School-based supports for child health and well-being

Before making investments in school-based supports for child health and well-being, city and county leaders should ensure this strategy addresses local needs.

The Urban Institute and Mathematica have developed indicator frameworks to help local leaders assess conditions related to upward mobility, identify barriers, and guide investments to address these challenges. These indicator frameworks can serve as a starting point for self-assessment, not as a comprehensive evaluation, and should be complemented by other forms of local knowledge.

The Urban Institute's Upward Mobility Framework identifies a set of key local conditions that shape communities’ ability to advance upward mobility and racial equity. Local leaders can use the Upward Mobility Framework to better understand the factors that improve upward mobility and prioritize areas of focus. Data reports for cities and counties can be created here.

Several indicators in the Upward Mobility Framework may be improved with investments in high-quality school-based supports programs. To measure these indicators and determine if investments in this strategy could help, examine the following:

• Effective public education: Average per-grade change in English Language Arts achievement between the third and eighth grades. These data are available from Stanford University’s Education Data Archive.
• Preparation for college: Share of 19- and 20-year-olds with a high school degree. These data are available from the Census Bureau’s American Community Survey.
• Access to healthcare: Ratio of residents to primary care physicians. These data are available from the U.S. Department of Health and Human Services’ Area Health Resource File.
• Safety from trauma: Number of deaths due to injury per 100,000 people. These data are available from the National Center for Health Statistics’ Mortality File and the CDC’s WONDER database.

Mathematica's Education-to-Workforce (E-W) Indicator Framework helps local leaders identify the data that matter most in helping students and young adults succeed. Local leaders can use the E-W framework to better understand education and workforce conditions in their communities and to identify strategies that can improve outcomes in these areas.

Several indicators in the E-W Framework may be improved with investments in high-quality school-based supports programs. To measure these indicators and determine if investments in this strategy could help, examine the following:

• 6th grade on track: Percentage of students in grade 6 with passing grades in English language arts and math, attendance of 90 percent or higher, and no in- or out-of-school suspensions or expulsions.
• 8th grade on track: Percentage of students in grade 8 with a GPA of 2.5 or higher, no Ds or Fs in English language arts or math, attendance of 96 percent or higher, and no in- or out-of-school suspensions or expulsions.
• 9th grade on track: Percentage of students in grade 9 with a GPA of 3.0 or higher, no Ds or Fs in English language arts or math, attendance of 96 percent or higher, and no in- or out-of-school suspensions or expulsions.
• Access to early intervention screening: Percentage of children with identified concerns who are connected to services or percentage of children needing selected special education services in kindergarten who were not identified and connected to services before kindergarten.
• Access to health, mental health and social supports: Ratio of number workers or students to number of health, mental health, and social services FTE staff (for example, school nurses, psychologists, and social workers).
• Mental and emotional well-being: Percentage of youth with mental or emotional health needs as identified by a universal screening tool.
• Physical development and well-being: Percentage of students meeting benchmarks on self-rated surveys of physical health, such as the California Healthy Kids Survey Physical Health & Nutrition module.

• Dedicated staff: Successful provision of school-based supports requires a staff member whose time is dedicated, at least in part, to the coordination of support services and to ensuring that the right student is receiving the right services at the right time. This may include leading processes to identify student needs, building partnerships with community organizations or external providers, engaging parents and guardians, and coordinating logistics. They may be employed by the school directly, or by the local government, district or a community-based organization and assigned to one or several schools. Ideally this coordinator has experience tailored to the environment of the school. For example, a school located in an area with a high prevalence of violence may seek coordinators with experience in trauma-informed practices or restorative justice.

• Active family and community engagement: Seamless communication processes with community, family members and caregivers is imperative, particularly because services may be provided to the child at school for which a parent may normally be present if received outside of school, like visits to doctors or dentists. Efforts should build in processes to educate parents on services provided and receive consent. Processes and structures may be defined in order to enable the identification of needs and partnerships with new types of service providers. Ideally, families and community organizations can be involved in determining needs, allowing for hyper-local decision-making and allocation of resources.

• Appropriate training and services for staff: Teachers and school staff should have proper certifications or be trained adequately for their role in providing services, in line with external standards for service providers like therapists, counselors, or registered nurses. It is also vital that staff members themselves are provided appropriate support and services to ensure their needs are met. Many evidence-based interventions require that educators and staff participate in the program–whether it be mindfulness training, group therapy sessions, or otherwise–before delivering to students. Others encourage staff to take advantage of mental health benefits, or provide other services to support the well-being of staff. Furthermore, schools should provide staff with adequate, paid time to complete training or carry out other required duties, such as collaborating with other staff on issues that arise with students.

• Referral mechanisms for complex or long-term care: Some students may be in need of more extensive or ongoing services related to needs such as physical or mental health, housing insecurity, or family instability, than can be provided through the scope of the in-school program. Schools should establish processes to refer students to external doctors, dentists, or other support services to ensure continuity of care. This might include healthcare navigator programs, federally qualified health centers, or local nonprofits.

• Services delivered during the school day: Providing access to services during the school day increases accessibility for students who may face barriers to participating at other times and frames supports, like group therapy, as a priority alongside academic classes. However, participation must be voluntary and disconnected from grades or mandatory academic evaluations to eliminate pressures students feel in other settings.

• Small group sizes: Group-oriented interventions, like group therapy or leadership development, should maintain small group sizes in order to foster an environment where each student feels like they have space to contribute. Expert practitioners recommend no more than fifteen students per staff member.

• Prioritize understanding and addressing individual needs: Centering equity requires a nuanced understanding of the context of individuals or specific groups of students. School-based supports should address needs revealed by examining school data and via direct engagement with students, teachers, families, and community organizations. In fully mature and operationalized Community School, for example, staff may recognize a specific need of an individual student and enlist community-based providers to ensure those needs are met.

• Focus on opportunities and growth, not only basic needs: An unintended consequence of a hyper-focus on ensuring basic needs are met is that it can forestall necessary attention on providing students in under-resourced environments stretch opportunities in which they can grow. Dedicated effort should be made to ensure resources are allocated both to providing such opportunities, while still targeting resources at students with the greatest needs.

• Ensure communications to students and families are accessible and thorough: A greater level of information and engagement may be required with students and families who are unfamiliar with the services being provided in school. Staff should be hired that speaks the same primary language of the broader community, and informational brochures and consent forms should be made available in the appropriate languages, as well as in both physical and digital forms. Students who are recent immigrants may need additional context on how medical or mental health processes work in the U.S. context. It may be required to account for longer appointment times for students to whom certain medical or dental services are new.

• Minimize unnecessary information requests: Undocumented students and their families face particular barriers to receiving public services provided in other contexts. Healthcare, in particular, is a challenge, as they are ineligible to participate in the Affordable Care Act exchange, and may fear visiting other institutions due to the nature of information collected by providers. Schools have the advantage of generally being a trusted institution within communities. They should minimize the information collected when providing support services like healthcare to only information that is necessary to carry out care. Expert practitioners, for example, advise against requesting any type of identification numbers when providing services.

• District leadership: Principals, superintendents, and other school officials play a vital role in establishing school-based supports as a priority and cultivating partnerships with community based organizations and other external partners that may provide services in the school setting. They are also critical in granting partner organizations access to facilities, data, and time during the school day to provide services to students.

• School coordinators and liaisons: Parent liaisons, community school coordinators, and other school operations staff may be key partners in helping to facilitate the coordination of schedules across classrooms and service providers.

• Teachers: Teachers often have the closest direct relationships with students and can play a critical role in identifying the needs of students. Their flexibility is also required when the provision of support services occurs during class time.

• Community-based organizations and service providers: Nonprofits, government agencies, businesses, hospitals, universities and other types of institutions can all be valuable partners to provide in-school supports for students. Beyond the provision of services, community-based organizations can also serve as the link between the school and the community at large–helping ensure communication flows to school leadership and teachers about events that occur in the community that may affect students’ wellbeing.

• Parents: Parental input and consent is a key aspect of providing support in-school to meet students’ needs. In some models, like Community Schools, they can also play a central role in identifying needs, establishing partnerships with providers, and coordinating support services.

• Local healthcare providers: In some cases, students may require ongoing or advanced care that exceeds the scope of the services provided in-school. Schools and their partners should foster relationships with long-term providers, such as Federally Qualified Health Centers, primary care physicians, and others, in order to link students to needed services.

• Utilize familiar channels to inform families of services and encourage participation: Existing channels, like parent-teacher conferences, may serve as effective opportunities to inform families about services that are available in-school. Schools can also leverage existing relationships between staff such as parent engagement coordinators, for example, to reach families. Channeling communications through organizations that are embedded within the community, like local nonprofits or faith-based institutions can also help increase awareness and utilization of services.

• Cultivate teacher buy-in: Given the critical role of teachers, it is important that they are on-board and well-supported in participating in school-based supports efforts. Schools can use existing staff meeting time to conduct training and inform staff about services and processes rather than adding additional meeting time. Teacher voice should also be included in the design of logistics to ensure classroom disruption is minimized. Additionally, teachers should be allowed to use existing work hours to complete necessary training or participate in services themselves.

• Seek blended funding sources: Funding for in-school services may come from a variety of sources, including district or municipal budgets, philanthropy, local nonprofits, or businesses that may provide services pro bono. School leadership or school coordinators may be responsible for seeking funding and resources from external sources, or for building relationships with local community organizing leaders who can facilitate relationships with the broader community.

• Plan for expected attendance: For enrollment-based programs, plan for attrition and absences to maximize program utilization. Some experts recommend over-enrolling by roughly 20% to account for inevitable attrition. It is also important to align services to be compatible with the existing academic calendar or state-mandated testing schedule.

• Enrollment, attendance, or number of students served: Metrics tied to achievement and well-being often take longer periods of time to show improvement, and outcomes related to well-being can be very difficult to measure. Schools that are earlier in their journey to provide support services in school should look to output metrics that indicate how well-utilized the provided services are. Attendance can be viewed both in terms of program attendance, for interventions like weekly group therapy programs, or general school attendance, which may be an indicator that students need support or have unmet needs.

• Staff participation: Some school-based supports, like trauma-informed schools, require staff participation both to implement the intervention with students, but also as participants and recipients of services themselves. Staff participation in training, mindfulness or group therapy sessions, may be critical to the overall success.

• Social-emotional learning indicators or holistic student assessment: Assessments that measure indicators like action orientation, perseverance, critical thinking, empathy, and learning interest can give a holistic picture on student well-being. Assessment tools that may be employed include the Survey for Academics and Youth Outcomes and Holistic Student Assessment.

• School health assessments: In addition to collaborative needs identification with families and caregivers, schools can also utilize assessments to identify opportunities to improve school health programs and policies, such as the CDC’s School Health Index self assessment tool.

• Grades: One goal of school-based supports is to enable academic achievement. Grades may serve as a measure of how successfully a student is participating in class, and they are also a strong predictor of high school graduation. They may be a more effective indicator than standardized test scores, which measure attainment of specific academic material. Experts caution that it may take time for grade improvement to occur.