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.

Clinician Perspectives on Screening for Adverse Childhood Experiences in School-Based Health Centers: A Qualitative Study.

Building and Sustaining a Framework to Expand Pediatric Acupoint Therapies at School-Based Health Centers and an Academic Tertiary Care Children’s Hospital in New York City

ABSTRACT School‐based health centers are ideally situated to provide sexual health services to adolescents but face a macropolitical climate with competing sets of interests. We apply an organizational theory to 2019–2021 interview data from 33 school‐based health center (SBHC) coordinators and their educator partners in Oregon to reveal the micropolitics that coordinators engage in to provide sexual health services to adolescents. Interviewees described how health practitioners' interest in providing sexual health services conflicts with anti‐contraception, puritanism, and parental rights interests across school boards, parents, students, and the public. SBHC coordinators strategically engage their influential power by building relational trust with educator partners, students, and parents. They also employ the micropolitical strategy of compromise, avoiding pushing too hard for their ultimate interests to maintain the relational trust and interests they have already achieved. These findings provide a parallel for research focused on other systems, especially systems also characterized by morality‐based conflict.

School-Based Health Centers and the Utilization of Primary Care in Rural Communities.

1.84 Utility of the Pediatric Symptom Checklist-Youth as a Screener for Psychosocial Needs in School-Based Health Centers in a Population With Low Child Opportunity Coefficient

To estimate changes in student mental health outcomes after the adoption of a school-based health center (SBHC). Using a retrospective, quasi-experimental design, this study compared changes in mental health diagnoses and healthcare utilization among students in school districts that adopted an SBHC to students in districts that did not adopt an SBHC, before and after adoption. A stacked difference-in-differences estimator was used to address the staggered adoption of SBHCs and the potential for heterogeneous treatment effects. Health conditions (measured via diagnosis codes) and health care use (measured via procedure codes and place-of-service codes) were obtained from Medicaid inpatient, outpatient, physician, and pharmacy claims. Information on the availability of SBHCs was obtained via census of 142 of Tennessee's 147 public school districts. Using secondary data from administrative health and education records, we probabilistically linked Tennessee students enrolled in Medicaid to public-school records from 2006 to 2021. We linked approximately 70% of students enrolled in a Tennessee public school to Medicaid records. We identified 41 districts with an SBHC between 2007 and 2019. After the adoption of an SBHC, districts with an SBHC had a 0.5 (95% CI: -0.9, -0.2) percentage point decline in the proportion of students with any mental health diagnosis, which corresponds to a 6.6% relative decline. This was driven by a decrease in the diagnosis of depression, anxiety, and attention deficit and hyperactivity disorder (ADHD). We also found a significant increase in outpatient mental health care visits and a decrease in emergency department visits for mental health conditions after the adoption of an SBHC. SBHCs are one mechanism through which the mental health needs of school-aged children are met. Timely and adequate resources are needed to ensure SBHCs can sustain their services in this time of need.

ABSTRACTBackgroundThis study examines how school‐based health centers (SBHCs) are implemented and sustained through schools and a healthcare system in a four‐county rural region in New York State.MethodsTwelve semi‐structured interviews were conducted with school superintendents and employees of the healthcare system, including SBHC medical providers (physician assistant, mental health therapist, nurse), SBHC manager, care coordinator, Chief of Pediatrics, and executive leader between January and April 2024. Interviews were thematically coded using collective impact and collective action frameworks.ResultsSBHCs are implemented and sustained through a strong collaborative culture, shared financial, physical, and human resources, and a common agenda for student well‐being. Trust and open communication were essential in clarifying roles and overcoming institutional challenges. Key barriers included funding for startup costs, challenges in data sharing and confidentiality, and different institutional priorities. Regular communication, local governmental support, and community trust helped mitigate these challenges.Implications for School Health Policy, Practice, and EquityPolicies should support schools and healthcare systems as equal partners, ensure sustainable funding, and provide clearer guidance on data sharing to advance health equity in rural areas.ConclusionsCollaborative partnerships, trust, and open communication between schools and healthcare systems are essential to support SBHCs in rural communities.

This study examines whether and how community schools’ integrated student support services (academic, socioemotional, health, and family support) contributed to improving whole-child/youth development and reducing systemic inequalities of students’ learning/wellness outcomes across New York State under the Every Student Succeeds Act (ESSA). Applying a quasi-experimental method with propensity score matching to the state’s 2018–2023 school survey and report card databases, it provides new evidence on the efficacy of community school programs on average and by subgroups (race/ethnicity, poverty, disability, English language learner, and housing status). The results of matched comparisons between community schools and non-community schools are mixed, after considering their differences in terms of student demographics and baseline conditions. Overall, community schools showed policy implementation fidelity with more state funding, policy-aligned practices, and school-based health centers/clinics. However, community schools had no discernable impacts on academic achievement and chronic absenteeism overall, except that the operation of school-based health centers was associated with a reduction in absenteeism. In contrast, community schools had more positive impacts on high school graduation rates, particularly among disadvantaged minority students; the impacts are attributable to policy-aligned practices, set-aside funding, and school-based health center dental programs. Educational policy and research implications are discussed.

Introduction: Adolescents and young adults (AYAs), especially those from underserved communities, often face barriers to sexual and reproductive health (SRH). This pilot study evaluated the implementation of mobile health technologies to promote SRH care, including the integration of the Rapid Adolescent Prevention ScreeningTM (RAAPS) and the Health-E You/Salud iTuTM (Health-E You) app at a School-Based Health Center (SBHC) in Los Angeles using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Methods: This multi-method pilot study included the implementation of an integrated tool with two components, the RAAPS electronic health screening tool and the Health-E You app, which delivers tailored SRH education and contraceptive decision support to patients (who were sex-assigned as female at birth) and provides an electronic summary to clinicians to better prepare them for the visit with their patient. Quantitative data on tool usage were collected directly from the back-end data storage for the apps, and qualitative data were obtained through semi-structured interviews and in-clinic observations. Thematic analysis was conducted to identify implementation barriers and facilitators. Results: Between April 2024 and June 2024, 60 unique patients (14-19 years of age) had a healthcare visit. Of these, 35.00% used the integrated RAAPS/Health-E You app, and 88.33% completed the Health-E You app only. All five clinic staff were interviewed and expressed that they valued the tools for their educational impact, noting that they enhanced SRH discussions and helped uncover sensitive information that students might not disclose face-to-face. However, the tools affected clinic workflows and caused rooming delays due to the time-intensive setup process and lack of integration with the clinic's primary electronic medical record system. In addition, they also reported that the time to complete the screener and app within the context of a 30-min appointment limited the time available for direct patient care. Additionally, staff reported that some students struggled with the two-step process and did not complete all components of the tool. Despite these challenges, clinic staff strongly supported renewing the RAAPS license and continued use of the Health-E You app, emphasizing the platform's potential for improving SRH care and its educational value. Conclusions: The integrated RAAPS and Health-E You app platform demonstrated educational value and improved SRH care but faced operational and technical barriers in implementing the tool. These findings emphasize the potential of such tools to address SRH disparities among vulnerable AYAs while providing a framework for future implementations in SBHCs.

School-based health centers and inspiring the next generation of biomedical leaders.

School-Based Health Centers (SBHCs) have the capacity to overcome youth barriers to care. However, most schools do not have on-campus SBHCs. At Denver Health, a large safety net hospital with 19 SBHCs in Denver Public Schools, we developed a SBHC virtual care program (VCP) to link school nurses with SBHC providers to provide medical care and address gaps in care for children attending the DPS schools without an on-campus SBHC. In establishing the SBHC VCP, several important steps emerged that others could consider when establishing similar programs. This manuscript will lay out helpful frameworks in the establishment of this SBHC VCP, including a theory of change model, a process map, and an appointment flow diagram. Since August of 2021, this program has been rolled out to 58 schools and seen close to 900 visits. The development of a SBHC VCP provides a framework for other SBHCs nationwide. Novel mechanisms such as the DPS SBHC VCP's framework can be leveraged within other SBHCs to expand SBHC reach to schools without an on-campus SBHC.

School based health centers (SBHCs) are essential for providing health care to students. Literature demonstrates student characteristics such as race and income are associated with SBHC utilization; however, little data exists on temporal trends in utilization. This gap in knowledge is crucial for informing policies and resource allocation. This study examined utilization across 27 SBHCs at elementary, middle, and high schools in King County, Seattle from 2017 to 2021. Negative binomial models with random intercepts were constructed to evaluate semester-level variation in utilization, accounting for school-level differences in race, income, and attendance. Interaction models were constructed to test for effect modification of utilization by race, income, and attendance. Findings indicate that higher rates of utilization occurred in the fall. There was a decrease in utilization during the study, potentially due to the pandemic. Lower school-level income was positively and significantly associated with higher utilization and none of the interaction models were significant. Our study holds important implications for planning and policy recommendations surrounding SBHC care delivery, such as the potential need for more staffing to meet the higher demand in the fall. SBHC utilization varies by semester and schools serving low-income communities may experience higher rates of utilization, requiring increased staffing needs.

Adolescents with a chronic medical condition (CMC) have an increased risk of developing a substance use (SU) disorder, despite the impact that SU may have on disease-related outcomes. School-based health centers (SBHCs) offer universal screening, brief intervention, and referral for adolescents with chronic medical conditions for substance use treatment. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based early intervention used to detect and address risky substance use that has yet to be broadly adopted in public schools. Moreover, despite extensive research supporting caregiver involvement in treatment for adolescent substance use, SBIRT models that actively engage caregivers are lacking. The primary goal of this qualitative study is the identification of contextual determinants (e.g., barriers and facilitators) of SBHCs implementation potential and adaptation needs of a family-based SBIRT protocol for integration into SBHCs. We are conducting this study in two SBHCs within the Chicago Public School system. In these SBHCS we are conducting focus groups with school partners (∼ 30 SBHC staff,∼25 adolescents with chronic medical conditions, and∼25 caregivers). Focus groups will be audio recorded and conducted in English. The semi-structured focus group guides were designed based on the Health Equity Implementation Framework (HEIF) and the Consolidated Framework for Implementation Research (CFIR). We will develop a codebook based on emerging codes from the transcripts and constructs from HEIF and CFIR. Emerging themes will be summarized highlighting similarities and differences between and within the different groups and SBHCs. Descriptive statistics and chi-square tests of associations will be used to assess the distribution of responses on the assessments between the different sites. This study will describe key implementation determinants and SBIRT-Family adaptation needs from the perspective of multiple end-users. Results will provide insights for a randomized pilot hybrid type 2 effectiveness implementation study of the adapted SBIRT-Family model in two SBHCs assessing effectiveness outcomes (SU and linkage to treatment) and implementation outcomes (reach, adoption, equity, and cost). This research protocol will provide formative data to inform the development of a highly scalable approach that can be used in SBHCs across the country to serve a vulnerable population of adolescents with chronic medical conditions.

There is a large body of research suggesting the role of school-based health centers (SBHCs) in improving outcomes for children with asthma, but there are no evidence-based guidelines for the care of children with asthma in SBHCs. We conducted a randomized trial to assess screening in children with asthma in an urban SBHC. Participants were screened for asthma triggers. The intervention group received home assessments and medical legal partnership (MLP) referrals as indicated. The primary outcome of asthma severity was assessed using the asthma control test (ACT). All participants completed semi-structured interviews to evaluate their experience. All families randomized to intervention qualified for and completed home remediation. There were no statistically significant differences in asthma severity. There was 100% retention of participants, and all participants rated their experience as good or excellent. This study demonstrates a high prevalence of home-based asthma triggers for children with asthma who receive care in SBHCs. Although not large enough to demonstrate significance in primary outcomes, participants were successfully recruited from a diverse population and retained through completion of the study. Participants rated their experience as good or excellent, suggesting that the recruitment and retention of diverse participants for clinical trials in SBHCs can be successful. Home-based asthma triggers for children with asthma who receive care in SBHCs are prevalent. Although complex collaborations are required, SBHCs are a viable site for clinical trials. More research is needed to understand the benefit of interventions in SBHCs to reduce asthma severity.

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.

Asthma has a high prevalence among children and is associated with negative outcomes and extreme costs. Asthma exacerbations, often preventable, have been associated with social determinants of health and social risk factors. It is unclear whether school-based health providers consider social information for asthma, possibly related to a lack of knowledge or data availability. Describe the information-gathering behaviors and approaches for social risk screening for patients with asthma exacerbations performed by school-based health center providers. We conducted a qualitative descriptive study with a purposive sample of school-based health center medical providers. We conducted four focus group sessions (total participants = 16 nurse practitioners) and employed thematic analysis to generate themes. We identified four major themes: (1) Information-gathering tactics, (2) diligence, (3) challenges accessing and assessing social determinants of health information, and (4) uncertainty. Major findings include: (1) There is a variety of information-gathering tactics used; (2) there are missed opportunities for social risk screenings in schools; (3) social risk screening is feasibly challenging; and (4) there is continued need for resources and increased awareness of screening. This study highlights the lived experiences of school-based health center providers in gathering information about social determinants of health and social risk factors. Challenges limit the ability to provide effective screening and referral to resources, particularly for school-age children with asthma. Our findings can be used for further research and development of informatics resources to promote effective social risk screening in school-based health centers.

Background: Adverse childhood experiences (ACEs) are potentially traumatic experiences that may promote poor mental health, including substance use and suicidality, as well as chronic pain. Telementoring may be used to provide education to school-based health center (SBHC) clinicians and other health professionals in the community to identify and support youth with ACEs. Methods: This study was an evaluation of the novel ACEs ECHO telementoring program, which incorporates didactics, case-based learning, and a community of practice to serve school-based health clinicians in New Mexico, a rural state with a high prevalence of ACEs. Results: In the program's first two years, there were 704 unique participants, including SBHC clinicians from 25 of New Mexico's 33 counties. The pre/post survey demonstrated that the participants reported increases in knowledge in identifying children that experienced ACEs (4.3 versus 3.7, p = 0.001) and confidence in supporting children who may be at high risk (4.1 versus 3.3, p = 0.001) compared with before they began attending the ACEs ECHO program. The participants also reported that they felt more hopeful that they could help youth with ACEs (4.2 versus 3.3, p = 0.001). Conclusions: The ACEs ECHO telementoring program may be considered for other rural states and globally as a capacity-building model to educate SBHC clinicians and other health professionals to identify youth at risk for adverse childhood experiences.

Efficacy of United States’ federally-funded interventions in increasing school capacities to improve student mental health and education outcomes in Tennessee

An electronic survey of transgender and nonbinary (TNB) adolescents was administered between June and August 2023 to identify potential facilitators of gender-affirming medical care (GAMC). Results indicated the most important facilitator was being able to access GAMC from their regular doctor. Accessing care via school-based health centers, a telemedicine visit with a gender specialist, and sharing videos about GAMC with parents were more important to those who had not been seen in a clinic that provides GAMC. Overall, this study offers important insights into how to improve access to GAMC for TNB adolescents who want but are not receiving this care.