In February, the telehealth company , including clinicians who worked directly with students and families, leaving about 500 employees. 

The company lost one of its biggest customers, the Los Angeles County Office of Education, last year. It shortened its contract with the Chicago Public Schools because of “challenges securing funding,” a spokeswoman said. And several districts across the country have also either ended their business with Hazel or have contracts that expire later this year. 

they are 鈥渞estructuring鈥� the company to put it in a better position as it pursues more stable sources of funding, like billing Medicaid and private insurance, now that the federal relief funds some districts used have expired. Company spokeswoman Emilie Fetterley said no additional layoffs are expected 鈥渁t this time鈥� and that many states and districts plan to renew their contracts. 

But according to internal memos, by a news outlet covering mental health, CEO Iyah Romm said the company was losing 鈥渢oo much money鈥� to meet its goals. Since the expiration of the Los Angeles contract, the company has even, at times, absorbed the cost of services, Fetterley said. 

Some say the company faces a difficult road ahead.

There is a 鈥渕assive need鈥� to address student mental health and behavior issues, said Adam Newman, co-founder of Tyton Partners, a consulting firm focused on the education sector. Until the relief funds ran out, 鈥渢here were enough dollars in the system for schools and districts to find ways to underwrite these types of programs. But the risk has always been: What’s the durable funding model?鈥�

In Missouri, the Ferguson-Florissant district, outside St. Louis, ended its business with Hazel last year.

鈥淭hey were great to work with,鈥� said spokeswoman Onye Hollomon. Hazel served about 2,000 students in the district, which used COVID relief funds to pay for the program. 鈥淥nce that phased out, we had to make that cut.鈥�

Los Angeles spent more than $28 million in one year to make Hazel available to the county鈥檚 80 districts, according to GovSpend, a data company tracking payments to government agencies. It funded its deal with the company by tapping a $389 million . Between March 2022 and May 2024, 804 schools in the county referred 9,337 students for services, according to data Hazel provided to the county. Of those, 4,162 students received at least one visit, with students participating in an average of six visits. Fetterley said once a student is referred to Hazel, parents don鈥檛 always follow through with a visit or may seek help elsewhere.

In addition to taking a loss on services for some students since last year, Hazel has relied on billing insurance, including Medi-Cal, the state鈥檚 Medicaid program, and contracts with individual districts. Leaders are currently negotiating contracts with districts for next school year. 

Hazel is also one of eight providers approved for a new program that allows 700 districts throughout California to be reimbursed for services by Medi-Cal or private insurers. It participates in a similar in Iowa, and in Nevada, the Clark County School District uses Medicaid funds to pay for Hazel services, but that ends in June. A spokesperson said the board has not yet decided whether to renew it.

鈥楳ade their mark鈥�

Telehealth programs, delivered through schools, were expanding long before the pandemic. They offer families convenient access to a remote doctor or therapist while preventing students from missing school for appointments that often turn into full-day absences. Hazel Health, founded in 2015 by health care executive Josh Golomb, was part of that growth. 

鈥淭elehealth providers have made their mark in school-based health care,鈥� said Nirmita Panchal, a senior policy manager at KFF, a nonprofit focusing on health policy. 鈥淭hey eliminate transportation barriers, where students may not be able to physically get to a provider.鈥�

During the pandemic, when learning and work suddenly went virtual, telehealth programs for schools . of school-based health centers showed that during the 2020-21 school year, more than 80% of respondents offered telehealth services, up from 19% in 2016-17. 

The financial landscape has since changed. A lot of districts are now cutting budgets to close deficits. GovSpend, which doesn鈥檛 capture all district spending, shows a decline in payments to , a similar company, since 2023, while , another virtual mental health provider, saw a more stable influx of funds from 2024 to 2025. 

Among providers, however, Hazel Health stands out. The company, which serves 6,000 schools in 21 states, initially focused on primary health care, with physicians prescribing over-the-counter medications for routine symptoms like stomach pain or headaches. In 2021, the company broadened its model to provide mental health services and respond to 鈥渞ising unmet student needs and limited access to care,鈥� Fetterley said. 

In Florida鈥檚 Duval County schools, Brittany Beimourtusting reached out to Hazel last school year when she was going through a divorce. Her middle child, she said, was having trouble adjusting.

鈥淚t was a single-parent household all of a sudden, and I thought, 鈥楬ow am I supposed to get him to get help because I think he could use therapy,鈥� 鈥� she said. The provider, she said, met with him about five times and helped him open up about what he was feeling. 鈥淚t was definitely worth it.鈥�

But when Superintendent Christopher Bernier looked for ways to save the district some money last year, a $1.4 million payment to Hazel was on the list.

鈥楢 connected system鈥� 

Four years ago, the startup鈥檚 future looked bright.

It attracted over $50 million from investors, including Fiore Ventures, founded by Walton family heiress Carrie Walton Penner. As recently as last year, Hazel was still eyeing growth. It made two acquisitions, including , which offers family therapy, to further expand mental health services. 

鈥淭ogether, we are building a connected system that supports children from their classrooms to their kitchen tables,鈥� wrote Andrew Post, then 贬补锄别濒鈥檚 president, in October. But he has since resigned, writing this month that it was time to turn to the 鈥渘ext chapter鈥� in his career.

贬补锄别濒鈥檚 was supposed to run through the end of 2027. Now it will end on June 30. Still, district officials said the layoffs have had no impact on the services students receive. In a pilot program that began in March 2025, the district made mental health services available to 84 high schools. As of January, 420 students had taken advantage of the program, the district said.

In December, Destiny Singleton, the honorary student member of the Chicago Board of Education, told members that students don鈥檛 always feel comfortable talking to school counselors about personal issues because those staff members are often focused on academic performance and preparing for college. That鈥檚 why talking to an outsider can be helpful. But she added that students at the district鈥檚 larger high schools are often unaware that Hazel is even an option.

Some Chicago parents, however, are wary of Hazel and say families don鈥檛 always know what they鈥檝e agreed to when they consent to allowing their child to meet with a Hazel provider. In to Chicago district leaders last year, student privacy advocates said they were concerned about whether Hazel properly secures students鈥� private information. 

The company鈥檚 acquisition of Little Otter, , raises red flags because Rebecca Egger, its CEO, formerly worked for Palantir, a federal contractor known for using AI to assist the Department of Homeland Security in its . 

In a response to Chicago officials, Romm, the CEO, wrote that Hazel does not 鈥渟ell, share, or use student data for any commercial purpose,鈥� and that it 鈥渄oes not have any relationship with Palantir, commercial or strategic.鈥�

Fetterley, the company spokeswoman, also said Hazel is in the early stages of rolling out chatbots to 鈥渟implify administrative tasks like scheduling for parents and clinicians,鈥� but that AI will never be a 鈥渟ubstitute for our human providers.鈥�

Even so, some districts see a much higher demand for in-person rather than virtual clinicians. In Broward County, Florida, where Hazel provides medical services, but not mental health support, 179 students completed a telehealth visit between August and December last year, according to district data. Over that same time period, more than 134,000 students visited a school clinic.

鈥淧arents want nurses,鈥� Cynthia Dominique, chair of the District Advisory Council and a parent in the district, told the school board in March. As a nurse practitioner, she questioned how a provider working remotely can diagnose and treat most common symptoms, like congestion or a sore throat.

鈥淚 can’t ask the registrar from the front desk, 鈥楥an you look in the kid鈥檚 mouth and tell me what you see?鈥� 鈥� she told 社区黑料. 鈥淭hey don’t know what they’re looking for.鈥�

For district leaders, however, 贬补锄别濒鈥檚 ability to keep kids from missing school provided an effective selling point.

During a 2023 meeting, Duval County School Board Member Darryl Willie said the program had saved the district 4,000 鈥渃lassroom hours鈥� during the 2021-22 school year.

鈥淲e’re talking about making sure we’re focused on reading, writing and math,鈥� he said. 鈥淭he only way we can do that is if students are in school, in classrooms, sitting in seats.鈥�

Disclosure: Walton Family Foundation provides financial support to 社区黑料.

Just weeks after approving limits on screen time for preschoolers, Alabama lawmakers are mounting a last minute push to set screen time limits for all public school students. 

The House Education Policy Committee Thursday approved , sponsored by Rep. Jeana Ross, R-Guntersville and filed on March 5.  The bill is an extension of the signed by Gov. Kay Ivey earlier this month. 

鈥淲hat I鈥檓 hoping this will accomplish is that these two acts will work together to create a continuous research based framework for developmentally appropriate technology you see from from early childhood to 12th grade,鈥� Ross said in an interview Friday.

Among other features, 搁辞蝉蝉鈥� bill would limit total screen time instruction in schools to two hours a day and mandate regular vision breaks after screen use.

搁辞蝉蝉鈥� limited screen time for children from birth until kindergarten in licensed child-care facilities, public kindergarten classrooms and specific Pre-K classes. Under the law, the Department of Early Childhood Education, Alabama State Department of Education and Department of Human Resources would collaborate on creative guidelines for appropriate screen time usage.

During committee, Reps. Alan Baker, R-Brewton, and Marcus Paramore, R-Troy, brought extending the limit to 12th grade and requiring students to follow the 鈥�20-20-20 rule鈥� during scheduled screen breaks. The 20-20-20 rule states every 20 minutes students must look at an object at least 20 feet away from them for at least 20 seconds. The method has been recommended by the to reduce and prevent eye strain.

Mark Dixon, president of A+ Education Partnership, a education nonprofit, said in an interview Friday the organization supported the bill. 

鈥淲e鈥檝e seen the benefits of the cell phone ban that legislature and Gov. Ivey passed last year; we were already seeing the benefits in classes this year, and A+ is support of limiting screen time in an age-appropriate manner,鈥� he said.

Messages seeking comment were left with School Superintendents of Alabama and Alabama Association of School Boards Friday.

During the meeting, Rep. Terri Collins, R-Decatur, who chairs the committee, said Rep. Chris Blackshear, R-Smiths Station, brought the idea of expanding the limit to 12th grade. Attempts to reach Blackshear were not immediately successful.

Under HB 584, a 17-member task force composed of educators; vision specialists and national experts in child development, digital media research or cognitive science will work in collaboration with the Alabama State Department of Education to develop guidelines for best practices for screen-based instruction.

鈥淲e want it to be high quality and to be used intentionally, again, just avoiding that passive use of technology, just like with the birth to age five kindergarten, but on up through 12th grade, our technology is intentional,鈥� Ross said.

Ross said after her original bill passed she heard concerns from parents about whether or not the bill would dictate what goes on in their homes. She said both bills only relate to instructional time in classrooms.

鈥淚t has nothing to do with what parents choose to do in their homes, but all to do with what happens in public schools and in places that receive public funds,鈥� she said.

The bill was not on Tuesday鈥檚 House agenda as of Friday afternoon. There are seven legislative days left in the 2026 regular session. 

is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Alabama Reflector maintains editorial independence. Contact Editor Brian Lyman for questions: info@alabamareflector.com.

School choice was a central point of disagreement, with Republican governors more likely to advocate for increased use of public funds for private schooling. A subset of Republican governors also focused on restricting transgender participation in women鈥檚 sports. Some Democratic governors fervently criticized Immigration and Customs Enforcement for conducting raids in and around schools.

But governors from both parties prioritized improving student achievement 鈥� especially in literacy 鈥� and increasing funding for public education and teacher pay. School nutrition emerged as a newly prominent area of shared focus. 

School Choice

Thirteen governors 鈥� all Republicans except for Arizona鈥檚 Katie Hobbs 鈥� referenced school choice in their speeches, with the vast majority promoting the use of public dollars for private education. 

Several governors advocated for expansion of their state鈥檚 private school choice programs, either by increasing funding or by broadening eligibility for participation. Missouri鈥檚 governor, Mike Kehoe, for example, proposed investing an additional $10 million in the MO Scholars Program. By contrast, South Carolina Gov. Henry McMaster focused on eligibility, calling for universal access to the state鈥檚 education scholarship trust fund, which is currently limited to low-income families. 

Three governors announced that they will opt in to the new federal tax credit scholarship program. South Dakota鈥檚 Larry Rhoden praised the program and said the state will work with private school, public school and homeschool leaders to prepare for implementation in January 2027.

Other governors highlighted the need for more guardrails in private school choice programs. Hobbs continued to call for increased oversight of Arizona’s universal ESA program, arguing that a program originally designed to support students with disabilities and military families

has become vulnerable to waste, fraud and abuse, while Idaho鈥檚 Brad Little called for greater accountability in his state鈥檚 choice program.

Meanwhile, Kehoe and Alaska Gov. Mike Dunleavy, who are both Republicans, urged state lawmakers to support more choices for students within public education. Kehoe set aside $7.5 million for open school district enrollment, and Iowa鈥檚 Kim Reynolds proposed that per-pupil funding follow students to charter schools. 

Higher Education

Twenty-two governors discussed higher education priorities, largely centered on financial aid and affordability. Colorado鈥檚 Jared Polis continued his commitment to making the first two years at the state’s public colleges free for low-income high school graduates, and Indiana鈥檚 Mike Braun announced a freeze on tuition and mandatory fees at every public university for the next two years.

Others proposed targeted scholarships. Nebraska Gov. Jim Pillen promised that every in-state student who scores a 33 or better on the ACT will receive a full scholarship, including housing, to the University of Nebraska. Georgia鈥檚 Brian Kemp proposed a $325 million investment in the state university’s needs-based DREAMS Scholarships.

Five governors proposed health sector-related higher education initiatives. New Mexico Gov. Michelle Lujan Grisham announced the construction and endowment of a new medical school. Idaho鈥檚 Little committed $1 million to support graduate medical education, while Kentucky Gov. Andy Beshear proposed $25 million for nursing student loan forgiveness. 

Workforce Development

Looking beyond traditional post-secondary pathways, 15 governors highlighted workforce development initiatives and the importance of aligning career and technical education with the demands of a dynamic job market. 

Both Republican and Democratic governors proposed expanding K-12 and postsecondary programs that connect students to apprenticeships in skilled trades, health care, education and technology. Hawaii Gov. Josh Green, who proposed construction apprenticeships directly tied to affordable housing initiatives and partnerships between schools and nonprofits to train the next generation of climate stewards 鈥� key priorities for the state.

Kehoe announced support for a specific trade: pet grooming. His budget includes funding for expanding a Kansas City nonprofit called Pawsperity, which he said has helped 200 low-income students achieve financial stability through a stable career.

The governors of Colorado and South Dakota called for stronger state-level coordination, proposing new agencies to track workforce readiness and expand access to CTE.

Early Learning/Child Care

In line with initiatives to strengthen the workforce, 20 governors 鈥� Democrats and Republicans 鈥� proposed expanding early care and learning to increase access and affordability for working parents. 

New York Gov. Kathy Hochul pledged to fully fund New York City Mayor Zohran Mamdani鈥檚 universal child care program for 2-year-olds for its first two years, while Grisham called for universal child care statewide in New Mexico. 

Seven governors 鈥� six Democrats and South Carolina鈥檚 McMaster 鈥� highlighted continued or new commitments to universal pre-K, while others suggested incremental expansions to early learning. Washington Gov. Bob Ferguson, for example, proposed using private investment to add 10,000 new seats in free early learning programs statewide, and Indiana鈥檚 Mike Braun suggested requiring businesses to have 鈥渟kin in the game鈥� to help reduce child care costs and expand access. 

Student Health

In last year鈥檚 addresses, several governors 鈥� predominantly Republicans 鈥� announced plans to ban cellphones in schools, with many framing the policies as necessary to protect students鈥� mental and behavioral health. 

This year, six Democrats and three Republicans proposed similar restrictions, though many emphasized improving student learning as the primary rationale. Kansas鈥檚 Laura Kelly, for example, proposed a school cellphone ban because the devices 鈥渁re making it much harder for our children to learn and for our teachers to teach.鈥� 

Still, student mental health was a concern, particularly regarding online safety. Republican Florida Gov. Ron DeSantis warned parents about artificial intelligence chatbots, citing concerns about their connection to teen suicides. Democratic governors in New York, Pennsylvania and Massachusetts proposed restrictions on social media use for children 鈥� Hochul鈥檚 plan includes disabling AI chatbots, blocking location sharing and restricting access to online sports gambling.

Notably, only two governors, Pennsylvania鈥檚 Josh Shapiro and Wisconsin鈥檚 Tony Evers, proposed new investments in K-12 mental health services.

School Nutrition

Nutrition and school meals emerged as a new priority in this year鈥檚 addresses, with many governors referencing the Trump administration鈥檚 campaign to improve food quality and wellness nationwide. Ten governors, both Democratic and Republican, introduced initiatives aimed at improving student nutrition. 

Kansas鈥� Kelly proposed making school meals free for all students now eligible for reduced pricing, and Hawaii鈥檚 Green extended free school meals to families at 300% of the federal poverty level.

Regarding the food itself, Little proposed a bill to remove artificial dye from school lunches, while California Gov. Gavin Newsom encouraged the continuation of efforts to remove highly processed foods from school cafeterias. Despite tightening restrictions, no alternatives or funding for healthier food were proposed. 

Three Republican governors, citing health concerns such as obesity, proposed removing candy, soda, energy drinks and other unhealthy foods from programs that provide federal subsidies for students when school is not in session: Supplemental Nutrition Assistance Program (SNAP) and Summer Electronic Benefit Transfer (EBT).      

This report was produced through a partnership between and 社区黑料. Senior Producer Meghan Gallagher of 社区黑料 developed the interactive maps.聽

As a practicing dentist in Montclair, California, I regularly see children whose ability to learn is undermined by untreated dental disease. They arrive in pain, exhausted from poor sleep, unable to concentrate and often embarrassed to smile or speak. These children are not outliers. They represent a widespread and preventable problem that directly affects academic success.

The connection between oral health and school performance is well-documented. A found that children with one or more untreated decayed teeth were significantly more likely to have poor academic performance and higher absenteeism rates than children without dental issues. consistently show that dental problems are linked to lower grades, difficulty completing homework and reduced psychosocial well-being.

This relationship is easy to understand. Dental pain interferes with sleep, nutrition, focus and emotional regulation. A child who spends the night awake with a toothache will struggle to pay attention the next day, if they even reach school. According to a study published in the American Journal of Public Health, children with poor oral health were nearly as their healthy counterparts.

Moreover, a child who feels embarrassed by visible dental issues may avoid participating in class or reading aloud. All the data lead us to the same conclusion: Frequent absences for emergency dental visits cause students to fall behind academically and socially, creating a cycle that becomes harder to break over time.

Unfortunately, poor oral health disproportionately affects children from low-income families and communities with limited access to dental providers. While California鈥檚 Medi-Cal dental coverage exists, and provider shortages mean many families struggle to find timely care. In 2022, fewer than half of received a preventive dental visit. I regularly hear the same story from these distressed parents. They called several offices before finding one that accepts Medi-Cal patients or has open appointments within weeks or even months.

As a result, minor dental issues often turn into painful infections that disrupt school attendance and learning. This is particularly concerning given that dental caries is the among children in the United States. When combined with socioeconomic disadvantage, limited access to care, and poor oral health becomes a serious public health issue. Across California, Hispanic children are as white children to experience untreated cavities.

If decision makers are serious about improving educational outcomes, oral health must be treated as part of the educational system, not as an optional or separate medical concern. School-based dental programs can play a critical role by providing preventive services, early screenings, fluoride treatments, and sealants directly where children already are.

A great example of good practice is the program in California. It is a demonstration project testing the delivery of health-related services and information via telecommunications technologies. Dental hygienists and assistants go to community sites such as schools, Head Start programs, day care centers and nursing homes to conduct exams and collect diagnostic information. Then the dentist uses the collected data to advise the local provider on the needed preventive and routine restorative care.

When necessary, patients are referred to dental offices for more complex needs. These lower-cost providers meet many of their patients鈥� oral health needs. Such programs, if funded by MediCal, would drastically reduce absenteeism and catch problems before they become emergencies.

Access also depends on policy. Policymakers must increase reimbursement rates to enable more dental providers to accept low-income patients, thereby expanding care for families who currently face long wait times or no options at all. Integrating dental screenings into existing school health services, alongside vision and hearing checks, would help ensure that oral health issues are identified early. At the same time, comprehensive oral health education that involves parents, teachers, and caregivers can reinforce prevention at home and in the classroom.

We would never expect a child with untreated vision problems to succeed without glasses or a child with hearing loss to learn without support. Expecting children to perform academically while experiencing a toothache and infection is no different.

Education begins with a child who is healthy, comfortable, and able to focus. If we truly care about learning, we must start treating children鈥檚 oral health as what it really is: a foundation for academic success, not an afterthought.

As education leaders, we cannot afford to limit our search for solutions to what we conventionally think of as “education interventions.” What if one of our most powerful tools for improving student outcomes has been overlooked because it doesn’t fit neatly into our current frameworks?

Early evidence that air filters could improve education outcomes started to emerge years before the COVID-19 pandemic and came from a surprising source: a natural gas leak in Aliso Canyon, California. In late 2015 the gas company, facing public pressure, installed commercial-grade air purifiers in every classroom within a five-mile radius. Michael Gilraine, an economist studying the incident, recognized a rare opportunity: Schools just inside the five-mile boundary received air filters, while demographically similar schools just outside the artificial boundary did not.

that students in schools with air filters saw their test scores jump: Math scores increased by about three months of learning, and English scores were close behind. The gains persisted and even grew over time. To put this effect size into context, students in the most prominent class-size study, the 鈥� who were randomly placed in much smaller classes averaging 15 students instead of 22 鈥� experienced roughly similar gains.

That intervention cost about $7,000 per student in today鈥檚 dollars. The Aliso Canyon air purifiers, electricity costs, and replacement filters combined cost about $1000 per classroom, approximately $30 per student, less than 1% of what Tennessee spent to reduce class sizes by a third. With recent innovations in air purifiers, annual costs per classroom could be considerably less.

If these effect sizes replicate 鈥� and further research is needed 鈥� air cleaning would significantly outperform the highest-regarded interventions in the U.S. education world for its cost, including the Perry Preschool study, high-dosage tutoring, and Head Start.

The evidence base for the education benefits of portable air cleaners 鈥� on top of the health benefits 鈥� is growing:

• A found that air purifiers cut student absenteeism by 12.5%, with even larger effects for students with higher starting rates of absenteeism. The intervention was highly cost-effective,
• Illness-related absences plummeted by 55% when .
• 聽Improving ventilation and removing mold in schools led to in English and math scores as well as pass rates.
• Israeli students on high-stakes exams when air pollution spiked on test day. were found in China.聽
• Even modest rises in air pollution in China.聽
• Just two hours of breathing filtered air .

Air quality improvements appear to create cascading benefits across multiple systems: First, there are direct cognitive gains. Fine particulate matter that students and staff inhale doesn’t just irritate lungs, it crosses into the bloodstream, triggers systemic inflammation and can even breach the blood-brain barrier. Breathing cleaner air helps you think faster, remember more and make fewer errors.

Second, there are direct health improvements, which in turn affect both attendance and performance. Reducing respiratory infections, allergies and asthma triggers keeps students and staff healthier and in school. Fewer sick days means more instructional time, less reliance on substitutes and better instructional continuity. And fewer infections mean fewer sick days for parents, too. At a time when measles cases are on the rise nationally, tuberculosis is at its highest rates in decades in multiple states and are showing the H5N1 influenza virus is airborne, this is a particularly critical moment to make sure our students can breathe safe air.

Third, this intervention helps address inherent inequalities in our education systems. Schools serving low-income communities are more likely to be near highways, industrial facilities and other sources of air pollution that are known to negatively impact students. These students are also more likely to learn in older buildings with poor ventilation and decaying materials whose dust, often toxic, ends up in students鈥� lungs. Cleaning the air is likely to benefit all students, but especially those who are worst off economically.

Thankfully the administrative burden, which often makes or breaks even highly promising interventions, is minimal. Reducing class sizes requires hiring more teachers, building more classrooms and restructuring schedules. High-dosage tutoring entails recruiting, training, scheduling and coordination. Air purifiers? Order them online, plug them in, and quickly change filters once a year 鈥� no need for expensive retrofits.

We cannot afford to ignore air quality in education. Many school systems recognized this during the pandemic and purchased new equipment, but some have turned off or unplugged their devices, perhaps thinking that they were only necessary during the height of COVID-19 transmission to help keep schools open. As we begin the new school year, let鈥檚 reconnect these devices and install new filters, often as little as $50 to $100 a classroom.

For school systems that don鈥檛 yet have portable air cleaners, consider first piloting and then rolling out system-wide. These districts should install devices in every classroom and staff room, aiming for a Clean Air Delivery Rate (CADR) of at least 30 cubic feet per minute per student and quieter than 50 decibels. Schools should monitor not just test scores but also absenteeism, nurse visits and teacher satisfaction.

Philanthropy can add air cleaning interventions to its portfolios alongside more traditional education grantmaking. They can create programs that provide devices to under-resourced schools, fund larger trials to further evaluate the promising findings to date, underwrite R&D for even more effective and quiet air purifiers for classrooms and develop bulk purchasing agreements to reduce costs.

Advocates and activists can build coalitions for indoor air quality standards in schools and funding for air quality programs. Researchers can advance large-scale randomized controlled trials examining student, teacher and even parent outcomes across grade levels.

We鈥檙e living through a paradigm shift in our understanding of indoor air quality which has handed education an unexpected gift: a simple, affordable, and powerful tool for improving education. We’d be foolish not to use it.

All Alaska students could be provided free breakfast and lunch at school, under a new bill in the Alaska Legislature.

Democratic Rep. Maxine Dibert of Fairbanks prefiled the legislation, , ahead of the legislative session that began on Tuesday. The bill would direct the state to provide sufficient funding to all districts to have breakfast and lunch for any student who requests it, free of cost.

鈥淚鈥檝e seen the effects of feeding our kids, and especially during COVID, when all kids got lunches and breakfast at no cost,鈥� said Dibert, who has been a teacher. 鈥淪o it was just very enlightening, and I would love to see that again for our families and for our students and for our school staff.鈥�

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During the COVID-19 pandemic, federal relief funding allowed schools to provide free meals due to federal waivers. But those funds sunsetted in 2022, resulting in some

, over half of Alaska鈥檚 students 鈥� 51% 鈥� were eligible for free or reduced price meals. An estimated 46%, or roughly 48,000 students, were enrolled to receive free school meals.

As an elementary school teacher in Fairbanks for 22 years, Dibert said she herself sometimes paid for her students to eat, rather than see them go hungry.

鈥淥ver the years, if a student didn鈥檛 have enough money, or their bill wasn鈥檛 paid, oftentimes I would even pay with my account,鈥� she said. 鈥淚 don鈥檛 know entirely how big those bills got, because I was on the classroom side of it. But I did really not like seeing kids come into the classroom sad that they couldn鈥檛 get breakfast or lunch.鈥�

Dibert, who is Koyukon Athabascan, also cited the current Yukon River salmon crash leaving communities and families who subsisted and shared fish going without.

鈥淢y grandparents lived out on the Yukon River, and as a child, they would always send us salmon from the Yukon River. And we always would have food on our table, lots of salmon,鈥� she said. 鈥淪o with no salmon on the Yukon, I know that鈥檚 a hardship to feed families, and it鈥檚 costly to families. So in that aspect, this bill could be very beneficial to ease the pain there, to help feed kids.鈥�

Education and health researchers point to universal free meals having for students, including improved academic performance, attendance and student health outcomes.

Dibert said the bill is in the beginning stages of the legislative process, so details will be worked out, but she hopes the program would also promote local foods on school menus, like salmon or moose. 鈥淚t would be working district by district, for sure,鈥� she said. 鈥淚 don鈥檛 want it to be canned, you know, protein, like, one grain, one fruit.鈥�

The allocations to school districts would also vary by region and food prices, she said, accommodating notoriously higher grocery prices in Alaska鈥檚 rural areas.

She said funding the proposal could include some federal or municipal contributions as well.

鈥淚t鈥檚 not that much to have the opportunity to feed our kids,鈥� she said.

Last year, the Legislature axed funding for making reduced-priced lunches free for low-income students, The estimated $480,000 in funding was to be taken from the Department of Corrections, but lawmakers voted against it.

Once the bill has been formally introduced during a House floor session, it will next be assigned to relevant committees for discussion and debate in the coming weeks.

is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Alaska Beacon maintains editorial independence. Contact Editor Andrew Kitchenman for questions: info@alaskabeacon.com.

The state dragged its sex education guidelines into a new millennium last year, updating health frameworks for pre-K through 12th grade students to include modern language on sexuality and consent. But a growing coalition that has pushed for the better part of a decade to keep sex ed in step with the times says there鈥檚 still more work to be done 鈥� if only the House of Representatives will get on board.

Supporters of the are taking a fifth swing at passing the legislation, which has made it through the state Senate four times only to fizzle in the House. The Senate is expected to vote on the bill next week, and proponents believe the tide is finally turning in their favor in both chambers.

鈥淚 just think that the time is now,鈥� said bill sponsor Sen. Sal DiDomenico, of Everett, who has pushed for the Healthy Youth Act for the past decade along with House sponsor Rep. Jim O鈥橠ay, of West Boylston. 鈥淚 think there’s momentum built up behind the bill,鈥� DiDomenico said. 鈥淭he coalition has been working very hard, getting support and just showing people that we don’t have time to wait 鈥� these are kids who are still making decisions every single day and still talking about this every single day in their own little groups, and we need to get that information in their hands so they can make the decisions going forward.鈥�

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Though the Department of Elementary and Secondary Education last year its sex and health education guidelines for the , with support from Gov. Maura Healey, the Healthy Youth Act has 鈥渢eeth鈥� that the framework does not, DiDomenico said.

Broadly, the act would require that state standards for sex and health education be inclusive, reflective of current science, and updated at least every 10 years. Cities and towns would be required to describe their sexual education curricula to the department each year, as well as report the number of students receiving that education.

The new DESE framework 鈥渋s a good suggestion,鈥� DiDomenico said. 鈥淚t鈥檚 a floor, but not really digging deep into the curriculum standards.鈥� For instance, he said, it still allows schools to choose to provide abstinence-only sex education. Under the Healthy Youth Act, any educational institution that offers a sex ed course has to provide 鈥渕edically accurate, age-appropriate, comprehensive sexual health education.鈥�

Under the act, health curriculum guidelines would cover human anatomy, reproductive and sexual activity, preventing sexually transmitted diseases and HIV/AIDS, effective use of contraceptives, discussing safe sexual activity and healthy relationships, and age-appropriate education on gender identity and sexual orientation that affirms a variety of gender and sexual identities.

The act would not override or change Massachusetts state law allowing schools to decide whether to offer sexual health courses and parents to opt their children out of that health segment. Parents and guardians would be informed by letter about the comprehensive sex education curriculum and informed of the opt-out option.

But the act would prevent the molasses-like evolution of sex ed frameworks that鈥檚 marked the last quarter-century. It isn鈥檛 enough, DiDomenico said, to bank on a sympathetic governor with an interest in inclusive health policy.

鈥淲e don’t know what the future brings us and who will be in that seat,鈥� he said. “So if we do not have a regular updating process, then it’s up to the will of the people who are in charge at that particular moment in time and if they decide to kick the can down the road, or they decide not to address it, or they decide to just ignore it and hope that someone else will take it up at a later date.鈥�

Gearing up for yet another tilt at the windmill, supporters have said this cycle that momentum is on their side 鈥� around 80 representatives and senators have signed on to versions of , including members of House leadership. This push coincided last year with a wave of anxiety about reproductive choices and support for LGBTQ+ people.

Speaker Ron Mariano, who stood alongside elected leaders and reproductive health organizations to for protecting access to medication abortion, said at the time about the sex ed bill that he was 鈥済oing through the details and having conversations with members.鈥� His office did not respond to requests for comment.

This first appeared on and is republished here under a Creative Commons license.

Fewer Kentucky kindergarteners were ready to learn in the 2022-2023 school year than in 2018, according to a new report that measures child welfare.

This insight comes from the , released by Kentucky Youth Advocates Wednesday. Kids Count is part of a national initiative from the Annie E. Casey Foundation.

Kentucky Youth Advocates (KYA) compiled the state鈥檚 report with data from the Administrative Office of the Courts, Kentucky Cabinet for Health and Family Services, Department for Medicaid Services, Kentucky Center for Statistics and others.

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Fewer kindergarteners being ready to learn is a symptom of , early childhood expert Sarah Taylor Vanover with KYA told the Lantern. For the past three years many children missed out on pivotal socialization. That means they鈥檙e coming into school without the skills to self-regulate and work with others, Vanover explained.

鈥淭hree and four -year-olds鈥ight have been having Zoom story times during the pandemic, but they weren鈥檛 getting to learn to play together,鈥� she said. These early years, Vanover said, are when children learn to use their words to express emotion. But a lot of kids now, she said, 鈥渕issed a lot of those things.鈥�

The report also found that more children were in foster care from 2020-2022 than 2015-2017. And, fewer children left foster care and were reunited with biological families.

KYA staff looked at 16 when compiling the Kids Count book. They include the number of children in poverty, foster care and the juvenile justice system; education achievements; teen births and more.

The data shows some positive markers for Kentucky鈥檚 youth. There were 2% more fourth graders proficient in reading in the 2022-2023 school year than in the 2021-2022 school year. The number of high school students graduating on time increased from 90% to 91%.

鈥淲e鈥檝e seen profound resilience of communities through recovery from natural disasters and the pandemic 鈥� yet those challenges present lasting impacts on family stability, mental health, education outcomes, and so much more,鈥� Terry Brooks, the executive director of Kentucky Youth Advocates , said in a statement. 鈥淎nd unless and until we tackle childhood poverty 鈥� impacting more than one in five young people 鈥� Kentucky kids will continue to fall behind.鈥�

Youth quoted in the report also said that during the next legislative session, lawmakers should invest in mental health resources, addressing food insecurities, substance use prevention and more.

Child population by race

Kentucky had 1,113,478 youth ages 0-19 in 2022, the new report shows. Of those, 854,336 are white, 105,880 are Black, 78,533 are Latinx, 21,579 are Asian, 1,462 are Native American or Native Alaskan, 1,182 are Native Hiwaiian or Pacific Islander and 50,506 are two or more races.

Economic Security

Nearly half 鈥� 44% 鈥� of Kentucky鈥檚 renters live in households that spend roughly a third of their income on rent and utilities. Eastern Kentucky counties are most affected by this, the data shows, with a swath of counties having 50-59% of their families paying a third of their income in rent and utilities.

The solution to this, the report says, is to invest in affordable and rural housing.

The report also includes a dive into , a sector long troubled in Kentucky and worsened by the COVID-19 pandemic.

The 鈥渟ignificant burden鈥� of child care, which costs more than $7,000 per year on average in Kentucky, means one in nine families experience an interruption in their workforce participation. Meanwhile, most of Kentucky鈥檚 counties 鈥� 79 out of 120 鈥� are child care deserts, meaning they don鈥檛 have enough child care to match the number of children in need of it.

There is also a waiting list for afterschool programs in Kentucky, which are also short staffed.

Advocates said the state should dedicate funding to this sector as a solution to the crisis. They also want to see lawmakers help Kentucky鈥檚 children get free meals at school. Currently 12% of Kentucky schools do not participate in , which allows the nation鈥檚 highest poverty schools and districts to serve breakfast and lunch at no cost to all enrolled students without collecting household applications, according to Kids Count.

How healthy are Kentucky鈥檚 children?

Researchers want to see lawmakers increase reimbursement rates for dental providers to expand the Medicaid network for dental care. That鈥檚 because they found that people with Medicaid who had fewer dental care options ended up getting emergency department care for 鈥渘on-traumatic dental conditions.鈥�

鈥淭his treatment is not only outside the scope of most (emergency department) providers but also expensive, costing Kentucky more than $44M annually,鈥� the report states.

Lawmakers should also consider investing in the mental health workforce through an increase in reimbursement rates, researchers said, since 1 in 6 children ages 13-17 have anxiety or depression.

On juvenile justice

Researchers want to see Kentucky lawmakers invest in community based alternatives to , which they say cost the state less than detention and are more effective. (During the interim, committee members dedicated to examining the have heard from a number of such programs).

It costs about $588 every day to jail a minor, the Kids Count report says, while costing about $75 in diversion.

鈥淜entucky has an established record of failing to meet the basic standard of care for kids in detention and improve outcomes of justice-involved youth,鈥� Kids Count states. 鈥淲hen a child makes a mistake, diversion and other community-based alternatives to detention, such as mental health services, mentoring, and educational supports are more effective in reducing recidivism. Youth who complete these programs also have a higher likelihood of completing high school, attending college, and earning more income in adulthood.鈥�

The insights in this report should be a 鈥渞oadmap鈥� for Gov. Andy Beshear as he enters his second term as Kentucky governor, Brooks said. It should also, he said, guide Kentucky鈥檚 lawmakers, who in 2024 will make budgetary decisions when they convene for the legislative session.

鈥淲hat we want these numbers to do,鈥� Brooks said during a Wednesday press conference, 鈥渋s galvanize Gov. Beshear. And we want it to galvanize (Senate President Robert Rivers鈥� and we want it to galvanize (House Speaker David Osborne) into creating a common ground, common sense agenda for the common good of Kentucky鈥檚 kids.鈥�

To read the full Kids Count report, visit

is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Kentucky Lantern maintains editorial independence. Contact Editor Jamie Lucke for questions: info@kentuckylantern.com. Follow Kentucky Lantern on and .

DENTON鈥� A North Texas school district plans to open a new school-based health clinic to serve its students covered by Medicaid, despite concerns from certain parents that the district is overstepping its role.

Leaders in the Denton Independent School District say the clinic will make health care more readily available for its students 鈥� 49% of whom are eligible for the federal free or reduced price lunch program, an indicator of economic hardship.

In August, the school board approved a partnership with North Texas nonprofit PediPlace to construct a medical clinic inside one of its high schools. The clinic, which is set to open in January, will be the second of its kind in Denton County, one of the fastest-growing counties in the state.

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PediPlace operates the other clinic in the county out of a high school in the neighboring Lewisville Independent School District. Both clinics provide preventive care, vaccinations and mental health screening and counseling.

Over five million children in Texas are on Medicaid, CHIP or are uninsured, making access to reliable health care difficult and time-consuming. Texas has made over the past several years as the number of uninsured people has decreased. And, the state is still second in child Medicaid and CHIP enrollment.

Because underinsured children struggle to obtain treatment, the gap in care leaves school nurses in a constant battle to support students鈥� health, says Denton ISD Director of Health Services Nicole Goodman.

鈥淲e may be able to get them in to get that one problem solved, but we don’t have somewhere to send them long-term,鈥� Goodman said.

The clinic will be built at Fred Moore High School, an early graduation high school with a small class size of 56 students. All 30,000 students enrolled in the district, regardless of which school they attend will be able to use the clinic as long as they are on Medicaid.

The new clinic opens as. School board meetings addressing the partnership were met with constant public comments from parents concerned about what one parent described as 鈥渦ndermining parental authority.鈥� Multiple parents described the clinic as a 鈥淧andora鈥檚 Box鈥� to more clinics in schools or district overreach.

鈥淕rooming and indoctrination of children will more easily happen if you decide to treat children on campus,鈥� Denton resident Mary Knox said during Denton school board鈥檚 Aug. 22 meeting.

Critics of the clinic worry students would access care without parental consent, especially mental health services or gender-affirming care. In reality, parents must accompany children in order for them to receive care at PediPlace, and the clinic does not offer any kind of gender-affirming care.

Denton ISD鈥檚 board of trustees ultimately approved the creation of the clinic, 6-1. Board member Amy Bundgus was the lone no vote.

While Denton ISD鈥檚 clinic was approved, other districts in the state have also experienced the brunt of parents鈥� rights advocates. The Humble Independent School District in Houston initially halted plans to build a clinic in one of its high schools due to concerns about gender-affirming care and birth control access. It鈥檚 moving forward after a 5-2 vote from Humble ISD鈥檚 school board.

There are almost 90 school-based health centers in Texas, almost all of them are concentrated in urban areas like Dallas, Fort Worth and Houston. Fewer still are geared solely toward students on Medicaid or CHIP.

The Texas Department of State Health Services funded a small number of school-based clinics across the state until 2021, when state agencies were asked to reduce their budget.

For lower-income family members unable to afford to take days off for doctor visits, school is often their first stop when a child needs to be treated.

鈥淐hildren would show up early to school to essentially be triaged by the school nurse so their parents could determine, did the child have to go to the doctor?鈥� said Larry Robins, PediPlace鈥檚 president and chief executive officer.

In the past decade, the number of health providers who accept Medicaid in Denton County has fallen, from 320 to 183, according to the United Way of Denton County. Dr. Marquis Nuby, a Denton pediatrician who accepts Medicaid, the federal health insurance plan for low income Americans, says finding a doctor who accepts Medicaid can be a daunting task. Many health care professionals in Texas have refused to accept Medicaid because of its .

鈥淭here鈥檚 kids that will come for my practice that may come from Mesquite, may come from Garland, may come from Wise county, may come from Fort Worth,鈥� Nuby said. 鈥淭hey come out here, because they鈥檙e struggling to find a spot.鈥�

And amid a growing national mental health crisis, Nuby said access to mental health treatment is crucial, especially for children.

鈥淪ince COVID, it became a tsunami,鈥� Nuby said. 鈥淓very time I see someone for mental health, I鈥檓 losing money.鈥�

Most school-based health centers are funded by nonprofits or other organizations, like Denton ISD鈥檚 partnership with PediPlace. Robins said that despite the 鈥渧ery different communal response鈥� the proposed clinic received compared to PediPlace鈥檚 first clinic in Lewisville ISD, he feels community support is stronger than ever.

鈥淚 don’t believe that communities would be increasing funding if they weren’t wholeheartedly supportive investors in our mission and in the quality work that we provide,鈥� Robins said.

This article originally appeared in at .

The Texas Tribune is a member-supported, nonpartisan newsroom informing and engaging Texans on state politics and policy. Learn more at texastribune.org.

NYC has attempted to combat that inequity in a variety of ways. Former Mayor Bill de Blasio implemented initiatives ranging from , which cost the city almost , to universal pre-K, while current Mayor Eric Adams has called for and a mandatory .

Such initiatives are expensive and can take years to fully implement, not to mention properly evaluate. Their success rate is also spotty. Universal pre-K ended up than those in the middle class. The Renewal Schools were dubbed a , an African-American publication, which noted that 鈥渙nly a quarter of the 100 schools targeted by the program were reported to have seen any improvement at all.鈥�

There is, however, a cost-effective and immediate tweak that has proven effective in raising grades and test scores, as well as reducing suspensions for middle and high school students, especially those who are low-income: Starting the school day after 8:30 a.m. 

A study from :

We find robust evidence linking later start times to increased test scores for middle school students. A one-hour delay in middle school start times predicts math scores 8% of a standard deviation higher and reading scores 4% of a standard deviation higher. 鈥� These results are particularly large for economically disadvantaged students.

confirms these results for both middle and high school students: 

In the wealthier school, there wasn鈥檛 much change in missed school hours. But at the school with more low-income kids, the new start time boosted attendance. During the academic year, the school recorded an average of 13.6 absences and 4.3 tardies for the first period. Before the schedule change, those yearly numbers were 15.5 and 6.2. 鈥� Lower-income kids sometimes get worse grades than their wealthier peers 鈥� (T)here are many reasons why this might happen. Anything that helps reduce this achievement gap is a good thing. That includes better class attendance.

The average NYC public middle or high school starts between 8 and 8:20 a.m. A in 2018 shifted the start time to 8:30 at five schools. Seeing positive results in attendance and discipline, 14 more were added to the initiative in 2019.

Assemblyman Harvey Epstein has submitted a , co-sponsored by state Sen. Robert Jackson, to make 8:30 a.m. the earliest permitted school starting time. Any school that chose to begin earlier would risk losing state aid.

Still, the majority of NYC schools start before 8:30, and, in fact 鈥� due to the newly negotiated teachers contract 鈥� several have recently announced they鈥檒l be .

Notable exceptions include the Bard High School Early College schools, which are some of the highest-performing in the city. The Queens campus sets aside for students who qualify for free or reduced-price lunch, while, at the Manhattan campus, that number is . Both schools .

At the other end of the admissions spectrum is Essex Academy, which accepts students at all academic levels, with 65% qualifying for free lunch, and has an . There, at 9:25 a.m..

Starting middle and high schools later would not only improve attendance and cut down on suspensions, leading to higher grades and test scores, but it is a fix that can be implemented with minimal cost. And here is the most important aspect: The worst thing that will happen with moving to a later school start time is鈥� nothing. No change for the better, but also no change for the worse.

At a price point of nearly zero, an equal amount of risk and no evidence of unforeseen consequences, what excuse does any school have for not giving a post-8:30 a.m. start time a try?

Girls will soon be able to access period products for free in Ohio school bathrooms.

The state鈥檚 new operating budget includes a $5 million appropriation for the current fiscal year to install dispensers that will provide free period products in schools that enroll girls in grades 6-12. The bill also allows schools to offer free period products to students younger than sixth grade if they so choose.

鈥淭here are cheers all across the state right now from women and girls who are going to be so excited to find out in the future girls will be able to access period products at no costs in their schools,鈥� Senate Minority Leader Nickie J. Antonio, D-Lakewood, said Wednesday afternoon during a press conference.

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The budget allocates up to $2 million in fiscal year 2024 for public, non-public and charter schools to install dispensers for feminine hygiene products in each of their buildings. It also provide $3 million toward purchasing the products.

鈥淲e have regulated the provision of toilet paper and paper towels in public restrooms, so too we should do the same for menstrual products,鈥� Antonio said. 鈥淚t鈥檚 unhygienic and a danger actually to one鈥檚 health not to have access to menstrual products, so just like toilet paper, we need to have free and accessible access.鈥�

Twenty-three other states have , including Alabama, California, Illinois and Maryland.

Missing school

Nearly because they don鈥檛 have access to period products.

鈥淚t really gets in the way of them being able to rise to their fullest potential,鈥� Antonio said. 鈥淲hen students lack access to period products, they face barriers and may avoid going out in public while wearing period stained clothing in public without the necessary sanctuary products.鈥�

Girls shouldn鈥檛 have to choose between going to school and being able to purchase period products, said State Senator Stephanie Kunze, R-Dublin.

鈥淢issing a school day or missing partial school days over time is a really significant loss of educational time for girls,鈥� she said.

Lawmakers and advocates expect to see girls attendance in schools improve as a result of Ohio鈥檚 budget provision.

School attendance at a New York City high school went up providing free tampons and pads in bathrooms.

Period poverty

About two-thirds of low-income women could not afford menstrual products at some point, according to research published in the .

One in six women and girls between the ages of 12 to 44 are below the federal poverty line in Ohio, said Hamilton County Commissioner Denise Driehaus. Ohio鈥檚 federal poverty line for .

鈥淭ranslation: they can鈥檛 always afford period products,鈥� she said

This budget provision aims to reduce period poverty.

鈥淚t鈥檚 going to be so important to those students in those schools to be able to have the best education they can,鈥� Driehaus said.

In an effort to cut costs, some women use the same period products for too long without changing it.

鈥淭hat鈥檚 a health risk,鈥� she said. 鈥淚f they are accessible products in school bathrooms, that would not be an issue. You go in and get the product and away you go.鈥�

The average women in the throughout her lifetime, according to a 2015 article in Huffington Post.

鈥淧roviding no-cost period products in Ohio schools enables students to attend class, reduces period poverty and fosters gender equity,鈥� Driehaus said.

Kinsey Sullivan, a high school student at St. Ursula Academy in Cincinnati, knows firsthand how important it is having free period products accessible in schools.

鈥淚 don鈥檛 know if you know how awkward it is to slide a pad up your sleeve to walk to the bathroom,鈥� she said. 鈥淓veryone is looking at you. You have to ruffle through your backpack to just find one and it would be so much easier if they were provided for you in your bathroom.鈥�

Sullivan said this will improve girls鈥� mental health and confidence overall.

鈥淎ll students deserve this opportunity to learn, thrive and feel supported in schools,鈥� she said. 鈥淚t鈥檚 time that tampons and pads are provided for in the same way as toilet paper and soap.鈥�

is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Ohio Capital Journal maintains editorial independence. Contact Editor David DeWitt for questions: info@ohiocapitaljournal.com. Follow Ohio Capital Journal on and .

Since 2020, the COVID-19 emergency 鈥� a federal declaration issued by the secretary of the Department of Health and Human Services 鈥� has driven a surge in telehealth utilization among older Americans, enabled by regulatory waivers and flexibilities from the Centers for Medicaid and Medicare Service.

The same is true for the over children and adolescents served by Medicaid, the state-run government program that helps pay health care costs for people with limited income. While states have broad flexibility to determine whether to cover telehealth services under Medicaid, now have policies that allow for the reimbursement of at least one type of service when provided via telehealth in schools; 24 states had similar policies prior to the pandemic. So while school-based telehealth is not new, catalytic advances in school-based telehealth implementation were based on the widely shared goals of protecting student health and well-being, minimizing visits to local emergency rooms 鈥� already stretched thin because of the pandemic and its financial impacts 鈥� and providing better care to children and adolescents to optimize in-person learning.

This expansion was, and remains, an important equity opportunity for students, families and schools. First, telehealth holds the promise of dramatically to, and availability of, different types of physical and mental health care, regardless of where a student lives. Second, telehealth can potentially reduce out-of-pocket costs for patients due to , particularly in rural geographies. Third, given the widespread concerns around school , telehealth represents an opportunity to maximize the impact of a capacity-limited workforce. Maybe most critically, telehealth decreases burdens on families and students, for example, by reducing transportation challenges that can hinder access to care, resulting in more time spent in class.  

Given the potential benefits of telehealth and that for some conditions, such school-based care can improve the quality and effectiveness of care, it would seem nonsensical to dramatically scale back this service that matured during the pandemic.

There are, however, lingering policy and programmatic concerns relative to school-based telehealth delivery and governance that must be addressed for it to remain a viable health care model. For instance, a recent HHS Office of Inspector General concluded that approximately $130 million billed to Medicare during the first year of the pandemic for telehealth services included practices deemed high risk. Medicare is of course, not Medicaid. That said, the provision of unnecessary services, waste and fraud that have been documented in Medicare telehealth services likely exist in state-level Medicaid programs 鈥� based on previous occurrences of 鈥攁nd necessitate additional safeguards if telehealth is to become sustainable in schools. Additionally, there is the potential for violations of the Controlled Substances Act. Providers have by the Drug Enforcement Agency for prescribing controlled substances improperly. As many telehealth providers are increasingly serving children and adolescent populations, the risks of inappropriate prescribing are concerning.   

The costs associated with a permanent extension of Medicare telehealth coverage pose another challenge. The Congressional Budget Office that a two-year expansion of Medicare telehealth flexibilities would cost $2.5 billion. Again, while Medicare does not serve school-age populations, it has implications for schools. Medicare鈥檚 is so significant that decisions around Medicare and telehealth will likely impact how Medicaid and private insurers reimburse school-based telehealth services. If Medicare coverage for telehealth ends next year, it is difficult to see Medicaid coverage for school-based services remaining in place without significant revisions to existing policies, well-resourced and coordinated advocacy campaigns or a significant change in the economic outlook. Given the current variability in Medicaid coverage across states, schools using telehealth have relied on additional funding streams including, private insurance, federal pandemic relief money and other state sources. The formula schools have put in place to pay for telehealth services will likely need to be altered, if not entirely rethought. 

The dynamics around an extension of COVID emergency flexibilities remain uncertain. Proposed legislation circulating in Congress would extend them, but the costs and policy concerns pose a severe challenge to any congressional action. What is clear is that the Centers for Medicaid and Medicare Service and the U.S. Department of Education need to issue guidance for states, districts and schools that outline the various Public Health Emergency scenarios and requisite actions. 
For now, district and school health leaders should ensure they deeply understand the status of emergency waivers and the flexibilities that their organizations are utilizing. They should also reorient themselves with federal and state and procedures that were in place before the pandemic. They should similarly educate partner providers and school-based health staff on the current uncertainty around the emergency’s expiration and explain the potential need for swift implementation of new policies and procedures should the emergency not be extended. This work has significant budget implications. Finally, they should ensure that any additional requirements imposed on their organizations by the emergency flexibilities that are not expiring meet ongoing regulatory requirements.

A recent study in JAMA Pediatrics found that schools are 鈥�,鈥� providing services to 57% of adolescents who needed care before the pandemic. In 2019, found 37% of high school students reported persistent feelings of sadness or hopelessness; 19% having seriously considered suicide; and 9% having attempted suicide. And the need is even more profound now. From April to October 2021, the proportion of pediatric emergency room visits that were mental health-related increased nearly a third for ages 12 to 17 and 24% for children aged 5 to 11. 

As is always the challenge in public education, the need far outweighs the resources available. But changes in federal Medicaid payment policy have paved the way for schools to access millions of dollars to fund school nursing, behavioral health and other services in schools.

For example, in 2014, the Centers for Medicare and Medicaid Services broadened a longstanding to allow schools to be reimbursed for providing covered services to any Medicaid-eligible child. But only have taken advantage of this funding stream by amending their Medicaid state plans (the document that defines the types of services and providers that are eligible for reimbursement) to reflect the new policy. 

Michigan to include behavioral health analysts, school social workers and school psychologists as covered providers, while the state legislature approved $31 million to fund behavioral health providers in schools. Since this change, there has been about a in the amount of Medicaid reimbursement being directed to schools. Louisiana amended its Medicaid state plan in 2015 and saw a 30% increase in its Medicaid revenue as the school nursing workforce . Last year, Georgia changed its plan to allow Medicaid to pay for more school health services. are covered by Medicaid or the state’s PeachCare system, so this shift is dramatic and creates an opportunity to bring hundreds of millions of dollars to Georgia鈥檚 school districts to support the most vulnerable students.

More states can position themselves to leverage Medicaid funding for schools by clarifying and expanding the scope of covered school health services and providers in their state Medicaid plans. But, some schools face additional barriers, such as complex billing processes. That issue is being addressed in the , which directs federal policymakers to issue guidance, launch a help center and release $50 million in planning grants in the next 12 months to assist state Medicaid agencies and local educational entities in overcoming these challenges. These supports are likely to include strategies and tools to reduce administrative burdens for billing, especially for rural schools, and best practices that schools and state Medicaid agencies can use to amend state plans so the services students need, and the providers who deliver them, become eligible for reimbursement by Medicaid.

The National Healthy Schools Collaborative鈥檚 prioritizes optimizing the ability of schools to bill Medicaid for school health services and, importantly, recognizes that when health and education officials fail to collaborate, it makes it very difficult to achieve this end. School nurses, district administrators and state education officials must get ready to collaborate with state Medicaid agencies to take advantage of supports the act will provide 鈥�  preparing data on the health needs of their school communities, the types of services provided in schools (and that schools could start providing if reimbursed) and the types of licenses and credentials required for personnel delivering services in schools. State Medicaid officials can then make sure state plan amendments reflect the exact types of services students need and that schools are capable of delivering.

How else can school nurses, district administrators, and state education officials prepare?

• which states reimburse for Medicaid. Share information about the forthcoming supports for increasing access to Medicaid funds for school health services and providers.
• Engage with school or district to collect community input on the health services they want to access, understand school communities’ unmet health needs and increase awareness of the availability of Medicaid services in school.
• Review the from local hospitals to further understand the significant health needs of the community and the resources available to address those needs.
• Make connections at the and advocate for reimbursing school providers for specific services (e.g., counseling, personal care, case management, immunizations) that are a priority for students.

These challenges and inequities are exacerbated when schools do not fully recognize the social-emotional needs of students and the critical interdependence between these needs and academic success. Many students don鈥檛 feel a sense of belonging in their own classrooms and school communities. This is a particular problem among low-income children of color who often don鈥檛 feel reflected in the curriculum or seen by their teachers. And when students don鈥檛 feel seen, heard and valued, they are less likely to show up to school and stay engaged in the classroom. 

The pandemic has demonstrated the importance of balancing a drive toward academic outcomes with self-care. So it was heartening to hear Schools Chancellor David Banks and appoint Dr. Jawana Johnson, chief of school culture, climate and well-being, to lead this work. Now more than ever, developing a strong sense of community and belonging at school is crucial.

One way to do this is to develop school communities where students can show up each day as themselves, knowing they are valued, listened to and cared for. It鈥檚 in these safe and supportive environments that students learn, grow and fail safely. Only then can they connect in deep, meaningful ways with their classmates and teachers, grapple with challenges and work collaboratively to solve issues that affect their lives and communities. 

At NYC Outward Bound schools and the schools in our national partner EL Education鈥檚 network, we call this space Crew 鈥� borrowed from the phrase, 鈥淲e are crew, not passengers鈥� coined by Outward Bound founder Kurt Hahn. Crew is an advisory structure through which eight to 16 students meet together regularly with the guidance and individualized support of an adult adviser, or Crew leader, to foster a collective sense of belonging, engagement and compassion for one another. This creates an ethos of community that permeates the whole school. What does this look like day to day? Crews of students discuss current events, go on field trips, work on college applications and celebrate both big and small wins together. During the pandemic, when students couldn鈥檛 physically be together, Crew emerged as a particularly important lifeline and social-emotional support system over Zoom. 

In my first two months as CEO of NYC Outward Bound Schools, I鈥檝e visited Crews in action at our 14 network schools and 49 new partner schools, seeing firsthand the learning that takes place and the love that extends beyond historical lines of division 鈥� race, culture, gender, economic status. In one particular Crew lesson, I witnessed middle school students lead discussions on race and equity, supported by an activity that had the kids choose a colored pencil that they thought best represented themselves and then see the beautiful multi-colored patchwork they created together.

Crew leads to more vibrant and connected school communities where students鈥� identities are affirmed and valued. But beyond anecdotal evidence, it鈥檚 important to examine two key student-level indicators 鈥� attendance and sense of belonging 鈥� that correlate strongly with academic outcomes and success. Research shows that students who report a stronger sense of community in their school are than those who don’t, and that kids who believe they have a voice in their school are seven times than those who do not feel that way.

Attendance is the most prescient indicator of 鈥� and in a , Crew was shown to have a statistically significant impact on attendance specifically resulting in a decrease in chronic absenteeism. There were half as many chronically absent students among the NYC Outward Bound Schools group than among the comparison group 鈥� 5.3% vs. 11.4%. Based on responses obtained from focus group interviews, overall perceptions of Crew were positive. Students and educators cited many benefits of Crew, including stronger relationships and community, academic and moral support, and family-school connections. Seventy-eight percent of students felt that their Crew leader cared about them.聽

In a post-lockdown world, New York City schools 鈥� and school communities everywhere 鈥� can鈥檛 afford to go back to old ways that were not serving students. There is one way forward, and that鈥檚 to prioritize students’ social-emotional needs. Building strong school communities centered around belonging is essential to ensuring children don鈥檛 slip through the cracks and have the support they need to thrive academically, socially and emotionally.

Vanessa Rodriguez joined NYC Outward Bound Schools as CEO in January 2022. She has worked in education for more than 25 years, serving students in public, charter and alternative schools across the country. She started her career as a teacher in the Bronx.

鈥淲e think that schools are the best place to reach the most children to talk about personal body safety,鈥� said Altschiller, a Stratham Democrat. 鈥淎nd that is their right. They have the right to be safe.鈥澛�

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This year, Altschiller and a group of Democratic lawmakers say it鈥檚 time for public school classrooms to take it on: sexual assault education and prevention. House Democrats are advancing a bill that would require consent to be taught in New Hampshire public schools as part of a school鈥檚 health education curriculum.聽

鈥淭he precedent for preventing harm and promoting well-being through education is clearly established,鈥� said Rep. Amanda Elizabeth Toll, the Keene Democrat spearheading the bill.聽

would require that schools include 鈥渁ge-appropriate instruction on the meaning of consent, respect for personal boundaries, and sexual violence prevention鈥� in the basic curriculum for all students.聽

At a hearing Tuesday, supporters of the bill said that the instruction would be valuable to head off incidents of violence and violation of personal space 鈥� both in adolescence and later in life.聽

鈥淲e see the importance of smoking prevention education because of the damaging health effects: it鈥檚 important enough to be part of health curriculums,鈥� said Emily Murphy, a prevention program specialist at HAVEN New Hampshire, a violence prevention center.聽鈥淭he negative health impacts of child sexual abuse and other forms of sexual violence are staggering.鈥�

Alberto Soto, currently the director of counseling at Middlebury College in Vermont, said he had treated young adults on both sides of the equation: those who have caused harm and those who have experienced it. The trauma caused by a violation of consent can follow students for years, Soto said.

鈥淭he only way that we can help prevent harm is through education and through preventative measures,鈥� Soto said.聽

For Renee Monteil, consent lessons were already built into her parenting approach for her two young daughters. When one toddler would bite another, Monteil would teach them not to, framing it around consent. But when it comes to sexual health, Montiel said, the lessons are some that all students should receive.聽

鈥淭eaching consent is teaching life skills,鈥� Monteil, of Keene, told lawmakers. 鈥淭eaching consent is also about giving all of our children the tools they need to navigate society safely. With confidence.鈥�

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The panel will hear from two guest speakers, Tariq H. Butt, MD, President of the Chicago Medical Society, and Michael Mandel, Chief Economic Strategist for the Progressive Policy Institute. Panelists include Michael Hinojosa, Superintendent of the Dallas Independent School District, Dr. Rosalind Osgood, Chair, Broward County Public School Board, Priscila Dilley, Chief Officer of the Leadership Academy Network Schools, and Maritza Guridy, National Parents Union, Northeast Regional Organizer. Asher Lehrer-Small, reporter for 社区黑料 and Tressa Pankovits, co-director of PPI鈥檚 Reinventing America鈥檚 Schools project will moderate. 

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