School-based health centers

SCHOOL-BASED HEALTH CENTERS

School-based health centers (SBHCs) are primary care clinics based on primary and secondary school campuses. Most SBHCs provide a combination of primary care, mental health care, substance abuse counseling, case management, dental health, nutrition education, health education and health promotion. An emphasis is placed on prevention and early intervention. Students in schools with SBHCs are predominantly members of minority and ethnic populations who have historically experienced under-insurance, uninsurance, or other health care access disparities. Most SBHCs report that the majority of their student population is eligible for the National School Lunch program, a common indicator of low SES.

• 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.

The centers often tailor their services and outreach specifically to the school's student population. 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.Facilities are 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. Though they were once quite controversial, the centers are now widely viewed as meeting the needs of a population of students that might otherwise go without healthcare, as many children suffer from unrecognized health problems due to lack of access to care.

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 was indicative of a perception in the public policy community that there was a need to develop programs in service of better health care for low-income individuals, including 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 issue. 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 and 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.

Controversy

Despite the growing number of school-based health care during the past three decades, the issue of providing reproductive health care at school-based health centers continues to spark controversy. Data has demonstrated how these controversies about reproductive health may frame more general concerns about school-based care. In response to these issues, in recent years SBHCs have begun requiring parents to sign written consents for their children to receive the full array of services the centers provide. Most facilities 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, assisted states over the past two decades 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 derived from various 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.

Even with this infusion of federal dollars, SBHCs still have a difficult time obtaining funding because many of their patients lack insurance, and when patients are insured, some of the services provided by the centers are not covered.