Identifying Effective School-Based Health Center Models and Practices Nationally - ABSTRACT School-based health centers (SBHCs) provide primary care, mental health care, and other health services in or near schools that serve youth populations who otherwise may have limited access to care. Although research has documented SBHCs’ impacts on healthcare access and outcomes, only limited research has assessed which specific SBHC models and practices are most effective. Rigorous research is needed to inform the selection and implementation of SBHC models and practices, particularly given the expansion and rapidly changing landscape of SBHC operations and the heightened recognition of and need to address disparities in access. We will address these knowledge gaps by capitalizing on a longstanding partnership between our University of California, San Francisco and School-Based Health Alliance teams collecting national data on SBHCs. We will first collect comprehensive data on staffing models and healthcare delivery practices from a representative sample of SBHCs nationally. This will help us create a standard classification of SBHC models and practices to strengthen SBHC research. We will then conduct a qualitative study to identify barriers and facilitators, such as care coordination; screening, treatment, and referral practices; and school health system integration, that can hinder and facilitate the provision of equitable care in SBHCs. Lastly, we will examine national data on schools with and without SBHCs to understand whether access to SBHCs, and which service models in particular, are associated with reduced disparities in academic outcomes, such as graduation rates, chronic absenteeism, and disciplinary actions. This 4-year mixed methods study will describe current trends in SBHC models and practices and identify the models and practices associated with reduced disparities. Our specific aims are to: 1) describe current trends in SBHC staffing models and practices nationally and create a classification system to strengthen future research, design, and implementation; 2) determine the care delivery, coordination, and school health system integration practices associated with more equitably serving youth who disproportionately experience disparities; and 3) examine the association between SBHC models and academic outcomes by race/ethnicity nationally. Findings from our research will inform SBHC policy, funding, and program decisions, and hold promise to elucidate the role SBHCs can play in reducing health inequities.
