BACKGROUND: The Horizon 2020 funded MOCHA-project (Models of Child Health Appraised) aims to identify optimal models for primary care for children and adolescents. Two main aspects of primary care for children refer to School Health Services (SHS) and Adolescent Health Services (AHS). The main goal of this study was to explore the structure and process elements of European School Health Services (SHS) and Adolescent Health Services (AHS) and to assess which elements seem to be beneficial for children’s and adolescents’ health. This main goal was divided into three objectives: 1) To explore the organization characteristics, service characteristics and health priorities of various models of school health services and adolescent health services in the European Union (EU) and European Economic Area (EEA) countries; 2) To assess effects and outcomes of the various models of school health services and adolescent health services in the EU and EEA for children (≥ 4 years of age) and adolescents and 3) To assess the costs of the various models of school health services and adolescent health services in the EU and EEA for children (≥ 4 years of age) and adolescents.

METHODS: Data on SHS and AHS were collected in 30 European countries. These data describe the structure and process of functioning of health systems, and health outcomes and costs. Data collection comprised a number of steps. We first adapted the PHAMEU (Primary Health Care Activity Monitor for Europe) framework for primary care for adults to SHS and AHS for children and adolescents. The adapted PHAMEU framework disentangles SHS and AHS in three essential structure dimensions (governance, economic conditions and workforce) and four process dimensions (access, comprehensiveness, continuity and coordination). Secondly, we collected data on these dimensions across 30 European countries via the MOCHA country agents and from existing databases. Thirdly, we analysed the data in order to describe basic and organizational models in the 30 countries. In the final step, we collected data on health outcomes and costs to relate this data to the models of step two.

RESULTS:

• The first objective of this study was to explore the organization, service characteristics and health priorities of various models of school health services (SHS) and adolescent health services (AHS) in the EU and EEA
• The second objective was to assess effects and outcomes of the various models of school health services and adolescent health services in The EU and EEA for children (≥ 4 years of age) and adolescents
• The third objective was to assess the costs of the various models of school health services and adolescent health services in The EU and EEA for children (≥ 4 years of age) and adolescents.

CONCLUSIONS: This report presents a comprehensive and informative overview of several features and indicators of SHS and AHS in the EU and EEA. One of the most important findings on SHS is that of the 30 countries, all except two have SHS. With regard to the countries which do have SHS, no great variations seem to exist between regions in the majority of countries, so SHS in these countries seem to be equally accessible for all children and adolescents. There are also some concerns. A first major concern is the lack of policies to ensure that SHS facilities, equipment, staffing and data management systems are sufficient to enable SHS to achieve their objectives in most of the countries. The second major concern regards a lack of collaboration between SHS professionals, teachers, school administration, parents and children, and local community actors (including other health care providers). The overall impression of AHS is that, although around half of the surveyed countries seem to have adopted policies or guidelines that secure to some extent an equal access to care for most adolescents, many regions or countries of the EU and EEA lag far behind the current standards of quality health care. A minority for instance are equipped to identify and respond to mental health emergencies and life-threatening behaviour. In addition, while many countries support the concept of confidential health care, only a small number provide guidelines to professionals as how to address adolescents’ competence. The issue of inter professional care also seems not well addressed in many countries, while many adolescent bio-psychosocial health problems need such a collaborative global approach. While it is difficult to measure the impact of this gap in the delivering of excellent care to adolescents, it may be assumed that the quality of the primary care services makes a difference in terms of the health of young people. Data on economic conditions was limited available. Estimates of costs of SHS could be calculated for eleven countries and compared to the organization of SHS. Large differences between these eleven countries regarding the costs of SHS were found. Incomplete information and various ways of financing SHS may have led to a distorted picture of the costs of SHS. In general, in countries where dedicated school doctors are available, working alone or in a team with nurses, the calculated SHS expenses are higher.

IMPLICATIONS: Although we were not able to build comprehensive models on SHS and AHS and relate these models to health outcomes, this project has resulted in a valuable overview of the different features and indicators of which SHS and AHS in different countries exist. This provides many options for countries regarding alternatives for their current system. With this overview, it is possible for countries, to see how other countries have organized parts of the SHS and AHS and which options are preferred by most of the countries.