Active parental consent for a school-based community violence screening: comparing distribution methods

BACKGROUND: Students are unable to benefit from many school programs designed to address their mental health needs if their parents do not consent to their participation. As part of an ongoing effort in a large urban school district to meet the mental health needs of students traumatized by violence exposure, this paper examines the impact of alternative approaches on parental response and consent rates for an initial screening to participate in a school mental health program. METHODS: Two alternative approaches were used to obtain consent for students to participate in a school-based intervention for students exposed to violence. For one cohort, consent forms were distributed along with school information and other school forms during a parent orientation meeting. In the other cohort, school mental health clinicians visited student homerooms to distribute consent forms and explain the program and evaluation to students. RESULTS: There were significantly higher rates of return of consent forms (89.8% vs 53.2%) and parents consenting to participate (69.6% vs 27.9%) among parents receiving consent forms at a school meeting than among parents whose forms were distributed to children in a classroom, with comparable rates of active refusals to participate (20.1% vs 25.3%). CONCLUSIONS: Overall return rates and rates of consent for screening participation were substantially higher when the consent form and accompanying materials were provided directly to parents rather than distributed in the classroom and sent home with students. These findings have implications for efforts to obtain active consent from parents for students to participate in school mental health programs.     

Parent Reactions to a School-Based Body Mass Index Screening Program

Background:  This study assessed parent reactions to school-based body mass index (BMI) screening.
Methods:  After a K-8 BMI screening program, parents were sent a letter detailing their child's BMI results. Approximately 50 parents were randomly selected for interview from each of 4 child weight–classification groups (overweight, at risk of overweight, normal weight, underweight) to assess parent recall of the letter, reactions to BMI screening, and actions taken in response to the child's BMI results.
Results:  Most parents found the BMI screening letter easy to read and had poor recall of numerical information (eg, the child's BMI percentile) but good recall of the child's weight classification (eg, normal weight or overweight). Most parents, and ethnic-minority parents in particular, supported school-based BMI screening. Parents of children whose weight was outside of the normal range were more likely to recall receiving the letter and talking to the child and the child's doctor about it. Parents who recalled their child as being overweight were more likely to report changing the child's diet and activity level. Most parents, and ethnic-minority parents in particular, wanted their child to participate in an after-school exercise program. An overweight condition in parents, but not children, was associated with an interest in family-based cooking and exercise classes.
Conclusions:  Most parents, and ethnic-minority parents in particular, viewed school-based BMI screening and after-school exercise programs favorably. Parents reported taking action in response to a BMI result outside of the normal range. Parents who were overweight themselves were particularly interested in family cooking and exercise classes.     

Parents of elementary school students weigh in on height, weight, and body mass index screening at school

School-based body mass index (BMI) screening and parent notification programs have been recommended as a childhood overweight prevention strategy. However, there are little empirical data available to guide decision making about the acceptability and safety of programs. A pilot study was conducted using a quasiexperimental research design. In fall 2004, children in 4 suburban elementary schools (kindergarten to sixth grade) in the St Paul/Minneapolis, MN, metropolitan area completed height/weight screening. The following spring, parents in 2 schools received letters containing height/weight and BMI results. A self-administered post-only survey examined parents' opinions and beliefs regarding school-based BMI screening and parent notification programs (response rate: 790/1133 = 70%). The chi2 test of significance was used to examine differences in program support by treatment condition, child's weight status, and sociodemographic characteristics. Among all parents, 78% believed it was important for schools to assess student's height/weight annually and wanted to receive height, weight, and BMI information yearly. Among parents receiving the letter, 95% read most/all of the letter. Most parents (80%) and children (83%) reported comfort with the information in the letter. Parents of overweight children were more likely to report parental discomfort as well as child discomfort with letter content. There was considerable parental support for school-based BMI screening and parent notification programs. Programs may be a useful overweight prevention tool for children. However, continued attention to how best to support parents and children affected by overweight is required.     

Rationale for the use of passive consent in smoking prevention research: politics, policy, and pragmatics

The empirical evaluation of school-based smoking prevention programs requires a broad sampling of subjects who are exposed to treatment or control conditions. The low base rate of ongoing smoking among young adolescents, the slow increase in smoking rates, and concerns about the representativeness of samples make it imperative that assessment of smoking and drug use include almost all students. Positive consent procedures outlined by regulations for the protection of human subjects (Department of Health and Human Services. Code of Federal Regulations, Part 46: Protection of Human Subjects. #45 CFR 46, 1983) require parental permission for minors to participate in a research project. However, those subjects who are at highest risk to smoke are least likely to have parental consent for such a project. Low participation rates and subject selection bias are serious threats to the external validity of studies that use a positive consent procedure. With passive consent, parents respond only if they wish to withhold consent; a nonresponse is interpreted as approval of their child's participation. The subject retains the right to consent or decline participation. Four criteria must be met to waive the requirement of positive parental consent. The passive consent procedure, as used in smoking prevention research, meets those criteria. Data are presented that support the use of this procedure. Research is recommended to examine how consent procedures can affect the results of prevention studies.     

Active Parent Consent for Health Surveys With Urban Middle School Students: Processes and Outcomes*

BACKGROUND: To achieve high participation rates and a representative sample, active parent consent procedures require a significant investment of study resources. The purpose of this article is to describe processes and outcomes of utilizing active parent consent procedures with sixth-grade students from urban, ethnically diverse, economically disadvantaged K-8 public schools involved in an evaluation of a middle school service-learning program. METHODS: As part of the evaluation of the Lead Peace-Plus service-learning program, active parent consent was obtained for participation in school-based health surveys conducted with sixth graders in 3 schools. To achieve acceptable rates of parent permission, we employed multiple procedures including regular communication with school staff, incentives for involved schools and teachers, a multipronged approach for reaching parents, and direct encouragement of students to return forms through repeated classroom visits, individual and classroom incentives. We used Fisher's exact tests to compare selected characteristics among students whose parents weren't reached, those whose parents refused, and those whose parents consented to survey participation. RESULTS: We achieved a parent response rate of 94.6% among sixth-grade students. No significant differences in student gender, race/ethnicity, school, or free/reduced lunch status were identified across parent consent status groups. Rates of absenteeism were significantly higher (p = .03) among students whose parents weren't reached compared to other groups. CONCLUSIONS: Employing a multifaceted active parent consent campaign can result in high rates of parental response with limited sampling bias among an urban, ethnically diverse and economically disadvantaged group of middle school students.     

MasterMind: Empower Yourself With Mental Health. A program for adolescents

BACKGROUND: Teachers need classroom-based programs to develop and support mental health fitness in adolescents because this age group faces significant challenges to their mental health. There is a paucity of such ready-made programs. This article describes the development and proposed implementation of a low-cost, effective, adaptable, 6-week, classroom-based workshop entitled MasterMind: Empower Yourself With Mental Health. MasterMind provides students with a "toolbox for mental health" by creating a safe environment for discussion of mental health and emotionally charged topics, by increasing student knowledge of mental health issues, and by providing tools to develop and maintain mental health. Instructional materials address topics identified through needs assessments. The program combines instruction and written exercises with "peer-teaching-peer" group activities, individual assignments, and open discussion. Specific methods are included to allow students to ask questions anonymously and to build each other's self-esteem. METHODS: MasterMind was implemented as a pilot program to a Seattle, WA, middle school class of 30 students and addressed self-esteem, media literacy, school resources, relationships, emotions, stress and ways to de-stress, and future goals. RESULTS: The students' enthusiasm and participation increased throughout the program, and they gave high satisfaction ratings to the topics covered. Additionally, the host teacher continued selected program activities after MasterMind was completed. CONCLUSIONS: MasterMind educates all students in a class, not just those with identified emotional problems, and can potentially identify children with mental health needs not already evident. The pilot program implementation of MasterMind shows that such programs have potential for providing adolescents with tools to optimize mental health.     

Cost-Effectiveness of a School-Based Emotional Health Screening Program

Background:  School-based screening for health conditions can help extend the reach of health services to underserved populations. Screening for mental health conditions is growing in acceptability, but evidence of cost-effectiveness is lacking. This study assessed costs and effectiveness associated with the Developmental Pathways Screening Program, in which students undergo universal classroom emotional health screening and those who have positive screens are provided with on-site clinical evaluation and referral.
Methods:  Costs are enumerated for screening and clinical evaluation in terms of labor and overhead and summarized as cost per enrolled student, per positive screen, and per referral. Cost-effectiveness is summarized as cost per student successfully linked to services. School demographics are used to generate a predictive formula for estimating the proportion of students likely to screen positive in a particular school, which can be used to estimate program cost.
Results:  Screening costs ranged from $8.88 to $13.64 per enrolled student, depending on the prevalence of positive screens in a school. Of students referred for services, 72% were linked to supportive services within 6 weeks. Cost-effectiveness was estimated to be $416.90 per successful linkage when 5% screened positive and $106.09 when 20% screened positive. A formula to estimate the proportion of students screening positive proved accurate to within 5%.
Conclusion:  Information concerning costs and effectiveness of school-based emotional health screening programs can guide school districts in making decisions concerning resource allocation.     

Body mass index measurement in schools

BACKGROUND: School-based body mass index (BMI) measurement has attracted much attention across the nation from researchers, school officials, legislators, and the media as a potential approach to address obesity among youth. METHODS: An expert panel, convened by the Centers for Disease Control and Prevention (CDC) in 2005, reviewed and provided expertise on an earlier version of this article. The panel comprised experts in public health, education, school counseling, school medical care, and a parent organization. This article describes the purposes of BMI measurement programs, examines current practices, reviews existing research, summarizes the recommendations of experts, identifies concerns, and provides guidance including a list of safeguards and ideas for future research. RESULTS: The implementation of school-based BMI measurement for surveillance purposes, that is, to identify the percentage of students in a population who are at risk for weight-related problems, is widely accepted; however, considerable controversy exists over BMI measurement for screening purposes, that is, to assess the weight status of individual students and provide this information to parents with guidance for action. Although some promising results have been reported, more evaluation is needed to determine whether BMI screening programs are a promising practice for addressing obesity. CONCLUSIONS: Based on the available information, BMI screening meets some but not all of the criteria established by the American Academy of Pediatrics for determining whether screening for specific health conditions should be implemented in schools. Schools that initiate BMI measurement programs should evaluate the effects of the program on BMI results and on weight-related knowledge, attitudes, and behaviors of youth and their families; they also should adhere to safeguards to reduce the risk of harming students, have in place a safe and supportive environment for students of all body sizes, and implement science-based strategies to promote physical activity and healthy eating.     

Very high compliance in an expanded MS-MS-based newborn screening program despite written parental consent

OBJECTIVES: In Bavaria, Germany, an expanded MS-MS-based newborn screening program was implemented in 1999. The coverage of new additional conditions and novelty of technology required introduction of written parental consent. Here we evaluated the influence of the consent procedure on compliance by systematic demographic tracking. METHODS: Comprehensive information was provided for parents, professionals, and the public. Screening notifications were matched with all birth notifications on name and date of birth. Parents of children without screening notification were contacted and counseled. RESULTS: Between August 1, 1999, and July 31, 2000, 123,284 children eligible for screening were born. Of these, 116,652 were matched successfully. Among 6,632 parents contacted, 2,516 (2%) did not respond. Three thousand thirty-four children were screened but the parents initially refused to participate in tracking. Five hundred ninety-four were screened outside the program. Four hundred eighty-eight untested newborns were identified. Three hundred twenty-five screening failures due to logistic problems were tested subsequently. Screening was definitely refused by the parents of 163 children (0.1% of target population). CONCLUSIONS: With appropriate information provided and surveillance by tracking, high compliance with newborn screening can be achieved despite a written consent requirement.     

Fruit and Vegetable Distribution Program Versus a Multicomponent Program to Increase Fruit and Vegetable Consumption: Which Should Be Recommended for Implementation?

BACKGROUND: Two primary school-based interventions were implemented, aimed at increasing fruit and vegetable (F&V) consumption by children, both with proven effectiveness: (1) a free daily F&V distribution scheme for all primary school children and (2) a multicomponent, age-specific program consisting of a classroom curriculum, parental involvement, and an environmental component. This article describes and compares the implementation, evaluation, and potential for adoption of the 2 interventions. METHODS: A total of 48 teachers who worked with either of these programs filled out a questionnaire at the end of the intervention period. Additionally, 24 of the teachers who worked with the multicomponent program filled out periodic monitoring reports during the intervention. RESULTS: Compared to the F&V distribution, the multicomponent program was less fully implemented and that implementation of activities decreased over time. Both programs were evaluated favorably, and about half of the teachers indicated that they were willing to use the program again in the following school year. Teachers who used the multicomponent program experienced more social pressure to implement the program. They rated the program they had used as more complex and risky than the other group rated the distribution program. CONCLUSIONS: The free distribution program has the greatest potential for being adopted by schoolteachers, but that efforts must be made to acquire funding for it. Until these resources are available, the multicomponent program seems to be a good alternative if improved as suggested.     

Developing school-based BMI screening and parent notification programs: findings from focus groups with parents of elementary school students.

School-based body mass index (BMI) screening and parent notification programs have been advanced as an obesity prevention strategy. However, little is known about how to develop and implement programs. This qualitative study explored the opinions and beliefs of parents of elementary school students concerning school-based BMI screening programs, notification methods, message content, and health information needs related to promoting healthy weight for school-aged children. Ten focus groups were conducted with 71 participants. Parents were generally supportive of school-based BMI screening. However, they wanted assurance that student privacy and respect would be maintained during measurement and that BMI results would be provided to parents in a neutral manner that avoided weight labeling. They also believed that aggregate results should be disseminated to the larger school community to support healthy change in the nutrition and physical activity environments of schools. Implications for practitioners and researchers are discussed.     

Parental Expectations of School Health Services

ABSTRACT: Parents, as consumers of health care for their children, have the opportunity to incorporate available school health services as part of their child's total health care. This study investigated whether parental expectations of school health services supported the role of health services in the school as part of a total health care delivery system. It also sought to establish differences in the level of parental expectations of school health services as they relate to family size, parental structure in the home, method of family medical payment and current mode of health care management. A three-part questionnaire was developed to elicit data about parental expectations of school health, family characteristics and current choice of health care. Data analysis showed that parents do expect and accept school health services to be a part of their child's total health care management. No significant relationship was found between parental expectations and family demographic factors or if the child's current health management was maintenance-oriented or crisis-oriented. The study suggests that opportunities for parental input into school health programming should be provided. Positive perceptions of school health services may be incorporated into program advocacy in the event of political and financial threats.     

Can children teach their parents about asthma?

The Open Airways for Schools (OAS) program has been shown to improve the self-management skills and health outcomes of students with asthma in Grades 3 to 5. This report examines the impact of OAS on students' parents. Because pilot studies showed that parental attendance at school-based sessions was low, the authors held six sessions at school for children and gave children homework assignments to complete with parents at home to teach parents about asthma and build support for children's self-management efforts. Analysis of 1-year follow-up data showed that children's participation in OAS was a significant predictor of parental self-management skills (p <.03) and that OAS children's communication was more strongly associated than controls' with parents' self-management (p = .05). The findings show that health education activities brought home from school by children can positively influence parents' self-management of a complex chronic disease such as asthma.     

School-located immunization programs: do parental preferences predict behavior?

Background

Little is known about parental attitudes regarding school-located immunization programs and their effect on program participation behaviors.

Objective

To determine the relationship between attitudes of middle school parents regarding school-located immunization programs and subsequent consent behaviors when such a program becomes available.

Methods

Primarily Hispanic, middle school parents completed questionnaires about school-located immunization programs. After questionnaire collection, immunization consent/refusal packets (English/Spanish) for a program providing Tdap and MCV4 vaccines were distributed at five Houston middle schools in low-income, urban areas. Responses regarding demographics, enrollment in a medical home, immunization location preferences, and knowledge of immunization recommendations were analyzed from questionnaires returned by those who later returned consent or refusal forms for school-located program participation. Frequency and chi square statistics were calculated using SPSS 18.0.

Results

Of 475 parents who completed the questionnaire and later sent a consent or refusal form, 289 (61%) consented to ≥1 vaccines for their child. Among those who consented: 71% were enrolled in a medical home; 42% had previously indicated that they did NOT prefer school as an immunization location; 32% had stated that they wanted to be present for their child's shots. Of those who sent refusal forms indicating they would access the vaccines from their own providers, 70% stated they wanted to be present for their child's vaccination.

Conclusions

A significant proportion of Hispanic, low-income middle school parents participating in a school-located immunization program had previously indicated that schools were not a preferred immunization site. Despite the availability of a medical home, a lack of preference for schools as a site, and the desire to be present during their child's injections when asked prior to program availability, these parents participated in the program when it was made available. Preferences noted in pre-program questionnaires may not predict parental consent behaviors for school-located immunizations.     

The “Generacion Diez” After-School Program and Latino Parent Involvement with Schools

The current study examines associations between participation in after-school programs and change in Latino parent involvement with schools. Hierarchical linear regression analyses demonstrated that parents of children who had higher after-school program attendance rates were significantly more likely to report increases in the quality of relationships with their children's teachers, frequency of parent-teacher contact, and engagement with their children's schooling over a two-year period. However, greater home educator contacts were related to decreases in quality and quantity of parent-school involvement. A primary implication is that attendance in school-based after-school programs may draw parents into children's regular-day school context. Editors' Strategic Implications The authors illustrate the promising practice of using after-school programs to promote parent involvement and to help integrate the often disparate family and school contexts for Latino children.     

Working With Non-Dental Groups to Influence Adoption of Self-Applied Fluoride Programs in Schools: One Approach

Although the use of self-applied fluorides in schools has been proven safe and effective, thousands of children are not benefiting from these procedures. This paper describes a dual promotional approach designed to increase the awareness of the need for school-based self-applied fluoride programs. A manned exhibit providing consultation and educational materials was displayed during the entire meeting of a state PTA and was supplemented by a presentation scheduled on the formal program. The workshop participants were parents of school-age children; most held decision-making positions in their local PTAs. Results of the workshop to date include: one participant prevented the demise of an established fluoride mouthrinsing program in her community; and the workshop leaders presented the merits of school-based self-applied fluoride programs to a local PTA and a county school health council. The same programs were described in a county PTA newsletter. These actions suggest that, given the appropriate information and assistance, parents of school children through their PTA can influence adoption of school-based fluoride programs. Furthermore, strategies directed toward members of other groups with an interest and decision-making role in children's health may be effective methods of influencing adoption of school-based self-applied fluoride programs and ultimately promoting children's oral health.     

Factors associated with student participation in a school-based hepatitis B immunization program

This study examined the relationship between participation in a school-based hepatitis B immunization program and teacher attitudes toward school-based health care and student socioeconomic factors. A survey addressing teachers' attitudes was administered to all teachers participating in the program. Information regarding student participation in school lunch programs and scores on national standardized tests were collected. Of the 4,874 fifth-grade students targeted for the program, 3,483 (72%) consented to be vaccinated and 3,232 (93% of 3,483) received all three doses of vaccine. Socioeconomic factors were the most important predictors of student participation in this school-based immunization program. Participation was significantly lower among students in schools with a high proportion of students receiving free or reduced-price school lunch and with low test scores. The only teacher factor associated with student participation was whether the teacher had returned the questionnaire. Strategies to increase immunization coverage in school-based programs should target children of low socioeconomic status.     

Parental and Staff Member Perceptions of Lab School Functions and Program Quality

The purpose of this exploratory study was to examine parental and staff member perceptions of the three-part mission commonly associated with child development laboratory schools, and how this mission impacts the program services being provided for enrolled children. Subjects were 363 parents of children enrolled in one of 15 lab schools, as well as 63 staff members working in these 15 programs. Although parents and staff members viewed lab school functions as having a somewhat positive or minimal impact on program quality, analyses revealed several significant differences in these perceptions based on the type of programs offered and their sponsoring institutions. Implications are drawn from the data for lab school programs.