O2032: School-based Health Centers Decrease Absenteeism in Rural Areas

Background: School-Based Health Centers (SBHCs) are a paradigm of healthcare for children and adolescents that has been in use for decades. Typically, SBHCs address well care (e.g. annual visits, immunizations), sick care (e.g. sore throats, sprained ankles) and chronic health conditions (e.g. asthma, depression). Most SBHCs include a mental health component, and some have dental health services. Most SBHCs are in urban schools but, increasingly, there are SBHCs in rural areas. SBHC sponsors include hospitals, health care systems, health departments, and federally qualified health centers. There are numerous benefits to students, families, and schools reported; some benefits relate to access to care, improved vaccination rates, decreased use of EDs and decreased hospitalizations. We looked at a rural population comparing absenteeism among students enrolled in school districts with a SBHC and demographically and fiscally similar neighboring districts without SBHCs.

Methods: We used standardized student attendance data as reported to the State Education Department by individual school districts. We compared attendance and the inverse, absence, as the number of days a student was present (or absent) as a proportion of the number of days each individual child was enrolled in the given school year. Data came from 38 school districts in a four-county rural area. Sixteen of the districts (20 schools) have SBHCs and 22 districts (26 schools) do not have SBHCs. Data were collected by schools at the individual student level including grades Kindergarten to 12th grade. The distribution of the aggregated absence rate of all students in the study is shown in Figure 1. and include a mean of 5.3% of days absent from the full population of 14,728 students in the 38 school districts. Because the data are skewed, median differences and significance tests were calculated by grade between students who enrolled in schools with and without SBHCs.

Results: There were 7,437 K-12 students in non-SBHC schools in 2019 and 7,291 in schools with a SBHC (see Table 1). We find variability by grade with primary grades consistently exhibiting less absenteeism in schools with SBHCs. For the full population of 14,728 students, students in schools with SBHCs had significantly less absenteeism.

Conclusion: SBHCs offer many advantages for parents with school-aged children who live in rural areas. A paucity of primary care child healthcare providers, distances to care facilities and lower SES may make accessing healthcare more difficult. The presence of a SBHC provides easy access to primary health and mental health services onsite and addresses illnesses and chronic conditions that may result in absences. In this rural four county region, the findings suggest a positive relationship of the presence of SBHCs on individual student attendance.