Implementation Outcomes and Impact of a School Health and Wellness Network Specialist Intervention in Chicago Public Schools

OBJECTIVES: To evaluate implementation, impact, and cost-effectiveness of a Network Specialist intervention focused on health and wellness policy implementation in Chicago Public Schools. Education sector (Multi-Tiered System of Supports) and implementation science (Implementation Outcomes Framework, SISTER) frameworks informed the intervention. DESIGN: Quasi-experimental case-comparison efficacy study conducted between 2020-2021 and 2022-2023. Annual survey data and key informant interviews were used to evaluate implementation outcomes (acceptability, appropriateness, and feasibility); survey and administrative data were used to assess impact and cost effectiveness using difference-in-difference (DID) analyses and an incremental cost-effectiveness ratio (ICER). SETTING: One elementary school Network located on Chicago's Westside (intervention) and 1 socio-demographically matched comparison Network (DID only). PARTICIPANTS: Network Specialists, school-level stakeholders, and school-level administrative data. INTERVENTION: The Network Specialist provided a multi-tiered system of support to schools for health and wellness policy implementation. MAIN OUTCOME MEASURE: Healthy CPS score (out of 100) and ICER. RESULTS: The Specialist served 20 schools/year and an average of 302 students/school. At least 85% of school stakeholders perceived high levels of acceptability, appropriateness, and feasibility of working with the Specialist to support policy implementation. Schools in the intervention Network increased their Healthy CPS scores by 8 percentage points (70.95% pre vs. 78.95% post; P = .03), whereas scores stayed the same in the comparison network (74.03% pre vs. 73.03% post; P = .68), for an estimated 9-percentage point DID-estimated impact (P = .04). The cost-effectiveness analysis indicated that it cost each school $414, on average, to increase their Healthy CPS score by 1 percentage-point. CONCLUSIONS: Having a designated district-level Specialist to provide multi-tiered supports to schools to help with health and wellness policy implementation is cost-effective and is valued and appreciated by schools. The Specialist connects schools to key resources and services which enables them to improve their school-level implementation of federal, state and local health and wellness policy requirements.