School Based Healthcare

11/20/2009  |  Divya Mohan Little

(This is part one of a three part series.)

A Problem and An Opportunity - Every day too many of our nation’s youth go without affordable, high quality health services. If a student is unhealthy and does not have access to health care, he/she will experience health and social problems that compromise academic potential, resulting in missed classes, poor academic performance, and even school failure.

Experienced educators know that the ill affects of poor health have a direct and negative impact on student success. Every minute a student is absent from class due to an untreated condition, they miss valuable lesson time with their teacher and classmates that can lead to weak test scores and poor grades.These results, if there is no intervention, can manifest into deeper problems such as the student falling behind academically, becoming discouraged, repeating a grade, and/or eventually dropping out.

Teachers cannot teach when a student with a toothache or untreated behavioral problems disrupts the learning environment, or if they are busy helping a child with an insulin shot, or administering other medication. Few would argue with the fact that health issues that affect children eventually spill into the classroom, and some see the connection between health and education as an opportunity to improve the education system.This is seen in the community school approach that is being embraced by leaders who want to address the educational experience of children and youth from a holistic perspective.

Why Bring Health Care to Schools?

Hundreds of schools and communities across the country are transforming health and education by uniting them under one roof.

School-based health centers (SBHCs) integrate comprehensive medical, mental health and social services on the school campus to optimize learning readiness. Opening school doors to health care creates pathways to children’s educational attainment and lifelong well-being. SBHCs are located in schools where students face barriers to accessing health care, thereby affecting their academic achievement.

School-based health centers deliver medical care to help students with chronic and acute conditions cope with disease, getting them back to the classroom faster and ready to learn. Mental health services focus on improving students’ emotional well-being, and decreasing high-risk, health-compromising behaviors such as drug, alcohol and tobacco use. Health surveillance and preventive services catch health problems early and promote a healthier, safer student body. Social services help children and families with the basic supports of food, shelter, and safety. Youth development services, another component of many SBHCs, also build social competencies and strengthen students’ connections to school and community. There are approximately 2000 SBHCs in 44 states, DC, the Virgin Islands and Puerto Rico, serving approximately 1,700,000 students, yet significant need exists for more SBHCs. Consider the startling and disturbing statistics that exist today:

  • Eight million uninsured children
  • 15 million children with mental health challenges
  • 4,717 communities with health professional shortages in the United States

Eleven percent of our nation’s children lack health insurance, jumping to 19 percent among poor children. Due to their safe and familiar location in the child’s school, SBHCs are able to provide patient-centered, professional care at little to no cost to the student. They deliver essential preventive health services such as well child exams, dental care, health education, and immunizations, and manage chronic diseases like asthma and diabetes. SBHCs also address mental health issues that complement special education, and reduce risks associated with health compromising behaviors.

Seventy percent of the schools hosting SBHCs report that more than half their school population is eligible for the U.S. Department of Agriculture’s Free and Reduced Lunch Program. The SBHC works best in partnership with the school and community. A “Healthy Learners Alliance” promotes partnerships with the SBHC, local public health agencies, community health organizations, and hospitals and involves teachers and coaches, school administrators and staff, and students, to eliminate inequities in educational achievement and health care access. School-linked integration efforts result from an increasing awareness that education goals are hampered by nonacademic factors such as: social, economic, health, and emotional difficulties faced by children and families. Access to culturally competent, high quality, first-contact primary care through schoolbased health centers is an effective way to reduce health inequities and improve health outcomes for socially disadvantaged children and adolescents. Schools provide a logical hub for many critical services and supports.

In the widely accepted model of service delivery, improving a child’s health status is addressed by providing medical care separately from other community services. In an integrated model, medical care would link the child and family to housing, safe neighborhoods, nutrition, social support, professional services, and particularly education. Community schools are recognized as a vehicle that “works” for moving from a linear to integrated paradigm of service delivery. The U.S. Secretary of Education, Arne Duncan, an ardent community schools supporter says, “The more we’re co-locating services, GED, ESL, health care clinics…the more those schools become the centers of community life, the better our children are going to do.”

Hundreds of community schools across the Nation are living examples of the Secretary’s vision (e.g. New York, NY; Chicago, IL; Evansville, IN; Tukwila, WA; and more ). These results-based schools are helping students be healthy, by addressing health challenges health disparities among disadvantaged students and their families. Community schools strive to achieve a core set of results to ensure that students are graduating ready to for college, careers and citizenship.

What are Community Schools?

Using public schools as a hub, community schools bring together a wide variety of partners within the community to offer a range of services and opportunities to children, youth, families and communities. An integrated focus on academics, health and social services, youth and community development along with community engagement, leads to improved student learning, stronger families and healthier communities.

Community schools function as both a place and a set of partnerships between the school and other community resources. They are the centers of the community, open to everyone — all day, every day, evenings and weekends.

What Are the Results?

Community schools focus on a core set of results that are crucial to the learning and development of students. Health outcomes are among the core set of results.

Unchecked or unaddressed health issues can create barriers to students’ learning. School-based health clinics, coordinated school health and community health centers, are all examples of partnerships occurring in many community schools. These centers offer services and supports, such as eye exams, dental care, and preventive health, inside a community school to improve health outcomes for students, families and communities. Partnerships between community schools and the healthcare community make a difference for students but also for their families and community. Health issues can be a key factor in whether or not students succeed academically or in life. If a child cannot read the chalkboard or comes to school with an empty stomach, their learning is affected.

Students inevitably perform better when they attend class healthy and ready to learn. School-based health centers (SBHC) deliver results that matter to schools. In Massachusetts, SBHC users had a 50 percent decrease in absenteeism and 25 percent decrease in tardiness two months after receiving school based mental health and counseling. In North Carolina, African American male SBHC users were three times more likely to stay in school than their peers who did not use the clinic. A Dallas, Texas SBHC demonstrated that medical services helped decrease absences by 50 percent among students who had three or more absences in a six-week period; students who received mental health services had an 85 percent decline in school discipline referrals. How Do SBHCs Function in Community Schools?

Sayre High School, a university assisted community school, collaborates with the Netter Center for Community Partnerships at the University of Pennsylvania, to address community health needs, with the Sayre Health Center. The federally funded health center provides students, families, and community members with clinical, educational, and health promotion services on site. In addition to addressing health issues, the health center serves to create an engaging curriculum.

For example, Sayre students interested in health careers get hands-on experience as they work with university doctors and community members in the field. The Health Center also engages parents and other community adults through Family Fitness Nights and offer free classes in healthy cooking The Sayre Health Center involves faculty, staff, and students from across the University. The multidisciplinary character of the program enables the work to be integrated into the curricula of both the public school and the University.

The Evansville-Vanderburgh School Corporation (EVSC) in Evansville, IN, in an effort to address the health disparities at Helfrich Park Middle School, has fully implemented a coordinated school health (CSH) model. The CSH model offers health education; physical education; health services; nutrition services; counseling, psychological, and social services; healthy school environment; health promotion for staff; and family and community involvement. School staff works with local hospitals to provide back-to-school physicals, dental care, and blood pressure screenings, along with the regular height and weight screenings.

The CSH model also benefits school staff, families, and community members. At the school level, the registered dietician consults both students and staff on their dietary habits, needs, etc. Health awareness is a key component of EVSC’s CSH work. Health education and programs such as walking clubs and dance-dance revolution are being provided before and after school, as well as during recess. Audra Offutt, a wellness coordinator at the community school at Helfrich Park Middle School says, “I feel like we are making a comprehensive effort to make a positive impact on the lives of our students!” The EVSC’s coordinated school health efforts are gaining attention nation-wide. The division of Adolescent and School Health of the U.S. Centers for Disease Control and Prevention (CDC) recently selected the EVSC as one of the nation’s leading sites for coordinated school health. After receiving more than 80 nominations from across the country, the CDC selected the EVSC’s program as one of only six models that exemplified best practices in coordinated school health.

To date, Helfrich’s results are strong and make the case for more CHCs and SBHCs. Schools report students sharing health experiences of trying new healthy foods or different physical activities. Additionally, parents report to teachers, administrators, and coordinators their appreciation for the health newsletters, lessons, and activities that are available to their child(ren). Many of those parents report the nutrition and physical activity for their families have been impacted positively at home.


Children who attend schools without a SBHC are at risk of receiving little or no health, dental and mental health services. A recent Institute of Medicine report noted the number of teens that already rely on safety net health providers, including SBHCs, as their only source of care. The rise of SBHCs, which are thriving in the community school environment, is a clarion call to the challenges faced by economically disadvantaged children and families in today’s economy. Schools must get engaged more deeply in this discussion and consider partnerships with health centers, bringing them into their buildings where the children are. Mandatory reimbursement for SBHCs under public insurance programs and/or a federal authorizing program for SBHCs are provisions that will ensure that SBHCs can continue to provide their valuable services to our nation’s most vulnerable population.

Comments & Ratings

  12/8/2012 10:26:00 PM

New Comment 
I teach at an alternative ed scohol. One of the vocational programs we have offered, in addition to shop, auto mechanics, etc., was an introductory program for students who wanted to enter a health care profession. The woman who taught the course was an RN, and the students learned ethics, medical terms, record keeping, and also visited job locations in various medical facilities.