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

Session Submission Type: Panel

Abstract

For decades, schools have been expanding their role in making physical and mental health care more accessible and affordable to children. The School-Based Health Centers (SBHCs) Reauthorization Act of 2020 described school-based health as a “powerful tool for achieving health equity among children and adolescents who experience disparities in health outcomes because of ethnicity, race, and/or family income.” As school-based health has become increasingly integrated into the educational system, aligning with broader goals of improving student attendance and overall student well-being, it is critical to understand its effectiveness in improving children’s health and education outcomes. The 2020 SBHCs Reauthorization Act only appropriated funding through fiscal year 2025, suggesting the importance of generating evidence to inform policies for sustaining and improving school-based health infrastructure and services across the U.S.

This panel includes four papers that use longitudinal data and rigorous empirical methods to examine how the opening of school-based health centers in a diversity of settings affects school-aged children’s healthcare utilization, health and mental health, and education outcomes. The studies include student populations or subgroups at greater risk of poorer outcomes, such as low-income students, those in underserved rural areas, and children affected by the opioid crisis.

The paper School-Based Health and Access to Care: Evidence from a School-Based Health Center Opening estimates the effects of opening an SBHC in a rural New York school district. The authors observe children’s health care visits across service types and over time and to compare health care utilization among children with and without access to the SBHC before and after its opening. Results show significant positive effects of the SBHC on health care access. A second paper, Impacts of California School Based Health Centers on Academic Achievement and Well-being, leverages the openings of over one hundred SBHCs in California from 2007-2023 to estimate the causal effects of gaining access to a SBHC on student outcomes. The findings to date indicate that opening an SBHC reduces self-reported depression and absenteeism associated with anxiety/depression and increases school connectedness. A third paper, Infrastructure and Attributes of School-based Health Associated with Healthcare Utilization and Improved Health and Education Outcomes among Children, draws on linked health and education data on Tennessee children (2006-2022) and detailed data on the health/mental health services infrastructure in schools with and without SBHCs to understand what types of school-based staffing, services, sponsors, and funding are most effective in supporting children’s access to healthcare and improving their health, mental health and education outcomes. The fourth paper, Healthcare in Schools: A Policy Solution for Children of the Opioid Crisis, uses national data to examine how comprehensive healthcare in school settings supports children with complex health needs. Using nationwide Medicaid claims data on school-aged children from 2015-2020, the authors examine who receives school-based healthcare and the health diagnoses of children experiencing parental opioid use disorder, comparing those with and without school-based healthcare use. Preliminary findings indicate that children using school-based healthcare also have substantially greater healthcare use in every dimension measured.

Policy Area

• Education

Secondary Policy Area

• Health Policy

Chair

• Liliane Nienstedt, Vanderbilt University

Discussant

• Robin T Jacob, University of Michigan Ann Arbor

Organizer

• Carolyn J. Heinrich, Vanderbilt University

Individual Presentations

• School-Based Health and Access to Care: Evidence from a School-Based Health Center Opening - Presenting Author: Zhuang Han, Cornell University; Non-Presenting Co-Author: Xue Zhang, Pennsylvania State University; Non-Presenting Co-Author: Sharon Tennyson, Cornell University

• Impacts of California School Based Health Centers on Academic Achievement and Well-being - Non-Presenting Co-Author: Christine Mulhern, RAND Corporation; Presenting Author: Catria Gadwah-Meaden, RAND School of Public Policy

• Infrastructure and Attributes of School-based Health Associated with Improved Health and Education Outcomes among Children - Presenting Author: Carolyn J. Heinrich, Vanderbilt University; Non-Presenting Co-Author: Kathryn Enriquez, Vanderbilt University; Non-Presenting Co-Author: Mason M Shero; Non-Presenting Co-Author: Carrie Fry, Vanderbilt University

• Healthcare in Schools: A Policy Solution for Children of the Opioid Crisis - Presenting Author: Lindsey Rose Bullinger, Georgia Institute of Technology; Non-Presenting Co-Author: Jiajing Scarlette Shi, Georgia State University; Non-Presenting Co-Author: Angelica Meinhofer, Weill Cornell Medicine