Are "No" and "No Thanks" the Same for School-based Health Center Enrollment?

Objective: We determined whether providing a decline option was associated with lower school-based health center (SBHC) consent rates. Methods: Data for this study are from a SBHC serving an urban public elementary and middle charter school. In the 2015-2016 school year, parents were asked to provide SBHC consent. In 2016-2017, parents who had not returned a form were asked to do so. Results: Among the 1919 students, SBHC enrollment for the 2015-2016 and 2016-2017 school years were 50% and 66%, respectively. In 2016, 44% did not return a consent form; by the end of 2017, the proportion dropped to 28%. The proportion of parents who declined to enroll was 6% both years. Conclusions: Providing parents with an option to decline SBHC enrollment does not reduce SBHC enrollment.