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Data Team Home

By Reese Hirota, Melissa Nuñez, James Wu, and Rose Martinez

On Wednesday, April 17, 2024, Council Members Narcisse, Schulman, Lee, and Joseph, chairs of the Committees on Hospitals, Health, Mental Health, Disabilities, and Addiction, and Education, respectively, will conduct a joint oversight hearing on School-Based Health Centers and Mental Health Clinics.

At this hearing, the Committees are interested in gaining an understanding of the landscape of SBHCs and SBMHCs in NYC. This includes, but is not limited to, where and how they are sited and maintained as well as scope of services offered. The Committees are also interested in related data, including rates of utilization and any other types of data that may be collected. Additionally, the Committees are interested in what kind of outreach is conducted to inform students and their families about the existence of SBHCs and SBMHCs, any plans to expand access to their services, and whether continuity of care is ensured for students who graduate or transfer. Lastly, the Committees are interested in coordination efforts in the running of SBHCs and SBMHCs with regard to comparing outcomes and identifying best practices.

The data team examined student health reports submitted to the Council along with other publicly accessible information to gain insights into the locations of SBHCs and SBMHCs and student health prevalences of in NYC. Their analysis yielded the following findings:

• School Districts 9 and 10 in the Bronx stand out as the two districts with the highest number of school-based health centers.
• When comparing the student asthma rate, the citywide rate is slightly lower than (14.10%) to those of school districts (14.28%) with SBHCs and those without (12.48%), where the rates are nearly the same.
• The number of school based health centers per 10,000 students appears to be linked with certain health and social indicators such as poverty, asthma, type 1 diabetes, type 2 diabetes, and severe allergic reactions.
• Despite a positive trend between SBHCs & asthma, school districts 15 & 3 stand out with fewer students in poverty and lower asthma rates compared to other districts with a high number of SBHCs.

School-Based Health Centers (SBHCs) are medical health centers located inside school buildings which are operated by local hospitals, medical centers, and community organizations. All SBHCs are overseen by the NY State Department of Health (NYSDOH) and NYC Department of Health and Mental Hygiene (DOHMH). Because of the convenient location, SBHCs are an important source of healthcare for many students in NYC public schools, especially those who lack access to primary care, and have been proven to lower school absences and parents’ time away from work. SBHCs are staffed with a team of health care professionals, which may include a physician, nurse practitioner, physician assistant, mental health professional, social worker, medical assistant, and health educators. SBHCs can only provide full health care services for students who have enrolled with a signed Parental Consent Form; otherwise, the SBHC can only provide first aid and emergency care and those services for which minors can consent to their own treatment.

For the 2023-24 School Year (“SY”), there are 138 SBHCs operating throughout the 5 boroughs, with 64 centers located in the Bronx; 39 in Manhattan; 21 in Brooklyn; 10 in Queens; and 4 in Staten Island as listed on the Department of Education’s website. In addition, DOE is required to report to the Council on student health services and the reporting includes information on the total number of students enrolled in schools with SBHCs. The most recent report submitted to the Council indicates that 171,062 students were enrolled in schools with SBHCs in SY 2021-22, including 70,297 students in the Bronx; 41,834 in Manhattan; 33,949 in Brooklyn; 15,824 in Queens; and 10,058 in Staten Island. The report for the 2023-24 school year is due on April 30, 2024.

According to NYC Public Schools, SBMHCs are clinics licensed and overseen by the NYS Office of Mental Health (OMH). Such clinics can be part of a larger health clinic or a stand-alone model, including a satellite clinic. SBMHCs provide individual, family, and group therapies, as well as psychiatric assessments, case management, school community outreach, and 24-hour crisis coverage for students.

In November 2023, Governor Kathy Hochul announced that more than $5.1 million was awarded to support 137 SBMHC satellites throughout NYS, including 82 high-need schools. In New York City, 52 high-need schools across 21 districts have received such funding awards.

In February 2024, the Governor announced an additional $20 million in start-up funding for SBMHC and launched a rolling application to make it easier for interested schools to access state funding. With support from a school wanting to establish a clinic satellite, OMH-licenseid providers can apply for start-up funding on a rolling basis rather than through the state procurement process previously used.59 Licensed OMH-licensed providers can submit an application to establish a school-based satellite clinic through the Mental Health Provider Data Exchange. Every new school satellite clinic will automatically be eligible for $25,000 in start-up funding. As mentioned, high-need schools, or those where more than 50 percent of students classified as coming from an economically disadvantaged household, are eligible for an additional $20,000.62

Over time, there have been minor variations in the count of school-based health centers. The numbers had been steadily rising since the 2015-2016 period, reaching their highest point during the post-pandemic school year of 2020-2021. However, there has been a decline since then, with the 2023-2024 school year marking the lowest count of operational centers. Notably, between the years of 2022-2023 and 2023-2024, nine centers were closed, with eight of them previously sponsored by H&H Gotham. School buildings, along with all school based health centers, were closed during the 2019-2020 school year.

Source: https://www.schools.nyc.gov/school-life/health-and-wellness/school-based-health-centers

School-Based Health Centers are managed by local hospitals, medical centers, and community organizations, with most being hosted by federally qualified health centers.

These centers are defined as community-based organizations offering comprehensive primary care and preventive services, including health, oral, and mental health/substance abuse care to individuals of all ages, irrespective of their ability to pay or health insurance status.

Source: Local Law 12 of 2016, on file with the City Council

Montefiore Medical Center, Morris Heights Health Center, and NYU Langone FHC lead as sponsors with the highest count of school-based health centers.

Combined, these three medical facilities accommodate close to half of the city’s school-based health centers, catering to 76,648 students, which constitutes 50% of all students with access to such facilities.

Source: Local Law 12 of 2016, on file with the City Council

Analyzing the distribution of school-based health centers across council districts, we observe that council district 17 boasts the highest number, trailed by council district 8 and then 16.

Together, these three districts host 30% of the city’s school-based health centers, catering to a combined student population of 35,457, which represents 23% of all students with access to such centers.

Source: Local Law 12 of 2016, on file with the City Council

In NYC, DOHMH identifies asthma as a leading cause of emergency room visits, hospitalizations and missed school days among children in the city’s poorest neighborhoods. The onset of asthma in children is often caused by environmental health factors, such as tree pollen, tobacco smoke, pet dander, mold, dust mites, pests, proximity to highways, gas and diesel emissions, and other pollutants. Asthma is more common among low-income Black and Latino children in NYC. In 2020, 57 out of 10,000 NYC children ages 5 to 17 visited an emergency department due to an asthma-related health event; in the Bronx, that number climbed to 100 out of 10,000, which is the highest percentage of any borough. Per a 2022 report, poverty is highly correlated with asthma prevalence. The report cites disrepair, mold, and pests as asthma attack triggers which are largely a result of disinvestment in neighborhoods of color. The highest rates of asthma emergency department visits for children 5 to 17 are concentrated in high poverty neighborhoods.

Diabetes is also an ongoing health issue for NYC children. Per the New York State Department of Health (DOH), diabetes is one of the most common chronic diseases of childhood, affecting over 13,000 children in New York State. Type 1 diabetes is the most prevalent type of diabetes in youth aged 0-19, with an overall prevalence of 154 cases per 100,000 children. Meanwhile, the rate of type 2 diabetes among youth aged 0-19 is much lower, but increasing. Research has demonstrated that type 2 diabetes is more common in certain racial and ethnic groups such as African Americans, American Indians, Hispanic/Latino Americans, and some Asian and Pacific Islander Americans, while type 1 diabetes is more common in the non-Hispanic White population. According to DOH, the increasing incidence of type 2 diabetes in youth is a “first consequence” of the obesity epidemic among young people. Overweight children are at increased risk for developing type 2 diabetes during childhood, adolescence, and later in life.

Below are scatter plots and accompanying maps showing the number of school-based health centers per 10,000 students by the prevalence of a certain factor (poverty, asthma, diabetes 1, diabetes 2, and anaphylaxis) within a NYC school district. The size of each point on the scatter plot is based on total enrollment; a larger dot means there are more students in that school district. The legend to the right of the map details the color scaling for both the scatter plot and the map.

There is a high correlation between asthma and the number of school-based health centers per 10,000 students. There is also a moderate correlation between poverty, diabetes 2, & anaphylaxis and SBHCs per 10,000 students, and a low correlation between diabetes 1 and SBHCs per 10,000 students.

Below is an interactive map of NYC’s school districts showing student health prevalence rates (asthma, diabetes 1 and 2, severe allergies), poverty and enrollment (the number of SBHCs per 10k students). In addition, it shows where all SY 2023-2024 schools are located, the schools that provide mental health services and have an SBHC, along with the 11 SBHCs that have closed since 2023. There is the option to toggle layers.

Map of School Based Health Centers and Health Indicators by School District

Source: Local Law 12 of 2016, on file with the City Council and DOE’s Demographic Snapshot Dataset

ENROLLMENT

The top 3 largest school districts are District 31 in Staten Island, District 2 in Manhattan, and District 24 in Queens with 61,838, 57,900, 54,197 students enrolled respectively. Of these, only District 24 has a poverty rate over 70%. District 2, with the most number of schools in the district (133), has 8 SBHCs serving 34 schools. Districts 31 and 24 have fewer SBHCs, 4 and 2 SBHCs respectively, serving only 7 schools each, and each district has 87 and 69 schools within the district, respectively.

ASTHMA
The top 3 school districts with the highest percentage of students with asthma are Districts 5 in Manhattan, District 7 in the Bronx, and District 16 in Central Brooklyn each having more than 32% of their students with asthma. The number of SBHCs in these districts range from 2, 8, and 0, respectively. These SBHCs each serve 3 (6%) and 20 (27%) schools in their districts.

District 16 may not have an SBHC as it has the lowest student enrollment with only 5,970 people. District 7 appears in the top 3 for both highest percentages in poverty and asthma.

POVERTY
The top 3 school districts with the highest percentage of students in poverty are Districts 7, 9 and 12 in the Bronx, surpassing 91%. These districts have 8, 13, and 7 SBHCs serving a total of 20 (27%), 37 (42%), and 29 (48%) schools respectively.

ALTOGETHER
SBHC Densities, Enrollment & Student Health Indicators
Decisions on SBHCs & SBMHCs placements & closures impact students & their communities. Despite a positive trend between SBHCs & asthma, school districts 15 & 3 stand out with fewer students in poverty and lower asthma rates compared to other districts with a high number of SBHCs.

Of the 11 districts with high densities of SBHCs per 10k students, only districts 15 and 3 have significantly fewer of their students in poverty, with 54% and 49% respectively. They also have some of the lowest reported asthma rates compared to the other 9 districts.

Legislation

The Committees will introduce the following bill to amend the New York City Charter and the administrative code of the City of New York in relation to:

• Requiring the New York City Department of Education to report the number of students reported to the office of school health as having a diagnosis of sickle cell disease or trait.
  Int. 341