School-Based Health Centers and Academic Outcomes: Using research to communicate with educators and policymakers

1
School-Based Health Centers and Academic
OutcomesUsing research to communicate with
educators and policymakers

• Gorette Amaral, MHS
• Institute for Health Policy Studies - University
  of California, San Francisco
• gorette_at_itsa.ucsf.edu

6th Annual Child Health Services Research Meeting
June 5, 2004 San Diego, CA
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Presentation Overview

• In April 2004, the National Assembly on
  School-Based Health Care (NASBHC) convened 25
  experts in the health and education fields to
• Discuss the educational policy context that is
  causing increased pressures upon SBHCs to
  document their impact on academic outcomes.
• Discuss existing research on SBHCs and academic
  outcomes and methodological challenges faced when
  conducting this research.
• Discuss how researchers and SBHCs can use data
  and other strategies to show educators, funders,
  and policymakers how they contribute to students
  educational experiences.

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BackgroundWhat is the educational policy
context?
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No Child Left Behind Act of 2001

• Requirements include
• Annual testing in reading, math and science
• Adequate Yearly Progress targets
• State and local report cards
• Teacher qualifications
• Penalties include
• Mandated staff development
• Supplemental student services
• Offering students the option to transfer schools

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Other Educational Policy Issues

• Funding tied to Average Daily Attendance
• Class size reduction and need for more teachers
  and space
• Graduation exit exams and high stakes testing
• With limited resources to meet these and other
  requirements, schools are examining all their
  activities and programs to see how they
  contribute to academic performance.

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BackgroundWhat are School-Based Health Centers
(SBHCs)?
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What are SBHCs?

• School-based health centers provide an
  integrated, comprehensive health care approach
  with a focus on prevention and early intervention
  to students on school campuses
• As of 2003, there are an estimated 1,500 SBHCs in
  45 states, serving over 1 million students

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National growth of SBHCs

1,380
10
17
1
0
3
44
3
20
0
0
38
44
159
0
42
31
7
17
26
0
1
56
20
32
43
27
2
33
34
102
15
59
1
6
6
2
41
12
116
7
30
6
26
3
32
7
40
70
1
1
80
150

1996
1998
2000
1983
1990
1992
1994
Source The George Washington University, 2001.
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Research What evidence exists of a link between
SBHCs and academic outcomes?
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Literature Review

• A thorough literature review conducted in 2003
  yielded 7 quasi-experimental studies on the link
  between SBHCs and academic outcomes.1
• 6 of the 7 studies found a desired relationship
  between SBHCs with at least one of 13 academic
  indicators
• However, each study had methodological
  limitations common to this type of research
• Insufficient evidence to prove a direct link
  between SBHCs and academic outcomes
• 1 Geierstanger SP, Amaral G, Mansour M, Walters
  SR. School-Based Health Centers and Academic
  Performance Existing Research, Challenges, and
  Recommendations. J Schl Health (in press).

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Summary of Findings

• Absences/attendance (3 out of 6 studies that
  measured this indicator found a desired
  relationship)
• Promotion to next grade (1 out of 3)
• Withdrawal/dropout rates (2 out of 2)
• Suspension rates (0 out of 2)
• Tardiness (1 out of 1)
• Graduation rate (1 out of 1)
• Education aspirations (1 out of 1)
• Credit accumulation (1 out of 1)
• Standardized test scores (1 out of 1)
• Disciplinary referrals (0 out of 1)
• Grade point average or receipt of a failing grade
  (0 out of 1)

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Limitations of Current Research

• Design limitations
• 3 studies were cross-sectional and most of those
  that did have a pre/post design measured
  insufficient follow-up time
• Variability in the selection and definition of
  indicators
• Difficult to generalize findings
• Programs called SBHCs can vary in scope and
  services
• 3 studies focused on unique groups of students or
  geographic locations

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Evidence does support indirect health-academic
performance connections

• Graduation
• GPA
• Standardized test scores

Health Risk Behaviors
Educational Outcomes
Physical illness Mental health Poor diet
Intentional injuries Self-esteem
Sexual behaviors Alcohol, tobacco, drug
use
Attendance Dropout Rates Behavioral
Problems
Educational Behaviors
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Next Steps How can SBHCs and researchers link
data and policy to communicate with educators,
funders, and policymakers?
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Recommendations for researchers

• Study outcomes of interest to educators
• Attendance indicators (i.e., seat-time)
• School connectedness
• Teacher retention or satisfaction
• Economic benefits of SBHCs
• Design methodologically rigorous studies
• Focus on students being treated for chronic
  conditions (i.e., asthma, depression, ADHD)
• Include a comparison group
• Study adequately large sample
• Allow sufficient follow-up time

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Recommendations for SBHCs

• Emphasize how SBHCs contribute to factors that
  enhance the educational climate
• Parental involvement
• Teacher/client satisfaction
• Provide sports physicals, first-aid,
  immunizations, asthma care, medication
  management, etc
• Handle urgent and emergent situations
• Teach schools health education curriculum
• Help develop school safety protocols
• Serve on school planning committees

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Recommendations for SBHCs

• Collect health data on conditions that indirectly
  affect student performance
• Asthma
• Pregnancy
• Depression
• Attention Deficit with Hyperactivity Disorder
  (ADHD)
• Immunization rates
• Document client success stories

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Dissemination of information

• Publish in health and education journals and
  present talks at health and education
  conferences/venues.
• Develop a toolkit for SBHCs including a
  PowerPoint presentation they can use to talk to
  administrators.
• Hire public policy consultants and learn how to
  use data for advocacy.
• Employ the help of partners such as the business
  community.