Comparing Frequent and Average Users of Elementary School-Based Health Centers in the Bronx, New York City. (Articles)

By Baquiran, Raymundo S.; Webber, Mayris P. et al. | Journal of School Health, April 2002 | Go to article overview

Comparing Frequent and Average Users of Elementary School-Based Health Centers in the Bronx, New York City. (Articles)


Baquiran, Raymundo S., Webber, Mayris P., Appel, David K., Journal of School Health


School-based health centers (SBHCs) represent one response to the expanding health needs and limited access to care experienced by financially disadvantaged children and adolescents. (1) New York State has the greatest number of SBHCs in the country, contributing 158 of the 1,157 reported nationally in 1998. (2) Within the state, 87% of the SBHCs are located in urban areas including New York City. (3)

SBHCs provide access to health care (4-7) for children and adolescents, and SBHCs are frequently the only source of regular care for children without medical coverage. Lack of health insurance is especially widespread in the Bronx, New York City, a borough where 31% of individuals live below the federal poverty level, and 30% are under 18 years old. (8) Equally notable is the effectiveness of SBHCs in reducing nonfinancial barriers to health care (9-12) like language, culture, education, and transportation. Recent studies also demonstrate SBHCs can reduce Medicaid costs. (13)

While elementary SBHCs account for one-third of all SBHCs in the country, and almost one-half of those in New York State, most published studies have been conducted in high schools.

For example, studies reported that frequent users of SBHCs among high school students were usually female (14,15) and that they made more mental health-related visits. (14) A previous study based in an elementary school setting described use of a new SBHC in Denver, Colo. (16) This study examined use of three well-established SBHCs in three large elementary schools in the Bronx, New York City (NYC). In addition, the study compares "frequent" and "average" service users by demographic characteristics and diagnostic categories, and discusses implications of these use patterns.

METHOD

Clinical Setting

Data for this study were collected from the three elementary schools in the Bronx, NYC, affiliated with the Montefiore School Health Program. About 92% of students in all three schools qualify for the free-lunch program. (17) During the school year under study, all schools were staffed by a health provider (either a nurse practitioner or general pediatrician), a clinical social worker (mental health provider), a licensed practical nurse (LPN), and an office assistant. All members of the health team work full-time in the clinic, which is open throughout the school year for at least eight hours per day.

All students enrolled in the school are eligible to register in the SBHC regardless of their insurance status, and no out-of-pocket payments are required for visits. Efforts are made to register students without any insurance so they can be provided a medical home. Cost of the service for these students is covered by the program. Parental consent is required to be seen and treated. Appointments are scheduled, but walk-in visits are accommodated. Children can self-refer or be referred by a parent, guardian, or teacher. The SBHC is the sole provider of health services in each school.

The Montefiore School-Based Health Centers provide a range of comprehensive primary care services including health care maintenance examinations, immunizations, screening tests, first aid for injuries and emergencies, diagnosis and treatment of acute and chronic medical problems, secondary and tertiary care referrals, and acute care. Mental health services include screening and risk assessment, individual patient therapy or counseling, and referral services.

Study Design

Data from encounter forms, completed primarily for reimbursement purposes, were analyzed for visits taking place between September 7, 1998 and June 30, 1999. The clinical or mental health provider who saw the child completed the forms. Variables studied include the child's age, gender, race/ethnicity, insurance status, primary diagnosis, and date of service or encounter.

Initial analyses compared characteristics of clinic users to characteristics of the total school population in the three schools. …

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