Clinical trial NCT04540003: School Based Health Care: A Model for Improving Educational Achievement for Children in Inner City Schools
Official title: School Based Health Care: A Model for Improving Educational Achievement for Children in Inner City Schools
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Educational Achievement
Keywords: school-based health centre
SBHC
School Support Team
SST
academic
inner city schools
standardized test scores
developmental pediatrics
education
achievement
Lead sponsor: Unity Health Toronto
Sponsor class: OTHER
Collaborators: name: Toronto District School Board
First posted: 2020-09-07
Enrollment: 147
Sex: ALL
Minimum age (years): 4
Maximum age (years): 13
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
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.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief 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.


Eligibility criteria: Inclusion Criteria:

* All students identified at the SST meetings requiring a developmental assessment.

Exclusion Criteria:

* Students without a developmental concern and not identified at the SST meeting will be excluded. No other specific exclusion criteria will be applied.

Primary outcomes:
measure: Educational achievement as assessed by numeric data from report cards.
timeFrame: Change from baseline to 18 months after identification at SST
measure: Educational achievement as assessed by Canadian Achievement Test 4 (CAT4) scores.
timeFrame: Change from baseline to 18 months after identification at SST
measure: Education achievement as assessed by Education Quality and Accountability Office (EQAO) scores
timeFrame: Change from baseline to 18 months after identification at SST
Secondary outcomes:
measure: Socio-demographic data and relationships to educational achievement
timeFrame: change from baseline to 18 months after identification at SST
measure: Wait time data will be determined retrospectively from chart review for the intervention group
timeFrame: date of SST meeting to date of developmental assessment
Other outcomes:
Locations:
city: Toronto
country: Canada
facility: Unity Health Toronto
state: Ontario
Study officials:
affiliation: Unity Health Toronto
name: Sloane Freeman, MSc,MD,FRCPC
role: PRINCIPAL_INVESTIGATOR
References:
citation: Breslau J, Miller E, Breslau N, Bohnert K, Lucia V, Schweitzer J. The impact of early behavior disturbances on academic achievement in high school. Pediatrics. 2009 Jun;123(6):1472-6. doi: 10.1542/peds.2008-1406.
citation: Reynolds AJ, Temple JA, Ou SR, Robertson DL, Mersky JP, Topitzes JW, Niles MD. Effects of a school-based, early childhood intervention on adult health and well-being: a 19-year follow-up of low-income families. Arch Pediatr Adolesc Med. 2007 Aug;161(8):730-9. doi: 10.1001/archpedi.161.8.730.
citation: Shevell MI, Majnemer A, Rosenbaum P, Abrahamowicz M. Profile of referrals for early childhood developmental delay to ambulatory subspecialty clinics. J Child Neurol. 2001 Sep;16(9):645-50. doi: 10.1177/088307380101600904.