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
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 (CPSTF) recommends worksite interventions
Increasing influenza vaccination coverage among both non-healthcare
workers and healthcare
activity and reducing weight among employees
Improving a variety of health
and safety behaviors
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
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.
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.
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
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
Schools and school districts have limited funds to spend on school support services, as seen by the
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
Program Clearinghouse Examples
Resources to Learn More
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.
Citation: The Online Journal of Issues in Nursing, 22(2)
A collection of resources including news, research, conferences/meetings, and other tools for researching and
implementing a workplace based clinic.
Rural 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.
School-Based Health Centers
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