How to help prevent chronic school absenteeism

When discussing school attendance and absenteeism, many focus on the academic impact that being absent from school will have. In her presentation “Every day counts: Pediatricians’ role in addressing school absenteeism” at the virtual 2020 American Academy of Pediatrics National Conference & Exhibition, Mandy Allison, MD, MSPH, Med, FAAP from the University of Colorado Anschutz Medical Campus in Aurora, challenged that view. She started off with a case study from her practice when asking about an 11-year-old girl’s school attendance highlighted a number of concerns beyond the vomiting that had brought the girl and her mother in for a visit.

First, Allison defined chronic absenteeism as missing so much school that the child is at academic risk. The absences can be for any reason, even excused absences. A child who misses 2 or 3 days per month is indicative of a chronically absent child. School absence can be driven by a number of things including bullying, health issues, academic struggles, biased discipline, housing and food insecurities, no safe way to get to school, or an unwelcoming school environment. There may also be misconceptions about absences such as only unexcused absences are an issue or that attendance only matters in higher grade levels. School attendance is strongly linked to academic success from early grades where it helps students attain reading proficiency to high school, when it helps students graduate and move on to complete college. Academic success has a link to health outcomes as lower educational attainment is associated with a lower income, lack of control over life with a lack of social support, decreased likelihood of regular exercise, increased mortality risk and lower life expectancy, and an increased likelihood of smoking.

Allison then discussed a 3-tier approach that can help prevent absenteeism. The first tier is geared for all children and teenagers. It includes asking about the number of missed days during clinic visits and praising good school attendance. The tier also recommends discussing how absences impact academic success as well as future health outcomes. Tier 1 systemic approaches include advocating for policies that promote school attendance, encouraging data sharing to understand absenteeism in the community, and supporting the efforts of school districts in the area to expand access to health insurance and medical services. The second tier is for patients who are missing 2 to 3 days of school per month. It encourages addressing family issues that could be preventing school attendance, suggesting a school team meeting to address the absenteeism, and collaborating with school professional to manage the challenges. Tier 3 address students who miss 4 or more days of school a month and includes working with the school to provide support services and discussing alternative educational options for the child.

Allison concluded her session with 3 changes that a clinician may want to make to his or her practice to better combat chronic absenteeism. The changes were:

1. Ask the child and family about how many days of school have been missed in the past month at every visit, when possible.

2. Find a way to promote school attendance in the practice and during clinic visits.

3. Know the chronic absenteeism rates in your community.