Clinician and Care Manager Perspectives on Addressing Chronic School Absenteeism in Primary Care Settings

To characterize primary care clinician and care manager perceptions and practice regarding chronic absenteeism.

In this qualitative study, we developed a semistructured interview guide using the Consolidated Framework for Implementation Research. We conducted Zoom interviews (July to August 2023) with primary care clinicians and care managers affiliated with a child-focused alternative payment model serving Medicaid- and Children's Health Insurance Program-enrolled children in a 5-county region of central North Carolina. Interviews were recorded, transcribed, and analyzed iteratively using a rapid qualitative analytic approach.

We interviewed 12 participants including 6 clinicians and 6 care managers serving families across urban, rural, academic, and community settings. Key themes included a lack of systematic and universal approaches to discussing school attendance, limited infrastructure for school-health system collaboration resulting in caregiver burden, importance of family engagement, and leveraging unique spheres of influence for multidisciplinary collaboration.

Clinicians and care managers support addressing chronic absenteeism but perceive provider, patient, and system-level barriers to identifying and addressing underlying needs. Perceived facilitators include leveraging strong relationships with families and multidisciplinary collaboration. Health system efforts to operationalize chronic absenteeism as a health metric and to coordinate services across health, education, and social sectors may improve long-term health and academic outcomes.