Infrastructure and Attributes of School-based Health Associated with Improved Health and Education Outcomes among Children

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

Abstract

It is increasingly understood that ensuring high-quality and equitable learning opportunities in K-12 education requires investing in interventions and supports that strengthen the foundations of children’s health and mental health and reduce stress and adversity experienced by children. The expansion of school-based health centers (SBHCs) nationwide has been critical to expanding children’s access to health and mental health services and reducing costs associated with their access to care and preventive services, particularly for economically disadvantaged and historically underserved children. Research also shows that SBHCs improve children’s education outcomes, such as reduced absences and dropout rates and improved test scores, as well as some health outcomes. However, there is little information on what features of SBHCs contribute to these improvements. As states and school districts continue to develop health and mental health services and supports and strategies to sustain them, there is considerable need for more evidence on the types of school-based health infrastructure, staffing, and services that are most effective in meeting students’ needs and improving their health and education outcomes. 

In this research, we draw on health insurance claims data for children enrolled Tennessee’s Medicaid program linked with administrative education records for students attending Tennessee public schools between 2006 and 2022, as well as interview data collected from school districts across Tennessee to document their school-based health infrastructure, programs, staffing, partnerships, health services offered, funding, and more. Data from the interviews were quantified and linked to the health and education administrative data to facilitate analyses of the associations between various types of school-based staffing, programs and services, partner providers, and funding and children’s access to healthcare and their health, mental health and education outcomes. The data include carefully constructed measures of school-aged children’s health and mental healthcare utilization, health and mental health conditions/diagnoses, and absences, chronic absences, disciplinary incidents, and other education outcomes. These data allow for empirical comparisons of the contrast in staffing, programs and services, and other features between school districts with and without SBHCs, as well as quasi-experimental analysis of how outcomes differ among students in school districts with access to differing levels and types of health and mental health services and supports.

To date we have conducted analyses using a staggered adoption difference-in-differences approach that show reductions in student mental health conditions among those with access to SBHCs, which our qualitative findings suggest might be related to increased health staffing in schools, earlier detection of mental health needs, and greater use of prevention strategies. In this new work that uses the quantified data from our interviews, we will empirically document the types of school-based staffing, services, funding, and other attributes that are effective in supporting children’s access to healthcare and improving their health, mental health and education outcomes.

Authors

• Carolyn J. Heinrich, Vanderbilt University
  Presenting Author

• Kathryn Enriquez, Vanderbilt University
  Non-Presenting Co-Author

• Mason M Shero
  Non-Presenting Co-Author

• Carrie Fry, Vanderbilt University
  Non-Presenting Co-Author