Youth in underserved communities lack access to consistent sources of high-quality health care. School-based health centers (SBHCs) address this challenge through the provision of primary care, mental health care, and other health services in schools. This article describes the current status of SBHCs nationally, including changes over the past twenty years. Data were collected through the School-Based Health Alliance's National School-Based Health Care Census. The number of SBHCs doubled from 1,135 in 1998-99 to 2,584 in 2016-17. During this time they adapted to the changing health care landscape and community needs. Sponsorship shifted predominantly to federally qualified health centers, and SBHCs provided access to primary care and, often, to mental, oral, and other health services to 10,629 schools and over 6.3 million students. SBHCs have grown steadily since 1998, and recent expansion through federally qualified health centers and telehealth technology forecasts even greater growth, innovation, and access for underserved communities. E ach day in the US, millions of children and adolescents-especially those of color and those who live in underserved communities-go to school with physical and mental health concerns that threaten their well-being and educational performance. 1 Youth living in impoverished communities have higher rates of asthma, substance use, anxiety and depression, and obesity and are at elevated risk of not having regular health maintenance visits. 2 Adolescents cite lack of access, concerns about confidentiality, and inconvenience as reasons for not using the health care system. 3 When adolescents seek health services, they often access care in multiple settings (schools, medical offices, family planning centers, mental health clinics, and emergency departments), with little continuity of care. 3 This fragmentation has farreaching consequences. In the short term, young people with unmet or poorly managed health care needs are more likely to be chronically absent from school, experience suspension, and drop out. 1,4 In the longer term, they are more likely to be underemployed and financially unstable. 5 There are costs to the health care system associated with fragmented and forgone care, overuse of the emergency department, and duplicated care-as well as costs to the education, welfare, and juvenile justice systems when health care needs are not met. 1 School-based health centers (SBHCs) are a logical response to the challenges that underserved youth face in health care access and use. The centers represent a shared commitment by a community's schools and health care organizations to address health care access and use among the nation's underserved communities and aim to support children's and adolescents' health, well-being, and academic success. The centers help youth and their families overcome access barriers-including transportation, time,

Telehealth is a growing model of delivering health care. School-based health centers (SBHCs) provide access to health care for youth in schools and increasingly use telehealth in care delivery. This article examines the recent growth of telehealth use in SBHCs, and characteristics of SBHCs using telehealth, including provider types, operational characteristics, and schools and students served. The percentage of SBHCs using telehealth grew from 7% in 2007-2008 to 19% in 2016-2017. Over 1 million students in over 1800 public schools have access to an SBHC using telehealth, which represents 2% of students and nearly 2% of public schools in the United States. These SBHCs are primarily in rural communities and sponsored by hospitals. This growing model presents an opportunity to expand health care access to youth, particularly in underserved areas in the United States and globally. Further research is needed to fully describe how telehealth programs are implemented in school settings and their potential impacts.

Objective: In this paper, we describe the implementation and outcomes of an initiative that engaged school-based health centers (SBHCs) in a learning community to create programmatic and policy school health changes beyond the health center walls. Methods: Sixty respondents completed impact surveys and 13 coalitions completed progress reports to document schoolwide wellness efforts and outcomes in stakeholder engagement, student healthy eating and active living, student social and emotional wellness, and school staff wellness. Results: Respondents reported pre- to post-intervention improvements in stakeholder engagement, including school administration promotion of school health policies (from 64% to 95%), and teacher participation in SBHC sponsored activities (from 63% to 98%). They reported schoolwide policy and programmatic achievements including increased opportunities for physical activity for students during school hours (from 55% to 85%), access to behavioral health counseling and support services to all students, either on-site or through referrals (from 62% to 89%), and offering healthy food or nutrition education to staff (from 10% to 73%). Conclusions: SBHC staff, school employees, and community members can work collaboratively to assess student physical and mental health needs, and develop and implement school policies and programs beyond the clinic walls.

BACKGROUND: Despite extensive literature on school-based health center (SBHC) characteristics and outcomes, their quality of care has not been examined nationally. Standardized quality metrics can inform health care delivery and improvement.METHODS: SBHC national performance measures (NPMs) were developed by reviewing measures from national child health quality initiatives and engaging stakeholders in a consensus-building process. NPMs were pilot-tested with 73 SBHCs and SBHCs nationally subsequently reported data.RESULTS: Five NPMs were selected including the percentage of clients annually who received at least one: (1) well-child visit, whether administered in the SBHC or elsewhere; (2) risk assessment; (3) body mass index screen with nutrition and physical activity counseling; and, if age-appropriate, (4) depression screening with follow-up treatment plan; and (5) chlamydia screening among sexually active clients. SBHCs experienced challenges with reporting during pilot-testing, particularly related to extracting data from electronic health records, and identified strategies to address challenges. Approximately 20% of SBHCs nationally voluntarily reported data during the initial year. IMPLICATIONS FOR SCHOOL HEALTH:Standardized performance measures can help SBHCs monitor and improve care delivery and demonstrate effectiveness compared to other child health delivery systems. CONCLUSION:Ongoing data collection will help examine whether measure adoption drives quality improvement for SBHCs nationwide.