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Connor KA, Spin P, Smith BM, Marshall BR, Calderon GV, Prichett L, Jones VC, Connor R, Cheng TL, Klein LM, Johnson SB. Effect of a Comprehensive School-Based Health Center on Academic Growth in K-8th Grade Students. Acad Pediatr 2024; 24:1124-1132. [PMID: 38588789 DOI: 10.1016/j.acap.2024.03.018] [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: 06/07/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE School-based health centers (SBHCs) improve health care access, but associations with educational outcomes are mixed and limited for elementary and middle school students. We investigated whether students enrolled in a comprehensive SBHC demonstrated more growth in standardized math and reading assessments over 4 school years versus nonenrolled students. We also explored changes in absenteeism. METHODS Participants were students enrolled in 2 co-located Title I schools from 2015-19 (1 elementary, 1 middle, n = 2480). Analysis of math and reading was limited to students with baseline and postbaseline scores (math n = 1622; reading n = 1607). Longitudinal regression models accounting for within-subject clustering were used to estimate the association of SBHC enrollment with academic scores and daily absenteeism, adjusting for grade, sex, body mass index category, health conditions, baseline outcomes (scores or absenteeism), and outcome pretrends. RESULTS More than 70% of SBHC-enrolled students had math (1194 [73.6%]) and reading 1186 [73.8%]) scores. Enrollees were more likely than nonenrollees to have asthma (39.7% vs 19.6%) and overweight/obesity (42.4% vs 33.6%). Adjusted baseline scores were significantly lower in math and reading for enrollees. Mean change from baseline for enrollees exceeded nonenrollees by 3.5 points (95% confidence interval [CI]: 2.2, 4.8) in math and 2.1 points (95% CI: 0.9, 3.3) in reading. The adjusted rate of decrease in daily absenteeism was 10.8% greater for enrollees (incident rate ratio 0.772 [95% CI: 0.623, 0.956]) than nonenrollees (incident rate ratio 0.865 [95% CI: 0.696, 1.076]). CONCLUSIONS SBHC enrollees had greater health and educational risk but demonstrated more growth in math and reading and less absenteeism than nonenrollees.
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Affiliation(s)
- Katherine A Connor
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Division of General Pediatrics (KA Connor, P Spin, BM Smith, GV Calderon, L Prichett, R Connor, TL Cheng, LM Klein, and SB Johnson), Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Paul Spin
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Division of General Pediatrics (KA Connor, P Spin, BM Smith, GV Calderon, L Prichett, R Connor, TL Cheng, LM Klein, and SB Johnson), Johns Hopkins University School of Medicine, Baltimore, Md; Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, EVERSANA (P Spin), Milwaukee, Wis.
| | - Brandon M Smith
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Division of General Pediatrics (KA Connor, P Spin, BM Smith, GV Calderon, L Prichett, R Connor, TL Cheng, LM Klein, and SB Johnson), Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Beth R Marshall
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Department of Population, Family, and Reproductive Health (BR Marshall), Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md.
| | - Gabriela V Calderon
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Division of General Pediatrics (KA Connor, P Spin, BM Smith, GV Calderon, L Prichett, R Connor, TL Cheng, LM Klein, and SB Johnson), Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Laura Prichett
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Division of General Pediatrics (KA Connor, P Spin, BM Smith, GV Calderon, L Prichett, R Connor, TL Cheng, LM Klein, and SB Johnson), Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Vanya C Jones
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Department of Health, Behavior, and Society (VC Jones), Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md.
| | - Ryan Connor
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Division of General Pediatrics (KA Connor, P Spin, BM Smith, GV Calderon, L Prichett, R Connor, TL Cheng, LM Klein, and SB Johnson), Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Tina L Cheng
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Division of General Pediatrics (KA Connor, P Spin, BM Smith, GV Calderon, L Prichett, R Connor, TL Cheng, LM Klein, and SB Johnson), Johns Hopkins University School of Medicine, Baltimore, Md; Department of Pediatrics (TL Cheng), University of Cincinnati, Ohio.
| | - Lauren M Klein
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Division of General Pediatrics (KA Connor, P Spin, BM Smith, GV Calderon, L Prichett, R Connor, TL Cheng, LM Klein, and SB Johnson), Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Sara B Johnson
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Division of General Pediatrics (KA Connor, P Spin, BM Smith, GV Calderon, L Prichett, R Connor, TL Cheng, LM Klein, and SB Johnson), Johns Hopkins University School of Medicine, Baltimore, Md.
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Ladegard K, Alleyne S, Close J, Hwang MD. The Role of School-based Interventions and Communities for Mental Health Prevention, Tiered Levels of Care, and Access to Care. Child Adolesc Psychiatr Clin N Am 2024; 33:381-395. [PMID: 38823811 DOI: 10.1016/j.chc.2024.03.004] [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: 06/03/2024]
Abstract
This article highlights the key role of schools in addressing rising mental health disorders among youth. It champions collaboration between health and educational sectors, emphasizing child and adolescent psychiatrists' significant contribution to school-based mental health literacy and interventions. This article encourages for child and adolescent psychiatrists' involvement in policy advocacy for accessible and inclusive mental health care, championing sustainable mental health services through advocating for funding, training, and policy support.
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Affiliation(s)
- Kristie Ladegard
- Department of Psychiatry, Denver Health, University of Colorado, 601 Broadway 7th Floor MC 7779, Denver, CO 80203, USA.
| | - Shirley Alleyne
- Psychiatry Residency Training Program, Lakeland Regional Health Medical Center, 1324 Lakeland Hills Boulevard, Lakeland, FL 33801, USA
| | - Jeylan Close
- Child & Family Mental Health & Community Psychiatry Division, Department of Psychiatry and Behavioral Sciences, National Clinician Scholars Program, Duke Margolis Center for Health Policy, Duke University, 710 W Main Street, Durham, NC 27701, USA
| | - Maura Dunfey Hwang
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 9 Strathmore Court, Wallingford, PA 19086, USA
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Sowa NA, Gaffney K, Sanders A, Murrell C. School-Based Tele-Behavioral Health: A Scoping Review of the Literature. THE JOURNAL OF SCHOOL HEALTH 2024; 94:571-580. [PMID: 38263701 DOI: 10.1111/josh.13435] [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: 08/17/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Telehealth utilization exploded during the COVID-19 pandemic, including within school-based health programs. School-based tele-behavioral health can help programs overcome barriers of access to care, but the current state and effectiveness of such programs are unknown. METHODS A scoping literature review was conducted. Studies were included if they described in-school behavioral health services delivered via telehealth for children ages 5 to 18. From the included studies, population, location, setting, intervention, telehealth modality, clinician type, and outcomes assessed were extracted. FINDINGS Eighteen studies met inclusion criteria. All described psychotherapy or medication management delivered by psychologists (n = 7) and/or psychiatrists (n = 11). Treatment included psychotherapy (N = 8), psychiatric consultation (N = 7), medication management (N = 4), crisis stabilization (N = 1), and caregiver education (N = 1). Eight studies provide qualitative or quantitative outcomes, with 4 examining clinical effectiveness. CONCLUSIONS Despite limited findings in the literature, school-based tele-behavioral health is feasible, effective, and acceptable for delivery of behavioral health care to children and adolescents.
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Affiliation(s)
- Nathaniel A Sowa
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katie Gaffney
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Amanda Sanders
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Caroline Murrell
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
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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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Goll CB, Sørlie T, Friborg O, Ottosen KO, Sæle RG. Poorer self-reported mental health and general health among first year upper secondary school students do not predict school dropout: a five-year prospective study. Front Psychol 2024; 15:1304314. [PMID: 38440235 PMCID: PMC10911125 DOI: 10.3389/fpsyg.2024.1304314] [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: 10/02/2023] [Accepted: 01/24/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction Education is important for socioeconomic, work and health status; thus, dropping out of secondary school is of major concern. In Norway, 1 out of 5 is dropping out from upper secondary education. Academic performance is a known predictor for dropout, but the role of mental and general health status is studied less. Methods By use of student data collected during the first school year we examined the accumulated risk of school dropout over 5 years. Students entering upper secondary school in a North-Norwegian region (Troms County) completed a comprehensive questionnaire during August 2010 (N = 1,676, 69% response rate). The contribution of mental and general health problems in predicting five-year dropout was of primary interest, adjusted for demographics and academic performance. Results One-third of the students had dropped out after 5 years. A logistic regression analysis showed no significant effect of mental and general health problems on dropout. Among the covariates, higher grades from lower secondary education reduced the chance of dropping out (OR = 0.31; p < 0.001). Subgroup analyses showed that students in the vocational track reported poorer mental and general health, compared to students in the general track, but this difference was not related to dropout. General track students were also less likely to drop out than vocational track students (OR for dropout 0.66; p < 0.05). Discussion In conclusion, lower grades from lower secondary education represented a warning flag for school dropout during upper secondary education whereas mental health issues were not.
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Affiliation(s)
- Charlotte Bjørnskov Goll
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Mental Health and Substance Abuse, University Hospital of North Norway (UNN), Tromsø, Norway
| | - Tore Sørlie
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Mental Health and Substance Abuse, University Hospital of North Norway (UNN), Tromsø, Norway
| | - Oddgeir Friborg
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Karl Ottar Ottosen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Rannveig Grøm Sæle
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
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Lim C, Chung PJ, Biely C, Jackson NJ, Puffer M, Zepeda A, Anton P, Leifheit KM, Dudovitz R. School Attendance Following Receipt of Care From a School-Based Health Center. J Adolesc Health 2023; 73:1125-1131. [PMID: 37702648 DOI: 10.1016/j.jadohealth.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/28/2023] [Accepted: 07/05/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE School-based health centers (SBHCs) may mitigate barriers to health care access and improve students' academic outcomes, but few studies test this hypothesis. We examined whether school attendance improved after students received care at an SBHC. METHODS We conducted a secondary analysis of data from 17 SBHCs affiliated with a single large urban school district and demographic and attendance data from SBHC users (N = 14,030) and nonusers (N = 230,046) from August 2015-February 2020. We examined the percent of full school days present each month for three years before and after students' first SBHC visit and a proxy visit date for SBHC nonusers. Propensity weighted linear regression models tested whether visiting an SBHC was associated with a change in the attendance trajectory compared to a matched sample of SBHC nonusers. RESULTS Among SBHC users, attendance trajectories declined more steeply prior to their first SBHC visit than after the first visit (preslope -0.71%, postslope -0.05%), whereas SBHC nonusers had a similar attendance trajectory over the entire period (preslope -0.18%, postslope -0.17%), with difference-in-difference 0.65. Changes in trajectories were more pronounced for students with a mental health encounter. Prior to the first SBHC mental health visit, SBHC users displayed a marked decline in monthly attendance (preslope -1.02%). After the first mental health visit, attendance increased (postslope 1.44%), with difference-in-difference 2.33. DISCUSSION SBHC utilization was associated with improved school attendance over time, particularly for students with a mental health diagnosis. Investing in SBHCs may reduce school absenteeism and support student health.
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Affiliation(s)
- Caryssa Lim
- Department of Health Systems Science, Kaiser Permanente School of Medicine, Pasadena, California.
| | - Paul J Chung
- Department of Health Systems Science, Kaiser Permanente School of Medicine, Pasadena, California; Departments of Pediatrics and Health Policy & Management, University of California Los Angeles, Los Angeles, California
| | - Christopher Biely
- Departments of Pediatrics and Health Policy & Management, University of California Los Angeles, Los Angeles, California
| | - Nicholas J Jackson
- Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - Maryjane Puffer
- The L.A. Trust for Children's Health, Los Angeles, California
| | - Alex Zepeda
- The L.A. Trust for Children's Health, Los Angeles, California
| | | | - Kathryn M Leifheit
- Departments of Pediatrics and Health Policy & Management, University of California Los Angeles, Los Angeles, California
| | - Rebecca Dudovitz
- Departments of Pediatrics and Health Policy & Management, University of California Los Angeles, Los Angeles, California.
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Rasiah S, Jüni P, Sgro MD, Thorpe KE, Maguire J, Freeman SJ. School-based health care: improving academic outcomes for inner-city children-a prospective cohort quasi-experimental study. Pediatr Res 2023; 94:1488-1495. [PMID: 36755187 PMCID: PMC9907190 DOI: 10.1038/s41390-023-02473-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/02/2022] [Accepted: 01/05/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND We examined whether a school-based health center model improved academic achievement compared to usual care. METHODS This was a quasi-experimental prospective cohort study. The primary outcome was an academic achievement. In addition, we analyzed sociodemographic characteristics and their relationship to academic achievement, and the wait time for a developmental assessment. RESULTS The differences in change of grades over time (from 2016/2017 to 2018/2019) were small for reading (-0.83, 95% CI -3.48, 1.82, p = 0.51), writing (-1.11, 95% CI -3.25, 1.03, p = 0.28), and math (0.06, 95% CI -3.08, 2.94, p = 0.98). The experimental arm's average wait time for developmental assessment was 3.4 months. CONCLUSION In this small, quasi-experimental prospective cohort study, we did not find evidence that our SBHC model improved academic achievement; however, the wait time at the SBHCs was considerably less than the provincial wait time for a developmental assessment. TRIAL REGISTRATION NCT04540003. IMPACT This study describes a unique and innovative school-based health center model. Our findings support the benefits of school-based health centers in diagnosing and treating children with developmental and mental health disorders for disadvantaged communities. This study did not find an improvement in academic achievement for school-based health center users. This study found that the wait time to developmental assessment was shorter for school-based health center users compared to the wait time reported in the community. Pandemic-associated school disruptions have highlighted the importance of accessible school-based health services for children requiring mental health and developmental assessments and care.
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Affiliation(s)
- Saisujani Rasiah
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Michael D Sgro
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Kevin E Thorpe
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jonathon Maguire
- Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Sloane J Freeman
- Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
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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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Ruff RR, Habib R, Godín TB, Niederman R. School-based caries prevention and the impact on acute and chronic student absenteeism. J Am Dent Assoc 2023; 154:753-759. [PMID: 37500236 DOI: 10.1016/j.adaj.2023.05.007] [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: 03/02/2023] [Revised: 05/01/2023] [Accepted: 05/11/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Poor oral health is significantly associated with absenteeism, contributing to millions of lost school hours per year. The effect of school-based dental programs that address oral health care inequities on student attendance has not yet been explored. METHODS CariedAway was a longitudinal, cluster-randomized, noninferiority trial of minimally invasive medicines for caries used in a school-based program. We extracted data on school absenteeism and chronically absent students from publicly available data sets for years before, during, and after program onset (2016-2021). Total absences and the proportion of chronically absent students were modeled using multilevel mixed-effects linear and 2-limit tobit regression, respectively. RESULTS In years in which treatment was provided through a school-based caries prevention program, schools recorded approximately 944 fewer absences than in nontreatment years (95% CI, -1,739 to -149). Averaged across all study years, schools receiving either treatment had 1,500 fewer absences than comparator schools, but this was not statistically significant. In contrast, chronic absenteeism was found to significantly decrease in later years of the program (b, -.037; 95% CI, -.062 to -.011). Excluding data for years affected by COVID-19 removed significant associations. CONCLUSIONS Although originally designed to obviate access barriers to critical oral health care, early integration of school-based dental programs may positively affect school attendance. However, the observed effects may be due to poor reliability of attendance records resulting from the closing of school facilities in response to COVID-19, and further study is needed. PRACTICAL IMPLICATIONS School-based caries prevention may also improve educational outcomes, in addition to providing critical oral health care. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT03442309.
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Yao N, Kowalczyk M, Gregory L, Cheatham J, DeClemente T, Fox K, Ignoffo S, Volerman A. Community health workers' perspectives on integrating into school settings to support student health. Front Public Health 2023; 11:1187855. [PMID: 37415701 PMCID: PMC10320159 DOI: 10.3389/fpubh.2023.1187855] [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: 03/16/2023] [Accepted: 05/23/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction While schools represent key venues for supporting health, they continue to experience gaps in health resources. The integration of community health workers (CHWs) into schools has the potential to supplement these resources but has been underexplored. This study is the first to examine perspectives of experienced CHWs about how CHWs can be applied in school settings to support student health. Methods This qualitative study involved conducting semi-structured interviews focused on implementation of CHWs in schools with individuals who held positions aligned with the CHW scope of work. De-identified transcripts were analyzed, and codes were organized into domains and themes. Results Among 14 participants, seven domains emerged about the implementation of CHWs in schools: roles and responsibilities, collaborations, steps for integration, characteristics of successful CHWs, training, assessment, and potential challenges. Participants shared various potential responsibilities of school-based CHWs, including educating on health topics, addressing social determinants of health, and supporting chronic disease management. Participants emphasized the importance of CHWs building trusting relationships with the school community and identified internal and external collaborations integral to the success of CHWs. Specifically, participants indicated CHWs and schools should together determine CHWs' responsibilities, familiarize CHWs with the school population, introduce CHWs to the school community, and establish support systems for CHWs. Participants identified key characteristics of school-based CHWs, including having familiarity with the broader community, relevant work experience, essential professional skills, and specific personal qualities. Participants highlighted trainings relevant to school-based CHWs, including CHW core skills and health topics. To assess CHWs' impact, participants proposed utilizing evaluation tools, documenting interactions with students, and observing indicators of success within schools. Participants also identified challenges for school-based CHWs to overcome, including pushback from the school community and difficulties related to the scope of work. Discussion This study identified how CHWs can have a valuable role in supporting student health and the findings can help inform models to integrate CHWs to ensure healthy school environments.
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Affiliation(s)
- Nicole Yao
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Monica Kowalczyk
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - LaToya Gregory
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Jeannine Cheatham
- Department of Pediatrics, University of Chicago, Chicago, IL, United States
| | - Tarrah DeClemente
- Office of Student Health and Wellness, Chicago Public Schools, Chicago, IL, United States
| | - Kenneth Fox
- Office of Student Health and Wellness, Chicago Public Schools, Chicago, IL, United States
| | - Stacy Ignoffo
- Sinai Urban Health Institute, Chicago, IL, United States
| | - Anna Volerman
- Department of Medicine, University of Chicago, Chicago, IL, United States
- Department of Pediatrics, University of Chicago, Chicago, IL, United States
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Weist MD, Splett JW, Halliday CA, Gage NA, Seaman MA, Perkins KA, Perales K, Miller E, Collins D, DiStefano C. A randomized controlled trial on the interconnected systems framework for school mental health and PBIS: Focus on proximal variables and school discipline. J Sch Psychol 2022; 94:49-65. [DOI: 10.1016/j.jsp.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 06/06/2022] [Accepted: 08/01/2022] [Indexed: 01/19/2023]
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Gruber JA, Anderson-Carpenter KD, McNall M, Clark SL. Understanding the Longitudinal Impact of School-Based Health Centers on Student Attendance. CHILD & YOUTH CARE FORUM 2022. [DOI: 10.1007/s10566-022-09691-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Psaki S, Haberland N, Mensch B, Woyczynski L, Chuang E. Policies and interventions to remove gender-related barriers to girls' school participation and learning in low- and middle-income countries: A systematic review of the evidence. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1207. [PMID: 36913193 PMCID: PMC8770660 DOI: 10.1002/cl2.1207] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Gender disparities in education continue to undermine girls' opportunities, despite enormous strides in recent years to improve primary enrolment and attainment for girls in low- and middle-income countries (LMICs). At the regional, country and subnational levels gender gaps remain, with girls in many settings less likely to complete primary school, less likely to complete secondary, and often less likely to be literate than boys. The academic and policy literatures on the topic of gender-related barriers to girls' education are both extensive. However, there remain gaps in knowledge regarding which interventions are most likely to work in contexts with different combinations of barriers. Objectives This systematic review identified and assessed the strength of the evidence of interventions and exposures addressing gender-related barriers to schooling for girls in LMICs. Search Methods The AEA RCT Registry, Africa Bibliography, African Education Research Database, African Journals Online, DEC USAID, Dissertation Abstracts, EconLit, ELDIS, Evidence Hub, Global Index Medicus, IDEAS-Repec, Intl Clinical Trials Registry, NBER, OpenGrey, Open Knowledge Repository, POPLINE, PsychINFO, PubMed, Research for Development Outputs, ScienceDirect, Sociological Abstracts, Web of Science, as well as relevant organization websites were searched electronically in March and April of 2019. Further searches were conducted through review of bibliographies as well as through inquiries to authors of included studies, relevant researchers and relevant organizations, and completed in March 2020. Selection Criteria We included randomized controlled trials as well as quasi-experimental studies that used quantitative models that attempted to control for endogeneity. Manuscripts could be either published, peer-reviewed articles or grey literature such as working papers, reports and dissertations. Studies must have been published on or after 2000, employed an intervention or exposure that attempted to address a gender-related barrier to schooling, analyzed the effects of the intervention/exposure on at least one of our primary outcomes of interest, and utilized data from LMICs to be included. Data Collection and Analysis A team of reviewers was grouped into pairs to independently screen articles for relevance, extract data and assess risk of bias for each included study. A third reviewer assisted in resolving any disputes. Risk of bias was assessed either through the RoB 2 tool for experimental studies or the ROBINS-I tool for quasi-experimental studies. Due to the heterogeneity of study characteristics and reported outcome measures between studies, we applied the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) approach adapted for situations where a meta-analysis is not possible to synthesize the research. Results Interventions rated as effective exist for three gender-related barriers: inability to afford tuition and fees, lack of adequate food, and insufficient academic support. Promising interventions exist for three gender-related barriers: inadequate school access, inability to afford school materials, and lack of water and sanitation. More research is needed for the remaining 12 gender-related barriers: lack of support for girls' education, child marriage and adolescent pregnancy, lack of information on returns to education/alternative roles for women, school-related gender-based violence (SRGBV), lack of safe spaces and social connections, inadequate sports programs for girls, inadequate health and childcare services, inadequate life skills, inadequate menstrual hygiene management (MHM), poor policy/legal environment, lack of teaching materials and supplies, and gender-insensitive school environment. We find substantial gaps in the evidence. Several gender-related barriers to girls' schooling are under-examined. For nine of these barriers we found fewer than 10 relevant evaluations, and for five of the barriers-child marriage and adolescent pregnancy, SRGBV, inadequate sports programs for girls, inadequate health and childcare services, and inadequate MHM-we found fewer than five relevant evaluations; thus, more research is needed to understand the most effective interventions to address many of those barriers. Also, nearly half of programs evaluated in the included studies were multi-component, and most evaluations were not designed to tease out the effects of individual components. As a result, even when interventions were effective overall, it is often difficult to identify how much, if any, of the impact is attributable to a given program component. The combination of components varies between studies, with few comparable interventions, further limiting our ability to identify packages of interventions that work well. Finally, the context-specific nature of these barriers-whether a barrier exists in a setting and how it manifests and operates-means that a program that is effective in one setting may not be effective in another. Authors' Conclusions While some effective and promising approaches exist to address gender-related barriers to education for girls, evidence gaps exist on more than half of our hypothesized gender-related barriers to education, including lack of support for girls' education, SRGBV, lack of safe spaces and social connections, inadequate life skills, and inadequate MHM, among others. In some cases, despite numerous studies examining interventions addressing a specific barrier, studies either did not disaggregate results by sex, or they were not designed to isolate the effects of each intervention component. Differences in context and in implementation, such as the number of program components, curricula content, and duration of interventions, also make it difficult to compare interventions to one another. Finally, few studies looked at pathways between interventions and education outcomes, so the reasons for differences in outcomes largely remain unclear.
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Ndetei DM, Mutiso VN, Musyimi CW, Alietsi RK, Shanley JR, Bhui KS. The feasibility of using life skills training in primary schools to improve mental health and academic performance: a pilot study in Kenya. BMC Psychiatry 2022; 22:131. [PMID: 35177007 PMCID: PMC8855590 DOI: 10.1186/s12888-022-03781-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 02/14/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There is no Kenyan evidence on the relationship between mental illness and academic performance. We aimed to determine the effect of life skills training on mental health and academic performance. METHODS We administered to 1848 primary school children a researcher designed socio-demographic questionnaire, and the Youth Self Report (YSR) and Child Behavior Checklist (CBCL) to their parents, followed by eight sessions of life skills training. We extracted data from the individual records of each child on overall performance pre and post training separated by one year. We conducted descriptive statistics, paired sample t-tests, multivariate linear regression analysis and linear mixed model analysis to assess changing patterns of academic performance and any predictive characteristics. RESULTS There was significant (p < 0.05) improvement in overall academic performance (aggregate marks and all individual subjects) for both lower primary and upper primary classes after the life-skills training intervention. For lower classes (2-4 grades) increase in academic performance was significantly associated with fathers and mothers education levels, region and class. For upper classes, (5-7 grades) increase in academic performance was associated with region, class and age. CONCLUSIONS Life skills training is recommended as it could improve academic performance, but predicted by socio-demographic factors.
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Affiliation(s)
- David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya. .,Department of Psychiatry, University of Nairobi, Nairobi, Kenya. .,World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya.
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Rita K Alietsi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Jenelle R Shanley
- School of Graduate Psychology, Pacific University, Forest Grove, USA
| | - Kamaldeep S Bhui
- Department of Psychiatry, University of Oxford, Oxford, England.,World Psychiatric Association Collaborating Centre for Research and Training, London, UK
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Montgomery P, Knerr W, Ross DA, Patterson J. The Effectiveness and Acceptability of Comprehensive and Multicomponent School Health Services: A Systematic Review. J Adolesc Health 2022; 70:192-207. [PMID: 34556422 DOI: 10.1016/j.jadohealth.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Comprehensive school-based health services were reviewed as part of preparing World Health Organization guidelines. METHODS Six databases were searched for controlled trials with schoolchildren aged 5-19 years, involving school-linked health services incorporating 4 of 7 health areas. RESULTS Seventeen quasi-experimental studies conducted in high-income countries found school health services associated with reductions in suicide planning (male: 7.1% vs. 7.7%, p < .01), hospitalization (relative risks 3.403, 95% confidence interval [CI] 1.536 to 8.473, p < .05), emergency department visits (odds ratio .85, 95% CI .75 to .95, p = .006), school absence (odds ratio .78, 95% CI .69 to .87, p < .0001), carrying weapons (male: 16.1% vs. 25.1%, p < .01), fighting (male: 32.6% vs. 43.1%, p < .01), sexual activity (53.5% vs. 60.5%, p < .05), drinking alcohol (60.1% vs. 70.5%, p < .001), using drugs (28.0% vs. 38.3%, p < .001), and physical activity (female: 57.4% vs. 50.4%, p < .01). They can be cost-saving, were also associated with smoking and less contraceptive use, and had no effect on depression prevalence. Acceptability/satisfaction was good. The certainty of evidence was low to moderate. Heterogeneity was high for some outcomes. CONCLUSIONS Results suggest moderate desirable and trivial undesirable effects of school health services in high-income countries. This article compiles evidence on effectiveness, cost-effectiveness, and acceptability into one review, enabling decision-makers to consider all essential factors.
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Affiliation(s)
- Paul Montgomery
- Department of Social Policy, Sociology and Criminology, School of Social Policy, Muirhead Tower, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
| | | | - David A Ross
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland (retired)
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Gailloud L, Gonzalez-Argoti T, Philip S, Josephs LS, Mantell JE, Bauman LJ. 'How come they don't talk about it in school?' Identifying adolescent barriers to PrEP use. HEALTH EDUCATION RESEARCH 2022; 36:505-517. [PMID: 34467401 PMCID: PMC8793170 DOI: 10.1093/her/cyab030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/11/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
Although 21% of new human immunodeficiency virus (HIV) diagnoses in the United States are in youth aged 13-24 years, adolescent awareness and uptake of the HIV prevention medication pre-exposure prophylaxis (PrEP) are low. This study explores the attitudes and challenges that adolescents face while taking PrEP. Thirty interviews were conducted with Black and Latine (we use the gender-inclusive term Latine rather than Latinx for more appropriate Spanish pronunciation) students aged 15-17 who received care at school-based health centers (SBHCs) in the Bronx, NY. Transcripts were coded inductively and deductively using thematic analysis. Most participants were unaware of PrEP, but nearly all were enthusiastic when informed about it; a majority denied that they would feel any stigma when taking PrEP. Despite this high receptivity, multiple barriers were identified, particularly confidentiality from parents, low perceived need of PrEP and concerns about daily adherence and side effects. Adolescents overall were enthusiastic about the availability of PrEP and felt it empowered them to have control over their health. SBHCs were considered trusted sources of confidential, accessible care, and we believe that they can be uniquely positioned to mitigate barriers to PrEP distribution in the future.
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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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Abstract
Since the early 1900s when school-based health services were first introduced, models of school-based health have evolved toward comprehensive and integrated models that include mental health. New and innovative models of Comprehensive Mental Health Systems offer a range of prevention and intervention strategies that are delivered across collaborative systems of community and school-based mental health. Studies of school-based health services indicate positive outcomes in health, mental health, and education. Child and adolescent psychiatrists can work with schools by providing direct service, consultation, and technical assistance to increase access, improve health equity, and optimize mental health outcomes for all youth.
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Affiliation(s)
- Erika Ryst
- Nevada Center for Excellence in Disabilities, College of Education and Human Development, University of Nevada, Reno, 4090 William J. Raggio Building, 1664 N. Virginia Street, Suite 4090, Mail Stop: 285, Reno, NV 89557, USA.
| | - Shashank V Joshi
- Stanford University, Stanford, CA, USA; Lucile Packard Children's Hospital @ Stanford, 401 Quarry Road, Stanford, CA 94305-5719, USA
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Rattermann MJ, Angelov A, Reddicks T, Monk J. Advancing health equity by addressing social determinants of health: Using health data to improve educational outcomes. PLoS One 2021; 16:e0247909. [PMID: 33730057 PMCID: PMC7968680 DOI: 10.1371/journal.pone.0247909] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 02/16/2021] [Indexed: 11/18/2022] Open
Abstract
Data from two social determinants of health-access to health care and access to a quality education-are combined to examine the impact of health on student achievement. Data from a high poverty, high performing K-8 school revealed a significant negative correlation between the number of visits to a school-based nurse and standardized academic assessments. Fixed effect regression confirmed the effect of total number of visits to the school-based nurse on performance on standardized assessments, and also revealed that two types of visits, neurological and gastrointestinal, were predictive of student performance. Taken together, these results suggest that when students are suffering from ill health their academic performance is negatively impacted. Implications for improving health equity through data-driven educational interventions are discussed.
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Affiliation(s)
- Mary Jo Rattermann
- Paramount Health Data Project, Indianapolis, Indiana, United States of America
| | - Azure Angelov
- Paramount Health Data Project, Indianapolis, Indiana, United States of America
| | - Tommy Reddicks
- Paramount Schools of Excellence, Indianapolis, Indiana, United States of America
| | - Jess Monk
- Paramount Schools of Excellence, Indianapolis, Indiana, United States of America
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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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21
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Connecting Kids to Care: Developing a School-Based Telehealth Program. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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22
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Soleimanpour S. School-Based Health Centers: At the Intersection of Health and Education. J Adolesc Health 2020; 67:317-318. [PMID: 32487488 PMCID: PMC7261217 DOI: 10.1016/j.jadohealth.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/06/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Samira Soleimanpour
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
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23
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Westbrook M, Martinez L, Mechergui S, Yeatman S. The Influence of School-Based Health Center Access on High School Graduation: Evidence From Colorado. J Adolesc Health 2020; 67:447-449. [PMID: 32532565 PMCID: PMC7483255 DOI: 10.1016/j.jadohealth.2020.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To examine the association between the introduction of a school-based health center (SBHC) and high school graduation rates. METHODS We use school-level longitudinal data from Colorado that combines data on the opening of SBHCs in high schools with 4-year high school graduation rates overall and by gender between 2000 and 2018. The analytic sample consists of high schools without an SBHC in 2000 (n = 132). We compare high schools that opened SBHCs over the period to those that did not and run school-level panel fixed effects models to assess the relationship between opening an SBHC and change in high school graduation rates. RESULTS Schools that subsequently opened SBHCs had larger minority populations and lower average graduation rates in 2000. Opening an SBHC was associated with a 4.1 percentage point increase in the overall graduation rate (p = .077). The gender-stratified analyses indicate young men's graduation rates were most sensitive to the presence of an SBHC, increasing 4.8 percentage points (p = .051), compared to young women's graduation rates increasing 3.0 percentage points (p = .163). CONCLUSIONS Our findings suggest that the benefits of SBHC access may extend beyond health-specific outcomes to graduation rates.
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Affiliation(s)
- Marisa Westbrook
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, Colorado.
| | - Lisette Martinez
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, Colorado
| | - Safa Mechergui
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, Colorado
| | - Sara Yeatman
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, Colorado
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Johnson V, Ellis RS, Hutcherson V. Evaluating a Strategy for Implementation and Sustainability of School-Based Health Centers in 3 Disparate Communities. THE JOURNAL OF SCHOOL HEALTH 2020; 90:286-294. [PMID: 31994216 DOI: 10.1111/josh.12875] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 02/07/2019] [Accepted: 03/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND School-based health centers (SBHCs) increase access to health care and improve academic achievement for underserved students. We report on the test of a strategy to take SBHCs to scale by addressing the issues of community need and support and financial sustainability. METHODS Using mixed methods, we collected data on student enrollment, utilization, health outcomes, seat time, patient revenues, surveys and key informant interviews from SBHCs located in 3 geographically and demographically different communities over a 2-year period. RESULTS The 3 health centers were comparable in their capacity to implement their operations and achieve quality outcomes but varied considerably in their abilities to achieve sustainability after 2 years of operation. All participated in a planning phase and were able to achieve community buy in and support which impacted their implementation. Only one of the SBHCs which had the highest patient utilization was able to generate enough revenue from patient billings to become sustainable after the second year. CONCLUSION Expanding SBHCs requires a period of planning to generate community buy in and support which is required for successful implementation. Sustainability requires sustained high clinic utilization and is enhanced by health centers that are able to receive high Medicaid reimbursements.
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Affiliation(s)
- Veda Johnson
- Professor, Director, , PARTNERS for Equity in Child and Adolescent Health, Department of Pediatrics, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA, 30303
| | - Ruth S Ellis
- Program Director, , PARTNERS for Equity in Child and Adolescent Health, Department of Pediatrics, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA, 30303
| | - Valerie Hutcherson
- Principal, , Village Research and Consulting, 3600 DeKalb Technology Parkway, Suite 140, Atlanta, GA, 30340
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Lyon AR, Charlesworth-Attie S, Vander Stoep A, McCauley E. Modular Psychotherapy for Youth With Internalizing Problems: Implementation With Therapists in School-Based Health Centers. SCHOOL PSYCHOLOGY REVIEW 2019. [DOI: 10.1080/02796015.2011.12087530] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Thayer AJ, Cook CR, Fiat AE, Bartlett-Chase MN, Kember JM. Wise Feedback as a Timely Intervention for At-Risk Students Transitioning Into High School. SCHOOL PSYCHOLOGY REVIEW 2019. [DOI: 10.17105/spr-2017-0021.v47-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Garcia BK, Agustin ML, Okihiro MM, Sehgal VM. Empowering 'Ōpio (Next Generation): Student Centered, Community Engaged, School Based Health Education. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2019; 78:30-34. [PMID: 31930199 PMCID: PMC6949472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Education and health are vital for children to thrive, especially for those from rural and disparate communities. For Native Hawaiians, the indigenous people of the State of Hawai'i, lokahi (balance) frames the concept of ola (health), consisting of physical, emotional, and spiritual health. The foundation of ola is embedded in the cultural values - kupuna (ancestors), 'āina (land), environment, and 'ohana (family). Unfortunately, since westernization, Native Hawaiians have significant health disparities that begin in early childhood and often continue throughout their lifetime. Native Hawaiians also have a history of educational disparities, such as lower high school an college graduation rates compared to other ethnic groups. Social and economic determinants, such as poverty, homelessness, and drug addiction, often contribute to these educational disparities. In rural O'ahu, the Waianae Coast Comprehensive Health Center recently established two school-based health centers at the community's high and intermediate schools to improve student access to comprehensive health services. Recognizing the need to improve student health literacy and address specific health issues impacting the community and students, two health educators were added to the school-based health team. This article describes: 1) the initial steps taken by the health educators to engage and empower students as a means to assess their needs, interests and facilitate student lokahi, ola, and wellness and; 2) the results of this initial needs assessment.
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Affiliation(s)
| | | | - May M Okihiro
- Waianae Coast Comprehensive Health Center, Wai'anae, HI
| | - Vija M Sehgal
- Waianae Coast Comprehensive Health Center, Wai'anae, HI
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Kearney CA, Gonzálvez C, Graczyk PA, Fornander MJ. Reconciling Contemporary Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability (Part 2). Front Psychol 2019; 10:2605. [PMID: 31849743 PMCID: PMC6895679 DOI: 10.3389/fpsyg.2019.02605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/04/2019] [Indexed: 01/08/2023] Open
Abstract
As noted in Part 1 of this two-part review, school attendance is an important foundational competency for children and adolescents, and school absenteeism has been linked to myriad short- and long-term negative consequences, even into adulthood. Categorical and dimensional approaches for this population have been developed. This article (Part 2 of a two-part review) discusses compatibilities of categorical and dimensional approaches for school attendance and school absenteeism and how these approaches can inform one another. The article also poses a multidimensional multi-tiered system of supports pyramid model as a mechanism for reconciling these approaches, promoting school attendance (and/or prevention of school absenteeism), establishing early warning systems for nimble response to school attendance problems, assisting with global policy review and dissemination and implementation, and adapting to future changes in education and technology.
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Affiliation(s)
| | - Carolina Gonzálvez
- Department of Developmental Psychology and Teaching, Universidad de Alicante, San Vicente del Raspeig, Spain
| | - Patricia A. Graczyk
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Mirae J. Fornander
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, United States
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Taylor LK, Goldberg MG, Tran MHD. Promoting Student Success: How Do We Best Support Child and Youth Survivors of Catastrophic Events? Curr Psychiatry Rep 2019; 21:82. [PMID: 31410584 DOI: 10.1007/s11920-019-1067-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW School mental health services have achieved recognition for increased access to care and intervention completion rates. While best practice recommendations include connection of school mental health programming to multi-tiered systems of support that promote early identification and intervention, many schools struggle to operationalize student screening for trauma exposure, trauma symptoms, and service identification. Relatedly, progress monitoring for trauma symptoms, and the effect of trauma on school functioning in the context of catastrophic events, can also be difficult to systematically collect. RECENT FINDINGS Research regarding the effects of catastrophic events, such as exposure to natural disasters, terrorist attacks, war, or the journey to refugee status on children and youths school functioning, indicates salient age and gender differences among student responses. In addition, school professionals have been identified as sources of social support for students and as potential brokers to school linked intervention resources for children, youth, and their families. Based on our review, we outline recommendations for school professionals, including potential changes to school policies and procedures, and delineate future research questions.
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Affiliation(s)
- Leslie K Taylor
- Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, 1941 East Rd, Houston, TX, 77054, USA.
| | - Melissa G Goldberg
- Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, 1941 East Rd, Houston, TX, 77054, USA
| | - Minh-Hao D Tran
- Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, 1941 East Rd, Houston, TX, 77054, USA
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School-based health services and educational attainment: Findings from a national longitudinal study. Prev Med 2019; 121:74-78. [PMID: 30763630 PMCID: PMC6400475 DOI: 10.1016/j.ypmed.2019.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/30/2018] [Accepted: 02/08/2019] [Indexed: 11/23/2022]
Abstract
This study examined whether availability and use of different types of school-based health services (SBHS) during adolescence were associated with educational attainment in adulthood. Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) were analyzed in 2018 to assess relationships between different types of SBHS provided by schools and use of SBHS among adolescents in 1995, and educational attainment in young adulthood (2001-02) and later adulthood (2008). Multi-level linear regression models included SBHS such as providing immunizations, physical exams and emotional counseling at the school level, and receiving a school-based physical exam, emotional counseling or family planning counseling at the individual level, with other school and individual characteristics included as covariates. At the school level, providing immunizations in 1995 was associated with higher educational attainment in 2001-02 and 2008. Providing physical exams and physical fitness/recreation centers also were marginally associated with higher educational attainment in 2001-02 and 2008, respectively. At the individual level, receiving a physical exam at school in 1995 was associated with higher educational attainment in 2001-02, while receiving emotional counseling at school was inversely associated with educational attainment in 2008. None of the other types of SBHS at the school or individual level were associated with later educational attainment. This study suggests that preventive SBHS such as immunizations, physical exams and physical fitness/recreation centers may contribute to academic achievement and higher educational attainment during young and later adulthood.
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Academic, Psychosocial, and Demographic Correlates of School-Based Health Center Utilization: Patterns by Service Type. CHILD & YOUTH CARE FORUM 2019. [DOI: 10.1007/s10566-019-09495-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Allison MA, Attisha E, Lerner M, De Pinto CD, Beers NS, Gibson EJ, Gorski P, Kjolhede C, O’Leary SC, Schumacher H, Weiss-Harrison A. The Link Between School Attendance and Good Health. Pediatrics 2019; 143:peds.2018-3648. [PMID: 30835245 DOI: 10.1542/peds.2018-3648] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
More than 6.5 million children in the United States, approximately 13% of all students, miss 15 or more days of school each year. The rates of chronic absenteeism vary between states, communities, and schools, with significant disparities based on income, race, and ethnicity. Chronic school absenteeism, starting as early as preschool and kindergarten, puts students at risk for poor school performance and school dropout, which in turn, put them at risk for unhealthy behaviors as adolescents and young adults as well as poor long-term health outcomes. Pediatricians and their colleagues caring for children in the medical setting have opportunities at the individual patient and/or family, practice, and population levels to promote school attendance and reduce chronic absenteeism and resulting health disparities. Although this policy statement is primarily focused on absenteeism related to students' physical and mental health, pediatricians may play a role in addressing absenteeism attributable to a wide range of factors through individual interactions with patients and their parents and through community-, state-, and federal-level advocacy.
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Affiliation(s)
- Mandy A. Allison
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, and Children’s Hospital Colorado, Aurora, Colorado; and
| | - Elliott Attisha
- Detroit Public Schools Community District, Detroit, Michigan
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Can Nurturing the Young Be the Key to Tackling Chronic Diseases in the Old? A Narrative Review With a Global Perspective. Ochsner J 2018; 18:364-369. [PMID: 30559622 DOI: 10.31486/toj.18.0054] [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: 11/08/2022] Open
Abstract
Background One of the greatest challenges in healthcare today is dealing with a growing burden of multimorbid chronic diseases in an aging population. Awareness is growing that a healthy start in life plays a critical role in reversing this trend, especially for young women, pregnant mothers, and children in their first 2 years of life. Methods We reviewed the international literature on early childhood nutrition and development, based on the landmark Lancet series on maternal and child nutrition and child development, and World Health Organization reports. Results Contemporary literature points to the importance of strategies that focus on early childhood for enhancing both health and socioeconomic outcomes. We discuss programs and initiatives that aim to improve the health of mothers and children at a global level, with a focus on high-income countries such as Australia and the United States. Conclusion Tackling the epidemic of chronic diseases requires a comprehensive life course approach that must include pregnant women and their young children. Healthcare systems and professionals play an important role. The health and well-being of the next generation must be everyone's business.
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Ruff RR, Senthi S, Susser SR, Tsutsui A. Oral health, academic performance, and school absenteeism in children and adolescents: A systematic review and meta-analysis. J Am Dent Assoc 2018; 150:111-121.e4. [PMID: 30473200 DOI: 10.1016/j.adaj.2018.09.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND The authors conducted a systematic review and meta-analysis to provide a summary estimate of the association between oral health and academic performance. TYPES OF STUDIES REVIEWED The authors conducted a systematic search of PubMed, Embase, and Google Scholar for studies on oral health, school absence, and academic achievement published in English from January 1945 through December 2017. Exposures included subjectively or objectively measured caries, oral pain, and periodontitis. Outcomes included school absence and school achievement. RESULTS The authors screened a total of 2,041 studies, from which they extracted data from 14 studies of 139,989 children (12 cross-sectional studies, 1 case-control study, and 1 longitudinal study). Five studies had school absence as the primary outcome, and 7 studies had student achievement as the primary outcome. Three studies included both outcomes. The authors found no studies for periodontitis. The average modified Newcastle-Ottawa Scale score was 3.93. The authors rated 10 studies as having a low risk of bias and 4 as having a high risk of bias. Qualitative synthesis suggested that poor oral health may have negative effects on student absenteeism and achievement, but study quality was highly variable. Results from meta-analyses indicated that poor oral health was significantly associated with increased odds of poor academic performance (pooled odds ratio, 1.52; 95% confidence interval, 1.20 to 1.83) and absenteeism (pooled odds ratio, 1.43; 95% confidence interval, 1.24 to 1.63). CONCLUSIONS AND PRACTICAL IMPLICATIONS Increased focus on the broader implications of improvements in oral health for children, such as educational or socioemotional development, is of further interest to practicing dentists owing to the greater connection between oral health and general health. The authors of this study found that caries or tooth pain had a negative association with academic achievement and school absenteeism. However, study quality was limited by inconsistent exposure and outcome definitions and a predominance of cross-sectional designs. Thus, causal conclusions are not supported.
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Noel-London K, Breitbach A, Belue R. Filling the Gaps in Adolescent Care and School Health Policy-Tackling Health Disparities through Sports Medicine Integration. Healthcare (Basel) 2018; 6:healthcare6040132. [PMID: 30428510 PMCID: PMC6316866 DOI: 10.3390/healthcare6040132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/06/2018] [Accepted: 11/10/2018] [Indexed: 12/29/2022] Open
Abstract
The School-Based Health Centre (SBHC) model of healthcare delivery in community health is designed to address the unique needs of adolescents. Through a collaborative interprofessional approach, they aim to provide comprehensive care with the goal of reducing health disparities in underserved, at-risk adolescents. Integration of sports medicine health professionals is a novel approach to increasing available services, as well as patient utilization, while addressing multiple public health issues, including lack of athletic training services for youth athletes.
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Affiliation(s)
- Kemba Noel-London
- College for Public Health and Social Justice Department of Health Management and Policy, Saint Louis University, St. Louis, MO 63104, USA.
| | - Anthony Breitbach
- Doisy College of Health Sciences, Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, MO 63104, USA.
| | - Rhonda Belue
- College for Public Health and Social Justice Department of Health Management and Policy, Saint Louis University, St. Louis, MO 63104, USA.
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Pilot Test of an Engagement, Triage, and Brief Intervention Strategy for School Mental Health. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-018-9277-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Dawson RS, Fashina O, Mallett LH. Outcomes of an Adolescent School-Based Health Initiative Needs Assessment. J Pediatr Health Care 2018; 32:e74-e79. [PMID: 29426728 DOI: 10.1016/j.pedhc.2017.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/31/2017] [Indexed: 12/01/2022]
Abstract
Adolescent School-Based Health Initiatives (ASBHIs) are designed to increase adolescent access to medical homes and services that are not otherwise available without significant barriers. ASBHIs have been proven to increase access to care for school-aged adolescents with unique needs and limited access to these much-needed medical services. For this descriptive study we conducted a needs assessment to understand and determine the needs and desires for a school-based health initiative in a middle school in the community. Survey topics included demographics, health care needs, and desired health resources. Most teachers (94%) and parents (83%) indicated that they would encourage their student/child to participate in an ASBHI program, and 57% of students reported that they would use an ASBHI program. Both parents (71%) and teachers (94%) indicated that student attendance would improve with an Adolescent School-Based Health Initiative. There is sufficient evidence for the need and utilization of an ASBHI program in this community.
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Splett JW, George MW, Zaheer I, Weist MD, Evans SW, Kern L. Symptom Profiles and Mental Health Services Received Among Referred Adolescents. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-017-9244-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Predictors of Disparities in Access and Retention in School-Based Mental Health Services. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-017-9233-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Larson S, Chapman S, Spetz J, Brindis CD. Chronic Childhood Trauma, Mental Health, Academic Achievement, and School-Based Health Center Mental Health Services. THE JOURNAL OF SCHOOL HEALTH 2017; 87:675-686. [PMID: 28766317 DOI: 10.1111/josh.12541] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 12/28/2016] [Accepted: 04/22/2017] [Indexed: 05/27/2023]
Abstract
BACKGROUND Children and adolescents exposed to chronic trauma have a greater risk for mental health disorders and school failure. Children and adolescents of minority racial/ethnic groups and those living in poverty are at greater risk of exposure to trauma and less likely to have access to mental health services. School-based health centers (SBHCs) may be one strategy to decrease health disparities. METHODS Empirical studies between 2003 and 2013 of US pediatric populations and of US SBHCs were included if research was related to childhood trauma's effects, mental health care disparities, SBHC mental health services, or SBHC impact on academic achievement. RESULTS Eight studies show a significant risk of mental health disorders and poor academic achievement when exposed to childhood trauma. Seven studies found significant disparities in pediatric mental health care in the US. Nine studies reviewed SBHC mental health service access, utilization, quality, funding, and impact on school achievement. CONCLUSION Exposure to chronic childhood trauma negatively impacts school achievement when mediated by mental health disorders. Disparities are common in pediatric mental health care in the United States. SBHC mental health services have some showed evidence of their ability to reduce, though not eradicate, mental health care disparities.
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Affiliation(s)
- Satu Larson
- San José State University, The Valley Foundation School of Nursing, One Washington Square, San José, CA 95192
| | - Susan Chapman
- University of California San Francisco, School of Nursing, Department of Social and Behavioral Sciences, Nurse Health Policy Program, 3333 California St., Ste. 265, San Francisco, CA 94118
- University of California San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California St., Ste. 265, San Francisco, CA 94118
- University of California San Francisco, Healthforce Center, 3333 California St., Ste. 265, San Francisco, CA 94118
| | - Joanne Spetz
- University of California San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California St., Ste. 265, San Francisco, CA 94118
- University of California San Francisco, Healthforce Center, 3333 California St., Ste. 265, San Francisco, CA 94118
- University of California San Francisco, School of Medicine, Department of Family and Community Medicine, 3333 California St., Ste. 265, San Francisco, CA 94118
- University of California San Francisco, School of Nursing, Department of Social and Behavioral Sciences; 3333 California St., Ste. 265, San Francisco, CA 94118
| | - Claire D Brindis
- University of California San Francisco, Philip R. Lee Institute of Health Policy Studies, 3333 California St., Ste. 265, San Francisco, CA 94118
- University of California San Francisco, School of Medicine, Department of Pediatrics and Department of Obstetrics, Gynecology, and Reproductive Health Services, 3333 California St., Ste. 265, San Francisco, CA 94118
- Adolescent and Young Adult Health National Resource Center, 3333 California St., Ste. 265, San Francisco, CA 94118
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Kase C, Hoover S, Boyd G, West KD, Dubenitz J, Trivedi PA, Peterson HJ, Stein BD. Educational Outcomes Associated With School Behavioral Health Interventions: A Review of the Literature. THE JOURNAL OF SCHOOL HEALTH 2017; 87:554-562. [PMID: 28580676 DOI: 10.1111/josh.12524] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 10/24/2016] [Accepted: 01/19/2017] [Indexed: 05/27/2023]
Abstract
BACKGROUND There is an unmet need for behavioral health support and services among children and adolescents, which school behavioral health has the potential to address. Existing reviews and meta-analyses document the behavioral health benefits of school behavioral health programs and frameworks, but few summaries of the academic benefits of such programs exist. We provide exemplars of the academic benefits of school behavioral health programs and frameworks. METHODS A literature review identified school behavioral health-related articles and reports. Articles for inclusion were restricted to those that were school-based programs and frameworks in the United States that included an empirical evaluation of intervention academic-related outcomes. RESULTS Findings from 36 primary research, review, and meta-analysis articles from the past 17 years show the benefits of school behavioral health clinical interventions and targeted interventions on a range of academic outcomes for adolescents. CONCLUSION Our findings are consistent with reports documenting health benefits of school behavioral health frameworks and programs and can facilitate further efforts to support school behavioral health for a range of stakeholders interested in the benefits of school behavioral health programs and frameworks on academic outcomes.
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Affiliation(s)
- Courtney Kase
- Behavioral and Policy Sciences, RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213
| | - Sharon Hoover
- University of Maryland School of Medicine
- National Center for School Mental Health, 737 West, Lombard Street 400, Baltimore, MD 21201
| | - Gina Boyd
- Behavioral and Policy Sciences, RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213
| | - Kristina D West
- Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, 200 Independence Avenue, SW, Washington, DC 20201
| | - Joel Dubenitz
- Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, 200 Independence Avenue, SW, Washington, DC 20201
| | - Pamala A Trivedi
- Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, 200 Independence Avenue, SW, Washington, DC 20201
| | - Hilary J Peterson
- Behavioral and Policy Sciences, RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213
| | - Bradley D Stein
- Behavioral and Policy Sciences, RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213
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Characteristic Differences Between School-Based Health Centers With and Without Mental Health Providers: A Review of National Trends. J Pediatr Health Care 2017; 31:484-492. [PMID: 28189399 DOI: 10.1016/j.pedhc.2016.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/28/2016] [Accepted: 12/29/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Minority racial/ethnic pediatric populations and those living in poverty are at greater risk of exposure to trauma, development of mental health disorders, and school failure yet are less likely to have access to mental health services (MHS). School-based health centers (SBHCs) staffed with mental health providers may be one strategy for decreasing health care disparities. METHODS Secondary analysis of the cross-sectional School-Based Health Alliance Census School Year 2010-2011 Report was conducted. Descriptive statistics and chi-square analysis were used to describe differences between SBHCs with and without onsite MHS. RESULTS A total of 70% of SBHCs offered MHS. SBHCs with more resources, more students, a longer history, and state funding were more likely to offer MHS, and geographic location had no impact on service availability. CONCLUSION Reviewing SBHC characteristics that enable inclusion of MHS may help stakeholders expand this model of care to address exposure to chronic childhood trauma.
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Denny S, Howie H, Grant S, Galbreath R, Utter J, Fleming T, Clark T. Characteristics of school-based health services associated with students' mental health. J Health Serv Res Policy 2017; 23:7-14. [PMID: 28662585 DOI: 10.1177/1355819617716196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective School-based health services (SBHS) have been shown to improve access to mental health services but the evidence of their effectiveness on students' mental health is lacking. Our objective was to examine associations between variation in the provision of SBHS and students' mental health. Methods A cross-sectional analysis of a nationally representative health and well-being survey of 8500 New Zealand high school students conducted in March-November 2012. Students' mental health is related to data on school health services obtained from clinic leaders and clinicians from 90 participating high schools. Results After adjustment for socio-demographic differences in students between schools, increasing levels of services were associated with progressively lower levels of student-reported depressive symptoms (p = 0.002), emotional and behavioural difficulties (p = 0.004) and suicidality (p = 0.008). Services with greater levels of nursing hours (p = 0.02) and those that performed routine, comprehensive psychosocial assessments (p = 0.01) were both associated with lower levels of student-reported depressive symptoms. Greater levels of nursing hours and doctor hours were associated with lower self-reported suicidality among students. Conclusions Although a causal association between school-based health services and students' mental health cannot be demonstrated, these findings support the benefit of such services and the need for a cluster randomized trial.
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Affiliation(s)
- Simon Denny
- 1 Associate Professor, Department of Paediatrics, Child and Youth Health, University of Auckland, New Zealand
| | - Hamish Howie
- 2 General Practitioner, Centre for Youth Health, Counties Manukau District Health Board, New Zealand
| | - Sue Grant
- 3 Professional Teaching Fellow, Department of Paediatrics, Child and Youth Health, University of Auckland, New Zealand
| | - Ross Galbreath
- 4 Research Associate, Department of Paediatrics, Child and Youth Health, University of Auckland, New Zealand
| | - Jennifer Utter
- 5 Senior Lecturer, School of Population Health, University of Auckland, New Zealand
| | - Theresa Fleming
- 6 Senior Lecturer, Department of Paediatrics, Child and Youth Health, University of Auckland, New Zealand
| | - Terryann Clark
- 7 Senior Lecturer, School of Nursing, University of Auckland, New Zealand
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Sprigg SM, Wolgin F, Chubinski J, Keller K. School-Based Health Centers: A Funder’s View Of Effective Grant Making. Health Aff (Millwood) 2017; 36:768-772. [DOI: 10.1377/hlthaff.2016.1234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Susan M. Sprigg
- Susan M. Sprigg ( ) is a research officer for innovation and learning at Interact for Health, in Cincinnati, Ohio
| | - Francie Wolgin
- Francie Wolgin is senior program officer at Interact for Health and executive director of Growing Well, both in Cincinnati
| | - Jennifer Chubinski
- Jennifer Chubinski is vice president of innovation and learning at Interact for Health
| | - Kathryn Keller
- Kathryn Keller is vice president of system strategies at Interact for Health. The authors acknowledge that much of the literature referenced in this article on the connection between student health and academic achievement is several years old. These articles, though, are the most recent that they could identify
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Weist MD, Bruns EJ, Whitaker K, Wei Y, Kutcher S, Larsen T, Holsen I, Cooper JL, Geroski A, Short KH. School mental health promotion and intervention: Experiences from four nations. SCHOOL PSYCHOLOGY INTERNATIONAL 2017. [DOI: 10.1177/0143034317695379] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
All around the world, partnerships among schools and other youth-serving systems are promoting more comprehensive school-based mental health services. This article describes the development of international networks for school mental health (SMH) including the International Alliance for Child and Adolescent Mental Health and Schools (INTERCAMHS) and the more recent School Mental Health International Leadership Exchange (SMHILE). In conjunction with World Conferences on Mental Health Promotion, SMHILE has held pre-conference and planning meetings and has identified five critical themes for the advancement of global SMH: 1) Cross-sector collaboration in building systems of care; 2) meaningful youth and family engagement; 3) workforce development and mental health literacy; 4) implementation of evidence-based practices; and 5) ongoing monitoring and quality assurance. In this article we provide general background on SMH in four nations, two showing strong progress (the United States and Canada), one showing moderate progress (Norway), and one beginning the work (Liberia). Following general background for each country, actions in relation to the SMHILE themes are reviewed. The article concludes with plans and ideas for future global collaboration towards advancement of the SMH field.
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Lyon AR, Pullmann MD, Whitaker K, Ludwig K, Wasse JK, McCauley E. A Digital Feedback System to Support Implementation of Measurement-Based Care by School-Based Mental Health Clinicians. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2017; 48:S168-S179. [PMID: 28278597 DOI: 10.1080/15374416.2017.1280808] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Evidence supports the utility of measurement-based care (MBC) to improve youth mental health outcomes, but clinicians rarely engage in MBC practices. Digital measurement feedback systems (MFS) may reflect a feasible strategy to support MBC adoption and sustainment. This pilot study was initiated to evaluate the impact of a MFS and brief consultation supports to facilitate MBC uptake and sustainment among mental health clinicians in the education sector, the most common mental health service delivery setting for youth. Following an initial training in MBC, 14 clinicians were randomized to either a digital MFS and brief consultation supports or control. Baseline ratings of MBC attitudes, skill, and use were collected. In addition, daily assessment ratings tracked 2 core MBC practices (i.e., assessment tool administration, provision of feedback) over a 6-month follow-up period. Clinicians in the MFS condition demonstrated rapid increases in both MBC practices, whereas the control group did not significantly change. For clinicians in the MFS group, consultation effects were significant for feedback and approached significance for administration. Over the follow-up period, average decreases in the current study were moderate with only 1 of the 2 outcome variables (administration) decreasing significantly. Inspection of individual clinician trajectories revealed substantial within-group trend variation. MFS may represent an effective MBC implementation strategy beyond initial training, although individual clinician response is variable. Identifying feasible and impactful implementation strategies is critical given the ability of MBC to support precision health care.
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Affiliation(s)
- Aaron R Lyon
- a Department of Psychiatry and Behavioral Health Sciences , University of Washington
| | - Michael D Pullmann
- a Department of Psychiatry and Behavioral Health Sciences , University of Washington
| | - Kelly Whitaker
- a Department of Psychiatry and Behavioral Health Sciences , University of Washington
| | - Kristy Ludwig
- a Department of Psychiatry and Behavioral Health Sciences , University of Washington
| | | | - Elizabeth McCauley
- a Department of Psychiatry and Behavioral Health Sciences , University of Washington
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Determinants and Functions of Standardized Assessment Use Among School Mental Health Clinicians: A Mixed Methods Evaluation. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 43:122-34. [PMID: 25875325 DOI: 10.1007/s10488-015-0626-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The current study evaluated why and how school mental health clinicians use standardized assessment tools in their work with youth and families. Quantitative and qualitative (focus group) data were collected prior to and following a training and consultation sequence as part of a trial program to assess school clinician's (n = 15) experiences administering standardized tools to youth on their caseloads (n = 191). Findings indicated that, although assessment use was initially somewhat low, clinicians used measures to conduct initial assessments with the bulk of their caseloads (average = 62.2%) during the implementation period. Clinicians also reported on factors influencing their use of assessments at the client, provider, and system levels; perceived functions of assessment; student responses to assessment use; and use of additional sources of clinically-relevant information (primarily educational data) for the purposes of assessment and progress monitoring. Implications for the contextual appropriateness of standardized assessment and training in assessment tools are discussed.
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Abstract
Community schools link students, families, and communities to educate children and strengthen neighborhoods. They have become a popular model for education in many US cities in part because they build on community assets and address multiple determinants of educational disadvantage. Since community schools seek to have an impact on populations, not just the children enrolled, they provide an opportunity to improve community health. Community schools influence the health and education of neighborhood residents though three pathways: building trust, establishing norms, and linking people to networks and services. Through such services as school-based health centers, nutrition education, family mental health counseling, violence prevention, and sexuality education, these schools build on the multiple reciprocal relationships between health and education. By developing closer ties between community schools and neighborhood health programs, public health professionals can help to mobilize a powerful new resource for reducing the health and educational inequalities that now characterize US cities. We suggest an agenda for research, practice, and policy that can build the evidence needed to guide such a strategy.
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Lai K, Guo S, Ijadi-Maghsoodi R, Puffer M, Kataoka SH. Bringing Wellness to Schools: Opportunities for and Challenges to Mental Health Integration in School-Based Health Centers. Psychiatr Serv 2016; 67:1328-1333. [PMID: 27417895 PMCID: PMC5831516 DOI: 10.1176/appi.ps.201500401] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE School-based health centers (SBHCs) reduce access barriers to mental health care and improve educational outcomes for youths. This qualitative study evaluated the innovations and challenges of a unique network of SBHCs in a large, urban school district as the centers attempted to integrate health, mental health, and educational services. METHODS The 43 participants sampled included mental health providers, primary care providers, and care coordinators at 14 SBHCs. Semistructured interviews with each participant were audio recorded and transcribed. Themes were identified and coded by using Atlas.ti 5.1 and collapsed into three domains: operations, partnership, and engagement. RESULTS Interviews revealed provider models ranging from single agencies offering both primary care and mental health services to colocated services. Sites where the health agency provided at least some mental health services reported more mental health screenings. Many sites used SBHC wellness coordinators and coordination team meetings to facilitate relationships between schools and health agency and community mental health clinic providers. Partnership challenges included confidentiality policies and staff turnover. Participants also highlighted student and parent engagement through culturally sensitive services, peer health advocates, and "drop-in" lunches. CONCLUSIONS Staffing and operational models are critical in the success of integrating primary care, mental health care, and education. Among the provider models observed, the combined primary care and mental health provider model offered the most integrated services. Despite barriers, providers and schools have begun to implement novel solutions to operational problems and family engagement in mental health services.
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Affiliation(s)
- Karen Lai
- Dr. Lai, Dr. Ijadi-Maghsoodi, and Dr. Kataoka are with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute, and Ms. Guo is with the School of Psychology, all at the University of California, Los Angeles (UCLA). Dr. Ijadi-Maghsoodi is also with the Health Services Research and Development Center, Department of Veterans Affairs (VA), Los Angeles. Ms. Puffer is with L.A. Trust for Children's Health, Los Angeles. Send correspondence to Dr. Kataoka (e-mail: )
| | - Sisi Guo
- Dr. Lai, Dr. Ijadi-Maghsoodi, and Dr. Kataoka are with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute, and Ms. Guo is with the School of Psychology, all at the University of California, Los Angeles (UCLA). Dr. Ijadi-Maghsoodi is also with the Health Services Research and Development Center, Department of Veterans Affairs (VA), Los Angeles. Ms. Puffer is with L.A. Trust for Children's Health, Los Angeles. Send correspondence to Dr. Kataoka (e-mail: )
| | - Roya Ijadi-Maghsoodi
- Dr. Lai, Dr. Ijadi-Maghsoodi, and Dr. Kataoka are with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute, and Ms. Guo is with the School of Psychology, all at the University of California, Los Angeles (UCLA). Dr. Ijadi-Maghsoodi is also with the Health Services Research and Development Center, Department of Veterans Affairs (VA), Los Angeles. Ms. Puffer is with L.A. Trust for Children's Health, Los Angeles. Send correspondence to Dr. Kataoka (e-mail: )
| | - Maryjane Puffer
- Dr. Lai, Dr. Ijadi-Maghsoodi, and Dr. Kataoka are with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute, and Ms. Guo is with the School of Psychology, all at the University of California, Los Angeles (UCLA). Dr. Ijadi-Maghsoodi is also with the Health Services Research and Development Center, Department of Veterans Affairs (VA), Los Angeles. Ms. Puffer is with L.A. Trust for Children's Health, Los Angeles. Send correspondence to Dr. Kataoka (e-mail: )
| | - Sheryl H Kataoka
- Dr. Lai, Dr. Ijadi-Maghsoodi, and Dr. Kataoka are with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute, and Ms. Guo is with the School of Psychology, all at the University of California, Los Angeles (UCLA). Dr. Ijadi-Maghsoodi is also with the Health Services Research and Development Center, Department of Veterans Affairs (VA), Los Angeles. Ms. Puffer is with L.A. Trust for Children's Health, Los Angeles. Send correspondence to Dr. Kataoka (e-mail: )
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Soto Mas F, Sussman AL. A Qualitative Evaluation of Elev8 New Mexico School-Based Health Centers. J Pediatr Health Care 2016; 30:e49-e59. [PMID: 27638129 DOI: 10.1016/j.pedhc.2016.08.004] [Citation(s) in RCA: 2] [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: 02/25/2016] [Revised: 07/29/2016] [Accepted: 08/12/2016] [Indexed: 11/18/2022]
Abstract
There is a scarcity of qualitative studies on school-based health centers (SBHCs). We established two primary aims for this study: (a) to assess stakeholders' perceptions of Elev8 New Mexico SBHCs' functionality and (b) to provide a snapshot of the overall contribution of the program to the schools and communities they serve. We collected the data through observations and semistructured interviews. We identified issues that diminish the functionality of SBHCs, such as limited infrastructure and services, lack of cooperation between school personnel and health care providers, and lack of long-term financial sustainability. These structural, interpersonal, and logistical issues limited the contribution of the SBHCs to the health of the students and the community at large. However, Elev8 New Mexico SBHCs serve communities with considerable education and health needs and constitute a unique opportunity to provide health education, disease prevention, and quality health care to a large number of youth and adults.
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