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.

Frequently asked

There are lots of ways schools teach English learners. Here’s how it works.

PHOTO: Andy Cross/The Denver Post
Lindsey Erisman works with 6-year-old students in an English Language Acquisition class at Denver's Cole Arts & Science Academy.

School district officials in Westminster this year signed an agreement with federal officials to change how they educate students who are learning English as a second language.

Similar agreements have also shaped how districts in Denver, Aurora, Adams 14, and Adams 12 educate their English language learner students. But many people, including parents and district insiders, may still have questions about the various complicated programs and requirements.

Although many of the language-education agreements are years old, most of the issues haven’t been resolved. In Adams 14, for instance, parents and advocates have protested a district decision to stop biliteracy programming, and have questioned the district’s compliance with its agreement to better serve English learners. District officials have pointed out that their obligation is teaching students English, not making them bilingual.

Now at least one charter school, KIPP, is looking to fill in that programming gap. Many other states have had a number of biliteracy and other bilingual programs at various schools for years, but Colorado has only more recently started to follow those trends.

So what’s the difference between the various language programs and services? And what is required by law and what isn’t? The following questions and answers might help clarify some of those questions as you follow the news around these issues.

Which students are designated as English language learners? Do parents get to decide, or do schools decide?

Federal guidance requires school districts have some way to identify English learners. Most commonly, districts survey all parents at school registration about their home language and the student’s first language. If that survey finds there might be an influence of another language at home, the student must be assessed to determine fluency in English. While the district has to identify all students who aren’t fluent in English as language learners, parents in Colorado can choose to waive the federally required services for their children. If so, the district doesn’t have to provide special services, but would still be required to monitor that the student is making progress toward acquiring English.

What educational rights do English language learners have?

English language learners have specific rights under the Lau v. Nichols Supreme Court case from 1974 and the subsequent Castañeda standards released in 1981. State laws also outline some requirements for school districts. Specifically, school districts must provide programs for all identified language learners to give them the opportunity to learn English and to access a comprehensive curriculum. The government does not state what that program should be, but provides some standards requiring that any program is theoretically sound and has a research base to support it. The program has to have qualified teachers, and a way to demonstrate that students are making progress in learning English and their academic content. While the civil rights officials consider many details to verify compliance, simply put, school districts have the legal obligation to identify students, serve them in a sound program, and monitor their progress.

What is the difference between bilingual education and “ELL services?”

Bilingual education (which is the program that has the most support for efficacy from the research community) offers students opportunities to learn in their native language while they are learning English. Bilingual programs can vary from short-term, or early-exit programs, to more longer-term developmental programs.

English language learner services do not need to provide opportunities for students to learn in the native language. Most commonly these services only offer English language development classes (generally 45 minutes per day). All other content instruction is offered only in English. ELL services are not bilingual.

What is English language development?

English language development must be a part of any program or model a district or school adopts. It is the class time when students are taught the English language. The government wants to see that English learners are given a dedicated time to learn English, when they are not competing with native English speakers. That means, often, English language development is offered as a time when students are pulled out of class to practice English, or as a special elective period students must take without their English-speaking peers.

The structure of this time period, who has access to it, or who teaches it, are areas commonly cited as problems by the federal Department of Education’s Office for Civil Rights.

Do students who are identified as English language learners retain that designation forever? What does it mean to be an “exited ELL?”

They’re not supposed to. Students who are English learners should be tested at least once a year to determine their English proficiency. When a student reaches a high enough level, school staff must determine if the student is now fluent in English. If so, the student becomes an “exited ELL.” The law requires districts to monitor for two years students who have exited and are no longer receiving services. There are, however, students who do not reach English fluency before graduating or leaving school.

What is the difference between being bilingual and being biliterate?

Bilingual generally refers to oral language in that bilingual people can understand and speak two languages but may not be able to read and write in those languages. Biliterate refers to being able to understand, speak, read, and write in two languages. Many people are bilingual but not biliterate. Biliteracy is considered to be a higher form of bilingualism.

What is the difference between dual language and biliteracy models?

Dual language and biliteracy models share many common components. Both models usually have biliteracy as their end goal for students. Dual language models may be “one-way” or “two-way.” One-way programs generally serve students who are designated as English language learners (also sometimes called emerging bilinguals). Two-way dual language programs include students who are native English speakers. The only major difference is that biliteracy models focus on using two languages in the language arts or literacy classes (reading and writing in two languages) whereas dual language focuses on using two languages across the entire school day’s curriculum.

What is an immersion model?

Immersion models traditionally are thought of as referring to programs primarily intended for students from the dominant language population to learn a second language. This is different from programs meant to teach English.

While native English students can choose whether or not to learn a second language, students who are English language learners do not have a choice in learning English.

What is sheltered instruction?

This type of instruction takes place in non-dual language schools, during regular content classes (such as math or science), and it’s one way schools try to make the content understandable to students who aren’t yet fluent in English.

This is especially common in schools where English learners speak a variety of languages. Crawford Elementary in Aurora, for instance, has had up to 35 different languages represented among its approximately 560 students. If there aren’t enough students who speak a common first language and also a teacher who speaks the same language as those students, then schools must teach through English, while making the English as accessible as possible.

In practice, this means an English-speaking teacher would use sheltered instruction techniques to help all children understand the lessons such as, physical props, a focus on building vocabulary, and sentence stems.

Denver designates schools as TNLI schools. What does that mean?

Denver created the TNLI label in 1999 to set the district apart from other bilingual program models. TNLI stands for Transitional Native Language Instruction. The Denver TNLI program is a transitional bilingual education program model with a label created just for Denver. It’s a model where instruction in Spanish is used to help students learn while they’re acquiring English, but still has a goal of making students fluent in English as soon as possible, at which point students move into mainstream English classrooms.

Is one of these models best suited for English learners?

Among researchers, it is commonly accepted that dual language or biliteracy models are the most effective to put English learners on par with their native speaking peers, in the long run.

Why do teachers have to be trained specifically to teach this population of students? What are teachers learning?

Educators and researchers say that teachers need to learn the differences and similarities between learning in one language and learning bilingually. Teachers need to learn about literacy methodology and how teaching literacy in Spanish (for example) is the same and different as teaching literacy in English. They have to learn how to teach English language development to students who are beginning to learn English (it is different than just teaching in English). These trainings also help teachers learn about cultural similarities and differences and about sources of culture conflict. Teachers need to be able to teach children English; how to use English to learn; and how the English language works. In bilingual settings teachers need to learn those three things for two languages. In short, the training needed to be a bilingual teacher is quite different. Colorado will soon require some of this training for all teachers.

What are the challenges districts have in offering these different programs? How do schools decide which type of model to offer?

The demographics of a district’s student population, and district politics play a large part in helping a district decide what model or program to use. Resources can also be a factor in deciding how to structure services or what programs to offer. In Adams 14, when the district leadership decided to pause the roll out of a biliteracy program, the district cited a lack of qualified bilingual teachers, among other things.

In Westminster, the school district’s unique competency-based approach, which removes grade levels and seeks to personalize instruction, was cited as a reason why the district had structured its English language development the way it had before the investigation by the Office for Civil Rights sought to change it.

Does Colorado provide guidance or oversight for how districts are doing this work?

The Colorado Department of Education offers some guidance for districts, but oversight of the districts’ compliance with what is required is limited. In practice, when parents suspect their children aren’t educated well, they have filed complaints with the federal government. In Denver, the complaints went through the Department of Justice. Investigations of most other metro-area districts have been conducted by the Department of Education’s Office for Civil Rights.

task force

Jeffco takes collaborative approach as it considers later school start times

File photo of Wheat Ridge High School students. (Photo by Nic Garcia/Chalkbeat)

The Jeffco school district is weighing pushing back start times at its middle and high schools, and the community task force set up to offer recommendations is asking for public input.

Nearby school districts, such as those in Cherry Creek and Greeley, have rolled out later start times, and Jeffco — the second largest school district in Colorado — in December announced its decision to study the issue.

Thompson and Brighton’s 27J school districts are pushing back start times at their secondary schools this fall.

The 50-person Jeffco task force has until January to present their recommendations to the district.

Supporters of the idea to start the school day later cite research showing that teenagers benefit from sleeping in and often do better in school as a result.

Jeffco is considering changing start times after parents and community members began pressing superintendent Jason Glass to look at the issue. Middle and high schools in the Jeffco district currently start at around 7:30 a.m.

The task force is inviting community members to offer their feedback this summer on the group’s website, its Facebook page, or the district’s form, and to come to its meetings in the fall.

Katie Winner, a Jeffco parent of two and one of three chairs of the start times task force, said she’s excited about how collaborative the work is this year.

“It’s a little shocking,” Winner said. “It’s really hard to convey to people that Jeffco schools wants your feedback. But I can say [definitively], I don’t believe this is a waste of time.”

The task force is currently split into three committees focusing on reviewing research on school start times, considering outcomes in other districts that have changed start times, and gathering community input. The group as a whole will also consider how schedule changes could affect transportation, sports and other after school activities, student employment, and district budgets.

Members of the task force are not appointed by the district, as has been typical in district decision-making in years past. Instead, as a way to try to generate the most community engagement, everyone who expressed interest was accepted into the group. Meetings are open to the public, and people can still join the task force.

“These groups are short-term work groups, not school board advisory committees. They are targeting some current issues that our families are interested in,” said Diana Wilson, the district’s chief communications officer. “Since the topics likely have a broad range of perspectives, gathering people that (hopefully) represent those perspectives to look at options seems like a good way to find some solutions or ideas for positive/constructive changes.”

How such a large group will reach a consensus remains to be seen. Winner knows the prospect could appear daunting, but “it’s actually a challenge to the group to say: be inclusive.”

For now the group is seeking recommendations that won’t require the district to spend more money. But Winner said the group will keep a close eye on potential tax measures that could give the district new funds after November. If some measure were to pass, it could give the group more flexibility in its recommendations.