Testimony Before the Council of the District of Columbia Committee on Health at the Budget Oversight Hearing on the Department of Health

By Rachel Johnston, Chief of Staff at the DC Charter School Alliance

Good afternoon, Chairperson Henderson and members of the Committee. My name is Rachel Johnston. I am a proud Ward 5 resident and the Chief of Staff at the DC Charter School Alliance, the local non-profit that advocates on behalf of public charter schools to ensure that every student can choose high-quality public schools that prepare them for lifelong success. 

Charter schools are committed to providing safe and healthy learning environments for the nearly half the District’s public school students they serve. Their staff have invested time and effort to ensure their students and families have access to the care they need to be healthy and in compliance with No Shots, No School. In fact, of the 125 eligible charter schools for the Children’s School Services (CSS) school nursing program, 94 percent have some nursing coverage, either from CSS or privately, are taking steps to get their health suite approved, or are waiting for staffing assignments. (1) 

I want to thank the CSS team and its leader, Dr. Andrea Boudreaux, for their ongoing effort to equitably staff charter schools’ health suites. I also want to thank Dr. Christina Grant and her team at the Office of the State Superintendent (OSSE) for their leadership and collaboration with our schools on No Shots, No School. OSSE has been particularly helpful this year in creating concise, easy-to-reference one-pagers that LEAs can share with their communities, and they’ve also helped streamline the student immunization process with standardized deadlines. Finally, I want to thank the Administration for the support they’ve provided to schools in their efforts to ensure students are immunized. Our schools continue to effectively partner with DC Health to expand vaccination access, including partnering on community health fairs and hosting mobile vaccine clinics on school campuses. 

While there is still room to improve immunization rates in DC, we appreciate the citywide effort to ensure students are healthy so they can actively engage in learning. Today, I focus on two areas where DC charter schools are still facing challenges and ways we believe DC Health can support.

School Health Challenges

Before I dive in, I want to share that we’re excited to see the recent increase in health suite coverage provided through CSS's new staffing model introduced this year to address the well-known national nursing shortages that are impacting our schools. CSS initially had challenges with staffing the new model, particularly last fall as the school year kicked off. But right now, our data shows nearly nine in ten charter schools with assigned CSS personnel are receiving 40 hours per week of coverage. 

While a vast majority of schools in the CSS program now have 40 hours of coverage, the first challenge I’d like to highlight is that the same individuals are often not providing that coverage. Consistency is necessary to build strong relationships with students, parents and school staff. Our schools rely on health suite personnel to support the everyday health needs of students and actively engage in the immunization compliance process. We look forward to working closely with CSS to improve consistency and ensure well-trained health suite staff can provide this support.

Second, we’ve heard from schools that have applied for health suites that the approval process can be inefficient, complex, and lengthy. Some have reported that it can take several years from application to approval with no clear timeline from the beginning. One primary reason cited is that feedback schools receive from DC Health is inconsistent, which prolongs the approval process. For example, DC Health’s first inspection will reveal three problems that need to be addressed, and the school will resolve those issues. Then, a second inspection will highlight different problems not identified in the first inspection. When DC Health doesn’t provide enough specific details about their requests, schools end up having to redo tasks they could have fixed properly the first time.

Recommendations for Resolving School Health Challenges

As you consider the FY25 budget, I want to share some recommendations for consideration to resolve these challenges our schools have faced. First, to address shortages of providers and ensure consistency of coverage, we recommend:

• The District join the Nurse Licensure Compact (NLC) (2), which would expand the pool of nurses immediately available for hire. Currently, 41 jurisdictions, including neighboring states Virginia and Maryland, are part of the NLC.

• CSS and DC Health partner with adult charter schools that have health certification programs to expand the pool of qualified personnel. Academy of Hope, Carlos Rosario, Briya, and the LAYC Career Academy all have alumni with a variety of medical certifications, who could be good candidates for health suite personnel.

• The Council ensure adequate funding is provided to pay school nurses on par with surrounding jurisdictions, including neighboring Prince George’s County. We understand that many tough decisions must be made in this budget cycle. Pay parity is crucial in hiring and retaining health suite staff. Even the smallest pay discrepancy makes a big difference in ensuring consistency in personnel across schools.

Second, some charter schools have expressed interest in Administration of Medication (AOM) training for additional staff to ensure students are adequately cared for when a nurse is not present, during the school day, on field trips, and during after school activities. Currently, 250 school staff are AOM trained across charter schools, with an additional 75 completing the process. This demonstrates a high interest in ensuring many staff are trained to support student medical needs. However, the current training program restricts the number of staff who can participate due to capacity limitations. We recommend DC Health identify additional AOM trainers that schools could voluntarily engage to train more staff and add extra capacity.

Finally, to improve the health suite approval process, we recommend DC Health standardize the approval process cycle and clearly outline the dates schools must submit interest to apply for a health suite for the following school year. We also urge DC Health to re-examine the approval checklist to clarify any gaps. This is critical to ensure schools aren’t asked to go through multiple inspections to have their health suites approved and ready to serve students.

Moving Forward

The health and wellness of their students are top priorities for our schools. As always, the DC Charter School Alliance welcomes the opportunity to continue collaborating to ensure all students have their health needs met so they can actively participate in learning.

Thank you for your time and attention, and I welcome your questions.

(1) Nursing and Administering Medication in DC Charter Schools. DC Charter School Alliance. April 2024.
(2) Nurse Licensure Compact.