School-based Health Clinics Research Articles

Development of Youth-Centered Health Messaging Posters for High School-Based Health Clinics in Hawaii.

Youth may be reluctant to seek health care from school health providers due to feeling embarrassed or stigmatized in the health office environment or worried about their confidentiality. The purpose of this project was to create a set of youth-centered health posters that promote youth engagement with nursing staff and to standardize health messaging across high schools in Hawaii school-based clinics. Two community advisory boards, 1 composed of 10 youth stakeholders (mean age 17 years) and the other of 7 adult stakeholders, informed poster development utilizing web-based discussion groups. The discussions were transcribed, and additional data was collected using field notes and anonymous digital messages. Adult advisory board members also provided feedback on suggested poster text through an online survey. Youth and adult advisory board participants identified 4 key health concerns facing youth: confidentiality, sexual health, relationships, and mental health. Based on input from the 2 advisory boards, 4 posters were developed, each centered on 1 key health issue. School-based posters can convey important messages to help youth understand their health care rights and responsibilities, as well as identify important issues open for discussion with nurses. Posters are an underutilized tool for school health providers to create welcoming, inclusive health care environments and facilitate health-related conversations with youth. This paper describes participant feedback about the characteristics of a memorable poster and briefly outlines current knowledge and recommendations for school health providers regarding each of the 4 health issues.

Retrospective audit of a school-based integrated health-care model in a specialised school for children with externalising behaviour.

Problematic externalising behaviours in adolescents are associated with high individual and societal burden. A school-based multidisciplinary health clinic, Ngaramadhi Space (NS), was developed at Yudi Gunyi School, a specialised behavioural school in Sydney, Australia, to improve access to holistic health-care and behavioural support. This evaluation aimed to describe the demographics, clinic attendance, health screening, recommendations made, and changes in Strengths and Difficulties Questionnaire (SDQ) scores of students attending the clinic. Retrospective evaluation of students including changes in SDQ scores using descriptive statistics (26 July 2016 to 14 May 2019; n = 79). Prior to the assessment, few students engaged with a paediatrician or mental health professional (22.8%; 27.8%, respectively). Child protection services were involved with 76%. NS attendance was high (failure-to-attend = 7.6%; cancellations = 8.9%). New issues found at the assessment included: parental separation (31.6%); trauma history (27.8%); substance use (19%); emotional wellbeing concerns (16.5%), learning difficulties (12.7%), domestic violence (12.7%) and medical conditions (10.1%). SDQ teacher reports showed a significant decrease in total difficulties scores (M = 6.2, SD = 6.165, P < 0.05, eta squared = 1.013 (large effect)) and all subsets. No significant differences in parent and self-reported SDQ. Students with problematic externalising behaviour have unmet health and social needs. The NS school-based integrated health-care model offers a novel, convenient and innovative way to engage these students. This approach has high initial attendance rates with teacher-reported SDQ results showing some behavioural improvement. Further qualitative studies are required.

3.62 Improving Access to Psychiatry Services in a School-Based Health Clinic: Effects of an Integrated Care Model on Reducing Linkage Wait Time

3.62 Improving Access to Psychiatry Services in a School-Based Health Clinic: Effects of an Integrated Care Model on Reducing Linkage Wait Time

Clinician and System-Level Facilitators for Successful School-Based Telehealth Implementation during COVID-19: Guiding Factors to Help Embrace Changes in Service Delivery

Abstract School-based mental health clinics are the ideal venue to provide mental health services for youth due to their accessibility and lack of stigma compared with other community treatment centers. There were challenges associated with the abrupt shift to remote education and clinic services caused by COVID-19, but some school-based mental health clinics excelled in their implementation of telehealth services. This study of New York schools found four main facilitators to implementing telehealth services among school-based mental health clinics: (1) strong collaborative relationships between the clinic and school setting, (2) active and responsive leadership, (3) provider experience in conducting telehealth, and (4) provider flexibility to accommodate the needs of children and families. Factors were identified at every level of the school-based mental health clinic and system that helped to facilitate exemplary telehealth service delivery and implementation.

The Teddy Bear Clinic: Engaging School-Aged Children in Health Education.

This article describes the use of play therapy in a school-based health clinic on an American Indian Reservation. The project used the play therapy model, a nursing intervention focused on using play materials in a therapeutic manner as a form of communication and self-expression for children, enhancing the development of social, emotional, and behavioral skills through the nursing process. The purpose of the Teddy Bear Clinic was to establish relationships among non-Native student nurses and Native American children and their community on a Northern Plains Indian Reservation. A discussion of the potential benefits addresses opportunities for school nurses and student nurses to enhance their understanding of children's perceptions of the health care clinic and the effects of historical trauma on the health and wellbeing of Native American children while offering an opportunity for young children to engage in the health care setting in a fun way, without fear or discomfort is provided.

Cognitive behavioral treatment for disordered gaming and problem gambling in adolescents: a pilot feasibility study.

BackgroundDisordered gaming and problem gambling (DG/PG) are associated with a range of functional impairments as well as psychiatric comorbidity. With the proliferation of digital gaming apps aimed at children and adolescents, which involve in-game purchases, there is increasing evidence that DG/PG are on the rise in this age range. The behavior can be detected in youth presenting at school-based health clinics and community psychiatric clinics. Cognitive behavioral therapy (CBT) is one of several recommended treatments for adults, but little evidence is available for the efficacy of this approach in adolescents with DG/PG.AimTo evaluate the acceptability and feasibility of a CBT-based intervention developed for adolescents with DG/PG, which can be delivered in routine psychiatric care facilities.MethodsAdolescents who were patients at a child and adolescent psychiatry service were screened for DG/PG. Those aged 12–17 years with pronounced symptoms were invited to participate in a 7-week CBT program called Relapse Prevention. Nine adolescents agreed to participate and five consented to repeated assessments of outcome (pre-, post-treatment, and 6-month follow-up). In addition to acceptability and satisfaction with treatment, symptoms of DG were assessed with standardized interview and self-report measures.ResultsThere were no dropouts from the treatment. Participants who completed treatment and all outcome assessments reported satisfaction with the treatment. The participants showed fewer symptoms of DG after treatment, and the proportion who met criteria for computer game addiction decreased from 56 to 0%. There was no reduction in the number of participants who met criteria for PG.ConclusionThis study provides preliminary evidence for the acceptability and feasibility of a CBT-based intervention for DG/PG in adolescents. Preliminary data suggest that the treatment may be effective for DG but not PG. Further studies are needed to evaluate the efficacy of this approach for both conditions.

Voter Support for Offering Sexual Health Services through School-Based Health Clinics

School-based health clinics (SBHCs) offer convenient, free, and much-needed health services to adolescents who have been shown to lack access to preventative care and treatment. With high rates of risky sexual behavior and associated negative health outcomes, SBHCs are particularly effective in providing sexual health services. This article presents results of a survey assessing support for such services through SBHCs. Data were collected using computer-assisted telephone interviewing (CATI) software. With significant differences found for each demographic variable assessed, findings document that the majority of participants supported offering all four sexual health services in both middle and high schools: STI/HIV testing, STI/HIV treatment, pregnancy testing, and providing condoms. These findings may be used to reduce barriers in providing SBHCs, advocate for policy change regarding SBHCs, add or expand current SBHCs, and support others in conducting similar studies hoping to document local support to implement these and other sexual health services. Although limited research shows that using local data can impact policy and facilitate local change, more studies are needed to explore the impact of using local data to implement change and further evaluate the impact of sexual health services through SBHCs.

The Adolescent Experience of Filling Prescriptions for the Treatment of Sexually Transmitted Infections

To describe adolescents' experience with treatment adherence when prescribed antibiotics for sexually transmitted infections (STIs) in emergency departments (ED). Adolescents diagnosed with STIs in two EDs and prescribed outpatient treatment were interviewed to identify barriers and facilitators to treatment adherence. Of 26 participants, 46.2% filled their prescriptions, 38.5% returned to the ED for treatment, 7.7% received treatment elsewhere, and 7.7% received no treatment. All adolescents who filled their prescriptions notified caregivers of their diagnosis, compared with 50.0% who returned to the ED (P=0.01). Adolescents identified cost, transportation, lack of insurance card, and lack of knowledge as perceived barriers to treatment adherence. Less than half of the participants were interested in school-based health clinics due to anonymity concerns. Most expressed interest in using mobile health (mHealth) to overcome adherence challenges. Adolescents identified multiple barriers to treatment adherence. Future work should explore the role of caregiver communication and incorporation of mHealth.

Improved asthma outcomes among at-risk children in a pharmacist-led, interdisciplinary school-based health clinic: A pilot study of the CAReS program

BackgroundDisparities in access to care and outcomes have been identified among children with asthma living in underserved communities. The Caring for Asthma in our Region’s Schoolchildren program was established to reduce disparities by providing school-based, comprehensive asthma care by a pharmacist-led, interdisciplinary team to high-risk pediatric populations in the Greater Pittsburgh area. ObjectiveTo investigate program impact on follow-up appointment attendance, delivery of guideline-based care, asthma control, asthma morbidity (emergency department [ED] visits, oral corticosteroid [OCS] requirement), and asthma-related knowledge and quality of life. MethodsThe study enrolled 50 children with asthma from 6 elementary schools (September 2014-December 2017). Children completed 5 visits over a 3-month period. McNemar’s test assessed improvement in guideline-based controller therapy use and reduced morbidity (ED visits or OCS requirement). Generalized estimating equation analyses determined the significance of monthly improvements in asthma control, asthma knowledge, and quality of life. ResultsA 100% show rate was achieved in nearly all participants (92.0%). Most of the patients were African-American (56%). In children with persistent disease, only 21.4% were prescribed controller therapy at baseline, which improved to 78.5% upon enrollment (P < 0.05). Asthma control statistically significantly improved (P < 0.05), and a reduction in percentage of patients who required an ED visit or an OCS burst pre-to postintervention was also statistically significant (31.3% vs. 14.6%, P < 0.05). The goal of 100% treatment plan knowledge was achieved in 67% of caregivers within 1 month and increased from 6% to 60% in children over 3 months (P < 0.05). Asthma-related quality of life also improved statistically significantly pre-to postintervention (P < 0.05). ConclusionsDisparities in asthma outcomes owing to inadequate access to health care can be addressed. Improved asthma control, asthma medication knowledge, quality of life, and reduced morbidity in high-risk pediatric patients are achievable as demonstrated by our study. Our findings support the feasibility and value of a pharmacist-led, interdisciplinary school-based health care delivery model in providing comprehensive asthma care to at-risk pediatric populations.

SCHOOL’S OUT: WHAT HAPPENED TO SCHOOL-BASED MENTAL HEALTH SERVICES (SBMHS) IN THE COVID-19 ERA?

Prior to the COVID-19 pandemic, over 90% of students in the United States attended “brick and mortar” public schools (PS). The reach of PS has facilitated school-based mental health services (SBMHS). In March 2020, schools closed abruptly and students transitioned to virtual learning. Numerous studies indicate a surge in child mental illness (CMI) during COVID-19 with an increase in the need for SBMHS. This Clinical Perspectives examines the impact of COVID-19 on the functioning of SBMHS in 4 states and nationally. After the panel introduction, the impact of COVID-19 on children’s mental health (CMH) and mechanisms to identify at-risk children will be briefly reviewed by Shirley Alleyne, MB, BS, and David Pruitt, MD. Next, each presenter will describe the impact of COVID-19 on SBMHS in their state, focusing on adaptations in the services offered and delivery methods, changes in SBMHS referral and attendance rates, and treatment outcomes. The presentations include: Dr. Alleyne, Quantum Leap: The Metamorphosis of a School-Based Mental Health Clinic in the COVID-19 Era; Brandon Johnson, MD, Supporting Our Most Vulnerable: The Pandemic's Impact on School-Based Day Treatment and LGBTQ Teens; Erika Ryst, MD, Flexible Adaptation of School Psychiatry Consultation to Meet the Needs of Schools During COVID-19; and Kristie Ladegard, MD, Sustaining the Mental Health of Our Youth: The Rapid Adaptation of School-Based Health Clinics During COVID-19. They will share recommendations to optimize SBMHS during periods of crisis. Participants will share their experiences with COVID-19 SBMHS. Sharon Hoover, PhD, will synthesize the presentations, reflecting on national changes in the delivery of SBMHS during COVID-19 and implications for future policy. The panel will then hold a Q&A session. SBMHS is essential to identifying and treating CMI during the COVID-19 pandemic. The use of telehealth and other innovative measures facilitated continuity of SBMHS with a decline in access to external CMH services. SBMHS referral and attendance rates varied across states with some common trends. COVID-19 has reinforced the critical importance of SBMHS to CMH. Concurrently, when a school is closed, its unique strength (being school-based) becomes its Achilles' heel. Policy considerations are necessary to maintain SBMHS during national crises, when its need is greatest.

7.1 QUANTUM LEAP: THE METAMORPHOSIS OF A SCHOOL-BASED MENTAL HEALTH CLINIC IN THE COVID-19 ERA

School-based mental health clinics (SBMHCs) are an excellent source of continuous child mental health (CMH) care for children with severe emotional dysregulation (SED). These clinics negate the multiple hurdles that families must navigate in accessing CMH care and afford direct input from the school’s educational and therapeutic staff. The University of Florida School Psychiatry Program (UFSPP) is a mobile SBMHC servicing children with SED in Florida. This presentation will examine the rapid changes made to sustain the UFSPP and school-based mental health services (SBMHSs) in Florida during the COVID-19 pandemic.

Attendance of an Initial Follow-up Visit after Long-Acting Reversible Contraception Insertion and Method Continuation Among Adolescents and Young Adults: A Retrospective Study.

To assess attendance of an initial follow-up visit after long-acting reversible contraception (LARC) insertion and whether follow-up was associated with a higher likelihood of method continuation in adolescents and young adults (AYAs). Retrospective chart review including patients receiving LARC (etonogestrel 68mg implant, levonorgestrel 52mg intrauterine device, or copper intrauterine device) between January 1, 2014, and August 1,2017. An urban adolescent center providing primary care and reproductive health services. A total of 331 patients 13-28years of age. Attendance of a follow-up visit 4-8weeks after LARC insertion. Follow-up was defined as visits addressing LARC method or routine physical examinations in the adolescent center or affiliated school-based health clinics. Continuation and discontinuation were defined as documented presence or removal, respectively, of device at various time points. Descriptive analyses, χ2 test, Fisher exact test, t test, and survival analysis were used. Approximately one-third (29.3%) of the patients attended a follow-up visit. Follow-up was associated with a higher likelihood of LARC removal in the first year (hazard ratio [HR]=2.10, 95% confidence interval [CI] 1.33-3.32). At 500days post-insertion and beyond, there was no difference in LARC continuation between AYAs who followed-up and those who did not (HR=1.07, 95% CI 0.67-1.71). Few AYAs attended an initial follow-up visit after LARC placement. These visits were associated with an increased likelihood of LARC removal in the first year; however, this association was not observed long term. More information is needed to determine how to approach follow-up this population.

The Adaptive Effect of Illness-Specific Panic-Fear on Asthma Outcomes in Mexican and Puerto Rican Children

JM Feldman, K Kaur, D Serebrisky, D Rastogi, FF Marsiglia, KJ Arcoleo. J Pediatr . 2019;214:178–186 To assess how illness-specific panic-fear is associated with asthma outcomes over a year period. The study population consisted of 267 Latino patients from age 5–12 years who were recruited from asthma/allergy clinics at 2 inner-city hospitals in the Bronx, New York ( n = 110) and 2 school-based health clinics in Phoenix, Arizona, and Phoenix Children’s Hospital Breathmobile ( n = 157) between June 2010 and October 2013. A number of measures were taken to assess the patients’ asthma symptoms and control. The participants completed the Childhood Asthma Symptom Checklist …

Effectiveness of School Based Health Clinics on Utilization of Sexual and Reproductive Health Services Among School Girls Aged 15-19 Years in Uganda: Cluster Randomized Trial

Background: Sexual and reproductive needs among adolescents remain largely unmet in Uganda, this coupled with poor access and utilization of adolescent sexual and reproductive health services among secondary school girls increases vulnerability to high risk sexual practices and adolescent pregnancy. This study aimed at evaluating the effect of providing school based sexual and reproductive health services on utilization of the services among school girls aged 15-19 years attending secondary schools in Uganda. Methods: The study used Cluster Randomized Controlled Trial (CRCT) design. Twenty secondary schools (clusters) were selected using cluster sampling and allocated 1:1 into control or intervention group stratified by geographical location. 1,182 (average cluster size of 60) girls aged 15-19 years were selected using simple random sampling. The intervention group received tailored Sexual and Reproductive Health (SRH) services information, in-school SRH services delivery and referral for a period of ten months. The control group received no intervention from the research team but had access to the usual public health care. Data was collected at baseline and end of study; descriptive statistics and inferential analysis was done as well as structural equation modeling using SPSS. Results: There was a significant variation in the proportion of school girls who reported receiving more than three services between the control group and intervention group (χ2 = 4.503, p = &lt; 0.001). The findings indicate that the utilization of SRH services was higher (65.4%) among the girls who had access to School Based SRH services (intervention group) compared 34.6% among the girls who had access to services within the public/government health facilities (control group). Conclusion: Provision of School Based SRH services is an effective intervention for improving utilization of sexual and reproductive health services among school going adolescents. This is key in addressing the SRH needs of adolescents and promoting safe sexual practices.

Supporting Adolescents and Young Adults Exposed to or Experiencing Violence During the COVID-19 Pandemic

Supporting Adolescents and Young Adults Exposed to or Experiencing Violence During the COVID-19 Pandemic

Prevalence of asthma at a school-based health clinic in Nicaragua.

Worldwide, it is estimated that 235-334 million people have been diagnosed with asthma. In Nicaragua, the current asthma rate for children 13-14 years of age was 15.2%. The purpose of this study was to determine the prevalence of asthma at this school-based health clinic in Managua, Nicaragua, associated symptoms or diseases, determine asthma classification, medications, and hospitalization rates. A retrospective chart review was performed on all pediatric patient's medical records seen in the clinic during a 5-day period (n = 105). A total of 23 patients (21.9%) had asthma documented in the medical chart and were included in the analysis. Of the 23 patients, 3 (13%) patients were classified with intermittent asthma while the rest of the patients (87%) were not classified. Albuterol was prescribed for 19 (86%) of the patients with two patients who had both albuterol and QVAR® prescribed. Six (26%) patients had a family history of asthma. This study demonstrated the prevalence of asthma in school-aged children in Nicaragua is significant and higher than previously reported. The lack of a classification of asthma prevents patients from potentially being treated appropriately.

180. Reaching Students Where they Learn- A Model School-Based Health Clinic and How a Health-Care Education Partnership Can Facilitate Investigations to Improve Teen Health

Describe a residency training program’s model for a healthcare-education sector partnership, how our work with schools achieves residency, school and community goals, and how we are able to use our partnership to conduct new investigations that further these goals. We will share findings from two current investigations at the school based clinic at Southwest High School. The first is a health improvement assessment that evaluates student demographics, social support, childhood experiences, school clinic utilization, and clinic satisfaction. The second is a feasibility assessment for use of an adverse childhood experience (ACE) survey.

Factors associated with using alternative sources of primary care: a cross-sectional study

BackgroundMobile (MHCs), Community (CHCs), and School-based health clinics (SBHCs) are understudied alternative sources of health care delivery used to provide more accessible primary care to disenfranchised populations. However, providing access does not guarantee utilization. This study explored the utilization of these alternative sources of health care and assessed factors associated with residential segregation that may influence their utilization.MethodsA cross-sectional study design assessed the associations between travel distance, perceived quality of care, satisfaction-adjusted distance (SAD) and patient utilization of alternative health care clinics. Adults (n = 165), child caregivers (n = 124), and adult caregivers (n = 7) residing in New Orleans, Louisiana between 2014 and 2015 were conveniently sampled. Data were obtained via face-to face interviews using standardized questionnaires and geospatial data geocoded using GIS mapping tools. Multivariate regression models were used to predict alternative care utilization.ResultsOverall 49.4% of respondents reported ever using a MCH, CHC, or SBHC. Travel distance was not significantly associated with using either MCH, CHC, or SBHC (OR = 0.91, 0.74–1.11 p > .05). Controlling for covariates, higher perceived quality of care (OR = 1.02, 1.01–1.04 p < .01) and lower SAD (OR = 0.81, 0.73–0.91 p < .01) were significantly associated with utilization.ConclusionsProvision of primary care via alternative health clinics may overcome some barriers to care but have yet to be fully integrated as regular sources of care. Perceived quality and mixed-methods measures are useful indicators of access to care. Future health delivery research is needed to understand the multiple mechanisms by which residential segregation influences health-seeking behavior.

Explanatory Model for Asthma Disparities in Latino Children: Results from the Latino Childhood Asthma Project.

BackgroundLittle research has been conducted that integrates, in one explanatory model, the multitude of factors potentially leading to disparities among Latino children.PurposeA longitudinal, observational study tested an explanatory model for disparities in asthma control between Mexican and Puerto Rican children with persistent asthma requiring daily controller medication use.MethodsMexican and Puerto Rican children aged 5–12 years (n = 267) and their caregivers (n = 267) were enrolled and completed interviews and child spirometry at baseline and 3, 6, 9, and 12 months postenrollment. A 12 month retrospective children’s medical record review was completed. Participants were recruited from two school-based health clinics and the Breathmobile in Phoenix, AZ, and two inner-city hospital asthma clinics in the Bronx, NY.ResultsStatistically significant differences in the social/contextual predictors of asthma illness representations (IRs) were noted between Mexican and Puerto Rican caregivers. The structural equation model results revealed differences in asthma control over time by ethnicity. This model accounted for 40%-48% of the variance in asthma control test scores over 12 months. Caregivers’ IRs aligned with the professional model of asthma management were associated with better children’s asthma control across 1 year. These results also supported the theoretical notion that IRs change over time impacting caregivers’ treatment decisions and children’s asthma control.ConclusionsThese findings extend a previous cross-sectional model test using a more comprehensive model and longitudinal data and highlight the importance of considering within-group differences for diagnosis and treatment of children coming from the vastly heterogeneous Latino umbrella group.Trial RegistrationTrial number NCT 01099800

Development of a School-Based Substance Treatment Model

The objective of this study was to develop a school-based substance treatment model and evaluate the feasibility and preliminary outcomes of treatment in a school-based setting to improve access to treatment for adolescents with substance use disorders. This study provided care to 41 youths (12 to 18 years old) in three school-based health clinics. The intervention consisted of 12 weeks of individual motivational interviewing, acceptance and commitment therapy, contingency management with urine drug screens, medication-assisted therapy, family sessions, and case management. Feasibility outcomes included the number of sessions attended, the Session Rating Scale, and qualitative feedback from patients (N = 41), therapists (N = 3), and a school principal. Preliminary treatment outcomes included the Timeline Followback Interview, a modified Outcome Rating Scale, and a questionnaire of school engagement. The average number of sessions completed was 7.4 (SD = 3.6), and the average Session Rating Scale score was 38.2 (0 = minimum alliance, 40 = maximum alliance). Qualitative interviews provided feedback to adapt the treatment model further. Youths reported significant pre-post improvements in emotional wellness, school engagement, and substance use. This study produced a school-based substance treatment model that is well-received by patients, demonstrated feasibility, showed positive preliminary outcomes, and is ready for further clinical testing.