Examining School-Based Health Centers as Vehicles for Health Equity among Chronically Absent Students

PROJECT SUMMARY/ABSTRACT Children with chronic absenteeism, defined as missing 10% or more school days, make up 13%-16% of public school students and are disproportionately from marginalized populations such as low-income, non-English speaking, Black, Latinx, and students with disabilities. Chronically absent students experience more chronic

illnesses, like asthma and obesity; are more likely to have behavioral health problems like depression and substance use; and are less likely to graduate from high school, which is a key social determinant of lifelong morbidity and mortality. school-based health centers (SBHCs) may improve health equity for students with

chronic absenteeism by reducing barriers to accessing care, addressing the specific health conditions associated with chronic absenteeism, avoiding the need to miss school to access healthcare and ultimately improving academic outcomes like attendance, grade point average, and graduation rates. However, few

studies characterize healthcare utilization and diagnoses for students with chronic absenteeism, or whether SBHC use increases primary care utilization, reduces emergency and inpatient care, and improves academic outcomes. We propose a 5-year study to determine whether SBHCs improve healthcare utilization and

academic outcomes for students with chronic absenteeism. We capitalize on unique partnerships in Los Angeles with one of the largest managed care organizations (Kaiser Permanente Southern California, KPSC), Medicaid insurance plans (LA Care), and the 2nd-largest school district in the nation (LAUSD), serving

~500,000 students a year. We propose to A) link electronic health and billing data from community clinics, managed care organizations, and 25 SBHCs in LAUSD with school district demographic and academic measures from 2015-2025. Using this unique dataset, we will B) identify children with different patterns of

chronic absenteeism and characterize their diagnoses and C) healthcare utilization, so that we can better identify pediatric populations at high-risk for unmet health needs and tailor health services, such as SBHCs, to meet their needs. We will then D) test whether students in high absenteeism classes who access SBHCs have

reduced emergency department visits (primary outcome) and hospitalizations, increased utilization of primary care, and improved academic performance (attendance, grade point average, and graduation rates) compared to a propensity weighted sample of chronically absent students who access community clinics or a managed

care organization alone. Finally, we will use the results of our analyses to engage students with chronic absenteeism in a human centered design process to identify and prototype SBHC interventions, including the expansion of or integration of SBHCs with other health systems, to improve care for children with chronic

absenteeism. This study examines whether SBHCs can improve health equity for an important marginalized population and is aligned with NIMHD’s mission to improve minority health and reduce health disparities.