Barbara Peoples, RN, is the Health Services Manager at Educational Service District 113 in Washington State, supervising school nurses in the region. She also carries direct school nursing responsibilities in several small area school districts. Until this summer, she served for 12 years as the District Nurse at Montesano School District in Montesano, Washington, supervising two other nurses in the district. Montesano School District serves 1,450 students from preK-12th grade and is a high acuity health district with many medically fragile students. While there, Barbara practiced Nurse Case Management for eight years with great success, meeting with junior high students who had chronic health issues (such as diabetes, asthma, and other chronic health conditions) or unmet health concerns (such as an undiagnosed mental health illness or physical need). Some of her students were also in the juvenile justice system, experiencing homelessness, or otherwise identified as at-risk of school failure and/or chronic absenteeism. Barbara is a member of the National Association of School Nurses and the School Nurse Organization of Washington.
How do you support students experiencing homelessness in your work?
We support students experiencing homelessness by addressing their health concerns and needs in many ways. If they have a life-threatening health concern, require medications at school, or have a medical referral, we work with the student to obtain the medications they require and help them find a medical home—preferably a local provider who will care for their physical and mental concerns–to ensure follow-up and completion of required paperwork. We help them obtain health insurance if they have none, working very closely with our counseling office in the schools. We also work alongside our attendance secretary to ensure that attendance problems related to their health and wellness don’t become a barrier for them. Common health problems could include any chronic health condition (e.g. asthma, diabetes, severe allergies, seizure disorders) or a mental health concern (e.g. ADHD, depression, anxiety) which requires students to have medications and regular medical care follow-up, just like any other student with these conditions. It takes a team effort for students to succeed, and the school nurse plays a large part in making contact with a provider; obtaining transportation for the student, if needed, to see that provider; and finding ways to have prescriptions filled. Then there’s follow-up with the student to ensure they are following health care provider orders and directions regarding their health condition(s) and/or medication administration. Helping them keep appointments is also a challenge. The counselors are also part of this team in helping students succeed–physically, mentally, and academically. The nurse cannot do it alone!
What could schools and educators/other support staff do to better enable you to help homeless students and their families?
Identifying students who are experiencing homelessness is sometimes difficult due to the privacy of the family or student. Sometimes we find out who needs that extra support from close friends of the student. Staff members collaborate to support these students and families by providing referrals for community resources and helping with basic needs through donations from private entities. Our counseling center, attendance secretary, nurses, teachers, and administrators work well as a team to support those students experiencing homelessness. This is done primarily by making known to the school nurse any physical or mental health need the student is facing. Once the need is known, then the school nurse can help the student get the help they need or want, with frequent follow-up. Sometimes it’s a long process to build trust and understanding with the student to facilitate real change and improvement.
Can you share some examples of how you use data at the school or district level to better serve students experiencing homelessness?
When I learn of students experiencing homelessness, usually through our school electronic system (Skyward indicator), my practice changes some to accommodate those students. I check on them with office visits if needed, and I work to ensure that both their basic needs and medical needs are being met. Also, if there is an extended absence, I try to follow up with these students to be sure they have resources to address the circumstances of the absences. I also work with other support people in that student’s life who can bring in medications, medication authorizations, or referral follow-ups.
What are some barriers you experience in serving students experiencing homelessness?
Lack of communication with families or students is a huge barrier in serving students experiencing homelessness. Because they are highly mobile, they are difficult to reach by phone—I often leave voicemails without return calls. Also, follow-ups are difficult for medical care when they tend to be inconsistent in receiving proper care or treatment follow-up (i.e. keeping medical appointments). Sometimes these gaps are due to transportation–but, most of the time, they just didn’t go to the appointment because other things were a priority that day.
What is one of your greatest accomplishments as a school nurse in supporting a student experiencing homelessness?
It is so rewarding to see a student who is really struggling to get to school, experiencing academic failure, and enduring mental or physical health issues learn to advocate for themselves thanks to our support and the support of the wraparound community. I have a former junior high Nurse Case Management student who became homeless during her 7th-grade year due to physical and sexual abuse that was happening in the home. She really struggled. It took a few years of misdiagnoses for the truth to surface due to the nature of the trauma she experienced. Once it was brought to light, she then was able to get the support she needed, a place to stay, and the proper counseling and medication so she could heal and move on from the abuse. With much support from various people in school and outside agencies, she graduated this year, on time! Yes, she had to do some summer school work and will need to go to Gravity, (“GED + Re-engagement Alternative Vocational Training for Youth”) for credit retrieval for two credits, but she walked with her class at graduation!