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

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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.