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Ward MM, Bhagianadh D, Ullrich F, Merchant KAS, Mena C. Overview of School-Based Telehealth Network Grant Program Services Delivered to Students in Rural Schools. J Sch Nurs 2024; 40:566-573. [PMID: 36464799 DOI: 10.1177/10598405221142498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Telehealth can expand and enhance access to school-based health care, but its use has been relatively limited. Recognizing that school-based health care is still not reaching many students, the Health Resources and Services Administration (HRSA) funded the School Based Telehealth Network Grant Program to expand telehealth in rural school-based settings to help to increase the availability and use of these services. The 19 grantees delivered telehealth to over 200 schools across 17 states, choosing which services they would deliver and how. Looking across the services, these fell into three categories - primary/urgent care, behavioral health, and other more specialized services. The majority of grantees offered multiple telehealth services with the combination of behavioral health and primary/urgent care the most common. The current study adds to the literature by elucidating that telehealth in schools can address multiple clinical conditions through separate services even though doing so involves using various combinations of clinicians providing different services.
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Affiliation(s)
- Marcia M Ward
- Department of Health Management and Policy, University of Iowa, Iowa City, USA
| | | | - Fred Ullrich
- Department of Health Management and Policy, University of Iowa, Iowa City, USA
| | | | - Carlos Mena
- Office for the Advancement of Telehealth, Health Resources and Services Administration, Rockville, USA
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Garbers S, Ancheta AJ, Gold MA, Maier M, Bruzzese JM. Sleeping Healthy, Living Healthy: Using Iterative, Participatory Processes to Develop and Adapt an Integrated Sleep Hygiene/Mind-Body Integrative Health Intervention for Urban Adolescents. Health Promot Pract 2024; 25:865-875. [PMID: 37491898 PMCID: PMC10808277 DOI: 10.1177/15248399231184453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Racial and ethnic minority adolescents living in urban settings experience sleep disparities. Few interventions have been developed to address these disparities. Guided by principles of participatory design and inclusion, our team developed a novel intervention that combined sleep hygiene education with mind-body integrative health (MBIH) practices to improve sleep quality among adolescents in New York City. The goal of this article is to describe our iterative development and design process, the final product, and future directions. Our participatory approach incorporated information from formative work with adolescents having lived experience, practitioners, and syntheses of published literature. The final intervention-Sleeping Healthy, Living Healthy-consists of six, 40-minute group sessions and one 20-minute individual session designed for high school students. Each session has a set of learning objectives, combining instruction, group activities, and discussions on sleep hygiene and MBIH topics. Our manualized intervention includes handouts created by a graphic design team that served as a review and reminder for home practice. We describe intervention implementation to two unique cohorts and detail our methods used to fine-tune the intervention between cohorts. Our partnership with and insights from both adolescents and practitioners serve as a guide for researchers aiming to use participatory methods to develop interventions to decrease health disparities in specific populations.
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Affiliation(s)
- Samantha Garbers
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - April J. Ancheta
- University of Pennsylvania, Philadelphia, PA, USA
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Melanie A. Gold
- Columbia University Mailman School of Public Health, New York, NY, USA
- NewYork-Presbyterian, New York, NY USA
| | - Malia Maier
- Columbia University Mailman School of Public Health, New York, NY, USA
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Abu Khait A, Menger A, Al-Atiyyat N, Hamaideh SH, Al-Modallal H, Rayapureddy H. The Association Between Proneness to Smartphone Addiction and Social Anxiety Among School Students and the Mediating Role of Social Support: A Call to Advance Jordanian Adolescents' Mental Health. J Am Psychiatr Nurses Assoc 2024:10783903241261047. [PMID: 39044424 DOI: 10.1177/10783903241261047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
BACKGROUND Social anxiety is an emerging public health issue associated with significant impairment of social functioning during adolescence. Among many determinants of social anxiety, proneness to smartphone addiction may significantly contribute to the development of social anxiety. To cope with the consequential development of social anxiety, adolescent school students may rely on various forms of social support. Particularly in the Middle East, including Jordan, the relationship between proneness to smartphone addiction and adolescent social anxiety is understudied. AIM To examine the mediating role of social support in the relationship between proneness to smartphone addiction and social anxiety in a sample of adolescent school students. METHODS In this cross-sectional study, 432 adolescents were recruited via a random cluster sample from public schools across three provinces in Jordan. The data were collected face-to-face using the Social Anxiety Scale for Adolescents, the Smartphone Addiction Proneness Scale, and the Multidimensional Scale of Perceived Social Support. RESULTS Significantly higher levels of social anxiety were associated with females of lower economic status who reported more gaming hours and higher levels of proneness to smartphone addiction. Familial social support significantly mediated the relationship between proneness to smartphone addiction and social anxiety, controlling for the other covariates in the social anxiety model. CONCLUSIONS Familial social support reduced the impact of proneness to smartphone addiction on social anxiety. Nurses may supplement treatment for reducing social anxiety in adolescents suffering from proneness to smartphone addiction by fostering sources of familial social support.
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Affiliation(s)
- Abdallah Abu Khait
- Abdallah Abu Khait, PhD, RN, PMHCNS, MSN, BSN, Department of Community & Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Austin Menger
- Austin Menger, PhD, MSc, Menger Analytics, New York, NY, USA
| | - Nijmeh Al-Atiyyat
- Nijmeh Al-Atiyyat, PhD, MSN, RN, Department of Adult Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Shaher H Hamaideh
- Shaher H. Hamaideh, PhD, MSN, RN, Department of Community & Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Hanan Al-Modallal
- Hanan Al-Modallal, PhD, MSN, RN, Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
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Davis CR, Eraca J, Davis PA. Improving Students Access to Primary Health Care Through School-Based Health Centers. THE JOURNAL OF SCHOOL HEALTH 2024; 94:674-681. [PMID: 38621387 DOI: 10.1111/josh.13455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND More than 20 million children in the United States lack access to primary health care. PRACTICE LEARNING Research shows that students with regular access to physical and mental health services have fewer absences, are more social, less likely to participate in risky behaviors, have improved focus and higher test scores. IMPLICATION FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY School-based health centers (SBHCs) can be an important, valuable and viable health care delivery option to meet the full-range of primary health care needs of students where they spend the majority of their wake hours, ie, in school. Children in rural and other underserved communities, as well as those underinsured, non-insured, economically challenged, underserved, and the most vulnerable among us are especially at risk. CONCLUSIONS This paper discusses the history, value, and importance of SBHCs from myriad perspectives, including physical and emotional wellbeing, academic and social success, and the promotion of a positive transition to adulthood. In addition, the authors' experiences that resulted in building the first SBHC in the Mid-Hudson Valley Region of New York State are shared. These experiences form the foundation for creating an important roadmap for individuals and school leaders that are interested in bringing a SBHC to their school and district.
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Affiliation(s)
| | | | - Patti A Davis
- Mid-Hudson Regional Partnership Center, Dutchess County Board of Cooperative Educational Services, Poughkeepsie, NY
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Perez M, Kelley A. Reproductive behaviors among school-based health center clients in New Mexico. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1244135. [PMID: 38774835 PMCID: PMC11107081 DOI: 10.3389/frph.2024.1244135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 04/08/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction School-based health centers (SBHCs) are an evidence-based model for providing contraceptives to adolescents. SBHCs ability to provide reproductive health services is often limited by school district policies, state laws, and health center policies. Methods We used data from the Teens Exploring and Managing Prevention (TEMPO) study to document demographic characteristics and birth control methods among patients at four SBHCs in New Mexico. A total of 264 teens were included in the baseline data collection at SBHCs in New Mexico. A baseline survey was administered via iPad, that specifically focused on questions related to sexual experiences and sexual health topics. Baseline questions included demographic questions, gender identity, sexual orientation, reasons for visits, reproductive practices, and birth control methods. Descriptive statistics were calculated, including means and standard deviations for continuous variables and categorical frequencies. Results Our findings present reproductive health behaviors among New Mexican patients attending schools with SBHCs. More than 74% of respondents were Hispanic or Latino. The most common reason teens went to the SBHC was for birth control, and just 62% of teens reported using birth control methods in the past. Discussion These behaviors are essential for policymakers to consider as they address policy gaps, the complex landscape of parental permission, reproductive rights, and health as a human right.
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Affiliation(s)
- Mayra Perez
- University of New Mexico Health Sciences Center, Office for Community Health, Community Health Worker Initiatives, University of New Mexico, Albuquerque, NM, United States
| | - Allyson Kelley
- Allyson Kelley & Associates PLLC, Sisters, OR, United States
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Harfield S, Purcell T, Schioldann E, Ward J, Pearson O, Azzopardi P. Enablers and barriers to primary health care access for Indigenous adolescents: a systematic review and meta-aggregation of studies across Australia, Canada, New Zealand, and USA. BMC Health Serv Res 2024; 24:553. [PMID: 38693527 PMCID: PMC11062015 DOI: 10.1186/s12913-024-10796-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/28/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Indigenous adolescents access primary health care services at lower rates, despite their greater health needs and experience of disadvantage. This systematic review identifies the enablers and barriers to primary health care access for Indigenous adolescents to inform service and policy improvements. METHODS We systematically searched databases for publications reporting enablers or barriers to primary health care access for Indigenous adolescents from the perspective of adolescents, their parents and health care providers, and included studies focused on Indigenous adolescents aged 10-24 years from Australia, Canada, New Zealand, and United States of America. Results were analyzed against the WHO Global standards for quality health-care services for adolescents. An additional ninth standard was added which focused on cultural safety. RESULTS A total of 41 studies were included. More barriers were identified than enablers, and against the WHO Global standards most enablers and barriers related to supply factors - providers' competencies, appropriate package of services, and cultural safety. Providers who built trust, respect, and relationships; appropriate package of service; and culturally safe environments and care were enablers to care reported by adolescents, and health care providers and parents. Embarrassment, shame, or fear; a lack of culturally appropriate services; and privacy and confidentiality were common barriers identified by both adolescent and health care providers and parents. Cultural safety was identified as a key issue among Indigenous adolescents. Enablers and barriers related to cultural safety included culturally appropriate services, culturally safe environment and care, traditional and cultural practices, cultural protocols, Indigenous health care providers, cultural training for health care providers, and colonization, intergenerational trauma, and racism. Nine recommendations were identified which aim to address the enablers and barriers associated with primary health care access for Indigenous adolescents. CONCLUSION This review provides important evidence to inform how services, organizations and governments can create accessible primary health care services that specifically meet the needs of Indigenous adolescents. We identify nine recommendations for improving the accessibility of primary health care services for Indigenous adolescents.
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Affiliation(s)
- Stephen Harfield
- UQ Poche Centre for Indigenous Health, University of Queensland, St Lucia, Australia.
- School of Public Health, University of Queensland, Herston, Australia.
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia.
- School of Public Health, The University of Adelaide, Adelaide, Australia.
| | - Tara Purcell
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Eliza Schioldann
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - James Ward
- UQ Poche Centre for Indigenous Health, University of Queensland, St Lucia, Australia
| | - Odette Pearson
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Peter Azzopardi
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Centre for Adolescent Health, Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Itriyeva K. Improving Health Equity and Outcomes for Children and Adolescents: The Role of School-Based Health Centers (SBHCs). Curr Probl Pediatr Adolesc Health Care 2024; 54:101582. [PMID: 38490819 DOI: 10.1016/j.cppeds.2024.101582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
School-based health centers (SBHCs) provide a critical point of access to youth in low-resource communities. By providing a combination of primary care, reproductive health, mental health, vision, dental, and nutrition services, SBHCs improve the health, wellbeing, and academic achievement of the students they serve. SBHCs operate in collaboration with schools and community primary care providers to optimize the management of chronic health conditions and other health concerns that may result in suboptimal scholastic achievement and other quality of life measures. Conveniently located in or near school buildings and providing affordable, child- and adolescent-focused care, SBHCs reduce barriers to youth accessing high quality health care. SBHCs provide essential preventive care services such as comprehensive physical examinations and immunizations to students without a primary care provider, assist in the management of chronic health conditions such as asthma, and provide reproductive and sexual health services such as the provision of contraceptives, screening and treatment for sexually transmitted infections (STIs), and management of pregnancy. Additionally, some SBHCs provide vision screenings, dental care, and nutrition counseling to students who may not otherwise access these services. SBHCs have been demonstrated to be a cost-effective model of health care delivery, reducing both health care and societal costs related to illness, disability, and lost productivity.
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Affiliation(s)
- Khalida Itriyeva
- Cohen Children's Medical Center, Division of Adolescent Medicine, Northwell, New Hyde Park, NY.
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Rungan S, Liu HM, Smith-Merry J, Eastwood J. Kalgal Burnbona: An Integrated Model of Care Between the Health and Education Sector. Int J Integr Care 2024; 24:14. [PMID: 38706536 PMCID: PMC11067974 DOI: 10.5334/ijic.7745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Kalgal Burnbona is a framework developed for applying school-based integrated care (SBIC) across Sydney Local Health District (SLHD). Description Kalgal Burnbona is an innovative and integrative framework developed to provide holistic, integrated, multidisciplinary child and family centred care to school-aged children from priority populations within SLHD, such as those belonging to the Aboriginal community. The expected outcomes include improved health, behavioural, education and social outcomes. This article contextualises the development of the Kalgal Burnbona framework from its beginnings as a pilot site called Ngaramadhi Space (NS) within the Healthy Homes and Neighbourhoods (HHAN) initiative, through to its evolution to an integrated partnership between the New South Wales (NSW) health and education sector. An example of how the framework can be implemented in other settings within SLHD is described. Discussion A tiered approach to integrated care across SLHD is postulated based on evidence from a mixed methods evaluation of NS and in line with the Rainbow Model of Integrated Care (RMIC). Kalgal Burnbona is an example of a community-driven response through collaborative partnerships to improve health, education and social outcomes. The framework described provides structure for multisector teams to work within, recognising that each community and school has its own history and needs. Conclusion The Kalgal Burnbona model can be scaled up to serve a wider network of students across SLHD. The initial successes of the model, which include improving access and engagement for children with unmet physical health, mental health and social needs while being accepted by communities provide evidence for policy changes and advocacy that centre on collaborative cross-sector partnerships.
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Affiliation(s)
- Santuri Rungan
- Croydon Health Centre, 24 Liverpool Road, Croydon, NSW, 2132, Australia
| | - Huei Ming Liu
- Menzies Centre for Health Policy, University of Sydney, Australia
- The George Institute for Global Health, University of New South Wales, Australia
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy (CDRP), Susan Wakil Health Building (D18), Camperdown Campus, The University of Sydney, NSW, 2006, Australia
| | - John Eastwood
- School of Population Health, University of New South Wales, Kensington, NSW, 2050, Australia
- Sydney Local Health District, Level 11, King George V Building, Missenden Road, Camperdown, NSW, 2050, Australia
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Rungan S, Smith-Merry J, Liu HM, Drinkwater A, Eastwood J. School-Based Integrated Care Within Sydney Local Health District: A Qualitative Study About Partnerships Between the Education and Health Sectors. Int J Integr Care 2024; 24:13. [PMID: 38706539 PMCID: PMC11067993 DOI: 10.5334/ijic.7743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction The unmet physical and mental health needs of school-aged children (5-18 years) in New South Wales (NSW), stemming from poor access and engagement with healthcare, can be addressed by school-based integrated care (SBIC) models.This research aims to understand why and how partnerships between the health and education sector, in SBIC models, are important in providing care for children, and to identify the facilitating factors and barriers for implementation. Methods A qualitative study was conducted using semi-structured interviews and thematic analysis. The principles of the 'Integrated People-Centred Health Service (IPCHS)' framework and Looman et al's (2021) implementation strategies for integrated care were considered. Results Themes within IPCHS framework: Strategy 1: Engaging and empowering people and communities - community-driven models, improved access to healthcare, positive outcomes for children and families, 'connection', and service provision for marginalised populations; Strategy 2: Strengthening governance and accountability - system integration and developing evidence base; Strategy 3: Reorienting the model of care - shifting healthcare to schools reduces inequity and provides culturally safe practice; Strategy 4: Coordinating services within and across sectors - integrating care and stable workforce; Strategy 5: Creating an enabling environment: leadership, stakeholder commitment, and adequate resourcing. Discussion Potential strategies for implementing SBIC models across NSW include community consultation and co-design; building multidisciplinary teams with new competencies and roles e.g. linkers and coordinators; collaborative and shared leadership; and alignment of operational systems while maintaining a balance between structure and flexibility. Conclusion SBIC models require high-level collaboration across sectors and with communities to provide a shift towards child and family centred care that improves engagement, access and outcomes in health delivery.
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Affiliation(s)
- Santuri Rungan
- Croydon Health Centre, 24 Liverpool Road, Croydon, NSW, AU
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy (CDRP), Susan Wakil Health Building (D18), Camperdown Campus, The University of Sydney, NSW, 2006, AU
| | - Huei Ming Liu
- Menzies Centre for Health Policy, University of Sydney, AU
- The George Institute for Global Health, University of New South Wales, AU
| | - Alison Drinkwater
- Centre for Disability Research and Policy (CDRP), Susan Wakil Health Building (D18), Camperdown Campus, The University of Sydney, NSW, 2006, AU
| | - John Eastwood
- School of Population Health, University of New South Wales, Kensington, NSW 2050, AU
- Sydney Local Health District, Level 11, King George V Building, Missenden Road, Camperdown NSW 2050, AU
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McCabe EM, Jameson BE, Grunin L, Yu G. Chronic Health Condition Management and School-Based Health Centers in New York: Findings From the 2020 School Health Profiles Survey. Policy Polit Nurs Pract 2024; 25:36-46. [PMID: 38099704 DOI: 10.1177/15271544231220360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
School-based health centers (SBHCs) are associated with numerous positive aspects of student health services. Many schools in the United States (US) do not have transparent policies on chronic health condition (CHC) management. Of particular concern is the underreporting of the delivery of health services in U.S. schools concerning CHC management and its relationship with the presence or absence of a SBHC. Data from the 2020 School Health Profiles (SHP) Survey were examined in New York public secondary schools. Specific health services were reviewed, together with the presence or absence of a SBHC, including daily medication administration, stock rescue medication, case management services, community partners, chronic disease-specific education, and assurance that students with CHCs were enrolled in an insurance program. A significantly greater proportion of schools with a SBHC compared with schools without a SBHC provided: (1) daily medication administration (92.9% vs. 86.5%; p < .001), (2) stock or rescue medication (84.9% vs. 77.4%; p < .001), (3) case management services (83.1% vs. 67.2%; p < .001), (4) disease-specific education for families (63.1% vs. 57.2%; p = .022), (5) student and family connection to community health services (84.2% vs. 76.5%; p < .001), and (6) ensured that a protocol existed whereby students with a CHC were enrolled in an insurance plan if eligible (79.6% vs. 66.8%; p < .001). Findings suggest that data on a national scale include essential facts for states to consider concerning school health policies and practices. Additional research should examine the intricacy of elements connected with school-based health care to understand better the care provided to children with CHCs.
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Affiliation(s)
- Ellen M McCabe
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Beth E Jameson
- College of Nursing, Seton Hall University, Nutley, NJ, USA
| | - Laura Grunin
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Gary Yu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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Rungan S, Montgomery A, Smith-Merry J, Liu HM, Eastwood J. Retrospective audit of a school-based integrated health-care model in a specialised school for children with externalising behaviour. J Paediatr Child Health 2023; 59:1311-1318. [PMID: 37964701 DOI: 10.1111/jpc.16515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/17/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023]
Abstract
AIM Problematic externalising behaviours in adolescents are associated with high individual and societal burden. A school-based multidisciplinary health clinic, Ngaramadhi Space (NS), was developed at Yudi Gunyi School, a specialised behavioural school in Sydney, Australia, to improve access to holistic health-care and behavioural support. This evaluation aimed to describe the demographics, clinic attendance, health screening, recommendations made, and changes in Strengths and Difficulties Questionnaire (SDQ) scores of students attending the clinic. METHODS Retrospective evaluation of students including changes in SDQ scores using descriptive statistics (26 July 2016 to 14 May 2019; n = 79). RESULTS Prior to the assessment, few students engaged with a paediatrician or mental health professional (22.8%; 27.8%, respectively). Child protection services were involved with 76%. NS attendance was high (failure-to-attend = 7.6%; cancellations = 8.9%). New issues found at the assessment included: parental separation (31.6%); trauma history (27.8%); substance use (19%); emotional wellbeing concerns (16.5%), learning difficulties (12.7%), domestic violence (12.7%) and medical conditions (10.1%). SDQ teacher reports showed a significant decrease in total difficulties scores (M = 6.2, SD = 6.165, P < 0.05, eta squared = 1.013 (large effect)) and all subsets. No significant differences in parent and self-reported SDQ. CONCLUSIONS Students with problematic externalising behaviour have unmet health and social needs. The NS school-based integrated health-care model offers a novel, convenient and innovative way to engage these students. This approach has high initial attendance rates with teacher-reported SDQ results showing some behavioural improvement. Further qualitative studies are required.
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Affiliation(s)
- Santuri Rungan
- Croydon Community Health Centre, Sydney Local Health District, Melbourne, New South Wales, Australia
| | - Alicia Montgomery
- Croydon Community Health Centre, Sydney Local Health District, Melbourne, New South Wales, Australia
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy (CDRP), The University of Sydney, Sydney, New South Wales, Australia
| | - Huei Ming Liu
- Croydon Community Health Centre, Sydney Local Health District, Melbourne, New South Wales, Australia
| | - John Eastwood
- Croydon Community Health Centre, Sydney Local Health District, Melbourne, New South Wales, Australia
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12
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Rungan S, Gardner S, Liu HM, Woolfenden S, Smith-Merry J, Eastwood J. Ngaramadhi Space: An Integrated, Multisector Model of Care for Students Experiencing Problematic Externalising Behaviour. Int J Integr Care 2023; 23:19. [PMID: 38107833 PMCID: PMC10723013 DOI: 10.5334/ijic.7612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/30/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Behavioural and emotional disorders are a significant cause of morbidity for young people aged 10-19 years. School-based health care (SBHC) provides an innovative approach to addressing these issues within Australia. Description We describe an innovative and integrative SBHC model called Ngaramadhi Space (NS) based at a specialised behavioural school called Yudi Gunyi school (YGS) in metropolitan Sydney, Australia. NS was developed in partnership with the Aboriginal community to provide holistic, integrated, multidisciplinary child and family centred care to students experiencing problematic externalising behaviour. We contextualise the historical factors leading to the development of NS, highlighting the importance of effective partnerships between sectors, and providing the theoretical framework and key components underpinning the model of care. Discussion In Australia, schools are an under-utilised resource for the delivery of health and support alongside education. Collaboration between sectors can be challenging but allows a more coordinated approach to the management of complex social and health issues. By forming effective partnerships with schools and communities, the health sector has an opportunity to improve access to health and social care in a culturally safe and acceptable way. This is in line with national and international frameworks for improving health service delivery and addressing inequity. Conclusion The health sector can play a pivotal role in improving the wellbeing of children by forming effective partnerships with schools and communities. The NS model is a practice-based example of this.
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Affiliation(s)
- Santuri Rungan
- Sydney Local Health District, University of Sydney, Sydney Institute for Women, Children & their Families, AU
| | | | - Huei-Ming Liu
- The George Institute for Global Health, University of New South Wales, AU
| | - Susan Woolfenden
- Sydney Local Health District, University of Sydney, AU
- Sydney Institute Women, Children and their Families, University of New South Wales, AU
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy, Sydney School of Health Sciences, The University of Sydney, AU
| | - John Eastwood
- University of New South Wales, Sydney, AU
- Ingham Institute of Applied Medical Research, Liverpool, NSW, AU
- University of Sydney, Sydney Institute for Women, Children and their Families and Sydney Local Health District, AU
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Burman C, Mendoza Diaz A, Leslie A, Goldthorp K, Jubb B, Simms AR, Eapen V. Critical success factors for school-based integrated health care models: Learnings from an Australian example. Health Promot J Austr 2023; 34:775-783. [PMID: 36538268 DOI: 10.1002/hpja.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/05/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
ISSUES ADDRESSED Integrated school-based health services have the potential to address the unmet health needs of children experiencing disadvantage, yet these models remain poorly evaluated. The current article examines an integrated social and health care hub located on the grounds of a regional Australian public primary school, the Our Mia Mia Wellbeing Hub, to identify critical success factors for this service and others like it. METHODS Semi-structured qualitative interviews were conducted with N = 55 multi-sector stakeholders comprising parents, students, school staff, social and health care providers, and local Aboriginal community members. Interview transcripts were analysed according to a grounded theory approach. RESULTS Six themes emerged from the analysis, reflecting important success factors for the model: service accessibility; service coordination; integration of education and health systems; trust; community partnerships; and perceptions of health. CONCLUSIONS Findings highlighted Our Mia Mia as a promising model of care, yet also revealed important challenges for the service as it responds to the varied priorities of the stakeholders it serves. SO WHAT?: Through capturing the perspectives of a large number of stakeholders, the current study provides valuable insight into key challenges and success factors for Our Mia Mia; these learnings can guide the development of other emerging school-based health services and integrated care hubs.
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Affiliation(s)
- Charlotte Burman
- BestSTART-SWS, Ingham Institute of Applied Medical Research, Nowra, NSW, Australia
| | - Antonio Mendoza Diaz
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
- Academic Unit of Child Psychiatry, Infant, Child and Adolescent Mental Health Service, NSW, Australia
| | - Andrew Leslie
- Nowra East Public School, Nowra, NSW, Australia
- Our Mia Mia Wellbeing Hub, Nowra, NSW, Australia
| | | | - Brendan Jubb
- Our Mia Mia Wellbeing Hub, Nowra, NSW, Australia
| | | | - Valsamma Eapen
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
- Academic Unit of Child Psychiatry, Infant, Child and Adolescent Mental Health Service, NSW, Australia
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Miehe J. Expanding School-Based Health Centers: Sustainable Partnerships and Building Access. THE JOURNAL OF SCHOOL HEALTH 2023; 93:930-933. [PMID: 37272218 DOI: 10.1111/josh.13350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 03/25/2023] [Accepted: 05/21/2023] [Indexed: 06/06/2023]
Abstract
Children require accessible, affordable health care to support health and education outcomes. Health care access is affected by children's social determinants of health. School-based health centers (SBHC) bypass larger social structures and social determinants of health, providing accessible health care to children. New SBHC development should consider university collaboration partnerships to establish funding sustainability. University interprofessional health programs allow for high-quality, advanced practice nurse care models to staff SBHCs. When developing an SBHC, founders should utilize access theory to ensure conformity between the targeted population's needs and health services. The dimensions of the theory assist in building and evaluating access. As the pandemic continues to cause health care access barriers for children, advocates, and policymakers should focus efforts on sustaining and expanding SBHCs.
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Palme' H, Skinner D, Bode S, Irwin MK. An Imperfect Space: Logistical Considerations in School-Based Health Centers. THE JOURNAL OF SCHOOL HEALTH 2023; 93:900-909. [PMID: 37356453 DOI: 10.1111/josh.13361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND From a range of perspectives, scholars have demonstrated the value of school-based health centers (SBHCs) in recent decades, but few studies have examined the logistics of establishing SBHCs. METHODS Semi-structured interviews were conducted with 9 hospital and 6 school employees involved in a network of SBHCs. After common themes were identified, cluster analysis was performed. Finally, quotes were identified within each thematic cluster for further qualitative analysis. RESULTS The most prominent themes were (1) differences in physical space (between schools and clinical settings), (2) collaboration and communication, and (3) privacy and compliance. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY This study points to several high yield considerations for the practice of SBHCs. First, we identified three distinct needs: (1) clear funding streams for construction costs for health services on school grounds, (2) improved understanding of SBHC space needs, and (3) blueprints for collaborating within SBHCs. Second, this study points to a future in which new-build and renovated schools should include space for SBHCs. CONCLUSIONS This qualitative thematic analysis provides a picture of health and educational professionals engaged in creative, collaborative, and adaptive work to meet children's health care needs within SBHCs, but also highlights the challenges of navigating physical space, compliance, and collaboration within SBHCs.
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Affiliation(s)
- Hannah Palme'
- Ohio University, Heritage College of Osteopathic Medicine, Dublin, OH
| | - Daniel Skinner
- Ohio University, Heritage College of Osteopathic Medicine, Dublin, OH
| | - Sara Bode
- School Health Services, Nationwide Children's Hospital, Associate Professor, Department of Pediatrics, The Ohio State University, Columbus, OH
| | - Mary Kay Irwin
- School Health Services, Nationwide Children's Hospital, Adjunct Assistant Professor, Department of Pediatrics, The Ohio State University, Columbus, OH
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Boudreaux M, Chu J, Lipton BJ. School-Based Health Centers, Access to Care, and Income-Based Disparities. JAMA Netw Open 2023; 6:e2334532. [PMID: 37721750 PMCID: PMC10507491 DOI: 10.1001/jamanetworkopen.2023.34532] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/13/2023] [Indexed: 09/19/2023] Open
Abstract
Importance School-based health centers (SBHCs) are primary care clinics colocated at schools. SBHCs have the potential to improve health care access and reduce disparities, but there is limited rigorous evidence on their effectiveness at the national level. Objective To determine whether county-level adoption of SBHCs was associated with access, utilization, and health among children from low-income families and to measure reductions in income-based disparities. Design, Setting, and Participants This survey study used a difference-in-differences design and data from a nationally representative sample of children in the US merged with SBHC indicators from the National Census of School-Based Health Centers. The main sample included children aged 5 to 17 years with family incomes that were less than 200% of the federal poverty level observed in the National Health Interview Survey, collected between 1997 to 2018. The sample was restricted to children living in a county that adopted a center between 2003 and 2013 or that did not have a center at any time during the study period. Analyses of income-based disparities included children from higher income families (ie, 200% or higher than the federal poverty level). Data were analyzed between January 2020 and July 2023. Exposure County-by-year SBHC adoption. Main Outcomes and Measures Outcomes included access (usual source of care, insurance status, barriers), ambulatory care use (general physician, eye doctor, dental, mental health visits), and health (general health status, missed school days due to illness). P values were adjusted for multiple comparisons using the sharpened q value method. Results This study included 12 624 unweighted children from low-income families and 24 631 unweighted children from higher income families. The weighted percentage of children in low-income families who resided in counties with SBHC adoption included 50.0% aged 5 to 10 years. The weighted percentages of the race and ethnicity of these children included 36.7% Hispanic children, 25.2% non-Hispanic Black children, and 30.6% non-Hispanic White children. The weighted percentages of children in the counties that never adopted SBHCs included 50.1% aged 5 to 10 years. The weighted percentages of the race and ethnicity of these children included 20.7% Hispanic children, 22.4% non-Hispanic Black children, and 52.9% non-Hispanic White children. SBHC adoption was associated with a 6.4 percentage point increase in dental visits (95% CI, 3.2-9.6 percentage points; P < .001), an 8.0 percentage point increase in having a usual source of care (95% CI, 4.5-11.5 percentage points; P < .001), and a 5.2 percentage point increase in insurance (95% CI, 1.2-9.2 percentage points; P = .03). No other statistically significant associations were found with other outcomes. SBHCs were associated with relative reductions in income-based disparities to dental visits by 76% (4.9 percentage points; 95% CI, 2.0-7.7 percentage points), to insured status by 63% (3.5 percentage points; 95% CI, 1.3-5.7 percentage points), and to having a usual source of care by 98% (7.2 percentage points; 95% CI, 5.4-9.1 percentage points). Conclusions and Relevance In this survey study with difference-in-differences analysis of SBHC adoption, SBHCs were associated with access to care and reduced income-based disparities. These findings support additional SBHC expansion.
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Affiliation(s)
- Michel Boudreaux
- Department of Health Policy and Management, University of Maryland, College Park
| | - Jun Chu
- Department of Sociology, Anthropology, and Public Health, University of Maryland, Baltimore County, Baltimore
| | - Brandy J. Lipton
- Department of Health, Society, and Behavior, University of California, Irvine
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Freeman SJ, Rasiah S, Cohen-Silver J, Xu K, Lebovic G, Maguire J. Mental Health Trajectories of Children and Caregivers Using School-Based Health Centers During the COVID-19 Pandemic. J Pediatr Health Care 2023; 37:511-518. [PMID: 37245129 PMCID: PMC10123352 DOI: 10.1016/j.pedhc.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION This was a prospective study of children registered at school-based health centers (SBHCs) in Canada. The objectives were to compare mental health trajectories of children and parents/caregivers who accessed SBHCs during the pandemic relative to those who did not. METHOD Parents/caregivers of children who attended SBHCs completed the Strengths and Difficulties Questionnaire (SDQ) and the Generalized Anxiety Disorder-7 (GAD-7) at three time points during the pandemic. The primary analysis used linear mixed models to examine the relationship between SBHC visits during the pandemic and children's SDQ score trajectories. The secondary analysis was the same for parents'/caregivers' GAD-7 scores. RESULTS There were 435 children included. SDQ and GAD-7 scores worsened over time for children and parents/caregivers who attended SBHCs during the pandemic compared to those who did not. DISCUSSION Children and parents/caregivers with worsening mental health symptoms may have sought care at SBHCs since they were accessible during the pandemic.
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Duck AA, Carr K, Lim CS, Robinson JC. Integrating Behavioral Health and Primary Care in an Inner-City High School: Expanded Care in a School-Based Clinic in Mississippi, 2018-2020. Public Health Rep 2023; 138:16S-21S. [PMID: 37226942 PMCID: PMC10226072 DOI: 10.1177/00333549221128221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Adolescence, a critical and rapid stage of human development, requires innovative approaches in the provision of health care. With considerable mental health issues occurring among adolescents, an urgent need exists to address their mental and behavioral health. School-based health centers can provide an important safety net, particularly for young people who lack access to comprehensive and behavioral health care. We describe the design and implementation of behavioral health assessment, screening, and treatment services in a primary care school-based health center. We reviewed primary care and behavioral health measures as well as the challenges and lessons learned of this process. Five hundred and thirteen adolescents and young adults aged 14-19 years from an inner-city high school in South Mississippi were screened for behavioral health issues from January 2018 through March 2020, and all 133 adolescents deemed at risk for behavioral health issues received comprehensive health care. Lessons learned included the importance of recruiting behavioral health providers to ensure sufficient staff, establishing academic-practice arrangements to ensure funding, increasing student enrollment by improving the return rate of consent for care, and enhancing data collection through process automation. This case study may help inform the design and implementation of integrated primary and behavioral health care in school-based health centers.
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Affiliation(s)
- Angela A Duck
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kayla Carr
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA
| | - Crystal S Lim
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jennifer C Robinson
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA
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19
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Hoskote AR, Croce E, Johnson KE. The Evolution of the Role of U.S. School Nurses in Adolescent Mental Health at the Individual, Community, and Systems Level: An Integrative Review. J Sch Nurs 2023; 39:51-71. [PMID: 35019803 DOI: 10.1177/10598405211068120] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
School nurses are crucial to addressing adolescent mental health, yet evidence concerning their evolving role has not been synthesized to understand interventions across levels of practice (i.e., individual, community, systems). We conducted an integrative review of school nurse roles in mental health in the U.S. related to depressive symptoms, anxiety, and stress. Only 18 articles were identified, published from 1970 to 2019, and primarily described school nurses practicing interventions at the individual level, yet it was unclear whether they were always evidence-based. Although mental health concerns have increased over the years, the dearth of rigorous studies made it difficult to determine the impact of school nurse interventions on student mental health outcomes and school nurses continue to feel unprepared and under supported in this area. More research is needed to establish best practices and systems to support school nursing practice in addressing mental health at all levels of practice.
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Affiliation(s)
- Ashwini R Hoskote
- Robert Wood Johnson Foundation Future of Nursing Scholar, 12330University of Texas at Austin School of Nursing
| | - Emily Croce
- 12330The University of Texas at Austin School of Nursing; Dell Children's Medical Group, Austin, TX
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Soleimanpour S, Geierstanger S, Goddard A, Cushing K, Fields P, Love H. Developing National Standardized Performance Measures for School-Based Health Centers: The National Quality Initiative. THE JOURNAL OF SCHOOL HEALTH 2023; 93:97-106. [PMID: 35915560 DOI: 10.1111/josh.13236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite extensive literature on school-based health center (SBHC) characteristics and outcomes, their quality of care has not been examined nationally. Standardized quality metrics can inform health care delivery and improvement. METHODS SBHC national performance measures (NPMs) were developed by reviewing measures from national child health quality initiatives and engaging stakeholders in a consensus-building process. NPMs were pilot-tested with 73 SBHCs and SBHCs nationally subsequently reported data. RESULTS Five NPMs were selected including the percentage of clients annually who received at least one: (1) well-child visit, whether administered in the SBHC or elsewhere; (2) risk assessment; (3) body mass index screen with nutrition and physical activity counseling; and, if age-appropriate, (4) depression screening with follow-up treatment plan; and (5) chlamydia screening among sexually active clients. SBHCs experienced challenges with reporting during pilot-testing, particularly related to extracting data from electronic health records, and identified strategies to address challenges. Approximately 20% of SBHCs nationally voluntarily reported data during the initial year. IMPLICATIONS FOR SCHOOL HEALTH Standardized performance measures can help SBHCs monitor and improve care delivery and demonstrate effectiveness compared to other child health delivery systems. CONCLUSION Ongoing data collection will help examine whether measure adoption drives quality improvement for SBHCs nationwide.
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Affiliation(s)
- Samira Soleimanpour
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois Street, Floor 7, San Francisco, CA, 94158
| | - Sara Geierstanger
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois Street, Floor 7, San Francisco, CA, 94158
| | - Anna Goddard
- School-Based Health Alliance, 1010 Vermont Ave NW, Suite 816, Washington, DC, 20005
- Managing Director of Medical Services & Quality Improvement and Pediatric Nurse Practitioner, , Child and Family Agency of Southeastern Connecticut, 255 Hempstead Street, New London, CT, 06320
| | - Katherine Cushing
- School-Based Health Alliance, 1010 Vermont Ave NW, Suite 816, Washington, DC, 20005
| | - Paula Fields
- School-Based Health Alliance, 1010 Vermont Ave NW, Suite 816, Washington, DC, 20005
| | - Hayley Love
- School-Based Health Alliance, 1010 Vermont Ave NW, Suite 816, Washington, DC, 20005
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Child Flourishing, School Engagement, Physical Activity, and Screen Time During the Coronavirus Disease 2019 Pandemic in 2020. Acad Pediatr 2023; 23:659-666. [PMID: 36623586 PMCID: PMC9822554 DOI: 10.1016/j.acap.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To examine changes in flourishing, school engagement, physical activity, and recreational screen time among school-aged children in the United States during the Coronavirus Disease 2019 (COVID-19) pandemic in 2020. METHODS In this cross-sectional study, data come from the 2018-2020 National Survey of Children's Health for 68,203 children aged 6 to 17 years. Flourishing is always/usually curious to learn, resilient and having self-regulation. School engagement is always/usually completing homework and having interest in doing well in school. Other outcomes are daily 60+ minutes physical activity or number of such days, and daily recreational screen time or 2+ hours/day. Weighted regression models compare 2020 to 2019 and 2019 to 2018 adjusting for child/household covariates and state indicators. RESULTS Among children age 6 to 17 years in 2020, there was a decline in flourishing (OR = 0.69; 95% CI, 0.63, 0.75), school engagement (OR = 0.71; 95% CI, 0.64, 0.79), physically active days (0.26 days, 95% CI, 35, 0.17), and daily 60+ minutes activity (OR = 0.91; 95% CI, 0.83, 1.00), and increase in daily recreational screen time (0.29 hours; 95% CI, 0.25, 0.34) and 2+ hours/day (OR = 1.65; 95% CI, 1.49-1.83) compared to 2019. These differences were observed across all evaluated demographic and socioeconomics subgroups. There were no significant differences between 2019 and 2018, indicating that the 2020-2019 differences were related to the pandemic rather than a continuation of prepandemic trends. CONCLUSIONS Children's flourishing, school engagement, and physical activity declined while recreational screen time increased during the COVID-19 pandemic in 2020. Monitoring these outcomes in the long-run is important to assessing needs and promoting children's learning and development.
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Beierwaltes P, Bell SE, Cornell R, Ostrow LG, Schmitz N, Verchota G, Clisbee D, Houston R, Eggenberger SK. A school-based health centre partnership: Faculty practice, nursing student learning and wellness in youth, families and community. J Clin Nurs 2023; 32:332-345. [PMID: 35146815 DOI: 10.1111/jocn.16246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 10/26/2021] [Accepted: 01/20/2022] [Indexed: 12/14/2022]
Abstract
AIMS AND OBJECTIVES This paper describes the development of a SBHC with an innovative model of care that grew out of a partnership between a public-school district and a university nursing programme in the midwestern region of the United States. BACKGROUND AND PURPOSE Persistent barriers to health and health care experienced by youth are well documented. School-based health centres (SBHCs) can improve educational and health outcomes, positively impacting health equity. Academic systems are positioned to address health care needs of the school-aged population, yet educators face challenges of accessing quality learning placements for students and faculty practice sites. METHODS A community-based collaborative methodology guided the planning phases that were driven by priority needs identified by families and stakeholders. With the mission of "partnering with students, families, and communities in the promotion of health and wellness through engagement in practice, education, and research," an ongoing dialogue over a two-year period led to articulating a vision, designing a plan and implementing a nurse-managed SBHC. The Standards for Reporting Qualitative Research (SRQR) checklist was considered in the preparation of this paper. RESULTS In three years, this SBHC has addressed and identified priority needs and served individual youth and families. The SBHC provides opportunities for the faculty to fulfil a practice requirement for certification and accreditation. Nursing students engage with youth and families in health education and health promotion while strengthening their technical and relational skills. Family nurse practitioner students gain valuable clinical experience. Faculty with expertise in family nursing guide family assessments, support family resiliency and direct therapeutic conversations with family units. CONCLUSION SBHCs serve youth, families, and community. This academic-practice partnership has the added benefit of providing faculty practice opportunities and nursing student experiential learning. RELEVANCE TO CLINICAL PRACTICE SHBCs provide practice opportunities that address needs in individuals, families, and communities. Partnerships should be considered at academic nursing programmes to support their needs and fulfil commitments to address health equity gaps.
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Affiliation(s)
| | - Sue Ellen Bell
- School of Nursing, Minnesota State University, Mankato, Mankato, Minnesota, USA
| | - Rhonda Cornell
- School of Nursing, Minnesota State University, Mankato, Mankato, Minnesota, USA
| | - Laurel Gail Ostrow
- School of Nursing, Minnesota State University, Mankato, Mankato, Minnesota, USA
| | - Nicole Schmitz
- School of Nursing, Minnesota State University, Mankato, Mankato, Minnesota, USA
| | - Gwen Verchota
- School of Nursing, Minnesota State University, Mankato, Mankato, Minnesota, USA
| | - David Clisbee
- School of Nursing, Minnesota State University, Mankato, Mankato, Minnesota, USA
| | - Rebecca Houston
- School of Nursing, Minnesota State University, Mankato, Mankato, Minnesota, USA
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Gizaw Z, Astale T, Kassie GM. What improves access to primary healthcare services in rural communities? A systematic review. BMC PRIMARY CARE 2022; 23:313. [PMID: 36474184 PMCID: PMC9724256 DOI: 10.1186/s12875-022-01919-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND To compile key strategies from the international experiences to improve access to primary healthcare (PHC) services in rural communities. Different innovative approaches have been practiced in different parts of the world to improve access to essential healthcare services in rural communities. Systematically collecting and combining best experiences all over the world is important to suggest effective strategies to improve access to healthcare in developing countries. Accordingly, this systematic review of literature was undertaken to identify key approaches from international experiences to enhance access to PHC services in rural communities. METHODS All published and unpublished qualitative and/or mixed method studies conducted to improvement access to PHC services were searched from MEDLINE, Scopus, Web of Science, WHO Global Health Library, and Google Scholar. Articles published other than English language, citations with no abstracts and/or full texts, and duplicate studies were excluded. We included all articles available in different electronic databases regardless of their publication years. We assessed the methodological quality of the included studies using mixed methods appraisal tool (MMAT) version 2018 to minimize the risk of bias. Data were extracted using JBI mixed methods data extraction form. Data were qualitatively analyzed using emergent thematic analysis approach to identify key concepts and coded them into related non-mutually exclusive themes. RESULTS Our analysis of 110 full-text articles resulted in ten key strategies to improve access to PHC services. Community health programs or community-directed interventions, school-based healthcare services, student-led healthcare services, outreach services or mobile clinics, family health program, empanelment, community health funding schemes, telemedicine, working with traditional healers, working with non-profit private sectors and non-governmental organizations including faith-based organizations are the key strategies identified from international experiences. CONCLUSION This review identified key strategies from international experiences to improve access to PHC services in rural communities. These strategies can play roles in achieving universal health coverage and reducing disparities in health outcomes among rural communities and enabling them to get healthcare when and where they want.
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Affiliation(s)
- Zemichael Gizaw
- grid.59547.3a0000 0000 8539 4635Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tigist Astale
- grid.452387.f0000 0001 0508 7211International Institute for Primary Health Care- Ethiopia, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Getnet Mitike Kassie
- grid.452387.f0000 0001 0508 7211International Institute for Primary Health Care- Ethiopia, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Borkowski V, Goddard A, Gaffney B. School-Based Health Centers: A Concept Analysis. J Pediatr Health Care 2022; 37:269-278. [PMID: 36470799 DOI: 10.1016/j.pedhc.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/23/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION This concept analysis aims to provide a conceptual definition for school-based health centers (SBHCs). Despite growing evidence of SBHC growth and impact, there is a gap in the conceptual clarity of SBHCs. METHOD A systematic review using Walker and Avant's 8-step method of concept analysis produced 369 articles, of which 17 were analyzed. PubMed, CINAHL, Embase, PsycINFO, and Cochrane Library were searched with no time limit to capture the history and development of SBHCs. Search terms included "school-based health" and "school-based health center." RESULTS Accessible and advanced practitioners, heterogeneity, integrated care and location, and youth-friendly provide defining attributions to SBHCs. Antecedents, consequences, and empirical referents are discussed. DISCUSSION This concept analysis highlights evidence supporting the potential impact of SBHCs as a health service model for advancing health equity. Clear criteria contribute to understanding SBHCs and serve as a basis for ongoing research and stakeholder collaboration.
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Affiliation(s)
- Vera Borkowski
- Child & Family Agency of Southeastern Connecticut, Inc., 7 Vauxhall Street, New London, CT, 06320; Vanderbilt University, School of Nursing, 461 21st Avenue South, Nashville, TN, 37240
| | - Anna Goddard
- Child & Family Agency of Southeastern Connecticut, Inc., 7 Vauxhall Street, New London, CT, 06320.
| | - Betsy Gaffney
- Child & Family Agency of Southeastern Connecticut, Inc., 7 Vauxhall Street, New London, CT, 06320
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Rates, Patterns, and Predictors of Follow-up Care for Adolescents at Risk for Substance Use Disorder in a School-Based Health Center SBIRT Program. J Adolesc Health 2022; 71:S57-S64. [PMID: 36122971 DOI: 10.1016/j.jadohealth.2022.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/17/2022] [Accepted: 02/28/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To examine rates, patterns, and predictors of follow-up care for adolescents screened as being at risk for substance use disorder (SUD) in a school-based health center (SBHC) Screening, Brief Intervention and Referral to Treatment (SBIRT) program. METHODS Electronic health records were extracted of adolescents who received health care services from one of three high school-based health centers implementing SBIRT. Patterns and predictors of engagement in follow-up care within 8 weeks following the week of a positive SUD risk screen were analyzed using item response theory (IRT) modeling. RESULTS Out of 1,327 adolescents receiving SBHC services, 81.2% completed a health screening questionnaire. Of screened adolescents, 17.7% were positive for SUD risk. Across the 8-week follow-up period, 65.4% of adolescents at risk for SUD received at least one follow-up visit. IRT modeling indicated that high levels of engagement in follow-up care were characterized by contact with a behavioral health care (BHC) provider. The percentage of adolescents having follow-up contact with a BHC provider increased significantly after the onset of the COVID-19 pandemic. Engagement in follow-up care was predicted by risk for depression, history of suicidal behavior, being female, and previous sexual activity. DISCUSSION SBHCs provide a favorable setting for screening and detecting adolescents at risk for SUD. Adolescents at risk for SUD should receive follow-up contact with a BHC provider. Enhanced follow-up engagement efforts may be warranted for adolescents at risk for SUD without risk for depression or suicidal history, as well as for females and those with previous sexual activity.
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Carrasco-Aguilar A, Galán JJ, Carrasco RA. Obamacare: A bibliometric perspective. Front Public Health 2022; 10:979064. [PMID: 36033824 PMCID: PMC9416003 DOI: 10.3389/fpubh.2022.979064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/22/2022] [Indexed: 01/25/2023] Open
Abstract
Obamacare is the colloquial name given to the Affordable Care Act (ACA) signed into law by President Obama in the USA, which ultimately aims to provide universal access to health care services for US citizens. The aim of this paper is to provide an overview of the political-legal, economic, social, management (or administrative), and medical (or health) repercussions of this law, using a bibliometric methodology as a basis. In addition, the main contributors to research on ACA issues have been identified in terms of authors, organizations, journals, and countries. The downward trend in scientific production on this law has been noted, and it has been concluded that a balance has not yet been reached between the coexistence of private and public health care that guarantees broad social coverage without economic or other types of barriers. The law requires political consensus to be implemented in a definitive and global manner for the whole of the United States.
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Sullivan E, Geierstanger S, Soleimanpour S. Mental Health Service Provision at School-Based Health Centers During the COVID-19 Pandemic: Qualitative Findings From a National Listening Session. J Pediatr Health Care 2022; 36:358-367. [PMID: 35074221 PMCID: PMC8598949 DOI: 10.1016/j.pedhc.2021.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/12/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION School-based health centers (SBHCs) provide health services to more than six million youth annually. When schools throughout the United States closed in spring 2020, many SBHCs were also forced to close physical operations.. METHOD This study uses qualitative data collected from SBHC representatives nationwide to examine supports and challenges affecting mental health services provision during the COVID-19 pandemic, changes in the provision of these services, and priorities for assessing and supporting student mental health needs in the 2021-2022 school year. RESULTS Partnerships, community and stakeholder buy-in, and student access were key supports to continuous care throughout the pandemic, whereas lack of available staff and lack of in-person access to students were key challenges. Patients demonstrated increased acuity of presenting mental health problems, more immediate and complex mental health challenges, and greater co-morbidities. DISCUSSION SBHCs pivoted, even with limited resources, to meet students' increasing needs for mental health care.
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Soleimanpour S, Geierstanger S, Lucas R, Ng S, Ferrey I. Risk and Resilience Factors Associated With Frequency of School-Based Health Center Use. THE JOURNAL OF SCHOOL HEALTH 2022; 92:702-710. [PMID: 35246989 DOI: 10.1111/josh.13176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/05/2021] [Accepted: 12/19/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND School-based health centers (SBHCs) provide health care to vulnerable youth. The purpose of the study was to identify characteristics of youth who use SBHCs with the highest frequency to understand their health needs and receipt of health services. METHODS This study examined cross-sectional survey data from adolescents in 3 urban school districts (n = 2641) to identify the characteristics of youth who use SBHCs with high frequency (10+ visits). Analyses included calculations of simple frequencies and percentages, chi-square tests of significance and multivariate regression. RESULTS High-frequency SBHC users were more likely to have seriously considered attempting suicide (adjusted odds ratio [AOR]: 3.2), be sexually active (AOR: 6.8), and have been victimized at school (AOR: 2.2) compared to their peers who did not use the SBHC. High-frequency SBHC users were also significantly more likely than their peers to report "always" getting mental health (AOR: 7.0) and sexual health (AOR: 6.6) care when needed, and having talked with a health care provider about their moods/feelings (AOR: 3.1) and how school is going (AOR: 3.2) in the past year. CONCLUSIONS These findings hold important relevance to demonstrating the value of SBHCs in increasing vulnerable youth's access to health care, particularly in urban settings.
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Affiliation(s)
- Samira Soleimanpour
- Philip R. Lee Institute for Health Policy Studies, University of California, 490 Illinois Street, Floor 7, San Francisco, CA, 94158, USA
| | - Sara Geierstanger
- Philip R. Lee Institute for Health Policy Studies, University of California, 490 Illinois Street, Floor 7, San Francisco, CA, 94158, USA
| | - Ruby Lucas
- Philip R. Lee Institute for Health Policy Studies, University of California, 490 Illinois Street, Floor 7, San Francisco, CA, 94158, USA
| | - Sandy Ng
- Philip R. Lee Institute for Health Policy Studies, University of California, 490 Illinois Street, Floor 7, San Francisco, CA, 94158, USA
| | - Ignacio Ferrey
- Center for Healthy Schools and Communities, Alameda County Health Care Services Agency, 1000 San Leandro Boulevard, Suite 300, San Leandro, CA, 94577, USA
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Aarafi H, Yadegari A, Dastgheib SA, Bahrami R, Shajari A, Nafei Z, Moghimi M, Mirjalili SR, Neamatzadeh H. Association of +1923C > T, -1112C > T and +2044A > G Polymorphisms in IL-13 Gene with Susceptibility to Pediatric Asthma: A Systematic Review and Meta-Analysis. Fetal Pediatr Pathol 2022; 41:259-277. [PMID: 32643534 DOI: 10.1080/15513815.2020.1783406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BackgroundPrevious studies have provided conflicting evidence implicating the IL-13 polymorphism and pediatric asthma. Thus, we performed a meta-analysis to combine and analyze the available studies to provide more accurate conclusions. Methods: A comprehensive retrieval in PubMed, EMBASE, Web of Science, and CNKI was performed up to February 05, 2020. Results: A total of 39 case-control studies including 15 studies with 4,968 cases and 7,091 controls were on +1923 C > T, ten studies with 3,175 cases and 2,983 controls on -1112 C > T, and 14 studies with 4,476 cases and 5,121 controls on +2044 A > G were selected. Pooled data showed that the IL-13 + 1923 C > T, -1112 C > T and +2044 A > G polymorphisms were significantly associated with risk of pediatric asthma. The IL-13 + 1923 C > T (Asians and Africans), -1112 C > T (Caucasians) and +2044 A > G (Asians) polymorphisms were more frequently associated in these ethnic groups. Conclusions: Our pooled data indicated that IL-13 + 1923 C > T, -1112 C > T and +2044 A > G polymorphisms were correlated with risk of pediatric asthma.
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Affiliation(s)
- Hossein Aarafi
- Department of Pediatrics, Yazd Branch, Islamic Azad University, Yazd, Iran
| | - Amirhossein Yadegari
- Medical Student, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyed Alireza Dastgheib
- Department of Medical Genetics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Bahrami
- Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Shajari
- Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Nafei
- Department of Pediatrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mansour Moghimi
- Department of Pathology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyed Reza Mirjalili
- Department of Pediatrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Neamatzadeh
- Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Department of Medical Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Haeder SF, Maxfield E, Ulmen K, Anderson S. When a school is more than just a school: Improving school-based health in the wake of COVID-19. WORLD MEDICAL & HEALTH POLICY 2022; 14:150-177. [PMID: 35600495 PMCID: PMC9111193 DOI: 10.1002/wmh3.498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/21/2021] [Accepted: 01/24/2022] [Indexed: 11/19/2022]
Abstract
The ongoing COVID-19 pandemic has posed tremendous challenges for economies and individuals around the world. At the same time, it has also laid bare the blatant and growing inequities that many individuals, particularly children, are confronted with on a daily basis. With communities in lockdowns and schools going virtual in many parts of the United States, the important role that schools and school-based services play in the lives of many children have gained new attention. Nonetheless, only 3% of American schools have school-based health centers on campus, and they remain relegated to the fringes of both health care and education. One key limitation has been the lack of appropriately trained health-care professionals. Over the past 2 years, we have interviewed dozens of individuals about their experiences in school-based health centers. Based on this study, we explore what it means for a health-care professional to work in school-based health care and how it differs from more traditional health-care settings. Our analysis particularly focuses on training and education, work environments, and their unique demands that come from being embedded within the educational setting. We conclude by addressing the important role that governmental policies could play in augmenting this crucial workforce.
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Affiliation(s)
- Simon F. Haeder
- School of Public PolicyThe Pennsylvania State UniversityUniversity ParkPennsylvaniaUSA
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Holmes LC, Orom H, Lehman HK, Lampkin S, Halterman JS, Akiki V, Supernault-Sarker AA, Butler SB, Piechowski D, Sorrentino PM, Chen Z, Wilding GE. A pilot school-based health center intervention to improve asthma chronic care in high-poverty schools. J Asthma 2022; 59:523-535. [PMID: 33322963 PMCID: PMC8281495 DOI: 10.1080/02770903.2020.1864823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To test the feasibility and effectiveness of a multifaceted intervention administered through school-based health centers (SBHCs) to improve asthma control for children in high-poverty schools with not well controlled asthma. METHODS Students 4-14 years old with persistent asthma were enrolled from three SBHCs. The centers' advanced practice providers received training on evidence-based asthma guidelines. Students randomized to the intervention received directly observed therapy of their asthma controller medication, medication adjustments as needed by the centers' providers, and daily self-management support. Students randomized to usual care were referred back to their primary care provider (PCP) for routine asthma care. RESULTS We enrolled 29 students. Students in the intervention group received their controller medication 92% of days they were in school. Ninety-four percent of follow-up assessments were completed. During the study, 11 of 12 intervention students had a step-up in medication; 2 of 15 usual care students were stepped up by their PCP. Asthma Control Test scores did not differ between groups, although there were significant improvements from baseline to the 7 month follow-up within each group (both p < .01). Both FEV1% predicted and FEV1/FVC ratio significantly worsened in the usual care group (both p = .001), but did not change in the intervention group (p = .76 and .28 respectively). CONCLUSIONS Our pilot data suggest that a multifaceted intervention can be feasibly administered through SBHCs in communities with health disparities. Despite the small sample size, spirometry detected advantages in the intervention group. Further study is needed to optimize the intervention and evaluate outcomes. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03032744.
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Affiliation(s)
- Lucy C. Holmes
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA,Corresponding author: Lucy C. Holmes, Department of Pediatrics, 1001 Main Street, Buffalo, New York 14203, (716) 323-0034,
| | - Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Heather K. Lehman
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Stacie Lampkin
- Department of Pharmacy Practice, D’Youville College, Buffalo, NY, USA
| | - Jill S. Halterman
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, USA
| | - Vanessa Akiki
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Alicia A. Supernault-Sarker
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | | | - Denise Piechowski
- John R. Oishei Children’s Hospital, Kaleida Health, Buffalo, NY, USA
| | | | - Ziqiang Chen
- Department of Biostatistics, University at Buffalo School of Public Health and Health Professions, Buffalo, NY USA
| | - Gregory E. Wilding
- Department of Biostatistics, University at Buffalo School of Public Health and Health Professions, Buffalo, NY USA
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Damian AJ, Oo M. Examining School Based Health Service Utilization Among Marginalized Youth in Connecticut During COVID. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2022; 59:469580221105998. [PMID: 35639361 PMCID: PMC9160907 DOI: 10.1177/00469580221105998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study examines how the coronavirus disease 2019 (COVID-19) is affecting utilization of medical and behavioral health services through school based health centers (SBHC s). METHODS We leveraged the electronic health records from one of the largest sponsors of SBHCs in the country, and tested differences in SBHC utilization with chi-square tests one year prior to the pandemic (pre-pandemic: March 2019-February 2020) compared to one year into the pandemic period (March 2020-February 2021). RESULTS A significant difference in SBHC utilization was found between pre-pandemic and pandemic periods (P <.001). 63.5% of SBHC patients accessed medical services pre-pandemic compared to 51.2% during the pandemic. In contrast, 36.5% of SBHC patients accessed behavioral services pre-pandemic compared to 48.8% during the pandemic, representing a 12.3% increase in SBHC behavioral service utilization since the pandemic. CONCLUSIONS SBHCs may serve as an invaluable means of ensuring youth, particularly those from disadvantaged communities, have access to needed behavioral health services during the current public health crisis.
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Affiliation(s)
| | - May Oo
- Department of Mental Health in Baltimore, Johns Hopkins University Bloomberg School of Public Health, Maryland, BL, USA
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Fox K, Burgess A, Williamson ME, Massey J, Shaler G, Pearson K, MacKenzie J, Merchant K, Zhu X, Ward M. Implementation of Telehealth Services in Rural Schools: A Qualitative Assessment. THE JOURNAL OF SCHOOL HEALTH 2022; 92:71-78. [PMID: 34806199 DOI: 10.1111/josh.13104] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/05/2021] [Accepted: 04/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In rural areas with health professional workforce shortages, telehealth offers an opportunity to address service gaps and meet the health needs of students. Few studies have examined telehealth implementation in rural schools. This study explores facilitators and barriers to the implementation of telehealth programs in rural schools and identifies strategies for successful implementation to inform future school-based telehealth initiatives. METHODS We conducted semi-structured qualitative interviews with 50 key informants involved in the implementation of telehealth programs funded through the School-Based Telehealth Network Grant Program. Researchers completed a thematic analysis of interview transcripts. RESULTS The most commonly cited barriers were technology, reimbursement for services, and facilitating acceptance of the telehealth among school staff, clinicians, parents, and students. Key informants identified strategies for facilitating program implementation, including technology training and support, marketing efforts, and integration into existing school processes. CONCLUSIONS School-based telehealth can augment clinical capacity in areas with clinician shortages. Entities interested in such an approach to care must engage with their school community to ensure successful implementation. For rural, school-based telehealth to gain greater adoption and be sustained, these services must be reimbursable by Medicaid and private insurers.
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Affiliation(s)
- Kimberley Fox
- University of Southern Maine, 34 Bedford Street, Portland, ME, 04104
| | | | | | - John Massey
- University of Southern Maine, 34 Bedford Street, Portland, ME, 04104
| | - George Shaler
- University of Southern Maine, 34 Bedford Street, Portland, ME, 04104
| | - Karen Pearson
- University of Southern Maine, 34 Bedford Street, Portland, ME, 04104
| | | | - Kimberly Merchant
- University of Iowa, College of Public Health, 145 North Riverside Drive, N242 CPHB, Iowa City, Iowa, 52242
| | - Xi Zhu
- University of Iowa, College of Public Health, 145 North Riverside Drive, N222 CPHB, Iowa City, IA, 52242
| | - Marcia Ward
- University of Iowa, College of Public Health, 145 North Riverside Drive, N236 CPHB, Iowa City, Iowa, 52242
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Nahum AS, Vongsachang H, Friedman DS, Collins ME. Parental Trust in School-Based Health Care: A Systematic Review. THE JOURNAL OF SCHOOL HEALTH 2022; 92:79-91. [PMID: 34773404 DOI: 10.1111/josh.13106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/18/2021] [Accepted: 04/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Health care delivery in schools is a frequently adopted approach to reduce health care inequalities. Lack of parental trust has been identified as impacting participation in school-based health care programs (SBHPs). The aim of our systematic review is to outline themes related to parental trust in SBHPs. METHODS We searched MEDLINE, Embase, CINHAL, ERIC, PsycInfo, and Web of Science for articles published between 1969 and 2019. Eligible studies (1) were peer-reviewed primary research articles; (2) were school-based health interventions or screening programs; (3) included parental trust data; and (4) were carried out on schoolchildren from pre-K to grade 12. Study location, data collection date, number of participants, demographics, intervention type, study aim and methodology, and all trust themes mentioned, were extracted. Studies were critically appraised using the CASP checklist for qualitative research. RESULTS We identified 9 themes related to parental trust in SBHPs: (1) safety; (2) effectiveness; (3) health professionals' training and credentials; (4) communication; (5) confidentiality; (6) providers; (7) government, authorities, and health service; (8) the pharmaceutical industry; and (9) research and data sharing. CONCLUSIONS The themes identified provide a framework for examining trust in SBHPs, and may guide the development of interventions to increase trust and engagement in SBHPs.
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Affiliation(s)
- Andrea S Nahum
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287
- UCL Medical School, University College London, 74 Huntley Street, Bloomsbury, London, WC1E 6DE, UK
| | - Hursuong Vongsachang
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - David S Friedman
- Massachusetts Eye and Ear Infirmary, Glaucoma Center of Excellence, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
| | - Megan E Collins
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA
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Ferenchak KS, Trieu SL, Franco R, Jackson NJ, Dudovitz R. Beyond Co-Location: Development of a School Health Integration Measure. THE JOURNAL OF SCHOOL HEALTH 2021; 91:970-980. [PMID: 34636051 DOI: 10.1111/josh.13088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND School-based health centers (SBHCs) can integrate health and educational services to achieve common goals of student wellness and success. As no method exists to quantify the degree of integration for clinics and partner schools, this study aimed to design such a measure. METHODS Measure items were drafted from the literature. Eleven school health experts from Los Angeles, CA, used a modified Delphi method to reach consensus around items for inclusion in a School Health Integration Measure (SHIM), evaluating each on its appropriateness, substantivity, and feasibility. Twenty-eight staff at 17 SBHC campuses pilot tested the SHIM to examine its psychometric properties. RESULTS From 36 items, the expert panel utilized 4 rounds to reach consensus on 12 items across 5 domains: health authority, integrated programming, marketing and recruitment, shared outcomes, and staff collaboration. In the SHIM pilot, scores ranged from 2.25 to 5 (possible 1-5, mean 3.53). The measure had high internal consistency (alpha = 0.9385) and was associated with participants' general assessment of integration at their sites (p = .001). CONCLUSIONS The SHIM provides a new tool to quantify health and educational service integration at SBHC sites, drive practice improvement, and test whether integration leads to better student outcomes.
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Affiliation(s)
- Kenny S Ferenchak
- Resident Physician, , Department of Pediatrics, University of Washington, Seattle Children's, 4800 Sand Point Way, NE, OC.7.830, PO Box 5371, Seattle, WA 98105; former Medical Student, UCLA David Geffen School of Medicine, UCLA David Geffen School of Medicine, 10833 Le Conte Avenue, Los Angeles, CA 90095
| | - Sang Leng Trieu
- Program Director, , The Los Angeles Trust for Children's Health, 333 S. Beaudry Avenue, 29th Floor, Los Angeles, CA 90017
| | - Rosina Franco
- Senior Physician, , Student Medical Services, Student Health and Human Services, Los Angeles Unified School District, 121 N. Beaudry Avenue, Roybal Annex, Los Angeles, CA 90012
| | - Nicholas J Jackson
- Assistant Professor, , UCLA Division of General Internal Medicine and Health Services Research, 1100 Glendon Avenue, Suite 1820, Los Angeles, CA 90024
| | - Rebecca Dudovitz
- Associate Professor, , Department of Pediatrics and Children's Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, and UCLA Mattel Children's Hospital, 10833 Le Conte Ave. 12-358 CHS, Los Angeles, CA 90095
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Habiyaremye MA, Clary K, Morris H, Tumin D, Crotty J. Which Children Use School-Based Health Services as a Primary Source of Care? THE JOURNAL OF SCHOOL HEALTH 2021; 91:876-882. [PMID: 34494271 DOI: 10.1111/josh.13085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/08/2021] [Accepted: 03/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND School-based health centers (SBHCs) offer primary and preventive health care for children and adolescents. Using nationally representative data, we aimed to examine which child and family characteristics are associated with using school-based health care providers as the primary source of health care, and whether care received from these providers met the criteria for a medical home. METHODS Using data from the 2016-2018 National Survey of Children's Health (NSCH), we analyzed children's usual source of care (school-based provider, doctor's office or clinic, other location, or none), and whether they received care meeting medical home criteria. RESULTS Based on a sample of 64,710 children, 0.5% identified school-based providers as their primary source of health care. Children who were older, uninsured, or living in the Northeast were significantly more likely to report school-based providers as their usual source of care. Children whose usual source of care was a school-based provider were less likely to receive care meeting medical home criteria than children who usually received care at a doctor's office. CONCLUSIONS While SBHCs improve access to care, our findings indicate potential challenges with establishing a medical home for children who usually receive health care from a school-based provider.
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Affiliation(s)
- Marie A Habiyaremye
- Department of Sociology, East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
| | - Kathryn Clary
- Department of Internal Medicine and Psychiatry, Duke University, 3710 Duke University Medical Center, Durham, NC, 27710, USA
| | - Hannah Morris
- Department of Pediatrics, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
| | - Jennifer Crotty
- Department of Pediatrics, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
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Najjar S, Saade M, Abdalla S, AlBuhairan F. Determinants of adolescents' perceptions on access to healthcare services in the Kingdom of Saudi Arabia: Jeeluna national survey findings. BMJ Open 2021; 11:e035315. [PMID: 34675008 PMCID: PMC8532543 DOI: 10.1136/bmjopen-2019-035315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The study aimed at identifying the determinants of adolescents' access to healthcare services. SETTING Intermediate and secondary schools across all 13 regions in the Kingdom of Saudi Arabia (KSA) from 2011 to 2012 through the Jeeluna national school-based survey. PARTICIPANTS Intermediate and secondary school students participated in the study. A multistage, cluster, random sampling technique was used. Participants responded to a self-administered questionnaire that addressed several domains. MAIN OUTCOME MEASURE Adolescents' perception of access to healthcare services. RESULTS Twenty-five per cent of participants reported difficulty in accessing healthcare. Women, early (younger) adolescents and adolescents with three siblings were less likely to report difficulty in accessing healthcare than men, late (older) adolescents and those with fewer than three siblings. Adolescents from low-income families and those with either mental or physical illness were more likely to report difficulty in accessing healthcare than adolescents from higher income families and those without mental or physical illnesses. CONCLUSIONS Disparities in access to care exist between certain subpopulations of adolescents. Efforts are needed to support enhancing access and making it more equitable. Training for healthcare professionals and targeted health policies are necessary to improve adolescents' access to health services in the KSA. TRIAL REGISTRATION NUMBER RC08-092; King Abdullah International Medical Research Centre.
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Affiliation(s)
- Shahenaz Najjar
- Health Informatics, Arab American University, Ramallah, Palestinian Territory, Occupied
- Population Health Research Section, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mayssa Saade
- King Abdullah International Medical Research Center, Riyadh, Riyadh, Saudi Arabia
| | - Sahar Abdalla
- Population Health Research Section, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Barts Cancer Institute, London, London, UK
| | - Fadia AlBuhairan
- Population Health Research Section, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Aldara Hospital and Medical Center, Riyadh, Riyadh, Saudi Arabia
- Johns Hopkins Bloomberg School of Public Health Center for Teaching and Learning, Baltimore, Maryland, USA
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Abstract
School-based health centers (SBHCs) are unique health care settings for our nation's school-aged children and adolescents. SBHCs represent the collaboration between the health and school communities to support the health and mental health needs and the academic achievements of children and adolescents, particularly students with health disparities or poor access to health care. SBHCs improve access to health care services for students by decreasing financial, geographic, age, and cultural barriers. This policy statement provides an overview of SBHCs, including the scope of services as well as some of the documented benefits and challenges. This policy statement also reviews the role of SBHCs in working with the pediatric medical home and provides recommendations that support the coordination of SBHCs with pediatric primary care providers and the pediatric medical home.
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Adekola AP, Mavhandu-Mudzusi AH. Addressing Learner-Centred Barriers to Sexuality Education in Rural Areas of South Africa: Learners' Perspectives on Promoting Sexual Health Outcomes. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2021; 20:1-17. [PMID: 34608403 PMCID: PMC8480970 DOI: 10.1007/s13178-021-00651-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 06/13/2023]
Abstract
Introduction The school-based sexuality education programmes in South Africa aim to improve the sexual and reproductive health of school-going adolescents. However, the high rate of unplanned pregnancy and sexually transmitted infections among learners in some schools in rural areas of King Cetshwayo district suggests that the programmes in these schools might not be effective due to certain learner-centred factors. Method This qualitative study explored lived experiences of 84 learners from nine public schools in 2020 through focus group interviews. Data was analysed using Interpretative Phenomenological Analysis. Results Learner-centred barriers to effective school-based sexuality education identified in this study were attitudes, age disparity, psychological status, peer pressure, socio-economic status, the exploratory attitude of learners, media, lack of role models, previous experiences, socio-economic status, and lack of parental love. These factors could reduce good sexual health. Learner-targeted interventions such as campaigns, using guest professionals, condom distribution, videos, on-site family planning, formal demonstrations, and on-site counselling could address these barriers. Conclusions Addressing these barriers and implementing the proposed interventions will enhance school-based sexuality education and consequently improve adolescents' sexual health. Policy Implications The findings could guide programming, implementation, and delivery of school-based sexuality education leading to improved adolescents' sexual and reproductive health.
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Affiliation(s)
- Ayobami Precious Adekola
- Department of Health Studies, College of Human Sciences, University of South Africa, Pretoria, South Africa
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Bains RM, White-Frese' J. Forging a Pathway for Quality Improvement in School-Based Health Centers: A Statewide Initiative. J Pediatr Health Care 2021; 35:479-484. [PMID: 34172353 DOI: 10.1016/j.pedhc.2021.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/16/2021] [Accepted: 04/29/2021] [Indexed: 11/15/2022]
Abstract
School-based health centers (SBHCs) provide quality health services to the children and youth they serve. Numerous studies have validated the access provided by SBHCs. The School-Based Health Alliance has captured descriptive data on the services provided. However, no standardized quality measures to benchmark performance across SBHCs exists. An initiative to establish standards that would uniformly capture quality of care delivered was essential. This article describes how five measures developed by the School-Based Health Alliance were implemented as a state-based quality improvement initiative after being tested in four states. The initiative led to the adoption of these measures for all state-funded SBHCs.
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McClain MB, Shahidullah JD, Harris B, McIntyre LL, Azad G. Reconceptualizing Educational Contexts: The Imperative for Interprofessional and Interagency Collaboration in School Psychology. SCHOOL PSYCHOLOGY REVIEW 2021. [DOI: 10.1080/2372966x.2021.1949247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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London EB, Yoo JH. From Research to Practice: Toward the Examination of Combined Interventions for Autism Spectrum Disorders. Brain Sci 2021; 11:1073. [PMID: 34439691 PMCID: PMC8391105 DOI: 10.3390/brainsci11081073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/25/2021] [Accepted: 08/06/2021] [Indexed: 12/04/2022] Open
Abstract
The use of biological (i.e., medications) in conjunction with applied behavior analysis is relatively common among people with ASD, yet research examining its benefit is scarce. This paper provides a brief overview of the existing literature on the combined interventions, including promising developments, and examines the existing barriers that hinder research in this area, including the heavy reliance on RCTs. Recommendations for possible solutions, including the creation of health homes, are provided in order to move toward a more integrated approach.
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Affiliation(s)
- Eric Bart London
- Department of Psychology, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road Staten Island, New York, NY 10314, USA;
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Serafino S, Rajoria M, Gold MA, Garbers S. Evaluation of sexual orientation and gender identity documentation at school-based health centers in New York City. J Eval Clin Pract 2021; 27:1004-1008. [PMID: 33295105 DOI: 10.1111/jep.13522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 11/27/2022]
Abstract
RATIONALE National organizations have called for routine collection of data on sexual orientation and gender identity (SOGI) in clinical settings to track access to and quality of care provided to sexual and gender minority patients to improve health outcomes. However, there are limited data on this implementation for among adolescent populations. METHODS A secondary data analysis from seven school-based health centers (SBHCs) in New York City explored SOGI documentation for 8888 adolescent patients in 2015 to 2018. Using Electronic Health Records, SBHC medical providers' implementation rate of patient SOGI documentation was assessed. Trends in SOGI documentation were reviewed. RESULTS At 18-month post-EHR modification and training, SOGI documentation increased and was sustained at 47%. Those documented as female were significantly more likely to have SOGI documentation compared to those documented as male (36% vs 26% for SO; 36% vs 25% for GI). CONCLUSIONS This study identified incomplete data collection in SOGI documentation among adolescents receiving medical and mental health services in SBHCs.
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Affiliation(s)
- Stephanie Serafino
- HIV Center for Clinical and Behavioral Studies; Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, New York, USA.,Office of Population Health, HIV Services, NYC Health + Hospitals, New York, NY, USA
| | - Melinda Rajoria
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA.,College of Health and Human Performance, Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Melanie A Gold
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA.,Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Samantha Garbers
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
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Westbrook M, Martinez L, Mechergui S, Scandlyn J, Yeatman S. Contraceptive Access Through School-Based Health Centers: Perceptions of Rural and Suburban Young People. Health Promot Pract 2021; 23:425-431. [PMID: 34338038 DOI: 10.1177/15248399211026612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE School-based health centers (SBHCs) have traditionally been concentrated in urban centers but have increasingly moved to rural and suburban settings. Adolescents living outside urban centers continue to experience barriers accessing contraceptives and reproductive health care. SBHCs are well positioned to reduce these barriers since they often offer convenient, in-school reproductive health care services. We describe the experiences of adolescents and emerging adults as they navigate access to contraceptives at SBHCs and nonschool locations in nonurban, low-income communities. METHOD We interviewed 30 sexually active individuals aged 15 to 21 living in rural and suburban communities in Colorado where high school SBHCs were recently introduced. Participants reflected on their experiences with or without in-school access to sexual and reproductive health services. RESULTS Overall, young people supported within-school access to contraceptives, citing convenience, low cost, and greater confidentiality and privacy compared with out-of-school providers, particularly in rural areas. At the same time, findings point to the need for SBHCs to overcome adolescents' and emerging adults' misunderstanding of age requirements to access confidential contraceptive services and their remaining concerns around confidentiality in the school setting. CONCLUSIONS Our results indicate that SBHCs in low-income rural and suburban areas provide essential contraceptive services that young people access and value. Policy makers in nonurban communities should look to the SBHC model to reduce barriers for young people accessing reproductive health care, and health care providers should work to ensure confidentiality and to correct misinformation about their right to access contraceptive services.
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Wu AC, Graif C, Mitchell SG, Meurer J, Mandl KD. Creative Approaches for Assessing Long-term Outcomes in Children. Pediatrics 2021; 148:s25-s32. [PMID: 34210844 PMCID: PMC8287841 DOI: 10.1542/peds.2021-050693f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
Advances in new technologies, when incorporated into routine health screening, have tremendous promise to benefit children. The number of health screening tests, many of which have been developed with machine learning or genomics, has exploded. To assess efficacy of health screening, ideally, randomized trials of screening in youth would be conducted; however, these can take years to conduct and may not be feasible. Thus, innovative methods to evaluate the long-term outcomes of screening are needed to help clinicians and policymakers make informed decisions. These methods include using longitudinal and linked-data systems to evaluate screening in clinical and community settings, school data, simulation modeling approaches, and methods that take advantage of data available in the digital and genomic age. Future research is needed to evaluate how longitudinal and linked-data systems drawing on community and clinical settings can enable robust evaluations of the effects of screening on changes in health status. Additionally, future studies are needed to benchmark participating individuals and communities against similar counterparts and to link big data with natural experiments related to variation in screening policies. These novel approaches have great potential for identifying and addressing differences in access to screening and effectiveness of screening across population groups and communities.
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Affiliation(s)
- Ann Chen Wu
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Medical School, Harvard University and Harvard Pilgrim Health Care, Boston, Massachusetts
| | - Corina Graif
- Department of Sociology and Criminology, Population Research Institute, Pennsylvania State University, University Park, Pennsylvania
| | | | - John Meurer
- Division of Community Health, Medical College of Wisconsin, Milwaukie, Wisconsin
| | - Kenneth D Mandl
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts
- Departments of Biomedical Informatics and Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
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Tran DMT, Silvestri-Elmore A. Healthcare-seeking behaviours in college students and young adults: a review. J Res Nurs 2021; 26:320-338. [PMID: 35251258 DOI: 10.1177/1744987120951594] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS To review the literature on college students' healthcare-seeking behaviours to uncover the current evidence and promote better healthcare-seeking behaviours and essentially better health outcomes in young adults. METHODS The researchers conducted an extensive literature review using CINAHL, Cochrane, PubMed, EBSCOhost and Google Scholar in the years 2018 and 2019. The search was limited to the past 18 years (2000-2018) and to studies reported in the English language focused on the general healthcare-seeking behaviour of college students. The search was also extended to young adults (aged 18-39 years). RESULTS A total of 56 articles were identified for abstract review and only 28 articles met the inclusion criteria for the final review. The following themes emerged to organise our findings: healthcare-seeking behaviour among college students, health information resource utilisation and its influence on healthcare-seeking behaviours and barriers to accessing care among college students. CONCLUSIONS This review summarises the current body of knowledge related to healthcare-seeking behaviour among college students, health information resource utilisation and its influence on healthcare-seeking behaviour and barriers to accessing care among this population. Important measures further to address the health needs and interventions for addressing these needs among the college student population are discussed.
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Affiliation(s)
- Dieu-My T Tran
- Assistant Professor, School of Nursing, University of Nevada Las Vegas, USA
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Goddard A, Sullivan E, Fields P, Mackey S. The Future of Telehealth in School-Based Health Centers: Lessons from COVID-19. J Pediatr Health Care 2021; 35:304-309. [PMID: 33518441 DOI: 10.1016/j.pedhc.2020.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In response to COVID-19, schools rapidly transitioned to virtual learning. School-based health centers (SBHCs) required immediate shifts from in-person to telehealth services to continue supporting students. METHOD A qualitative analysis of nationally-led "Listening and Learning" sessions by the School-Based Health Alliance revealed substantial innovation and expansion of telehealth services. RESULTS Providers and sponsoring organizations shared challenges and mechanisms for troubleshooting barriers during online webinars to provide support, education, and resources to SBHCs. DISCUSSION Lessons learned during the COVID-19 pandemic demonstrate the value of SBHCs, which continue to target barriers to health care access, protect the most vulnerable, and decrease the spread of disease. Telehealth implementation by SBHCs can support schools and communities, mitigate future strain on the health care system by continuing to keep youth from over-burdened emergency departments and provide needed mental health care. State and federal policy changes can ensure the continued provision of telehealth by SBHCs for disadvantaged youth.
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Garbers S, Suruki C, Falletta KA, Gold MA, Bruzzese JM. Psychosocial stress, sleep quality and interest in mind-body integrative health sleep intervention among urban adolescents in the school-based health setting. Complement Ther Med 2021; 58:102714. [PMID: 33766621 PMCID: PMC10119780 DOI: 10.1016/j.ctim.2021.102714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mind-body integrative health (MBIH) interventions to improve adolescent sleep are lacking. The study characterized sleep quality and bedtime-related psychosocial stressors among urban minority adolescents, explored associations between demographics factors, stressors and sleep quality, and gauged interest in a MBIH sleep intervention. MATERIALS AND METHODS 167 school-based health center (SBHC) patients (mean age = 16.3; 64 % female; 68 % Latino) participated in a needs assessment as part of a quality improvement project. They reported bedtime-related psychosocial stressors using items from the Adolescent Sleep Hygiene Scale (ASHS), sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and interest in a MBIH-based sleep intervention. Chi-square and logistic regression examined associations between demographics, stressors, sleep quality, and interest in the intervention. RESULTS 67 % had poor sleep quality. Females, compared to males, had 2.23 higher odds (95 % Confidence Interval [CI]: 1.12, 4.42) of having poor sleep quality. Nearly 80 % experienced bedtime-related stressors (25 % experienced one stressor, 17 % two stressors and 37 % three or more stressors); relative to those reporting no stressors, those reporting 3+ stressors had 3.15 higher odds (95 % CI: 1.27, 7.84) of having poor sleep quality. Most (77 %) reported they would participate in an SBHC-based intervention that utilized MBIH modalities preferring both one-on-one and group sessions. CONCLUSIONS Urban, predominantly Hispanic and Black, SBHC adolescent patients have poor sleep quality and report bedtime-related psychosocial stressors. Their interest in MBIH interventions to address sleep problems represents a unique opportunity for practitioners and complementary therapists to offer MBIH interventions to a population at high-risk for poor sleep quality.
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Affiliation(s)
- Samantha Garbers
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, 60 Haven Avenue, Room B4-417, New York, NY, 10032, United States.
| | - Caitlyn Suruki
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, 60 Haven Avenue, Room B4-417, New York, NY, 10032, United States; Intrinsik Ltd 1608 Pacific Avenue, Suite 201, Venice, CA 90291, United States.
| | - Katherine A Falletta
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, 60 Haven Avenue, Room B4-417, New York, NY, 10032, United States; MiracleFeet, 107 Conner Drive, Suite 230, Chapel Hill, NC 27514, United States.
| | - Melanie A Gold
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, 60 Haven Avenue, Room B4-417, New York, NY, 10032, United States; Department of Pediatrics, Columbia University Irving Medical Center, College of Physicians & Surgeons, New York, NY, United States.
| | - Jean-Marie Bruzzese
- Columbia University School of Nursing, 560 West 168th Street, Room 632, New York, NY, 10032, United States.
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Blacksin B. Civic engagement: School-based health centers and public health nursing. Public Health Nurs 2021; 38:357-366. [PMID: 33715209 DOI: 10.1111/phn.12871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/14/2020] [Accepted: 01/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To understand how the events of the 1996 formation of a school-based health center (SBHC) both illustrate the concept of civic engagement and embody historic aspects of public health nursing practice. DESIGN Case study design. SAMPLE Interviews, documents, epidemiologic records, and field observations. RESULTS The three themes discovered were collaboration to achieve public good, equity and social justice, creation of a long-term partnership, and demonstration of leadership using grassroots advocacy. CONCLUSION The SBHC case serves as a contemporary example of public health nurses' leadership in the current practice arena. The experience of nurse leadership evokes the historic mission and practice of public health nursing.
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Affiliation(s)
- Beth Blacksin
- Adjunct Faculty, School of Nursing, University of Missouri-Kansas City, Kansas City, MO, USA
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Beaton L, Williams I, Sanci L. Exploring adolescent and clinician perspectives on Australia's national digital health record, My Health Record. Aust J Prim Health 2021; 27:102-108. [PMID: 33715770 DOI: 10.1071/py20169] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/19/2021] [Indexed: 11/23/2022]
Abstract
Adolescence is often a time when risk-taking behaviours emerge and attendance at primary health care is low. School-based health services can serve to improve access to health care. Clinicians play a key role in improving adolescents' health literacy and capacity to make informed care decisions. Australia's national digital health record, My Health Record (MHR), has posed significant challenges for both clinicians and adolescents in understanding impacts on patient privacy. Guidance is required on how best to communicate about MHR to adolescents. This exploratory qualitative study aims to examine adolescents' understanding of MHR, clinicians' knowledge of MHR and their use of MHR with adolescents. Focus groups with students, school health and well-being staff and semistructured interviews with GPs and nurses were undertaken in one regional and one urban secondary school-based health service in Victoria. Transcripts from audio recorded sessions were examined using thematic analysis. Resulting themes include minimal understanding and use of MHR, privacy and security concerns, possible benefits of MHR and convenience. The results suggest opportunities to address gaps in understanding and to learn from adolescents' preferences for digital health literacy education. This will support primary care clinicians to provide best-practice health care for adolescents.
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Affiliation(s)
- Laura Beaton
- Department of General Practice, The University of Melbourne, Third Floor, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia; and Corresponding author
| | - Ian Williams
- Department of General Practice, The University of Melbourne, Third Floor, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, Third Floor, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia
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