Impacts of California School Based Health Centers on Academic Achievement and Well-being

• In Event: The Role of School-based Health in Improving the Health and Wellbeing of Underserved and At-risk Children

Abstract

There is broad interest in improving education and health outcomes, especially among children who live in low-income households or in rural areas with less access to healthcare (NCES 2019; Reardon, 2018). Negative health and education outcomes may be intertwined, as worse health outcomes may impact school attendance and engagement, and in turn achievement and educational attainment. Understanding how to improve health and education outcomes is especially important as schools grapple with high absenteeism, declining achievement and youth mental health concerns (Dee, 2024; Fahle et al., 2024; CDC, 2024).  

School Based Health Centers (SBHCs) may improve health and education outcomes by making physical and mental health care more accessible and affordable to children. SBHCs are health clinics typically located on a school campus and operated by a local health organization. There are over 2,5000 nationwide and they are usually staffed with nurses and doctors who provide routine physical, mental, and reproductive health services. A small literature finds that school health services increase access to care, improve mental health, and reduce suicide attempts (Golberstein et al.,2024; Heinrich, Shero & Fry, 2025), however, there is minimal large scale or rigorous evidence on SBHC impacts on health and education.

We estimate the causal effects of gaining access to a SBHC using a differences-in-differences design which leverages the openings of over one hundred SBHCs in California from 2007-2023. We examine how student outcomes change when their school receives a SBHC, controlling for school and year fixed effects. We also examine robustness to recent DiD methods and how impacts vary across student and school characteristics.

We use data from the California School Based Health Alliance to identify where SBHCs are located, their dates of operation, and services provided. Then we link these data to student level information from the California Department of Education and the California Healthy Kids Survey. These data cover roughly four million students in California public schools from 2006-2023 and they include information on student attendance, standardized test scores, high school graduation, mental health, school connectedness, and substance abuse.

California’s SBHCs are geographically distributed and located in a mix of elementary, middle, and high schools. The majority of California’s SBHCs offer medical care, and the share offering mental health and dental care has increased over time. In addition, California SBHCs are most likely to be located in urban areas and schools that serve a higher share of students in poverty.

Using our differences-in-differences design, we find that opening a SBHC leads to fewer students self-reporting depression, reductions in anxiety/depression related absenteeism and higher rates of school connectedness. We are currently fitting models to assess SBHC impacts on attendance rates, test scores, and high school graduation, as well as models to assess differences across subgroups. These preliminary findings indicate that SBHCs can improve student well-being and we anticipate that the remaining results (to be ready this summer) will provide helpful insight into how SBHCs influence a broader range of outcomes and indicate the students and communities for whom SBHCs are most impactful.

Authors

• Christine Mulhern, RAND Corporation
  Non-Presenting Co-Author

• Catria Gadwah-Meaden, RAND School of Public Policy
  Presenting Author