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School-Based Health Centers

School-based health centers (SBHCs) provide primary healthcare and other services to students in kindergarten through 12th grade. SBHCs are often located within an actual school building or may be located nearby at another facility. Some SBHCs may provide healthcare and health education to family members and other community members as well. In 2017, 823 SBHCs were operating in rural locations in the U.S. Increasingly, SBHCs serve schools and communities in rural and frontier areas by using technology to provide remote healthcare visits, and help to overcome geographic barriers and a lack of transportation access. These SBHCs serve schools and communities in rural and frontier areas by using technology to provide remote healthcare visits, and help to overcome geographic barriers and a lack of transportation access.

To provide these telehealth services, SBHCs are connected with offsite medical settings by using tablets or computers and an internet connection. School nurses or other onsite school staff help operate certain medical equipment, such as a stethoscope, at the SBHC. They also help set up the remote visit with the medical provider who uses the computer or tablet to virtually examine the patient. The doctor is able to see the patient through the computer and complete a virtual exam to make diagnosis and treatment plan.

Some of the services SBHCs provide include:

  • Vaccinations
  • Health and mental health screenings
  • Prevention education and peer group education
  • Vision, hearing, and dental services
  • Substance use treatment and prevention services
  • Reproductive health services

The Community Preventive Services Task Force recommends the implementation of SBHCs in low-income communities to improve educational and health outcomes. They also note that SBHCs are likely to improve health equity and address SDOH. In addition to providing healthcare services to students and families in rural communities, SBHCs can also address other unmet health and social needs. For example, some SBHCs address common youth behavioral health issues such as stress, personal safety, depression and anxiety, and other social risk factors that can influence academic success and overall well-being.

Educational attainment is one of the leading social determinants of health (SDOH). Research shows the connection between better health outcomes and education: children who are in better health miss fewer days of school and perform better in school. Similarly, people who have higher educational attainment have better overall health outcomes. SBHCs can help local schools meet the health needs of children and the community, therefore improving school attendance, increasing the opportunity for academic achievement, and improving overall health outcomes.

Examples of Rural School-Based Health Centers Addressing SDOH

  • The Center for Rural Health Care Innovation in North Carolina runs a school-based telehealth program called Health-e-Schools that operates in 4 rural school districts. The program connects students with a doctor through video conferencing. Onsite school nurses help connect youth with these services.
  • The Southwest Open School School-Based Health Clinic provides several types of medical services to students and community residents under the age of 21. These services include vaccinations, physical examinations, treatment of illness, and behavioral healthcare. Twice a year the SBHC also provides dental screening and cleaning for students.
  • The Hancock County Middle/High School, School Based Health Center in Appalachia uses family nurse practitioners to provide primary care, urgent care, and mental health services for all members of a family. The SBHC is physically located within the school building. Students in the Eastern Tennessee State University College of Nursing program can also complete clinical placements at this SBHC.

Implementation Considerations

Implementation considerations for running and staffing a SBHC may be similar to considerations for implementing other rural healthcare programs. In rural areas designated as Health Professional Shortage Areas, it may be more difficult to find healthcare professionals to staff SBHCs.

Technology limitations and lack of broadband access can pose challenges to implementing telehealth SBHC models. Not all SBHCs have the resources to provide telehealth services and, similarly, not all areas are connected to this technology. Securing funding for this technology can also be a potential limitation.

Programs may also need to consider the impact of potential stigma youth can experience from their peers when receiving care within a school setting. For additional implementation considerations related to implementing SBHCs and other school-based health programs see the School-Based Services Integration Model in the Rural Services Integration Toolkit.

Resources to Learn More

The Evidence on School-Based Health Centers: A Review
Document
Results from a literature review which shows that SBHCs improve access to healthcare services for children and communities which can lead to improved outcomes.
Author(s): Arenson, M., Hudson, P.J., NaeHyung, L. & Lai, B.
Citation: Global Pediatric Health, 6
Date: 2/2019

Mountains, Plains, Cities, Schools: An Analysis of Colorado's Rural and Urban School-Based Health Centers
Document
Describes SBHCs operating in rural and urban areas in Colorado, including descriptions of funding sources, services provided, and an overview of users.
Author(s): Bailey, M., Bontrager, J., Goeken, D., Clark, B., Foster, C. & Triedman, N.
Organization(s): Colorado Health Institute
Date: 5/2017

School-Based Health Centers to Advance Health Equity: A Community Guide Systematic Review
Document
Systematic review of literature providing evidence of how SBHCs can advance health equity for children by improving educational and health outcomes.
Citation: American Journal of Preventive Medicine, 51(1), 114-126
Date: 7/2016

School-Based Health Centers: Improving Health, Well-being, and Educational Success
Document
Discusses the role of SBHCs for improving health, well-being and education for youth in the U.S.
Organization(s): American Public Health Association
Date: 2/2018

Telehealth and School-Based Health Centers: Lessons and Best Practices from Early Adopters
Presentation Slides
Webinar slides describing how SBHCs can use telehealth to expand healthcare coverage for children and examples of programs implementing this model.
Organization(s): School-Based Health Alliance
Date: 3/2016