School-Based Health Center Use

As school-based health centers (SBHC) continue to grow, it is important to study their use.

1. the extent to which mental health problems exist in the students with access to the centers;
2. whether those students are using the available services;
3. if they are satisfied with the services; and
4. the reasons for nonuse.

The above issues were studied in an urban high school with a 2-year-old SBHC by administering questions during physical education classes. The 630 respondents were 45% male, 55% female; 61% black, 29% Hispanic; 54% in grades 9 or 10, 46% in grades 11 or 12. Sixty percent of the students were registered in the SBHC.

Seventy-five percent of registered students reported three or fewer visits; females were more likely than males to be frequent users of SBHC services (more than three visits). Mental health problems among all participants included depression in 31%, use of alcohol daily in 5%, suicidal ideation in 16% (history of a suicide attempt in 10%), and knowing someone who had been murdered in 50%.

Frequent users, average users, and nonusers did not differ by age, grade, race, or any of the measured mental health problems. Males were more likely to be in the nonuser category. Among the 472 students who completed the survey section on SHBC perceptions, 305 described health center use as follows: 92% were satisfied, 74% believed visits were kept confidential, 61% told their parents about each visit, and 51% considered the SBHC their regular health care source. The health center was used for mental health services by 34% and sexuality-related care by 15%.

The 167 students who described reasons for not using the SBHC most frequently reported that they already had a physician (60%), did not need it (50%), did not get around to it (30%), parents were opposed (20%), were not comfortable (19%), did not know about the service (19%), and did not want problems known (19%).

The authors concluded that, in this urban high school: (1) average users, frequent users, and nonusers did not differ in the mental health problems measured in this study; (2) those who used the SBHC indicated strong satisfaction with the care received; and (3) those who did not use the SBHC chose to stay away for a variety of reasons, most commonly the availability of other care or the perception of lack of need.

(Pastore D. School-based health center utilization. Arch Pediatr Adolesc Med 1998; 152:763-767)

COMMENT: The most disturbing finding in this study is the fact that half of the subjects knew someone who had been murdered. Although the venue was New York City, it still sends cold chills up my spine and makes me wonder how far behind that figure the rest of us are.