Homelessness Screening Tool Improves Care Coordination With School Nurses

There are currently more than 1.5 million students who are homeless, according to Federal data. Care for youth experiencing homelessness can be enhanced by strengthened coordination between school nurses and primary care providers (PCPs), according to research presented at the National Association of Pediatric Nurse Practitioners (NAPNAP) National Conference on Pediatric Health Care held March 13 to 16, 2024, in Denver, Colorado.

A project team consisting of a primary nurse practitioner (PNP), 2 Boston Public Schools nurses, and 3 expert nurse consultants evaluated a screening tool that was developed based on feedback from 114 school nurses in Massachusetts. The tool (Table) had a content validity score of 1.00 according to a review from 6 expert nurses.

TABLE. SNAP EHR —  Children Experiencing Homelessness Initial Student Screening Tool

Areas of Focus	Screening Questions	Responses
Lack of educational continuity	Attendance issues?	Yes/No
	Missing records needed to enroll?	Yes/No
Poor health and nutrition	Missing immunizations and medical records?	Yes/No
	Chronic hunger or food hoarding?	Yes/No
	Fatigue (may be falling asleep in class)?	Yes/No
Transportation and attendance issues	Erratic attendance and tardiness?	Yes/No
	Numerous absences?	Yes/No
	Lack of participation in afterschool activities?	Yes/No
	Lack of participation in field trips?	Yes/No
Poor hygiene	Wearing clothes for several days?	Yes/No
	Inconsistent grooming?	Yes/No
Social and behavioral concerns	Extreme shyness?	Yes/No
	Unwilling to form relationships with peers and teachers?	Yes/No
	Anxiety, exhibiting anger or embarrassment when asked about current address?	Yes/No
	Avoidance of questions related to current address?	Yes/No
	Statements made about staying with grandparents, other relatives, friends, or in motels and campgrounds?	Yes/No
	Statements such as: “I don’t remember the name of the last school I was in.”?	Yes/No
	Statements such as: “We’ve been moving around a lot.”?	Yes/No

If a student responded yes to all questions in any focus area or yes to at least 3 questions overall, the tool recommended close monitoring. If a student responded yes to all questions in any 2 focus areas and up to 6 questions overall, the tool recommended that the school nurse refer the patient for further assessment. If a student responded yes to all questions in 3 or more focus areas or yes to more than 6 questions overall, the tool recommended immediate follow-up and intervention.

“This collaboration between school nurses and primary care NPs offers the opportunity to discern homelessness earlier and consequently implement services for these vulnerable children at an earlier time and can result in a decrease in the development of issues related to homelessness,” said Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP.

A team of nurses and school professionals completed a 15-item modified Systems Usability Scale to assess the tool’s usefulness at the local, state, and national level. The resulting data from 210 respondents, collected both in-person and virtually, indicated that the tool is a practical, easy-to-use resource for collecting information. Participants also indicated that the students’ responses to the questions included valuable additions to the child’s electronic medical record.

By improving care coordination between school nurses and PCPs, the screening tool helps youth experiencing homelessness receive timely follow-up care when appropriate. These referrals can be crucial to address the effects of homelessness on a child’s physical and mental health.

While this study focused on measuring the screening tool’s efficacy in the public school setting, the study authors note that it may also be of use for college students at on-campus clinics, as well as primary and chronic care.

Funding for the project was through Teacher Leadership Fund Grants, Boston Public Schools 2021-23.

Visit Clinical Advisor’s conference section for more coverage of NAPNAP 2024.