School-Based Health Centers and Chronic Absenteeism: Statewide Evidence From Oregon

• In Event: Analyzing the Relationship Between School-Based Health Centers and Schools

Abstract

Objectives/Purposes:
Since student absenteeism is often due to poor health, reform efforts that solely address school learning environments are poorly suited to solving this acute educational problem. In this project, we propose to evaluate a more promising strategy: School based health centers (SBHCs.) SBHCs aim to eliminate barriers to consistent quality healthcare by offering routine well-child exams, immunizations, vision and dental screenings, alcohol and drug counseling, mental health services, and reproductive health services on school grounds.

In this study, we examine the relationship between Oregon’s School-Based Health Centers (SBHC) and chronic absenteeism, prior to and following the outset of the COVID Pandemic. Specifically, we address the following research questions:
1. To what extent are SBHC openings associated with changes in ratees of chronic absenteeism?
2. To what extend foe SBHC presence moderate the relationship between schools’ poverty concentrations and chronic absenteeism?

Theoretical Framework:
The theory of change underlying this study is relatively simple. Low-income students suffer both higher rates of health problems and less access to care (e.g., Orfield, Basa, & Yun, 2001; Festinger & Duckman, 2004; Egbuonu & Starfield, 1982; Forrest, Starfield, Riley, & Kang, 1997). SBHCs work to reduce barriers to care, plausibly improving health at individual and community levels, or reduce the likelihood of unnecessary absences for doctor visits, especially for students with chronic illnesses who could receive care at school and return to class (e.g., Wade et al., 2008), subsequently reducing rates of chronic absenteeism.

Data Sources:
We use 7 years of school-level chronic absenteeism data (both overall and for students classified by ODE as Economically disadvantaged) along with basic demographic information, paired with data from OHA on SBHC opening dates. In the models presented here, the sample is restricted to centers opening within 5 years of the window of observed absenteeism.

Analytic Methods
We employ a Difference-in-Differences strategy comparing changes in rates of chronic absenteeism following center openings, with tests for prior trends and outcomes shifts relative to staggered SBHC openings’ event studies are shown below (Angrist & Pischke 2008). We also report estimates from preliminary moderation analysis assessing the extent to which SBHC presence weakens the relationship between school poverty rates (% economically disadvantaged) and chronic absenteeism.

Preliminary Results:
Preliminary estimate from two-way fixed effect models do not show a consistent relationship between SBHC access and subsequent school absenteeism rates. However, event studies point to significant declines in chronic absenteeism in the year following SBHC openings among economically disadvantaged students, as well as overall rates. We also find preliminary evidence that the presence of SBHCs moderates the relationship between school poverty and schools’ rates of chronic absenteeism, such that high poverty schools with SBHCs have lower rates of chronic absenteeism than would be expected in the absence of the SBHC.

Significance:
The findings from this study paired with ongoing qualitative work, point to both the potential for SBHCs to serve as valuable tools in promoting school attendance, and the need for further resources and strategy to derive larger equitable impacts on school going.

Authors

• Walker A. Swain, University of Georgia
  Presenting Author

• Caprial E. Farrington, University of Georgia
  Non-Presenting Author

• Thurston Domina, University of North Carolina - Chapel Hill
  Non-Presenting Author