The role of school health services in reducing health and educational disparities: examining usage rates of student health services in the Seattle School District

Abstract

As public schools become increasingly populated by immigrant children, poor children, and children of color, determining how school health services may contribute to health status and subsequent academic achievement should be explored and analyzed.In an effort to contribute to this knowledge, this mixed-method study enumerates, describes, and analyzes individual-level school health usage rates of middle and high school students in Seattle Public Schools (SPS). Quantitative data included 51,767 student encounters with school nurses, and 35,971 encounters with school-based health providers. The data sets were disaggregated by race, poverty, ethnicity, and immigration status to determine whether such variables may be associated with increased use of school health services. Qualitative data was obtained through surveys completed by school nurses, and by a focus group. These data helped to interpret the quantitative findings.Findings revealed that poverty was heavily associated with increased use of school health services. African American, Hispanic, immigrant, and some subpopulations of Asian students had the highest rates of visits to both types of school health providers. The study also revealed that school nurses saw far more children than did school-based health center (SBHC) providers. Primary reasons for visiting school nurses were for physical health, and the top reasons for visiting a SBHC were for mental or reproductive health. Because this study shows that many children who seek health services in higher amounts are the same ones who are at academic risk, better collaboration between school health and educational systems may be warranted.