School Nurses and Chronic Absenteeism in Schools: A Qualitative Study on Experiences, Perspectives, and Roles

Regular attendance is integral for students' academic success; it also affects adolescents' physical and mental health. Very few studies consider (a) differences between partial- and full-day absences regarding chronic absenteeism (CA; missing school ≥15 days in an academic year); or (b) roles of school nurses in addressing student absenteeism. This study describes school nurses' perceptions of factors related to CA and differences between partial- and full-day absences by analyzing qualitative data from six focus groups with 21 Midwestern school nurses. Four themes emerged: Absenteeism at the intersection of family and health; Absenteeism at the intersection of family and school; Absenteeism at the intersection of family and ecological systems; and School nurse roles in supporting chronically absent students. Findings highlight the importance of school nurses by describing their role in identifying students who are at risk for CA, allowing for effective assessment and intervention with students before patterns of CA become habitual.

Feasibility Assessment of a School Nurse-Led Approach Using Chronic Absenteeism to Establish the School-Based Active Surveillance Process

This article shares what was learned from the feasibility assessment of a nurse-led school-based active surveillance (SBAS) pilot to track chronic absenteeism using myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) as an exemplar. This pilot encompassed a 3-year period with training and feedback from school nurses (SNs) on data collection and ME/CFS. SNs found that the SBAS process helped them effectively identifying undiagnosed conditions. The assessment revealed the importance of focusing outreach efforts and establishing relationships with the school leadership in developing health policies and programs in the school setting. The pilot data were used to develop a manual to guide SNs for the SBAS process. This can be viewed as a model for SNs in establishing a surveillance to identify and track conditions like ME/CFS. With overlapping symptoms of Long COVID to ME/CFS, this assessment may provide insights for additional efforts to understand the impact of Long COVID on students' education.

Factors influencing school re-entry among adolescents in Kenya

BACKGROUND

The number of out-of-school children and adolescents has been increasing globally. In sub-Saharan Africa, an estimated 23 million adolescents leave school due to poverty, teenage pregnancy, and unspecified illnesses. The reasons for absenteeism are well-known but the factors involved in the decision to return to school have not been analyzed. This study aimed to identify the factors that promote primary school re-entry among chronic adolescent absentees in rural sub-Saharan Africa.

METHODS

Qualitative data were gathered through participant observation, in-depth interviews, and focus group discussions involving nine pupils who returned to school after chronic absenteeism and 140 adult stakeholders in Mbita sub-county, Kenya. Data were analyzed using thematic analysis.

RESULTS

The thematic analysis results showed that four factors promoted school re-entry, namely: (1) social norms: "school for a better life"; (2) linkage of community and school; (3) supportive environment; and (4) using discipline to make adolescents serious about their education.

CONCLUSIONS

School re-entry among chronic absentees in Mbita sub-county is promoted by both community and school factors. It was observed that social norms regarded an education as a "passport to a better life." Adolescents, teachers, and community leaders view education as a means of improving one's socio-economic status. Two essential elements of health-promoting schools, a supportive environment and a linkage with community, effectively promoted returning to the school among adolescents. The introduction of health-promoting schools was recommended to implement a school re-entry policy in Kenya effectively.

Chronic Absenteeism: Risks and Protective Factors Among Low-Income, Minority Children and Adolescents

BACKGROUND

Low-income and racial/ethnic minority students often face distinct challenges in attending school eading to lower academic performance, low graduation rates, and overall, an indicator of diminished long-term social and financial stability. Chronic absenteeism is a national problem and to address this, a better understanding of risks and points of intervention for the students most at risk is needed. This cross-sectional study sought to assess risks and protective factors associated with chronic absenteeism in a predominantly low-income minority school district in Southern.

METHODS

Conducted in southern California, students (N = 24,439) ages 9 to 21 years were recruited. A logistic regression was used to assess the role poor physical and mental health, safety, bullying, and family risk factors attributed to chronic absenteeism.

RESULTS

Results revealed that asthma (odds ratio [OR] = 1.35, p < .001), being overweight/obese (OR = 1.38, p < .01), presence of family risk factors (OR = 1.49, p < .001), bullying (OR = 0.84, p < .05) and perceptions of safety at school (OR = 1.24, p < .05) increased the odds of chronic absenteeism, while protective factors such as support (OR = 1.30, p < .001), increased sleep (OR = 0.96, p < .001) and positive growth mindset (OR = 0.96, p < .001), mitigated it.

CONCLUSION

This study not only identifies risk but protective factors worth adhering to, to promote school attendance. Future research should further examine the role of mental health in chronic absenteeism.

Five Years and Moving Forward: A Successful Joint Academic-Practice Public Partnership to Improve the Health of Hawaii's Schoolchildren

BACKGROUND

In 2014, the Hawaii Department of Education (DOE), the only statewide school system in the United States, predominately enrolled children (keiki) from underserved communities and lacked school nurses or a school health program. Chronic absenteeism due to health concerns was identified as a barrier to academic success.

METHODS

The DOE and a public university created Hawaii Keiki: Healthy and Ready to Learn (HK), a program to provide school-based services for 170 Title 1 schools in urban and rural settings and build momentum for statewide collective action. HK has maintained support from public and private entities to address student health.

RESULTS

This paper describes 5 years of program development, implementation, and continuing challenges. Most recently in 2020-2021, HK pivoted in the face of school campus closings due to COVID-19 with strategic plans, including telehealth, to move forward in this changed school environment.

CONCLUSIONS

The HK program has increased awareness of students' needs and is addressing the imperative to build health services within public schools. The multipronged approach of building awareness of need, providing direct services, educating future care providers, and supporting sound policy development, has an impact that goes beyond any one individual area.

Residential Mobility Among Elementary School Students in Los Angeles County and Early School Experiences: Opportunities for Early Intervention to Prevent Absenteeism and Academic Failure

School connectedness is closely linked to academic success: students who are engaged at school have better attendance and academic performance, and are less likely to drop out. Residential mobility – having moved homes – can increase the risk of a negative academic trajectory (e.g., absenteeism and academic failure). Increasing housing instability in the United States due to rising housing costs, especially in urban areas, has made residential mobility a growing concern. While existing research has examined residential mobility among students and its connection to long-term consequences such as absenteeism and academic failure, less is known about how residential mobility relates to potential intermediate school experiences (e.g., school disconnectedness, low perceived academic ability, and experiences with school violence and harassment) that contribute to a negative academic trajectory. This study examines associations between residential mobility in elementary school and school experiences in a large urban jurisdiction. Data were collected from a sample of public elementary school students in Los Angeles County (5th grade, n = 5,620) via the California Healthy Kids Survey (2013–2014). Descriptive, Chi-square, multiple logistic regression analyses, and predicted probabilities were performed to examine the relationships between past-year residential mobility and indicators of school connectedness and school-based relationships, perceived academic performance, and exposure to violence and harassment. More than a third (36.6%) of students in the analysis sample moved at least once in the past year. After adjusting for neighborhood and family factors, a higher number of past-year moves was significantly associated with poorer school experiences, including lower odds of school connectedness for high-movers (2+ moves) [adjusted odds ratio (AOR) = 0.77; 95% confidence interval (CI) = 0.68–0.86], compared to non-movers. Movers had lower odds of perceived academic ability (1 move: AOR = 0.72; CI = 0.63–0.83; 2+ moves: AOR = 0.55; CI = 0.44–0.69), but higher odds of exposure to violence and harassment as a victim (1 move: AOR = 1.26, CI = 1.17–1.37; 2+ moves: AOR = 1.34, CI = 1.17–1.54), and as a perpetrator (1 move: AOR = 1.21, CI = 1.08–1.36; 2+ moves: AOR = 1.54, CI = 1.24–1.92). These results highlight the value of developing and implementing strategies that can identify and support students who move at young ages, to prevent student disengagement and promote attendance and academic success early in their life trajectory.

Effect of Sociodemographics, Health-Related Problems, and Family Structure on Chronic Absenteeism Among Children

BACKGROUND

From 5 to 7.5 million schoolchildren are chronically absent, defined as missing ≥15 days of school within a year. Students miss schools due to various reasons such as health, socioeconomic status, and environmental factors. We examined child's health and behavior, family structure, and sociodemographics to understand chronic absenteeism.

METHODS

The population included children ages 6 to 17 years from the Medical Expenditure Panel Survey years 2008-2013. Multivariable logistic regressions were used to identify the risk factors of chronic absenteeism, adjusting for the complex sampling design.

RESULTS

Among sociodemographic variables, age ≥14 years, race/ethnicity, lower-income family, public health insurance, US born, and speaking English at home were associated with absenteeism. Asians, Mexican Hispanics, and blacks have lower absenteeism than whites. Among health-related variables, children using an inhaler for asthma, having behavioral problems, and less healthy than other children were more likely to be chronically absent. Among family variables, a smaller family size was a risk factor for absenteeism.

CONCLUSIONS

Asthma and behavioral problems were highly associated with chronic absenteeism. The identification of children at risk for chronic absenteeism will help the educational professionals identify the barriers to academic achievements and develop integrated educational interventions and policies to support disadvantaged children.

There's a New Alphabet in Town: ESSA and Its Implications for Students, Schools, and School Nurses

The 2015 passage of the Every Student Succeeds Act (ESSA) provides state education agencies with more local control over educational planning, requires development of state accountability plans, and provides opportunities for advocacy surrounding school nursing-sensitive indicators of student success. Federal Title I, II, and IV funds are available for state and local education agency utilization in meeting educational needs of impoverished students and for development of high-quality instructional and support personnel. As Specialized Instructional Support Personnel, school nurses can utilize ESSA Title funding to positively impact chronic absenteeism, school climate, and school nurse staffing. ESSA can be a resource for funding school health services and professional education. This article will assist school nurses in better understanding ESSA and how funding is allocated to states and local education agencies.

Chronic Student Absenteeism: The Critical Role of School Nurses

Routine school attendance is necessary for youth to develop into well-educated, successful adult citizens who will make significant contributions to society. Yet over 5 million students in the United States are chronically absent missing more than 10% of school in a year. The growing problem of chronic absenteeism among youth can be linked to increases in chronic health conditions in childhood such as allergies, asthma, diabetes, and obesity. School nurses are in an ideal position to play a vital role in reducing chronic student absenteeism, enabling youth to achieve their maximum learning potential. However, the role of the school nurse has not historically been recognized as a key factor for assisting youth to be present and regularly engaged in school. This feature article highlights a hospital-funded school nurse program within the state of Michigan that has reduced chronic absenteeism rates by placing school nurses into schools where previously there were none. The program implemented a number of initiatives that were instrumental in increasing the health and safety of students and provides a unique "before and after" glimpse of how school nursing reduces chronic student absenteeism rates and validates the essential role of the nurse within the educational system.