This piece originally appeared in Principal Magazine.
Since the COVID-19 pandemic, schools across the country have struggled with a basic priority: ensuring that students attend classes regularly. At the same time, school leaders and staff want to prioritize student health and well-being. Fortunately, these priorities work hand in hand. Research shows that healthy schools can support regular student attendance.
But creating a healthier school can be hard. FutureEd’s Attendance Playbook: Smart Strategies for Reducing Student Absenteeism Post-Pandemic, developed in partnership with the nonprofit Attendance Works, includes more than two dozen strategies that schools can use to improve student attendance. The following are five health-focused strategies taken from the playbook that have proven track records in elementary schools. Adopted as part of a comprehensive plan to improve attendance, these strategies can reinforce each other to create a healthier, more welcoming, and more supportive environment for students.
1. LAUNDRY AT SCHOOL
About 15 percent of U.S. households—and much higher percentages in low-income communities—lack at-home washers and dryers. They rely on commercial laundromats, which can be expensive and time-consuming. If laundry is put on hold, students might experience bullying because of dirty clothes, be sent home for coming to school out of uniform, or skip school out of embarrassment.
In response, a handful of schools have pioneered providing laundry services on-site. Though the research base is still relatively small, the available data shows evidence of improved attendance.
This year, 154 schools in 40 states helped provide clean clothes to about 50,000 students, thanks to donations of washers, dryers, and laundry supplies from the Whirlpool appliance company. In 2022–2023, nearly 80 percent of students in participating high-risk elementary schools improved their attendance, and nearly 61 percent of those students were no longer at risk for chronic absenteeism by the end of the school year.
Other schools are developing community partnerships to obtain washers and dryers. In Kansas City, Missouri, Banneker Elementary School partnered with the local United Way to add laundry facilities in 2021. Banneker’s share of students attending school 90 percent of the time or more has since jumped from slightly below half to more than three-quarters, and at least five more district elementary schools launched on-site laundry services as a result.
2. SCHOOL-BASED HEALTH CARE
Illness remains the No. 1 reason students miss school. Asthma alone accounts for nearly 14 million missed days of school, according to the Centers for Disease Control and Prevention. Health includes dental issues, too—a 2012 study by the University of Southern California’s School of Dentistry showed that a third of absences among economically disadvantaged elementary school students are due to dental problems.
Nearly 2,600 schools in the U.S. serving 6.3 million students have on-site clinics that promote healthy living and offer preventive care for chronic health conditions.
Health services can include:
- Health screenings,
- Immunizations, and
- Nursing care.
Such services not only help prevent and treat illnesses, but also save the time students miss due to routine medical appointments or being sent home when they feel sick. School-based health centers also boost students’ attendance and sense of connection to school, studies suggest.
Telehealth. The use of telecommunications such as interactive videoconferencing to deliver health care services has become more common in schools since the pandemic. A school nurse might connect a student troubled by asthma to an off-site provider who listens to the child’s lungs remotely and determines an appropriate treatment without the student having to leave school, for example. Telehealth can increase access to primary and specialty care, improve care coordination for students with chronic health conditions, and strengthen collaboration among providers, schools, and parents. Telehealth can also decrease lost work time for parents, reduce ER visits and hospitalizations, and cut health care costs.
One of the biggest challenges in providing school-based health services is the cost. Telehealth services are often more affordable than running an on-site clinic, but research suggests that school-based health centers can deliver care less expensively than health care facilities. “For each dollar spent on school nurses, $2.20 was saved in parent loss of work time, teacher time, and procedures performed in school rather than in a more costly health care setting,” according to an American Academy of Pediatrics study.
School-based health centers. Interest in creating school-based health centers for physical and mental health ailments is increasing. In February, New York Gov. Kathy Hochul announced that the state would provide $20 million for schools to launch on-site mental health clinics.
A successful school-based health center requires:
- Strong community partnerships,
- A sound business model,
- Stable funding sources, and
- High-quality clinical practices
3. RETHINKING RECESS
Daily recess offers students playtime that enhances physical health and builds social skills. Thoughtfully supervised recess periods can help students build positive relationships and a stronger connection to school, which often increases attendance.
Studies suggest that recess can also help students focus on schoolwork. A 2010 study by Georgia State University researchers compared fourth grade students’ behavior on days when they were allowed recess and days when they stayed in class. About 60 percent of the students worked more, fidgeted less, or both on recess days. A program in Texas that provided four 15-minute recesses during the day achieved similar results, according to a 2018 Texas Christian University study. General physical fitness is associated with better school attendance, research indicates.
Recess can introduce problems such as bullying or children feeling excluded. The nonprofit Playworks offers a solution: a recess coach who trains school staff to establish safe norms at recess, incorporate inclusive tweaks to traditional playground games and introduce new ones, and de-escalate students when they become too high-energy. The program can designate older children as playground leaders or “junior coaches.”
A study from policy research organization Mathematica and Stanford University found 43 percent fewer reports of bullying or exclusion in schools using the Playworks model. Administrators at the K–8 Loma Linda School in Phoenix attribute a two-thirds chronic absence rate decrease in part to the Playworks model.
4. HEALTHY SCHOOL BUILDINGS
The pandemic increased public awareness of the importance of healthy buildings to good attendance and academic success. Research shows that adequate ventilation and effective hand-washing protocols for students and staff can improve attendance.
A 2020 U.S. Government Accountability Office report found that 36,000 schools nationwide had inadequate heating, ventilation, and air conditioning (HVAC) systems before the pandemic. The billions of dollars Congress provided in pandemic relief aid has allowed many school districts to begin addressing some of these needs: Half of the 5,000 district spending plans reviewed in a FutureEd analysis included money for HVAC upgrades.
Good ventilation can contribute to better attendance, according to a 2013 study led by Mark Mendell at the Lawrence Berkeley National Laboratory. Updating classroom ventilation systems to state standards in the 150 California classrooms studied over two years produced a 3.4 percent decline in illness-related student absences.
Not all schools might be able to make ventilation upgrades, but many schools can contribute to good attendance by adopting strong hand-washing protocols. Danish nurse and researcher Inge Nandrup-Bus conducted a three-month pilot program at two schools in Denmark with students ages 5 to 15. At the first school, students were required to wash their hands before their first class, before lunch, and before going home; the second school did not change its hand-washing practices.
Nandrup-Bus’ 2009 report revealed that the school with hand-washing protocols saw a 66 percent decrease in pupils absent four or more days during the previous year, and a 20 percent increase in children with zero absences. The following year, she introduced the hand-washing intervention at what had been the control school, and it saw significant declines in illness-related absences, too.
Hand-washing protocols require school bathrooms to have working sinks, running water, and soap. Handsanitizing stations on playgrounds, around campus, and in classrooms can enhance basic hand-washing.
5. COMMUNITY SCHOOLS
The Coalition for Community Schools defines a community school as “a place and a set of partnerships” whose integrated focus on academics, health and social services, youth and community development, and community engagement leads to improved student learning, stronger families, and healthier communities. A community school is a hub for the community that provides access to education, health care, social services, extended learning, mentoring, tutoring, and more for children and parents.
Research shows that school-community collaborations can help schools reduce absenteeism. A 2020 RAND Corp. study found that New York City’s community schools saw reductions in chronic absenteeism in all grades and across all years of the study. A 2022 study from the Annenberg Institute reported that New York’s model delivered a 5.6 percentage point reduction in chronic absenteeism that was sustained over three years.
Such a collaborative approach works best with a school-based coordinator who can orchestrate the work of community partners, the studies suggest. Data systems that can track and share student attendance, grades, and disciplinary records are key to coordinating and measuring the effects of community-supported programs. Real-time, accessible data reports contributed to the success of New York City’s community schools.
Since 2021, the Biden administration has increased the pool of federal grants for community schools fivefold. Many state legislatures are supporting community schools in their budgets, too. The federal government also offers guidance on developing the data-sharing agreements school districts and community partners will need for successful community schools.
Health-based absenteeism strategies avoid a punitive approach to reducing truancy that research has found to be largely unsuccessful. Instead, the strategies promote conditions that strengthen the educational experiences of all students: a safe, welcoming school climate and stronger bonds between students and teachers. They set the stage for teachers to provide rigorous, relevant instruction by creating conditions that encourage students to attend school regularly
