Health Centers and Schools:

Uniting for Young People’s Success

School-based health care is a powerful investment in the health and academic potential of children and adolescents. This model delivers convenient, accessible, and wide-ranging primary and mental health care services to students where they already spend most of their time: in school.

At the heart of the model is the partnership between the schools and health centers* that give or support the services offered to the students. This resource explores:

–  the value of school and health center collaboration,
–  the benefits that health centers and schools get from the collaboration, and
–  the supports in place that help health centers work with their local schools.

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*In this document, unless otherwise noted, the term “health center” is used to refer to organizations that receive grants under the Health Center Program as authorized under section 330 of the Public Health Service Act, as amended (referred to as “grantees”) and FQHC Look-Alike organizations, which meet all the Health Center Program requirements but do not receive Health Center Program grants. It does not refer to FQHCs that are sponsored by tribal or Urban Indian Health Organizations, except for those that receive Health Center Program grants.”

Health centers are partnering with schools all over the country!

Eastern Iowa Health Center Cedar Rapids, IA

Service Provided: classroom-based health education

What's Happening:

Situated in a county surrounded by rural areas facing severe health care provider shortages, Eastern Iowa Health Center — a federally qualified health center (FQHC) serving 7,206 patients and Title X grantees — has partnered with Cedar Rapids School District to provide sexual health education to its students. Providing this type of education in the Midwest can be challenging, but the health center rose up to that challenge. Currently, a nurse practitioner rotates through all the district schools to provide ad-hoc health education.

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Central Ozarks Medical Center, Richland, MO

Services provided: primary care, oral health, behavioral health, vaccinations, sports physicals, school health fair, and staff health education training

What's Happening:

Central Ozarks Medical Center is nestled in the small town of Richland, MO, and serves more than 11,000 patients. The center aims to provide comprehensive care that’s truly integrated, becoming a resource not just for the patient, but for the whole community. In keeping with that goal, they’ve partnered with several Missouri school districts to provide behavioral health services. Most services are provided in elementary schools, helping students build a good foundation for their education and handle behavioral problems before they become severe.

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Family Practice & Counseling Network, Philadelphia, PA

Services provided: reproductive health services and after-school youth development program

What's Happening:

In West Philadelphia, the Family Practice and Counseling Network (FPCN), a group of federally qualified health centers utilizing nurse practitioners to deliver primary care, behavioral health, dental, and preventive services to more than 23,000 patients, is integrating itself into area high schools to find new ways to help adolescents access the health services they need. Since 2015, FPCN has partnered with local schools as “health resource centers.” Students can meet with FPCN staff during lunch for health resource coordination, family planning advice, and sexually-transmitted infection (STI) prevention.

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Keystone Rural Health Center, Franklin County, PA

Services provided: primary care, vaccinations, health education, and sports physicals

What's Happening:

A nun for 17 years, Nurse Joanne Cochran founded Keystone Health in rural Chambersburg, PA, 31 years ago. A federally qualified health center (FQHC) serving more than 44,500 patients since 1995, Keystone has proudly offered sexual health education and treatment to the community since 2003. In 2015, it opened a school-based health center. However, its work with students goes beyond the walls of the health center and into the classroom, as the partnership between the school and the FQHC brings sorely needed sexual health education to rural teenagers. Getting sexual health education into rural classrooms wasn’t easy. It took a lot of patience and partnership.

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Sunshine Community Health Center, Talkeetna, AK

Services provided: primary care, oral health, mental health, sports physicals, staff health education training, and a after-school youth development program

What's Happening:

Two hours north of Anchorage, AK sits Sunshine Community Health Center, a federally qualified health center (FQHC) serving 3,352 patients plus the students at two local schools. Sunshine Health knows there’s more to providing for the community than clinical care. They also run an after-school transit program that allows youth to take part in sports and other enrichment activities. They run “Parent Cafes” where parents learn about adverse childhood experiences (ACEs) and trauma-informed care. They hold an annual Color Run within the schools to raise awareness and provide education surrounding suicide and depression.

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Valle Del Sol, Phoenix, AZ

Services provided: behavioral health, Medicaid outreach and enrollment, school health fair, and staff health education training

What's Happening:

In the Phoenix Metro Area, Federally Qualified Health Center (FQHC) Valle del Sol is coordinating healthcare for more than 4500 students in six Arizona school districts. Not only does the center’s chief medical officer train and supervise the school nurses providing that care, Valle del Sol creates a care team specially tailored to the needs of each school. To ensure the team is a true collaboration between the FQHC and the school, that team always includes a teacher or staff member.

Valle del Sol doesn’t stop there. It also provides behavioral health services, sponsors health fairs, and trains teachers in how to best support students’ behavioral health needs.

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Getting Started Infographic

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Powering up a partnership in your community can seem like a big task — but it doesn’t have to be! Try out some of these ideas for ways to get started and important tips to keep in mind.

Additional Resources

Kelleher K, MD and Gardner W, PhD. Out of Sight, Out of Mind  — Behaviorial and Developmental Care for  Rural Children. The New England Journal of Medicine, April 6, 2017 (376;14). This article offers potential solutions for the health disparities facing children living in rural areas, including integrating health centers and schools.

Robinson L, PhD; Holbrook J, PhD; Bitsko R, PhD; et al. Differences in Health Care, Family, and Community Factors Associated with Mental, Behavioral, and Developmental Disorders Among Children 2-8 Years in Rural and Urban Areas — United States, 2011–2012. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. MMWR Surveill Summ, 2017; 66. This report discusses the various health disparities for children with mental, behavioral, and developmental disorders across both rural and urban communities.

Lynch, Karen. The Family Practice and Counseling Network Opt-Out Letter.The School District of Philadelphia, Office of Student Support Services, August 2017. This letter is one example of an “opt-out” policy, where students automatically have consent to participate in the health center-school partnership program, and parents can choose to “opt-out,” rather than having to “opt-in.”

National Contacts

American Academy of Pediatrics’ Council on School Health
Veda Johnson, MD
Executive Committee Member

Migrant Clinicians Network
Karen Mountain, MBA, MSN, RN
Chief Executive Officer

National Association of School Psychologists
Katherine Britton
Manager, Special Projects

American Association of School Administrators
Kayla Jackson, MPA
Project Director, Coordinated School Health

National Association of Community Health Centers
Kathleen McNamara, MA, RN
Assistant Director of Clinical Affairs

National Center for Health and Public Housing
Jose Leon, MD
Chief Medical Officer

American Federation of Teachers
Shital Shah, MS
Associate Director, Education Issues

National Association of School Nurses
Margaret Cellucci
Director of Communications

National Health Care for the Homeless Council
Juli Hishida, MS
Project Manager

Acknowledgements: This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under cooperative agreement number U30CS09738-08-00, award title “Technical Assistance to Community and Migrant Health Centers and Homeless” for $450,000. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.

This resource was prepared by Anna Burns; Anna Mizzi; Seleena Moore, MPH; Suzanne Sellman, MA; and Andrea Shore, MPH. We gratefully acknowledge the support of the following who generously provided information for their programs:

  • Mary’s Center
  • E.L. Haynes Public Charter School
  • Central Ozarks Medical Center
  • Eastern Iowa Health Center
  • Family Practice & Counseling Network
  • Keystone Rural Health Center
  • Sunshine Community Health Center
  • Valle Del Sol

We are especially grateful to CAS Video Productions for the creation of the “Health Centers and Schools: Uniting for Young People’s Success” video and The Reinvestment Fund for contributing footage.

Eastern Iowa Health Center

What’s Happening Continued…  That said, they’ve “only just started,” explains Joe Lock, president and chief executive officer of Eastern Iowa Health Center. As the community gets more comfortable, the nurse practitioner has been referring students to the health center for more comprehensive care.

Note that in addition to working with the Cedar Rapids School District, the health center contracts with multiple school districts in the area, providing a nurse practitioner to oversee primary care several days a week. These nurse practitioners refer extensively to Eastern Iowa Health’s network of health centers.

Path to Get There. Initially, the partnership between Eastern Iowa Health Center and Cedar Rapids School District focused on providing a sexual health curriculum in the middle schools. Despite initial pushback from the community, the FQHC persisted. It started small, from one sexual health education class a year to today, offering a monthly class for students to take.

Eastern Iowa Health Center is part of the community: they see more than 50,000 patients a year and their leadership serves alongside other community leaders on the local health council led by the school district. These relationships proved invaluable in gaining the trust needed to develop services in schools. In fact, many school leaders have become champions of the health center’s services, working within the school itself to help the health center expand sexual and reproductive health education.

On the Horizon. Looking forward, Eastern Iowa Health Center hopes to capitalize on the strong relationships they’ve built to place OB/GYNs in schools and expand their sexual health curricula. “We want to focus on more than sexual health, but this is a place where we can really make a difference,” Lock explains. The FQHC also built a new dental health center and wants to bring dental health into the schools — providing even better access to clinical services that empower students to reach their highest potential.

Central Ozarks Medical Center

What’s Happening Continued…  Central Ozarks utilizes data sharing agreements in most of its schools. Once a parent consents, the therapist can observe a student in the classroom and lunchroom, giving them valuable insight to support the student. Parents are then updated via weekly phone calls.

Path to Get There. “Our way in the door is full-time behavioral health in the schools,” explains Robert Stiles, chief executive officer for Central Ozarks Medical Center.

Central Ozarks started a school partnership in the 2016-17 school year by providing a nurse practitioner to support the local school nurse; however, they wanted to do more. Due to funding cuts, districts had eliminated school psychologist positions. Central Ozarks saw this as an opportunity to expand their services and began offering weekly therapy sessions in each school.

At first, teachers were skeptical, not wanting to lose out on precious classroom time. In one district, students were being referred to Central Ozarks’ main clinic site, leading to even more missed classroom time. But Central Ozarks knew that having care onsite would mean fewer no-shows at the clinic, less inconvenience to parents, and more student seat time. By the end of the school year, schools saw major changes in classroom environments, as students were getting the care they needed. Once teachers were on board, they were able to help parents feel comfortable with the idea, paving the way to expanding services.

On the Horizon. Central Ozarks has worked hard to overcome barriers to providing behavioral health in schools, including Individualized Education Program or IEP restrictions frustrating the billing process and initial teacher skepticism. In the 2017-18 school year, Central Ozarks will provide therapy services in five schools districts, reaching approximately 20,000 students. “This partnership took on a life of its own. We agreed to do it for one district, then another district asked us to step in, then another,” said Stiles. But Central Ozarks is still looking to expand the model, bringing in new provider types—especially dental health—and bringing services to more schools. Stiles explains: “We’ve been expanding throughout the community, and this is the logical next step.”

By keeping the goal of community health in mind, and helping the community see the results of that goal, Central Ozarks Medical Center has been able to support rural youth by providing services where youth can most easily access them: at school.

 

Family Practice & Counseling Network

Path to Get There. Grants from the Pennsylvania Department of Health (PDOH) and the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) allowed Keystone to offer expanded HIV/AIDS and sexually-transmitted infection (STI) services to the community in 2011. However, chlamydia cases in the community kept increasing. Keystone wanted to do more.

In 2013, Nurse Cochran approached PDOH to request additional funding. The request was denied. Within one year, close to one out of every five people tested for chlamydia tested positive — with the most new cases occurring in 13 to 20 year olds. Nurse Cochran took hold of the situation, writing an article for the local newspaper. And then another. And then another. With the new data in hand, Keystone wanted to get into the schools to provide education aimed directly at those who clearly needed it most.

As the public began to understand the gravity of the situation, Nurse Cochran spoke at a school board meeting about the importance of linking the FQHC with the school. “Kids were learning about sexually transmitted diseases when they got one,” she explained. “Before, no parent would believe it was their child doing those things. They just don’t talk about ‘those nasty things’ — but we needed to.”
In 2016, the local school board allowed Keystone Health to design a sexual health curriculum, and in September 2017, the curriculum will roll out into all schools, not just the high schools.

Nurse Cochran provides these words of wisdom on how Keystone achieved its goal of bringing desperately needed sexual health education services to the schools. “It is all about relationships. We went to school board meetings to show the personal side of accessible care by bringing in former patients. We built community trust and we showed the community the reality of the situation, supported by good data. Now, the school board is requesting we expand services to include dental, occupational therapy, and behavioral health.”

On the Horizon.
In addition to offering expanded health care services through its school-based health center, Keystone hopes to work with other FQHCs that are interested in partnering with local schools or school districts. “I’ve talked to many chief executives of FQHCs, and we need to get into the schools,” Cochran explains. “This has been a wonderful relationship. We have kids who go home and say ‘Mom, you’re not brushing your teeth, you’re not doing it the right way.’ We have a full community impact. All we have to do is get to the schools. When we can, we can do a lot.” 

Keystone Rural Health Center

Path to Get There. Grants from the Pennsylvania Department of Health (PDOH) and the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) allowed Keystone to offer expanded HIV/AIDS and sexually-transmitted infection (STI) services to the community in 2011. However, chlamydia cases in the community kept increasing. Keystone wanted to do more.

In 2013, Nurse Cochran approached PDOH to request additional funding. The request was denied. Within one year, close to one out of every five people tested for chlamydia tested positive — with the most new cases occurring in 13 to 20 year olds. Nurse Cochran took hold of the situation, writing an article for the local newspaper. And then another. And then another. With the new data in hand, Keystone wanted to get into the schools to provide education aimed directly at those who clearly needed it most.

As the public began to understand the gravity of the situation, Nurse Cochran spoke at a school board meeting about the importance of linking the FQHC with the school. “Kids were learning about sexually transmitted diseases when they got one,” she explained. “Before, no parent would believe it was their child doing those things. They just don’t talk about ‘those nasty things’ — but we needed to.”

In 2016, the local school board allowed Keystone Health to design a sexual health curriculum, and in September 2017, the curriculum will roll out into all schools, not just the high schools.

Nurse Cochran provides these words of wisdom on how Keystone achieved its goal of bringing desperately needed sexual health education services to the schools. “It is all about relationships. We went to school board meetings to show the personal side of accessible care by bringing in former patients. We built community trust and we showed the community the reality of the situation, supported by good data. Now, the school board is requesting we expand services to include dental, occupational therapy, and behavioral health.”

On the Horizon. In addition to offering expanded health care services through its school-based health center, Keystone hopes to work with other FQHCs that are interested in partnering with local schools or school districts. “I’ve talked to many chief executives of FQHCs, and we need to get into the schools,” Cochran explains. “This has been a wonderful relationship. We have kids who go home and say ‘Mom, you’re not brushing your teeth, you’re not doing it the right way.’ We have a full community impact. All we have to do is get to the schools. When we can, we can do a lot.” 

Sunshine Community Health Center

Path to Get There.  Established nearly 30 years ago, Sunshine Health filled a need for a community where the closest health care provider was 70 miles away. They are designated as a Rural Health Clinic, and serve as an integral part of the community. In 2016, when local schools faced budget cuts, slashing crucial funding for school nurses and counselors, district principals came straight to Sunshine Health for help. During that first year, Sunshine Health provided sports physicals on-site and trained teachers to identify and refer students with behavioral health problems utilizing the curriculum “Positive Action Program.” Since that time, Sunshine has expanded its onsite services to include oral health and primary care.

“Whatever we can fit in with education and other services is how we do it,” explains Melody White, chief executive officer for Sunshine Community Health Center. “We don’t come in with a ‘this is what we’re going to do’ attitude. It’s ‘how can we do it, and what’s going to be effective?’”

On the Horizon. While still in the early stages of forming its relationship with the local schools, White sees it as an extension of the community focus Sunshine Health always had: “We preach healthy communities, but that means we need to start with the young people in our community. The schools are one of the best places for us to do that.”

Valle del Sol

What’s Happening Continued…  The center’s Community Health Workers also train community members at Parent Teacher Association meetings and school events to get healthy thinking out of the school hallways and into homes across the districts.

Path to Get There. After providing behavioral health services for a diverse community for more than 45 years, Valle del Sol became an FQHC in 2014. Over time, President and CEO Kurt Sheppard and his team realized that their behavioral health patients were dying 20-25 years younger than those without behavioral needs due to co-existing physical health conditions and unmet primary care needs. “We felt we owed better to the folks we were serving in our community, so that’s why we sought FQHC status,” Mr. Sheppard shared. As Mr. Sheppard explains, their expanded mission of community outreach has long included working in schools because they wanted to “bring services to those who need it most, right where they are.”

That outreach is part of what makes Valle del Sol such a known and trusted part of the community. In 2015 when school districts’ funding for nurses decreased, those schools reached out to Valle del Sol to oversee the health services. Teachers started off skeptical, since other organizations have tried “family-centric models in the past, with less than ideal results,” Mr. Sheppard explained. “But our team added elements that didn’t exist in prior models.”

As Valle del Sol started services, it worked carefully to bring families and students to the table, and also offered informal training around behavioral health to teachers. These strategies to work with all the stakeholders increased community buy-in to the program. The success was clear in the cultural shift and growing support inside the school. Its work has since expanded out of that initial need, growing in large part through word of mouth between districts.

But Valle del Sol didn’t stop at clinical work. The FQHC aims not just to increase health outcomes, but to truly empower the community. As managed care has become more prevalent, they’ve focused more on Medicaid enrollment and re-enrollment, ensuring community members have access to the care they need. Through its Connect2Lead program, Valle del Sol helps young people advocate for themselves, giving them both everyday life skills and important knowledge about their own health.”

On the Horizon. Through outreach and a focus on community empowerment, Valle del Sol has been able to expand their reach, magnify their impact, and support students and families. They hope to build upon this foundation in the future, adding primary health services, growing the school nurses’ training program, and possibly establishing a school-based health center. “The future of care isn’t in these big beautiful buildings,” Sheppard sums up, “It’s taking the services and the care to where people live, where they work, making sure they have access. It’s creating a community of care.”