School Based Health Care: A Model for Improving Educational Achievement for Children in Inner City Schools
Condition: Educational Achievement
Study type: Interventional

Summary: 
      Developmental problems have tremendous impact on children, affecting academic achievement and
      mental health later in life.The process of receiving a developmental assessment is long and
      arduous, and may require multiple physician visits taking over one year. Although a
      relatively new concept in Canada, School-Based Health Centres (SBHCs) have been successfully
      implemented in over 1900 schools in the United States.The first SBHC in Ontario, and Canada
      as a whole, was established through the Model Schools Pediatric Health Initiative (MSPHI) and
      is dedicated to reducing health inequities for inner city children by reducing barriers and
      providing accessible clinical care. To provide more conclusive evidence on the relative
      benefits of SBHCs as compared to traditional health care access, this study will use a
      prospective cohort quasi-experimental study design to compare differences in educational
      achievement for developmental assessments in the SBHC model relative to standard care. As per
      standard of care, students having difficulty in school are identified by the Toronto District
      School Board (TDSB) internal research staff and are presented to the monthly School Support
      team (SST) meetings. Historically physicians do not attend SST meetings, however, as a part
      of the SBHC program, pediatricians will participate in monthly SST meetings. Schools assigned
      to the intervention group will have SBHC physicians attend SST meetings, while schools
      assigned to the control group will not.

      The overall objective of this study is to examine educational achievement, as defined by
      standardized test scores and report cards in students who use an inner city SBHCs for
      developmental concerns relative to those who do not. We hypothesize students attending
      schools in which SST meetings have a pediatrician present, that are referred to a SBHC, will
      score higher and show a greater increase in standardized test scores and report cards (from
      baseline to follow-up) than students attending schools in which SST meetings do not have a
      pediatrician present and access services through traditional means in the community (standard
      of care).The secondary objectives are: a) to examine socio-demographic data for these
      students and its relationship to educational achievement and b) to determine wait times to
      developmental assessment for students in the intervention group who attend the SBHCs using
      retrospective chart review.
    


Intervention name(s): Access to School Based Health Centre
Intervention type(s): Other
Intervention description(s): The SBHC will be staffed by a family physician, two pediatricians and a developmental pediatrician, each with at least one half-day of clinic time per week from September through June. The SBHC is also staffed by a clinic coordinator who is responsible for booking appointments on a first-referral, first-serve basis.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: This project will be a prospective cohort quasi-experimental study design to compare the benefits of using SBHCs as opposed to the traditional health care by evaluating educational achievements. The study period includes September 2017-June 2018 and September 2018-June 2019. Of 16 inner city schools not previously exposed to the SBHC in the TDSB, some schools (n=8) will be in the control arm following the standard of care while others (n=8) will have access to SBHC. Students presented to SST meetings whose outcomes include the need for a developmental/pediatric assessment at the 16 schools will be identified by TDSB internal research staff. To conduct our primary analysis, standardized test scores and numeric data from report cards will be analyzed using a linear mixed effect model where the schools are the random effects and the baseline test scores and report cards are adjusted for by including it as a covariate.
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: school-based health centre; SBHC; School Support Team; SST; academic; inner city schools; standardized test scores; developmental pediatrics; education; achievement