Healthy, Present, and Learning: Cross-Sector Strategies to Reduce Health-Related Absences

This GLR Learning Tuesdays conversation explored the critical connection between health, attendance, and early literacy. Moderated by Hedy Chang of Attendance Works, the session introduced a forthcoming collaborative toolkit from Johns Hopkins Center for School Health, Attendance Works, the National Association of School Nurses, and Healthy Schools Campaign: Prevent Health-Related Absences: Take Immediate Action to Advance Health, Well-being, and Attendance.

Toolkit authors — Elliott Attisha, DO, FAAP, of Attendance Works; Beth Marshall, DrPH, MPH, of Johns Hopkins Bloomberg School of Public Health; and Kimberly Stanislo, DNP, APRN-CNP, LSN, NCSN, CPNP-PC, of National Association of School Nurses — shared why it is important to prevent health-related absences and provided immediate, actionable strategies that schools and health partners can use to reduce preventable absences and strengthen learning and literacy.

The Current Reality
Chronic absenteeism nearly doubled during the pandemic — reaching almost 30% of students — and remains elevated, affecting nearly 1 in 4 today. The challenge is most acute for our youngest learners, who are in the crucial window for building foundational reading skills. Data shows a clear “Nike swoosh” pattern: absences begin early, and without early intervention in preschool and kindergarten, they escalate over time.

Why Preventing Health-Related Absences Matters
In the post-COVID landscape, rising anxiety, depression, and other behavioral health challenges are keeping more students out of school. These issues — compounded by longstanding health disparities — fall most heavily on economically disadvantaged communities and widen early achievement gaps. Many absences also stem from fear, stress, or a lack of connection at school; with nearly 40% of adolescents reporting they don’t feel close to others at school, belonging is as essential as physical well-being.

Because families attribute more than half of absences to health-related causes — with root issues often tied to health care access, housing instability, and family stress — schools cannot solve this challenge alone. A public health approach that unites education, health care, and community partners; uses data for shared decision-making; and emphasizes proactive, preventative strategies is essential to ensuring students can fully participate in early learning.

Toolkit Strategies to Address Health-Related Absences
Preventing health-related absences requires a proactive, whole-child approach rooted in four key strategies:

• Strategy 1: Prevention: Build healthy, supportive school environments through clear policies, routine screenings, nutritious food, after-school programs, and strong relationships. School nurses and support staff are central to early identification and trust-building with families.
• Strategy 2: Messaging: Offer clear, consistent, culturally relevant guidance about attendance and when to keep a child home. Messages should be positive, jargon-free, aligned across sectors, and delivered by trusted adults — helping families understand the whole-child benefits of showing up.
• Strategy 3: Identifying Health Needs: Use detailed attendance data and health information together to uncover root causes. When paired with screenings and assessments, data helps schools spot issues like chronic illness, anxiety, or unmet basic needs so they can intervene early and effectively.
• Strategy 4: Collaboration: Adopt a team-based approach that brings educators, school health professionals, and community partners around a single, coordinated plan. Collaboration reduces stigma, improves referrals and support, and addresses attendance patterns affecting groups of students — not just individuals.

Practitioners Bringing the Work to Life
A panel of practitioners — Cristie Granillo, Ph.D., MS, M.Ed., of Loma Linda University Health, California; Joey Millwood and Joy Schofield, LCSW, M.Ed., of Hall County Schools, Georgia; and Hannah Sam of Waterbury Public Schools, Connecticut — joined the conversation to share hopeful, practical examples of communities putting these strategies into action. These district stories show that with coordinated, whole-child approaches, preventing health-related absences is truly achievable.

Schools and districts across the country are showing what it looks like to put these strategies into action. At Kingsbury Elementary in Waterbury, Connecticut, leaders blend strong data practices with whole-child support — reviewing health and attendance needs before school begins, reaching out to families early, communicating clearly, and nurturing a trauma-informed school climate rooted in positive relationships.

In Hall County, Georgia, a districtwide commitment to mental health equips all staff with training to recognize early warning signs and respond with empathy. Large-scale skills groups help students build mindfulness, emotional regulation, and resilience, reducing anxiety and suicidal ideation while improving attendance.

In San Bernardino, California, community health and education workers reconnect students and families by meeting them where they are — literally. Through home visits, they identify barriers such as transportation challenges or immigration-related fears, make warm handoffs to clinical partners, and coordinate support across agencies. These examples show how deeply intertwined health, safety, belonging, and attendance are — and how whole-family, cross-sector approaches can dramatically reduce chronic absenteeism.

Overcoming Barriers to Collaboration

Panelists acknowledged persistent challenges, including siloed systems, data-sharing limitations, and insufficient school health staffing. They emphasized the need to strengthen health infrastructure, use existing data more strategically, and align goals under unified, whole-child plans.

“Attendance teams need to take a whole-child approach, especially when viewing absences through a health lens. This means removing stigma and negativity and instead focusing on building trusting relationships. The guiding question becomes, ‘How can we support you?’ rather than ‘Why aren’t you here?’ Ultimately, the team is united around a shared goal: ensuring every student is healthy, safe, and ready to learn.”

– Kim Stanislo, National Association of School Nurses

Looking Ahead
The new toolkit will be available in mid-January on the Johns Hopkins Center for School Health website. The webinar closed with a shared message of hope: When schools, health systems, and communities work together, sustainable reductions in chronic absence are possible — and every child can be healthy, present, and prepared to thrive.

If you were able to attend the session, we would love to hear your feedback! We appreciate your help in filling out the following form as we seek to learn and understand the perspectives, ideas, critiques and recommendations that better inform our key audiences.