- What stakeholders may be needed along the way? Describe the role of each stakeholder, and the questions they may want answered about the intervention. Also briefly describe how a successful intervention would impact that stakeholder, and how an unsuccessful program might impact that stakeholder. Stakeholders may be individuals, groups, or organizations. (20 points)
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| Data on school- level expenditures show that many high poverty schools receive a small amount of state and local funding, which results in students not having access to resources1. These students tend to have limited access to healthcare due to their family situation, family income status, and if insurance plans. Typically families who live in high poverty school districts cannot afford very good insurance which in turn creates difficultly for healthcare options. More than 40% of schools receive federal Title I money. Title I provides financial assistance to local educational agencies and schools that have a high percentage of children from low-income families. For this study, I will be using “Priority Schools” located in Atlanta Georgia. Priority schools are classified as the lowest five percent of Title I schools in regards to academic achievement2. There are more than 60 Atlanta Public schools and DeKalb County schools, elementary, middle and high school, are among those that the Department of Education considers the lowest performing in the state2. The students that make up these priority schools are considered as Black, non-Hispanic, Multiracial and Hispanic. These students are considered disadvantaged and a majority of these students have subsided lunches3. For this study, there will be a mixture of elementary, middle, and high school making up 15 schools in the Atlanta Public School district that will partake in this community guide project. The public health problem is that these students seem to experience worse health and typically don’t have a great heath care system.These students tend to miss more days of school from illness and hunger and then it is difficult for these students to get caught up4. Addressing these obstacles can be so vital to their education and long term health. School-based health centers are created to provide health services to students K-12 and can be offered on the campuses of the schools in this study, or an off campus site. This study will be established in schools that serve the low-income communities. This is needed in these communities because this could be the only health care provider these students have access too and has the capability to improve their personal healthcare but also their knowledge of healthcare. These health centers will include vaccinations, prenatal care for females that are high school aged- post puberty, and information on health risk behaviors. These health centers will also give students an opportunity to partake in extra curriculum activities and begin good healthcare habits that can have an impact on their education and lifestyle.
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Part 2: Intervention Identification
- State and define the intervention strategy – what does it mean? What populations has this strategy been used with? What settings has it been used in? How are your community characteristics similar or different to those of the communities in which the strategy has been effective? (20 points)
The intervention is School-Based Health Centers (SBHC). SBHC’s must provide primary health care and may also include mental health care, social services, dentistry, and health education. This intervention has been used in low-income communities with racial and ethnic minority populations based on evidence of effectiveness in improving educational and heal outcomes, it has been used in Michigan, Denver Colorado and 36 inner city schools across the nation. School based health centers provide health services to students PreK-12th grade. These centers are offered off-site, meaning not on the campus of their schools or on campus. My community characteristics are similar to these of this study because I am using the Atlanta Public School system and within that schools that are considered “Priority Schools” that are located in low-incomes communities where racial and ethnic populations make up the majority of the people in these school districts. According to the task force, low income communities are targeted with hopes of reducing gaps in education and improve health equity. The difference is that I am starting at the elementary level all the way through high school, where this strategy included Pre-K. This intervention will target schools that are below the average for socioeconomic status as well as a racially/ ethically diverse school district. Schools that are greater than 40% diverse will be used in this study.
- Is the strategy recommended by the Task Force? Why or why not? (10 points)
Yes this strategy is recommended by the Task Force. It was recommended because the students in this implementation come from low-income and racial and ethnic minority populations. These students will experience poor health, typically don’t have a consistent place of health care and because of that will miss more days of school. These students are also at risk for hunger, vision and dental issues because of the lack of regular healthcare visits. The results for this task force were High School completion increased, Grade Point Average increased, Immunizations increased, clinical preventive services increased, as well as other sickness-related outcomes were improved.
- Provide at least 3 examples from existing articles (peer-reviewed preferably, but could come from other places). These should be different than the research-tested intervention programs(RTIP) listed already. You can include or link to this information, but you should provide different examples. (45 points total)
- Describe the intervention – what did the authors do? What was the procedure? How long was the intervention? Please describe individual components as well as the broader intervention plan.
- What were the outcomes measured?
- What amount of change did they find?
Article 1: The Impact of School-Based Health Centers on the Health Outcomes of Middle School and High School Students.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920993/
- Intervention- Authors used a prospective cohort design to measure health outcomes annually over a 2 year period by a student self-report. Seven middle schools and nine high school students were recruited from matched schools in Michigan. Five sits contained well-established school based health centers, six sites contained newly implemented SBHC’s and 5 schools that did not have SBHC’s. Comparison sites were matched up on the basis of the percentage of students that received free/ reduced priced lunch, the racial/ ethnic population of the student body and school size. Data was obtained from 744 students in both years of the study. Students who participated completed a self- administered survey called the Child Health and Illness Profile-Adolescent Edition each year.
- Health outcomes were examined in 5 different categories. How satisfied the students were with health, physical discomfort, emotional discomfort, physical activity and nutrition. Nutrition was then divided into healthy eating and unhealthy eating. The authors also examined the differences in the effects of SBHC’s use at the student level depending on gender and grade.
- At year 2, students that used school based health centers experienced greater satisfaction with their health, more physical activity, and greater consumption of healthy food than the students who did not participate in school based health centers. The results discussed were that despite the involvement of SBHCs in school activities, there were no school-level effects on student health outcomes. There were no significant differences in health outcomes among students who attended schools with no SBHCs.
Article 2: School Based Health Centers Found to Improve Access, Quality of Care for Low-Income Adolescents
http://www.healthinschools.org/News-Room/EJournals/Volume-8/Number-7/School-Based-Health-Centers-Found-to-Improve-Access-of-Care.aspx
- Using Denver Public Schools enrollment data and electronic medical chart data and immunization registries from Denver health, researches examined the experiences over a one-year period of a cohort of 14-17 year old high school students who were uninsured or insured by medicaid or the State Children’s Health Insurance Program. This intervention/ study was a one year study. This study was looking at if the SBHCs that were already implemented in Denver were being utilized. In Denver there are 11 SBHC’s 9 community clinics, 2 urgent care centers and a tertiary care hospital with an emergency department. At the time of this specific study school based health centers were in 7 of the 11 Denver public high schools that were considered to have a majority of racial/ ethnic minority students as well as low-income families.
- In the annual report of this study, the Denver School based health center’s said that 94% of students attending a school with a SBHC were enrolled and 35%-60% of them actually used the center during the school year.
- Analyzing these findings from the one- year study, there were differences between the SBHC and the community clinic users. SBHC has higher visit rates for preventive services because there was no charge for the care and the students did not have to need transportation because it was on school grounds and they could go during the school day. School Based Health Centers were also more likely to have users receive an influenza vaccine, a tetanus booster, and a hepatitis B vaccine.
Article 3: Are School Based Mental Health Services Effective? Evidence from 36 Inner City Schools
Armbruster, P. & Lichtman, J. Community Ment Health J (1999) 35: 493. doi:10.1023/A:1018755100381
- The intervention is an university- affiliated children’s psychiatric outpatient clinic implemented a program that provides mental health services in inner city schools. 220 children were compared with a sample served in the urban school where 256 children participated. This school based program was developed as a result of prior studies that identified the urban, minority, disadvantaged, single parent, at risk students. An outpatient psychiatric clinic for children, which provides school based mental health services in 98% of the city’s public schools, they created a study to evaluate and compare the effectiveness of school based services. This intervention happened in 36 inner city schools which receive on site services from therapists from the central clinic. The study was over 11 months from July to June. The two groups were comprised of children and adolescents between 5 and 18 years of age. Both school and clinic groups were assigned Children’s Global Assessment Scale and Global Assessment of Functioning scores.
- The school cases and clinic cases were compared to the total sample in terms of age, gender, and ethnicity. The scores and diagnoses were presented to the multidisciplinary team.
- The results indicate that school based mental health services show improvement comparable to the clinic- based services, and have the potential for bridging the gap between need and utilization by reaching disadvantaged children who would otherwise not have access to these services.
Part 3: Intervention Fit
- Provide a logic model and SMART Objectives for your intervention. You should have a SMART objective for each behavior you anticipate changing. (35 points; 10 points for SMART objectives, 25 points for the logic model)
Smart Objectives:
- Elementary School, middle, as well as high school children in the Atlanta Public School systems will increase healthcare visits by 30% by the end of the intervention period.
- Participants will reduce school days missed by 50% from sickness by using the health clinics by the completion of the intervention.
- Parents/ guardians will have an increased knowledge of health care and the school based health centers through attendance and utilization through a log from the centers
- The attitudes students have towards doctors appointments will be more positive after a survey is given at the end of the intervention.
- 70% of the students parent’s will utilize the school-based health centers by the completion of this intervention
- 3 times a semester, the doctor and clinic nurses will visit the schools the school the health centers are located at to improve relations with students.
It is relevant to the intervention because they whole point was to encourage students to be more in tuned with their health and create a healthier lifestyle and so it should be noted. It will be done with the school based health centers are fully implemented in the schools and each student along with parent/ guardian has been informed about the details and availability of the clinic.
| Inputs/Resources | Activities | Outputs | Short-term Outcomes | Intermediate Outcomes | Long-term Outcomes |
| Medicaid
Community Dr offices will be used, as well as the nurses office during school hours
Nurses, nurse practitioners, doctors, physician assistants
community service groups
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Since these SBHC’s will be used by low income families, medicaid will be utilized. During the school day, staff from a Practice will be available at the school health center. Community service organizations will encourage and remind students to utilize this opportunity. | At the beginning of the school year, each student will receive a pamphlet explaining what a school based health center is and why it is important. The healthcare staff will come to each respective school twice a week, will be open at the main office everyday and will stay open later twice a week. | Students perception of doctors or healthcare visits are not always scary or bad. Preventative measures are a good thing. Taking care of yourself creates good habits and will have long term benefits. | Students will not get sick as often and not fall behind in school. They will become more aware of symptoms of a sickness. | The grade completion, graduation rates, immunization numbers and health knowledge will continue to increase. The number of days of school missed will decrease. The feedback from the doctors and the community will be positive and that it will have a ripple effect for generations. |
- Explain the logic of why this intervention may work. For example, why would teaching children about healthy eating change their actual eating behaviors? Or why would adding sidewalks increase physical activity for transportation or recreation? (15 points)
- I believe this intervention may work because it is expected that providing free services will increase their use and effectiveness. It gives students the ability to take personal responsibility in their own health. It allows them to become educated on a variety of healthcare issues. If a student in middle school begins to partake in this strategy and they realize that they do not feel behind in school due to missing days from sickness, than this will instill a routine of taking care of their body. Will this intervention work, in theory yes it should. Students should want to live a healthy life but if it is not instilled in them by their family, than they do not see it as a necessity. I think it would be a positive influential factor if a doctor from the clinic went to the schools and discussed the purpose of the clinic, the hours, the different locations and reiterate to the students, that everyone needs the clinic and it can be extremely beneficial for them in the long run. I think this could be a big barrier to overcome in order to have this intervention succeed and to dismiss the stigma that the doctors office is a scary place. Even if students don’t necessarily utilize the health center, it can still be considered a positive if the students become educated on their health.
- Discuss limitations of the selected strategy, and things to look out for/be mindful of along the way. Examples may be limitations of resources, community capacity, or anticipated effect of the intervention. (15 points)
- Something to be mindful for this strategy is that SBHC benefits depend on population density and larger city schools. If this is going to be used in a more rural setting, than it will need to be modified. In a rural setting things are more spaced out and so the school based health clinics may not be that influential convenient and maybe off campus locations are better for them to access. Financing can also bring about a limitation since SBHC are relevant to low income communities, its needed to ensure that the SBHC is funded properly. Offering services both during and outside of school hours increases effectiveness as well as continuing to offer a range of services can have a huge benefit factor for the long term health of a student. Because this strategy is impacting a low income community, it needs to be user friendly and encourage routine use.
- What data would you collect to know if you are implementing the strategy the way it was intended (process evaluation/implementation monitoring)? Refer back to your logic model and the Logic Model module as needed. Be sure to cover dose, reach, fidelity, and implementation. (40 points)
- I would collect school attendance records to compare a students attendance rate before the SBHC to when the student had access to SBHC. I would gather past medical history, immunization records. I would continue to send home with the students reminders about the health center and then craft a survey to see if parents were receiving information that was sent home. I would survey the business and business community centers to see if including them would create a more inviting including environment and encourage students and families to partake in the community. The community business survey would be more geared toward revenue for that month. It would ask if the businesses saw an increase in their sales, as well as an increase in foot traffic in these businesses. The businesses will receive the survey every other month. I would conduct the survey every other month to each of the students in my study group and they would be asked on the frequency of the utilization of the clinic, how many days of school they missed, if they were sick and what they were diagnosed with. My thought behind this is that it allows some time to pass, in hopes that they don’t forget, but also it would not become a burden of something they have to do weekly or even monthly. On the survey I would also include which health center they went too, if it was the on campus or off campus, the reason for going (this will be optional, if they would prefer not to answer).
Part 4: Reflection
- Oftentimes when working with communities, the initial plan is not what ultimately happens. What would your second choice strategy be for your identified behavior and community? Why would you choose this strategy? In other words, in what ways would this strategy also address the needs of the community based on your assessment for Part 1? (25 points)
- If my initial plan did not work, my second choice strategy would be to start this intervention in just one school and then see how it is receieved and expand into other schools what the data results taken from the first school. It still addresses the needs of the community, but on a smaller scale. It would still look at absentee rates, immunization records, utilization of the clinic and how their family & community businesses are affected.
- Reflect on how you may use the Community Guide, Nutrition Education Library, and other resources in the future. What did you like about these resources? What didn’t you like? Provide suggestions on how you would make the sites easier for practitioners to use. (20 points)
- Using the community guide is a great resource to look at studies you’re interested in and how they were conducted and if they succeeded, did what they wanted to and had lasting impacts on a group of people. I liked how detailed the studies were and how user friendly the website was. The layout of the intervention was easy to read and understand. I appreciated the ability to keyword search a topic I was interested and I think practitioners would find that valuable as well. I didn’t feel like i was sifting though studies I did not find interesting because I could just go to the search bar.