School Determinants and Racial Disparities in Access to School-Based Mental Health Resources

• In Event: Investigation of Policies for Increasing Children’s Receipt of Medicaid-funded School-based Health Services

Abstract

Over the last decade, school-based mental health (SBMH) resources in New York City (NYC) public schools, including Article 31 and 28 clinics, staff training, and counselors, have expanded to address students' growing mental health needs. This study examines the distribution and impact of these resources amid an emerging youth mental health crisis, exacerbated by the COVID-19 pandemic, during which mental health-related emergency department (ED) visits surged. Using administrative data from NYC public schools and Medicaid claims, we analyze two critical questions: (1) Which students are most likely to access SBMH resources? and (2) Is access to these resources associated with reduced mental health-related ED visits during the pandemic?

To address the first question, we use a regression model to estimate the probability that a school offers SBMH services, incorporating predictors such as the demographic composition of students, school characteristics (e.g., grade span, co-location), and infrastructure indicators. For the second question, we examine the relationship between SBMH service access and ED visits, hypothesizing that greater pre-pandemic resource access correlates with lower ED visits and that disparities in access exacerbate mental health outcome disparities. Our population of interest includes 6th–12th grade students enrolled in NYC public schools (excluding special education and specialized schools) from 2019 to 2022. By integrating data on SBMH service availability, student demographics, and health outcomes, this study aims to illuminate disparities in SBMH access and inform equitable mental health policy interventions for youth.

Our results show that schools serving Hispanic/Latino students have a 1.4 percentage point higher probability of offering SBMH services for every 10 percent increase in that student population, compared to schools serving a larger proportion of Black students, with even larger differences observed in comparison to schools serving White and Asian students. Additionally, we observe that high schools have a higher probability of receiving SBMH services. However, recent findings in the literature indicate the need to expand these services to schools serving sixth to eighth-grade students to prevent severe outcomes later.

Author

• Juan Agustin Echenique, New York University
  Presenting Author