The LA Trust Impact Report 2024

The Impact Report

Highlighting School-Based Health Centers and Wellness Centers at LAUSD

2024

Table of Contents INTRODUCTION Title page Contents page Message from the Executive Director The Los Angeles Trust for Children’s Health Vision

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WELLNESS CENTER AND SCHOOL-BASED HEALTH CENTER DATA Overall Reach Wellness Center and School-Based Health Center Directory Demographics

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Dental Health

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Preventive Primary Care and Diagnoses

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Top Medical Diagnoses

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Increases in Care

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Mental Health

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Recommendations

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Increased Dental Services and Preventive Care Student Utilization of Wellness Centers for Well-Child Exams and Vaccinations Linking Overweight, Obesity, Asthma, and Mental Health to Chronic Absenteeism Surge in Well-Child Exams and Contraception Management for Youth Impact on Chronic Absenteeism and Academic Performance

ACKNOWLEDGMENTS Funders and Expert Advisory Council Members Clinic Partners 2

The Impact of School-Based Health Centers, The Los Angeles Trust for Children’s Health, 2024

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Executive Director Message Maryjane Puffer I’m excited to share the outcomes of our recent data report highlighting the impact of Wellness Centers and School-Based Health Centers (SBHCs) throughout L.A. Unified during the 2022-2023 school year.

Our findings from the participation of 14 Wellness Centers and 3 SBHCs in the Data xChange initiative during the last academic year reveal the significant benefits these centers bring to students and their families.

Almost 50,000 patients were cared for through over 160,000 visits, an average of 3.2 visits per patient. This tells us that the centers serve as a primary source of care for many. Notably, 35% of these patients accessed a blend of medical, dental, and mental health services, underlining the comprehensive nature of the care provided.

The data also draws attention to the link between chronic absenteeism and health problems like obesity, asthma, and mental health disorders. By tackling these health challenges, we aim to reduce absenteeism and boost academic achievement. The increase in access to care, especially the rise in well-child exams and contraception management visits, not only fosters better health outcomes but also lessens the strain on emergency healthcare services.

This report underscores the importance of our work in navigating the intricacies A remarkable uptake was seen in dental of student health and education. services, with over 12,000 patients receiving Comprehensive, accessible healthcare care through almost 34,000 visits. Half services help make strides in meeting of the student-age patient dental visits immediate health needs and building a included preventive care. Similarly, over foundation for a healthier, brighter future half of the student-age patients received for our students. This report shows the preventive primary care services, such as impact of our collective efforts to support well-child exams and vaccinations, essential the health and success of every student in for sustained health and wellness. The Los Angeles. Your continued support of our report also highlights the readily accessible mission is greatly appreciated. mental health support available at LAUSD’s school-based health centers.

The Impact of School-Based Health Centers, The Los Angeles Trust for Children’s Health, 2024

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Impact of School-Based Health Centers in 2022-2023 The vision of The Los Angeles Trust for Children’s Health (The L.A. Trust) is that every student is healthy and successful.

The L.A. Trust provides support to the Los Angeles Unified School District (LAUSD) Wellness Centers that were developed to serve the areas of highest need. These Wellness Centers enhance the availability of medical, dental, and mental health services by providing them in convenient oncampus locations for children and families, consequently lowering rates of school

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absenteeism. This provides students with more opportunities to learn and succeed in school. The following data shows the impact on students and families of the 14 Wellness Centers and 3 School-Based Health Centers (SBHCs) that participated in the Data xChange during the 2022-2023 school year. Through the Data xChange, clinic data is matched with LAUSD academic data to show the links between health and academic outcomes, including attendance and grades.

The Impact of School-Based Health Centers, The Los Angeles Trust for Children’s Health, 2024

Overall Reach During the 2022-2023 school year, Wellness Centers and SBHCs provided care to 49,486 patients through 160,110 visits. Patients visited 3.2 times on average and almost 2/3 of patients had two or more visits, evidence that SBHCs are their regular source of care.

Patients can receive integrated care services through the Wellness Centers and SBHCs. While most (65%) received medical care only, 35% received a combination of care services that included medical, dental, and mental health. Patients who received dental or mental health services also came in for medical care.

49,486 Patients 160,110 Visits 3.2 Average Visits

The Impact of School-Based Health Centers, The Los Angeles Trust for Children’s Health, 2024

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Wellness Centers and School-Based Health Centers Directory

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Crenshaw High School WC* 15.

Manual Arts High School WC* 16.

Hyde Park WC* 17.

Washington Prep WC* Belmont High School WC 18.

Garfield High School WC* Santee Educational Complex WC* 19.

Hollywood High School WC* 20.

Elizabeth Learning Center WC* Gage WC Jefferson High School WC* Maywood Center for Enriched Studies WC* Maclay Health Center for Children WC* Monroe High School WC

Carson High School WC* Fremont High School WC* Jordan High School WC (Reopening 2024)** Locke Early Education WC (Reopened 2024)** Sylvia Mendez WC* Roosevelt High School WC (Opened 2024) *WC & SBHC data included in report.

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Metropolitan High School SBHC** San Pedro Elementary** Lincoln High School SBHC* Nevin Elementary School Dental Clinic** Wadsworth Avenue Elementary** San Fernando High School Teen Health Center* Sun Valley Health Center* Los Angeles High School SBHC**

**Participate in the Data xChange but did not send data in 2022-23 because they had not reopened.

The Impact of School-Based Health Centers, The Los Angeles Trust for Children’s Health, 2024

Demographics Wellness Centers serve students, their families, and the community. Latines (68%) continue to make up the largest proportion of patients. About 60% of all patients were female. Slightly more than half (52%) of student-age patients seen were 14-19 years old.

The Impact of School-Based Health Centers, The Los Angeles Trust for Children’s Health, 2024

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Dental Seven Wellness Centers and three SBHCs provided dental services to 12,434 patients through 33,959 visits. Patients visited 2.7 times on average; about 60% of patients had two or more visits. There was a 19% increase in dental services provided to all patients and a 7% increase among student-age patients. Half of the student-age patient visits (50%) included preventive care services. The chart compares the total number of patients ages 6-19 who had a dental visit to the number who received an initial comprehensive exam and periodic exam. The number of 6–19-year-old patients who went for a dental visit and the number who received an initial comprehensive exam remained the same across the two years. The increase in periodic exams showed an increase in the number of patients returning for regular exams.

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The Impact of School-Based Health Centers, The Los Angeles Trust for Children’s Health, 2024

Preventive Primary Care and Diagnoses

Student-age patients visited the Wellness Centers 2.7 times on average. More than half (58%) visited two or more times a year, indicating that the Wellness Centers are likely their primary source of care. Most student-age patients visited the Wellness Centers for preventive care services including well-child exams and vaccines. More than half of patients ages 6-19 (53%) and patients ages 0-5 (58%) received an annual well-child exam. About 15% of 6-19-year-olds and 19% of 0-5-year-olds received the flu vaccine. Close to half (46%) of patients under 5 and 12% of patients 6-19 received childhood immunizations.

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The Impact of School-Based Health Centers, The Los Angeles Trust for Children’s Health, 2024

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Top Medical Diagnoses Overweight or obesity (35%) and asthma (5%) were the most common medical diagnoses and co-occurred among student-age patients. The rates of overweight and obesity have continued to rise, increasing from 30% in 2021-22 to 35% in 2022-23. Most student-age patients who were overweight or obese received a well-child exam (69%). These exams are critical to identify and monitor children’s physical and mental health needs. About 6% of student-age patients who were overweight or obese have asthma, while 44% of student-age patients with asthma are overweight or obese.

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The Impact of School-Based Health Centers, The Los Angeles Trust for Children’s Health, 2024

Mental health diagnoses among 6–19-year-old patients

About 18% of 6–19-year-old patients who were overweight or obese had a mental health diagnosis compared to 8% of all patients ages 6–19 who had a mental health diagnosis. A mental health diagnosis included depression, anxiety, attention deficit disorders, and others. About 31% of LAUSD students who visited a Wellness Center were diagnosed with being overweight or obese. About 75% of these students were chronically absent, missing on average of 21.3 days of school in 2022-23. This is much greater than LAUSD’s 2022-23 absenteeism of 37% reported on the LAUSD data dashboard, Open Data where chronic absenteeism is defined as missing 15 days or more.1 Chronic absenteeism has increased locally and nationally. While several factors are linked to absenteeism, health can be one factor contributing to absenteeism. Connecting students to care at the Wellness Centers can help improve health and academic outcomes.

The Impact of School-Based Health Centers, The Los Angeles Trust for Children’s Health, 2024

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Increases in Care

Over half of 0 to 21-year-olds (55%) received well-child exams — up from 45% last year. Regular well-child exams can lead to better health outcomes, fewer hospitalizations, and emergency room visits.

Last year, The L.A. Trust reported a decrease in contraception management visits for all patients when comparing data from 2018-19 to 2021-22. Data from 2022-23 shows 12% of 14-19-year-olds received contraception management care. This increased by a rate of 18% among high school-age patients.

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The Impact of School-Based Health Centers, The Los Angeles Trust for Children’s Health, 2024

Mental Health

The proportion of 6–19-year-old patients diagnosed with anxiety, including post traumatic stress disorder (PTSD) (3%) or depression (2%) has remained the same over the last couple of years. Depression is comorbid with anxiety/PTSD. About 14% of patients aged 6–19 who were diagnosed with anxiety/PTSD were also diagnosed with depression.

The prevalence of anxiety and depression was somewhat higher among LAUSD students who visited a Wellness Center or a mental health agency partner in 2022-23.

Of LAUSD students who visited a Wellness Center, 5% of students were diagnosed with anxiety and 6% were diagnosed with depression. Students with these diagnoses had among the lowest attendance rates compared to other students. About 83% of students with an anxiety diagnosis were chronically absent missing an average of 31.9 days of school. Similarly, 91% of students diagnosed with depression were chronically absent, missing an average of 31.6 days of school. The rates of absenteeism were similar among males and females, However, more females were diagnosed with anxiety (68%) or depression (73%) than males.

The Impact of School-Based Health Centers, The Los Angeles Trust for Children’s Health, 2024

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LAUSD students diagnosed with depression or anxiety had among the lowest weighted grade point averages (GPAs) at 2.2 and 2.3 respectively. Their average GPAs were lower than the overall average of all students (2.8). The chart shows the average GPA by age with the size of the bubbles representing the number of students diagnosed with anxiety.

Among students diagnosed with anxiety, GPA decreased and was at the lowest for 15-year-old students and increased among the older age group. The same trend was true for students diagnosed with depression. The 15-year-old students diagnosed with depression had the lowest GPA (2.0) and GPA increased slightly as students got older. This trend was not observed across the previous year. However, the GPA for students with depression or anxiety was consistently low across all years.

The link between chronic absenteeism and lower GPA to depression and anxiety highlights the importance of reaching out and supporting students with mental health and other health needs. This data provides a snapshot of students with mental health diagnoses, however, a recent study that included multiple years of data pre-COVID showed that an initial visit to a Wellness Center for a mental health concern improved students’ attendance over time.2 When students get the health care and mental health care they need, they are more likely to attend and succeed in school and graduate from high school.

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The Impact of School-Based Health Centers, The Los Angeles Trust for Children’s Health, 2024

Recommendations for School-Based Health Integration Based on the Data

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Integrating primary care, dental, and mental health services supports whole-child wellness. Clinics may need to change protocols in order for patients to receive integrated primary care, oral health, and behavioral screenings. Whole person care practice is in line with California Advancing and Innovating Medi-Cal (CALAIM) reforms.

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With the continued rise in obesity among children (25% in 2021, 30% in 2022, and 35% in 2023), engage in more partnerships with community organizations and school programs to promote healthy eating and active living interventions.

Consider replacing soda, energy drinks, and sugary beverages from the school vending machines with more nutritious drinks and remove unhealthy snacks.

Consider adopting practices from The Alliance for a Healthier Generation.3

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The prevalence of co-occurring health and mental health conditions among students demonstrates that regular screenings for health and mental health concerns are critical. An initial visit can lead to better health and academic outcomes and improve attendance.4 Best practices for screening include having reminders in patient records to screen for depression, chlamydia and risk assessments. etc.

Chronic absenteeism may be related to physical health, mental health, or social factors. Addressing these needs can help improve attendance and academic achievement. Work with school administrators and mental health counselors to identify and refer students who may benefit from care at the Wellness Centers.

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Develop and distribute detailed report cards to students, parents, clinic managers, and throughout school site to raise awareness of the available health resources. This awareness can empower individuals to advocate for themselves, and engage in local health programs, including insurance coverage.5

The Impact of School-Based Health Centers, The Los Angeles Trust for Children’s Health, 2024

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Acknowledgments Data xChange Funders • • • • •

The Ahmanson Foundation Blue Shield of California Foundation California Health Care Foundation Cedars-Sinai Medical Center DentaQuest Partnership for Oral Health Advancement • Essential Access Health • Max Factor Family Foundation

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Harbor Community Benefit Foundation Kaiser Permanente W. M. Keck Foundation L.A. Care Health Plan Ralph M. Parsons Foundation Sorenson Impact Center UniHealth Foundation

Expert Advisory Council Members • • • • • • • • • • • •

• Advancement Project • California School-Based Health Alliance • Common Spirit Community Clinic Association of LA County • • Community Coalition • First 5 Los Angeles • Gina Airey Consulting • Inner City Struggle Kaiser Permanente • L.A. Care Health Plan LAUSD Student Health & Human Services • LAUSD Office of the Chief Medical Director

LAUSD Office of Data & Accountability Los Angeles County Department of Public Health Los Angeles County Office of Education Rising Communities School-Based Health Alliance (national) St. John’s Community Health The Children’s Health Partnership UCLA Center for Healthier Children, Families and Communities UCLA Pediatric Health Services Research Unite-LA

PLUS All the healthcare providers, educators, and agencies working together to improve student health and school-based healthcare in Los Angeles.

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The Impact of School-Based Health Centers, The Los Angeles Trust for Children’s Health, 2024

Thank you to our clinic partners

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Data xChange participating clinics: Carson High Crenshaw High Elizabeth Learning Center Fremont High Garfield High Hollywood High Hyde Park Jefferson High Jordan High

Lincoln High Locke Early Education Los Angeles High MACES Maclay Middle School Manual Arts High Mendez High Metropolitan High

Nevin Avenue Elementary Roosevelt High San Fernando Teen Clinic San Pedro Elementary Santee Education Complex Sun Valley Health Center Wadsworth Elementary Washington Prep

References 1. Attendance. LAUSD Open Data dashboard. (2024, March). https://my.lausd.net/opendata/dashboard?language=en# 2. Lim C, Chung PJ, Biely C, et al. School Attendance Following Receipt of Care From a School-Based Health Center. J Adolesc Health. Dec 2023;73(6):1125-1131. doi:10.1016/j.jadohealth.2023.07.012 3. https://www.healthiergeneration.org/our-work/schools 4. School Attendance Following Receipt of Care From a School-Based Health Center. Journal of Adolescent Health. July 5, 2023. https://www.jahonline. org/article/S1054-139X(23)00377-4/pdf 5. https://www.thelatrust.org/medical-sm-toolkit

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For more information, please contact: Maryjane Puffer, Executive Director Maryjane@thelatrust.org