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Accounted For is a series that looks at the impact of chronic absenteeism — defined as missing 10 percent or more of a school year for any reason — on learning.

Accounted For: Can School Clinics Improve Attendance?

Adrian Clark | Flickr

This story is part four of Accounted For, an ongoing project of St. Louis Public Radio that explores the connection between chronic absenteeism — defined as missing three and a half weeks or more of school — and classroom success. As educators in Missouri  shift their focus from big picture attendance data to individual students, they are looking at how school clinics can help keep kids in school. 

Nurse practitioner Kathy Woods wraps a blood pressure cuff around the arm of Roosevelt High School senior Caleb Branch.

“Where are you going to go to college? Have you made up your mind yet?” Woods asked Branch.

“I’m going to be attending Missouri Western next year,” Branch responded.

“Cool!” Woods exclaimed as she inflated the cuff around Branch’s arm.

Branch didn’t have to leave campus for this quick check up. Instead, the barrel-armed football player made a pit stop at the clinic run by Mercy health care on the school’s first floor.

While the electronic blood pressure machine inhales, beeps and finally exhales, Branch and Woods chat away about everything from school work to weight lifting.

“It’s like having a family inside a school,” Branch said.

It’s not unusual, Woods said, for students such as Branch to pop in just to say hello or catch up with staff.

“Sometimes I think they just need somebody to talk to,” Woods said.  “They just want somebody to listen to their aches and pains. They just want somebody to say, ‘It’ll be all right, it’s OK.’”

It wasn’t always like this.

Credit Tim Lloyd / St. Louis Public Radio
St. Louis Public Radio
Nurse Practitioner Kathy Woods (left) and Sharron Neumeister, regional director of community health for Mercy (right), stand in an exam room in the health clinic at Roosevelt High School.

About half of the roughly 520 students currently enrolled at Roosevelt weren’t there six weeks after the start of the school year. Developing sturdy relationships amidst a constant churn of incoming and outgoing students can be a challenge. So when the clinic opened its doors this past school year with the help of a $500,000 grant from Boeing, students greeted it with a healthy dose of skepticism.

Woods and her staff needed to break the ice.  

As with a lot of high schools, sports are a big deal at Roosevelt, and Woods spotted an opening. 

Before students can make the team, they have to get a physical.  So, Woods thought, what if they marketed the clinic as an easy place for students to get medical clearance before hitting the field?

The students came in droves.  The coaches loved it — and Woods had a hit on her hands.

“I think the first month we did like 120 physicals, and that was our in,” Woods said. 

Often athletes sit near the top of the school’s social strata, and getting buy-in from the cool kids was a critical first step.

Credit Tim Lloyd / St. Louis Public Radio
St. Louis Public Radio
Roosevelt High School senior Caleb Branch says its not unusual for students to drop the clinic to say hello. "It’s like having a family inside a school," he says.

 "As the year went on, we noticed that the students would tell each other, ‘if you need help, go to the clinic,’ ” said Principal Crystal Gale.  “We realized that the clinic had really become part of the school culture.”

The clinic continues to expand its services and collaborates with teachers to develop health-related lesson plans. It hosts a weekly girls group to discuss a range of topics, from hygiene to healthy relationships, and it recently added a behavioral health specialist to its full-time staff. 

To date, the clinic has had well over 1,100 visits. Woods said asthma accounts for the majority of chronic health issues treated by the clinic.  

“When a kid comes in here, we’re hoping we provide a safe environment, some place to talk, some place to work out problems,” Woods said.  “That’s our goal.”

The early struggles Woods and her staff experienced aren’t unusual. John Schlitt — interim president for the School Based Health Alliance, a nonprofit that represents school based clinics across the country — said most successful school clinics initially have a hard time building strong relationships with students.   

“What the school-based health centers have to do is say, ‘look, we aren’t the school, what happens in these wall stays in these walls,’” Schlitt said.

This can be a tough sell, Schlitt said, especially for teenagers who worry about having all of their personal information shared with administrators. But when the connection is forged, he said everything else can start falling into place.   

“Kids don’t always get the message in school, that we care about you here,” Schlitt said.  “That we’re going to treat you with respect. That we’re going to treat you with cultural humility.  That we’re going to take time to get to you know and we’re going to support you.  Those are things you have to convince adolescents of over time, it doesn’t happen right away.”   

Schlitt said that a school clinic isn’t a cure all for academic ills. But when executed well, it can be woven deep into a fabric of wrap around services designed to keep kids on track.

Moving the academic needle?

Last year about half of the students at Roosevelt missed at least three and a half weeks of school, enough to be considered chronically absent. This year, administrators are on track to cut down that number by around 10 percentage points.

They call the health clinic a key part of the reduction — and are planning to do research to measure whether its services are improving attendance and classroom success.  

“We have a strong hypothesis that we’re making an impact, but we don’t have numbers right now,” said Sharron Neumeister, regional director of community health for Mercy.  “We just partnered with Washington University, and we’re going to look at some of the relationships.  What kind of cause and effect is there with having a clinic on site in a high school on absenteeism, grades and behavior.” 

They won’t be alone in their search for answers.  Researchers and community health organizations across the country want to uncover how or if school clinics can improve attendance and academic performance.

'As we speak there are several studies going on. Of the few studies that are published, all of them have found a positive association with school clinics and attendance.' — Samira Soleimanpour, researcher with the School Based Health Alliance.

  “As we speak, there are several studies going on,” said Samira Soleimanpour, a researcher with the School Based Health Alliance.  “Of the few studies that are published, all of them have found a positive association with school clinics and attendance.” 

Researchers in western New York compared attendance between two schools that both had school nurses, but only one had a clinic. Based on the data, they concluded that school clinics have a direct impact on attendance rates, regardless of race, gender, poverty status or a preexisting condition.  

It was a similar story in Seattle. Researchers there found that students who received medical services through a school clinic had significantly higher attendance over the course of five semesters.  The study also determined that students who received mental health services through a school clinic had improved GPAs, or grade point averages.

While academics involved in both studies saw promising results, they noted that more research is needed.  But that can be easier said than done.

The often complicated web of health problems that keep a child from attending school can be hard to untangle. On top of that, dealing with bureaucratic hierarchies, differing data collection methods and privacy concerns can be tricky.   

The nonprofit Elev8 Baltimore runs three school clinics in partnership with Baltimore Medical System, a nonprofit health-care provider. Between 2010 and 2013, the clinics at three East Baltimore schools had a total of more than 11,300 visits.   

"If we can remove all the barriers that keep a child from coming to school on a regular basis, that's a huge hurdle to overcome." — Nicole Johnson, senior director of Elev8 Baltimore.

  “If we can remove all the barriers that keep a child from coming to school on a regular basis, that’s a huge hurdle to overcome,” said Nicole Johnson, senior director of Elev8 Baltimore.  “School-based health centers can be a big part of that.”

Like the clinic at Roosevelt High School, Johnson said they’re drawing up plans to measure whether their clinics have helped keep kids in school and performing up to standard.

Even though they’re struggling to get all the numbers in place, Johnson said, early on they learned how immunizations and addressing chronic health problems like asthma — a well-documented culprit behind poor attendance — can fill empty desks.      

“It’s that step toward achievement through attendance that makes this intersection between health and chronic absenteeism so critical right now,” Johnson said. 

"So, how do you find the right partners who can work with the schools?” 

Tomorrow, Tim Lloyd reports from Valley Middle School in House Springs where an in-school dental clinic attends to the needs of poor students.

Tim Lloyd was a founding host of We Live Here from 2015 to 2018 and was the Senior Producer of On Demand and Content Partnerships until Spring of 2020.