A student’s health impacts their ability to attend school and learn effectively. In particular, oral health, asthma and behavioral health impact school attendance most severely. The Colorado Alliance for School Health (the Alliance) recognizes that more and more children are living with complicated medical issues that require support, including assessment, management and technical nursing skills throughout their school day.

Research tells us that students who attend school regularly have better academic outcomes, including graduation rates. Students who are chronically absent in Kindergarten are much less likely to be learning at grade level by the time they reach 3rd grade. School attendance in transition years like 5th, 6th and 9th grades, when bodies are changing, and behavioral health concerns and chronic illness management issues may peak, has significant impact on academic outcomes. In order to be at school, students and their families need to feel safe, secure and have their health needs met. These health needs include behavioral, oral and physical matters. Unmet health needs can result in chronic complaints of not feeling well, resulting in missed school days and learning time, and establishing poor attendance habits.

How can these students feel safe and secure in their communities so they are healthy enough to attend school? Relationship-building and exploration of successes, barriers and gaps in all types of healthcare services is already underway with two school district partners in Colorado. Alliance work will include exploration of community strengths and service gaps, identification of available data and determination of supports needed to promote shared academic and health outcomes. Addressing equity in access and delivery of healthcare services without judgement is a main goal of the Alliance.

The National Association of School Nursing and its Colorado chapter, CASN, research the intersection of health and education, monitor global research findings and educate school nurses on how to be early adopters of practices resulting in increased school attendance. While there are many organizations attempting to reach families that need assistance, many barriers remain. There is great value in working as an Alliance to tackle the complexity related to student health and academic outcomes. By collaborating with school nurses in Colorado, as well as other state organizations, the Alliance aims to facilitate coordination to meet the needs of students and families.

Paired with the work of the Alliance and its stakeholder organizations, school nurses can be the catalyst for a family to access health care by conducting a home visit or listening to a student or parent talk about their unmet health needs or safety concerns. As a trusted profession, nurses are often the first person in a school that a student or family reach out to when expressly seeking help. Nurses are trained to think about a person’s health needs from a holistic lens, incorporating social determinants of health and their impact on the student’s ability to attend school and engage in the learning process. The greatest charge of a school nurse is to reduce barriers for a student so they can access their education in the least restrictive environment.

School nurses

• Assess student health needs, participate in IEP’s, 504’s and coordinate care

• Provide state required screenings

• Coordinate communicable disease surveillance in collaboration with the public health department

• Develop and promote health education related to all aspects of health and chronic disease

• Provide direct care services

• Train and delegate unlicensed assistive personnel (UAP) in schools to perform daily and emergent skilled nursing tasks including, response to seizures, allergies, asthma and diabetes and medication administration.

As a result, school nurses are poised to impact population health and population management because they are with students every day, observing their diverse health needs and applying their medical knowledge. In schools where nurses are present, students miss less school for health-related reasons. The nurse can be part of an attendance or school engagement team, conduct outreach to families to meet individual needs, ensure families have access to care needs, advocate for a district-wide approach to chronic absenteeism and encourage specific data collection related to health and absenteeism. The Alliance is exploring the analysis and application of data collected as it relates to identifying actionable interventions impacting health and academic outcomes.

The Alliance aims to assist schools in examining absenteeism as one of the few metrics in Colorado that meets the Every Student Succeeds Act criteria. (ESSA-reauthorization of the 1965 Elementary and Secondary Education Act, which established the federal government's expanded role in public education. The Every Student Succeeds Act passed both chambers of Congress with bipartisan support). The data collected can be compared across school districts and the state. Initial work in this area already reveals inequity related to the impact that social determinants of health,health issues and healthcare access have on student attendance at school. It is going to take innovative approaches to address healthcare delivery and management through collaborative efforts between healthcare providers, community services, schools and non-traditional sectors like housing, transportation and labor to best support student attendance and positive academic outcomes. This is the work of the the Alliance.    

Click here to read more about health and school attendance at attendanceworks.org

Click here to find out more about school nursing at National Association of School Nursing

Karen Hecker, BSN, RN, Nationally Certified School Nurse, Member-Colorado Alliance for School Health
Nurse Consultant-Children’s Hospital Colorado/ Regional Nurse Specialist-Colorado Department of Education
School Health Services Cadre development