Schools and Health: An Essential Partnership for the Effective Care of Children with Chronic Conditions

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

AIM

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.

METHODS

Retrospective evaluation of students including changes in SDQ scores using descriptive statistics (26 July 2016 to 14 May 2019; n = 79).

RESULTS

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.

CONCLUSIONS

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.

Ngaramadhi Space: An Integrated, Multisector Model of Care for Students Experiencing Problematic Externalising Behaviour

Introduction

Behavioural and emotional disorders are a significant cause of morbidity for young people aged 10-19 years. School-based health care (SBHC) provides an innovative approach to addressing these issues within Australia.

Description

We describe an innovative and integrative SBHC model called Ngaramadhi Space (NS) based at a specialised behavioural school called Yudi Gunyi school (YGS) in metropolitan Sydney, Australia. NS was developed in partnership with the Aboriginal community to provide holistic, integrated, multidisciplinary child and family centred care to students experiencing problematic externalising behaviour. We contextualise the historical factors leading to the development of NS, highlighting the importance of effective partnerships between sectors, and providing the theoretical framework and key components underpinning the model of care.

Discussion

In Australia, schools are an under-utilised resource for the delivery of health and support alongside education. Collaboration between sectors can be challenging but allows a more coordinated approach to the management of complex social and health issues. By forming effective partnerships with schools and communities, the health sector has an opportunity to improve access to health and social care in a culturally safe and acceptable way. This is in line with national and international frameworks for improving health service delivery and addressing inequity.

Conclusion

The health sector can play a pivotal role in improving the wellbeing of children by forming effective partnerships with schools and communities. The NS model is a practice-based example of this.

The Effect of Neighborhood Disorganization on Care Engagement Among Children With Chronic Conditions Living in a Large Urban City

Neighborhood context plays an important role in producing and reproducing current patterns of health disparity. In particular, neighborhood disorganization affects how people engage in health care. We examined the effect of living in highly disorganized neighborhoods on care engagement, using data from the Coordinated Healthcare for Complex Kids (CHECK) program, which is a care delivery model for children with chronic conditions on Medicaid in Chicago. We retrieved demographic data from the US Census Bureau and crime data from the Chicago Police Department to estimate neighborhood-level social disorganization for the CHECK enrollees. A total of 6458 children enrolled in the CHECK between 2014 and 2017 were included in the analysis. Families living in the most disorganized neighborhoods, compared with areas with lower levels of disorganization, were less likely to engage in CHECK. Black families were less likely than Hispanic families to be engaged in the CHECK program. We discuss potential mechanisms through which disorganization affects care engagement. Understanding neighborhood context, including social disorganization, is key to developing more effective comprehensive care models.

Addressing Barriers to Accessing Head Start Programs via the Medical Home: A Qualitative Study

OBJECTIVES

High quality early childhood education and childcare programs, such as Early Head Start and Head Start (EHS/HS), play a critical role in early childhood development, learning, and quality of life. This study was designed to determine barriers to applying and enrolling in EHS/HS in an urban community and the potential role of the medical home in overcoming these barriers.

METHODS

Four 90-minute focus groups were conducted with 41 various stakeholders, including EHS/HS coordinators, personnel from early childhood policy organizations, medical personnel, and families who have previously applied to EHS/HS. Participants were recruited from an academic clinic and early childhood organizations in Chicago. Researchers transcribed the focus groups and independently analyzed data using open and focused coding to identify common themes.

RESULTS

Results demonstrate that medical personnel and families have a limited understanding of EHS/HS as a resource. Participants describe a multitude of difficulties navigating the EHS/HS application, misalignment of requirements and poor communication between EHS/HS programs and the medical home.

CONCLUSIONS FOR PRACTICE

Multiple barriers exist for families enrolling children into EHS/HS. We recommend several interventions based in the medical home that may improve the enrollment process, allowing more eligible families to access high-quality early childhood services, such as EHS/HS.

Trends in School Attendance for Low-Income Children with Chronic Health Conditions: Results from a Randomized Controlled Trial

BACKGROUND

In this study, we aimed to determine how school attendance changed over time for children on Medicaid with chronic health conditions enrolled in a comprehensive care coordination program called Coordinated HEalthcare for Complex Kids (CHECK).

METHODS

Medicaid beneficiaries from one managed care organization were randomized into 2 arms: CHECK program services or usual care. The final sample was 1322.

RESULTS

The mean age was 10.9 (SD = 3.7) years old and children were mostly non-Hispanic Black (62.6%) or Hispanic (34.9%). The median school attendance at baseline was 94.9% (IQR 88.9, 97.9); over one-fourth of children (28.4%) were chronically absent. School attendance was not associated with race/ethnicity, risk level, and health condition. In a model including a significant time/grade interaction, school attendance increased over time for children in pre-kindergarten (OR = 1.52, 95% CI: 1.38, 1.68; p < .001) and kindergarten to 5th grade (OR = 1.21, 95% CI: 1.17, 1.26; p < .001), and decreased for children in 6th to 8th grade (OR = 0.80, 95% CI: 0.77, 0.83; p < .001). No differences were seen in school attendance or chronic absenteeism associated with enrollment in the CHECK program.

CONCLUSIONS

School attendance improved for most of the low-income children with chronic health conditions in our cohort, except for children in middle school.

Exploring Racial Disparities in Mental Health Diagnoses and Neighborhood Disorganization Among an Urban Cohort of Children and Adolescents with Chronic Medical Conditions

Objective: This article describes the demographic distribution of, and association between, neighborhood disorganization and mental health diagnosis by race in a large cohort of urban children with chronic medical conditions. Methods: Data for this study were from Coordinated Healthcare for Complex Kids (CHECK), a health care demonstration project funded by the Center for Medicare and Medicaid Innovation. We conducted regression analyses to examine the relationship between neighborhood disorganization and mental health diagnosis among 6,458 children enrolled in CHECK. Results: The most common mental health diagnoses were mood disorders (8.6%), Attention-Deficit/Hyperactivity Disorder (7.4%), conduct disorders (6.1%), and anxiety disorders (4.8%). Black children had the highest neighborhood disorganization scores compared with other racial/ethnic categories. However, Black children had the lowest proportion of mental health diagnoses. Lower neighborhood disorganization was associated with having a mental health diagnosis; however, when adding race/ethnicity to the model, neighborhood disorganization no longer was significant. Conclusions: Level of neighborhood disorganization was highly correlated with racial/ethnic composition of the neighborhoods, and Black children disproportionately resided in highly disorganized neighborhoods compared with other groups. Neighborhood disorganization may not have sufficient variability within the racial/ethnic categories, which may explain the absence of an interaction between race/ethnicity and mental health diagnosis.

Chicago Public School nurses examine barriers to school asthma care coordination

OBJECTIVE/DESIGN

Well documented asthma disparities in Chicago pose a continual challenge for the Chicago Public Schools (CPS). Coordinated Healthcare for Complex Kids (CHECK) is a health care demonstration project funded by a Centers for Medicare and Medicaid Services Health Care Innovation Award. A collaborative partnership was formed between CHECK and CPS. With CHECK support, CPS administered a survey to 160 nurses to understand the asthma problems nurses perceived and interest in intervention.

RESULTS

Seventy-five per cent (n = 120) completed the survey. While asthma was the top diagnosis managed by 95%, 72% reported gaps in asthma understanding. Appropriate communication between school nurses and providers occurred 33% of the time; 18% believed they received sufficient support to follow-up on deficient paperwork. The barriers mentioned were lack of medications (73%), time (67%), and communication with providers (61%). When asked their opinions on potential interventions, 78% of nurses supported web-based applications, 66% community health workers (CHW), and 66% stock albuterol in schools.

CONCLUSIONS

The greatest barriers for CPS nurses with asthma management are time and communication. Potential interventions such as web-based communication applications and CHW in schools were well received.