School clinics have improved health equity but reach only a small number of students, research shows

School-based health centers (SBHCs) are clinics located in or near public schools to provide convenient health care to students. What started as three clinics in three states half a century ago, growing into a network of more than 2,500 SBHCs serving more than 6.3 million students in 48 states and Washington, D.C.

Despite this growth, they still only serve a small portion of the country 59 million students from public schools. In addition, they still offer a relatively limited number of services, even though these services have expanded beyond primary care and typically include preventive health, behavioral health, oral health, and reproductive health services.

Although those who use SBHCs are very satisfied With regard to the services provided, little is known so far about the public’s general perceptions of SBHCs—perceptions that could have major implications for the future of SBHCs.

To fill this gap, Simon F. Haeder, Ph.D., and Daniel Marthey, Ph.D., both from the Department of Health Policy & Management at Texas A&M University School of Public Health, along with a colleague from Ohio University, asked more than 4,000 adults in the United States for their opinions on seven common health care services offered in public schools: primary care, preventive care, immunizations, preventive dental care, preventive eye care, mental health care, and nutritional counseling.

The study was published in the Journal of School Health. It follows Haeder and Marthey’s other recent work published in the news Contraception that specifically focused on reproductive health services.

“Previous research clearly shows that SBHCs increase access to health care and health education, including mental health care, and that these benefits can also lead to increased school attendance, higher grades and lower dropout rates,” Haeder said. “But these centers have also been controversial from the start.”

Haeder said the controversy stems primarily from the provision of reproductive health care services and, to a lesser extent, from perceived infringement of parental rights, disruption of the educational mission and paternalism.

“We sought to determine not only the level of broad public support for SBHC services, but also the characteristics that might predict the level of support or opposition to specific services that SBHCs typically provide,” Haeder said. “These findings could support efforts to improve access to health care for school-aged children.”

After collecting demographic data from the 4,196 respondents, the researchers asked respondents about their general attitudes toward school health centers, asking questions such as, “Do you think it is appropriate or inappropriate for schools to operate these school health centers?” school grounds?” The researchers used t-tests and weighted linear regression models to compile and analyze the results.

“We found that the public overwhelmingly supports SBHCs, in broad terms and also for the specific services they typically provide,” Marthey said.

More than three in four respondents supported the provision of all seven health care services covered in the survey, with an average of 81.1% “probably” or “definitely” supporting SBHC services. Support among parents of minor children was higher than among the total sample.

Nutritional advice received the most support (89.2% “probably yes” or “definitely yes”), followed by preventive eye care (87%), mental health care (83.6%), preventive care (80.9%), primary care ( 78% ), preventive dental care (75%) and, finally, vaccination services (72.5%).

“The relative lack of support for vaccination services reflects the current controversy over this issue, yet support for vaccination services has been extremely high,” Marthey said.

Additionally, the study found consistent associations for trust in school principals. Women tended to be more supportive of SBHC services than men, except in the area of ​​vaccinations, where no difference was found. Parents of minor children were more supportive than others.

Urban respondents were more supportive than suburban respondents in all areas except preventive care and mental health care, and rural respondents were the least supportive in this category. Those with liberal political views expressed the most support, followed by moderates and conservatives. There were major political differences, especially in the field of vaccinations.

“This broad support indicates that increasing knowledge about SBHCs and providing stable funding for them should be priorities for policymakers, health care providers and other stakeholders,” Haeder said.