School-Based Health

Improving Access to Health Care

School-Based Health Services provide comprehensive physical and mental health care where it is easily accessible to students.

School-Based Health Services help overcome some barriers that keep children and youth from accessing health care, such as:

  • Cost
  • Lack of health insurance
  • Providers who don't accept Medicaid
  • Lack of transportation
  • Inconvenient appointment times
  • Worries about lack of confidentiality


School-based health services attend to the unmet health care needs of all school-age children. There is a special benefit for adolescents (ages 10-19), because they have the lowest utilization of health care services of any age group and are the least likely to seek care at a provider's office.1

School-based mental health services have the potential for bridging the gap between need and utilization by reaching children who might not have access to these services and by providing early access to services.

Some of the benefits of School-Based Health Services include:

  • Providing services to children when and where the services are needed
  • Screening to prevent and treat diseases and other health threats
  • Providing a safe confidential place for students to talk
  • Offering preventive care
  • Strengthening the involvement and connection between schools and families
  • Reducing the barriers to learning
  • Identifying students at risk for violence and substance abuse and intervening early
  • Reducing the use of emergency rooms for primary care
  • Providing good investments for business by reducing parental work absences


Background
In 1970, the first School-Based Health Center (SBHC) opened its doors in Dallas, Texas. There are now over 1,500 SBHCs in 45 states and the District of Columbia,2 26 of which are in Maine. The National Survey of School-Based Health Centers 2001-02, indicates the majority (62%) of SBHCs are located in urban areas. In Maine, 48% of SBHCs are located in rural areas, 38% are located in urban areas, and 14% are located in suburban areas.3

Many SBHCs offer diagnosis and treatment of acute care, and management of chronic illnesses, as well as education, counseling, and referral as needed to community providers. Services are provided by a physician's assistant, nurse practitioners, mental health providers, and school nurses. A medical director oversees clinical services. Health Center staff work closely with school staff.4

There are many tasks involved in the planning and development of a School-Based Health Center, such as:

  • Conducting a needs assessment survey
  • Identifying funding
  • Writing a proposal
  • Planning services
  • Developing a budget
  • Forming a Community Development Board to help guide the development process
  • Working out arrangements and policies with the school
  • Designing and renovating physical space
  • Obtaining equipment and supplies
  • Hiring administrators and staff
  • Negotiating relationships with school staff
  • Marketing services to school faculty, staff, students, and parents
  • Developing a long-term fundraising plan5

Communities form Advisory Boards to help determine if a SBHC is needed, what form it should take, and if there is enough local support. To assess the needs of the community, most Advisory Boards will conduct a survey of students, parents, and staff. Once the Community Advisory Board has decided to support/create a SBHC, they decide what the hours of operation will be, how it will be administered, and what services to offer. Each SBHC is designed to meet the needs of the community. Often SBHCs are sponsored and operated by a hospital, community health center, or health department.6 Eight states have developed operating standards outlining how the Advisory Board is formed, what services it can offer, staffing requirements, facility requirements, hours of operation, etc.7

The Carnegie Corporation, W.K. Kellogg Foundation, regional and community foundations, private corporations, hospitals, and health organizations have supported school-based health centers.

In Maine, the average yearly operating cost of a SBHC is $48,880.00, which does not include in-kind funds.8 The Department of Human Services, Bureau of Health, will fund in part 19 of the 26 SBHCs. These funds are part of a state match to the Federal Maternal and Child Health Block Grant, and from the fund for a Healthy Maine (tobacco settlement dollars). Other sources of support and funding are: school and local hospital collaborations, federal government grants, Medicaid and private insurance reimbursement, local donations and grants, and patient fees.9

1 Access to Health Care Part 1: Children (Vital and Health Statistics, Series 10, no. 10), 1997, National Center for Health Statistics, Center for Disease Control, US Dept. of Health and Human Services.
2 School-Based Health Center Census 2001-02. [online at: http://www.nasbhc.org/EQ/2001census/Census2001-02.pdf].
3 Maine School-Based Health Center Fact Sheet: School Year 2001-02. [online at: http://www.nasbhc.org/EQ/2001census/ME.pdf].
4 Maine School-Based Health Centers. August 2004. Maine Department of Health and Human Services, Bureau of Health, Teen and Young Adult Health Program.
5 Ibid.
6 Ibid.
7 Sate Standards for School-Based Health Centers. [online at: http://www.nasbhc.org/APP/Categories_of_State_Standards.pdf].
8 Department of Health and Human Services, Bureau of Health, 2003-04 School Year.
9 Fast Facts: School-Based Health Centers in Maine and the United States. Maine Department of Health and Human Services, Bureau of Health.

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