School Screening Research Articles

Adolescent Suicide Risk Screening: A Secondary Analysis of the SHIELD Randomized Clinical Trial

To evaluate the effectiveness of adolescent suicide risk screening to increase initiation of mental health services via a secondary analysis using data from the SHIELD (Screening in High Schools to Identify, Evaluate and Lower Depression) randomized clinical trial, which evaluated school-based screening for major depressive disorder (MDD). Students in 14 Pennsylvania high schools were randomized by grade to either the usual school practice of targeted referral for behavior raising a concern for suicide risk or universal screening using the Patient Health Questionnaire-9 (PHQ-9), with any response >0 to item 9 regarding suicide risk considered positive. Students identified in either arm were referred to the Student Assistance Program (SAP), which is mandated in all Pennsylvania schools. The SAP determined follow-up. Study groups were compared using mixed-effects logistic regression. The participants comprised 12 909 students, with 6473 (50.1%) randomized to universal screening. The study group was 46% female and 43% Hispanic or non-Hispanic Black. Adolescents in the universal screening arm had 7.1-fold greater odds (95% CI, 5.7-8.8) of being identified as at risk for suicide, 7.8-fold greater odds (95% CI, 4.6-13.1) of follow-up needs, and 4.0-fold greater odds (95% CI, 2.0-7.9) of initiating mental health treatment. Although the PHQ-9 is a MDD screening tool, its use in universal screening increased identification and treatment initiation for adolescents at risk for suicide. This confirms the value of universal screening and suggests that a suicide-specific risk assessment would have even greater impact on treatment initiation for identified youth. ClinicalTrials.gov: NCT03716869.

Exploring Views and Professional Learning Needs of Comprehensive, Integrated, Three-Tiered (Ci3T) Leadership Teams Related to Universal Behavior Screening Implementation.

Research conducted to date has highlighted barriers to initial adoption of universal behavior screening in schools. However, little is known regarding the experiences of those implementing these procedures and there have been no studies conducted examining the experiences of educators in different stages of implementing various tiered systems of supports. Universal screening is foundational to a successful Comprehensive, Integrated Three-Tiered (Ci3T) model of prevention—an integrated tiered system addressing academics, behavior, and social and emotional well-being. Therefore, the perspectives of Ci3T Leadership Team members at different stages of Ci3T implementation were solicited through an online survey that sought to understand (1) current school-based screening practices and (2) individual beliefs regarding those practices. A total of 165 Ci3T Leadership Team members representing five school districts from three geographic regions across the United States, all of whom were participating in an Institute of Education Sciences Network grant examining integrated tiered systems, reported the screening procedures were generally well-understood and feasible to implement. At the same time, results highlighted continuing professional learning may be beneficial in the areas of: (1) integrating multiple sources of data (e.g., screening data with other data collected as regular school practices) and (2) using those multiple data sources to determine next steps for intervention. We discuss educational implications, limitations, and directions for future inquiry.

School and non-school day screen time profiles and their differences in health and educational indicators in adolescents.

Sedentary behavior and screen-based devices in particular have been negatively associated with a wide range of health and educational indicators. However, few have examined these relationships separately for school days and non-school days, and none have used a person-centered approach. This study aimed to identify school and non-school day screen time profiles, as well as examine possible differences in health indicators (physical fitness, fatness, physical activity, sleep duration, and Mediterranean diet) and academic performance. This study involved the participation of 1573 Spanish adolescents aged 12-16 years (54.73% girls). Academic performance was measured through grades in Mathematics, Language, English, and Physical Education. Physical fitness was measured through a battery of tests (cardiorespiratory fitness was measured using the 20 m shuttle run test, and muscular strength with both handgrip and standing long jump tests), while fatness (skinfold thicknesses) was assessed with calipers. Finally, physical activity, screen time, sleep duration, and adherence to the Mediterranean diet were measured using self-reported questionnaires. Hierarchical cluster analyses based on square Euclidian distances and Ward's method were performed based on daily minutes of screen time recorded on school and non-school days. We identified four clusters labeled and described as: (1) "High-high": highest screen time on school and non-school days; (2) "High-low": high screen time on school days and low screen time on non-school days; (3) "Low-high": low screen time on school days and high screen time on non-school days; (4) "Low-low": lowest screen time on school and non-school days. Adolescents who belonged to the "High-high" profile had worse health-related behaviors (i.e., physical activity, sleep duration, and adherence to Mediterranean diet) and academic performance than most other profiles, while adolescents who belonged to "Low-low" profile showed the opposite pattern. Adolescents in the "Low-high" profile had a higher sleep duration on school days and better academic performance than those in the "High-low" profile. No differences in body fat, cardiorespiratory fitness, and muscular strength were found between the four different profiles. The results suggest that adolescents who accumulated a large amount of screen time on school and non-school days reported worse health-related behaviors and academic performance. Moreover, adolescents who had high screen time on school days reported only a short sleep duration on school days and worse academic performance than on non-school days. Conducting interventions to reduce screen time in these four profiles, particularly in the groups of students with more screen time on school days, becomes essential to improving adolescents' healthy lifestyles and academic performance.

Grey areas in community-based research with rural Alaska Native partners

In The Lancet Global Health, Susan Emmett and colleagues present compelling evidence in favour of mobile health screening for hearing loss in rural children and the effectiveness and economic value of telemedicine referral to improve access to specialty follow-up care.1 The cluster-randomised trial was conducted in 15 rural communities populated almost entirely by Alaska Native people. Telemedicine referral more than doubled the percentage of children who received medical follow-up within 9 months compared with standard primary care referral (68·5% vs 32·1%); mobile health screening outperformed standard school screening for detecting possible hearing impairment; and both mobile health screening and telemedicine referral were extraordinarily cost-effective.

Mobile health school screening and telemedicine referral to improve access to specialty care in rural Alaska: a cluster- randomised controlled trial

School-based programmes, including hearing screening, provide essential preventive services for rural children. However, minimal evidence on screening methodologies, loss to follow-up, and scarcity of specialists for subsequent care compound rural health disparities. We hypothesised telemedicine specialty referral would improve time to follow-up for school hearing screening compared with standard primary care referral. In this cluster-randomised controlled trial conducted in 15 rural Alaskan communities, USA, we randomised communities to telemedicine specialty referral (intervention) or standard primary care referral (control) for school hearing screening. All children (K-12; aged 4-21 years) enrolled in Bering Straight School District were eligible. Community randomisation occurred within four strata using location and school size. Participants were masked to group allocation until screening day, and assessors were masked throughout data collection. Screening occurred annually, and children who screened positive for possible hearing loss or ear disease were monitored for 9 months from the screening date for follow-up. Primary outcome was the time to follow-up after a positive hearing screen; analysis was by intention to treat. The trial was registered with ClinicalTrials.gov, NCT03309553. We recruited participants between Oct 10, 2017, and March 28, 2019. 15 communities were randomised: eight (750 children) to telemedicine referral and seven (731 children) to primary care referral. 790 (53·3%) of 1481 children screened positive in at least one study year: 391 (52∤1%) in the telemedicine referral communities and 399 (50∤4%) in the primary care referral communities. Of children referred, 268 (68·5%) in the telemedicine referral communities and 128 (32·1%) in primary care referral communities received follow-up within 9 months. Among children who received follow-up, mean time to follow-up was 41·5 days (SD 55·7) in the telemedicine referral communities and 92·0 days (75·8) in the primary care referral communities (adjusted event-time ratio 17·6 [95% CI 6·8-45·3] for all referred children). There were no adverse events. Telemedicine specialty referral significantly improved the time to follow-up after hearing screening in Alaska. Telemedicine might apply to other preventive school-based services to improve access to specialty care for rural children. Patient-Centered Outcomes Research Institute.

Various Risk Factors of Overweight and Obesity among Children Aged 5-16 Years.

To determine the determinants of overweight and obesity among children aged 5-16 years. Descriptive study. Emergency and Outpatient Department of National Institute of Child Health, from October 2020 till July 2021. All children of either gender ranged between 5 and 16 years were enrolled. Children with ≥85 and <95 percentile were labeled as overweight and ≥95 percentile as obese. Other determinants like physical factors, high screen time, and environmental factors were noted. Frequency and percentages were computed for gender, residence, overweight, obesity, and physical and environmental factors. Mann-Whitney U-test was applied to determine the median difference of quantitative variables between overweight/obese and healthy children. The comparison was done to see the association of the presence of overweight/obesity with respect to the baseline characteristics. Binary logistic regression analysis was also applied. Of 184 children, 99 (53.8%) were males and 85 (46.2%) females. The median age was 9 (7-12) years. There were 25 (13.6%) overweight and 80 (43.5%) obese children. In combination, the frequency of overweight/obesity was found to be 105 (57.1%). After adjusting for other covariates, the odds of overweight and obesity were significantly higher for children with age ≤9 years (adjusted OR: 3.40, 95% CI: 1.51-7.66) and male gender (adjusted OR: 3.95, 95% CI: 1.80-8.68). However, lower odds of overweight/obesity were observed among children with low physical activity at school (adjusted OR: 0.31, 95% CI: 0.14-0.66) and low screen time (≤4 hours) (adjusted OR: 0.24, 95% CI: 0.11-0.55). Children aged 5 to 16 years had a much greater frequency of overweight and obesity. Factors such as younger age, male gender, lower physical activity, and high time screen have been demonstrated to contribute significantly. Children, Obese, Overweight, Risk factors, Pakistan.

HYPERTENSIVE HEART DISEASE IN ADOLESCENCE. PRELIMINARY RESULTS OF THE PESESCAD-HTA STUDY

Objective: Identify the presence of hypertensive heart disease and its relationship with prehypertension and hypertension Design and method: A descriptive, cross-sectional study was carried out in 385 prehypertensive adolescents and 128 adolescents with essential hypertension, aged 12–15 years, from among a total of 1,545 adolescents screened in the School Screening for High Blood Pressure in Adolescents Project (PESESCAD-HTA). An echocardiogram was performed in 513 adolescents (prehypertensive plus hypertensive). For the multivariate analysis of risk factors related to LVH, a decision tree was obtained using the chi square automatic interaction detector (CHAID) technique. Results: Among prehypertensive and hypertensive adolescents, the prevalence of left ventricular hypertrophy was 6.49% (CI = 4.43–9.41) and 21.09% (CI = 14.92–58.95), respectively. In the sample of 513 individuals with prehypertension and hypertension, a decision tree was designed, using the chi square automatic interaction detector (CHAID) technique, with the presence of left ventricular hypertrophy as the dependent variable. Conclusions: The best predictors of left ventricular hypertrophy were a family history of obesity, and its interaction with the age and the sex of the adolescent.

Tuberculosis, focussed tools and the right schools: estimated impact and cost of a targeted student screening programme for tuberculosis infection.

The World Health Organization (WHO) recommends targeted screening for latent tuberculosis infection (LTBI) among high-risk populations. Recent studies that evaluate targeted school-based programmes in low burden settings are scarce. To evaluate a school screening programme for recently arrived migrant students from moderate and high tuberculosis (TB) burden countries and estimate (1) the number of cases of active TB that were prevented and (2) the cost per case of active TB prevented. Students were screened with tuberculin skin tests (TST) at schools with a high migrant population intake. Those with positive results were referred for specialist evaluation. Outcomes were retrospectively assessed using 5 years of prospectively collected data. Cost data were collected. Main outcomes measured were the number of children were diagnosed with LTBI who completed treatment, and programme costs. Of 4728 student screened, 295 (6.2%) were diagnosed with LTBI. Of these, 273 (92.5%) were offered preventive therapy, 242 (82.0%) commenced and 204 (69.2%) completed therapy. The number needed to screen (NNS) was 23 per completed course of preventive treatment for LTBI. Assuming a 10% lifetime risk of reactivation, the NNS was 386 per case of TB disease notification avoided. The cost of screening was A$23 932 per case of TB disease avoided. This TB strategy is supported by the high rate of TB infection in the student group, the treatment uptake and completion rates. Cost-benefit is linked with lifetime risk of TB reactivation. Targeted school screening programmes represent an important opportunity for TB control in low-burden settings.

Workplace interventions to reduce the risk of SARS-CoV-2 infection outside of healthcare settings.

Workplace interventions to reduce the risk of SARS-CoV-2 infection outside of healthcare settings.

Demographic characteristics and ocular needs of children attending child eye clinics in Cross River State, Nigeria: a retrospective analysis of clinical records

ObjectivesTo describe the demographic characteristics and ocular needs of children attending four child eye clinics in Cross River State, Nigeria, to inform the development of a sustainable spectacle cross-subsidisation scheme.DesignRetrospective...

Musculoskeletal Evaluation of Preschool Children Referring to the School Screening Center

Background: One of the biggest global challenges of the 21st century is the increasing burden of non-communicable (chronic) diseases. Objectives: Considering the high prevalence of systemic and musculoskeletal diseases and the need for further epidemiological studies to provide health programs, we conducted this research. Methods: In this cross-sectional study, a total of 344 primary school children referred to the East Tehran Health Center and examined during a certain period of the autumn of 2019 were enrolled. Demographic information and history of systemic diseases were collected using a questionnaire. Height and weight measurements and feet and spine examinations were performed by the researcher. Results: In summary, 50.3% were girls, and 49.7% were boys. In terms of body mass index (BMI), 10.2% were underweight, 70.3% were normal, 10.8% were overweight, and 8.7% were obese. The highest prevalence of diseases was obesity (8.7%), followed by musculoskeletal diseases (8.1%), which included only the flatfoot. Conclusions: Screening programs are recommended from an early age to prevent diseases. To reduce the rate of musculoskeletal disorders and obesity in children, identifying and following them in the early stages of the disorders is recommended for early diagnosis and appropriate treatment.

Parents’ and Teachers’ Knowledge of Trauma and Post-Traumatic Stress Disorder in Children and Adolescents and Their Agreement Towards Screening

BackgroundTrauma exposure is common in children and adolescents. Parents and other key adults, such as teachers, are necessary to facilitate help-seeking behavior, which involves recognizing trauma and adverse reactions and awareness of accessing treatments. Where screening measures in schools are used to detect post-traumatic stress disorder (PTSD), the attitudes of parents and teachers towards screening need to be considered.ObjectiveTo examine whether parents and teachers can accurately detect trauma events, symptoms and effective treatments. In addition, to assess how supportive parents and teachers are towards PTSD screening in schools.MethodA total of 439 parents and 279 teachers completed online questionnaires assessing PTSD knowledge across three domains: traumatic events, PTSD symptoms and evidence-based treatments. Responses of acceptability of using PTSD screening tools in schools were elicited.ResultsTeachers and parents were accurate in recognizing trauma events and PTSD symptoms. However, understanding was inclusive, with events not considered traumatic and non-PTSD diagnostic criteria being endorsed. Trauma-Focussed Cognitive-Behavioral Therapy was recognized as an effective treatment for PTSD, but Eye-Movement Desensitization and Reprocessing was not. Treatments not recommended by health guidelines were frequently endorsed. The majority of participants were supportive of PTSD screening in schools, but a minority were not.ConclusionsParents and teachers are able to recognize trauma events and symptoms of PTSD, although this tends to be overly inclusive. Schools could be targeted to promote understanding trauma among parents and teachers. Agreement with screening is encouraging and further research is warranted to understand barriers and facilitators.

The sexual and reproductive health needs of school-going young people in the context of COVID-19 in rural KwaZulu-Natal, South Africa

Background: The impact of school closures due to COVID-19 raised widespread concerns about children’s health and well-being. We examine the impact on the sexual health needs of learners in the context of COVID-19 related lockdowns in rural KwaZulu-Natal, South Africa. Methods: In july–November 2020 and August–November 2021 we conducted 24 in-depth interviews and 8 group discussions with teachers and learners from 4 schools, community members and key education stakeholders. All interviews were conducted by telephone. We used a thematic analysis approach and Nvivo 12 software to manage the data. Results: Four main themes related to the COVID-19 pandemic emerged from the data: the sexual and reproductive health (SRH) of learners in the lead-up to the pandemic; the impact of COVID-19 on learners’ SRH and wellbeing; the opportunities schools provided to support sexual well-being of learners during the pandemic; and the role of schools in supporting SRH for learners during the pandemic. Learners and stakeholders reported that the SRH of young people was affected by alcohol misuse, poor SRH knowledge and few pathways to link learners with services. Stakeholders working with schools reported that a lack of access to biomedical interventions (e.g., contraception) increased learner pregnancies. Gender-based violence in learners’ households was reported to have increased during the COVID-19 pandemic related to loss of income. School closures disrupted the provision of a safe space to provide SRH and HIV-education through Life Orientation lessons and school nurse talks. This loss of a safe space also left learners vulnerable to sexual and physical violence. However, once schools re-opened, daily COVID-19 screening in schools provided the opportunity to identify and support vulnerable children who had other social needs (food and uniforms). Conclusion: The COVID-19 pandemic may have increased SRH needs and vulnerability of school-going children in a high HIV-burden rural setting. School shutdowns reduced the opportunity for schools to provide a vital safe space and information to enhance SRH for adolescents. Schools play a vital health promotion and social protection role.

Parental Views Regarding Distance Learning of Primary School Children and Screen Time during the Covid-19 Pandemic Process

This research aims to explore the views of parents regarding primary school students’ distance education experiences, the difficulties they face, the support they need in this process, and their screen time during the COVID-19 pandemic period during which face-to-face education was suspended and distance education was started. The sample of the study consisted of 400 parents whose children were attending primary school. An online questionnaire was used as a data collection tool. Findings showed that children had difficulty in completing the given learning activities during distance education, and they needed adult support to complete these activities. In general, the participants stated that they were satisfied with the given instruction during the distance education process, but they wanted make-up lessons. It was observed that schools carry out educational activities with simultaneous collective lessons during distance education, and most of the difficulties children faced were caused by a lack of interest and resources. Finally, it was investigated that most of the primary school children spend more than 2 hours a day in front of the screen without parental supervision in this process. At the end of the research, some suggestions were offered such as planning the instructional activities more appropriately by making use of the experiences gained during the pandemic, developing effective learning materials by improving the digital knowledge and skills of teachers, and providing various pieces of training for parents.

Letter to the Editor for the article "20-year follow-up study of celiac patients identified in a mass school screening: compliance to gluten-free diet and autoimmunity".

Letter to the Editor for the article "20-year follow-up study of celiac patients identified in a mass school screening: compliance to gluten-free diet and autoimmunity".

Prevalence of risk factors for obesity, diabetes mellitus and hypertension in high school children and screening of high-risk children for glycosuria: A cross-sectional study in Dharwad District, India

Background: India is currently undergoing a demographic and epidemiological transition leading to the occurrence of hypertension and type 2 diabetes, which were once considered as disease of the elderly among the adolescents. Methods: A cross-sectional study was conducted in Dharwad district, Karnataka, including 1600 students between 11–17 years age group, across both private and government schools located in both rural and urban areas; information on socio-demographic variables, physical activity, dietary habits, substance abuse, and family history of hypertension, diabetes mellitus and level of stress among participants was collected. Anthropometric measurements were taken, blood pressure was measured, general physical examination was done to look for signs of insulin resistance. Urine was examined for the presence of glucose using urine glucose strips in overweight children with ≥2 risk factors (American Diabetes Association criteria for children). Results: Prevalence of overweight/obesity was 4.6% and hypertension was 14.8%. Multivariate logistic regression done for variables found significant in univariate analysis on comparison of risk factors between overweight and normal children showed higher odds for family h/o diabetes (OR = 1.14, CI: 0.58–2.23), private school (OR = 1.5, CI: 0.75–2.96), high socio-economic status (OR = 2.0, CI: 0.95–4.30), hypertension (OR = 2.0, CI: 0.95–4.30) and acanthosis nigricans (OR = 219, CI: 71.49–672.42) among overweight and for variables found significant in univariate analysis on comparison of risk factors between hypertensives and normotensives showed higher odds for inadequate sleep (OR = 1.4, CI: 1.00–1.87), private school (OR = 1.32, CI: 0.96–1.81), high SES (OR = 1.43, CI: 0.95–2.14), psychological stress (OR = 1.97, CI: 1.42–2.73) and obesity (OR = 6.98, CI: 3.75–12.98). Conclusions: Health education on healthy diet consumption and physical activity, BMI calculation and tracking of blood pressure should be integrated into school health programs.

Potential for Use of Portable Ultrasound Devices in Rural and Remote Settings in Australia and Other Developed Countries: A Systematic Review.

IntroductionPoint of care ultrasound (POCUS) has become more common for rapid evaluation. Applications are limited by lack of training of users, difficulty maintaining ultrasound competencies, access to equipment for optimal imaging, and limitations in quality control. Such barriers exist in low-resource, underserved health care settings.ObjectiveThe aim was to explore the use of POCUS in under-resourced health care settings, such as rural and remote locations in Australia and other countries. Key variables include health outcomes, quality of care, service availability, examinations types performed, equipment used, who performs the examinations, and the ultrasound training received.MethodsLiterature was identified via CINAHL, Cochrane, Embase, Medline, PubMed, SCOPUS, and Web of Science, plus grey literature. Recommended guidelines were followed, and only research-based articles were included, with searches limited to English language and 2010–present.ResultsAfter screening, 23 articles were reviewed. No studies had low risk of bias and, overall, the quality was poor and only two studies used random sampling. The majority were from developing countries, with only one performed in Australia. Echocardiographic screening in schools was common. Others included emergency department (ED) patients, abdominal aorta screening, obstetric scans, and intensive care unit (ICU) management. Operators included ED doctors, medical students, nurses, community healthcare workers and general practitioners, who received limited training in protocol-driven scanning, often monitored by experts. In comparison to clinical assessment, standard ultrasound or other imaging, accuracy was of the order of 70–95%, depending on the condition, with high efficacy in improving patient care.ConclusionLack of studies of POCUS in Australia and other developed countries suggests a need for further research. Current evidence supports use of limited ultrasound using portable machines in locations with limited access to diagnostic ultrasound performed by sonographers, which has the potential to improve health outcomes in under-resourced communities in Australia and elsewhere.

Screening in schools: the acceptability and feasibility of guidance counsellors using YouthCHAT

ABSTRACT The acceptability to, and feasibility of, guidance counsellors using YouthCHAT to screen New Zealand secondary school students for mental health issues and risky health behaviours was investigated. Participants were eight guidance counsellors using YouthCHAT in two schools. Over eight months, School A implemented a systematic school-wide screening programme, screening 43% of their student body, whereas School B adopted an opportunistic screening approach, screening <1%. Semi-structured interviews were conducted with guidance counsellors, and data were analysed using a general inductive approach. All participants reported YouthCHAT an acceptable tool; however, while it was well used in School A, usage rates were low in School B. With a structured protocol for screening in place, the use of YouthCHAT by guidance counsellors shows promise.

Minimising young children\u2019s anxiety through schools (MY-CATS): protocol for a cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of an online parent-led intervention compared with usual school practice for young children identified as at risk for anxiety disorders

BackgroundIdentifying and supporting young children who are at risk of developing anxiety disorders would benefit children, families, and wider society. Elevated anxiety symptoms, inhibited temperament, and high parental anxiety are established risk factors for later anxiety disorders, but it remains unclear who is most likely to benefit from prevention and early intervention programmes. Delivering an online intervention through schools to parents of young children who have one or more of these risks could maximise reach. The primary aim of this trial is to evaluate the effectiveness and cost-effectiveness of delivering an online parent-led intervention, compared with usual school provision only, for children (aged 4–7) identified as at risk for anxiety disorders on the basis of at least one risk factor. We also aim to identify the characteristics of children who do and do not benefit from intervention and mechanisms of change from the intervention.MethodsThe design will be a parallel group, superiority cluster randomised controlled trial, with schools (clusters) randomised to intervention or usual school practice arms in a 1:1 ratio stratified according to level of deprivation within the school. The study will recruit and randomise at least 60 primary/infant schools in England, and on the basis of recruiting 60 schools, we will recruit 1080 trial participants (540 per arm). Parents of all children (aged 4–7) in sampled Reception, Year 1, and Year 2 classes will be invited to complete screening questionnaires. Children who screen positive on the basis of anxiety symptoms, and/or behavioural inhibition, and/or parent anxiety symptoms will be eligible for the trial. Parents/carers of children in schools allocated to the intervention arm will be offered a brief online intervention; schools in both arms will continue to provide any usual support for children and parents throughout the trial. Assessments will be completed at screening, baseline (before randomisation), 6 weeks, 12 weeks, and 12 months post-randomisation. The primary outcome will be the absence/presence of an anxiety disorder diagnosis at 12 months.DiscussionThe trial will determine if delivering an online intervention for parents of young children at risk of anxiety disorders identified through screening in schools is effective and cost-effective.Trial registrationISRCTN 82398107. Prospectively registered on Jan. 14, 2021.

Exploring the potential of a school-based online health and wellbeing screening tool: professional stakeholders\u2019 perspectives and experiences

BackgroundSupporting children and young people’s (CYP) mental and physical health is a global policy priority but detecting need and facilitating access to health services and support is challenging. This paper explores professional stakeholders’ perspectives of the acceptability, utility and effectiveness of a school-based online health and wellbeing screening tool, the Digital Health Contact (DHC). The DHC, delivered by Public Health School Nurses (PHSN), aims to identify, and put in place strategies to support, unmet health needs among CYP.MethodsWe employed a qualitative study design, using semi-structured interviews. Fourteen key stakeholders involved in the design and implementation of the DHC (commissioners, providers, PHSN and healthcare staff, school leaders) were purposively sampled. Data were analysed thematically.ResultsOur analysis generated two key themes: the perceived benefits of the DHC; and challenges in delivering the DHC. Stakeholders perceived the universal application of the DHC with linked follow-up intervention as an effective means of identifying and supporting CYP with unmet needs, and an efficient way to target limited service resources. There were barriers around enabling school engagement in the DHC, typically in terms of logistics, school infrastructure, and perspectives of fit with schools. These barriers were seen as being negated through developing effective working relationships between schools and PHSN. Effective relationships could highlight the potential benefits of participation. Overall, the DHC was seen as a valuable and effective use of resources, with a low burden on school staff.ConclusionsThe DHC, as a universal school-based health and wellbeing screening tool with linked follow-up intervention, has great potential in identifying and supporting unmet health needs among CYP. The perspectives and experiences of those involved in delivering the DHC highlight important considerations which may enable effective implementation and delivery of school screening programmes across other areas.