SBHC Literature Database

SBHC Literature DatabaseUse this resource to explore peer-reviewed articles that have been published about school-based health care (SBHC) from the 1970s to the present.

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Primary Topic AreaSecondary Topic AreaGrade-Level FocusYear PublishedCitationMore Info
AcademicsAbsenteeismHigh School1993McCord MT, Klein JD, Foy JM, Fothergill K. School-based clinic use and school performance. The Journal of Adolescent Health. Mar 1993;14(2):91-98.
AcademicsAbsenteeismNot Specified1996Klerman LV. Can School-Based Health Services Reduce Absenteeism and Dropping Out of School? The Journal of Adolescent Medicine. 1996;7(2):249-260.
AcademicsBehavioral HealthHigh School2010Walker SC, Kerns SE, Lyon AR, Bruns EJ, Cosgrove TJ. Impact of School-Based Health Center Use on Academic Outcomes. The Journal of Adolescent Health. 2010;46(3):251-257.
AcademicsDropoutHigh School2011Kerns SE, Pullmann MD, Walker SC, Lyon AR, Cosgrove TJ, Bruns EJ. Adolescent use of school-based health centers and high school dropout. Archives of Pediatrics & Adolescent Medicine. Jul 2011;165(7):617-623.
AcademicsAbsenteeismElementary2009Foy JE, Hahn K. School-based health centers: A four year experience, with a focus on reducing student exclusion rates. Osteopathic Medicine and Primary Care. 2009;3:3.
AcademicsSchool Climate/ ConnectionK-122012Strolin-Goltzman J, Sisselman A, Auerbach C, Sharon L, Spolter S, Corn TB. The moderating effect of school type on the relationship between school-based health centers and the learning environment. Social Work in Public Health. 2012;27(7):699-709.
AcademicsSchool Climate/ ConnectionK-122010Strolin-Goltzman J. The relationship between school-based health centers and the learning environment. The Journal of School Health. Mar 2010;80(3):153-159.
AcademicsLiterature ReviewK-122004Geierstanger SP, Amaral G, Mansour M, Walters SR. School-based health centers and academic performance: research, challenges, and recommendations. The Journal of School Health. Nov 2004;74(9):347-352.
AcademicsLiterature ReviewK-122007Murray NG, Low BJ, Hollis C, Cross AW, Davis SM. Coordinated school health programs and academic achievement: a systematic review of the literature. The Journal of School Health. Nov 2007;77(9):589-600.
AcademicsSchool Climate/ ConnectionK-122013Stone S, Whitaker K, Anyon Y, Shields JP. The relationship between use of school-based health centers and student-reported school assets. The Journal of Adolescent Health. Oct 2013;53(4):526-532.
AcademicsSchool Climate/ ConnectionK-122014Strolin-Goltzman J, Sisselman A, Melekis K, Auerbach C. Understanding the relationship between school-based health center use, school connection, and academic performance. Health & Social Work. May 2014;39(2):83-91.
AcademicsAbsenteeismHigh School2010Van Cura M. The relationship between school-based health centers, rates of early dismissal from school, and loss of seat time. The Journal of School Health. Aug 2010;80(8):371-377.
Access to CareBehavioral HealthHigh School1991Balassone ML, Bell M, Peterfreund N. A comparison of users and nonusers of a school-based health and mental health clinic. The Journal of Adolescent Health. May 1991;12(3):240-246.
Access to CareBehavioral HealthHigh School1996Anglin TM, Naylor KE, Kaplan DW. Comprehensive school-based health care: high school students' use of medical, mental health, and substance abuse services. The Journal of Pediatrics. Mar 1996;97(3):318-330.
Access to CareBehavioral HealthNot Specified1993Wolk LI. Frequent school-based clinic utilization: a comparative profile of problems and services needs. The Journal of Adolescent Health. 1993;114:458-463
Access to CareBehavioral HealthElementary1999Kaplan DW, Brindis CD, Phibbs SL, Melinkovich P, Naylor K, Ahlstrand K. A comparison study of an elementary school-based health center: effects on health care access and use. Archives of Pediatrics & Adolescent Medicine. Mar 1999;153(3):235-243.
Access to CareBehavioral HealthHigh School1998Kaplan DW, Calonge BN, Guernsey BP, Hanrahan MB. Managed care and school-based health centers. Use of health services. Archives of Pediatrics & Adolescent Medicine. Jan 1998;152(1):25-33.
Access to CareViolence/AbuseHigh School2015Lewis C, Deardorff J, Lahiff M, Soleimanpour S, Sakashita K, Brindis CD. High school students' experiences of bullying and victimization and the association with school health center use. The Journal of School Health. May 2015;85(5):318-326..
Access to CarePolicyHigh School2003Juszczak L, Melinkovich P, Kaplan D. Use of health and mental health services by adolescents across multiple delivery sites. The Journal of Adolescent Health. Jun 2003;32(6 Suppl):108-118.
Access to CareEmergency Department UseElementary2001Young TL, D'Angelo S L, Davis J. Impact of a school-based health center on emergency department use by elementary school students. The Journal of School Health. May 2001;71(5):196-198.
Access to CareEmergency Department UseHigh School2002Key JD, Washington EC, Hulsey TC. Reduced emergency department utilization associated with school-based clinic enrollment. The Journal of Adolescent Health. Apr 2002;30(4):273-278.
Access to CareEmergency Department UseMiddle & High School1996Santelli J, Kouzis A, Newcomer S. School-based health centers and adolescent use of primary care and hospital care. The Journal of Adolescent Health. Oct 1996;19(4):267-275.
Access to CareRisk Assessment/ BehaviorMiddle & High School1996Kisker EE, Brown RS. Do school-based health centers improve adolescents' access to health care, health status, and risk-taking behavior? The Journal of Adolescent Health. May 1996;18(5):335-343.
Access to CareUtilizationMiddle & High School1996Keyl PM, Hurtado MP, Barber MM, Borton J. School-based health centers. Students' access, knowledge, and use of services. Archives of Pediatrics & Adolescent Medicine. Feb 1996;150(2):175-180.
Access to CareUnmet NeedsHigh School1997Zimmer-Gembeck MJ, Alexander T, Nystrom RJ. Adolescents report their need for and use of health care services. The Journal of Adolescent Health. Dec 1997;21(6):388-399.
Access to CareHealth PromotionNot Specified2008Brown MB, Bolen LM. The school-based health center as a resource for prevention and health promotion. Psychology in the Schools Journal. Jan 2008;45(1):28-38
Access to CareUnmet NeedsMiddle & High School2001Britto MT, Klostermann BK, Bonny AE, Altum SA, Hornung RW. Impact of a school-based intervention on access to healthcare for underserved youth. The Journal of Adolescent Health. Aug 2001;29(2):116-124.
Access to CareDisparities in careNot Specified2001Berti L, Zylbert S, Rolnitzky L. Comparison of health status of children using a school-based health center for comprehensive care. The Journal of Pediatric Health Care. 2001;25(1):244-250
Access to CareUtilizationHigh School1995Brindis C, Kapphahn C, McCarter V, Wolfe AL. The impact of health insurance status on adolescents' utilization of school-based clinic services: implications for health care reform. The Journal of Adolescent Health. Jan 1995;16(1):18-25.
Access to CareRisk Assessment/ BehaviorHigh School2007Klein JD, Handwerker L, Sesselberg TS, Sutter E, Flanagan E, Gawronski B. Measuring quality of adolescent preventive services of health plan enrollees and school-based health center users. The Journal of Adolescent Health. Aug 2007;41(2):153-160.
Access to CarePolicyElementary1997Jones ME, Clark D. Increasing access to health care: a study of pediatric nurse practitioner outcomes in a school-based clinic. The Journal of Nurse Care and Quality. Apr 1997;11(4):53-59.
Access to CareUnmet NeedsMiddle & High School2010Soleimanpour S, Geierstanger SP, Kaller S, McCarter V, Brindis CD. The role of school health centers in health care access and client outcomes. The American Journal of Public Health. Sep 2010;100(9):1597-1603.
Access to CareRisk Assessment /BehaviorHigh School1996Walter HJ, Vaughan RD, Armstrong B, Krakoff RY, Tiezzi L, McCarthy JF. Characteristics of users and nonusers of health clinics in inner-city junior high schools. The Journal of Adolescent Health. May 1996;18(5):344-348.
Access to careDisparities in careMiddle School2014Parasuraman SR, Shi L. Differences in Access to Care Among Students Using School-Based Health Centers. The Journal of School Nursing. Nov 5 2014.
Access to CareUtilizationMiddle & High School2014Parasuraman SR, Shi L. The role of school-based health centers in increasing universal and targeted delivery of primary and preventive care among adolescents. The Journal of School Health. Aug 2014;84(8):524-532.
Access to CareQuality of CareHigh School2013Gibson EJ, Santelli JS, Minguez M, Lord A, Schuyler AC. Measuring school health center impact on access to and quality of primary care. The Journal of Adolescent Health. Dec 2013;53(6):699-705.
Access to CareQuality of CareHigh School2007Allison MA, Crane LA, Beaty BL, Davidson AJ, Melinkovich P, Kempe A. School-based health centers: improving access and quality of care for low-income adolescents. The Journal of Pediatrics. Oct 2007;120(4):e887-894.
Access to CareQuality of CareK-122000Klostermann BK, Perry CS, Britto MT. Quality improvement in a school health program. Results of a process evaluation. The Journal of Evaluation and the Health Professions. Mar 2000;23(1):91-106.
Access to CareSatisfaction with CareMiddle & High School2014Bains RM, Franzen CW, White-Frese J. Engaging African American and Latino adolescent males through school-based health centers. The Journal of School Nursing. Dec 2014;30(6):411-419.
Access to CareSatisfaction with CareMiddle & High School2014O'Leary ST, Lee M, Federico S, et al. School-based health centers as patient-centered medical homes. The Journal of Pediatrics. Nov 2014;134(5):957-964.
Access to CareSatisfaction with CarePreschool2005Gance-Cleveland B, Yousey Y. Benefits of a school-based health center in a preschool. The Journal of Clinical Nursing Research. Nov 2005;14(4):327-342.
Access to carePatient-Centered Medical HomeNot Specified2014North SW, McElligot J, Douglas G, Martin A. Improving access to care through the patient-centered medical home. The Journal of Pediatric Annals. Feb 2014;43(2):e33-38.
Access to CareUtilizationElementary2006Johnson V, Hutcherson V. A study of the utilization patterns of an elementary school-based health clinic over a 5-year period. The Journal of School Health. Sep 2006;76(7):373-378.
Access to CareUtilizationElementary2002Baquiran RS, Webber MP, Appel DK. Comparing Frequent and Average Users of Elementary School?Based Health Centers in the Bronx, New York City. The Journal of School Health. 2002;72(4):133-7.
Access to CareRural HealthK-122008Wade TJ, Mansour ME, Guo JJ, Huentelman T, Line K, Keller KN. Access and utilization patterns of school-based health centers at urban and rural elementary and middle schools. Public Health Reports. Nov-Dec 2008;123(6):739-750.
AsthmaAcademicsElementary2003Webber M, Carpiniello K, Oruwariye T, Yungtai L, Burton W, Appel DK. Burden of asthma in inner-city elementary schoolchildren: Do school-based health centers make a difference? Archives of Pediatrics and Adolescent Medicine. 2003;157(2): 125-129.
AsthmaEconomicsK-122011Tai T, Bame SI. Cost-Benefit Analysis of Childhood Asthma Management Through School-Based Clinic Programs. The Journal of Community Health. Apr 2011;36(2):253-260.
AsthmaEmergency Department UseElementary & Middle School2005Guo JJ, Jang R, Keller KN, McCracken AL, Pan W, Cluxton RJ. Impact of School-Based Health Centers on Children with Asthma. The Journal of Adolescent Health. Oct 2005;37(4):266-274.
AsthmaAccess to CareElementary School2005Webber MP, Impact of asthma intervention in two elementary school-based health centers in the Bronx, New York City. Pediatric Pulmonology 2005;40:487-493
AsthmaMedicationHigh School2011Bruzzese JM, Kingston S, Sheares BJ, Cespedes A, Sadeghi H, Evans D. Feasibility and preliminary outcomes of a school-based intervention for inner-city, ethnic minority adolescents with undiagnosed asthma. The Journal of Patient Education and Counseling. Nov 2011;85(2):290-294.
AsthmaQuality of CareHigh School2011Bruzzese JM, Sheares BJ, Vincent EJ, Du Y, Sadeghi H, Levison MJ, Mellins RB, Evans D. Effects of a school-based intervention for urban adolescents with asthma. A controlled trial. American Journal of Respiratory and Critical Care Medicine. Apr 2011;183(8):998-1006
AsthmaSustainabilityNot Specified2014Hollenbach JP, Cloutier MM. Implementing school asthma programs: Lessons learned and recommendations. The Journal of Allergy and Clinical Immunology. Dec 2014;134(6):1245-1249.
AsthmaClinical OutcomesPreK, Elementary & Middle School2001Lurie N, Bauer EJ, Brady C. Asthma Outcomes at an Inner-City School-Based Health Center. The Journal of School Health. Jan 2001;71(1):9-16.
AsthmaPolicyNot Specified2014Lynn J, Oppenheimer S, Zimmer L. Using public policy to improve outcomes for asthmatic children in schools. The Journal of Allergy and Clinical Immunology. Dec 2014;134(6):1238-1244.
Behavioral HealthSustainabilityNot Specified2000Jennings J, Pearson G, Harris M. Implementing and Maintaining School-Based Mental Health Services in a Large, Urban School District. The Journal of School Health. May 2000;70(5):201-205.
Behavioral HealthAccess to CareNot Specified2006Brown MB, School-based health centers: implications for counselors. The Journal of Counseling and Development. 2006;84(2):187-191
Behavioral HealthClinical OutcomesHigh School1996Weist MD, Paskewitz DA, Warner BS, Flaherty LT. Treatment outcome of school-based mental health services for urban teenagers. Community Mental Health Journal. 1996;32(2):149-157.
Behavioral HealthUnmet NeedsMiddle & High School2012Gampetro P, Wojciechowski EA, Amer KS. Life concerns and perceptions of care in adolescents with mental health care needs: a qualitative study in a school-based health clinic. The Journal of Pediatric Nursing. Jan-Feb 2012;38(1):23-30.
Behavioral HealthQuality of CareHigh School2000Gall G, Pagano ME, Desmond MS, Perrin JM, Murphy JM. Utility of psychosocial screening at a school-based health center. The Journal of School Health. Sep 2000;70(7):292-298.
Behavioral HealthQuality of LifeNot Specified2008Guo JJ, Wade TJ, Keller KN. Impact of school-based health centers on students with mental health problems. Public Health Reports. Nov-Dec 2008;123(6):768-780.
Behavioral HealthViolence/AbuseHigh School2015Miller E, Goldstein S, McCauley HL, et al. A school health center intervention for abusive adolescent relationships: a cluster RCT. The Journal of Pediatrics. Jan 2015;135(1):76-85.
Behavioral HealthViolence/AbuseHigh School2014Dick RN, McCauley HL, Jones KA, et al. Cyber dating abuse among teens using school-based health centers. The Journal of Pediatrics. Dec 2014;134(6):e1560-1567.
Behavioral HealthSubstance UseHigh School2003Robinson WL, Harper GW, Schoeny ME. Reducing substance use among African American adolescents: Effectiveness of school-based health centers. The Journal of Clinical Psychology: Science and Practice 2003;10(4):491-504.
Behavioral HealthUtilizationHigh School2011Amaral G, Geierstanger S, Soleimanpour S, Brindis C. Mental health characteristics and health-seeking behaviors of adolescent school-based health center users and nonusers. The Journal of School Health. Mar 2011;81(3):138-145.
Behavioral HealthUtilizationHigh School1998Pastore DR, Juszczak L, Fisher MM, Friedman SB. School-based health center utilization: a survey of users and nonusers. Archives of Pediatrics & Adolescent Medicine. Aug 1998;152(8):763-767.
DentalAcademicsElementary2014Detty AM, Oza-Frank R. Oral health status and academic performance among Ohio third-graders, 2009-2010. The Journal of Public Health Dentistry. Fall 2014;74(4):336-342.
DentalAcademicsK-122012Guarnizo-Herreno CC, Wehby GL. Children's dental health, school performance, and psychosocial well-being. The Journal of Pediatrics. Dec 2012;161(6):1153-1159.
DentalEconomicsElementary2013Siruta KJ, Simmer-Beck ML, Ahmed A, Holt LA, Villalpando-Mitchell T, Gadbury-Amyot CC. Extending oral health care services to underserved children through a school-based collaboration: Part 3--a cost analysis. The Journal of Dental Hygiene. Oct 2013;87(5):289-298.
DentalSustainabilityNot Specified2005Albert DA, McManus JM, Mitchell DA. Models for delivering school-based dental care. The Journal of school health. May 2005;75(5):157-161.
EconomicsAccess to CareElementary2000Adams EK, Johnson V. An Elementary School-Based Health Clinic: Can it Reduce Medicaid Costs? The Journal of Pediatrics. Apr 2000;105(4 Pt 1):780-788.
EconomicsDisparities in careK-122010Guo JJ, Wade TJ, Pan W, Keller KN. School-based health centers: cost-benefit analysis and impact on health care disparities. The American Journal of Public Health. Sep 2010;100(9):1617-1623.
EconomicsQuality of LifeElementary & Middle School2010Wade TJ, Guo JJ. Linking improvements in health-related quality of life to reductions in Medicaid costs among students who use school-based health centers. The American Journal of Public Health. Sep 2010;100(9):1611-1616.
ImmunizationAccess to CareMiddle & High School2010Federico SG, Abrams L, Everhart RM, Melinkovich P, Hambidge SJ. Addressing Adolescent Immunization Disparities: A Retrospective Analysis of School-Based Health Center Immunization Delivery. The American Journal of Public Health. Sep 2010;100(9):1630-1634.
ImmunizationAccess to CareHigh School2014Golden SD, Moracco KE, Feld AL, Turner KL, DeFrank JT, Brewer NT. Process evaluation of an intervention to increase provision of adolescent vaccines at school health centers. The Journal of Health Education & Behavior. Dec 2014;41(6):625-632.
ImmunizationAccess to CareMiddle & High School2009Daley MF, Curtis CR, Pyrzanowski J, et al. Adolescent immunization delivery in school-based health centers: a national survey. The Journal of Adolescent Health. Nov 2009;45(5):445-452.
ImmunizationAccess to CareMiddle School2012Kempe A, Barrow J, Stokley S, et al. Effectiveness and cost of immunization recall at school-based health centers. The Journal of Pediatrics. Jun 2012;129(6):e1446-1452.
Access to CareMedicationMiddle & High School2006Mears CJ, Charlebois NM, Holl JL. Medication adherence among adolescents in a school-based health center. The Journal of School Health. Feb 2006;76(2):52-56.
ObesityEvaluationElementary & Middle School2014Aldrich H, Gance-Cleveland B, Schmiege S, Dandreaux D. Identification and assessment of childhood obesity by school-based health center providers. The Journal of Pediatric Health Care. Nov-Dec 2014;28(6):526-533.
ObesityClinical OutcomesHigh School2013Kong AS, Sussman AL, Yahne C, Skipper BJ, Burge MR, Davis SM. School-based health center intervention improves body mass index in overweight and obese adolescents. The Journal of Obesity. 2013;2013:575016.
ObesityAccess to CareHigh School2010Stephens MM, McLean K, Cannatelli K, Stillman PL. Identification of overweight, obesity, and elevated blood pressure: a school-based health center performance improvement initiative. The American Journal of Medical Quality. Jan-Feb 2011;26(1):34-38.
ObesityHealth PromotionHigh Schools2013Sussman AL, Montoya C, Werder O, Davis S, Wallerstein N, Kong AS. An adaptive CBPR approach to create weight management materials for a school-based health center intervention. The Journal of Obestiy. 2013;
ObesityQuality of CareK-122009Oetzel KB, Scott AA, McGrath J. School-based health centers and obesity prevention: changing practice through quality improvement. The Journal of Pediatrics. Jun 2009;123 Suppl 5:S267-271.
ObesityClinical OutcomesMiddle & High School2014Love-Osborne K, Fortune R, Sheeder J, Federico S, Haemer MA. School-based health center-based treatment for obese adolescents: feasibility and body mass index effects. The Journal of Childhood Obesity. Oct 2014;10(5):424-431.
ObesityAccess to CareNot Specified2005Edwards B. Childhood obesity: a school-based approach to increase nutritional knowledge and activity levels. Nursing Clinics of North America. 2005 Dec 2005;40(4):661-669.
EvaluationClinical OutcomesMiddle & High School2010McNall MA, Lichty LF, Mavis B. The impact of school-based health centers on the health outcomes of middle school and high school students. The American Journal of Public Health. Sep 2010;100(9):1604-1610.
Access to CareRisk Assessment/BehaviorMiddle School1994Dryfoos JG. Medical clinics in junior high school: Changing the model to meet demands. The Journal of Adolescent Health. 1994;15(7):549-557.
EvaluationClinical OutcomesElementary & Middle School2008Wade TJ, Mansour ME, Line K, Huentelman T, Keller KN. Improvements in health-related quality of life among school-based health center users in elementary and middle school. The Journal of Ambulatory Pediatrics. Jul-Aug 2008;8(4):241-249.
Access to CareSustainabilityK-122003Brindis CD, Klein J, Schlitt J, Santelli J, Juszczak L, Nystrom RJ. School-based health centers: accessibility and accountability. The Journal of Adolescent Health. Jun 2003;32(6 Suppl):98-107.
Access to CareSustainabilityNot Specified1997Brindis CD, Sanghvi RV. School-based health clinics: remaining viable in a changing health care delivery system. The Journal of Annual Review of Public Health. 1997;18:567-587.
Access to CareSustainabilityNot Specified1996Santelli J. School health centers and primary care for adolescents: a review of the literature. The Journal of Adolescent Health. 1996;18:357-366
Access to CareSustainabilityNot Specified2001American Academy of Pediatrics. School health centers and other integrated school health services. Committee on School Health. The Journal of Pediatrics. Jan 2001;107(1):198-201.
Access to CareEvaluationPreK-122010Clayton S, Chin T, Blackburn S, Echeverria C. Different setting, different care: integrating prevention and clinical care in school-based health centers. The American Journal of Public Health. Sep 2010;100(9):1592-1596.
Access to CareDisparities in careNot Specified2009Fleming R. What role can school health providers play in health care reform? The Journal of School Health. Nov 2009;79(11):513-515.
EvaluationUnmet NeedsElementary & High School2008Silberberg M, Cantor JC. Making the case for school-based health: where do we stand? The Journal of Health Politics, Policy and Law. Feb 2008;33(1):3-37.
Access to CareSustainabilityNot Specified2012Keeton V, Soleimanpour S, Brindis CD. School-based health centers in an era of health care reform: building on history. The Journal of Current Problems in Pediatric and Adolescent Health Care. Jul 2012;42(6):132-156; discussion 157-138.
Access to CareEconomicsNot Specified1998Zimmerman DJ. School and Adolescent health and managed care. The American Journal of Preventive Medicine. 1998;14(1):60-66
EvaluationNursingNot Specified2000Shuler PA. Evaluating student services provided by school-based health centers: applying the Shuler Nurse Practitioner Practice model. The Journal of School Health. Oct 2000;70(8):348-352.
PolicyNursingNot Specified2011Bannister A, Kelts S. NASN position statement: the role of the school nurse and school-based health centers. NASN School Nurse. May 2011;26(3):196-197.
PolicyPatient-Centered Medical HomeNot Specified2014Larson SA, Chapman SA. Patient-centered medical home model: do school-based health centers fit the model? The Journal of Policy, Politics & Nursing Practice. Aug-Nov 2013;14(3-4):163-174.
PolicyAccess to CareNot Specified2012Council on School Health. School-based health centers and pediatric practice. Pediatrics. Feb 2012;129(2):387-393.
PolicySchool-Linked Health CentersNot Specified1998Fothergill K, Ballard E. The school-linked health center: a promising model of community-based care for adolescents. The Journal of Adolescent Health. Jul 1998;23(1):29-38.
PolicySustainabilityNot Specified2008Schlitt JJ, Juszczak LJ, Eichner NH. Current status of state policies that support school-based health centers. Public Health Reports (Washington, D.C. : 1974). Nov-Dec 2008;123(6):731-738.
PolicySustainabilityK-122007Richardson JW. Building bridges between school-based health clinics and schools. The Journal of School Health. Sep 2007;77(7):337-343.
Access to CareRisk Assessment/BehaviorHigh School2012Hutchinson P, Carton TW, Broussard M, Brown L, Chrestman S. Improving adolescent health through school-based health centers in post-Katrina New Orleans. Children and Youth Services Review. 2012;34(2):360-368.
PolicyEvaluationK-122012Sisselman A, Strolin-Goltzman J, Auerbach C, Sharon L. Innovative services offered by school-based health centers in New York City. Children and Schools. Oct 2012;43(4):213-221
Quality of CareAccess to CareNot Specified2003Gance-Cleveland B, Costin DK, Degenstein JA. School-based health centers. Statewide quality improvement program. The Journal of Nursing Care Quality. Oct-Dec 2003;18(4):288-294.
Reproductive HealthAccess to CareHigh School2015Minguez M, Santelli JS, Gibson E, Orr M, Samant S. Reproductive health impact of a school health center. The Journal of Adolescent Health. Mar 2015;56(3):338-344.
Reproductive HealthAccess to CareHigh School2012Denny S, Robinson E, Lawler C, et al. Association between availability and quality of health services in schools and reproductive health outcomes among students: a multilevel observational study. The American Journal of Public Health. Oct 2012;102(10):e14-20.
Reproductive HealthAccess to CareHigh School2011Ethier KA, Dittus PJ, DeRosa CJ, Chung EQ, Martinez E, Kerndt PR. School-based health center access, reproductive health care, and contraceptive use among sexually experienced high school students. The Journal of Adolescent Health. Jun 2011;48(6):562-565.
Reproductive HealthAccess to CareMiddle & High School2000Crosby RA, St Lawrence J. Adolescents' use of school-based health clinics for reproductive health services: data from the National Longitudinal Study of Adolescent Health. The Journal of School Health. Jan 2000;70(1):22-27.
Reproductive HealthAccess to CareMiddle & High School2003Coyne-Beasley T, Ford CA, Waller MW, Adimora AA, Resnick MD. Sexually active students' willingness to use school-based health centers for reproductive health care services in North Carolina. The Journal of Ambulatory Pediatrics. Jul-Aug 2003;3(4):196-202.
Reproductive HealthBehavioral HealthMiddle & High School2012Mason-Jones AJ, Crisp C, Momberg M, Koech J, De Koker P, Mathews C. A systematic review of the role of school-based healthcare in adolescent sexual, reproductive, and mental health. System Review. 2012;1:49.
Reproductive HealthContraceptionHigh School2003Blake SM, Ledsky R, Goodenow C, Sawyer R, Lohrmann D, Windsor R. Condom availability programs in Massachusetts high schools: relationships with condom use and sexual behavior. The American Journal of Public Health. Jun 2003;93(6):955-962.
Reproductive HealthContraceptionHigh School2005McCarthy SK, Telljohann SK, Coventry B, Price J. Availability of services for emergency contraceptive pills at high school-based health centers. Perspectives on Sexual & Reproductive Health Journal. Jun 2005;37(2):70-77.
Reproductive HealthContraceptionHigh School1992Santelli J, Alexander M, Farmer M, et al. Bringing parents into school clinics: Parent attitudes toward school clinics and contraception. The Journal of Adolescent Health. 1992;13(4):269-274.
Reproductive HealthContraceptionHigh School2003Sidebottom A, Birnbaum AS, Nafstad SS. Decreasing barriers for teens: Evaluation of a new teenage pregnancy prevention strategy in school-based clinics. American Journal of Public Health. Nov 2003;93(11):1890-1892.
Reproductive HealthContraceptionHigh School2008Sidebottom A, Harrison PA, Donna A, Finnegan K. The varied circumstances prompting requests for emergency contraception at school-based clinics. The Journal of School Health. May 2008;78(5):258-263.
Reproductive HealthContraceptionHigh School2011Smith P, Novello G, Chacko M. 173. Does Immediate Access to Birth Control Help Prevent Pregnancy? A Comparison of Onsite Provision Versus Off-Campus Referral for Contraception at Two School-Based Clinics. The Journal of Adolescent Health. 2011;48(2):S107-S108.
Reproductive HealthContraceptionHigh School2001Zimmer-Gembeck MJ, Doyle LS, Daniels JA. Contraceptive dispensing and selection in school-based health centers. The Journal of Adolescent Health. Sep 2001;29(3):177-185.
Reproductive HealthContraceptionHigh School1985Dryfoos JG. School-based health clinics: A new approach to preventing adolescent pregnancy? The Journal of Family Planning Perspectives. 1985;17(2):70-75.
Reproductive HealthContraceptionK-122000Fothergill K, Feijoo A. Family planning services at school-based health centers: findings from a national survey. The Journal of Adolescent Health. Sep 2000;27(3):166-169.
Reproductive HealthContraceptionMiddle & High School2003Santelli JS, Nystrom RJ, Brindis C, et al. Reproductive health in school-based health centers: findings from the 1998-99 census of school-based health centers. The Journal of Adolescent Health. Jun 2003;32(6):443-451.
Reproductive HealthContraceptionMiddle & High School1989Kirby D, Waszak C, Ziegler J. Six school based clinics: Their reproductive health services and impact on sexual behavior. The Journal of Family Planning Perspectives. 1989;23(1):6-16.
Reproductive HealthContraceptionMiddle, High School & Higher Education 2010Blank L, Baxter SK, Payne N, Guillaume LR, Pilgrim H. Systematic review and narrative synthesis of the effectiveness of contraceptive service interventions for young people, delivered in educational settings. The Journal of Pediatric and Adolescent Gynecology. Dec 2010;23(6):341-351.
Reproductive HealthContraceptionNot Specified1988Dryfoos JG. School-based health clinics: Three years of experience. The Journal of Family Planning Perspectives. 1988;20(4):193-200.
Reproductive HealthImmunizationPreK-122011Gold R, Naleway AL, Jenkins LL, et al. Completion and timing of the three-dose human papillomavirus vaccine series among adolescents attending school-based health centers in Oregon. The Journal of Preventive Medicine. Jun 2011;52(6):456-458.
Reproductive HealthLiterature ReviewK-122008Strunk JA. The effect of school-based health clinics on teenage pregnancy and parenting outcomes: an integrated literature review. The Journal of School Nursing. Feb 2008;24(1):13-20.
Reproductive HealthLiterature ReviewNot Specified2012Daley AM. Rethinking school-based health centers as complex adaptive systems: maximizing opportunities for the prevention of teen pregnancy and sexually transmitted infections. The Journal of Advanced Nurse Science. Apr 2012;35(2):E37-46.
Reproductive HealthPrenatal CareHigh School1992Setzer JR, Smith DP. Comprehensive school-based services for pregnant and parenting adolescents in West Dallas, Texas. The Journal of School Health. 1992;62(3):97-102.
Reproductive HealthPrenatal CareHigh School1983Taylor B, Berg M, Knapp L, Edwards L. School-based prenatal services: Can similar outcomes be attained in a nonschool setting? The Journal of School Health. 1983;53(8):480-486.
Reproductive HealthPrenatal CareHigh School1977Edwards L, Steinman M, Hakanson E. An Experimental Comprehensive High School Clinic. The American Journal of Public Health. 1977;67(8):765-766.
Reproductive HealthPrenatal CareHigh School2003Barnet B, Duggan AK, Devoe M. Reduced low birth weight for teenagers receiving prenatal care at a school-based health center: effect of access and comprehensive care. The Journal of Adolescent Health. Nov 2003;33(5):349-358.
Reproductive HealthPrenatal CareHigh School1979Berg M, Taylor B, Edwards L, Hakanson E. Prenatal care for pregnant adolescents in a public high school. The Journal of School Health. 1979;49:32-35.
Reproductive HealthTeen PregnancyHigh School1993Kirby D, Resnick MD, Downes B, et al. The effects of school-based health clinics in St. Paul on school-wide birthrates. The Journal of Family Planning Perspectives. 1993;25(1):12-16.
Reproductive HealthTeen PregnancyHigh School2006Ricketts SA, Guernsey BP. School-based health centers and the decline in black teen fertility during the 1990s in Denver, Colorado. The American Journal of Public Health. Sep 2006;96(9):1588-1592.
Access to CareRural HealthMiddle & High School2000Crespo RD, Shaler GA. Assessment of school-based health centers in a rural state: the West Virginia experience. The Journal of Adolescent Health. Mar 2000;26(3):187-193.
Satisfaction with CareNursingMiddle School2007Benkert R, George N, Tanner C, Barkauskas VH, Pohl JM, Marszalek A. Satisfaction with a school-based teen health center: a report card on care. The Journal of Pediatric Nursing. Mar-Apr 2007;33(2):103-109.
SustainabilityEconomicsHigh School1987Siegel L, Krieble T. Evaluation of school-based high school health services. The Journal of School Health. 1987;57(8):323-325.
SustainabilityEconomicsNot Specified2004Swider SM, Valukas A. Options for sustaining school-based health centers. The Journal of School Health. Apr 2004;74(4):115-118.
SustainabilityEconomicsHigh School1992Fisher M, Juszczak L, Friedman SB, Schneider M, Chapar G. School-Based Adolescent Health Care : Review of a Clinical Service. The American Journal of Diseases of Children. 1992;146(5):615-621.
SustainabilityEconomicsElementary & Middle School2009Mavis B, Pearson R, Stewart G, Keefe C. A work sampling study of provider activities in school-based health centers. The Journal of School Health. Jun 2009;79(6):262-268.
SustainabilityPolicyK-122003Guerra NG, Williams KR. Implementation of school-based wellness centers. Psychology in the Schools. Sept 2003;40(5):473-487
SustainabilityEconomicsK-122008Nystrom RJ, Prata A. Planning and sustaining a school-based health center: cost and revenue findings from Oregon. Public Health Reports (Washington, D.C. : 1974). Nov-Dec 2008;123(6):751-760.
Youth InvolvementAccess to CareHigh School2005Mandel LA, Qazilbash J. Youth voices as change agents: moving beyond the medical model in school-based health center practice. The Journal of School Health. Sep 2005;75(7):239-242.
Youth InvolvementPolicyMiddle & High School2008Soleimanpour S, Brindis C, Geierstanger S, Kandawalla S, Kurlaender T. Incorporating youth-led community participatory research into school health center programs and policies. Public Health Reports (Washington, D.C. : 1974). Nov-Dec 2008;123(6):709-716.
AcademicsDropoutK-122013Krisberg K. School-based health centers emerge as resources for dropout prevention. Nation's Health. 2013;43(4):8
Access to CareSustainabilityNot Specified1999Friedrich MJ. Twenty-five years of school-based health centers. The Journal of the American Medical Association. 1999;281:781-782
PolicyAccess to CareNot Specified1991Lear J, Gleicher H, St. Germain A, Porter P. Reorganizing health care for adolescents: The experience of the school-based adolescent health care program. The Journal of Adolescent Health. 1991;12:450-458.
Reproductive HealthContraceptionHigh School1989Galavotti C, Lovick SR. School-based clinic use and other factors affecting adolescent contraceptive behavior. The Journal of Adolescent Health Care. Nov 1989;10(6):506-512.
Reproductive HealthPolicyHigh School2015Herrman J. Stakeholder perceptions of the provision of reproductive health services by school-based health centers as they may inform public policy. Policy, Politics and Nursing Practice. 2015;0(0):1-12
Reproductive HealthContraceptionHigh School2015Gilmore K, Hoopes AJ, Cady J, Amies Oelschlager A-M, Prager S, Vander Stoep A. Providing Long-Acting Reversible Contraception Services in Seattle School-Based Health Centers: Key Themes for Facilitating Implementation. Journal of Adolescent Health. 2015;56(6):658-665.
Behavioral HealthLiterature ReviewK-122015Bains RM, Diallo AF. Mental Health Services in School-Based Health Centers: Systematic Review. The Journal of School Nursing. 2015.
ImmunizationHealth PromotionMiddle School1992Beilenson P, Santelli J. An urban school-based voluntary MMR booster immunization program. Journal of School Health. 1992;62(2):71-73.
Reproductive HealthContraceptionMiddle/High School1987Hirsch MB, Zabin LS, Streett RF, Hardy JB. Users of reproductive health clinic services in a school pregnancy prevention program. Public Health Reports. 1987;102(3):307-316.
Reproductive HealthEconomicsMiddle/High School1988Zabin LS, Hirsch MB, Smith EA, et al. The Baltimore pregnancy prevention program for urban teenagers. II. What did it cost? Family Planning Perspectives. 1988;20(4):188-192.
Reproductive HealthAccess to CareMiddle/High School1991Zabin LS, Stark HA, Emerson MR. Reasons for delay in contraceptive clinic utilization. Adolescent clinic and nonclinic populations compared. The Journal of Adolescent Health. 1991;12(3):225-232.
Behavioral HealthAccess to CareMiddle/High School2014Bains RM, Franzen CW, White-Frese J. Engaging African American and Latino adolescent males through school-based health centers. The Journal of School Nurses. 2014;30(6):411-419.
EconomicsLiterature ReviewMiddle/High School1998Santelli J, Vernon M, Lowry R, et al. Managed care, school health programs, and adolescent health services: opportunities for health promotion. Journal of School Health. 1998;68(10):434-440.
PolicySustainabilityK-122012AAP Council on School Health. School-based health centers and pediatric practice. Pediatrics. 2012;129(2):387-393.
ObesityAccess to CareK-82014Aldrich H, Gance-Cleveland B, Schmiege S, Dandreaux D. School-based health center providers' treatment of overweight children. Journal of Pediatric Nursing. 2014;29(6):521-527.
Reproductive HealthContraceptionMiddle/High School2012Kohn JE, Hacker JG, Rousselle MA, Gold M. Knowledge and Likelihood to Recommend Intrauterine Devices for Adolescents Among School-based Health Center Providers. Journal of Adolescent Health. 2012;51(4):319-324.
Reproductive HealthAccess to CareHigh School2015Stein T, Louis MS, Gold M. Teen Acceptance of an Intrauterine Device (IUD) Service Within a School-Based Health Center. Journal of Pediatric and Adolescent Gynecology. 2015;28(2):e46-e47.
PolicyAccess to CareHigh School2015Ortega-Peluso C, Akkaya-Hocagil T, Leung SY, et al. Routine HIV testing capacity, practices, and perceptions among school-based health center providers in New York State after enactment of the 2010 amended HIV testing law. Journal of Acquired Immune Deficiency Syndromes. 2015;68 Suppl 1:S30-36.
Access to CareRisk Assessment/BehaviorMiddle/High School2015Runton NG, Hudak RP. The Influence of School-Based Health Centers on Adolescents' Youth Risk Behaviors. Journal of Pediatric Health Care. 2015.
Access to CareSatisfaction With CareMiddle/High School2014Breland DJ, McCarty C, Whitlock KB, et al. Health in Schools Study (HIS): Gender Differences in School-based Health Center Use. Journal of Adolescent Health.2014; 54(2):S67-S68.
SustainabilityAccess to CareMiddle/High School2015Blank MJ. Building Sustainable Health and Education Partnerships: Stories From Local Communities. Journal of School Health. 2015;85(11):810-816.
Access to CareContraceptionMiddle/High School2011Daley AM. Contraceptive services in SBHCs: A community experience in creating change. Policy, Politics & Nursing Practice. 2011;12(4):208-214.
Quality of CareRisk Assessment/BehaviorMiddle/High School1997Brey, LC and Gans Epner, J. Improving the delivery of clinical preventive services in school-based health centers (SBHCs). Journal of Adolescent Health. 1997;20:159-159.
Satisfaction With CareSchool Climate/ ConnectionMiddle/High School1996Santelli J, Kouzis A, Newcomer S. Student attitudes toward school-based health centers. The Journal of Adolescent Health. 1996;18(5):349-356.
Quality of CareRisk Assessment/BehaviorK-122002Gall GB. Comprehensive risk assessment for adolescents in school-based health centers. The Nursing Clinics of North America. 2002;37(3):553-564.
Quality of CareRisk Assessment/BehaviorMiddle/High School1996Fleming M, Brey L. Study of school-based health centers (SBHCs) as a setting for integrating guidelines for adolescent preventive services (GAPS). Journal of Adolescent Health. 1996;18:157-157.
PolicyLiterature ReviewMiddle/High School2001Pastore DR, Murray PJ, Juszczak L. School-based health center: position paper of the Society for Adolescent Medicine. The Journal of Adolescent Health. 2001;29(6):448-450.
Reproductive HealthPolicyMiddle/High School2015Herrman JW. Stakeholder Perceptions of the Provision of Reproductive Health Services by School-Based Health Centers as They May Inform Public Policy. Policy, Politics, & Nursing Practice. 2015;16(1-2):51-62.
Access to CareLiterature ReviewK-122011Juszczak L, Ammerman A. Reaching adolescent males through school-based health centers. Journal of Adolescent Health. 2011;48(6):538-539.
Behavioral HealthClinical OutcomesMiddle/High School2011Lyon AR, Charlesworth-Attie S, Stoep AV, McCauley E. Modular psychotherapy for youth with internalizing problems: implementation with therapists in school-based health centers. School Psychology Review. 2011;40:569.
Reproductive HealthAccess to CareMiddle/High School2011Minguez M, Santelli J, Gibson E, Orr M, Wheeler E. Evaluation of a NYC School-Based Health Center Providing Comprehensive Reproductive Health Care. Journal of Adolescent Health.2011; 48(2):S118-S119.
ObesityQuality of CareK-122011Rafalson L, Eysaman J, Quattrin T. Screening obese students for acanthosis nigricans and other diabetes risk factors in the urban school-based health center. Clinical Pediatrics. 2011;50(8):747-752.
Access to CareUnmet NeedsMiddle/High School2014Rafferty JR. Where are the Boys… Using Peer Leadership to Address Barriers to Male Adolescent Utilization of an Urban School-Based Health Center. Journal of Adolescent Health. 2014;54(2):S73-S74.
ImmunizationAbsenteeismHigh School2009Mears CJ, Lawler EN, Sanders LD, 3rd, Katz BZ. Efficacy of LAIV-T on absentee rates in a school-based health center sample. The Journal of Adolescent Health. 2009;45(1):91-94.
EvaluationLiterature ReviewK-122016Bersamin M, Garbers S, Gold MA, et al. Measuring Success: Evaluation Designs and Approaches to Assessing the Impact of School-Based Health Centers. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. 2016;58(1):3-10.
Access to CareDisparities in careHigh School2016Koenig KT, Ramos MM, Fowler TT, Oreskovich K, McGrath J, Fairbrother G. A Statewide Profile of Frequent Users of School-Based Health Centers: Implications for Adolescent Health Care. J Sch Health. 2016;86(4):250-257.
Access to CareRural HealthK-122016Schwartz KE, Monie D, Scribani MB, et al. Opening School-Based Health Centers in a Rural Setting: Effects on Emergency Department Use. J Sch Health. 2016;86(4):242-249.
EconomicsLiterature ReviewK-122016Ran T, Chattopadhyay SK, Hahn RA, Community Preventive Services Task Force. Economic Evaluation of School-Based Health Centers: A Community Guide Systematic Review. Am J Prev Med. 2016;51(1):129-138.
EvaluationLiterature ReviewK-122016Knopf JA, Finnie RK, Peng Y, et al. School-Based Health Centers to Advance Health Equity: A Community Guide Systematic Review. Am J Prev Med. 2016;51(1):114-126.
AcademicsSchool Climate/ ConnectionHigh School2016Bersamin M, Garbers S, Gaarde J, Santelli J. Assessing the Impact of School-Based Health Centers on Academic Achievement and College Preparation Efforts: Using Propensity Score Matching to Assess School-Level Data in California. J Sch Nurs. 2016;32(4):241-5.
Unmet NeedsSatisfaction With CareHigh School
2017Ramos MM, Sebastian RA, Stumbo SP, McGrath J, Fairbrother G. Measuring Unmet Needs for Anticipatory Guidance Among Adolescents at School-Based Health Centers. Journal of Adolescent Health. Online: 2017.
EvaluationContraceptionHigh School1980Edwards LE, Steinman ME, Arnold KA, Hakanson EY. Adolescent pregnancy prevention services in high school clinics. Family Planning Perspectives. 1980;12(1):6-7,11-14.
PolicySustainability Not Specified2001Morone JA, Kilbreth EH, Langwell KM. Back to school: a health care strategy for youth. Health Affairs. 2001;20(1):122-136.
Disparities in careBehavioral HealthNot Specified2017Larson S, Spetz J, Brindis CD, Chapman S. Characteristic Differences Between School-Based Health Centers With and Without Mental Health Providers: A Review of National Trends. Journal of Pediatric Health Care. Online: 2017.
ContraceptionClinical OutcomesHigh School2016Sangraula M, Garbers S, Garth J, Shakibnia EB, Timmons S, Gold MA. Integrating Long-Acting Reversible Contraception Services into New York City School-Based Health Centers: Quality Improvement to Ensure Provision of Youth-Friendly Services. Journal of Pediatric and Adolescent Gynecology. Online: 2016.
Literature ReviewEvaluationNot Specified2016Community Preventive Services Task F. School-Based Health Centers to Promote Health Equity: Recommendation of the Community Preventive Services Task Force. American Journal of Preventive Medicine. 2016;51(1):127-128.
Literature Review
Sustainability Not Specified2016Brindis CD. The "State of the State" of School-Based Health Centers: Achieving Health and Educational Outcomes. American Journal of Preventive Medicine. 2016;51(1):139-140.
Access to CarePolicyNot Specified2016Bersamin MM, Fisher DA, Gaidus AJ, Gruenewald PJ. School-Based Health Centers' Presence: The Role of School and Community Factors. American Journal of Preventive Medicine. 2016;51(6):926-932.
Primary and Secondary Topic Areas
Absenteeism
Academics
Access to Care
Asthma
Behavioral Health
Clinical Outcomes
Contraception
Dental
Disparities in care
Dropout
Economics
Emergency Department Use
Evaluation
Health Promotion
Immunization
Literature Review
Medication
Nursing
Patient-Centered Medical Home
Obesity
Policy
Prenatal Care
Quality of Care
Reproductive Health
Risk Assessment/Behavior
Rural Health
Satisfaction With Care
School Climate/ Connection
Substance Use
Sustainability
Teen Pregnancy
Unmet Needs
Utilization
Violence/Abuse
Youth Involvement
Objective: School-based health centers offer an efficient mechanism for delivering health services to large numbers of underserved youth; however, their availability varies across communities. Data on sociocontextual variables were analyzed to investigate factors that inhibit and facilitate school based health centers.

Finding: The presence of a local non-school-based family planning clinic was the strongest correlate of SBHC presence. School size, percentage non-white, and percentage receiving free or reduced-price lunches were positively associated with SBHC presence. Percentage who voted Republican in the 2012 general election and teen pregnancy rates were negatively associated with SBHC presence. None of the predictors were associated with number of services provided by SBHCs, but nonetheless, school and community factors appear to play a role in supporting or impeding the establishment of SBHCs.

Link: Article Abstract
Objective: School-Based Health Centers often struggle with the higher expectations of accountability matched with fewer available resources. Increased focus on prevention, quality improvement, and non-clinical determinants of health may provide more opportunities for centers to find sustainable funding.

Finding: The Patient Protection and Affordable Care Act (ACA), along with other movements in modern American healthcare show a shift towards prevention and a greater understanding of non-clinical determinants of health. That, paired with increased available resources for quality evaluation and improvement, represents an opportunity to expand and sustain school-based health center programming.

Link: Article Abstract
Objective: To describe school-based health centers and highlight their effectiveness in improving health and academic outcomes.

Finding: School-based health centers improve academic and health outcomes, especially for high needs or low income populations.

Link: Article Abstract
Objective: School-based health centers are positioned to provide youth-friendly family planning services--particularly long acting reversible contraceptives (LARCs)--that adolescents frequently are unable to access. A quality improvement project was undertaken to assess quality of care before, during, and after LARC services at 3 SBHCs, and to identify specific strategies for improving these LARC services.

Finding: Within the domain of communication, two key themes emerged: balancing need for information with concerns about being overwhelmed by information; and interest in information that directly addresses misconceptions about LARCs. Suggested strategies included providing postprocedure “care packages” with information and supplies, and supporting a peer-based network of adolescent LARC users and previous patients to serve as a resource for new patients. Most importantly, this quality improvement project, conducted in a unique setting, gave adolescents a voice.

Link: Article Abstract
Objective: Minority racial/ethnic pediatric populations and those living in poverty are at greater risk of exposure to trauma, development of mental health disorders, and school failure yet are less likely to have access to mental health services. School-based health centers staffed with mental health providers may be one strategy for decreasing health care disparities.

Finding: A total of 70% of SBHCs offered mental health services. SBHCs with more resources, more students, a longer history, and state funding were more likely to offer services. Reviewing SBHC characteristics that enable inclusion of mental health services may help stakeholders expand this model of care.

Link: Article Abstract
Objective: The article describes school-based health centers, the opportunities they provide, and the challenges they face, particularly from opposition to reproductive health services, and sustainability challenges.

Finding: SBHCs offer an important opportunity to reach youth in a place best suited to provide coordinated services they often underutilize otherwise.

Link: Article Abstract
Objective: This article describes the development of the pregnancy prevention program, details the services offered, and attempts to evaluate its impact.

Finding: High school health center family planning patients were significantly less likely to be lost to follow-up than were the adolescents served in the hospital-based MIC teenage contraceptive clinic. The long-term contraceptive continuation rates were higher among patients receiving services in the high school clinic than in the MIC teen clinic, regardless of race/ethnicity.

Link: Article Abstract
Objective: The validated Youth Engagement with Health Services survey measures adolescent health care quality. The survey response format allows adolescents to indicate whether or not their needs for anticipatory guidance were met. Here, the authors describe the unmet needs for anticipatory guidance reported by adolescents and identify adolescent characteristics related to unmet needs for guidance.

Finding: Among participants, 47.4% reported at least one unmet need for guidance from a health care provider in the past year. Topics with the highest proportions of adolescents reporting unmet needs included healthy diet (19.5%), stress (18.0%), and body image (17.0%). Adolescents at risk for depression and those with minority or immigrant status had increased unmet needs for guidance. Adolescents reporting receipt of patient-centered care were less likely to report unmet needs for guidance. Interventions to improve patient-centered care and preventive counseling for vulnerable youth populations may be warranted.

Link: Article Abstract
Objective: This study examines the association between school-based health center (SBHC) presence and school-wide measures of academic achievement and college preparation efforts. Publicly available educational and demographic data from 810 California public high schools were linked to a list of schools with an SBHC. Propensity score matching, a method to reduce bias inherent in nonrandomized control studies, was used to select comparison schools. Regression analyses, controlling for proportion of English-language learners, were conducted for each outcome including proportion of students participating in three College Board exams, graduation rates, and meeting university graduation requirements.

Finding: Findings suggest that SBHC presence is positively associated with college preparation outcomes but not with academic achievement outcomes (graduation rates or meeting state graduation requirements). Future research must examine underlying mechanisms supporting this association, such as school connectedness. Additional research should explore the role that SBHC staff could have in supporting college preparation efforts.

Link: Article Abstract
Objective: A systematic literature search was conducted for papers published through July 2014. Using Community Guide systematic review methods, reviewers identified, abstracted, and summarized available evidence of the effectiveness of SBHCs on educational and health-related outcomes. Analyses were conducted in 2014-2015.

Finding: Because SBHCs improve educational and health-related outcomes in disadvantaged students, they can be effective in advancing health equity.

Link: Article Abstract
Objective: Using economic systematic review methods developed for The Community Guide, 6,958 papers were identified for the search period January 1985 to September 2014. After two rounds of screening, 21 studies were included in this review: 15 studies reported on cost and nine on benefit; three studies had both cost and benefit information. All expenditures in this review were presented in 2013 U.S. dollars.

Finding: The economic benefit of SBHCs exceeds the intervention operating cost. Further, SBHCs result in net savings to Medicaid.

Link: Article Abstract
Objective: This retrospective, controlled, quasi-experimental study used an ED patient data set from the Bassett Healthcare Network in rural New York to compare ED visits between school-aged children from 12 SBHC schools before and after the SBHC opening. Time series analysis was used to determine trends in SBHC schools and 2 control schools without SBHCs over the 18-year study period.

Finding: The opening of SBHCs in rural settings results in a slight, but significant, increase in ED use, which is contrary to previous cross-sectional studies in urban settings.


Link: Article Abstract
Objective: Medical claims/encounter data were analyzed from 59 SBHCs located in secondary schools in New Mexico during the 2011-2012 school year. We used Pearson’s chi-square test to examine the differences between frequent (?4 visits/year) and infrequent users in their patterns of SBHC care, and we conducted logistic regression to examine whether frequent use of the SBHC predicted receipt of behavioral, reproductive, and sexual health; checkup; or acute care services.

Finding: SBHCs deliver core health care services to adolescents, including behavioral, reproductive, and checkup services, to high need populations. American-Indian youth, more than their peers, use SBHCs for behavioral health and checkups.

Link: Article Abstract
Objective: A review of the literature finds that SBHC evaluation studies have been diverse, encompassing different outcomes and varying target populations, study periods, methodological designs, and scales.

Finding: A complex picture emerges of the impact of SBHCs on health outcomes, which may be a function of the specific health outcomes examined, the health needs of specific communities and schools, the characteristics of the individuals assessed, and/or the specific constellation of SBHC services. SBHC evaluations face numerous challenges that affect the interpretation of evaluation findings, including maturation, self-selection, low statistical power, and displacement effects. Using novel approaches such as implementing a multipronged approach to maximize participation, entering-class proxy-baseline design, propensity score methods, data set linkage, and multisite collaboration may mitigate documented challenges in SBHC evaluation.

Link: Article Abstract
Objective: To determine the effectiveness of the intranasal LAIV-T in decreasing school absenteeism in a school-based vaccination initiative and to compare the acceptability of LAIV-T versus TIV among adolescents.

Finding: LAIV-T was associated with a reduction in nonsuspension absences and was well
accepted by students. Administration of LAIV-T may be a convenient and effective method to
mass-immunize students in a school setting and help establish herd immunity within the community.

Link: Article Abstract
Objective: Adolescent men have higher mortality and morbidity than their female peers resulting from many preventative conditions, including substance abuse, accidental injuries, and violence. However, use of primary care decreases as adolescent men age (opposite to the trend among females) and this gender disparity persists through adulthood. School-based health centers (SBHC) were established to target unmet adolescent health needs with accessible, low cost, comprehensive care. In theory, they address many barriers identified by adolescent males, but low utilization persists. Using the principles of community-based participatory research and peer leadership, a forum was established at a selected urban high school aiming to empower male student leaders in identifying and addressing relevant health issues and barriers preventing their demographic from accessing primary care, especially their SBHC.

Finding: Adolescents exert a powerful influence on the attitudes and behaviors of one another. A selected group of urban high school adolescent males designed a peer leadership program aimed at building leadership skills and health literacy. The program has demonstrated its ability to fostert agency and initiative among participants in advocating for and reducing stigma associated with seeking preventative healthcare. Future research will assess the project's effectiveness in impacting school-wide attitudes and behaviors.

Link: Article Abstract
Objective: To determine the prevalence of acanthosis nigricans (AN) and other diabetes risk factors in urban school health clinics.

Finding: AN can be easily identified by trained health care professionals even in busy school-based health center settings. Checking for AN and appropriate education and counseling should become a routine part of electronic documentation in overweight youth.

Link: Article Abstract
Objective: To examine the impact of a NYC School-Based Health Center (SBHC) on school-wide reproductive health indicators including access to care, reproductive health education, and contraceptive use. Access to comprehensive reproductive health care, which results in improved contraceptive use, should reduce unplanned pregnancy among students.

Finding: Access to comprehensive reproductive health services via a NYC SBHC led to increased use of reproductive health care and use of hormonal contraception among the student body. SBHCs can be an important point of access to reproductive health care for students. Our research design may be useful in evaluation of existing school-based health interventions where true baseline data are lacking.

Link: Article Abstract
Objective: To describe the training and consultation procedures implemented to adapt and pilot modular psychotherapy for use by therapists treating youth with depression and anxiety in school-based health centers (SBHCs).

Finding: Findings indicated that participating therapists were able to successfully select appropriate students for treatment, systematically track their use of treatment modules, and administer standardized measures to monitor symptom change in 94% of their sessions. In the context of these findings, we discuss practitioner engagement barriers and solutions, school-based therapist use of standardized assessment tools, and the utility of a brief SBHC intervention model.

Link: Article Abstract
Objective: To address primary barriers to care identified by young men—embarrassment, lack of privacy, and easy access.

Finding: Adolescents need access to comprehensive, confidential health services to ensure their health and well-being now and in the future. As Ethier's study shows, if SBHCs are properly staffed, structured, and trained to provide reproductive health care and outreach, there is exceptional opportunity to fill an existing gap in how this population receives health care. Yet, SBHCs aren't a magical panacea; reaching adolescent males—like improving academic performance—only happens with concerted staff effort backed by sustainable local, state, and federal support.

Link: Article Abstract
Objective: The purpose of this study was to determine the perspectives of key stakeholders related to accessing reproductve health services in SBHCs

Finding: Findings reflect strong stakeholder support for the inclusion of RHS in SBHCs as a way to promote teen sexual health. Nurses have an important role in influencing policies related to teen reproductive health such as those addressed in this study.

Link: Article Abstract
Objective: To state the Society for Adolescent Medicine's official stance on SBHCs

Finding: SBHCs serve as an excellent site for research on adolescent health issues. In addition to a continued emphasis on measuring outcomes, SBHCs offer unique opportunities to study adolescent specific interventions such as smoking cessation, HIV-testing programs and others. Furthermore, SBHCs provide unique opportunities to evaluate mental health interventions for adolescents. At this time SAM voices its unequivocal support of the comprehensive SBHC model.

Link: Article Abstract
Objective: To identify factors that influence the successful integration of comprehensive clinical preventive services (CCPS) inSBHCs.

Finding: CCPS were successfully integrated at the 4 SBHCs studied. The identified factors can influence the success of integrating CCPS that utilize a model like GAPS. How each of these factors applies to various health care settings and to individual sites aswell as additional factors that may influence success warrants further study.

Link: Article Abstract
Objective: To analyze risk assessment instuments and procedures within SBHCs

Finding: Providing comprehensive clinical services in school-based health centers affords the advanced practice nurse the opportunities for professional growth and fulfillment. Nurse practitioners are the primary clinician in the majority of SBHCs. A substantial body of knowledge exists supporting the needs of adolescents, as well as methods by which nurse practitioners may assess, document, and intervene in order to improve health outcomes in this age group. To help move the field of school-based health care from innovation to mainstream, nurse practitioners need to continue to be part of the development of conceptual frameworks, appropriate methods, and evaluation of the process and outcomes. Educational achievement, reduction of adolescent morbidity, and access to care/reimbursement for care all have great significance in policy development. The extent to which nurse practitioners in SBHCs can provide evidence of making a difference will determine the success of this important health care venue for adolescents and as well as demonstrate their own professional excellence.

Link: Article Abstract
Objective: To extrapolate on what little is known about student attitudes toward school-based health centers (SBHCs) or about factors that influence SBHC enrollment.

Finding: Students overwhelmingly supported school-based health centers. Personal experience and peer influences were important in shaping student attitudes. We found evidence of a "learning curve" gradient in student attitudes such that students with the greatest exposure to SBHCs (as measured by attending a SBHC school, enrolling in the SBHC, and using the health center) had the most favorable attitudes.

Link: Article Abstract
Objective: To examine changes in the delivery of clinical preventive services to adolescents in SBHCs following the incorporation of the AMA's Guidelines for Clinical Preventive Services (GAPS).

Finding: This study suggests that the quality of cliulcal preventive services delivered to adolescents in SBHCs can be improved through an intervention that includes training, use of standardized protocols, and technical assistance. The incorporation of GAPS resulted in positive outcomes in all SBHCs studied; it led to improved quality of care, re-engaged parents in their adolescent's health care, and improved organizational operations. These findings are part of a larger ongoing evaluation which will include data from > 90 SBHCs in nine states by March, 1997.

Link: Article Abstract
Objective: To investigate and theorize the mechanisms for creating the community change involved in providing contraceptive access at SBHCs

Finding: School Based Health Centers (SBHCs) are teen-friendly community resources currently underutilized in efforts to prevent teen pregnancy. Much of the decline in the teen birth rate has been attributed to increased access and use of contraception by adolescents. Yet 60% of SBHCs nationwide are prohibited from prescribing and/or dispensing contraception. Pregnancy prevention efforts targeting increased contraceptive availability and accessibility are likely to be enhanced by changing existing policies that restrict contraceptive services to adolescents through SBHCs nationwide. This article describes a successful community-based effort to change school district policy to provide contraceptive access through the SBHCs. The Transtheoretical model (TM) is applied retrospectively to describe this change process and provides a useful framework for nurses to consider in guiding community health policy initiatives.

Link: Article Abstract
Objective: To see if schools and districts with strong health partnerships reflecting a community schools strategy show improvements in students' school lives or health.

Finding: The schools and districts with strong health partnerships reflecting a community schools strategy have shown improvements in attendance, academic performance, and increased access to mental, dental, vision, and health supports for their students. To build deep health-education partnerships and grow community schools, a working leadership and management infrastructure must be in place that uses quality data, focuses on results, and facilitates professional development across sectors. The leadership infrastructure of community school initiatives offers a prototype on which others can build. Moreover, as leaders build cross-sector relationships, a clear definition of what scaling up means is essential for subsequent long-term systemic change.

Link: Article Abstract
Objective: This study is an examination of youth's perceptions of health care services in school-based health centers (SBHC). While studies have found that female youth use SBHCs more frequently and male youth are under-utilizers of SBHC, we have little information about youth's attitudes about seeking care in these settings.

Finding: The results of this study show that regardless of gender, youth in this study would choose not to use the SBHC for health care and prefer other centers. In addition, our results are consistent with other studies that more females utilize the SBHCs compared to males. Although SBHCs have been shown to be ideal centers for adolescents to utilize health care resources, they may not be the youth's first choice. Further research is needed to understand youth behaviors associated with increased utilization of SBHCs especially in the adolescent male.

Link: Article Abstract
Objective: The purpose of this quantitative study was to investigate health risk behaviors (as defined by the Youth Risk Behavior Survey) that were influenced by having access to a new school-based health center (SBHC), using two urban school systems in the Mid-Atlantic region.

Finding: Schools remain a critical part of adolescents' development, and access to SBHCs offers a safety net to students whose families may not have health insurance. However, the new SBHC did not have a significant effect on the student's risk behaviors.

Link: Article Abstract
Objective: To assess whether New York State SBHCs implemented provisions to have providers routinely offer HIV testing to patients aged 13-64 years, regardless of risk, and link individuals with HIV to medical care.

Finding: On-site HIV testing was reported to be available at 71% of SBHCs. Linkages to age-appropriate HIV care were reported to be available at 85% of SBHCs. The routine offer of HIV testing for eligible students was reported to be implemented at 55% of SBHCs. Forty-one percent reported that HIV testing was offered to at least half of eligible students during the 2010–2011 school year. New York City and high school providers were more likely to report the routine offer of HIV testing, on-site testing, linkages to care, perceive students as willing to test, indicate fewer barriers, and report having offered testing to a majority of eligible students in the previous year.

Link: Article Abstract
Objective: To evaluate adolescents’ acceptance and use of IUD services on-site at a school-based health center (SBHC) in the Bronx, NY.

Finding: IUDs remain an important method of contraception, especially for adolescents, but these services may be difficult to obtain for many young people. Offering IUD insertions in school-based health centers was found to be acceptable to the teens surveyed and most chose their school health center site out of convenience.

Link: Article Abstract
Objective: The American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention recommend intrauterine devices (IUDs) as safe and highly effective contraceptives for adolescents. Nevertheless, many U.S. providers do not recommend or provide IUDs to adolescents—a population at high risk for unintended pregnancy. The purpose of this study was to identify barriers to IUD provision for adolescents.

Finding: Half (55%) of all respondents would be likely to recommend an IUD to a patient under age 20 years. Respondents were less likely to recommend an IUD for patients with history of recent STD (31%), remote pelvic inflammatory disease (37%), and patients not in a monogamous relationship (38%). Whereas 77% of respondents indicated that IUDs are safe for adolescents, 18% of those respondents would be unlikely to recommend an IUD to a patient under age 20 years. While 86% of respondents knew that IUDs can be used in nulliparous women, 25% of those respondents would be unlikely to recommend an IUD to a patient who has never been pregnant. Additionally, 61% believed that counseling patients about IUDs would take more time than other methods. Misinformation about risks associated with IUDs and beliefs about patient eligibility may present barriers to provision.

Link: Article Abstract
Objective: This descriptive study was to determine self-reported treatment practices of school-based health center (SBHC) providers when caring for overweight/obese children.

Finding: Providers (N = 33) from SBHCs in 6 states (AZ, CO, NM, MI, NY, and NC) completed a baseline survey before being trained on obesity recommendations. SBHC providers reported patient/parent barriers to be more significant to treatment than clinical/setting barriers (p < 0.0001). Most providers (97%) indicated childhood obesity needs treatment, yet only 36% said they initiate treatment in children who do not want to control their weight. SBHC providers also did not commonly refer overweight/obese children to specialists.

Link: Article Abstract
Objective: To identify challenges and opportunities and to propose recommendations in regards to SBHCs becoming more frequent, and possibly replacing a student's medical home.

Finding: This policy provides an overview of SBHCs and some of their documented benefits, addresses the issue of potential conflict with the medical home, and provides recommendations that support the integration and coordination of SBHCs and the pediatric medical home practice.

Link: Article Abstract
Objective: To provide background information and present arguments regarding partnerships between MCOs and schools, with specific attention to health promotion behavior.

Finding: Although MCOs and school health programs share some convergent goals related to prevention, they also share some clearly competing and conflicting priorities. However, partnerships between MCOs and schools may be critical for the effective coordination and delivery of comprehensive adolescent health services. If public health agencies and school health programs are to work successfully with MCOs, their partnerships must be built on the common interests shared by these groups. Partnerships must be innovatively designed to overcome barriers to collaboration. All parties should recognize that partnerships between MCOs, school health programs, and public health agencies could create substantial opportunities to improve the health of our nation’s youth.

Link: Article Abstract
Objective: To build on previous evidence that Latino and African American males seek mental health services at SBHCs more often than in other settings, and to understand why these adolescents sought services and their perceptions of the services.

Finding: African American and Latino males are less likely to seek mental health services and obtain adequate care than their White counterparts. They are more likely to receive mental health services in school-based health centers (SBHCs) than in other community-based settings. The purpose of this article was to understand the issues and reasons these adolescents sought mental health services at SBHCs and what their perceptions of the services were. A content analysis of 22 individual interviews was conducted using Krippendorff’s method. Five themes emerged from the analysis of the data: the burdens and hurdles of my life, the door is always open, sanctuary within chaos, they get to us, and achieve my best potential. Each of the themes is explored in detail with rich quotations from the adolescents. The findings illuminate the daily struggles these adolescents faced and the impact mental health services in SBHCs had on their daily lives.

Link: Article Abstract
Objective: To analyze the reasons for the delay in seeking contraceptive services after experiencing intercourse. Emphasis is placed on the young people’s reasons for delaying services to derive information about how health center services may be more accessible to them.

Finding: Because delay in accessing contraceptive services is a serious obstacle to prevention of unintended pregnancy in adolescence, reasons for delay are probed in a junior and senior high school population and compared with results obtained among 435 young black women previously surveyed in 32 U.S. health centers. The 388 students surveyed before exposure to pregnancy prevention services are compared with 422 surveyed after ?2 years exposure to a successful educational/health central intervention program. Particular attention is paid to reasons cited by those who never utilized services important reasons cited by all groups include fear that contraception is dangerous (cited by 40.0% at baseline), fear of parental discovery (30.5%), and awaiting “closer” partner relationships (31.3%). The last reason was often cited a year or more after initiating coitus. That the perception of birth control as dangerous is a barrier to contraception is confirmed by the large proportions who cited it among those who had never used health central services. Programmatic implications of the findings are discussed.

Link: Article Abstract
Objective: To analyze the cost of the Baltimore Pregnancy Prevention Program for Urban Teenagers with respect to age, gender, and services received.

Finding: An experimental pregnancy prevention program for junior and senior high school students consisted of classroom lectures, informal discussion groups and individual counseling in the schools and group education, individual counseling and reproductive health care in a nearby health center. The structure of the program allowed for extensive individual counseling for students who desired it, and the reported costs are therefore considered generous. School-based services utilized 40 percent of a total three- year budget of $409,250, and health center services, 60 percent. The average cost per student served was $122, with the average per female student almost four times that per male and the average per senior high student more than twice that per junior high student. Students who utilized more expensive types of services, such as individual counseling and medical services in the health center, also used other program offerings more frequently. Services to students who attended only class lectures cost an average of $13.20 to deliver, while students who utilized all services cost the program an average of $546 each.

Link: Article Abstract
Objective: This paper describes the use of a reproductive health care health center associated with a school pregnancy prevention program which had demonstrated success. The program operated in one junior and one senior high school in a large city during the 3 school years from 1981 to 1984. Three facets of the 818 users of the program health center are explored: (a) who enrolled in the health center, (b) why they enrolled and what contraceptive methods they received, and (c) their continuation with the health center.

Finding: The main findings are (a) teens of both sexes used the health center, and junior high males used it in surprisingly large numbers; (b) there were no major school or sex differences in the characteristics of those who enrolled; (c) most students enrolled to obtain a contraceptive method; (d) although many females served by the health center had previously used another family planning health center, the majority of them had unmet needs; (e) the rate of health center continuation was high; and (f) certain factors contributed to health center continuation. These findings suggest that a health center in a school-linked setting can successfully attract students to use its services and it may offer certain advantages for reaching sexually active teens in search of contraceptive protection.

Link: Article Abstract
Objective: An examination of the implementation of a school-based program to raise rates of voluntary MMR boosters in sixth-grade cohorts.

Finding: Multiple methods were used to raise student, parent, and school official awareness of MMR booster recommendations, including mail, television ads, public speeches, and individual outreach. Approximately 35% of sixth-grade parents return consent cards for vaccination. 28% of students were immunized, with an additional 5% providing documentation of a prior MMR booster. Yet, two-thirds of sixth graders remained undocumented or un-revaccinated. Given lack of parental knowledge about new MMR recommendations, time, money, and a resistance to vaccinations from some parents, a fully voluntary approach is unlikely to succeed. However, the success of the program shows that schools can be excellent points of public health intervention, especially in communities with poor access to primary care.

Link: Article Abstract
Objective: A systematic review of literature was undertaken to review evidence on the effectiveness of delivery of mental health services in SBHCs.

Finding: Databases were searched extensively for research studies published between January 1990 and March 2014. Twenty-three studies were selected for review. SBHCs provide access and eliminate barriers to mental health services. Students who exhibited high-risk behaviors were more likely to have sought services at the SBHC. However, there is a lack of high-quality research evaluating mental health services in the SBHCs and their effect on children and adolescents.

Link: Article Abstract
Objective: An examination of the implementation of a program that provides long-acting reversible contraception (LARC) services within school-based health centers (SBHCs) and identification of barriers and facilitators to implementation as reported by SBHC clinicians and administrators, public health officials, and community partners.

Finding: Results suggest LARC counseling and procedural services can be implemented in an SBHC setting to promote access to effective contraceptive options for adolescent women. The most cited barriers across key informant groups were: perceived lack of provider procedural skills and bias and negative attitudes about LARC methods. The most common facilitators identified across groups were: clear communication strategies, contraceptive counseling practice changes, provider trainings, and stakeholder engagement. Two additional barriers emerged in specific key informant groups. Technical and logistical barriers to LARC service delivery were cited heavily by SBHC administrative staff, community partners, and public health officials. Expense and billing was a major barrier to SBHC administrative staff.

Link: Article Abstract
Objective: The purpose of this study was to determine the perspectives of key stakeholders related to access to reproductive health services (RHS) in school-based health centers (SBHCs).

Finding: Participants in this study agreed that RHS must be: 1) teen friendly, 2) convenient, 3) confidential, 4) low- or no-cost, 5) developmentally appropriate, 6) evidence-based, 7) medically accurate, and 8) part of holistic care. Subthemes and exemplar quotes also revealed important insights into public opinion about RHS at SBHCs. Overall, findings reflect strog stakeholder support for the inclusion of RHS in SBHCs as a way to promote teen sexual health.

Link: Article Abstract
Objective: This study investigates adolescent risk taking, preventive behavior, and contraceptive use using a self-administered questionnaire in a sample of 260 inner-city high school students targeted by a school-based health center.

Finding: Results of this study suggest that programs may be having some success in encouraging and enabling sexually active adolescents to use contraception and to use it more consistently. Multivariate models consisting of individual and environmental variables significantly predicted sexual activity and contraceptive use. Older age at first intercourse, higher number of welfare benefits received by the household (including Medicaid, food stamps, and free or reduced price lunch), and use of the school-based health center were significant positive predictors of more frequent contraceptive use by adolescents.

Link: Article Abstract
Objective: The article reports on the progress of 23 health centers established under the School-Based Adolescent Health Care Program funded by The Robert Wood Johnson Foundation. The authors describe the historical development of school-based health centers (SBHCs) and program implementation.

Finding: In the late 1980s, the Robert Wood Johnson Foundation launched a multi-site demonstration effort, the School-Based Adolescent Health Care Program, to test on a large scale the ability of SBHCs to increase access to health care for low-income young people, to provide comprehensive services at the school, and to secure the commitment of community institutions to participate in and sustain the SBHCs.

Link: Article Abstract
Objective: This article presents an overview of school-based health centers (SBHCs) in terms of accessible services, growing numbers and long-term funding. Recommendations for financial sustainability are provided and three SBHCs that provide access to physical and mental health services are described.

Finding: By providing accessible physical and mental health services to young children and adolescents in need, SBHCs help remove or at least reduce such impediments to learning. Mental health services are deemed to have the most impact. By 1998 there were 1157 school-based health programs nationwide. Most centers (63%) were located in urban schools, although the number in rural areas are increasing. While high schools house the majority of these health centers, the number located in elementary and middle schools are also growing. Funding programs will most likely use a managed care model to deliver services, and SBHCs must document their work, provide data and emphasize their public health function in order to forge relationships with MCOs.

Link: Article Abstract
Objective: This article addresses high school completion and the need to achieve equity in education status and in health among adolescents. It uses the case of a school-based health center (SBHC) and one of their patients in Colorado to demonstrate the ability of SBHCs to prevent dropouts.

Finding: SBHCs have the ability to identify and address health-related issues that cause students to dropout of school. For every student that comes into an SBHC, an assessment for psychosocial issues that go far beyond the initial problem that brought them to the center, can help determine if students struggle with drug and alcohol issues or issues at home that contribute to poor school attendance and dropout. A challenge for SBHCs is their ability to make those connections in the entire school population, not just in students enrolled at the center. Although a significant amount of consistent evidence supports the impact of SBHCs on reducing dropout rates, the connection is still very complicated to make on the ground.

Link: Article Abstract
Objective: This article describes two case studies and lessons learned in the implementation of youth-led community-based participatory research (CBPR) aimed at improving school-based health center (SBHC) programs and policies in Alameda County, CA.

Finding: Results of this study suggest that youth voice can play a crucial role in advancing policies that are of mutual concern and, at times, can expedite policy and program efforts. The program also provided opportunities to engage under-represented youth in research-related career pathways far earlier in their educational experience, adding in the short term to their sense of self-confidence and achievement. Pursuing strategies that help provide young people with a sense of purpose and connectivity to adults represents a practice that could be replicated widely.

Link: Article Abstract
Objective: This article describes a 34-week pilot project aimed at improving health care service delivery for adolescents by offering youth a distinct role as advisory board members who help shape policy, provide feedback, guidance, and direction to a school-based health center (SBHC) program in Boston.

Finding: This experience demonstrated that young health care consumers, with support, can focus their attention and begin to utilize analytical thinking skills to shape health outcomes and inform service delivery. Students' increased awareness of SBHC service elements led to identification of obstacles to youth participation in care, feedback regarding positive and negative health care experiences within the SBHC, as well as with external health care providers, and ideas about unrecognized needs leading to gaps in services.

Link: Article Abstract
Objective: A discussion of Oregon's School-Based Health Center (SBHC) State Program Office methodology and findings regarding costs and revenues for planning and operating Oregon SBHCs.

Finding: The study found that the median startup costs for Oregon SBHCs ranged from $49,750 to $128,250, depending mostly on the status and renovation needs of the school space. Median annual operations costs ranged from $90,750 to $208,500, depending mostly on provider hours and types, but were as high as $402,500 for expanded centers operating year-round with full-time staffing and mental health services. FQHCs relied significantly more on billing and federal dollars. Non-FQHs relied more on state and other funding. Public insurance students used the centers more frequently than students with private insurance, and there was a large variability in the relationship between the proportion of students with free and reduced lunch and the number of unduplicated clients with public insurance.

Link: Article Abstract
Objective: A description of the planning, implementation, and evaluation of school-based Wellness Centers in Riverside, CA, as part of the Safe Schools/Healthy Students Initiative funded by the SAMHSA.

Finding: Although the Wellness Centers appear to have been a very good idea, the planning, implementation, and evaluation challenges clearly compromised their potential to enhance children’s development and prevent problems such as violence. Some problems were almost unavoidable. For example, there was a mismatch between federal grant funding schedules and operational policies and procedures of the school district. It is unrealistic to expect any agency, particularly a large bureaucracy such as a school district, to begin a program immediately after funds are received.

Link: Article Abstract
Objective: A description of provider activities in a convenience sample of school-based health centers (SBHCs) to determine the relative proportion of time that health center staff engaged in various patient care and non-patient care activities, for planning purposes and measure change over time.

Finding: Results found that a significant amount of provider activity was directed at the delivery of health care; direct patient care and health center operations combined accounted for approximately 75% of health center activity. Patient, classroom, and group education activities, as well as contacts with parents and school staff accounted for 20% of all health center activity and represent important SBHC functions that other productivity measures such as billing data might not consistently track. Limited variations in activities were found across health center sites and according to season.

Link: Article Abstract
Objective: This study provides recommendations regarding the establishment and maintenance of school-based health centers based on analysis of data from a health center located in a New York City high school.

Finding: The school-based health center described in this study was established with the cooperation and support of the New York City Department of Health, the New York City Board of Education, two hospitals, and the Robert Wood Johnson Foundation. The number of students enrolled grew from 335 to 1283 within the first 2.5 years, and a total of 7920 visits were made for a variety of problems. This growth required integrated support, and strategies particularly for consent and confidentiality. Background characteristics signified that students were at-risk youth, and less than two thirds were not covered by either private insurance or Medicaid. Inadequate reimbursement will represent the greatest hurdle for growth of SBHCs. Staffing and flexible hours are also essential for SBHC success.

Link: Article Abstract
Objective: This paper describes funding options and strategies for long-term financial sustainability for school-based health centers (SBHCs).

Finding: Overall, SBHCs that remain stable and vibrant find multiple funding sources, provide a variety of services, and embed themselves in the community, at both the local and government levels. These centers gain supporters willing to work to maintain services, and with a variety of funding sources, prove least vulnerable to changes in funding trends. For SBHCs to maintain and enhance their valuable role, they should consider operational and structural measures, including third-party billing, developing a governance structure, and providing dedicated staff time for grant writing and grant management.  

Link: Article Abstract
Objective: This article describes the cost-effectiveness of the Middletown Adolescent Health Project (MAHP), a school-based, comprehensive health services project

Finding: Cost comparisons for medical care at the high school vs. private care were substantial. Potential out-of-pocket expenses for obtaining care in a private physician's office were 89% more than through the MAHP.

Link: Article Abstract
Objective: This study reports on adolescent satisfaction with pediatric nurse practitioner (PNP) care using a tool developed specifically for a middle school school-based health center (SBHC) in Detroit, Michigan.

Finding: Results demonstrated high satisfaction (approximately 3.7 out of 4) with care using a reliable tool designed for adolescents, which incorporated a grading rubric for the evaluation criteria. The nurse practitioner received high marks for listening to the students and treating the students with respect. Yet, statistical differences by grade level were found. The satisfaction tool was found to be reliable and consistent with adolescents' perspectives on satisfaction with health care.

Link: Article Abstract
Objective: This study assesses the capability of a network of school-based health centers (SBHCs) to provide access to care for rural youth in West Virginia, especially those who have no insurance or are covered by some form of public assistance.

Finding: Enrollment in rural schools averaged 86%, as compared to 46% in urban schools by the end of Year 3, which was significantly higher. The utilization rates showed a similar pattern. By the end of the third year, the rate at rural schools was 70%, compared to 63% for urban schools. The enrollment, utilization, and visit rates all demonstrate that the majority of clients in the SBHCs receive some type of public assistance or are uninsured. Nearly two-thirds of all encounters are by youth who are in this category. For medical visits, “well child” and EPSDT were the most common diagnoses.

Link: Article Abstract
Objective: An examination of the changes in African-American adolescent fertility rates from 1990 to 1997 in high-school areas with school-based health centers (SBHCs) and compared them over time with changes in rates in high-school areas without SBHCs in Denver, Colorado.

Finding: In 1992, the adolescent fertility rate for schools with SBHCs was 165, compared with 86 for schools without centers. In 1997, the rate for both settings was 38 and not significantly different. Between 1992 and 1997, the African-American adolescent fertility rates at the three schools with SBHCs fell by 77%, from a high of 165 to a low of 38 births per 1000 adolescents. For the four schools without SBHCs, the rate fell 56%, from a high of 96 in 1991 to a low of 38. The rapid and significant decline in African-American adolescent fertility in school areas with SBHCs strongly suggests that attending to the health needs of students at risk of pregnancy resulted in a radically lowered risk of fertility.

Link: Article Abstract
Objective: An examination of the effects of St. Paul health centers in Minnesota on birthrates in their respective public high schools, using a newly developed methodology for estimating student birthrates.

Finding: The data, based on a new methodology to estimate student birthrates, indicate that the school-based health centers in St. Paul did not significantly reduce birthrates in their respective schools. Instead, the data revealed large year-to-year fluctuations. Birth-rates were just as likely to increase after health centers opened as they were to decrease, and the mean birthrate for all schools combined was significantly greater after the health centers were opened than before.

Link: Article Abstract
Objective: This retrospective analysis demonstrates the impact of a comprehensive, interdisciplinary program of prenatal care in a regular public school setting, to achieve early and continuous prenatal care, on minimizing obstetrical complications of pregnant students.

Finding: The data demonstrated that the study group initiated care earlier and had more total prenatal visits than did the comparison group. Also demonstrated were fewer obstetrical complications in the study group than in the comparison group. The comparison group had more low birth weight infants and more complicated deliveries than did the study group. Therefore, the results of this study support the initial objective and may have significance for educators and health personnel.

Link: Article Abstract
Objective: This study examines and compares access to care, comprehensiveness of care, and birth outcomes for Baltimore teenagers 18 years or younger in a school-based vs. hospital-based comprehensive adolescent pregnancy program (CAPP).

Finding: The findings come from a sample of 390 adolescents 18 years old or younger, predominantly African-American and economically disadvantaged, who delivered a baby between 1995 and 1997. A major finding is that teenagers who received prenatal care in a school-based CAPP were significantly less likely to deliver a low birth weight infant compared with teenagers receiving care at a hospital. Teens attending the school-based site initiated care significantly later than at the hospital-based site. Yet, overall adequacy of care (quantity) did not contribute significantly to the odds of low birth weight. When present, comprehensive care attenuated the odds, but when together with adequacy, the difference in low birth weight by site became even less significant.

Link: Article Abstract
Objective: This report describes the planning and implementation of a comprehensive high school health center physically within a junior-senior high school in the inner city of Saint Paul, Minnesota.

Finding: Acceptance of the school health center by pregnant students increased steadily. Thirty-five percent of the pregnant girls used the health center during the first full school year and 92.3 percent during the 1975-76 school year. Of the total 38 students who were followed in the prenatal health center, 21 have delivered to date. All but one began prenatal care by 16 weeks of gestation and non had less than 6 prenatal visits. The post-partum school drop out rate decreased from 45 to 10 per cent and no repeat pregnancies occurred in those who returned to school.

Link: Article Abstract
Objective: This study evaluates whether enhancement of hospital-based prenatal care of adolescents results in pregnancy outcomes are comparable to those found in adolescents receiving care at school-based health centers (SBHCs).

Finding: Data demonstrated that the SBHC initiated care much earlier and had significantly more prenatal visits than the hospital clinic, but the hospital clinic demonstrated a dramatic improvement in both areas when compared to the first study prior to enhancement. Rates of obstetrical complications and infant outcomes were more similar for both groups than in the initial study. Therefore, similar services at non-school sites can be greatly enhanced and can demonstrate significant improvement in obstetrical outcomes, similarly to SBCs.

Link: Article Abstract
Objective: This study assesses the differences in numbers of prenatal care visits, postpartum care, repeat deliveries, and school continuation rates among adolescent student mothers in Dallas, Texas who receive services from school-based health centers (SBHCs) in comparison with categorical health centers.

Finding: Adolescents attending the SBHC were more likely to be in school at conception and averaged more prenatal visits than those served by the categorical provider. However, during the pregnancy and following the delivery, school dropout rates for the two sets of teens converged. School continuation rates were higher among a subset of adolescents attending the Dallas Independent School District school for pregnant teens than among other teens. Hispanic teens were two times more likely than their African-American counterparts to drop out of school. No differences were found in repeat birth rates, by ethnicity, health center site, or school attended.

Link: Article Abstract
Objective: This article discusses the benefits of rethinking school-based health centers (SBHCs) as complex adaptive systems (CASs) for providing care to adolescents and their potential to emerge as a community resource to augment prevention efforts aimed at teen pregnancy and STIs.

Finding: In the case study and literature reviewed, authors found that SBHCs possess the essential elements of CASs and, in many cases, the flexibility to contribute notably in teen pregnancy and STI prevention efforts. However, SBHCs need to be allowed to self-organize and to better assist teens to make educated, informed decisions about sexual activity and contraceptive use. SBHCs utilize a adolescent-friendly approach to care that meets teens where they are and encourages self-efficacious behaviors, but local, state, and national level restrictions on contraceptive services at the SBHC need to be lifted to allow health centerians the flexibility to better meet the sexual health needs of teens.

Link: Article Abstract
Objective: This inquiry provides a metasynthesis of the literature that reviews, examines, and summarizes evidence relating to the effect of school-based health centers on teenage pregnancy and parenting outcomes.

Finding: The author concluded that school-based health centers can provide important services to pregnant and parenting teenagers. School-based health centers were associated with a reduction in absenteeism and drop-out rates among pregnant and parenting teens (five studies), a possible reduction in developmental delay in children (two studies), encouragement for ongoing participation in school and an improvement in the health of the teenager and her child (two studies), a reduced incidence of low-birth weight babies (three studies), and an increase in the decision to use contraceptives and a wish not have a repeat pregnancy (two studies).

Link: Article Abstract
Objective: This study evaluates completion of the HPV vaccine series, and compliance with the recommended intervals between doses, among adolescents who initiated the series in 19 Oregon SBHCs. 

Finding: Four hundred and fifty persons initiated the human papillomavirus series in 2007. By December 2008, 21% had just one dose, 29% two, and 51% had received all three doses. Series completion increased significantly with age, differed significantly between race groups (highest among white persons [56%]; lowest among black persons [38%]), and did not differ significantly by insurance status. Mean intervals between doses did not differ significantly by race or insurance status.

Link: Article Abstract
Objective: A summary of the current status of comprehensive school-based health centers (SBHCs) in the United States, focusing on the proliferation of facilities over the period 1985-1988, the lessons learned from this experience and the outlook for comprehensive school health services in the coming years.

Finding: There is some evidence indicating that participation in school-based health centers may have a positive impact on contraceptive practice. It appears that the future of comprehensive SBHCs does not hang on the ability of the opposition to block their development. The future rests on the adequacy of funding, the resolution of policy issues at the local level and the availability of trained manager and health practitioners. The continued growth of the SBHC movement will require strong advocacy, documentation of benefits and coalition-building and leadership.

Link: Article Abstract
Objective: This systematic review and narrative synthesis of literature determines the effectiveness of contraception service interventions for young people that were delivered in educational settings.

Finding: Twenty-nine papers were identified. Authors found that an intensive case management intervention conducted by a culturally matched school-based social worker can be effective in preventing repeat adolescent pregnancy, at least for the duration of the intervention. School-based health centers (SBHCs) appeared to be most effective when contraception provision is made available on site, either comprehensively or as a condom availability program, when compared to interventions which only offer health care assessments or counselling. Studies demonstrate that multicomponent interventions, such as “Safer Choices” and “STAND” are effective in their objectives, as are generic interventions in preventing specific individual problem behaviors.       

Link: Article Abstract
Objective: An evaluation of reproductive health programs and their impact on sexual behavior and contraceptive use in six diverse school-based health centers (SBHCs) in the United States.

Finding: Survey data indicated that the health centers neither hastened the onset of sexual activity nor increased its frequency. Additionally, the health centers had varying effects on contraceptive use, yet providing contraceptives on site was not enough to significantly increase their use: in only one of the three sites that did so, students in the health center school were significantly more likely than students in the comparison school to have used birth control during last intercourse. Although not statistically significant, on school-wide pregnancy rate, use of condom and pills increased where pregnancy prevention and STD campaigns were high priorities.

Link: Article Abstract
Objective: This report describes the state of reproductive health care in school-based health centers (SBHCs) serving adolescents in 1998–1999 and examines factors influencing prevention services, on-site access to contraception, and policies allowing independent access to health care.

Finding: Most SBHCs were able to provide services either on-site or by referral. Counseling, screening, pregnancy testing, and STD/HIV services were often provided on-site; contraceptive services were often available only by referral. While virtually all SBHCs required minor adolescents to obtain parental permission to use the health center, many SBHCs allowed adolescents to access specific services independently under state minor consent laws. Over 75% of SBHCs report prohibitions about providing contraception on-site, and these prohibitions generally reflect local decision-making, policies of the school, the school district, or the health center itself, rather than guidance by state laws.

Link: Article Abstract
Objective: This study investigated reproductive and sexual health services delivery in school-based health centers (SBHCs), and examined the source of restrictions on SBHCs providing these services through a national SBHC survey.

Finding: This study demonstrates that regardless of grade level, region, or setting, 85% of SBHCs serving teens provided at least one reproductive health service. Most centers, however, limited these services, and only 25% provided one or more contraceptive methods on-site. Fewer than 10% of SBHCs provided emergency contraceptive pills. Rural centers were less likely than urban and suburban SBHCs to offer on-site reproductive health care, particularly contraceptive services. Lastly, 75% of SBHCs reported restrictions on providing contraceptive services; the most common source being school district policy.

Link: Article Abstract
Objective: A description of the development and diffusion of school-based health services and speculation on the potential of school-based health centers (SBHCs) for preventing teenage pregnancy, decreasing student absenteeism and upgrading the quality of medical care.

Finding: The school-based programs studied revealed that when family planning services are delivered within a context of comprehensive health care, adolescents can get contraceptives without being identified as sexually active by classmates. School-based programs can enhance contraceptive continuation by frequent contact and regular follow-up. This type of health center can bypass laws that prevent school nurses from treating students for minor illnesses, and improve students' general health and attendance, especially for high-risk youth. However, multiple funding sources, unacceptable regulations and staffing present as challenges to this model.

Link: Article Abstract
Objective: This study determines whether initiation of on-site dispensing of hormonal contraceptives in six urban school-based health centers (SBHCs) reduced time to initial selection, and increased their consistent use among sexually active females.

Finding: Among females who receive more than one family planning visit at school-based health centers (SBHCs) and who choose hormonal contraceptives at least one time, on-site dispensing of hormonal contraceptives in SBHCs is associated with earlier and a longer period of selection. On-site dispensing does not, however, appear to increase the proportion of females who select hormonal contraceptives at some time during family planning care, and does not reduce the proportion of abstinent females. The results could not determine whether on-site dispensing was associated with shorter intervals from first intercourse to seeking family planning services.

Link: Article Abstract
Objective: This exploratory comparison determines whether or not receipt of hormonal contraception on-site at an inner-city school-based health center (SBHC) affects subsequent pregnancy rates among student patients.

Finding: The overall pregnancy rate for students in both health centers was 10.9% (13/119). The pregnancy rate was significantly higher at the SBHC with a referral policy compared to the SBHC with onsite services. The pregnancy rate was also significantly higher for students without a prior history of pregnancy in the school with a referral policy (21.6%) versus the school with onsite services (4.7%). A significantly higher frequency of students kept their appointments for hormonal contraception at the SBHC with a dispensing policy, as compared to the SBHC with a referral policy. The difference between the mean duration of the observation period and type of birth control used between both health centers was not statistically significant. 

Link: Article Abstract
Objective: An evaluation to refine the emergency contraception (EC) health centeral protocol and improve pregnancy prevention efforts in high school-based health centers (SBHCs) by analyzing information on EC use and subsequent contraception use of EC patients.

Finding: Condom use and hormonal methods were both reportedly problematic for this student population, and EC appears to fill a critical need for some adolescents. Students most frequently reported needing EC due to unprotected sex, condom failure, and hormonal misuse. Findings showed that students evolved over time with respect to their decision to be sexually active as well as their selection of contraceptive method. A hormonal method was eventually adopted following two thirds of the instances in which no protection or only a condom had been used. Overall, young EC seekers varied considerably in terms of sexual experience, consistency of contraception use, anxiety about pregnancy risk, and actual pregnancy risk.

Link: Article Abstract
Objective: This study evaluates the effects of the change in distribution systems on students' receipt of requested contraceptives and demand for contraceptives from school-based health centers (SBHCs) among 15-17 year-old adolescents in Minneapolis.

Finding: Under the voucher system, 41% of students received all requested contraceptives, and 59% received at least one. In contrast, 99% of students received all requested contraceptives under the direct distribution system. Under the voucher system, only 25% to 50% of students received requested condoms or oral contraceptives, compared with 100% under direct distribution. The percentage of students requesting contraceptives from an SBHC was 11% in both study periods. However, demand for hormonal methods increased slightly under direct distribution (6.1% to 7.3%). The average number of requests per student was higher under the voucher system.

Link: Article Abstract
Objective: This survey explores the attitudes toward health center quality of care, desired services, and contraceptive distribution among the parents of school-based health center (SBHC) enrollees prior to implementing a change in SBHC policy to allow dispensing of contraceptives.

Finding: Parents overwhelmingly endorsed current health center services including family planning for sexually active teens, annual physicals, and drug and alcohol counseling. Most parents rated the SBHC as excellent (25%) or very good (36%), although 27% found it difficult to rate the health centers. Parent attitudes toward contraception was context specific: 63% endorsed and almost one third opposed prescribing and dispensing. If a child was already having sex, 76% of parents supported and 14% opposed. With parental permission, 93% supported contraception and only 3% were opposed.

Link: Article Abstract
Objective: This study assesses the provision of education, referral and prescription services for emergency contraceptive pills by school-based health centers (SBHCs) located in public high schools in the United States.

Finding: From the data, 60% of high SBHCs offered education and referrals for emergency contraceptive pills, and about 30% offered prescriptions. Centers that believed students would be more likely to use the pills or cited the opportunity to discuss traditional contraceptive methods had elevated odds of offering education services. Centers citing pregnancy prevention had elevated odds of offering referrals or prescriptions. SBHCs that did not provide services for emergency contraceptive pills were either not intending to do so, or intending or preparing to do so in the next year. Most, if not all, of those preparing to do so will open in the next year. Due to specific barriers, it is uncertain if those no intending to do so ever will. 

Link: Article Abstract
Objective: This study determines whether relationships exist between the presence or absence of condom availability programs in Massachusetts high schools and adolescent sexual practices.

Finding: Sexual intercourse rates were not higher in schools where condoms were made available. Adolescents enrolled in condom availability schools were less likely to be sexually active or to report recent sexual intercourse, and no associations with age at first intercourse or numbers of sexual partners were found. Sexually active adolescents in these schools were more likely to report having used condoms during their most recent sexual encounter. Positive associations remained significant after controls for condom use instruction, suggesting that such instruction may be a necessary, but by itself insufficient, condition for condom use.

Link: Article Abstract
Objective: This report provides a review of the evidence on the effects and cost-effectiveness of school-based health centers (SBHCs) on adolescent sexual, reproductive health, and mental health.

Finding: From the 27 studies reviewed, the authors found that there is little robust scientific evidence of the effectiveness of SBHCs on sexual and reproductive or mental health outcomes. There were no known RCTs and comparison group crossover was evident. Inconsistent findings, potentially due to substantially different methodology to compare and define SBHCs, were found. The vast majority of the studies were related to access and health center utilization. It appears that girls tend to use services more than boys, and that increased mental health difficulties are associated within greater SBHC use. The most commonly cited reason for non-use was students’ perception of being healthy, already having a physician and concerns about confidentiality and parental objections. Ease of access was the most frequently mentioned reason for use.

Link: Article Abstract
Objective: This study describes sexual behaviors and past health care utilization among sexually active students in seven NC schools and student willingness to obtain information and services related to STI and pregnancy prevention in school-based health centers (SBHCs) if available.

Finding: The results suggest that many sexually experienced students would use SBHCs for reproductive health and STI services if they became available. Among 949 students, 75% had used SBHCs, 51% reported they would use SBHCs for information to protect against pregnancy and STIs, 51% for pregnancy testing, and 48% for birth control if available. Reproductive and STI services were more likely used by female than male students, and especially female students from lower socioeconomic families. Female students who inconsistently use contraception would be more likely to use services than consistent users; and past health care did not influence willingness to use reproductive/STI services in SBHCs if available.

Link: Article Abstract
Objective: This study explores adolescents' utilization of school-based health centers (SBHCs) for reproductive health services and identified variables associated with using SBHCs for reproductive health services in a national sample of students in grades 7-12.

Finding: Data indicated that SBHCs are one of adolescents' least-used venues for reproductive health services. Only one in ten adolescents indicating use of family planning (FP) and/or STD-related services in the past year received these services from an SBHC. This finding was unrelated to availability of services in SBHCs. Females were about twice as likely as males to receive FP or counseling services, although a sizable portion of males reported utilization. Residence in a partly rural area, younger age, and identifying as Asian, American Indian or Hispanic were related to increased use of SBHCs for either type of service, while identifying as African-American and not having a driver's license were each related to increased use of SBHCs for FP and counseling services.

Link: Article Abstract
Objective: This study examines whether students from Los Angeles, CA high schools, selected from areas with high rates of teen births and STDs, will differ in their receipt of reproductive health care and use of contraception depending on whether they have access to a school-based health center (SBHC).

Finding: Among female participants, access to SBHCs was associated with increased contraceptive use and STD screening, but not associated with receipt of reproductive health services for female or male students. Irrespective of access to an SBHC, more than 70% of students received some form of reproductive health care and most students used a condom the last time they had sex. Despite greater use of contraceptives among females with access to an SBHC, about 30% used neither condoms nor hormonal contraception the last time they had sex. Overall, females were more likely to receive disease and pregnancy prevention care, and females with access to SBHCs were more likely than those without access to have received such services.

Link: Article Abstract
Objective: This study determines the association between availability and quality of school health services and reproductive health outcomes among sexually active students from 96 New Zealand high schools.

Finding: Results of this study found an inverse association between the availability of school-based health services, in terms of hours of nursing and doctor time per 100 students, and the number of pregnancies among students. However, more than 10 hours of nursing and doctor time per 100 students are required before significant differences in pregnancy-related outcomes at the school level are seen. No associations between doctor visits, team-based services or health screening and reproductive health outcomes among students were revealed. Overall, the availability of school-based health services among New Zealand secondary schools is limited, with fewer than 20% of schools providing five or more hours of doctor or nursing time per 100 students per week.

Link: Article Abstract
Objective: This study examines the impact of a New York City public high school-based health center (SBHC) providing comprehensive reproductive health, by measuring students' willingness to use their SBHC for these services, receipt of reproductive health education and contraceptive counseling, and use of contraception compared to a similar NYC high school without an SBHC.

Finding: Students in the SBHC were more likely to report receipt of health care provider counseling and classroom education about reproductive health and a willingness to use an SBHC for reproductive health services. Use of hormonal contraception measured at various time points (first sex, last sex, and ever used) was greater among students in the SBHC. Most students in grades 10-12 using contraception in the SBHC reported receiving contraception through the SBHC. Comparing students in the nonintervention school to SBHC nonusers and SBHC users, we found stepwise increases in receipt of education and provider counseling, willingness to use the SBHC, and contraceptive use.

Link: Article Abstract
Objective: A report on a statewide quality improvement program that established certification standards for school-based health centers (SBHCs), verified the credentials of providers at the centers, and measured quality of care in centers across the state.

Finding: The 45 SBHCs in Colorado provided 50,000 visits to underserved youth in the 1998-1999 school year. Most patients reported that it was easy to get an appointment at the SBHCs and statewide, 93% of the youth reported that care was above average. The individual centers were provided with data about their performance on each measure, and statewide percentages were established as benchmark data, that allow SBHCs to set goals for improvement. The study identified areas of need for continuing education for providers at the SBHCs, and statewide training programs have become available to enhance skills.

Link: Article Abstract
Objective: The report provides detailed information about programming in New York City school-based health centers (SBHCs), and recommendations for future research, including program evaluations, are offered.

Finding: NYC SBHC providers reported a wide range of programming, including numerous services to students and their families. The programs are innovative and creative yet practical in addressing the core needs of the community. The descriptive and mainly qualitative, anecdotal nature of the Phase 2 information and data allows for a deeper understanding and examination of the inner workings of the SBHCs. Anecdotes provided by SBHC staff suggest that students and their families benefit from the programs described in this report. Especially noteworthy are peer education programs that allow students to share their own knowledge in a relatable manner.

Link: Article Abstract
Objective: An evaluation of the effectiveness of school-based health centers (SBHCs) in increasing access to and utilization of essential health services, promoting healthy lifestyles, and facilitating good decision-making skills in students of six New Orleans public high schools.

Finding: Results indicate that adolescents with access to SBHCs report higher rates of utilization of essential health services, particularly vital mental health services, but they are also less likely to engage in behaviors that put their health at risk, including drug use, risky sexual activity, violence, smoking, unhealthy eating habits and lack of exercise. Sensitivity testing using Rosenbaum bounds confirms that the results are relatively insensitive to selection bias arising from unobservable school- or student-level confounders.

Link: Article Abstract
Objective: An overview of the role of federal, state, and local governmental agencies in the development and implementation of public education policy and funding in an effort to provide school-based health centers (SBHCs) the foundation for building a bridge between the health and education lexicon.

Finding: Though SBHCs and schools are both committed to enhancing the lives of children, these institutions speak different languages and are accountable to very different types of public and private bodies. Strategic reasoning between supporters of SBHCs and education policy makers is critical because of the limitations of time and money for those delivering educational services. Additional projects (e.g., SBHCs), no matter how well conceived, will be difficult to promote unless officials can be convinced that collaboration in school-based health care actually enhances compliance with the No Child Left Behind Act.

Link: Article Abstract
Objective: This study explores the current status of the role of state school-based health center (SBHC) initiatives, their evolution over the last two decades, and their expected impact on SBHCs' long-term sustainability.

Finding: Although state initiatives are not necessary for SBHCs to flourish, they reinforce a standard of care and quality assurance, impact legitimacy with public and private insurers, seed interest in new programs, and reduce the burden of sustainability for local programs. As of 2005, 19 states had funding initiatives that included responsibilities for monitoring, oversight, and technical assistance, with the majority of these initiatives supporting a significant proportion of the total number of SBHCs in their state. In four years, the number of SBHCs in states with initiatives increased by 26% compared with 9% in state without; and survey respondents were as likely to identify advocacy within the state group, as advocacy by grassroots.

Link: Article Abstract
Objective: This review examines the nature of the linkages between school-linked health centers (SLHCs) and schools; the centers’ services, staffing, financing, and other operational details; and the advantages of this model of care.

Finding: Although each SLHC has a unique program design, the study identified characteristics common to all sites. In general, SLHCs provide comprehensive medical, reproductive health, mental health, and health education services designed for adolescents. Staffed with a minimum of an administrator, a primary care provider, a nurse, and an administrative assistant, SLHCs serve students from more than one school as well as out-of-school youth. SLHCs develop formal and/or informal linkages with schools to improve outreach and follow-up services.

Link: Article Abstract
Objective: This policy provides an overview of school-based health centers (SBHCs), addresses the issue of potential conflict with the medical home, and provides recommendations that support the integration and coordination of SBHCs and the pediatric medical home practice.

Finding: Overall, SBHCs can meet the definition of the medical home for their patients by (1) ensuring linkage so that services are available 24 hours per day, seven days a week, and 52 weeks per year, even when schools are closed; (2) encouraging parental participation and education about the health care needs of youth; (3) working collaboratively with primary care practices, school districts, and community agencies; and (4) coordinating all specialty and subspecialty consultations, referrals, and collaborations. It is recommended that coordination of care is facilitated, access to SBHC services is supported and school health advisory counsels are developed to plan and monitor services.

Link: Article Abstract
Objective: This article illustrates how the definition of a patient-centered medical home (PCMH), as represented by the NCQA survey tool, is not a good fit for describing how school-based health centers (SBHCs) can function as PCMHs; and provides policy recommendations to better recognize the attributes of SBHCs as PCMHs.

Finding: The majority of SBHCs do not fit the NCQA representation of a PCMH. For the large majority, the NCQA survey tool in its current form will be unable to acknowledge how the SBHC model of care, with its ability to increase access to quality affordable primary and preventive care, serves as a medical home for many children and adolescents. Challenges include the NCQA’s definitions of enhanced access, culturally effective care, and quality improvement; and use of hours of operation and health IT to heavily weight the final PCMH score. Most SBHCs, for example, work with limited or minimal budgets and the hours of operation and heath IT are not an investment priority for SBHC budgets.

Link: Article Abstract
Objective: This consensus report describes the position of the National Association of School Nurses (NASN) on the role of school nurses and school-based health centers (SBHCs).

Finding: NASN holds the position that a combination of school nursing services and SBHCs can facilitate positive health outcomes for students. SBHC services complement the work of school nurses, who are responsible for the entire population of students by providing a referral site for students without another medical home. SBHCs provide comprehensive services to students enrolled in the program. The two should integrate to provide a continuum of care. The relationship should be complementary and not competitive.

Link: Article Abstract
Objective: This paper presents Wholistic Evaluation Guidelines for school-based health centers (SBHCs) coordinated and/or staffed by nurse practitioners.

Finding: To effectively address student health needs, a wholistic approach is required. This paper presents guidelines for evaluating SBHC services from a wholistic vantage point. The Shuler Nurse Practitioner Practice Model was used as the theoretical basis for the guidelines because it presents a wholistics approach to patient assessment, problem identification/diagnosis determination, treatment, and evaluation.

Link: Article Abstract
Objective: A discussion of the current rapid expansion of managed care in the United States and the opportunities and dilemmas for improving adolescent health.

Finding: A unique collaborative relationship between HealthPartners, a managed care organization in Minneapolis, Minnesota, and Health Start, a nonprofit organization based in St. Paul, Minnesota, that manages the eight school-based health centers in the St. Paul Public Schools.

Link: Article Abstract
Objective: This review presents the history and growth of school-based health centers (SBHCs), and the literature demonstrating their impacts to better understand how this model of care has and could further help promote the health of our nation's youth.

Finding: This discussion recognizes that it may not be feasible for SBHCs to be established in every school campus in the country. However, the author acknowledges lessons learned from the synergy of the health and school settings have major implications for the delivery of care for all providers concerned with improving the health and well-being of children and adolescents.

Link: Article Abstract
Objective: An exploration of the disconnect between the evidence and the discourse on school-based health centers (SBHCs) through the evaluation of SBHCs in Newark, New Jersey, and a critical assessment of the evaluative literature and public discourse on school health centers to argue that a number of important issues are being overlooked by both research and advocacy.

Finding: A growing body of research, including this survey in Newark, New Jersey, suggests that SBHCs can help with the persistent unmet health needs of American schoolchildren. However, in the rush to embrace this new option, variations in the health needs of communities are often overlooked, as is the question of whether and how SBHCs can best meet these needs. Despite the cautions of experts that third-party reimbursement cannot cover health center expenses and is difficult to obtain, pursuit of reimbursement continues to dominate the thinking of some SBHC sponsors and stakeholders, helping to promote a health center model that in some communities is very likely not to be the best way to address student needs or to build on health center strengths.

Link: Article Abstract
Objective: This statement presents some of the major themes of health care reform with an analysis of school health providers' current and potential future role in meeting health care reform goals.

Finding: In addressing the major issues confronting health care in this country, it is important to remember that school-based health providers have and will always be part of the solution. They provide an effective way to improve access to care and to provide quality and continuity of care, particularly for underserved children. By caring for a diverse population of students, they are 1) more attuned to unique cultural or ethnic differences that influence the health status and outcomes, and 2) can address health care disparities. School providers promote a number of prevention strategies and strengthen public health; and although lower costs are associated, a balance between fair pay for school providers that is commensurate with that of community providers, and the necessity of reducing overall health care costs needs to be addressed.

Link: Article Abstract
Objective: This statement describes four innovative Californian school-based health center (SBHC) programs focusing on obesity prevention, asthma, mental health, and oral health that represent new models of health care for children and adolescents.

Finding: SBHCs provide a place-based form of health care and create unique opportunities to integrate care with primary, secondary, and tertiary prevention. From the Healthy Hearts program, 60% of the students who participated for the entire 2004 to 2005 school year lowered their BMI score, with a mean reduction of 0.9 points. The Oakland Kicks Asthma program found that participating students had fewer activity limitations and emergency room visits than they did before the program began. Through an innovative extension of health centeral mental health services, the James Morehouse Project created a campuswide dialogue about race that contributed to an improved school environment. The Health Linkages program worked with schools and preschools to deliver oral health education, and provided over 5,000 children with fluoride varnish.

Link: Article Abstract
Objective: This statement offers guidelines on the integration of expanded school health services, including school-based and school-linked health centers, into community-based health care systems.

Finding: Schools can successfully expand access to health care services for all students, particularly underserved populations, when the program includes careful community assessment and endorsement, is integrated with the school's existing health program, has a sound plan for financial sustainability, and pays adequate attention to quality assurance, evaluation, promotion, and integration with a medical home. School health services can be an effective vehicle for integrating psychosocial care and education with medical care. Pediatricians should become actively involved in any community effort to develop an integrated school health services initiative.

Link: Article Abstract
Objective: The purpose of this review was to assist policymakers, program managers, school-based health center (SBHC) health centerians, and researchers in assessing the ability of SBHCs to meet the primary care needs of adolescents.

Finding: Primary health care facilities are rarely able to serve the diverse health care needs of adolescents independently. Therefore, the success of SBHCs will rely ultimately on their ability to establish a unique and sustainable niche within the larger health care delivery system. Successful SBHCs require a stable mix of support from both public and private sources. It is particularly important that policymakers facilitate productive relationships between SBHCs and the financiers of health care.

Link: Article Abstract
Objective: This review discusses how school-based health centers (SBHCs) can capitalize on their strategic position to reach adolescents, respond to their health needs, and reduce barriers to care; and how SBHCs can effectively integrate themselves into a rapidly evolving United States health care delivery system.

Finding: To be competitive in the new era of managed care, SBHCs will have to further prove their cost-effectiveness. It will be critical that investment in preventive care for young people is not overlooked as an investment that will pay dividends in reduced expenditures for social and health needs in the future. Enabling SBHCs to provide services in coordination with managed care systems would go far toward ensuring access to care for adolescents while also addressing health needs unique to this population. Coordinated services would preserve the multiple points of entry into the health care system that are so critical to access and the appropriate use of services, as well as resolving the central issue of confidentiality and privacy.

Link: Article Abstract
Objective: An examination of the current experience of school-based health centers (SBHCs) in meeting the needs of children and adolescents, changes over time in services provided and program sponsorship, and program adaptations to the changing medical marketplace.

Finding: The number of SBHCs in the United States has increased 10-fold, from 120 in 1988 to nearly 1200 in 1998. No longer primarily in urban high schools, health centers now operate in diverse areas in 45 states, serving students in every grade. An estimated 1.1 million students have been reached, although that only accounts for 2% of children enrolled in U.S. schools. Despite the fact that SBHCs have highly variable sponsorship, services, staffing, and geographic locations, and target some of the most challenging health behaviors, it is unlikely that SBHCs will fill the service gap for millions of uninsured and underinsured children and adolescents.

Link: Article Abstract
Objective: To examine the role of school-based health centers (SBHCs) on changes in student health-related quality of life (HRQOL) over a 3-year period among elementary and middle school students in Kentucky and Ohio.

Finding: This study demonstrates the positive effects that SBHCs have on the health and HRQOL of elementary and middle school students. Adjusting for school- and individual-level covariates, there was a significant improvement in student-reported HRQOL over the three years for the SBHC user group compared with the comparison school group. Other significant predictors of student-reported HRQOL included student age, gender, health insurance, and household income. There were no differences across groups by using parent proxy reports of HRQOL.

Link: Article Abstract
Objective: This study documents the development of an initiative undertaken by the Columbia University School of Public Health to provide medical, mental health, and social services in inner city junior high school-based health centers (SBHCs).

Finding: Four health centers were implemented in the Washington Heights area of New York City, the first school-based health centers located in junior high schools in the country. After seven years, the program had the capacity to serve over 4,000 students who presented an overwhelming array of physical, psychological, social, and family problems. Almost 23,000 visits were made to the health centers in 1994: 49% for medical services, 38% for social services, and 13% for health education. A form of triage was implemented to track the highest risk students into intensive individual and group interventions using primary health screening, mental health services, and pregnancy prevention services.

Link: Article Abstract
Objective: An analysis of the impact of school-based health centers (SBHCs) (including SBHC type: comparison, implementation, established; and individual-level effect of user status) on a range of health and health behavior outcomes among middle and high school students in Michigan over a two year period.

Finding: The results found no school-level effects of SBHC type on student health outcomes. There were no significant differences in health outcomes among students who attended schools with no SBHCs, newly implemented SBHCs, or established SBHCs. SBHC use was associated with an improved subjective sense of overall health. Although SBHC users in general did not experience significantly fewer physical symptoms compared with nonusers, female SBHC users experienced significantly fewer symptoms of physical discomfort at time 2 than did female nonusers. Health center users reported engaging in more physical activity and eating more healthy food at time 2 than did nonusers.

Link: Article Abstract
Objective: This article discusses an obesity prevention and management program that was designed and implemented by the staff of a school-based health center (SBHC) in Louisiana.

Finding: The results of the obesity prevention and management program described in this article suggest that SBHC services, offered free of charge, make weight management more accessible. SBHCs have a unique opportunity to ensure that schools stay in the forefront of obesity prevention and management.

Link: Article Abstract
Objective: This study evaluates whether a health educator (HE) providing additional contact time with students and helping them set personal goals to improve lifestyle would lead to improved BMI outcomes in overweight or obese adolescents from two school-based health centers (SBHCs) located in a high school and a high school/middle school in Colorado.

Finding: Results found that, in an SBHC setting, this intervention was successful with recruitment and retention. Nearly 100% of students in both groups received recommended preventive services, compared with 40% of participants at baseline. The intervention reached a subset of students with high morbidity, including severe obesity in 20% of participants. However, the addition of an HE did not lead to improved BMI outcomes in the intervention group. Mental health issues were present in 14% of the entire cohort, with no difference between the IG and CG in prevalence of mental health concerns, although additional unidentified factors, including sports participation, may have contributed to improved BMI outcomes in the control group.

Link: Article Abstract
Objective: This study examines whether a quality improvement initiative aimed at medical providers in school-based health centers (SBHCs) would improve the recognition and management of pediatric obesity in 13 SBHCs in New Mexico.

Finding: The results indicate that QI training offered to providers in SBHCs was effective in changing provider behaviors in treating pediatric overweight. Documentation of BMI percentile, a corresponding weight-category diagnosis, assessing readiness to change, and key messages did not occur before the trainings. From baseline to midpoint, each of these 5 variables had a statistically significant increase after the trainings were offered. Two variables, however, had significant decreases from the midpoint to final data collection: documentation of weight-category diagnosis and documentation of readiness to change for patients with a BMI at ?85th percentile. The other three variables did not have significant changes from the midpoint to end.

Link: Article Abstract
Objective: This study aimed to create an effective weight management intervention to address the growing prevalence of adolescent metabolic syndrome.

Finding: The Community Advisory Council (CAC) and university-based research team reached consensus on the final content of nutrition and physical activity topics to produce a DVD and health centerian toolkit through six monthly sessions. These materials used in the school-based health center (SBHC) intervention resulted in a greater reduction of body mass index when compared to adolescents receiving standard care.

Link: Article Abstract
Objective: The goal of this project was to incorporate the practice of calculating BMI and obtaining blood pressure for all students who seek medical care at school-based health centers (SBHCs) in Delaware to identify, treat and refer overweight and obese student as well as those with hypertension and prehypertension.

Finding: Of the 1548 students assessed, 16% were overweight, 15% were obese, 4% were in the prehypertensive range and 1% were in the hypertensive range. Approximately 44% required follow-up services, 40% were recommended for nutritional counseling, and PCP referrals were made for 16%. The initiative resulted in a 120% increase in the number of referrals to the center's registered dietitians compared to the prior year. A few critical lessons emerged: (1) health centerians were not comfortable using the word 'obese' with students and parents; and (2) the initial algorithms did not address how to handle students with BMIs classified as low body weight. The algorithm was modified and those students were referred the centers’ registered dietitians and/or PCPs.

Link: Article Abstract
Objective: This study explores the feasibility of Adolescents Committed to Improvement of Nutrition and Physical Activity (ACTION), a school-based health center (SBHC) weight management intervention for overweight, and obese students among two urban high school SBHCs in New Mexico.

Finding: The ACTION SBHC weight management program was feasible and demonstrated improved outcomes in BMI percentile and waist circumference. Of 60 students enrolled, 51 completed pre- and post-measures. ACTION students (n = 28) had improvements in BMI percentile and waist circumference as compared with students receiving standard care (n = 23). No differences were found between the two groups in blood pressure, HOMA-IR, triglycerides, and HDL-C.

Link: Article Abstract
Objective: This descriptive study evaluates obesity care assessment practices of school-based health center (SBHC) providers prior to completing training on obesity guidelines from SBHCs in six states (AZ, CO, NM, MI, NY, and NC).

Finding: Most providers reported using body mass index percentile (93.9%) to assess weight. In caring for overweight/obese children, providers reported screening for hypertension 100% of the time and cardiovascular disease 93.9% of the time, and approximately two thirds reported requesting total cholesterol and lipid profile laboratory assessments. Some assessment guidelines were not routinely followed. SBHCs serve a high-risk population, and providers in this study may benefit from additional training on assessment guidelines and quality improvement processes to improve adherence to current guidelines.

Link: Article Abstract
Objective: This study assesses medication fill, initiation, and adherence rates among adolescents aged 10 years or older in a school-based health center (SBHC) in Chicago, Illinois to identify major barriers to medication compliance.

Finding: This study found that approximately half of all participating students who received a prescription at an SBHC did not get the prescription filled. The prescription fill rate was 55%. Reasons for not getting a prescription filled include loss of the prescription (29%), inability to get to a drug store (29%), forgetting to go to the drug store (19%), feeling that the medication was not needed (16%), and inability to pay for the medication (7%). Among students who filled their prescriptions, 76% reported that they always took their medication at the appropriate time, 22% reported that they sometimes forgot to take their medication and 2% reported that they never took their medication. However, almost 90% reported that it is very important to take medications exactly as their doctors instructed.

Link: Article Abstract
Objective: An assessment of the immunization rates achieved with recall among 6th grade girls (in a demonstration study); the effectiveness of recall among 6th grade boys (in an RCT); and the cost of conducting recall in school-based health centers (SBHCs).

Finding: At the end of the demonstration study, 77% of girls had received ? 1 vaccine and 45% had received all needed adolescent vaccines. Rates of receipt among those needing each of the vaccines were 68% for tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine, 57% for quadrivalent meningococcal conjugate vaccine, and 59% for the first HPV. At the end of the RCT, 66% of recalled boys had received ? 1 vaccine and 59% had received all study vaccines, compared with 45% and 36%, respectively, of the control group. Cost of conducting recall ranged from $1.12 to $6.87 per recalled child immunized.

Link: Article Abstract
Objective: This investigation assesses, in a national random sample of school-based health centers (SBHCs), current immunization practices (including vaccines offered, methods for improving immunization rates, mechanisms for vaccine financing, and perceived barriers to adolescent vaccination), and examines the reported experiences of SBHCs regarding HPV vaccination.

Finding: SBHCs appear to be fully engaged in vaccine delivery to adolescents, with 84% of SBHCs offering vaccines to adolescents, and most SBHCs offering a wide array of vaccines including influenza and HPV vaccines. Most SBHCs reported using recommended, but often underused, strategies to improve immunization delivery, such as assessing health center immunization rates, conducting reminder/recall activities, and participating in immunization information systems. Surveyed SBHCs were concentrated in schools with high proportions of socioeconomically disadvantaged adolescents, who may be at particular risk for missing needed immunizations. However, the role that SBHCs currently play in vaccinating privately insured students may be more limited, given identified challenges with billing private insurance for vaccination.

Link: Article Abstract
Objective: A process evaluation of an intervention to increase school-based health center-located vaccination to better understand the feasibility and challenges of such interventions among school-based health centers (SBHCs) in four traditional high schools in one district in central North Carolina.

Finding: This low-resource intervention successfully obtained consent for at least one vaccine from 10% of parents whose children were enrolled in an SBHC. Parents indicated the intervention materials were clear and persuasive and provided reminders about adolescent vaccination and information about the SBHC vaccination program. Most parents who consented opted to provide global consent, using the “all recommended vaccine” checkbox, rather than identifying specific vaccines. However, this study identified two topics that require more explanation in vaccination program material: vaccination costs and male HPV vaccination. 

Link: Article Abstract
Objective: A comparison of completion rates for adolescent immunization series administered at SBHCs to completion rates for series administered at CHCs within a single integrated delivery system among patients aged 12-18 years in Denver, Colorado.

Finding: In this analysis SBHCs were found to be superior to CHCs as a setting for completion of adolescent immunization series, even after adjusting for significant demographic differences. Children and adolescents seen in SBHCs were more likely to be up to date for hepatitis B, Tdap, varicella, measles/mumps/ rubella, HPV for patients aged 16 to 18 years, and the HPV/Tdap/MCV4 immunization series for female patients aged 16 to18 years. SBHC users were more likely to complete series that required multiple doses (hepatitis B, Tdap, varicella, and HPV), with the exception of hepatitis A. CHC users were more likely to be up to date for tetanus/diphtheria vaccinations. There were no differences by site of care for hepatitis A or MCV4 vaccinations.

Link: Article Abstract
Objective: An examination of whether improvements in pediatric health-related quality of life (HRQOL) stemming from use of school-based health centers (SBHCs) resulted in lower Medicaid costs among SBHCs in two school districts in the Greater Cincinnati, Ohio area during their first three years of operation.

Finding: The analysis indicated that the relationship between changes in HRQOL and changes in Medicaid costs was independent of SBHC status. The total sample yielded statistically significant reductions in the amount of $36.39 for every 1-point increase in total HRQOL. The reductions in Medicaid costs for physical ($35.36) and psychosocial ($25.96) HRQOL were also significant. We found significant Medicaid cost reductions for every 1-point increase in student-reported total ($8.94) and psychosocial ($7.79) HRQOL. A 1-point increase in student-reported physical health was associated with a nonsignificant decrease in Medicaid costs of $6.12.

Link: Article Abstract
Objective: This study measures the impact of school-based health centers (SBHCs) on addressing health care disparities among students in schools with SBHCs and without SBHCs among school-aged students enrolled in schools in the Greater Cincinnati, Ohio, area between 1997 and 2003. A cost-benefit analysis was also conducted.

Finding: The findings show that SBHCs have a significant ability to reduce health care access disparities among African-Americans and disabled students because these groups received more primary care since SBHCs were opened in September 2000. Because Medicaid was the primary payer of services to children and adolescents, we also looked at the cost benefits to Ohio Medicaid. Increased Medicaid costs of $1,179,264 (increased dental care of $121,344 plus increased mental health services of $1,057,920) were offset by the total savings of $1,713,228 (savings of $1,395,456 from prescription drugs and savings of $317,772 from hospitalization for students with asthma). Net 3-year Medicaid savings were $533,964 which equals roughly $35.20 savings per child/year.

Link: Article Abstract
Objective: This analysis evaluates and compares the Medicaid health care costs per child for those children whose primary caregiver is the Whitefoord Elementary school-based health center (SBHC) located in Atlanta, Georgia to children in an area without an SBHC between 1994 and 1996.

Finding: The placement and operation of the WESBHC in the Whitefoord Elementary community enhanced the downward trend in total Medicaid expenses taking place for children in these inner-city Atlanta communities over the 1994–1995 period. A major effect of the health center was the reduction in the probability that children use the emergency department, and hence, emergency room expenses. Another important effect of the health center was an increase in Early and Periodic Screening, Diagnostic and Treatment (EPSDT) expenses per child. It seems that the WESBHC, by increasing access, had the expected effect on increased primary care.

Link: Article Abstract
Objective: This report provides a description of the models, reasons for selection, and sustainability of the school-based health centers (SBHCs) in New York City that provide a dental component, sponsored by the Children's Aid Society and Columbia University.

Finding: In summary, it is important that SBHCs are complemented by dedicated program directors who collaborate with parents, community-members, school administrators, principals, district supervisors, and other healthcare providers to ensure program longevity. These relationships ensure successful implementation of paradigms and are key to program success in obtaining valid patient-parental consents and permission to bring children to the dental health center. Staff commitment to program goals is also essential to program success.

Link: Article Abstract
Objective: The purpose of this study was to conduct a thorough cost analysis of the Miles of Smiles program (a program to improve the access to oral health care) for low-income elementary school students from Olathe School District in Kansas during the 2008-2009 school term.

Finding: Although this study supports the contribution that the program has made in improving access to care for vulnerable populations, it also highlights the financial challenges in long-term sustainability of such a program. A total of $17,104 could have been reimbursed for services provided to Medicaid eligible children, however, only $1,618 was billed and collected due to data collection and tracking challenges. Even so, the entire amount represented approximately 67% of the total production and approximately 16% of the overall costs of operating the program. The potential amounts of reimbursement suggest that the program does not generate enough revenue to sustain itself without external funding. Additionally, services were provided during only 22% of the time that school was in session. It is possible that if the program were operating at a higher capacity, more reimbursement could be generated to help offset the expenditures.

Link: Article Abstract
Objective: This study evaluates the effects of child dental health on school performance and psychosocial well-being in a large, nationally representative US sample of children aged 6-17 years.

Finding: We found that poorer child dental health is significantly associated with reduced school performance and psychosocial well-being, and that larger associations between dental problems and psychosocial outcomes for adolescents exist. Children with dental problems are more likely to have problems at school, and are less likely to do all required homework. On average, children with a dental problem miss almost one school day per year more than other children. Similarly, very good/excellent dental health is associated with less shyness and more friendliness. In contrast, poor/fair dental health is associated with more shyness and feeling worthless/inferior and unhappy/sad/depressed.

Link: Article Abstract
Objective: This analysis sought to determine the association between academic performance and untreated caries controlling for other school-level health and demographic characteristics, including presence of a school-based dental sealant program (SBSP), among Ohio's third-grade children.

Finding: This research supports previous findings that health indicators are significant predictors of academic achievement and school performance. The prevalence of untreated caries was found to be significantly inversely associated with school performance, but only in schools without SBSPs after controlling for school-level characteristics (income, race, geography, and size). Controlling for school-level characteristics in schools with school-based health centers (SBHCs) eliminated any significant association between untreated caries and school performance. Additionally, further analysis of the state-funded SBSPs indicates a 15 percent reduction in the number of students who needed dental care between the treatment year and the follow-up year.

Link: Article Abstract
Objective: This study compares the demographic and mental health characteristics of school-based health center (SBHC) users and nonusers in a New York SBHC, and determines whether more-frequent SBHC users differ from less-frequent users and if patients are satisfied with services.

Finding: The results indicate that the average users, frequent users, and nonusers in this urban high school did not differ by any of the measured mental health problems. The health center was used for mental health services by 34% and sexuality-related care by 15%. Among survey respondents, 92% were satisfied with health center services, 79% were comfortable being seen in the SBHC, 74% believed visits were kept confidential, 61% told their parents about each visit, and 51% considered the SBHC their regular health care source. The two most frequently reported reason for not using the SBHC was that they already had a physician (60%) and did not need it (50%),

Link: Article Abstract
Objective: This study compares mental health risk profile and health utilization behaviors of adolescent school-based health center (SBHC) users and nonusers and discusses the role that SBHCs can play in addressing adolescent health needs among 9th and 11th graders from four high schools in Alameda County, California.

Finding: This study found that students who had considered suicide, had the most frequent trouble sleeping, and experienced frequent sadness or depression were at an increased likelihood of enrolling in their school's SBHC, particularly for mental health services. There was no relationship between SBHC use and students' reports of receiving the medical care they needed in the past year, although SBHC users were more likely than nonusers to have obtained mental health care and to rely on a varied system of health care resources. The availability of an SBHC on the school campus did not substitute for an adolescent's primary source of health care. Finally, neither insurance status nor a student's “usual” source of health care was predictive of general SBHC use. However, being on public assistance or having no insurance was predictive of a student seeking SBHC mental health services.

Link: Article Abstract
Objective: An exploration of the impact of school-based health centers (SBHCs) on the substance use behaviors of low-income African-American adolescents in grades 9-11 from seven inner-city public schools with and without SBHCs.

Finding: The results show that SBHC exposure was associated with decreased rates of cigarette and marijuana use, but not for alcohol consumption. Although not statistically significant, students in schools with SBHCs smoked fewer cigarettes than students in non-SBHC schools among 9th and 11th graders. Students in SBHC schools smoked marijuana on more occasions than students in non-SBHC school. Among 11th graders, marijuana use was significantly and nearly 3 times less among SBHC students than non-SBHC students. These findings point to a very promising intervention approach for the prevention and amelioration of substance abuse among low-income African-American adolescents.

Link: Article Abstract
Objective: This study estimates the prevalence of cyber dating abuse among youth aged 14-19 years seeking care at school-based health centers and associations with other forms of adolescent relationship abuse (ARA), sexual violence, and reproductive and sexual health indicators.

Finding: The overall prevalence of cyber dating abuse was 41%, suggesting that cyber dating abuse appears to be more common among youth seeking care in confidential health settings compared with the general adolescent population. Female participants were more likely to report cyber dating abuse than males. Exposed females were 2 to 4 times more likely not to use any form of contraception and 3 to 6 times more likely to have experienced recent reproductive coercion, compared with unexposed females. Compared with no exposure, low- (“a few times”) and high-frequency (“once or twice a month” or more) cyber dating abuse were significantly associated with physical or sexual ARA and nonpartner sexual assault.

Link: Article Abstract
Objective: This study tests the effectiveness of a brief relationship abuse education and counseling intervention in among students aged 14-19 years in 11 school-based health centers (SBHCs) in Northern California.

Finding: Changes in prespecified outcomes of adolescent relationship abuse (ARA) knowledge and attitudes for the entire sample were not significant. Exposure to the SHARP intervention was associated with improvements in recognition of sexual coercion, and among youth recently experiencing ARA, improvements in recognition of ARA and knowledge of ARA resources. Disclosure to SBHC providers about unhealthy relationships was greater among participants in the intervention health centers. Although the intervention did not have significant effects on use of harm reduction strategies, relative reductions in overall ARA, as well as cyber dating abuse and physical/sexual violence victimization were promising.

Link: Article Abstract
Objective: This study evaluated the impact of school-based health centers (SBHCs) on mental health care services and psychosocial health-related quality of life (HRQOL) in four SBHC interventions and two matched non-SBHC school districts from 1997 to 2003.

Finding: This study found that SBHCs did appear to have an influence based on student self-rated physical HRQOL and parent-rated pediatric psychosocial HRQOL. In fact, the increases in student self-rated psychosocial HRQOL among the SBHC users over time was far above the "minimal health central effect of four points" HRQOL score change. In the full sample, authors found a significant SBHC group by time interaction indicating an improvement across all dimensions of student-reported HRQOL, over time among SBHC users compared with the comparison school students.

Link: Article Abstract
Objective: This study evaluates the utility of the Pediatric Symptom Checklist when completed by youth (PSC-Y) among adolescents seen at a school-based health center (SBHC), and the extent to which identification of psychosocial dysfunction and referral to mental health services improved academic functioning.

Finding: In this study, 14% of the sample scored above the PSC-Y cutoff. Adolescents identified with psychosocial dysfunction on the PSC-Y were significantly more likely to be female and to have higher rates of teenage parenthood. PSC-Y adolescents had significantly lower academic functioning and higher rates of absences and tardiness. Two months after the screen and referral, PSC-Y adolescents significantly decreased their absences by almost 50% and tardies by 25%.

Link: Article Abstract
Objective: An exploration of the perceptions of mental health needs of 18 inner-city teens between 12-18 years of age with diagnosed behavioral or mental health issues from a school-based health center (SBHC) in Chicago.

Finding: Results revealed concern for their personal and family relationships, education and vocational goals, health maintenance, and financial independence. Most pressing resource needs related to their ability to receive health maintenance and coping skills and to adapt to complex life challenges they faced in their urban neighborhood. Participants remarked that if the health center did not identify their needs for mental health care, they would most likely have not received services.

Link: Article Abstract
Objective: This pilot study assessed the treatment outcome of mental health services for high school students enrolled in a school-based health center in Baltimore.

Finding: In this pilot study, preliminary support for the treatment effectiveness of school-based mental health services for inner-city teenagers was provided. Compared to students who received no mental health services during the 1992-93 academic year (n = 34), treated students (n = 39) showed significant declines in depression, and improvements in self-concept from pre to post intervention. Scrutiny of means for the two groups indicates that nontreated students actually showed increases in depression at post assessment (see Table 1). In addition, the treatment group evidenced nonsignificant declines in anxiety and anger following participation in therapy.

Link: Article Abstract
Objective: This article provides a review of the issues and opportunities that school-based health centers (SBHCs) offer for the counseling or school mental health profession, followed by a discussion of the implications for counseling practice and counselor education.

Finding: Integrating mental health services with primary health care services enhances the identification and treatment of both physical and emotional problems. The increased availability of mental health services in schools reduces the stigma of seeking mental health care and increases accessibility of that care. As a whole, however, the counseling profession has had low visibility in organized efforts to provide school-based health services.

Link: Article Abstract
Objective: This article provides a review of the first comprehensive school-based mental health center in Texas established in 1969 by the Dallas Public School District, and offers recommendations into school-based physical health and mental health services.

Finding: In the initial stages of program development, program administrators can identify specific needs and develop appropriate local responses while fostering community buy-in. Coordinated programs at the system level have the advantage of potentially much greater resources to draw on. The current iteration of national health care financing reform presents a major challenge to collaborative school-based services. In the future, some SBHCs will continue to provide integrated services supported by local community organizations, others will become independent managed care network providers supported by local foundations. Regardless of form, SBHCs and mental programs will need to forge clearer links.

Link: Article Abstract
Objective: This article informs the reader of recommended policies and to make the policy process more accessible to researchers whose expertise on childhood asthma can become a catalyst for policy change.

Finding: Policy change at the state and school district levels can target a variety of problems, including addressing inadequate access to medication, documentation of need, use of asthma management plans, health services capacity in schools, and lack of awareness and understanding among parents, school staff, and students, as well as poor indoor and outdoor air quality. School-based health services to improve asthma management need to be accompanied by public policies that can help to sustain services, create greater equity across schools, and improve outcomes for children. Asthma experts can advance policy solutions by engaging in multiple stages of the policy process, not the least of which is engaging in research that can help in estimating which policy solutions are the best fit for a given jurisdiction.

Link: Article Abstract
Objective: This study measured asthma outcomes after initiation of an inner-city elementary school-based health center (SBHC) with a schoolwide focus on asthma detection and treatment serving children in preschool through eighth grade in Minneapolis, Minnesota.

Finding: This schoolwide intervention that included identification of children with asthma, education, family support, and health centeral care using an elementary school-based health center was effective in improving asthma outcomes for children. Hospitalization rates for asthma decreased over the study period. Outpatient visits for care in the absence of asthma symptoms doubled and the percentage of students seeing a specialist for asthma increased. While no change occurred in school absenteeism, parents reported that their children had less awakening with asthma and that asthma was less disruptive to family plans.

Link: Article Abstract
Objective: A summary of the key themes from three articles on school-centered asthma programs, a discussion of how to apply the framework of implementation research, and a provision of recommendations for future work.

Finding: The themes from the three articles include the importance of trust and building strong partnerships, the importance of interaction and communication between multiple key stakeholders (ecological framework), the central and often overlooked role of the primary care health centerian, the need for sustainable resources, and the importance of context and public policy. To create a framework for school interventions, implementation research suggests building trust, engaging primary care health centerians, developing the role of asthma specialists, creating a partnership team, and ensuring sustainable resources.

Link: Article Abstract
Objective: To test the efficacy of Asthma Self-Management for Adolescents (ASMA), a school-based intervention for adolescents and medical providers among Latino/a and African American high school students in the 9th and 10th grade.

Finding: Relative to control subjects, ASMA students reported significantly more confidence to manage their asthma; taking more steps to prevent symptoms; greater use of controller medication and written treatment plans; fewer night awakenings, days with activity limitation, and school absences due to asthma; improved QOL; and fewer acute care visits, emergency department visits, and hospitalizations. In contrast, steps to manage asthma episodes, daytime symptom frequency, and school-reported absences did not differentiate the two groups. Most results were sustained over the 12 months. ASMA is efficacious in improving asthma self management and reducing asthma morbidity and urgent health care use in low-income urban minority adolescents.

Link: Article Abstract
Objective: A pilot study to describe and test the feasibility of asthma self-management for adolescents with undiagnosed asthma (ASMA-Undx), an 8-week school-based intervention for 30 urban adolescents in 9-11 grade.                   

Finding: All intervention students participated in the three group sessions; 64% received all five individual coaching sessions. Academic detailing telephone calls made by a pediatric pulmonologist reached 83% of the students' PCPs. Relative to controls, a significantly greater proportion of ASMA-Undx students were diagnosed (79% versus 6%, respectively), and prescribed asthma medication (57% versus 6%, respectively). Barriers to diagnosis and treatment included students' and parents' lack of knowledge about asthma.

Link: Article Abstract
Objective: This study determines if asthma morbidity (specifically, ED use, community provider use, and hospitalizations for asthma) could be reduced by incorporating an aggressive intervention at two schools with school-based health center (SBHCs).

Finding: Children in the two intervention SBHC schools were less likely to have visited a community provider for asthma in the prior six months compared to children attending control schools. There was no difference in community provider use or emergency department use for asthma between children attending nonintervention SBHCs and control schools. School type did not affect asthma hospitalization rates, which declined in all groups.

Link: Article Abstract
Objective: This study assessed the impact of school-based health centers (SBHCs) on risk of hospitalization and ED visits and to estimate the impact on costs for hospitalization and ED visits for children with asthma among children in K-8 grade in Cincinnati, Ohio.

Finding: After the SBHCs opened, the relative risk of hospitalization decreased 2.4-fold and the risk of ED visits decreased 34% for students with asthma. Because a significant interaction effect for the cost of hospitalization before and after the SBHCs opened was found, the potential cost-savings for hospitalization was estimated as $970 per child with asthma. The pattern of hospitalization, including hospitalizations for asthma, mental health disorders, sinusitis, bronchitis, and pneumonia, decreased for children in the intervention group after the SBHCs opened. No such pattern was found in the non-SBHC comparison group. In addition, the results indicate that children enrolled in Medicaid MCOs or in CHIP also had lower risks of ED visits than children enrolled in other programs, such as a Medicaid blind or disabled program.

Link: Article Abstract
Objective: An examination of the cost-benefit of SBHC programs as an alternative to traditional medical services for managing childhood asthma for: (a) reduction in medical care costs of emergency room, hospital costs and outpatient physician care, and (b) savings in opportunity costs.

Finding: The costs of nurse staffing for a nationwide SBHC program were estimated at $4.55 billion compared to the estimated medical savings of $1.69 billion, including ER, hospital, and outpatient care. In contrast, estimated total savings for opportunity costs of work loss and premature death were $23.13 billion. Medical savings alone would not offset the expense of implementing an SBHC program for prevention and monitoring childhood asthma. However, even modest estimates of reducing opportunity costs of parents’ work loss would be far greater than the expense of this program.

Link: Article Abstract
Objective: A comparison of outcomes including hospitalizations, emergency department visits, and school absenteeism in 949 elementary school children with asthma from 6 elementary schools in The Bronx, NY who have and do not have access to an SBHC. 

Finding: This study reports a strikingly lower asthma-related hospitalization rate in children who attend schools with SBHCs compared with those attending comparison schools. In addition to reduced hospitalization rates, a gain of 3 days of school for asthmatic children attending schools with an SBHC compared with asthmatic children attending a comparison school was found. However, there was no significant influence of SBHCs on ED use. This underscores the importance of improving asthma management skills in parents of young children.

Link: Article Abstract
Objective: This study examined patterns of enrollment, use, and frequency of use in SBHCs, as well as referral, diagnosis, and disposition of SBHC visits in four rural and four urban school districts implementing SBHCs from 2000 to 2003.

Finding: SBHC enrollment was greater in urban districts but rate of utilization was higher in rural districts. Black students, students with public or no health insurance, and students with asthma or attention deficit disorder had higher enrollment and utilization. Rural parents referred more children to SBHCs than urban parents. Teachers referred more students who were black, had asthma, had no public or health insurance, or had acute-type health issues. Total visits increased during the three years, with the largest increase in mental health services. Students who were younger, white, attended rural schools, had public or health insurance, or had infections were more likely to be sent home. Those with chronic conditions and visits for mental health were more likely to be returned to class.

Link: Article Abstract
Objective: An analysis of health care utilization at three school-based health centers (SBHCs) in the Bronx, New York City, and compared characteristics of "frequent" and "average" service users among students who received services at least once between September 1998 and June 1999.

Finding: Results found that of the total number of health center users, 28% were classified as “frequent” and 72.4% were "average" users. "Frequent" and "average" users contributed 72.5% and 27.5% of all visits during this time period. Older children (8-13 year olds) were more likely to make frequent visits. The two groups did not differ by gender, insurance status, or race/ethnicity. “Frequent” health center users were more likely to be seen for mental health visits and for chronic medical care. “Average” health center users were more likely to be seen for health care maintenance visits, acute medical care, and injuries/emergencies. The two most common diagnoses for “frequent” health center users were ADHD and asthma, but immunizations and visits for superficial wounds for “average” service users.

Link: Article Abstract
Objective: The purpose of this study was to determine the utilization pattern of an elementary school-based health center in Atlanta, Georgia over a 5-year period.

Finding: Results revealed high health center utilization for all users each year. The most frequent encounters by diagnostic category were respiratory followed by health supervision, skin disorders, and symptoms. There was a significant decrease in encounters for the categories of ear and injuries and poisonings and an increase in encounters for emotional conditions between the first and last year. Finally, an analysis of health center users by insurance types revealed an unvarying distribution over of the study period.

Link: Article Abstract
Objective: This report describes the role and location of school-based health centers (SBHCs) in the United States, as well as the need for SBHCs and use of telehealth technologies to overcome geographic barriers to SBHC access in their role in the patient-centered medical home.

Finding: Telehealth not only has the potential to make SBHCs more efficient and sustainable, but also synergistically enhances the ability of school-based health initiatives to deliver the core elements of the PCMH model. Fragmentation of care remains a concern as health care access points increase, yet telehealth school-based health centers (tSBHCs) are well-positioned to both improve access to and maintain the continuity of the PCMH. Incorporating SBHCs and tSBHCs into a PCMH will improve the scope of care and strengthen local health care communities.

Link: Article Abstract
Objective: This study compares the benefits of a school-based health center (SBHC) with a School Health Survey and selected HEDIS measures in preschool children with and without access to an SBHC.

Finding: Results revealed that preschoolers with access were less likely to use community health centers and more likely to use the SBHC. Preschoolers without access had significantly more hospitalizations. More families without access to an SBHC (22.1%) reported that they felt their ED visit could have been handled by a PCP than families with access (12.3%). There were also significant differences between the groups in satisfaction with length of appointments, convenient hours, access to health center, and necessity of missing school. Families with access to an SBHC were more likely than those without to report no problems in accessing care. Lastly, more families with access to an SBHC met the eligibility requirements for insurance.

Link: Article Abstract
Objective: This study determines, in a low-income, urban population, 1) adolescents' reasons for visiting school-based health centers (SBHCs), 2) the value parents place on SBHC services, and 3) adolescents' and parents' assessment of how well SBHCs fulfill criteria for a medical home.

Finding: The top three reasons for visits were for illness (78%), vaccines (69%), and sexual health education (63%). Factors reported as very important by 75% of parents in the decision to enroll their adolescent in an SBHC included health center offering sick or injury visits, sports physicals, and vaccinations. Over 70% of adolescents gave favorable responses to questions about medical home criteria. Most parents (83%) reported that they could always or usually trust the SBHC provider to take good care of their child; 82% were satisfied with provider-to-provider communication.

Link: Article Abstract
Objective: The purpose of this article was to understand the issues and reasons that adolescents sought mental health services at school-based health centers (SBHCs) and what their perceptions of the services were among African-American and Latino males in four high schools and three middle schools set in low-income areas of Connecticut.

Finding: Five themes emerged from analysis of the data depicting the experiences of the adolescents interviewed. The themes were “the burdens and hurdles in my life,” “the door is always open,” “sanctuary within chaos,” “they get to us,” and “achieve my best potential.” Issues including unresolved anger, family relationships, risky behavior, suicide ideation, negative peer pressure, and depression that led them to initially seek services were highlighted. Access to services in the SBHCs allowed these young men to promptly address their issues in a safe environment, thereby avoiding excessive disruption to their school day.

Link: Article Abstract
Objective: This study evaluates the process, components of, and barriers to the successful implementation of a multifaceted school-health program, The Children First (CF) Plan, designed to improve the quality of school-based health centers (SBHCs) and the services provided.

Finding: The CF Plan was designed to develop communication systems, enhance health prevention efforts, improve management of student illnesses, and increase the effectiveness of service-delivery related to physical and mental health. Findings from the process evaluation indicate improvement in health services delivered at the intervention schools. More student physical health and mental health needs were met through direct services or referrals to other services, and immunization compliance increased. Obtaining buy-in, learning the school culture, defining roles, and keeping a sense of humor were identified as keys to implementing the program successfully. Although communication improved, it was still considered a primary barrier to implementation. Collaborative efforts also revealed improved delivery of services to children and families.

Link: Article Abstract
Objective: A comparison of visit rates, emergency care use, and markers of quality of care between adolescents aged 14 to 17 years who use school-based health centers (SBHCs) and those who use other community centers within a safety-net health care system for low-income and uninsured patients in Denver, Colorado.

Finding: The authors found that SBHCs play an important role in improving access to high-quality health care for low-income and minority adolescents in Denver. SBHC users were more likely to have had an HMV and to have received recommended vaccines compared with adolescents who only used the other health centers in the DH system. Although overall immunization rates remained low in this study, with fewer than half of adolescents receiving indicated vaccines, hepatitis B, tetanus, and influenza immunization rates were higher among SBHC users compared with other users. Compared with other users, SBHC users made more primary care visits and were less likely to use urgent/ED sites, although they were more likely to be uninsured.

Link: Article Abstract
Objective: An assessment of the impact of one school-based health center (SBHC) located in a New York City high school (grades 9–12) on a variety of primary care measures, including access to care, quality of care, and willingness to use an SBHC in comparison with a NYC high school without an SBHC.

Finding: Access to care and quality of care were greater for students attending a school with an SBHC. Students with access to an SBHC reported higher rates of having a regular healthcare provider and had greater awareness of the confidential services available to young people in the state of New York. Students in the school with an SBHC and SBHC users also reported greater health care quality on measures such as health care provider respect for their concerns, time spent in a visit, and provider explanation of topics discussed. The students at the SBHC school and SBHC users also described greater discussion of certain key adolescent topics such as sexual activity, birth control use, emotions, future plans, diet and exercise.

Link: Article Abstract
Objective: The purpose of this study was to use a nationally representative sample of adolescent school-based health center (SBHC) users aged 12 to 17 years to examine the association between user characteristics and utilization of primary and preventive care, and perceptions of SBHC care and staff.

Finding: Results found that over half of all adolescents (56%) reported being sexually active, whereas nearly 30% reported recently smoking cigarettes or drinking alcohol. For mental health-related measures, reported prevalence was higher than those observed in the general population of adolescents. They found that although most reported having a well-child visit (60%) at the SBHC and receiving a primary care service at the SBHC (64%) within the past 6 months, just 6% received a preventive care service. African-American/non-Hispanic adolescents were more likely to have had a well-child visit at the SBHC compared with White/non-Hispanic adolescents. Additionally, perceptions of care among the adolescent sample were overwhelmingly positive.

Link: Article Abstract
Objective: This study used a nationally representative sample of adolescent school-based health center (SBHC) users aged 12 to 17 years to investigate the differences in access to care based on sociodemographic and health status characteristics among SBHCs in medically underrepresented areas.

Finding: Results suggest that SBHCs are delivering equitable access to health care services, regardless of demographics or socioeconomic status. Few significant differences were observed for race/ethnicity or insurance status. Insured adolescents were less likely to report an SBHC as their sole usual source of care. No significant differences were found in ability to access care at SBHCs with regard to gender. Results showed no differences in usual source of care or barriers to obtaining care or services. However, it was found that even having access to an SBHC is not enough to overcome barriers to fulfilling certain health care needs. Those with serious emotional concerns reported unmet needs for mental health care.

Link: Article Abstract
Objective: To compare the demographic, behavioral, psychosocial, and academic characteristics of users versus nonusers of junior high school-based health centers (SBHCs) in New York City.

Finding: Compared to students who did not use the health centers, students who used the health centers were more likely to have had unprotected sexual intercourse, to have had suicide intentions or attempts, to be suspended from school for fighting, to be exposed to violence and the illicit drug culture, to hold beliefs favoring involvement in sexual intercourse and suicidality, and to have failed subjects in school.

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Objective: The authors describe the impact of school-based health centers (SBHCs) on adolescents' access to care and their mental and physical health outcomes in Alameda County, California.

Finding: The Alameda County SBHCs were able to overcome traditional barriers to care and serve ethnically and racially diverse clients. The majority of clients were screened for risk factors and received comprehensive primary care, consistent with medical guidelines. Although national data demonstrate higher unmet needs, approximately one in ten clients (11%) did not get needed mental health services from any source, despite being registered SBHC clients. The majority of clients (81%) reported in the client survey that the SBHC helped them to use protection more often when they had sexual intercourse. Confidentiality was reported as a main reason they liked the SBHC. However, participants felt that larger waiting rooms and expanded health center spaces would increase confidentiality.

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Objective: The article reports a study that examined health care delivered by a pediatric nurse practitioner in an elementary school setting and selected indices of access to health care.

Finding: Indices of access to health care mentioned in this document include Medicaid certification; early periodic screening, diagnosis, and treatment; and linkage with existing resources. Findings suggest that greater availability of care may encourage parents to seek early preventive care for their children.

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Objective: An evaluation of whether quality of care provided to adolescents enrolled in a community-based managed care plan was better for those who also received some care at school-based health centers (SBHCs) in Rochester, New York.

Finding: The findings show that adolescents who used an SBHC were more likely to have received preventive counseling on pregnancy and STDs, and were more likely to report that the care they received was helpful. However, SBHC users were also significantly more likely to report using two or more sources of care in the previous 12 months than the other two groups. Less than half of adolescents in the Commercial and Medicaid samples reported that they completed a screener questionnaire at their last well visit, and about half of SBHC users reported completing it. When controlled for other variables, results showed that use of a screener or trigger questionnaire had a strong impact on reported health care quality.

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Objective: This study examines variations among students with different health insurance coverage in their use of school-based health centers (SBHCs) and determines if insurance status is a significant factor in predicting SBHC use among 2860 adolescents attending three urban high schools with onsite SBHCs in northern California.

Finding: The study found that the two groups with the largest percent utilization of SBHCs were students who had conventional private insurance and those with HMO coverage. The lowest utilization rates occurred among students without insurance or with Medicaid coverage. There was no significant difference in use of or reasons for use of medical services at the SBHCs among students according to insurance status. However, a greater proportion of students on Medicaid used SBHC mental health and reproductive health services. Students without any health insurance were significantly more likely to not receive care from any source when it was needed and were more likely to not seek care because of high cost.

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Objective: A comparison of health problems and medical coverage of homeless and housed children who used a school-based health center (SBHC) in New York City for comprehensive care during the 1998-99 school year.

Finding: Study findings identify homeless children as being at increased risk for health problems and lack of medical coverage. Homeless children were 2.5 times as likely to have health problems and three times as likely to have severe health problems as housed children. The most common health problems identified in the homeless population were asthma (33%), vision (13%), mental health (9%), and acute problems (8%). Lack of medical coverage was evident in 58% of homeless children, compared with 15% of housed children.

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Objective: A study to examine the use of a multidimensional school-based intervention to increase adolescents' use of needed medical care and preventive care and decrease emergency room use among 7-12 graders in six intervention schools and six comparison schools.

Finding: The results show that in both years, 45% or more of the students in both groups reported not seeking medical care they believed they needed. However, none of the other utilization outcomes, including emergency room use, dental visits, mental health visits and health center or nurse visits in the past year demonstrated a significant interaction. However, the direction of the results all favored the intervention group. Perceived health status was associated with all health care variables except having a health center or office medical visit in the past year. As health status declined, students reported they were more likely to report unmet needs, as well as an emergency room visit, mental health services, and school nurse use.

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Objective: This article describes the role and primary functions of school-based health centers (SBHCs) and how these centers can provide important prevention and health promotion services for children and adolescents.

Finding: SBHCs have positively affected children by providing both preventive services and easily accessible care for acute and chronic illnesses. The impressive growth of SBHCs in all areas of the United States means that school psychologists will increasingly have the opportunity to partner with these centers. School psychologists have a lot to offer SBHCs and can be key players in establishing collaborative services that better integrate SBHC services with those provided by school-based student services staff.

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Objective: This study describes student access to general and specific health care services, identifies populations of students who reported unmet needs for health care services, and highlights particular types of care that adolescents needed but did not obtain, among 9-12 graders attending 50 schools in Oregon.

Finding: A majority of high school adolescents had visited health care providers within the year prior to study. However, the number of adolescents who reported unmet specific health care needs within the same time period remained substantial. Nineteen percent reported not receiving one or more of ten specific types of care when needed in the last year. Females, some racial/ethnic minorities, rural, and sexually-active adolescents were more likely to report unmet needs. Most frequently, adolescents reported they needed but did not receive care for an illness (7%) or for personal or emotional problems (6%).

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Objective: An examination of students' knowledge, barriers to access, and use of services among 149 middle school and 131 high school African-American students attending school-based health centers (SBHCs) in two urban public schools in Baltimore.

Finding: Knowledge about SBHC services was generally high, except with respect to the need for an appointment for non-emergency visits (40% correct) and the availability of dental service referrals (51% correct). Frequent barriers to access include difficulty in obtaining a teacher's permission to leave class (55%), requiring parental permission for enrollment (31%), and concern about confidentiality (26%). Barriers to access were reported more frequently by students in the middle school than in the high school.

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Objective: The authors compares access to care, health status and risk-taking behaviors between a cohort of students attending 19 participating schools with a national sample of urban youths.

Finding: The school-based health centers increased students' access to health care and improved their health knowledge. However, the estimated impacts on health status and risky behaviors were inconsistent, and most were small and not statistically significant. In summary, school-based health centers can increase students' health knowledge and access to health-related services, but more intensive or different services are needed if they are to significantly reduce risk-taking behaviors.

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Objective: Assessing the impact of school-based primary care on adolescents' use of hospital and emergency room care was measured among students (grade 6-12) in nine Baltimore schools with school-based health centers (SBHCs) and four schools without health centers.

Finding: Access to school-based, primary health care was associated with increased use of primary care, reduced use of emergency rooms, and fewer hospitalizations. Students from schools with health centers were more likely to report the use of certain health services in the past 4 years. Although, self-reported emergency room use (38%) and hospitalization (19%) were common among students in schools with health centers, these students were less likely to report hospitalization. Emergency room use was also lower but only for students attending the school with a health center for more than one year.

Link: Article Abstract
Objective: An evaluation of the change in emergency department utilization before and after enrollment in a school-based health center (SBHC) at the first health center in an urban public high school with a student body of approximately 900 students aged 10-15 years.

Finding: The emergency department visit rate decreased for students enrolled in both the school and the SBHC and for students only enrolled in the school and not the SBHC for each school year evaluated. This decrease was significant only for the SBHC sample with a 41-57% decrease in emergency department utilization, 18% greater than the decrease in students who did not use the SBHC. Accessible, prevention-oriented health care provided in an SBHC can decrease the utilization of episodic health care in an emergency department.

Link: Article Abstract
Objective: The authors evaluated the impact of access to an elementary school school-based health center (SBHC) on emergency department visits by a subset of students attending the elementary school and enrolled in the center in a high-poverty, inner-city neighborhood.

Finding: Major reasons for emergency department visits included trauma (32%), otitis media (15%), upper respiratory infections (9%), and gastroenteritis (6%). Implementation of an elementary SBHC resulted in a significant decrease in non-urgent emergency department visits. No difference existed in urgent emergency department visits. Medicaid-insured children were more likely to use the emergency department than privately insured or uninsured children. Reducing emergency department visits can decrease medical costs and support the cost effectiveness of SBHCs.

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Objective: An assessment of the role that school-based health centers (SBHCs) play in facilitating access to care among 451 low-income, inner-city high school students, and the extent to which SBHCs and a community health center network provide similar or complementary care.

Finding: SBHC users averaged 5.3 visits per year. Minority youth who used the SBHC had the highest visit rates. Visits to SBHCs were primarily for medical and mental health services. Visits at community health center network (CHN) sites were 97% medical. Urgent and emergent care use in the CHN system was four times more likely for adolescents who never used an SBHC. This study supports the view that SBHCs provide complementary services. It also shows their unique role in improving utilization of mental health services by hard-to-reach populations.

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Objective: This study examined the association between urban adolescents' experiences of school-based bullying and victimization and their use of school-based health centers (SBHCs) among 2063 high school students in 5 northern California school districts.

Finding: Students who were bullied or victimized at school had significantly higher odds of using the SBHCs compared with students who were not, and were also significantly more likely to report confidentiality concerns. The magnitude of associations was largest for Asian/Pacific Islander students, though this was likely due to greater statistical power. African-American students reported victimization experiences at approximately the same rate as their peers, but were significantly less likely to indicate they experienced bullying.

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Objective: An exploration of the use of physical and mental health services for adolescents who are enrolled in managed care with access to a school-based health center (SBHC) compared to those without during three academic years in Denver, Colorado.

Finding: The results found that adolescents with access to an SBHC were more than ten times more likely to make a mental health or substance abuse visit, with 98% of these visits occurring at the SBHC compared with adolescents without access to an SBHC. Adolescents with access to an SBHC had between 38% and 55% fewer after-hours (emergency or urgent) visits than adolescents without access. A greater percentage, 80.2%, of adolescents with access to SBHCs had at least one comprehensive health supervision visit compared with 68.8% of adolescents without access. Furthermore, there was a much higher rate of documentation of screening for high-risk health behaviors in the SBHC.

Link: Article Abstract
Objective: An assessment of the effects of an urban elementary school-based health center (SBHC) on access to and use of physical and mental health services by children aged four to 13 years.

Finding: Compared with respondents at comparison schools, respondents whose children had access to an SBHC had less difficulty receiving physical health care for their children. Access to an SBHC was independently and significantly related to less emergency department use, a greater likelihood of having had a physician's visit since the school year began, and a greater likelihood of having had an annual dental examination. Respondents who reported the SBHC as their most-used health service were significantly more satisfied with their service than respondents who mostly used community health centers.

Link: Article Abstract
Objective: The purpose of this study is to compare frequent users of school-based health center services (SBHC) with students who have an average rate of utilization in Denver Colorado.

Finding: The average SBHC utilizers were found to be representative of the entire student population based on age, race, gender, and grade. The frequent users were more likely to be females and had a lower grade point average than average users. The frequent health center users differed in their initial primary diagnoses as well as in the types of subsequent visits, having a significantly higher percentage of mental health-related visits than did average users.

Link: Article Abstract
Objective: An exploration of the use patterns of adolescent students enrolled in three Denver school-based health centers (SBHCs) and a comparison of these patterns with adolescents' use of medical, mental health, and substance abuse services located in non-school-based settings among students in grades nine through twelve.

Finding: Adolescents attending SBHCs had higher visit rates for health and medical care than adolescents using traditional sources of medical care. The proportions of student users of SBHC mental health and substance abuse counseling services were commensurate with the estimated prevalences of these problems in this country's adolescent population. In addition, the mean numbers of visits to mental health counselors in SBHCs compared favorably with adolescent visit rates for mental health services in other settings. Too little information is available about adolescent use of substance abuse services in non-school-based settings to make similar comparisons.

Link: Article Abstract
Objective: The authors compared student health and mental health knowledge, behavior, and access to services for school-based health center (SBHC) users and nonusers in Washington state.

Finding: Data from comparisons of health center users and nonusers revealed differences in health- and mental health-related knowledge and behavior and access to needed care. The health center was found to serve adolescents at high risk for a variety of psychosocial problems (e.g., drug use, depression, dropout). Some evidence exists to support the idea that health center users had greater access to needed physical and mental health care. SBHC users also gave high ratings of the staff and services.

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Objective: This study sought to understand the relationship between school-based health centers (SBHCs) and academic outcomes such as early dismissal and loss of seat time among students at two urban high schools in western New York.

Finding: Students with access to an SBHC were significantly less likely to be sent home during the school day than those who received school nursing services alone. Similarly, students not enrolled in an SBHC lost three times as much seat time. Students who were not enrolled but had access to an SBHC in their school had the greatest loss of seat time. The author concluded that SBHCs were able to increase student learning and seat time.

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Objective: The purpose of this study was to 1) compare differences between school-based health center (SBHC) users and nonusers on school connectedness and academic performance and 2) test the pathways between SBHC usage and academic performance among 793 students from one elementary, one middle, and one high school in a large northeastern urban metropolis.

Finding: Users of SBHCs, compared with nonusers, had higher levels of school connectedness in: school bonding, attachment, and commitment to educational future. No significant differences in attendance were found. School connection and attendance were positively related to GPA and promotion to next grade level. GPA had a significant direct effect on promotion to the next grade level. This suggests that higher school connectedness offsets the potentially negative effects of lower attendance and tardiness.

Link: Article Abstract
Objective: An examination of the relationship between student-reported school-based health center (SBHC) utilization and 1) caring relationships with program staff; and 2) school assets among 7,314 students in 15 schools from the San Francisco Unified School District.

Finding: Use of SBHCs positively relates to student-reported caring relationships with health center staff and school assets. Findings suggest a linear dose-response relationship between students who used an SBHC one to two times, three to five times, and > 10 times (vs. no reported use) and their reports of caring adults in the SBHC. A linear dose-response relationship was not found for school assets. For each asset subscale (caring relationships with adults, high expectations, and meaningful participation), students who reported use of the SBHC > 10 times reported significantly stronger assets. The strongest effect was observed in students who used an SBHC > 10 times.

Link: Article Abstract
Objective: This article presents a systematic review of the literature to examine evidence that school health programs aligned with the Coordinated School Health Program (CSHP) model improve academic success.

Finding: Scientifically rigorous evaluation of school health programs is challenging to conduct due to issues related to sample size, recruitment, random assignment to condition, implementation fidelity, costs, and adequate follow-up time. However, school health programs hold promise for improving academic outcomes for children.

Link: Article Abstract
Objective: The authors reviewed the methods, findings, and limitations of studies that have examined the relationship between school-based health centers (SBHCs) and academic performance. It also discusses factors that influence student academic performance.

Finding: Although the current research base provides insufficient evidence to demonstrate a direct link between SBHCs and academic performance, the literature demonstrates the influence of several intermediate outcomes which, in combination with social and educational factors, can influence academic performance indirectly; such as health status, resiliency, school climate or connectedness. The author also describes several strategies for SBHCs to demonstrate their contributions.

Link: Article Abstract
Objective: This study investigates the relationship between school-based health centers (SBHCs) and the overall school learning environment among students in 416 public schools in a large northeastern city.

Finding: This study offers evidence that the presence of SBHCs in the urban schools has enhanced certain aspects of the learning environment for students and parents. Schools with SBHCs were perceived more favorably by students and parents than schools without health centers. Specifically, students and/or parents rated the following aspects of the learning environment more favorably: academic expectations, communication, and school engagement.

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Objective: An investigation of the moderating effects of school type on the relationship between school-based health centers (SBHCs) and the learning environment among underserved students in elementary, middle, and high public schools in one large urban northeastern city.

Finding: Findings indicate that SBHCs in middle and elementary schools are associated with greater levels of school engagement and satisfaction with the learning environment than those in high schools. Specifically, in elementary schools with SBHCs, participants perceive that there is better communication with school employees and also feel more engaged with the school. Students and parents in middle schools with SBHCs perceive better communication, safety, respect, engagement, and academic expectations than those in the comparison schools. 

Link: Article Abstract
Objective: A description of first grade student exclusion rates during a four year collaborative experience with an on-site, community school-based health center (SBHC) of Vallejo City Unified School District and Touro University College of Osteopathic Medicine.

Finding: The SBHC described in this study has been well accepted by the local community and serves a population that is largely uninsured. The authors found that first grade student exclusion rates for failure to meet the state-mandated physical examination requirement fell 74% over the first four years of the SBHC's operation. Reduction in first grade student exclusion rates enhances student education and reduces the loss of attendance-based state matching funds.

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Objective: This study aims to determine the association between use of school-based health centers (SBHCs) and school dropout among students in their first semester of ninth grade from an urban public school district in 2005.

Finding: This study originally found an association between low to moderate SBHC use and reductions in dropout for high school students, especially for students at higher risk for dropout. However, findings were retracted after accounting for the issue of attending school through graduation having an effect on measured SBHC use, rather than SBHC use impacting graduation.

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Objective: A comparison of academic outcomes among school-based health center (SBHC) users and nonusers, and an examination of whether or not SBHC medical and mental health use influences academic outcomes among ninth graders enrolled in the Seattle school district between September 2005 and January 2008.

Finding: Attendance increased significantly for SBHC medical users compared to nonusers. Increases in grade point averages were observed for mental health users compared to nonusers. Discipline incidents were not found to be associated with SBHC use. For a high-risk group of users, SBHC use was associated with academic improvements. The authors conclude that the moderating effect of type of use reinforces the importance of looking at subgroups when determining the impact of SBHC use on outcomes.

Link: Article Abstract
Objective: The author examines what is known about the impact of health on absenteeism and dropping out, and the effects of programs that have tried to address these problems.

Finding: This article identifies health-related problems, family-related problems, and school-related problems as reasons for absenteeism. Programs that address absenteeism and dropout include truancy reduction programs, school-linked programs, and health problem-related programs. Overall, school-based health centers (SBHCs) can help reduce dropout and absenteeism among adolescents, but not easily. SBHCs should routinely receive information on absenteeism and potential dropouts. Physical or emotional problems can be identified and ameliorated by SBHCs, leading to reduction in absences and in dropout potential.

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Objective: An examination of the effect of health center registration and use on academic success among students in an alternative high school.

Finding: The likelihood of being absent or suspended was the same among students who were registered to use the health center and those who actually used the health center in comparison to non-registered students. However, students who used the health center were significantly more likely to stay in school and graduate or be promoted than non-registered students. This relationship was strongest for black males. Only health center use and percent of enrolled days absent were significantly associated with graduation/promotion.

Link: Article Abstract
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