School Health Policy Series: Part 3 – Three Strikes for Student Health

By | December 2, 2019

This year, teachers striking across the country have found common ground on a priority outside of typical debates around salaries or pensions. Educators in three major cities–Los Angeles, Oakland, and Chicago–among others, have been calling for more school counselors, librarians, nurses, psychologists, and social workers to support their students’ development beyond academic benchmarks.

These public calls have helped bring attention to the ways in which staffing and funding shortages, especially in large urban and high-poverty school districts, have added pressure on educators to support their students’ mental, social, and emotional wellbeing in addition to their already-taxing jobs in the classroom.

What’s a nurse’s office without a nurse?

Recently, I was struck by a quote from a teacher striking in Chicago, who reported that her school’s social worker is responsible for more than 2,000 students. In a 180-day school year, this social worker would need to connect with at least 11 unique students every single day in order to reach each student under her care once per year.

National education data suggests that the outcry we’re hearing from teachers across the country shouldn’t be surprising. A 2018 study of the school nursing workforce [pdf] found that less than 40% of schools across the country had a full-time nurse on site. Another 25% of schools did not employ a nurse at all. The rest employed a nurse part time, meaning a nurse might travel between multiple schools throughout the week. On days without a nurse on site, the nurse’s office could be staffed by a school secretary or other staff who can’t do much more than send a child home.

School districts are facing similar constraints with counselors and social workers. The average school counselor caseload was 464 students in 2015-2016 [pdf]. This is nearly double the 250-to-1 ratio recommended by the American School Counselor Association. Larger caseloads prevent counselors from focusing on school-wide initiatives such as bullying. This might also contribute to higher rates of burnout and turnover among counselors.

Unfortunately, voters may not realize that funding and hiring for these critical health-related services are directly shaped by their state’s education policies. Even school nurses are usually funded only through dollars marked for education and special education services. This means that state education policy, especially related to funding, plays a critical role in shaping access to health and social services in schools.

The curious case of California

My work in education research is based in California, which is known for progressive politics. Yet the state seems to be doing especially poorly when it comes to staffing its schools. In the 2018 Getting Down the Facts II report–a statewide research effort of education policies and funding–California ranked 39th among all states for school nurses, averaging one nurse per 2,240 students. California also ranked 50th for counselor staffing, averaging only one counselor per 1,000 students statewide.

Because of these low rankings, calls for mental health supports in California schools are rising. In February 2019, policy consultants writing in EdSource reported that school leaders across the state frequently mention the need for resources to support student mental health and wellness. This has become increasingly urgent while responding to the impacts of many wildfires across the state and the growing concerns about school violence.

Over the same year, our research has highlighted similar concerns from school district leaders across southern California. Many of the district leaders we spoke with reported that increasing mental health support staff and services for students is a major priority for new spending. We also listened to teachers, principals, and leaders in several districts talk about the rise of unmet mental health needs they are observing among their students. This was particularly true in districts receiving higher numbers of displaced and newly-arrived students and families.

Promisingly, recent changes in both federal and California education policy have begun to reduce a 20-year emphasis on test scores and increase the emphasis on the “whole child”. Indicators related to student wellbeing, for example, are now being included in school accountability structures. However, much work remains to be done to respond to the concerns we’re hearing from educators.

California’s Local Control Funding Formula: Fixing the problem?

In 2013, the passage of the Local Control Funding Formula (LCFF) reshaped 40 years of education funding in California. With this change, state education money that was once strictly earmarked into more than 50 different categories of spending is now able to be spent more flexibly according to school district context, needs, and goals.

As an analogy, let’s say that the state provided a school district with $50 to purchase groceries. Prior to the LCFF, each dollar was only allowed to be spent on the type of food that the state preassigned, with the intent to ensure every student would be served a nutritious meal. Your tomato dollar was only for tomatoes. Even if you needed bananas more, you could not spend an unused tomato dollar on bananas. With the LCFF funding changes, the school district has more power to decide where and how to spend the $50, according to what is needed.

As we’ve heard in our research, the LCFF has begun to give California school districts greater autonomy and flexibility to hire mental health and other support staff using education funds. Helpfully, the introduction of the publicly-available California Dashboard has also brought attention to non-academic measures of student and school success. This includes measures of attendance and school climate, which has reportedly helped broaden conversations and goal-setting among school and district leadership. These are measures that school health-related staff can directly impact.

The reality, however, is that the money base for making substantial changes remains minimal. Education spending has remained heavily tied to property taxes since the passage of Proposition 13. California also has one of the lowest rates of spending per student in the country. LCFF may have provided more flexibility to hire support staff to meet the goals of the teacher’s strikes, but it has not done much to increase the money available for hiring across the school system.

Listening to educators about what students need to thrive

As a nation, we tend to disagree on the appropriate role of schools in supporting student health in addition to learning. Should schools be encouraged to provide additional health and social supports that might help more students thrive? Or should schools be protected to focus on their primary role of education, to give students the best shot at succeeding in college or careers?

In my own work, one truth has rung clear: few people perform their best when they don’t feel happy, safe, rested, and supported. This is true of students just as much as adults. As my colleague pointed out at the beginning of this blog series, research on Adverse Childhood Experiences is helping us understand the long-term effects of stress in childhood. Research in neuroscience is helping to explain why. A 2018 report [pdf] commissioned by the Aspen Institute highlights just how interconnected social, emotional, and academic development are in the brain, and how important all of the these dimensions are for student learning.

But perhaps most importantly, educators across the country are telling us firsthand that they are concerned about student social, emotional and mental health. They say they need additional support staff in their schools. The critical question facing us now is: what are we willing to do about it?

Editor’s Note: You can read the introduction to the school health series here. Part 1 of the series addressed the challenge and potential of screening for ACEs in schools. Part 2 discussed the controversial role of athletic trainers in school sports. The final part in the series, focusing on the challenges faced by the national school lunch program, will be available next Thursday.

Haley Nelson

Haley Nelson

Haley Nelson is an education policy researcher working toward a Ph.D. in Los Angeles, California. Her research interests lie in the intersection of health and social supports in K-12 public schools. Prior to beginning her Ph.D., she worked with New York City public schools for four years, first with school-based health programs and then in a policy role in the New York City Department of Education. She holds a M.S. in Community Health Education from Teachers College, Columbia University.
Haley Nelson

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