EFICIENCIA DEL PROGRAMA

Allison et al. (2007) conducted a retrospective cohort study over a 20 month period with 3,599 pupils aged 14-17 years within the USA. It examined the use of school based health clinics [SBHCs] (known as drop in clinics within the UK) by adolescents from low income families, and compared the quality of care with other health care providers. The study found that 22% of the cohort had accessed a SBHC, but a potential concern was that 45% had not accessed any health care at all. Of those that did access a SBHC, the median visit rate was three visits per year per person, demonstrating that young people do have ongoing health needs. This suggests that providing easily accessible school nursing services within schools could increase the uptake of health care facilities making them more effective in prevention and early intervention work.

Ingram and Salmon (2010) support these findings. In their UK study most pupils questioned (n=515) stated they had easy access to the school nurse, and were aware of their availability. Importantly, several pupils stated that if the school

47 nurse clinic was not readily available, they would not seek health advice or support from anywhere else. However, no statistics were given and so the term ‘several’ could be misleading. In addition cultural issues were briefly explored in the report, as a group of Muslim faith pupils stated they would not access the school nurse at all in case their family or community found out. Therefore, advertising and marketing services aimed at dispelling concerns around confidentiality is vital. Ingram and Salmon (2010) also found that pupils wanted the school nurse drop in clinic to be available more often and have longer opening hours. These findings concur with both Peckham and Carlson (2003) and Madge and Franklin (2003), who also reported that pupils wanted more access to the school nurse.

In 2011 the British Youth Council was commissioned by the Department of Health to conduct a large scale survey of young people’s views about the role of the school nurse. In total 1599 young people aged 11- 18 years completed an individual online quantitative questionnaire, which was followed up with several national focus groups involving 202 young people, in order to gather richer data about their views and opinions. Three key themes were identified from the study, one of which was that 51% of the young people wanted early access to help and support in relation to mental health, including support in times of need for example, family problems, self-harm, depression low self-esteem and someone they could confide in (BYC, 2011). The sample population were already involved with the British Youth Council; therefore they could be considered to be an articulate, informed and empowered group and not representative of all young people. Yet 49% were unsure of how to access the school nurse, and did not know that they were qualified nurses. In addition 51% indicated they would like more support.

48 Therefore it could be argued that groups of young people who are more vulnerable such as those attending pupil referral units, in the care of local authorities, at risk of sexual exploitation, living in violent households, bereaved young people would potentially require enhanced levels of support in order to reduce health inequalities.

Chase et al’s. (2010) multifaceted study across five different areas in England supports these findings. The sample size was smaller (n=204) with no details given as to how the sample was selected, but it did include a wider age range of young people (age 9 years and above). Unlike the BYC (2011) survey, a significant amount of detail was provided on how ethical considerations were addressed in order to protect the young people taking part. Chase et al. (2010) also found that very few of the young people attending high school knew who or how to access the school nurse. Like the previous studies the young people concurred with their counterparts, indicating they wanted more information on how to contact the school nurse, and well as early support from someone they could talk to confidentially and who would listen to them.

Similarly Kendal, Keeley and Callery (2011) conducted a qualitative study in the same year, in three high schools in a UK city. None of the 54 young people identified the school nurse as someone they felt they could access for emotional support as they did not know how to contact them. However, the young people did highlight that they wanted support from someone who would be friendly, confidential, they could trust and that they could talk to about difficult and sensitive emotions such as feeling lonely, sad, anxious and fearful. The study

49 stated that the next phase was to train school staff to provide such interventions. This is a surprising recommendation given that the young people stated they felt teachers would not be confidential, lacked empathy and just wanted to solve the problem quickly as opposed to listen to them. Interestingly, school nurses already have these skills and could provide more support to schools if given more investment, as working in partnership with others could be a more cost effective approach then training and up skilling other or new staff (DfES, 2006; Merrell et

al., 2007; Caan, 2010; DH, 2012; Godson, 2013a; Godson, 2013b; DH/PHE, 2014a).