School Based Healthcare:

Why it is Common Sense

03/31/2010  |  ADRIENNE AMMERMAN
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(This is part two of a three part series on school-based health care.)

School-based health centers (SBHCs) provide primary care, mental health services, and sometimes oral health care to students where they are: in school. In part one of this series from the National Assembly on School-Based Health Care (NASBHC) we learned why school-based health care is important, and why SBHCs are an integral component of the community schools model. In this second part of the series we explore what makes school-based health care programs part of a common-sense approach to ensuring that all children and adolescents in the United States are healthy and achieving to their fullest potential.

SBHCs Meet the Needs of Children and Teens

SBHCs are designed to meet the health care needs of students, and are considered one of the most effective strategies for delivering high quality, comprehensive, and culturally-competent primary and preventive care to adolescents — a population that can be difficult to reach. At SBHCs, developmentally-appropriate health services are provided by qualified health professionals, incorporating the principles and practices of pediatric and adolescent health care recommended by the American Medical Association, the American Academy of Pediatrics, and the American Association of Family Physicians. 

SBHCs provide critical services regardless of the student’s ability to pay, and in a location that meets students where they spend most of their waking hours: at school. Because of their location, SBHCs are first-hand witnesses to factors that impact student health and academic achievement — including bullying, school violence, depression, stress, and poor eating habits — which health providers outside a school setting may miss. SBHC staff have the time and the resources to address the many challenges students may bring with them to the classroom.

“School-based health centers make sense because kids like them,” explains Robert Nystrom, Adolescent Health Manager, Oregon Public Health Division. “It’s almost as elementary as that:
SBHCs are friendly, they’re responsive, and they’re within five minutes and 50 feet of their world.”

SBHCs Help Kids Access Care and Stay Healthy

“I see my peers and they’re not educated on their own health,” says Alexis Miller, a 10th grade student in Greenville, NC, who does not have a health center at her school. “I think that if we had more school-based health centers we’d have healthier teenagers.”

Miller is right. A national multi-site study of SBHCs conducted by Mathmatica Policy Research found a significant increase in health care access by students who used them — 71 percent of students reported having a health care visit in the previous year compared to 59 percent of students who lacked access to a SBHC.

“Data from multiple sources suggest that kids vote with their feet,” says Dr. John S. Santelli, Heilbrunn Professor of Clinical Population and Family Health Chair at Columbia University. “When a young person has access to a school health clinic they are more likely to be seen for primary care, and more likely to receive counseling and other preventive services.”

Numerous evaluations indicate that SBHCs lead to notable improvements in adolescent access to healthcare when compared with utilization in other settings. This is especially true for sensitive services such as family planning, mental health, and substance abuse services. Students who report depression and past suicide attempts demonstrate greater willingness to seek counseling in a SBHC. In addition, students with perceived weight problems report more willingness to use a school clinic for nutrition information and sexually active students are more willing to seek information on pregnancy prevention and to have general disease screenings.

 “It’s common sense that if you put a service right next to where the population is that you’re trying to attract, and if you remove almost all barriers from accessing those services, you’re going to get dramatically better use,” says Linda Juszczak, Executive Director of NASBHC. “School health clinics go into places where there is high need or a hard-to-reach population, and they do an exemplary job of increasing access in general — and in particular for males and those impacted by health disparities.”

SBHCs Make Kids Healthier and Ready to Learn

Many educators are painfully aware that poor health has a direct and negative impact on students’ success in school and in life. SBHCs not only improve health care access, they may possibly improve student success.

Although direct links between SBHCs and student test scores and grades can be difficult to capture, we know that SBHCs deliver results that matter to schools, including reducing absenteeism, tardiness, dropouts and discipline referrals. Students have to be present and engaged in order to learn. Studies draw major links between SBHCs and improved attendance. A 2009 report issued by the Oregon Department of Human Services Public Health Division found that more than half (53 percent) of surveyed clinic users reported they did not miss a class while using the center services, while a majority (75 percent) estimated they would miss one or more classes if they had to leave their school to access health services. A study by Montefiore Medical Center (New York, NY) of inner-city, elementary school SBHCs treating children with asthma found a reduction in hospitalization and an increase in school attendance.

“There’s no intervention for algebra in school-based health centers, but health and mental health status is an important predictor of educational success,” says Nystrom. “A kid with a chronic condition like asthma that is managed at school is likely to miss less class time. If a center can intervene early in a mental health issue or prevent an unintended pregnancy, a youth is more likely to remain in school and engaged in learning.”

As a bridge between health and education, SBHCs are well positioned to reduce dropouts through a variety of interventions and collaborations. For example, one study in Dallas, Texas found that students who received mental health services at their SBHC had an 85 percent decline in school discipline referrals.

Nidia Escobar, 19, is a member of the California School Health Centers Association Youth Board: “Right now I’m in community college, but if I hadn’t had health center at my school I probably wouldn’t even have graduated from high school. I had problems that were so personal and so big ... if the health center wasn’t there for me it would have been too much of an obstacle to overcome on my own.” 

Why SBHCs?

 “For the past 25 years I’ve worked in every health care model in the country — from community health centers, to private practices, to school-based practices,” says Dr. Veda Johnson, Assistant Professor of Pediatrics at Emory University School of Medicine. “School-based health centers are the best model of health care in this country for at-risk populations — and that’s coming from a pediatrician. SBHCs increase access to health care, eliminate barriers and improve health outcomes for essentially every patient enrolled.”

SBHCs are popular with providers, with parents, with kids, and with educators and school administrators for a very simple reason: they’re common sense, and they work. SBHCs assure equal access for all children and adolescents to critical health care services — leading to opportunities for success in school and in life.

Adrienne Ammerman is director of communications at the National Assembly on School-Based Health Care. For more information visit www.nasbhc.org.

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