging and … one of the most important aspects of this work is pulling all these efforts together into a coherent, coordinated effort.

How do you envision pulling all those different groups together?

The way you get the common ground….is encourage the people who are the leaders within the schools to recognize that this initiative has to be seen as a coherent effort with different parts…That’s probably going to require a dedicated individual, changes in the staffing patterns, where you have a coordinator that recognizes different people are playing different roles, but they’re all forming a single, coherent program. Just helping people appreciate that having these problems in siloes, and the funding and research and programs and policies in those siloes, is not going to have nearly as beneficial effect on kids.

But if the grant-funding for these efforts is siloed, how do you address the various problems in a coordinated way?

That’s a really tough question and I don’t think there’s an easy answer to that question. That’s the existing infrastructure….so I don’t think that’s an ocean liner that’s easy to turn around very quickly. But I think there is a need to find ways to work within that structure to pull these different efforts together to form a coherent program…. and, over time, to look for leadership among agencies that have an opportunity to fund multidisciplinary approaches addressing multiple problems simultaneously.

That leadership’s likely to come from foundations that have the flexibility to do so, from individual philanthropists and potentially from government agencies….There’s really a need for leadership from the U.S. Department of Education and from state education departments.

Is there an audience out there that still needs to hear your message?

Virtually, all the different groups that I’ve spoken with tend to be receptive to it. It’s kind of a common sense message…I think that on a rehetorical level there’s lots of support for this. I think the challenge is translating these ideas into action…into policies, programs, accountability and data collection…evaluating it, showing the beneficial effects it can have.

I think one of the groups that’s important that we haven’t talked about so far are the people who prepare school administrators and school teachers, that is the colleges of education throughout the United States.

How did you get into this work?

I originally was interested in medicine and started off in a pre-med track and then the more I learned about the health of the population and seeing that it would make much more sense to focus on prevention. …The more I learned about prevention, it just became so clear to me that the schools were the social institution within our society that had just such a tremendous potential to make a difference in shaping the lives of youth.

I came to Teachers College about 30 years ago to pursue this agenda and it’s …not until very recently that I feel that it’s coming closer to becoming more of a reality and seeing lots of meaningful changes in the schools.

It’s only about the last 10 to 15 years that the research has strengthened to the extent where you can say this is how and why these problems affect academic achievement. This is how they affect cognition and memory and attention. This is how they affect school connectedness and why school connectedness is important….This is how they affect absenteeism. It’s taken until now for the research in neurosciences and child development and epidemiology to really get to the point where it seems pretty unequivocal that these are important factors that affect children’s motivation and ability to learn.

How I Help

Students were obsessed with social media. Here’s what this middle school counselor did about it.

PHOTO: Hero Images | Getty Images

In our “How I Help” series, we feature school counselors, social workers, and psychologists who have been recognized for their work. You can see other pieces in the series here.

Students at Eagle Valley Middle School in western Colorado were spending lots of time on social media, and too often their comments turned mean. Counselor Kayleen Schweitzer decided things needed to change, so last year she spearheaded a schoolwide campaign urging students, staff and parents to take a five-day break from social media. More than 150 people signed the pledge.

The results were encouraging. Participating students reported that they had more free time and were getting to bed earlier. Some even said the break made them realize they had been addicted to social media.

Schweitzer, who was named 2018 Middle School Counselor of the Year by the Colorado School Counselor Association, talked about how campaign organizers got students to participate, what she wants parents to know about middle-schoolers, and why she wants students to regard visiting a counselor as normal.

This interview has been condensed and lightly edited.

Why did you become a school counselor?

When I was 15, I lost my father. It was very unexpected and I found out at school. When I returned to school no one checked on me or followed up to see if I was doing OK. I remember wishing I had more support at school. That was the first time I realized that one day I wanted to be someone who could be there for students going through a hard time or transition.

When I was in college my favorite classes had to do with child development. I went on to pursue a degree in family and human services and a graduate degree in school counseling. I’m definitely happy with my decision to be a school counselor and I look forward to going to work every day.

Tell us about an effort or initiative you spearheaded at your school that you’re particularly proud of?

In the 2016-17 school year, my principal Katie Jarnot and I identified a need for something that would help with some of the conflicts occurring at our school. Katie came across a national program called No Place For Hate. It was just what we were looking for. In the 2017-18 school year, we brought No Place For Hate to our school. It has been amazing and powerful.

We noticed a lot of mean behavior on social media and that our students were spending so much time online. Also, with a surge of recent research into the detrimental effects of screen time, social media, and the correlation to depression and anxiety, it was clear there needed to be a change. So Eagle Valley Middle School’s No Place for Hate Coalition created a schoolwide activity that attempted to give students, staff, and parents a glimpse into positives that can come from limiting social media use and taking back control of our lives. We asked our school community to commit to giving up social media for five days.

During those five days, everyone who took the pledge was asked to do a daily reflection on the differences that they noticed. We offered a chance to win prizes as an incentive. To our surprise, we had 110 students (about one-third of our school), 18 staff, and 30 parents sign up.

Though not everyone completed the five days, we felt we brought some awareness to this problem. Students noticed how much more time they had when not using social media and they were able to get to bed earlier. Some actually admitted this activity helped them realize that they are addicted to social media. A few parents reported they were able to be more present with their family at night and have fewer distractions.

Is there a tool, curriculum or program you couldn’t live without in your job?

The tool I couldn’t live without is Google forms. Students can fill out a form to let me know they need to see me. When they fill out the form it notifies me with an email and I can see who is requesting to see me. It also allows me to keep data on what issues my students need support with. This helps me plan what supports I need to put in place through classroom guidance lessons, small groups, and individual counseling.

What’s the biggest misconception you’ve encountered about your role in the school where you work?

The biggest misconception I have encountered is that it’s a bad thing to go to the school counselor and that you need to have a huge problem. I have noticed that some middle school students are embarrassed to be seen going to the school counselor. I have worked really hard to make it normal to come to me and teach them that the strongest, most successful people need help sometimes.

You spend lots of time with students. Knowing what you know, what advice would you give to parents?

I would remind parents that students’ frontal lobes are not fully developed and when they say they don’t know why they did something, they are probably being honest. I would also let them know that even if a student says they want parents to give them space and leave them alone, it’s not really what they want or need.

Tell us about a time when you managed to connect with a challenging student or a student facing a difficult situation. How did you do it?

I have a student who is now in eighth grade and has been coming to see me on a regular basis when she needs support. As a sixth-grader, she was so closed off and worried about being seen coming to talk to me. I have been very consistent with her and kept reminding her that I’m always here if she needs anything. I ended up running a group with her and a lot of her friends. She saw that her friends loved coming to see me and were willing to talk to work through some of their problems. I also spent time with her and showed her it was a safe place to talk. Over time she broke down her walls and was able to trust me. Today, she stops by when she is doing well and when she is struggling. She loves to come and eat lunch with me. She has grown so much and I’m going to miss her dearly when she goes to high school.

What is the hardest part of your job?

The hardest part of my job is going home and worrying about my students. You always wish you could do more or make students see things can get better and they are enough. Middle school is such a hard time for students as they struggle to find where they fit in and deal with personal changes.

Tell us about a memorable time — good or bad — when contact with a student’s family changed your perspective or approach.

In my first years as a school counselor, I had a student who was consistently falling asleep in class and missing a ton of school. When I had a meeting with his family, I found out that his mother was a single mom and his grandma, who also lived in the house, was very sick. The student was staying home to help take care of his grandma and his siblings so his mom could work and make money for the family. His father was an alcoholic who was in and out of rehab.

I realized that different cultures have unique values and priorities. It also taught me that you never know what someone is going through so we need to really take time to talk to kids to figure out what is happening in their personal lives before jumping to conclusions.

You spend your days trying to help students and staff with any number of things. How do you wind down after a stressful day?

The way I wind down after a stressful day is to come home and spend time with my children. They are still young and innocent. I try to really enjoy this precious time with them when they have fewer worries and just want to have fun. I also love spending time with friends and clearing my mind of the worries of my job. Last, I enjoy catching up with email and work-related tasks as every time I scratch out something on my to-do list I seem to get stress relief.

Chilling effect

Five ways a proposed immigration rule could impact Colorado students and schools

PHOTO: JGI/Jamie Grill | Getty Images

Advocates for immigrant families fear that a proposed federal rule governing green card decisions could lead to more children going hungry and losing housing and health care. That, in turn, could pose challenges for educators and schools.

The proposed rule would allow the government to penalize some legal immigrants who have used public benefits by denying them permanent residency — a possibility that could prompt families to forgo any kind of government help. For children in those families, many of them citizens, the result could be hunger pangs, untreated illness, or outsized worry that their parents won’t be able to stay in the U.S. Inside schools, the new rule could mean more time and energy spent addressing students’ basic needs and the loss of funding from some public programs.

Fear that immigrants will shy away from benefit programs is nothing new. Stricter immigration rules since President Trump took office — stepped-up raids, efforts to discontinue the DACA program, and family separations at the U.S.-Mexico border — have already led to a chilling effect on the legal use of public benefits by immigrants. Advocates say changes to the so-called “public charge” rule will only exacerbate the problem.

The rationale behind the proposed rule, a stricter version of one that’s been in place for years, is to prevent immigration by people who will end up dependent on government help. Opponents of the rule say it punishes working-class immigrants who may need short-term aid, but contribute much more to the country’s economy over the long term.

The existing public charge rule penalizes immigrants for using programs such as Temporary Assistance for Needy Families or long-term care. The proposed version adds several more to the list, including Medicaid, food stamps, and housing vouchers. Free and reduced-price school meals aren’t included in the existing or proposed rule.

Mónica Parra, program manager of the Denver school district’s migrant education program, said families she works with are reluctant to sign up for any kind of help, even assistance heating their homes during the winter.

“They’d rather struggle or find other ways to get support,” she said. “It’s going to be very challenging to keep students motivated, but also safe. Maybe they’re going to be cold. Maybe they’re going to get sick.”

The proposed public charge rule doesn’t apply to refugees and asylum-seekers, and doesn’t penalize immigrants for public benefits used by their children. Still, like other advocates, Parra said she hears anxiety about the proposed rule from all kinds of immigrants, including citizens and those who already hold green cards.

They worry that using public benefits could get their own legal status revoked or hurt their chances to sponsor family members who want to immigrate to the U.S.

“The fear has always been there in these communities,” she said. “Now, people are even more afraid.”

The new public charge rule likely won’t take effect for months. First, there will be a 60-day public comment period, scheduled to start Wednesday, and then Trump administration officials will consider the comments and decide whether to make any adjustments.

Here’s a look at some of the ways the proposed rule could affect Colorado schools and students.

More kids come to school hungry

There are at least two ways schools could see more hungry students walking through their doors due to the public charge rule. First, families may be afraid to take advantage of food stamps — either by deciding not to enroll, or by dis-enrolling current recipients, such as citizen children.

Both Denver and Adams counties have seen dips in the number of people participating in the program over the last couple years. In Denver, about 2,000 fewer children receive the benefit now than in November 2016 when President Trump was elected. However, city officials caution that it’s hard to make a direct connection between falling participation and federal immigration policies since historically low unemployment rates may also be contributing to the trend.

While free and discounted school lunches are not part of the public charge rule, some advocates report that immigrant parents have been wary of enrolling their kids since Trump’s election. By law, public schools must serve students regardless of their immigration status and can’t ask for information regarding a family’s or student’s status.

A week after the Department of Homeland Security released a draft of the new public charge rule on its website, the Eagle County school district emailed parents asking them to help squash the rumor that signing children up for free or reduced-lunches “will inform ICE,” a reference to the U.S. Immigration and Customs Enforcement agency.

The letter concluded, “There is NO RISK in applying for free and reduced lunch, help us spread the word.”

So, what happens when kids go to school hungry? They may have trouble paying attention, misbehave more easily, or suffer from headaches or stomach aches. In short, less learning.

More children without health insurance, more student absences

The public charge rule’s chilling effect could have a major impact on child health, according to a recent Colorado Health Institute analysis. An estimated 48,000 Colorado children — the vast majority of them citizens — could be disenrolled from one of two public health insurance programs, Medicaid or Child Health Plan Plus. That would double the state’s rate of uninsured children from 3 percent to 6.7 percent, according to the institute.

The reason for so much dropoff is that health insurance is typically a family affair. So even when different rules govern adults and children in the same family, they tend to be enrolled as a group or not at all.

When students don’t have health insurance, school attendance and performance can suffer. For example, children may be absent more if they lack help managing chronic conditions like asthma, or if they’re not getting treatment for acute illnesses or painful dental problems.

Loss of health-related funding for schools and school-based clinics

School districts stand to lose two health-related funding streams if the number of uninsured children swells. The first would impact the state’s 62 school-based health clinics, which would likely see a drop in Medicaid and Child Health Plan Plus reimbursements if fewer students enroll in those programs.

Such an enrollment decline, which some clinic leaders have already reported, could make it harder for school-based clinics to stay afloat financially, said Bridget Beatty, executive director of the Colorado Association for School-Based Health Care.

With more uninsured students, “The need will go up,” she said, “but conversely the ability to financially sustain them will get more challenging.” 

In addition, 53 Colorado school districts receive funding through a program that could be affected by the proposed public charge rule. It’s called the School Health Services Program and allows districts to seek Medicaid reimbursements for services provided to low-income students with disabilities. That money can be used for health-related efforts that benefit all students, such as the addition of school nurses, wellness coordinators, or suicide prevention programs.

Funding received through the program ranges from a couple thousand dollars in small districts to a few million in large districts.

High-poverty schools have a harder time offering universal free meals

Nearly 40,000 students in 20 Colorado school districts can eat school meals for free because their schools participate in a federal program designed to make breakfast and lunch easily accessible to low-income students. But that number could drop if the public charge rule decreases food stamp participation.

The special meal program, called Community Eligibility Provision, is open to schools or districts where at least 40 percent of students come from families that use certain public benefits, including food stamps or Temporary Assistance for Needy Families. Unlike in traditional school lunch programs, parents don’t have to fill out applications for free or reduced-price meals.

“Any time when you have eligible families not participating in SNAP, it does have a negative impact on community eligibility,” said Crystal FitzSimons, director of school programs at the national nonprofit Food Research and Action Center.

Even if schools or districts remain eligible for the program, a drop in students getting public benefits could mean a change in how schools are reimbursed for the free meals, she said. That, in turn, could make the program less financially viable for schools or districts to participate.

Immigrants could turn away from publicly funded early childhood programs

Crystal Munoz, who heads the nonprofit Roots Family Center in southwest Denver, worries that the Spanish-speaking families her program serves will stop using programs like Head Start, state child care subsidies, and the Denver Preschool Program, which provides tuition assistance to the city’s 4-year-olds.

Even though those programs aren’t part of the proposed rule, there’s still trepidation, she said. It’s because of the constant flurry of rule changes and the generally negative tone around immigration right now.

“We find ourselves very afraid to even give out resources or referrals to certain programs because we’re not sure,” she said. “For us, it’s waiting and seeing.”

She said if families do drop out of Head Start or other child care programs, it could push children — many of them citizens — into unlicensed care with relatives or neighbors, or force parents to cut back work hours to stay at home with them.