School-Based Health Centers
Research Findings: Summary

(Updated Fall 2006)

Outcomes reported from SBHC studies published in peer reviewed journals

Who uses School-Based Health Centers (SBHCs)? School-based mental health services have the potential for bridging the gap between need and utilization by reaching disadvantaged children who would otherwise not have access to these services. Compared with a central community-based mental health clinic, the school-based population served was markedly socioeconomically disadvantaged, minority and as psychiatrically impaired as the central clinic population. Implications for services in schools are discussed. (Armbruster, Gerstein, Fallon, 1997).Students with less access to health care (uninsured) and those with greater health care needs (self-reported health conditions that limited daily activities) were more likely than other students to visit the SBHC (Kisker, Brown, 1996).

SBHC registered students were similar in gender, ethnicity and age to all students enrolled in the school (McCord, Klein, Joy, Fothergill, 1993).

Average users (3 visits per year) of the SBHC were representative of entire student population based on age, race, gender and grade point average. Frequent users (15 or more visits per year) were more likely to be female and have a lower grade point average (Wolk, Kaplan, 1993).

Anemia and emotional problems were reported more frequently by students from SBHC schools (Santelli, Kouzis, Newcomer, 1996).

What is the impact of SBHCs on students’ visits to any health care provider? Based on Medicaid expenditures, elementary students with access to a school-based health center had a greater utilization rate for EPSTD preventive services compared to a similar population having no access to a school-based health center. (Adams, Johnson, 2000)

Students who use SBHCs as their primary health care provider were more satisfied with their services compared to users of community and hospital clinics (Kaplan, Brindis, Phibbs, Melinkovich, Naylor, Ahlstrand, 1999).

Elementary students with access to a SBHC had a greater likelihood of having had a physician’s visit and a dental examination during the school year than students without access to a SBHC. (Kaplan, Brindis, Phibbs, Melinkovich, Naylor, Ahlstrand, 1999).

Uninsured students with access to a SBHC had an easier time obtaining physical health and dental services compared to uninsured students without access to a SBHC (Kaplan, Brindis, Phibbs, Melinkovich, Naylor, Ahlstrand, 1999).

Adolescents with access to a SBHC were 10 times more likely to make a mental health or substance abuse visit (Kaplan, Calonge, Guernsey, Hanraham, 1998).

A greater percentage, 80.2 percent, of adolescents with access to SBHCs had at least one comprehensive health supervision visit compared to, 68.8 percent of adolescents without access (Kaplan, Calonge, Guernsey, Hanraham, 1998).

SBHCs were successful in coordinating care for the adolescents they served with far higher rates of referral completion than previously reported. In addition, SBHCs seemed to improve access for the majority of the students studied, particularly those lacking insurance or source of health care (Hacker, Weintraub, Fried, Ashba, 1997).

There was a higher percentage of students at SBHC schools who visited any health care provider during their senior year compared to what would have been expected if they followed the trend of urban youths nationally (Kisker, Brown, 1996).

Adolescent users of SBHCs had higher use of any health care provider than adolescents in the general population (Anglin, Naylor, Kaplan, 1996).

Students in schools with school-based health centers were more likely to report seeing social workers and counselors (Santelli, Kouzis, Newcomer, 1996).

What is the impact of SBHCs on children’s health care expenditures? A study of total health service expenditures for Medicaid-enrolled children attending a school with a SBHC found that total Medicaid expenditures for these children were lower than for a comparable group of school children who did not have access to an SBHC (Adams, Johnson, 2000).
What is the impact of SBHCs on percentage of students who have a medical home? There was an increase in the percentage of students attending SBHC schools who had a medical home compared to what would have been expected if they followed the trend of urban youths nationally (Kisker, Brown, 1996).
What is the impact of SBHCs on use of hospital emergency rooms? A study conducted in Ohio found that the risk of hospitalization and emergency department visits for children with asthma decreased significantly with school-based health center program. The potential cost savings for hospitalization was estimated as $970 per child. (Guo, Jang, Keller, McCracken, Pan, Cluxton, 2005)

Medicaid-enrolled elementary students using a school-based health center had statistically significant lower emergency department expenditures compared to a similar population without access to a school-based health center. (Adams, Johnson, 2000)

There was a significant decrease in emergency department utilization for elementary children with access to a SBHC compared to those without access to a SBHC (Kaplan, Brindis, Phibbs, Melinkovich, Naylor, Ahlstrand, 1999).

Adolescents with access to a SBHC had fewer after hours emergent or urgent care visits compared to adolescents without access to a SBHC (Kaplan, Calonge, Guernsey, Hanraham, 1998).

There was no impact on students attending SBHC schools in their use of hospital emergency rooms compared to what would have been expected if they followed the trend of urban youths nationally (Kisker, Brown, 1996).

School-based health center showed a protective effect on emergency use but only among students with the longest tenure in the school (Santelli, Kouzis, Newcomer, 1996).

What is the impact of SBHCs on student health status? Students diagnosed with asthma enrolled in four school-based health centers in Ohio had a decreased risk of hospitalization and emergency department visits compared to students without access to school-based health centers. (Guo, Jang, Keller, McCracken, Pan, Cluxton, 2005)

A study conducted at an urban high school found the following: (1) average users, frequent users, and nonusers of a SBHC did not differ in the mental health problems measured in this study; (2) those who used the SBHC indicated strong satisfaction with the care received; and (3) those who did not use the SBHC chose to stay away for a variety of reasons, most commonly the availability of other care or the perception of lack of need. (Pastore, Juszczak, Fisher, Friedman, 1998).

There was no impact on self-reported physical health status among students attending SBHC schools compared to what would have been expected if they followed the trend of urban youths nationally (Kisker, Brown, 1996).

Based on self report inventories, students who received no mental health services during the academic year showed no change in mental health status, whereas treated students showed significant declines in depression and improvements in self-concept from pre to post intervention (Weist, Paskewitz, Warner, 1996).

Fewer students attending SBHC schools reported considering suicide compared to what would have been expected if they followed the trend of urban youths nationally (Kisker, Brown, 1996).

There was no impact on the likelihood that students attending SBHC schools had attempted suicide compared to what would have been expected if they followed the trend of urban youths nationally (Kisker, Brown, 1996).

Repeated chlamydia and gonorrhea screening and treatment in schools with school-based health centers are associated with declines in chlamydia prevalence among boys. Expansion of STD screening and treatment programs to school settings is likely to be a critical component of a national strategy to control bacterial STDs. With repeated testing, chlamydia prevalence among boys dropped to half the rate of comparison schools (3.2% vs 6.4%). Among girls chlamydia prevalence declined only slightly (10.3% vs. 11.9% in comparison schools). (Cohen, Nsuami, Martin, Farley, 1999)

What is the impact of SBHCs on sexual activity? There was a smaller percentage of students of SBHC schools who by the end of their senior year had ever had sexual intercourse compared to what would have been expected if they followed the trend of urban youths nationally (Kisker, Brown, 1996).Among SBHCs studied, a SBHC that focused specifically on family planning, there was a delay in students’ initiation of sexual activity compared to what would have been expected if they followed the trend of urban youths nationally (Kisker, Brown, 1996).

Seniors in SBHC schools were no less likely to have had recent sexual intercourse than what would have been expected if they followed the trend of urban youths nationally (Kisker, Brown, 1996).

What was the impact of SBHCs on reported use of any effective contraceptive method? There was a decrease in percent of students in SBHC schools using contraception at last intercourse compared to what would have been expected if they followed the trend of urban youths nationally (Kisker, Brown, 1996).
What is the impact of SBHCs on pregnancy and birth rates? The results of a study showed a rapid and significant decline in Black adolescents’ fertility in schools with school-based health centers. This strongly suggests that attending to the health needs of students at risk of pregnancy in SBHCs resulted in lowered risk of fertility. (Ricketts, Guernsey, 2006)

There was no significant impact on the pregnancy or birth rates of students attending SBHC schools compared to what would have been expected if they followed the trend of urban youths nationally (Kisker, Brown, 1996).There was no significant impact on the rate of pregnancy among students being served by six SBHCs (a reinterpretation of St. Paul data) (Kirby, Waszak, Ziegler, 1991).

What is the impact of SBHCs on smoking, alcohol, or marijuana use? There was no impact on smoking, alcohol, or marijuana use by SBHC school students compared to what would have been expected if they followed the trend of urban youths nationally (Kisker, Brown, 1996).
What is the impact of SBHCs on school absences? There was no impact on absences due to illness on students attending SBHC schools compared to what would have been expected if they followed the trend of urban youths nationally (Kisker, Brown, 1996).Clinic users were absent a lower percentage of the time compared to students who were registered but did not use the clinic as well as students who were not registered for the clinic (McCord, et al., 1993).
What is the impact of SBHCs on progression through and graduation from high school? There was a slightly greater percentage of students attending SBHC schools who progressed through school at the expected pace compared to what would have been expected if they followed the trend of urban youths nationally (Kisker, Brown, 1996).Students who were registered to use the clinic were more likely to graduate or be promoted than students who were not registered for the clinic (McCord, et al., 1993).

African-American male students were more than three times as likely to stay in school if they had registered for the clinic (McCord, et al., 1993).

What is the impact of SBHCs on health knowledge? With more hours of health education per student came significantly higher SBHC utilization for non physical examination/illness-injury treatment visits (Kisker, Brown, 1996).Students attending SBHC schools gained more knowledge about health issues during the high school years than would have been expected if they followed the trend of urban youths nationally (Kisker, Brown, 1996)

Study Outcomes Measured Methodology
Adams KE, Johnson V, 2000 To determine the effects of a school-based health center on a state’s Medicaid program by examining, total Medicaid expenditures for children who had access to a school-based health center compared to those who did not.

Additional questions posed by this study include:

Have the types of services used (e.g., prevention care, ER, etc.) for those whose primary care provider is the WESBHC changed over time?

How does this change compare to the change in utilization over time for a similar group of children whose primary care provider is not a SBHC

Are Medicaid health care expenses lower for those whose primary source of care WESBHC before and after the start of the clinic and/or compared with those whose primary care is not a school-based clinic?

Analyzed claims data from 1994-1996 for Medicaid enrolled children 4 through 12 years old served by the Whitefoord Elementary School Health Center (WESBHC) and similar children in a comparison school district without a center.
Anglin TM, Naylor KE, Kaplan DW, 1996 Compared utilization of medical, mental health and substance abuse services among students who use school-based health centers with students who used traditional sources of care. Diagnoses data from 27,886 visits to three school-based health centers; National Ambulatory Medical Care Survey data were used as comparison
Armbruster P, Gerstein S, Fallon T, 1997 Compared the clinical and sociodemographic characteristics of users of mental health services in SBHCs versus an university affiliated outpatient clinic. Data gathered through self-report questionnaire and clinical assessment. Mental health services were provided to 44 students in thirteen urban schools and to 304 students in an university affiliated outpatient clinic.
Cohen, DA, Nsuami M, Martin DH, Farley TA, 1999 To determine whether repeated school-based screening and treatment for chlamydia and gonorrhea will decrease the prevalence of infection among students Three high schools with school-based health centers serving over 2000 students were provided the opportunity to be tested during three consecutive school years; five comparable schools with 5063 students enrolled served as wait-listed controls
Guo JJ, Jang R, Keller K`ken AL, Pan W, Cluxton RJ, 2005 Assessed impact of school-based health centers on hospitaliztion and emergency department visits for children with asthma. Three primary data sources were used for this study: (1) Annual school enrollment databases provided by SBHC and non-SBHC schools from 2000 to 2003. (2) The Ohio Medicaid medical claims databases capturing pharmacy, medical, hospital inpatient, and outpatient istitutional claims. (3) Summary data from the SBHCs encounter databases.
Hacker KA, Weintraub TA, Fried LE, Ashba J, 1997 Compared referrals from school-based health centers to a sponsoring hospital to determine factors influencing successful referral completion and to assess SBHCs’ ability to coordinate care. A total of 138 referrals gathered from eight school-based health centers were compared to the sponsoring hospital via medical records, clinic logs, and hospital registration system.
Kaplan DW, Brindis CD, Phibbs SL, Melinkovich P, Naylor K, Ahlstrand K, 1999 Measured the use of health services, access to physical and mental health services and health services satisfaction by children aged 4 to 13 years. A retrospective cohort analysis of parent surveys from a comparable intervention (SBHC) and a comparison of urban elementary schools.
Kaplan DW, Calonge NB, Guernsey BP, Hanrahan MB, 1998 Compared the utilization of primary and subspecialty medical, mental health, and substance abuse treatment services, emergent care and screening for high risk behaviors among students in managed care and have access to a SBHC compared to students in managed care without access to a SBHC Retrospective cohort study. Sample size of 342 adolescents- 240 with access to a SBHC and 116 adolescents without access-with a total of 3394 visits over a three year time span
Kisker EE, Brown RS, 1996 Compared health care utilization, health knowledge, high-risk behaviors, health status, pregnancy rates, school attendance, and educational outcomes among students from 19 schools participating in RWJ national program with a national representative sample of urban youth Self-report: self-administered questionnaire to all students enrolled in participating school’s entry level (9/10 grade) and cohort sample; re-interviews in spring of graduation year
McCord MT, Klein JD, Joy JM, Fothergill K, 1993 Compared school performance (absence, suspension, withdrawal, graduation) of students who used the center with those did not use the center Registration and utilization data came from clinic information system; school and demographic data came from school attendance records
Pastore DR, Juszczak L, Fisher MM, Friedman SB, 1998 Measured the mental health problems of students with access to a school-based health center, how satisfied users are with services at the SBHC, and reasons why students do not use the school-based health center Anonymous survey administered in physical education classes to 639 students in a New York urban high school
Ricketts S, Guernsey B, 2006 Compared Black adolescent fertility rates in high schools with school-based health centers to those rates to high schools without school-based health centers Fertility rates were estimated for high-school areas with and without school-based health centers with geocoded birth certicifates and school enrollment data
Santelli J, Kouzis A, Newcomer S, 1996 Compared primary care, emergency room, and hospitalization among students in schools that house a school-based health center with students from schools that do not Self-report: anonymous questionnaire among representative sample classrooms in 9 middle and high schools with centers and 4 schools without
Weist MD, Paskewitz DA, Warner BS, 1996 Compared psychological adjustment of students using mental health services with students using only health services Abbreviated measures of anger, anxiety and depression scales were administered pre- and post-treatment with both treatment and control groups
Wolk LI, Kaplan DW, 1993 Compared demographic, behavioral and social risk data of frequent users of school-based health center services with students who have an average utilization Demographic and utilization data from clinic encounter information system; students’ GPA and “free lunch” status obtained from school

 


 

BIBLIOGRAPHY

Adams, K.E., Johnson, V. (2000). An Elementary School-Based Health Center: Can It Reduce Medicaid Costs? Pediatrics. 105 (3), 780-788.

Anglin, T.M., Naylor, K.E., Kaplan, D.W. (1996). Comprehensive school-based health care: high school students’ use of medical, mental health, and substance abuse services. Pediatrics. 97(3), 318-329.

Armbruster P, Gerstein SH, Fallan, T (1997). Bridging the Gap Between Service Need and Service Utilization: A School-Based Mental Health Program. Community Ment Health J. 33(3), 199-211.

Cohen, DA, Nsuami M, Martin DH, Farley TA. (1999). Repeated School- based Screening for Sexually Transmitted Diseases: A Feasible Strategy for Reaching Adolescents. Pediatrics 104 (6):1281-1285.

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Hacker, K.A., Weintraub, T.A., Fried, L.E., Ashba, J. (1997). Role of School-based Health Centers in Referral Completion. J of Adol Health. 21, 328-334.

Kaplan, D.W. , Brindis, C.D., Phibbs, S.L., Melinkovich, P., Naylor, K., Ahlstrand, K. (1999). A Comparison Study of an Elementary School-Based Health Center: Effects on Health Care Access and Use. Arch Pediatr Adolesc Med. 153, 235-243.

Kaplan, D.W., Calonge, B.N., Guernsey, B.P., Hanrahan, M.B. (1998). Managed Care and School-Based Health Centers: Use of Health Services. Arch Pediatr Adolesc Med. 152, 25-33.

Kirby, D., Waszak, C., Ziegler, J. (1991). Six school-based clinics: their reproductive health services and impact on sexual behavior. Fam Plann Perspect. 23:6-16.

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