A Multidisciplinary, Mixed Methods Analysis of the Implementation and Efficacy of School-Based Health Centers and Mechanisms through which SBHCs Improve Child Mental Health and Education Outcomes

项目总结 学校面临着日益增长的儿童心理健康需求，这些儿童因社会孤立而加剧， 新冠肺炎疫情期间，经济压力增加，社会监督减少。美国公众 学校是为儿童提供心理健康服务的最常见的机构切入点，并且以学校为基础 卫生中心(SBHC)日益成为弱势儿童的“医疗之家”。然而，还有一些 在我们对SBHC的有效性及其达到的程度的理解上存在重大差距 服务不足的儿童亚群。关于儿童心理健康的研究在很大程度上忽视了对儿童心理的研究 健康结果：很少有研究试图深入研究SBHC具有 改善儿童结局的潜力；我们缺乏关于SBHC有效性的纵向研究。我们会填满 这些研究中的关键差距并产生关于计划和政策杠杆的新的、可概括的知识 社区卫生保健中心可用于提高其效力，减少儿童健康和教育方面的不平等现象 结果。我们提议的研究的一个关键创新是我们使用了高质量的、联系在一起的健康和教育 包含田纳西州在以下任何时间点拥有医疗补助记录的儿童人口的数据集 时间在2006年至2019年之间，计划在2025年之前增加数据。我们的纵向数据很久以前就开始了 《平价医疗法案》资助了田纳西州SBHC的扩建，使之前有很长的基准期 绝大多数SBHC开业了。我们将采用严格的准实验方法，将 纵向数据，比较获得SBHC的学校和没有获得SBHC的学校的孩子 获得儿童健康中心提供的服务，并研究儿童健康中心对儿童心理健康的影响 教育结果，包括按有色人种儿童、移民儿童、居住在 农村地区，以及那些有特定健康状况的人。我们也会加深对 SBHC可通过以下方式改善儿童心理健康和教育成果的机制：1) 制定和测试以儿童为中心的概念框架，以深入审查组织和 实施SBHC以及限制或促进其有效性的因素；2)承诺 全面记录传统的校园内、与学校联系的、移动的 和远程保健SBHC，并填补我们对它们在农村地区和 通过移动/远程医疗选项，以及3)及时生成有关SBHC如何调整其 新冠肺炎大流行期间的服务提供方式以及儿童健康服务中断的程度 获得心理和行为健康服务的机会不成比例地影响到处境不利或服务不足的人 儿童的子组。我们将积极传播研究结果，以确保它们能为项目提供信息 战略、政策和评估工具，州和地方机构可以用来提高 为最需要精神卫生服务的儿童提供服务。

PROJECT SUMMARY Schools face rising mental health needs among children that have been exacerbated by social isolation, increased economic stress, and reduced societal supervision during the COVID-19 pandemic. U.S. public schools are the most common institutional entry point to mental health services for children, and school-based health centers (SBHCs) increasingly serve as a “medical home” for vulnerable children. Yet there are significant gaps in our understanding of SBHCs’ effectiveness and the extent to which they are reaching underserved subgroups of children. Research on SBHCs has largely neglected the study of children’s mental health outcomes; few studies have sought to study in-depth the mechanisms by which SBHC have the potential to improve children’s outcomes; and we lack longitudinal research on SBHC effectiveness. We will fill these critical gaps in research and generate new, generalizable knowledge on program and policy levers that SBHCs can deploy to increase their effectiveness and reduce inequities in children’s health and education outcomes. A key innovation of our proposed research is our use of a high-quality, linked health and education dataset that encompasses the population of children in Tennessee who have a Medicaid record at any point in time between 2006 and 2019, with the plan to add data through 2025. Our longitudinal data begin well before the Affordable Care Act-funded expansion of SBHCs in Tennessee, allowing for a long baseline period before the large majority of SBHCs opened. We will employ rigorous quasi-experimental methods with the linked longitudinal data to compare children in schools that gained access to a SBHC with those in schools without access to services provided by SBHCs and examine SBHC impacts on children’s mental health and educational outcomes, including by subgroups of children of color, children of immigrants, children living in rural areas, and those with specific health conditions. We will also advance our understanding of the mechanisms by which SBHCs may improve children’s mental health and education outcomes by: 1) elaborating and testing a child-centered conceptual framework for examining in-depth the organization and implementation of SBHCs and factors that constrain or enable their effectiveness; 2) undertaking a comprehensive documentation of the operations and services of traditional on-campus, school-linked, mobile, and telehealth SBHCs and filling gaps in our understanding of how they are operating in rural areas and through mobile/telehealth options, and 3) generating timely new information on how SBHCs adapted their service delivery approaches during the COVID-19 pandemic and the extent to which disruptions in children’s access to mental and behavioral health services disproportionately affected disadvantaged or underserved subgroups of children. We will actively disseminate the study findings to ensure that they inform program strategies, policies, and evaluation tools that state and local agencies can use to improve the efficacy of SBHCs in serving children most in need of mental health services.