School and Workplace-based Healthcare
School and workplace-based healthcare can also help to reduce barriers to care that may result from a lack of transportation. School-based health centers (SBHCs) generally operate as primary care clinics, with a nurse practitioner, physician assistant, or physician providing services to students and, in some cases, local community members. Facilities are located in or near schools and emphasize early prevention and treatment, and permit coordination between medical care providers and school personnel for children with complex needs. Many SBHCs are affiliated with federally-qualified health centers (FQHCs) or county health departments.
The range of services available may vary depending on capacity and state regulations, but can include mental health counseling, immunizations, physical exams, vision and dental screenings, and health education. Schools can play an important role in rural health systems because they help overcome access barriers, including challenges related to transportation and missing work for parents. SBHCs are recommended by the Community Preventive Services Task Force as an effective method for improving health outcomes and health equity.
Similarly, workplace-based clinics are designed to provide easily-accessible care for employees who are unable to take time off work to seek services. The Community Preventive Services Task Force recommends worksite interventions as an effective means for:
- Increasing influenza vaccination coverage among both non-healthcare workers and healthcare workers
- Improving diet/physical activity and reducing weight among employees
- Improving a variety of health and safety behaviors
- Increasing smoking cessation among workers
The Rural Health Information Hub's Rural Services Integration Toolkit has more information on both school-based services and worksite models, including how these programs can be implemented through rural programs, and provides resources for additional information.
Examples of Rural School and Workplace-Based Healthcare Programs
- The School-Based Health Center Dental Outreach program in rural Louisiana seeks to improve oral health among children by integrating oral health assessments into primary care visits with school-based nurse practitioners. The program has helped to increase the rate of fluoride varnish treatments and improve the number of timely referrals to dentists. The medical team also plays a role in dental case management if additional care at a dental clinic is needed.
- The Munson Healthcare Charlevoix Hospital School Nurse Program is a hospital-supported program that brings healthcare providers to schools in rural Michigan without a dedicated school nurse. In addition to successfully providing direct services like screenings, education, and case management, the program was also found to decrease rates of student absenteeism. Nurses in the program work full-time in the schools during the school year, and rotate into the hospital during vacations and in the summer.
- The Southeast Mississippi Rural Health Initiative is a non-profit primary healthcare services provider that staffs 22 school-based clinics at elementary, middle, and high schools. Students receive care at no out-of-pocket cost, and services are provided to both students and community members.
- The Wolves Wellness Center is the first SBHC in Merced County, California. The SBHC is located in a high school in which 90% of the students live in poverty. In addition to serving students, the clinic offers their families and other community members mental health services, dental services, primary care visits, medication management, and referrals to other community-based organizations for more specialized needs.
- The JM Family Enterprises, Inc.'s Health & Wellness Center in Commerce, Georgia offers an onsite clinic staffed with a team of physicians, nurses, dietitians and physical therapists. The clinic provides services for employees, as well as dependents ages 16 and older. Services include vaccines, laboratory testing, wellness exams, and chronic disease management.
Considerations for Implementation
Providing care at school instead of in off-site clinics increases the likelihood that students will obtain primary care and preventive services including immunizations and vision or dental screenings. Schools with access to SBHCs also see increased rates of attendance. In part, this may be related to the ability of the student to obtain services without needing the parent to remove the child from class to visit the clinic. Some jurisdictions may decide against providing reproductive health or contraception services at SBHCs. Clinic staff should be prepared to provide referrals to other community organizations or providers as needed.
In most states, parents will need to provide written consent before their child can become a patient at an SBHC. Other states permit consent by minors of a certain age. Signed consent forms will need to be kept on-site or otherwise stored appropriately based on state law. SBHCs will need to obtain consent for unaccompanied minor community members in addition to students who wish to use their services.
Schools and school districts have limited funds to spend on school support services, as seen by the shortages of full-time school nurses in rural areas. For this reason, SBHCs often seek funding from a number of different sources. Some SBHCs are supported by private foundations, while others receive state funding. Most also bill insurers, including public insurers like Medicaid and the Children's Health Insurance Program.
Considerations for implementation of worksite programs are discussed in the Worksite Model of the Rural Services Integration Toolkit.
Program Clearinghouse Examples
Resources to Learn More
Benefits of On-Site Clinics
Describes the history and value of on-site clinics, focusing on the healthcare cost savings for both employers and employees.
Author(s): O'Keefe, L.C. & Anderson, F.
Location: The Online Journal of Issues in Nursing, 22(2)
This toolkit is designed for programs and communities interested in developing and implementing school-based health centers. It includes sample needs assessments, parental consent forms, policies and procedures to consider, and satisfaction surveys that can be used for evaluation.
Organization(s): The Center for Health and Health Care in Schools
A collection of resources including news, research, conferences/meetings, and other tools for researching and implementing a workplace based clinic.
Health Equity Through Education Programs and Policies: School-Based Health Centers
Details the Community Preventive Services Task Force findings on the educational and health outcomes of using SBHCs.
Organization(s): Community Preventive Services Task Force
School-Based Health Centers: A Framework for Success
The Rural Health Consortium (RHC) is a professional network for school-based care providers and administrators in rural Colorado. This report from a meeting of the RHC outlines keys to success, provides examples of successful programs, and outlines challenges and opportunities for SBHCs to reach students in need, particularly immigrant and uninsured children in rural communities.
Organization(s): Colorado Association for School-Based Health Care
The School-Based Health Alliance
This national advocacy organization supports school-based health clinics with resources, training, and networking support. Also includes a list of links to state-level affiliates.
This fact sheet about school-based health centers provides some general information about the role of these programs providing primary care services in underserved communities. It also provides some additional information about federal Section 4101(a) grants, including eligibility and conditions for grant money (at this time, new grants are not being funded).
Author(s): Valeta, M.
Organization(s): National Conference of State Legislatures
Workplace Health Promotion
Includes links to resources designed to help employers create or expand worksite based health programs.
Organization(s): Centers for Disease Control and Prevention