‘What is this about? Let’s play this out’: the experience of integrating primary health care registered nurses with school learning and support teams

Abstract

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.

Critical success factors for school‐based integrated health care models: Learnings from an Australian example

“…This is a valuable contribution to the current study and highlights the importance of conducting qualitative research to capture the less tangible impacts of innovation in health care provision. These benefits are particularly important given current Australian efforts to integrate health and social services in schools, which can be seen through the application of the WHIN program in Broken Hill, 26 and the integration of paediatric health services into an urban special purpose school focusing on behavioural concerns 27 . Another example is the establishment of the Australian School‐Based Health Alliance in 2022.…”

Exploring the impact of integrated health and social care services on child health and wellbeing in underserved populations: a systematic review

“…We identified three types of integrated health and social care services: Targeted support for CYP and their families, where specified groups with additional needs were identified and then receive a range of health and care interventions (38)(39)(40)(41)(42)(43)(44)(45); Collaborative health and social support, involving health and social care organisations work together to deliver shared and complementary services (46)(47)(48)(49); and School centred health and social care, in which health and social care services embedded or directly linked to educational facilities (50)(51)(52)(53). A summary of the key characteristics of each of the types of integrated care model can be found in Table 3 and below we summarise the results of the studies identified within each.…”

“…The Australian qualitative studies explored the views of nursing link workers and teachers and learning support workers working together in primary and secondary schools in Australia (52,53).…”

“…Both school and nursing staff reported that care navigation improved, with better information sharing and identification of unmet needs (eg mental health) but there were challenges in defining the nurses' roles and how they worked alongside school support staff (52,53) .…”

Chronic Health Condition Management and School-Based Health Centers in New York: Findings From the 2020 School Health Profiles Survey

“…Despite this commitment, the commitment between schools and SBHCs is often through offering space on the school campus for the SBHC (Geierstanger et al, 2021). School and SBHC services often struggle in a collaborative culture of program implementation, relationships, and integration of school health professionals into the school education team (Blacksin, 2021;Knopf et al, 2016;Sanford et al, 2022). Despite welldocumented literature on the relationship between health and learning (Best et al, 2021(Best et al, , 2018Knopf et al, 2016;Love et al, 2019;Yoder, 2020), principals and teachers may be more likely to understand and learn about SBHC services and health policies when it involves their classroom procedures, responsibilities, and curricula (Buller et al, 2018;Davis & Lynch, 2018).…”