Impact of school-based health centers on students with mental health problems

Abstract

Objectives: School-based health centers (SBHCs) play an increasingly major role in providing mental health services for students. This study evaluated the impact of SBHCs on mental health-care services and psychosocial health-related quality of life (HRQOL).

Methods: Four SBHC intervention and two matched non-SBHC school districts were examined from 1997 to 2003. The SBHC intervention began in 2000. Data included child and parent pediatric HRQOL and Ohio Medicaid claims. A longitudinal quasi-experimental time-series repeated measures design was used for this study, involving analysis of covariance to assess health costs and regression analyses for HRQOL scores.

Results: After the SBHC program, proportions of students accessing mental health-care services for urban and rural SBHC intervention schools increased 5.6% (chi2 = 39.361, p < 0.0001) and 5.9% (chi2 = 5.545, p < 0.0001), respectively, compared with increases of 2.6% (chi2 = 2.670, p = 0.1023) and 0.2% (chi2 = 0.006, p = 0.9361) for urban and rural non-SBHC schools, respectively. Using data from 109 students with mental health problems based on Medicaid claims, the study found SBHC students had significantly lower total health-care costs (F = 5.524, p = 0.005) and lower costs of mental health services (F = 4.820, p = 0.010) compared with non-SBHC students. While improvements over time in HRQOL for SBHC students compared with non-SBHC students and students from non-SBHC schools were observed, only some were statistically significant.

Conclusions: SBHC programs increase the proportion of students who receive mental health services and may improve pediatric HRQOL. SBHC students with mental health problems had lower total Medicaid reimbursements compared with non-SBHC students.

Figures

Figure 1. Flow chart of selecting cohort students with mental health problems, 1997–2003

SBHC = school-based health center PedQOL = pediatric quality of life

Figure 2. Percentage of students who accessed mental health services before and after SBHC program implementation, by rural and urban areas (n=5,057)a

aAll data for this figure are based on Medicaid medical claims with diagnosis codes from 1997 to 2003. Urban nonSBHC = students subtotal in urban schools without SBHC program (n=913); 2.6% changed, χ2=2.670, p=0.1023 Urban SBHC = students subtotal in urban schools with SBHC program (n=3,148); 5.6% changed, χ2=39.361, p<0.0001 Rural nonSBHC = students subtotal in rural schools without SBHC program (n=471); 0.2% changed, χ2=0.006, p=0.9361 Rural SBHC = students subtotal in rural schools with SBHC program (n=525); 5.9% changed, χ2=5.545, p<0.0001 SBHC = school-based health center

Figure 3. Mean total health-care reimbursement costs per child across SBHC groups over six years (three years before and three years after SBHC implementation) for students with mental disorders (n=109)

aEstimated marginal means are mean total costs per child. bTimes 1, 2, and 3 refer to 1997, 1998, and 1999—academic years before the SBHC program; Times 4, 5, and 6 refer to 2000, 2001, and 2002—academic years after the SBHC program. SBHC = school-based health center SBHCR=1 for students in non-SBHC schools, SBHCR=2 for students in SBHC schools, and SBHCR=3 for students who used SBHCs during the intervention period.

Figure 4. Mean mental health-care reimbursement costs per child across SBHC groups over six years (three years before and three years after SBHC implementation) for students with mental disorders (n=109)

aEstimated marginal means are mean costs for mental health care per child. bTimes 1, 2, and 3 refer to 1997, 1998, and 1999—academic years before the SBHC program; Times 4, 5, and 6 refer to 2000, 2001, and 2002—academic years after the SBHC program. SBHC = school-based health center SBHCR=1 for students in non-SBHC schools, SBHCR=2 for students in SBHC schools, and SBHCR=3 for students who used SBHCs during the intervention period.