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NHS Scotland's nine care pathways for school nurses evaluated

Initiatives intended to help improve children’s health and well-being 

Initiatives intended to help improve children’s health and well-being 

Picture: iStock

School nurses practise differently in all countries. A policy initiative in Scotland introduced nine care pathways for school nurses to refocus their work, including more home visits, to improve pupils’ health and well-being. 

The pathways are:

  • Mental health and well-being.
  • Substance abuse.
  • Child protection.
  • Domestic abuse.
  • Homelessness.
  • Looked-after children.
  • Young people involved in the justice system.
  • Young carers. 
  • Children changing schools.

Pathways included a referral process for education staff to the school nurses.

Two pilot areas

This initiative was piloted in two areas and a realist evaluation undertaken with qualitative interviews of nurse managers, school nurses and quantitative analysis of referrals.

The evaluation found that the implementation process varied between the two sites. In one, previous working patterns remained and the expectation was that this new system could be fitted in, while the other involved more re-organisation of workloads.

The nine pathways were found to streamline the process of referral to the school nurses; aiding early identification of pupils’ problems; and onward referral to specialist services. 

Ill-equippped to deliver interventions

However, school nurses reported they were ill-equipped to deliver interventions (as intended in the new programme) for less severe problems, particularly on the mental health and well-being pathway, despite the training programme delivered in both sites.

The authors concluded greater capacity building strategies were required for school nurses.


Compiled by Vari Drennan, professor of healthcare and policy research at Kingston and St George’s, University of London

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