When school nurses aren’t enough

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Schoolchildren have had particularly tough times getting through the tedious months of the pandemic, with recent reports showing students are four to seven months behind in math and reading compared to previous years, and the most vulnerable students show the most significant drops.

But while schools have generally tried to improve student performance by focusing on academic tests and extra lessons, too often they have overlooked a major factor in their success: physical, mental and social health. This is especially true for children living in economically disadvantaged communities, who, unlike their peers in wealthier communities, often lack access to quality health care and resources.

There are many reasons why these children often struggle to do well in school, but education experts say there is no better time than now to devote more resources to their often access. limited to necessary health services. Just as shouting does not enable a deaf person to hear or better enlighten a blind person to see, giving facts and figures to young people with untreated health problems will help them learn.

Charles E. Basch, professor of health and education at the College of Teachers at Columbia University, wrote in a special issue of the Journal of School Health in 2011: “healthier students are better learners”, a fact he called “the missing link in school reforms to close the achievement gap”. In the report, he said that schools trying to improve educational outcomes should focus their efforts on reducing health disparities that could be detrimental to a student’s education.

“The health needs of children have not been seen as a central mission of schools,” Dr Basch told me. “Yet there is a clear link between mental and physical health and children’s ability to learn. And by not adequately meeting those needs, he said, “society is losing talent.”

Enter School Health Centers – facilities located within or near the school itself that not only tend to treat acute health issues like cuts and bruises, but also provide a range of health care services. health, including primary, mental and dental care; addiction counseling; nutrition education and more. “They bring health care to where the kids are, and they’re a great way to deliver health care to kids who might not otherwise have it,” said Nicholas Freudenberg, professor of public health at the City University of New York School. of Public Health.

School-based health centers are an essential feature of community schools and other public schools which have increasingly recognized how difficult it is for many children to detect and properly treat their health problems. These challenges can be particularly acute for those living in low-income urban centers or rural areas. If a parent has to take time off work or find a babysitter, or if transportation is unavailable or unaffordable to bring a child to a medical visit, needed services are too often overlooked until they are there is a crisis, experts said.

The not-for-profit Paramount Health Data Project, which recently released a report about the health conditions of students in public and private schools in Indiana, found that the more children attended the school nurse, the poorer their academic performance on statewide tests, me. says Azure Angelov, project manager. Data from the project suggests “that students who frequently visit the school nurse are simply in poor health and often do not feel well during the school day,” wrote Dr Angelov and colleagues in the report. “It has an impact on their ability to learn. “

Although the majority of public schools have at least one full-time or part-time nurse, this is hardly enough to care for children who often have complex and interrelated health issues that can hamper learning. For example, a child with poorly controlled asthma may avoid exercise and have trouble sleeping – when the brain consolidates its memory. In addition to medication and routine monitoring, this child may need nutrition and exercise advice and help to clear allergens from the home.

Dr Basch said too often education reformers focus on unique issues, such as children who come to school hungry.

“Providing breakfast alone will not be enough,” he said, “nothing will have a constant effect on a child’s ability to learn. A coordinated strategy that addresses multiple issues at once, added Dr Basch, will better help children be successful.

It is precisely this kind of coordination and follow-up provided by school-based health centers, thousands of which now exist across the country, said Dr Freudenberg.

Although hunger and nutrition are increasingly addressed by schools and supported by federal programs, mental health issues like depression and anxiety often fall under the radar. When teachers think a child is struggling with emotional issues, having public services in or near the school can improve that child’s academic performance, Dr Freudenberg said.

In addition, school-based health centers are often open to families and can connect parents with the health services they need for themselves or for other household members.

“The pandemic has highlighted the fact that many children in poor communities do not have healthy food or access to mental health services,” he said, adding that as the pandemic subsides and as children return to school, community support for their unmet health needs will be critical.

And not just for young or poor children or those who have lost close family members to Covid-19. Many high school students also face significant health issues, especially if they have suffered from crippling depression or anxiety related to the pandemic-induced disruptions in their lives.

“Kindergarten to Grade 12 students are likely to have health issues over the course of their lives that can and should be addressed by schools to improve learning as well as their health,” said Dr. Freudenberg. “Schools can help them learn to cope with difficult interpersonal situations. “

For example, in New York City, he said, school-based health programs that provide sexual and reproductive care have helped reduce rates of sexually transmitted infections and teenage pregnancy, enabling more young people to stay in school.

Yet Dr Basch and his co-authors pointed out in a 2015 report on health barriers to learning that “schools alone cannot fill education gaps or eliminate health disparities. Families, communities, health systems, legislators and the media each have essential roles.


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