Association of School-Based Health Center Availability With Child Mental Health Outcomes.

To explore adolescent students' use of school based health and medical care and mental health and substance abuse counseling services and to compare adolescents' patterns of use of medical, mental health, and substance abuse services located in school-based and traditional settings. Retrospective analysis of computer-stored, standardized data for all student visits during a 4-year period. Three high school-based student health centers. A total of 3818 adolescent students who used services provided by the school-based health centers (SBHCs). Frequencies of student visits to medical providers and mental health and substance abuse counselors and frequencies of diagnostic assignments. During a 38-month period, 3818 students attending senior high school made a total of 27 886 visits to three SBHCs. They represented 63% of students enrolled in the SBHCs and approximately 42% of the total school population. There were no significant demographic differences between students attending the SBHCs and the overall student body. However, compared with students who were enrolled in the SBHCs but did not use them, users were more likely to be female and Hispanic. Ninety-four percent of students using the services had visits with medical providers; 25% had visits with mental health counselors; and 8% of students had visits with substance abuse counselors. The total annual mean number of student visits was 4.7, and the annual mean numbers of visits for students who used the following services were: medical, 3.3; mental health, 5.8; and substance abuse, 6.8. An average of 1.4 diagnoses were made per visit. The most common major diagnostic categories were emotional problems (29% of all diagnoses), health supervision (13%), respiratory problems (11%), reproductive health problems (11%), and substance abuse problems (8%). Almost one fourth of the students had contact with more than one of the three categories of service provicer. Visit frequency increased significantly for students who used two categories of provider (13 to 15 mean total visits compared with 4 to 5 mean total visits for students who used just one category of provider) and escalated to a mean of 32 total visits if all three categories of service were used. Adolescents attending SBHCs had higher rates of visits for health and medical care than adolescents using traditional sources of medical care. The proportions of student users of SBHC mental health and substance abuse counseling services were commensurate with the estimated prevalences of these problems in this country's adolescent population. In addition, the mean numbers of visits to mental health counselors in SBHCs compared favorably with adolescent visit rates for mental health services in other settings. Too little information is available about adolescent use of substance abuse services in non-school-based settings to make similar comparisons. In summary, adolescent users of SBHCs seemed to have a higher use of medical, mental health, and probably substance abuse counseling services than did adolescents in the general populations. These findings are consistent with the interpretation that SBHCs do enhance adolescents' access to care for medical, mental health, and substance abuse problems.

The number of school-based health centers (SBHCs) has grown from 40 in 1985 to >900 in 1996. During the 1996-1997 school year there were 914 SBHCs, 32% of which were located in elementary schools. Despite the relatively large number of elementary SBHCs in existence, SBHCs serving elementary-aged students are not adequately represented in the literature. To analyze physical and mental primary health care utilization in a comprehensive elementary SBHC for an underserved Hispanic population. Retrospective analyses of services used at an elementary SBHC during the 1995-1996 school year. We describe physical and mental health services utilization provided by SBHC staff who offered a range of primary medical and mental health services. The study population was predominately Hispanic, and comprised of 811 elementary school students (grades preschool through fifth) registered for SBHC use. Analyses were conducted on 591 students who used the SBHC. The 591 SBHC users made 2443 visits, ranging between 1 and 54 visits/individual; mean 4 visits/student. Two thirds of visits (1638) were medical provider visits, and 33% (798) were mental health provider visits. Most students (75%) saw a medical provider exclusively, 9% saw a mental health provider exclusively, and 16% of students were seen by both. Mean duration of medical provider visits +/-SD was 15 +/- 13 minutes, mean for mental health provider visits +/-SD, 37 +/- 16 minutes. Of the 3035 diagnoses, 64% were medical and 36% were mental health diagnoses. These diagnostic frequencies are grouped as follows: acute medical (31%), health maintenance (22%), depression (10%), non-Diagnostic and Statistical Manual of Mental Disorders-IV mental health diagnoses (8%), conflict disorder/emotional disturbance (8%), chronic medical (8%), academic/learning disorder (7%), anxiety disorder (3%), and other (4%). High rates of SBHC utilization by this population and the range of diagnoses recorded suggest health care delivered in a comprehensive, culturally-sensitive SBHC has the potential for impacting the health and well-being of underserved elementary-aged students.

School-based health centers (SBHCs) provide students with convenient access to physical, mental, and dental health services, which is particularly important in rural areas with long travel distances and limited availability of primary care. To examine the association between SBHCs and school attendance in a rural region. This cross-sectional study compared attendance rates among students in school districts with and without SBHCs in rural upstate New York. Student attendance data from the 2015 to 2016 through the 2018 to 2019 school years were obtained for 52 schools in 32 districts within a regional education service area. Analysis included students in kindergarten through 12th grade from 18 schools in 14 districts with SBHCs and 34 schools in 18 districts without SBHCs. Multivariable logistic regression was used to model the association between SBHC access and risk of chronic absenteeism. Statistical analysis was performed from May 2024 to February 2025. Access vs no access to an SBHC based on which district a student was enrolled in. In districts with SBHCs, all schools had SBHCs. Absenteeism was calculated as the number of days absent divided by the total days enrolled and classified by federal and state chronic absenteeism categories: not at risk (0%-4.99% absent), at risk of chronic absenteeism (5%-9.99% absent), and chronically absent (≥10% absent). Attendance data were available for 66 303 students (kindergarten through 12th grade; 49.4% female) during 4 years: 30 046 from SBHC districts and 36 257 from non-SBHC districts. Across all but 1 school year, non-SBHC students were significantly more likely than SBHC students to be classified as chronically absent or at risk for chronic absenteeism. Students in SBHC districts had 12% greater odds of being not at risk for chronic absenteeism after accounting for grade, sex, school year, economic disadvantage, and community characteristics of wealth and district size (odds ratio, 1.12; 95% CI, 1.08-1.16). Evidence of a stronger association was found between SBHC access and reduced absenteeism among elementary school students and among children attending schools with higher student poverty and higher community wealth. This cross-sectional study of rural students in kindergarten through 12th grade found that students in SBHC districts had significantly fewer absences than students in non-SBHC districts in the same region. These findings suggest that by providing primary care services at school, SBHCs may help decrease absenteeism among students in rural communities.

School-based health centers (SBHCs) provide accessible healthcare for children, but not all have dedicated mental health providers. The COVID-19 pandemic and school shutdowns were associated with worsened student mental health, but the impact on the utilization of SBHCs without mental health providers remains unclear. This study examines utilization before and after school shutdowns at one such SBHC. Data are from a SBHC at a school serving 1600 K-8 students and includes electronic health records (EHR) and staff interviews. Visits between 2016 and 2023 (n = 6223) were characterized by whether the student had a mental and/or behavioral health diagnosis (MBHD) and whether the visit addressed a mental health concern. Negative binomial regression was used to compare visit rates, controlling for age, gender, and MBHD. Staff interviews (n = 9) were analyzed for emergent themes. The proportion of visits by students with a MBHD rose from 11.2% to 17.6% (p < 0.01) post-shutdowns. These students visited the SBHC more frequently than peers before (IRR 1.5 [1.25-1.94]) and after shutdowns (IRR 1.39 [1.14-1.69]). Qualitative findings underscored increased needs post-shutdowns. Additional support for SBHCs includes expanded partnerships with teachers and mental health providers. Students with MBHDs increasingly relied on their SBHC, emphasizing the link between physical and mental healthcare.

There are increasing numbers of children and adolescents who are affected by chronic health or emotional problems. Many children and adolescents do not receive adequate services in the community, and, untreated, these problems often become a barrier for success in school (Adelman & Taylor, 1998). Meeting the physical and mental health needs of these children and their families presents a formidable professional challenge that requires the coordinated efforts of many disciplines, including health education, nursing, nutrition, school counseling, and school psychology (Zins & Wagner, 1997). School-based health centers (SBHCs) are one example of interdisciplinary efforts to provide comprehensive physical and mental health care for children and adolescents. Most SBHCs have adopted a primary care orientation and offer physicals, acute care treatment for illnesses and minor injuries, and often provide ongoing care for chronic illnesses. Some provide dental care, and many provide preventive and health promotion programs. Originally established in urban areas, they are quickly developing in rural and suburban areas as well because they provide enhanced access to a variety of services in one convenient location. There is a growing body of evidence that SBHCs have positive effects for students. Children using SBHCs have a net gain in their number of health care visits and are much more likely to access mental health services when an SBHC is available in their school. This is especially true for children who are typically underserved: children in rural areas, minority youth, and homeless children. SBHC services also have been shown to result in a decrease in emergency room visits and referrals for specialty treatment. Students receiving school-based mental health care have an increase in academic achievement, reduced disciplinary problems, and fewer absences from school. Consumer satisfaction studies have found that students are very satisfied with SBHC services, are comfortable being seen in a center, and find the range of services acceptable. SBHCs are being established at an increasing rate, and they are becoming a part of mainstream health care in the United States (Koppelman & Lear, 2000). Although in operation for 25 years, SBHCs have received little attention in the counseling literature. Many school practitioners are not familiar with these centers and issues related to providing full-service health care through the schools. This article reviews one of the few special journal issues on SBHCs that have focused on school mental health providers. * Article Reviews The May 2003 issue of Psychology in the Schools presented a series of articles on the issues involved in the implementation of SBHCs. Although many of the articles were written from the perspective of school psychologists, the information in the issue is applicable to other school and community mental health practitioners. Several articles from this issue are reviewed, followed by a discussion of the implications for counseling practice and counselor education. Development of SBHCs Meyers and Swerdlik (2003) described the barriers and opportunities affecting the development of SBHCs in their article School-Based Health Centers: Opportunities and Challenges for School Psychologists. They discussed the influence of various factors on the establishment of SBHCs, such as system reforms, school system governance, the importance of SBHC to stakeholders, and availability of funding. They reviewed some of the factors that may impede the development of SBHCs, including definitional confusion, community stigma, limited resources, lack of integration and coordination of services, and an emphasis on a narrow role of medical services. There are a number of strategies that were suggested by Meyers and Swerdlik (2003) to overcome the formidable challenges in the development of SBHCs. Many solutions can be implemented during program establishment by approaching development as system-level reform and by becoming a player at the table, educating stakeholders, and conducting effective needs assessments. …

The Evidence for SBIRT in Adolescents

To assess the effects of an elementary school-based health center (SBHC) on access to and the use of physical and mental health services 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. Elementary SBHC services, including preventive physical health care; the care of minor short-term illnesses, injuries, and stable ongoing medical conditions, dental screenings; and mental health counseling. All parents of students at both schools were asked to complete a survey. Return rates on the survey were 78.3% (570/728) and 77.0% (440/571) at the intervention and comparison schools, respectively. The use of health services, access to health services, and health service satisfaction. Compared with respondents at comparison schools, respondents whose children had access to an SBHC had less difficulty (P = .01) receiving physical health care for their children, ie, treatment of illnesses and injuries, immunizations, and physical examinations (odds ratio, 0.66; 95% confidence interval, 0.48-0.91). Access to an SBHC was independently and significantly related to less emergency department use (odds ratio, 0.63; 95% confidence interval, 0.40-0.99; P<.05), a greater likelihood of having had a physician's visit since the school year began (odds ratio, 1.92; 95% confidence interval, 1.39-2.65; P<.01), and a greater likelihood of having had an annual dental examination (odds ratio, 1.36; 95% confidence interval, 1.01-1.83; P<.05). Measured by a 12-item scale, respondents who reported the SBHC as their most-used health service were significantly more satisfied with their service than respondents who mostly used community clinics (z=-5.21; P<.01) or hospital clinics (z=-4.03; P<.01). Independent of insurance status and other confounding variables, underserved minority children with SBHC access have better health care access and use than children without SBHC access, signifying that SBHCs can be an effective component of health delivery systems for these children.

Schools and school-based health centers (SBHCs) play an important role in reducing disparities in access to mental health treatment. However, there is a need to increase student engagement in school mental health services. This study sought to understand the perceptions of low-income minority youth on help-seeking and barriers to mental health services at SBHC sites. A network of SBHCs, called Wellness Centers, developed as part of a strategic plan to serve students and community members in under-resourced areas of a large urban school district. We conducted focus groups with 76 middle and high school students at nine SBHC sites through a community-academic partnered approach from January to May 2014. The focus groups were audio-recorded, transcribed, and major themes coded with Atlas.ti.5.1. Students identified teachers as a primary source of support for mental health issues, followed by peers and mental health counselors. Students felt that trust and connection were vital for help-seeking. Barriers to using SBHCs included: embarrassment; fear of judgment; concerns about confidentiality; a sense that they should keep things inside; and lack of awareness. Despite the resources available at SBHCs, students face barriers to help-seeking. SBHCs can help teachers and school staff gain awareness of mental health issues and services available to students. The students' recommendations-making SBHCs more comfortable, raising mental health awareness, and bolstering connections with school and SBHC staff-may improve engagement in mental health services at schools with SBHCs.

School-Based Health Center Utilization: A Survey of Users and Nonusers

Mitigating the Impact of Coronavirus Disease-2019 on Child and Family Behavioral Health: Suggested Policy Approaches

Study of the Status of Mental Health in Mothers with Parenting Style in the Children with Attention Deficit and Hyperactivity Disorder (ADHD)

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth.

As school-based health centers (SBHCs) continue to grow, it remains important to study use of the centers. The extent to which mental health problems exist in the students with access to the centers, whether those students are using the available services, if they are satisfied with the services, and the reasons for nonuse by those students who do not enroll are all meaningful questions. The above issues were studied in an urban high school with a 2-year-old SBHC by administering questions during physical education classes on health center use and mental health concerns. The 630 respondents were 45% male, 55% female, 61% black, 29% Hispanic, 54% in grades 9 or 10, 46% in grades 11 or 12. Sixty percent of the students were registered in the SBHC; 40% were not registered. Seventy-five percent of registered students reported average use (< or =3 visits); females were more likely than males (P=.017) to be frequent (>3 visits) users of SBHC services. Mental health problems among all participants included depression in 31%, use of alcohol 1 time or more per month in 21%, use of alcohol daily in 5%, suicidal ideation in 16%, history of a suicide attempt in 10%, knowing someone who had been murdered in 50%, and being in at least 1 fight at school in 26%. Frequent users, average users, and nonusers did not differ by age, grade, race, or any of the measured mental health problems. Among the 472 students who completed the survey section on SBHC perceptions, 305 described health center use: 92% were satisfied with health center services, 79% were comfortable being seen in the SBHC, 74% believed visits were kept confidential, 61% told their parents about each visit, and 51% considered the SBHC their regular health care source. The health center was used for mental health services by 34% and sexuality-related care by 15%. The 167 students who described reasons for not using the SBHC most frequently reported that they already had a physician (60%), did not need it (50%), prefer continuing previous health care (45%), did not get around to it (30%), parents were opposed (20%), were not comfortable (19%), did not know about the service (19%), and did not want problems known (19%). We conclude that, in this urban high school, (1) average users, frequent users, and nonusers 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.

Adolescents’ use of school-based health centers and receipt of mental health supports

Current challenges in school-based health center care: COVID, mental health care, immigrant youth, expansion of telemedicine