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-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
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
Health Centers website has information about applying for funding for a center.
Whole School, Whole Community, Whole Child (WSCC): Rural communities are also implementing the
Centers for Disease Control and Prevention’s (CDC) evidence-based
Whole School, Whole Community, Whole Child
(WSCC) model to promote the healthy development of school-age children. This initiative involves eight key
- Health education
- Physical education
- Health services
- Nutrition services
- Counseling, psychological, and social services
and safe school environment
- Health promotion for staff
- Family/community involvement
leaders can use the
School Health Index to assess the strengths and
weaknesses of their school and identify key components of WSCC to prioritize their goals.
The CDC has information about implementing a
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
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).
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 WSCC 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
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
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
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
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
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
This article reviews four innovative school-based programs, focusing on obesity, asthma, mental health, and oral
Author(s): Clayton, S., Chin, T., Blackburn, S., & Echeverria, C.
Citation: American Journal of Public Health, 100(9), 1592–1596
School-Based Health Alliance
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
School-Based Health Centers in an Era of Health
Care Reform: Building on History
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.
Citation: Current Problems in Pediatric and Adolescent Health Care, 42(6), 132–158