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On-site health clinics boost attendance in rural classrooms

Students miss less class time in rural upstate New York schools that host comprehensive health clinics, according to Cornell University research that is the first to confirm such benefits in rural areas. The work is also informing a legislative proposal to expand access to these clinics.
Analyzing more than 66,000 students in a four-county region over four years, the researchers found that children on average were 15% less likely to be at risk of chronic absenteeism in districts with school-based health centers (SBHCs) that can treat them onsite, run by a nonprofit hospital system, compared to those in districts without clinics.
The impact was strongest among elementary students, who are more likely to miss school if an adult must keep them home or remove them to see a doctor. Accessing quality health care is often more challenging in rural areas, the researchers said, where distances to health care may be longer, public transit is more limited and health care professionals are scarcer.
“These students tend to miss fewer classes and fewer days of school when there’s a clinic in the building,” said John Sipple, professor of global development. “Rather than the school nurse calling a parent to pick up their child, the child can be treated right in the school and often can go back to class.”
Sipple led the data analysis reported in “School-Based Health Centers and School Attendance in Rural Areas,” published in JAMA Network Open.
The research is part of a larger initiative investigating health disparities among rural youth via a $3 million National Institutes of Health grant.
School-based health centers have primarily been studied in urban areas. Sipple said the four adjacent counties studied – Chenango, Delaware, Otsego and Schoharie – provided a natural experimental sample of very similar districts except for school-based clinic access. All 52 schools spanning 32 districts were relatively small, with mostly white and lower-income student populations; but 18 schools (in 14 districts) housed Bassett clinics providing physical, mental and dental health services. The study data tracked more than 30,000 students in schools with clinics and 36,000 in schools without them, from 2015-2019.
In previously published research investigating the same region, the team found that students enrolled in schools with clinics also received more medical care, including more preventative treatment for asthma, and relied less on emergency room visits. Recognizing the clinics’ benefits to rural families, the Brooks School’s State Policy Advocacy Clinic has helped draft legislation proposing to expand their access to the younger siblings of enrolled students. Sipple said policies should facilitate opening more school-based clinics, easing funding and staffing issues.
“Expanding the number of school-based health centers should be a priority to enhance the well-being of urban and rural communities,” Sipple said.