Testimony Before the Council of the District of Columbia Committee on Health DC Health Performance Oversight Hearing
By Rachel Johnston
Chief of Staff, DC Charter School Alliance
Good morning, Chairperson Henderson and members of the Committee. My name is Rachel Johnston, and I’m a Ward 4 resident and the Chief of Staff at the DC Charter School Alliance, the local advocacy organization dedicated to supporting DC’s public charter schools who serve nearly half of the District’s public school students.
DC charter schools are deeply committed to supporting students’ health so they can fully engage in learning. Charter schools have reached 97% compliance with student immunizations in key grades, with 46 charter schools achieving 100% compliance – a result of deep engagement with families and a strong partnership with OSSE and DC Health. Additionally, 113 PreK-12 charter schools have either participated in DC Health’s School Health Services program or have a private nurse. And there are over 500 trained AOMs across charter schools, an increase from 373 this time last year. Our schools rely on partnership from the city to make and sustain this progress.
We thank the DC Health School Services team, including Dr. Jamara Washington and Sabrina Gandy, for their engagement with us and our schools over the last six months as the program transitioned from Children’s School Services to in-house management. They have met periodically with school leaders to provide updates and answer questions, and they recently shared a list of roles and responsibilities for health suite staff — providing the clarity we have requested for several years.
However, we have concerns about the direction of the program given the level and quality of support schools have experienced this year. At this time last year, every school in the program had full-time coverage. When the transition began last summer, DC Health stated, “Health suite operations will remain consistent, with trained staff available at schools from 8 am to 4:30 pm each day.” Unfortunately, that has not been the reality. Today, 1 in 3 schools does not have full-time coverage and nearly 2 in 3 schools have coverage from a health tech, not a licensed practical nurse (LPN) or registered nurse (RN) – which is out of compliance with the current law. We also have heard concerns about the quality of support, including staff readiness to respond in emergency situations.
This comes as pediatric chronic health conditions—including diabetes, epilepsy, and asthma—are on the rise. The most recent pre-pandemic national analysis shows an increase of 130,000 children with these conditions per year since 1999.1 School health staff play a critical role in ensuring these students can engage in learning by managing emergencies, monitoring chronic conditions, and serving as health experts for school communities. They cannot fulfill that role if they are not consistently present.
I recognize that this year’s budget cycle will be challenging. We therefore offer recommendations that we believe would strengthen current support without significant fiscal impact.
Be transparent with schools. During last summer’s transition, communication was limited. What was shared including DC Health’s aforementioned public statement and FAQs for school leaders—emphasized continuity and increased access. While the level of communication has improved since last summer, that messaging has not aligned with schools’ lived experience. We understand transitions bring challenges and that DC Health continues to hire. However, earlier this month one school received an email stating: “As a reminder each school is allotted 20 hours of coverage weekly unless there is a treatment (g-tube feedings, catheterizations, or colostomy care), in such cases coverage will be provided daily. If your school does not have the proper AOM support (minimum of 2), please reach out to….” This mixed messaging creates confusion. Schools need clarity on DC Health’s plan and whether full-time coverage remains the goal and a likely reality, so they can plan accordingly.
Examine and revise the current strategy to recruit, hire, and train staff. We know there are vacancies DC Health has been unable to fill, suggesting the current hiring and retention approach may not be sufficient. We recommend exploring alternative recruitment strategies and strengthening preparation and training before staff are assigned to health suites.
Identify alternative ways to meet students’ needs. Given budget constraints and current coverage levels, we should consider how to deliver school-based health services differently without reducing access or quality. We offer two options for consideration:
Pilot direct funding to schools to hire their own RN or LPN. Several charter schools already employ their own nurses, demonstrating that this is feasible. Building on lessons from the Department of Behavioral Health (DBH)’s Pilot 1B program, we recommend a streamlined grant that fully covers the cost of a nurse. Schools opting into this model could decline a DC Health clinician, reducing hiring pressure for DC Health across nearly 200 health suites and likely decreasing the number of partially covered schools.
Expand access to AOM and CPR training. Provide schools with a list of approved AOM trainers they may contract with (rather than providing only one option: DC Health’s program) and partner with FEMS to expand CPR training access. While AOM- and CPR-trained staff are not substitutes for licensed clinicians, both are critical to student safety. CPR training is also required under the Cardiac Planning and Response Amendment Act of 2024.
Meaningful improvements must be made to ensure student health needs are met. As always, the DC Charter School Alliance values our partnership with the city and the agencies and organizations working to support student health. We look forward to collaborating as we look ahead. Thank you for your time and attention, and I welcome your questions.
