Quality Improvement in a School Health Program

Abstract

A process evaluation of a school health program designed to improve students' health and educational success is presented. The program included a pediatric nurse practitioner and two nurses placed in three high-risk, urban intervention schools. It is a part of a larger multidimensional pilot intervention project (The Children First Plan). Implemented services and the implementation process are described. Key components for a successful implementation included obtaining buy-in, learning the school culture, defining roles, and keeping a sense of humor. Collaborative efforts among the nursing team, other children-first plan providers, and the school staff improved service delivery. Lack of communication was the primary barrier. In addition, differing philosophies among systems (education, social services, health), problems with referral and feedback, and lack of appropriate providers hampered service delivery. Recommendations for continued program improvement and replication projects are provided.

School-Based Health Centers to Advance Health Equity

“…Of the 46 studies in the analytic data set, 23 studies in 24 papers 51–55,57,58,60–62,70–73,75,77,81–84,86,93,95,96 assessed SBHC whole-school effects by comparing all students in SBHCs with all students in non-SBHC settings (14 studies 51–53,55,58,60–62,73,81,84,86,93,96 ) or students in schools before and after the implementation of SBHCs (eight studies 54,57,71,75,77,82,83,95 ); one study in two papers 70,72 included both comparisons. Seventeen studies in 18 papers 46–49,56,65–69,74,78,85,88,89,91,92,94 assessed SBHC user–only effects by comparing users with non-users within SBHC schools (eight studies 46,68,69,78,88,91,92,94 ) or SBHC users with users of healthcare sources in non-SBHC settings (nine studies in ten papers 47–49,56,65–67,74,85,89 ).…”

“…Thirty-two studies in 33 papers 46–48,51–53,55–62,65,68,69,74,75,77,79,81–83,86–88,90–93,95,97 were published after 2000, and only four studies in five papers 49,54,70,72,89 before 1990. Only three studies 51,75,92 evaluated hybrid school-based and school-linked centers, and no studies evaluated exclusively school-linked centers or mobile clinics.…”

“…Only three studies 51,75,92 evaluated hybrid school-based and school-linked centers, and no studies evaluated exclusively school-linked centers or mobile clinics. Results of this review are largely applicable to the urban context, as only ten studies in 11 papers 51,52,58,70,72,75,76,79,90,92,96 were conducted in mixed rural and urban or suburban areas, and none in predominantly rural areas.…”

“…Only three studies 51,75,92 evaluated hybrid school-based and school-linked centers, and no studies evaluated exclusively school-linked centers or mobile clinics. Results of this review are largely applicable to the urban context, as only ten studies in 11 papers 51,52,58,70,72,75,76,79,90,92,96 were conducted in mixed rural and urban or suburban areas, and none in predominantly rural areas. Applicability to younger grade levels is limited, as most studies (26 studies in 28 papers 46–49,52,54,55,59,62,65,66,68–74,81,82,85,87,89,91,92,94,96,97 ) evaluated high school SBHCs, whereas one study 83 assessed middle school SBHCs, seven studies 57,58,67,77,83,93,95 evaluated pre-Kindergarten or elementary school SBHCs, and the remaining 12 studies 51,56,60,61,75,76,78,79,84,86,88,90 assessed combinations of grade levels.…”

“…The effects of the range of SBHC services were evaluated: 23 studies in 24 papers 49,52–56,59,69–72,74,77–79,82,85,88,89,91–93,96,97 compared SBHCs that provided primary care only (often including reproductive services); nine studies in ten papers 47,48,62,68,73,75,81,87,90,94 assessed SBHCs that also provided mental health care; and 13 studies 46,51,58,60,61,65–67,76,83,84,86,95 provided some combination of primary care and mental, dental, or social services. Most studies (28 studies in 29 papers 47,48,52–56,58,59,62,69,75–79,81–83,85–88,91–94,96,97 ) did not report hours of operation; among those that did, only two SBHCs 49,89 were open for fewer than normal school hours.…”