How a Misunderstanding about what an SBHC is Can Cost a Community its Access to Health Care

By Laura Brey, Senior Training and Technical Assistance Specialist, School-Based Health Alliance

A recent story about two school-based health centers (SBHCs) closing in Tennessee struck a nerve with me. Without the full details, it appears that this was a situation where there wasn’t a fit between the SBHC and its sponsor. This is not an unfamiliar situation to us. Sometimes, a health center sees an SBHC as a gateway to generate more billable primary care visits, and the school wants the school nursing functions afforded by the health center’s RNs. When the sponsoring agency can’t sustain the SBHC, it pulls the plug, and the students and school are left without access to health care services.

It doesn’t have to end this way. With proper guidance, health centers can run a robust SBHC business. But first, both collaborating partners have to understand the primary functions of an SBHC. SBHCs are different than other community health care (CHC) models, and cannot simply be transplanted onto school grounds. The primary difference between an SBHC and a CHC is that an SBHC focuses on the needs of the student population, and serving them. For example, it is notoriously difficult to get teens to utilize health care services. So, high functioning SBHCs go out into the school and find their patients.

This fundamental misunderstanding of the business models that sustain SBHCs is the direct result of lack of common SBHC planning and operating guidelines, and standards to guide the development and ongoing evaluation of SBHCs at the federal and state levels. As a result there has not been a roadmap for the school and the sponsoring health agency to follow. This can be a huge hurdle, especially when billable visits are an important marker of success.

To avoid situations like this, when deciding on whether to establish a new SBHC, it’s important that all stakeholders understand the foundations of a strong school-based health care business practice. The School-Based Health Alliance has established seven principles for SBHCs and a sustainability infographic that provide guidelines, tools, and resources on how to benchmark a program and provide a framework for accountability and continuous improvement. We recommend using the principles and sustainability infographic as the roadmap for establishing new SBHCs.

Job number one for SBHCs is to assure the host school that your chief mission is theirs: school success for all students. The school is our number one client: unhappy educators can shut an SBHC down if the link to students’ academic progress isn’t well communicated or valued. Another distinctive difference between a CHC and an SBHC is that the SBHC has responsibility to the entire school population, not just the patients who walk through the clinic doors. This means routine health promotion activities, education, and marketing to influence health-compromising behaviors school-wide.

More detail about the principles and the sustainability infographic can be found on our website. In addition, if you’re working in an SBHC and are struggling, please reach out to us. We offer a variety of free resources, like webinars and tools, along with our subscription-based collection of resources—the Blueprint—and our consulting services.


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