Health Equity and Rural Education (HERE!) Clinical Trial: A Healthcare-Community Partnership Leveraging School-Based Community Health Workers to Improve Student Attendance

摘要 在18岁以下的年轻人中，精神健康问题和自杀企图增加，导致一项声明 全国儿童心理健康紧急状态，农村社区尤其面临健康风险 卫生公平方面的差距越来越大。解决健康的社会决定因素(SDOH)需求是 通过更广泛的健康和教育举措支持儿童的重要基础，包括改善 出勤率超过四分之一的儿童有长期出勤率低和相关负值的风险 结果。学校是解决这些健康和教育差距的一个有希望的方式，在这些差距中，大多数孩子 他们花了大部分时间，往往是农村社区值得信赖的中心。以学校为基础的健康中心是 有能力满足卫生需求，但往往没有能力满足日益增长的社会决定因素 儿童及其家庭的健康需求。社区卫生工作者(CHW)已经成为一种 弥合高医疗保健和高社会服务需求之间的差距，拟议的临床试验是第一次 评估校本CHW对教育结果(出勤率)的影响。目前的研究利用了 强大的医疗保健-学校-社区网络，以评估以学校为基础的社区卫生的影响 堪萨斯州东南部的工人，该州最贫穷的农村地区。建议的集群随机化 交叉试验将测试健康公平和农村教育(此处！)校本社区卫生工作者 (CHW)干预，与12个农村校本卫生中心的强化日常护理进行比较。临床部 试验将包括三个为期18个月的队列，以告知1200人的学校和学生水平的结果 从幼儿园到12年级的学生。在目标1中，我们将比较#年农村青年的入学结果 学校以CHW干预为基础，与处于强化日常护理条件下的青少年进行比较。在目标2中，我们将 比较以学校为本的CHW干预措施与EUC对学校利用率的影响情况- 以卫生中心现场和远程保健服务以及社会情感学习和学校氛围为基础。我们会 还将探讨RE-AIM(干预覆盖、采用、实施和维护)领域，包括 与影响和可持续性有关的农村因素。通过利用医疗保健社区 伙伴关系，就在这里！临床试验是重新想象学校提供护理服务的第一步。如果成功，则 最终目标是推动这种可持续、可扩展的干预措施，以满足个人需求、进步 社区一级健康的社会决定因素，并最终促进系统一级的健康公平。

ABSTRACT Mental health issues and suicide attempts have risen among young people under 18, resulting in a declaration of a national state of emergency for child mental health, with rural communities particularly at risk for health disparities and with widening gaps in health equity. Addressing social determinants of health (SDOH) needs is a crucial foundation to support children with broader health and education initiatives, including improving school attendance with over one in four children at risk for chronic poor attendance and associated negative outcomes. Schools are a promising way to address these health and education disparities where most children spend most of their time and are often a trusted center of rural communities. School-based health centers are equipped to address health needs, but often do not have capacity to meet growing social determinants of health needs of children and their families. Community health workers (CHW) have emerged as a way to bridge this gap between high healthcare and high social service’s needs,with the proposed clinical trial the first to evaluate school-based CHW impact on an education outcome (attendance). The current study leverages a robust healthcare-school- community network to evaluate the impact of school-based community health workers in Southeast Kansas, the poorest rural region of the state. The proposed cluster randomized crossover trial will test the Health Equity and Rural Education (HERE!) school- based community health worker (CHW) intervention, compared to Enhanced Usual Care in 12 rural school-based health centers. The clinical trial will include three 18-month cohorts to inform school-level and student-level outcomes across 1,200 Kindergarten through 12th grade students. In Aim 1, we will compare attendance outcomes for rural youth in the school based CHW interventions versus youth in an Enhanced Usual Care condition. In Aim 2, we will compare the school-based CHW intervention with the EUC condition related to impact on utilization of school- based health center onsite and telehealth services and on socio-emotional learning and school climate. We will also explore the RE-AIM (intervention reach, adoption, implementation, and maintenance) domains, including rural factors associated with impact and sustainability. Through leveraging the healthcare-community partnership, the HERE! clinical trial is a first step in reimagining care delivery at school. If successful, the ultimate goal is to advance this sustainable, scalable intervention that meets individual needs, advances community level social determinants of health, and ultimately, advances health equity at the system level.