Healthcare in Schools: A Policy Solution for Children of the Opioid Crisis

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

Abstract

Children have been heavily impacted by the opioid crisis. In the past two decades, the U.S. has experienced increasing numbers of babies born with neonatal abstinence syndrome, more children living with adults with opioid use disorder (OUD), and higher rates of children entering the foster care system due to parental substance use. Despite this increase in exposure to adults with OUD, we know little about the policy solutions that can mitigate the consequences of the crisis for these children.

In this paper, we present new empirical work examining one potential solution: bringing comprehensive healthcare to school settings. Comprehensive school-based healthcare includes primary care, prevention, and mental and behavioral health treatment. By providing these types of care in school settings for children with complex health needs, school-based healthcare can ameliorate some of the barriers to accessing healthcare such as transportation, time, costs, and discontinuity of care.

To study the effects of school-based healthcare on children affected by the opioid crisis, we rely on nationwide Medicaid claims data of children ages 5-18 from 2015-2020. Using a longitudinal sample of person-years from children with a parent who has been diagnosed with opioid use disorder (n=8,141,410), we find that about 13 percent received school-based healthcare, with some variation in receipt by age and race/ethnicity. Receipt of school-based healthcare was increasing between 2015-2019 but dropped slightly in 2020 likely due to the COVID-19 pandemic.

We first report the various health diagnoses of children experiencing parental OUD, split by school-based healthcare use. On average, children using school-based healthcare have more complicated health needs, as measured by a higher prevalence of mental health, behavioral health, depression, anxiety, ADHD/autism, and trauma diagnoses. Compared to children not using school-based healthcare, children using school-based healthcare also have substantially greater healthcare use in every dimension measured. This difference is particularly stark for rehabilitation, mental health, transportation, and hearing services. This increase in healthcare occurs mostly after their first use of school-based care and persists for at least four years following their first school-based health visit. The jump in healthcare use following the first use of school-based healthcare is greatest for rehabilitative and mental health services, though is sustained longer for mental health and nursing services. For example, in the year before school-based healthcare receipt, 26 percent of children were receiving mental health treatment. Following their first school-based healthcare visit, 49 percent of children were receiving mental health treatment, dropping to 33 percent four years later. We intend to use a combination of tables and figures to document this evidence.

Children experiencing parental OUD have complicated and unmet health needs. Bringing healthcare to schools is one potential solution to getting these children the mental and behavioral healthcare they need. Furthermore, school-based healthcare may serve as a “gateway” to the healthcare system more generally, as receipt of services continues for these children beyond their first school-based visit.

Authors

• Lindsey Rose Bullinger, Georgia Institute of Technology
  Presenting Author

• Jiajing Scarlette Shi, Georgia State University
  Non-Presenting Co-Author

• Angelica Meinhofer, Weill Cornell Medicine
  Non-Presenting Co-Author