Case Study: Building a Collaboration with West County Health Centers to Address School Absenteeism

Project Activities: Obtaining the Data

The first activity the West County ROOTS team focused on was obtaining access to school data.

At the beginning of the grant year, West County was planning to obtain the school data, merge it with the health center’s data, analyze it to identify how health issues were contributing to absenteeism, and then identify ways to partner with the district to reduce absenteeism. In addition, school system staff wanted WCHC to help them develop a data dashboard, something that West County was quite adept at doing, having built up a significant data analysis and visualization capacity to facilitate quality improvement.

However, gaining access to the school data took much longer than expected; in fact, it took most of the grant year. The main challenge centered on privacy concerns. School data are protected by FERPA, the Family Educational Rights and Privacy Act, which limits how data can be shared, just as HIPAA limits access to health care data.

It took a number of meetings and calls between WCHC and school system technical and legal staff over the course of eight months to develop a way to address the school system’s legal concerns. The solution that the two organizations devised was that just two people at WCHC, and no one else, be granted access to school data personal identifiers (e.g. names, addresses) to limit the potential for inappropriate disclosure of private information. In addition, WCHC used data infrastructure that helped hide sensitive information so it was not discoverable. A legal agreement specifying how data would be exchanged, merged, and used was developed to codify the process.

Because of this delay, the WCHC ROOTS team wasn’t able to get access to the data until eight months into the grant year. Next, the team had to match the school records with the health center’s records. The WCHC data team found that 57 percent of the students were also patients, as were 47 percent of guardians and contacts. Further analysis of the data was delayed for several months in the summer of 2018 when many of the school system partners went on vacation. The West County Team is currently in the process of analyzing data.

Project Activities: Understanding Partners’ Needs

The ROOTS team also used human-centered design principles to better understand their partner’s needs.

While the details of the data sharing agreement were being worked out, West County staff used the down time to better understand their community partners’ needs, using human-centered design principles and tools. To collect data in an engaging way, the ROOTS project lead developed a ‘Discovery Kit,’ a set of nine activities designed to help partners reflect on and express their thoughts about collaborating with West County around school absenteeism. Examples of kit activities included hands on projects that explored participants’ attitudes and expectations about the school/health center collaboration, ways that the clinic might be able to influence school absenteeism, and causes of school absenteeism.

Discovery Kits were distributed to the school superintendent, two school board members, the school secretary, a 5^th grade teacher, and the attendance case manager to gather a variety of perspectives. After Kit recipients worked through the exercises over a three week period, ROOTS staff conducted a one-hour interview with each one about the experience. Exercises and interviews were analyzed to identify common themes.

The interviews with school district staff and board members revealed four areas of health-related needs: 1) more mental and behavioral health services in schools, 2) parenting classes, 3) social and emotional support for teachers, and 4) training in trauma-informed care. WCHC also identified other areas where they could collaborate with the school system, including around nutrition education.

In addition, WCHC found out that there were misunderstandings in the community about the cost of the health center’s services. Many people thought that WCHC required insurance, for example, and many were unaware of the center’s sliding scale fee structure. The fact that the ROOTS Project Team lead was a graduate of the school district seemed to significantly increase trust between school system and health center staff. A number of participants also commented on the positive impact that seeing a graduate from the school in a leadership role at the health center could have on current students. This connection led to the creation of an internship at the health center for students to help analyze interviews.

In addition to yielding numerous insights about how the health center and the school system could both benefit from partnering, the reactions to the Discovery Kits were highly positive.

“I like the idea that this kit was three-dimensional. It really gave me the opportunity to explore things from a different perspective. While I don’t consider myself creative, I felt creative. And for those like me that don’t consider themselves creative, they will find that the interview provides them with every opportunity to communicate their perspective.”

~ Guerneville Resident

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“It was cool to go through these activities and synthesize my thoughts. Getting to the journal at the end kind of made me think about what all this means. Where do I see gaps or opportunities?”

~ Community Outreach Coordinator

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“I call it the fun kit! It allowed for processing and thinking deeper. I was able to be creative and through this exploration I was able to reconsider projects. It really triggered my passions!”

~ Community Organizer

Next Steps

Now that WCHC has access to the data, they will be analyzing it to try to answer questions like, “Why do certain families have a higher absenteeism rates?”, “Are there correlations between school performance and clinical outcomes?”, “How can the health center and the school system work together to reduce absenteeism?” They plan on using analytic techniques such as social network analysis and geospatial analysis to identify families that would benefit from increased support.

The health center is also collaborating with the school system to train school staff in trauma-informed care. One school principal and two teachers attended a WCHC all-staff meeting to participate in a session on trauma-informed care, and a West County provider trained in early childhood and adolescent behavioral health has also begun participating in truancy and other case management meetings with school staff. WCHC staff hope that this is just the beginning of an ongoing collaborative relationship that will to address area young peoples’ physical and mental health needs.

In addition, now that WCHC has learned how to access data from other systems, it is looking for ways to apply those learnings to other efforts. Areas of interest include integrating with HMIS (Homeless Management Information System) data to better coordinate services for people experiencing homelessness, and sharing data with law enforcement and behavioral health agencies for opioid abuse response and prevention.

West County is also interested in exploring ethical considerations related to data analytics based on publicly-accessible private information such as criminal justice history, motor vehicle department data, and credit scores. Questions include patients’ reactions to providers having access to these data, and whether it is ethical to use that kind of information as part of patient care.

West County Health Centers’ Advice for Data Sharing Collaboration

• Data sharing can be a tool to build partnerships. Although working through the technical and legal issues was time consuming, ultimately West County found that the process strengthened their relationship with the school system and set them up for even more collaboration going forward. The school system also benefited by gaining access to the health center’s data analytic capacity. Based on their collaborative relationship, West County has extended their work with the school system staff to include trauma-informed care.
• Active support from agency leaders is key to make data sharing efforts work. Because data sharing often involves challenging legal and technical issues, active support from leaders is essential to figure out how to overcome complex barriers.
• Personal relationships matter. The ROOTS project came about because West County and school system leaders worked together on a community board. Furthermore, the collaboration grew even deeper when school system staff learned that the ROOTS Project Lead was a graduate of that very school system.
• Open-ended exploration through Discovery Kits uncovered new areas of collaboration. The Discovery Kits and interviews with school system leaders and staff helped West County identify a number of additional collaboration opportunities around health care access, nutrition education, and trauma-informed care.