Impacts of School-based Health Centers on Health Care Access and Health Outcomes for Children Living with Disabilities

About This Grant

PROJECT SUMMARY Access to quality health care is a persistent public health challenge for children living with disabilities (CWD) and contributes to elevated rates of poor physical and mental health, especially for CWD who live in low- income households, live in rural areas, or are Black or Hispanic. School-based health centers (SBHCs) are a promising health care delivery intervention for children and families that provide primary care and other preventive services at no or reduced costs and on or near school grounds, thereby overcoming financial and transportation barriers to care. Prior studies suggest that SBHCs improve health care access and health and academic outcomes but benefits to CWD have not been examined. This proposed study will address this gap using a sequential explanatory mixed methods design to examine the impacts of SBHCs on outcomes among CWD in California and Oregon, states with longstanding SBHC programs and diverging approaches to SBHCs. Using multiple years of health insurance claims data and survey data, we will: (Aim 1) characterize access to and use of SBHCs and (Aim 2) estimate SBHC impacts on health care utilization and health outcomes among CWD (overall and by impairment type) and examine differences by income, urbanicity, and race and ethnicity. Using in-depth interviews with CWD, parents of CWD, and clinicians at SBHCs (Aim 3), we will elicit stakeholder perspectives on the perceived barriers and facilitators to SBHC utilization among CWD. The proposed research is timely and important due to the rapid expansion of SBHCs (128% increase between 1998 and 2017) and recent increases in funding to support SBHCs ($25 million increase between Fiscal Years 2021 and 2022). Elucidating whether and how CWD benefit from SBHC access and use is critical to understanding whether continued expansion and funding will contribute to (or exacerbate) health care access barriers and poor health in CWD.