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Primary Submission Category: Mental health/function
School-based health centers, community services, and youth mental health in rural communities
Authors: Xue Zhang, Mildred Warner,
Presenting Author: Xue Zhang*
Research question: How are school-based health centers (SBHC) and community services associated with youth mental health in rural communities?
Significance: Rural youth face growing mental health challenges and limited access to health and social services. Schools can function as community hubs to address these gaps, and SBHCs have emerged as a strategy to expand access to care. However, little is known about how SBHC access and community services jointly shape youth mental health. Understanding these relationships can inform cross-sector strategies among educators, health providers, and community organizations.
Data and methods: We linked electronic health record data from 2024 with a school survey across 38 school districts in a four-county rural region of New York State. Outcomes include whether students had mental health-related visits (bipolar disorder, anxiety, depression, suicide-related conditions, or substance use disorders) and, among those students, whether these visits occurred in emergency departments. Key exposures include SBHC access and the availability of services promoting social engagement (e.g., after-school programs) and basic needs (e.g., food pantries). We ran logistic regressions adjusting for age, sex, Medicaid coverage, social determinants of health (SDOH) diagnoses, and behavioral health provider visits.
Preliminary results: Among 16,636 students aged 5-18, 54% had access to a SBHC. SBHC access was associated with a lower likelihood of mental health visits, after adjusting for behavioral health provider visits. Mental health visits were more likely among female students and students with Medicaid coverage, older age, and SDOH-related diagnoses. Districts with more social engagement services were associated with lower probabilities of both mental health visits and emergency department visits. The findings highlight the role of SBHCs and coordinated school and community services in improving youth mental health in rural communities.