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.

Advertisements

Evidence for ESSA Celebrates its First Anniversary

Penguin 02 22 18On February 28, 2017 we launched Evidence for ESSA (www.evidenceforessa.org), our website providing the evidence to support educational programs according to the standards laid out in the Every Child Succeeds Act in December, 2015.

Evidence for ESSA began earlier, of course. It really began one day in September, 2016, when I heard leaders of the Institute for Education Sciences (IES) and the What Works Clearinghouse (WWC) announce that the WWC would not be changed to align with the ESSA evidence standards. I realized that no one else was going to create scientifically valid, rapid, and easy-to-use websites providing educators with actionable information on programs meeting ESSA standards. We could do it because our group at Johns Hopkins University, and partners all over the world, had been working for many years creating and updating another website, the Best Evidence Encyclopedia (BEE; www.bestevidence.org).BEE reviews were not primarily designed for practitioners and they did not align with ESSA standards, but at least we were not starting from scratch.

We assembled a group of large membership organizations to advise us and to help us reach thoughtful superintendents, principals, Title I directors, and others who would be users of the final product. They gave us invaluable advice along the way. We also assembled a technical working group (TWG) of distinguished researchers to advise us on key decisions in establishing our website.

It is interesting to note that we have not been able to obtain adequate funding to support Evidence for ESSA. Instead, it is mostly being written by volunteers and graduate students, all of whom are motivated only by a passion for evidence to improve the education of students.

A year after launch, Evidence for ESSA has been used by more than 36,000 unique users, and I hear that it is very useful in helping states and districts meet the ESSA evidence standards.

We get a lot of positive feedback, as well as complaints and concerns, to which we try to respond rapidly. Feedback has been important in changing some of our policies and correcting some errors and we are glad to get it.

At this moment we are thoroughly up-to-date on reading and math programs for grades pre-kindergarten to 12, and we are working on science, writing, social-emotional outcomes, and summer school. We are also continuing to update our more academic BEE reviews, which draw from our work on Evidence for ESSA.

In my view, the evidence revolution in education is truly a revolution. If the ESSA evidence standards ultimately prevail, education will at long last join fields such as medicine and agriculture in a dynamic of practice to development to evaluation to dissemination to better practice, in an ascending spiral that leads to constantly improving practices and outcomes.

In a previous revolution, Thomas Jefferson said, “If I had to choose between government without newspapers and newspapers without government, I’d take the newspapers.” In our evidence revolution in education, Evidence for ESSA, the WWC, and other evidence sources are our “newspapers,” providing the information that people of good will can use to make wise and informed decisions.

Evidence for ESSA is the work of many dedicated and joyful hands trying to provide our profession with the information it needs to improve student outcomes. The joy in it is the joy in seeing teachers, principals, and superintendents see new, attainable ways to serve their children.

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.

New Policy Institute at Johns Hopkins Will Promote Evidence in Education

Not so long ago, it was awfully lonely advocating for enhancing the role of evidence in educational policy. I’m delighted to see that this is changing, and new allies are taking up the cause. I’ve written before about Results for America, the new efforts supported by the Arnold Foundation, and other developments that are moving forward evidence-based education, including support from OMB and from the Knowledge Alliance.

Now there is yet another force for evidence-based policy in education, and it is from my own university, Johns Hopkins. The Johns Hopkins University School of Education has just announced a new policy center, to be led by David Steiner, who previously was the dean at the School of Education at Hunter College and, before that, Commissioner of Education for the state of New York. David is joined by a Hunter colleague, Ashley Berner. They hope to create a policy center that is non-partisan and committed to supporting evidence in education. Because of his background, David is particularly interested in mobilizing state superintendents and other education leaders beyond the one-mile radius of Congress and the White House, where evidence-based reform has had its main impact so far.

The union of David and Ashley with the Johns Hopkins School of Education has extraordinary potential. They bring deep experience in educational leadership and policy to a School of Education that already has a lot going in in that arena. Beyond our own efforts at the Center for Research and Reform in Education (CRRE), there is Bob Balfanz and his colleagues at the Center for Social Organization of Schools. Our dean, David Andrews, is very committed to making an impact in national policy. Besides, we are in Baltimore, a one-hour train trip from Capitol Hill that costs $7 each way.

There is a lot to do to move education policy toward a strong evidence base, and the movement, such as it is, needs all the help it can get. ESEA is up for reauthorization, and maybe this time we can get evidence to be central to competitive programs and perhaps even formula programs, such as Title I. This is an exciting time for evidence-based policy, and all of us involved in it should welcome David and Ashley to our ranks!

Reading and Vision

A few years ago, I was touring a ruined abbey in Scotland. In a small museum containing objects found in excavations of the site were a pair of eyeglasses worn by monks in the 13th century.

The relationship between vision and reading is not exactly news. Since most adults eventually need reading glasses, most people reading this blog probably have personal experience with the transformational impact they can have.

Along with colleagues at the Johns Hopkins Hospital’s Wilmer Eye Clinic and the Johns Hopkins School of Education, we are doing a study of the relationship between vision and reading in inner-city schools in Baltimore. Our project is not finished, so I can’t report on all aspects of our findings. But what we have found so far is profoundly disturbing.

We are giving comprehensive vision tests to second- and third-graders in some of the most impoverished schools in the city. We are finding high rates of visual impairment, which can be corrected by eyeglasses. Yet only 1 to 3 percent of the children have glasses in school.

The state of Maryland requires vision screening in first grade, and many of these children were found to need glasses previously. Yet a hundred things go wrong in getting glasses on kids’ faces in inner-city schools. Some kids are missed in the screening. Those who are identified get a letter sent to the parents, who may or may not follow up. Some cannot afford glasses, while others qualify for assistance to purchase glasses but do not know how to go through the procedures to get them. Glasses frequently get broken or lost or stolen, and there are no procedures to replace them. As a result, few kids who need them have glasses in school, even just one year after the screening year.

A key factor in all of this is that vision is seen as a health problem, not the school’s problem. Schools do not have resources for eyeglasses, so even though they are accountable for children’s reading, and even though school leaders and teachers know full well that a lot of their kids just need glasses, they feel helpless in solving this simple problem. Title I funds, for example, cannot be used for glasses. The result is that many children are receiving very expensive remedial services, tutoring, or special education, when a $20 pair of glasses would actually solve the problem.

In our project, we are testing kids, and, for those who need them, we are providing two pairs of glasses, one for home and one for school. Teachers are given craft boxes to hold the glasses and facilitate distributing them each day. If glasses are broken, they are replaced. Eyeglasses are in these days, and the kids are very proud of their glasses. Compared with other interventions for struggling readers, the cost of a few pairs of glasses is trivial. Not every struggling reader is struggling due to poor eyesight, but imagine if 20 or 10 or even 5 percent of children in high-poverty schools are struggling in reading or other subjects due to vision problems that are easily remediated with ordinary eyeglasses.

I’m always reluctant to get ahead of the data, but imagine for a moment what it would mean if we do find that significant numbers of inner-city kids are failing year after year just because they lack glasses. Hopefully, this finding would lead to government and private programs throughout the U.S. providing eyeglasses in schools and giving teachers and administrators responsibility to see that children receive and use their glasses. This could make a huge difference in one easily recognizable subgroup of struggling readers.

At a larger level, think what such a finding might say about poverty and education. Educators naturally seek educational solutions to educational problems in high-poverty schools, reasoning that they cannot solve problems of housing, crime, unemployment, and so on. Yet there may be some non-educational interventions that they could use to improve student outcomes. What matters is the outcomes, and it is crucial that proven solutions be allowed to cross traditional boundaries if they require it.

At a larger level still, consider how families get into poverty in the first place. How many kids with poor eyesight fail in school, lose motivation, and ultimately lose access to positive futures? How many impoverished parents were once children with poor eyesight, or other easily solved health difficulties? How many inner-city communities suffer from having many young people who perceive no hope due to reading difficulties that could have been prevented?

Eyeglasses are not new, and they are not magic. Yet they may well be part of a solution to fundamental and persistent problems of education.