51 Mental Health Trajectories of Children and Caregivers who Accessed School-based Health Centres during the COVID-19 Pandemic

Abstract Background School-based health centres (SBHCs) improve health care access for students with mental health concerns, especially for disadvantaged communities who face access barriers. During the pandemic, health care access was restricted; however our SBHCs remained accessible. How SBHCs supported children’s and parents’/caregivers’ mental health during the pandemic is unclear. Objectives The primary objective of this study was to compare the trajectory of mental health symptoms in children who used SBHCs during the pandemic compared to those who did not. Design/Methods This was a prospective longitudinal cohort study of children who used SBHCs serving disadvantaged children with developmental and mental health conditions. A mental health survey which included the Strengths and Difficulties Questionnaire (SDQ) and the Generalized Anxiety Disorder-7 (GAD-7) was used at three time points during the pandemic for children registered with SBHCs. The primary analysis compared the trajectory of SDQ scores over time between children who accessed the SBHCs during the pandemic and those that did not. The secondary analysis was the same, using the GAD-7 scores for parents/caregivers. Results There were 435 children included in the study. The mean age was 10.7 years (SD=3.2). Two hundred and ninety-five children (67.8%) identified as male. One hundred and twenty-eight (29.4%) children had an annual family income of less than $30,000.00. After adjusting for age, gender, and diagnoses, children who attended SBHCs had higher SDQ scores over time relative to children who did not (0.15, 95% CI 0.03 to 0.28, p=0.02). Specifically, the total SDQ score increased by 0.14 (95% CI: 0.02, 0.27; p = 0.03) per month in those who accessed SBHCs during the pandemic, while the change in total SDQ score per month was -0.01 (95% CI: -0.06, 0.03; p = 0.55) in those who did not. Parents of children who attended SBHCs also had higher GAD-7 scores over time (0.16, 95% CI = 0.06 to 0.27, p = 0.002) compared with those whose children did not visit the SBHCs. Conclusion Mental health symptoms and anxiety symptoms worsened among children and parents/caregivers who attended a SBHC at least once during the pandemic. SBHCs may have decreased access barriers for children and parents/caregivers with socioeconomic risk factors who experienced mental health symptoms during the pandemic, when other healthcare options were limited. Longitudinal studies with longer follow up would help determine the role of SBHCs in supporting at-risk children and parents/caregivers with mental health needs during the pandemic.