Best practices for states to address health related chronic school absences

A recent National Association of School Boards of Education (NASBE) Policy Update looks at the impact of health on chronic absences and what states can do to address this issue. Chronic absences from school can severely set back academic learning and is considered an early warning sign of school dropout[1]. Untreated health conditions are the leading causes of chronic absences, and the American Academy of Pediatrics recently noted that chronic absence was a better predictor of school failure than test scores and urged pediatricians to work with schools to reduce its incidence.[2] Students who experience poverty are more likely to experience chronic illness and less likely able to make up for their school absences.

NASBE looks to California, New Jersey, and Connecticut for ways state board of education can play a key role in addressing the health-related drivers of chronic absence. These states are confronting the issue by asking key questions, supporting a culture of attendance, promoting the use of actionable data, building state capacity and leveraging funding to address health-related issues among students, and sharing accountability for chronic school absences and including non-education state agencies.

Advocacy & Communication Solutions, LLC (ACS) works with both superintendents and school boards of education to impact policy changes that support school readiness and success. For example, ACS works closely with The Ohio 8 Coalition, a coalition of the eight largest school districts in Ohio, which embeds clinics or clinicians in the schools to address non-academic and health needs of students and families. ACS also partners with NASBE to engage state boards of education to influence early childhood policies that consider the whole child, birth through age eight, and their impact on later school success.




[1] Alan Ginsburg et al., “Absences Add Up: How School Attendance Influences Student Success” (Attendance Works, August 2014).

[2] Mandy A. Allison and Elliott Attisha, “The Link between School Attendance and Good Health,” Pediatrics 143, no. 2 (Itasca, IL: American Academy of Pediatrics, 2019).

International & Regional Organizations Recognize Advocacy & Communication Solutions (ACS)

International & Regional Organizations Recognize Advocacy & Communication Solutions (ACS)

Advocacy & Communication Solutions (ACS) was recently recognized for its work to design and implement a communication campaign and for its overall business growth.

ACS’ work for the Franklin County Department of Job & Family Services received a Gold Hermes Creative Award in the Communication/Marketing Campaign category. Among thousands of entrants, the international competition honored the public awareness campaign to educate preschool providers on the importance of improving their quality ratings with the state and to educate parents on the importance of choosing high-quality preschool. The effort enrolled 200 providers in training to become rated and increased awareness levels among parents about the State’s quality rating system.

Company co-founders Lori McClung & Scarlett Bouder are 2019 honorees in the Northeast Ohio Smart 50 Awards. This award recognizes the top executives of the 50 smartest companies in the Northeast Ohio region for their ability to effectively build and lead successful organizations. ACS’ founders will be honored at a ceremony on June 27, 2019.

ACS Helps Design and Facilitate State Board of Education Early Childhood Education Workgroup

Advocacy & Communication Solutions (ACS) Vice President Rebecca Cohen helped design and facilitate the National Association for School Boards of Education (NASBE) inaugural Early Childhood Education (ECE) Workgroup meeting for state school board members. Twelve state board of education members from 11 states traveled to Alexandria, Virginia for an intensive two-day peer learning session on May 1-2, 2019.

During the meeting, work group participants explored evidence-based research, ECE best practices, and ways to better align the early childhood and K-12 systems in their states. A highlight of the meeting was a site visit to the Drew Model Elementary School in Arlington, Virginia, where the work group observed high-quality preschool classrooms for 3-, 4-, and 5-year-olds, and engaged school leaders and teachers in a discussion about how to ensure public schools are offering a high-quality ECE program.

Participants also heard from national experts about the components of high-quality programming, including the latest research around equity, high-quality preschool programs across states, the well-being of the ECE workforce, and new research around infant and toddler programs. ACS presented information about public opinion research and the importance of understanding audience perspectives before undergoing any communication or advocacy effort.

“The connection between the first five years of a child’s life and K-12 education is not always clear for district and state leadership,” said Kenneth Mason, state board member from Georgia and work group co-chair. “As school board members, we have a responsibility to promote practices and policies that support young children in preparing them for later school success. This workgroup gives me the knowledge and tools to take concrete next steps in my state.”

The intersection between K-12, ECE, and workforce development is an ongoing area of focus for ACS and several of our clients. ACS has worked with NASBE since 2017 to help states elevate policies that bolster the ECE workforce and better align with K-12 to prepare children for school and beyond.

PRE4CLE Convenes Community Leaders to Remedy Inequities for Cuyahoga County’s Children of Color

Kids who start behind, often stay behind. Unfortunately, that’s particularly true for children of color in Ohio, according to a comprehensive report from Groundwork Ohio. In Cuyahoga County, just 22 percent of African-American and black children and 19 percent of Hispanic children demonstrate kindergarten readiness, as opposed to 52 percent of white children in the county.

PRE4CLE, Cleveland’s plan to expand high-quality preschool, convened a community conversation in April of 100 educators, nonprofit leaders, and others with a stake in Cleveland’s early childhood education system to generate ideas that will create more equitable outcomes for Cleveland’s children.

The Early Childhood Equity Forum, hosted by PRE4CLE, Groundwork Ohio, Starting Point, and Invest in Children, was profiled by Fresh Water Cleveland.

“This is not an easy conversation, but it may be the most important issue that we can tackle to create better outcomes for Cleveland’s children,” PRE4CLE’s Director Katie Kelly told Fresh Water Cleveland. “The data show that we have not closed the gap for children of color in our community, and we can’t keep doing the same things and expect that to change. We’re encouraged by the response to (the Equity Forum), especially the open and honest dialogue, thoughtful ideas, and optimism in the room related to working toward true change—in ourselves and in our community.”

ACS helped draft and launch the plan in 2014 to bring PRE4CLE to life. Since that time, ACS continues to provide advocacy, strategic communication, and media outreach services to PRE4CLE.

Health Care Leaders Identify Promising Strategies to Address Social Determinants of Health

As we discussed in our 2019 edition of 10 Issues to Watch, health care systems and payers are increasing their attention on and investment in addressing social determinants of health (SDOH) – conditions like income, employment, education, housing, safety, transportation options, and others that influence individual and population health. In a recent piece, PatientEngagementHIT writer Sara Heath highlights a few promising strategies, which we’ve summarized here:

  • Food security. The Blue Cross Blue Shield Institute (BCBS Institute) is partnering with the Health Care Service Corporation (HCSC) and foodQ, a food delivery service, to connect people in Dallas and Chicago food deserts with nutritious food for $10 per month. The program will be open to people in certain zip codes regardless of insurance status or carrier.
  • Affordable housing. Kaiser Permanente is working with Bay Area organizations Enterprise Community Partners (Enterprise) and East Bay Asian Local Development Corporation (EBALDC) to create sustainable and affordable local housing options. Kaiser Permanente and Enterprise invested in a 41-unit housing complex, which EBALDC is managing. Additionally, Kaiser and Enterprise each promised matching $50 million donations to create a national loan fund for affordable housing in Kaiser’s care areas, including eight states and Washington, D.C.
  • The BCBS Institute used zip code data to target patients living in transportation deserts and partnered with Lyft to secure rides. Rideshare companies like Lyft, which have also created partnerships with hospitals, physician offices, and other healthcare organizations, have made a dent in medical transportation. (In February, the company announced an expanded effort with BCBS Institute to provide rides to Medicare Advantage members.)

Whether we are pushing for access to quality early childhood education in Louisiana, working to enhance healthy community in South Carolina, or helping Enterprise Community Partners advocate for policies that protect access to affordable housing, Advocacy & Communication Solutions sees our work as inherently supporting individuals achieve health and well-being. We’re excited to continue working with our diverse and passionate partners to move the dial on social determinants of health.

New Bipartisan Federal Policies Aim to Address Poor Maternal and Infant Health Outcomes

In 2018, three important pieces of legislation were signed into law that have the potential to move the dial on our nation’s abysmally high maternal and infant mortality rates, as summarized below and by policy experts at the Nurse-Family Partnership.

  • The Preventing Maternal Deaths Act of 2018 (H.R. 1218) authorizes and funds administration of new state and local Maternal Mortality Review Committees (MMRCs), composed of multidisciplinary experts who count pregnancy-related deaths and identify prevention opportunities. Bill supporters see MMRCs as critical to efforts to address racial and ethnic disparities in maternal mortality rates, especially as data collects over time and across states. In early March, the Centers for Disease Control and Prevention (CDC) announced the resultant $43 million grant program for states.
  • The PREEMIE Reauthorization Act of 2018 (S. 3029) renews various programs focused on addressing preterm birth. Provisions include renewal of the CDC’s research and prevention programs focused on the topic, reauthorization of the Health Resources and Service Administration’s (HRSA) work to promote healthy pregnancy and prevent preterm birth, expansion of the charge of the Secretary’s Advisory Committee on Infant Mortality to examine severe maternal morbidity, and creation of an entity within the Department of Health and Human Services to coordinate all federal activities and programs related to preterm birth, infant mortality and other adverse birth outcomes.
  • The Improving Access to Maternity Care Act (H.R. 315) requires HRSA to identify areas of the country with a maternity care health professional shortage and ensure the necessary health professionals within the National Health Service Corps are assigned to those target areas. It also requires that HRSA track and publish data on maternity care needs in these underserved areas. This is an important opportunity to expand access to maternity care for women in rural areas, given that more than half of rural counties in the United States have no hospital-based obstetric services.

As Advocacy & Communication Solutions continues working with organizations committed to improving maternal and infant health, such as First Year Cleveland, we are enthusiastic to see this kind of bipartisan support for maternal health policies with state and local implications.

ACS is Expanding; Welcomes Nikki Reiss

Advocacy & Communication Solutions, LLC is pleased to announce Nikki Reiss as our new Senior Strategist. Ms. Reiss will direct and support government relations and advocacy, policy analysis, strategic communication planning, and strategy development for ACS clients in Ohio and across the country.

Ms. Reiss brings a sharp legal mind and more than 15 years of experience in public policy and strategic thinking to the ACS team. Reiss joined ACS team after serving as the Policy Director for the Richard Cordray/Betty Sutton gubernatorial/lieutenant gubernatorial campaign in Ohio. In that role, she was responsible for advising and educating the candidates on relevant policy issues, overseeing the development of all campaign policy positions, managing stakeholder outreach and policy working groups, and managing the campaign policy rollout schedule.

“Nikki brings a wealth of knowledge and skills to our firm.” Said Lori McClung, ACS Chief Executive Officer, “From Medicaid to early childhood, coalition building to authentic community engagement, and the ability to navigate rules and regulations that impact non profits, government and philanthropy, Nikki provides a level expertise that will enhance and deepen our firm’s national footprint.”

For more than a decade Ms. Reiss led government affairs strategies at a prominent law firm with clients in the healthcare, energy, gaming, manufacturing, and insurance sectors with their strategic planning, relationship building, legislative priorities, public affairs, and grassroots engagement. Reiss also led the Ohio Medicaid Coalition, an effort of more than 250 organizations devoted to protecting various Medicaid policies.

“Ms. Reiss certainly has the experience we seek in an ACS team member. Just as important as her capabilities is her commitment to the issues, clients, and people we serve every single day.” said ACS President Scarlett Bouder. “Ms. Reiss understands that our role as a firm is to partner with our clients to clear the path for increasing opportunity for individuals and make communities stronger for the long term.”

“I am thrilled to put my experience and passion behind the work with ACS clients across the country.” Said Reiss. “Diving deep into critical issues, building new and growing existing relationships, and being a part of ground changing projects is what makes this position so appealing.”

Ms. Reiss was a 2001 Fellow with Ohio’s Legislative Service Commission, and currently serves as Board President for Dress for Success Columbus. She is a member of the Bar in the State of Ohio and the United States District Court for the Southern District of Ohio. Nikki earned a B.A., summa cum laude, from Ohio Wesleyan University and her J.D. from Boston College Law School. She is a native of Sidney, Ohio and resides in Columbus.


Rapid Re-Housing Works to Reduce Homelessness: New Evidence from The Urban Institute

Rapid re-housing is a short-term, crisis intervention model that has expanded in recent years to help households quickly, minimize the time spent homeless, prevent a return to homelessness, increase self-sufficiency, and ultimately end homelessness. In October 2018, The Urban Institute released a brief that reviews the evidence to date regarding the effectiveness of rapid re-housing in ending homelessness. The research shows:

  • The approach enables families and veterans to exit homeless shelters and live in housing units in the private rental market faster than they would on their own and for lower cost. 59% of the families who used rapid re-housing assistance spent an average of 2 months in shelter, while 41% of families who did not use assistance spent more than 5 months in shelter.
  • Rapid re-housing not only helps families exit shelter faster, but also ensures that they have a stable housing arrangement upon exit. Research shows that rapid re-housing effectively achieves the latter outcome, with at least 70% of those in Federal programs successfully securing permanent housing.
  • Most families and veterans do not become homeless again; though many struggle with ongoing housing affordability, like other low-income renters. Research found that most families who receive assistance do not reenter shelter at high rates – in fact, one study found that just 10% of families returned to shelter within 12 months of exiting the rapid re-housing program.
  • Several studies found that families and individuals who received rapid re-housing assistance were able to modestly increase their incomes during and after the program.
  • Rapid re-housing could be a scalable and cost-effective crisis response intervention that could help communities address homelessness more effectively. It is less expensive than emergency shelter and transitional housing. These savings result in substantial savings for the system, which can then serve more families or the same families for longer periods. The monthly cost of rapid re-housing per family is 82% less than the cost of shelter – providing flexible dollars to families to gain access to additional services.

There is still a lot to learn about the long-term implications of rapid re-housing for communities who implement the model, including system-level implications (impact on shelter capacity or overall numbers of homelessness) and if rapid re-housing can be effective in tight rental markets where vacancy rates are low and there is a short supply of affordable housing.

Advocacy and Communication Solutions (ACS) has worked with several organizations whose mission is to assist families through housing transitions. This includes Housing First, who works to reduce chronic homelessness, and A Place 4 Me, dedicated to prevent and end youth homelessness, both in Cuyahoga County (Ohio). ACS worked with both organizations to drive awareness and effective communication through planning, targeted messaging, and media outreach.

Medicaid Expansion Boosts Health and Employment

Several states, including Ohio and Michigan, have recently released study results that show Medicaid Expansion continues to improve health and support employment of their states’ residents. This research showed significant benefits, such as:

  • Michigan has seen financial benefits from its expansion, which now covers more than 650,000 residents. In a paper released by Economist Sarah Miller of University of Michigan’s Ross School of Business, research showed that since the expansion in 2014, enrollees saw an overall reduction of medical bills in collection by 57%, and their average debt was reduced by 28%. This is a huge improvement for a state whose residents average 80% subprime or lower credit scores.
  • Ohio’s report showed that Medicaid expansion has cut the uninsured rate among low-income adults by 60%. Additionally, expansion makes it easier to work, and 83.5% of working beneficiaries said having Medicaid make it easier to find and maintain employment.

Advocacy & Communication Solutions, LLC (ACS) is deeply involved in advocacy and communication related to Medicaid and related policy issues including First Year Cleveland, HMS and others. Visit the ACS Medicaid Glossary to learn more about this timely issue. Feel free to contact ACS if you have any questions.


Insurance Companies Take New Approach to Addressing Social Determinants of Health

America’s health insurers – in partnership with state- and federal-programs – have begun to address the non-medical, social, and physical environments which affect a person’s overall health – also called the Social Determinants of Health (SDOH or SDH). Research continues to show that these factors, such as housing, access to healthy food, education, and employment directly impacts health risks and outcomes and have been brought to light by high-profile programs like Healthy People 2020.

So where do insurance companies come in?

American health insurers, in addition to Medicare and Medicaid, have begun to invest in services and policies that seek to help patients overcome barriers related to housing, medicine, food to ultimately improve the life and health of patients and their families, and save millions of dollars for insurers and taxpayers.

According to Forbes, UnitedHealth (the nation’s largest health insurer) has invested $350 million since 2011 in affordable housing. Anthem has committed $380 million. And Medicare and Medicaid programs have begun to re-adjust their reimbursement models to include additional services that will help keep people out of ERs and hospital beds.

“Obviously, states cannot afford to pay for everything, but until you meet those basic needs, it’s almost impossible to address their healthcare,” said Jeff Myers, president of Medicaid Health Plans of America, in the Forbes article. “It’s hard to get a diabetic to focus on eating well if they don’t know where they are going to live.”

Kaiser Permanente recently committed $200 million to reduce homelessness – by increasing access to and availability of secure housing – to keep their members healthy. According to Business Insider, the company also sponsors school programs, increases access to healthy food and others services, gaining support from powerhouses like Berkshire Hathaway, who call these programs the future of American health care.

According to Non Profit Quarterly, some Medical Institutions are tackling these issues on their own. Nationwide Children’s Hospital in Columbus, OH, committed $6.6 million to build and renovate affordable housing to improve neighborhood health. According to one Nationwide pediatrician, poor and unstable housing leads to chronic diseases, and many are exposed to toxins and community violence – which directly impact children’s’ development.

Advocacy & Communication Solutions, LLC (ACS) works with several clients from the nonprofit, philanthropic, and government sectors that directly and indirectly address Social Determinants of Health for the betterment of families and communities including First Year Cleveland, HMS, and The Ohio 8 Coalition, among others.