Physician and Educator Co-design of a Canadian School-Based Health Centre Referral Form: a Quality Improvement Study

A school-based health centre (SBHC) in Toronto, Canada, supports students with academic, developmental, and behaviour-related challenges. The educators in this centre complete a referral form to provide information to the SBHC. The present study aimed to a) collaborate with the educators to co-design the existing SBHC referral form and b) provide the educators with a resource on a common pediatric disorder. The current quality improvement study was performed using a Plan-Do-Study-Act (PDSA) cycle. Data was collected from November 2020 to January 2021. Twenty-three educators rated their understanding of the original SBHC referral form using a 6-point Likert scale. The symptom descriptors flagged by >10% of the educators as unclear were updated and re-evaluated through a second survey. The educators voted on a common medical issue for which a pamphlet was created and evaluated for its effectiveness. Statistical analysis was performed using GraphPad Prism. Paired data were assessed by Wilcoxon rank-order test, unpaired data with Fischer’s exact, and proportions via Chi-squared test. The original referral form had 13/48 (27%) presenting symptoms identified for revision. After this revision, significantly fewer presenting symptoms met the criteria for revision (3/50, 6%; P<0.01). Most educators (10/23, 43%) requested an educational pamphlet on childhood anxiety. The majority of them (13/16, 81%) strongly agreed that they knew more about childhood anxiety after reviewing the resource and all of them (16/16, 100%) thought the resource would be helpful and could be shared with parents. Collaboration with the educators to co-design a SBHC referral form clarified its descriptors, enhancing the communication between the two parties in the referral process. Physician-created educational resource enhanced the educators’ knowledge about anxiety.