Systematic reviews of intervention studies that evaluated school-based or school-linked health services delivered by a health provider were included. One reviewer (JL) assessed all SRs and a second (KK) duplicated appraisal of 10%, with 94% agreement and only minor disagreements that did not impact grades of confidence. Education on the wearing of spectacles in addition to vision screening as compared to vision screening alone did not have a significant effect [21]. Eleven SRs included studies located in countries with high-income or upper-middle income economies only [19,20,2325,2933,37,38,39]. Meta-analysis indicated small, yet statistically significant, reductions in body mass index (BMI), BMI z-score, and BMI percentile for both obesity treatment and prevention [26]. Suggested citation: National Association of School Nurses. From the limited amount of information available in existing systematic reviews, the strongest evidence supports implementation of anxiety prevention programs, indicated asthma education, and vision screening with provision of free spectacles. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Framework for 21st Century School Nursing Practice, Call for Conference Presentation Submissions, NCPD Contact Hours Certificates and Transcripts, Electronic health records: An essential tool in keeping students healthy, Healthcare Information and Management Systems. Building on a method suggested by Shea and colleagues [17], grades of confidence in the results of each SR were generated based on critical flaws and non-critical weaknesses. Interventions with evidence for effectiveness addressed autism, depression, anxiety, obesity, dental caries, visual acuity, asthma, and sleep. This overview found 20 SRs covering 270 primary studies. Confidence in results ranged from high (three or fewer non-critical weaknesses) to critically low (more than three critical flaws with or without non-critical weaknesses) [17]. Click to Enlarge | PDF [PDF 466 KB] | JPEG | PNG. This overview measured overlap using the corrected covered area (CCA) [16] and did not exclude overlapping studies. The formula for the CCA is: Strongest evidence in favor of oral health interventions emerged from a SR on universal topical application of fluoride gel for the prevention of dental caries [25]. The details of the quality appraisal of primary studies included in the SRs are given in Table B in S4 Appendix. Third, the scopes of individual SRs often differ from the scope of the overview, a problem that Ballard and Montgomery call a scope mismatch [13]. Retain all of your child's school accounts can help you see trends and patterns over time. In the remaining twelve SRs, 50% to 74% of included studies fulfilled all the inclusion criteria [19,20,2225,28,31,32,3436]. In emergencies, school officials can provide information from education records to protect the health or safety of the student or others. This implies that a narrower range of SRs would have been eligible if a stricter cut-off had been selected, and vice versa. If school health services are to truly improve the health of children and adolescents, they must comprehensively address the most pressing problems of this population. PLOS ONE promises fair, rigorous peer review, 1654 references were screened and 20 systematic reviews containing 270 primary studies were assessed narratively. Citation: Levinson J, Kohl K, Baltag V, Ross DA (2019) Investigating the effectiveness of school health services delivered by a health provider: A systematic review of systematic reviews. The significance of records management to public healthcare facilities and institutions includes operational cost reduction and elimination of duplicated overhead costs; eliminates the creation. A health book contains the names of students/Pupils who brings complains to the clinic, . Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland. State and local stakeholders are encouraged to use other data, such as youth behavior surveys and public health surveillance, to identify which health risks have the greatest impact on students. These SRs contained 270 primary studies, 225 of which were unique and 45 were included in more than one SR. School health services (SHS), as defined in thisguideline, are services provided by a health workerto students enrolled in primary or secondaryeducation, either within school premises or in ahealth service situated outside the school. Thank you for taking the time to confirm your preferences. Chung and colleagues systematically reviewed and meta-analyzed universal sleep education programs as compared to no additional sleep intervention from Australia, New Zealand, Brazil, and Hong Kong (Table 3G) [20]. If consensus was not possible during title/abstract or full text screening, a third reviewer (DR), who had the casting vote, would have been asked to independently screen the article. In addition, school-age childrenand adolescents have positive physical, sexual,psychosocial and neurocognitive health anddevelopment needs as they progress from childhoodto adulthood. We would like to thank Tomas Allen for his guidance and support in designing the search strategy. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. In a sensitivity analysis that we conducted comparing systematic* with systematic review we found that the number of search results increased almost three-fold, but did not reveal any new articles that would eventually have met the subsequent eligibility criteria (search results available on request). Academic performance records, such as grades and report cards, provide insight about. Leading causes of disability-adjusted life years (DALYs) for 1019 year olds were iron deficiency anemia, road injury, depressive disorders, lower respiratory infections, and diarrheal diseases [47]. The AMSTAR 2 checklist [17] was used to appraise quality of included SRs. Mostly favorable evidence of effectiveness was found in a SR of social-emotional interventions for refugee and war-traumatized youth from 26 countries [36]. To investigate the effectiveness of school health services for improving the health of school-age children and adolescents, a systematic review of systematic reviews (overview) was conducted. David Anthony Ross, Affiliation: (2019). All information these cookies collect is aggregated and therefore anonymous. School health assessments give schools a snapshot in time of programs and policies that address student and staff health. The National Survey of Children's Health (NSCH 2016-2017) estimated that over 22 million U.S. school-aged children are living with one or two or more health conditions, 11 million have special health care needs, and 7.5 million are not receiving needed care coordination (Child and Adolescent Health Measurement Initiative, 2016-2017).With school-aged children spending an average of 180 . PRISMA flowchart showing reasons for exclusion of potential systematic reviews. Eleven SRs included only cluster- and individually-randomized controlled trials [1921,24,27,28,30,32,34,37], seven SRs included other types of controlled and uncontrolled experimental studies in addition to RCTs [22,25,26,31,33,35,36], and two SRs included only QEs [29] or controlled clinical trials [23]. In this overview, SRs with at least 50% of included studies fulfilling all criteria were included after extensive discussion between the authors and experts in the field. Further, the exclusion of interventions delivered by non-health providers reduces the quantity and breadth of SRs included in this overview. broad scope, and wide readership a perfect fit for your research every time. A recent guideline from the International Agency for Prevention of Blindness (IAPB) reiterates the importance of free spectacles and goes further to suggest that low- and middle-income countries (LMIC) adopt comprehensive school eye health programs [43]. A strength of this overview is that it attempted to answer a question that has not yet been answered regarding the effectiveness of both comprehensive and specific school health services delivered by a health provider. Duplication of effort is something all three organizations would like to avoid. A school health assessment is a systematic collection, review, and analysis of information about school health-related policies and programs for the purpose of improving students' health and educational outcomes. Saving Lives, Protecting People, School Health Index: A Self-Assessment and Planning Guide, National Center for Chronic Disease Prevention and Health Promotion, Physical Activity and Sedentary Behaviors and Academic Grades, Tobacco Product Use Behaviors and Academic Grades, Other Health Behaviors and Academic Grades, Characteristics of an Effective Curriculum, Tips for Promoting School Employee Wellness, Physical Education Curriculum Analysis Tool, Health Education Curriculum Analysis Tool (HECAT), Body Mass Index (BMI) Measurement in Schools, Inclusive School Physical Education and Physical Activity, Physical Activity Before and After School, What School Nutrition Professionals Need to Know About COVID-19, Modifying School Spaces During Mealtimes to Reduce Spread of COVID-19, Supporting Students with Chronic Health Conditions in School-Based OST Programs, Healthy and Supportive School Environments, Strategies to Create a Healthy and Supportive School Environment, Strategies to Help Parents and Families Create Healthy and Supportive School Environments, How Families Can Support Student Health and Emotional Well-being, Toolkit for Schools: Engaging Parents to Support Student Health and Emotional Well-being, Youth Risk Behavior Surveillance System (YRBSS), School Health Policies and Practices Study (SHPPS), e-Learning Series: Training Tools for Healthy Schools, Comprehensive School Physical Activity Program, Guide to Evaluating Professional Development, Understanding the Training of Trainers Model, Professional Development Follow-Up Support, How to Build a Training Cadre: A Step-by-Step Process, Guide to Promoting Professional Development, Whole School, Whole Community, Whole Child (WSCC), Encourage healthy eating in school and at home, Dental Sealants Can Improve Students Oral Health, Give Your Kids a Healthy Body and Mind This Summer, Engaging Parents to Promote Healthy Schools, Funded Nongovernmental Organizations for Healthy Schools, BAM! It should include not only personal data of the pupil but also his school-attainments, health report, personality traits and participation in activities. In order for policy makers and leaders in school health to make evidence-based recommendations on which services should be available in schools, who should deliver them, and how should they be delivered, more SRs must be done. However, the degree of overlap across all 20 SRs was graded as being small (CCA = 1), while there was high overlap in SRs on mood disorders (CCA = 11). However, all included primary studies were delivered in HIC [26]. For useful recommendations to be made regarding school health services, cost-effectiveness must be more closely examined by primary studies and SRs. Health Record to Teacher: Purpose: 1. Independent Oversight and Advisory Committee, WHO guideline on school health services: Web Annex A. Compendium, WHO guideline on The computer software organizes data in ways that are easy to interpret and put to use. This overview primarily found evidence for special research interventions, suggesting a need for assessment of routinely-delivered school health services. Gold and colleagues assessed daily music therapy as an intervention to improve verbal and gestural communicative skills and reduce behavioral problems in children diagnosed with autism spectrum disorder [23]. In 2015, the global means for the primary and secondary net school enrollment rates were 90% and 65%, respectively, thus the potential reach of school health services is wide [8]. The 20 SRs covered eight health areas: nine on mental health [19,23,24,28,29,3234,36], four on oral health [18,25,27,30], two on asthma [31,37], and one SR each on sleep [20]; obesity [26]; vision [21]; menstrual management [22]; and sexual and reproductive health (SRH) [35]. | 3 Registration Options. A meta-analysis of two studies on sanitary pad provision found a moderate but statistically non-significant effect on school attendance. In 1995, WHO launched the GlobalSchool Health Initiative, which aimed to strengthenapproaches to health promotion in schools. CCA values for all health areas and calculations are available in Tables C and D in S5 Appendix. 80% (n = 16) of SRs included in this overview were given ratings of low or critically low confidence using the AMSTAR 2 checklist, although this is not unusual given the stringency of the checklist. The Advantages of Digitizing School Health Records Digitalization of documents is becoming more popular. Meaningful use (MU) of Electronic Health Records (EHRs) is an important development in the safety and security of health care delivery in the United States. Instead, the authors determined which of the 16 items on the checklist were critical for this overview and which of the items were non-critical. not in schools), an active control, or a waitlist control; (d) interventions aimed to improve one or more health outcomes, as defined by the SR authors; and (e) study designs were either randomized controlled trials (RCTs), quasi-experimental studies (QEs), or other non-randomized intervention studies. The final two items in the four-item checklist are (3) date of publication to ensure that results are up-to-date, and (4) matching of the scope to confirm that primary studies within SRs are relevant to the overview. In 2015, the top five leading causes of death for 59 year olds were lower respiratory infections, diarrheal diseases, meningitis, drowning, and road injury [47]. The 2017 Global Accelerated Action for the Health of Adolescents (AA-HA!) However, it was unclear whether these studies involved a health provider [22]. Data Availability: All relevant data are within the manuscript and its Supporting Information files. Improvements in trauma-related symptoms and impairment were found through narrative assessment of creative expression interventions, cognitive behavioral interventions, and multifaceted interventions [36]. S4 Appendix. Although all SRs were included if at least 50% of the primary studies within them fulfilled all inclusion criteria, SRs where closer to 100% of primary studies fulfilled all criteria were considered to be better matched than those with closer to 50%. http://www.who.int/school_youth_health/gshi/en/, http://www.schoolsandhealth.org/Pages/WASH.aspx, http://www.who.int/school_youth_health/resources/information_series/en/, https://data.worldbank.org/?year_high_desc=false, http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD012595.pub2/full, http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD005023.pub3/full, http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD004381.pub2/abstract, http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002280.pub2/abstract, https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups, https://eppi.ioe.ac.uk/cms/Default.aspx?tabid=2418, http://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment, https://www.iapb.org/resources/school-eye-health-guidelines/, http://apps.who.int/iris/bitstream/handle/10665/43027/924159215X_eng.pdf;jsessionid=7E674C27FAC37B003AB96A2DC13C7407?sequence=1, http://apps.who.int/iris/bitstream/handle/10665/204176/9789241510066_eng.pdf?sequence=1, http://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight, http://www.who.int/healthinfo/global_burden_disease/en/, Corrections, Expressions of Concern, and Retractions. This systematic review of systematic reviews, henceforth referred to as an overview, will inform the upcoming development of a WHO guideline that addresses the school health services component of health-promoting schools and feeds into the FRESH framework. This initiative is dedicated to promoting development of school health programs and increasing the number of health-promoting schools, characterized by WHO as a school constantly strengthening its capacity as a healthy setting for living, learning and working [1]. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Schools are considered to be an ideal platform for oral health promotion through education, services, and the school environment [6]. Characteristics of included systematic reviews. Thus, responsibility for interventions may need to be redistributed in countries with limited access to health professionals. An important consideration in overviews is the degree of overlap, or the use of the same primary study in multiple included SRs. The gaps in the SR literature identified by this overview will inform the commissioning of new SRs by WHO to feed into evidence-based global recommendations. There is no definitive guidance on how to correct for overlap, as both including or excluding overlapping SRs presents potentially biased results [13,15]. More than half of included SRs analyzed mental health and oral health interventions, and no SRs were found that assessed other relevant health areas, such as vaccinations, communicable diseases, injuries, etc. The most promising evidence from a SR was on topical application of fluoride gel for the prevention of dental caries [25], although the necessity of this intervention may be questioned where flouridated commerical toothpaste is readily available. Citations identified from the systematic search were uploaded to Covidence systematic review software [12] and duplicates were automatically deleted. 2. Additionally, at least 94 countries or territories include some form of school health services that are routinely delivered, as opposed to special research interventions [9]. Kavanagh and colleagues examined depression and anxiety group counseling programs based on cognitive behavioral therapy (CBT) and found statistically significant reductions of depressive symptoms at both four weeks and three months follow-up [24,39]. WHO has long recognized the link between healthand education and the potential for schools to playa central role in safeguarding student health andwell-being. It provides useful information on the progress and development made within the school. These cookies may also be used for advertising purposes by these third parties. The remaining Cochrane review was given a critically low level of confidence, though this may be because it was published in 2006 and standards for both the methods and reporting of Cochrane reviews have improved in recent years. Evans and colleagues reviewed seven RCTs from China, India, and Tanzania on vision screening for correctable visual acuity deficits at or before school entry (Table 3H) [21]. Articles that received conflicting votes (ineligible vs. potentially or probably eligible) were discussed and consensus was reached. The search strategy is presented in S2 Appendix. To be included in this overview, at least 50% of studies within each SR had to fulfill all inclusion criteria. 425 of these articles were ineligible. Outcome measures were collected from included studies. Prevention and treatment of mood disorders was assessed in five SRs, all of which targeted children and adolescents using RCTs of established programs. They help us to know which pages are the most and least popular and see how visitors move around the site. No literature is currently available showing the number of hospitals and health care systems that provide EHR access to school nurses. Due to the diversity in outcome measures and intervention intensities, the authors felt unable to make any evidence-based recommendations [30]. You may know to keep a file of those records. Second, the ability of overviews to make valid and accurate conclusions is dependent upon the accuracy, rigor, and inclusiveness of the SRs themselves. Panelists evaluate questions based on best practices and emerging research on addressing heath behaviors and the school health environment. To receive email updates about this page, enter your email address: We take your privacy seriously. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. The school nurse will be an integral member of a child's larger healthcare team, assuring implementation of the plan of care and providing timely information from the school health record about student response to care. PubMed, Web of Science, ERIC, PsycINFO, and the Cochrane Library were searched systematically. Meta-analysis results indicated a statistically significant effect on the before-after change in caries prevalence [25]. 1720 references were identified from the systematic literature search. About eight-in-ten U.S. murders in 2021 - 20,958 out of 26,031, or 81% - involved a firearm. Valentina Baltag, Yet no SRs on vaccinations fulfilled the inclusion criteria for this overview, suggesting the need for these SRs to be conducted, focusing on whether vaccinations for this age group should be delivered as part of a school health service or not, rather than on whether the vaccination per se is effective. Although at least 102 countries have school health services, there is no rigorous, evidence-based guidance on which school health services are effective and should be implemented in schools. Julia Levinson, Schools offer a unique platform for health care delivery. 570 were duplicates, leaving 1150 titles and abstracts to be screened. Due to the heterogeneity of the SRs included in this overview, it was not possible to perform a meta-analysis. Cookies used to make website functionality more relevant to you. The guidance confirms that disclosures of student educational records (including certain health records) are only permitted by FERPA with the prior written consent of an eligible student or the student's parent/legal guardian (non-eligible student) or if one of the permissive exceptions to the general consent requirement applies. Comprehensive school programs that promote healthy school environments, health and nutrition literacy, and physical activity are one of the six key areas for ending childhood obesity recommended by WHO [45]. In allWHO regions, school-age children and adolescents(those aged 519 years) experience a range oflargely preventable health problems, includingunintentional injury, interpersonal violence, sexualand reproductive health issues, communicablediseases, noncommunicable diseases and mentalhealth issues. Furthermore, this overview exposes a mismatch between the SR literature on effectiveness of school health services and the actual school health services that are most commonly delivered. Risk of bias across SRs was determined using Ballard and Montgomerys four-item checklist for overviews of SRs [13]. The four SRs that included PRP found mixed evidence [34] or no evidence of effectiveness [19,24,28,39], bringing the popularity of this intervention into question. Results from this overview suggest that certain interventions can be effective in improving child and adolescent health outcomes, and thus may be worthwhile for integration into school health programs. Competing interests: The authors have declared that no competing interests exist. Vision screening linked with free provision of spectacles, as a component of a comprehensive school eye health program, is an example of a cost-effective form of school health services that may be implemented. 20 SRs fulfilled all inclusion criteria and were included in this overview. Table D. Classification of primary studies within included systematic reviews for use in corrected covered area calculation. Five of the included studies examined the same weekly sleep education program from the Australian Centre for Education in Sleep. Schools offer a unique opportunity toimplement effective health services at scale forchildren and adolescents. This overview found only one SR that assessed obesity treatment and prevention delivered by a health professional in schools, despite the fact that over 340 million school-age children and adolescents were overweight or obese in 2016 [46]. Because all three school health assessments are based on best practices and focus on known youth health risks, many of the assessment items are similar. This is problematic given that health disparities for children and adolescents are greater in LMIC and LIC than in higher income countries [10]. Evans and colleagues found strong evidence from China, Tanzania, and India that school vision screening for correctable visual acuity deficits increased wearing of spectacles when spectacles were provided at no cost [21].