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Student ratios improve for district health professionals, but numbers are still overwhelming

on October 14, 2018

When counselor Teresa Pamintuan arrived in the West Contra Costa County Unified School District more than a decade ago, hundreds of students would be trying to get in to see her every day. She would try to squeeze in dozens of seniors a day for 20-minute one-on-one meetings to help map out their career and college goals. She often skipped lunch.

But as the district’s lead counselor in the past year, she has helped reform the overwhelming caseload for school healthcare professionals so they don’t burn out and can better help students.

As a result, the district has made a significant improvement in the ratio of students to support personnel, although there is still currently a shortage of nurses, psychologists and counselors at schools in the district.

The district has made progress despite a tight budget by partnering with outside agencies and adding unlicensed personnel to the staff, Pamintuan and experts say.

But still, district psychologist LaShante Smith, said the district was struggling to meet the needs of students affected by trauma because there were too few specialists for the number of students needing help.

Recent data shows that the ratio of students to nurses, psychologists and counselors improved in the last six years, according to the California Department of Education. But the numbers did not decrease enough to meet the nationally recommended ratios.

The district ratio for students to psychologists is now about 600 to one, a decrease from more than 1,000 students to one in 2011. The state is currently performing worse than the district with a ratio of more than 1,100 students to one psychologist. The suggested ratio for psychologists is 500 students to one, according to the National Association of School Psychologists.

But the district ratios for students to counselors and nurses are worse than the state’s ratios.

In the district, school counselors saw an improvement in their numbers, with the ratio of students to counselors falling to about 700 students for every counselor in 2017, compared to nearly 900 students per counselor in 2011. The state ratio for counselors is currently better than the district’s, with a little over 600 students to one.

But neither the district nor California have enough counselors, according to the American School Counselor Association. There should be a ratio of 250 students for every counselor, the association says, suggesting more than twice as many counselors are needed at both the district and state levels.

The ratio for district nurses to students improved from nearly 30,000 students to one, six years ago, to about 6,500 students to one in 2017. The state ratio for nurses is about 2,500 students to one. The ideal ratio of students to nurse is 750 students to one, according to the National Association of School Nurses, which suggests significantly more nurses are needed in the district and state schools.

Jill Brickner, a school nurse who’s worked for the district in the past decade, is also a certified elementary school teacher.


To make up for the huge shortfall, public health nurse Jill Brickner said that during the past three years, the district has been recruiting community members and unlicensed aides to work at different schools. The district has also collaborated with outside agencies to hire licensed vocational nurses, which helps reduce costs.

Meeting the needs of the students with too small a staff has been a struggle, Brickner said, but she’s been impressed with the efforts of the district.

“One of the things I’ve seen from this district is they have a real heart for these kids, especially kids with fragile diagnoses,” Brickner said. “We’ve made it a priority to keep them safe.”

To try to meet student needs, the different school sites offer varying services, including health clinics where community members take care of students instead of nurses.

Other clinics offer mental health services, but don’t provide other medical care.

Nick Berger, the district director of special education, said the health clinics are a great resource for students despite school nurses not working in them.

But Berger said while community members have been filling in for the lack of nurses, nonprofessionals haven’t been used in place of other health professionals.

Smith, who has been a district psychologist for the past six years, said the district also needs to make sure its resources are focused on collecting data on high needs students, training and stakeholders.

State funding should enable the district to train students in how to cope with trauma, she said. Psychologists need to train teachers to use strategies that are restorative and responsive to the trauma students’ experience, she said.

“Students are resilient and need skills to help them deal with their trauma,” she said. “If we are trying to create an environment for them to thrive, they need support in order for their skills to manifest.”

Brickner, the district nurse, said progress has been made in the last two years since the United Teachers of Richmond fought for health professionals to get competitive pay, but the challenge has been to fund that budget.

Berger, the special education director, said he hoped the pay upgrade would also serve as an incentive to get more health professionals to apply for district positions. There haven’t been enough applicants during this hiring period, he said.

Psychologist Smith said that, even with the lack of manpower, health professionals are determined to serve the students.

“It really takes a village,” she said. “They also need support beyond the school. The community needs to get involved.”


  1. Giorgio Cosentino on November 11, 2018 at 10:41 am

    Please tighten up the process for referrals made by teachers, to have a student evaluated. Years ago, teaching in a WCCUSD high school, I completed, and submitted, the paperwork for a student who I had concerns about. As a new teacher, with a lot on my plate, I figured I had done my part. The mistake I made was in not following up. Maybe there should have been a procedure that would have resulted in my receiving confirmation that the student was evaluated.

    In this case, the following school year, the student showed up to school with a loaded gun. He was subsequently arrested without incident. This occurred possibly in 2000 or 2001, in Richmond. I later found out he was never evaluated, that the paperwork, I was told, had been lost. Mistakes happen, I get that, but this was hard for me to accept.

    To M.V., and your family, I apologize for letting you down. You deserved the helped you needed, immediately. I remember the writing assignments of M.V., that he came from a home that was unstable, a lot of moving as a result of his dad’s work situation, and that he had dreams of some day owning a very nice home, with a movie theater, and such. The WCCUSD is the safety net for so many of these kids. With large class size, and less experienced teachers, and overworked psychologists, these kids can fall through the cracks.

    Although the teachers have received a large pay raise, which might slow teacher turnover, I hope this salary increase did not slow the process of reducing class size. For these students, we need BOTH experienced teachers, and a more manageable class size, and a smaller caseload for our school psychologists. Good luck to all!

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