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

摘要 心理健康问题和自杀企图在18岁以下的年轻人中有所上升， 全国儿童心理健康紧急状态，农村社区尤其面临健康风险 在卫生公平方面的差距日益扩大。解决健康的社会决定因素（SDOH）的需求， 一个重要的基础，以支持儿童更广泛的健康和教育举措，包括改善 四分之一以上的儿童面临长期出勤率低的风险， 结果。学校是解决这些健康和教育差距的一个有希望的方法， 花了大部分时间，往往是农村社区值得信赖的中心。学校健康中心 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个 评估学校社区卫生工作对教育成果（出勤率）的影响。目前的研究利用了 建立强有力的保健-学校-社区网络，以评价学校社区保健的影响 工人在东南部堪萨斯，最贫穷的农村地区的国家。拟议的群集随机化 交叉试验将测试健康公平和农村教育（在这里！）校本社区卫生工作者 (CHW)在12个农村学校卫生中心，与加强卫生保健相比，临床 试验将包括三个18个月的队列，以告知1200名学生的学校和学生水平的结果。 幼儿园到12年级的学生。在目标1中，我们将比较以下国家农村青年的入学结果： 以学校为基础的CHW干预措施与处于强化健康护理条件下的青少年。在目标2中，我们将 比较以学校为基础的CHW干预与EUC条件对学校利用的影响- 基于现场保健中心和远程保健服务以及社会情感学习和学校氛围。我们将 还探讨了RE-AIM（干预范围、采用、实施和维护）领域，包括 与影响和可持续性相关的农村因素。通过利用医疗保健社区 合作伙伴，在这里！临床试验是重新构想学校护理服务的第一步。如果成功， 最终目标是推进这种可持续的、可扩展的干预措施，以满足个人需求， 社区一级健康的社会决定因素，并最终在系统一级促进健康公平。

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.