SBHC Grade Level Enrollment in CT

Introduction

Equitable access to quality healthcare is a high priority issue among children in Connecticut.

Healthcare is an ongoing issue within the United States, and especially the state of Connecticut. A range of factors such as availability of nearby healthcare providers, socioeconomic status, insurance status, etc all impact who does and does not have access to quality healthcare. For these reasons, healthcare inequity is a large problem facing the state of Connecticut, with certain groups of people being more privy to healthcare than others. This healthcare inequity within Connecticut is one of the main reasons for the recent implementation of school-based health centers (SBHCs) in various schools across the state by the Connecticut Association of School Based Health Centers (CASBHC). CASBHC works with various sponsoring agencies to install SBHCs in schools across the state. According to CASBHC directly, their mission “positions SBHCs as leaders in the broader healthcare system for CT’s children and adolescent,” with the goal of improving healthcare for this population (CASBHC). These health centers offer an assortment of services, primarily medical, mental/behavioral health, and dental. Different SBHCs may offer one or more of these services to the student population in these schools.

To better understand equitable access to SBHCs, this study investigates the question: how does access to school-based healthcare through SBHCs vary by grade levels served? In the state of Connecticut there are 1,547 publicly-funded schools that residents of Connecticut can enroll in depending on where they live. These schools vary drastically in the number of students enrolled which is dependent on a variety of factors. For example, a large portion of students enroll in schools based on their home address, ultimately meaning they enroll in a school that serves their precise town/living location. On the other hand, some students enroll in charter schools, magnet schools, etc through things like a lottery, meaning that these students may not reside in the town that their school is in. It is because of reasons like these that enrollments in the various schools across Connecticut vary and fluctuate from year to year.

Data shows that within the 1,547 schools in Connecticut, there are 497,673 students enrolled from grades prekindergarten (gPK) to grade 12 (g12). However, it is important to understand that among each grade, the number of students enrolled is not exactly the same. As previously noted, the enrollments in each grade vary from year to year as a function of the population throughout the state of Connecticut. As such, it is relevant and vital to understand the distribution of student enrollment by grade in Connecticut. Especially of importance is analyzing the distribution of enrollment by grade in schools offering SBHCs to their students to better comprehend if SBHCs are equitably offered for each grade level in particular. This information is extremely valuable to CASBHC as it will highlight grade levels that are lacking access to SBHCs and allow them to direct future efforts toward implementing new SBHCs that specifically serve this population of students.

Findings & Analysis

Before delving into the findings, it is important to note that these visualizations will show a progression from total student enrollment by grade levels, to total student enrollment by grade level in schools with SBHCs, then finally show the percentages of total student enrollment by grade level that students attending schools with SBHCs make up. Analyzing the data in this format will allow for the best understanding of trends in access to school-based healthcare at each individual grade level.

Based on the visualization below, we can see that when looking at the raw numbers of total student enrollment across all grade levels, there is a relatively equal number of students in each grade during the 2024-25 school year. The largest difference in grade level enrollment is between grade 9, which has 40,837 students enrolled, and prekindergarten, which has 20,544 students enrolled. While the difference is nearly two fold, this is not uncommon or unexpected as many young children of the prekindergarten age often remain in early childhood education centers or at home until they reach the age eligibility to enroll in kindergarten, which is typically the first grade offered in many schools in Connecticut. Aside from prekindergarten, the greatest percent difference between total enrollment in grade levels is 28.08% (between g9 and g1), with most of the percent differences between other grade levels being significantly less than that. Overall, Figure 1 depicts a representation of how there is a relatively equal number of students enrolled in each grade across all Connecticut schools.

Figure 1: Total Student Enrollment by Grade Level in All Connecticut Schools (interactive chart)

Among only the schools that offer SBHCs, it can be observed that there are significantly higher enrollments in upper grades (g6-g12) compared to lower grades (g1-g5), as depicted in Figure 2 below. Raw enrollment numbers for grades prekindergarten through grade 5 range from around 5,000 - 10,000 students. However, raw enrollment numbers for grades 6 through grade 12 range from around 13,000 - 20,000 students. When comparing grades, this means that some upper grades in schools with SBHCs have anywhere from 2-4 times the amount of students that lower grades have. Overall, it is evident in Figure 2 that more students in upper grade levels attend schools with SBHCs, and thus have more access to school-based healthcare.

Figure 2: CT Schools with SBHCs Show Higher Total Enrollment in Upper Grades (g6-g12) (interactive chart)

When analyzing enrollments by grade level specifically in schools with SBHCs, it becomes clear that upper level grades (g6-g12) have not only larger enrollments (Figure 2), but also make up a larger overall percent of the total student enrollments by grade when compared to total enrollment in all schools as shown in Figure 3 below. That is, grades 6 through grades 12 have a significantly higher percentage of total student enrollment in schools with SBHCs than in grades prekindergarten through grade 5. The percent of total enrollment of students in schools with SBHCs by grade level for upper grades (g6-g12) range from 30% to nearly 51% of the total enrollment across all Connecticut schools. Particularly of note is grade 9, which has 50.9% of total students in Connecticut in grade 9 enrolled in a school with an SBHC. On the other hand, the percent of total enrollment of students in schools with SBHCs by grade level for lower grades (gPK-g5) range from around 26% to around 29% of the total enrollment across all Connecticut schools. For example, grade 1 only has 26.9% of total students in Connecticut in grade 1 enrolled in a school with an SBHC. When comparing grade levels,the lower grade levels (gPK-g5) have an average of 27.6% of total students in Connecticut attending a school with an SBHC whereas the upper grade levels (g6-g12) have an average of 44.5% of total students in Connecticut attending a school with an SBHC. The difference in these averages is nearly two fold, which indicates that there is a distinct pattern of increased student enrollment in schools offering SBHCs in the upper grade levels, ultimately meaning students in upper grades have more access to SBHCs than their lower grade level peers. This is crucial moving forward as it suggests that the community and organizations like CASBHC should consider increasing the amount of SBHCs in schools that serve lower grade levels to make access to school-based healthcare across grade levels more equitable.

Figure 3:There are Higher Percentages of Total Students Enrolled in Schools With SBHCs in Upper Grades (g6-g12), with Grade 9 Having the Highest Percentage of Enrollment (interactive chart)

Methods & Limitations

Methods

In order to create this data story regarding equity of enrollment and access to SBHCs by grade I utilized many online sources and tools. First, the data that was collected on schools offering SBHCs and which grade levels they serve came from the CASBHC website. They offer a mapping tool on their website which displays all SBHC locations throughout Connecticut along with details on each center including things like grade levels served, address, services offered, hours of operation, and so on. Throughout this semester I have been working as a research assistant directly for Professor Jack Dougherty and CASBHC, aiding them in cleaning up the existing data on SBHCs. As a result, the quantitative dataset on google sheets that I used to complete my data analysis was created by me, with assistance from Professor Jack Dougherty. In addition to the SBHC data, I also collected data regarding school enrollments in Connecticut from EdSight, which is Connecticut’s official source for education data. With the data from both the SBHC dataset and EdSight, I used the xlookup function on google sheets to match schools with their enrollments by grade level and SBHC status in order to create a comprehensive dataset with all the relevant information needed to create my visualizations. Finally, to create the visualizations in the findings section of this data story I used Data Wrapper, an online tool for making data visualizations (see Figures 1-3).

Limitations

While my findings offer novel insights into the equitable access to SBHCs across CT grade levels, it is important to note some limitations that exist. First of all, while the dataset that I worked with from CASBHC (see “sources & methods” section) includes 332 schools that offer SBHCs, my data and visualizations include 330 schools with SBHCs. This is due to the fact that I was unable to verify two of the schools listed in the dataset as still being in operation or still offering services, thus they were removed. Removing two schools from the dataset was not ideal but seeing as I could not verify them it was done to maintain validity of the existing data and my analysis of it. Additionally, as it was only two schools removed, this change was not estimated to have any significant effects on the data, therefore the presented data and visualizations remain reliable.

Moreover, a large uncertainty that remains within the data is the fact that access to SBHCs does not mean usage or comprehensiveness. First, just because students are enrolled in a school with an SBHC does not mean that they are actually using the services provided. For example, if a school has a large population and very limited staff at the SBHC, it may mean that the SBHC cannot adequately provide services to all students in the school. Thus, having access to a SBHC does not necessarily mean that all students in that particular school are able to use the services. Secondly, just because a school has an SBHC does not mean that it offer comprehensive care. For instance, based on the dataset used (see Sources below), we know that not all SBHCs offer all services. Some SBHCs may only offer medical services while others may offer medical, mental/behavioral health, and dental services. As a result, it is important to keep in mind that access to SBHCs does not guarantee comprehensiveness of services. These questions of usage rates and comprehensiveness of SBHCs are crucial for CASBHC moving forward as they should possibly look into staffing/resources of SBHCs as well as services offered in them.

Finally, another uncertainty that exists within the data is that enrollment in a school with an SBHC does not mean students can use it unless their parent/guardian has signed a permission slip giving them consent to utilize it. This once again connects back to the uncertainty of usage rates since I could not determine how many of the students enrolled had parents sign off on their access to the SBHCs. This is another area that can be further analyzed by CASBHC seeing as there are many reasons why parents may not be giving consent for their children to use SBHCs. For example, it may be a matter of lack of knowledge about the SBHC in their child’s school or possibly that there are language barriers for parents in schools with a high number of multilingual learners and they cannot understand what the permission slip is asking. Regardless, this can certainly be another avenue of future research to expand upon enrollment numbers and include the number of students that are signed up for the SBHC’s services too.

References

Adams, E. K., Strahan, A. E., Joski, P.J., Hawley, J. N., Johnson, V. C. & Hogue, C. J. (2020). Effect of elementary school-based health centers in georgia on the use of preventive services. American Journal of Preventative Medicine, 59(4), 504-512. https://pubmed.ncbi.nlm.nih.gov/32863078/.

Bains, R. M. & Diallo, A. F. (2016). Mental health services in school-based health centers: Systematic Review. The Journal of School Nursing, 32(1), 8-19.https://pubmed.ncbi.nlm.nih.gov/26141707/.

Connecticut Association of School Based Health Centers. (2021). Connecticut Association of School Based Health Centers. https://ctschoolhealth.org.

Connecticut Association of School Based Health Centers. (2025, November 11). CT SBHC Updated 2025-11-11. https://docs.google.com/spreadsheets/d/1wsycNjSOLnj9gZ7wepTs7jyuzS7PvquCZEUsugSmMJs/edit?usp=sharing

Datawrapper. (2019, January 30). Create Charts and Maps with Datawrapper. https://www.datawrapper.de.

EdSight Home Page. (n.d.). CT.gov. https://public-edsight.ct.gov/?language=en_US

Knopf, J. A., Finnie, R. K.C., Peng, Y. Hahn, R. A., Truman, B. I., Vernon-Smiley, M., Johnson, V. C., Johnson, R. L., Fielding, J. E., Muntaner, C., Hunt, P. C., Jones, C. P., Fullilove, M. T. & Community Preventive Services Task Force. (2016). School-based health centers to advance health equity. American Journal of Preventive Medicine, 51(1), 114-126.https://doi-org.ezproxy.trincoll.edu/10.1016/j.amepre.2016.01.009.