326 - Changing Landscape of School-Based Health Centers in California, 2011-2023

Laura J. Faherty, Maine Medical Center/RAND, Cape Elizabeth, ME, United States; Ashley M. Kranz, RAND, Arlington, VA, United States; Jessica V. Richard, Rand Corporation, Arlington, VA, United States; Catria Gadwah-Meaden, Pardee RAND Graduate School; RAND Corporation, Boston, MA, United States; Christine Mulhern, RAND, Santa Monica, CA, United States

Background: School-based health centers (SBHCs), which provide primary care such as screenings and reproductive services, reduce access barriers. They typically are located in underserved communities and are associated with improved utilization and outcomes in disadvantaged populations. Recently, new policies and funding streams have enabled SBHCs to open in California (CA); other factors have led to SBHC closures. This changing landscape of CA SBHCs has not been studied.

Objective: To examine, for 2011-2023, (1) school- and community-level characteristics associated with CA schools having access to a SBHC; (2) characteristics associated with schools gaining or losing SBHC access; (3) changes in SBHC services offered.

Design/Methods: We use national data on school and community characteristics and data from the CA School Based Health Alliance on SBHC locations and services from 2011 and 2023. Our sample consists of 278 SBHCs located on school grounds, or off-site but linked to a school, serving 9,448 schools. T-tests compare differences in means between schools with and without a SBHC and schools that gained or lost SBHC access.

Results: Three percent of CA schools had access to a SBHC at any point during the study period. They were more likely to be high schools, to be in cities, and to enroll larger shares of students of color and students receiving free/reduced price lunch (Table 1). Of SBHCs in our sample, 31% newly opened and 7% closed. There were 30 more SBHCs in California in 2011 than 2023. Compared to SBHCs that closed, those that opened served larger schools, (by 412 students on average, P=0.02), were less likely to serve elementary schools (75% vs. 36%, P=0.02), and otherwise served schools with similar sociodemographic characteristics (Table 1). The share of SBHCs that offered medical services decreased (83% in 2011-2013; 76% in 2020-2023). The share that offered mental health services and dental services increased by 14 and 48 percentage points, respectively. The share of SBHCs that offered reproductive services increased in 2014-2016 to 74% but dropped to its pre-2014 level (around 60%) in 2017-2019 (Figure 1).

Conclusion(s): CA schools had access to 30 more SBHCs in 2011 than in 2023, and these new SBHCs were more likely to serve high schools and larger schools. While more SBHCs offered mental health and dental services, the share that provided medical care declined. Since 2014-2016, the share of SBHCs providing reproductive services declined.

Table 1: Characteristics of California schools and communities with and without a school-based health center (SBHC) and with a SBHC that newly opened or closed, 2011 and 2023


Figure 1: Percentage of California school-based health centers that provided medical services, mental health services, dental services, and reproductive health services for four time periods from 2011-2013 to 2020-2023