Catherine Sanford

Objective: To quantitatively describe the healthcare needs of a cohort of kindergarten children in a low-socioeconomic rural community to inform school entry health check programs and school-based healthcare services. Study type: Medical record review. Methods: Data were extracted from the community health electronic medical records of children who started primary school in 2019 at one of the five study schools and who received at least one occasion of service from a nurse-led School-Based Primary Health Care Service for a health or developmental concern. Data extracted included demographics, presenting concerns, challenges to accessing care, service activities, and referrals. Results: Of the 140 children enrolled in kindergarten in the sample schools, 84 (60%) had an occasion of service for a health or developmental concern. Of these 84 children, speech and language concerns (43%) were most frequently observed, followed by metabolic/nutrition (26%), behaviour (16%), and vision (16%) concerns. Evidence of challenges to accessing care was identified in 40% of cases. Sixty percent of identified children were referred to another provider. Conclusion: The high prevalence of health and developmental concerns and challenges to accessing care found in this study supports the need for school entry health check models that provide ongoing support to families.

Changes in public health profiles and moves towards inclusive models of education have led to significant number of students in mainstream schools with special health needs. Addressing these needs requires collaboration between health professionals, educators and families. Integrated models of school-based health care can facilitate this collaboration; however, there is little evidence to guide their implementation. The School-Based Primary Health Care Service (SB-PHCS) is one such service that has been established in far west New South Wales. The School-Based Primary Health Care Service embeds health district-employed registered nurses with school learning support teams to increase service access, and improve health and education outcomes for students. We conducted focus groups with nurses and learning support teams to explore their experiences of implementing the School-Based Primary Health Care Service. Focus group transcripts were analysed using framework analysis. We found that defining the role and working across systems were challenges to program implementation, whereas a collaborative culture, relationship building and flexibility in work processes facilitated the integration of nurses into the school teams. We recommend others embarking on similar initiatives involve key stakeholders early in service development, understand each other’s systems and processes, and provide clarity about the new role, but plan to adapt the role to fit the context. This study will be of interest to those involved in the implementation of integrated models of school-based health care.

Children and adolescents in rural Australia experience poorer health and educational outcomes than those in urban areas. This paper presents findings from a qualitative study exploring the role of primary health care registered nurses (RNs) working in the School-Based Primary Health Care Service in Broken Hill, far west New South Wales. The Service integrates health district-employed RNs with school learning and support teams to increase service access and improve health and education outcomes for students. The findings show that RNs used care navigation to reduce barriers to care by addressing healthcare candidacy with students and families. The RNs also linked schools, families and health and social care services, and facilitated intersectoral collaboration to improve the support provided to students experiencing health and developmental issues. Integrating health district-employed RNs with existing student support services is a promising approach to improving the health and education of disadvantaged students. This study provides individual- and system-level explanations of the role of the school-based primary health care RN and can inform the development of similar services elsewhere.