Research examines connections in health, student performance

New research from the Indianapolis-based Paramount Health Data Project showcases the group’s first longitudinal data sets revealing connections between student health and academic performance. The study’s conclusion suggests schools that focus on tracking and improving student health can achieve better performance outcomes.

The ABCs of Academic Health, released by Dr. Addie Angelov, Dr. Mary Jo Rattermann, and Monica Reed, is a “first attempt at releasing information to our community that provides evidence-based insights into the interactions of health and education within educational contexts.” The researchers follow three schools in urban Indianapolis over five years from the 2017-18 school year to the 2021-22 school year. All three schools are in roughly the same area of the city, serve predominantly minority communities, and most of their students qualify for free or reduced lunch.

Each school is presented under anonymous names for confidentiality. There is the “A School,” referenced as “Ascent Collegiate School,” which is a K-8 school that has been rated an “A” school by the Indiana Department of Education for the past nine years and is recognized as a national Blue Ribbon School. The “B School,” called “Brilliant Central School” (BCS) is a K-12 school that has been rated a “B” school by IDOE for the 2018-19 and 2019-20 academic years. BCS earned an “Approaching Expectations” designation from the U.S. Department of Education. Finally, the “C School,” referred to as the “Catalyst School” (CS), is a K-6 school that has been rated a “C” school by the IDOE. CS earned a designation of “Does Not Meet Expectation” from the U.S. Department of Education.

The research largely focuses on tracking student “Health Care Visits” – meaning visits to the school nurse – over the course of the school years. The study then also tracks student assessment scores over three years for students considered “healthy” and “at-risk,” based on the number of healthcare visits they had in each school year.

Two of the three schools opted to identify themselves publicly as part of the study.

The “A School” is Indianapolis-based charter school network Paramount Schools of Excellence, which is often referred to as one of the most successful charters in the city, given its high performance ratings over the years.

The “C School” is the former Ignite Achievement Academy that was a charter school under Indianapolis Public Schools’ innovation network from 2017 to 2022. Ignite, at the time, was meant to be the solution to revive the long-failing Elder Diggs School 42 on the westside of Indianapolis.

You probably recall Ignite has since left IPS and rebranded under a new charter as The Genius School. However, during the timeframe of this report, the school was still Ignite Achievement Academy and will be referred to as such. The Genius School continues to face academic performance issues now, however, those are not necessarily relevant to this data.

Over the timeframe this research takes place, it is important for you to note that Ignite Achievement Academy arrived and left IPS within these four years due to “poor performance” under challenging circumstances. Some already-low test scores from Elder Diggs School 42 dropped even lower on the charter’s watch, while attendance fell below the district average and staff retention rates became the worst in the district, according to reports from Chalkbeat Indiana.

Elevated Lead in Lowest-performing School

With the Ignite Achievement Academy, one of the most shocking takeaways revealed about this school in the research is not from Paramount Health Data Project’s data collection alone, but also from separate lead testing done during this same timeframe.

The school building Ignite operated out of at the time was found by the Marion County Health Department to harbor lead levels reaching an estimated four times higher than the legal limit, according to an MCHD report released in 2019.

Researchers note its relevancy in the study.

During the same period that these data were collected, “the Greater Indianapolis NAACP and the Marion County Health Department were conducting lead testing in the schools across Marion County. This testing consisted of water testing, paint testing, and blood testing of school buildings and K-1 students.”

The Marion County Health Department released the results of a survey of county schools in January 2019 showing that 161 of the 297 facilities tested were in violation of Environmental Protection Agency standards for lead levels in drinking water. Paramount School of Excellence and the B School were found to not be in violation of the EPA’s standards.

“We have external pieces of data that are telling us this building is highly toxic and has been for years so the reality is, the C School is a hot mess, health-wise,” Dr. Angelov tells us.

The noticeable effects health had on student performance and behavior is what prompted Ignite’s co-founder and Head of School Shy-Quon Ely (who also continues to lead the Genius School) to join the PHDP’s research and other lead poisoning testing efforts with the NAACP. Hints of possible lead poisoning and other health issues became clear based on student behaviors, he tells us.

“We were noticing some things in the children that were just, you know, not normal, some of the behaviors, some of the cognitive deficits that we were seeing,” Ely observes. He continues, “we were just looking at all of the data points that we could . . .  understanding that there’s something that seems to be going on here with the health of the kids with some of the extreme behaviors.”

As a result of the elevated lead levels, Ignite remediated the issue by shutting down water fountains and distributing water bottles to students. Ely, however, also recognizes that if lead levels are high in that school building, that could mean some students’ homes in the area are also affected, so those health factors were beyond their control.

Again, since its split from IPS and rebrand in 2022, the school has since moved locations. A different charter school, Liberty Grove Schools, operates from the Elder Diggs School 42 campus currently. The 2019 report from the Marion County Health Department indicated that the elevated lead levels were resolved by the schools tested after remediation efforts. However, according to a story in November produced by WRTV-TV in Indianapolis, most schools have not done follow-up testing in the last four years.

Health Care Visit and Performance Data

Looking back to the data collected in the ABCs of Academic Health on Health Care Visits during the school day, the percentage of enrolled students who visited the school nurse over the study’s timeframe ranged from 67% for Paramount School of Excellence, 54% for the B School, and 80% for Ignite Achievement Academy, for an average of 67% of enrolled students across the entire dataset. In average health visits per student, Paramount ranked highest, with 9.2 visits, then Ignite with 7.9 visits, and B School with 6.2 visits. Overall, the average visit across the dataset was 7.93.

The complete dataset is comprised of 50,509 Health Care Visits (HCV) to the school nurse’s office from 3,659 individual students. The researchers further state, “the longitudinal nature of this dataset means that an individual student can contribute data over multiple academic years, consequently there are 6,240 ‘HCV students’ and only 3,659 unique students who contributed data to the overall dataset.”

“It’s a longitudinal study with 1,000 data points,” Dr. Angelov explains. “It’s really taking a deep dive into what does it look like for health to inform education and education to inform health and what trends did we see?”

Another important note in this research, the Covid-19 pandemic emerged during the middle of the research in 2020. As a result, health care visits dropped in the 2020-21 school year when students were largely at school virtually. They then rebounded in 2021-22, but still not higher than pre-pandemic, the research shows.

The most common reason for health care visits overall, according to the research, were for medication distribution, across all three schools. The second most frequent visit, gastrointestinal issues, trails significantly behind. The data also notably shows disproportionately high levels of African American males and Multiracial students receiving daily medication. Students with Individualized Education Programs also contribute a good portion to the number of visits, including to take medications.

With this data in mind, the study then compares school assessments between “healthy students” and “at-risk” students.

This is where data gets somewhat tricky . . . because you would assume the best way to track performance would be to look at schools’ ILEARN scores. But the researchers note that during this time, a hold-harmless phase was put on ILEARN scores, due to issues with the newly administered assessment.

Because of these validity issues, state approved benchmark assessments were used for the analysis. Paramount School of Excellence and Ignite Achievement Academy used different nationally recognized academic assessments, and the study reports, “because these are different assessments, a comparison of the absolute scores is not informative, consequently the measures of interest are percent growth from fall testing to spring testing and a comparison of the assessment scores of healthy and at-risk students within each school.”

Noteworthy patterns in assessments the study points out, first being that all students at both schools achieve 10% to 13% in growth between testing periods in the aggregate assessment scores, suggesting that all students. Also interesting: at Paramount School of Excellence, healthy students begin and end the school year with substantially higher assessment scores when compared to students at risk with a different by 76 points in the fall and 64 points in the spring. Students at Ignite Achievement Academy, however, do not show much of a difference in assessment scores between healthy students and students at risk.

Ultimately, from the data, the researchers conclude that healthy stuednts perform better academically, pointing to the fact that “the school with the highest population of  healthy students and the lowest number of students on medication, has the highest academic achievement.”

Dr. Angelov asserts, “the reality what we’re trying to push is one we know that health outcomes push education outcomes without question, and we believe that they predict them.”

Paramount School of Excellence CEO Tommy Reddicks does credit the school’s focus on health data for some of its high performance, so what they do is working.

Reddicks, a board member at the Paramount Health Data Project, for years since leading the charter school network has focused on tracking data in the school district to use it to help identify students who may be struggling and intervene early.

“We find with the health data is that there’s an academic cliff reached by every student with so many nurse visits,” Reddicks observes, “And if you’re going to the nurse X amount of times, and that’s your academic cliff, and we’re doing nothing as a school to support that student, they’re going to fall off that cliff.”

Reddicks sees this research as valuable because there is not a lot of data out there over time proving the connections between student health and performance.

“There’s just the assumption that poor health equals poor outcomes. And everybody can say, ‘my child’s sick, so they’re not going to do well.’ But what’s the data telling us?” Reddicks explains.

Though essentially running a new charter school now at The Genius School, Ely intends to continue focusing on student health data to better help families and students. As we’ve mentioned, The Genius School continues to face performance challenges, with its charter set to expire at the end of the school year, and it’s now facing a recent rejection from a different authorizer.

“I think the research validated our experience over there. And it certainly from my perspective now, I’m glad that we had the wherewithal to put ourselves out there to get into the study,” Ely notes. “Because it was just really wanting to know what we didn’t know and figure out how we could get better to resources for our families.”

In terms of lead levels affecting student performance, the Paramount Health Data Project research also suggests “the city and schools must be given evidence-based academic interventions to combat the learning issues related to toxic levels of lead. The research team adds, “current lead testing efforts fall short of providing schools and communities of tangible ways to address this issue when schools test above the legal limit for multiple years in a row.”

Additionally, the study reaches a conclusion that the number of students taking daily medication is notable, suggesting further studies to understand how taking medications as a child could connect to opioid addiction later.

The PHDP report also calls for more schools to utilize Certified Nursing Assistants and telehealth to navigate shortages in school nurses, stating, “a CNA staff position partnered with a high-quality telehealth service would be a highly effective way for schools to meet the needs of their students, regulations, and their budgets.”

What can the state do, policy wise?

Dr. Angelov has been working for years to get more officials to take attention to research on health and academic outcomes. She describes the effort as a “slow walk” garnering more attraction each years. She has met with Indiana State Department of Health officials, Secretary of Education Katie Jenner, and legislative leadership about the issue.

“I’ve never seen anything that has a greater impact, and no information about it. So the reality is, is I feel like that is the role that our organization plays and why we’re needed is to continually move this issue up the rank,” Dr. Angelov adds.