CPLH implemented the project between August 1999 and June 2002. The CSHDP evaluated the impact of school-linked services on health and educational outcomes through June 2003. Several articles were submitted for publication, and so far two were published: "Urban Elementary School Personnel's Perceptions of Student Health and Student Health Needs" in Ambulatory Pediatrics and "Health Related Quality of Life in Urban Elementary School children" in Pediatrics.

CSDHP was a collaboration among the Cincinnati Health Department, the Cincinnati Public Schools (CPS), and the Cincinnati Children's Hospital Medical Center. CSDHP involved the implementation and evaluation of three different models of school-linked health services over three years in six K-8th grade CPS schools. The outcomes evaluated in the project include child's perception of health-related quality of life (HRQL), school connectedness, school absences, emergency department utilization, and referrals to off-site services. The process evaluation examined characteristics of school-linked health service users, the number of student encounters, reasons for visits, chronic illnesses of students, and parental satisfaction with services. Data were also collected for children with asthma on process measures related to asthma care as well as asthma health related quality of life. Highlights include:

• The baseline HRQL data show that these students rated themselves sicker than a typical chronically ill child would score. The children ion the study scored an average of 67.2. A healthy child should score 83 or above and a chronically ill child scores 777 or lower. However, the parents average score was 83.4, the score of a healthy child.
• There were no significant differences by model of school-linked healthcare services for health related quality of life, school connectedness, school absences, or emergency department utilization.
• There were significant differences in the number of referrals and the number of completed referrals at schools with more health services, including that having additional healthcare professionals assists in getting children connected to outside health resources.
• At the end of the study, 64% of the students were no longer enrolled in one of the six schools. The high attrition in these schools limits the ability to draw firm conclusions from this study.
• Students with asthma in the school with the highest level of school-linked health services had better scores on the worry subscales of the asthma quality of life tools compared to the model with intermediate level of additional health services. This suggests that interventions with specific populations within school-linked programs may have more benefit on functional health outcomes.

One of the largest limitations of this study was the high degree of student mobility in the population being studied. While high mobility in the population was anticipated, it superceded CSHDP's projections. This mobility makes it difficult to definitively conclude that school-linked health services do not influence the outcomes measured as part of this study. It is possible that the most high-risk student may have been influences by services, but they were no longer present to have those outcomes measured. The principal investigator of the CSHDP is conducting further research regarding the etiology and impact of school mobility and the relationship of school mobility to behavioral health problems in school-aged children.

Even though significant outcomes were not found in this study, the CSDHP plays a role in the field of school health evaluation. The CSDHP project team used their lessons learned to help others in Cincinnati and nationally on the best practices of collecting data in a school system. The principal investigator is recognized as a national expert on evaluating school health programs. The experience of this study will, and has, influenced the design and implementation of other studies, including the Foundation's SBHC Health Outcomes Study.