Journal of School Health最新文献

Background: School-based health centers (SBHCs) have been shown to offer substantial benefits to students but we know little about how the public thinks about them. We sought to assess US public attitudes about SBHCs and the provision of 7 health service lines-primary care, preventive care, vaccinations, preventive dental care, preventive vision care, mental health care, and nutrition counseling.

Methods: We administered a national online survey (N = 4196) of US adults using Lucid, a large, internet-based, opt-in panel to assess public attitudes about SBHCs as well as 7 commonly offered health services in SBHCs. We then used t-tests and weighted linear regression models to carry out our study objectives.

Results: Unadjusted analysis revealed that more than 2 in 3 respondents supported SBHCs in general as well as the provision of all health services in SBHCs. Regression analysis indicated that ideology, partisanship, and trust in public school principals served as consistent predictors of attitudes when controlling for demographic and health characteristics. The provision of vaccinations stood out as particularly controversial. Subanalysis of parents found even higher levels of support as well as a more subdued role of ideology and partisanship.

Conclusions: The US public broadly supports the provision of health services in SBHCs. Our results should inform policymakers, advocates, and providers seeking to improve access to health care among school-aged children, particularly for underserved populations. Increasing knowledge about SBHCs and providing stable funding should be a priority. In the immediate future, SBHCs may offer an important buffer against ongoing Medicaid disenrollments.

A key component of student health and well-being is mental health. The rates of diagnosable mental health concerns among students are high—the lifetime prevalence for at least 1 mental health disorder was nearly 50% in a large, nationally representative sample of adolescents from 2010,¹ and prevalence has increased among school-age children and adolescents in recent years.² Notably, only about half of youth with mental health concerns receive treatment,^{3, 4} and rates of treatment receipt are lower among marginalized or low-income youth.^{3, 5} When children and adolescents do receive mental health treatment, they frequently access these services through their preK-12 schools.^6-8 Compared to clinic-based settings, schools offer many advantages for mental health service provision, including promoting access to care and reducing stigma⁹ particularly within under-resourced settings.¹⁰

Unfortunately, there are significant implementation challenges to the uptake and delivery, as well as the study, of mental health services within schools. The primary mission of schools is academic education, and many schools, particularly those serving marginalized or low-income students, frequently lack the resources to achieve their academic mission. As a result, there are often limited resources left to deliver mental health services, especially if they are not directly aligned with the schools' academic mission.⁹ Furthermore, school-based mental health practitioners face multilevel barriers when implementing interventions, including characteristics about the intervention itself (eg, usability, contextual fit), the individual (eg, stress and burnout), the team (eg, turnover), and the school (eg, funding for sustainability), as well as factors related to the macro-level community (eg, service fragmentation).^{11, 12}

Applying concepts from the field of implementation science, the scientific study of strategies to facilitate the uptake of evidence-based practices into real-world service delivery,¹³ has the potential to benefit school mental health research and practice. One way to support successful uptake is to develop and test implementation strategies (ie, the techniques used to enhance the adoption, implementation, or sustainment of interventions), which are key to ensure that school mental health interventions are implemented as intended within schools. The School Implementation Strategies Translating ERIC (ie, Expert Recommendations for Implementing Change) Resources (SISTER) is a compilation of 75 implementation strategies¹⁴ for the school context. SISTER provides a taxonomy of strategies (eg, provide consultation/coaching; monitor the implementation effort) to help researchers and school part