Original Research
Kicking the can down the road: referral services and a school-based primary health care service for rural primary school children
AUTHORS
Catherine V Sanford1 MPH, Research Academic/PhD Candidate *
David Lyle1 PhD, Academic Associate, (Head of Department at the time of the research)
Sarah Dennis2,3,4 PhD, Professor of Allied Health
Danielle K White5 BN, GradCert (Paed), Senior Lecturer, Academic Career Development and Strategic Support
Karen Harding-Smith1,6 BN, GradCert CFH, Research Assistant and Primary Health Care Registered Nurse (at the time of the research)
Armando Teixeira-Pinto7,8 PhD, Professor of Biostatistics
Rebecca J Smith6 B.Occ.Th., GradCert Clinical Redesign, Integrated Care Manager - Allied Health and Integrated Community Services
Robert Dyson9 BEd, Networked Specialist Facilitator
Emily Saurman10 PhD, Senior Lecturer – Rural and Remote Public Health
AFFILIATIONS
1 Broken Hill University Department of Rural Health, Faculty of Medicine and Health, The University of Sydney, Corrindah Court, PO Box 457, Broken Hill, NSW 2880, Australia
2 Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, The Susan Wakil Health Building, Western Avenue, NSW 2006, Australia
3 South Western Sydney Local Health District Liverpool, NSW 2170, Australia
4 Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW 2170, Australia
5 Broken Hill University Department of Rural Health, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Corrindah Court, PO Box 457, Broken Hill, NSW 2880, Australia
6 Far West Local Health District, NSW Health, 1-2 Sulphide Street, Broken Hill, NSW 2880, Australia
7 Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building, Fisher Road, NSW 2006, Australia
8 Centre for Kidney Research (Westmead), Hawkesbury Road, Westmead, NSW 2145, Australia
9 NSW Department of Education, 1A Wentworth Road, Broken Hill, NSW 2880, Australia
10 Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Bloomfield Campus, 1502 Forest Road, Orange, NSW 2800, Australia
ACCEPTED: 26 January 2026
Early Abstract:
Introduction: Several new school-located nurse models have recently been established in Australia. These services aim to improve health and education outcomes for children in less advantaged communities, however, data describing their activities and impact are limited. The School-Based Primary Health Care Service (SB-PHCS) was implemented in Broken Hill, a rural community in Far West New South Wales, Australia. The service aims to improve the health and educational outcomes of local children by facilitating access to health care. This study describes the referrals to other services supported by the SB-PHCS and the subsequent use of treatment and therapy services by the primary school children.
Methods: We conducted a review of the community health electronic medical records of public primary school children referred to the SB-PHCS in 2019. Data extracted included demographics, presenting problems, referrals to other services that were supported by the SB-PHCS, type of SB-PHCS support provided, and client use of the services they were referred to. Cases were followed until 30 June 2020. This sub-study examines the records of children who had referrals to other services that were supported by the SB-PHCS.
Results: In 2019, 270 public primary school children were referred to the SB-PHCS, representing 20% of local enrolments. Of these, 146 children received support from the SB-PHCS for a referral to another service (11% of enrolments). The services most referred to were speech pathology (23% of referrals to other services) and occupational therapy (20% of referrals to other services). Service use data were available for 160 referrals. Service use within the study period was highest for medical and mental health services (75-100% of referrals with available service use data) and lowest for allied health services (41-63% of referrals with available service use data). Forty-one percent of speech therapy referrals and 48% of occupational therapy referrals were still on a waiting list at end of follow-up.
Conclusion: Actively supporting less advantaged families to access services to address health and developmental issues has potential for long-term health, educational, and social benefits. However, for services like the SB-PHCS to facilitate access to other services, those services must be available, accessible, and adequately resourced. In rural communities and other underserved settings, alternative service models using school-based allied health services, telehealth, and/or paraprofessionals are needed to address these service gaps.
Keywords: Allied health, child health, healthcare access, nursing, primary health care, rural health, school health.