The effects of school health services for children and young people's health and growing up conditions
Systematic review
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Norwegian Knowledge Centre for Health Services was commissioned by the Directorate of Health to summarize the available research on the effect of school health services for children and young people's health and growing up conditions.
Key message
Background: Health clinics and school health is a statutory service in Norway. The municipalities have the responsibility and freedom to organize activities in an appropriate manner, adapted to local needs, as long as current laws and regulations are followed.
Aim: Norwegian Knowledge Centre for Health Services was commissioned by the Directorate of Health to summarize the available research on the effect of school health services for children and young people's health and growing up conditions. This review will be used as a basis to study measures to strengthen school health services. Our key findings are:
- Screening and early psychological intervention of children with depression may reduce depression in children and adolescents.
- Early interventions based on cognitive behaviour therapy may have a small effect on reducing the incidence of anxiety among school children in general and to reduce anxiety among school children who already have symptoms of anxiety.
- Combination of education and distribution of contraceptives may reduce number of unwanted pregnancies.
- Smoking prevention programs in schools seem to have an effect on reducing smoking prevalence, smoking initiation and intended smoking
- School-based programs for children with asthma seems to increased knowledge and self-management.
The review could only partly answer our questions; we did not identify any systematic reviews that focused on health care personnel in a school health service as it is organized in Norway. We did, however, identify a number of preventive and health promotion initiatives implemented at schools where health care professionals are involved.
Summary
Background
Health care centres and school health is a statutory service in Norway. The municipalities have the responsibility and freedom to organize activities in an appropriate manner, adapted to local needs, as long as current laws and regulations are followed. The service aim to contribute to more good years of life (preventing early death) with good health and reduce inequalities in health between social classes, ethnic groups and gender. There should be a low-threshold, easily accessible to users (Hdir 2003). All municipalities in Norway, with the exception of one, provided school health services at all primary schools, and most municipalities had school health at all high schools in 2005. The county owns and operates the high schools, while it is the municipality that has the statutory responsibility for school health services. Therefore it is necessary for the municipalities and counties to cooperate in offering services.
The plan for mental health care in Norway aim to provide 800 additional man-years to mental health care in the health care centres and school health services during the decade 1999-2008. Until 2006, there was an increase of about 400 man-years. There are more public health nurses than before in the service, but there has been a reduction in the number of doctor-years and the number of physical therapists in recent years.
Norwegian Knowledge Centre for Health Services was commissioned by the Directorate of Health to summarize the available research on the effects of school health services for children and young people's health and environment. Our review might be used as the basis for considering measures to strengthen school health services.
Methods
We searched systematically for scientific literature in the following databases:
Medline, Embase, PsycInfo, British Nursing Index, ISI Web of Knowledge, Cochrane Library, CDR Databases, PEDro, OT Seeker, Eric and SveMed
The inclusion criteria were:
Study design: Systematic reviews.
Population: Children and adolescents (6-18 years).
Intervention: Health promotion and preventing interventions carried out by health personnel in a school health service, targeted at individuals or groups.
Comparison: No intervention or standard care.
Outcome: Mental health: Well-being, quality of life, depression. Physical health: Functional ability, injury/illness, absenteeism. Behaviour: Level of physical activity, tobacco/alcohol use, diet, sexual behaviour. Knowledge about health service , further referrals.
Language: No language limitations.
The exclusion criteria were:
Study design : Non-systematic reviews and systematic reviews of low quality .
Intervention: Programs run by other actors than those related to school health. Vaccination, mapping of height /weight, testing of sight and hearing.
Two authors independently assessed reviews for inclusion and assessed methodological quality by using inclusion schemes and check lists. The quality of the evidence was assessed using GRADE.
Results
We identified 1082 publications in the search. After reviewing titles, abstracts and articles in full text and assessed methodological quality, we included thirteen systematic reviews and three overviews of overviews in the report. We have summarized sixteen publications covering the following aspects of school health: Mental health, sexual health, alcohol and tobacco, the organization of services, personnel, interventions to specific groups. We have not found any systematic reviews that deal with school health services as it is organized in Norway.
This report shows that available school health service might lead to increased use of primary health care services for children and young people. Screening and early psychological intervention of children with depression may reduce depression in children and adolescents. Early interventions based on cognitive behaviour therapy may have a small effect on reducing the incidence of anxiety among school children in general and to reduce anxiety among school children who already had symptoms of anxiety. Combination of education and distribution of contraceptives may reduce the number of unwanted pregnancies. Smoking prevention programs in schools seem to have an effect on reducing smoking prevalence, smoking initiation and intended smoking. School-based programs for children with asthma seem to increase knowledge and self-management.
Discussion
We did not find any systematic reviews that dealt with health care personnel in a school health service as it is organized in Norway, but we identified a number of prevention and health promotion initiatives implemented at schools where health professionals are involved. Most included systematic reviews have focused on interventions implemented at the school, and we know little about the extent to which school health services are involved. Some of the interventions border to treatment rather than prevention.
A main problem in finding and evaluating research that is relevant to the topic is that school health services are defined in different ways in the literature, like which services are provided and who the target groups are. Most studies are conducted in countries outside Scandinavia. Many of the included studies are American and from a different type of school health service where the focus might be more on treatment and medical conditions. There are few countries outside Scandinavia organising school health services the same way.
Conclusions
We have not found any systematic reviews that deal with health personnel in a school health service as it is organized in Norway, but we have identified a number of prevention and health promotion initiatives implemented at the school where health professionals are involved.
It can generally be methodologically difficult to investigate health promotion and preventing interventions, but there is a need for research and evaluation of school health services. There needs to Norwegian studies on the field, for example in relation to prevent psychological problems, increase physical activity and preventing obesity in children and young people.