Opportunities

1. Create a new position in state education agencies or regional education intermediaries responsible for healthy schools (e.g., boards of cooperative education services) that would coordinate technical assistance, policy, and funding across state agencies and offices; where applicable, this position should work closely with state agencies serving children, youth, and families.

2. Designate resources to provide training and technical assistance to district staff who can conduct a healthy schools audit of district spending to assess alignment with the WSCC components.

3. Identify and address the workforce implications of promoting health, wellness, and safety in schools, including how collective bargaining, state occupational safety, health programs and requirements, and adjusted job responsibilities may come into play and incorporate the relevant relationships between labor and management representatives.

4. Provide guidance on how to integrate education data (e.g., chronic absenteeism, school climate, preschool enrollment, workforce program participation, and school readiness assessments) into state health data systems (e.g., birth records and vital statistics, immunizations, Medicaid, and Children’s Health Insurance Program, social services data, and accountability systems).

5. Expand school Medicaid programs to allow school districts to bill Medicaid for all medically necessary services delivered to all Medicaid-enrolled students, and provide guidance to support implementation.

Opportunities

1. Implement equitable school finance systems using student-based state school funding formulas with weights to ensure adequate funding across different demographic populations and educational contexts and to ensure that all students’ educational and health needs are met.

2. Include budget line items for healthy school priorities that focus on the whole child, with language broad enough to incorporate all elements of the WSCC model.

3. Provide funding to districts for nurses, school psychologists, school counselors, physical educators, occupational health and safety staff, and social workers.

4. Recognize all qualified health professionals who deliver health services in school-based settings as Medicaid eligible, and expand codes for care coordination to include school professionals essential to student treatment plans.

5. Incentivize districts to provide school-located health services in schools serving high percentages of economically disadvantaged students.

Opportunities

1. Incentivize districts and schools to include age-appropriate barriers to learning (e.g., asthma, vision, hearing, dental health, mental and social-emotional wellness, environmental exposure) in annual screenings, either onsite or in collaboration with children’s primary care providers.

2. Provide funding for school-based health clinics in medically underserved geographies.

3. Expand research and development on the investment in telehealth and other technologies that augment, complement, and strengthen the work of existing staff and expand access to remote care.

4. Ensure appropriate reimbursement for telehealth services, particularly for rural districts and communities that have pervasive shortages of providers.

5. Provide guidance and incentives to health care companies and health plans to implement the tenets of high-quality primary care, defined by the National Academy of the Sciences, Engineering, and Medicine report as “the provision of whole-person integrated, accessible, and equitable health care by interprofessional teams that are accountable for addressing the majority of an individual’s health and wellness needs across settings and through sustained relationships with parents, families, and communities.”

6. Provide incentives, including funding, for health care providers to sponsor school-based health centers.

Opportunities

1. Issue guidance to school districts for utilizing federal and state funds to modernize schools for the 21st century, including broadband expansion, disaster preparedness, and ensuring that furniture, fixtures, and school spaces facilitate teaching and learning for students with various needs, including students with disabilities.

2. Create incentive programs for health plans to develop and deepen partnerships with schools to expand the reach and impact of mental health services.

3. Ensure local public health agencies are prepared to support students and educators who are at risk or have environmental exposures at school.

4. Immediately and fully remediate environmental hazards in schools including radon, asbestos, lead in drinking water, and Polychlorinated Biphenyls (PCBs).

5. Issue recommendations to encourage the use of environmentally preferable purchasing or green cleaning in schools.

6. Conduct annual surveys of state-wide school infrastructure conditions and make them publicly available along with funding to support infrastructure improvements.

7. Support comprehensive, local adoption and enforcement of modern building and infrastructure codes.

8. Incorporate the values and vision for adequate and equitable school facilities and grounds into the state education agency’s mission, vision, and strategic plans.

9. Encourage Local Education Agencies to establish standing infection prevention and control programs.

Case Study

In Minnesota, The Department of Public Health published an evidence driven Ventilation Guidance for Schools based on recommendations developed by The American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE) and The Harvard School of Public Health Schools for Health program. The Harvard program includes a five-step strategy to ventilation efficacy in schools which is important not only for mitigating the risk posed by COVID-19, but also for addressing the risk posed by other respiratory pathogens and irritants. The strategy details how to measure classroom dimensions, perform audio and visual checks of systems, measure or estimate outdoor ventilation rates, compare results to targets, and implement supplemental air cleaning strategies to meet targets. Implementing a program like this can help to create a safe working and learning environment for all students and school staff.

Opportunities

1. Expand school Medicaid programs to allow school districts to bill Medicaid for all Early and Periodic Screening, Diagnostic, and Treatment services.

Case Study

Michigan submitted a state plan amendment (SPA) in response to a 2014 Centers for Medicare and Medicaid Services (CMS) letter reversing the longstanding “free care rule” that had limited Medicaid reimbursement for services only included in a Medicaid-enrolled student’s Individualized Education Program. The SPA submitted was approved by CMS in 2019 which allowed Michigan to seek reimbursement for services to all Medicaid-enrolled students, not only those with IEPs and further expanded the range of providers who could bill for services provided. The program, known as Caring for Students (C4S) has successfully expanded access to a range of behavioral health and nursing services that were previously inaccessible to a large number of students.

Opportunities

1. Develop guidance, training, and technical support to districts on how to leverage funding streams in support of whole child health.

Case Study

In Massachusetts, the Department of Elementary and Secondary Education (DESE) launched a public awareness campaign on COVID-19 focused on how parents, teachers, and students can work together to keep each other healthy and safe. Utilizing an archived and open source website to communicate with the school community, DESE has published guidance on a wide-range of topics including classroom education, transportation, vaccine information, and other health education issues to develop improved health literacy among stakeholders. DESE regularly updates the platform with policies and guidance to promote information sharing and foster dialogue between school and public health officials, teachers, parents, and students. By keeping all stakeholders informed and working from a common basis of understanding, DESE is able to build a sense of collective responsibility over school health.

Opportunities

1. Explore data sharing agreements, while protecting student privacy, that allow healthy schools staff to and health care systems to seamlessly work together.

Opportunities

1. Target immediate and comprehensive loan forgiveness programs and service scholarships to educators and healthy schools personnel serving high-poverty student populations (e.g., Title 1 schools).

2. Provide clear direction on how to access and apply for loan forgiveness programs and create supporting resources (e.g., a help) desk.

3. Obtain and publish annual loan forgiveness status by school job classification and demographics.

4. Support the coordination between state-funded preparation programs for educators and district administrators to improve pre-service focused education on meeting the holistic needs of students.

5. Coordinate with districts and unions to gather data on shortages. Ensure that data capture racial and socioeconomic disparities so policies and programs can effectively address inequities.

6. Offer high-quality professional learning opportunities and training to educators and healthy schools personnel focused on the whole child and that address self-care, secondary traumatic stress, compassion fatigue, and burnout prevention. Include the development of health-related curricula focused on both individuals’ health and occupational health and safety.

7. Provide incentives, resources, and technical assistance to local districts, particularly in shortage areas, to establish residency programs with current K-12 school students.

8. Broaden personnel eligible for Medicaid reimbursement to include staff in internships or residency programs to support recruitment.

9. Create a state task force charged with reviewing educator recruitment and retention data, disaggregated by subgroups, and share that data publicly to inform the development of locally-driven strategies to address shortages.

Case Study

In North Carolina, Governor Roy Cooper issued Executive Order 113 which established the, “Developing a Representative and Inclusive Vision for Education” (DRIVE) Task Force comprised of a diverse and representative group of stakeholders whose goal is to achieve greater equity and inclusion in the education field. The Task Force is charged with submitting a report that will assess “the state’s progress in increasing educator diversity in K-12 public schools, identify short, mid-range, and long-term strategies to increase educator diversity, identify stakeholders, assets, and sources of funding that can be leveraged to recruit, retain, develop, and support more educators of color, propose metrics and standards by which the Governor can evaluate the state’s success in achieving its goals under the Plan, improve recruitment, retention, development, and support of educators of color, and identify priorities for increasing educator diversity in the state.”

Opportunities

1. Create a cross-agency group to coordinate family engagement (e.g., state departments of education, health, children and families, justice, environment, and occupational safety and health).

2. Hold focus groups and conduct surveys for all families on perceptions of the education system.

Opportunities

1. Broadcast funding opportunities and share how to best leverage funding to improve health and education outcomes.

2. Call attention to examples of state-level networks, coalitions, and collaboratives in education that include (or could include) community-based organizations and those working on school health, children’s health, and occupational safety and health.

Case Study

In Rhode Island, the Rhode Island Healthy Schools Coalition addresses childhood obesity through a model focused on community partners. The coalition also provides no-fee guidance and program services to school communities focused on overall school wellbeing enhancements. With a mission to make, “all RI schools healthy places for children to learn, grow, and thrive,” the organization leverages the resources of its private and public sector partners to, “develop and implement strong, comprehensive wellness policies.” The organization operates at the intersection of health and education to provide technical assistance for policy and practices, provide resources and tools, and deliver programs that emphasize a healthy whole child vision within all schools.