Health Equity and Rural Education (HERE!) Clinical Trial

The HERE pilot study will consist of two phases to strengthen and finalize the HERE school-based community health worker (SB-CHW) intervention. The 6-month Phase I will provide broad stakeholder feedback on the proposed model and rationale, the SB-CHW intervention, the associated domains and measures, and the evaluation. The following 18-month Phase II will align with the school year and provide a feasibility test of the training, intervention, data collection, and analyses.

• School-Based Community Health Worker (SB-CHW) intervention (Behavioral): The school-based community health worker will support students with chronic poor attendance and their parent/guardian for a minimum of two 30-minute encounters focused on addressing social determinants needs, understanding the range/student encounter varies greatly due to the intensity of the social need(s) (e.g., crisis/noncrisis) and the number of needs being jointly addressed. The SB-CHW will build relationships across encounters and apply trauma-informed best practices.
• Enhanced Usual Care (EUC) Methods (Behavioral): The network of school-based health centers without school-based community health workers will receive reminders of the the existing online social services directory.

Primary outcomes

• School Based Health Services Utilization [At study completion (an average of 10 months/1 school year)]: The number of visits to School Based Health Centers (SBHC)
• School Attendance [At study completion (an average of 10 months/1 school year)]: The number of school days in attendance, collected by ½ day increments 1(b) determination whether the student continues to meet the definition of chronic poor attendance (Yes/No)

Secondary outcomes

• Parent & Child Self-Sufficiency and Needs [At enrollment, at study completion (an average of 10 months/1 school year)]: Arizona Self-Sufficiency Matrix. An 18-item self-report measure assessing needs on a 5-point Likert scale, including Housing, Employment, Income, Food, Childcare, Children's Education, Adult Education, Health Care Coverage, Life Skills, Family/Social Relations, Mobility, Community Involvement, Parenting Skills, Legal, Mental Health, Substance Abuse, Safety, and Disabilities.
• Child and Adolescent Needs and Strengths [At enrollment, at study completion (an average of 10 months/1 school year)]: Child and Adolescent Needs and Strengths (CANS) is a validated semi-structured interview that assesses children's exposure to potentially traumatic experiences \& level of traumatic stress symptoms, as well as considering strengths (Kisiel \& Fehrenbach, 2015).
• Family Engagement [At enrollment, at study completion (an average of 10 months/1 school year)]: The Family Engagement Survey -- Version 2 (FES), a validated measure of family and school engagement consisting of 20 items rated on a Likert-type scale from 1 (Strongly Disagree) to 5 (Strongly Agree).
• School-Based Community Health Worker Interactions [At study completion (an average of 10 months/1 school year)]: Number of CHW interactions with the student, parent/guardian, and/or both
• Process for Enhanced Usual Care [At enrollment, at study completion (an average of 10 months/1 school year)]: Use of resources from the online social services directory (yes/no)

Sex: All, ages: 12 Years to any, accepts healthy volunteers

Phase I Stakeholder Interviews (nonintervention):

Inclusion Criteria:

* A member of the program's Community Advisory Board, including community health workers;
* Caregiver of a child ages 12-18 from the Southeast Kansas region; or
* Student at least 12 years in age.

Phase II Feasibility Pilot- SB-CHW Intervention and Enhanced Usual Care Conditions

Inclusion Criteria:

* Children ages 12-18 and their parents/guardians from the Southeast Kansas region
* Student with or at risk for chronic poor attendance (missing 10% or more of the days that school has been in session at any point in the school year)

Exclusion Criteria:

* Parents/guardians or youth with profound intellectual/cognitive disability will be excluded.

• Eve-Lynn Nelson, PhD, Principal investigator, University of Kansas Medical Center

NIH grants: R56NR021161