Opportunities for Innovation: Community Responsive Special Health Services in Charter Schools

By / 5.15.2019

After Hurricane Maria devastated Puerto Rico, almost 25,000 students left the island. Puerto Rico’s Department of Education closed a quarter of its schools in response to their intensified economic crisis, damaged facilities and infrastructure, and decreased student population. Those students who remained missed an average of 78 days of school. Faced with this catastrophe, legislators passed the Education Reform Act on March 29th, 2018, which, among other things, allowed for the creation of charter schools.

Charter schools (or Escuelas Alianzas as they are called in Puerto Rico) are free public schools that receive government funding but operate independently of the school district in which they are located. Freed from the top-down mandates that constrain district-operated schools, charter schools receive increased school-level autonomy in exchange for greater accountability for results. Puerto Rico’s Governor Ricardo Rosselló believed that the Education Reform Act could redesign the public school system to meet the demands of the 21st century, by decentralizing to give school leaders more autonomy.

The hurricane further damaged an already struggling system, critically impacting both health and education in Puerto Rico. According to a survey of over 95,000 students in Puerto Rico, 45.7 percent reported damage to their own homes, 32.3 percent experienced shortages of food or water, and 16.7 percent still had no electricity five to nine months after the hurricane. Many Puerto Ricans still do not have consistent access to clean drinking water, food, and health care.

The Boys and Girls Club of Puerto Rico—who had been waiting for this opportunity for years—opened Proyecto Vimenti, the island’s first and only charter school, under the leadership of executive director Eduardo Carrera. According to Carrera, the Boys and Girls Club opened the school with the intention to “break the generational cycle of poverty.”  The U.S. Census Bureau estimated that 57 percent of children in Puerto Rico lived below the poverty line before the hurricane.

Through its partnership with the Boys and Girls Club, Proyecto Vimenti has been able to provide special services to its students. They provide special health services like eye exams and hearing tests in addition to many other offerings. When the school provided health screenings to their kindergarteners and first graders, they discovered that many of its students had untreated vision and hearing problems. Through these screenings, school officials were able to provide assistive supports like glasses early in a child’s education  and thereby avoid many special education misdiagnoses.

However, Proyecto Vimenti is not the first charter school to see the connection between a student’s health and their academic performance. Students with health problems such as asthma, poor vision, diabetes, and tooth pain are more likely to be chronically absent, resulting in poorer academic outcomes and increased likelihood of dropping out of school. Unsurprisingly, children living in poverty are disproportionally affected by  health issues. Charter schools, often serving the poorest students, are able to use their flexibility to form community partnerships that can provide these important health services within their schools. Their autonomy allows them to implement innovative solutions in ways that district-operated schools seldom can.

Consider the case of Native American Community Academy (NACA) in Albuquerque, New Mexico. Founded in 2006, NACA, a charter school serving middle and high school students, has integrated health education and improving wellness as core elements of the school’s mission. NACA received a grant from the U.S. Department of Health and Human Services in 2011 to build a school-based health center. The health center provides a variety of services such as dental care and access to a primary care physician. The school leadership intentionally sought out community partners who had expertise with Native American students and the specific health problems their community faces. NACA now has over 150 community partners including the University of New Mexico and First Nations Community Healthsource. NACA’s model, which connects the specific health needs of the student’s community with student wellness, has been so successful that the network has grown to seven campuses throughout the state.

KIPP Ujima Village Academy and KIPP Harmony Academy in Baltimore also saw the value of connecting health services to their school. These two schools, housed in the same building, serve over 1,500 students, approximately 83 percent of whom receive subsidized meals. Within its building, KIPP houses a clinic run by the Johns Hopkins Children’s Program. KIPP and its health services partners believe they can reduce chronic absenteeism by providing urban children in poverty with health and psychosocial care.

Staffed by two nurses, a nurse practitioner, and a pediatrician, the clinic provides vision exams, dental services, and behavioral health care in addition to other primary services. Students can be treated on site, which means that parents do not have to leave work to take their child to an emergency center, and health staff can better manage students with a chronic condition, such as asthma or diabetes, because of the regularity with which they see them. In Baltimore, access to regular health care is especially important for students with asthma, as the prevalence of childhood asthma within the city is over twice the national average, approximately 20 percent compared to about 10 percent.

For KIPP, the results of the clinic are telling. After two years of operation, the two schools combined had a 23 percent drop in chronic absenteeism among students with asthma.

Funding realities make implementing health services in every public school a challenge. In a time when only 39 percent of public schools have a full time nurse, it‘s not surprising that only 2.5 percent of public schools offer on-site primary-care services. Indeed, the two KIPP schools received a five-year, five-million-dollar grant from the nonprofit Rales Center to fund their clinic

However, it’s also no coincidence that the Rales Center chose to bestow their grant upon a charter school. Dr. Kate Connor, the medical director of the Rales Health Center, explained that when deciding where in Baltimore to locate the new health clinic, KIPP was the obvious choice.  She said, “[KIPP] is really oriented towards educational innovation, and their leadership had begun to recognize the necessity of providing comprehensive wraparound services in order to support students’ not just direct educational needs but other things that determine educational success and relate to educational success in the lives of kids and families.”