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

对校本健康中心和 SBHC 改善儿童心理健康和教育成果的机制的实施和效果进行多学科、混合方法分析

• 批准号: 10636247
• 负责人: MELINDA J BUNTIN
• 金额: $ 82.8万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10636247
• 关键词: Address; Adolescent; Affect; Affordable Care Act; Area; COVID-19 pandemic; Child; Child Health; Child Mental Health; Communities; Data; Data Reporting; Data Set; Dimensions; Disadvantaged; Documentation; Economics; Education; Effectiveness; Equity; Evaluation; Face; Family; Funding; Health; Health Personnel; Health Services; Health Services Accessibility; Healthcare Systems; Home; Immigrant; Inequity; Institution; Institutional Racism; Interview; Knowledge; Link; Low income; Medicaid; Medical; Mental Health; Mental Health Services; Methods; Modeling; Mothers; Outcome; Partnership Practice; Personal Satisfaction; Policies; Population; Professional counselor; Program Development; Quasi-experiment; Research; Research Methodology; Resources; Risk; Role; School Enrollments; School-Age Population; Schools; Services; Site Visit; Social isolation; Social support; Stress; Students; Subgroup; Supervision; Surgeon; Surveys; Tennessee; Testing; Time; Trauma; Youth; access disparities; behavioral health; child mental health service; child poverty; children of color; coping; educational atmosphere; health care availability; health care service; improved; innovation; long-standing disparities; mHealth; marginalization; multidisciplinary; neglect; operation; pandemic disease; prevent; programs; racial disparity; racial population; rural area; school based health center; service delivery; stressor; telehealth; theories; tool; underserved community

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.

项目概要 学校面临着儿童日益增长的心理健康需求，而社会孤立加剧了这种需求， COVID-19 大流行期间，美国公众的经济压力增加，社会监督减少。 学校是儿童心理健康服务最常见的机构切入点，并且以学校为基础 健康中心（SBHC）越来越多地充当弱势儿童的“医疗之家”。 我们对 SBHC 的有效性及其所达到的程度的理解存在重大差距 对 SBHC 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 的机制。 改善儿童结局的潜力；并且我们缺乏对 SBHC 有效性的纵向研究。 研究中的这些关键差距并产生了有关计划和政策杠杆的新的、可推广的知识， SBHC 可以部署以提高其有效性并减少儿童健康和教育方面的不平等 我们提出的研究的一个关键创新是我们使用高质量的、相互关联的健康和教育。 数据集包含田纳西州在任何时间点拥有医疗补助记录的儿童人口 时间范围为 2006 年至 2019 年，计划在 2025 年之前添加数据。我们的纵向数据早在 平价医疗法案资助田纳西州 SBHC 的扩张，允许在之前有一个较长的基线期 绝大多数SBHC的开业，我们将采用严格的准实验方法进行链接。 用于比较获得 SBHC 的学校的儿童与没有获得 SBHC 的学校的儿童的纵向数据 获得 SBHC 提供的服务并检查 SBHC 对儿童心理健康的影响 教育成果，包括有色人种儿童、移民儿童、生活在 我们还将加深对农村地区和有特殊健康状况的人的了解。 SBHC 可通过以下方式改善儿童的心理健康和教育成果：1) 阐述和测试以儿童为中心的概念框架，以深入审查组织和 SBHC 的实施以及限制或促进其有效性的因素 2) 采取 全面记录传统校内、校内、移动、 和远程医疗 SBHC，并填补我们对其在农村地区运作方式的理解空白 通过移动/远程医疗选项，以及 3) 及时生成有关 SBHC 如何调整其策略的新信息 COVID-19 大流行期间的服务提供方法以及对儿童的干扰程度 弱势群体或服务不足者在获得精神和行为健康服务方面受到的影响尤为严重 我们将积极传播研究结果，以确保它们为计划提供信息。 国家和地方机构可以用来提高效率的战略、政策和评估工具 SBHC 为最需要心理健康服务的儿童提供服务。