School Based Health Centers and Academic Success

Background:  Recently, schools of social work are partnering with public school systems and community based hospitals to implement school based health and mental health centers.   School based health centers (SBHC) are designed to increase health and mental health care access for all youth regardless of age, race, income or insurance status. Approximately 30% of the enrollees use the SBHC as their medical home.  However, since the implementation of the No Child Left Behind, there has been increased pressure on schools to be accountable for demonstrating the impact of SBHCs on improving the learning environment and academic outcomes.   The literature suggests that both student health and the school learning environment influence academic performance.  Previous research has indicated a relationship between SBHCs and improved school connection and academic indicators, however the pathway remains unclear.  The purpose of this study is to test a theoretical path model using structural equation modeling.  The model suggests that SBHC usage is positively associated with attachment and bonding, which in are in turn associated with attendance, commitment to educational future , GPA and grade promotion. 

Methods: Approximately seven -hundred students from one elementary, one middle and one high school with SBHCs in the Bronx participated in a survey.  The survey included questions about health status and school connectedness.  The school connectedness questions had previously been used and validated.  Administrative data such as school attendance, grade promotion, and GPA was collected from school databases for each student participants.   Structural equation modeling was used to analyze the pathways from SBHC usage to GPA and grade promotion.

 Results: Findings indicate a good model fit.  The fit of the model was evaluated using the sample covariance matrix as input and a weighted least squares (WLS) solution.  The model is statistically overidentified.  A variety of indices of model fit were evaluated.  The overall chi-square was non-significant (X² = 5.97 (df=8); p=.65). The Root Mean Square Error of Approximation (RMSEA) was .00 with confidence interval ranging from .00 to .04.  Both the Comparative Fit Index (CFI) and the Tucker-Lewis Index (TLI) were greater than or equal to 1.0. The PCLOSE was .98. The indices uniformly point toward a good model fit.  According to the standardized estimates, the strongest pathways led from attachment to bonding and commitment (.62, .46). 

 Conclusions: The findings from this illustrate the pathway from SBHC usage to bonding and attachment.  It also shows that attachment significantly affects both bonding and commitment, which are in turn related to attendance, GPA and grade promotion. Social workers are trained to engage individuals, families and communities.  By providing services that help students feel more connected to school,  social workers acting as community health liaisons within SBHCs may not only affect school connectedness, but also affect overall academic performance of recipients.