150 - Parent Decisions for Children with Medical Complexity to Attend In-Person School during COVID-19

Poster Number: 150
Publication Number: 150.305

Ryan J. Coller, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Michelle M. Kelly, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Jens Eickoff, University of Wisconin-Madison, Madison, WI, United States; Gemma G. Warner, American Family Children's Hospital, Madison, WI, United States; Sabrina Butteris, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Mary Ehlenbach, Univ of WI School of Medicine & Public Health, Madison, WI, United States; Shawn Koval, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Barbara J. Katz, Family Voices of Wisconsin, Madison, WI, United States; Ellen R. Wald, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Joseph A. McBride, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Nicole Werner, University of Wisconsin-Madison, Madison, WI, United States; Kristina Devi Howell, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Madeline Q. Kieren, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Qianqian Zhao, University of Wisconsin School of Medicine and Public Health, MADISON, WI, United States; Gregory DeMuri, Univ of Wisconsin School of Medicine and Public Health, Madison, WI, United States

Background: Families of children with medical complexity (CMC) struggle deciding whether to send their child to school during COVID-19. Understanding how frequently families of CMC are declining in-person school, and predictors of parent decisions about school attendance could provide policy and intervention targets to promote safe school attendance.

Objective: Determine frequency of in-person school attendance for CMC during the COVID-19 pandemic and identify parent perceptions associated with in-person attendance.

Design/Methods: This prospective cohort study invited all English- and Spanish- speaking parents of children with at least 1 complex chronic condition (CCC), ages 5-17 years, cared for at our academic medical center, to participate at the end of the 2020-2021 academic year. Only children attending school in-person prior to the pandemic were included. Survey items were derived from the Health Belief Model (HBM), and 5-point Likert scales indicated opinions for each question. HBM constructs were modeled using exploratory factor analysis by creating scales of highly correlated survey items. In-person school was defined dichotomously as attending full/hybrid in-person school vs. fully virtual despite having the option for in-person school. Associations between in-person school and HBM constructs were determined with logistic regression and structural equation models adjusted for CMC grade and prior COVID-19 infection.

Results: Among n=1,330 families (response rate 44.7%), n=1049 reported their CMC was attending in-person school (78.9%). Table 1 summarizes sample characteristics. CMC attending in-person school were more often in lower grades (p=0.003), had prior COVID-19 infection (p < 0.001), or more CCCs (p=0.0014). A SEM path model (Figure 1) illustrates significant associations between in-person school and three HBM constructs: parent motivation (i.e., desire for in-person school), perceived barriers (i.e., school implementation of mitigation strategies), and cues (i.e., school encouraging child attendance). Predicted probabilities (95% CI) of in-person school based on model indicators are in Table 3; e.g., those perceiving fewer barriers had 97% (95-99%) predicted probability for in-person school compared to those perceiving more barriers (86% (79-91%)), p< 0.0001.Conclusion(s): One-in-five CMC in a large Midwest population were not attending school at the end of the last academic year. Implementing mitigation strategies and encouraging child attendance may be promising strategies to address this disparity, and monitoring trends over time is necessary.
Table 1. Respondent Characteristics Surveyed at the End of the 2020-2021 Academic Year
Table 3. Predicted Probability of In-Person School Attendance at the end of the 2020-2021 Academic Year for Children with Medical Complexity† value ≥ median
‡ value < median