When Facing Some of the Greatest Health Challenges, SBHCs Demonstrate They Can Rise to the Occasion

By Iliana White, Program Manager, School-Based Health Alliance

It has been demonstrated time and time again that school-based health centers (SBHCs) provide high quality, comprehensive care to students where they spend most of their time—in school. The model, however, can be viewed simply as a source of direct services and one-on-one encounters. SBHCs have long had the potential to do far more—they usually are staffed with multidisciplinary teams, with individuals that serve as “barometers” in acknowledging factors that affect students’ health, educational attainment, and overall well-being. Could SBHCs validate that they are positioned to address population health issues to the degree they service students on an individual basis? With our Hallways to Health program, part of Kaiser Permanante’s Thriving Schools initiative, we put the SBHC model to the test of tackling health issues that have a high visibility of concern and priority among both the primary care and public health arenas.

Clifton Bush at the 2014 Hallways to Health meeting.

Photo from the 2014 Hallways to Health mid-point meeting.

Recently, I was part of mid-point meeting for our Hallways to Health initiative, which was intended to reflect on progress made in the first year of implementation, challenges encountered, and how the SBHCs will utilize the 2014-15 school year to continue to facilitate improvements in the areas of obesity prevention, social and emotional health, and school employee wellness. I wasn’t sure what to expect at the conclusion of this first year. We asked a group of centers to break outside of their clinic walls to tackle three large health priorities and aim towards changing the environment of their host school. Oh, and by the way, embark on this challenge using a rapid quality improvement collaborative—yes, rapid.

This was never going to be easy. We asked the SBHCs, and their state affiliates, to take on a lot. In addition, we used a learning collaborative model and were not prescriptive in how we expected the SBHC cohort (consisting of a variety of school types, ages served, and sponsors) to make improvements in each of the focus areas. They had to assess that themselves, come up with some strategies, and test these approaches. The complexity, the breadth, and the condensed time frame are all factors that could easily spur skepticism and fear that the SBHCs are being set up to fail in this type of endeavor.

NOT SO! I was blown away at what the SBHCs were able to accomplish within one school year. The amount of energy, enthusiasm, and momentum of the participants was highly encouraging—even from those individuals who may have been initially overwhelmed by the project. The promising outcomes to date are extensive: increased parent and caregiver engagement, new or improved school wellness councils, strengthened collaboration with school staff, increased visibility and integration of SBHC services, and better capacity of SBHC staff to carry out broader health promotion efforts.

The SBHCs’ effort has generated significant changes that can foster future policy and environmental improvements to make their school setting healthier. One school resurrected their school garden, while another site instituted physical activity breaks in the classroom during the regular bell schedule. Several SBHCs are now offering group interventions to address obesity, conflict resolution, and depression. And more and more SBHC staff are seen as a resource by teachers, administrators, and other school staff—even among those sites that have been operating for years.

The issues at hand are not easy to solve, but SBHCs have demonstrated so far they are willing to be part of strategies (and hopefully sustained solutions!) to alleviating the burden within schools—a microcosm of the greater community. The Institute of Medicine deemed schools the “heart of health;” I view SBHCs as the pulse. We’re finding new ways to strengthen our “pulse” when it comes to healthy eating and active living.


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