Effect of a comprehensive school-based health center on academic growth in K-8th grade students

Objective School-based health centers (SBHCs) improve healthcare access, but associations with educational outcomes are mixed and limited for elementary and middle school students. We investigated whether students enrolled in a comprehensive SBHC demonstrated more growth in standardized math and reading assessments over four school years versus non-enrolled students. We also explored changes in absenteeism. Methods Participants were students enrolled in two co-located Title I schools from 2015-19 (1 elementary, 1 middle, n=2,480). Analysis of math and reading was limited to students with baseline and post-baseline scores (math n=1,622; reading n=1,607). Longitudinal regression models accounting for within-subject clustering were used to estimate the association of SBHC enrollment with academic scores and daily absenteeism, adjusting for grade, sex, body mass index category, health conditions, baseline outcomes (scores or absenteeism), and outcome pre-trends. Results More than 70% of SBHC-enrolled students had math (1,194 [73.6%]) and reading 1,186 [73.8%]) scores. Enrollees were more likely than non-enrollees to have asthma (39.7% vs 19.6%) and overweight/obesity (42.4% vs 33.6%). Adjusted baseline scores were significantly lower in math and reading for enrollees. Mean change from baseline for enrollees exceeded non-enrollees by 3.5 points (95% CI: 2.2, 4.8) in math and 2.1 points (95% CI: 0.9, 3.3) in reading. The adjusted rate of decrease in daily absenteeism was 10.8% greater for enrollees (IRR 0.772 [95% CI: 0.623, 0.956]) than non-enrollees (IRR 0.865 [95% CI: 0.696, 1.076]). Conclusion SBHC enrollees had greater health and educational risk but demonstrated more growth in math and reading and less absenteeism than non-enrollees. WHAT’S NEW Elementary and middle school students enrolled in a comprehensive school-based health center showed greater academic growth on a commonly used standardized assessment than non-enrolled peers, despite greater health and educational risk at baseline.