Asthma kept Stephanie Godbolt’s grandson John home from school time and time again. John’s school, Tench Tilghman Elementary, serves 425 students, more than 95 percent of whom are black and 95 percent of whom also qualify for free or reduced price lunch. The school sits in Baltimore’s Patterson Park neighborhood on the city’s southwest side, just a few blocks away from Johns Hopkins Hospital. John’s asthma got so bad, he was missing nearly a week of school each and every month for six months. And he was losing ground academically.
John is one of almost 7 million American children who suffer from asthma—which is nearly one in 10. Asthma is a leading cause of school absenteeism, accounting for about 14 million absences each school year, or one-third of all school days missed. Children with persistent asthma are three times more likely than their peers to have 10 or more absences each school year, which puts them at risk of falling behind academically.
Health issues impacting student attendance—such as asthma—vary greatly among communities and even within subpopulations of a community. For example, while the overall rate of childhood asthma in California is 15.4 percent, levels range from 5.8 percent in San Benito County to 32.5 percent in Merced County. While the overall childhood asthma rate in Chicago is about 13 percent, rates by neighborhood vary from near zero to 44 percent.
In Baltimore City, where John lives, children under 18 have an asthma rate of 20 percent—more than twice the national average. This contributes to chronic absenteeism rates of more than 16 percent for elementary students, 34 percent for middle school students and 44 percent for high school students. But it doesn’t have to be this way: Research shows 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. The services delivered by school nurses and in on-site health centers are key for ensuring that students have access to the care they need to manage their health conditions.
And that’s exactly what Tench Tilghman Elementary did. In 2012, the school opened a full-service health clinic that deals with asthma, lead exposure and other health challenges that urban children disproportionately face. Tench Tilghman brings health services to the campus and connects families to resources in the community. Equipped with a list of students missing required immunizations, the school clinic was able to deliver the shots on campus. Family advocate Stephanie Mack connects families with asthmatic children to the Green and Healthy Homes Initiative, which offers free home inspections to eliminate asthma triggers. Children also receive free dental services.
Since the clinic opened, the chronic absence rate at Tench Tilghman has dropped from 17 percent to 11 percent. “Students can go to school and not worry about having an asthma attack,” said Brittany Beth, a U.S. Department of Education official who toured the facility. “When mom can’t take them to the doctor, they are covered, and the dental services they receive twice each year might be the only dental services they get.”
The nurse there worked with Godbolt on an asthma plan and helped ensure that her grandson John had the support he needed at school. His attendance improved.
We featured John’s story in our Mapping the Early Attendance Gap report that we co-authored with Attendance Works. The Mapping the Early Attendance Gap report highlights how states can engage key champions, including education leaders, health providers, businesses and parent organizations; use data to identify students and schools with high chronic absence rates, especially in the early grades; and learn from places that have improved attendance despite challenging conditions.
John’s story reflects why figuring out the reasons behind chronic absenteeism is so important. So often, those reasons are health-related. Ensuring students are able to go to school each day in a healthy environment and have access to health services is key in making sure our students are able to unlock their full potential.