SBH Services and Finance Models

School health services were defined in 1995 by the Centers for Disease Control and Prevention as a “coordinated system that ensures a continuum of care from school to home to community health care provider and back.”[i] Today, the delivery of health services varies across school buildings, districts, and states. Diversity of staffing profiles, scopes of services, sponsoring agency, and finance models is largely influenced by student need, community health care resources, funding availability, local preference, leadership, and perception of health services among education administrators and decision-makers.[ii]

This disparity is illustrated even within city blocks: one school has intermittent access to a part-time nurse’s aide, while another offers comprehensive, full-time medical, behavioral, dental and vision care, all within a full-service, community school model.

The most common arrangements for health services in schools include:

Basic school health services:
Common health-related functions in schools are most likely performed by a registered nurse (RN) or nurse aide, if and as they are available. Range of services provided include: first aid, administration of medications, health assessments and counseling, skilled nursing for students with special care needs, mandated screenings for vision and hearing, maintenance of student health records, immunization record-keeping, and management of chronic conditions. These services have traditionally been funded by the local school district and special education budgets. Alternative funding sources may include health care systems, public health funds, community organizations, and Medicaid reimbursement.
School-based mental health care:
To mitigate the growing demand for children’s mental health services, some schools have expanded the breadth and reach of their services to include partnerships with community behavioral health organizations. School-based mental health programs generally organize services around a three-tiered framework: primary prevention, early intervention, and treatment. Programs may focus exclusively on one or all tiers.
The aim is to improve school and behavioral functioning, reduce referrals to highly restrictive settings, and increase academic participation (e.g., attendance, reduced suspensions).  The benefits of such a partnership with community-based agencies are many: 1) schools add considerable bench strength to their efforts for supporting students’ social and emotional health; 2) onsite providers can bill through their sponsor agency thereby eliminating administrative burden from schools; and 3) students have direct access to a system of care should the need for intensive or specialty services arise.
Oral health in schools:
School-based oral health programs educate students and families on the importance of oral health and deliver a continuum of services (from screenings and sealants to exams and treatment) that help prevent the onset of disease and ensure students and families are connected to an ongoing source of community-based dental care. Funding sources include local school districts, public health funds, foundation grants, community dentists, and Medicaid reimbursement.
Vision services in schools:
Vision services, eye exams, refractions,
School-based health center:
Located in predominantly low-income areas, school-based health centers (also referred to as wellness zones, adolescent clinics, health resource centers, etc)  provide comprehensive medical, behavioral, and oral health care to children and adolescents in a setting immediately accessible to them: their school. Distinct from (and complementary to) the basic services model described above, this delivery model provides diagnostic and treatment services directly on the school site. Research has demonstrated positive outcomes with the model: increased use of services, decreases in emergency department visits and Medicaid expenditures, and increased participation in school.

More than 2,400 school-based health centers are in operation today across 49 states and the District of Columbia. They are typically administered by a community health organization in partnership with the host school and financed with non-education funds (e.g. public health grants, patient revenue).

[i] Small ML, Majer LS, Allensworth DD, Farquhar BK, Kann L, Pateman BC. (1995), School Health Services. Journal of School Health, 65: 319–326.

[ii] Schools and Health: Our Nation’s Investment. Institute of Medicine (US) Committee on Comprehensive School Health Programs in Grades K-12; Allensworth D, Lawson E, Nicholson L, Wyche J, editors. Washington (DC): National Academies Press (US); 1997.