A school-based health center (SBHC) represents a shared commitment between a community’s schools and health care organizations to support the health, well-being, and academic success of its students. For the schools’ part, facilities and utilities are donated and building-level policies facilitate students’ enrollment and utilization.
Local health organizations bring into the partnering school expertise and linkages to an array of services—medical, nursing, behavioral counseling, oral health care, reproductive health, nutrition education, vision services, and health promotion—that enable children and adolescents to thrive in the classroom and beyond. The ultimate goal of the partnership is to create a culture of health within the school and among its inhabitants.
The School-Based Health Alliance, in partnership with our state affiliates and experts from the school-based health care field, developed a set of seven core competencies that represent the knowledge, expertise, policies, practices, and attributes that every SBHC is expected to demonstrate in its pursuit of student wellness. SBHC staff and administrators can use these as a framework to achieve excellence in delivering care in a school setting.
The core competencies are gaining wide recognition. The Health Resources and Services Administration, for example, highlighted them in a 2016 funding opportunity announcement.
The SBHC assures students’ access to health care and support services to help them thrive.
- Location: health center is located in a facility—either fixed or in portable space—within the school building or on school campus.
- Operations: health center makes on-site services available whenever the school is open, or as needed, to serve the needs of the student population. Student access is heightened by SBHC policies that accept walk-ins and offer same-day appointments when possible; the school and SBHC have a clear protocol for referrals from faculty and staff.
- Facility: health center operates within an appropriate physical plant that complies with laws and regulations governing health facilities, is conducive to efficient health care practice, and is welcoming to students and safeguards their privacy.
- Consent: health center obtains from parent/guardian/caregiver of enrolled students informed written consent covering all services, and a HIPAA compliant consent form allowing the school nurse or other school health services staff to share health information with health center or other HIPAA covered entity unless student is 18 or older, an emancipated minor, or as otherwise allowed by state law.
- After-hours care: health center puts in place a system for patients to access care when center is not open (e.g. primary care physician on-call, nurse hotline, emergency room, urgent care center, or behavioral health crisis line).
- Non-discrimination: health center does not discriminate against patients based upon race, color, sexual orientation, religion, national origin, age, disability, sex, health insurance status, or ability to pay.
- Other populations: health centers that make services available to populations other than students or out-of-school youth (such as faculty and/or school personnel, family of student users, or other people in the community), prioritize the care of the student body and assure their safety and privacy. This may be accomplished by offering student-only hours or organizing a separate entrance and/or waiting room area for non-students.
The SBHC team and services are organized explicitly around relevant health issues that affect student well-being and academic success.
- Comprehensive service scope: health center delivers primary care services designed to promote the optimal social, emotional, and behavioral health of students, as well as minimize the effects of poverty, chronic disease, social determinants of health, and other adverse childhood experiences on their school success.
- Evidence-based standards: health center is guided by evidence-based standards of care on issues affecting healthy development, including strength and risk assessment, well care exams, immunizations, obesity, school failure, asthma, ADHD, exposure to violence and trauma, sexual and reproductive health, depression, substance use, and oral and vision care.
- Competence: health center services and materials are developmentally appropriate and respectful of cultural and linguistic diversity.
- Confidentiality: health center protects confidentiality of patient information as required by state and federal law when transmitted through conversation, billing activity, telemedicine, or release of medical records.
- Patient engagement: health center encourages students (as age-appropriate) to be effective advocates and consumers of their own health care by encouraging them to schedule their appointments, manage medications, ask questions about their care, and improve their health literacy.
- Youth advisors: health center meaningfully engages students in a variety of functions, including community asset mapping and needs assessment, evaluation of services, youth-led outreach and promotion, peer-to-peer health education, and advocacy mobilization on behalf of their health needs.
The SBHC, although governed and administered separately from the school, integrates into the education and environment to support the school’s mission of student success.
- Shared vision for student success: health center has a formalized understanding of how it collaborates with school administration, teachers, and support staff—school nurses, psychologists, and counselors—to ensure the partnership meets student needs efficiently, effectively, and seamlessly.
- Shared outcomes: health center partners with the school to achieve improved outcomes for students struggling with attendance, behavior, or academic performance issues.
- Integration: health center and school personnel participate jointly in the development and governance of policies, procedures, and structures that support student health and academic achievement (school improvement, school wellness, alternatives to discipline, Individual Education Program or IEP team, and Americans with Disabilities Act) .
- Crisis response and support: health center serves as partner in the management of school’s crisis prevention and intervention plans.
The SBHC routinely evaluates its performance against accepted standards of quality to achieve optimal outcomes for students.
- Quality improvement: health center implements a quality assurance system that monitors and evaluates the appropriateness, effectiveness, and accessibility of its services.
- Satisfaction: health center routinely assesses patient and community satisfaction with services and assess unmet needs.
- Performance: health center collects and reports on key performance measures, including individual and population-level outcomes, to assure accountability to partners, payers, funders, and other stakeholders.
The SBHC promotes a culture of health across the entire school community.
- School climate: health center actively promotes building-level policies and practices that assure a safe and healthy school environment for all students and staff.
- Student body wellness: health center advances population health and preventive services through group, classroom-based, and school-wide inclusive modalities to screen for and minimize risk factors, promote community assets, and address social determinants of health (e.g., nutrition education, trauma support groups, asthma education, physical activity, and health careers).
- Family wellness: health center engages parents/guardians/caregivers in health education and promotion events to promote family wellness.
- Staff wellness: health center assesses the health and wellness needs of school staff and offers services, such as support groups, stress management activities, and health literacy.
- Health authority: health center contributes subject matter expertise on health education curriculum, school wellness policies, and health-related programs and services (nutrition, physical activity, safety, discipline) that support student well-being.
The SBHC coordinates across relevant systems of care that share in the well-being of its patients.
- Care coordination: health center coordinates and integrates efforts (including exchange of health information as appropriate) with existing systems—primary care, behavioral health, oral health, vision providers, and health plans—to improve continuity of care, reduce fragmentation, and prevent duplication of services.
- Care partners: health center has formal partnership referral and follow-up linkage agreements and protocols with the broader health care community to ensure access to after-hours care (e.g., primary care physician, nurse hotline, emergency room, urgent care center, or behavioral health crisis line) and coverage beyond clinical capacity—including oral, reproductive, behavioral, and specialty health care.
- Parent/guardian/caregiver engagement: health center informs and educates parents/guardians/caregivers about a child’s health issues and involves them as supportive participants in the student’s health care whenever appropriate and possible.
The SBHC employs sound management practices to ensure a sustainable business.
- Administrative systems: health center is supported by a fiduciary (or sponsor) agency that provides administrative and clinical systems, including medical supervision, liability coverage, human resources, procurement of medical equipment and supplies, quality improvement, training and leadership development, health information technology, marketing, and practice/fiscal management.
- Billing infrastructure: health center has the capacity to collect patient revenue efficiently through use of health information management systems, dedicated administrative personnel, and policies and procedures.
- Analysis of financial standing: health center creates a business plan with financial performance metrics that take into account, among other things, the cost of the program, expected patient volume by provider, and payer source. In monetizing services, all expenses of the program—direct and indirect alike, including staffing, facilities, pharmacy, administration, billing, care coordination, and health promotion—are taken into account.
- Sustainable resources: health center employs sound business models based on financial planning strategies that rely on a diversity of stable and predictable funding sources, maximize patient revenue, and minimize the role of grants to support operations for the long-term.