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Health strategies to improve outcomes by adolescence

Health strategies can improve elementary and middle school-aged children's physical and social-emotional development, create more positive learning environments at school, and reduce engagement in risky behaviors.

Children who experience strong academic and social outcomes by adolescence are more likely to graduate from high school, continue on to post-secondary education, and obtain high quality employment.

How do outcomes in elementary and middle school affect economic mobility?

Reading at grade level by third grade is among the strongest predictors of high school graduation and college attendance. 1 2

Until the end of third grade, children are learning to read. Starting in fourth grade, they are reading to learn. After third grade, struggling readers have difficulty comprehending curriculum materials, diminishing their ability to keep up with classmates and reducing their overall academic motivation.

Reading interventions before third grade increase adolescent and adult literacy. 3

For 85-90 percent of poor readers, evidence-based programs implemented before third grade can increase skills to grade level. If interventions are delayed until children are nine years or older, 75 percent of below average readers will continue to have literacy problems through high school and adulthood.

Middle school math performance is a strong predictor of future academic and professional success. 4 5

Students who complete algebra by 8th grade attend college at higher rates than students who do not complete algebra.

Completing algebra early has a positive impact on highly mobile career trajectories. 6

The earlier that students are able to complete algebra, the earlier they are able to move on to more advanced math coursework. This has strong implications for career trajectory, particularly the ability to pursue STEM majors in college.

Strong high school math accomplishment helps students avoid remedial coursework in college. 7 8

Between 60 and 70 percent of entering freshman in community colleges enroll in remedial coursework, with the majority of these students needing remediation in math. 40 percent of students in remedial courses at two-year colleges and 25 percent of students in four-year colleges do not complete their degree.

Categories of successful interventions

  • Child wellness programs: School-based programs that seek to improve student wellbeing, create healthier learning environments, and reduce conflict between students
  • Nutrition programs: Programs that provide healthy breakfast and lunch options to students for free or reduced prices
  • School-based health programs: Physical or mental health programs provided at schools. Some programs offer services to family and community members

Evidence-based interventions

Intervention Type Category Evidence Level ARP Eligibility
Community gardens Strategy
  • Built environment improvements
  • Community health programs
  • Nutrition programs
Strong (second-highest tier) Yes
Community schools Strategy
  • Community schools
Strong (second-highest tier) Yes
Cross-age youth mentoring Strategy
  • Mentoring, counseling, and case management
Strong (second-highest tier) Yes
Extracurricular activities Strategy
  • After-school, extracurricular, and summer programs
Proven (highest tier) Yes
Families and Schools Together Program
  • Parent training and support
Proven (highest tier) Yes
Farmers markets Strategy
  • Community health programs
  • Nutrition programs
Strong (second-highest tier) Yes
Green space and parks Policy
  • Built environment improvements
Strong (second-highest tier) Yes
Juvenile diversion programs Strategy
  • Diversion programs
Strong (second-highest tier) Yes
Multi-component school-based obesity prevention programs Strategy
  • Nutrition programs
  • School-based health programs
Proven (highest tier) Yes
Multisystemic therapy for juvenile offenders Strategy
  • Mentoring, counseling, and case management
Proven (highest tier) Yes
Places for physical activity Policy
  • Built environment improvements
Proven (highest tier) Yes
Restorative justice programs Strategy
  • Restorative justice programs
Strong (second-highest tier) Yes
Safe Routes to School Strategy
  • Child wellness programs
  • Neighborhood safety strategies
Proven (highest tier) Yes
School breakfast programs Strategy
  • Nutrition programs
Proven (highest tier) Yes
School dental programs Strategy
  • School-based health programs
Proven (highest tier) Yes
School fruit and vegetable gardens Strategy
  • Nutrition programs
  • School-based health programs
Proven (highest tier) Yes
School-based health centers Strategy
  • School-based health programs
Proven (highest tier) Yes
School-based prevention programs for aggressive and disruptive behavior Strategy
  • Child wellness programs
Proven (highest tier) Yes
School-based social emotional instruction Policy
  • Child wellness programs
Proven (highest tier) Yes
School-based violence and bullying prevention programs Strategy
  • Child wellness programs
  • Mentoring, counseling, and case management
Proven (highest tier) Yes
School-wide positive behavioral interventions and supports Strategy
  • Child wellness programs
  • Teacher training and professional development
Proven (highest tier) Yes
Targeted truancy interventions Strategy
  • Dropout prevention programs
Proven (highest tier) Yes
Trauma-informed schools Strategy
  • Child wellness programs
  • Mentoring, counseling, and case management
Strong (second-highest tier) Yes
Treatment for serious juvenile offenders Strategy
  • Mentoring, counseling, and case management
Proven (highest tier) Yes
Footnotes
  1. Goerge, Lesnick, and Smithgall, "Third Grade Reading Level Predictive of Later Life Outcomes," Chapin Hall 2010
    https://www.chapinhall.org/research/third-grade-reading-level-predictive-of-later-life-outcomes/
  2. Fiester, "Early Warning! Why Reading by the End of Third Grade Matters," Annie E. Casey Foundation 2010
    https://www.ccf.ny.gov/files/9013/8262/2751/AECFReporReadingGrade3.pdf
  3. Lesnick, Goerge, Smithgall, and Gwynne, "Reading on Grade Level in Third Grade: How Is It Related to High School Performance and College Enrollment?" Annie E. Casey Foundation 2010
    https://www.aecf.org/resources/reading-on-grade-level-in-third-grade-how-is-it-related-to-high-school-perf/
  4. Balfanz, Herzog, and Mac Iver, "Preventing Student Disengagement and Keeping Students on the Graduation Path in Urban Middle-Grades Schools: Early Identification and Effective Interventions," Educational Psychologist 2007
    https://new.every1graduates.org/wp-content/uploads/2012/03/preventing_student_disengagement.pdf
  5. Hein, Smerdon, and Sambolt, "Predictors of Postsecondary Success," American Institutes for Research 2013
    https://ccrscenter.org/sites/default/files/CCRS%20Center_Predictors%20of%20Postsecondary%20Success_final_0.pdf
  6. U.S. Department of Education, "A Leak in the STEM Pipeline: Taking Algebra Early," 2018
    https://www2.ed.gov/datastory/stem/algebra/index.html
  7. Bailey, "Rethinking Developmental Education in Community College," Community College Research Center 2009
    https://ccrc.tc.columbia.edu/media/k2/attachments/rethinking-developmental-education-in-community-college-brief.pdf
  8. Complete College America, "Time is the Enemy," Lumina Foundation 2011
    https://www.luminafoundation.org/wp-content/uploads/2017/08/time-is-the-enemy.pdf