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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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Sullivan EE, Love HL, Fisher RL, Schlitt JJ, Cook EL, Soleimanpour S. Access to Contraceptives in School-Based Health Centers: Progress and Opportunities. Am J Prev Med 2022; 62:350-359. [PMID: 34922786 DOI: 10.1016/j.amepre.2021.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The U.S. has a higher adolescent pregnancy rate than other industrialized countries. School-based health centers can improve access to contraceptives among youth, which can prevent unplanned pregnancies. This cross-sectional study examines the characteristics and predictors of contraceptive provision at school-based health centers in 2016-2017 and changes in and barriers to provision between 2001 and 2017. METHODS In 2020-2021, the authors conducted analyses of the National School-Based Health Care Census data collected from 2001 to 2017. The primary outcome of interest was whether adolescent-serving school-based health centers dispense contraceptives, and a secondary outcome of interest was the policies that prohibit school-based health centers from dispensing contraceptives. A multivariate regression analysis examined the associations between contraceptive provision and various covariates, including geographic region, years of operation, and provider team composition. RESULTS Less than half of adolescent-serving school-based health centers reported providing contraceptives on site. Those that provided contraceptives were more likely located in the Western and Northeastern regions of the U.S., older in terms of years of operation, and staffed by a wide variety of health provider types. Among school-based health centers that experienced policy barriers to providing access to contraceptive methods, most attributed the source to the school or school district where the school-based health center was located. CONCLUSIONS School-based health centers are an evidence-based model for providing contraceptives to adolescents but not enough are providing direct access. Understanding the predictors, characteristics, and barriers influencing the provision of contraceptives at school-based health centers may help to expand the number doing so.
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Affiliation(s)
- Erin E Sullivan
- Research and Evaluation, School-Based Health Alliance, Washington, District of Columbia.
| | - Hayley L Love
- Research and Evaluation, School-Based Health Alliance, Washington, District of Columbia
| | - Rebecca L Fisher
- New York City Department of Health and Mental Hygiene, Office of School Health & Bureau of Maternal, Infant, and Reproductive Health, New York, New York
| | - John J Schlitt
- Research and Evaluation, School-Based Health Alliance, Washington, District of Columbia
| | - Elizabeth L Cook
- Reproductive Health and Family Formation, Child Trends, Bethesda, Maryland
| | - Samira Soleimanpour
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
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Haeder SF, Maxfield E, Ulmen K, Anderson S. When a school is more than just a school: Improving school-based health in the wake of COVID-19. WORLD MEDICAL & HEALTH POLICY 2022; 14:150-177. [PMID: 35600495 PMCID: PMC9111193 DOI: 10.1002/wmh3.498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/21/2021] [Accepted: 01/24/2022] [Indexed: 11/19/2022]
Abstract
The ongoing COVID‐19 pandemic has posed tremendous challenges for economies and individuals around the world. At the same time, it has also laid bare the blatant and growing inequities that many individuals, particularly children, are confronted with on a daily basis. With communities in lockdowns and schools going virtual in many parts of the United States, the important role that schools and school‐based services play in the lives of many children have gained new attention. Nonetheless, only 3% of American schools have school‐based health centers on campus, and they remain relegated to the fringes of both health care and education. One key limitation has been the lack of appropriately trained health‐care professionals. Over the past 2 years, we have interviewed dozens of individuals about their experiences in school‐based health centers. Based on this study, we explore what it means for a health‐care professional to work in school‐based health care and how it differs from more traditional health‐care settings. Our analysis particularly focuses on training and education, work environments, and their unique demands that come from being embedded within the educational setting. We conclude by addressing the important role that governmental policies could play in augmenting this crucial workforce. School‐based services can play an important role in providing more equitable health‐care access to students. Only 3% of American schools have school‐based health centers on campus. A key limitation in expanding school‐based care has been the lack of appropriately trained health‐care professionals. Our analysis explores the training and education, work environments, and their unique demands that come from being embedded within the educational setting.
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Affiliation(s)
- Simon F Haeder
- School of Public Policy The Pennsylvania State University University Park Pennsylvania USA
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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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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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Habiyaremye MA, Clary K, Morris H, Tumin D, Crotty J. Which Children Use School-Based Health Services as a Primary Source of Care? THE JOURNAL OF SCHOOL HEALTH 2021; 91:876-882. [PMID: 34494271 DOI: 10.1111/josh.13085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/08/2021] [Accepted: 03/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND School-based health centers (SBHCs) offer primary and preventive health care for children and adolescents. Using nationally representative data, we aimed to examine which child and family characteristics are associated with using school-based health care providers as the primary source of health care, and whether care received from these providers met the criteria for a medical home. METHODS Using data from the 2016-2018 National Survey of Children's Health (NSCH), we analyzed children's usual source of care (school-based provider, doctor's office or clinic, other location, or none), and whether they received care meeting medical home criteria. RESULTS Based on a sample of 64,710 children, 0.5% identified school-based providers as their primary source of health care. Children who were older, uninsured, or living in the Northeast were significantly more likely to report school-based providers as their usual source of care. Children whose usual source of care was a school-based provider were less likely to receive care meeting medical home criteria than children who usually received care at a doctor's office. CONCLUSIONS While SBHCs improve access to care, our findings indicate potential challenges with establishing a medical home for children who usually receive health care from a school-based provider.
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Affiliation(s)
- Marie A Habiyaremye
- Department of Sociology, East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
| | - Kathryn Clary
- Department of Internal Medicine and Psychiatry, Duke University, 3710 Duke University Medical Center, Durham, NC, 27710, USA
| | - Hannah Morris
- Department of Pediatrics, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
| | - Jennifer Crotty
- Department of Pediatrics, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
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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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Ijadi-Maghsoodi R, Bonnet K, Feller S, Nagaran K, Puffer M, Kataoka S. Voices from Minority Youth on Help-Seeking and Barriers to Mental Health Services: Partnering with School-Based Health Centers. Ethn Dis 2018; 28:437-444. [PMID: 30202197 PMCID: PMC6128338 DOI: 10.18865/ed.28.s2.437] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Schools and school-based health centers (SBHCs) play an important role in reducing disparities in access to mental health treatment. However, there is a need to increase student engagement in school mental health services. This study sought to understand the perceptions of low-income minority youth on help-seeking and barriers to mental health services at SBHC sites. Setting A network of SBHCs, called Wellness Centers, developed as part of a strategic plan to serve students and community members in under-resourced areas of a large urban school district. Participants and Procedures We conducted focus groups with 76 middle and high school students at nine SBHC sites through a community-academic partnered approach from January to May 2014. The focus groups were audio-recorded, transcribed, and major themes coded with Atlas.ti.5.1. Results Students identified teachers as a primary source of support for mental health issues, followed by peers and mental health counselors. Students felt that trust and connection were vital for help-seeking. Barriers to using SBHCs included: embarrassment; fear of judgment; concerns about confidentiality; a sense that they should keep things inside; and lack of awareness. Conclusions Despite the resources available at SBHCs, students face barriers to help-seeking. SBHCs can help teachers and school staff gain awareness of mental health issues and services available to students. The students' recommendations-making SBHCs more comfortable, raising mental health awareness, and bolstering connections with school and SBHC staff-may improve engagement in mental health services at schools with SBHCs.
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Affiliation(s)
- Roya Ijadi-Maghsoodi
- VA Health Service Research & Development Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA; UCLA Division of Population Behavioral Health, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Kacy Bonnet
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA
| | - Sophie Feller
- UCLA Center for Health Services and Society, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Kathleen Nagaran
- UCLA Center for Health Services and Society, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | | | - Sheryl Kataoka
- UCLA Center for Health Services and Society, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
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Paschall MJ, Bersamin M. School-Based Health Centers, Depression, and Suicide Risk Among Adolescents. Am J Prev Med 2018; 54:44-50. [PMID: 29132951 PMCID: PMC5736426 DOI: 10.1016/j.amepre.2017.08.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/21/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION This study examined whether increasing availability of mental health services at school-based health centers in Oregon public schools would be associated with a decrease in the likelihood of depressive episodes and suicide risk among adolescents. METHODS The study included 168 Oregon public schools that participated in the Oregon Healthy Teens Survey in 2013 and 2015. Twenty-five schools had a school-based health center, and 14 of those schools increased the availability of mental health services from 2013 to 2015. The Oregon Healthy Teens Survey included questions about having a depressive episode, suicidal ideation, and attempting suicide in the past year. Multilevel logistic regression analyses were conducted in 2017 to examine associations between increasing mental health services and the likelihood of past year depressive episodes, suicidal ideation, and suicide attempts. Analyses also compared student subgroups defined by demographic characteristics (e.g., gender). RESULTS Students at school-based health center schools that increased availability of mental health services were less likely to report depressive episodes (OR=0.88, p<0.01), suicidal ideation (OR=0.84, p<0.01), and suicide attempts (OR=0.82, p<0.01) from 2013 to 2015 compared with all other schools. Significant risk reductions in past year depressive episodes and suicidal ideation were also observed in school-based health center schools that increased availability of mental health services relative to other schools with school-based health centers. No significant differences were observed for student demographic subgroups. CONCLUSIONS This study suggests that increasing availability of school-based mental health services can help to reduce depressive episodes and suicide risk among adolescents.
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Affiliation(s)
- Mallie J Paschall
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California.
| | - Melina Bersamin
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
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Paschall MJ, Bersamin M. School-based mental health services, suicide risk and substance use among at-risk adolescents in Oregon. Prev Med 2018; 106:209-215. [PMID: 29126919 PMCID: PMC5764796 DOI: 10.1016/j.ypmed.2017.11.004] [Citation(s) in RCA: 8] [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: 06/14/2017] [Revised: 09/16/2017] [Accepted: 11/01/2017] [Indexed: 10/18/2022]
Abstract
This study examined whether an increase in the availability of mental health services at school-based health centers (SBHCs) in Oregon public schools was associated with the likelihood of suicidal ideation, suicide attempts and substance use behaviors among adolescents who experienced a depressive episode in the past year. The study sample included 168 Oregon public middle and high schools and 9073 students who participated in the Oregon Healthy Teens Survey (OHT) in 2013 and 2015. Twenty-five schools had an SBHC, and 14 of those schools increased availability of mental health services from 2013 to 2015. The OHT included questions about having a depressive episode, suicidal ideation, attempting suicide in the past year, and substance use behaviors in the past 30days. Multi-level logistic regression analyses were conducted in 2017 to examine associations between increasing mental health services and the likelihood of these outcomes. Analysis results indicated that students at SBHC schools that increased mental health services were less likely to report any suicidal ideation [odds ratio (OR) (95% C.I.)=0.66 (0.55, 0.81)], suicide attempts [OR (95% C.I.)=0.71 (0.56, 0.89)] and cigarette smoking [OR (95% C.I.)=0.77 (0.63, 0.94)] from 2013 to 2015 compared to students in all other schools. Lower frequencies of cigarette, marijuana and unauthorized prescription drug use were also observed in SBHC schools that increased mental health services relative to other schools with SBHCs. This study suggests that mental health services provided by SBHCs may help reduce suicide risk and substance use behaviors among at-risk adolescents.
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Affiliation(s)
- Mallie J Paschall
- Prevention Research Center, Pacific Institute for Research and Evaluation, 180 Grand Avenue, Suite 1200, Oakland, CA 94612, United States.
| | - Melina Bersamin
- Prevention Research Center, Pacific Institute for Research and Evaluation, 180 Grand Avenue, Suite 1200, Oakland, CA 94612, United States
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Gregg A, Chen LW, Kim J, Tak HJ, Tibbits M. Patient-Centered Medical Home Measurement in School-Based Health Centers. J Sch Nurs 2017; 35:189-202. [PMID: 29237335 DOI: 10.1177/1059840517746728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
School-based health centers (SBHCs) have been suggested as potential medical homes, yet minimal attention has been paid to measuring their patient-centered medical home (PCMH) implementation. The purposes of this article were to (1) develop an index to measure PCMH attributes in SBHCs, (2) use the SBHC PCMH Index to compare PCMH capacity between PCMH certified and non-PCMH SBHCs, and (3) examine differences in index scores between SBHCs based in schools with and without adolescents. A total of six PCMH dimensions in the SBHC PCMH Index were identified through factor analysis. These dimensions were collapsed into two domains: care quality and comprehensive care. SBHCs recognized as PCMHs had higher scores on the index, both domains, and four dimensions. SBHCs based in schools with just young children and those with adolescents scored similarly on the overall index, but analysis of individual index items shows their strengths and weaknesses in PCMH implementation.
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Affiliation(s)
- Abbey Gregg
- 1 Department of Community Medicine and Population Health, Institute for Rural Health Research, University of Alabama, Tuscaloosa, AL, USA
| | - Li-Wu Chen
- 2 Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jungyoon Kim
- 2 Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE, USA
| | - Hyo Jung Tak
- 2 Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE, USA
| | - Melissa Tibbits
- 3 Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, NE, USA
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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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Abstract
BACKGROUND Internationally, nurses have been in the forefront of delivering health care services in the school environment and whilst health care delivery in secondary and high schools is evaluated, this is not the case for services delivered in primary/elementary schools. In countries such as New Zealand there is no significant inter-service collaboration between health and education; therefore, the delivery of health services remains fragmented and underdeveloped. OBJECTIVES This discussion paper reviews the history and development of nurse-led school-based health services internationally and provides an insight into the current provision of primary school-based health services in New Zealand. DESIGN The initial approach to this paper was to gain an understanding of the history of school-based health services internationally and to explore the relationship between health and education in relation to this. This assisted in providing some context and comparison with the current provision of school-based health services in New Zealand. Discussion outcome: Internationally, it is acknowledged that schools provide not only a location to deliver health services to children but also the opportunity to reach entire families and communities yet surprisingly, the development of school-based health services within the primary/elementary school sector has received minimal attention in New Zealand and worldwide. CONCLUSIONS This paper supports the need for further research concerning the feasibility, provision and effectiveness of school-based health services in primary/elementary schools. In order to be effective, this should incorporate the shared needs and values of all stakeholders. The authors argue the need to develop an inter-service, collaborative, national framework for the delivery of school nursing services within the primary school sector in New Zealand. Impact statement: A collaborative framework for health service delivery into primary schools can enable early establishment of supportive health relationships with families.
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Affiliation(s)
- Sarah Williams
- a Starship Children's Health , Auckland District Health Board , Auckland , New Zealand
| | - Annette Dickinson
- b School of Clinical Sciences/Faculty of Health and Environmental Sciences , Auckland University of Technology , South Campus (M2), Private Bag 92006, Auckland 1142 , New Zealand
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Graham RA, Osofsky JD, Osofsky HJ, Hansel TC. School based post disaster mental health services: decreased trauma symptoms in youth with multiple traumas. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/1754730x.2017.1311798] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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15
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The Prevalence of Postgraduate Education in Youth Health Among High School Clinicians and Associated Student Health Outcomes. J Adolesc Health 2016; 59:555-561. [PMID: 27640327 DOI: 10.1016/j.jadohealth.2016.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/06/2016] [Accepted: 07/07/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Despite numerous calls to improve training in adolescent health, there is little known about the prevalence or effectiveness of specialized training in adolescent health. METHODS A two-stage random sampling cluster design was used to collect nationally representative data from 8,500 students from 91 high schools. Student data were linked to data from a survey of school health clinicians from participating schools on their level of training in youth health. Multilevel models accounting for demographic characteristics of students were used to estimate the association between nurses and physicians training in youth health and health outcomes among students. RESULTS Almost all nurses and physicians reported some training in youth health, either having attended lectures or study days in youth health (n = 60, 80%) or completed postgraduate papers in youth health (n = 13, 17.3%). Students in schools where the nurses and physicians had received postgraduate training in youth health were less likely than students from schools with clinicians having attended lectures or study days in youth health to report emotional and behavior difficulties (11.8 vs. 12.7, p = .002) and binge drinking (19.6% vs. 24.9%, p = .03). There were no significant associations between depressive symptoms, suicide risk, cigarette, marijuana, contraception use, or motor vehicle risk behaviors among students and level of training among clinicians in their schools' health service. CONCLUSIONS Postgraduate training in youth health among nurses and physicians in school health services is associated with fewer students reporting mental health difficulties and binge alcohol use. These findings support specialized training in youth health for clinicians working predominantly with young people.
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16
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Knopf JA, Finnie RKC, Peng Y, Hahn RA, Truman BI, Vernon-Smiley M, Johnson VC, Johnson RL, Fielding JE, Muntaner C, Hunt PC, Phyllis Jones C, Fullilove MT. School-Based Health Centers to Advance Health Equity: A Community Guide Systematic Review. Am J Prev Med 2016; 51:114-26. [PMID: 27320215 PMCID: PMC5759331 DOI: 10.1016/j.amepre.2016.01.009] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/04/2016] [Accepted: 01/19/2016] [Indexed: 11/23/2022]
Abstract
CONTEXT Children from low-income and racial or ethnic minority populations in the U.S. are less likely to have a conventional source of medical care and more likely to develop chronic health problems than are more-affluent and non-Hispanic white children. They are more often chronically stressed, tired, and hungry, and more likely to have impaired vision and hearing-obstacles to lifetime educational achievement and predictors of adult morbidity and premature mortality. If school-based health centers (SBHCs) can overcome educational obstacles and increase receipt of needed medical services in disadvantaged populations, they can advance health equity. EVIDENCE ACQUISITION A systematic literature search was conducted for papers published through July 2014. Using Community Guide systematic review methods, reviewers identified, abstracted, and summarized available evidence of the effectiveness of SBHCs on educational and health-related outcomes. Analyses were conducted in 2014-2015. EVIDENCE SYNTHESIS Most of the 46 studies included in the review evaluated onsite clinics serving urban, low-income, and racial or ethnic minority high school students. The presence and use of SBHCs were associated with improved educational (i.e., grade point average, grade promotion, suspension, and non-completion rates) and health-related outcomes (i.e., vaccination and other preventive services, asthma morbidity, emergency department use and hospital admissions, contraceptive use among females, prenatal care, birth weight, illegal substance use, and alcohol consumption). More services and more hours of availability were associated with greater reductions in emergency department overuse. CONCLUSIONS Because SBHCs improve educational and health-related outcomes in disadvantaged students, they can be effective in advancing health equity.
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Affiliation(s)
- John A Knopf
- Community Guide Branch, Division of Public Health Information Dissemination, CDC, Atlanta, Georgia
| | - Ramona K C Finnie
- Community Guide Branch, Division of Public Health Information Dissemination, CDC, Atlanta, Georgia
| | - Yinan Peng
- Community Guide Branch, Division of Public Health Information Dissemination, CDC, Atlanta, Georgia
| | - Robert A Hahn
- Community Guide Branch, Division of Public Health Information Dissemination, CDC, Atlanta, Georgia.
| | - Benedict I Truman
- Office of the Associate Director for Science, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), CDC, Atlanta, Georgia
| | | | - Veda C Johnson
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia
| | | | | | - Carles Muntaner
- University of Toronto, Bloomberg Faculty of Nursing, Toronto, Ontario, Canada
| | | | - Camara Phyllis Jones
- Satcher Health Leadership Institute at the Morehouse School of Medicine, Atlanta, Georgia
| | - Mindy T Fullilove
- Columbia University Mailman School of Public Health, New York, New York
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17
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LeCloux M, Maramaldi P, Thomas K, Wharff E. Health Care Resources and Mental Health Service Use Among Suicidal Adolescents. J Behav Health Serv Res 2016; 44:195-212. [PMID: 27146895 DOI: 10.1007/s11414-016-9509-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Developing policies and interventions that increase rates of mental health service use for suicidal adolescents is crucial for suicide prevention. Data from a sample of suicidal youth (n = 1356) from the National Longitudinal Study of Adolescent Health (Add Health) were analyzed to examine whether type of insurance, receipt of routine medical care, and access to school-based mental health treatment predicted mental health service use cross-sectionally and longitudinally. Rates of mental health service use were low in cross-sectional analyses at all three waves (∼11%-30%), despite the fact that respondents were at high risk for suicide attempts and depression. With demographic factors and symptom severity controlled, only receipt of a routine physical predicted an increased likelihood of mental health service use at wave I and in longitudinal analyses. Implications discussed include the utility of universal suicide screenings and integrated behavioral health care as potential intervention strategies for this population.
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Affiliation(s)
- Mary LeCloux
- School of Social Work, West Virginia University, Morgantown, WV, USA.
| | - Peter Maramaldi
- School of Social Work, Simmons College, Boston, MA, USA.,Harvard School of Dental Medicine, Harvard University, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Kristie Thomas
- School of Social Work, Simmons College, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Elizabeth Wharff
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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18
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Runton NG, Hudak RP. The Influence of School-Based Health Centers on Adolescents' Youth Risk Behaviors. J Pediatr Health Care 2016; 30:e1-9. [PMID: 26298683 DOI: 10.1016/j.pedhc.2015.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 07/03/2015] [Accepted: 07/10/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Youth risk behaviors that are developed during adolescence are likely to continue into adulthood, increasing chances of morbidity, mortality, and chronic health conditions. The Centers for Disease Control and Prevention identified six critical risk behaviors (unintentional injuries and violence, sexual behaviors leading to pregnancies and infections, alcohol and other drug use, tobacco use, poor dietary habits, and insufficient physical activities) and developed the Youth Risk Behavior Survey to monitor them. The purpose of this quantitative study was to investigate which health risk behaviors were affected by a new school-based health center (SBHC), using two urban school systems in the Mid-Atlantic region. METHOD The Youth Risk Behavior Survey was administered at two schools in 2007 and 2011. Logistic regression was used to predict whether the dependent variables had changed based on the new SBHC. RESULTS Overall, the new SBHC did not have a significant effect on the student's risk behaviors. DISCUSSION Schools remain a critical part of adolescents' development, and access to SBHCs offers a safety net to students whose families may not have health insurance.
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19
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Bersamin M, Garbers S, Gold MA, Heitel J, Martin K, Fisher DA, Santelli J. Measuring Success: Evaluation Designs and Approaches to Assessing the Impact of School-Based Health Centers. J Adolesc Health 2016; 58:3-10. [PMID: 26707224 PMCID: PMC4693147 DOI: 10.1016/j.jadohealth.2015.09.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 10/22/2022]
Abstract
Since the founding of the first school-based health centers (SBHCs) >45 years ago, researchers have attempted to measure their impact on child and adolescent physical and mental health and academic outcomes. A review of the literature finds that SBHC evaluation studies have been diverse, encompassing different outcomes and varying target populations, study periods, methodological designs, and scales. A complex picture emerges of the impact of SBHCs on health outcomes, which may be a function of the specific health outcomes examined, the health needs of specific communities and schools, the characteristics of the individuals assessed, and/or the specific constellation of SBHC services. SBHC evaluations face numerous challenges that affect the interpretation of evaluation findings, including maturation, self-selection, low statistical power, and displacement effects. Using novel approaches such as implementing a multipronged approach to maximize participation, entering-class proxy-baseline design, propensity score methods, data set linkage, and multisite collaboration may mitigate documented challenges in SBHC evaluation.
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Affiliation(s)
- Melina Bersamin
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California.
| | - Samantha Garbers
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Melanie A Gold
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York; Department of Pediatrics, Columbia University Medical Center, New York, New York; School Based Health Centers, New York-Presbyterian Hospital, New York, New York
| | - Jennifer Heitel
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Kathryn Martin
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Deborah A Fisher
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - John Santelli
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York
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20
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Bains RM, Diallo AF. Mental Health Services in School-Based Health Centers: Systematic Review. J Sch Nurs 2015; 32:8-19. [PMID: 26141707 DOI: 10.1177/1059840515590607] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Mental health issues affect 20-25% of children and adolescents, of which few receive services. School-based health centers (SBHCs) provide access to mental health services to children and adolescents within their schools. A systematic review of literature was undertaken to review evidence on the effectiveness of delivery of mental health services in SBHCs. Databases were searched extensively for research studies published between January 1990 and March 2014. Data analysis was based on the method proposed by the Centre for Reviews and Dissemination. Twenty-three studies were selected for review. Each study was explored for accessibility and content of mental health services in SBHCs. SBHCs provide access and eliminate barriers to mental health services. Students who exhibited high-risk behaviors were more likely to have sought services at the SBHC. However, there is a lack of high-quality research evaluating mental health services in the SBHCs and their effect on children and adolescents.
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21
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Lewis C, Deardorff J, Lahiff M, Soleimanpour S, Sakashita K, Brindis CD. High school students' experiences of bullying and victimization and the association with school health center use. THE JOURNAL OF SCHOOL HEALTH 2015; 85:318-326. [PMID: 25846311 DOI: 10.1111/josh.12256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/06/2014] [Accepted: 12/26/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Bullying and victimization are ongoing concerns in schools. School health centers (SHCs) are well situated to support affected students because they provide crisis intervention, mental health care, and broader interventions to improve school climate. This study examined the association between urban adolescents' experiences of school-based bullying and victimization and their use of SHCs. METHODS Data was analyzed from 2063 high school students in 5 Northern California school districts using the 2009-2010 California Healthy Kids Survey. Chi-square tests and multivariate logistic regression were used to measure associations. RESULTS Students who were bullied or victimized at school had significantly higher odds of using the SHCs compared with students who were not, and were also significantly more likely to report confidentiality concerns. The magnitude of associations was largest for Asian/Pacific Islander students, though this was likely due to greater statistical power. African American students reported victimization experiences at approximately the same rate as their peers, but were significantly less likely to indicate they experienced bullying. CONCLUSIONS Findings suggest that SHCs may be an important place to address bullying and victimization at school, but confidentiality concerns are barriers that may be more common among bullied and victimized youth.
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Affiliation(s)
- Catherine Lewis
- School of Social Welfare, University of California, 50 University Hall, #7360 Berkeley, CA 94720-7360.
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22
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Parasuraman SR, Shi L. Differences in Access to Care Among Students Using School-Based Health Centers. J Sch Nurs 2014; 31:291-9. [PMID: 25377930 DOI: 10.1177/1059840514556180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Health care reform has changed the landscape for the nation's health safety net, and school-based health centers (SBHCs) remain an important part of this system. However, few large-scale studies have been conducted to assess their impact on access to care. This study investigated differences in access among a nationally representative sample of adolescent SBHC users. An analysis using multivariate logistic regression examined the association between student characteristics and access to care. We found no differences based on race/ethnicity or insurance status among adolescent SBHC users; however, we did observe significant differences with regard to unmet health needs. School nurses serve as invaluable frontline staff who can facilitate equitable access to care, provide high-quality primary care, coordinate care for students with community health services, and advocate for policy and funding support of SBHCs as a critical part of the safety net for underserved adolescents.
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Affiliation(s)
- Sarika Rane Parasuraman
- Division of General Pediatrics & Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leiyu Shi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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23
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Bains RM, Franzen CW, White-Frese’ J. Engaging African American and Latino Adolescent Males Through School-Based Health Centers. J Sch Nurs 2014; 30:411-9. [DOI: 10.1177/1059840514521241] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
African American and Latino males are less likely to seek mental health services and obtain adequate care than their White counterparts. They are more likely to receive mental health services in school-based health centers (SBHCs) than in other community-based setting. The purpose of this article was to understand the issues and reasons these adolescents sought mental health services at SBHCs and what their perceptions of the services were. A content analysis of 22 individual interviews was conducted using Krippendorff’s method. Five themes emerged from the analysis of the data: the burdens and hurdles of my life, the door is always open, sanctuary within chaos, they get to us, and achieve my best potential. Each of the themes was explored in detail with rich quotations from the adolescents. The findings illuminated the daily struggles these adolescents faced and the impact mental health services in SBHCs had on their daily lives.
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Affiliation(s)
- Ranbir Mangat Bains
- University of Connecticut, Storrs, CT, USA
- Barnard Environmental Magnet School Based Health Center, New Haven, CT, USA
| | - Carolyn W. Franzen
- Marriage and Family Therapy Program, University of Connecticut, Storrs, CT, USA
- Windham School Based Health Center, Windham, CT, USA
| | - Jesse White-Frese’
- Connecticut Association of School Based Health Centers, North Haven, CT, USA
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24
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Larson SA, Chapman SA. Patient-centered medical home model: do school-based health centers fit the model? Policy Polit Nurs Pract 2013; 14:163-174. [PMID: 24658646 DOI: 10.1177/1527154414528246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
School-based health centers (SBHCs) are an important component of health care reform. The SBHC model of care offers accessible, continuous, comprehensive, family-centered, coordinated, and compassionate care to infants, children, and adolescents. These same elements comprise the patient-centered medical home (PCMH) model of care being promoted by the Affordable Care Act with the hope of lowering health care costs by rewarding clinicians for primary care services. PCMH survey tools have been developed to help payers determine whether a clinician/site serves as a PCMH. Our concern is that current survey tools will be unable to capture how a SBHC may provide a medical home and therefore be denied needed funding. This article describes how SBHCs might meet the requirements of one PCMH tool. SBHC stakeholders need to advocate for the creation or modification of existing survey tools that allow the unique characteristics of SBHCs to qualify as PCMHs.
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25
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Mason-Jones AJ, Crisp C, Momberg M, Koech J, De Koker P, Mathews C. A systematic review of the role of school-based healthcare in adolescent sexual, reproductive, and mental health. Syst Rev 2012; 1:49. [PMID: 23098138 PMCID: PMC3621403 DOI: 10.1186/2046-4053-1-49] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 10/09/2012] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Accessible sexual, reproductive, and mental healthcare services are crucial for adolescent health and wellbeing. It has been reported that school-based healthcare (SBHC) has the potential to improve the availability of services particularly for young people who are normally underserved. Locating health services in schools has the potential to reduce transport costs, increase accessibility and provide links between schools and communities. METHODS A systematic review of the literature was undertaken. Pubmed, Psychinfo, Psychnet, Cochrane CENTRAL, and Web of Science were searched for English language papers published between January 1990 and March 2012 RESULTS Twenty-seven studies were found which fitted the criteria, of which, all but one were from North America. Only three measured adolescent sexual, reproductive, or mental health outcomes related to SBHC and none of the studies were randomized controlled trials. The remaining studies explored accessibility of services and clinic utilization or described pertinent contextual factors. CONCLUSIONS There is a paucity of high quality research which evaluates SBHC and its effects on adolescent sexual, reproductive, and mental health. However, there is evidence that SBHC is popular with young people, and provides important mental and reproductive health services. Services also appear to have cost benefits in terms of adolescent health and society as a whole by reducing health disparities and attendance at secondary care facilities. However, clearer definitions of what constitutes SBHC and more high quality research is urgently needed.
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Affiliation(s)
- Amanda J Mason-Jones
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
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26
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Sterling S, Valkanoff T, Hinman A, Weisner C. Integrating substance use treatment into adolescent health care. Curr Psychiatry Rep 2012; 14:453-61. [PMID: 22872492 PMCID: PMC3638945 DOI: 10.1007/s11920-012-0304-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Substance use (SU) problems are common among adolescents, a serious health risk for them and a major public health problem, but are inadequately addressed in most pediatric health care settings. Primary care offers an excellent context for SU assessment and treatment for adolescents and their families, offering better access and a less stigmatized environment for receiving treatment than specialty programs. This paper examines the literature on the integration of substance use treatment with adolescent health care, focusing on 2 areas: Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Emergency Departments and Primary Care, and School- and College-Based Health Centers.
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Affiliation(s)
- Stacy Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612-2403, USA.
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27
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Keeton V, Soleimanpour S, Brindis CD. School-based health centers in an era of health care reform: building on history. Curr Probl Pediatr Adolesc Health Care 2012; 42:132-56; discussion 157-8. [PMID: 22677513 PMCID: PMC3770486 DOI: 10.1016/j.cppeds.2012.03.002] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
School-based health centers (SBHCs) provide a variety of health care services to youth in a convenient and accessible environment. Over the past 40 years, the growth of SBHCs evolved from various public health needs to the development of a specific collaborative model of care that is sensitive to the unique needs of children and youth, as well as to vulnerable populations facing significant barriers to access. The SBHC model of health care comprises of on-school site health care delivery by an interdisciplinary team of health professionals, which can include primary care and mental health clinicians. Research has demonstrated the SBHCs' impacts on delivering preventive care, such as immunizations; managing chronic illnesses, such as asthma, obesity, and mental health conditions; providing reproductive health services for adolescents; and even improving youths' academic performance. Although evaluation of the SBHC model of care has been complicated, results have thus far demonstrated increased access to care, improved health and education outcomes, and high levels of satisfaction. Despite their proven success, SBHCs have consistently faced challenges in securing adequate funding for operations and developing effective financial systems for billing and reimbursement. Implementation of health care reform (The Patient Protection and Affordable Care Act [P.L. 111-148]) will profoundly affect the health care access and outcomes of children and youth, particularly vulnerable populations. The inclusion of funding for SBHCs in this legislation is momentous, as there continues to be increased demand and limited funding for affordable services. To better understand how this model of care has and could further help promote the health of our nation's youth, a review is presented of the history and growth of SBHCs and the literature demonstrating their impacts. It may not be feasible for SBHCs to be established in every school campus in the country. However, the lessons learned from the synergy of the health and school settings have major implications for the delivery of care for all providers concerned with improving the health and well-being of children and adolescents.
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Affiliation(s)
- Victoria Keeton
- Department of Family Health Care Nursing, University of California, San Francisco, California, USA
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Hansel TC, Osofsky HJ, Osofsky JD, Costa RN, Kronenberg ME, Selby ML. Attention to process and clinical outcomes of implementing a rural school-based trauma treatment program. J Trauma Stress 2010; 23:708-15. [PMID: 21171131 DOI: 10.1002/jts.20595] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The Louisiana Rural Trauma Services Center was established to provide, improve, and enhance urgently needed assessment, treatment, crisis management, and consultation services for children and adolescents exposed to traumatic events in three rural southeastern Louisiana parishes. The purpose of this study is to describe the process of implementing the rural school-based trauma treatment program and to evaluate its effectiveness in 115 students. Through attention to process including the three-tiered approach of relationship building, trauma training, and trauma services, the school-based trauma treatment program proved effective in reducing trauma symptoms. This study is important to support the widespread implementation of school-based mental health services.
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Affiliation(s)
- Tonya Cross Hansel
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
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29
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Wade TJ, Guo JJ. Linking improvements in health-related quality of life to reductions in Medicaid costs among students who use school-based health centers. Am J Public Health 2010; 100:1611-6. [PMID: 20634449 DOI: 10.2105/ajph.2009.185355] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether improvements in pediatric health-related quality of life (HRQOL) stemming from use of school-based health centers (SBHCs) resulted in lower Medicaid costs. METHODS We analyzed data on 290 students from a 3-year, longitudinal SBHC evaluation conducted in Cincinnati, Ohio, in 2000 to 2003, including 71 with a mental health diagnosis and 31 with asthma, who had linked Ohio Medicaid records. HRQOL was measured using the Pediatric Quality of Life Inventory. Panel regression examined whether changes in parent-reported and student self-reported HRQOL predicted changes in Medicaid costs. RESULTS After adjustment for gender, age, SBHC status, and Medicaid type, we found cost reductions for every 1-point increase of parent-reported total ($36.39; P<.01), physical ($35.36; P<.05), and psychosocial ($25.94; P<.01) HRQOL. Significant cost reductions were also associated with student-reported total ($8.94; P<.05) and psychosocial ($7.79; P<.05) HRQOL increases. These effects were significant among the asthma subgroup but not the mental health subgroup. Physical HRQOL ($6.12; P=.27) effects were not significant. CONCLUSIONS Improvements in pediatric HRQOL translate into lower Medicaid costs, supporting the use of HRQOL as an outcome for evaluating SBHCs.
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Affiliation(s)
- Terrance J Wade
- Department of Community Health Sciences, Brock University, 500 Glenridge Ave, St Catharines, Ontario, Canada, L2S 3A1.
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30
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Guo JJ, Wade TJ, Pan W, Keller KN. School-based health centers: cost-benefit analysis and impact on health care disparities. Am J Public Health 2010; 100:1617-23. [PMID: 20634450 DOI: 10.2105/ajph.2009.185181] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the impact of school-based health centers-which provide essential health care for students by aiming to eliminate many access barriers-on health care access disparities and conducted a cost-benefit analysis. METHODS We employed a longitudinal quasi-experimental repeated-measures design. Primary data sources included the Ohio Medicaid claims, enrollment file with race/ethnicity, and survey reports from parents. We used hierarchical linear modeling to control unbalanced data because of student attrition. We assessed quarterly total Medicaid reimbursement costs for 5056 students in the SBHC and non-SBHC groups from 1997 to 2003. We calculated net social benefit to compare the cost of the SBHC programs with the value that SBHCs might save or create. RESULTS With SBHCs, the gap of lower health care cost for African Americans was closed. The net social benefits of the SBHC program in 4 school districts were estimated as $1,352,087 over 3 years. We estimated that the SBHCs could have saved Medicaid about $35 per student per year. CONCLUSIONS SBHCs are cost beneficial to both the Medicaid system and society, and may close health care disparity gaps.
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Affiliation(s)
- Jeff J Guo
- University of Cincinnati Medical Center College of Pharmacy, 3225 Eden Ave, Cincinnati, OH 45267-0004, USA.
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32
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Wade TJ, Mansour ME, Guo JJ, Huentelman T, Line K, Keller KN. Access and utilization patterns of school-based health centers at urban and rural elementary and middle schools. Public Health Rep 2009; 123:739-50. [PMID: 19711655 DOI: 10.1177/003335490812300610] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We examined patterns of enrollment, use, and frequency of use in school-based health centers (SBHCs), as well as the referral, diagnosis, and disposition of SBHC visits among newly implemented SBHCs. METHODS Four rural and four urban school districts implementing SBHCs were examined from 2000 to 2003. Total school enrollment for students was 13,046. SBHC enrollment and medical encounter data were tracked using a Web-based medical database. Descriptive analyses were conducted to evaluate primary care access and utilization patterns. RESULTS A total of 7,460 (57.2%) students were enrolled in their SBHCs, of which 4,426 used the SBHC at least once for a total of 14,050 visits. SBHC enrollment was greater in urban districts but rate of utilization was higher in rural districts. Black students, students with public or no health insurance, and students with asthma or attention deficit disorder had higher enrollment and utilization. Rural parents referred more children to SBHCs than urban parents. Teachers referred more students who were black, had asthma, had no public or health insurance, or had acute-type health issues. Total visits increased during the three years, with the largest increase in mental health services. Students who were younger, white, attended rural schools, had public or health insurance, or had infections were more likely to be sent home. Those with chronic conditions and visits for mental health were more likely to be returned to class. CONCLUSION Utilization patterns suggest improved access to needed health care for disadvantaged children. SBHCs are an important part of the safety net for the populations they are intended to serve.
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Affiliation(s)
- Terrance J Wade
- Department of Community Health Sciences, Brock University, St. Catharines, ON, Canada.
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