Document Type : Research Article (s)
Authors
1 Temerty School of Medicine, University of Toronto, Toronto, Canada
2 Department of Paediatric Medicine, University of Toronto, Toronto, Canada
Abstract
Background: A school-based health centre (SBHC) in Toronto, Canada, supports students with academic, developmental, and behaviour-related challenges. The educators in this centre complete a referral form to provide information to the SBHC. The present study aimed to a) collaborate with the educators to co-design the existing SBHC referral form and b) provide the educators with a resource on a common pediatric disorder.
Methods: The current quality improvement study was performed using a Plan-Do-Study-Act (PDSA) cycle. Data was collected from November 2020 to January 2021. Twenty-three educators rated their understanding of the original SBHC referral form using a 6-point Likert scale. The symptom descriptors flagged by >10% of the educators as unclear were updated and re-evaluated through a second survey. The educators voted on a common medical issue for which a pamphlet was created and evaluated for its effectiveness. Statistical analysis was performed using GraphPad Prism. Paired data were assessed by Wilcoxon rank-order test, unpaired data with Fischer’s exact, and proportions via Chi-squared test.
Results: The original referral form had 13/48 (27%) presenting symptoms identified for revision. After this revision, significantly fewer presenting symptoms met the criteria for revision (3/50, 6%; P<0.01). Most educators (10/23, 43%) requested an educational pamphlet on childhood anxiety. The majority of them (13/16, 81%) strongly agreed that they knew more about childhood anxiety after reviewing the resource and all of them (16/16, 100%) thought the resource would be helpful and could be shared with parents.
Conclusion: Collaboration with the educators to co-design a SBHC referral form clarified its descriptors, enhancing the communication between the two parties in the referral process. Physician-created educational resource enhanced the educators’ knowledge about anxiety.
Keywords
- Brindis CD, Klein J, Schlitt J, Santelli J, Juszczak L, Nystrom RJ. School-based health centres accessibility and accountability. J Adolesc Health. 2003;32(suppl 6):98-107. doi: 10.1016/S1054-139X(03)00069-7. PubMed PMID: 12782448. ##
- Geierstanger SP, Amaral G, Mansour M, Walters SR. School-based health centres and academic performance: research, challenges, and recommendations. J Sch Health. 2004;74(9):347-52. doi: 10.1111/j.1746-1561.2004.tb06627.x. PubMed PMID: 15656260. ##
- Hamm EM. Managing asthma in the classroom. Childhood Education. 2004;81(1):16-19. doi: 10.1080/00094056.2004.10521286. ##
- Richardson J. Building bridges between school-based health clinics and school. J Sch Health. 2007;77(7):337-43. doi: 10.1111/j.1746-1561.2007.00217.x. PubMed PMID: 17680891. ##
- Gall G, Pagano ME, Desmond MS, Perrin JM, Murphy JM. Utility of psychosocial screening at a school-based health centre. J Sch Health. 2000;70(7):292-8. doi: 10.1111/j.1746-1561.2000.tb07254.x. PubMed PMID: 10981284; PubMed Central PMCID: PMC3306214. ##
- McCord MT, Klein JD, Foy JM, Fothergill K. School-based clinic use and school performance. J Adolesc Health. 1993;14(2):91-8. doi: 10.1016/1054-139x(93)90091-3. PubMed PMID: 8476879. ##
- Stephan S, Mulloy M, Brey L. Improving collaborative mental health care by school-based primary care and mental health providers. School Mental Health. 2011;3:70-80. doi: 10.1007/s12310-010-9047-0. ##
- Zakrzewska JM. Referral letters – how to improve them. Br Dent J. 1995;178(5):180-2. doi: 10.1038/sj.bdj.4808697. PubMed PMID: 7702954. ##
- Ringeisen H, Henderson K, Hoagwood K. Context matters: schools and the “research to practice gap” in children’s mental health. School Psychology Review. 2003;32(2):153-168. doi: 10.1080/02796015.2003.12086188. ##
- Jerome L, Gordon M, Hustler P. A comparison of American and Canadian teachers’ knowledge and attitudes towards Attention Deficit Hyperactivity Disorder (ADHD). Can J Psychiatry. 1994;39(9):563-7. doi: 10.1177/070674379403900909. PubMed PMID: 7874659. ##
- Koller JR, Bertel JM. Responding to today’s mental health needs of children, families and school: Revisiting the preservice training and preparation of school-based personnel. Education and Treatment of Children. 2006;29(2):197-217. ##
- Leblanc L, Richardson W, Burns KA. Autism spectrum disorder and the inclusive classroom: effective training to enhance knowledge of ASD and evidence-based practices. Teacher Education and Special Education. 2009;32(2):166-179. doi: 10.1177/0741932507334279. ##
- Barned NE, Knapp NF, Neuharth-Pritchett S. Knowledge and attitudes of early childhood preservice teachers regarding the inclusion of children with autism spectrum disorder. Journal of Early Childhood Teacher Education. 2011;32(4):302-321. doi: 10.1080/10901027.2011.622235. ##
- Helps S, Newsom-Davis I, Callias M. Autism: The teacher’s view. Autism. 1999;3:287-298. doi: 10.1177/1362361399003003006. ##
- Vereb RL, DiPerna JC. Research Brief: Teachers’ knowledge of ADHD, treatments for ADHD, and treatment acceptability: an initial investigation. School Psychology Review. 2004;33(3): 421-428. doi: 10.1080/02796015.2004.12086259. ##
- Chung PJ, Patel DR, Nizami I. Disorder of written expression and dysgraphia: definition, diagnosis and management. Transl Pediatr. 2020;9(Suppl 1): S46-S54. doi: 10.21037/tp.2019.11.01. PubMed PMID: 32206583; PubMed Central PMCID: PMC7082241. ##
- Graham A, Phelps R, Maddison C, Fitzgerald R. Supporting children’s mental health in schools: teacher views. Teachers and Teaching. 2011;17(4):479-496. doi: 10.1080/13540602.2011.580525. ##
- Aguiar AP, Kieling RR, Costa AC, Chardosim N, Dorneles BV, Almeida MR, et al. Increasing teachers’ knowledge about ADHD and learning disorders: an investigation on the role of psychoeducation intervention. J Atten Disord. 2014;18(8):691-698. doi: 10.1177/1087054712453171. PubMed PMID: 22851210. ##
- Shelemy L, Harvey K, Waite P. Supporting students’ mental health in schools: what do teachers want and need? Emotional and Behavioural Difficulties. 2019;24(1):100-116. doi: 10.1080/13632752.2019.1582742. ##
- Ramsawh HJ, Chavira DA. Association of childhood anxiety disorders and quality of life in a primary care sample. J Dev Behav Pediatr. 2016;37(4):269-76. doi: 10.1097/DBP.0000000000000296. PubMed PMID: 27096571. ##
- Wood J. Effects of anxiety reduction on children’s school performance and social adjustment. Dev Psychol. 2006;42(2):345-9. doi: 10.1037/0012-1649.42.2.345. PubMed PMID: 16569172. ##
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