My uncle was a pipe-fitter in Chicago, and he used to tell me as a kid to “measure twice to cut once.” He was making sure I knew the importance of preparation and estimation in helping me take the best action for a particular situation. His words have taken on even greater meaning in working with disenfranchised youth to ensure they are healthy enough to succeed academically, socially, and later in the workforce. But first, as my sage tio used to tell me, it starts with the assessment.
As an example, an honors student at Sullivan High School in the Rogers Park neighborhood in Chicago recently shared how the SMART clinic staff at her school recognized that she was dealing with anxiety and fighting bouts of depression thanks to a health survey she took at the beginning of the school year. "Everyone sees me as perfect. I'm involved in extra-curricular activities. I'm a leader. My grades were always great but were starting to slip. Before I was asked to come to the clinic for my health screening, no one thought I had a care in the world. My parents, friends, and teachers … thought I missed school because I was sick, not because I couldn't force myself to get out of bed that day or was overwhelmed with a fear that I wasn't good enough. Now, I have a support system. Because of the SMART clinic, I participate in group (therapy), share with my social worker and open up more with those closest to me. I even learned to meditate to help reduce my anxiety before a big test or presentation. My grades have bounced back, and I’m excited about my future.”
SMART is a public-private partnership between CVS Health, Ginn Group Consulting and Hispanic Heritage Foundation in coordination with Chicago Public Schools and Heartland Health Centers. The innovative model seeks to improve the academic outcomes of students by integrating preventive physical, social and mental health care deep into the school system. At the core of the effort is ensuring that students are at their desks at first bell in the morning to give them the best chance at wearing a cap and gown later.
According to a report by the Robert Wood Johnson Foundation (RWJF) titled The Relationship Between School Attendance and Health, chronic absenteeism is a national issue that puts more than 6.5 million schoolchildren at risk for falling behind academically, dropping out of school and serious long-term health, employment, and financial consequences. The study looked into the reasons behind chronic absenteeism and found three main areas: physical, mental and social health. Not coincidentally, these are the focus of the SMART model interventions.
The RWJF report says American schoolchildren with treatable and remediable physical conditions such as asthma miss a combined 14 million days of school each year. On the mental health side, fear, depression, social anxiety and other issues can make it difficult for children to feel comfortable going to school, as illustrated by the student at Sullivan. Social factors are also important to address in ensuring a student’s environment foments productivity in the classroom.
If not addressed, these factors can affect graduation rates. According to the report, a student who is “chronically absent for any year between eighth and twelfth grade is over seven times more likely to drop out.” The potentially harmful effects of absenteeism and an unhealthy student go well beyond the high school years, and, if untreated, can impact not only their education and wellness but also financial and workforce situations. And in the case of the young student at Sullivan, if untreated, the results can be tragic.
The SMART model was developed to specifically address those three key factors (physical, mental and social health) by proactively engaging students with early health assessments to support overall wellness – instead of the other way around which traditionally has put the onus on the students, who are often reticent, to ask for help and having healthcare providers in a reactive position. In a SMART clinic, health care professionals, as well as social workers, become part of the school family working symbiotically with students, teachers, counselors, coaches, and administrators. In this “active access” model for education, healthcare providers actively bring students into the school’s health care system as individuals with unique needs with the ultimate goal of supporting academic achievement goals. And it’s working.
Since the SMART Flagship pilot was instituted at Sullivan High four years ago, the population of students receiving health care has jumped from 15-20 percent to 85-90 percent with 85 percent of students filling out health assessment surveys. Regular attendance by students has also risen to 90 percent and the average absenteeism has dropped by a half. In addition to Illinois, the SMART model is also currently in Alabama schools and the program is being expanded to Pennsylvania and the District of Columbia this year (a white paper on the outcomes of the first four years of the effort will be presented at a Congressional Briefing in Washington, DC, this May).
Not being left out are the children that are most in need including refugee and undocumented students, who are also being extended care. To that, a teacher at Sullivan High School, which is a 92 percent free-or-reduced lunch school, stated with pride, “my kids have been running a long time and when they get to Sullivan, they can stop running.” And get healthy.
It’s time to get SMART about improving academic health to ensure long-term productive outcomes for not only the students but for our communities and country.