School-based Health Centers Associated with Decreased Absenteeism Among Students in Rural Communities

Background: School attendance and its converse, absenteeism, is the subject of much interest. Absenteeism and chronic absenteeism in particular, is associated with poverty and is just as likely to be prevalent in rural as compared to urban and suburban areas. The relationship between school attendance and health has been documented in a recent Policy Statement from the American Academy of Pediatrics, Council on School Health.
School-Based Health Centers (SBHCs) provide an accessible source of physical, mental, and dental health services to students from pre-kindergarten through grade 12 on school campuses. The Bassett Healthcare Network is a health care system in rural, central New York State. The network’s 8-county service region covers 5,600 square miles, has very little public transportation and falls below average on measures of socio-economic development. Bassett Healthcare Network runs 20 SBHCs in 16 school districts in 4 counties. All are National Committee for Quality Assurance (NCQA)-recognized patient-centered medical homes. Of the 9,201 students in total school enrollment 82.7% of the students (preK-12) are enrolled in the SBHCs with 86.5% of the enrolled students actively receiving care. In the 2017-2018 school year, 37,675 SBHC health visits were recorded.
We are unaware of reports showing the impact of SBHCs on school attendance in rural communities. Our study aimed to determine the effect of SBHCs on the attendance at two local schools with SBHCs compared to three other local schools without SBHCs. We hypothesized that absenteeism would be less frequent in schools with well-established SBHCs as compared to schools without a SBHC.

Methods: We obtained de-identified, individual student attendance data from the schools. We determined percent of students eligible for free/reduced price lunch and calculated distance from the school to a medical facility. We compared absenteeism rates (calculated as the number of days absent divided by total number of days enrolled) for the SBHC versus non-SBHC schools. All students in the SBHC schools were included in the analysis, irrespective of SBHC enrollment, as it was not possible to distinguish SBHC enrollees in the attendance data.

Results: Total data file included 1,793 K-12 students. SBHC and non-SBHC schools were similar in terms of free-reduced lunch (48.4% vs 53.7%) and mean distance in miles to a medical center (15.0 vs 13.6). Median percent of enrolled days absent was significantly higher among students in non-SBHC schools compared to students in SBHC schools (Table 1). Differences in the distribution of students by quartile of absence were statistically significant (P < 0.0001) and persisted by gender and grade.

Conclusion: In this rural area of New York State, students in schools with SBHCs were absent at lower rates than their peers in schools without SBHCs.