School Attendance and Health on the Rise with Hawai’i Keiki Program


First page of the Hawai`i Keiki School-based Health Centers In Action storyHawai’i Keiki, a program formed through the partnership between the Hawai’i Department of Education and the University of Hawai’i at Mānoa, used The Community Guide to substantially improve student attendance and promote health equity. They provided schools with trained nurses and established CPSTF-recommended school-based health centers (SBHCs) to offer treatment and preventive health care. Before the SBHCs were established, 90% of students with illnesses or injuries were sent home. With Hawai’i Keiki, 90% of these students are treated and sent back to class to learn. (Released 2019)
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Lessons Learned

  • Collaboration is Key Collaboration between the University of Hawai’i, Kapi’olani Community College, and the Department of Education was key in convincing school principals of the program’s potential. Pooling resources allowed the Hawai’i Keiki team to create the most effective program possible.
  • Use the Latest Technology The electronic health record system created a more comprehensive and accessible way for school nurses and school health assistants to keep student records. Being able to access a student’s full health record at the touch of a button saves valuable time and resources and provides continuity of care.
  • Harness the Power of Data Tracking student health data provides impact data and helps decision makers plan ahead. It also allows the Department of Education and state health department to predict and prepare for outbreaks and seasonal health concerns.


One way to improve health equity among underserved populations is by starting with young children and adolescents. The Community Preventive Services Task Force (CPSTF) recommends school-based health centers (SBHCs) to improve educational and health outcomes. SBHCs provide primary health care on- or off-site and may also provide mental health care, social services, dentistry, and health education. Students with access to care are less likely to miss school and important learning opportunities.

The Hawai’i Department of Education (DOE) teamed up with the University of Hawai’i at Mānoa to create Hawai’i Keiki (children) a program aimed at improving student health, reducing absenteeism, and increasing health equity. Since its inception in 2014, the program has opened five SBHCs and implemented a statewide electronic health record system. In the next few years, they plan to open more SBHCs and expand services provided at all centers to include administration of dental sealants for younger children an intervention recommended by the CPSTF to prevent cavities and maintain good dental health.

Hawai’i Keiki decision makers have turned to The Community Guide to find the latest evidence-based recommendations from the CPSTF. “The Community Guide is something that guides us and sets our strategic directions,” said Dr. Mary Boland, dean of the School of Nursing and Dental Hygiene, University of Hawai’i at Mānoa.

Catering to the Keiki

In 2014, a team of leaders from Hawai’i schools went to a conference in Cincinnati to learn how other states handled health disparities and absenteeism. What they learned inspired them to create Hawai’i Keiki, integrate more nurses into schools, and establish SBHC programs to provide screening, direct services, and continuity of care. “This was an opportunity for nursing to lead in creating change,” Dr. Boland said. “Out of that came the idea of using nurse practitioners, because of convenience and resources available.”

In 2016, fifteen recently-graduated nurse practitioners were assigned to work in schools with especially high absentee rates. In addition to providing treatment for acute conditions and illnesses, the nurses provided screenings and preventive treatment. Within three years, Hawai’i Keiki established SBHCs at five of the schools where nurses were assigned.

The Power of Partnerships

To strengthen the program and increase the selection of nurse practitioners, the DOE and University of Hawai’i at Mānoa enlisted Kapi’olani Community College to adjust their training for school health assistants to work alongside nurses in the new SBHCs. Both nursing schools saw an opportunity to serve the community while providing hands-on experience for students in their nursing and school health assistant programs. When the nurses and assistants trained locally, they were more prepared for some of the island state’s specific health problems, such as uku (lice) outbreaks and skin conditions due to humidity. “It’s been a tremendous way to expand services and help [nursing] students see health equity in a way they can’t in the classroom,” Dr. Boland said.

The involvement of the University of Hawai’i at Mānoa added credibility when appealing to decision makers, especially school principals who weren’t sold on the idea. Carrying the prestige of the university, the Hawai’i Keiki team was able to enlist support using data and anecdotes from the first few SBHCs developed. “It’s difficult to convince people using just numbers,” Dr. Boland explained. “You have to share the stories of kids to convince people.”

Tracking Data and Moving Forward

While personal stories increased interest in developing new intervention strategies, data helped people understand the potentially larger public health implications. As a part of their SBHC program, Hawai’i Keiki implemented an e-school health records system. They trained staff from 256 schools across the state to manage and report student health data to the Hawai’i State Department of Education and Department of Health. Data have been used to facilitate patient care and evaluate health trends that can help public health officials predict and prepare for future health concerns.

The tracking system serves as a single repository for the state’s public school student health records. The system tracks and reports the amount of time students spend in the health room, how often students are sent home, and certain health trends. This data follows students as they move to different schools within the state education system.

Implementing the tracking system and creating the SBHCs has already had a major impact on absenteeism. Before the health centers were established, 90% of students with illnesses or injuries were sent home, whereas now 90% are sent back to class following appropriate treatment. Collecting data has been valuable for the health centers, and it has kept educators and administrators informed about the program’s impact. With limited resources available to them, schools need to see the value in these programs.

In light of the program’s successes, Hawai’i Keiki is expanding in 2019. They are opening four new SBHCs with additional staff and services, piloting a weekly after-school clinic for teachers and staff, and instituting a grant-funded telehealth program that connects SBHC providers with pediatric specialists. As Hawai’i Keiki continues to grow, the medical and education professionals in charge will continue to use relevant CPSTF recommended strategies and interventions.