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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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Patte KA, Gohari MR, Faulkner G, Bélanger RE, Leatherdale ST. Inequitable Changes in School Connectedness During the Ongoing COVID-19 Pandemic in a Cohort of Canadian Adolescents. THE JOURNAL OF SCHOOL HEALTH 2024; 94:509-518. [PMID: 38373417 DOI: 10.1111/josh.13443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND We examined whether subgroups of adolescents experienced disparate changes in school connectedness-a robust predictor of multiple health outcomes-from before the COVID-19 pandemic to the first full school year following pandemic onset. METHODS We used 2 waves of prospective survey data from 7178 students attending 41 Canadian secondary schools that participated during the 2019-2020 (T1; pre-COVID-19 onset) and 2020-2021 (T2; ongoing pandemic) school years. Fixed effects analyses tested differences in school connectedness changes by gender, race, bullying victimization, socioeconomic position, and school learning mode. RESULTS Relatively greater declines in school connectedness were reported by students that identified as females, were bullied, perceived their family to be less financially comfortable than their classmates, and attended schools in lower income areas. Marginally greater school connectedness declines resulted among students attending schools that were fully online at T2 than those at schools using a blended model. CONCLUSION Results point to disparate school connectedness declines during the pandemic, which may exacerbate pre-existing health inequities by gender and socioeconomic position, and among bullied youth. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY Effective strategies to improve school climates for equity denied groups are critical for pandemic recovery and preparedness for future related events.
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Affiliation(s)
- Karen A Patte
- Department of Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Mahmood R Gohari
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Guy Faulkner
- School of Kinesiology, University of British Columbia, Lower Mall Research Station Room 337, 2259 Lower Mall, Vancouver, British Columbia, Canada, V6T 1Z3
| | - Richard E Bélanger
- Projet COMPASS-Québec, VITAM-Centre de recherche en santé durable de l'Université Laval, 2480 chemin de la Canardière, Quebec City, QC, Canada, G1J 2G1
- Departement of Pediatrics, Faculty of Medecine-Université Laval, Ferdinand Vandry Pavillon, 1050 Avenue de la Médecine, Quebec City, QC, Canada, G1V 0A6
| | - Scott T Leatherdale
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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McCabe EM, Jameson BE, Grunin L, Yu G. Chronic Health Condition Management and School-Based Health Centers in New York: Findings From the 2020 School Health Profiles Survey. Policy Polit Nurs Pract 2024; 25:36-46. [PMID: 38099704 DOI: 10.1177/15271544231220360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
School-based health centers (SBHCs) are associated with numerous positive aspects of student health services. Many schools in the United States (US) do not have transparent policies on chronic health condition (CHC) management. Of particular concern is the underreporting of the delivery of health services in U.S. schools concerning CHC management and its relationship with the presence or absence of a SBHC. Data from the 2020 School Health Profiles (SHP) Survey were examined in New York public secondary schools. Specific health services were reviewed, together with the presence or absence of a SBHC, including daily medication administration, stock rescue medication, case management services, community partners, chronic disease-specific education, and assurance that students with CHCs were enrolled in an insurance program. A significantly greater proportion of schools with a SBHC compared with schools without a SBHC provided: (1) daily medication administration (92.9% vs. 86.5%; p < .001), (2) stock or rescue medication (84.9% vs. 77.4%; p < .001), (3) case management services (83.1% vs. 67.2%; p < .001), (4) disease-specific education for families (63.1% vs. 57.2%; p = .022), (5) student and family connection to community health services (84.2% vs. 76.5%; p < .001), and (6) ensured that a protocol existed whereby students with a CHC were enrolled in an insurance plan if eligible (79.6% vs. 66.8%; p < .001). Findings suggest that data on a national scale include essential facts for states to consider concerning school health policies and practices. Additional research should examine the intricacy of elements connected with school-based health care to understand better the care provided to children with CHCs.
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Affiliation(s)
- Ellen M McCabe
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Beth E Jameson
- College of Nursing, Seton Hall University, Nutley, NJ, USA
| | - Laura Grunin
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Gary Yu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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Maier MC, Gold MA, Vacca SH, Garbers S. Mixed-methods Exploration of Telehealth-supported Long-acting Reversible Contraceptive Services in School-based Health Centers: How Much Added Value? J Pediatr Health Care 2023; 37:599-608. [PMID: 37256251 DOI: 10.1016/j.pedhc.2023.05.004] [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] [Received: 04/05/2023] [Accepted: 05/10/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION This study explored adolescent and young adult preferences and experiences with telehealth-supported long-acting reversible contraceptive (LARC) services in New York City school-based health centers (SBHCs) during COVID-19. METHOD Sequential mixed methods included post-LARC insertion surveys and in-depth interviews. RESULTS Survey respondents (n = 45) were aged 14-21 years and predominantly Hispanic (53.3%). Only four respondents completed a postinsertion visit via telehealth. Most (82.2%) preferred in-person for future LARC visits; none preferred telehealth. Four themes emerged in interviews (n = 15): LARC self-efficacy and autonomy; SBHC convenience and accessibility; comfort with SBHC providers; and preference for in-person visits despite telehealth benefits. DISCUSSION Although telehealth theoretically adds value to LARC service delivery, uptake and preference for telehealth in the SBHC context were low. Despite the perceived acceptability of telehealth, adolescents and young adults prefer in-person SBHC visits, suggesting SBHC access may eliminate barriers to care that telehealth seeks to overcome.
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Rates, Patterns, and Predictors of Follow-up Care for Adolescents at Risk for Substance Use Disorder in a School-Based Health Center SBIRT Program. J Adolesc Health 2022; 71:S57-S64. [PMID: 36122971 DOI: 10.1016/j.jadohealth.2022.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/17/2022] [Accepted: 02/28/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To examine rates, patterns, and predictors of follow-up care for adolescents screened as being at risk for substance use disorder (SUD) in a school-based health center (SBHC) Screening, Brief Intervention and Referral to Treatment (SBIRT) program. METHODS Electronic health records were extracted of adolescents who received health care services from one of three high school-based health centers implementing SBIRT. Patterns and predictors of engagement in follow-up care within 8 weeks following the week of a positive SUD risk screen were analyzed using item response theory (IRT) modeling. RESULTS Out of 1,327 adolescents receiving SBHC services, 81.2% completed a health screening questionnaire. Of screened adolescents, 17.7% were positive for SUD risk. Across the 8-week follow-up period, 65.4% of adolescents at risk for SUD received at least one follow-up visit. IRT modeling indicated that high levels of engagement in follow-up care were characterized by contact with a behavioral health care (BHC) provider. The percentage of adolescents having follow-up contact with a BHC provider increased significantly after the onset of the COVID-19 pandemic. Engagement in follow-up care was predicted by risk for depression, history of suicidal behavior, being female, and previous sexual activity. DISCUSSION SBHCs provide a favorable setting for screening and detecting adolescents at risk for SUD. Adolescents at risk for SUD should receive follow-up contact with a BHC provider. Enhanced follow-up engagement efforts may be warranted for adolescents at risk for SUD without risk for depression or suicidal history, as well as for females and those with previous sexual activity.
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Effectively Supporting Youth with Chronic Illness in Schools: External Partnerships and Training Recommendations. Pediatr Clin North Am 2022; 69:695-707. [PMID: 35934494 DOI: 10.1016/j.pcl.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Across Western countries, approximately 15% to 20% of school-aged children and adolescents have a health-related disorder, with incidence rates of childhood chronic health conditions (CHCs) increasing. This contribution comprehensively reviews disease-level, school-level, and systems-level issues related to effectively supporting children with CHCs succeed from both psychosocial and educational perspectives. This article also delineates training needs as they pertain to graduate preparation and/or professional development to equip school personnel to appropriately address students' needs. The article concludes with recommendations for evidence-based prevention and intervention strategies and potential avenues for interdisciplinary collaboration and models of coordinated care for these medically compromised youth.
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Li S, Xu X, Lai S, Song S, Liu Q. Depression and sleep disorders among AIDS orphans in an HIV/AIDS high-epidemic area in China. Child Care Health Dev 2022; 48:595-604. [PMID: 35023201 DOI: 10.1111/cch.12964] [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: 08/03/2021] [Revised: 12/19/2021] [Accepted: 01/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Liangshan Yi Autonomous Prefecture is home to the largest population of Yi ethnic minority within mainland China. Due to the high HIV/AIDS epidemic, many Yi children become AIDS orphans who lost one or both parents to AIDS-related causes. This study explored the prevalence and correlates of AIDS orphans' depressive symptom, sleep disorders and their comorbidity. METHODS A cross-sectional survey was conducted to collect pertinent information from 467 AIDS orphans and 856 non-orphans of Yi ethnic minority. Depressive symptoms were screened by a two-item Patient Health Questionnaire (PHQ-2). The symptoms of insomnia were assessed by the Insomnia Severity Index (ISI), which was complemented by one item from the Pittsburgh Quality Sleep Index (PSQI) to measure the frequency of nightmare. RESULTS The prevalence of depression (26.8% vs. 20.4%, P = 0.009) and comorbidity of depression, insomnia and nightmare (7.5% vs. 4.3%, P = 0.046) was significantly higher for AIDS orphans than for non-orphans. Risk factors such as ostracization and self-reported poor physical health had stronger effects on depressive symptoms and sleep disorders for AIDS orphans than for non-orphans. On the other hand, peer support, as an important protective factor, was significantly and negatively associated with depressive symptoms and sleep disorders for AIDS orphans. CONCLUSIONS AIDS orphans of Yi ethnic minority reported higher levels of depressive symptoms and comorbidity of depression and sleep disorders than their non-orphan counterparts. These symptoms were exacerbated by ostracization and self-rated poor physical health but lowered by peer support.
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Affiliation(s)
- Shiying Li
- Department of Sociology and Psychology, School of Public Administration, Sichuan University, Chengdu, China
| | - Xiaohe Xu
- Department of Sociology and Psychology, School of Public Administration, Sichuan University, Chengdu, China.,Department of Sociology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Shimin Lai
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Research Center for Palliative Care, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China
| | - Shasha Song
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Research Center for Palliative Care, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China
| | - Qiaolan Liu
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Research Center for Palliative Care, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China
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Too EK, Chongwo E, Mabrouk A, Abubakar A. Adolescent Connectedness: A Scoping Review of Available Measures and Their Psychometric Properties. Front Psychol 2022; 13:856621. [PMID: 35664205 PMCID: PMC9159472 DOI: 10.3389/fpsyg.2022.856621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Adolescent connectedness, a key component of positive youth development, is associated with various positive health outcomes. Several measures have been developed to assess this construct. However, no study has summarized data on the existing measures of adolescent connectedness. We conducted this scoping review to fill this gap. We specifically aimed to: (i) identify the existing measures of adolescent connectedness, (ii) determine the most frequently used measures among the identified measures, and (iii) summarize the psychometric properties of these measures with a keen interest in highlighting their cross-cultural utility and validity. Methods We searched CINAHL, Embase, PsycInfo, PubMed, and Web of Science databases for relevant articles published since database inception to 7th February 2021. Our search structure contained the key words "Adolescents", "Connectedness", and "Measures". We also searched Open Gray for potentially relevant gray literature. Results We identified 335 measures from 960 eligible studies assessing various domains of adolescent connectedness, including school, family, community, peer, ethnic, racial, cultural, religious/spiritual, and self-connectedness. Most of the included studies (72.1%) were from North America and Europe. Most of the measures (n = 132, 39.4%) were measures of school connectedness among adolescents. Of the identified measures, 60 of them met our criteria of frequently used measures (i.e., the top five most used measures per domain of connectedness). These frequently used measures were used across 481 of the included studies with 400 of them reporting their psychometric properties. The reported reliability of these measures was adequate (Cronbach's alpha ≥ 0.70) in 89.8% of these studies. These measures also appeared to be valid in terms of their face, content, construct, criterion, convergent, discriminant, concurrent, predictive, measurement invariance, and cross-cultural validity. Conclusions There exists a wide array of measures of adolescent connectedness. Sixty of these measures have been frequently used across studies and appear to be reliable and/or valid. However, this evidence is mostly from North America and Europe. This is a reflection of the limitation of this review where only studies published in English were considered. It might also reflect the paucity of research in other regions of the world. More research is needed for clearer insights.
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Affiliation(s)
- Ezra K. Too
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
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Lai S, Zhou J, Xu X, Li S, Ji Y, Yang S, Tang W, Zhang J, Jiang J, Liu Q. Subjective well-being among AIDS orphans in southwest China: the role of school connectedness, peer support, and resilience. BMC Psychiatry 2022; 22:197. [PMID: 35303813 PMCID: PMC8933895 DOI: 10.1186/s12888-022-03833-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/03/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Few studies have explored the health and development of AIDS orphans using the positive youth development (PYD) framework. Grounded in this framework, the main objective of this study is to examine how internal assets (i.e., resilience) and external assets (i.e., school connectedness, peer support) affect subjective well-being among Yi AIDS orphans in the Liangshan Yi Autonomous Prefecture, Sichuan province, China. METHODS A cross-sectional survey was conducted by interviewing 571 AIDS orphans and 979 non-orphans of Yi ethnic minority from 5th-10th grades. Structural equation models (SEM) were utilized to identify and estimate the direct and indirect effects of internal and external assets on subjective well-being. RESULTS The average score of subjective well-being was significantly lower for AIDS orphans than for in non-orphans (P < 0.05). Resilience, school connectedness, peer support (number of friends, caring friends), and self-rated physical health had significant and positive direct effects on subjective well-being. In addition, the effects of school connectedness, and peer support on subjective well-being were mediated by resilience. CONCLUSIONS Positive individual and school-related contextual assets can bolster subjective well-being among AIDS orphans. The design of health intervention programs for AIDS orphans should incorporate these positive development assets.
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Affiliation(s)
- Shimin Lai
- grid.13291.380000 0001 0807 1581Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China ,grid.13291.380000 0001 0807 1581Department of Medical Affairs, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - Junmin Zhou
- grid.13291.380000 0001 0807 1581Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xiaohe Xu
- grid.215352.20000000121845633University of Texas at San Antonio, San Antonio, USA ,grid.13291.380000 0001 0807 1581Department of Sociology and Psychology, School of Public Administration, Sichuan University, Chengdu, China
| | - Shiying Li
- grid.13291.380000 0001 0807 1581Department of Sociology and Psychology, School of Public Administration, Sichuan University, Chengdu, China
| | - Yuanyi Ji
- grid.13291.380000 0001 0807 1581Nosocomial Infection Management Department, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan People’s Republic of China
| | - Shujuan Yang
- grid.13291.380000 0001 0807 1581Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Wanjie Tang
- grid.13291.380000 0001 0807 1581Centre for Educational and Health Psychology, Sichuan University, Chengdu, China
| | - Jianxin Zhang
- grid.13291.380000 0001 0807 1581Department of Maternal, and Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jianjun Jiang
- Department of Palliative Care, West China School of Public Health and West China Fourth Hospital, Research Center for Palliative Care, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China.
| | - Qiaolan Liu
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China. .,Department of Palliative Care, West China School of Public Health and West China Fourth Hospital, Research Center for Palliative Care, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China.
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Fox K, Burgess A, Williamson ME, Massey J, Shaler G, Pearson K, MacKenzie J, Merchant K, Zhu X, Ward M. Implementation of Telehealth Services in Rural Schools: A Qualitative Assessment. THE JOURNAL OF SCHOOL HEALTH 2022; 92:71-78. [PMID: 34806199 DOI: 10.1111/josh.13104] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/05/2021] [Accepted: 04/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In rural areas with health professional workforce shortages, telehealth offers an opportunity to address service gaps and meet the health needs of students. Few studies have examined telehealth implementation in rural schools. This study explores facilitators and barriers to the implementation of telehealth programs in rural schools and identifies strategies for successful implementation to inform future school-based telehealth initiatives. METHODS We conducted semi-structured qualitative interviews with 50 key informants involved in the implementation of telehealth programs funded through the School-Based Telehealth Network Grant Program. Researchers completed a thematic analysis of interview transcripts. RESULTS The most commonly cited barriers were technology, reimbursement for services, and facilitating acceptance of the telehealth among school staff, clinicians, parents, and students. Key informants identified strategies for facilitating program implementation, including technology training and support, marketing efforts, and integration into existing school processes. CONCLUSIONS School-based telehealth can augment clinical capacity in areas with clinician shortages. Entities interested in such an approach to care must engage with their school community to ensure successful implementation. For rural, school-based telehealth to gain greater adoption and be sustained, these services must be reimbursable by Medicaid and private insurers.
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Affiliation(s)
- Kimberley Fox
- University of Southern Maine, 34 Bedford Street, Portland, ME, 04104
| | | | | | - John Massey
- University of Southern Maine, 34 Bedford Street, Portland, ME, 04104
| | - George Shaler
- University of Southern Maine, 34 Bedford Street, Portland, ME, 04104
| | - Karen Pearson
- University of Southern Maine, 34 Bedford Street, Portland, ME, 04104
| | | | - Kimberly Merchant
- University of Iowa, College of Public Health, 145 North Riverside Drive, N242 CPHB, Iowa City, Iowa, 52242
| | - Xi Zhu
- University of Iowa, College of Public Health, 145 North Riverside Drive, N222 CPHB, Iowa City, IA, 52242
| | - Marcia Ward
- University of Iowa, College of Public Health, 145 North Riverside Drive, N236 CPHB, Iowa City, Iowa, 52242
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McCabe EM, Davis C, Mandy L, Wong C. The Role of School Connectedness in Supporting the Health and Well-Being of Youth: Recommendations for School Nurses. NASN Sch Nurse 2021; 37:42-47. [PMID: 34836466 DOI: 10.1177/1942602x211048481] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The importance of students feeling connected in school cannot be overstated, as this perception is crucial to support their health and well-being. A lack of school connectedness can lead to adverse physical and mental health outcomes, including bully victimization. Numerous factors, including individual, social, and environmental, influence students' perceived sense of school connectedness. School nurses are well positioned to establish and maintain school connectedness due to their knowledge, accessibility to students, and familiarity with the school environment. This article details the importance of school connectedness and describes the associations between school connectedness, bullying, and mental health. In addition, we offer recommendations geared toward school nurses regarding strengthening school connectedness and promoting a culture of care and inclusivity within school environments, especially salient in the context of the COVID-19 pandemic.
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Affiliation(s)
- Ellen M McCabe
- Assistant Professor, Hunter College, Hunter College School of Nursing, New York, NY
| | | | | | - Cindy Wong
- Hunter College School of Nursing, New York, NY
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Nguyen AJ, McDaniel H, Braun SS, Chen L, Bradshaw CP. Contextualizing the Association Between School Climate and Student Well-Being: The Moderating Role of Rurality. THE JOURNAL OF SCHOOL HEALTH 2021; 91:463-472. [PMID: 33821509 PMCID: PMC10568539 DOI: 10.1111/josh.13026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/08/2020] [Accepted: 01/28/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND In rural communities, understanding and improving school climate may benefit youth facing unique contextual challenges to well-being. As education research rarely focuses on rural schools, we aimed to examine school climate and student well-being with a particular focus on rural schools, compared to suburban schools. METHODS Cross-sectional survey data were collected from 62,265 students in 22 rural and 78 suburban Maryland middle and high schools. Student self-report data were collected on school climate (safety, engagement, and environment) as well as internalizing problems, behavior problems, stress, substance abuse, and future orientation. Multiple-group, multilevel models were fit to compare between rural and suburban schools. RESULTS On average, rural students reported significantly lower perceptions of safety and engagement than suburban students. Safety and engagement were generally associated with higher youth well-being. A number of moderated effects were observed, which generally suggested stronger associations between school-level climate-particularly engagement-and more positive outcomes for rural compared to suburban students. CONCLUSIONS Students' perceptions of safety and engagement were associated with student well-being, in some cases with stronger associations for rural students. These findings suggest that efforts to improve school climate may be particularly impactful for rural students.
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Affiliation(s)
- Amanda J Nguyen
- School of Education & Human Development, University of Virginia, 405 Emmet Street South, PO Box 400281, Charlottesville, VA, 22904
| | - Heather McDaniel
- School of Education & Human Development, University of Virginia, 405 Emmet Street South, PO Box 400281, Charlottesville, VA, 22904
| | - Summer S Braun
- School of Education & Human Development, University of Virginia, 405 Emmet Street South, PO Box 400281, Charlottesville, VA, 22904
| | - Lingjun Chen
- University of Texas, MD Anderson Cancer Center, PO Box 301402, Houston, TX, 77230
| | - Catherine P Bradshaw
- School of Education & Human Development, University of Virginia, 405 Emmet Street South, PO Box 400281, Charlottesville, VA, 22904
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Coulter RWS, Paglisotti T, Montano G, Bodnar K, Bersamin M, Russell ST, Hill AV, Mair C, Miller E. Intersectional Differences in Protective School Assets by Sexuality, Gender, Race/Ethnicity, and Socioeconomic Status. THE JOURNAL OF SCHOOL HEALTH 2021; 91:318-330. [PMID: 33740272 PMCID: PMC8432425 DOI: 10.1111/josh.13005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/03/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND School assets-such as connectedness, caring relationships with adults, high behavioral expectations from adults, and meaningful participation-are associated with positive outcomes for adolescents. However, little is known about how school assets differ among adolescents with intersecting marginalized identities. METHODS We used the 2013-2014 California Healthy Kids Survey (N = 320,462 students) to examine differences in school assets with respect to sexuality, gender, race/ethnicity, and socioeconomic status using adjusted multilevel linear regression models. RESULTS Sexual minority, gender minority, racial/ethnic minority, and low socioeconomic status adolescents had significantly lower protective school assets. For all outcomes, the differences between sexual minority and heterosexual adolescents were more pronounced among nontransgender girls than nontransgender boys; however, these differences were not consistently present among racial/ethnic minority students. For school connectedness and meaningful participation, differences for racial/ethnic minorities versus white adolescents were more pronounced among nontransgender girls than nontransgender boys. Differences between transgender adolescents and nontransgender boys were more pronounced for white adolescents compared to some other racial/ethnic minority students. Overall, adolescents with certain multiple marginalized identities had lower school assets. CONCLUSIONS Interventions are needed to strengthen school assets among marginalized students, thereby helping mitigate health and education inequities.
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Affiliation(s)
- Robert W S Coulter
- Assistant Professor, , Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 6129 Public Health Building, 130 De Soto Street, Pittsburgh, PA, 15261., USA
| | - Taylor Paglisotti
- Data Analyst Coordinator, , Department of Pediatrics, School of Medicine, University of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA, 15213-1444., USA
| | - Gerald Montano
- Assistant Professor of Pediatrics, , Department of Pediatrics, School of Medicine, University of Pittsburgh, University Center, Suite 225, 120 Lytton Avenue, Pittsburgh, PA, 15213-1481., USA
| | - Kaitlin Bodnar
- Research Assistant, , University of Pittsburgh, Graduate School of Public Health, P.O. Box 7319, Pittsburgh, PA, 15213., USA
| | - Melina Bersamin
- Senior Research Scientist, , Prevention Research Center, 1516 East Franklin Street, Chapel Hill, NC, 27514., USA
| | - Stephen T Russell
- Professor, , Department of Human Development and Family Sciences, Population Research Center, University of Texas at Austin, 108 E Dean Keeton Street, Austin, TX, 78712., USA
| | - Ashley V Hill
- Postdoctoral Researcher, , Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, University Center, Suite 302.4, 120 Lytton Avenue, Pittsburgh, PA, 15213-1481., USA
| | - Christina Mair
- Associate Professor, , Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 6136 Public Health Building, 130 De Soto Street, Pittsburgh, PA, 15261., USA
| | - Elizabeth Miller
- Professor, , Department of Pediatrics, School of Medicine, University of Pittsburgh, University Center, Suite 302.2, 120 Lytton Avenue, Pittsburgh, PA, 15213-1481., USA
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14
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Bidirectional Associations Between School Connectedness and Mental Health Problems in Early Adolescence: A Cross-Lagged Model. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09440-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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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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16
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Vance SR, Boyer CB, Glidden DV, Sevelius J. Mental Health and Psychosocial Risk and Protective Factors Among Black and Latinx Transgender Youth Compared With Peers. JAMA Netw Open 2021; 4:e213256. [PMID: 33769506 PMCID: PMC7998078 DOI: 10.1001/jamanetworkopen.2021.3256] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Black and Latinx transgender youth experience stigma that may increase their susceptibility to mental health symptoms. OBJECTIVE To compare past-year mental health symptoms and psychosocial factors among Black and Latinx transgender youth, White transgender youth, and Black and Latinx cisgender youth. DESIGN, SETTING, AND PARTICIPANTS This survey study used data from the 2015-2017 Biennial California Healthy Kids Survey with a weighted sample (N = 45 269) representative of California's secondary school population. The analytic sample (n = 19 780) included Black and Latinx transgender youth, White transgender youth, and Black and Latinx cisgender youth in the 9th and 11th grades. Data analysis was conducted from July 2020 to February 2021. MAIN OUTCOMES AND MEASURES Outcomes include past-year depressive symptoms and suicidality. Psychosocial risk factors include school-based victimization, gender-based harassment, sexuality-based harassment, and race-based harassment; protective factors include school connectedness and caring adult relationships. RESULTS The analytic sample of 19 780 participants (in 9th grade: weighted percentage, 51% [95% CI, 50% to 52%]; female participants: weighted percentage, 50% [95% CI, 49% to 51%]) included 252 Black and Latinx transgender youth (weighted percentage, 1.3% [95% CI, 1.1% to 1.5%]), 104 White transgender youth (weighted percentage, 0.7% [95% CI, 0.6% to 0.8%]), and 19 424 Black and Latinx cisgender youth (weighted percentage, 98.0% [95% CI, 97.8% to 98.2%]). For Black and Latinx transgender youth, estimated prevalence of depressive symptoms and suicidality were 50% (95% CI, 44% to 57%) and 46% (95% CI, 39% to 52%), respectively. Logistic regression models adjusted for grade, living arrangement, and reported sex indicated that compared with White transgender youth, Black and Latinx transgender youth had similar odds of depressive symptoms (adjusted odds ratio, 0.6; 95% CI, 0.4 to 1.1) and suicidality (adjusted odds ratio, 1.1; 95% CI, 0.6 to 1.8) and similar odds of all forms of harassment (eg, race-based harassment: adjusted odds ratio, 1.5; 95% CI, 0.8 to 2.6). Regression models indicated that compared with White transgender youth, Black and Latinx transgender youth had similar levels of victimization (adjusted linear regression coefficient, 0.5; 95% CI, -0.3 to 1.3) and caring adult relationships (adjusted linear regression coefficient, -0.6; 95% CI, -1.4 to 0.09) but lower levels of school connectedness (adjusted linear regression coefficient, -1.6; 95% CI, -2.9 to -0.4). With similar analyses, compared with Black and Latinx cisgender youth, Black and Latinx transgender youth had higher odds of depressive symptoms (adjusted odds ratio, 2.7; 95% CI, 2.0 to 3.7) and suicidality (adjusted odds ratio, 5.9; 95% CI, 4.3 to 8.0), higher odds and levels of all forms of harassment and victimization (eg, race-based harassment: adjusted odds ratio, 3.2; 95% CI, 2.4 to 4.5), and lower levels of school connectedness (adjusted linear regression coefficient, -2.6; 95% CI -3.3 to -1.8) and caring adult relationships (adjusted linear regression coefficient, -0.9; 95% CI -1.3 to -0.5). CONCLUSIONS AND RELEVANCE In this study, Black and Latinx transgender youth had high rates of mental health symptoms, with rates comparable with White transgender youth but higher than Black and Latinx cisgender youth. Their unique pattern of psychosocial risk and protective factors for these mental health symptoms should be factored in clinical preventive services and school-based interventions to support them.
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Affiliation(s)
- Stanley Ray Vance
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco
| | - Cherrie B Boyer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Jae Sevelius
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco
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17
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Matteau-Pelletier L, Bélanger RE, Leatherdale S, Desbiens F, Haddad S. Sex-Related Differences in Adolescent Cannabis Use: Influences of School Context and School Connectedness. THE JOURNAL OF SCHOOL HEALTH 2020; 90:878-886. [PMID: 32954535 DOI: 10.1111/josh.12950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/20/2020] [Accepted: 07/07/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Boys use cannabis at a younger age and more frequently than girls. It has been suggested these sex differences might vary according to students' relationship to school. We explored whether the association between sex and adolescents' cannabis use varies among schools and according to students' school connectedness. METHODS The study population consisted of all students from 11 secondary schools in the greater Québec City area. The sample included 6185 respondents in years 1 to 5 at the secondary level (equivalent to grades 7-11). Study outcomes were monthly cannabis use and early cannabis use. RESULTS The association between sex and monthly cannabis use varied significantly among schools after controlling for students' main characteristics and school socioeconomic environment. We found a statistically significant modifying effect of school connectedness on the association between sex and monthly cannabis use. For early cannabis use, we found no modifying effect of school connectedness nor any association with sex. CONCLUSIONS Measures to reduce adolescents' cannabis use could be better adapted to local context and more tailored to specific higher-risk groups. School connectedness is a protective factor for cannabis use, although this effect appears stronger for girls than boys.
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Affiliation(s)
- Laurence Matteau-Pelletier
- Public Health and Preventive Medicine, Université Laval, 1050, Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Richard E Bélanger
- Centre de Recherche sur les Soins et les Services de Première Ligne de l'Université Laval, 2525, Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada
| | - Scott Leatherdale
- Applied Public Health Research, School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, ON, N2L 3G1, Canada
| | - François Desbiens
- Public Health for the Capitale Nationale Region, 2400 Avenue D'Estimauville, Quebec City, QC, G1E 6W2, Canada
| | - Slim Haddad
- Centre de Recherche sur les Soins et les Services de Première Ligne de l'Université Laval, 2525, Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada
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18
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An examination of classes of school climate perceptions among Latinx middle school students. J Sch Psychol 2020; 82:70-84. [PMID: 32988464 DOI: 10.1016/j.jsp.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 05/22/2020] [Accepted: 08/02/2020] [Indexed: 11/21/2022]
Abstract
Several studies have replicated the finding that Latinx students tend to have less favorable perceptions of school climate than their White peers. However, because most research compares Latinx students to a White standard, little is known about variation within the Latinx group and thus the opportunity to produce strength-defining counter-narratives has been missed. Using latent class analysis, this study identified meaningful classes of school climate perceptions within 20,050 Grade 7 Latinx students in California. Five climate classes were identified, lending support to the hypothesis that substantial heterogeneity of school climate perceptions exists within the Latinx student population. The results support the utility of latent class modeling for examining school climate perceptions beyond traditional variable-centered approaches. Countering the prevailing deficit narrative, the results indicate that nearly half of all Latinx respondents reported generally positive perceptions of school climate. Conversely, supporting the need for environmental supports that encourage Latinx students to voice their concerns and make decisions regarding systems that affect them, over three-quarters of the responses suggested that Latinx students perceive meaningful participation at school negatively. The results suggest the possibility of a cascade effect in the development of the psychological experience of the school, such that some dimensions of school climate perceptions may be antecedents to others. Implications for further research and intervention are discussed.
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Zhang L, Finan LJ, Bersamin M, Fisher DA. Sexual Orientation-Based Depression and Suicidality Health Disparities: The Protective Role of School-Based Health Centers. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2020; 30 Suppl 1:134-142. [PMID: 30230104 PMCID: PMC6430702 DOI: 10.1111/jora.12454] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study's purpose was to examine whether school-based health centers (SBHCs) support mental health indicators among sexual minority youth (SMY). Data came from the 2015 Oregon Healthy Teens Survey with 13,608 11th graders in 137 public high schools in Oregon. Regression results revealed significant SBHC by SMY status interactions indicating relative reductions in likelihood of depressive episodes (30%), suicidal ideation (34%), and suicide attempts (43%) among SMY in schools with SBHCs. SMY students in SBHC schools reported lower likelihood of a past-year depressive episode, suicidal ideation, and suicide attempt versus those attending non-SBHC schools. Conversely, no differences in these outcomes were observed for non-SMY by SBHC status. SBHCs may help reduce mental health disparities among SMY, a marginalized, underserved population.
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Affiliation(s)
- Lei Zhang
- Pacific Institute for Research and Evaluation
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20
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Arenson M, Hudson PJ, Lee N, Lai B. The Evidence on School-Based Health Centers: A Review. Glob Pediatr Health 2019; 6:2333794X19828745. [PMID: 30815514 PMCID: PMC6381423 DOI: 10.1177/2333794x19828745] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/16/2018] [Accepted: 12/18/2018] [Indexed: 11/18/2022] Open
Abstract
Context. Pediatricians working toward health equity require health care delivery mechanisms that take on dual roles: mitigating the health effects of a maladaptive social ecosystem while simultaneously working to improve the ecosystem itself. School-based health centers (SBHCs) perform these dual roles by providing medical, mental/behavioral, dental, and vision care directly in schools where young people spend the majority of their time, maximizing their opportunity to learn and grow. Evidence Acquisition. Databases were searched extensively for research studies published between January 2000 and December 2018. Evidence Synthesis. The authors began with 3 recent high-impact reviews that covered SBHC history, health outcomes, cost-benefit, and impact on health equity. Informed by these articles, the authors organized the evidence into 4 broad categories of impact: Financial, Physical Health (including medical, vision, and dental), Mental Health, and Educational Outcomes. Using these 4 categories, the authors then performed a robust literature search using PubMed for studies that fit into these themes. Conclusions. SBHCs increase access to health services for children, families, and communities, which ultimately leads to positive short- and long-term outcomes in service of a broad range of stakeholders. Educational impact requires further attention on both outcomes and methodological approaches. Three current public health topics of importance were identified that SBHCs might be well-suited to address: Youth Gun Violence, Adverse Childhood Experiences, and the Health of American Indian/Alaskan Native communities in the United States.
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Affiliation(s)
| | | | | | - Betty Lai
- Boston College, Chestnut Hill, MA, USA
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