When Michelle Bell started as the manager of the Nursing and Wellness Department at San Diego Unified School District in 2012, the school nursing program was all over the map. Nurses were itinerant, and focused primarily on mandated services, medication compliance and training staff, rather than providing care. Some of the district’s 225 schools had five days a week of nurse coverage, but only if principals were willing to spend their discretionary funding for it; far more didn’t have any coverage. In just five years, she has managed to move the district to a new model that provides equitable coverage across the district, and does so without a major influx of new funding. To change the district’s model, she started by talking to principals about how a centralized nursing model would promote equity, continuity of care, student safety and student access to health care. “To me it’s just a normal way of thinking about health-related services,” she explains.
One of Bell’s first objectives was to promote efficient use of staff resources, such as organizing school clusters to cut down on driving time for staff serving more than one school, making sure that health techs, who work 32 hours a week, were splitting that time over five school days, rather than four standard 8-hour office days, or changing the way special education health techs’ time was allocated between schools.
Making sure that each school has the right level of staffing has been a major challenge, but Bell uses an Acuity model to create a full picture of each school’s needs. The model incorporates a wide range of indicators, including the percentage of low-income students, students with Individualized Education Programs (IEPs) and chronic absenteeism rates. “Acuity validates what we believe,” Bell says. It also helps them solve problems. If, for example, a school that doesn’t quite meet the criteria for additional staffing based on low-income students, but the model shows a real need at that school, it can help them reorganize resources to make sure that school gets sufficient coverage.
Recently, the Nursing and Wellness Program has increased its focus on attendance and chronic absenteeism. Starting with 27 pilot schools and the equivalent of 2.2 staff members’ time, Bell is working with the district’s attendance committee and the schools’ student attendance review teams to think about how to educate parents about the impact of chronic absenteeism. “The Attendance Nurses are meeting monthly with their schools and having tabletop discussions around best practices,” she says. One goal is to create ongoing trainings for preschool and kindergarten parents to highlight the importance of early attendance for student achievement.
They also work to educate the teachers about why solving physical and social-emotional health issues are so important to helping kids be in school and ready to learn. “They just can’t learn without resolving those barriers,” Bell says.
This is a big year for the program. The superintendent has made wellness and attendance top priorities. Bell is hopeful that data will show that putting resources into attendance has made a difference.
Bell’s extraordinary leadership and resourcefulness has increased access to school health services for San Diego’s students. Resources are the biggest challenge with staffing school health services, and Bell does a masterful job of braiding together Title I funding, district general funds, and special education funding, along with principal discretionary funding, to make coverage equitable and strong. Bell’s work also underscores the value of leveraging existing data to make the case for school health services.