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A few weeks ago, we wrote about the promise of school-based health centers (SBHCs). We also heard from Linda Gann, an official in Colorado’s Montrose County School District RE-1J who helped spearhead efforts to open two of these centers in her district. She told us about how her district came to embrace SBHCs as part of a broad strategy to address the needs of its growing Hispanic community and her experience planning and implementing these centers. Today Nurse Practitioner Jennifer Danielson tells us more, giving us a look at the day to day work that happens at her clinic.

Public School Insights: Tell me about school-based health clinics.

Danielson: One of the biggest keys to understanding school-based health clinics is that they are all different. There are some similarities, but a district or a school can tailor a clinic to meet its needs.

For example, our clinic works differently from others in that a lot of clinics have an enrollment form that parents sign at the beginning of the year. If their children go to the school nurse at any point, they get funneled back to a nurse practitioner or a physician's assistant. Sometimes the clinic calls the parents and sometimes it does not. Kids are essentially pre-consented to get care throughout the school year.

At our clinic, we talk to the parent for every visit. So while we are physically on a school campus, we function in a lot of ways like any small medical clinic or doctor's office. Everything is by appointment, though we do accept some walk-ins if we are available. And a parent is either present or part of the visit over the phone every time we see the kids. Kids never come see me without their parents wanting them to be seen and ...

About two weeks ago, we posted a conversation with two leaders from Boston's City Connects (CCNX) program, which is working with 11 schools to link each child to a "tailored set of intervention, prevention and enrichment services in the community." The approach has helped raise grades and test scores for the mostly low income children in these schools.

We recently spoke with people in two CCNX schools. Traci Walker Griffith is principal at the Eliot K-8 School, and Kathleen Carlisle is the CCNX site coordinator at the Mission Hill School. Each has an insider's view of this remarkable program at work.

Public School Insights: How has City Connects worked in your school? What changes have been made since it began?

Traci Walker Griffith: A number of changes have occurred at the Eliot School. I came in as principal in March of 2007. In May of 2007 the school was identified as one that would take on City Connects.

We were fortunate because the mission and vision of the Eliot School aligned with City Connects in that we are serving the whole child--academically, socially, emotionally. So we have worked amazingly well together in identifying students’ academic and social/emotional needs. And as we began the program I found that the structures and systems that it offers—whole class review, individual student review, and providing a school site coordinator to maintain and sustain partnerships—really aligned with what we wanted to start at the Eliot School at the time.

Kathleen Carlisle: I would echo many of the things that Traci just said. The whole child philosophy especially stands out in my mind—that is a City Connects and also a Mission Hill philosophy. And I think that the presence of City Connects in Mission Hill has especially impacted the identification of student needs and ways to meet those needs, be they social/emotional, academic, health or family. I think there has been greater connection between supports and needs, and also consistent follow-up.

Public School Insights: Do you have a sense of the results of the City Connects work in your respective schools?

Traci Walker Griffith: When I came on at the Eliot, a school identified as underperforming and in correction, all of the pieces we needed to put in place to increase student achievement were aligned with what City Connects was working on: identifying services and enrichment opportunities for students both inside and outside the school; working with community agencies that in the past had difficulty working ...

An innovative program out of Boston College is making a big difference for children in 11 Boston elementary schools. City Connects (CCNX) works with the schools to link each child to a "tailored set of intervention, prevention and enrichment services located in the community."

Its efforts have gone a good distance towards closing achievement gaps between the low-income children in the program and children who meet state averages. CCNX's results offer powerful support for what should be common sense: When we address the challenges poor students face both within and beyond schools, they flourish.

A rigorous study (PDF) of the program's outcomes tells a pretty stunning story:

  • The beneficial impact of BCNX [the former name of CCNX] on student growth in academic achievement (across grades 1 to 5) was, on average, approximately three times the harmful impact of poverty.
  • By the end of grade 5, achievement differences between BCNX and comparison students indicated that the BCNX intervention moves students at the 50th percentile up to or near the 75th percentile, and the students at the 25th percentile up to or near the 50th.
  • For multiple outcomes, the treatment effects were largest for students at greatest risk for academic failure. For example, English language learners experienced the largest treatment benefits on literacy outcomes, by third grade demonstrating similar report card scores to those proficient in English in comparison schools. In fact,as a result of BCNX, there was no longer an achievement gap between these students.
  • After grade 5, the lasting positive effects ofthe BCNX intervention can be seen in middle-school MCAS scores. The size ofthe positive effect of BCNX ranged from approximately 50% to 130% as large as the negative effects of poverty on these scores.1

We recently caught up with two of the program's leaders: Dr. Mary Walsh, its Executive Director, and Patrice DiNatale, its Director of Practice.

Public School Insights: What is City Connects?

Walsh: City Connects is a systemic, evidence-based approach to school-based student support. It involves assessing, in conversation with teachers and other school staff, each child in the school at the beginning of the school year and then developing a tailored student support plan based on that student's strengths and needs in four areas: academic, social emotional/behavioral, health and family.

That support plan involves accessing services, supports, resources and enrichment for the child, both school-based resources as well as, and importantly, community resources. A trained professional with a Master’s degree—either ...

[First published April 22, 2008]

LastChildinWoods.jpg In a few days, a new and expanded edition of Richard Louv’sLast Child in the Woods, will hit bookstores around the country. Louv’s book has fueled an international movement to combat what he calls “nature deficit disorder,” children’s growing alienation from the natural world. (Louv’s term for the disorder is quickly catching on, turning up in major newspapers, on television, and even in a February cartoon by Bloom County creator Berke Breathed.)

A quotation from our recent telephone interview with Louv elegantly captures the thrust of his argument: “[T]he message we’re sending kids is that nature is in the past and probably doesn’t count anymore, the future’s in electronics, the boogeyman lives in the woods, and playing outdoors is probably illicit and possibly illegal.”

Development is choking off access to nature, kids are succumbing to the attractions of televisionRichardLouv.jpg and computers, and—yes—time for school recess has dwindled dramatically in the past decade. To make matters worse, Louv argues, parents, educators, and even environmentalists have been complicit in erecting barriers to the natural world. We keep our children indoors to protect them from real or (very often) imagined dangers, we regulate and confine their play, and we tell them to not to disturb delicate flowers, quiet streams or pristine undergrowth.

Louv does find encouraging signs of change in the rapid growth of “Leave No Child Indoors” movements around the country. (Many movement leaders credit Louv’s book for greatly accelerating that growth.) Nature is far too elemental a human need, he argues, for Nature Deficit Disorder to grow unchecked. For an overview of "No Child Left Inside" initiatives around the country, see the Children and Nature Network.

Hear a recording of highlights from the interview (5 minutes):

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Or check out the transcript below:

PUBLIC SCHOOL INSIGHTS: What, in a nutshell, is the central argument of Last Child in the Woods?

LOUV: The central argument is that you have an increasing pace in the last three decades, approximately, of a rapid disengagement between children and direct experiences in nature. And that this has profound implications, not only for the health of future generations but for the health of ...

[Editor's note: This is the second in a series of three posts on school-based health centers. Yesterday we briefly reviewed evidence supporting the use of these clinics. Today, Linda Gann talks about how her district founded two such centers. Soon Jennifer Danielson will take us through a day in the life of a nurse practitioner and tell us how her school-based health center has impacted kids.]

School-based health clinics have shown a great deal of promise in improving health outcomes for students, decreasing Medicaid costs at a time when every penny counts and even in potentially raising academic outcomes for low-income students. But yet there are only about 2,000 school-based health clinics (SBHCs) in the United States. Why don’t more districts take this approach? Does it seem too expensive? Too risky? Too separate from the district’s academic mission?

We recently spoke to Linda Gann, Communications and Special Project Coordinator in Colorado’s Montrose County School District RE-1J, to learn more about how her district came to embrace SBHCs. She also told us about her experience planning and implementing the district’s first school-based health clinic three years ago and its second a few months ago. Some keys to their success? The clinics get all their funding outside the general fund. They keep the community engaged in and informed about these efforts. And they consider not only the physical but also the mental health needs of students.

SBHCs alone will not close the achievement gap. But in Montrose, they are part of a broad strategy to address the needs of its growing Hispanic community. And that strategy appears to be working—for example, the district has a 20% higher graduation rate for Hispanic students than the state does.

Here's the story as Gann told it to us in a recent phone conversation.

About Montrose County School District RE-1J

I think from a researcher’s standpoint our district is almost a perfect universe, as far as data analysis goes. We are located in west central Colorado. We are five hours away from Denver. We are about 1,100 square miles, with two distinct communities. Montrose is about 30,000 people. Olathe is probably about 8,000 people. So we are not very large. And we are separated from our neighboring districts by open space, so it is really easy to tell where our school district stops and another one starts.

In our district, we have 6,500 students. District-wide, 54% receive a free or reduced price lunch. But on the south end of our district, which is close to the ski resort of Telluride, the houses are larger, and there are more families considered upper middle class.  The free and reduced price lunch population at the elementary school in that area is about 11%. On the north end of our district, the free and reduced price lunch population is 80%. ...

It has long been suggested that health disparities between low-income kids and their peers contribute to the academic achievement gap. If you are looking for evidence to support that theory, a recent research review by Charles E. Basch—Healthier Students are Better Learners: A Missing Link in School Reforms to Close the Achievement Gap—offers it.

Long story short (and it is a long report), Basch describes the evidence showing how groups of children differ in the incidence of (and access to care for) each of seven “educationally relevant health disparities”: vision, asthma, teen pregnancy, aggression and violence, physical activity, breakfast, and inattention and hyperactivity. He also reviews evidence on the “causal pathways affecting educational outcomes” (I think that means he shows that not only are there disparities, but that these disparities actually do affect achievement).

One brief, and extremely simplified, example: Children with asthma sleep less. Children who sleep less tend to have worse academic performance than those who sleep more, because sleep influences cognitive function. Low-income children, for a variety of reasons, have asthma at higher rates than middle- and upper-income children. So even assuming ...

I continue to be amazed by the fact that it has become taboo in some school reform circles to talk about strategies for clearing away non-academic barriers to student learning. Calls to address problems like hunger or poor health are often seen as excuses for poor schooling rather than as concrete strategies to improve the lot of children. This tendency strikes me as very counterproductive.

It's not the job of schools to ensure medical care and proper nutrition, we're told. It's not the job of schools to do what parents should be doing. Those are lovely sentiments. Many teachers and other school staff would probably agree that the job they thought they signed up for didn't involve finding health care for children, getting them warm clothing in the winter, or offering them breakfast when they're hungry.

But such expectations don't mean a whole lot when a child in your classroom can't concentrate because she has a tooth ache, can't see the board because she needs eye glasses, or is hungry because she went without breakfast. High-sounding talk about what a school's "mission" should or shouldn't be must ...

When the President's Blueprint for Reauthorization of the Elementary and Secondary Education Act appeared last month, Chuck Saylors was struck by what he didn't see: much attention to parent engagement. The President's budget proposal had already seemed to eliminate the Parent Information and Resource Centers (PIRCs), the only federal program devoted solely to parent engagement in schools. (The Learning First Alliance just released a statement urging a much stronger federal focus on parent engagement.)

Saylors recently told us about the National PTA's work to make parent and family enagement a national priority. Despite his disappointment with the Blueprint, Saylors is optimistic. The administration seems ready to listen, he told us, and the PTA is not about to let up on its fight for parents.

Public School Insights: What are the biggest legislative priorities this year at PTA?

Saylors: There are several things on the agenda, but I am going to say that the reauthorization of ESEA is probably the issue of the day for us. We want to make sure that ESEA is reauthorized in a timely manner and we want to do everything that we can to get parents involved in the process. There are a lot of components to the legislation that need to be addressed, and we want to make sure that a parent voice is at the table.

Public School Insights: Is your sense that the blueprint the Obama administration offered for this reauthorization included the parent voice?

Saylors: I have to admit that I'm very disappointed that it was not more direct in including parental engagement. There are some brief references, but as the leader of the PTA I can tell you that I am very disappointed in the fact that there's not more concrete reference to parental engagement in the blueprint.

That being said, I have to publicly admit that PTA does have a good working relationship with the administration and we are very thankful for that. But this is ...

Thomas Edison Elementary School in Port Chester, NY has earned its reputation as a success story. A decade ago, only 19% of Edison’s fourth graders were proficient in English language arts. Last year 75% were. Proficiency rates in math and social studies are even higher. Not bad for a school where over 80% of students live in poverty.

If you ask the school’s principal, Dr. Eileen Santiago, the decision over ten years ago to turn Edison into a full-service community school has played a key role in its transformation. Working with strong community partners, the school offers on-site health care, education for parents, counseling for children and their families, and after-school enrichment. Add that community focus to a robust instructional program and close attention to data on how students are doing, and you get a stirring turnaround story.

Dr. Santiago recently told us more.

Public School Insights: Tell me about your school.

Santiago: I have served as principal of this school for 14 years. And I have always felt fortunate that I came into a school with many, many caring people. I did not walk into a school where the adults felt negatively about the children.

However, I was faced with other concerns. One of them was that the school had a pretty significant level of poverty. We were at over 80% free lunch. We continue to have that level of poverty today.

In addition, Edison has always served an immigrant population. The school was constructed in 1872, so you can imagine that the population has changed a lot over the years. Today the population is primarily multi-ethnic Hispanic, coming from different areas of the Hispanic world. And many of our children are undocumented immigrants. That in itself adds several levels of challenge: ...

"In the 21st century, the best anti-poverty program is a world-class education." That sentence from the State of the Union address is bound to spark debate, and here's why:

We know too many well-educated people who are out of work. We can all name the well-educated people who helped plunge the nation into the deepest recession in many decades. Education alone guarantees nothing, and people in schools are right to get their backs up when others imply that schools manufacture poverty. There are just too many other culprits nowadays.

But we should face facts. High school dropouts barely stand a chance, even in good times. Children who can't clear even the lowest hurdles in state tests face a grim future if things don't turn around for them. Schools that lose more than half their students to the streets don't do much to promote social mobility in a ...

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