Health Services to Promote Attendance

A National Center on Health (NCH) Tip Sheet

See PDF version: Health Services to Promote Attendance [PDF, 224KB]

From the first day of enrollment, a young child's attendance matters! Good attendance leads to lifelong learning and positive habits necessary for school and work. When young children are chronically absent from Head Start, Early Head Start, or child care, often they are likely to continue to be chronically absent in elementary school.1 Others may drop-out as they get older.2 Absenteeism decreases children's opportunity to engage in learning, impacting their development in all domains of the Child Development and Early Learning Framework. (See Making the Link Between Health and School Readiness to learn more about the impact of health on child development). Note: This resource is under review.

Chronic absenteeism is defined as missing one or more out of 10 school days for any reason.3

"Chronic absenteeism in kindergarten, and even pre-K, can predict lower test scores, poor attendance and retention in later grades, especially if the problem persists for more than a year."4 For example, in Baltimore, Maryland, a quarter of preschool and kindergarten students who were chronically absent were retained in later grades, compared to nine percent of students who attended regularly.5 Additionally, preschoolers in a Tulsa, Oklahoma Head Start program who attended class regularly showed more growth in literacy skills than those who were frequently absent.6

Well-defined policies and procedures that are clear to all staff and families are powerful program tools that can increase attendance. When paired with strategies that engage families to keep children healthy, absenteeism is reduced and children are able to learn. This tip sheet can help program managers begin to plan and evaluate their health services to support children's attendance and improve their school readiness.

How Can the Head Start Management Team and Their Staff Use Health Services to Address Attendance Issues?

While programs are able to identify when children are absent, understanding why* is critical to finding the right solutions for attendance issues. Managers and staff who understand the health-related causes for absenteeism are better able to design systems that improve child attendance and school readiness outcomes. They are also prepared to individualize their approaches to the needs of individual families when health-related attendance problems occur.

Program health managers can help to ensure that children are more likely to regularly attend all program activities by developing and implementing a variety of  health policies and procedures that:

  1. introduce staff and parents to health and safety activities that help decrease children's absenteeism because of illness and injury; and
  2. support staff and parents on how to identify illnesses early and seek treatment when required.

Health mangers can reduce absenteeism by reviewing their policies and procedures to ensure that they address prevention, early identification, and prompt treatment goals.  For example, health managers ensure that:

  • Classroom staff know and can recognize the early signs of illness so that they can effectively use the program's daily health check [PDF, 56KB] procedures.
  • Staff and parents fully understand and embrace the program's short-term exclusion policies so that children are included when they are healthy enough to attend.
  • Staff implement hand-washing, diapering, and other hygiene and sanitation policies and procedures to reduce the spread of illness. They also provide training to parents on ways to reduce the spread of illness at home.
  • Staff promote child safety and reducing injuries by implementing effective policies and procedures for identifying and removing hazards.
  • Family service workers engage families to find and create a safe environment for children to recuperate.
  • Staff arrange necessary supports for families to attend follow up visits for treatment (for example, transportation to and from visits, identifying and making referrals to specialists, and scheduling appointments when family members are available).
  • Teachers send education kits home for children absent due to illness or injury so that they can continue to learn at home.

How can staff support families in reducing absenteeism?

The conversation about attendance between families and staff is crucial. Staff begin by helping families understand that attendance matters. When families learn how to keep children healthy, identify illness early and get the right treatment quickly, they can improve their children's attendance. Program staff can begin by building families' "health literacy" including basic health skills that connect attendance to child development. They can also partner with families to improve their children's attendance by:

  • Helping families review and understand program policies and procedures and their impact on attendance
  • Developing attendance policies that include:
    • A home visit from the health manager or family service worker after the child has been absent for more than 3 consecutive days (45 CFR 1305.8(b));
    • Developing a schedule of home visits for families whose children are chronically absent; and
    • Providing individualized family health literacy opportunities for families of children who are chronically absent.
  • Supporting families in accessing a medical and dental home to ensure ongoing care, early identification of illness, and effective treatment as needed
  • Including solutions for attendance issues in individualized plans for children with special health care needs and/or disabilities

Together, families, managers, and staff can keep children healthy and safe to improve child attendance and offer children more opportunities to learn. They can set the stage for children's success in school.

How can ongoing monitoring and self-assessment support health managers in improving attendance?

Health managers can use ongoing monitoring and self-assessment systems to make sure health strategies are working and meeting the goal of improving attendance. Throughout the year, they can constantly review attendance data to measure success. If groups of children continue to be absent because of illness, the manager may meet with staff to brainstorm new solutions to improve children's attendance rates. When attendance is an issue for an individual child, the health manager may offer to meet with the staff and family together.  Programs also can use their annual self-assessment process to look at trends over time and examine how health has impacted attendance.

Throughout the year, health managers will want to ask questions about:

  • Percentage of children absent overall
  • Percentage of absences related to infectious disease
  • Patterns that explain the reason for absences
  • Training needed for staff and family members

They can often find the answers by examining:

  • Child Health Records to determine whether children are up to date on well child health (including oral health), treatment and follow up;
  • Daily health check records and health observations by family members that identify signs and symptoms of illness and injury;
  • Nutrition assessment forms to identify nutrition concerns that impact wellness;
  • Injury and incident reports that identify injuries that cause absenteeism;
  • Staff's anecdotal notes or case notes that may contain family, health, developmental, or behavioral concerns; and
  • Attendance data that defines why children are absent

Health managers can collaborate, use and share data with the management team and the Health Services Advisory Committee (HSAC) to identify successful strategies, remaining challenges, new concerns, and possible solutions.

* Please note, this resource focuses on health-related reasons for absenteeism (e.g., illness and injury).

Health literacy is defined as "the degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health."

  1. Erlich, S.B., Gwynne, J.A., Stitziel Pareja, A., and Allensworth, E.M. with Moore, P., Jagesic, S., and Sorice, E. (2013). Preschool Attendance in Chicago Public Schools: Relationships with Learning Outcomes and Reasons for Absences. Chicago, Il: The University of Chicago Consortium on Chicago School Research. Retrieved from:
  2. Ibid.
  3. Bruner, C., Discher, A., and Chang, H. (2011) "Chronic Elementary Absenteeism: A Problem Hidden in Plain Sight: A Research Brief from Attendance Works and Child & Family Policy Center." Education Week.
  4. Shieh, J. (2012). Attendance in the Early Grades. Bethesda, MD: Attendance Works. Available at: [PDF, 205KB]
  5. Connolly, Faith; & Olson, Linda S. Early Elementary Performance and Attendance in Baltimore City Schools' Pre-Kindergarten and Kindergarten, Baltimore Education Research Consortium. March 2012.
  6. Community Action Project Tulsa County. Attendance Works Peer Learning Network Webinar. February 27, 2012.
  7. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010) National Action Plan to Improve Health Literacy. Washington, DC.

Health Services to Promote Attendance. HHS/ACF/OHS/NCH. 2014. English.

Last Reviewed: December 2014

Last Updated: November 14, 2016