In Your Neighborhood

The social determinants of chronic school absenteeism

What is needed to change policy, moving beyond data points to address root causes of chronic absenteeism

Courtesy of 2014 Rhode Island Kids Count Factbook

A new fact sheet and data point set on chronic absenteeism in Rhode Island for children in kindergarten through grade three has been created by Rhode Island Kids Count in partnership with The Providence Plan.

By Richard Asinof
Posted 9/29/14
The focus on chronic absenteeism in early elementary education in Rhode Island opens the door to ask questions about root causes related to unhealthy house, elevated levels of lead in children, and mitigation of mold, a leading cause of chronic asthma. The ability to make the data graphic pleasing is a step forward, but it doesn’t necessarily translate into better politics or policies. That will require a new kind of engaged community.
Where is the real estate industry in this policy debate? What responsibility do the landlords and Realtors who sell and rent properties that are substandard have in improving the conditions? Is there a direct economic equation that can be mapped out about the higher education and health costs – and higher taxes – that are a direct result of substandard, unhealthy housing, showing what the average Rhode Island taxpayer is assessed in taxes as a result? What is the connection between toxic stress in children and the chronic conditions of elevated levels of lead and asthma? Which candidate – Fung or Raimondo – will address the issue of unhealthy housing as an economic determinant as well as a social determinant?
Providence Journal reporter John Kostrzewa’s story on jobs leading up to the newspaper’s Public Occurrence event on “the middle class squeeze” contains a glaring omission. By his own statistics cited in the story, the industry sector that has shown the greatest improvement is health care and social assistance, growing by 5,600 jobs. But despite that the health care industry is the largest private employer in the state, that sector is absent from Kostrzewa’s analysis. Why?
The failure to document and map and understand the economic development potential of Rhode Island’s health innovation market undercuts the ability of state leaders to fully understand and invest in this growing sector – including HealthSourceRI’s future. The connection between unhealthy housing, poor school performance, higher health costs and diminished future economic potential is documented and proven. All it takes is someone who can read the reports – and report on them.

PROVIDENCE – All the stars – and the data points – will be aligned at the news conference about “The importance of reducing chronic absence in the early grades” in Rhode Island, scheduled to be held on Monday afternoon, Sept. 29.

The evidence-based, data driven policy recommendations – displayed in the new graphic formulation and backed by a bevy of leaders and analysts – state the obvious: to improve educational achievement [and future economic potential] by Rhode Island students, a concerted effort needs to address the growing problem of chronic absenteeism in the first school years, beginning with kindergarten.

In advance of the news conference, there has been well-coordinated media splash [with kudos to Katy Chu].
• An op-ed in The Providence Journal about how data can drive better decision-making by the Providence Plan on Saturday before the event;
• An interview discussing chronic absenteeism on Sunday before the event on Cox and Verizon cable TV, conducted by Rhode Island Kids Count Executive Director Elizabeth Burke Bryant, with Cranston Schools Superintendent Judy Lundgren and Central Falls Superintendent Fran Gallo;
• And, [borrowing from Johnny Carson’s The Great Carnac routine], I predict a front-page story by Providence Journal education reporter Linda Borg on Monday morning in advance of the event, as well as a story on Rhode Island Public Radio.

The bright stars appearing at the podium Monday are: Elizabeth Burke Bryant, executive director, Rhode Island Kids Count, Patrick McGuigan, executive director, The Providence Plan; Stephanie Geller, policy analyst, Rhode Island KIDS COUNT; Rebecca Lee, information group director, The Providence Plan; Julia Steiny, consultant, The Providence Plan; Deborah Gist, R.I. Commissioner of Education; Anna Cano-Morales, director of the Latino Policy Institute; and Dr. Ailis Clyne, president of the R.I. Chapter of the Academy of Pediatrics and medical director of the Division of Community, Family Health, and Equity at the R.I. Department of Health.

The facts are not in dispute:
• During the 2013-2014 school year, 16 percent of Rhode Island kindergarten students, 12 percent of first graders, 10 percent of second graders, and 10 percent of third graders were chronically absent.
• Children who were chronically absent in kindergarten have lower levels of achievement in math and reading as far out as the seventh grade and are twice as likely to be retained.

Neither, for that matter, are the recommended solutions:
• Develop systems that provide frequent reports on student absenteeism at the state, district, and school levels. These reports should include breakdowns by subgroup (e.g., grade, income), analyze patterns of absenteeism (e.g., days of week, month of year), and identify individual students with troubling absenteeism patterns so appropriate strategies for intervention can be identified.
• Monitor attendance regularly and contact parents as soon as troubling absence patterns appear. Intervene early to get students back on track before absences build up and students fall behind.
• Nurture a culture of attendance by helping parents to understand the importance of coming to school on time and every day in the early grades.

But tying the proverbial bell on the cat – changing policies and budgets to address the social determinants of chronic absenteeism – that’s where the waters get a bit murky.

Causes of chronic absenteeism
What are the causes of chronic absenteeism? The news release cites: “chronic illness, lack of access to health care, unreliable transportation, lack of clean or appropriate clothes, lack of affordable housing, bullying, or ambivalence or alienation from school can all lead to chronic absence.”

With chronic illness, the leading health cause of chronic absenteeism is asthma – and poor housing quality in Rhode Island is the root cause of chronic asthma. As the newly launched R.I. Alliance for Healthy Homes pinpointed, the absence of clear law regarding the regulation of mold remediation is one area where policy needs meet the reality of in-the-house causation.

If Rhode Island wants to improve school attendance, addressing the root causes of asthma is a winning strategy – more than helping parents understand the importance of coming to school on time and every day in the early grades. But it will take political will and reallocation of budget resources – and leadership by the next governor.

Nowhere is the correlation between chronic absence, poor educational performance, higher costs of education and diminished economic potential more clearly drawn than with what happens with children afflicted with elevated levels of lead in their blood, a result in many cases of older, poorly maintained housing in Rhode Island’s urban communities.

And, all of this is documented in a R.I. Datahub report [See link to report below.]

Families, the report said, “Encounter a number of challenges when they are exposed to unhealthy housing conditions. Unhealthy housing can be associated with chronic sickness in children keeping them out of school. Research finds that asthma is a leading cause of absenteeism. Concurrently, lead exposure has been found to be a reliable proxy for unhealthy housing conditions that exacerbate asthma."

Further, the report said: “Because housing quality affects a child’s ability to grow, think, learn, relax, and form critical early bonds, the impact of unhealthy housing on a child’s educational outcomes is substantial. In this [Datahub] story, we’ll use lead poisoning as a proxy for unhealthy housing and examine correlations with various educational measures.”

The report found that: “Almost 20 percent of R.I. kindergarten students have had blood lead levels [higher than the federal standards] of lead poisoning.

What does that mean for students? The report said:
• As exposure to lead increases, so does student absenteeism.
• Grade retention also increases with increased exposure to lead.

In a graphic presentation of the data, the report put together a composite analysis of three key indicators of unhealthy housing: the percent of housing built before 1980, the percent of children younger than six years old living below federal poverty levels, and the percent of children younger than six years old with elevated blood lead levels.

All that is needed to complete the graphic is an overlay showing the location of where standardized testing of students falls below the norm, where reading and math levels of proficiency are deficient.

As the report found, “children with elevated blood lead levels have been found to demonstrate decreased cognitive functioning and to have lower IQ scores.” The findings had very real implications for the classroom, the report continued, because studies found that “these students typically have lower scores on measures of math and reading abilities, nonverbal reasoning, vocabulary and grammatical-reasoning and short-term memory.”

The report also showed a bar chart that illuminated the great disparity in the academic performance of third-graders: For the 2009-10 school year, 78 percent of students with the lowest blood lead levels were proficient in reading, but only 48 percent of students in the highest blood lead levels category were proficient.

Finally, the report linked the higher special education costs to elevated levels of lead in children’s blood.

To sum up the report’s findings, it found an association between lead exposure in children and lower NECAP scores, higher rates of absenteeism, grade repetition, increased spending on special education, and graduation rates.

“Costs of lead poisoning, such as special education costs, lost future earnings, or other costs associated with compromised health, may put a strain on parents and families as well as the fiscal health of the state,” the report said. “These results provide evidence that unhealthy housing can substantially impact the lives of children in Rhode Island outside the home. Unfortunately, health hazards in the home are often not a concern until after a child becomes sick with lead poisoning, asthma, or another condition.”

Drilling deeper
ConvergenceRI spoke at length with Stephanie Geller, the policy analyst at Rhode Island Kids Count, to talk about the new data focused on chronic absenteeism in early education in Rhode Island.

She cited the above-mentioned R.I. Datahub report on lead poisoning, but cautioned against a one-size-fits-all analysis in looking at chronic absenteeism.

“We need to be cautious,” Geller began. “There are many interrelated factors in a child’s achievement levels – children who are living in poverty, children who also live in unhealthy homes, children who do not have access to healthy foods, children who attend lower-performing schools.” All of them, she continued, “are interrelated. It’s hard to tease out which is the cause of the lower achievement.”

Geller told ConvergenceRI that the event on Monday was focused on early elementary school attendance, and in particular, “the effect of chronic absence in kindergarten on later academic achievement.”

When you are in kindergarten, Geller explained, the problems are somewhat different than when you’re an older student going to high school. “When you’re in kindergarten, a child’s presence or absence is entirely under the control of the parent.”

Chronic absenteeism in kindergarten, Geller continued, appeared to influence future chronic absenteeism, according to the data. “We think that there is a lack of awareness about the importance of kindergarten,” she said. “About what kindergarten really is today, with reading and literacy and mathematical skills development.” What the focus of the data will demonstrate, she said, “is a recognition of how important it is for children to come to school, highlighting that September is school attendance awareness month.”

Who will connect the dots?
On Oct. 1, a forum for the candidates running for governor in 2014, entitled “Health and Prosperity in Rhode Island,” had been scheduled by Brown’s Taubman Center. But the agreement between the Fung and Raimondo camps to only do four forums precluded participation. As a result, questions about the connection between unhealthy housing, the lack of access to affordable health care, future health care policy, and the economic consequences of chronic asthma, lead poisoning, and chronic absenteeism will be missing from the political dialogue – unless the news media suddenly wake up from its long slumber.

In all the candidates’ discussion about jobs and the middle class, as well as the Publick Occurrence forum sponsored by The Providence Journal later this week, will questions about the connections between chronic asthma and lead poisoning and poor educational performance and future economic potential figure in the conversations?

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