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Burman C, Mendoza Diaz A, Leslie A, Goldthorp K, Jubb B, Simms AR, Eapen V. Critical success factors for school-based integrated health care models: Learnings from an Australian example. Health Promot J Austr 2023; 34:775-783. [PMID: 36538268 DOI: 10.1002/hpja.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/05/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
ISSUES ADDRESSED Integrated school-based health services have the potential to address the unmet health needs of children experiencing disadvantage, yet these models remain poorly evaluated. The current article examines an integrated social and health care hub located on the grounds of a regional Australian public primary school, the Our Mia Mia Wellbeing Hub, to identify critical success factors for this service and others like it. METHODS Semi-structured qualitative interviews were conducted with N = 55 multi-sector stakeholders comprising parents, students, school staff, social and health care providers, and local Aboriginal community members. Interview transcripts were analysed according to a grounded theory approach. RESULTS Six themes emerged from the analysis, reflecting important success factors for the model: service accessibility; service coordination; integration of education and health systems; trust; community partnerships; and perceptions of health. CONCLUSIONS Findings highlighted Our Mia Mia as a promising model of care, yet also revealed important challenges for the service as it responds to the varied priorities of the stakeholders it serves. SO WHAT?: Through capturing the perspectives of a large number of stakeholders, the current study provides valuable insight into key challenges and success factors for Our Mia Mia; these learnings can guide the development of other emerging school-based health services and integrated care hubs.
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Affiliation(s)
- Charlotte Burman
- BestSTART-SWS, Ingham Institute of Applied Medical Research, Nowra, NSW, Australia
| | - Antonio Mendoza Diaz
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
- Academic Unit of Child Psychiatry, Infant, Child and Adolescent Mental Health Service, NSW, Australia
| | - Andrew Leslie
- Nowra East Public School, Nowra, NSW, Australia
- Our Mia Mia Wellbeing Hub, Nowra, NSW, Australia
| | | | - Brendan Jubb
- Our Mia Mia Wellbeing Hub, Nowra, NSW, Australia
| | | | - Valsamma Eapen
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
- Academic Unit of Child Psychiatry, Infant, Child and Adolescent Mental Health Service, NSW, Australia
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Boudreaux M, Chu J, Lipton BJ. School-Based Health Centers, Access to Care, and Income-Based Disparities. JAMA Netw Open 2023; 6:e2334532. [PMID: 37721750 PMCID: PMC10507491 DOI: 10.1001/jamanetworkopen.2023.34532] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/13/2023] [Indexed: 09/19/2023] Open
Abstract
Importance School-based health centers (SBHCs) are primary care clinics colocated at schools. SBHCs have the potential to improve health care access and reduce disparities, but there is limited rigorous evidence on their effectiveness at the national level. Objective To determine whether county-level adoption of SBHCs was associated with access, utilization, and health among children from low-income families and to measure reductions in income-based disparities. Design, Setting, and Participants This survey study used a difference-in-differences design and data from a nationally representative sample of children in the US merged with SBHC indicators from the National Census of School-Based Health Centers. The main sample included children aged 5 to 17 years with family incomes that were less than 200% of the federal poverty level observed in the National Health Interview Survey, collected between 1997 to 2018. The sample was restricted to children living in a county that adopted a center between 2003 and 2013 or that did not have a center at any time during the study period. Analyses of income-based disparities included children from higher income families (ie, 200% or higher than the federal poverty level). Data were analyzed between January 2020 and July 2023. Exposure County-by-year SBHC adoption. Main Outcomes and Measures Outcomes included access (usual source of care, insurance status, barriers), ambulatory care use (general physician, eye doctor, dental, mental health visits), and health (general health status, missed school days due to illness). P values were adjusted for multiple comparisons using the sharpened q value method. Results This study included 12 624 unweighted children from low-income families and 24 631 unweighted children from higher income families. The weighted percentage of children in low-income families who resided in counties with SBHC adoption included 50.0% aged 5 to 10 years. The weighted percentages of the race and ethnicity of these children included 36.7% Hispanic children, 25.2% non-Hispanic Black children, and 30.6% non-Hispanic White children. The weighted percentages of children in the counties that never adopted SBHCs included 50.1% aged 5 to 10 years. The weighted percentages of the race and ethnicity of these children included 20.7% Hispanic children, 22.4% non-Hispanic Black children, and 52.9% non-Hispanic White children. SBHC adoption was associated with a 6.4 percentage point increase in dental visits (95% CI, 3.2-9.6 percentage points; P < .001), an 8.0 percentage point increase in having a usual source of care (95% CI, 4.5-11.5 percentage points; P < .001), and a 5.2 percentage point increase in insurance (95% CI, 1.2-9.2 percentage points; P = .03). No other statistically significant associations were found with other outcomes. SBHCs were associated with relative reductions in income-based disparities to dental visits by 76% (4.9 percentage points; 95% CI, 2.0-7.7 percentage points), to insured status by 63% (3.5 percentage points; 95% CI, 1.3-5.7 percentage points), and to having a usual source of care by 98% (7.2 percentage points; 95% CI, 5.4-9.1 percentage points). Conclusions and Relevance In this survey study with difference-in-differences analysis of SBHC adoption, SBHCs were associated with access to care and reduced income-based disparities. These findings support additional SBHC expansion.
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Affiliation(s)
- Michel Boudreaux
- Department of Health Policy and Management, University of Maryland, College Park
| | - Jun Chu
- Department of Sociology, Anthropology, and Public Health, University of Maryland, Baltimore County, Baltimore
| | - Brandy J. Lipton
- Department of Health, Society, and Behavior, University of California, Irvine
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Mendoza AM, Drescher MJ, Eberman LE. The Integration of Patient-Centered Care and the Biopsychosocial Model by Athletic Trainers in the Secondary School Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085480. [PMID: 37107762 PMCID: PMC10138988 DOI: 10.3390/ijerph20085480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 05/11/2023]
Abstract
Our purpose was to explore the degree to which secondary school athletic trainers (SSATs) perceive they are integrating the principles of patient-centered care (PCC) and the biopsychosocial (BPS) model in their practice. We used a cross-sectional design to explore the primary research question. We used the Global Perceptions of Athletic Trainer Patient-Centered Care (GPATPCC) tool and the Biopsychosocial Model of Health (BPSMH) tool, both measured on a 4-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree, with an unscored "unsure" option). We sent the survey to 5665 SSATs through the National Athletic Trainers' Association. Results indicate participants expressed strong agreement (mode = 4) with 7 of the 14 statements and agreement (mode = 3) with the remaining 7 statements of the GPATPCC tool (grand mean = 3.4 ± 0.8). Overall, participants rated their level of agreement on the BPSMH as agreeing (mode = 3) for each item (grand mean = 3.0 ± 1.0). SSATs perceive they are integrating the principles of PCC and the BPS model in clinical practice. These findings align with two previous studies concluding that patients, parents, and providers believe athletic trainers provide care that is focused on whole-person healthcare.
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Giorgi EM, Drescher MJ, Winkelmann ZK, Eberman LE. Validation of a Script to Facilitate Social Determinant of Health Conversations with Adolescent Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192214810. [PMID: 36429530 PMCID: PMC9690555 DOI: 10.3390/ijerph192214810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 05/13/2023]
Abstract
Current social determinants of health (SDOH) tools exist to assess patient exposure; however, healthcare providers for the adolescent population are unsure of how to integrate SDOH knowledge into clinical practice. The purpose of this study was to validate a focused history script designed to facilitate SDOH conversations between clinicians and adolescents through the use of the Delphi method. Six individuals (1 clinician, 5 educators/researchers) participated as expert panelists. Panelists provided critical feedback on the script for rounds 1 and 2. For rounds 3-7, panelists received an electronic questionnaire asking them to indicate agreement on a 6-point Likert scale (1 = strongly disagree, 6 = strongly agree). We defined consensus as mean item agreement ≥ 5.0 and percent agreement ≥ 80%. In round 7, panelists rated overall script level of agreement. After seven rounds of feedback, the focused history script achieved content validity with 100% of panelists agreeing on the final 40-item script. A focused history script for the SDOH was content validated to aid conversations between healthcare providers and adolescent patients on factors that affect their life, school, and play. Addressing social determinants of health with adolescent patients will improve cultural proficiency and family-centered care delivered by school healthcare professionals.
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Affiliation(s)
- Emily M. Giorgi
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN 47803, USA
- Correspondence: ; Tel.: +1-916-822-1338
| | - Matthew J. Drescher
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN 47803, USA
| | - Zachary K. Winkelmann
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - Lindsey E. Eberman
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN 47803, USA
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Cinar E, Anaby D, Dostie R, Camden C. Perspectives of International Experts on Collaborative Tiered School-Based Physiotherapy Service Delivery. Phys Occup Ther Pediatr 2022; 42:595-614. [PMID: 35535646 DOI: 10.1080/01942638.2022.2073799] [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: 10/18/2022]
Abstract
AIMS The purpose of this Phase II study is to identify the perceived strengths and weaknesses of a collaborative tiered school-based physiotherapy (PT) service delivery model, considering its core attributes and tiered interventions identified in the first phase of the study (Phase I), and explore the potential facilitators and barriers to implementing the model internationally. METHODS Three focus group discussions were conducted with international experts (n = 16) Discussions focused on the core attributes and tiered interventions of the model in Phase I. Data were analyzed using a framework approach and SWOT (strengths, weaknesses, opportunities, and threats) analysis. RESULTS Themes surrounding the perceived characteristics of the model included comprehensiveness, guiding document, collaborative approach, and inclusiveness. Additional themes were related to the implementation that included governance, professional roles, workload, implementation in different countries, advocacy, and available opportunities. A framework table was tabulated to present the strengths and weaknesses of the service delivery model and available opportunities, and potential barriers to implementation. CONCLUSIONS This study revealed international perspectives regarding a proposed collaborative tiered school-based PT service delivery model and presented a framework to guide clinicians, researchers, and policymakers for the implementation of tiered approaches.Relationships between health and education have been more pronounced in recent years, and interactions between healthcare and the education system have evolved (Zajacova & Lawrence, 2018). Recent recommendations of the World Health Organization (WHO) and UNESCO suggest that "every school should be a health-promoting school", and provided intervention guidelines for the global standards for health-promoting schools (WHO., 2021a). In the meantime, education sectors in different countries have shifted inclusive education policy, with a focus not only on students with disabilities, but all students (Whitley & Hollweck, 2020). In conjunction with the changes in both education and school health services (WHO., 2021b), researchers in the field of speech-language therapy (SLT), occupational therapy (OT) (Camden et al., 2021), and physiotherapy (PT) (Cinar et al., 2021), have been exploring tiered approaches to delivering services in schools, and searching for collaborative strategies to encourage interaction between stakeholders in health and education sectors.
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Affiliation(s)
- Eda Cinar
- Research Centre of the Sherbrooke, University Hospital Centre, Sherbrooke, Quebec, Canada
| | - Dana Anaby
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
| | - Rosalie Dostie
- Sherbrooke University and Research Centre of the Sherbrooke University Hospital Centre, Quebec, Canada
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- The Members of PRISE (Physiotherapists-inteRnatIonal School-basEd) PT Network
| | - Chantal Camden
- School of Rehabilitation, Sherbrooke University and Research Centre, Sherbrooke University Hospital Centre, Sherbrooke, Quebec, Canada
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Ferenchak KS, Trieu SL, Franco R, Jackson NJ, Dudovitz R. Beyond Co-Location: Development of a School Health Integration Measure. THE JOURNAL OF SCHOOL HEALTH 2021; 91:970-980. [PMID: 34636051 DOI: 10.1111/josh.13088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND School-based health centers (SBHCs) can integrate health and educational services to achieve common goals of student wellness and success. As no method exists to quantify the degree of integration for clinics and partner schools, this study aimed to design such a measure. METHODS Measure items were drafted from the literature. Eleven school health experts from Los Angeles, CA, used a modified Delphi method to reach consensus around items for inclusion in a School Health Integration Measure (SHIM), evaluating each on its appropriateness, substantivity, and feasibility. Twenty-eight staff at 17 SBHC campuses pilot tested the SHIM to examine its psychometric properties. RESULTS From 36 items, the expert panel utilized 4 rounds to reach consensus on 12 items across 5 domains: health authority, integrated programming, marketing and recruitment, shared outcomes, and staff collaboration. In the SHIM pilot, scores ranged from 2.25 to 5 (possible 1-5, mean 3.53). The measure had high internal consistency (alpha = 0.9385) and was associated with participants' general assessment of integration at their sites (p = .001). CONCLUSIONS The SHIM provides a new tool to quantify health and educational service integration at SBHC sites, drive practice improvement, and test whether integration leads to better student outcomes.
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Affiliation(s)
- Kenny S Ferenchak
- Resident Physician, , Department of Pediatrics, University of Washington, Seattle Children's, 4800 Sand Point Way, NE, OC.7.830, PO Box 5371, Seattle, WA 98105; former Medical Student, UCLA David Geffen School of Medicine, UCLA David Geffen School of Medicine, 10833 Le Conte Avenue, Los Angeles, CA 90095
| | - Sang Leng Trieu
- Program Director, , The Los Angeles Trust for Children's Health, 333 S. Beaudry Avenue, 29th Floor, Los Angeles, CA 90017
| | - Rosina Franco
- Senior Physician, , Student Medical Services, Student Health and Human Services, Los Angeles Unified School District, 121 N. Beaudry Avenue, Roybal Annex, Los Angeles, CA 90012
| | - Nicholas J Jackson
- Assistant Professor, , UCLA Division of General Internal Medicine and Health Services Research, 1100 Glendon Avenue, Suite 1820, Los Angeles, CA 90024
| | - Rebecca Dudovitz
- Associate Professor, , Department of Pediatrics and Children's Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, and UCLA Mattel Children's Hospital, 10833 Le Conte Ave. 12-358 CHS, Los Angeles, CA 90095
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O'Dea B, King C, Subotic-Kerry M, O'Moore K, Christensen H. School Counselors' Perspectives of a Web-Based Stepped Care Mental Health Service for Schools: Cross-Sectional Online Survey. JMIR Ment Health 2017; 4:e55. [PMID: 29158207 PMCID: PMC5715202 DOI: 10.2196/mental.8369] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/12/2017] [Accepted: 09/30/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mental health problems are common among youth in high school, and school counselors play a key role in the provision of school-based mental health care. However, school counselors occupy a multispecialist position that makes it difficult for them to provide care to all of those who are in need in a timely manner. A Web-based mental health service that offers screening, psychological therapy, and monitoring may help counselors manage time and provide additional oversight to students. However, for such a model to be implemented successfully, school counselors' attitudes toward Web-based resources and services need to be measured. OBJECTIVE This study aimed to examine the acceptability of a proposed Web-based mental health service, the feasibility of providing this type of service in the school context, and the barriers and facilitators to implementation as perceived by school counselors in New South Wales (NSW), Australia. METHODS This study utilized an online cross-sectional survey to measure school counselors' perspectives. RESULTS A total of 145 school counselors completed the survey. Overall, 82.1% (119/145) thought that the proposed service would be helpful to students. One-third reported that they would recommend the proposed model, with the remaining reporting potential concerns. Years of experience was the only background factor associated with a higher level of comfort with the proposed service (P=.048). Personal beliefs, knowledge and awareness, Internet accessibility, privacy, and confidentiality were found to influence, both positively and negatively, the likelihood of school counselors implementing a Web-based school mental health service. CONCLUSIONS The findings of this study confirmed that greater support and resources are needed to facilitate what is already a challenging and emotionally demanding role for school counselors. Although the school counselors in this study were open to the proposed service model, successful implementation will require that the issues outlined are carefully addressed.
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Affiliation(s)
- Bridianne O'Dea
- Black Dog Institute, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Catherine King
- Black Dog Institute, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | | | - Helen Christensen
- Black Dog Institute, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
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Oland AA, Booster GD, Bender BG. Psychological and lifestyle risk factors for asthma exacerbations and morbidity in children. World Allergy Organ J 2017; 10:35. [PMID: 29075362 PMCID: PMC5644196 DOI: 10.1186/s40413-017-0169-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/13/2017] [Indexed: 12/13/2022] Open
Abstract
Asthma is the most common childhood illness and disproportionately affects low-income, minority children who live in urban areas. A range of risk factors are associated with asthma morbidity and mortality, such as treatment non-adherence, exposure to environmental triggers, low-income households, exposure to chronic stress, child psychological problems, parental stress, family functioning, obesity, physical inactivity, and unhealthy diets. These risk factors often have complex interactions and inter-relationships. Comprehensive studies that explore the inter-relationships of these factors in accounting for asthma morbidity and mortality are needed and would help to inform clinical intervention. Considerable research has focused on interventions to improve adherence, asthma management, asthma symptoms, and quality of life for patients with asthma. Educational interventions combined with psychosocial interventions, such as behavioral, cognitive-behavioral, or family interventions, are beneficial and provide care in schools, homes, and emergency rooms can help to address barriers to accessing care for children and families. Additional recent research has explored the use of multidisciplinary, collaborative, integrated care with pediatric asthma patients, providing promising results. Integrated care could be ideal for addressing the multitude of complex psychosocial and wellness factors that play a role in childhood asthma, for increasing patient-centered care, and for promoting collaborative patient-provider relationships. Further research in this area is essential and would be beneficial.
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Lai K, Guo S, Ijadi-Maghsoodi R, Puffer M, Kataoka SH. Bringing Wellness to Schools: Opportunities for and Challenges to Mental Health Integration in School-Based Health Centers. Psychiatr Serv 2016; 67:1328-1333. [PMID: 27417895 PMCID: PMC5831516 DOI: 10.1176/appi.ps.201500401] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE School-based health centers (SBHCs) reduce access barriers to mental health care and improve educational outcomes for youths. This qualitative study evaluated the innovations and challenges of a unique network of SBHCs in a large, urban school district as the centers attempted to integrate health, mental health, and educational services. METHODS The 43 participants sampled included mental health providers, primary care providers, and care coordinators at 14 SBHCs. Semistructured interviews with each participant were audio recorded and transcribed. Themes were identified and coded by using Atlas.ti 5.1 and collapsed into three domains: operations, partnership, and engagement. RESULTS Interviews revealed provider models ranging from single agencies offering both primary care and mental health services to colocated services. Sites where the health agency provided at least some mental health services reported more mental health screenings. Many sites used SBHC wellness coordinators and coordination team meetings to facilitate relationships between schools and health agency and community mental health clinic providers. Partnership challenges included confidentiality policies and staff turnover. Participants also highlighted student and parent engagement through culturally sensitive services, peer health advocates, and "drop-in" lunches. CONCLUSIONS Staffing and operational models are critical in the success of integrating primary care, mental health care, and education. Among the provider models observed, the combined primary care and mental health provider model offered the most integrated services. Despite barriers, providers and schools have begun to implement novel solutions to operational problems and family engagement in mental health services.
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Affiliation(s)
- Karen Lai
- Dr. Lai, Dr. Ijadi-Maghsoodi, and Dr. Kataoka are with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute, and Ms. Guo is with the School of Psychology, all at the University of California, Los Angeles (UCLA). Dr. Ijadi-Maghsoodi is also with the Health Services Research and Development Center, Department of Veterans Affairs (VA), Los Angeles. Ms. Puffer is with L.A. Trust for Children's Health, Los Angeles. Send correspondence to Dr. Kataoka (e-mail: )
| | - Sisi Guo
- Dr. Lai, Dr. Ijadi-Maghsoodi, and Dr. Kataoka are with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute, and Ms. Guo is with the School of Psychology, all at the University of California, Los Angeles (UCLA). Dr. Ijadi-Maghsoodi is also with the Health Services Research and Development Center, Department of Veterans Affairs (VA), Los Angeles. Ms. Puffer is with L.A. Trust for Children's Health, Los Angeles. Send correspondence to Dr. Kataoka (e-mail: )
| | - Roya Ijadi-Maghsoodi
- Dr. Lai, Dr. Ijadi-Maghsoodi, and Dr. Kataoka are with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute, and Ms. Guo is with the School of Psychology, all at the University of California, Los Angeles (UCLA). Dr. Ijadi-Maghsoodi is also with the Health Services Research and Development Center, Department of Veterans Affairs (VA), Los Angeles. Ms. Puffer is with L.A. Trust for Children's Health, Los Angeles. Send correspondence to Dr. Kataoka (e-mail: )
| | - Maryjane Puffer
- Dr. Lai, Dr. Ijadi-Maghsoodi, and Dr. Kataoka are with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute, and Ms. Guo is with the School of Psychology, all at the University of California, Los Angeles (UCLA). Dr. Ijadi-Maghsoodi is also with the Health Services Research and Development Center, Department of Veterans Affairs (VA), Los Angeles. Ms. Puffer is with L.A. Trust for Children's Health, Los Angeles. Send correspondence to Dr. Kataoka (e-mail: )
| | - Sheryl H Kataoka
- Dr. Lai, Dr. Ijadi-Maghsoodi, and Dr. Kataoka are with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute, and Ms. Guo is with the School of Psychology, all at the University of California, Los Angeles (UCLA). Dr. Ijadi-Maghsoodi is also with the Health Services Research and Development Center, Department of Veterans Affairs (VA), Los Angeles. Ms. Puffer is with L.A. Trust for Children's Health, Los Angeles. Send correspondence to Dr. Kataoka (e-mail: )
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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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Albright K, Barnard J, O'Leary S, Federico S, Saville A, Lockhart S, Lee M, Eblovi D, Dickinson M, Kile D, Kempe A. School-Based Health Centers as Medical Homes: Parents' and Adolescents' Perspectives. Acad Pediatr 2016; 16:381-6. [PMID: 26329018 DOI: 10.1016/j.acap.2015.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 06/01/2015] [Accepted: 06/01/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Preventive health services are underutilized by US adolescents, especially those from low-income populations. School-based health centers (SBHCs) have been endorsed as primary medical homes for adolescents. This study was undertaken to determine how adolescent SBHC users and their parents perceive SBHCs, particularly whether SBHCs fulfill each of the elements of a medical home as defined by the American Academy of Pediatrics. METHODS Middle and high school adolescents who had been enrolled in a SBHC in a major metropolitan school district for a minimum of 1 year were interviewed about their perceptions of and experiences with SBHCs. English- and Spanish-speaking parents of SBHC-enrolled adolescents also participated in focus groups on this topic. RESULTS Four focus groups with parents (n = 30) and 62 interviews with adolescents were completed. Both adolescents and parents indicated satisfaction with the quality and utilization of SBHC services, reporting that SBHCs were highly accessible and family centered. Many students preferred to access care at their SBHC instead of their primary care practice because of the convenience, perceived trustworthiness, compassion, and high quality of care at the SBHC. A few parents reported unmet medical needs from their adolescent's SBHC, and some differences emerged between English- and Spanish-speaking parents. CONCLUSIONS Adolescents' and parents' perceptions of care received at these SBHCs are consistent with features of the medical home model. These findings suggest that SBHCs can provide coordinated, compassionate care to students in a large, urban school system and may be perceived as more accessible than traditional primary care settings.
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Affiliation(s)
- Karen Albright
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, Colo; Department of Community & Behavioral Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colo.
| | - Juliana Barnard
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - Sean O'Leary
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, Colo; Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - Steve Federico
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colo; Denver Health and Hospital Authority, Denver, Colo
| | - Alison Saville
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - Steven Lockhart
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - Michelle Lee
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - Darren Eblovi
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - Miriam Dickinson
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, Colo; Department of Family Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - Deidre Kile
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - Allison Kempe
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, Colo; Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colo
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12
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Ahern NR, Bramlett T. An Update on Teen Pregnancy. J Psychosoc Nurs Ment Health Serv 2016; 54:25-8. [PMID: 27648871 DOI: 10.3928/02793695-20160119-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
After years of high teen birth rates, there is currently a decline in U.S. pregnancy and birth rates among teens. Nevertheless, these rates continue to be higher than those of most global counterparts, and psychosocial and physical adversities still occur for pregnant teens and their children. The declining birth rates may be due to teens making better choices about contraceptive use and sexual behaviors. Psychiatric-mental health nurses are in key positions to enhance pregnancy prevention for teens. [Journal of Psychosocial Nursing and Mental Health Services, 54(2), 25-28.].
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Kinchin I, Tsey K, Heyeres M, Cadet-James Y. Systematic review of youth mental health service integration research. Aust J Prim Health 2016; 22:304-315. [DOI: 10.1071/py15114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/09/2015] [Indexed: 11/23/2022]
Abstract
Quality mental health care is based on the integration of care across organisations and disciplines. The aims of this study were, first, to assess the extent, characteristics and reported outcomes of publications concerned with youth mental health service integration in Australia and internationally; and second, to investigate the study design quality of evaluative interventions and determine whether the studies report on the cost-effectiveness of the integration in order to inform the reform of youth mental health services by Queensland Health. A systematic search of the peer-reviewed literature and a narrative synthesis were undertaken of English language publications from 21 electronic databases. Inclusion criteria were: published 1998–2014 (inclusive); peer-reviewed research; focused on mental health services integration; reported data for youth aged 12–25 years. The methodological quality of evaluative interventions was assessed using the Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project (EPHPP). Twenty-five studies met the inclusion criteria: one (4%) was classified as a measurement research, 13 (52%) as descriptive, and 11 (44%) as interventions including five (45%) evaluative interventions. Four out of the five evaluative interventions reported positive effects of youth mental health service integration. Particular problems included ambiguity of definitions, absence of economic or cost analyses and insufficient consumer involvement. The methodological quality of the interventions was variable with, on average, a moderate level of selection bias and study design. Despite a slight increase in the number of studies in the last couple of years, there are important gaps in the evidence base for youth mental health service integration processes. The relatively small number of evaluative studies and lack of economic evaluations point to the need for additional research in this important area.
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Blacksin BA, Kelly PJ. Connecting Teens to Caring Adults in a School-Based Health Center: A Case Study. J Community Health Nurs 2015; 32:89-103. [DOI: 10.1080/07370016.2015.1024543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Miller E, Goldstein S, McCauley HL, Jones KA, Dick RN, Jetton J, Silverman JG, Blackburn S, Monasterio E, James L, Tancredi DJ. A school health center intervention for abusive adolescent relationships: a cluster RCT. Pediatrics 2015; 135:76-85. [PMID: 25535265 DOI: 10.1542/peds.2014-2471] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Few evidence-based interventions address adolescent relationship abuse in clinical settings. This cluster randomized controlled trial tested the effectiveness of a brief relationship abuse education and counseling intervention in school health centers (SHCs). METHODS In 2012-2013, 11 SHCs (10 clusters) were randomized to intervention (SHC providers received training to implement) or standard-of-care control condition. Among 1062 eligible students ages 14 to 19 years at 8 SHCs who continued participation after randomization, 1011 completed computer-assisted surveys before a clinic visit; 939 completed surveys 3 months later (93% retention). RESULTS Intervention versus control adjusted mean differences (95% confidence interval) on changes in primary outcomes were not statistically significant: recognition of abuse = 0.10 (-0.02 to 0.22); intentions to intervene = 0.03 (-0.09 to 0.15); and knowledge of resources = 0.18 (-0.06 to 0.42). Intervention participants had improved recognition of sexual coercion compared with controls (adjusted mean difference = 0.10 [0.01 to 0.18]). In exploratory analyses adjusting for intensity of intervention uptake, intervention effects were significant for increased knowledge of relationship abuse resources and self-efficacy to use harm reduction behaviors. Among participants reporting relationship abuse at baseline, intervention participants were less likely to report such abuse at follow-up (mean risk difference = -0.17 [-0.21 to -0.12]). Adolescents in intervention clinics who reported ever being in an unhealthy relationship were more likely to report disclosing this during the SHC visit (adjusted odds ratio = 2.77 [1.29 to 5.95]). CONCLUSIONS This is the first evidence of the potential benefit of a SHC intervention to address abusive relationships among adolescents.
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Affiliation(s)
- Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;
| | - Sandi Goldstein
- California Adolescent Health Collaborative, Public Health Institute, Oakland, California
| | - Heather L McCauley
- Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kelley A Jones
- Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rebecca N Dick
- Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Johanna Jetton
- California Adolescent Health Collaborative, Public Health Institute, Oakland, California
| | - Jay G Silverman
- Division of Global Public Health, School of Medicine, University of California-San Diego, La Jolla, California
| | - Samantha Blackburn
- California School-Based Health Alliance, Oakland, California; School of Nursing, California State University-Sacramento, Sacramento, California
| | - Erica Monasterio
- Department of Family Health Care Nursing, School of Nursing, University of California-San Francisco, San Francisco, California
| | - Lisa James
- Futures Without Violence, San Francisco, California; and
| | - Daniel J Tancredi
- School of Medicine, University of California-Davis, Sacramento, California
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Curtis BL, McLellan AT, Gabellini BN. Translating SBIRT to public school settings: An initial test of feasibility. J Subst Abuse Treat 2014; 46:15-21. [DOI: 10.1016/j.jsat.2013.08.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 07/29/2013] [Accepted: 08/02/2013] [Indexed: 11/30/2022]
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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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Korenblum C, Vandermorris A, Thompson G, Kaufman M. It is time to make the grade: Reaching Canadian youth through school-based health centres. Paediatr Child Health 2013. [DOI: 10.1093/pch/18.5.235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cohen AK, Syme SL. Education: a missed opportunity for public health intervention. Am J Public Health 2013; 103:997-1001. [PMID: 23597373 DOI: 10.2105/ajph.2012.300993] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Educational attainment is a well-established social determinant of health. It affects health through many mechanisms such as neural development, biological aging, health literacy and health behaviors, sense of control and empowerment, and life chances. Education--from preschool to beyond college--is also one of the social determinants of health for which there are clear policy pathways for intervention. We reviewed evidence from studies of early childhood, kindergarten through 12th grade, and higher education to identify which components of educational policies and programs are essential for good health outcomes. We have discussed implications for public health interventions and health equity.
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Cohen AK, Schuchter JW. Revitalizing communities together: the shared values, goals, and work of education, urban planning, and public health. J Urban Health 2013; 90:187-96. [PMID: 22711169 PMCID: PMC3675725 DOI: 10.1007/s11524-012-9733-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Inequities in education, the urban environment, and health co-exist and mutually reinforce each other. Educators, planners, and public health practitioners share commitments to place-based, participatory, youth-focused, and equitable work. They also have shared goals of building community resilience, social capital, and civic engagement. Interdisciplinary programs that embody these shared values and work towards these shared goals are emerging, including school-based health centers, full-service community schools, community health centers, Promise Neighborhoods, and Choice Neighborhoods. The intersection of these three fields represents an opportunity to intervene on social determinants of health. More collaborative research and practice across public health, education, and planning should build from the shared values identified to continue to address these common goals.
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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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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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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: 122] [Impact Index Per Article: 10.2] [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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