An Evaluation of School-Based Health Centers' Program Elements

Purpose: School-Based Health Centers (SBHCs) are being evaluated for their effectiveness worldwide. They consist of facilities providing health care services to children located on or near a school campus. SBHCs have a goal of advancing equity at the intersection of health and education, especially for students facing barriers to needed services. SBHCs use differing strategies that need to be assessed to identify which are most effective in implementing positive change for students. The purpose of this study is to analyze which aspects of SBHC mental and behavioral health services have been demonstrated to be successful in providing the best possible care to students. Three specific research questions were addressed: 1) what SBHC outcomes have been evaluated in the literature 2) what barriers to implementation are identified, 3) are there models that integrate on-site and telehealth service delivery.

Methods: This study was conducted in accordance with PRISMA guidelines for rapid systematic reviews using Covidence software. Key words were searched in PubMed, Scopus, Cinahl, and PsycINFO databases, and resulted in 436 articles being identified. After duplicates were removed, 230 studies remained. Titles and abstracts of these studies were screened using defined inclusion and exclusion criteria screen. Following the screening, 13 studies were included for complete review. Data extraction was performed addressing the three research questions above and included use of school-based health centers before and after the 2020 pandemic.

Results: 1) SBHC outcomes identified in the 13 studies included academic performance, tardiness, attendance, discipline, school connectedness, and commitment to educational future. 2) Two studies examined barriers to implementation and identified high turnover among staff and patients, insufficient buy-in, and insufficient time for training and planning. 3) Two studies were identified that examined hybrid models combining telehealth and on-site care

Conclusions: SBHC use is significantly associated with increases in GPA over time and these effects are moderated by the types of services used. SBHC use indirectly impacts academic performance by improving health and emotional well-being, but the association with attendance was variable. Tardiness was increased in SBHC users, but SBHC users reported higher scores relating to school bonding. This implied that the users reported happiness at school and looked forward to going to school. While these outcomes are of importance to school stakeholders, students, and families, the measurement of mental health outcomes in existing studies is limited. Implementation of school-based health centers had its challenges, including high turnover among staff, lack of buy-in and leadership among staff, and insufficient time for planning and training. Integrating educators and school-based health clinics could create more buy-in as staff would be more aware and potentially more supportive of school-based mental health clinics overall. There was limited evidence that met inclusion criteria regarding the hybrid model, however, the evidence showed that the hybrid model increased access to care. Studies also found that SBHC use increased significantly following the pandemic of 2020, due to increased health awareness and mental health struggles that occurred during this time.