O2025: Changes in Mental Health School-health Center Utilization: Data from 2018-2022

Background: Adolescent mental health conditions have been increasing at a rapid pace, which has been compounded significantly by the impact of COVID-19. In 2021, adolescent mental health was declared a national emergency, with emphasis on the disproportionate impact on children from communities of color. One intervention to address increasing prevalence in mental health needs is through school-based health centers (SBHCs) which offer adolescents access to medical professionals through their school.

Methods: Data from an ongoing evaluation of five SBHCs in South Carolina was used to explore trends in mental health service utilization throughout four academic years (2018-2019, 2019-2020, 2020-2021, and 2021-2022*). To approximate the changes to condition severity, a binary, proxy measure was created based on repeated visits during the same school year to a SBHC for a mental health condition. Multiple logistic regression models were run to estimate the odds of a visit being classified as a mental health visit for each COVID-19 school year compared to the 2018-2019 school year, and of being classified as a severe mental health visit, adjusting for demographics.
*Data is not yet complete for the 2021-2022 school year

Results: The sample included 1185 students seen over 2120 visits during the four-year study period (Mage=13, 49% female, 42% Hispanic, and 68% had Medicaid). Over the study period, 613 (29%) visits were classified as a mental health encounter and 458 (22%) encounters were for severe mental health visits. The odds of any visit being for a mental health encounter during 2020-2021 compared to the 2018-2019 school year was 2.98 times higher (95% CI: 2.26, 3.93, p<.0001). The odds of a visit being related to a mental health encounter during 2019-2020 and 2020-2021 school years when compared to 2018-2019 did not show significant change, although both increased in odds. Similar results were seen with severe encounters, with a significant increase in the odds of a visit being for a severe encounter during 2020-2021 being 3.46 times higher compared to the 2018-2019 school year (95% CI: 2.55, 4.70, p<.0001). The increase in odds during the 2019-2020 and 2021-2022 school years did not show significant results from the 2018-2019 school year.

Conclusion: Significant increases in the odds of both the likelihood of a visit being for a mental health encounter and a severe mental health encounter could be associated with the impact of COVID-19 on the mental health of adolescents seeking services from SBHCs. The nonsignificant changes, but subsequent increase from the 2018-2019 school year to the 2019-2020 school year echo increasing trends in mental health prevalence prior to the onset of the pandemic, and the change in significance from the 2019-2020 school year to the 2020-2021 school year may be indicative of this exponentiated change.