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Background:

Children experiencing homelessness are at an increased risk for adverse health and academic outcomes. School-based health centers (SBHC) may improve outcomes for this population, but it is unknown whether students experiencing homelessness use SBHCs, or how school attendance might impact this relationship. This study addresses this gap by analyzing student housing status, school attendance, and SBHC use in a large urban school district.

Objective: 

The objective of the study is to determine associations among housing status, school attendance, and SBHC utilization in children. 

Methods: 

This analysis utilized the Data xChange from The Los Angeles Trust for Children’s Health which links demographic, school, and healthcare utilization data for each child in a large urban school district from 2015 to 2024 (n=425,383).

The primary exposure was homelessness as determined by an annual school district assessment asking parents to report whether their child was currently (i.e., at the beginning of the school year or time of enrollment) living in temporary shelter or places not ordinarily used as a regular sleeping accommodation. Students were categorized as “ever homeless” if they answered yes at least once between 2015-2024 and “never homeless” if they answered no every year between 2015 and 2024. Chi square and t-tests compared demographic characteristics, absenteeism and SBHC utilization by housing status. Logistic regressions tested whether housing status was associated with SBHC use and chronic absenteeism adjusting for grade, gender, race/ethnicity, and foster status.

Results: 

Students currently experiencing homelessness made up 3.4% (n=16,143) of the study population and an additional 3.4% (n=14,424) previously experienced homelessness. The adjusted prevalence of SBHC use was significantly higher in students who had ever experienced homelessness (6.8%) than in their never homeless peers (4.9%, p<0.001). Similarly, adjusted prevalence of SBHC behavioral health use was significantly higher in students who had ever experienced homelessness (12.3%) than their never homeless peers (7.4%, p<0.001). Preliminary analysis of students who visited SBHCs shows prevalence of obesity, overweight, asthma, ADD, anxiety, substance use and well child checks to be similar among students who had ever experienced homelessness and their never homeless peers. More students who had ever experienced homelessness had a mental health related (16.9%), PTSD (5.0%), depression (5.3%), STI (0.8%), or chlamydia (0.6%) diagnosis than their housed peers (12.8%, 2.4%, 4.0%, 0.3% and 0.22% respectively, p<0.05 for all). 

The adjusted prevalence of chronic absenteeism was significantly higher in students currently (41.4%) and previously (35.3%) experiencing homelessness compared to their never homeless peers (24.1%, p<0.001 for all). Homelessness remained significantly associated with chronic absenteeism and SBHC use, even after controlling for demographic characteristics.

Conclusions: 

Students who have experienced homelessness were more likely to be chronically absent and utilize SBHCs than their never homeless peers. SBHCs may be a useful touchpoint to improve health equity for this vulnerable population.