Federal School-Based Health Center Bill Gaining Bipartisan Support

September 6, 2018

Federal School-Based Health Center Bill Gaining Bipartisan Support

As schools open their doors to students for a new academic year, a growing number of supporters in Congress have joined together to sponsor legislation that authorizes a federal school-based health care program. “Even as it seems that our nation is irrevocably divided along partisan lines, an issue like the health, wellbeing, and safety of children and adolescent can unite political leaders,” said John Schlitt, president of the School-Based Health Alliance, praising the bipartisan spirit of the legislative coalition.

H.R. 5899 was introduced in May 2018 by a bipartisan group of members, including John Faso, Fred Upton, John Sarbanes and Paul Tonko.

Issues confronting young people like opioid and other illicit drug use, suicide and violence are front of mind for Congress; school-based health centers represent an important part of the solution for many communities.

“I’m helping to lead the charge on this important, bipartisan bill because I want to continue our support for our nation’s children and help them succeed in every facet of life,” said Rep. Fred Upton. “By reauthorizing the SBHC program for 2018 to 2023, I’m aiming to continue crucial services.”

“Access is the number one healthcare issue facing our community, and I’m working to fix that with common sense bills like this one,” said Rep. Jeff Denham (R-Calif) in a statement about his support for H.R. 5899.

The number of bill sponsors has grown over the summer to 32, including 11 Republicans and 21 Democrats. Carlos Curbelo (R-FL), Rodney Davis (R-IL), and David Valadao (R-CA) joined on this week.

See the Alliance’s initial statement upon the bill’s introduction.


Alliance Receives Federal Award to Lead School-Based Health Services Quality Improvement & Sustainability Initiative

August 16, 2018
School Health and Mental Health Organizations Receive 5-Year Federal Award to Lead School-Based Health Services Quality Improvement and Sustainability Initiative

WASHINGTON, DC—The School-Based Health Alliance (“The Alliance”) and the Center for School Mental Health (CSMH) were jointly awarded a cooperative agreement from the federal Maternal and Child Health Bureau (MCHB) at the Health Resources and Services Administration to lead innovation and improvement in quality of care through school-based health services. The two organizations are eager to build on the momentum of the previous four years leading the School Health Services National Quality Initiative (NQI), and work collaboratively with their partners, including the Center for Health and Health Care in Schools at George Washington University, project advisors, and school health providers from across the nation to ensure the highest quality of care for children and adolescents receiving services in schools.

The 5-year agreement will support the partnering organizations’ efforts to improve the quality of care delivered by school-based health centers (SBHCs) and comprehensive school mental health systems (CSMHSs) nationwide. The Alliance and its partners will:

  • Review and refine current national performance measures;
  • Conduct three quality improvement collaboratives of cohorts comprising SBHCs and CSHMHs (be on the lookout for partnership opportunities Spring 2019);
  • Facilitate a Community of Practice for state agencies and state-level organizations to accelerate and spread innovation and improvement in quality care, best business practices, and policies to support school health services sustainability and growth;
  • Provide technical assistance to SBHCs, CSMHSs, and schools not participating in CoIIN cohorts, encouraging adoption of CoIIN-generated strategies and innovations;
  • Integrate contemporary and emerging child and adolescent behavioral health topics, issues and conditions (e.g., adverse childhood experiences, opioid use) and emerging practices (e.g., telehealth, trauma-informed practices, restorative justice, social/emotional learning) in performance measure refinement, screening tools, implementation guidance, webinar series, and resources; and
  • Support states to effectively assess and address social determinants of health in school-based health services.

“The inequitable distribution of health and education resources across our communities has created profound and unjust disparities in outcomes for young people,” said John Schlitt, president of the Alliance. “School-based health services represent the intersection of our nation’s health and education systems. And, when organized in partnership with community systems of care, the provision of health and mental health services in schools can level the playing field for all children and adolescents by eliminating the health disparities that plague our nation’s most vulnerable students.” Dr. Sharon Hoover, CSMH Co-Director, adds “Schools are the de facto mental health system for our youth, and this effort will continue to drive forward the quality and sustainability of services and supports that address the mental health of all students.”

Opportunity for Collaboration:

In Spring 2019, the Alliance and CSMH will invite the school-based health services field to participate in the National Quality Initiative Collaborative Improvement and Innovation Network (NQI CoIIN) learning collaborative. School-based health services teams, sponsors, and community and state-level organizations will have the chance to learn from one another as well as experts in the field to collectively make improvements in SBHS.

About the Partners:

The School-Based Health Alliance is a nonprofit 501(c)3 organization that was founded in 1995 to serve as the national voice for school-based health care. The Alliance supports the school-based health care field by providing technical assistance, resources, and trainings so they can provide the best-quality health care to their patients. In addition, the Alliance advocates for policies on the local, state, and federal level that strengthen school health, and supports its technical assistance and advocacy work—and the entire school-based health care field—through quality research and evaluation.

The Center for School Mental Health, in the Division of Child and Adolescent Psychiatry at the University of Maryland School of Medicine, is committed to enhancing understanding and supporting implementation of comprehensive school mental health policies and programs that are innovative, effective, and culturally and linguistically competent, across the development spectrum (from preschool through post-secondary), across three tiers of mental health programming (promotion, prevention, intervention).


13 SBHCs Revolutionized the Way We Think About Wellness: Here’s How

July 26, 2018

13 SBHCs Revolutionized the Way We Think About Wellness: Here’s How

By Jordanna Snyder, Hallways to Health program manager

How can wellness spill out from school-based health centers (SBHCs) into the surrounding hallways, the school staff offices, and into the community itself? What role can SBHCs play in school-wide health promotion and illness prevention?

Over the last four years, I’ve had the pleasure of working closely with amazing school-based health practitioners in thirteen SBHCs in California, Georgia, Maryland, Oregon, and Washington. Through generous funding from Kaiser Permanente, the School-Based Health Alliance distributed grants to those SBHC sponsor organizations in a quest to answer those very questions. We named the initiative, Hallways to Health (H2H).

Several grantees elected to use their H2H funds to hire a dedicated coordinator or health educator, while others chose to expand the hours of existing SBHC practitioners and designate one of their own staff as project coordinator.  Our state partners at the California School-Based Health Alliance, the Georgia School-Based Health Alliance, the Maryland Assembly on School-Based Health Care, and the Oregon School-Based Health Alliance supported the H2H sites with coaching and technical assistance.

This cadre of Hallways to Health coordinators worked tirelessly to foster the systemic conditions—values, beliefs, norms, policies, practices, programs, services, and partnerships—to advance health and enable ALL children to thrive in the classroom.

By formalizing a liaison role between their SBHC and school, the coordinators discovered new ways to address student social determinants of health like food insecurity; united with principals to improve academic outcomes; partnered with teachers to introduce health education in both classrooms and staff professional development trainings; set up parent education nights and family events; and strengthened school and district health and wellness policies.

I got to know these school health leaders through site visits, on monthly calls, and in annual group gatherings where they shared ideas with one another and bonded into a creative, high-energy network. I couldn’t believe how innovative, driven, and persistent they were. They were fearlessly willing to try on new rolesthinking outside the box and outside of the traditional scope of their clinical practices. And boy, did they excel!

After four years of intense H2H work across the sites, we witnessed major increases in the number of SBHC staff, school administrators, teachers, and students involved in school-wide health efforts. We also saw H2H champions craft sustainable programs and policies in areas like student social and emotional health, healthy eating, and active living. We even watched programs transform the health habits of school staff as well.

This year, we’ve reached hundreds of other SBHCs by traveling the country and spreading the Hallways to Health gospel—that SBHCs can be catalysts for broad, school-wide wellness—via in-person and virtual trainings. More SBHCs are now motivated to start their own H2H-style programs than ever before.

The collective work of our H2H sites has been catalogued in a brand new toolkit, “Creating a School-Wide Culture of Wellness.” It contains everything you need to know to hit the ground running.

This toolkit synthesizes Hallways to Health work into the key steps it took coordinators to plan, grow, and sustain their school-wide wellness efforts. In each section, you’ll find best practices, helpful tips, stories, video interviews, and sample tools.

I can’t thank our thirteen H2H sites enough for letting us share their journeys with the broader school-based health care field, and I can’t wait for you to check out what they’ve been able to do!

Visit the Hallways to Health Toolkit

Visit our webinar archive to view a four-part webinar series that introduces each section of the toolkit.


School-Based Health Alliance Urges Trump Administration to End Policy of Separating Families at U.S. Border

June 19, 2018

School-Based Health Alliance Urges Trump Administration to End Policy of Separating Families at U.S. Border

Washington, DC—The School-Based Health Alliance issued the following statement today on the current crisis of family separation at the U.S. border: 

“The situation at the border is a moral crisis. It is also a public health disaster.

Over the past several months, the federal government has forcibly separated thousands of young children from their parents and adult caregivers at the US-Mexico border as part of the Trump Administration’s “zero tolerance” immigration policy. This includes families who legally present themselves at an official border crossing to seek asylum in the U.S.  President Trump asserts repeatedly that he is not responsible for this policy and is unable to fix it, citing a law passed by Congressional Democrats. The news media and policy experts have refuted both claims. What is true is that this Administration is using children as leverage to advance its immigration agenda.

Separating children from their adult caregivers as a government policy is cruel, inhumane and immoral. It is also reckless and disastrous policy for children’s mental health and well-being.

Dr. Colleen Kraft, pediatrician and President of the American Academy of Pediatrics (AAP), recently visited a detention center in Texas that houses migrant children separated from their parents. She noted that while basic needs such as food, shelter, and diaper changes were being met, workers at the center were instructed not to pick up or touch the children.

Imagine you are a young child who has recently made the arduous and uncertain journey from your home country to the U.S. border, likely fleeing due to traumatic conditions and violence, only to be forcibly separated from the only sense of comfort and security you know. You are in a foreign place, you don’t speak the language, you don’t know if you will ever see your parents again and there is no adult who is allowed to physically comfort you.

We don’t have to imagine what the lifelong impact of this kind of trauma might be: public health research tells us. The prolonged stress of being held in detention without the protective buffering of a parent or caring adult relationship can lead to a toxic stress response in children. Toxic stress disrupts brain and organ development, significantly increasing the risk for physical and behavioral health problems into adulthood, including heart disease, diabetes, substance abuse, depression and post-traumatic stress disorder. And then there are the long term impacts that are less measurable: a child’s sense of justice, of right and wrong, and their ability to trust.

Immigration policy is complicated. Meeting the basic mental health needs of children is not. It is unspeakably cruel to sacrifice the latter as a political strategy to advance the former.”

The School-Based Health Alliance stands with our national partners, including the American Academy of Pediatrics, the American Public Health Association, the American Psychological Association and others in aggressively opposing the separation of families at the border. We urge the Trump Administration to end this unnecessary and harmful policy.

For more information, please contact Senior Policy and Program Manager Suzanne Mackey.


Announcing Our 2018 Award Winners

May 24, 2018

Announcing Our 2018 Award Winners

By John Schlitt, President

Each year for nearly two decades, the School-Based Health Alliance has recognized luminaries in the school-based health care field with a Lifetime Achievement award. During the national convention we honor select individuals and institutions who have demonstrated a strong commitment to the mission of school-based health care. We celebrate leaders who embody the spirit of innovation, dedication, and collaboration, who go above and beyond to manifest the vision of quality school-based health care for all young people. And while we’re pleased to honor that tradition once again in 2018, we’ve complemented the veteran award with a Rising Star tribute to individuals early-to-mid-level in their careers who are actively solving pressing issues in school-based health care.

First, the lifetime achievement award, and because I’ve been privileged to work with so many extraordinary individuals, it often feels deeply personal. This one’s no exception.

It’s been my great pleasure to have known and worked with Dr. Veda Johnson for over 20 years to expand and promote school-based health centers nation-wide as a proven model of healthcare for at-risk and underserved youth. A pediatrician and school-based health care pioneer, Dr. Veda Johnson’s tireless advocacy and enduring vision have changed the face of pediatric care in Atlanta, across the state of Georgia, and nationwide. Dr. Johnson is a leading authority on school-based health care models. She has spent her entire career pushing health care out of the medical complex and into neighborhoods and schools so that all children, no matter their race, ethnicity, socioeconomic status, or zip code, have limitless opportunities to thrive.

Over the past two decades Dr. Johnson has served on the School-Based Health Alliance Board of Directors, been a welcome presence as faculty at our national conventions, and, at our behest, periodically testified before Congress about the school-based health care model. Dr. Johnson currently serves as the Alliance’s liaison to the American Academy of Pediatrics Council on School Health where she is establishing a framework for collaboration between the two organizations.

Her many outstanding contributions to the growth and sustainability of school-based health centers span academic, research, education, training, philanthropy and advocacy realms.

Our 2018 Rising Star is Amanda Forsmark, a health educator with Great Lakes Bay Health Centers, who’s been a part of the Saginaw High School-Based Health Center in Michigan since 2011.  During her time there, she has established a state-recognized Teen Advisory Council (TAC) that is financially self-sustaining, runs a variety of innovative programs for youth peers, and has won several state-wide and national awards for their work.  Some of their programs include: state and national advocacy projects related to health care for teens; a “Respect Campaign” that resulted in lowering bullying rates at Saginaw High School; “REAL TALK” annual youth symposium to educate young people about healthy sexual choices; and an “I’m Healthy and I Know It – I Work Out!” program that fosters healthy eating and exercise after school hours.

Amanda “loves to work with young people and to see her students create positive change in their community.”  Her infectious smile and calm, “can-do” attitude make her a joy to be around, and her peers, school/community partners, and the young people she works with all rave about her passion, competence, reliability, creativity, and dedication to the SBHC and TAC models.

Congratulations to Veda and Amanda! We’ll see you in Indianapolis.


Legislation Introduced in Congress to Reauthorize SBHC Program

May 22, 2018

Legislation Introduced in Congress to Reauthorize SBHC Program

Today, a bipartisan group from the U.S. House of Representatives introduced legislation to reauthorize the School-Based Health Centers (SBHC) program. House members John Faso (R-NY), Paul Tonko (D-NY), Fred Upton (R-MI) and John Sarbanes (D-MD) sponsored H.R. 5899 to extend the School-Based Health Centers program authorization through 2023. The program’s statutory authorization expired in 2014.

In his public statement about the bill, Congressman Faso recognized that “the reauthorization is long overdue.” “New York has the largest statewide network of SBHCs in the country and they are increasingly important in rural Upstate communities.” These health providers fill geographic service gaps and ensure that students are receiving necessary care, such as preventative check-ups, dental services, and mental health services. I am glad we have a bipartisan coalition that recognizes the importance of SBHCs.”

“School-based health centers are a critical source of healthcare for students including those with struggling mental health challenges or substance use disorders,” said Congressman Tonko. “In the midst of our nation’s opioid epidemic, these centers have become even more important, especially in communities where there is limited access to substance use and mental health care. I am proud to stand with my colleagues in a bipartisan basis to support this important measure that serves students and families across Upstate New York.”

“My home state of Michigan has 121 school-based health centers,” said Congressman Upton. “These health care providers fill a critical need for our kids including mental health services. I’m glad to join this bipartisan coalition supporting this reauthorization to ensure school-based health centers continue to help our kids succeed in every facet of life.”

“Thousands of children across the country depend on school-based health centers to deliver primary care, mental health services and dental treatment,” said Congressman Sarbanes. “This bipartisan effort will ensure that school-based health centers have the resources they need to keep our children healthy and help them succeed in the classroom.”

The reauthorization of school-based health centers is a critical step forward for children. At the heart of the SBHC model is the incontestable fact that healthy students are better learners. SBHCs represent a key strategy for ensuring our children and adolescents receive high-quality primary and mental health care services in a location that’s safe, convenient, and accessible. In this critical time, SBHCs are also meeting the increased mental health needs of the lesser known victims of the national opioid epidemic – children who are affected by their parents’ or families’ struggles with addiction.


Marching for Our Lives: Because High School Is Stressful Enough

April 18, 2018

Marching for Our Lives:
Because High School Is Stressful Enough

By Anna Burns, Manager, Communications and Public Policy

Saturday, March 24 was an extraordinarily beautiful Saturday in the District. I stayed up late the night before, crafting witty, heartfelt March for Our Lives posters with some girlfriends. I was tired, certainly, but more than anything, I was excited. It’s time for another history-making rally.

As I arrived at the march, camera dangling from my neck and phone in hand, I scanned the crowd. (And when I say crowd, I mean crowd in the truest sense of the word.) Here’s what I saw: people from every walk of life, every skin tone, and every gender exuding a sense of hope and togetherness.

On one corner there’s a small child holding up a poster larger than himself: “Am I worth more than a gun to you?”

Hundreds of thousands of people flooded my city today in response to the recent tragedy at Marjorie Stoneman Douglas High School in Parkland, Florida. The senseless violence of students being killed in the midst of a school day traumatizes all of us and has had repercussions throughout our country and around the world. Those students have been utterly devastated by the loss of their classmates, teachers, and friends, but they refuse to be silent. Weeks of activism have culminated in this march. Outside of DC, 1.7 million people orchestrated 752 marches around the nation; 104 marches took place around the world.

Why am I here? I haven’t been directly affected by gun violence, fortunately. But what did one commentator say on CNN this morning? That until you’re personally touched personally by violence, you just don’t feel it? That may be true for many people. But for me, I’m here because of a gut feeling of right from wrong. No parent should have to bury their own child. No child should ever have to attend the funeral of their teachers or friends. Children shouldn’t be afraid to go to school. Period.

And then there’s my professional work. As communications and public policy manager for the School-Based Health Alliance, I dedicate hours each day to redefining health for kids and teens, especially in a place that should be a safe access point for support, health care, and compassion—their school. As a children’s health advocate, I can’t just “talk the talk”. I must walk the walk. In this case, that walk brings me down Pennsylvania Avenue.

The Parkland tragedy is part of a painful narrative of violence in our country which has claimed the lives of people young and old, students in school, and music-lovers at a concert; people going about their daily lives, people who left home in the morning fully expecting to safely return after school or work or a fun evening out. Except that again and again, chaos and killing interrupts these activities—without warning, purpose, limits, or mercy.

Gun violence claims around 96 American lives each day. Seven of these lives are young people. Guns lead to more deaths than the next 12 leading causes of teen death combined. A staggering 187,000 children in the U.S. have been directly involved in mass school shootings. And while black students make up 16.6 percent of the school-age population, they experience school shootings at twice the rate of their white peers.

Gun violence threatens the lives of children each and every day in a variety of settings—not just in schools. Millions of kids from inner cities live in constant fear of gun violence—a stressful assault on their developing minds and bodies. March for Our Lives speaker Zion Kelly, from Washington, DC, spoke to the crowd about losing his twin brother last fall when an armed robber shot and killed him. Edna Chavez, from South Central LA, described her pain as she watched someone shoot and kill her brother in their neighborhood. For her, gun violence is a normal part of her life. She learned to dodge bullets before she even learned to read.

The crowd pulsates with fervor and passion and fills me with optimism and pride. Pride for the teens who are forgoing teenage rites of passage—prom dress shopping, the anxiety of their upcoming college careers—and instead hosting town halls and meeting with elected officials to fight for their right to be safe.

They are letting adults know—with great passion, courage, savvy, and strength—that we are failing them. Their voices are raw and shrewd, unrefined and clear, strong and innocent. They reject policymakers’ “thoughts and prayers”. Words aren’t enough. They demand action. Their lived experiences are incomprehensible to many adults—myself included. My school never had active shooter drills, which are now commonplace at every school in America. Kids learn how to hide in supply closets and underneath desks to shield themselves from death.

The afternoon stretches on into evening. The sidewalks fill up with the usual rally detritus: discarded posters, stickers, and flyers. I take a look at the signs:

  • “When I said I’d rather die than go to chemistry, it was hyperbole.”
  • “We walk in their shoes because they can’t.”
  • “High school is stressful enough without more guns.”
  • “18 in November.”
  • “Mental illness is global. Mass shootings are American.”

As the crowd disperses to their own corners of the world, we ask ourselves: Where do we go from here? How do we leverage the momentum of today’s events so that Congress acts with meaningful legislation aimed at preventing gun violence in schools and communities, and not piecemeal stopgap measures meant to placate students?

Join millions of advocates demanding transformative change. Only with a legion of voices, in public debates and via subsequent ballot-box repercussions, can we make our schools safe again. Gun violence? #NeverAgain.


Creating Freedom from Violence

April 18, 2018

Creating Freedom from Violence

By John Schlitt, President

Enough is enough. Never again. Now is the time. It seems unimaginable, but the national gun violence prevention movement, fueled by unthinkable acts and media-savvy youth activists, may have finally reached a tipping point in our public discourse. Inspired by the righteous indignation of young people who refuse to accept violence as a norm, advocates are emboldened to demand commonsense solutions from their elected policymakers to end the violence visited upon our children.

The gun violence experienced in the communities of Parkland, Newtown, and Littleton is horrific and extreme. And extraordinarily rare. But the apparent randomness and brutality of mass shootings in schools shakes us to the core. Our schools should be sanctuaries for children to thrive – not fear for their lives. We never thought it could happen here. Violence lives in other communities. We aren’t exempt.

Like most policy debates about human behavior, answers will not come easily. And it’s tempting to fixate on the rarest, most extreme cases, to relieve the symptoms of the disease, rather than to fully understand its root causes.

Some communities, while raising their voices in solidarity with the gun violence movement, have a legitimate grievance about the narrative being played out in the media. Where’s the attention on the violence, fear, anxiety, and trauma, the lived experiences that are all too familiar and routine – particularly for young people of color and especially young males of color? Why are their experiences any less unconscionable, less actionable?

As a compassionate society, we should not tolerate any threat to the wellbeing of young people – no matter its lethality. Harm comes in many forms. Bullets, yes. But so too: abuse, assault, neglect, apathy, disrespect, discrimination, intolerance, and bigotry. The effects of these assaults on children’s health and wellbeing are corrosive and long-lasting. The scale is unfathomable. Consider:

  • 63,000 children were victims of sexual abuse in 2013. One child every six minutes.
  • One-third of children have been physically assaulted within the past year; about half will have been assaulted in their lifetime.
  • One in four children witness an act of violence in their home, school, or community; 5% will witness gun violence this year.
  • Suicide is the second leading cause of death for children and adolescents.
  • Twenty-eight percent of students in grades 6-12 say they have been bullied at school.
  • 7 million children have a parent in jail or prison – a known adverse childhood experience with devastating developmental consequences.

Rather than pushing for quick-fix solutions that may have no effect on the underlying causes of violence (think armed officers at the school building door), it‘s time we took the long view and imagined something better for our children. What does freedom from violence look like? It’s not hard to envision the structural conditions that help immunize young people from violence.

We don’t have to stretch our imaginations too far. We have the tools and knowledge. Leading trauma authorities and advocates like Nadine Burke-Harris and Jeff Duncan-Andrade speak passionately to the role of sustained trauma and toxic stress that, when unchecked and unattended to, result in the very worst outcomes for children and adolescents. There is now a groundswell of proponents across the health, education, philanthropic, and civil rights sectors advancing the concept of schools as community-builders that strengthen adult-student relationships, ensure emotional and physical safety, and foster a sense of connectedness. Here are three models transforming the educational experience and making safety, respect, and empathy practiced core values.

Restorative justice – a significant re-thinking of discipline practices – is taking hold in schools across the country. The approach is grounded in group identity and community cohesion: acts that do harm to one member do harm to the entire community. Students are empowered as equal stakeholders in the administration of justice. Highly structured practices, such as mediation conferences, peer courts, and healing circles, are inclusive and cooperative rather than hierarchical and punitive. Participants are not seen as offenders and victims. The goals of this model are to repair the harm, restore the rupture, and hold each other accountable.

Trauma-informed schools take their cues from neuroscience, which shows that relentless exposure to traumatic events in childhood can lead to maladaptive circuitry in the brain. Problems with social, emotional, and cognitive functioning are not uncommon among children who experience toxic levels of stress. Educators are trained to recalibrate their classroom management style with sensitivity toward underlying causes of students’ behavior. Rather than react to explosive outbursts with disciplinary infractions, school staff instead strive to defuse the situation by getting to the meaning behind the behavior – repairing the harm caused by the complex trauma that interferes with learning and giving students the skills to manage their stress and make positive choices. In trauma-informed parlance, “What’s wrong with you?” becomes “What happened to you?” It opens new insights into the “why” rather than the “what”.

In the same vein, many schools are embracing the idea that social and emotional skills and behaviors can be taught. In fact, social and emotional learning objectives are getting equal time with reading, writing, and arithmetic to help socialize young people and create safe and supportive academic environments. Instruction – whether organized as a distinct course or integrated into the academic curriculum – focuses on mastering skills like self-reflection, social awareness, self-management, nonviolent conflict resolution, and responsible decision-making. Evaluators have found marked improvements in mental health, social skills, and academic achievement.

This extraordinary, catalytic gun violence movement would do well to focus its potent political will on mobilizing communities to work in cross-sector partnerships to create the conditions in our schools that foster safety, healing, security, connectedness, respect, equity, and agency. We shouldn’t accept any less for our children than freedom from ALL violence. Only then will we interrupt the cycle of harm.


National Center for Safe and Supportive Learning

Collaborative for Academic, Social, and Emotional Learning

Restorative Justice Resources for Schools

United States Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. Child Maltreatment Survey, 2013 (2014).


School Nurses and School-Based Health Centers: A Conversation with Paula Fields

March 23, 2018

Paula and her granddaughter at a concert, enjoying sugar-free icy slushes

Paula Fields, MSN, BSN, RN is a senior program manager at the School-Based Health Alliance. 

First, tell us about yourself!

I am a nurse, a mom, a MiMi of a Type 1 diabetic grandchild, and a fierce advocate for children and school-based health care! I’ve worked to establish and grow school-based health centers for over 20 years in my home state of West Virginia.

It’s easy to confuse the roles of school nurses and school-based health centers (SBHCs), though we know that both are critical parts to improve student health outcomes. Can you shed some light on the differences between school nurses and school-based health centers?

To answer that question, I first have to smile. You see, when I first started my life’s work of establishing and growing SBHCs many years ago, even I didn’t understand the role of school nurses and vice versa! We tried to figure out each other’s respective roles as we worked together—all while  keeping the students as our focus. What we learned? The importance of the three “C’s”: cooperation, coordination, and collaboration. Since that time I’ve had the pleasure of interacting both personally and professionally with a host of school nurses. As I’ve worked with school nurses more and more, I’ve come to add a few other words to the three “C’s”: appreciation, courtesy, and respect.

First things first: school nurses are responsible for managing the daily health needs of ALL students. Terms such as Free Appropriate Public Education, IEPs, 504s, care plans, immunization compliance, and health promotion come to mind. As I mentioned, I have a granddaughter with Type I diabetes and it’s challenging for me to care for her, even with my nursing background. She has an insulin pump, continuous glucose monitor, and more alarms and needed interventions than I could ever have imagined. She’s the only child I provide care for—and believe me, it’s hard! If it’s so difficult to provide care to only one little girl, you can imagine the difficulty and scope of the work that school nurses do by serving ALL students… including those with health conditions like my granddaughter. For students needing medical care, school nurses can refer them to a school-based health center.

School-based health centers serve over 3,000 schools across the nation. Located in or on school grounds, SBHCs provide primary health care among other things. SBHC providers differ from school nurses in that they can diagnose and treat illnesses, prescribe medications, and may also provide oral, behavioral, and vision care. SBHCs work cooperatively with the school, school nurses, and parents. They also work with—but don’t replace—a student’s primary care provider.

As working parents, we were fortunate that our children attended a middle and high school with an SBHC. The SBHC worked with us and our children’s pediatrician to ensure our children received the care they needed.

One time, I remember I was working in another state (championing SBHCs) and their dad was working in an underground coal mine. I received a call. “Mom, I have pink eye.” I responded, “Ok, what can I do for you? I’m in another state, Dad can’t leave work, and your pediatrication is an hour away.” My child responded, “I’ll go to the SBHC!”

I could not help but feel proud. You see, this is a prime example of how having access to services at school teaches students how to navigate the health care system, take ownership of their well-being, and become independent. My child visited the SBHC and was diagnosed with conjunctivitis. But the care didn’t even stop here! The SBHC contacted his pediatrician and  called in a prescription to the pharmacy. The prescription needed to be paid for and picked up, but neither my husband nor I could leave work. And here’s the incredible part: the SBHC and school nurse worked together, paid for, and picked up the prescription. Ultimately, my child saw a provider, was prescribed medication, and received treatment before either of us as parents could have secured care. I’m telling you—our children win when we work together!

It sounds like both school nurses and school-based health centers have the same goal in mind: making sure students are healthy and ready to learn. What does having a school-based health center in addition to a school nurse make possible?

The bottom line is that students benefit when SBHCs and school nurses work together. This collaboration enhances continuity of care through information sharing and even saves the school dollars as students progress toward graduation. Working together yields multiple benefits: improving access to care, reducing student absences, increasing classroom seat time, decreasing parent/guardian missed work time for visits, and improving students’ health and academic outcomes, to name a few.

Research shows that school nurses and SBHCs lead to improvements in education and health outcomes for our nation’s children, and it’s important to know that one does not replace the other.

I wholeheartedly believe that healthy students are better learners, that it takes a village, and we’re stronger together.


2018 Awareness Month Wrap-Up

March 14, 2018
The 2018 National School-Based Health Care Awareness Month was one for the record books.

Every February, the school-based health care field recognizes our accomplishments and raises awareness about how school-based health centers (SBHCs) are revolutionizing the way children and adolescents access health care services. This year, we tapped into a topic that is front-of-mind for many Americans. In light of the increasing need for mental health services for children and youth in the wake of our nation’s opioid crisis, the school-based health care field considered this question: How are SBHCs uniquely suited to provide care to the kids and teens whose lives are most affected by the opioid epidemic?

Your response to our 2018 awareness month was astounding, and we are humbled by the outpouring of activity during February. You facilitated official proclamations in your state legislature for the commemoration, hosted youth-led advocacy campaigns, shared your stories via social media and newsletters, and made your school-based health center staff feel remarkably special.

Awareness Month wouldn’t have been complete without our annual Twitter chat, “Healthy Minds, Healthy Bodies: SBHCs and Child/Adolescent Health.” Along with school-based health care advocates from across the country, we took Twitter by storm on Tuesday, February 20! More than 200 people participated in the #SBHCmonth18 chat, garnering 4.6 million impressions and reaching 1.1 million Twitter accounts. Participants included everyone from pediatricians and mental health providers to state health departments and hospital systems. Check out the #SBHCmonth18 executive summary here.

On Wednesday, February 28, the School-Based Health Alliance held two congressional briefings in honor of National School-Based Health Care Awareness Month. Child health experts from around the country shared how school-based health centers (SBHCs) are meeting the increased mental health needs of the lesser known victims of this epidemic – children who are affected by their parents’ or families’ struggles with addiction. And since the briefings, we’ve had several congressional offices reach out to the Alliance to learn more about the SBHC model and the Hallways to Health Act (S. 356/H.R. 1027), as well as our other legislative priorities. Even better? Members of Congress are now championing one of our biggest legislative priorities: the SBHC Authorization!

In February, the Health Resources and Services Administration (HRSA) announced the availability of up to $10 million in funding for school health center capital investments. Talk about good timing!


The Maryland Assembly on School-Based Health Care held a raffle on Twitter to encourage its members to celebrate awareness month. The Howard County Health Department even received a Certificate of Recognition from their county government to officially honor February as National School-Based Health Care Awareness Month!


Our Michigan affiliate received a Governor’s Proclamation announcing School-Based Health Care Awareness Month, and their Capitol Rotunda even had an exhibit with story boards from their students expressing their love for their SBHCs. The Michigan School-Based Health Alliance gathered extraordinary stories from their young people. We encourage you to read about the power of SBHCs through the eyes of students on their website.

New Mexico

Awareness month was in full swing this year in New Mexico. The New Mexico Alliance for School-Based Health Care (NMASBHC) joined their Federally Qualified Health Center partners for Primary Care Day on February 7. On that day, NMASBHC educated their legislators about the critical health care SBHCs provide. The SBHC at Capital High in New Mexico also gave Senator Stefanics a tour of their SBHC—a great way to finish up National School-Based Health Care Awareness Month.

New York

On February 6, the New York School-Based Health Alliance and over 400 participants from across the state took over Albany to advocate for SBHC funding. Our national Youth Advisory Council member Fathima Lye outlined her experience on our blog. How did SBHCs in NY celebrate awareness month in their centers?


  • Charlotte SBHC created a Valentine’s-themed newsletter with information about the team and services provided for the school staff. SBHC staff even included valentines—each teacher received a newsletter and valentine in their mailbox.
  • Edison Tech celebrated awareness month by hosting a school-wide STD screening program in collaboration with their local county department of health. During STD testing week, students wrote on pink slips of paper about why they love their SBHC.  The students’ responses were entered into a drawing for prizes.  As a result, the Edison Tech SBHC got to see all the reasons why their students love them, which they proudly displayed throughout the school! 
  • School #33’s newsletter focused on awareness month, and they even decorated the bulletin board outside the Health Center to celebrate and describe who they are and what they do.
  • School #9 created anti-stress kits for the entire school staff to remind them that taking care of ourselves is just as important as caring for the students! 97% of School #9’s students are enrolled in the SBHC. SBHC staff continue to reach out to families that are new to the school-many displaced from Puerto Rico, to enroll them and work with the case manager for insurance and referrals to primary care offices in the community.
  • Freddie Thomas SBHC took the opportunity to promote healthy tips for its students. They used a bulletin board to highlight simple healthy lifestyle ideas anyone can adopt!

The Oregon School-Based Health Alliance gathered student advocates on February 6 to storm their state capitol for their 11th annual Advocacy Day.

The students shared their heartfelt SBHC stories with their legislators to promote the importance of youth voice in access to health services and advocate for the health needs of their communities. On February 1, 2018, Oregon Governor Kate Brown officially proclaimed February as School-Based Health Care Awareness Month.


South Carolina

In addition to using the Bradshaw Institute’s social media platform to post about school-based health care throughout February, staff from the hospital visited the middle school SBHCs they sponsor. At each school, students signed a huge thank you banner for their SBHC providers that they hung inside the health room.

Again, thanks to all of you for helping us redefine health for kids and teens. We can’t wait to see what happens during 2019 Awareness Month!