Differences Exist in Utilization of School Based Health Centers by School Semester and by Proportion of Low-Income Students.

Abstract

Background: School based health centers (SBHCs) are essential for providing health care to students. Literature demonstrates student characteristics such as race and income are associated with SBHC utilization; however, little data exists on temporal trends in utilization. This gap in knowledge is crucial for informing policies and resource allocation.

Methods: This study examined utilization across 27 SBHCs at elementary, middle, and high schools in King County, Seattle from 2017 to 2021. Negative binomial models with random intercepts were constructed to evaluate semester-level variation in utilization, accounting for school-level differences in race, income, and attendance. Interaction models were constructed to test for effect modification of utilization by race, income, and attendance.

Results: Findings indicate that higher rates of utilization occurred in the fall. There was a decrease in utilization during the study, potentially due to the pandemic. Lower school-level income was positively and significantly associated with higher utilization and none of the interaction models were significant.

Implications: Our study holds important implications for planning and policy recommendations surrounding SBHC care delivery, such as the potential need for more staffing to meet the higher demand in the fall.

Conclusion: SBHC utilization varies by semester and schools serving low-income communities may experience higher rates of utilization, requiring increased staffing needs.