Student
Checkup
Student
Checkup
ore than a year later, with vaccination rates increasing by the day and case positivity rates seemingly stabilized, “regular” life is beginning to resume across California. More than 9,000 of the state’s roughly 11,000 K-12 schools were allowing in-person instruction again or had plans to do so soon, Gov. Gavin Newsom said in April.
While most students will be returning to campuses in some capacity by fall, they are not all the same individuals they were the last time they strapped their backpacks on and left the classroom. Distance learning, family stress, lack of access to nutritious food and decreased exercise are just a few factors that have altered students’ physical and mental health.
Now experts and local educational agencies are looking for ways to intervene.
A nominee for Bakersfield City School District’s Teacher of the Year, physical education teacher Richard Ribaudo pivoted his lesson plan to make online fitness videos at the onset of the pandemic.
“I made a Google classroom that was available for the whole school and I created a different workout video every day of the week, Monday through Friday, and would post it for them to do,” said Ribaudo, who works at Sierra Middle School. “We also posted it to our Instagram page for our PE department and we were getting more traffic through there … We really turned to social media to try to get the videos out there and get students moving.”
As time went on the district’s PE instructors expanded on that library of videos. Using free resources like ck12.org, which has a teen health literacy curriculum, Ribaudo and his colleagues “essentially became health teachers,” he explained. “The bulk of what we do is based on health lessons and everyday there would also be a new workout video for the kids to follow along with.”
Even with the exemplary initiative and creativity showcased in Bakersfield City SD, Ribaudo worried that students would be in the worst shape of their life following quarantine. He shared that it’s hard to know who is actively participating in workouts as students aren’t required to have their cameras on.
Come fall, Ribaudo expects to continue to incorporate the health curriculum while supporting other subject areas and overall literacy. Adhering to any health and safety guidelines, he does want to get the physical part of physical education back, however, using activities like disc golf, cornhole and running. He knows how important physical health is to students’ academic success.
Ribaudo’s masters project while attending California State University, Fresno, focused on a sample group of English learners. He compared the test scores of those who received the state’s recommended PE instructional time with those who were pulled out of PE for additional language instruction and found that those who met recommended PE time scored higher on their tests.
In September 2020, the California Association for Health, Physical Education, Recreation and Dance surveyed K-12 educators to assess the status of PE during the pandemic. Among the organization’s findings, two in 10 elementary schools did not offer PE and four in 10 programs had less instructional time. Roughly 54 percent of K-12 PE educators indicated that limitations were placed on their ability to instruct. Additionally, there are concerns about the continued marginalization of PE and district’s plans for PE once face-to-face instruction returned.
Citing scientific evidence that PE and physical activity is integral to the development of children, the organization concluded that students affected by the pandemic are struggling and “stakeholders must take an active approach in shaping the future of physical education.”
A recent study by University of Southern California Keck School of Medicine doctoral students that looked at the early effects of the pandemic on physical activity in American children in spring 2020 concluded that “short-term changes in physical activity and sedentary behavior in reaction to COVID-19 may become permanently entrenched, leading to increased risk of obesity, diabetes and cardiovascular disease in children.” Researchers advised that programmatic and policy strategies focus on promoting activity and reducing sedentary behavior.
“Now more than ever we need our students to be of good mind, spirit and body. Our kids need to be out and busy moving. It helps them on every level,” Ribaudo said, adding that current circumstances aside, schools rely on parents/guardians to encourage healthy habits at home. “As restrictions ease, encourage them to get outside with safe practices.”
That boils down to roughly one nurse per every 2,410 students. The National School Nurses Association recommends at least one nurse per 750 “well” students, with ratios decreasing to as little as one-on-one based on the needs of a student population.
California is one of just 10 states that doesn’t have a state-level school nurse consultant. Assembly Bill 285, by Assemblymember Chris Holden (D-Pasadena), would have changed that by placing a school nurse consultant at CDE to work with LEAs and school nurses to promote services and programs that address students’ ever-changing needs. The bill was placed in suspense. Still moving forward is Assemblymember Marc Berman’s (D-Menlo Park) AB 563, which would establish an Office of School-Based Health Programs to administer health-related programs under the CDE and advise it on issues related to the delivery of school-based Medi-Cal.
“Children don’t leave their health issues at the school’s front door and I think that’s something we often forget,” said Sheri Coburn, director of Comprehensive Health Programs at the San Joaquin County Office of Education.
San Joaquin COE was one of the only county offices that took on the role of administering the vaccine to educators and had inoculated more than 13,000 educators by the beginning of April, Coburn recalled.
A school nurse since 1989 and past president of the California School Nurses Organization, Coburn has been working on site one day a week in a small rural district since September. Though her workload has increased “twelve-fold” during the pandemic, she clarified that many of the practices were already in place.
“Prior to the pandemic we were doing some of what it requires, in that we assess children when they present with health issues, we watch over infection control and do things like make sure there’s good hand washing,” she said. “If children do need some procedures in the educational setting because they have specialized health care needs, we can provide those.”
There are many additional responsibilities school nurses must now take on, according to Coburn, including daily symptom checks, conducting contact tracing and completing the accompanying paperwork, distributing personal protective equipment, implementing infection control methods, working with risk managers and educating staff and parents about the virus.
As students returned to campuses in her district, specifically those with conditions such as asthma or diabetes, Coburn said they worked with parents to write care plans to keep them safe.
Coburn urged districts to look at the research on having a nurse as it relates to absenteeism and attendance, as well as the cost-saving element of having a school nurse who can help determine the correct course of treatment. Telehealth services can also be helpful, she added.
Beyond physical health, school nurses can also monitor students’ mental health, as evidence shows that pandemic-related hardships have taken a great toll. In Coburn’s county, four student suicides occurred in the pandemic’s first year.
“Children need trusted, caring adults. Home can provide that, but children can also connect with providers at school,” Coburn said. “Children will more often present with somatic problems like a tummy ache or a headache that represent some kind of mental issue going on long before they’ll admit to it because sometimes, they can’t put words to it. If I have a kid that’s constantly coming to the office with a stomach or headache, I, as a nurse, really take a look because I know something else is happening.”
“What we didn’t expect was the mental health crisis that came in batches,” Howard said. Almost immediately after the shutdown, there was a series of children that came through the hospital that had attempted suicide, Howard recalled. “It was extreme in the nature of which the children were both presenting numbers-wise and what they chose to do to themselves.”
After reaching out to colleagues across the state, Howard found that they were seeing similar ebbs and flows in cases — sometimes coinciding with events like graduation.
In his district, parents said that some children were doing well in distance learning while others were withdrawn. The district increased counseling services, which seems to have helped, but Howard suspects that they may not know about the children facing the biggest issues, due to isolation.
Howard worries about the long-term effects on this “COVID generation” of teens who missed major life milestones, but welcomes a continued focus on mental health needs, and is hopeful that students, especially younger ones, will be resilient.
Alameda COE trustee and state Mental Health Services Oversight and Accountability Commission member Ken Berrick founded Seneca, a nonprofit providing children with care through a model that integrates school climate and tiered mental health supports. Through his work, he has observed the hardships students face and is more concerned about young people who are “turning inward” than those who are acting out.
A past president of the California County Boards of Education, Berrick said his organization is developing a program for school-anxious and school-phobic children where they can maximize online learning opportunities. Students would start by connecting with a therapist and teacher, become a part of a virtual classroom and get comfortable with their counterparts.
“Eventually, if we do this well, they will want to meet their peers and they can be integrated into a school setting with people they’re comfortable with,” Berrick said.
Berrick is also involved in a mobile response program pilot happening in San Francisco where existing resources typically reserved for those already involved in the child wellness and mental health systems has been expanded to support disengaged students. The expansion of similar outreach systems is being considered throughout the state.
He also wants to address proper nutrition, a component of physical and mental health and academic success that is sometimes overlooked. “Everyone knows that they are closely related,” Berrick said. “I always say that if you do a mental health check and you don’t know the last time a student ate or slept then you’ve neglected the most fundamental aspect of a mental health assessment.”
Feeding America projected that 42 million people, including 13 million children, may experience food insecurity in 2021. According to its report, “The Impact of the Coronavirus on Food Insecurity,” that is an improvement from updated 2020 projections of 15 million children. Significant racial disparities in food insecurity that were present prior to the pandemic remain, the report noted.
Families are navigating unemployment or reduced hours, and not being on-campus presented a barrier to receiving the free food a sizeable portion of California students depend on. During the 2019–20 school year, 59 percent of students ages 5-17 were eligible to receive free of reduced-price lunches at school, according to CDE data. LEAs leapt into action and offered food distribution programs during distance learning but issues like transportation to and from pick-up locations remained for some.
The United States Department of Agriculture has extended a range of flexibilities that allow school meal programs to serve free, healthy meals through 2021–22 school year.
“I’m talking with education colleagues about how they’re doing learning loss mitigation and again we are seeing a very uneven distribution by socioeconomic class of how far kids got behind,” he said. “Preliminary indications are not pretty but there are a lot of resources.”
School climate and culture will be more important than ever before, he said. Officials should consider how to link climate and culture to existing multi-tiered systems of support to better help struggling students.
“Having a comprehensive approach to school climate and culture that everyone agrees on and supports is absolutely crucial,” Berrick said. “That approach will help you see which students need greater support.”
This can be done without spending a fortune, though Berrick thinks someone should oversee the creation and implementation of such plans. If not, “no matter what you do, you’ll just have a series of slogans. It has to be implemented in a way that’s cohesive and energizing and has to support every student and faculty member,” he said.
Heather Kemp is a staff writer for California Schools.