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ABSTRACT
School-based health centers (SBHCs) provide comprehensive health care services to children through facilities that are located directly within their school. Although traditionally located in low-income urban communities, SBHCs are becoming more prevalent in rural schools, and we propose that they may have important positive impacts in those communities. By reducing distance to care providers, capitalizing on the role of schools as a known local institution, providing consistent preventive care, and leveraging understanding of community challenges in providing health care services, SBHCs can increase health care access and positively impact social determinants of health. They may also contribute to community development if establishing and maintaining the SBHCs community activates community capitals and enhances resource sharing, communication and relationship building. We expand on these ideas by providing a case study of SBHC development and outcomes using data from a not-for-profit healthcare organization that operates a network of SBHCs in four adjacent rural counties of New York state.
Disclosure statement
No potential conflict of interest was reported by the authors.
Notes
2. Because school district boundaries do not correspond to county lines, assigning school districts to counties involves some judgment calls. The Healthcare Organization opened a new SBHC in 2020, and so currently operates SBHCs in 16 of the school districts.
3. Per NYS Health Department regulation.
4. Appalachian Regional Commission. Counties in Appalachia. Available at: https://www.arc.gov/appalachian-counties-served-by-arc/ Accessed October 1, 2021.
5. https://www.ers.usda.gov/webdocs/DataFiles/53180/25589_NY.pdf?v=0, accessed April 24, 2022.
6. County and state statistics were obtained from the U.S. Census Bureau, www.census.gov/quickfacts Accessed December 6, 2021. Comparisons are based on authors’ calculation of population-weighted averages across counties.
7. Starting in 2016, the federal government required school districts to report Economically Disadvantaged students rather than the time-honored tradition of reporting the percent Free-and-Reduced-Price Lunch (FRPL) students in a district. The Economically Disadvantaged category includes all FRPL students but also includes any other students whose families receive any other public service (e.g. Supplemental Nutrition Assistance Program (SNAP)).
8. Geisz notes that the initiative was spear-headed by a “core group of interested community members” (pg. 54).
9. Requirements are detailed on pg. 19 of the NYSDOH Guidelines.
10. This information is based on examination of several executed MOAs provided by the SBHC program practice manager for the Healthcare Organization.
11. Information on opening dates and enrollments and patient satisfaction was provided by the SBHC program practice manager for the Healthcare Organization.
12. Summary of responses to patient satisfaction surveys was provided by the SBHC program practice manager for the Healthcare Organization.
13. With less than 100% enrollment rates in a treatment, this intent-to-treat (ITT) approach is biased toward the null of finding no differences between the treated (SBHC districts, in our case) and control (non-SBHC districts) groups. With the high enrollment rates, we do not expect a substantial bias, but any such bias would work against our hypothesis that SBHCs lead to differences in healthcare utilization.
14. BOCES were established by New York in 1948 to provide shared educational programs and services to school districts in the state. https://www.boces.org/about-boces/.