Education and Health in Colorado | Colorado Health Institute

With the 2024-25 school year underway, now is a good time to recognize the crucial role schools play in children’s health. One study showed that around 75% of students who seek mental health care and services do so in a school setting.

In recent years, Colorado leaders have launched multiple efforts to support students’ mental and physical health. The Colorado Health Access Survey (CHAS) provides data to help us understand why the state is exploring new ways to best address the health disparities students may be experiencing.

Mental Health Care

The CHAS asks about the mental health of school-age children (ages 5 to 18), defined by the number of days of poor mental health they had in the previous month. In 2019, 9.6% of school-age children reported having eight or more poor mental health days in the past month. By 2023, that number had jumped to 16.5%.

To address the growing mental and behavioral health challenges among students, the state legislature earlier this year voted to permanently continue the I Matter program. The program is a no-cost therapy initiative for Colorado students that began during the pandemic. It offers up to six free telehealth or in-person counseling sessions to students from elementary through high school. The inclusion of telehealth reflects the growing increase in utilization of telemedicine, which can benefit school-age children. CHAS data showed almost a 20% increase in the use of telemedicine services for mental health from 2021 to 2023.

This year, the Colorado legislature enacted the School Psychologist Licensure Interstate Compact, which is another effort to address students’ mental health needs. The compact aims to create a way for school psychologists to get licenses to work in any member state of the compact, making it easier to move between states and improving access to practice. School-age children had a harder time accessing needed services pre-pandemic (11.2% in 2019) and post-pandemic (16.2% in 2023). Addressing the workforce shortage for mental health providers can ease some of this burden.

The CHAS will continue tracking children’s mental health in future surveys so Colorado policymakers can understand where to focus their work.

Since 2009, the CHAS has surveyed roughly 10,000 randomly selected households every other year. The survey asks questions about one designated household member. If that person is under 18, an adult responds on their behalf.

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Reproductive Health Care

Some schools serve as school-based health centers (SBHCs), which provide a variety of on-site health services for students. These services can include preventive and primary reproductive health services to help reduce disease rates and promote safer behaviors among adolescents. While services can differ between centers, they typically include education on human sexuality, behavioral risk assessments, counseling, pregnancy testing, contraception access or referrals, and diagnosis and treatment of sexually transmitted infections (STIs).

In 2023, nearly 19% of 12- to 18-year-olds said they received counseling or information on birth control from a doctor or health care provider in the past 12 months. Colorado schools can help create opportunities to increase reproductive health awareness.

Reproductive health care can look different for many schools; while some schools offer direct services through SBHCs, many cover reproductive health care through curriculum instruction. In 2019, Colorado passed HB 19-1302, which creates a standard approach to comprehensive sexual education. This means providing accurate information on preventing pregnancy and STIs and teaching about healthy relationships. The law does not mandate instruction on pregnancy options, but if it is included, it must cover all possible outcomes and provide instruction about the health benefits and potential side effects of using contraceptives and barrier methods to prevent pregnancy.

School-based health centers lead to increased use of contraception and sexual health visits, and lower rates of unintended pregnancies. School-based health services can also connect students with community health providers to help them access contraception, get STI tests, and receive counseling.

Oral Health Care

Poor oral health can have a major impact on a child’s engagement and performance at school. One national study showed that children miss about 34 million hours of school each year for dental pain issues.

In Colorado, 6.5% of school-age children reported having fair or poor oral health in 2023. Poor oral health can include cavities and tooth decay, which are common chronic diseases of childhood. Lack of access to preventive dental health care could result in a student missing learning time and falling behind on their studies. Fortunately, the CHAS showed that nine in 10 Colorado children visited the dentist in 2023, after the number had dipped during the pandemic.

Some racial and ethnic differences emerge in students’ access to oral health care. The 2023 CHAS showed that 87.4% of Hispanic/Latino school-aged children saw a dentist or dental hygienist in the past 12 months, while 92.1% of non-Hispanic/Latino white children did. According to the Centers for Disease Control, “about 33% of Mexican American children and 28% of non-Hispanic Black children (ages 2 to 5) have had cavities in their primary teeth, compared with 18% of non-Hispanic white children.” These data show that children of color are accessing dental health care at a lower rate and experiencing a higher prevalence of poor dental health when compared to non-Hispanic/Latino white children.

Schools can serve as a one-stop shop for students needing preventive oral health care. Colorado is piloting an oral health screening program at some schools. For many families facing barriers to oral health care, this screening program may be the safety net children need, which could especially help children of color who experience lack of quality oral care at higher rates.

Other Basic Needs

Students may struggle to focus on learning or even show up to class if they can’t meet other basic needs. One study showed that students who experience food insecurity have lower academic performance and are more likely to fail and leave school.

According to the 2023 CHAS, food insecurity more than doubled among young children from 2019 to 2023. The CHAS defines food insecurity as not having enough money to eat as much as you felt you should have in the past year. In 2019, 2.8% of school-age children experienced food insecurity. The number grew to 6.3% in 2023. Furthermore, levels of children’s food insecurity differed by racial background. One USDA national study showed that in 2023, 27% of Latino children faced food insecurity, meaning about one in four Latino kids lacked consistent access to food.

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To address growing food insecurity, Colorado voters passed Proposition FF, which created the Healthy School Meals for All program. This initiative allows all K-12 students in Colorado to receive free school lunches, regardless of their income, and helps to eliminate the stigma associated with free or reduced-price lunch programs. With Colorado establishing a universal school lunch program, it joins a few states in the effort to address food insecurity among youth. Future CHAS surveys may help gauge the success of this statewide school lunch program.

Another effort to support students’ basic needs came in the form of a requirement that schools provide free menstrual products, ensuring that students can focus on class and not on seeking out or paying for these products. Beginning in the 2024-2025 school year, middle and high schools must provide these products in girls' bathrooms. The goal for the newly signed law is to have all Colorado schools provide free menstrual products in all relevant student bathrooms by June 30, 2028.

Conclusion

Schools are crucial in fostering the health and safety of children and adolescents and aiding them in developing lifelong healthy habits. When students are healthy, they perform better academically, and the benefits of academic success extend throughout their lives, positively impacting their long-term health. Data from the Colorado Health Access Survey can help us understand the impact of school efforts and where new outreach is needed.