Use of School-Based Health Centers May Prevent High School Dropout in Urban Teens

Urban high school students with low-to-moderate use of school-based health centers (SBHCs) may be at a decreased risk of dropout compared with those who do not use these services, according to a study published online in the Archives of Pediatrics & Adolescent Medicine [doi:10.001/archpediatrics.2011.10].

Researchers from the University of Washington and Public Health-Seattle and King County studied the relationship between SBHC use and time to dropout in one urban school district. They noted that previous research identified an association between SBHC use and other academic indicators, such as grade point average and attendance, among students with an increased risk of academic failure. However, researchers had not previously evaluated the longitudinal relationship between SBHC and dropout over the course of high school. The studied cohort was comprised of youth in one urban school district scheduled to graduate in spring 2009, based on high school entry date. The cohort included all students beginning high school in the fall semester of 2005, and excluded students who dropped out during that semester, transferred into the district during that semester, or with no available data on grade point average by spring 2006.

As described by the researchers, the SBHCs in the district studied are each staffed by a midlevel medical provider, a master’s-level mental health counselor, and a clinic coordinator. The centers are open before, during, and after school hours. Physical health services provided included primary care, immunizations, well-child examinations, management of chronic conditions, reproductive health and family planning services, and minor acute care. Mental health services include treatment for conditions such as depression, interpersonal issues, and anxiety, primarily through individual counseling. Groups were divided into students who used SBHCs at any point during the time enrolled (n=1754), and students who never used SBHC services (n=1580).

Students in the SBHC user group were more likely to be female, have had a school nurse visit separate from the SBHC, be eligible for free or reduced lunch, and be African American. Users of SBHC services were less likely to have limited English proficiency, be white, or be Asian. Time to dropout was calculated as the number of semesters between the first semester of freshman year and the semester of nongraduation, defined as being expelled, attaining maximum age without graduation, completing a General Educational Development program, or leaving school for various reasons without returning or confirming transfer to another school. The top 10% of SBHC users were categorized as high users. Low SBHC users averaged between 0.125 and 0.5 visits per semester, and moderate users averaged between 0.51 and 2.5 visits per semester.

Compared with students who did not use SBHCs, those with low use of SBHCs had a 33% decreased likelihood of dropout at any point; those with moderate use had a 32% decreased likelihood of dropout, and high use was not significantly associated with dropout compared with nonusers. Among students who dropped out before high school graduation, those who used SBHCs dropped out approximately 1 semester later than those who did not use SBHC services. Overall, the researchers reported strong inverse relationships between SBHC use and dropout, particularly among youth at a higher relative risk for dropout (defined as attendance <90%, grade point average <2.5, free or reduced lunch status, being African American, or being Hispanic).

Based on their findings, the researchers concluded that SBHCs might lessen the achievement gap among high-risk students, who were more likely to use and benefit academically from SBHC use. They also concluded that SBHCs have a role in dropout prevention efforts. The authors stressed that their exclusion criteria could have removed students at a greater risk of dropout, and their findings may not be generalized to the entire student population. Also, their findings may be specific to an urban setting, and therefore may not be applicable to rural or suburban areas.