1. Blending Student Services
Chronically Missing School Indicator
Lori Paisley | Executive Director | Coordinated School Health |

2. Why is chronic absenteeism rate important?
Multiple research studies link poor attendance with reduced academic outcomes.
Only looking at average daily attendance rate tends to mask attendance problems, particularly within subgroups.
Harmful effects of poor attendance are cumulative.
Districts and schools have access to rich attendance data that can be monitored throughout the school year.
Chronic absenteeism is a condition that can be successfully addressed.

3. Attendance defined
Average Daily Attendance: How many students show up to school every day?
The percent of enrolled students who attend school each day.
Truancy: Who is missing school without permission?
Typically refers only to unexcused absences.
Chronic Absence: Which students are missing so much school they are academically at risk?
Broadly means missing school for any reason – excused, unexcused, suspended/expelled. Commonly defined as missing 10 percent or more of instructional days.

8. While 47 percent of non-chronically absent students were proficient in third grade, only 28 percent of chronically absent students were proficient

9. Chronic absence in ninth grade is a significant predictor of high school graduation
Just over 15 percent of ninth grade students are chronically absent. Chronic absence, along with grades in ninth grade, according to many researchers are the biggest predictors of ninth grade success. In Tennessee, the patterns are clear. The patterns of disengagement that lead to drop out tend to be present in ninth grade. Over half of the dropouts in the 2011 cohort were chronically absent in ninth grade.

10. Step 1: Identify differences across schools
District X Elementary Schools
Average daily attendance rate
% of students chronically absent
% of ED students
School A
93.8
17.9
87.6
School B
94.7
12.1
58.5
School C
95..0
9.9
77.5
School D
96.3
6.7
42.8

11. Step 2: Unpack contributing factors
Myths
Absences are only a problem if they are unexcused
Sporadic versus consecutive absences are not a problem
Attendance only matters in older grades
Barriers
Lack of access to dental and health care
Poor transportation
No safe path to school
Trauma
Homelessness
Avoidance
Child struggles academically and socially
Bullying
Ineffective school discipline
Family had negative school experience
Undiagnosed disability
Disengagement
Lack of engaging and relevant instruction
Few meaningful relationships with adults in school
Poor school climate

12. Data sources Student management system/attendance
Student management system/discipline
Coordinated School Health/school nurses
Student/family support services
Student and parent focus groups
Transportation

13. Step 3: Create a tiered support system
Are any districts beginning to implement RTI2-B statewide?

14. Need to reframe attendance

15. Recognize that Going to School Reflects When Families Have
Hope
for a better future
Faith
that school will help you or your child succeed
Capacity
Resources, skills, knowledge needed to get to school

16. What are those resources?
Coordinated School Health (CSH), school nurses, school counselors, social workers, Family Resource Center,
school psychologists, SROs, health providers,
community stakeholders, mental health providers, Family
Engagement Director
Tennessee is the only state in the nation that has CSH
in each school district.
CSH 8 components: PE, Health Education, Health Services, Nutrition, Healthy School Environment, School Counseling/Psychological/Social Services, Student/Family/Community Involvement, Staff Wellness
Serves as “coordinator” not the “direct service” provider.

17. Health’s Key Role in Attendance
3 Chief Causes of Chronic Absenteeism:
1) Misconceptions about the importance of
regular attendance
2) Aversion to showing up for class
3) Barriers to reaching school every day
Health, whether physical or mental, plays a part in all three!
Health providers, in school and out, are essential to finding solutions.

18. Chronic Health Conditions in TN
In , 205,254 students had a chronic illness or disability diagnosis (21% of all students statewide).
Most common: asthma (34%), ADD/ADHD (26%), severe allergies (17%).
Between and , total number of students with chronic illnesses or disability diagnoses increased by 236%.
In , there were 3,885,680 student visits to a school nurse. 87% percent of those visits resulted in a student’s ability to return to class instead of being sent home.
Tennessee Department of Education, Office of Coordinated School Health, Annual School Health Services Report

19. Asthma
Asthma continues to be the #1 chronic health condition in the nation and in Tennessee.
Why?
District Success Story: Loudon County Schools
Melisa Fuhrmeister, OCSH State Coordinator
Former Loudon County Schools CSH Coordinator

20. Asthma & Absenteeism
Asthma is a leading chronic illness among children in the United States
Asthma is one of the leading causes of
school absenteeism
On average, in a classroom of 30
children, about 3 are likely to have asthma.
Children with asthma miss THREE times as much schools as healthy children
Asthma can interfere with a child’s ability to sleep, play, do well in school and family activities
"Asthma and Schools." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 17 June Web. 17 Apr

21. Asthma in Tennessee Schools
During the school year, there were 68,927 students in Tennessee schools with an asthma diagnosis
Students diagnosed with asthma represent the most common type of chronic illness/disability among Tennessee students (34 percent of all diagnoses)
Since , the number of students diagnosed with asthma has increased by 85 percent
Tennessee Department of Education, Office of Coordinated School Health, Annual School Health Services Report

22. Asthma-friendly Schools
Asthma-friendly schools are those that make the effort to create safe and supportive learning environments for students with asthma
They have policies and procedures that allow students to successfully manage their asthma
With proper management, asthma symptoms can be kept under control
"Asthma and Schools." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 17 June Web. 17 Apr

23. Managing Asthma in Schools
Research and case studies that looked at ways to best manage asthma in schools found that successful school-based asthma programs—
Establish strong links with asthma care clinicians to ensure appropriate and ongoing medical care
Target students who are the most affected by asthma at school to identify and intervene with those in greatest need
Get administrative buy-in and build a team of enthusiastic people, including a full-time school nurse, to support the program
Use a coordinated, multi-component and collaborative approach that includes school nursing services, asthma education for students and professional development for school staff
Support evaluation of school-based programs and use adequate and appropriate outcome measures
"Asthma and Schools." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 17 June Web. 17 Apr

24. Get Prepared!
Are there policies for nebulizer, inhaler and peak flow meter use?
Do students have easy access to vital medications and devices?
Does each student diagnosed with asthma have an Asthma Action Plan?

25. Coordinated School Health Can Help!
Partner with a local asthma care clinic
Schedule Pulmonary Function Tests (PFTs)
Schedule professional development opportunities related to asthma care for faculty and staff
Provide asthma resources for staff
Work with school nurses to be sure all students diagnosed with asthma have an Asthma Action/Management Plan

26. Asthma Action Plan

27. Pulmonary Function Tests (PFTs)
PFTs are tests that measure how well the lungs take in and release air
By measuring how much air is exhaled and how quickly, the test can evaluate a broad range of lung diseases including asthma.

28. Allergy, Asthma, & Sinus Center Pilot Program
11 school districts participated: Alcoa City, Anderson County, Blount County, Dickson County, Lenoir City, Loudon County, Putnam County, Roane County, Scott County, Cumberland County, Williamson County, Metro-Nashville Davidson County
61 Tennessee schools participated in the pilot during the school year
Students who returned completed registration and release forms were tested and results were provided directly to the parent/guardian
Total PFTs performed: 1,883 students
Abnormal PFT/Follow-up recommended: 448 students

29. Take Aways from the Pilot Program…
More inhalers were brought to nurses following the screenings
Nurses had tangible data to be able to address symptoms with parents and students
Screenings exhibited the importance of Asthma Education for teachers

30. Snapshot from Loudon County Schools

31. Asthma Badges

32. 7 Educationally Relevant Health Disparities
Vision
Asthma
Teen Pregnancy
Aggression and Violence
Physical Activity
Poor Nutrition
ADD/ADHD

33. Recommendations Use your CSH coordinator! Use your data!
Work with district partners to create YOUR tiered system of support!
Reframe attendance!
Remember families need: Hope+Faith+Capacity
Tap into your resources!
Contact us if you need anything!

34. Coordinated School Health Contacts
Lori Paisley, Executive Director
Melisa Fuhrmeister, State Coordinator