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Principal Investigator: Melinda J Buntin
Organization: VANDERBILT UNIVERSITY
Fiscal Year: 2024
Award: $812,584
Funding agency: National Institute of Mental Health
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.
Terms: <0-11 years old><Access to Care><Address><Adolescent><Adolescent Youth><Affect><Affordable Care Act><Area><Black Box><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Child><Child Health><Child Mental Health><Child Youth><Children (0-21)><Communities><Counselor><Data><Data Reporting><Data Set><Dimensions><Disadvantaged><Documentation><Economics><Education><Educational aspects><Effectiveness><Equity><Evaluation><Face><Family><Funding><Health><Health Care Providers><Health Care Systems><Health Personnel><Health Services><Health Services Accessibility><Healthcare Providers><Healthcare Systems><Healthcare worker><Home><Immigrant><Inequity><Institution><Institutional Racism><Interview><Knowledge><Link><Low income><Medicaid><Medical><Mental Health><Mental Health Services><Mental Hygiene><Mental Hygiene Services><Methods><Modeling><Mothers><Obamacare><Outcome><Partnership Practice><Personal Satisfaction><Policies><Population><Professional counselor><Program Development><Psychological Health><Quasi-experiment><Quasi-experimental analysis><Quasi-experimental approach><Quasi-experimental design><Quasi-experimental methods><Quasi-experimental research><Quasi-experimental study><Quasi-experimental technique><Racial Group><Research><Research Methodology><Research Methods><Research Resources><Resources><Risk><Role><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><School Enrollments><School-Age Population><Schools><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Site Visit><Social isolation><Social support><Stress><Students><Subgroup><Supervision><Surgeon><Survey Instrument><Surveys><Systematic Racism><Systemic Racism><Tennessee><Testing><Time><Trauma><Youth><Youth 10-21><access disparities><access to health care><access to health services><access to healthcare><access to services><access to treatment><accessibility disparities><accessibility of health care><accessibility to health care><accessibility to health services><accessibility to healthcare><availability of services><behavioral health><care access><child mental health service><child poverty><children of color><classroom environment><college atmosphere><collegial atmosphere><collegiate atmosphere><coping><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><data representation><data representations><disparities in access><disparities in race><disparity due to race><economic><education atmosphere><educational atmosphere><educational environment><faces><facial><health care access><health care availability><health care personnel><health care service><health care service access><health care service availability><health care worker><health provider><health service access><health services availability><health workforce><healthcare access><healthcare accessibility><healthcare availability><healthcare personnel><healthcare service><healthcare service access><healthcare service availability><homes><improved><inequality due to race><inequality in access><inequity due to race><inequity in access><inequity in accessibility><innovate><innovation><innovative><intellectual atmosphere><juvenile><juvenile human><kids><learning atmosphere><learning environment><long-standing disparities><long-standing inequalities><long-standing inequities><m-Health><mHealth><marginalization><medical personnel><mental health care><mental healthcare><mobile health><multidisciplinary><neglect><operation><operations><pandemic><pandemic caused disruption><pandemic created disruption><pandemic disease><pandemic disruption><pandemic induced disruption><pandemic related disruption><prevent><preventing><programs><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial disparity><racial inequality><racial inequity><racial population><racial subgroup><racially unequal><research and methods><rural area><rural location><rural region><school age><school atmosphere><school based health center><school based health clinic><school climate><school health center><school health clinic><service availability><service delivery><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><social role><social support network><stressor><telehealth><theories><tool><training atmosphere><treatment access><treatment provider><under served community><underserved community><university atmosphere><well-being><wellbeing><youngster><youth of color>