School-based health centers

SCHOOL-BASED HEALTH CENTERS

School-based health centers (SBHCs) are clinics based on school campuses, typically in under-served urban communities, which provide medical services free of charge to enrolled students and their families. The clinics' offerings vary from center to center, but they most commonly include primary healthcare services and screening. Examples of their services include immunizations, mental health services, nutritional counseling, reproductive health services and dental care. Acute illnesses and chronic conditions are commonly treated at the centers. The centers focus on preventive health and early intervention for pervasive problems such as childhood obesity, and on mental health and well being.

SBHCs often tailor their services and outreach specifically to the school's student population. The centers are generally staffed by one or more different types of health care providers, including nurse practitioners, physician assistants, social workers, substance abuse counselors, and mental health professionals.

Because school-based health centers treat students who might otherwise not have a usual source of care over a long period of time, they have taken on the role of a patient-centered medical home for under-served students. Research has shown that the services provided by SBHCs lead to a reduction in emergency room visits and hospital admissions. Further, the centers aid in reducing school absences and promoting healthy behaviors.

HISTORY

President Lyndon Johnson’s War on Poverty in the mid-1960s is credited with bringing into focus the significance of health issues among impoverished school-age children. The enactment of Medicaid in 1965 underscored the need to develop public policy in service of better health care for low-income children. In 1967, Philip J. Porter, head of pediatrics at Cambridge City Hospital in Massachusetts and director of Maternal and Child Health for the city's health department, began to address this need: He assigned a nurse practitioner to work on site in an elementary school to deliver primary medical care to enrollees. Four additional health clinics were opened in Cambridge schools in the years that followed.

During the early 1970s, school-based health centers staffed by nurse practitioners, part-time physicians, and mental health professionals were established in Dallas and St. Paul. In the following decades, SBHCs began to spring up in states throughout the nation, ultimately serving students in all 50 U.S. states and some of its territories.

STRUCTURE/DEMOGRAPHICS

School-based health centers generally operate as a partnership between the school district and a community health organization, such as a community health center, hospital, or the local health department. Approximately 2,000 school-based health centers operate nationwide, according to the most recent National Assembly on School-Based Health Care census. That figure amounts to less than two percent of schools in the country.

SBHCs have been the center of controversy with regard to whether they should be allowed to provide contraception to adolescents. In recent years, most SBHCs now require parents to sign written consents for their children to receive the full array of services the centers provide. Frequently, the centers have an advisory board consisting of community representatives, parents, youth, and family organizations to provide planning and oversight.

FUNDING

Historically, federal funding for school-based health centers came primarily from the maternal and child health block grant and the Healthy Schools/Healthy Communities program. However, as SBHCs have begun to focus on third-party reimbursement, Medicaid has also become an important source of support. Making the Grade, a national grant program of the Robert Wood Johnson Foundation, has set forth with the mission to assist states in developing the long-term financing policies required to sustain school-based health centers.

About 20 percent of SBHCs receive funding through the Health Resources and Services Administration (HRSA) Health Center Program. HRSA is a division of the U.S. Department of Health and Human Services (DHS). Other funding is cobbled together from various funding sources such as community-based health centers, healthcare systems, foundation grants, and state and local funds.

In July of 2011, $95 million was awarded to 278 school-based health center programs nationwide, as part of the Affordable Care Act (ACA). This was the first award in a series of allocations to the School-Based Health Center Capital Program. The ACA's allocations for this program will ultimately total $200 million in funding for SBHCs over four years. The awards will enable recipients to expand their offerings and to increase their collective capacity by over 50 percent.

Despite this infusion of federal dollars, however, SBHCs still struggle to find funding because many of their patients lack insurance, and even when patients are insured, some of the services provided by the centers are not covered.

STATISTICS

• • Most SBHCs report that the majority of their student population is eligible for the National School Lunch program, a common indicator of low SES.
  • 70 percent of the student body in schools with SBHCs are minorities. They include Hispanic/Latino (36.8%), Black (non-Hispanic/Latino) (26.2%), Asian/Pacific Islander (4.4%), Native American/Alaskan Native (1.7%) and “other” (1.4%) youth.
  • SBHCs are increasingly remaining open year round and extending their hours beyond the school day. Moreover, they are offering their services to other members of the community other than their own students, including family members and young people from other schools.
  • SBHCs serve all school-levels: in elementary schools (20%), middle/junior high schools (15%), high schools (30%) and a mix of elementary, middle, and high schools (21%). They are located in urban (59%), rural (27%), and suburban (14%) communities in all regions of the country.

Schools, school districts, counties, school health center operators and funding sources have worked to accelerate the growth and development of SBHCs as a population-based approach to addressing school communities’ health and students' educational outcomes.

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