All in for Attendance: Education and Public Health Leaders Release Framework to Address Chronic Absence from Schools

Public health and education experts from Johns Hopkins University, Kaiser Permanente, and Attendance Works have released a new public health framework for understanding and addressing chronic absence. The framework, led by experts at the Johns Hopkins Bloomberg School of Public Health, includes specific actions to improve student attendance by encouraging collaboration across education, health care, and other social service organizations. 

More than one in four children in the U.S. are chronically absent from school, defined as missing 10% or more of school days. These children not only experience less academic success, but also are more likely to have long-term health challenges, impaired social development, and less success financially. Research shows that chronically absent students are much less likely to be reading at grade level by the end of third grade. Students who are not reading proficiently by the end of third grade are four times less likely to graduate from high school on time than their proficient peers.

Chronic absence is often considered an education issue. Yet many of the root causes can originate outside the school setting and may include limited access to health care, housing instability, and family stress. There are also significant disparities among students who experience chronic absence. Those most affected are students in minoritized communities, in lower socioeconomic neighborhoods, and those with disabilities. 

“Missing school is not just a personal choice or a problem with the school. It is a warning sign that may signal unmet education, health or social needs, and systemic inequities,” says Catherine Falconer, PhD, MPH, visiting scholar at the Johns Hopkins Bloomberg School of Public Health and principal author of the report. “There is an opportunity here to help communities collaborate across sectors and shift from a reactive response to a proactive one, one where everyone works together to address the root causes of school absence and create the conditions for all students to thrive.”

The framework, “All in for Attendance: Collective action for public health strategies that address chronic absence,” frames chronic absence as a public health challenge and offers steps a community can take that address the root causes of school absence. The three principles are:

1. Use school attendance data as a vital sign of student and community well-being
   Student attendance data is often underutilized, inconsistent, or not tracked and shared effectively. The guide urges standardized data collection and wider use of attendance data to track absence patterns and connect them to broader measures of family and community well-being. The guide underscores the importance of secure and confidential data-sharing between schools, social services, health care providers, and other groups to enable earlier, more coordinated responses.
2. Develop strategic partnerships to align goals and drive progress on chronic absence
   The guide offers specific actions to help communities strengthen relationships among educators, health practitioners, public health departments, and community-based agencies to align on goals, share data responsibly, combine resources, and coordinate strategies that promote attendance and family engagement. These include outlining specific roles and responsibilities for each group, ways to align on shared messaging, and strategies to streamline funding or other resources.
3. Develop strengths-based policies and programs to promote school attendance and prevent chronic absence 
   It is difficult for schools alone to address the root causes of chronic absence. The framework suggests that communities should invest in the environmental and social conditions that can support the whole child, including health, housing, transportation, and family support. It also suggests moving away from punishment-based policies and toward supportive, collaborative approaches to address school absence. This will require ongoing evaluation of local programs and continued community buy-in. 

“Addressing chronic absence requires a commitment to changing practice,” says Josh Sharfstein, MD, vice dean for Public Health Practice and director of the Bloomberg American Health Initiative at the Bloomberg School. “Educators, clinicians, public health officials, and others need to work together to make sure children attend school." 

The framework, drawn from research and education and public health experts, highlights real-world examples that illustrate how these principles can be put into practice including in Cincinnati, Baltimore, and Oregon. 

“Public health interventions have created some of the most meaningful improvements in health and safety in the past century,” says Bechara Choucair, MD, executive vice president and chief health officer at Kaiser Permanente. “We are eager for this opportunity to improve well-being and educational outcomes for millions of students by taking a holistic, evidence-based approach to chronic absence.”

“Physical- and mental health-related absences are still the top reason for missing school,” says Hedy Chang, executive director and founder of Attendance Works. “Pediatricians and school health staff can help families reduce unnecessary health-related absences by prioritizing prevention, expanding access to medical care, and messaging the importance of showing up to school regularly for well-being and learning.”

The complete framework and other resources are available here.

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Media contacts: Caitlin Hoffman at choffman@jhu.edu and Su Tellakat at stellak1@jh.edu.