Education Policy: Chronic Absenteeism

Our nation’s efforts to provide a quality education to all children are threatened by startling rates of chronic absenteeism, often affecting very young children who face chronic health conditions.

Chronic Absenteeism Directly Affects Lifetime Learning

Chronic absenteeism—or missing 10 percent or more of school days for any reason, excused or unexcused—detracts from learning and is a proven early warning sign of academic risk and school dropout. Nationwide, a staggering number of children are chronically absent, often at a very young age and often without attracting attention or intervention.

While the causes are multi-fold, one stands out as especially significant: student health.

Students with unmanaged chronic health conditions (such as asthma or diabetes) are more likely to miss class because of the symptoms of their illness or because they are receiving medical treatment during the school day. Students can also be chronically absent because of health issues such as fever, flu, dental pain, vision problems or mental health and anxiety issues.

Compounding the problem is the fact that many students do not have access to healthy school environments.

The crisis of health-related chronic absenteeism is especially poignant as it primarily affects young children in ways that can shape academic outcomes for their entire school career. For example, research shows that children who are chronically absent in both kindergarten and first grade (such as a child who suffers frequent asthma attacks) are much less likely to be reading at grade level by the third grade; and students who are not reading at grade level by the third grade, in turn, are four times more likely to drop out of high school.

Policy change to support student health is a critical step to addressing chronic absenteeism and a key opportunity to make a profound positive impact on children’s lifelong learning and health. It also offers a natural opportunity for collaboration among the health, public health and education sectors.

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The Challenge We’re Facing

Our nation now has the highest graduation rates in its history and education leaders—from policymakers at the state and federal level to educators on the ground in schools—are working hard to ensure all students receive a quality education. Yet even the most thoughtful efforts to reduce dropout rates and address the achievement gap are threatened by the problem of chronic absenteeism. Chronic absenteeism isn’t just a matter of truancy or skipping school. In fact, many of these absences are excused and tied directly to health factors.

A snapshot of the current environment shows:

  • 5 million to 7.5 million students across the U.S. miss nearly a month of school each year.
  • Children who are chronically absent in both kindergarten and first grade are much less likely to be reading at grade level by the third grade; and students who are not reading at grade level by the third grade, in turn, are four times more likely to drop out of high school.
  • Rates of chronic illness are highest among students from low-income families, communities of color and those with disabilities.
  • Asthma is a leading cause of school absenteeism, accounting for one-third of all days of missed instruction. Children with persistent asthma are more than three times as likely to have 10 or more absences than their peers.
  • Children between 5 and 17 years miss nearly two million school days per year nationwide due to dental problems. A full twenty percent of children aged 5 to 11 years have at least one untreated decayed tooth.

Chronic Health Conditions

Students with unmanaged chronic health conditions (such as asthma or diabetes) are more likely to miss class because of the symptoms of their illness or because they are receiving medical treatment during the school day.

The examples of asthma and oral health illustrate the scale of this challenge:

  • Asthma. Nearly one in 10 children (9.9 percent) age 4-14 are diagnosed with asthma. Asthma is a leading cause of school absenteeism, accounting for one-third of all days of missed instruction. Children with persistent asthma are more than three times as likely to have 10 or more absences than their peers. Asthma can be exacerbated by factors in the school environment, particularly issues such as mold or harsh cleaning chemicals that have an impact on indoor air quality. Yet it doesn’t have to be this way: Research has shown that creating healthy indoor environments and providing adequate levels of school nursing can all but eliminate the disparity in attendance between students with asthma and their peers.
  • Oral health. A full 20 percent of children age 5-11 have at least one untreated decayed tooth. Among school-age children, tooth decay is the most common chronic disease, five times more prevalent than asthma. Children age 5-17 miss nearly two million school days in a single year nationwide due to dental health-related problems. Children with poor oral health status are nearly three times more likely than their counterparts to miss school as a result of dental pain. Tooth decay and dental pain are easily treatable if students have access to dental care; the consequences of leaving such pain untreated are significant not only for children’s lifetime health but also for their education. Schools can take on this issue by partnering with public health and health providers to increase access to dental services.

Of course, the problem of health-related chronic absence goes far beyond these two issues. Research indicates that other common health conditions resulting in missed school include diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), influenza, diabetes, obesity, seizure disorders, mental health and anxiety, and vision problems. Other health-related factors such as food insecurity, housing insecurity and violence in the community also play a significant role.


Access to Healthy School Environments

Compounding the problem is the fact that many students do not have access to healthy school environments.

For example, less than 50 percent of the nation’s students have access to a full-time school nurse or school counselor, and less than 5 percent of the nation’s students have access to health services through a school-based health center. In addition, one in five schools in the United States reports unsatisfactory indoor air quality, a known trigger of asthma attacks. Low-income children are less likely to have access to a healthy school environment. Students in low-income schools are less likely to have recess and high-quality physical education than students in higher income schools. In addition, students in low-income schools are more likely to have no school nurse or have higher ratios of students to nurses than higher-income schools.

Despite the scale of this problem, we must remember that health-related chronic absenteeism is not an inevitable fact of childhood. Keep reading for more on what we’re doing and what you can do.

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Reducing Absenteeism by Supporting Healthy Schools

A key piece of addressing health-related chronic absenteeism is ensuring that children are able to attend school in healthy school environments. A healthy school environment includes regular access to school health services (including physical, mental, dental, vision and behavioral services), healthy school food, physical activity, good indoor air in a clean and well-maintained building, access to water and a supportive school climate and culture.

HSC works at the national, state and local levels to ensure that both the health and education sectors understand the connection between chronic absenteeism and student health and have the tools and information necessary to understand and address the health-related causes of chronic absenteeism. HSC also works to ensure policies and programs are in place that support state and local efforts to address chronic absenteeism and bring attention to the important connection between chronic absenteeism and achievement. HSC is currently undertaking several efforts to address chronic absenteeism.


National

Every Student, Every Day Initiative
In October 2015, the U.S. Department of Education (ED) launched the Every Student, Every Day initiative, which is working to galvanize multi-sector support to catalyze federal, state and local efforts to address chronic absenteeism. The National Collaborative on Education and Health, which HSC co-convenes with Trust for America’s Health, played a key role in informing the development and launch of this initiative. HSC is working with ED and key partners, such as Attendance Works, to support the implementation of the Every Student, Every Day initiative and ensure that health is prioritized within this federal effort.

A key focus of this initiative will also be bringing states and school districts together to develop plans for addressing chronic absenteeism. HSC will play a key role in helping these states and school districts think about the health-related causes of chronic absenteeism and access the tools and resources necessary to support student health and wellness and, in turn, reduce chronic absenteeism.

Implementation of the Every Student Succeeds Act
In December 2015, President Obama signed into law the bipartisan Every Student Succeeds Act of 2015 (ESSA). This is a reauthorization of the Elementary and Secondary Education Act which was last reauthorized in 2001 as the No Child Left Behind Act. The new Every Student Succeeds Act includes several provisions that address chronic absenteeism. For example, ESSA adds chronic absenteeism as a required indicator to school report cards for Title 1 schools (schools with high numbers or high percentages of low-income students). In addition, ESSA allows professional development funding to be used to provide training to school personnel on how to address chronic absenteeism.

HSC is working to ensure these key provisions of ESSA are implemented and that the appropriate guidance and resources are provided to states and school districts to support implementation.

National Collaborative on Education and Health
HSC, in partnership with Trust for America’s Health, co-convenes the National Collaborative on Education and Health which is working to transform the conditions of health in schools across the country. Chronic absenteeism is a key focus of the Collaborative. Through the Collaborative HSC is working to develop guidance for both the health and education sectors that can be used to support efforts to address chronic absenteeism. For example, the Collaborative is working to develop guidance that schools can use to better understand the major student health issues impacting their student population. The Collaborative is also working to support the inclusion of chronic absenteeism data in health and public health data systems, such as Community Health Needs Assessments.


State Level

States are uniquely positioned to catalyze efforts to address chronic absenteeism and can play a critical role in analyzing the data to determine who missing too much school and why. Mapping the Early Attendance Gap: Charting a Course for Student Success, a report released by Attendance Works and Healthy Schools Campaign, was informed by the efforts of the National Collaborative on Education and Health. The report emphasizes the key role states can play in changing patterns of chronic absenteeism. The report highlights the connection between health and attendance and the power of states to tackle absenteeism by tapping key champions, leveraging data and learning from leaders who have improved attendance despite challenging conditions.

In Illinois, HSC worked with advocates and legislators to pass a bill that establishes an Illinois Attendance Commission. The Commission has been charged with “identifying strategies, mechanisms, and approaches to help parents, educators, principals, superintendents and the State Board of Education address and prevent chronic absenteeism.” HSC currently serves on the Commission, which was launched in late 2015. The Commission represents an important vehicle for advancing efforts to address chronic absenteeism in Illinois.


Chicago

HSC’s efforts to create healthier school environments in Chicago directly support the connection between healthy students and good attendance. In Chicago, HSC works to ensure that educators understand how student health and wellness impact attendance. Many of the policies and programs HSC supports in Chicago have a proven impact on student attendance, including universal, in-classroom breakfast and increased access to school health services.

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What You Can Do

There is much that can be done—especially through collaboration among the education, public health and medical communities—to address this issue and relieve the lifelong burden it places on young children. For key areas for action include the following:

Actionable Data: Creating Early Warning Systems
Having actionable data is key to determining the extent to which there is a chronic absenteeism problem in a school or district and identifying the causes. Most school officials measure attendance in terms of average daily attendance, a measure which does not lend itself to developing early warning systems that enable schools to identify students that are on track to miss a significant amount of the school year. Supporting the collection of actionable data that can be used to create early warning systems and better understand the problem is critical to improving student attendance.

At the state or school district level, you can:

  • Invest in the development of more effective state and local data systems that include attendance and can easily generate information about which and how many students are chronically absent by grade, school, district and student subpopulation.
  • Support development of data reports that are easy to use and understand.
  • Offer information and resources to promote data sharing while respecting confidentiality.

Positive Messaging: Changing the Narrative
The current, dominant student absenteeism narrative blames parents and punishes students. Neither of these strategies is effective in supporting families and students in attending school and ensuring students are ready to learn. As a result, there is a need to change the student absenteeism narrative to one that engages and empowers families, students and communities around the issue of student attendance. Changing the narrative is key to making the case for action to address chronic absenteeism and engaging multiple sectors around this issue.

At the state or school district level, you can:

  • Develop new messages that raise awareness about chronic absenteeism without placing the blame on students and families; promote a commitment to unpacking the underlying reasons for students missing school; help families understand the adverse consequences of absences adding up; and ensure that communications are culturally and linguistically meaningful and relevant.
  • Build a national coalition of key stakeholders — including school superintendents, state decision makers, principals, teachers, health professionals, parent leaders and others — to deliver the new messages via their organizational channels.
  • Identify and mobilize key spokespeople to reinforce the new public narrative.

Capacity Building: Developing and Implementing Early Interventions
It is essential to build the capacity of schools and communities to implement effective early warning systems and interventions that use student attendance data and support students and families in improving attendance. In order for communities to feel that they have the knowledge and support necessary to implement effective interventions to address chronic absenteeism, it is necessary to ensure they have access to model interventions, technical assistance and additional resources. The federal and state governments, stakeholder organizations and others can play a key role in ensuring these resources are in place. A collective impact model should be used to ensure that the sole responsibility of addressing chronic absenteeism does not fall on schools and that a unified strategy is implemented to engage multiple sectors in a community.

At the state or school district level, you can:

  • Provide a robust set of tools and a strong complement of training opportunities for key stakeholders at the state and local levels.
  • Define model strategies for unpacking and addressing chronic early absence that can be used to guide efforts across the country.
  • Highlight case studies of effective efforts and articulate the strategies and best practices that can be learned from these examples.
  • Promote peer learning opportunities across states to share strategies for helping districts and schools to partner with health providers and other local stakeholders.

Shared Accountability: Setting Performance Standards
Systems are needed that promote and incentivize schools and communities to improve student attendance. For example, chronic absence can be built into accountability systems used by districts and states, such as school report cards, to measure progress and identify where additional support is needed to improve student performance.

At the state or school district level, you can:

  • Encourage states to create a common definition of chronic absence, including what constitutes a day of absence, so that data can be compared across districts and schools.
  • Promote the inclusion of chronic absenteeism data in school turnaround efforts.
  • Support the inclusion of chronic absenteeism measures in state school report cards and other state accountability systems.
  • Offer models to states for working with school districts to integrate chronic absenteeism into their school improvement plans.
  • Integrate chronic absenteeism into community health needs assessments.

Stay Informed + Stay Connected

Informing yourself about the issues involved in school health and sharing this information with others is an important step in creating meaningful change. It’s about learning, sharing and sparking conversations that get people thinking. We encourage you to:


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Education Policy Resources

Access related resources below, or go to our main Resource Center to access resources across all of our program and policy areas.

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Mapping the Early Attendance Gap

Attendance Works and the Healthy Schools Campaign are delighted to partner on the development, writing and release of Mapping the Early Attendance Gap: Charting a Course for Student Success. Our organizations share a deep commitment to ensuring that all children -- regardless of race or socioeconomic background – are able to show up for class, learn and thrive in a healthy school environment. September 2015

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HSC and TFAH Comments on ESSA Title 1

Jan. 21, 2016

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Letter of Support for Chronic Absenteeism

October 5, 2015 Dear Secretary Duncan, We the undersigned organizations are writing to express our support of the U.S. Department of Education’s national effort to address chronic absenteeism. We commend you for your leadership in increasing awareness of chronic absenteeism as a national problem and we are committed to working with you to support efforts to eliminate chronic absenteeism in our nation’s schools.

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Brief on Chronic Absenteeism and School Health

National Collaborative on Health and Education Brief on Chronic Absenteeism and School Health, May 2015

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Leading Health Conditions Impacting Student Attendance: Chart

This chart was prepared by the National Collaborative on Education and Health, an initiative co-convened by Healthy Schools Campaign and Trust for America’s Health that is working to transform the health and education sectors to support the conditions of health in schools across the country. The chart addresses chronic absenteeism by providing an overview of prevalent health conditions that affect student attendance.

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Absences Add Up: How School Attendance Influences Student Success

By Alan Ginsburg, Phyllis Jordan and Hedy Chang August 2014 This analysis of national testing data shows that students with higher absenteeism rates have lower scores on national standardized tests. It reinforce a growing body of research confirming the connection between school attendance and student achievement and reveals the critical importance of intervening as soon as absences begin to add up, whether early in a child’s school career or at the beginning of the school year. The good news is poor attendance can be turned around when policies and practices encourage schools and communities to partner with students and their families to monitor their data and implement promising and proven practices.

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Present, Engaged, and Accounted For: The Critical Importance of Addressing Chronic Absence in the Early Grades

Hedy N. Chang | Mariajosé Romero September 2008 This report seeks to raise awareness of the critical importance of chronic early absence, synthesize available data on the scope of the challenge, and share emerging insights about how schools and communities can use chronic early absence to identify and address challenges affecting the social, educational and physical well-being of children and their families before problems become intractable.

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National Collaborative on Education and Health Chronic Absenteeism Working Group Report

Draft Report on the Chronic Absenteeism Working Group of the National Collaborative on Education and Health October 2015

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CDC’s Healthy Schools Website

A resource for data, multimedia, tools, training and resources from the CDC.

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No Child Left Behind 2002

To close the achievement gap with accountability, flexibility, and choice, so that no child is left behind.