Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Health Centers, Medicaid,

Intervention Description: This study measures effects on the receipt of preventive care among children enrolled in Georgia's Medicaid or Children's Health Insurance Program associated with the implementation of new elementary school-based health centers. The study sites differed by geographic environment and predominant race/ethnicity (rural white, non-Hispanic; black, small city; and suburban Hispanic). A quasi-experimental treatment/control cohort study used Medicaid/Children's Health Insurance Program claims/enrollment data for children in school years before implementation (2011-2012 and 2012-2013) versus after implementation (2013-2014 to 2016-2017) of school-based health centers to estimate effects on preventive care among children with (treatment) and without (control) access to a school-based health center. Data analysis was performed in 2017-2019. There were 1,531 unique children in the treatment group with an average of 4.18 school years observed and 1,737 in the control group with 4.32 school years observed. A total of 1,243 Medicaid/Children's Health Insurance Program-insured children in the treatment group used their school-based health centers.

Intervention Results: Significant increases in well-child visits (5.9 percentage points, p<0.01) and influenza vaccination (6.9 percentage points, p<0.01) were found for children with versus without a new school-based health center. This represents a 15% increase from the pre-implementation percentage (38.8%) with a well-child visit and a 25% increase in influenza vaccinations. Increases were found only in the 2 school-based health centers with predominantly minority students. The 18.7 percentage point (p<0.01) increase in diet/counseling among obese/overweight Hispanic children represented a doubling from a 15.3% baseline.

Conclusion: Implementation of elementary school-based health centers increased the receipt of key preventive care among young, publicly insured children in urban areas of Georgia, with potential reductions in racial and ethnic disparities.

Study Design: Quasi-experimental treatment/control cohort study

Setting: Elementary schools with school-based health centers in urban areas in Georgia

Population of Focus: Children with (treatment) and without (control) access to a school-based health center

Sample Size: Total of 1,531 unique children in the treatment group (those with access to school-based health centers) and 1,737 unique children in the control group (those without access to school-based health centers)

Age Range: Children aged 7 to 9 years old

Intervention Components (click on component to see a list of all articles that use that intervention): SCHOOL, School-Based Health Centers, CLASSROOM_SCHOOL

Intervention Description: We sought to compare visit rates, emergency care use, and markers of quality of care between adolescents who use school-based health centers and those who use other community centers within a safety-net health care system for low-income and uninsured patients.

Intervention Results: Although school-based health center users (n = 790) were less likely than other users (n = 925) to be insured (37% vs 73%), they were more likely to have made > or = 3 primary care visits (52% vs 34%), less likely to have used emergency care (17% vs 34%), and more likely to have received a health maintenance visit (47% vs 33%), an influenza vaccine (45% vs 18%), a tetanus booster (33% vs 21%), and a hepatitis B vaccine (46% vs 20%).

Conclusion: These findings suggest that, within a safety-net system, school-based health centers augment access to care and quality of care for underserved adolescents compared with traditional outpatient care sites.

Study Design: Retrospective cohort design

Setting: Denver, Colorado Health safety-net system

Population of Focus: Adolescents ages 14-17 within Denver Health safety-net system (study population was limited to uninsured or insured by Medicaid or SCHIP)

Data Source: Administrative databases maintained by Denver Health and Denver Public Schools

Sample Size: Total (N=3599)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Health Centers, Teacher/Staff Training, Assessment,

Intervention Description: The core BRISC strategy is implemented in four sessions. In session 1, the SMHP engages the student, assesses current functioning using brief standardized assessment measures, and identifies “top problems” (Weisz et al., 2011). The student is asked to informally monitor a behavior related to one of their top problems (e.g., time spent with friends, days feeling “blue,” number of disputes with parents). In session 2, the SMHP introduces a structured problem-solving framework, and the student chooses a “top problem” to address. Using a structured approach, the student outlines a concrete goal, brainstorms possible steps toward this goal, identifies a specific step, and troubleshoots barriers (D'Zurilla & Nezu, 2010). In session 3, a set of evidence-based, skill-based elements (communication skills, stress and mood management, realistic thinking) are taught, if needed, to help modify the step tried or to identify and support the student’s next step(s). In session 4, the student and SMHP review progress and identify a “post-BRISC pathway”: (1) end treatment/problem resolved, (2) supportive monitoring by the SMHP or other school staff, (3) continued treatment from the SMHP, or (4) referral to more specialized or intensive services. SMHPs are also encouraged to refer students to supportive school-based services (e.g., tutoring, special education), if indicated. BRISC-assigned SMHPs attended a 1.5-day in-person training by two Ph.D.-level clinical psychologists that incorporated strategies (e.g., modeling, role play) found to facilitate uptake of new skills (Rakovshik & McManus, 2010). Although therapists in both conditions were already deployed full time by their agencies into the school setting, the training also reviewed how to manage the unique challenges of SBMH work as it applies to the BRISC framework (e.g., adjusting to school schedules, triaging to school and community supports). SMHPs received bi-weekly phone consultation/coaching from the trainers that included a review of adherence checklists completed by the clinician following each of their sessions, case presentations, and review of and feedback on their BRISC implementation.

Intervention Results: Services Received: Student Report - Results of analyses of longitudinal service receipt as assessed via the SACA are shown in Table 2 and Fig. 2 (model results with confidence intervals are available as online resource 3). There were no differences at baseline between conditions on the proportion of students receiving school-based mental health services. From baseline to 2 months, the proportion of students receiving SMH services, and the number of services received, increased for both conditions. From 2 to 6 months, the proportion of students receiving SMH and the number of SMH services decreased more for the BRISC condition. At 6 months, there were no significant differences between the groups on the proportion of students receiving SMH services, but the number of SMH services received was significantly less for BRISC. This demonstrates that BRISC was associated with increased SMH services between baseline to 2 months and decreased SMH services by 6 months. The proportion of BRISC students who used outpatient MH services significantly decreased across all time points, while the proportion of students in SAU receiving outpatient services decreased from baseline to 2 months and then increased. At 6 months, significantly fewer BRISC students received outpatient services. Clinician Report - Clinician report of client status after 4 sessions was limited to the 9 BRISC and 13 SAU SMHPs still participating in the study in the final year of the study (N=45 and N=65 students, respectively). As shown in Table 3, there was a significant difference after 4 sessions (χ2 = 18.9, p = .004), with adjusted standardized residuals indicating students in the BRISC condition were more likely than SAU to have concluded treatment with no further services planned (37.8% vs. 12.3%, RR = 3.07, RD = 0.25) and to be referred to outside MH services (15.6% vs 3.1%, RR = 5.06, RD = 0.12). SAU students were more likely to continue school-based treatment with no additional services planned (61.5% vs. 35.6%, RR = 0.58, RD =  −0.26).

Conclusion: This project evaluated the potential for improving the efficiency of SMH via a school-based assessment, brief intervention, and triage approach for students with socio-emotional concerns. BRISC provides a first-line intervention using consistent assessment to inform level and type of ongoing services needed in a prevention-oriented, multi-tiered delivery model. Research questions focused on feasibility, fidelity, student report of problems, and ability of BRISC to promote efficiency within SMH. We also measured a range of mental health outcomes over 6-month follow-up to evaluate whether this emphasis on efficiency compromised these outcomes compared to SMH “as usual.” SMHPs who participated in the study were predominantly outpatient clinic providers deployed to the school setting. Their training and established practice were geared to traditional, longer term supportive therapy. The structured, measurement-based, and goal-oriented BRISC approach represented a different way of practicing aligned with data-informed, multi-tiered frameworks used by schools. Despite the learning curve required and deviation from typical practice, SMHPs rated BRISC as feasible, acceptable, and appropriate. Importantly, the majority of SMHPs rated BRISC as easy to learn, “compatible with the school mission,” and “likely to improve students’ social, emotional, and academic success.” SMHPs delivered BRISC with fidelity; however, session 3 fidelity was lower than for other sessions. This was likely due to the complexity introduced by the option to use evidence-based treatment elements as needed. A second key finding was that SMHPs in the BRISC condition were significantly more likely (53% to 15%) to report that they had completed treatment after 4 sessions than SAU. BRISC-assigned SMHPs were also more likely to refer students to alternative and/or more intensive services. Students in the BRISC condition were also significantly more likely to report receipt of SMH at 2 months and less likely to report SMH services at 6 months. These results support the hypothesis that BRISC can promote SMH that is more efficient and better aligned with MTSS and public health frameworks. Finally, we asked whether SMHPs’ use of a brief strategy to achieve greater efficiency would compromise mental health outcomes. To the contrary, students served via BRISC showed significantly greater improvement on their self-rated top mental health problems at 2 and 6 months. Symptom and functioning measures showed significant improvement, but slopes did not differ by condition. Students served by BRISC SMHPs were less likely to receive outpatient care at 6 months. This finding could indicate that BRISC more effectively addressed students’ “top problems” to an extent that reduced their need for longer-term mental health services. Or, it could be that students in the BRISC condition felt more confident in their school-based provider to help them in the future, reducing the need for clinic-based services. Such questions will need to be examined in more in-depth research with longer follow-up.

Study Design: Cluster randomized controlled trial

Setting: 15 school districts in the United States (Maryland, Minnesota, Washington)

Population of Focus: High school students referred to/seeking school mental health services

Sample Size: 457 students

Age Range: 13-18 years old (High School students)

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Health Centers, Screening Tool Implementation,

Intervention Description: The study describes the implementation of a Screening, Monitoring, and Referral to Treatment (SMARTT) initiative at an urban middle school-based health center. The initiative involved the use of the Pediatric Symptom Checklist-17-Youth (PSC-17-Y) as a screening tool to identify adolescents at risk for mental health conditions. Adolescents who screened positive or had other identified clinical concerns were offered an on-site mental health referral. Referral outcomes were recorded, and adolescents who accepted referrals were tracked for follow-up visits.

Intervention Results: One out of four adolescents had a positive PSC-17-Y or negative screen with other identified concerns. Approximately half of these at-risk adolescents accepted a mental health referral, and 86% of those who declined agreed to the PCM visit. More than two-thirds of the PCM group did not need continued monitoring and support at follow-up, and 85.4% of youth who had a mental health assessment accepted mental health services.

Conclusion: Yes, there were statistically significant findings in the study. For example, younger adolescents (10-11 years old) were less likely to have a positive PSC-ES compared to 12-year-old adolescents (p = .021) and 13-year-old adolescents (p = .0004). In addition, younger adolescents were less likely to have a positive total score on the PSC-17-Y compared to 12-year-old adolescents (p = .0026) and 13-year-old adolescents (p = .0091). Furthermore, individuals with a positive PSC-17-Y total score (p = .013) and those with a positive PSC-17-Y in one subscale plus the total score (p = .050) were more likely to accept an on-site mental health referral than those with a negative score but with other concerns.

Study Design: The study design was a retrospective chart review of electronic health records and corresponding clinical tracking data.

Setting: The study was conducted in an urban school-based health center (SBHC).

Population of Focus: The target audience for this study includes healthcare providers, educators, and policymakers who are interested in improving access to and utilization of mental health services for young adolescents in school-based health centers.

Sample Size: The study included a total sample size of 741 adolescents.

Age Range: The age group of the adolescents in this study ranged from 10 to 16 years old, with a mean age of 12.2 years old.

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Health Centers, Nurse/Nurse Practitioner, Teacher/Staff Training,

Intervention Description: Male high school students are at particular risk of forgoing sexual health care. ABSTRACT: Purpose: Adolescent males are less likely to receive health care and have lower levels of sexual and reproductive health (SRH) knowledge than adolescent females. The purpose of this study was to determine if a school-based structural intervention focused on school nurses increases receipt of condoms and SRH information among male students. Methods: Interventions to improve student access to sexual and reproductive health care were implemented in six urban high schools with a matched set of comparison schools. Interventions included working with school nurses to improve access to sexual and reproductive health care, including the provision of condoms and information about pregnancy and sexually transmitted disease prevention and services. Intervention effects were assessed through five cross-sectional yearly surveys, and analyses include data from 13,740 male students.

Intervention Results: Nurses in intervention schools changed their interactions with male students who visited them for services, such that, among those who reported they went to the school nurse for any reason in the previous year, those in intervention schools reported significant increases in receipt of sexual health services over the course of the study compared with students in comparison schools. Further, these results translated into population-level effects. Among all male students surveyed, those in intervention schools were more likely than those in comparison schools to report increases in receipt of sexual health services from school nurses.

Conclusion: With a minimal investment of resources, school nurses can become important sources of SRH information and condoms for male high school students.

Study Design: Longitudinal quasi-experimental study

Setting: Urban high schools in a public school district in Los Angeles County, California

Population of Focus: Male high school students from urban high schools

Sample Size: Total of 13,740 male high school students (T1: 2,709 male students; T2: 2,636 male students; T3: 2,690 male students; T4: 2,910 male students; T5: 2,795 male students)

Age Range: Adolescents males ages 14 to 18 years

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Health Centers

Intervention Description: We evaluated access and quality of health services at an urban high school with a SHC compared with a school without a SHC, using a quasiexperimental research design. Data were collected at the beginning of the school year, using a paper and pencil classroom questionnaire (n = 2,076 students). We measured SHC impact in several ways including grade by school interaction terms.

Intervention Results: Students at the SHC school were more likely to report having a regular healthcare provider, awareness of confidential services, support for health services in their school, and willingness to utilize those services. Students in the SHC school reported higher quality of care as measured by: respect for their health concerns, adequate time with the healthcare provider, understandable provider communications, and greater provider discussion at their last visit on topics such as sexual activity, birth control, emotions, future plans, diet, and exercise. Users of the SHC were also more likely to report higher quality of care, compared with either nonusers or students in the comparison school.

Conclusion: Access to comprehensive health services via a SHC led to improved access to health care and improved quality of care. Impact was measureable on a school-wide basis but was greater among SHC users.

Study Design: a quasiexperimental research design

Setting: an urban high school

Data Source: a paper and pencil classroom questionnaire

Sample Size: n = 2,076 students

Age Range: High school age

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Health Centers,

Intervention Description: The Primary Healthcare Registered Nurse: Schools-Based (PHCRN:SB) strategy is a specific intervention described in the paper. The strategy is designed to enhance nursing service and practice responsiveness to the rural context, primary healthcare principles, and community experiences and expectations of healthcare. It is underpinned by a cross-sector collaboration between a local health district, school education, and a university department of rural health. The paper describes the key components of the strategy, including community engagement, identification of the right health professional with the right scope of practice, and the design and implementation of a potential solution. The paper does not analyze a multicomponent intervention, but rather describes the design and implementation of the PHCRN:SB strategy.

Intervention Results: Although in the early stages of implementation, key learnings have been acquired and strategic, relationship, resource and workforce gains achieved.

Conclusion: Evidence indicates that to effectively address the challenges confronting disadvantaged children and adolescents we need to build supportive services that coordinate care across agencies in the same community, specifically those engaging with the same families. Increasing our understanding of the health needs of children and adolescents, and the application of this knowledge in the development of responsive primary healthcare policies and practices is necessary in establishing safe, health promoting environments and improved health outcomes (Viner et al., Reference Wall, Higgins and Hunter2012; Moore et al., 2015).

Study Design: The paper is a descriptive paper that describes the design and implementation of the Primary Healthcare Registered Nurse: Schools-Based (PHCRN:SB) strategy. It does not have a specific study design, but rather provides a detailed description of the strategy, its key components, and the learnings acquired during its implementation.

Setting: The study setting for the Primary Healthcare Registered Nurse: Schools-Based (PHCRN:SB) strategy is in rural New South Wales, Australia. The strategy is designed to address the health, education, and social inequities confronting rural children and adolescents. It is implemented through a cross-sector collaboration between a local health district, school education, and a university department of rural health, indicating a multi-faceted approach involving healthcare, education, and academic institutions in the rural setting of New South Wales, Australia.

Population of Focus: The target audience for the paper "A community engaged primary healthcare strategy to address rural school student inequities" includes healthcare professionals, policymakers, educators, and researchers with an interest in primary healthcare, community engagement, and addressing health and social inequities among rural school students. The paper provides insights into the design and implementation of the Primary Healthcare Registered Nurse: Schools-Based (PHCRN:SB) strategy, which may be of interest to those involved in healthcare service delivery, public health, and education, particularly in rural and underserved communities.

Sample Size: The paper does not report a specific sample size as it is not a research study that involves data collection or analysis. Instead, it describes the design and implementation of the Primary Healthcare Registered Nurse: Schools-Based (PHCRN:SB) strategy, which is a community engaged primary healthcare strategy aimed at addressing health, education, and social inequities faced by rural school students in Australia. The paper provides information on the key components of the strategy, the collaboration between different sectors, and the potential benefits of the strategy.

Age Range: The paper does not specify a specific age range for the school students who are the target of the Primary Healthcare Registered Nurse: Schools-Based (PHCRN:SB) strategy. However, it does mention that the strategy seeks to address the health, education, and social inequities confronting rural children and adolescents. Therefore, it can be inferred that the age range of the school students targeted by the strategy is likely to be between 5-18 years old, which is the typical age range for primary and secondary school students in Australia

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Health Centers, CLASSROOM_SCHOOL

Intervention Description: During October 2008 through March 2009, in 4 Denver public SBHCs, we conducted (1) a demonstration study among 265 girls needing ≥ 1 recommended adolescent vaccine and (2) an RCT among 264 boys needing vaccines, with half randomized to recall and half receiving usual care. Immunization rates for recommended adolescent vaccines were assessed 6 months after recall. First dose costs were assessed by direct observation and examining invoices.

Intervention Results: At the end of the demonstration study, 77% of girls had received ≥ 1 vaccine and 45% had received all needed adolescent vaccines. Rates of receipt among those needing each of the vaccines were 68% (160/236) for tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine, 57% (142/248) for quadrivalent meningococcal conjugate vaccine, and 59% (149/253) for the first human papillomavirus vaccine. At the end of the RCT, 66% of recalled boys had received ≥ 1 vaccine and 59% had received all study vaccines, compared with 45% and 36%, respectively, of the control group (P < .001). Cost of conducting recall ranged from $1.12 to $6.87 per recalled child immunized.

Conclusion: SBHC-based recall was effective in improving immunization rates for all adolescent vaccines, with effects sizes exceeding those achieved with younger children in practice settings.

Study Design: RCT (for boys)

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Screening Tool Implementation, Referrals, School-Based Health Centers,

Intervention Description: The ProfScreen intervention involved a two-stage screening process. In the first stage, students completed a self-report questionnaire on mental health problems and risk behaviors. In the second stage, students considered at-risk based on the screening were invited for a clinical interview with a mental health professional and, if necessary, referred for subsequent treatment.

Intervention Results: Of the total N = 12,395 SEYLE study participants, 3070 were randomised to the ProfScreen and 3257 to the control group. Of those, 4172 (65.9%) completed the 12 month follow-up, were not emergency cases, and had complete data. Among those complete cases, 2583 (61.9%) students were considered at-risk for mental problems or risk behaviour at baseline; comprising 1314 (50.9%) students of the ProfScreen and 1269 (49.1%) of the control group. 535 (40.7%) students of the ProfScreen group attended the clinical interview and 149 (27.9%) of these were referred to subsequent treatment (Fig. 1). Subsequent data analyses refer to the 2583 students that were at-risk for mental health problems or risk behaviour at baseline. Compared to the control group, students of the ProfScreen group screened more often positive for suicidal tendencies and problems in social relationships at baseline (Table 1). The effect sizes of these differences were small. Sex, age, and all other baseline screening parameters did not differ between the ProfScreen and control group (Table 1).Effects of the ProfScreen intervention Of the total 2583 students at-risk for mental health problems or risk behaviour, 93 (3.6%) engaged in professional treatment within one year after the baseline assessment; 53 (4.1%) of the ProfScreen and 40 (3.1%) of the control group. Most of these students engaged in professional one-to-one therapy, followed by medication (see Online Resource 3). Neither follow-up service use (Table 2, unadjusted models in Online Resource 4) nor follow-up at-risk state (Table 3, unadjusted models in Online Resource 5) differed significantly between the ProfScreen and the control group, revealing no overall effects of the ProfScreen intervention.Post-hoc investigations for complete ProfScreen participation Within the ProfScreen intervention group, 40.7% participants took part in the interview offered (stage two of the intervention), referred to as ‘ProfScreen completers’. Post-hoc analyses of possible differences between ProfScreen completers and non-completers revealed that ProfScreen completers were younger (t(2581) = 5.22, p < 0.001). Looking only at the n = 535 ProfScreen completers, 29 (5.4%) engaged in professional treatment. Compared to the control group, ProfScreen completers had higher odds of engaging in service use with a professional, within one year after the intervention (OR = 1.78) (Table 4, unadjusted models in Online Resource 4). Regarding follow-up at-risk state, there were no differences between ProfScreen completers and participants of the control group (Table 5, unadjusted models in Online Resource 5).

Conclusion: Assignment to the ProfScreen intervention as implemented within the school-based SEYLE study had no effect on professional service use nor at-risk state compared to participation in the control group. The two-stage ProfScreen intervention suffered from low participation rates in the second part, the interview for clinical evaluation by professionals. Complete participation was positively associated with follow-up service use for young people at-risk for mental problems and risk behaviours, but the intervention was only able to reach 41% of eligible students for full participation. Overall, the present study highlighted two major difficulties in school-based screenings: less than half of the sample accepted the invitation for a clinical interview, and subsequently, only few students engaged in professional treatment. Thus, prior to the implementation of large-scale school-based screening programs as a regular tool to address young people’s mental health, further evidence and improvement of interview attendance rates as well as particular interventions targeting barriers to professional help are necessary.

Study Design: The study was a randomized controlled trial (RCT).

Setting: The study was conducted in 11 European countries as part of the SEYLE project.

Population of Focus: The target audience includes adolescents in school settings who were at risk for mental health problems and risk behaviors.

Sample Size: The total sample size was 4,172 students.

Age Range: The students were aged 15 ± 0.9 years.

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Health Centers, Education on Disease/Condition,

Intervention Description: School-based health centers (SBHCs) are an essential part of a comprehensive approach to address the health needs of youth. SBHCs that provide sexual health services (SHS) show promising results in improving reproductive health outcomes among youth. Despite the positive impact SBHCs can have, few school districts have SBHCs, and even fewer provide SHS. This article describes a successful 5-year project to provide SHS through SBHCs in a large county in the southeast United States. A community collaborative, including the schools, health department, community agencies and a local university, was created to address the project goals and objectives. Various steps were taken to plan for the SBHCs, including documenting community support for SHS offered through SBHCs, identifying school sites for SBHCs, and the process for offering pregnancy, STD (sexually transmitted disease), and HIV testing, treatment, and referrals.

Intervention Results: The staff at the SBHCs were successful in recruiting students to attend educational sessions and to receive testing and treatment. Student feedback was overwhelmingly positive.

Conclusion: Lessons learned about the importance of the partnership's collaboration, using recommended clinic protocol, ensuring clear communication with school staff, and employing youth friendly recruitment and clinic practices are shared.

Study Design: Program evaluation

Setting: School-Based Health Centers (SBHCs) with Sexual Health Services (SHS) within the Duval County Public Schools (DCPS) system in Duval County, Florida

Population of Focus: Adolescents aged 13 to 19 years old who attended public schools in Duval County, Florida

Sample Size: 2,200 teens

Age Range: Adolescents aged 13 to 19 years old

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Health Centers

Intervention Description: Reproductive health indicators among students at four urban high schools in a single building with an SHC in 2009 were compared with students in a school without an SHC, using a quasi-experimental research design (N = 2,076 students, 1,365 from SHC and 711 from comparison school). The SHC provided comprehensive reproductive health education and services, including on-site provision of hormonal contraception.

Intervention Results: Students in the SHC were more likely to report receipt of health care provider counseling and classroom education about reproductive health and a willingness to use an SHC for reproductive health services. Use of hormonal contraception measured at various time points (first sex, last sex, and ever used) was greater among students in the SHC. Most 10th-12th graders using contraception in the SHC reported receiving contraception through the SHC. Comparing students in the nonintervention school to SHC nonusers to SHC users, we found stepwise increases in receipt of education and provider counseling, willingness to use the SHC, and contraceptive use.

Conclusion: Students with access to comprehensive reproductive health services via an SHC reported greater exposure to reproductive health education and counseling and greater use of hormonal contraception. SHCs can be an important access point to reproductive health care and a key strategy for preventing teen pregnancy.

Study Design: quasi-experimental research design

Setting: four urban high schools

Data Source: N/A

Sample Size: (N = 2,076 students, 1,365 from SHC and 711 from comparison school)

Age Range: High school age

Intervention Components (click on component to see a list of all articles that use that intervention): Education on Disease/Condition, Counseling (Parent/Family), School-Based Health Centers,

Intervention Description: SACRED Connections was a 5-year RCT that formed an effective university-community partnership to culturally adapt, implement, and evaluate a brief evidence-based motivational substance use intervention among NA youth in Midwestern rural communities.

Intervention Results: Findings of this 5-year RCT revealed a statistically significant protective relationship between Native Reliance and baseline lifetime and past month alcohol and marijuana use; additionally, the likelihood of reporting marijuana use at 3 months post-intervention was significantly lower among the active condition than among the control condition.

Conclusion: As supported by the literature (Getty, 2010; Liddell & Burnette, 2017; Marsiglia & Booth, 2015), the partnership between the researchers and the tribal community was critical to the success of this project and resulted in effective cultural tailoring. The partnership with the tribal community ensured that NA cultural values were integrated into implementation and not simply acknowledged (Burnette & Figley, 2016; Whitbeck, 2006; Whitbeck et al., 2012), which facilitated tribal community ownership (Whitbeck, 2006). D&I science, specifically the RE-AIM model, provided a framework that guided the adaptation of the evidence-based practice, Motivational Interviewing, for implementation allowing for adaptations while still holding to the integrity of the evidence-based practice and supporting “long standing partnerships beyond the term of the research” (Whitbeck, 2006). Results demonstrated that: (1) a culturally responsive MI-based brief intervention may be effective in reducing substance use among NA youth with statistically significant reductions in marijuana use at 3 months; (2) Native Reliance theory is an appropriate framework and protective factor; and (3) an intentional, well planned, and flexible university-tribal partnership utilizing CBPR methods and a D&I model allowed effective implementation and engagement with a hard to reach underserved community.

Study Design: Randomized Controlled Trial (RCT)

Setting: The study "SACRED Connections" took place in Midwestern rural communities in the United States. The setting for the study was school-based initiatives, specifically targeting Native American youth aged 12-17 in six rural public high schools across two counties

Population of Focus: Native American youth aged 12-17

Sample Size: The study included 434 participants, including tribal community elders, Health Educators, and youth.

Age Range: Adolescents aged 12-17

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, School-Based Health Centers

Intervention Description: In 2013, Ronald McDonald House Charities, a non-profit organization, partnered with Children’s Hospital of Erlanger to provide a mobile clinic trademarked Ronald McDonald Care Mobile utilising a large, box-style truck equipped with examination rooms and a telemedicine portal. Initially, starting with three elementary schools in Bradley County, Tennessee, USA, the programme rapidly expanded to include schools in five other participating Tennessee counties. Only three schools in Bradley County have the option of in-person visits. All other schools access care via telemedicine portals. Funding is provided through multiple grants and community partners. If a student does have insurance, the insurance carrier is billed for the visit, but students without insurance are treated free of charge. Prior to the 2018–2019 school year, only limited data were collected.

Intervention Results: Our first goal was to perform physicals for children not attached to a primary care physician. During the 2018–2019 school year, 28 patients presented for a well-child check. However, 16 of these (57%) did not have a primary care physician. Of note, 19% of students presenting for any complaint did not have a primary care physician on file (172 students). All well-child checks were performed in-person on the Care Mobile. Our second goal was to provide medical consultations and treatment for acute illnesses. A total of 1446 persons were seen for sick visits. Of these, 424 were telemedicine visits (352 students and 72 staff), while 1022 were in-person visits. The five most common diagnoses that the nurse practitioner managed during the 2018–2019 school year included acute pharyngitis, acute upper respiratory infection, streptococcal pharyngitis, fever and acute maxillary sinusitis. Finally, our third goal was to lower absenteeism rates. There were 1446 sick person visits (1253 students and 193 staff). Twenty-two per cent of the students (276 persons) returned to class while 74% (142 persons) of staff returned to work.

Conclusion: The mobile/telemedicine health clinic is a novel innovation to increase access to acute care and reduce school absenteeism among both students and staff, potentially saving schools hundreds to thousands of dollars.

Setting: School

Population of Focus: Children in K-12 rural schools in Tennessee)

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Health Centers, Screening Tool Implementation, Referrals,

Intervention Description: The Rhode Island Suicide Prevention Initiative (SPI) which links schools to mental health services through a coordinated screening, referral and follow-up system.

Intervention Results: Over 3 years, 328 students were referred by schools to mental health services, with 258 completing the referral (78.7% referral rate). Most parents consented to share info and participate in follow-up.

Conclusion: SPI links schools with mental health services to increase students receiving needed treatment. Evaluations of similar programs are limited. SPI reached multiple districts and age groups, with wrap-around follow-up services. This serves as a model for expanding school-based suicide screening and mental health referrals.

Study Design: Pre-post analysis of referral program data

Setting: Public schools in Rhode Island

Population of Focus: Students at risk for suicide, schools, mental health agencies

Sample Size: 328 students referred over 3 years

Age Range: 5-19 years old

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Health Centers, Technology-Based Support,

Intervention Description: The intervention aligns with a discernable strategy and involves a multicomponent approach. The West Virginia Children’s Access Network (WVCAN) project implemented a multidisciplinary telehealth model into three school-based health centers (SBHCs) in West Virginia. The primary outcomes of the intervention were to increase youth access to psychiatric care and reduce wait times, with secondary outcomes focusing on satisfaction and sustainability . The intervention involved the use of comanaged direct care and consultation and stabilization models, which included the use of a child and adolescent psychiatrist to assist patients with diagnostic clarity and stabilization followed by a transition back to the SBHC primary provider. Case consultations were offered for acute crises or established patients . This intervention aligns with the strategy of providing consultative care to primary care providers, which has been recommended as an approach with robust evidence for improving patient care . The WVCAN project aimed to provide school-based psychiatry services in West Virginia’s rural areas by child psychiatrists and psychologists trained in telepsychiatry, addressing disparities for children with mental health needs in schools . The intervention involved the use of telehealth equipment and the services of a part-time child psychiatrist, as well as ongoing support from case managers and periodic self-assessments to examine strengths and weaknesses of the program

Intervention Results: The primary referral sources for the program were largely initiated by local therapists, case managers, parents, teachers, and school counselors, with lack of access to local specialists and long wait times cited as the most common referral reasons. A total of 98 appointments were provided, of which 65 were kept, for a no-show rate of 17%. Two hospitalizations were reported among the served youth, and the full impact of the project will be discussed when all data are available

Conclusion: The conclusion emphasizes the importance of telehealth as an efficacious and cost-effective model to screen and provide specialty services to children in rural areas, while also increasing compliance. It also highlights the potential of the WVCAN project as an exemplar of a school–telepsychiatry partnership that brings services to the setting where youths are most accessible, thereby disrupting the known cycle of underuse of psychiatric care experienced by youths who wait for service

Study Design: The PDF describes the strategies used to implement and integrate the telehealth model, as well as the barriers, challenges, and judicious resource use involved in the WVCAN project. It also reports on the number of appointments provided, the rate of appointments kept, and the occurrence of hospitalizations among the served youth. However, it does not provide statistical analyses or discuss the significance of these findings in a quantitative or statistical sense.

Setting: The study setting described in the PDF "An Innovative Approach to Care: Integrating Mental Health Services Through Telemedicine in Rural School-Based Health Centers" is focused on rural areas in West Virginia, specifically within school-based health centers (SBHCs). The document discusses the implementation of a multidisciplinary telehealth model into three SBHCs in West Virginia, located in Barbour, Pocahontas, and McDowell counties. The primary focus of the study setting is on integrating mental health services into these rural school-based health centers using telemedicine to address the mental health needs of children and adolescents in underserved areas. The setting reflects the specific geographic and healthcare context of rural West Virginia, where access to specialized mental health care may be limited. Therefore, the study setting is centered on the integration of telemedicine-based mental health services within rural school-based health centers in West Virginia, highlighting the unique challenges and opportunities associated with providing mental health care in this context.

Population of Focus: The target audience for the PDF "An Innovative Approach to Care: Integrating Mental Health Services Through Telemedicine in Rural School-Based Health Centers" includes professionals and stakeholders involved in mental health care, telemedicine, and school-based health services. This may encompass healthcare providers, mental health professionals, educators, policymakers, and individuals interested in addressing mental health disparities in rural communities through innovative telehealth models. The document provides insights into the implementation, challenges, and potential benefits of integrating mental health services through telemedicine in rural school-based health centers, making it relevant to professionals and stakeholders seeking to improve access to mental health care for children and adolescents in underserved areas. Additionally, individuals and organizations involved in telehealth program development, policy advocacy, and addressing mental health disparities in rural populations may also find the content of the PDF relevant to their work.

Sample Size: The PDF does not explicitly state the sample size of the West Virginia Children’s Access Network (WVCAN) project. The document primarily provides an overview of the strategies used to implement and integrate the telehealth model, as well as the barriers, challenges, and judicious resource use involved in the project. It reports on the number of appointments provided, the rate of appointments kept, and the occurrence of hospitalizations among the served youth, but it does not provide a specific sample size in the traditional sense of a research study.

Age Range: The PDF does not explicitly mention the specific age range of the youths served by the West Virginia Children’s Access Network (WVCAN) project. However, it focuses on increasing youth access to psychiatric care and reducing wait times for youths who were unable to access these services through other means. The project aimed to provide school-based psychiatry services in West Virginia’s rural areas by child psychiatrists and psychologists trained in telepsychiatry. Therefore, it can be inferred that the project targeted children and adolescents of school age. While the PDF does not provide a specific age range, it emphasizes the importance of addressing the mental health needs of children and adolescents in rural areas through the WVCAN project.

Intervention Components (click on component to see a list of all articles that use that intervention): SCHOOL, School-Based Health Centers, CLASSROOM_SCHOOL

Intervention Description: We describe the implementation of an "expanded medical home" partnering a primary care practice (the Ypsilanti Health Center [YHC]) with local school-based health centers (the Regional Alliance for Healthy Schools [RAHS]), and to assess whether this model improves access to and quality of care for shared patients.

Intervention Results: At baseline, patients seen at YHC/RAHS had higher compliance with most quality metrics compared with those seen at YHC only. The proportion of shared patients significantly increased because of the intervention (P < .001). Overall, patients seen in the expanded medical home had a higher likelihood of receiving quality metric services than patients in YHC only (odds ratio, 1.8; 95% confidence interval, 1.57-2.05) across all measures.

Conclusion: Thoughtful and intentional implementation of an expanded medical home partnership between primary care physicians and school-based health centers increases the number of shared high-risk adolescent patients. Shared patients have improved compliance with quality measures, which may lead to long-term improved health equity.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Regional Alliance for Healthy Schools (SBHCs) in middle and high schools and UMHS Ypsilanti Health Center

Population of Focus: Middle and high school youth ages 10– 21 years and a part of Michigan “safety net” network

Data Source: The University of Michigan Hospital and Health Systems electronic health records

Sample Size: Total (N=1471 at baseline)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): SCHOOL, School-Based Health Centers, PROVIDER/PRACTICE, Patient-Centered Medical Home, Nurse/Nurse Practitioner, PATIENT/CONSUMER, Referrals, Peer Counselor

Intervention Description: We describe the implementation of an "expanded medical home" partnering a primary care practice (the Ypsilanti Health Center [YHC]) with local school-based health centers (the Regional Alliance for Healthy Schools [RAHS]), and to assess whether this model improves access to and quality of care for shared patients.

Intervention Results: At baseline, patients seen at YHC/RAHS had higher compliance with most quality metrics compared with those seen at YHC only. The proportion of shared patients significantly increased because of the intervention (P < .001). Overall, patients seen in the expanded medical home had a higher likelihood of receiving quality metric services than patients in YHC only (odds ratio, 1.8; 95% confidence interval, 1.57-2.05) across all measures.

Conclusion: Thoughtful and intentional implementation of an expanded medical home partnership between primary care physicians and school-based health centers increases the number of shared high-risk adolescent patients. Shared patients have improved compliance with quality measures, which may lead to long-term improved health equity.

Study Design: Quasi-experimental: Nonequivalent control group; Qualitative

Setting: Michigan primary care and consortium of school-based health centers

Population of Focus: Adolescents

Data Source: • Record review of preventive health measures • University of Michigan Health System Quality Management Program quality measures • Qualitative data

Sample Size: n=2200 adolescents; 9338 visits

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Health Centers,

Intervention Description: The intervention described in the provided PDF file involves the implementation of new elementary school-based health centers (SBHCs) in Georgia. These SBHCs were established to provide access to healthcare services for children enrolled in Georgia's Medicaid or Children's Health Insurance Program (CHIP) ,[object Object],. The SBHCs were implemented in different geographic environments and served predominantly minority populations, including rural non-Hispanic white, small city black, and suburban Hispanic communities ,[object Object],. The study focused on the effects of these SBHCs on the receipt of preventive care among children with access to the SBHCs compared to those without access ,[object Object],.The implementation of the SBHCs aimed to increase access to key preventive care services, such as well-child visits, influenza vaccination, diet counseling, and preventive dental care, among publicly insured children in urban areas of Georgia. The study findings indicated significant increases in well-child visits, influenza vaccination, and diet counseling among obese/overweight Hispanic children associated with the implementation of the SBHCs ,[object Object],. Overall, the intervention involved the establishment of new SBHCs in different community settings with the goal of increasing access to preventive care services for children enrolled in Georgia's Medicaid or CHIP programs.

Intervention Results: The results of the study described in the provided PDF file indicate that the implementation of new elementary school-based health centers (SBHCs) in Georgia was associated with significant increases in the receipt of preventive care among publicly insured children in urban areas of Georgia ,[object Object],. Specifically, the study found significant increases in well-child visits and influenza vaccination among children with access to the SBHCs compared to those without access ,[object Object],. The study also found a significant increase in diet counseling among obese/overweight Hispanic children associated with the implementation of the SBHCs ,[object Object],. However, the study did not find significant differences in emergency department visits or hospitalizations associated with the implementation of the SBHCs ,[object Object],. The study also found that the effects of the SBHCs were largely consistent with a systematic review of SBHC studies based on whole school and user analyses ,[object Object],.

Conclusion: The conclusion of the study described in the provided PDF file is that the implementation of elementary school-based health centers (SBHCs) in Georgia increased the receipt of key preventive care among young, publicly insured children in urban areas of Georgia with potential reductions in racial and ethnic disparities ,[object Object],. The study findings suggest that the implementation of SBHCs may be an effective means of increasing access to preventive care services for publicly insured children in urban areas, particularly among minority populations ,[object Object],. The study also highlights the importance of access to high-quality health care for child development and prevention of diseases with pathways that begin in early and middle childhood ,[object Object],. The study authors recommend the further expansion of elementary SBHCs in Georgia as one means of addressing unmet needs and disparities among lower-income children in non-rural areas ,[object Object],. They also suggest that further understanding of the barriers to success of SBHCs in Georgia's rural areas is needed ,[object Object],.

Study Design: The study design described in the provided PDF file involves the implementation of a difference-in-differences approach using multivariate logistic regression models to assess the impact of the implementation of new school-based health centers (SBHCs) on the receipt of preventive care among Medicaid/CHIP-enrolled children. The study compares the receipt of preventive care among Medicaid/CHIP children with access to the SBHCs to those without access to an SBHC ,[object Object],. The statistical models included various controls such as age, race/ethnicity, Medicaid eligibility category, relation of child to head of household, months in Medicaid/CHIP during the school year, and school-level variables ,[object Object],. The analyses were conducted using Stata, version 16.1 ,[object Object],. The study also involved the creation of analytic files for August through May of school years 2011–2012 through 2016–2017, and unique encrypted IDs were used to follow individual Medicaid/CHIP children over time ,[object Object],. Additionally, the study population was largely non-white, with over 70% being either Hispanic or non-Hispanic black in the pre-period ,[object Object],. Overall, the study design involved a rigorous statistical approach and comprehensive data analysis to assess the impact of SBHC implementation on the receipt of preventive care among Medicaid/CHIP-enrolled children.

Setting: The setting described in the provided text is related to the implementation of school-based health centers (SBHCs) in different types of schools, including urban, small city, and rural areas. The study compares the impact of SBHC implementation on the use of preventive care services in these different settings ,[object Object],. The specific schools and their characteristics are detailed in Table 1, which includes information about the counties, school environments, and ZIP codes ,[object Object],.

Population of Focus: The target audience for the provided PDF file is not explicitly stated. However, the document provides information about accessing scientific literature through the National Library of Medicine, which suggests that the target audience may be researchers, healthcare professionals, and other individuals interested in accessing scientific literature. Regarding the study described in the text, the target audience is likely researchers, policymakers, and healthcare professionals interested in understanding the impact of school-based health centers on the use of preventive care services among children in different settings.

Sample Size: The sample size in the study described in the provided PDF file varies depending on the specific analysis being conducted. For example, the study population for one analysis included children in school district areas with a new school-based health center (SBHC), and the sample size for this population was detailed in Table 4, with child/school year observations ranging from 2,204 to 7,375 depending on the specific type of school ,[object Object],. Additionally, the total number of child/school year observations for Medicaid/CHIP-enrolled children in at least one month of both pre and post periods was reported as 13,888, with the number of child/school year observations for users of services being smaller at 7,994 ,[object Object],.

Age Range: The age range of the population studied in the provided PDF file varies depending on the specific analysis being conducted. However, the study focuses on children aged 5-12 years who were ever enrolled in Georgia Medicaid or PeachCare (CHIP) ,[object Object],. For example, Table 2 provides characteristics of Medicaid/CHIP-enrolled children in school district areas pre- and post-SBHC implementation, with the age range of the population being 5-7 years and 8-12 years ,[object Object],. Overall, the study focuses on children aged 5-12 years who were enrolled in Georgia Medicaid or PeachCare (CHIP) and who were in school district areas with or without a new school-based health center (SBHC).

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, School-Based Health Centers, Planning for Transition, HEALTH_CARE_PROVIDER_PRACTICE, Pediatric to Adult Transfer Assistance, Care Coordination, Quality Improvement/Practice-Wide Intervention

Intervention Description: This pilot study implemented and assessed the use of a structured HCT process, the Six Core Elements of HCT, in two school-based health centers (SBHCs) in Washington, DC. The pilot study examined the feasibility of incorporating the Six Core Elements into routine care and identified self-care skill gaps among students. Quality improvement methods were used to customize, implement, and measure the Six Core Elements and HCT supports.

Intervention Results: After the pilot, both SBHCs demonstrated improvement in their implementation of the structured HCT process. More than half of the pilot participants reported not knowing how to find their doctor’s phone number and not knowing what a referral is.

Conclusion: These findings indicate the need for incorporating HCT supports into SBHCs to help students build self-care skills necessary for adulthood.

Study Design: Cohort pilot evaluation

Setting: Schools

Population of Focus: High school students

Sample Size: 560

Age Range: Grades 9-12