Investigators from Seattle, WA examined whether school-based health center (SBHC) use by high school students was associated with academic achievement. They hypothesized that using a SBHC for medical visits would be associated with improved school attendance and that using a SBHC for mental health visits would be associated with improvements in discipline referrals, grade average, and attendance.
SBHC users and nonusers were identified using a SBHC database for all enrolled youth in the Seattle school district from 2005 to 2008. The study population was a cohort who began ninth grade in Fall 2005 in one of 13 high schools with a SBHC onsite or nearby. Study students were classified as SBHC users or nonusers based on whether they had at least one SBHC visit during the Fall 2005 semester. Data on grade averages, school attendance, and discipline referrals were collected on these students during the subsequent five semesters. Students who accessed SBHC services after the Fall 2005 semester (n=993) were excluded.
The study population consisted of 444 SBHC users and 1,861 nonusers. SBHC users were significantly different from nonusers in that they had more single-parent or other guardianship, were more likely to be in special education, and were more likely to be eligible for the free lunch program (P<.001 for each). Discipline incidents were infrequent overall, and were not associated with SBHC use. Both medical and mental health users of SBHCs had lower grade point averages (GPA) than nonusers in Fall 2005 (P<.05 and P<.0001, respectively). Over the study period, GPA increased for all groups; however, GPA increased more rapidly for mental health SBHC users than for nonusers (P<.05). Both medical and mental health users of SBHCs had lower attendance rates than nonusers in the beginning of the study period (P<.05 and P<.001, respectively). Initially, the medical user group experienced a decline in attendance rate compared with the nonuser group (P<.05); however, subsequently there was an increase in attendance rate compared with the nonuser group (P<.05). The change in attendance rate for the mental health user group did not significantly differ from the change experienced by the nonuser group.
The authors conclude that SBHC use was associated with improvements in academic performance over time for a specific cohort of users.
SBHCs operate in almost 2,000 schools in the US1 and have been shown to increase access to health and mental health services, especially for high-risk groups, such as those living in low income areas and ethnic minority youth.2,3 SBHC use has been found to lower Medicaid-funded emergency room expenses4 and to improve student-reported health-related quality of life, especially among children of lower socioeconomic status.5
Research showing that academic outcomes...