Comparing frequent and average users of elementary school-based health centers in the Bronx, New York City

Risk and Resilience Factors Associated With Frequency of School-Based Health Center Use

BACKGROUND

School-based health centers (SBHCs) provide health care to vulnerable youth. The purpose of the study was to identify characteristics of youth who use SBHCs with the highest frequency to understand their health needs and receipt of health services.

METHODS

This study examined cross-sectional survey data from adolescents in 3 urban school districts (n = 2641) to identify the characteristics of youth who use SBHCs with high frequency (10+ visits). Analyses included calculations of simple frequencies and percentages, chi-square tests of significance and multivariate regression.

RESULTS

High-frequency SBHC users were more likely to have seriously considered attempting suicide (adjusted odds ratio [AOR]: 3.2), be sexually active (AOR: 6.8), and have been victimized at school (AOR: 2.2) compared to their peers who did not use the SBHC. High-frequency SBHC users were also significantly more likely than their peers to report "always" getting mental health (AOR: 7.0) and sexual health (AOR: 6.6) care when needed, and having talked with a health care provider about their moods/feelings (AOR: 3.1) and how school is going (AOR: 3.2) in the past year.

CONCLUSIONS

These findings hold important relevance to demonstrating the value of SBHCs in increasing vulnerable youth's access to health care, particularly in urban settings.

Frequent users of the pediatric emergency department

OBJECTIVES

Emergency department (ED) crowding is associated with increased morbidity and mortality. Its etiology is multifactorial, and frequent ED use (defined as more or equal to five visits per year) is a major contributor to high patient volumes. Our primary objective is to characterize the frequent user population. Our secondary objective is to examine risk factors for frequent emergency use.

METHODS

We conducted a retrospective cohort study of pediatric emergency department (PED) visits at the Montreal Children's Hospital using the Système Informatique Urgence (SIURGE), electronic medical record database. We analysed the relation between patient's characteristics and the number of PED visits over a 1-year period following the index visit.

RESULTS

Patients totalling 52,088 accounted for 94,155 visits. Of those, 2,474 (4.7%) patients had five and more recurrent visits and accounted for 16.6% (15,612 visits) of the total PED visits. Lower level of acuity at index visit (odds ratio [OR] 0.85) was associated with a lower number of recurrent visits. Lower socioeconomic status (social deprivation index OR 1.09, material deprivation index OR 1.08) was associated with a higher number of recurrent visits. Asthma (OR 1.57); infectious ear, nose, and sinus disorders (OR 1.33); and other respiratory disorders (OR 1.56) were independently associated with a higher incidence of a recurrent visit within the year following the first visit.

CONCLUSION

Our study is the first Canadian study to assess risk factors of frequent pediatric emergency use. The identified risk factors and diagnoses highlight the need for future evidence-based, targeted innovative research evaluating strategies to minimize ED crowding, to improve health outcomes and to improve patient satisfaction.

A Statewide Profile of Frequent Users of School-Based Health Centers: Implications for Adolescent Health Care

BACKGROUND

The purpose of this study is to describe patterns of care and service use among adolescent school-based health center (SBHC) users in New Mexico and contrast patterns and services between frequent and infrequent users.

METHODS

Medical claims/encounter data were analyzed from 59 SBHCs located in secondary schools in New Mexico during the 2011-2012 school year. We used Pearson's chi-square test to examine the differences between frequent (≥ 4 visits/year) and infrequent users in their patterns of SBHC care, and we conducted logistic regression to examine whether frequent use of the SBHC predicted receipt of behavioral, reproductive, and sexual health; checkup; or acute care services.

RESULTS

Most of the 26,379 adolescent SBHC visits in New Mexico were for behavioral health (42.4%) and reproductive and sexual health (22.9%). Frequent users have greater odds of receiving a behavioral, reproductive, and sexual health; and acute care visit than infrequent users (p < .001). American Indians, in particular, have higher odds of receiving behavioral health and checkup visits, compared with other races/ethnicities (p < .001).

CONCLUSIONS

SBHCs deliver core health care services to adolescents, including behavioral, reproductive, and checkup services, to high need populations. American-Indian youth, more than their peers, use SBHCs for behavioral health and checkups.

Mental Health Services in School-Based Health Centers: Systematic Review

Mental health issues affect 20-25% of children and adolescents, of which few receive services. School-based health centers (SBHCs) provide access to mental health services to children and adolescents within their schools. A systematic review of literature was undertaken to review evidence on the effectiveness of delivery of mental health services in SBHCs. Databases were searched extensively for research studies published between January 1990 and March 2014. Data analysis was based on the method proposed by the Centre for Reviews and Dissemination. Twenty-three studies were selected for review. Each study was explored for accessibility and content of mental health services in SBHCs. SBHCs provide access and eliminate barriers to mental health services. Students who exhibited high-risk behaviors were more likely to have sought services at the SBHC. However, there is a lack of high-quality research evaluating mental health services in the SBHCs and their effect on children and adolescents.

Understanding the relationship between school-based health center use, school connection, and academic performance

School-based health centers (SBHCs) benefit the overall health of underserved communities. In fact, there is an abundance of evidence suggesting the positive effects that SBHCs have on physical and mental health. However, research related to understanding the relationship of SBHCs to academic outcomes such as performance and school connectedness is sparse. The purpose of the current study was to (a) compare differences between elementary, middle, and high school student SBHC users and nonusers on school connectedness and (b) test the pathways between SBHC usage and academic performance. A structural equation model was tested and found significant pathways between SBHCs, school connectedness, and academic performance.

Racial/ethnic disparities in chronic diseases of youths and access to health care in the United States

Racial/ethnic minorities are 1.5 to 2.0 times more likely than whites to have most of the major chronic diseases. Chronic diseases are also more common in the poor than the nonpoor and this association is frequently mediated by race/ethnicity. Specifically, children are disproportionately affected by racial/ethnic health disparities. Between 1960 and 2005 the percentage of children with a chronic disease in the United States almost quadrupled with racial/ethnic minority youth having higher likelihood for these diseases. The most common major chronic diseases of youth in the United States are asthma, diabetes mellitus, obesity, hypertension, dental disease, attention-deficit/hyperactivity disorder, mental illness, cancers, sickle-cell anemia, cystic fibrosis, and a variety of genetic and other birth defects. This review will focus on the psychosocial rather than biological factors that play important roles in the etiology and subsequent solutions to these health disparities because they should be avoidable and they are inherently unjust. Finally, this review examines access to health services by focusing on health insurance and dental insurance coverage and access to school health services.

The moderating effect of school type on the relationship between school-based health centers and the learning environment

School-Based Health Centers (SBHCs) have improved access to primary and preventive health care for underserved children and youth by bringing comprehensive health services into the schools while addressing critical health problems that make it difficult for students to learn. Despite the findings on the positive effects of SBHCs on health outcomes, the literature investigating the relationship between SBHCs and the learning environment is scant. This study utilizes a quasi experimental study to investigate the moderating effects of school type on the relationship between school based health centers and the learning environment. Findings indicate that SBHCs in middle and elementary schools are associated with greater levels of school engagement and satisfaction with the learning environment than those in high schools.

Access and utilization patterns of school-based health centers at urban and rural elementary and middle schools

OBJECTIVE

We examined patterns of enrollment, use, and frequency of use in school-based health centers (SBHCs), as well as the referral, diagnosis, and disposition of SBHC visits among newly implemented SBHCs.

METHODS

Four rural and four urban school districts implementing SBHCs were examined from 2000 to 2003. Total school enrollment for students was 13,046. SBHC enrollment and medical encounter data were tracked using a Web-based medical database. Descriptive analyses were conducted to evaluate primary care access and utilization patterns.

RESULTS

A total of 7,460 (57.2%) students were enrolled in their SBHCs, of which 4,426 used the SBHC at least once for a total of 14,050 visits. SBHC enrollment was greater in urban districts but rate of utilization was higher in rural districts. Black students, students with public or no health insurance, and students with asthma or attention deficit disorder had higher enrollment and utilization. Rural parents referred more children to SBHCs than urban parents. Teachers referred more students who were black, had asthma, had no public or health insurance, or had acute-type health issues. Total visits increased during the three years, with the largest increase in mental health services. Students who were younger, white, attended rural schools, had public or health insurance, or had infections were more likely to be sent home. Those with chronic conditions and visits for mental health were more likely to be returned to class.

CONCLUSION

Utilization patterns suggest improved access to needed health care for disadvantaged children. SBHCs are an important part of the safety net for the populations they are intended to serve.

Sexually active students' willingness to use school-based health centers for reproductive health care services in North Carolina

OBJECTIVE

School-based health centers (SBHCs) in North Carolina offer limited reproductive health care services. We investigate sexually active students' willingness to seek these services at SBHCs if available and predictors of willingness to seek services.

METHODS

Cross-sectional survey of 949 sexually experienced students in 2 middle and 5 high schools in North Carolina in 1994. Bivariate and multivariate analyses tested the influence of sociodemographic characteristics, risk of pregnancy/sexually transmitted infections (STIs), and past health care utilization on willingness to use SBHCs for sexuality-related services.

RESULTS

Participants were 52% female, 52% black, and median age at first coitus was 13.0 years. Many (49%) had sex at least once a month. Most (52%) reported inconsistent contraception use. One-fifth (18%) of females had been pregnant; 10% of males reported getting a partner pregnant. Seventy-five percent had used SBHCs. Most reported they would use SBHCs for information to protect against pregnancy and STIs (58%), pregnancy testing (51%), and birth control (48%) if available. Females were more likely than males to report they would use these services (adjusted odds ratio = 3.4, 95% confidence interval = 1.9-6.7), especially those receiving free lunch (adjusted odds ratio = 2.9, 95% confidence interval = 1.2-6.8]) and those with inconsistent use of contraception. We found no association between past health care and willingness to use SBHC services.

CONCLUSIONS

Most sexually experienced students report they would use their SBHC for reproductive/STI services if they were available. Absence of these services in SBHCs represents a missed opportunity to provide health care to adolescents who are at substantial risk of pregnancy and STIs.