School-based Care Research Articles

Unmet Dental Needs in Children Following Suspension of School-Based Oral Health Services Due to COVID-19.

Dental caries (tooth decay) is the world's most prevalent noncommunicable disease and can lead to pain, infection, and edentulism. Many children with caries lack access to traditional dental services. School-based caries prevention can increase access to care and reduce health inequities. Disruptions in school-based care due to pandemic control policies may result in children losing access to their primary dental care option. The CariedAway project was a school-based caries prevention program in operation from 2019 to 2023 in urban schools with a high proportion of low-income, minority students. Program operations were suspended for 2 years due to the COVID-19 pandemic. We estimated the prevalence of untreated decay, swelling, fistula, and pulpal involvement in participants at baseline and again after restrictions were lifted. A total of 2998 children between the ages of 5 and 13 years were enrolled and received preventive care prior to pandemic shutdowns, and 1398 (47%) completed a follow-up observation after 2 years. At baseline, approximately 30% had untreated caries on any dentition, 11% of children presented with evidence of dental sealants, and no participants had swelling, fistula, or pulpal involvement. After 24 months, 12% of participants had swelling fistula, or pulpal involvement that was not treated during the pandemic period. There are considerable unmet dental needs in high-risk children that may be further exacerbated by a lack of access to care during disease outbreaks.

Associations between types of care and parenting practice and social-emotional development among Asian American young children

PurposeThis study examined the associations between types of preschool child care and parenting practices and social-emotional outcomes among Asian American kindergarten-age children. MethodBased on the Early Childhood Longitudinal Study-K: 2011 (n = 1530), types of care (Head Start, school-based child care, private center-based, and informal/exclusive parental care) and parenting practices (parental expectation, parental investment, and parenting teaching behaviors) were examined for their associations with children’s social-emotional skills (approach to learning, social skills, child-teacher relationship scores, and children’s behavior questions). ResultsCompared to children cared for by informal/exclusive parental care, children who attended school-based care had higher approach to learning skills and focused attention skills, and those who enrolled Head Start had lower externalizing problem behavior scores. Children who frequently read books showed positive social-emotional development (higher approach to learning, self-control, focused attention, and inhibitory control scores and lower externalizing problem behavior scores). ImplicationsAlthough enrolling in formal center-based care at preschool age had positive associations with Asian American children’s social-emotional skills, Asian American children were less likely to enroll in formal center-based care, including Head Start. Asian American parents should be informed of their eligibility for and the availability of formal center-based care, as well as the importance of parental-child interaction to promote their children’s positive social-emotional skills.

School Readiness Among Children With Congenital Heart Disease.

School Readiness Among Children With Congenital Heart Disease.

Adolescent Knowledge of When to Use Inhaled Asthma Medications: Implications for Management

PurposeIt is unclear how often adolescents with persistent asthma know when to use different inhaled medications (as-needed rescue vs. daily controller; ‘accurate use’), or whether this knowledge is associated with clinical asthma outcomes. This study aimed to characterize adolescent knowledge of accurate use; examine whether accurate use is associated with controller medication adherence, asthma symptoms, or exacerbations requiring acute health care services; and determine whether knowledge of accurate use improves following regular exposure to controller medications with school-based directly observed therapy (DOT). MethodsWe analyzed baseline and 7-month data from the School-Based Asthma Care for Teens trial. Adolescents (12–16 years) identified inhaled medications on a chart and stated when each is used. We compared accurate use with adolescent-reported adherence, recent symptoms, and asthma-related acute health care visits; and exposure to DOT. Analyses were limited to subjects with controller medication. ResultsOf 430 participants, 252 had controller medication at baseline. Knowledge of accurate use was described by 62%, and associated with adherence (odds ratio [OR]: 2.06, 95% confidence interval [CI]: 1.12–3.83). By 7 months, 313 adolescents had controller medication; 75% described accurate use, which was associated with adherence (OR: 3.46, 95% CI: 1.83–6.54), health care (OR: 0.39, 95% CI: 0.20–0.79), and DOT exposure (OR: 1.83, 95% CI: 1.10–3.32). Associations with adherence and health care at 7 months persisted in adjusted analyses. DiscussionAdolescent knowledge of accurate medication use was linked with greater adherence (baseline, 7 months), less acute health care (7 months), and exposure to in-school DOT. Interventions to support adolescents with persistent asthma should consider school-based care strategies and facilitate adolescent understanding of when to use different medications.

Systems of communication in school-nurse led care coordination: A concept analysis.

To analyze the concept of systems of communication in school nurse-led care coordination to develop an operational definition that will inform intervention development. Communication has been identified as an essential attribute in care coordination. However, previous concept analyses of care coordination did not clearly define systems of communication or consider the context of school-based care coordination. Defining and conceptualizing systems of communication has important implications for improving school nurse-led care coordination. Concept analysis was conducted using Walker and Avant's eight-step concept analysis method. The literature was searched to identify supporting literature that was analyzed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Systems of communication in school nurse-led care coordination can be defined as systems wherein care team members, led by the school nurse, collaborate by communicating information and knowledge through an individualized healthcare plan that is student/family-centered and shared through information systems. Attributes require developing an individual health plan that incorporates care coordination needs, information sharing with student/family consent, and a clear delineation of team member roles. Consequences include student/family outcomes, team member knowledge, and efficiency and accuracy of information. Concept clarification and a synthesized definition allow for more effective measurement development for effective communication in school nurse-led care coordination. Students with healthcare needs in the school environment require systems of communication that efficiently work toward school nurse-led care coordination that addresses the student's health and academic outcomes.

Developing a web-based system for coordinating school-based care for students with social, emotional, and behavioral problems

Many students with social, emotional, and behavioral problems receive school-based services. Multi-Tiered System of Support (MTSS) is the one most frequently referenced systems for coordinating services. The goal of this framework is to effectively match assessment and services to the needs of individual students. In many schools this process is limited by a lack of an overall coordinating system. As a result, many students receive services for social, emotional and behavioral problems that are unlikely to be effective, are not guided by progress monitoring, and not adequately informed by current and historical data. The Beacon System is a web-based tool created to enhance the quality of service provision for students with social, emotional, and behavioral problems by supporting continuous progress monitoring, helping educators know what services are likely to be helpful for a particular student according to their age and presenting problems, and providing educators and school mental health professionals with information to help them implement both familiar and unfamiliar interventions. Additionally, the Beacon system will enhance educators’ abilities to coordinate with a student’s entire intervention team and allow for continuity as a child changes grades, teachers, or schools. Enhancing these parts of the overall process can improve educators’ efforts to achieve the goals of MTSS to provide effective interventions matched to the students’ needs. The purpose of this manuscript is to describe the iterative development process used to create Beacon and highlight specific examples of some of the methods. In addition, we will describe how feedback from stakeholders (e.g., teachers, school mental health professionals) was used to inform decisions about design. Finally, we will describe the final development steps taken prior to pilot implementation studies and our plans for additional data collection to inform continued development of Beacon. This includes the strategies being used to measure outcomes at multiple levels including assessing a variety of behaviors of the professionals in the schools as well as student outcomes. These data will inform continuous development work that will keep us moving toward our goal of enhancing the outcomes of students with social, emotional and behavioral problems.

Care and Safety of Schoolchildren with Type 1 Diabetes Mellitus: Parental Perceptions of the School Nurse Role.

Schoolchildren with type 1 diabetes mellitus (T1DM) need supervision in the management of their disorder by the school nurse, securing proper care and safety in the school environment. The aim of this study was to investigate the parents’ perceptions regarding the care and safety of their children with T1DM at school. In this cross-sectional study, 356 parents of children with T1DM attending primary and secondary school (convenience sample) completed the “Parents’ Opinions about School-based Care for Children with Diabetes” and the “Safety of children with T1DM at school”. The majority (58.8%) noted that their children received some care from a school nurse, less than half (44.6%) declared feeling very safe concerning diabetes care, and 42.5% reported high levels of diabetes management satisfaction. Younger age of the child (p < 0.001), school nurses’ advanced diabetic care skills (p < 0.001), existence of school nurse’s office (p < 0.05) and higher educational level of the father were positively correlated with higher parental feelings of safety and satisfaction. The presence of a school nurse was associated with higher academic performance (p < 0.001), significantly fewer absences due to the disorder (p < 0.001) and better diabetes management (p < 0.043). The daily presence of a school nurse in school decreases absenteeism, greatly improves school performance and enhances diabetic management of schoolchildren with T1DM.

150-LB: Diabetes and School Health (DASH) Program—An Innovative School-Based Health Model to Optimize Care for Youth with Type 1 Diabetes

Objectives: Pediatric type 1 diabetes (T1D) care requires collaboration of families, diabetes team and caregivers. Youth spend most of the time in school so care optimization in school is crucial. There are no evidence-based guidelines for school-based care, and management varies based on local legislation, school district, and staffing. An innovative school-based program provides an opportunity to standardize care, improve outcomes, reduce inequities, and inform guidelines for school T1D care. Methods: The Nationwide Children's Hospital (NCH) Diabetes and School Health (DASH) program is a novel school-based intervention. The intradisciplinary DASH team provides on-site education to students/staff, addresses medical/psychosocial concerns, coordinates delivery of medications/supplies, and facilitates communication. The pilot aimed to enroll 50 students identified as high risk based on their Diabetes Composite Score, a risk assessment tool developed by NCH. Qualitative and quantitative data was obtained for students, caregivers, and staff, including A1C, acute care utilization, educational mastery, quality of life, psychosocial, and health equity measures. Results: 50 students over 35 schools enrolled in the pilot. The majority used injections, 50% never used a continuous glucose monitor, and the average baseline A1C was 12%. More than 60% identified as an ethnic minority. Survey data showed over 50% of students felt others did not appreciate the burden of T1D care and endorsed T1D "burn out." Over 50% of caregivers endorsed feeling defeated/discouraged by T1D care, and worry about T1D related complications. Conclusions: DASH is a novel school-based program that provides support, education, and oversight to students at high risk of T1D complications. The program aims to standardize school-based care, empower school staff, improve self-efficacy, address inequities, decrease T1D complications and provide a framework for school based care. Disclosure A. C. H. Wood: None. A. M. Moffett: None. K. Simms: None. M. Moore: None. E. Suli: None. M. K. Irwin: None. E. Edwards: None. K. Gandhi: None.

A Systematic Review of Early Childhood Exclusionary Discipline

Young children (birth to age 5) are more likely to be expelled or suspended than school-aged children, but we know comparatively little about the precursors to and prevention of exclusion in early childhood settings. Furthermore, what research has been conducted has not been systematically synthesized to inform policy and funding decisions. The present review seeks to determine how early childhood exclusion is defined and assessed in the academic literature. Studies measuring early childhood suspension or expulsion were systematically gathered and coded for study characteristics, definitions, and measures of exclusionary discipline and disparity, and factors associated with exclusion rates. Results (n = 20) show an accelerating pace of inquiry that attends to multiple levels of the ecological system (children, teachers, and programs) across diverse settings (home-, center-, and school-based care). Additional research that draws on data spanning multiple types of early care and education settings is needed to inform legislation and intervention funding decisions.

Teacher Perceptions on In-School Care and Support for Children with Intellectual Disability and a History of Sexual Abuse

This study investigated teachers’ perceptions on in school-based care and support for children with intellectual disabilities and a history of sexual abuse. The participants were a convenience sample of 28 teachers from four special educational needs schools in Gauteng Province, South Africa (females = 80%, age range = 30 to 55 years). The teachers participated in a focus group discussion on school-based quality of care and support for intellectually disabled children with a history of sexual abuse. A focus group interview schedule was designed and administered to collect the data. A thematic method of data analysis was used to collect the data.Two themes resulted from the data analysis: infrequency (80%) and short duration of support, and educator sensitivity. The most important point to consider is that the affected children are referred to the relevant structure and that parents are frequently consulted throughout the process. It is highly recommended that the issue of sexual abuse of children with disability should be handled with great care and sensitivity.

Living With Diabetes: Perceived Barriers of Adolescents.

Type 1 diabetes mellitus is the most common endocrine disease during infancy and adolescence. Diabetes causes serious coping problems during adolescence because of the need for continuous observation and because of diabetes-related complications. Thus, adolescents must adapt to and effectively manage their diabetes. This study was designed to determine the perceived barriers to home care in adolescents with Type 1 diabetes using the Health Promotion Model. Eighteen adolescents were selected from the qualified patients who applied to a diabetes polyclinic at a training and research hospital in western Turkey. Interview questions were created based on the Health Promotion Model. A phenomenological analysis of the data was conducted using the content analysis method. The barriers that participants identified as negatively impacting their ability to manage their disease effectively were categorized into the three themes of "negative feelings about having diabetes," "personal barriers," and "environmental barriers." The barriers identified included school, friends, family, fear of complications, lack of information, and personal characteristics, among others. This qualitative study enables us to understand what patients feel because the participants explained their difficulties in managing their disease and in maintaining metabolic control. The findings provide an understanding of the subjective experiences of adolescent patients with diabetes. The findings of this study are intended to be helpful in restructuring training in clinics, raising diabetes awareness among teachers and students, socializing diabetic adolescents, and providing family-centered education.

Telehealth delivery of adherence and medication management system improves outcomes in inner-city children with asthma.

Healthcare disparities exist in pediatric asthma in the United States. Children from minority, low‐income families in inner‐city areas encounter barriers to healthcare, leading to greater rates of poorly controlled asthma and healthcare utilization. Finding an effective way to deliver high‐quality healthcare to this underserved population to improve outcomes, reduce morbidity and mortality, and reduce healthcare utilization is of the utmost importance. The purpose of this study was to assess the feasibility and efficacy of a novel school‐based care delivery model that incorporates video‐based telehealth (VBT) medical and self‐management visits with electronic inhaler monitoring to improve asthma outcomes. Over a 6‐month period, children from inner‐city, low‐income schools with uncontrolled asthma completed seven scheduled medical visits with an asthma specialist and five self‐management visits with an adherence psychologist at school using VBT. Composite Asthma Severity Index (CASI) scores and electronic inhaler monitor data were recorded and analyzed. A total of 21 patients were enrolled in the study. Study subjects with higher baseline severity (CASI ≥ 4 at visit 1) demonstrated a greater reduction in their score than those with lower baseline severity (CASI < 4 at visit 1). The CASI domains showed improvement in daytime symptoms, nighttime symptoms, and exacerbations. Adherence results demonstrated a significant improvement in adherence from baseline to postintervention. Study retention was 100%. This study demonstrates that a multicomponent medical and behavioral interventional program delivered by VBT to a school‐based setting is feasible and can significantly improve asthma outcomes and care in a challenging population.

Implementing Mental Health Services for Children and Adolescents: Caregiver Involvement in School-Based Care.

This study compared clinician contact with clients' caregivers by service setting, specifically schools, which are the most common service setting for youths. Data were from a state-funded cognitive-behavioral therapy training initiative. Clinicians (N=177) completed pretraining and postconsultation surveys including retrospective reports of caregiver contact and amount of school-based practice. School-based clinicians were less likely than non-school-based clinicians to report any contact with caregivers. Full-time school-based clinicians were less likely than part-time school-based clinicians to report any contact with caregivers. School-based clinicians also were less likely than clinicians in other settings to have in-person contact with caregivers, and full-time school-based clinicians were less likely than part-time school-based clinicians to report in-person contact with caregivers. Given the inherent advantages of school-based treatment, integration of mental health services for youths in schools is increasingly supported by funding and policy. The findings of this study suggest, however, that investing in strategies to engage caregivers in such treatment may be worthwhile.

Chronic Physical Health Conditions, Mental Health, and Sources of Support in a Longitudinal Australian Child Population Cohort.

This study examined associations between chronic physical health conditions (identified from hospital records) that are subject to school health care plans, and children's emotional, behavioral, and social functioning during early (∼5 years of age) and middle childhood (∼11 years). Participants were 21,304 Australian children from a representative longitudinal population cohort derived by multi-agency record linkage. Hospital presentations (admitted patients and emergency department) identified children with asthma (n = 1,573), allergies and anaphylaxis (n = 738), type 1 diabetes (n = 59), epilepsy (n = 87), and any of these conditions (n = 2,275), relative to 19,029 children without these presentations. Logistic regression analyses determined associations between these exposures and (i) emotional, behavioral, social, and overall vulnerabilities reported by teachers (early childhood) and children (middle childhood), and (ii) self-reported lack of sources of support (middle childhood). Prevalence of any condition in hospital records was 7.5% by early childhood, and 10.7% by middle childhood. Relative to peers without these presentations, small increases in risk of overall problems, and selected emotional, behavioral, and social problems, were apparent for children with any condition, and asthma specifically, in early and middle childhood. Large and pervasive effects were apparent for epilepsy, limited small effects in middle childhood only for allergies and anaphylaxis, and no increases in risk associated with type 1 diabetes examined in middle childhood. No condition was associated with increased risk of lacking supports. Children with hospital records of chronic conditions, particularly epilepsy and asthma, might benefit from school-based care plans that integrate their physical and mental health support needs.

Critical Appraisal on Randomized Controlled Trial to Improve Care for Urban Children with Asthma

Objective-to evaluate the impact of the School-Based Asthma Therapy trial on asthma symptoms among urban children with persistent asthma. Design-Randomized trial, with children stratified by smoke exposure in the home and randomized to a school-based care group or a usual care control group. Setting-Rochester, New York. ParticipantsChildren aged 3 to 10 years with persistent asthma. Interventions-Directly observed administration of daily preventive asthma medications by school nurses (with dose adjustments according to National Heart, Lung, and Blood Institute Expert Panel guidelines) and a home-based environmental tobacco smoke reduction program for smoke-exposed children, using motivational interviewing. Main Outcome Measure-Mean number of symptom-free days per 2 weeks during the peak winter season (November-February), assessed by blinded interviews. Results-We enrolled 530 children (74% participation rate). During the peak winter season, children receiving preventive medications through school had significantly more symptom-free days compared with children in the control group (adjusted difference=0.92 days per 2 weeks;95% confidence interval, 0.50-1.33) and also had fewer nighttime symptoms, less rescue medication use, and fewer days with limited activity (all P&lt;.01). Children in the treatment group also were less likely than those in the control group to have an exacerbation requiring treatment with prednisone (12% Vs 18%, respectively; relative risk=0.64; 95% confidence interval, 0.41-1.00). Stratified analyses showed positive intervention effects even for children with smoke exposure (n=285; mean symptom-free days per 2 weeks: 11.6 for children in the treatment group Vs 10.9 for those in the control group; difference=0.96 days per 2 weeks; 95% confidence interval, 0.39-1.52).Conclusions-The School-Based Asthma Therapy intervention significantly improved symptoms among urban children with persistent asthma. This program could serve as a model for improved asthma care in urban communities.

School-Based Caries Prevention, Tooth Decay, and the Community Environment

The school and community context can contribute to inequity in child oral health. Whether the school and community affect the effectiveness of school-based caries prevention is unknown. The association between the school and community environment and dental caries, as well as their moderating effects with school-based caries prevention, was assessed using multilevel mixed-effects regression. Data were derived from a 6-y prospective cohort study of children participating in a school-based caries prevention program. For the school and community, living in a dental-shortage area and the proportion of children receiving free or reduced lunch were significantly related to an increased risk of dental caries at baseline. Caries prevention was associated with a significant per-visit decrease in the risk of untreated caries, but the rate of total caries experience increased over time. Caries prevention was more effective in children who had prior dental care at baseline and in schools with a higher proportion of low socioeconomic status students. There was significant variation across schools in the baseline prevalence of dental caries and the effect of prevention over time, although effects were modest. The school and community environment have a direct impact on oral health and moderate the association between school-based caries prevention and dental caries. Knowledge Transfer Statement: School-based caries prevention can be an effective means to reduce oral health inequity by embedding dental care within schools. However, the socioeconomic makeup of schools and characteristics of the surrounding community can affect the impact of school-based care.

26.2 Substance Use Treatment in Urban Schools

The goal of this session is to present initial results in an effort to increase access to mental health/substance treatment by providing school-based care.

Emerging Mental Health Diagnoses and School Disruption: An Examination Among Clinically Referred Children and youth

Previous research linking school disruption with mental health problems has largely relied on assessments of academic achievement to measure school disruption. Early disruptive classroom behaviour (e.g., conflict with school staff, negative attitudes toward school), however, may precipitate poor academic performance and may stem from emerging mental health concerns, particularly among young children. To address this gap in the literature, 912 clinically referred children and youth (ages 4–18 years old) were assessed using the interRAI Child and Youth Mental Health (ChYMH) assessment utilizing a cross-sectional study design. The ChYMH assessment evaluates school disruption independently of academic achievement, and includes a comprehensive assessment of the child’s mental health functioning, needs, and preferences. A logistic regression analysis revealed that various provisional mental health diagnoses (i.e., attention-deficit/hyperactivity disorder, disruptive behaviour, mood disorders, and, to a lesser extent, anxiety) were associated with disruption in the classroom. Implications for school-based care planning are discussed.

Ensuring Access to Oral Health Care for Children: School-Based Care by Dental Therapists - A Commentary.

Ensuring Access to Oral Health Care for Children: School-Based Care by Dental Therapists - A Commentary.

High spend on school-based care for childhood ASD in the US

High spend on school-based care for childhood ASD in the US