School-based health center use by K-12 students dropped during early part of pandemic, but behavioral health need remained high

While school-based health centers saw monthly visits by Oregon K-12 students drop between the 2018-2019 and 2019-2020 school years due to pandemic-related school closures, they remained a vital health care access point for young people—particularly in the area of behavior health.

According to Oregon Health Authority’s 2021 Oregon School-Based Health Centers Status Report, overall school-based health center use fell from 130,586 visits in 2018–2019 to 121,144 visits in 2019–2020—a 7% decrease. But behavioral health visit and client counts slightly increased during that time, from 6,466 clients and 43,982 visits in 2018-2019 to 6,537 clients and 44,258 visits in 2019-2020.

“Overall use of school-based health centers went down due to the pandemic, but the need for their services remained high,” explained Rosalyn Liu, MPH, interim manager for Adolescent and School Health Program at the OHA Public Health Division. “Not surprisingly, much of that need was in behavioral health.”

Awareness of the effect school-based health centers have on student health and wellness has grown in the last decade, with the Affordable Care Act providing $200 million for 2010 through 2013 to support capital grants to improve and expand services at these centers. Oregon school-based health centers are located within schools or on school grounds, providing medical care, behavioral health services and, often, dental services. Because of these easily accessible services, school-aged youth have an equal opportunity to learn, grow and thrive.

As of July 1, 2020, Oregon had 78 certified school-based health centers in 25 counties. Seventy-six percent of them are federally qualified health centers, and 47% are state-recognized patient-centered primary care homes.

During the 2019–2020 service year (July 1, 2019-June 30, 2020), school-aged youth (5-21 years old) accounted for 74% of all visits. Of those:

  • 52% of visits were for primary care.
  • 46% of visits were for behavioral health.
  • 2% of visits were for dental health.
  • In 54 school-based health centers, more than half of the youth clients (53%) had Medicaid coverage.

In addition, 8% of all visits were via telehealth, and 97% of school-based health centers had a behavioral health provider on-site.

Behavioral health services, the report indicated, dropped drastically in April, May and June 2020—like physical health services—after schools closed in March 2020. But telehealth, or use of digital services such as videoconferencing applications, internet services and smart phones, helped fill the services void, according to interviews with Oregon school-based health center coordinators and staff. Although the ease of transitioning to telehealth varied across sites, it was particularly useful for continue providing high-quality behavioral health care to youth and was described, at times, as easier to implement in the behavioral health field than the physical health field.

Telehealth had its challenges, Liu said, but it ended up being an important tool for helping school-based health centers continue providing services during the pandemic.

“There was lag time in implementing telehealth services due to equipment needs or establishing policies, and workflow. Plus, many patients had limited or no internet or computer access, or lacked familiarity with technology,” she said. “When telehealth wasn’t possible, patients were allowed to have visits through their phones, and in one case, a center used a grant to purchase tablets for patients who had access to Wi-Fi services.”

Telehealth also helped ensure patients had access to services when transportation or mobility issues limited their ability to go to a clinic.

“Telehealth provided a solution to continue delivering high-quality care to youth,” Liu added.

This press release was provided by the Oregon Health Authority