PROJECT SUMMARY
Schools face rising mental health needs among children that have been exacerbated by social isolation,
increased economic stress, and reduced societal supervision during the COVID-19 pandemic. U.S. public
schools are the most common institutional entry point to mental health services for children, and school-based
health centers (SBHCs) increasingly serve as a “medical home” for vulnerable children. Yet there are
significant gaps in our understanding of SBHCs’ effectiveness and the extent to which they are reaching
underserved subgroups of children. Research on SBHCs has largely neglected the study of children’s mental
health outcomes; few studies have sought to study in-depth the mechanisms by which SBHC have the
potential to improve children’s outcomes; and we lack longitudinal research on SBHC effectiveness. We will fill
these critical gaps in research and generate new, generalizable knowledge on program and policy levers that
SBHCs can deploy to increase their effectiveness and reduce inequities in children’s health and education
outcomes. A key innovation of our proposed research is our use of a high-quality, linked health and education
dataset that encompasses the population of children in Tennessee who have a Medicaid record at any point in
time between 2006 and 2019, with the plan to add data through 2025. Our longitudinal data begin well before
the Affordable Care Act-funded expansion of SBHCs in Tennessee, allowing for a long baseline period before
the large majority of SBHCs opened. We will employ rigorous quasi-experimental methods with the linked
longitudinal data to compare children in schools that gained access to a SBHC with those in schools without
access to services provided by SBHCs and examine SBHC impacts on children’s mental health and
educational outcomes, including by subgroups of children of color, children of immigrants, children living in
rural areas, and those with specific health conditions. We will also advance our understanding of the
mechanisms by which SBHCs may improve children’s mental health and education outcomes by: 1)
elaborating and testing a child-centered conceptual framework for examining in-depth the organization and
implementation of SBHCs and factors that constrain or enable their effectiveness; 2) undertaking a
comprehensive documentation of the operations and services of traditional on-campus, school-linked, mobile,
and telehealth SBHCs and filling gaps in our understanding of how they are operating in rural areas and
through mobile/telehealth options, and 3) generating timely new information on how SBHCs adapted their
service delivery approaches during the COVID-19 pandemic and the extent to which disruptions in children’s
access to mental and behavioral health services disproportionately affected disadvantaged or underserved
subgroups of children. We will actively disseminate the study findings to ensure that they inform program
strategies, policies, and evaluation tools that state and local agencies can use to improve the efficacy of
SBHCs in serving children most in need of mental health services.
