Comprehensive School Program Promotes Student Health and Academic Growth


Johns Hopkins Children’s Center school health model can benefit students nationwide as schools look to address effects of pandemic

Intentionally integrating health and education in a large school setting pays off by facilitating and enhancing health and academic growth, according to Johns Hopkins Medicine researchers with the Rales Center for the Integration of Health and Education at Johns Hopkins Children’s Center.

In a report reviewing the Rales Center school health program’s impact after its first five years, the research team highlights the most promising aspects of the model, which they feel is ready to be implemented in schools throughout the country that are in systematically minoritized neighborhoods (communities marginalized by policies perpetuating inequality based on factors such as income, race or ethnicity). The researchers report that the program had a positive impact on student health and academic engagement, that it was linked to reductions of chronic absenteeism and that it reduced barriers to educational success.

Over the last five years, the Rales Center team has implemented, refined and evaluated its innovative school health model at KIPP Baltimore, which consists of two public charter schools serving more than 1,600 grades K–8 students in one school building.

The model provides on-site pediatric health care services, family resource support, and student and staff wellness programs. The Rales health center, which has been an integrated part of the KIPP school community since 2015, includes a pediatrician/medical director, a pediatric nurse practitioner, a medical assistant, two school nurses and a family advocate. Additional Rales Center wellness staff members collaborate with KIPP Baltimore staff to implement student health education, and social and emotional learning programs. Students have access to a full range of services and programs that address areas including chronic disease management, mental health counseling, vision screening and glasses, and physical, health and wellness activities. Health care professionals collaborate with educators to identify and address students’ needs, which might have previously gone unnoticed or unaddressed.

During the pandemic, the critical role of school-based health and wellness programs — services to which many students have not had access for more than a year — has become very clear, say the Johns Hopkins Medicine researchers.

“It’s a robust model that could pay dividends for health and educational outcomes in a post-pandemic future,” says Rales health center medical director Katherine Connor, M.D., M.S.P.H., assistant professor of pediatrics at the Johns Hopkins University School of Medicine.

The researchers state in their report that the Rales Center model enabled staff to identify and support students who were facing health and social risks. The researchers observed that students with chronic health conditions who participated in the model adhered more strongly to their medication regimens and were less prone to chronic absenteeism than KIPP Baltimore students who were not enrolled in the program.

Based on the report’s findings, Rales Center staff identified students with poorly controlled asthma and devised disease management programs for these children, who made up more than 30% of the total student population. By 2018, asthma medication adherence was greater than 80% for students enrolled in the program. Additionally, the Rales Center prevented approximately 263 emergency department visits for asthma concerns in the first through fourth years of the program.

Chronic absenteeism also decreased for students with asthma and attention deficit/hyperactivity disorder (ADHD), two conditions for which the Rales Center staff provides daily medications at school. From 2014 to 2016, students with ADHD who received support from the Rales Center showed a 50% decrease in chronic absenteeism, while 49% of students with severe asthma missed fewer school days because of their condition. Students enrolled in the program showed more growth in their reading and math scores than those not in the program, although impacts on test scores were modest.

Rales Center researchers say these improvements highlight how a fully integrated school health program can help support both good health and academic achievement — the building blocks of well-being and productivity in adulthood.

“Our findings demonstrate the critical role of comprehensive school-based health programs in protecting the potential of every student, but particularly those living at the economic margins,” says Sara Johnson, Ph.D., M.P.H., Rales Center director and an associate professor of pediatrics at the Johns Hopkins University School of Medicine.

“Our research has demonstrated that every dollar invested in the program returns more than $4 of social benefit,” Johnson adds.

“Robust school health programming should be adequately funded in high-needs schools and districts nationwide,” says Connor. “While we know that not every school and district will be able to scale models like ours, implementing even individual aspects of the program can lead to improvements in student health and academics, and this, in turn, can provide cost-saving benefits to health care and educational systems.”

An executive summary of the five-year outcomes report, as well as detailed information about program components, can be found on the Rales Center website.