Emergency department visits for mental and behavioral health disorders by students enrolled in a school-based health center.

Abstract

Introduction: The prevalence of mental and behavioral health disorders (MBHDs) in children is rising, along with the use of emergency departments (EDs) for care. School-based health centers (SBHCs) are accessible clinics that can provide integrated primary care and behavioral health services and are associated with decreased acute health care utilization. However, little is known about the relationship between SBHC enrollment and ED utilization for MBHD. We sought to describe ED utilization for MBHD among children enrolled in a comprehensive SBHC.

Method: Descriptive, cross-sectional analysis of Medicaid data for SBHC-enrolled students (SBHC users and nonusers) in Grades K-8, September 2015-August 2019, compared to propensity score-matched children not enrolled in the school. We calculated ED visit rates using 10th revision of the International Classification of Diseases codes for MBHD and ranked MBHD codes by percentage of encounters.

Results: A total of 1,173 SBHC-enrolled students (SBHC users: n = 816; SBHC nonusers: n = 357) and 2,594 controls were included. SBHC-enrolled students and controls were well matched (mean age = 10.7 years, SD = 3.5, 51% female, and 82.7% Black, non-Hispanic). ED visit rates with any code for MBHD differed between the subset of SBHC users (49.9 visits/1,000) and the controls (72.5/1,000). Depression was the top reason for primary presentations for MBHD among SBHC users versus attention-deficit/hyperactivity disorder for controls.

Discussion: ED visit rates for MBHD were lower among SBHC users compared to controls. SBHCs may prevent low-acuity ED visits for MBHD by leveraging an integrated approach to behavioral health in the education setting. (PsycInfo Database Record (c) 2025 APA, all rights reserved).