School-Based Health Centers

Since the early 1980s, in collaboration with the Robert Wood Johnson Foundation (RWJF), CHHCS has contributed to the development of the school-based health center model of prevention and care for students in k – 12 schools. In its earlier work the Center was known as the School-Based Adolescent Health Care Program National Program Office (1987 – 1992) and the Making the Grade National Program Office (1993 – 2000).

  • Through a multi-site demonstration grant program, The School-Based Adolescent Health Care Program, the national program office staff provided technical support, assessed project data and published the findings and insights on school-based health centers (SBHCs). See: Lear JG, Gleicher HB, St. Germaine A, Porter PJ. Reorganizing Health Care for Adolescents: The Experience of the School-based Adolescent Health Care Program, J Adolescent Health 1991; 12:450-458. Lear JG. Building a Health/Education Partnership: The role of school-based health center. Pediatric Nurs. 1992; 18(2):172-173. Juszczak L, Fisher M, Lear J, Friedman S. Back to School: Training Opportunities in School-Based Health Centers, Dev and Behavioral Pediatrics. 1995; 16(2): 101-104.
  • In a second SBHC multi-site grant initiative – Making the Grade: State and Local Partnerships to Establish School-Based Health Centers, with the support from RWJF, CHHCS staff collaborated with leadership in 9 states to build policy frameworks to support expansion of the SBHC model. See: Lear JG. Health Care Goes to School: An Untidy Strategy to Improve the Well-Being of School-Age Children, in Social Policies for Children, Washington, DC: The Brookings Institution, 1996. Lear JG, Montgomery L, Schlitt J, Rickett K. Key Issues Affecting School-Based health Centers and Medicaid, J School Health. 1996; 66 (3):83-87. Koppelman J and Lear JG. “The New Child Health Insurance Expansions: How will school-based health centers fit in? J of School Health. 1998; 68(10): 441-446.
  • In the final multi-grant initiative that focused exclusively on school-based health centers – Caring for Kids: Expanding Dental and Mental Health Services Through School-Based Health Centers – CHHCS provided support to 8 SBHCs that focused on strengthening their mental health programs and to 7 SBHCs that added or expanded oral health programs.
    See: Dental and Mental Health Programs in School-Based Health Centers: A snapshot from the Caring for Kids grant initiative, 2005 presentations.

School nursing

As the school-based health center initiatives evolved, CHHCS began to deepen its work with other school health programs, particularly school nursing and school mental health. The Center’s initial focus on a more comprehensive view of school health took the form of historical reviews in journal articles and presentations, for example: Lear JG. School-based services and adolescent health: Past present and future, Health Care in Schools, Adolescent Medicine: State of the Art Reviews (AM:STARS) June 1996. Other publications include: Robinson V, Lear JG, Eichner N. School Nurses, School-Based Health Centers and Childhood Overweight: A report from the Center for Health and Health Care in Schools & Center for and Health Care in Schools – Medication Management in Schools: A System Approach to Reducing Risk and Strengthening Quality in School Medication Management.

School-Connected Mental Health Programs to Support Immigrant and Refugee Youth

With support from RWJF, 15 sites across the U.S. developed model mental health programs that engage schools, families, students, mental health agencies and other community organizations to build effective, easily-accessed services for children and youth. Over a four-year period (2006 – 2010), the 15 grantees as well as other colleagues in the field developed a number of resources to help other schools and their communities develop a culturally competent and accessible school community.
Stories describing individual case studies available here.

Mental Health Programs for K – 12 Schools

Growing recognition of the importance of school programs and staff in promoting positive behaviors and emotional well-being in students has generated a growing body of work on school-connected behavioral health care. An annotated bibliography of current research linking behavioral health interventions with students’ educational outcomes is located here, and a December 2008 report reviewing the history of school mental health in the District of Columbia and identifying best and promising practices in program development, professional training, and financing strategies in other states and localities is available here. In Fall 2011, the Center convened national experts to discuss the status of efforts to integrate health and education systems around school-connected behavioral health-promoting efforts. Findings from the culminating project, the Thought-Leaders Forum are found here.

School-Connected Oral Health Programs

In addition to its oral health work through the Caring for Kids initiative, in 2009-2010, CHHCS assisted the Health Resources and Services Administration (HRSA) and RWJF in organizing a conference of oral health experts, state and federal dental officials, school-based and school-linked health center leaders to identify essential components of a school-connected oral health care demonstration project. The Center developed a proceedings document to be used in informing key audiences at Health Resources and Services Administration (HRSA) and the RWJF school based health center oral health demonstration grant.

As follow-up to the HRSA conference, CHHCS conducted a literature review of school-based oral health and interviewed 25 key informants (state and federal policy makers, workforce experts, foundation officials, university-based educators, and researchers) interested in children’s oral health and in school-based health care. Findings from the interviews were published in November 2011. D Behrens, JG Lear. Strengthening children’s oral health: Views from the field. Health Affairs, 30 (11); 2011: 2208-2213.

Other publications from CHHCS

1. D Behrens and JG Lear. Strengthening Children’s Oral Health: Views from the Field. Health Affairs 2011:30(11): 2208-2213.
2. JG Lear. Astoria Revisited: New Hope in the Struggle to Link Community- and School-Based Care? Archives of Pediatrics and Adolescent Health, March 2011, Vol. 165, No. 3, pp. 279-281.
3. JG Lear, EA Barnwell, D Behrens. Health-Care Reform and School-Based Health Care. Public Health Reports 2008:123, No. 6, pp 704 – 709.
4. JG Lear. “Health at School: A Hidden Health Care System Emerges from the Shadows.” Health Affairs 2007:26, No. 2, pp 409 – 420.
5. Price OA , Lear JG. School Mental Health Services for the 21st Century: Lessons from the District of Columbia School Mental Health Program. Center for Health and Health Care in Schools, George Washington University, December 2008.
6. JG Lear. “Schools and adolescent health: Strengthening services and improving outcomes.” Journal of Adolescent Health. Supplement to Vol. 31, No. 6: 310-320. December 2002.
7. JG Lear. “School-Based Health Centers: A long road to travel.” Archives of Pediatrics and Adolescent Health. February 2003, Vol 157:118-119.
8. JG Lear, N Eichner, J Koppelman, “The growth of school-based health centers and the role of state policies: results of a national survey.” Archives of Pediatrics and Adolescent Health, November, 1999, Vol. 153, No. 11, pp 1154-1159.
9. JG Lear. Children’s Health and Children’s Schools: A collaborative approach to strengthening children’s well-being. In Children’s Health at School. Eds. James Knickman and Steven Isaacs. Jossey-Bass. March 2006.