School-Based Health Center Use for Mental and Behavioral Health Disorders Before and After the COVID-19 Pandemic: A Mixed-Methods Study.

Background: School-based health centers (SBHCs) provide accessible healthcare for children, but not all have dedicated mental health providers. The COVID-19 pandemic and school shutdowns were associated with worsened student mental health, but the impact on the utilization of SBHCs without mental health providers remains unclear. This study examines utilization before and after school shutdowns at one such SBHC.

Methods: Data are from a SBHC at a school serving 1600 K-8 students and includes electronic health records (EHR) and staff interviews. Visits between 2016 and 2023 (n = 6223) were characterized by whether the student had a mental and/or behavioral health diagnosis (MBHD) and whether the visit addressed a mental health concern. Negative binomial regression was used to compare visit rates, controlling for age, gender, and MBHD. Staff interviews (n = 9) were analyzed for emergent themes.

Results: The proportion of visits by students with a MBHD rose from 11.2% to 17.6% (p < 0.01) post-shutdowns. These students visited the SBHC more frequently than peers before (IRR 1.5 [1.25-1.94]) and after shutdowns (IRR 1.39 [1.14-1.69]). Qualitative findings underscored increased needs post-shutdowns.

Implications for school health policy, practice, and equity: Additional support for SBHCs includes expanded partnerships with teachers and mental health providers.

Conclusions: Students with MBHDs increasingly relied on their SBHC, emphasizing the link between physical and mental healthcare.