Original articleImpact of School-Based Health Center Use on Academic Outcomes
Section snippets
SBHC Impact on Academic Outcomes
The positive impact of SBHC use on important public health-related outcomes is well documented and is an important justification for the continued place of SBHCs within the public health system [3], [11], [12], [13], [14]. However, the increased political demand for academic accountability in school health services particularly heightens the need for well-controlled, longitudinal studies examining the specific academic impact of SBHC use [15]. Additionally, identifying potential differences in
Objectives and Hypothesis
The present study examines the relationship between SBHC use and several indicators of academic achievement through a well-controlled, quasi-experimental longitudinal design using administrative data and propensity score matching to control for group differences at baseline. There were two goals for this study. The first goal was to examine SBHC service use as a predictor of academic outcomes, including attendance, discipline referrals, and grade point average (GPA). We hypothesized that use of
Sample
The present study is a retrospective comparison of SBHC users and nonusers taken from a linked school district and SBHC database for all enrolled youth in the Seattle school district from September 2005 through January of 2008. Our study sample consisted of a cohort of ninth graders who began high school in September 2005 in one of 13 high schools with either an onsite SBHC or, in the case of three alternative high schools, access to a SBHC at a geographically proximal school. The linked school
Attendance
Overall student attendance remained fairly steady over the five semesters (semester averages = 90.1%, 88.1%, 89.3%, 86.4%, and 89.3%), with a noticeable dip in the fourth semester (Spring 2007). Table 2 describes the parameter estimates and correlations for users and outcomes. We used the quadratic LGM controlling for propensity score to test differences in users and nonusers in baseline and rate and curve of change over time for attendance; the raw scores over the five semesters are
Discussion
One of the primary missions in the SBHC movement is reaching youth who are underserved by public and private healthcare systems, particularly those youth who are at risk for social and educational failures [28]. The purpose of this study was to examine the effects of general and specific SBHC use (medical and mental health use) on educational outcomes for high-risk high school students, using a well-controlled, longitudinal model. The results indicate that, with low to moderate effect sizes,
Conclusions
Our study found that SBHC use is significantly associated with increases in attendance rates and GPA over time for a specific cohort of users, and that these effects are moderated by types of services used. These results support the theory that SBHC use indirectly impacts academic performance through improving health and emotional well-being. Additional longitudinal, well-controlled research with an integrated process evaluation on how academic outcomes are impacted by youth receiving
Acknowledgments
We gratefully acknowledge the support of Sid Sidorowicz and the staff at the City of Seattle Office of Education, Ming-Yu Fan at the University of Washington for statistical consultation, and Emily Brulotte for assistance in editing.
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