Schools have a lot to do. They are responsible for ensuring that their students develop skills and confidence in all subjects, as well as social-emotional learning, citizenship, patriotism, and much more.
Yet schools also have a unique capability and a strong need to ensure the physical health of their students, particularly in areas of health that affect success in the schools’ traditional goals. This additional goal is especially crucial in high-poverty urban and rural schools, where traditional health services may be lacking and families often struggle to ensure their children’s health. In high-poverty schools, there are many children who will unnecessarily suffer from asthma, lack of needed eyeglasses, hearing problems, and other common ailments that can have a substantial deleterious effect on student learning.
In partnership with health providers and parents, schools are ideally situated to solve such chronic problems as uncontrolled asthma, uncorrected vision problems, and uncorrected hearing problems. One reason this is so is that every student attends school, especially in the elementary grades, where the staff is likely to know each child and parents are most likely to have good relationships with school staff.
Every school should have a qualified nurse every day to deal with routine health problems. It is shocking that there are no nurses, or just part-time nurses, in many high-poverty schools. However, in this blog, I am proposing a strategy that could have a substantial impact on the health problems that need constant attention but could be managed by well-trained health aides, following up on more time-limited assistance from other health professionals. The idea is that each school would have a full- or part-time Preventive Health Aide (PHA) who would work with students in need of preventive care.
Asthma. In big cities, such as Baltimore, as many as 20% or more of all children suffer from uncontrolled asthma. For some, this is just an occasional problem, but for others it is a serious and sometimes life-threatening disease. In Baltimore and similar cities, asthma is responsible for the largest number of emergency department visits, the largest number of hospitalizations, and the largest number of deaths from all causes for school-aged students. Asthma can also cause serious problems with attendance, leading to negative effects on learning and motivation.
There is a very simple solution to most asthma problems. Based on a doctor’s diagnosis, a student can use an inhaler: safe, effective, and reliable if used every day. However, in high-poverty schools, the great majority of students known to have asthma do not take their medicine regularly, and they are therefore at serious risk.
Asthma cannot be cured, but it can be managed with daily inhaler use (plus, as necessary, access to rescue inhalers for acute situations). For the many children in high-poverty schools who are not regularly using their inhalers, there is a simple and effective backup: Directly Observed Therapy (DOT), which involves a health aide or nurse, most often, giving students their full daily dose of inhalant. As one example, Baltimore’s KIPP school has a specially-funded health clinic, and they have a health aide work in a room near the cafeteria to give DOT to all students who need it. Research on DOT for asthma has found substantial reductions in emergency department visits and hospitalizations, possibly saving children’s lives. By the way, at a cost of about $7,500 per hospitalization and $820 per emergency room visit, it would not take much reduction in asthma to pay the salary of a health aide.
Vision. Along with the Wilmer Eye Clinic at Johns Hopkins Hospital, the Baltimore Department of Health, the Baltimore City Public Schools, Vision to Learn (which has vans that do vision services at school sites) and Warby Parker (an eyeglass company that provides free eyeglasses for disadvantaged children), we have been working for years on a project to provide eyeglasses to all Baltimore City K-8 students who need them. We have provided almost 10,000 pairs of eyeglasses so far. It is crucial to give students eyeglasses if they need them, but we have discovered that giving out free eyeglasses does not fully solve the problem. Kids being kids, they often lose or break their glasses, or just fail to use them. We have developed strategies to observe classes at random to see how many students are wearing eyeglasses, with celebrations or awards for the classes in which the most students are wearing their eyeglasses, but this is difficult to do across the whole city. Preventive Health Aides could easily build into their schedules random opportunities to observe in teachers’ classes to note and celebrate the wearing of eyeglasses once students have them.
Hearing. Many children cannot hear well enough to benefit from lessons. The Baltimore City Health Department screens students at school entry, first grade, and eighth grade. Few students need hearing aids, but many suffer from smaller problems, such as excessive earwax. Health aides might supplement infrequent hearing screenings with more frequent assessments, especially for children known to have had problems in the past. Preventive Health Aides could see that children with hearing problems are getting the most effective and cost-effective treatments able to ensure that their hearing is sufficient for school.
Other Ailments. A trained Preventive Health Aide ensuring that treatments are being administered or monitored could make a big difference for many common ailments. For example, many students take medication for ADHD (attention deficit-hyperactivity disorder). Yet safe and effective forms of ADHD medication work best if the medication is taken routinely. A treatment like DOT could easily do this. Other more rare problems that could be managed with regular medication and observation could also help many children. With greater knowledge and collaboration with experts on many diseases, it should be possible to provide cost-effective services on a broad scale.
Health care for children in school is not a frill. As noted earlier, many common health care problems have serious impacts on attendance, and on vision, hearing, and other school-relevant skills. If school staff take up these responsibilities, there needs to be dedicated funding allocated for this purpose. It would be unfair and counter-productive to simply load another set of unfunded responsibilities on already overburdened schools. However, because they may reduce the need for very expensive hospital services, these school-based services may pay for themselves.
You hear a lot these days about the “whole child.” I hope this emphasis can be extended to the health of children. It just stands to reason that children should be healthy if they are to be fully successful in school.
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.