How Tutor/Health Mentors Could Help Ensure Success for All Students

I’d like to introduce you to Janelle Wilson, a tutor/health mentor (THM) at a Baltimore elementary school.  She provides computer-assisted tutoring to groups of four to six second and third graders at a time, in seven daily forty-minute sessions. Another tutor/health monitor does similar work with grades k-1, and another, grades 4-5. But that’s not all they do.

As Ms. Wilson walks through the intermediate wing of the school, you notice something immediately.  She knows every kid, every teacher, and every parent she encounters. And they know and respect her.  As she walks down the hall; she greets kids by name, celebrating their successes in tutoring and gently teasing them.  But listen in on her conversation.  “Hey, Terrell! Super job on your math!  But wait a minute, where are your glasses?”  Terrell looks for them.  “Sorry, Ms. W.!” he says, “I left them in class.” “Well, go get them” says Ms. Wilson, “You can’t become the superstar I know you can be without your glasses!”

What Ms. Wilson does, beyond her role as a tutor, is to make sure that all students who need glasses, hearing aids, asthma medication, or other specialized accommodations, are consistently using them. She also keeps parents up-to-date to help them help their children succeed.

blog_11-8-18_tutoring_500x333

Ms. Wilson is not a teacher, not a school nurse, not a health aide, not a parent liaison, but she has aspects of all these roles.  A year ago, she was finishing her B.A. in theater at a local university.  But today, after intensive training and mentoring for her role, she is responsible for the unique educational and health needs of 140 students in grades 2-3, in partnership with their teachers, their parents, medical professionals, and others who care about the same kids she works with.  On any given day, she is tutoring about 35 of those students, but over time she will tutor or otherwise interact with many more.

Ms. Wilson is hard to catch, but finally you get a word with her. “What’s the difference between what you do and what teachers do?” you ask. Ms. Wilson smiles. “My job is to try to make sure that each child’s unique needs is being met. Teachers do a great job, but there are only so many hours in the day. I try to be an extra right arm for all of the teachers in grade 2 and 3, focused on making sure all students succeed at reading.  That is the most crucial task in the early grades. It is hard for a teacher with 25 or 30 students to make sure that every struggling reader is getting tutoring or wearing their eyeglasses or taking their medicine. I can help make sure that each child gets what he or she needs to be a successful reader. That means educational needs, especially tutoring, but also glasses, hearing aids, even asthma medication. If there is anything a child needs to succeed beyond classroom teaching, that’s my job!”

Ms. Wilson does not exist, and as far as I know, few if any educators anywhere do what I am describing. If Ms. Wilson’s role did exist, combining the use of proven tutoring approaches with a structured role in maintaining children’s health and well-being, she could make an enormous difference in increasing the achievement of struggling learners, and putting them on the path to success in school and beyond.

Beyond Tutoring

Constant readers may have noticed that I’ve been writing a lot in recent blogs about tutoring: One-to-one and one-to-small group, by teachers and by paraprofessionals.  This got started because I have been working with colleagues on quantitative syntheses of research on effective programs for students struggling with elementary reading (Inns et al., 2018), secondary reading (Baye et al., in press, 2018), and elementary math (Pellegrini et al., 2018). In every case, outcomes for tutoring, including tutoring by paraprofessionals and tutoring to groups of two to six students, produced achievement outcomes far larger than anything else.  Since then, I’ve been writing about ways to enhance the cost-effectiveness and practicality of tutoring.  I even described a state-wide plan to use cost-effective tutoring to substantially reduce gaps and accelerate achievement.

I’ve also written a lot about the importance of ensuring that all students in high-poverty schools receive, wear, and maintain eyeglasses, if they need them.  We have been working in Baltimore and Chicago on plans to do this.  What we have found is that it is not enough to give children glasses.  The key is getting students to wear them every day, to take care of them, and to replace them if they are lost or broken.  All of this requires that someone keep track of who needs glasses and who is wearing them (or not). Today, only teachers can do this, because they are the only people who see every child every day. But it is not reasonable to add one more task on top of everything else teachers have to do.

What if schools recruited paraprofessionals and trained them to be responsible not only for tutoring small groups of students, but also for making sure that those who need glasses get them, wear them, and take care of them? A teacher/health mentor (THM) could work with parents to get necessary permissions to receive vision testing, for example, and support and then work with the children they tutor to make sure they have and wear glasses. They might also attend to children who have hearing aids, or have to take medications, such as asthma inhalers.  These are not medical tasks, but just require good organization skills and most importantly, good relationships with children, parents, and teachers. Medical professionals would, of course, be needed to assess students’ vision, hearing, and medical needs to prescribe treatment, but for problems with vision, hearing, or asthma, for example, the medical solutions are inexpensive and straightforward, but ensuring that the solutions actually solve the problems takes 180 days a year of monitoring and coordinating. Who better to do this than someone like Ms. Wilson, who tutors many students, knows them and their parents well, and has the dedicated time to make sure that students are using their glasses or taking their medication, if that is what they need?

Tutor/heath mentors like Ms. Wilson could take responsibility for ensuring that students’ routine medical needs are being met as part of their work in the school, especially during times (such as the beginning and end of the school day) when tutoring is impractical.

THMs could not and should not replace either teachers or school nurses. Instead, their job would be to make sure that students receive and then actually utilize educational and medical services tailored to their needs that are most critical for reading success, to make sure that teachers’ educational efforts are not undermined by an inability to meet the specific idiosyncratic needs of individual children.

A THM providing computer-assisted tutoring to groups of 4 to 6 for 40 minutes a day should be able to teach 7 groups of 28 to 42 children a day. A school of 500 students could, therefore, tutor 20% of its students (100 students) on any given day with three THMs. These staff members would still have time to check on students who need health mentoring. Knowing the educational impact of tutoring, that’s very important work on its own terms, but adding simple health mentoring tasks to ensure the effectiveness of medical services adds a crucial dimension to the tutoring role.

I’m sure a lot of details and legalities would have to be worked out, but it seems possible to make effective use of inexpensive resources to ensure the educational and visual, auditory, and other health well-being of disadvantaged students. It certainly seems worth trying!

References

Baye, A., Lake, C., Inns, A., & Slavin, R. (in press). Effective reading programs for secondary students. Reading Research Quarterly.

Inns, A., Lake, C., Pellegrini, M., & Slavin, R. (2018). Effective programs for struggling readers: A best-evidence synthesis. Paper presented at the annual meeting of the Socieity for Research on Educational Effectiveness, Washington, DC.

Pellegrini, M., Inns, A., & Slavin, R. (2018). Effective programs in elementary mathematics: A best-evidence synthesis. Paper presented at the annual meeting of the Society for Research on Educational Effectiveness, Washington, DC.

Photo credit: Courtesy of Allison Shelley/The Verbatim Agency for American Education: Images of Teachers and Students in Action

This blog was developed with support from the Laura and John Arnold Foundation. The views expressed here do not necessarily reflect those of the Foundation.

Advertisements

Teachers’ Crucial Role in School Health

These days, many schools are becoming “community schools,” or centering on the “whole child.”  A focus of these efforts is often on physical health, especially vision and hearing. As readers of this blog may know, our group at Johns Hopkins School of Education is collaborating on creating, evaluating, and disseminating a strategy, called Vision for Baltimore, to provide every Baltimore child in grades PK to 8 who needs them with eyeglasses. Our partners are the Johns Hopkins Hospital’s Wilmer Eye Institute, the Baltimore City Schools, the Baltimore City Health Department, Vision to Learn, a philanthropy that provides vision vans to do vision testing, and Warby Parker, which provides children with free eyeglasses.  We are two years into the project, and we are learning a lot.

The most important news is this:  you cannot hope to solve the substantial problem of disadvantaged children who need glasses but don’t have them by just providing vision testing and glasses.  There are too many steps to the solution.  If things go wrong and are not corrected at any step, children end up without glasses.   Children need to be screened, then (in most places) they need parent permission, then they need to be tested, then they need to get correct and attractive glasses, then they have to wear them every day as needed, and then they have to replace them if they are lost or broken.

blog_7-12-18_500x333

School of Education graduate student Amanda Inns is writing her dissertation on many of these issues. By listening to teachers, learning from our partners, and trial and error, Amanda, ophthalmologist Megan Collins, Lead School Vision Advocate Christine Levy, and others involved in the project came up with practical solutions to a number of problems. I’ll tell you about them in a moment, but here’s the overarching discovery that Amanda reports:

Nothing can stop a motivated and informed teacher.

What Amanda found out is that all aspects of the vision program tended to work when teachers and principals were engaged and empowered to try to ensure that all children who needed glasses got them, and they tended not to work if teachers were not involved.  A moment’s reflection would tell you why.  Unlike anyone else, teachers see kids every day. Unlike anyone else, they are likely to have good relationships with parents.  In a city like Baltimore, parents may not answer calls from most people in their child’s school, and even less anyone in any other city agency.  But they will answer their own child’s teacher. In fact, the teacher may be the only person in the school, or indeed in the entire city, who knows the parents’ real, current phone number.

In places like Baltimore, many parents do not trust most city institutions. But if they trust anyone, it’s their own child’s teacher.

Cost-effective citywide systems are needed to solve widespread health problems, such as vision (about 30% of Baltimore children need glasses, and few had them before Vision for Baltimore began).  Building such systems should start, we’ve learned, with the question of how teachers can be enabled and supported to ensure that services are actually reaching children and parents. Then you have to work backward to fill in the rest of the system.

Obviously, teachers cannot do it alone. In Vision for Baltimore, the Health Department expanded its screening to include all grades, not just state-mandated grades (PK, 1, 8, and new entrants).  Vision to Learn’s vision vans and vision professionals are extremely effective at providing testing. Free eyeglasses, or ones paid for by Medicaid, are essential. The fact that kids (and teachers) love Warby Parker glasses is of no small consequence. School nurses and parent coordinators play a key role across all health issues, not just vision. But even with these services, universal provision of eyeglasses to students who need them, long-term use, and replacement of lost glasses, are still not guaranteed.

Our basic approach is to provide services and incentives to help teachers be as effective as possible in supporting vision health, using their special position to solve key problems. We hired three School Vision Advocates (SVAs) to work with about 43 schools entering the vision system each year. The SVAs work with teachers and principals to jointly plan how to ensure that all students who need them will get, use, and maintain their glasses. They interact with principals and staff members to build excitement about eyeglasses, offering posters to place around each school. They organize data to make it easy for teachers to know which students need glasses, and which students still need parent permission forms. They provide fun prizes, $20 worth of school supplies, to all teachers in schools in which 80% of parents sent in their forms.  They get to know school office staff, also critical to such efforts.  They listen to teachers and get their ideas about how to adapt their approaches to the school’s needs.  They do observations in classes to see what percentage of students are wearing their glasses. They arrange to replace lost or broken glasses.  They advocate for the program in the district office, and find ways to get the superintendent and other district leaders to show support for the teachers’ activities directed toward vision.

Amanda’s research found that introducing SVAs into schools had substantial impacts on rates of parent permission, and adding the school prizes added another substantial amount. Many students are wearing their glasses. There is still more to do to get to 100%, but the schools have made unprecedented gains.

Urban teachers are very busy, and adding vision to their list of responsibilities can only work if the teachers see the value, feel respected and engaged, and have help in doing their part. What Amanda’s research illustrates is how modest investments in friendly and capable people targeting high-leverage activities can make a big difference across an entire city.

Ensuring that all students have good vision is critical, and a hit-or-miss strategy is not sufficient. Schools need systems to bring cost-effective services to thousands of kids who need help with health issues that affect very large numbers, such as vision, hearing, and asthma. Teachers still must focus first on their roles as instructors, but with help, they can also provide essential assistance to build the health of their students.  No system to solve health problems that require daily, long-term monitoring of children’s behavior can work at this scale in urban schools without engaging teachers.

Photo credit: By SSgt Sara Csurilla [Public domain], via Wikimedia Commons

This blog was developed with support from the Laura and John Arnold Foundation. The views expressed here do not necessarily reflect those of the Foundation.

Evidence-Based Resources Needed for Flint

I’m sure you are aware of the catastrophe in Flint, Michigan. 100,000 citizens of that city were exposed to water contaminated by lead and other toxic chemicals, and were then lied to about it by their state and local political leaders. Flint was the topic of the cover story in the February 1 Time magazine (“The Poisoning of an American City”). The story has been reported coast to coast, and in one of the presidential debates, Hillary Clinton noted the perfectly obvious, that this could never have happened in a middle-class suburb.

I won’t retell the whole story, but in essence, Flint, which is primarily under the political control of unelected state managers, made two disastrous decisions. First, in response to an increase in costs for clean Lake Huron water, Flint leaders decided to pump water from the nearby Flint River (“a sewer,” a resident noted). Second, the same leaders failed to add chemicals to keep the polluted water from dissolving lead in old pipes, also to save money. The result was drinking water with lead levels far higher than national standards. Early on, a courageous pediatrician, Dr. Mona Hanna-Attisha, noted elevated lead levels in young children and many other symptoms of poisoning, including anemia, rashes, hand tremors, and seizures. She persistently complained to anyone who would listen, but no action was taken until a September 2015 study found that children under five had twice the lead levels prevailing before the change in water sources.

Lead poisoning is devastating to the nervous systems of infants. It leads to diminished cognitive functioning, as measured by IQ tests and school performance, across a person’s entire life. Even low-level exposure has destructive effects. Dr. Hanna-Attisha noted, “If you were going to put something in a population to keep them down for generations to come, it would be lead.” It so happens that Baltimore has also long struggled with lead poisoning due to peeling paint in poor sections of the city. Freddie Gray, the young man who died in a police van, had lead poisoning as a child, performed poorly in school, and as a result was supporting himself with petty crime and drug-dealing. That’s how he got into the van in the first place.

In a January 30 article in the New York Times, the heroine of the Flint story, Dr. Hanna-Attisha, was asked what should be done for the roughly 8,000 children under 6 who were exposed to lead-contaminated water for up to two years. She said, “We have to throw every single evidence-based resource at these kids, starting now.” Since the effects of lead poisoning itself cannot be reversed, what she was referring to was proven early childhood programs, visiting nurse programs, and nutrition improvements. She might have added tutoring for children who need it, eyeglasses, and proven comprehensive school reforms, among many other interventions.

The kids in Flint certainly deserve special attention and immediate effective intervention. But in what disadvantaged area in the U.S., or anywhere, would we not say the same? Flint is remarkable because it is acute, and because the political betrayals expose the system that disregards the needs of disadvantaged people. But the chronic problems of poverty in America need just the same solutions.

There are approximately 52,000 Title I schools in the U.S. I would suggest, for starters, that every principal of every one of these schools, and every mayor, governor, legislator, and national, state, and local education leader, frame and display Dr. Hanna-Attisha’s statement in their office:

“We have to throw every single evidence-based resource at these kids, starting now.”

And then they should do it. Starting now.