Evaluation of a Collaborative Pilot Program for
School-based Public Health Nurse Services in
Perth County Catholic Elementary Schools
October 2007
Prepared for
The Board of Health of the Perth District Health Unit
Huron-Perth Catholic District School Board
Julie P. Megens, RN, BScN, Public Health Nurse
Carol MacDougall, RN, BScN, MA, Public Health Manager
Sharon McConnell, BSc, BEd, MSc, Health Information Analyst
ACKNOWLEDGEMENTS
Thank you to everyone who helped to make this pilot program a success. From the Huron-Perth Catholic District School Board:
Martha Dutrizac Joanne Lombardi
Each of the administrators from Huron-Perth Catholic District School Board elementary schools in Perth County:
Holy Name of Mary School Jeanne Sauvé School St. Aloysius School St. Ambrose School St. Joseph’s School St. Mary’s School
St. Patrick’s School (Dublin) St. Patrick’s School (Kinkora)
From the Perth District Health Unit: Cathie Alexander Tracy Allan-Koester Karen Bergin-Payette Melissa Ditner Debbie Grant Meghan Heinbuch Annette Hoyles Marie Pavey Jessica Thompson
Perth District Health Unit School-based Public Health Nurses: Glenda Blair
Brienne Card-Faulhafer Jessica Witmer
Stephanie Woodstock
TABLE
OF
CONTENTS
Executive Summary... 5 Introduction ... 8 Method... 9 Results... 10 Pre-Pilot Survey ... 10Student Record Lists... 13
Student Survey and Parent/Child Survey ... 16
Post-Pilot Survey ... 19
Administrator Focus Groups ... 26
School-based Public Health Nurse Focus Group ... 32
Discussion ... 37 Conclusions ... 41 Recommendations... 41 References ... 42 Abbreviations ... 43 Glossary... 44
LIST OF FIGURES
Figure 1.1 School Staff Level of Agreement that Students’ PSE Health Needs Were Met at School—Pre-Pilot
Figure 1.2 School Staff Level of Agreement that Students Who Received Services, Received Them in a Timely Manner—Pre-Pilot
Figure 1.3 School Staff Perceptions of the Ease of Connecting Students with PSE Health Needs to an Appropriate Service Provider—Pre-Pilot
Figure 1.4 School Staff Selection of Barriers Perceived to Hinder Access to Service Providers—Pre-Pilot
Figure 2.1 Number of New Students and Caseload per Month Figure 2.2 Student Health Issues
Figure 2.3 Major Categories of Student Health Issues
Figure 3.1 Students’ and Parents’ Perceptions of the Student’s Relationship with the SBPHN in the SBPHN Support Service
Figure 4.1 School Staff Perceptions of the Ease of the SBPHN Support Service Referral Process
Figure 4.2 School Staff Perceptions of School Improvements Since the Introduction of the SBPHN Support Service
Figure 4.3 School Staff Perceptions of the Characteristics of the SBPHN in the SBPHN Support Service
Figure 4.4 School Staff Perceptions of School Improvements Since the Introduction of the SBPHN Consultation and Referral Service
Figure 4.5 School Staff Perceptions of the Characteristics of the SBPHN in the SBPHN Consultation and Referral Service
LIST OF TABLES
Table 5.1 Administrators’ Perceptions of the Impact of the SBPHN Services on Students, Parents and School Staff
Table 5.2 Administrators’ Perceptions of the Strengths of the SBPHN Services
Table 5.3 Administrators’ Recommendations for Improvement of the SBPHN Services Table 5.4 Administrators’ Perspectives on the Continuation of the SBPHN Services Table 6.1 SBPHNs’ Perceptions of Facilitators to Program Implementation
Table 6.2 SBPHNs’ Perceptions of Barriers to Program Implementation Table 6.3 SBPHNs’ Perceptions of the Strengths of the SBPHN Services
EXECUTIVE SUMMARY
INTRODUCTIONThe Perth District Health Unit (PDHU) has been providing School-based Public Health Nurse (SBPHN) services in the Avon Maitland District School Board (AMDSB) since January 2000. Success in the AMDSB [3,4] and an inquiry by the Board of Health of the PDHU led to an exploratory expansion of SBPHN services into the Huron-Perth Catholic District School Board (HPCDSB). A pilot program was implemented between January 29 and June 22, 2007 in the Perth County elementary schools of the HPCDSB.
Two types of service were implemented: the School-based Public Health Nurse Support Service (SBPHN Support Service) and the School-based Public Health Nurse Consultation and Referral Service (SBPHN Consultation and Referral Service). In the SBPHN Support Service, SBPHNs work with students,
parents, and school staff to provide supportive counselling in a safe, accepting, non-judgmental environment to enhance learning and promote healthy growth and development. SBPHNs encourage students to recognize their own strengths and utilize them in their everyday lives. In the SBPHN Consultation and Referral Service, SBPHNs primarily provide information and consultation to parents and school staff regarding student needs, with minimal direct involvement with students. Service is provided through telephone and/or email consultation, with supportive counselling services prioritized to students with the highest need.
Five schools participated in the SBPHN Support Service and three schools participated in the SBPHN Consultation and Referral Service pilot program. The total cost of staff resources equaled one full-time equivalent (FTE) of a Public Health Nurse (PHN), which was cost-shared between the PDHU and the HPCDSB. Four experienced PHNs provided the services to the schools at 0.8 FTE. The remaining 0.2 FTE covered additional PHN and other health unit resources for coordination and evaluation activities.
EVALUATION GOALS
The goals of the PDHU and HPCDSB SBPHN Support Service and SBPHN Consultation and Referral Service pilot program evaluation were to:
1. Describe how the services responded to the physical, social, and emotional (PSE) health needs of students
2. Measure the impact of the services on students, parents, and school staff
3. Determine the need for continuation of the SBPHN Support Service and the SBPHN Consultation and Referral Service in the HPCDSB.
METHOD
Three sources of data were used: Student Record Lists (SRLs), surveys, and focus groups. The SRL is a tool used to capture information on the profile of each student seen by the SBPHN for supportive
counselling. Each student is assigned a unique number and cannot be identified by name. A pre-pilot survey was used to assess school staff perceptions of the current situation for students with PSE health needs prior to initiation of the SBPHN services. A series of post-pilot surveys for students 12 years of age and older, parents of children under 12, and school staff were used to evaluate the impact of the program on all participants. Lastly, focus groups were held with administrators and with SBPHNs to provide a qualitative review of the services.
RESULTS Pre-Pilot Survey
• Few school staff (14%) strongly agreed or agreed with the statement ‘I am confident that the PSE health needs of students (and their families) at my school are being met’
• Most school staff were ‘not sure’ (59%) or strongly disagreed or disagreed (37%) with the
statement: ‘I am confident that of those students (and their families) at my school who are currently receiving services to address their PSE health needs have received these services in a timely manner’
• Nearly all school staff (90%) indicated that it would be ‘very helpful’ (58%) or ‘helpful’ (32%) to have a service provider on-site at their school to support the PSE health needs of students (and their families).
Student Record Lists
• A total of 71 students (4% of the student population) received SBPHN services during the five-month pilot period
• SBPHNs met with 56% of students within 24 hours of the referral, and 77% within two weeks • The SBPHNs referred students to a community service or health service, with 11% and 7% of
students referred, respectively. The most common referral was to the Huron-Perth Centre. • The leading student health issues were relationships with peers (57%) and stress/coping (51%) • When student health issues are grouped by major category, students received service for issues
related to ‘social health and life skills’ (96%), ‘mental health’ (78%), and ‘physical health’ (19%).
Student Survey and Parent/Child Survey
• 29% of parents were ‘unlikely’ or ‘very unlikely’ to seek outside assistance for their child had the SBPHN Support Service not been available at their child’s school
• Students and parents strongly agreed or agreed that the SBPHN: cared about helping the student (100%), could be trusted (100%), was a good listener (100%), made the student feel comfortable (97%), maintained confidentiality (94%), and was able to give the student information that he/she could understand (94%)
• All students and parents were ‘very satisfied’ (61%) or ‘satisfied’ (39%) with the SBPHN Support Service
• 86% of students and parents strongly agreed (63%) or agreed (23%) that they would recommend the SBPHN Support Service to others.
Post-Pilot Survey – SBPHN Support Service
• 83% of school staff found it ‘very easy’ or ‘easy’ to connect students with PSE health needs to the SBPHN Support Service
• The majority of school staff (88%) either strongly agreed or agreed with the statement: ‘I am confident that with the addition of the SBPHN, my school has improved its ability to meet the PSE health needs of our students (and their families)’
• School staff strongly agreed or agreed that the SBPHN Support Service had improved: ‘the PSE health of students the SBPHN has worked with’ (88%), ‘the learning ability of those students who are working with the SBPHN to address their PSE health needs’ (73%), ‘the PSE health of the student population in general’ (70%) and ‘the early identification of students (and their families) with PSE health needs’ (60%)
• 96% of school staff were ‘very satisfied’ (46%) or ‘satisfied’ (50%) with the SBPHN Support Service.
Post-Pilot Survey – SBPHN Consultation and Referral Service
• Similar percentages of school staff identified that consultation or referral to the SBPHN for students/families with PSE health needs was ‘very easy’ or ‘easy’ (36%) or ‘neither easy nor difficult’ (43%)
• 64% of school staff strongly agreed or agreed that the SBPHN Consultation and Referral Service increased access to support for students/families with PSE health needs
• School staff neither agreed nor disagreed (53%) with the statement: ‘I am confident that with the addition of the SBPHN Consultation and Referral Service, my school has improved its ability to meet the PSE health needs of our students/families’
• 80% of school staff were ‘very satisfied’ (40%) or ‘satisfied’ (40%) with the SBPHN Consultation and Referral Service.
Administrator Focus Groups
Overall, administrators described that both the SBPHN Support Service and the SBPHN Consultation and Referral Service had a positive impact on students, parents, and school staff. SBPHN role and knowledge were discussed as both impacts and strengths of the program in the two service models. Recommendations for improvement include increase time, and improve the visibility, connections, and profile of the services. Administrators unanimously recommended program continuation in the HPCDSB, however, with a modification of the SBPHN Consultation and Referral Service.
School-based Public Health Nurse Focus Group
Throughout the SBPHN focus group, several themes were repeated. Communication was discussed as both a facilitator and a barrier. It was also cited as a strength with families, and recommended as an area for improvement with school staff and the administrator. Review of the SBPHN role and referral
process was described as a facilitator to program implementation, and yet orientation and education of students, parents, and school staff regarding the role of the SBPHN and referral processes was
recommended as an area for improvement. Finally, expansion of service into the HPCDSB secondary school was identified as an area for improvement.
CONCLUSIONS
The pre-pilot request for services to address the physical, social, and emotional health needs of HPCDSB Perth County elementary students was met during the pilot program through the provision of SBPHN services to 4% of the total student population.
The SBPHN Support Service had a positive impact on students, parents, school staff, and
administrators. While the SBPHN Consultation and Referral Service had a more neutral impact on school staff, administrators discussed in their focus group a positive impact on themselves, school staff, and families.
A strong need for continuation of the SBPHN Support Service and the SBPHN Consultation and Referral Service in the HPCDSB has been demonstrated during this short pilot period. However, modification of the current SBPHN Consultation and Referral Service is recommended.
RECOMMENDATIONS
1. The PDHU and the HPCDSB partnership continue to jointly fund the SBPHN Support Service and SBPHN Consultation and Referral Service
2. Provide consistent program initiation activities across all schools to increase awareness, visibility, and profile of the SBPHN Support Service and SBPHN Consultation and Referral Service among students, parents, and school staff
3. Enhance communication between SBPHNs, administrators, and school staff to improve service delivery
4. Explore ways to improve the SBPHN Consultation and Referral Service
5. Provide sufficient work space and physical resources for SBPHNs at the schools to allow for the provision of effective and confidential service to students
6. Review and clarify confidentiality and consent processes
7. Explore expansion of the SBPHN Support Service into the HPCDSB Perth County secondary school
8. Continue process evaluation and assessment of student, parent, administrator, and school staff satisfaction to improve service provision
9. Examine other elements of the SBPHN role in future evaluations, e.g., group counselling and participation in school health and other committee meetings
10. Include objectives and methods specific to the SBPHN Consultation and Referral Service in future evaluations
11. Explore ways to evaluate the impact of the SBPHN Support Service and SBPHN Consultation and Referral Service on physical, social, and emotional health outcomes and student learning 12. Disseminate the findings of this report provincially and nationally as appropriate.
INTRODUCTION
BACKGROUNDPerth County is a rural area with some urban centres situated in Southwestern Ontario. It has a
population of 74,340 residents (2006Census) [1] and a population density of 33.5 per km2 [2].The Board of Health of the Perth District Health Unit (PDHU) has strongly supported public health nursing services in both public and separate schools for many years. However, funding cutbacks that began in 1996 resulted in withdrawal of these services. Staff from both elementary and secondary schools, and family physicians, subsequently expressed a significant need for Public Health Nurses (PHNs) to be present in Perth County schools to counsel and support students and coordinate school health needs [3].
The PDHU School-based Public Health Nurse Support Service (SBPHN Support Service) was initiated as a pilot program in Perth County schools of the Avon Maitland District School Board (AMDSB) in 2000. Success of the pilot led to expansion of the program, which now services 17 elementary and five
secondary schools [3,4]. The School-based Public Health Nurse Consultation and Referral Service (SBPHN Consultation and Referral Service) was introduced in the AMDSB in 2005.
In January 2007, both the PDHU and the HPCDSB secured funding to cost-share a SBPHN pilot program from January to June. Therefore, the SBPHN Support Service began in five HPCDSB Perth County elementary schools, with three additional elementary schools receiving the SBPHN Consultation and Referral Service. The total cost of staff resources equaled one full time equivalent (FTE) of a PHN. Four experienced PHNs provided the services to the schools at 0.8 FTE. The remaining 0.2 FTE covered additional PHN and other health unit resources for coordination and evaluation activities.
In the SBPHN Support Service, School-based Public Health Nurses (SBPHNs) work with students, parents, and school staff to provide supportive counselling in a safe, accepting, non-judgmental environment to enhance learning and promote healthy growth and development. SBPHNs encourage students to recognize their own strengths and utilize them in their everyday lives. Referrals to the service come from students, parents, and school staff. SBPHNs are present in the schools for a defined amount of time, which varies from school to school (e.g. ½ day per week, 1 day per week).
In the SBPHN Consultation and Referral Service, SBPHNs are available to parents and school staff for information and consultation regarding student needs, with minimal direct involvement with students. Service is provided through telephone and/or email consultation, with supportive counselling services prioritized to students with the highest need.
SBPHN practice in both service models also includes: brief contacts with students, parents, and school staff; referrals to health and other community services; health promotion activities; health displays; education sessions; and group counselling sessions (support groups). SBPHNs may also participate in school health and other committee meetings and tragic event response support team events as
necessary. This evaluation, however, is strictly limited to the one-on-one supportive counselling role of the SBPHN.
EVALUATION GOALS
The goals of the PDHU and HPCDSB SBPHN Support Service and SBPHN Consultation and Referral Service pilot program evaluation were to:
1. Describe how the services responded to the physical, social, and emotional (PSE) health needs of students
2. Measure the impact of the services on students, parents, and school staff
3. Determine the need for continuation of the SBPHN Support Service and the SBPHN Consultation and Referral Service in the HPCDSB.
METHOD
Three sources of data were used to evaluate the pilot program. A brief description of each data source is described here, with more details included in each section of the results.
Student Record Lists
The Student Record List (SRL) is a tool used to record the service profile of each student seen by the SBPHN. Each student is assigned a unique number and cannot be identified by name. The SRL captures data on student demographics, date of referral and first contact, student health issues
discussed with the SBPHN, number of visits (school, home, and other), consultations with parents and school staff, external referrals, and discharge and transfer information.
Surveys
In total, five surveys were developed for the pilot program, as described below:
• One pre-pilot survey was distributed to school staff at all schools receiving the SBPHN Support Service or the SBPHN Consultation and Referral Service
• Two post-pilot surveys were developed for school staff; one for the SBPHN Support Service and one for the SBPHN Consultation and Referral Service
• The Student Survey was created to evaluate the impact of the SBPHN Support Service on students aged 12 and over
• The Parent/Child Survey was mailed to parents of children under 12 years of age to evaluate parents’ perceptions of their child’s experiences with the SBPHN Support Service.
Focus Groups
Towards the end of the pilot period, focus groups were held with school administrators and SBPHNs participating in the SBPHN Support Service or the SBPHN Consultation and Referral Service.
Analysis
RESULTS
PRE-PILOT SURVEY
OBJECTIVESTo obtain and assess school staff perceptions prior to the initiation of the SBPHN Support Service and the SBPHN Consultation and Referral Service in the HPCDSB with respect to the:
1.
Skill and ability of school staff to meet the PSE health needs of students and their families2.
Accessibility of available services3.
Need for service within the HPCDSB to meet the PSE health needs of students and their families4.
Receptiveness to the proposed SBPHN services. METHODA pre-pilot survey was completed by administrators at the inauguration of the SBPHN services on January 24. The survey was then sent via email to the administrators who were instructed to forward the survey to their school staff. Completion of the survey was voluntary and anonymous.
RESULTS
Completed surveys were returned by 78 school staff. Survey results from school staff assigned to receive the SBPHN Support Service, and those assigned to receive the SBPHN Consultation and Referral
Service were combined, as this was a baseline survey distributed prior to initiation of either service.
Skill and Ability
Few school staff (14%) strongly agreed or agreed with the statement: ‘I am confident that the PSE health needs of students (and their families) at my school are being met’. More respondents were not confident and strongly disagreed (7%), disagreed (48%), or were ‘not sure’ (31%) with the statement (Figure 1.1). School staff were asked to comment on why they chose their response to the above statement, in an open-ended format. The main reasons for indicating that they strongly disagreed, disagreed, or that they were ‘not sure’ that the PSE health needs of students (and their families) were being met at school included (n=49):
• Teachers did not have enough time or support in the classroom to deal with all students’ issues (18%)
• A lack of knowledge, confidence, training, experience (18%)
• There were too many students who need more assistance than can be provided or too many families in need (12%).
Figure 1.1 School Staff Level of Agreement that Students’ PSE Health Needs Were Met at School—Pre-Pilot 14 31 48 7 0 10 20 30 40 50 60 70 80 90 100 Strongly agree or agree
Not sure Disagree Strongly disagree
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Most school staff were ‘not sure’ (59%) or strongly disagreed or disagreed (37%) with the statement: ‘I am confident that of those students (and their families) at my school who are currently receiving services to address their PSE health needs have received these services in a timely manner’ (Figure 1.2).
Reasons why school staff strongly disagreed, disagreed, or were ‘not sure’ that services were received in a timely manner included (n=48):
• Took too long to get help or special education services (25%) • Long waiting lists for services (21%).
Figure 1.2 School Staff Level of Agreement that Students Who Received Services, Received Them in a Timely Manner—Pre-Pilot
59 30 7 0 10 20 30 40 50 60 70 80 90 100
Not sure Disagree Strongly disagree
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Note: Percentages do not add up to 100% as not all categories are shown.
Accessibility
Fifty percent of school staff had the perception that connecting students (and their families) with PSE health needs to an appropriate service provider was ‘somewhat difficult’ or ‘very difficult’, while 46% were ‘not sure’ (Figure 1.3).
Figure 1.3 School Staff Perceptions of the Ease of Connecting Students with PSE Health Needs to an Appropriate Service Provider—Pre-Pilot
46 34 16 0 10 20 30 40 50 60 70 80 90 100
Not sure Somew hat difficult Very difficult
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Note: Percentages do not add up to 100% as not all categories are shown.
School staff were asked to indicate from a pre-supplied list which barriers they perceived hindered access to an appropriate service provider. More than one barrier could be selected. The main barrier selected was ‘wait lists’ (71%). See Figure 1.4 for the full listing of barriers selected.
Figure 1.4 School Staff Selection of Barriers Perceived to Hinder Access to Service Providers— Pre-Pilot 13 22 28 42 50 63 71 0 10 20 30 40 50 60 70 80 90 100 Ot her Transportat ion issues on part
of school or f amily Lack of appropriat e services in
local area Lack of time at the school t o
make ref errals Financial cost t o t he family of
accessing services Knowledge of an appropriate service provider Wait lists B a rri e r Percent
Need for Service
Nearly all school staff (90%) indicated that it would be ‘very helpful’ (58%) or ‘helpful’ (32%) to have a service provider on-site at their school to support the PSE health needs of students (and their families). School staff were asked to comment on why they indicated that having an on-site service provider would be ‘very helpful’ or ‘helpful’ in an open-ended format. The main reasons identified by the 53 respondents were:
• It is helpful to have someone knowledgeable, someone who could provide information to staff (19%)
• Students would be seen immediately, needs would be addressed quicker, access to services would be quicker (17%)
• Would provide time to deal with more issues, would provide another resource (15%)
• Parents were more likely to agree to service that would be provided at the school, school is more accessible, it’s easier for parents (9%).
Receptiveness to Service
Respondents (n=60) provided general comments about how they felt about the initiation of the SBPHN services. The predominant attitude toward the service was positive. Some examples of comments provided include:
• “Excellent idea – a definite need”
• “I think it is a great initiative and that there is a strong need in the school for such a service, especially concerning students emotional health”
• “I think that having a School-based Public Health Nurse Support Service/Consultation and Referral Service is a wonderful idea that is long overdue. I think that it would allow students or parents to be in touch with a professional in a much more timely manner”.
STUDENT RECORD LISTS
OBJECTIVETo describe how the SBPHN services responded to the PSE health needs of students.
METHOD
The Student Record List (SRL) is a tool used to record the service profile of each student seen by the SBPHN. Each student is assigned a unique number and cannot be identified by name. The SRL captures data on student demographics, date of referral and first contact, student health issues
discussed with the SBPHN, number of visits (school, home, and other), consultations with parents and school staff, external referrals, and discharge and transfer information.
RESULTS
The total student population in the HPCDSB Perth County elementary schools was 1786 at the start of the 2006-2007 school year. Between January 29 and June 22, 72 students were referred to either the SBPHN Support Service or the SBPHN Consultation and Referral Service. Seventy-one students, or 4% of the student population, received supportive counselling services and one student, referred in June, remained on a waiting list. By school, the percentage of students receiving service ranged from 0 to 6.1%. In schools receiving the SBPHN Support Service, an average of 5.0% of the student population received service. Fewer students (1.2%) received service in the SBPHN Consultation and Referral Service schools.
Client Demographics
Of all students receiving service, 51% were in junior kindergarten (JK) to grade 4, and 49% were in grades 5 to 8. A higher percentage of females (54%) received SBPHN services than males (46%). In JK to grade 4, a similar percentage of females (49%) and males (51%) received services. In grades 5 to 8, a higher percentage of females (60%) received service than males (40%).
Sources of Referral
Students could refer themselves and/or be referred by other sources. The most common sources of referral were teachers (44%), administrators (31%), parents (29%), and students themselves (12 years and older) (18%).
Caseload
A total of 71 students received SBPHN services during the five-month pilot period. The highest number of new students to the service occurred in February and March (21 new students per month) and declined to 5 new students in June. The caseload of both new and continuing students increased gradually to a maximum of 58 students in May (Figure 2.1).
Figure 2.1 Number of New Students and Caseload per Month 23 44 53 58 50 5 10 21 21 10 0 10 20 30 40 50 60 70 80 90 100
January February March April May June
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Caseload New clients *
* Insufficient time period to accumulate data (pilot began January 29).
Frequency of Service
SBPHNs provided service to students and their families in-school (school visits), at home (home visits), or through telephone consultation or family visits at locations other than home (telephone
consultations/other visits).
In total, SBPHNs provided 345 school visits to 99% (n=70) of the students on caseload. Students met with the SBPHN for a median of 4 visits, with a minimum of 1, and a maximum of 13 visits. At the end of the pilot program, 29% of students were discharged. Students that were discharged met with the SBPHN for a median of 3 visits, with a minimum of 1, and a maximum of 10 visits. Nine percent of all students (either discharged or not discharged at the end of the pilot) met with the SBPHN only once. More students received 2 to 3 visits (30%), 4 to 6 visits (33%), or 7 or more (29%) visits with the SBPHN. SBPHNs also provided 21 home visits to 8% (n=6) of the student caseload, and 77 telephone consultations/other visits to 63% (n=45) of students.
Timeliness of Service
Timeliness of service was measured by calculating the number of days between the date of referral to the service and the date of the student’s first contact with the SBPHN. SBPHNs met with 56% of students within 24 hours of the referral. The remaining students were seen within 24 hours to 14 days (21%), or 15 days or greater (24%).
External Referrals
SBPHNs refer some students from their caseload to an external community or health service. SBPHNs referred 11% of students to a community service, and 7% to a health service. The most common referral was to the Huron-Perth Centre (8%), a children’s mental health community service.
Student Health Issues
Student health issues were identified by students, parents, school staff, and/or the SBPHN. Students may receive service for more than one health issue simultaneously. Students (all students regardless of whether discharged at the end of the pilot period or not) received service for a median of 4.5 health issues, a minimum of 1, and a maximum of 14 health issues. The leading student health issues were relationships with peers (57%) and stress/coping (51%). Other frequently discussed health issues were family dynamics (43%), communication (42%), and self esteem (40%) (Figure 2.2).
Figure 2.2 Student Health Issues 7 7 10 11 13 18 19 21 29 32 35 40 42 43 51 57 0 10 20 30 40 50 60 70 80 90 100 Depression
Substance use family member Abuse Grief Blended family Sibling relationships Bullying Conflict resolution Problem Solving Divorce/separated Parent/child relationship Self esteem Communication Family dynamics Stress/Coping Peer relationships Percent Client issues
When student health issues are grouped by major category1, students received service for issues related to ‘social health and life skills’ (96%), ‘mental health’ (78%), and ‘physical health’ (19%) (Figure 2.3)1.
Figure 2.3 Major Categories of Student Health Issues
1 Social Health and Life Skills includes: Attendance, Behaviour, Communication, Conflict Resolution, Legal Issues, Family Functioning
(Family Violence, Divorce, Single Parent, Blended Family, Family Loss, Family Dynamics), Parenting, Problem Solving/Decision Making, Relationships (Peer, Parents, Siblings, Intimate, Bullying)
Mental Health includes: Abuse, Anger, Grief, ADHD/LD, Depression, Family Mental Health Disorder, Risk to Self, Risk to Others, Self Esteem,
Stress/Coping
Physical Health includes: Basic Needs, Eating Disorder, Healthy Eating/Weights, Hygiene, Medical Condition, Pediculosis, Physical Activity,
Pregnancy, Sexual Health, STI/HIV/AIDS, Substance Use (Self, Parent, Peer), Tobacco Use (Self, Parent, Peer)
96 78 19 0 10 20 30 40 50 60 70 80 90 100
Social health and life skills Mental health Physical health
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STUDENT SURVEY AND PARENT/CHILD SURVEY
OBJECTIVESThe objective of the Student Survey was to obtain and assess students’ perceptions of their experiences with the SBPHN Support Service. The objective of the Parent/Child Survey was to obtain and assess parents’ perceptions of their child’s experiences with the SBPHN Support Service.
METHOD
Surveys were developed for students 12 years and older and parents of students younger than 12 years of age receiving the SBPHN Support Service. Parents were encouraged to involve their child in
completion of the survey. The Student Survey was validated by students aged 12 to 14 receiving the SBPHN Support Service in the AMDSB.
The Student Survey and the Parent/Child Survey contained many identical questions. The Parent/Child Survey included additional questions to determine who completed the survey, whether parents were likely to seek assistance for their child if the SBPHN Support Service was not available at their school, and asked for information about the strengths and areas needing improvement for the SBPHN Support Service. Analysis of the responses to the identical questions revealed that there were no significant differences between the Student Survey and the Parent/Child Survey. Data for these questions, therefore, were combined.
The Student Surveys were given by the SBPHNs to each student starting on April 30. The SBPHN left the room while the student completed the survey. A box was provided where the completed surveys could be deposited to ensure confidentiality. The Parent/Child Survey was addressed to the parents and mailed on April 24. A self-addressed stamped envelope was included. Two weeks after mailing, a follow-up telephone call was made to each family to remind them to complete the survey.
RESULTS
Survey Response
The Student Survey response rate was 94% (18 surveys returned, out of 19 given) and the Parent/Child Survey response rate was 47% (17 surveys returned, out of 36 sent).
Respondent Characteristics
Student Survey and Parent/Child Survey respondents included students in JK to grade 8. Two thirds (63%) of the respondents represent female students. Thirty-six percent of children helped their parent complete the Parent/Child Survey. Parent/Child Surveys were completed by the mother (76%) and father (16%).
Access to Services
Students and parents of children using the service initially learned about the SBPHN Support Service through different sources. Students indicated that they found out about the SBPHN from their principal (56%) and/or the SBPHN (50%). Parent/Child Survey respondents indicated that they found out about the SBPHN from the principal (59%) and/or teachers (41%).
Likelihood of Parents to Seek Outside Assistance
Parents were asked the likelihood that they would have sought outside assistance for their child had the SBPHN Support Service not been available at their child’s school. Results indicated that 29% were ‘very likely’, 41% were ‘likely’ and 29% of parents were ‘unlikely’ or ‘very unlikely’ to seek outside assistance for their child.
Satisfaction with the SBPHN Support Service
All students and parents were either ‘very satisfied’ (61%) or ‘satisfied’ (39%) with the SBPHN Support Service. Students and parents strongly agreed or agreed that the SBPHN was a good listener (100%), made the student feel comfortable (97%), cared about helping the student (100%), could be trusted
(100%), was able to give the student information that he/she could understand (94%), and maintained confidentiality (94%). Eighty-six percent of students and parents strongly agreed (63%) or agreed (23%) that they would recommend the SBPHN Support Service to others.
Additional questions were asked to identify if the respondents perceived that the SBPHN helped the student to develop strategies to deal with health issues. Respondents were more likely to ‘strongly agree’ or ‘agree’ that the SBPHN helped the student find his/her own solutions (100%), while 65% indicated that the SBPHN helped the student discover his/her own strengths (Figure 3.1).
Figure 3.1 Students’ and Parents’ Perceptions of the Student’s Relationship with the SBPHN in the SBPHN Support Service
0 10 20 30 40 50 60 70 80 90 100 P e rcen t
Strongly agree Agree
Strongly agree 76 65 64 63 63 62 53 37 34
Agree 24 32 36 23 38 32 41 63 31
Good
listener Comfortable Cared
I would
recommend Trusted Understand Confidential
Own solutions
Own strengths
Note: Percentages may not add up to 100% as not all categories are shown.
Comments from Students and Parents
Ninety-four percent of students provided additional comments about the service. Some examples of comments provided include:
• “I think you should keep the program running. It’s an excellent service”
• “I think the SBPHN services were very useful, even though I will not be attending an elementary school next year. I hope that this service will continue to happen for elementary schools. The SBPHN helped me through a couple of tough times and it was very useful”
• “It’s nice to see that we kids can come to someone with our problems”.
Ninety-four percent of parents identified strengths, areas needing improvement, and additional
comments about the SBPHN Support Service. Some examples of strengths of the service identified by parents were:
• “Interaction with child – establishing trust – professionalism”
• “It gives you someone other than the teachers to talk to – helps not only students but teachers and parents”
Examples of areas needing improvement included:
• “Clarity on the reason they are having the interaction (child wasn’t sure why)”
• “There is nothing directly towards the nurses that needs improvement. The only thing may be that there should be more of them!”
• “They need to contact both parents that are involved” • “More updates on progress”.
Some additional comments provided by parents:
• “This service is needed in today’s society especially where both parents work and also where there are single parents”
• “I would like a phone call or a letter about the situation and notes sent home on tips ‘how to deal with issues’ and relationship building with children, parents, and siblings”
• “I feel the service provided has helped my family/children in understanding how to deal/overcome certain situations”.
POST-PILOT SURVEY
OBJECTIVESTo obtain and assess school staff perceptions of the SBPHN Support Service and the SBPHN Consultation and Referral Service with respect to:
1. Accessibility of the service to school staff
2. Access to support for students (and their families) with PSE health needs 3. The impact on students, families, and school staff
4. Satisfaction
5. Strengths and areas needing improvement.
METHOD
Self-administered surveys were provided to school staff three months after the introduction of the SBPHN services within the HPCDSB. Surveys were distributed to the schools at the end of April, with a return date no later than the end of May. Separate surveys were developed for each of the SBPHN Support Service and the SBPHN Consultation and Referral Service. Many of the survey questions were identical on both surveys, however some questions were tailored for the two different service delivery models. Five schools received the SBPHN Support Service post-pilot survey and three schools received the SBPHN Consultation and Referral Service survey. All administrators, teachers, educational
assistants, resource support persons, and other support persons in the eight participating schools were asked to complete a post-pilot survey. Completion of the survey was voluntary and anonymous.
RESULTS
The SBPHN Support Service and SBPHN Consultation and Referral Service post-pilot survey response rates were similar at 36.5% (50 surveys returned, out of 137 delivered) and 36.4% (16 surveys returned, out of 44 delivered), respectively.
Among staff who completed the surveys, 42% of those receiving the SBPHN Support Service indicated that they referred a student (21 referred a student, out of 50 completed surveys) and 50% of those receiving the SBPHN Consultation and Referral Service indicated that they referred a student (8 referred a student out, of 16 completed surveys). Given the small sample size of respondents completing the survey for the SBPHN Consultation and Referral Service, findings for this service are presented as an overview and need to be interpreted with caution.
SBPHN SUPPORT SERVICE
Accessibility of the Service to School Staff
Eighty-three percent of SBPHN Support Service survey respondents found it ‘very easy’ or ‘easy’ to connect students with PSE health needs to this service.
With regards to the referral process, of the 21 respondents who made a referral to the SBPHN Support Service the following procedures were identified as ‘very easy’ or ‘easy’:
• ‘Deciding which students to refer’ (86%) • ‘Completing the paperwork’ (69%)
• ‘Informing students 12 years of age and older of the referral’ (67%) • ‘Contacting parents for consent of students <12 years of age’ (61%).
Only 25% of respondents indicated that ‘following up with parents who don’t return paperwork’ was ‘very easy’ or ‘easy’ (Figure 4.1).
Figure 4.1 School Staff Perceptions of the Ease of the SBPHN Support Service Referral Process 86 69 67 61 25 0 10 20 30 40 50 60 70 80 90 100
Deciding to ref er Completing paperw ork Informing students 12+ of
referral
Contacting parents f or consent
Follow ing up w ith parents to return paperw ork
P e rcen t Ve ry Ea s y o r Ea s y
There was no strong consensus as to whether the time the SBPHN had been allotted to their school was sufficient to meet the PSE health needs of students (and their families). Similar percentages of
respondents indicated that the time allotted was sufficient (33%), insufficient (40%), or neither sufficient nor insufficient (27%).
Access to Support for Students (and Their Families) with PSE Health Needs
The majority of respondents (92%) strongly agreed or agreed that there was an increase in access to support for students (and their families) with PSE health needs when the SBPHN Support Service was available at the school.
Of school staff who made a referral to the SBPHN Support Service, equal percentages strongly agreed or agreed (40%) or neither agreed nor disagreed (40%) that they would have referred students (and their families) with PSE health needs to an outside agency if the SBPHN Support Service was not available at their school. However, 61% strongly disagreed or disagreed that the students (and their families) they referred would have received assistance for their PSE health needs even if the SBPHN Support Service was not available at their school.
Impact
The majority of school staff either strongly agreed or agreed (88%) with the statement: ‘I am confident that with the addition of the SBPHN, my school has improved its ability to meet the PSE health needs of our students (and their families)’. Respondents were asked to indicate why they strongly agreed or agreed using a pre-supplied list. The main responses selected were:
• ‘The SBPHN Support Service provides students access to someone with dedicated time to meet their PSE health needs’ (89%)
• ‘The SBPHN has the expertise to meet the PSE health needs of students’ (68%).
School staff were asked to indicate their level of agreement with several aspects of school improvement since the introduction of the SBPHN Support Service. School staff strongly agreed or agreed that the SBPHN Support Service had improved (Figure 4.2):
• ‘The PSE health of students the SBPHN has worked with’ (88%) • ‘The efficiency of response to problem situations’ (86%)
• ‘The learning ability of those students who are working with the SBPHN to address their PSE health needs’ (73%)
• ‘Time available to educate rather than attend to the PSE health needs of students (and their families)’ (70%)
• ‘Problem solving with children and families’ (70%)
• ‘The PSE health of the student population in general’ (70%)
• ‘My level of stress as an educator in dealing with the PSE health needs of students (and their families)’ (60%)
• ‘The early identification of students (and their families) with PSE health needs’ (60%) • ‘Communication between the school and families’ (60%).
Figure 4.2 School Staff Perceptions of School Improvements Since the Introduction of the SBPHN Support Service 88 86 73 70 70 70 60 60 60 12 14 27 30 30 30 38 38 40 0 10 20 30 40 50 60 70 80 90 100
The health of students referred to the SBPHN
Efficiency of response to problems
The learning ability of students referred
Time available to educate Ability to problem solve Health of student population in
general
Stress level for educators Early identification of health
needs
Communication between school and families
P
e
rcen
t
Strongly Agree or Agree Neither Agree nor Disagree
Note: Percentages may not add up to 100% as not all categories are shown.
Responding to questions that asked school staff to evaluate characteristics of the SBPHN, school staff (n=50) strongly agreed or agreed that the SBPHN (Figure 4.3):
• ‘Acted in a professional manner’ (100%) • ‘Was approachable’ (100%)
• ‘Was available at scheduled times’ (100%) • ‘Was knowledgeable’ (93%)
• ‘Participated as a member of the school team’ (82%)
• ‘Communicated well with staff, students, and families’ (82%).
Fewer school staff (49%), however, strongly agreed or agreed that the SBPHN ‘was easy to contact outside scheduled times’.
Figure 4.3 School Staff Perceptions of the Characteristics of the SBPHN in the SBPHN Support Service 73 71 57 57 58 26 27 29 43 36 24 82 23 0 10 20 30 40 50 60 70 80 90 100 Acted professionally
Was approachable Was available at scheduled times Was knowledgeable A member of school team Communicated well with staff/families Was easy to contact outside scheduled times P e rcen t
Strongly agree Agree
0
Note: Percentages may not add up to 100% as not all categories are shown.
Satisfaction
Nearly all school staff were either ‘very satisfied’ (46%) or ‘satisfied’ (50%) with the SBPHN Support Service.
Strengths
School staff were asked to identify strengths of the SBPHN Support Service in an open-ended format. Thirty school staff provided responses. Some examples of these responses are as follows. The SBPHN:
• Was approachable, trustworthy, had a good rapport with students
• Had the expertise to deal with students’ needs, was a trained professional, provided peace of mind to staff
• Was readily available, had the time to deal with underlying issues for children, was able to help students who otherwise would not have received help in a timely manner
• Was an accessible resource that provided time, resources, and support for students, school, and the community
• Allows teachers more time to educate, was a team player to support staff • Maintained confidentiality.
Areas Needing Improvement
School staff were also asked to identify areas needing improvement for the SBPHN Support Service in an open-ended format. Twenty-six school staff provided responses. Some examples of these include:
• More time for the SBPHN to be available at the school • Have access to the SBPHN outside scheduled hours
• Better workspace with a calm atmosphere where students would feel comfortable opening up to someone new
• Referral process needs to be improved • Calling students down to the office.
Comments
School staff were given the opportunity to provide general comments about the SBPHN Support Service in an open-ended format. Twenty-three school staff provided comments. Some examples include:
• “This is a wonderful service being provided! It is long overdue. Bravo to our board for being proactive and making it happen!”
• “I have not yet needed to refer a student in my class, however, am grateful this service is available. It is valuable and necessary for our school.”
• “The students participating eagerly await the opportunity to meet with the SBPHN. They enjoy the one-on-one time, and that there is someone else to listen to them. Thank-you for your service.” • “This is a beneficial resource for our students as well as the entire school community”
• “This support service is essential for each school. Social and emotional (and health issues) are increasing each year…By having the expertise of our SBPHN we as educators can focus more on academics…This is an essential service.”
Additional feedback is summarized as follows:
• SBPHN is a pleasure, delight, professional partner, exceptional member of school staff, supportive
• Positive experience for children/staff/family, parents more willing to receive support from SBPHN, or share more freely with person who is not teacher or administrator, valuable link to families in difficulty, is able to address delicate topics
• Wonder if a social worker is more qualified, some students need more than SBPHN can provide, further supports have been recommended for serious referrals, some areas of physical health could still be part of SBPHN role
• Updates on student progress would be helpful, more time is needed.
SBPHN CONSULTATION AND REFERRAL SERVICE Accessibility of the SBPHN Services to School Staff
Among school staff receiving the SBPHN Consultation and Referral Service, similar percentages of respondents identified that consultation or referral to the SBPHN for students/families with PSE health needs was ‘very easy’ or ‘easy’ (36%) or ‘neither easy nor difficult’ (43%).
Respondents who made a referral to the SBPHN Consultation and Referral Service (n=8) identified the following aspects of the referral process as ‘very easy’ or ‘easy’:
• ‘Deciding which students to refer’ (63%) • ‘Completing the paperwork’ (63%).
When asked whether the time the SBPHN had been allotted to their school was sufficient to meet the PSE health needs of students/families, 47% of respondents indicated that the time was ‘neither sufficient nor insufficient’.
Access to Support for Students and/or Families with PSE Health Needs
Almost two-thirds (64%) of respondents strongly agreed or agreed that the SBPHN Consultation and Referral Service increased access to support for students/families with PSE health needs.
Of respondents who made a referral to the SBPHN Consultation and Referral Service, the majority strongly agreed or agreed (78%) that they would have referred students/families with PSE health needs to an outside agency if the SBPHN Consultation and Referral Service was not available at their school.
Impact
School staff neither agreed nor disagreed (53%) with the statement: ‘I am confident that with the addition of the SBPHN Consultation and Referral Service, my school has improved its ability to meet the PSE health needs of our students/families’. Respondents (n=8) were asked to indicate why they neither agreed nor disagreed with the statement. The main response provided was an open-ended comment regarding the lack of contact or use of the service (62%).
School staff were asked to indicate their level of agreement with several aspects of school improvement since the introduction of the SBPHN Consultation and Referral Service. Fifty-eight to seventy-five percent of school staff identified that they ‘neither agree nor disagree’ that there were the following improvements (Figure 4.4).
Figure 4.4 School Staff Perceptions of School Improvements Since the Introduction of the SBPHN Consultation and Referral Service
58 58 60 64 67 67 73 75 75 0 10 20 30 40 50 60 70 80 90 100
Time available to educate Communication between school and
families
Stress level for educators Ability to problem solve The health of students referred to the
SBPHN
Early identification of health needs Efficiency of response to problems The learning ability of students referred Health of student population in general
Percent neither agree nor disagree
Responding to questions that asked school staff to evaluate characteristics of the SBPHN, all school staff receiving the SBPHN Consultation and Referral Service strongly agreed or agreed (100%) that the SBPHN ‘acted in a professional manner’ (Figure 4.5). Fifty percent or less of school staff strongly agreed or agreed with the remaining statements provided in Figure 4.5.
Figure 4.5 School Staff Perceptions of the Characteristics of the SBPHN in the SBPHN Consultation and Referral Service
42 42 42 50 50 58 58 58 50 100 0 10 20 30 40 50 60 70 80 90 100
Acted professionally Was available at scheduled times
Was knowledgeable A member of school team
Communicated well with staff/families
Was easy to contact outside scheduled times Pe rc e n t
Strongly agree or agree Neither agree nor disagree
*
0
* Too unreliable to be published
Satisfaction
Most school staff were ‘very satisfied’ (40%) or ‘satisfied’ (40%) with the SBPHN Consultation and Referral Service.
Strengths
School staff were asked to identify strengths of the SBPHN Consultation and Referral Service in an open-ended format. Eight school staff provided responses. Examples of these are summarized below. The SBPHN:
• Was a source of support and resources for students, families, and school staff • Provided schools with a contact to access other services
• Was professional, approachable, trustworthy, friendly, connected with students • Had expertise to deal with students’ needs, was knowledgeable.
Areas Needing Improvement
Respondents were also asked to identify areas needing improvement for the SBPHN Consultation and Referral Service in an open-ended format. Seven school staff provided responses. Examples include:
• Increase awareness of SBPHN Consultation and Referral service via communication with students, and feedback to teachers on family/student progress
• Presence in the school, easier access, increase visibility.
Comments
School staff were given the opportunity to provide general comments about the SBPHN Consultation and Referral Service in an open-ended format. Six school staff provided comments. Some examples of these comments include:
• Unfamiliar with the service
• Excellent, valuable, beneficial, hope the service continues
• Recommend that the service be presented by SBPHN to the school to improve uptake of service • Social worker may be more suited for this service.
ADMINISTRATOR FOCUS GROUPS
OBJECTIVESTo obtain and assess administrators’ (principal and/or vice principal) perceptions of the SBPHN Support Service and the SBPHN Consultation and Referral Service with respect to the:
1. Impact on administrators, school staff, students and their families 2. Strengths of the services in the HPCDSB
3. Recommendations for improvement
4. Continuation of the services in the HPCDSB.
METHOD
Two focus groups were conducted with administrators of schools participating in the SBPHN pilot program. One focus group was conducted with administrators of the schools receiving the SBPHN Support Service. The other focus group was conducted with administrators of the schools receiving the SBPHN Consultation and Referral Service.
Two PHNs and two community health students from the PDHU not affiliated with the SBPHN services acted as facilitators and recorders for the focus groups. One PHN facilitated each focus group, with the community health student taking notes. A digital recorder was used to record the sessions. Sessions ranged from 45 minutes to one hour in length.
Digital recordings were transcribed verbatim. Transcripts were analyzed for themes. Themes were described by context and direct quotations and organized by objective.
RESULTS
Six administrators participated in the SBPHN Support Service Administrator Focus Group, representing the five SBPHN Support Service pilot schools. Three administrators representing the three SBPHN Consultation and Referral Service schools participated in the SBPHN Consultation and Referral Service Administrator Focus Group. All participating HPCDSB elementary schools were represented by either a principal or vice principal, or both.
Impact
Overall, several important similarities were found between the two focus groups. Firstly, both focus groups discussed the positive impact of the two respective services on administrators themselves, students, parents, and school staff. Administrators receiving the SBPHN Support Service openly provided examples of where the service positively impacted students and their own work as
administrators. Administrators receiving the SBPHN Consultation and Referral Service also described an overall positive impact for students and families who received the service.
The second common response between the focus groups was that of knowledge. Both focus groups commented on the positive impact that the SBPHNs’ knowledge base and connection to community services had on the school community.
Another important theme that arose was a description of the role that the SBPHN played for the school community. Administrators receiving the SBPHN Support Service commented on how the objective, non-authoritative, confidential role of the SBPHN improved administrators’ perceptions and decision-making related to specific student situations. Administrators from the SBPHN Consultation and Referral Service schools described the “peace of mind” provided by having access to the SBPHN for
consultation when needed.
Lastly, time arose as a theme for both focus groups. Administrators from the SBPHN Support Service commented on the capacity of the SBPHN to provide time relief for them in their role as administrators. Administrators receiving the SBPHN Consultation and Referral Service discussed the inappropriateness
of the length of time given in the pilot period to accurately determine the impact of the consultation and referral model (Table 5.1).
Table 5.1 Administrators’ Perceptions of the Impact of the SBPHN Services on Students, Parents, and School Staff
‘From your observations, what impact has the SBPHN Support Service/SBPHN Consultation and Referral Service had on you, your school staff, and your students and their families?’
SBPHN Support Service Administrator Focus Group SBPHN Consultation and Referral Administrator
Focus Group
Positive Impact
• Overall positive impact for students, parents, administrators, and school staff
• Descriptors used include: ○ “big difference” ○ “support invaluable” ○ “tremendous support”
• SBPHN provided non-judgmental, confidential services in a relaxed, safe environment, which assisted students to share feelings and develop coping strategies
“…she was able to tap into their emotions…she provided them with…coping strategies”
• Improved behaviour and increase in self-referrals noted as outcomes
• Received positively by parents despite some initial hesitations • “Positive nature” of the program and ability to “hook into family
dynamics” facilitated parent trust resulting in increased parent
referrals and community acceptance
Positive Impact
• Although actual referrals were few, of those that were made, there was an observably positive impact for school staff and families
Role: Objective, Non-Authoritative, Confidential Support
• SBPHN provided objective perspective, which, with consent, assisted administrator to see the “big picture” for any given family situation
• SBPHN viewed as providing non-authoritative, non-disciplinarian, confidential support
• SBPHN viewed as non-judgmental “helpful hand” which facilitated students’ and families’ sharing of their “big picture”
• SBPHN perceived as “helpful” for decision-making by increasing administrator awareness of all possible variables for any given student situation
• Positive perception of SBPHN increased student and parent referrals, and as one administrator noted: “from those students who
may not have been originally identified”
Role: “Peace of mind”
• Knowing that the service was there if needed was seen as beneficial
“Peace of mind knowing there was someone to contact to help to initiate the process whenever we did have a need…that for me is a real big selling point of this program”
Knowledge and Skill
• Provided added knowledge base and skill set to school community • Diversity of SBPHN role, ability to assist students and parents, and helpfulness of consultation with the administrator and school staff regarding specific student issues provided added skill set • Knowledge of and connection with community services regarded
as very helpful to school community
“We’re not trained as counselors, you know, we use our common sense…problems that come forward to us are things that we’re not necessarily trained in…”
Knowledge
• SBPHN knowledge of and connection with community services were of benefit • Provision of an “abundance of information”
Time: Relief
• Capacity of SBPHN Support Service to relieve administrators of time spent dealing with certain student issues
• SBPHN is a resource for administrators to redirect student
situations that are specifically within the SBPHNs scope of practice
Time: Pilot Constraints
• Much discussion regarding the restrictions of time given the short pilot to accurately determine the impact of the consultation and referral model
• Diversity of SBPHN role and effectiveness of service described as contributors to time relief
“…as a principal, a tremendous support, tremendous…it has taken a lot off our plates…”
Strengths of the SBPHN Services
Role re-emerged as a theme as it was identified as a strength of the SBPHN services. Administrators from the SBPHN Support Service commented heavily on the qualities of the SBPHNs, their knowledge of and connections with community services, as well as service provision directly within the school setting as strengths of the service. The SBPHN Consultation and Referral Service administrators reiterated the theme of “peace of mind” regarding the role of the SBPHN in the consultation and referral model in providing reassurance that assistance was there if and when required.
Similarly, as in previous statements on impact, administrators from the SBPHN Support Service
described strengths in terms of the positive experience for students and families and the support the service provided to administrators. Administrators from the SBPHN Consultation and Referral Service referred again to knowledge as an important strength. New and important themes that arose were respect for the Catholic value system, and the efficiency of the consultation and referral model (Table 5.2).
Table 5.2 Administrators’ Perceptions of the Strengths of the SBPHN Services
‘What are the strengths of the SBPHN Support Service/SBPHN Consultation and Referral Service?’
SBPHN Support Service Administrator Focus Group SBPHN Consultation and Referral Administrator
Focus Group
Role: Qualities, and Access
• The majority of participants described strengths in terms of the qualities of the SBPHN that were demonstrated in their work with students:
○ “positive”
○ “passion for their work” ○ “personality”
○ “caring”
○ “compassionate” ○ “enthusiasm”
“I think also a strength is…their personality and their passion towards what they’re doing, they don’t just necessarily see it as a job…they’re positive, passionate people who really genuinely care and…that’s very important.”
• Physical presence of SBPHN within the school, and availability to students, parents, and school staff were viewed as facilitators to program access and timeliness of service provision
• Diversity of the SBPHN role was viewed positively
Role: “Peace of mind”
• Although service was not required at all times, the
“peace of mind” of knowing the service is available
when required is of benefit
• Provides another “tool in the toolbox” to assist administrators in dealing with unpredictable situations with students and families • A “lifeline for families”
Knowledge
• Knowledge base and connections with community services
Knowledge
• Health information and knowledge of and connections with community services
Positive Experience for Students and Families
• Overall agreement that program was a positive experience for students and families
• SBPHN perceived as an objective observer who facilitated trust, and connections with students and their families; she “meets them
where they’re at”
• Students shared experiences with SBPHN with other students;
“word of mouth”
• Students returned to the SBPHN for continued support
“It’s all very positive experiences…the fact that the kids want to go back and see somebody, especially an adolescent, means well you must have some connection with them, because otherwise they wouldn’t even be going there.”
Efficiency
• Model is efficient in terms of finances and time, as services are provided as required
• Efficient for schools with fewer referrals or geographical barriers
