Current Problems in Pediatric and Adolescent Health Care
School-Based Health Centers in an Era of Health Care Reform: Building on History
Section snippets
Historical Background
The origins of school-based health can actually be traced back to the early 1900s with the public health nursing movement.1, 11 At that time, student absenteeism rates because of communicable disease, such as measles, scarlet fever, whooping cough, and tuberculosis, were high.11 In an attempt to contain contagious illnesses, the Board of Health in New York City instituted a “rule of exclusion” in schools, sending home any child with a contagious disease—but without any treatment or plan of
Meeting the Needs of Underserved Populations
SBHCs are well positioned to address the unmet physical and mental health needs of underserved youth populations by increasing accessibility and continuity of health care directly on the school campus.
SBHCs and Health and Social Outcomes
SBHCs have been found to impact a variety of health and social outcomes. A summary of the literature demonstrating these impacts is provided in the following text.
Supporting the Larger School Environment
The scope of SBHC services expands beyond the provision of individual client health-related services to reach the broader school community. For example, SBHC staff deliver health education curricula in classrooms; conduct health fairs for students, staff, and parents; serve on educational committees; and provide consultations to teachers and other school staff to support and address students' needs in their classrooms.
The relationship between emotional or behavioral dysfunction and poor
Providing Meaningful Opportunities for Youth Participation
In addition to their health and academic impacts, SBHCs provide opportunities to expose youth to projects that promote healthy development and empowerment. The concept of youth development has been defined as “the ongoing growth process in which all youth are engaged in attempting to: (1) meet their basic personal and social needs to be safe, feel cared for, be valued, be useful, and be spiritually grounded, and(2) to build skills and competencies that allow them to function and contribute in
Serving Students' Families, School Staff, and Community Members
More than two-thirds of SBHCs nationwide reported providing services to individuals beyond the student population at the schools in which they are located.3 These individuals include students from other schools in the community (58%); out-of-school youth (34%); faculty and school personnel (42%); family members of students (42%), and other community members (24%).3 Recently, the number of SBHCs that serve nonstudent populations nationwide has increased. Contributing factors may include
Evaluation and Quality Improvement
SBHC evaluation and quality improvement efforts have helped to refine and advance this model of care, although these areas can benefit from further attention as the model expands.
SBHC Financing and Sustainability
To consider how the SBHC model could be brought to “scale” and potentially play a more important role in schools across the country, 2 important factors must be acknowledged: costs associated with establishing and operating the model and fiscal sustainability.
Policy/Advocacy and Health Care Reform
Historically, most advocacy efforts for SBHCs have materialized on the state level. Over the past 20 years, the number of state SBHC initiatives has increased from 5 to 19.22 These initiatives are often characterized by state health departments establishing SBHC programs within their departments, as well as allocating funding to and authorizing legislation for SBHCs. As mentioned previously, state initiatives played a significant role in the expansion of SBHCs by securing state funding,
Implications and Future Directions
This article has provided an overview of the documented role of SBHCs in improving health and social outcomes and their promise in making a contribution to reducing health inequities. Throughout the country, SBHCs are a key strategic partner in providing critical access to health care for youth. In summary, there are several implications for the future of SBHCs in the current era of health care reform, as well as implications for health care providers who may be delivering care in communities
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Cited by (0)
This research was supported in part by grants from the Maternal and Child Health Bureau, Health Resources and Services Administration, and the United States Department of Health and Human Services (U45MC00002 and U45MC 00023). The authors would like to also acknowledge Serena Clayton, PhD, Executive director, California School Health Centers Association; Sara Geierstanger, MPH, Senior researcher, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco; and Linda Juszczak, DNSc, MPH, MS, CPN, Executive director, National Assembly on School-Based Health Care, for their contributions and support.