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Education Service Agencies and Health Services: Dynamic Changes in a Post COVID World

October 3, 2023

By Dr. Amber Loubiere

Education Service Agencies (ESAs) across the nation are reevaluating how Health and Wellness Services will operate in a post-COVID world. Recent studies indicate that school closures, social isolation, quarantine, and other circumstances students endured throughout the COVID-19 pandemic have adversely impacted children and youth in many ways (Ashwin, Cherukuri, & Rammohan, 2022). Students today are experiencing decreased physical activity, and increased exposure to social media leading to heightened anxiety and mental health issues, gaps in academic achievement, and a host of other issues. The COVID-19 pandemic was akin to a massive boulder being dropped into a glasslike lake causing colossal ripples for years to come, ripples professionals are still uncovering and seeking to understand. ESAs will play an instrumental role in the coming years by helping schools establish the support systems students need to recover.

Health services related to vaccines

One of the most cogent pieces of legislation borne out of the need to address post-pandemic exigencies was the American Rescue Plan Act of 2021 signed into law on March 11, 2021, by President Joe Biden. The Act included the CDC Crisis Response Cooperative Agreement COVID-19 Public Health Workforce Supplemental Funding Grant, totaling $2,000,000,000. The purpose of the grant is to establish, expand, train, and sustain the State, Tribal, Local, and Territorial (STLT) public health workforce to support COVID-19 prevention, preparedness, response, and recovery initiatives with a particular focus on school-based health programs (CDC, 2021). Many ESAs across the nation opted to join the cooperative, using the grant funds in several creative ways.

Perhaps the most common use of funds, consistent with the grant’s explicitly stated terms and conditions, has been the distribution and administration of vaccines without discriminating on non-public-health grounds within a prioritized group (CDC, 2021). Education Service Agencies are partnering with local health districts to set up vaccine locations throughout the community or, in many cases, onsite at the Education Service Center, to administer flu and COVID-19 boosters and vaccines to anyone who shows up. Vaccines, totaling 665 million doses, have been administered across the United States with a cumulative effect of preventing more than 18 million additional hospitalizations and more than 3 million deaths (Fitzpatrick, et al., 2022). Of those doses, approximately 32.6 million vaccinations were administered to children and youth between the ages of 6 months and 17 years old (AAP, 2023). ESAs played a significant role in increasing awareness and providing opportunities for school-aged youth to receive those doses and will continue to support the fight against COVID-19 and the seasonal flu through pop-up clinics strategically placed around the community several times throughout the year.

Additional staff

Another way in which ESCs are utilizing their grant funds has been the hiring of additional staff. A minimum of 25% of the $2,000,000,000 jurisdictional award is required to support school-based health programs. Of the remaining 75%, at least 40% of the funds are to be allocated for local hiring, including hiring contractors or contracted employees. ESAs, especially those with a significant number of rural districts that cannot afford to hire an onsite school nurse, have been able to use the grant funds to hire school nurses and school-based health services personnel, including hiring school-based nurses, converting current nurses from part-time to full-time work, increasing hours, increasing nursing salaries, or otherwise supporting retention efforts
(CDC, 2021).

An ESA Example: Supporting Nursing Staff

ESA Education Service Center Region 12 in Waco, Texas, an ESC covering over 11,000 square miles, much of which is rural, used its allocation to hire eight additional nurses who contract with school districts, driving to the campuses one or more times per week to provide a host of services ranging from annual screenings to health and wellness education and the myriad of other activities school nurses perform. Aside from conducting host sites for vaccine clinics and focusing on the hiring and retention of staff, health and wellness at ESAs is focused more than ever on education. In 2022, Congress introduced the Improving Mental Health and Wellness in Schools Act (H. R. 5526). The bill requires local education agencies (LEAs) to include school wellness policies on goals for mental health promotion as well as education and nutrition guidelines for reducing childhood eating disorders. LEAs must include registered dieticians and school-based mental health providers in the development, implementation, and review of said policies. With bills such as HR 5526 establishing new precedents for what school-based health and wellness services should
include, school nurses are finding themselves increasingly wearing the additional hat of health and wellness educators in the classroom. In fact, nurses are spending more time than ever outside
the walls of the health office.

School-Based Nursing Grant Coordinator Suzanna Avalos described the changes ESAs are seeing, supporting, and mentoring school nurses through in schools post-COVID: The way school nurses practice in the aftermath of COVID-19 is vastly different. Pre-COVID, nurses were viewed as providing little more than band-aids and ice packs in many districts, responsible for providing basic first aid in a crisis, and little more than that. Post-COVID, though, has really expanded how we become involved. We are moving out of the office and into the classroom to teach good handwashing, proper mouth covering for a cough, and the importance of vaccines. We are moving out of the office and into the community to facilitate pop-up clinics that spread awareness, answer the community’s questions, address concerns, and increase vaccine participation. We are moving out of the office and into the administrator’s conference room, sitting in on 504s and IEPs for students who are medically fragile or who are receiving services as a result of a mental health diagnosis. We find ourselves moving out of the office to meet students where they are rather than requiring them to come to us for services such as daily medication distribution in an effort to prevent the spread of infection. Also, the emphasis on the importance of relationships has never been so urgent. The nurse belongs to the students, to the staff, and to the community. The nurse is seen as a comforter, a confidante, and an advocate. Many will come to the nurse seeking advice, sharing concerns, and asking for minor services such as blood pressure monitoring. Staff are more inclusive than ever, remembering to invite their campus nursing staff to social events, retirement parties, and campus events such as graduation.

Nurse Avalos went on to share how campus-based nurses are impacting events like Title I Parent and Family Engagement events. The School Nurse is often invited by the administration to be a guest speaker on flu prevention, the importance of immunization, or to increase awareness during national events such as American Heart Month, Breast Cancer Awareness Month, etc. As the school-based health and wellness staff find themselves increasingly pulled in a multitude of directions, interagency wraparound service support is critical. ESAs have discovered a new partnership in the telehealth services initiative. School-based telehealth expands and improves a student’s ability to access healthcare providers and is especially helpful for rural communities and under-funded urban communities. Students are able to see a healthcare provider in the school’s health office for annual appointments, to monitor conditions such as diabetes or asthma, and for behavioral health care to increase focus on learning. The telehealth initiative improves access to different types of care, reduces time away from class, and decreases time and travel costs for the parent or guardian (HRSA, 2023). For under-funded districts with no nursing staff present, telehealth services are especially valuable. Students with complex medical needs should not suffer the results of the nursing and funding shortage facing the nation today. In April 2022, Dr. David Auerbach and colleagues conducted a study in which they determined nursing staff across the nation decreased by more than 100,000 from 2020 to 2021, the most significant resignation the nursing workforce has seen over the past four decades (Auerbach, et al., 2022). The educational setting has certainly felt the toll of that reduction in the nursing workforce, and ESAs recognize that no matter how much grant funding is available to attack a substantive problem, if the professional is not even available to step up and fill the need, finding other avenues and coming up with creative solutions will have to be the answer.

One important detail Nurse Suzanna Avalos stressed when discussing the role of the ESA and school-based nursing staff is that a school nurse must always be prepared for what’s next. Telehealth services may well be the future of healthcare for children and youth. With the initiative still in its infancy, school-based telehealth services are already indicating significant positive results in early intervention, affordability, increased healthcare provider access, increased attendance rates, and a collaborative team approach involving student, family,
provider, and school staff (Nix, 2021).


American Academy of Pediatrics. (2023, February 1). Summary of data publicly reported by the Centers for Disease Control and Prevention. Retrieved from covid-19-vaccination-trends/

Ashwin, A. Cherukuri, S. and Rammohan, A. (2022, May 21). Negative effects of COVID-19 pandemic on adolescent health: Insights, perspectives, and recommendations. Journal of
Global Health. Retrieved from,can%20adv

Auerbach, D., Buerhaus, P., Donelan, K., and Staiger, D. (2022, April 13), A worrisome drop in the number of young nurses. Health Affairs. Retrieved from

Center for Disease Control. (2021, May 14). CDC Crisis Response Cooperative agreement: COVID-19 public health workforce supplemental funding guidance. Retrieved from (2022). H.R.5526 - Improving Mental Health and Wellness in Schools Act; 117th Congress (2021-2022). Retrieved from

Fitzpatrick, M., et al., (2022, December 13). Two years of U.S. COVID-19 vaccines have prevented millions of hospitalizations and deaths. To the Point (blog), Commonwealth
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Health Resources & Services Administration. (2023). Introduction to school-based telehealth. Retrieved from

Nix, L. (2021, September 14). Seven reasons why school-based telehealth makes sense. Global Partnership for Telehealth. Retrieved from releases/seven-reasons-why-school-based-telehealth-makes-sense-301369560.html

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