School-Based Health Centers in an Era of Health Care Reform: Building on History

Abstract

School-based health centers (SBHCs) provide a variety of health care services to youth in a convenient and accessible environment. Over the past 40 years, the growth of SBHCs evolved from various public health needs to the development of a specific collaborative model of care that is sensitive to the unique needs of children and youth, as well as to vulnerable populations facing significant barriers to access. The SBHC model of health care comprises of on-school site health care delivery by an interdisciplinary team of health professionals, which can include primary care and mental health clinicians. Research has demonstrated the SBHCs’ impacts on delivering preventive care, such as immunizations; managing chronic illnesses, such as asthma, obesity, and mental health conditions; providing reproductive health services for adolescents; and even improving youths’ academic performance. Although evaluation of the SBHC model of care has been complicated, results have thus far demonstrated increased access to care, improved health and education outcomes, and high levels of satisfaction. Despite their proven success, SBHCs have consistently faced challenges in securing adequate funding for operations and developing effective financial systems for billing and reimbursement. Implementation of health care reform (The Patient Protection and Affordable Care Act [P.L. 111-148]) will profoundly affect the health care access and outcomes of children and youth, particularly vulnerable populations. The inclusion of funding for SBHCs in this legislation is momentous, as there continues to be increased demand and limited funding for affordable services. To better understand how this model of care has and could further help promote the health of our nation’s youth, a review is presented of the history and growth of SBHCs and the literature demonstrating their impacts. It may not be feasible for SBHCs to be established in every school campus in the country. However, the lessons learned from the synergy of the health and school settings have major implications for the delivery of care for all providers concerned with improving the health and well-being of children and adolescents.

Improving Adolescent Health Policy: Incorporating a Framework for Assessing State-Level Policies

“…Policies aimed at increasing the number of US adolescents who have health insurance coverage, for example, can enhance prevention, treatment, or amelioration of a variety of health issues (2,24,25). Uninsured children and adolescents are six times less likely to receive needed care and three times more likely to use expensive emergency department care than their insured counterparts (2,40). Thus, policy efforts to improve effective care by increasing access to health insurance, requiring better care coordination, and family-centered care, for example, through the Affordable Care Act of 2010 (ACA), could result in higher-quality care for children and adolescents, while simultaneously reducing disparities (24,25).…”

Building a National Culture of Health: Background, Action Framework, Measures, and Next Steps

“…SBHCs, which are collaborations between an educational system and a traditional health care provider, are a major component of the nation's health care safety net that not only enable children with acute or chronic illness to attend school but also provide health and wellness through health promotion and disease prevention activities (Keeton, Soleimanpour, and Brindis, 2012). Head Start and…”

Characteristic Differences Between School-Based Health Centers With and Without Mental Health Providers: A Review of National Trends

“…The school-based health center (SBHC) is a model of pediatric primary care delivery that offers comprehensive services provided by a multidisciplinary team on school grounds (Keeton, Soleimanpour, & Brindis, 2012). SBHCs have been shown to increase access to and utilization of high-quality cost-effective health care services for children and adolescents, especially in underserved populations (Anyon et al, 2013;Bains, Franzen, & White-Frese, 2014;Guo et al, 2005;Soleimanpour, Geierstanger, Kaller, McCarter, & Brindis, 2010;Wade et al, 2008).…”