School Based Health Centers - An approach to address health disparities among rural youth.

ABSTRACT Low-income rural youth face economic and social factors that may negatively impact health, and challenges in accessing health care. School-Based Health Centers (SBHCs) are an innovative response to increase access, but their impact in rural communities is not well documented. This project proposes a multilevel mixed-methods evaluation of an SBHC network operating in 4 low-income rural counties in New York state. Run by the Bassett Healthcare Network, these SBHCs are permanent, on-site, year-round and attend to the full range of healthcare needs (physical, dental, mental, chronic and acute) at no out-of-pocket cost to patients. The setting permits a quasi-experimental design to assess SBHC impact by comparing 16 school districts with SBHCs and 22 school districts without. The project involves a multi-disciplinary team of Cornell University and Bassett researchers and community partners. The project will use both qualitative data (from semi-structured interviews and focus groups) and quantitative data (administrative data, survey, and patient healthcare visit data) and multilevel analytical methods to address three aims: Aim 1. Assess the impact of SBHCs on healthcare utilization. We will assemble a panel dataset of all patient visits to Bassett healthcare facilities over 12 years (2011-2022) to measure healthcare utilization (frequency, location, services) for preventive care (well-care, vaccinations) and care for acute and chronic conditions ( asthma, mental health) among children in school districts with and without SBHCs. Aim 2. Assess the impact of SBHCs on cross-agency collaboration. We will assess provision of social services in the 4-county study area through document research, focus groups, interviews with school and community leaders, and a survey of agency leaders. We will identify and measure factors that differentiate the level of cross agency collaboration among healthcare providers, community agencies, and local governments for each school district. Aim 3. Assess the impact of SBHCs and cross-agency collaboration on school performance and on community healthcare utilization. Combining data from multiple levels (patient, school district, and county) will enable us to assess the different roles SBHCs play in improving health. Community outcome measures include school attendance and broader community healthcare utilization. Study results will enhance understanding of how SBHCs may shape health outcomes and contribute to individual and community wellbeing to inform rural health policy.