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School-Based Services Integration Model

Rural communities are increasing access to services for students through programs that link school systems with local healthcare and social service programs. Services integration in rural school settings can help high-risk children and their families overcome barriers to care, such as transportation. This model is particularly powerful for integrating services for high-risk children because it considers the needs of the whole child so that they may learn and achieve their full potential. Rural communities have implemented different types of school-based models:

School-Linked Services: In a school-linked services program, the school connects students and families to community organizations to increase access to health and human services. These services may or may not be available on school grounds. School administrators play an important role in building partnerships between the school and community organizations to ensure that students have access to services. School-linked services models may be implemented through a mobile unit that regularly visits the school, a collaborative that links the school to community agencies that provide health and human services, or through family referrals to services.

School-Based Health Centers (SBHC): SBHCs provide a variety of services to improve the overall health of students and their family members, including primary care, immunizations, health screenings, and health education. Some SBHCs also offer behavioral health and substance abuse services, oral health services, vision and hearing screenings, and reproductive health services. The HRSA School-Based Health Centers website has information about applying for funding for a center.

Coordinated School Health Model: Rural communities are also implementing the Centers for Disease Control and Prevention’s (CDC) evidence-based Coordinated School Health Model to promote the healthy development of school-age children. This initiative involves eight key components:

  • Health education
  • Physical education
  • Health services
  • Nutrition services
  • Counseling, psychological, and social services
  • Healthy and safe school environment
  • Health promotion for staff
  • Family/community involvement

School program leaders can use the School Health Index to assess the strengths and weaknesses of their school and identify key components of Coordinated School Health to prioritize their goals. The CDC has information about implementing a Coordinated School Health program.

Rural programs that are planning to integrate services in school settings might consider conducting a needs assessment to understand the needs of students and their families, or using the School Health Index to evaluate their capacity to offer school-linked services. Other key steps in implementing a school-based model may include:

  • Creating a vision and developing goals for the program
  • Identifying financial resources
  • Bringing partners together to discuss opportunities to collaborate
  • Determining policies
  • Discussing confidentiality
  • Conducting outreach or communications about the availability of services
  • Preparing parental consent forms/permissions and seeking permission (for example, some programs seek parental permission at the beginning of the school year during registration and other programs seek parental permission at the point of care/service).
  • Evaluating progress

Similar to the Multigenerational Approach Model, this model may include programs for children and their families, including peer support groups, family support services, employment workshops and adult education for parents.

Examples of Rural School-Based Services Programs

  • The Kentucky Family Resource and Youth Services Centers help improve the school performance of academically at-risk students by addressing social and health-related barriers to learning. Centers can adapt the programs they offer in order to meet the specific needs of students and families in the community. Centers can offer a wide range of services, including: child care, referrals to health and social services, and family crisis and behavioral health counseling.
  • The rural Coordinated School Health program serving each of the Louisiana Growing Up Fit Together Delta Region B parishes provides health education on obesity, opportunities to engage in physical education, nutrition services, and access to oral health education and preventative services.
  • The Santa Cruz County Adolescent Wellness Network (AWN) in Nogales, Arizona has developed a school-linked health program to increase access to care for students in kindergarten through 12th grade in their rural U.S.-Mexico Border community. Services include referrals to a primary care provider, education, and case management provided by community health workers, and trainings for teachers and school administration.
  • Health-e-Schools links students to full-time, off-site family nurse practitioners through teleconferencing to address common health issues, such as earaches, chronic disease management, and sports physicals. This program was developed to reduce transportation barriers and health professional shortages in western North Carolina.
  • The West Tennessee Delta Consortium, which provides health screenings through a mobile clinic and classroom health education on healthy behaviors, adapted its curriculum to align with the Common Core Standards to help gain access to schools concerned about losing class time.

Considerations for Implementation

While all school-based services integration models require partnerships in the community, the school-based health center (SBHC) model requires dedicated staff to operate and coordinate the program within the school, as well as training for teachers and staff to implement the program.

School administrators and the school board may play an important role in these models as well. In SBHCs, the school board has authority over the types of services and programs offered. School administrators play an important role in creating partnerships between the school and community organizations. Teachers play an important role, and must understand the programs and services, so that they are able to answer questions from students and families. These models may also increase the workload for some staff, including teachers, nurses and social workers, who may need to coordinate with community organizations.

Ultimately, school-based models require a high-level of collaboration among various stakeholders, including representatives from local service agencies, school leaders, administrators, teachers, parents, and community members. These models change the way the school interacts with the community — either by becoming a hub for providing health and human services or linking students to services in the community.

One additional consideration for school-based integration is transportation to healthcare providers, if health services are not offered on-site at the school. Rural programs may also need to take additional steps to mitigate stigma associated with behavioral health and substance abuse services offered in the school setting. Other considerations for programs working with children are discussed on Module 3: Considerations for Services Integrations Programs for Children.

Resources to Learn More

Different Setting, Different Care: Integrating Prevention and Clinical Care in School-Based Health Centers
Document
This article reviews four innovative school-based programs, focusing on obesity, asthma, mental health, and oral health.
Author(s): Clayton, S., Chin, T., Blackburn, S., & Echeverria, C.
Location: American Journal of Public Health, 100(9), 1592–1596.
Date: 9/2010

School-Based Health Alliance
Website
This nonprofit’s website provides training, information, and a variety of resources to those working in the school-based healthcare field. Resources include webinars, interactive maps, advocacy issues, and sustainability models.

School-Based Health Centers in an Era of Health Care Reform: Building on History
Document
This article reviews the growth and history of School-Based Health Centers in the U.S. and the role they serve in meeting the healthcare needs of school age children. Specific health issues are summarized and evaluation and implications are discussed.
Author(s): Keeton, V., Soleimanpour, S., & Brindis, C.
Location: Current Problems in Pediatric and Adolescent Health Care, 42(6), 132–158.
Date: 7/2012