Community Health Workers in Schools: A Systematic Review

Harries, Michael; Xu, Nuo; Bertenthal, Michael; Luna, Viridiana; Akel, Mary J; Volerman, Anna

doi:10.1016/j.acap.2022.08.015

Cited by 4 publications

(4 citation statements)

References 56 publications

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“…19,20 In developed countries, recent studies highlighted the role of CHWs in school-based interventions for children. 21,22 Almost half of the study's population reported signs of STH infection, which increased the need to visit the clinic, decreasing their time in class. The results of this study are consistent with those of previous studies that reported a high prevalence of STH infections 23,24 .…”

Section: Discussionmentioning

confidence: 99%

Optimizing community health workers and non-biomedical approaches to assess the burden of soil-transmitted helminthiasis in a school-aged population in rural Rwanda

Manzi,

Katz,

Nguyen

et al. 2024

Preprint

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Background: Soil-transmitted helminths (STHs) remain a major public health problem in many low- and middle-income countries, especially among children. The conventional methods for diagnosing STHs require well-equipped laboratories and trained personnel, often scarce or inaccessible in rural and remote settings. Algorithmic non-biomedical screening tools are a potential strategy for CHWs to ensure rapid detection and referral of children with possible STH infection. We aimed to evaluate the feasibility of a community health worker-led screening program in rural Rwanda. We also sought to describe the Knot, a model leveraging community health workers (CHWs) as school-based health agents (SBHAs) to facilitate the screening, referral, and follow-up of children with presumptive STH, as well as the engagement of teachers and community members in preventive interventions. Methods: We conducted a cross-sectional study among 746 school-aged children in Musanze district, Rwanda, between August 2021 and November 2022. We used Beta CommScreen, an algorithmic non-biomedical screening tool that collects socio-demographic, anthropometric, and symptomatic data, as well as water, sanitation, and hygiene (WASH) indicators, to assess the risk of STH infection. The SBHAs engaged teachers and community members in developing a bundle of interventions, such as deworming campaigns, WASH education, and targeted home visits. We used multivariate logistic regression analysis to identify factors associated with presumptive STH infection. We analyzed the data using Stata version 15.1. Results: Of 746 children screened by the SBHA, 322 (43%) reported signs of STH infections, and 220 (29%) were referred to the clinic for treatment, the rest of children (102, 14%) were provided with deworming medication at school. Having a CHW for routine monitoring and not walking barefoot were associated with lower risk of STH symptoms (OR = 0.36, 95% CI: 0.21,0.64) and (OR = 0.49, 95% CI:0.08,3.11), respectively. Not washing hands before eating and after using the toilet were not significantly associated with possible STH infections (OR = 7.40, 95%CI:0.79,68.94) and (OR = 3.82, 95%CI:0.37,39.37). Other factors, including the place of residence and age, were also not associated with STH symptoms. Conclusions: We found the CHWs were able to use a simple algorithmic screening tool to identify a high burden of symptoms of possible STH. This CHW-based approach to carry out school-based screening of STH infections builds on the strong CHW system in Rwanda, although strengthening referrals to ensure all symptomatic children receive treatment is needed. Strengthening the connection between schools and community-based health services can further expand disease prevention and treatment, furthering Rwanda’s success in improving health and wellbeing.

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Section: Discussionmentioning

confidence: 99%

Optimizing community health workers and non-biomedical approaches to assess the burden of soil-transmitted helminthiasis in a school-aged population in rural Rwanda

Manzi,

Katz,

Nguyen

et al. 2024

Preprint

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“…Participants in this study detailed additional responsibilities specific to school settings, such as education on school health policies and guidance to all school community members–not solely individuals with health conditions–about responding to health emergencies. While few studies have detailed the responsibilities of CHWs in school-based programs, a systematic literature review of CHWs in schools observed the majority of interventions reported positive outcomes, with nearly all successful interventions involving CHWs providing health education or coaching to students ( 13 ). Other research has identified needs within schools that CHWs can address; for example, one study showed school staff and parents viewed each other as responsible for providing nutrition education to students ( 40 ).…”

Section: Discussionmentioning

confidence: 99%

“…To address the deficiencies in school health services, the integration of community health workers (CHWs) into school settings can support student health and foster a culture of health within school communities ( 13 ). Community members and/or individuals who possess a thorough understanding of the community can become CHWs who serve as culturally competent liaisons between health and social services and the community ( 14 ), supporting education, counseling, navigation, and advocacy ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

“…Although there is strong evidence for the positive impact of CHWs and the CHW workforce is expanding ( 30 ), the implementation of CHW interventions in schools has been underexplored ( 31 ). This study is the first to examine the perspectives of experienced CHWs about how CHWs can be integrated and utilized in US school settings to work as part of school-based health teams to support student health and healthy school environments.…”

Section: Introductionmentioning

confidence: 99%

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Community health workers' perspectives on integrating into school settings to support student health

Yao

Kowalczyk

Gregory

et al. 2023

Front. Public Health

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IntroductionWhile schools represent key venues for supporting health, they continue to experience gaps in health resources. The integration of community health workers (CHWs) into schools has the potential to supplement these resources but has been underexplored. This study is the first to examine perspectives of experienced CHWs about how CHWs can be applied in school settings to support student health.MethodsThis qualitative study involved conducting semi-structured interviews focused on implementation of CHWs in schools with individuals who held positions aligned with the CHW scope of work. De-identified transcripts were analyzed, and codes were organized into domains and themes.ResultsAmong 14 participants, seven domains emerged about the implementation of CHWs in schools: roles and responsibilities, collaborations, steps for integration, characteristics of successful CHWs, training, assessment, and potential challenges. Participants shared various potential responsibilities of school-based CHWs, including educating on health topics, addressing social determinants of health, and supporting chronic disease management. Participants emphasized the importance of CHWs building trusting relationships with the school community and identified internal and external collaborations integral to the success of CHWs. Specifically, participants indicated CHWs and schools should together determine CHWs' responsibilities, familiarize CHWs with the school population, introduce CHWs to the school community, and establish support systems for CHWs. Participants identified key characteristics of school-based CHWs, including having familiarity with the broader community, relevant work experience, essential professional skills, and specific personal qualities. Participants highlighted trainings relevant to school-based CHWs, including CHW core skills and health topics. To assess CHWs' impact, participants proposed utilizing evaluation tools, documenting interactions with students, and observing indicators of success within schools. Participants also identified challenges for school-based CHWs to overcome, including pushback from the school community and difficulties related to the scope of work.DiscussionThis study identified how CHWs can have a valuable role in supporting student health and the findings can help inform models to integrate CHWs to ensure healthy school environments.

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Community Mental Health Workers: Their Workplaces, Roles, and Impact

Heetderks-Fong,

Bobb

2024

Community Ment Health J

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Community Health Workers in Schools: A Systematic Review

Cited by 4 publications

References 56 publications

Optimizing community health workers and non-biomedical approaches to assess the burden of soil-transmitted helminthiasis in a school-aged population in rural Rwanda

Optimizing community health workers and non-biomedical approaches to assess the burden of soil-transmitted helminthiasis in a school-aged population in rural Rwanda

Community health workers' perspectives on integrating into school settings to support student health

Community Mental Health Workers: Their Workplaces, Roles, and Impact

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