Sunday, June 1, 2025
6/1/2025
Understanding the Short- and Long-Term Impacts of School-Based Health Centers - PROJECT SUMMARY/ABSTRACT School-based health centers (SBHCs) aim to improve child and adolescent health by providing health care at schools. SBHCs have become increasingly widespread in recent decades, with over 2,500 SBHCs serving more than 6 million students. While existing research finds that SBHCs are positively correlated with health care use and contemporaneous educational outcomes, differences between students at schools with and without SBHCs may confound these estimates. Moreover, while a large literature shows that childhood health has lasting impacts on later adult health, human capital, and economic outcomes, surprisingly little is known about the impacts of SBHCs on students’ long-run trajectories. This project aims to advance knowledge on these issues by using difference-in-difference models to measure the causal effects of SBHCs on students’ health care utilization and their short- and long-term behavioral, educational, and economic outcomes. The project will examine the effects of SBHCs on the provision of psychotropic medications for school-aged youth using 13 years of data covering the near universe of antidepressant, anti-anxiety, and antipsychotic prescriptions across the entire US linked with information on the openings of over 1,800 SBHCs. The project will also consider impacts on youth health care use more generally using nearly a decade of administrative Medicaid claims data covering the entire US. The project will further estimate the effects of SBHCs on a range of student outcomes—including attendance, disciplinary actions, high school graduation, college enrollment/graduation, and adult employment and earnings—using 26 years of administrative data on all public school students in Texas linked with information on the openings of 54 SBHCs. For student-level outcomes observed before and after an SBHC opening, the analysis will compare the before/after change in outcomes of students at schools that experienced an SBHC opening relative to the before/after change over the same period for students at matched control schools without SBHCs. The analysis of prescription and other health care outcomes will follow a similar design, comparing before/after changes in outcomes in areas surrounding schools following an SBHC opening relative to the before/after change over the same period in areas either slightly further away from the treated school or in areas near matched control schools. For long-term student-level outcomes only observed post-exposure, the analysis will compare outcomes among students enrolled in schools at the time of the SBHC opening to those who already aged out of the school relative to the difference between these cohorts at matched control schools. The project will identify groups of students that are most affected by SBHC access by conducting subgroup analyses by student characteristics such as race/ethnicity and socioeconomic background. The project will also conduct separate analyses by service offerings and staffing patterns to compare effects by SBHC characteristics. Results will help policymakers, schools, health care providers, and parents understand the impacts of SBHCs on youth, thereby helping inform discussions about further expansions of such centers across the US.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).