Community health contexts and school suspensions of students with disabilities

Abstract

PurposeStudents with disabilities with unmet health care needs are vulnerable to adverse educational outcomes, including exclusionary discipline. We examined the association between schools' spatial proximity to health care providers and their use of suspension to discipline students with disabilities. MethodsThe study sample included the 398 public secondary schools in the Boston Metropolitan Statistical Area. We merged census-tract and school-level data from several sources, including the American Community Survey, the Health Resources and Services Administration, the Massachusetts Department of Public Health, and the U.S. Department of Education. Zero-inflated beta regression models were used to examine the association between schools' locations in medically underserved areas (MUAs) and the out-of-school suspension rates of students qualifying for special education services in the 2013–14 school year. Nested models and mediation analysis were used to parse the effects of medical underservice and neighborhood poverty on suspension rates. ResultsThe suspension rate of students with disabilities was about 5 percentage points higher in schools located in medically underserved areas compared to schools that are not in MUAs, controlling for school- and neighborhood-level characteristics (z = 1.97, p < .05). Medical underservice significantly mediated the effect of neighborhood poverty on suspensions of students with disabilities (indirect effect, p < .05), accounting for 44% of the total effect of poverty. ConclusionsThe findings indicate that schools with limited geographic access to health care services may more likely to use suspension as a tool to manage the behavior of students with disabilities.