Illness: A Barrier To Attending School

Dec 2, 2013


Another installment in our year-long series Empty Desks: The Effects of Chronic Absenteeism

Ever since they were babies, eight-year-old twins Tyin and Connor Nease of Essex have been in and out of hospitals and doctors’ offices. The highly energetic boys suffer from hemophilia, a disorder that prevents their blood from clotting. The twins often experience severe bleeding if they get a cut, bruise, or sometimes, for no apparent reason. Their mom, Carrie Nease said they missed 20 days of school last year.

“For no reason, they will have bleed after bleed after bleed,” Nease said. “If they have a fever, we have to go down for labs and here’s another absence. These guys will maybe have a port infection and be in the hospital for a week .”

The twins have to take high doses of a clotting medication intravenously through surgically implanted ports and another medicine to keep their bodies from rejecting the clotting medication. Tyin is in remission and only has to take the medication every other day but Connor, who is paler and a bit thinner, is on a daily routine that takes hours to administer.

Like the Nease twins, a significant number of the more than 85,000 students in Maryland who miss 20 or more days of school annually are chronically absent because of illnesses. Officials don’t know exactly how many that is because they have just started tracking those students. The illnesses can range from heart ailments, gunshot wounds and cancer to more manageable sicknesses, such as asthma, sickle cell anemia and diabetes.

Some of these students miss more than 50 percent of their classes, which makes it hard for them to keep up.

Baltimore city and county school districts have short- and long-term programs to provide in-home and hospital instruction for these students when needed. However, because of the  unpredictability of the twins’ bleeds, their parents decided to home school them, which the boys seem to prefer over public school. “When it was raining outside my teacher never let me do inside recess,” Tynin said. “It’s (home school) more easier,” said Connor, who added that he gets more attention on assignments at home.

Their mother said homeschooling has solved the boys’ absenteeism problems. “Now that I’m homeschooling them, these guys won’t miss because of being in the hospital. When you’re in the public school system, you miss school because of a bleed, when you’re home, it’s not an issue,” Nease said.

But not all parents can home school their sick children.

For those who can’t, there is CHIP, the Chronic Health Impaired Program, in Baltimore city. Parents with a doctor’s referral can sign up to have a teacher come to their homes when their children need to miss school. The program was started in the early 1960s when there were more than 2,000 students in the district suffering from asthma.

CHIP and Health Services director, Dr. Louise Fink, says asthma remains a problem. “Last year, we had 600 children with asthma and this year we already have 924 with asthma in CHIP,” Fink said. “Those are children who get to school 50 percent of the time but maybe two days a week, they can’t make it.”

More than 1,100 district students are enrolled in CHIP with a range of ailments, including broken limbs and mental health issues. “Those children would have been marked absent otherwise and currently they’re not because we’re instructing them,” Fink said.

Education researchers are only beginning to document and analyze the needs of students who are chronically absent because of illness.

Dr. Robert Balfanz, a senior researcher at Johns Hopkins University, co-authored the only national study on chronic absenteeism. He says these students’ parents often don’t have health insurance. “Many folks are not able to get the types of treatment they need on a regular basis to overcome their health challenges and they end up staying out of school,” Balfanz said.

And, as with students who are chronically absent because of transportation and housing problems, poverty plays a major role in health-related absences. “We know that in poverty almost any health issue gets magnified, “ Balfanz said. We know that too many of our children come to school without a good breakfast and they may get lunch at school but not a good dinner and try to get by on high energy junk food and it wears you down and you decide, I won’t go to school today.”

Long-Term Care 

The city also has a program called Home and Hospital that sends teachers into homes and hospitals to teach students with long-term illnesses that cause them to miss more than half their classes. Janet Lippman, the program’s coordinator, said they insist that their teachers stay in touch regularly with the parents and classroom teachers to “make sure that what they’re teaching is exactly what the classroom teacher is teaching...Our teachers are receptive to the students calling them after class. They have their cell phone numbers and email addresses if they have questions or need help,” she said.

Lippman said they usually serve about 800 students a year. A small percentage of them are international students in the Baltimore area for specialized surgeries at Johns Hopkins University. Sadly, Lippman said, some students who receive instruction through her program are terminally-ill.

“Every year, we have four or five who are terminally ill. We give them time off and work with them sometimes in the summer. We work around their needs.” Baltimore County also has long and short term programs similar to the city’s, for sick students. Lois Behles of Parkville said she has had mixed results with the in-home and hospital teachers assigned to her sons over the years.

“It depended on the tutor,” Behles said. “Some tutors are retired and have lots of time, but others are teaching all day and had the workload of so many other students. Also, the home and hospital program had its own text books on grade level, but they were not the same texts my children used and sometimes they felt overwhelmed.”

Both of Behles’ sons have spina bifida. Adam is now in college, but was mainly home schooled because he missed so many days when he attended public schools. “It was deemed unfeasible by the teachers and me,” Adam said. “I was absent at least half of the school year, so it was pointless in going when I couldn’t complete the work.”

His brother Nathan Behles, an eighth grader, has been in and out of schools as well. His mother said he repeated one grade because he was sick a lot and not able to keep up with the assignments. “Usually when I missed a lot of days, it’s all about surgeries,” Adam said. “I’ve had quite a few in my life, like 50 or 60 surgeries, since birth.”

Nathan also has major bowel problems and is a special needs student. His mom says he did not have a tutor for the first two months of this school year. “They offered me one tutor; she was eager but she wasn’t specialized in special education. The second one, he would come out later in the evening which would not work out for our family,” Behles said. That’s because Nathan’s bowel management procedures that have to be done every other evening, take four hours, leaving him exhausted. He now has a tutor he likes, but she canceled this particular day because her own child was sick.

For children with illnesses that can be managed by nurses and nurse practitioners, such as asthma, some city and county schools have full-service health clinics. Nicole Johnson, director of Elev8, a non-profit organization that operates two fully-staffed, school-based clinics in the city, says for some parents it’s a trust issue. “If we can build their confidence in our ability to take care of their children that will have a direct impact on the level of chronic absenteeism that we see that are health related absences,” Johnson said.

But according to Balfanz, more needs to be done. “Those school-based health clinics are sort of reactive,” he said. “If a kid finds their way to a clinic, the clinic takes care of them, but we need to be more proactive and go out and find the kids who need help and organize more school wide responses.”

Balfanz said educators need to create partnerships with health care providers to provide “basic preventive health care for kids...Otherwise, we do all these school reforms and the students are not there to benefit from them.”

As for students who miss a lot of school because they’re sick, Adam and Nathaniel Behles had this advice for them. “Don’t give up, work very hard and don’t let your illness get you down,” Nathaniel said. “When you need help, don’t try to do work solo because that exacerbates the problem,” Adam added. “I was reluctant to because it’s tough and you have the feeling everyone is staring at you but the alternative is getting a bad grade, so I’d just ask for help.

Empty Desks is made possible through a grant from Open Society Institute-Baltimore: investing in solutions to Baltimore’s toughest problems.