Provision of School-Based Preventive Health Services to Improve Health and Education Outcomes Among School-age Children and Adolescents in Colorado

ABSTRACT Certain populations are more likely to face barriers to receipt of preventive health services in traditional medical settings. Specifically, residents of rural areas and households with lower socio-economic status are more likely to lack a primary care medical home, report logistical challenges accessing medical offices (e.g., lack of transportation, clinic hours, long wait times), and live in areas with poor access to primary care. Over the past few decades, School-Based Health Centers (SBHC) have been successfully used as a model of healthcare delivery to overcome some of these access barriers with many offering preventive health services as part of comprehensive primary care. Yet, only 13% of public school students in the United States had access to an SBHC in the 2016-17 school year, representing an opportunity to expand this care delivery model to reach more students in need. Because most SBHCs are located in urban and low-income communities, they are often assumed to improve health care access and outcomes. However, there have been few systematic investigations of the causal impacts of SBHCs’ preventive service delivery on health and education outcomes among school-aged children and adolescents. To fill this critical gap, this study will apply quasi-experimental methods, microsimulation modeling, and a modified positive deviance approach grounded in implementation science to examine the impact of SBHCs on health and education outcomes among school-aged children in Colorado. We aim to: (1) Describe SBHCs and the services they offered in Colorado from 2018-2024, their local context, and how SBHC and school populations changed over time; (2) Estimate causal impacts of SBHCs on health behaviors (e.g., substance use, self-reported mental health) and education outcomes (e.g., absenteeism) among school-aged children (5-17 years) from 2018-2024; (3) Simulate potential local- and state-level impacts of SBHCs on health and education outcomes in Colorado school-age populations; and (4) Qualitatively investigate contextual barriers to and facilitators of recent SBHC implementation in Colorado. Study findings will be immediately actionable for SBHC implementers and policymakers seeking to improve health outcomes and school attendance among children and adolescents.