Costs and Effects of School-Based Licensed Practical Nurses on Elementary Student Attendance and Chronic Absenteeism
Stephen M. Leach; Fiona M. Hollands; Eva Stone; Robert Shand; Laura Head; Yixin Wang; Bo Yan; Dena Dossett; Florence Chang; Yuan Chang Ginsberg; Yilin Pan (2023). Prevention Science, v24 n1 p94-104. Retrieved from: https://eric.ed.gov/?id=EJ1365070
-
examining16,025Students, grades1-5
Single Study Review
Review Details
Reviewed: March 2026
- Single Study Review (findings for School-based licensed practical nurses - Leach et al. (2023))
- Quasi-Experimental Design
- Meets WWC standards with reservations because it uses a cluster quasi-experimental design that provides evidence of effects on individuals by satisfying the baseline equivalence requirement for the individuals in the analytic intervention and comparison groups.
This review may not reflect the full body of research evidence for this intervention.
Evidence Tier rating based solely on this study. This intervention may achieve a higher tier when combined with the full body of evidence.
Findings
|
Outcome measure |
Comparison | Period | Sample |
Intervention mean |
Comparison mean |
Significant? |
Improvement index |
|---|---|---|---|---|---|---|---|
|
Attendance rate |
School-based licensed practical nurses - Leach et al. (2023) vs. Business as usual |
0 Days |
Full sample;
|
0.94 |
0.95 |
No |
-- |
|
Chronic absenteeism |
School-based licensed practical nurses - Leach et al. (2023) vs. Business as usual |
0 Days |
Full sample;
|
14.00 |
13.00 |
No |
-- |
Evidence Tier rating based solely on this study. This intervention may achieve a higher tier when combined with the full body of evidence.
Sample Characteristics
Characteristics of study sample as reported by study author.
-
17% English language learners -
Female: 48%
Male: 52% -
Urban
-
- B
- A
- C
- D
- E
- F
- G
- I
- H
- J
- K
- L
- P
- M
- N
- O
- Q
- R
- S
- V
- U
- T
- W
- X
- Z
- Y
- a
- h
- i
- b
- d
- e
- f
- c
- g
- j
- k
- l
- m
- n
- o
- p
- q
- r
- s
- t
- u
- v
- x
- w
- y
Kentucky
-
Race Black 45% Other or unknown 25% White 30% -
Ethnicity Hispanic 15% Not Hispanic or Latino 85% -
Eligible for Free and Reduced Price Lunch Free or reduced price lunch (FRPL) 79% No FRPL 21%
Study Details
Setting
The study took place in 46 public elementary schools within Jefferson County Public Schools (JCPS), an urban school district in Louisville, Kentucky. Most schools (43 of 46) were Title I–eligible.
Study sample
Participants were students in grades 1–5 from 23 intervention schools staffed with a full-time licensed practical nurse (LPN) and 23 comparison schools with usual health services. Students were excluded from the study if they had fewer than 10 days of enrollment or they were not enrolled in the school district in the year before the study. After these exclusions, a total of 7,932 students in intervention schools and 8,093 in comparison schools were included in the study. Approximately 15% of students were eligible for special education services, 17% were English learners; and 18% had a chronic health condition prior to the start of the study.
Intervention Group
Intervention schools added a full-time LPN in addition to trained unlicensed assistive personnel (UAPs) that all schools provided. LPNs operated dedicated health offices stocked with medical supplies, such as stethoscopes, defibrillators, and albuterol, in addition to basic first-aid supplies that all schools received.
Comparison Group
Comparison schools offered health services as usual delivered by trained unlicensed assistive personnel (UAPs) without the support of an LPN. UAPs had access to basic first aid supplies and a sick room or basic health office. UAP time was increased in lieu of LPN placement during the study period.
Support for implementation
Six advanced practice registered nurses supervised LPNs and UAPs. Advanced practice registered nurses and three screening nurses—who screened students for hearing, vision, and dental concerns—oversaw health services across the district and were available to all schools. The study team did not add additional implementation supports.
An indicator of the effect of the intervention, the improvement index can be interpreted as the expected change in percentile rank for an average comparison group student if that student had received the intervention.
For more, please see the WWC Glossary entry for improvement index.
An outcome is the knowledge, skills, and attitudes that are attained as a result of an activity. An outcome measures is an instrument, device, or method that provides data on the outcome.
A finding that is included in the effectiveness rating. Excluded findings may include subgroups and subscales.
The sample on which the analysis was conducted.
The group to which the intervention group is compared, which may include a different intervention, business as usual, or no services.
The timing of the post-intervention outcome measure.
The number of students included in the analysis.
The mean score of students in the intervention group.
The mean score of students in the comparison group.
The WWC considers a finding to be statistically significant if the likelihood that the finding is due to chance alone, rather than a real difference, is less than five percent.
The WWC reviews studies for WWC products, Department of Education grant competitions, and IES performance measures.
The name and version of the document used to guide the review of the study.
The version of the WWC design standards used to guide the review of the study.
The result of the WWC assessment of the study. The rating is based on the strength of evidence of the effectiveness of the intervention. Studies are given a rating of Meets WWC Design Standards without Reservations, Meets WWC Design Standards with Reservations, or >Does Not Meet WWC Design Standards.
A related publication that was reviewed alongside the main study of interest.
Study findings for this report.
Based on the direction, magnitude, statistical significance, and sample size of the findings within a domain, the WWC assigns effectiveness ratings as one of the following: Tier 1 (strong evidence), Tier 2 (moderate evidence), Tier 3 (promising evidence), uncertain effects, and negative effects. For more detail, please see the WWC Handbook.
The WWC may review studies for multiple purposes, including different reports and re-reviews using updated standards. Each WWC review of this study is listed in the dropdown. Details on any review may be accessed by making a selection from the drop down list.
Tier 1 Strong indicates strong evidence of effectiveness,
Tier 2 Moderate indicates moderate evidence of effectiveness, and
Tier 3 Promising indicates promising evidence of effectiveness,
as defined in the
non-regulatory guidance for ESSA
and the regulations for ED discretionary grants (EDGAR Part 77).