UC Berkeley

Given persistent racial disparities in access to health and social services, scholars and advocates have long argued that intensive school-based support programs are a critical condition for the success of disadvantaged students of color. Yet surprisingly little is known about the actual dynamics of service use across by race in educational settings. Data from school health programs in a large and diverse urban school district (n= 6,696 students served across 15 sites) indicate that the provision of services in schools improves access for many historically underserved groups of youth. However, racial disproportionalities observed in students' use of psychosocial interventions warranted further investigation. Drawing on institutional theory and research from special education, this study used archival, administrative, and survey data to examine racial group differences in service utilization and their relationship to school staff members' referral practices. Using multilevel modeling techniques, analyses of racial group differences in service use (n=8,466 students, 15 schools) remained significant after controlling for students' risk taking behaviors and demographic covariates. Black, Latino, Pacific Islander and Multiracial youth were all more likely to access their school health program than White or Asian youth. Referrals by teachers, administrators and school counselors were significantly associated with service use for Black and Pacific Islander youth only. Multinomial regression analyses of referral data (n= 690 referrals, 3 schools) revealed that school staff members were also more likely to refer Black and Pacific Islander students for emotional concerns. In contrast, they were more likely to refer Asian and White youth for social or relational issues, and Latino youth for substance abuse. This study is the first of its kind to examine the role of referrals in students' use of school health programs.