School-based Health Centers Research Articles

The Value of Mental Health Screening for Adolescents Attending School-Based Health Centers

Although 65% of school-based health centers (SBHCs) offer mental health services, at-risk youth are commonly overlooked or do not follow up when referrals are made. Universal screenings may increase identification of those in need of mental health support. We examined the number of youth at three SBHCs referred for mental health consultations. Comparisons were made between provider referrals and those with elevated scores on the Youth Pediatric Symptom Checklist-17 (Y-PSC-17). Of the 585 patients in this study, 37 (6.32%) were referred solely by their Y-PSC-17 score, 36 (6.15%) youth were singularly referred by providers, and 19 (3.25%) were referred by both modalities. Almost three-quarters ( n = 67; 72.8%) of identified youth elected to receive psychotherapeutic services. Approximately half of the youth referred by providers ( n = 19; 52.8%) received individual services, while 36.11% ( n = 13) received group services. Smaller proportions of youth with elevated Y-PSC-17 scores received individual ( n = 7; 18.9%) and group services ( n = 11; 29.7%). Youth referred solely by a medical provider had significantly lower scores than those identified through an elevated Y-PSC-17 score. Findings highlight the necessity of universal screening in pediatric settings in addition to physician referrals to provide a supplemental layer of prevention and early identification of behavioral health concerns. In this study, 40% referrals would have been missed if both modalities were not in place. Educating medical providers on youth mental health concerns may enhance identification of those in need of mental health supports and in turn improve long-term outcomes.

Expanding School-Based Health Centers: Sustainable Partnerships and Building Access.

Children require accessible, affordable health care to support health and education outcomes. Health care access is affected by children's social determinants of health. School-based health centers (SBHC) bypass larger social structures and social determinants of health, providing accessible health care to children. New SBHC development should consider university collaboration partnerships to establish funding sustainability. University interprofessional health programs allow for high-quality, advanced practice nurse care models to staff SBHCs. When developing an SBHC, founders should utilize access theory to ensure conformity between the targeted population's needs and health services. The dimensions of the theory assist in building and evaluating access. As the pandemic continues to cause health care access barriers for children, advocates, and policymakers should focus efforts on sustaining and expanding SBHCs.

Mixed-methods Exploration of Telehealth-supported Long-acting Reversible Contraceptive Services in School-based Health Centers: How Much Added Value?

This study explored adolescent and young adult preferences and experiences with telehealth-supported long-acting reversible contraceptive (LARC) services in New York City school-based health centers (SBHCs) during COVID-19. Sequential mixed methods included post-LARC insertion surveys and in-depth interviews. Survey respondents (n=45) were aged 14-21 years and predominantly Hispanic (53.3%). Only four respondents completed a postinsertion visit via telehealth. Most (82.2%) preferred in-person for future LARC visits; none preferred telehealth. Four themes emerged in interviews (n=15): LARC self-efficacy and autonomy; SBHC convenience and accessibility; comfort with SBHC providers; and preference for in-person visits despite telehealth benefits. Although telehealth theoretically adds value to LARC service delivery, uptake and preference for telehealth in the SBHC context were low. Despite the perceived acceptability of telehealth, adolescents and young adults prefer in-person SBHC visits, suggesting SBHC access may eliminate barriers to care that telehealth seeks to overcome.

Disparities in Implementing COVID-19 Prevention Strategies in Public Schools, United States, 2021-22 School Year.

During the COVID-19 pandemic, US schools have been encouraged to take a layered approach to prevention, incorporating multiple strategies to curb transmission of SARS-CoV-2. Using survey data representative of US public K-12 schools (N = 437), we determined prevalence estimates of COVID-19 prevention strategies early in the 2021-22 school year and describe disparities in implementing strategies by school characteristics. Prevalence of prevention strategies ranged from 9.3% (offered COVID-19 screening testing to students and staff) to 95.1% (had a school-based system to report COVID-19 outcomes). Schools with a full-time school nurse or school-based health center had significantly higher odds of implementing several strategies, including those related to COVID-19 vaccination. We identified additional disparities in prevalence of strategies by locale, school level, and poverty. Advancing school health workforce and infrastructure, ensuring schools use available COVID-19 funding effectively, and promoting efforts in schools with the lowest prevalence of infection prevention strategies are needed for pandemic preparedness.

Mental Health Trajectories of Children and Caregivers Using School-Based Health Centers During the COVID-19 Pandemic

This wasa prospective study of children registered at school-based health centers (SBHCs) in Canada. The objectives were to compare mental health trajectories of children and parents/caregivers who accessed SBHCs during the pandemic relative to those who did not. Parents/caregivers of children who attended SBHCs completed the Strengths and Difficulties Questionnaire (SDQ) and the Generalized Anxiety Disorder-7 (GAD-7) at three time points during the pandemic. The primary analysis used linear mixed models to examine the relationship between SBHC visits during the pandemic and children's SDQ score trajectories.The secondary analysis was the same for parents'/caregivers' GAD-7 scores. There were 435 children included. SDQ and GAD-7 scores worsened over time for children and parents/caregivers who attended SBHCs during the pandemic compared to those who did not. Children and parents/caregivers with worsening mental health symptoms may have sought care at SBHCs since they were accessible during the pandemic.

The Impact of School Closures on Service Utilization in School-Based Health Centers.

The pandemic was followed by a severe mental health crisis in youth with both an increase in the prevalence of mental health problems and a decrease in requests for and access to care. data were extracted from the school-based health center records in three large public high schools that include under-resourced and immigrant communities. Data from 2018/2019 (pre-pandemic), 2020 during the pandemic, and then in 2021 after the return to in-person school were compared regarding the impact of in-person, telehealth, and hybrid care. Despite the increase in mental health needs globally, there was a dramatic decrease in referrals, evaluations, and the total number of students seen for behavioral health care. The time course of this decrease in care was specifically associated with the transition to telehealth, although treatment did not return to pre-pandemic levels, even after in-person care became available. Despite ease of access and increased need, these data suggest that telehealth has unique limitations when delivered in school-based health centers.

Socioeconomic determinants of asthma health.

The current review provides an assessment of the recent pediatric literature evaluating socioeconomic drivers of asthma incidence and morbidity. The review addresses the specific social determinants of health related to housing, indoor and outdoor environmental exposures, healthcare access and quality, and the impact of systematic racism. Many social risk factors are associated with adverse asthma outcomes. Children living in low-income, urban neighborhoods have greater exposure to both indoor and outdoor hazards, including molds, mice, second-hand smoke, chemicals, and air pollutants, all of which are associated with adverse asthma outcomes. Providing asthma education in the community - via telehealth, school-based health centers, or peer mentors - are all effective methods for improving medication adherence and asthma outcomes. The racially segregated neighborhoods created by the racist 'redlining' policies implemented decades ago, persist today as hotspots of poverty, poor housing conditions, and adverse asthma outcomes. Routine screening for social determinants of health in clinical settings is important to identify the social risk factors of pediatric patients with asthma. Interventions targeting social risk factors can improve pediatric asthma outcomes, but more studies are needed related to social risk interventions.

70. Description of an Integrated Adolescent Mental Health Clinic for Inner-City Youth at a School-Based Health Center (SBHC) in Washington, DC: An Innovative Approach

70. Description of an Integrated Adolescent Mental Health Clinic for Inner-City Youth at a School-Based Health Center (SBHC) in Washington, DC: An Innovative Approach

School-based health care: improving academic outcomes for inner-city children-a prospective cohort quasi-experimental study.

We examined whether a school-based health center model improved academic achievement compared to usual care. This was a quasi-experimental prospective cohort study. The primary outcome was an academic achievement. In addition, we analyzed sociodemographic characteristics and their relationship toacademic achievement, and the wait time for a developmental assessment. The differences in change of grades over time (from 2016/2017 to 2018/2019) were small for reading (-0.83, 95% CI -3.48, 1.82, p = 0.51), writing (-1.11, 95% CI -3.25, 1.03, p = 0.28), and math (0.06, 95% CI -3.08, 2.94, p = 0.98). The experimental arm's average wait time for developmental assessment was 3.4 months. In this small, quasi-experimental prospective cohort study, we did not find evidence that our SBHC model improved academic achievement; however, the wait time at the SBHCs was considerably less than the provincial wait time for a developmental assessment. NCT04540003. This study describes a unique and innovative school-based health center model. Our findings support the benefits of school-based health centers in diagnosing and treating children with developmental and mental health disorders for disadvantaged communities. This study did not find an improvement in academic achievement for school-based health center users. This study found that the wait time to developmental assessment was shorter for school-based health center users compared to the wait time reported in the community. Pandemic-associated school disruptions have highlighted the importance of accessible school-based health services for children requiring mental health and developmental assessments and care.

Connecting Behavioral Health Specialists With Schools: Adapting a Telementoring Series During COVID-19.

To address the daunting behavioral and mental health needs of Kansas' rural and underserved communities, Telehealth ROCKS (Rural Outreach for the Children of Kansas) Schools project partnered with school-based health centers, school districts, and special education cooperatives to provide a range of telebehavioral health intervention services and teletraining. This project used the Project Extension for Community Healthcare Outcomes (ECHO) telementoring framework to connect specialty providers with school/community providers for web-based continuing education and case consultation to support students with special education needs. Our team created the Function Friday for Better Behavior ECHO series to address challenging behaviors in schools, based on the concept of functional behavior assessment and function-based treatment. Part of the ECHO series came into being after the onset of the COVID-19 pandemic. This article describes how our ECHO series provided an effective mechanism for supporting school and community providers during the pandemic, and participating educators utilized skills as they transitioned from onsite education to the virtual learning environment with students.

School-based health centers and rural community health

ABSTRACT School-based health centers (SBHCs) provide comprehensive health care services to children through facilities that are located directly within their school. Although traditionally located in low-income urban communities, SBHCs are becoming more prevalent in rural schools, and we propose that they may have important positive impacts in those communities. By reducing distance to care providers, capitalizing on the role of schools as a known local institution, providing consistent preventive care, and leveraging understanding of community challenges in providing health care services, SBHCs can increase health care access and positively impact social determinants of health. They may also contribute to community development if establishing and maintaining the SBHCs community activates community capitals and enhances resource sharing, communication and relationship building. We expand on these ideas by providing a case study of SBHC development and outcomes using data from a not-for-profit healthcare organization that operates a network of SBHCs in four adjacent rural counties of New York state.

50 Years Ago in TheJournalofPediatrics: Pediatric Nurse Practitioners: 50 Years of Partnering for Children's Health

Silver HK. A blueprint for pediatric health manpower for the 1970's: the 1972 George Armstrong Lecture. J Pediatr 1973;82:149-56. Dr Henry Silver's lecture to the Ambulatory Pediatric Association is as resonant today as it was 50 years ago. He noted that there was an inadequate supply of pediatric health care providers and recounted a few rejected solutions, such as shortening the medical school curriculum. The focus of his lecture, however, was emphasizing the importance of nurse practitioners (NPs) in providing care for children. The first NPs in the US graduated from Dr Silver's program in 1965 after 4 months of postnursing training. Dr Silver found that both pediatricians and parents were satisfied with care received from the NP when using a combined model: having a NP provide care with a physician available for consultation as needed. NPs showed the potential to provide quality health care in primary are settings, and Dr Silver proposed that their roles could be expanded into the community by providing care in school-based clinics. The role of the NP has continued to evolve, and training has become more intense since Dr Silver's “blueprint for pediatric health manpower” lecture. NPs can select a master's program that can be completed in 2-3 years and, for those interested in educational advancement, a post-master's doctoral program that can be completed in 2-3 years. They also have the option to select the primary care or acute care tracks. The primary care track focuses education within the primary care setting, specialty clinics, or in the community, whereas the acute care track focuses on the care of hospitalized patients. Today, NPs have a presence in a variety of settings fulfilling their roles in the “diagnosis and management of acute and chronic illness, health promotion, disease prevention, health education and counseling.”1American Association of Nurse PractitionersDiscussion Paper: Standards of Practice for Nurse Practitioners, 2019 update.https://storage.aanp.org/www/documents/advocacy/position-papers/StandardsOfPractice.pdfDate accessed: October 11, 2020Google Scholar NPs play critical roles partnering with pediatricians in the care of children in primary care offices, school-based health centers, neonatal intensive care units, as members of surgical teams, and many other areas. Dr Silver was prescient in his call for enhancing the care for children by partnering with NPs, yet the shortage of health care providers is likely to continue. By the year 2030, there is estimated to be 76.3 million children in the US, with a decreasing number of pediatricians and only 1025 pediatric NPs becoming licensed yearly.2Gigli K.H. Beauchesne M.A. Dirks M.S. Peck J.L. White Paper: Critical shortage of pediatric nurse practitioners predicted.J Pediatr Health Care. 2019; 33: 347-355Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar It remains as important as ever for pediatricians and NPs to continue working together and encourage ongoing development of both workforces.

School-Based Health Centers: A Concept Analysis

This concept analysis aims to provide a conceptual definition for school-based health centers (SBHCs). Despite growing evidence of SBHC growth and impact, there is a gap in the conceptual clarity of SBHCs. A systematic review using Walker and Avant's 8-step method of concept analysis produced 369 articles, of which 17 were analyzed. PubMed, CINAHL, Embase, PsycINFO, and Cochrane Library were searched with no time limit to capture the history and development of SBHCs. Search terms included "school-based health" and "school-based health center." Accessible and advanced practitioners, heterogeneity, integrated care and location, and youth-friendly provide defining attributions to SBHCs. Antecedents, consequences, and empirical referents are discussed. This concept analysis highlights evidence supporting the potential impact of SBHCs as a health service model for advancing health equity. Clear criteria contribute to understanding SBHCs and serve as a basis for ongoing research and stakeholder collaboration.

Teen and caregiver perspectives on success, clinician role, and family involvement in ACTION PAC, a weight management intervention trial.

Describe perspectives of teens and caregivers regarding motivations, successes, and challenges related to participation in ACTION PAC (ClinicalTrials.gov: NCT02502383), a two-year weight management trial. Intervention group participants received 16 short motivational interviewing (MI) sessions with school-based health center (SBHC) primary care clinicians over two years. Post-study, we conducted semi-structured interviews with purposefully sampled intervention group teens and their caregivers. Interviews were audio recorded, transcribed, and managed in NVivo 11. Three independent coders analyzed the data, developed a coding tree, examined how codes intersected and clarified relationships through memo writing. The clinician's role and use of motivational interviewing and family involvement in behavior changes were cited as critical to success. Some adolescents noted difficulty in sustaining behavior changes post-intervention and social and systemic barriers to behavior change. Future studies should identify strategies to sustain teen motivation, better involve families, and address systemic barriers. In this study, which simulated real-world SBHC conditions, adolescents appreciated the use of an MI approach and felt that was key to their success, indicating the potential to continue use of this approach to motivating behavior changes in SBHC settings.

Parent Engagement with a School-Based Health Center Consent Process Predicts Student Attendance and School Transition.

School-based health centers (SBHCs) fill critical pediatric health care access gaps but typically require parental consent for enrollment. Families' responses to SBHC consent form outreach efforts may reflect broader school engagement. This study investigated whether SBHC consent form return predicted subsequent chronic absenteeism and school transition, indicators of student and family school engagement. Multivariable logistic regression was used to compare the odds of being chronically absent or transitioning out of a US elementary/middle school (n=1917) during 2015-2016 and 2016-2017 for those who declined SBHC enrollment or did not return a consent form, compared to those who enrolled. Compared to enrolled students, those who declined had 78% lower odds of chronic absenteeism [95% CI: 0.09, 0.54]. Families who did not respond had 2.8 times greater odds of their student transitioning out of school [95% CI: 2.15, 3.58] but were no more likely to be chronically absent. Consent form return may predict aspects of broader students and family school engagement.

Readiness to implement screening, brief intervention, and referral to treatment in school-based health centers.

The purpose of this study was to evaluate the readiness of a university-based school-based health center (SBHC) program to implement the screening, brief intervention, and referral to treatment (SBIRT) model.We completed preimplementation surveys and interviews with providers, staff, and administrators at participating SBHCs (N = 19) to measure current protocols for and barriers to addressing adolescent substance use and barriers and facilitators to implementing SBIRT. We used the R = MC2 heuristic (readiness equals motivation, general organizational capacity, and innovation-specific capacity) to interpret findings from the data.Using the R = MC2 heuristic, we identified factors that may aid implementation, including the prioritization of substance use and a supportive organizational culture, as well as potential barriers, including competing high-priority health issues and a lack of resources for innovation.This study contributes to the emerging literature on the implementation of the SBIRT model with adolescents and in SBHCs and demonstrates the practical applicability of the R = MC2 heuristic for assessing implementation readiness. SBHCs are ideal locations for addressing substance use but SBHC providers also face unique challenges when implementing the SBIRT model.

Rates, Patterns, and Predictors of Follow-up Care for Adolescents at Risk for Substance Use Disorder in a School-Based Health Center SBIRT Program

PurposeTo examine rates, patterns, and predictors of follow-up care for adolescents screened as being at risk for substance use disorder (SUD) in a school-based health center (SBHC) Screening, Brief Intervention and Referral to Treatment (SBIRT) program. MethodsElectronic health records were extracted of adolescents who received health care services from one of three high school-based health centers implementing SBIRT. Patterns and predictors of engagement in follow-up care within 8 weeks following the week of a positive SUD risk screen were analyzed using item response theory (IRT) modeling. ResultsOut of 1,327 adolescents receiving SBHC services, 81.2% completed a health screening questionnaire. Of screened adolescents, 17.7% were positive for SUD risk. Across the 8-week follow-up period, 65.4% of adolescents at risk for SUD received at least one follow-up visit. IRT modeling indicated that high levels of engagement in follow-up care were characterized by contact with a behavioral health care (BHC) provider. The percentage of adolescents having follow-up contact with a BHC provider increased significantly after the onset of the COVID-19 pandemic. Engagement in follow-up care was predicted by risk for depression, history of suicidal behavior, being female, and previous sexual activity. DiscussionSBHCs provide a favorable setting for screening and detecting adolescents at risk for SUD. Adolescents at risk for SUD should receive follow-up contact with a BHC provider. Enhanced follow-up engagement efforts may be warranted for adolescents at risk for SUD without risk for depression or suicidal history, as well as for females and those with previous sexual activity.

Utilizing SBIRT as a Framework for Transforming How We Think About Prevention and Early Intervention for Youth and Young Adults

Utilizing SBIRT as a Framework for Transforming How We Think About Prevention and Early Intervention for Youth and Young Adults

School-Based Health Center Utilization During COVID-19 Pandemic-Related School Closures.

BackgroundLittle is known regarding utilization of school‐based health centers (SBHCs) during prolonged school closures, such as those that occurred during the COVID‐19 pandemic. We sought to compare SBHC utilization before and after pandemic‐related school closures across a network of SBHCs affiliated with a large Southern Californian urban school district.MethodsWe conducted a secondary analysis of encounter data extracted from electronic health records from 12 SBHCs that remained open despite school closures, including patient demographics and diagnostic and billing codes. We used the Clinical Classifications Software Refined to group encounters for common primary care conditions. Utilization before and during pandemic‐related school closures was compared using logistic regression with cluster‐robust standard errors to account for clustering within clinics, after adjusting for month of encounter.ResultsDuring the pandemic, study SBHCs conducted 52,530 encounters and maintained ∼4040 encounters/month. The frequency of encounters for annual preventative health exams increased for school‐aged patients but decreased for other age groups while the frequency of encounters for mental health problems increased for all age groups.Implications for School Health Policy, Practice, and EquityDespite pandemic‐related school closures, SBHCs appeared play a critical role in providing primary care to vulnerable communities.ConclusionsSBHCs may hold value beyond their co‐location with academic instruction.

Developing National Standardized Performance Measures for School-Based Health Centers: The National Quality Initiative.

Despite extensive literature on school-based health center (SBHC) characteristics and outcomes, their quality of care has not been examined nationally. Standardized quality metrics can inform health care delivery and improvement. SBHC national performance measures (NPMs) were developed by reviewing measures from national child health quality initiatives and engaging stakeholders in a consensus-building process. NPMs were pilot-tested with 73 SBHCs and SBHCs nationally subsequently reported data. Five NPMs were selected including the percentage of clients annually who received at least one: (1) well-child visit, whether administered in the SBHC or elsewhere; (2) risk assessment; (3) body mass index screen with nutrition and physical activity counseling; and, if age-appropriate, (4) depression screening with follow-up treatment plan; and (5) chlamydia screening among sexually active clients. SBHCs experienced challenges with reporting during pilot-testing, particularly related to extracting data from electronic health records, and identified strategies to address challenges. Approximately 20% of SBHCs nationally voluntarily reported data during the initial year. Standardized performance measures can help SBHCs monitor and improve care delivery and demonstrate effectiveness compared to other child health delivery systems. Ongoing data collection will help examine whether measure adoption drives quality improvement for SBHCs nationwide.