Examining School-Based Health Centers (SBHCs) As Vehicles to Improve Health Outcomes Among Chronically Absent Students

• In Event: Unpacking The Role of Student Health Challenges in Chronic Absenteeism

Abstract

Background: Children with chronic absenteeism, defined as missing 10% or more of school days, are disproportionately low-income, non-English speaking, Black, Latinx, and living with disabilities. They experience more chronic illnesses like asthma and obesity; are more likely to have behavioral health problems like depression and substance use; and are less likely to graduate from high school, which is a key social determinant of lifelong morbidity and mortality. School-based health centers (SBHCs) may improve health outcomes for students with chronic absenteeism by reducing barriers to accessing care, addressing specific health conditions associated with chronic absenteeism, avoiding the need to miss school to access healthcare, and ultimately improving academic outcomes like attendance, grade point average, and graduation rates. However, few studies characterize the range of diagnoses and healthcare use among students with chronic absenteeism, or examine whether SBHCs can increase primary care use, reduce emergency and inpatient care, and improve academic outcomes.

Methods: In this retrospective observational study, we will merge and analyze administrative absenteeism, health diagnoses, healthcare utilization, and academic data from 2015-2025. We capitalize on unique partnerships in Los Angeles with two of the nation’s largest managed care (Kaiser Permanente Southern California, KPSC) and Medicaid insurance (LA Care) plans and the country’s 2nd-largest school district (Los Angeles Unified School District, LAUSD). We will merge electronic health and billing data from LA Care-affiliated community clinics, KPSC facilities, and 25 LAUSD-affiliated SBHCs with LAUSD student demographic and academic measures from 2015-2025.

In Aim 1, we will identify chronic absenteeism trajectories using Latent Class Growth Analysis and then assess prevalence and timing of diagnoses of four major absenteeism-related health conditions (asthma, anxiety, depression, and overweight or obesity) across absenteeism classes. In Aim 2, we will describe and compare healthcare utilization (SBHC use, primary care use, ED use, and hospitalizations) in different trajectory classes to identify potential health gaps for chronically absent students. In Aim 3, we will examine whether, among students with and without chronic absenteeism, SBHC use is associated with a) fewer emergency room and hospital encounters; b) increased primary care use; c) longer time intervals between absenteeism events and increased school days attended; and d) improved grade point averages (GPA) and graduation rates, compared to similar students (propensity weighted by demographic characteristics, baseline school attendance, healthcare utilization, and healthcare conditions) who do not use SBHCs.

Anticipated findings: Based on prior data, we anticipate that three major trajectories will emerge beyond our reference group of no chronic absenteeism: increasing, decreasing, and persistently high chronic absenteeism. We hypothesize that the persistently high chronic absenteeism group will exhibit higher rates of the chronic disease, lower rates of primary care utilization, and higher rates of ED visits and hospitalizations than the other groups. Further, we hypothesize that SBHC utilization will be associated with improved academic and healthcare utilization outcomes. This study will provide critical and timely information about the degree to which chronic absenteeism is likely related to unmet health needs and whether SBHCs might improve both academic and health outcomes for this important population.

Author

• Rebecca Dudovitz, University of California - Los Angeles
  Presenting Author