School-Based Health Centers – Effectiveness
The Picture of Health: State and Community Leaders on School-Based Health Care


Kids Need More Health Care

Children generally are the picture of health. And when they do become sick or are injured, most children also have access to a health care professional. However, too many children in the United States, particularly children from poor families, are at risk for multiple health problems. For example, poor children may experience two-to-three times the usual incidence for certain medical conditions, many of which are preventable. The most common health problems affecting children today include injuries, chronic illnesses such as asthma, and mental health problems. In addition, kids are engaging more frequently in risky behaviors that may lead to health problems, including smoking, binge drinking, and unsafe sex.

The number of children at risk for poor health has increased as children have lost access to care because their parents have lost their health insurance. Currently, about 16 percent, or 11 million, of America’s children are uninsured. Even for children who do have health insurance, barriers to care exist. For example, parents may be unable to miss work to take their child to see a doctor. And in many low-income communities, health care facilities are few and often inadequate.

The national, state, and community leaders whose thoughts are captured on these pages believe school-based health centers to be part of the solution to these problems. They represent countless leaders across the country who have committed energy and resources to “making it happen.”

Today’s children and adolescents face more complicated problems than previous generations. This is clear to me from the letters I receive from teenagers who are struggling, often alone, with problems they shouldn’t have to face. School-based health centers can help these kids by providing medical care so they can remain physically fit and mentally healthy.”

Ann Landers, Syndicated Columnist

We tend to think of adolescence as the healthiest time of life, but the shocking fact is in my professional lifetime the health of every age group of American society has improved except for teenagersŠ When I was Surgeon General, many of the public health issues I dealt with – smoking, AIDS, alcohol, pregnancy, depression – had an alarming adolescent dimension. . .We need to start thinking of health and education as interlocking spheres. After all, isn’t school the best place for a primary health care facility – available, convenient, confidential, and responsive not only to the adolescent, but to the family?”

C. Everett Koop, M.D., Former U.S. Surgeon General

The fact that 40 percent of children in this nation do not receive preventive health care services is indicative of so much that is wrong with our health care system. We are missing so many opportunities to improve the nation’s health. It can be such a simple thing. We need to begin interventions before families start to break down. We need to actively reach out to kids and teach them that they can help themselves. We need to offer culturally appropriate services that build on the strengths of children and their families. If implemented appropriately, school-based health centers offer a logical place to undertake these activities.”

T. Berry Brazelton, M.D., Pediatrician and Author

Families and Communities are Making it Happen

Over the last two decades, communities across the country have created school-based health centers in response to troubling statistics on children’s health status. From Portland, Maine to Portland, Oregon, local leaders representing diverse interests have forged alliances to improve access to comprehensive health care services for school-age children. Numbering less than 50 in the early 1980s, school-based health centers are now operating in more than 900 schools around the nation. They are found in all types of schools – elementary and secondary; rural, urban, and suburban. They are organized by a variety of sponsors – hospitals, community health centers, school districts, and public health departments. And they are supported by diverse community organizations.

When the school-based health center opened at Central High, I was right there on the advisory board to make sure parents’ concerns were listened to. And we got students involved as advisors too. It’s been a great success and a real relief to me. Knowing the staff is there helps me accept my child’s growing independence.”

Terri Vega, Parent and President, Central High School PTA, Bridgeport, Connecticut

As chair of the newly formed Baltimore City Advisory Board for School-Based Health Centers, I am delighted to participate in this significant effort. The centers are instrumental in helping children stay in school and be successful in their education. And that’s good for the community.”

Andy Tomko, Business Information Systems Project, Baltimore Gas and Electric Company

When Cabrini opened its first school-based health center in 1995 at Northwood K-12 school, 98 percent of the parents gave permission for their children to be treated there. The school board and principal were extremely supportive. It was a perfect example of how a private-public partnership can benefit the community. Our experience at Northwood has confirmed our belief in school-based health centers. That is why we’re opening three more in central Louisiana.”

Sister Olive Bordelon, President & CEO, St. Frances Cabrini Hospital, Alexandria, Louisiana

After proving that the school-based health centers were needed, we gained strong support from both the school board and school district. Today, there are 11 school-based health centers in Multnomah County. And of the $3.2 million annual budget that supports the centers, $2.5 million is supplied by the county. School-based health centers have really made a big difference in the lives of our kids.”

Gretchen Miller Kafoury, City Commissioner, Portland, Oregon; Former County Commissioner, Multnomah County, Oregon

Community development corporations are about building healthy communities – which start with healthy people. With four in ten of our neighborhood residents living without medical insurance, we realized we had a community at risk. By offering health services in our middle school, we are able to prevent many long-term health problems – and the costs associated with them.”

Don Softley, Director, Island View Village Development Corp., Detroit, Michigan

It takes collaboration and commitment to build a school-based health center program. We have eight centers in Denver and many more schools want to participate. Because five organizations put aside turf issues, we’ve been able to help children in ways never possible before.”

Roberto Quiroz, CEO, Mental Health Corporation of Denver, and Chair, Denver School-Based Health Center Coordinating Council

States are Making it Happen

The rapid increase in the number of school-based health centers over the last decade is due in great part to the interest of state governments. Many states have adopted policies that recognize the value of school-based health centers in meeting the health care needs of school-age children. In 1996, for example, 34 states provided financial support to school-based health centers through state revenues and federal block grant funds. In addition, Medicaid offices in a number of states have established reimbursement policies that facilitate payment for services provided by the centers. And 21 states have created special offices to provide technical assistance to communities that are establishing school-based health centers.

When we began encouraging managed care organizations to contract with school-based health centers, they asked for some assurances that school-based health centers’ standards of care match their own. So we developed quality standards on a whole range of issues for school-based health centers. The state Medicaid office has been quite supportive of our efforts, and a number of HMOs have negotiated contracts. We continue to meet with school-based health center and managed care representatives every month to keep improving the system.”

Anne Sheetz, Director of School Health, Massachusetts Department of Health

School-based health centers are a key component in New York’s efforts to improve the health of children and families. Approximately 150,000 New York children rely on school-based health centers for primary health care needs. These centers provide students with immediate access to comprehensive services to address critical health and mental health problems.”

Governor George Pataki, State of New York

School-based health centers provide a comfortable setting for kids, and there’s no traveling involved. They’re a very sensible idea. In designing Maryland’s Medicaid managed care program, we made sure that school-based health centers will be eligible for Medicaid and that managed care organizations cannot refuse to contract with them.”

Rep. Marilyn Goldwater, Maryland House of Representatives

West Virginia offers managed care plans an increased capitation rate if they contract with public providers, including school-based health centers. We’re trying to enhance support for public providers to make sure they maintain their critical role in taking health care beyond the doctor’s office.”

Henry G. Taylor, MD, MPH, Commissioner, West Virginia Bureau for Public Health

I‘m very excited about what we’re doing with school-based health centers in Umatilla County. So many of the children we saw in Juvenile Court came from dysfunctional families, and their needs for health care were all too apparent. With the availability of school-based health centers, they have the opportunity to secure at least basic care. Some of our problem children might even stay in school to take advantage of the health care.”

Robert B. Abrams, Retired Juvenile Judge, Circuit Court of Oregon

The Louisiana legislature was debating a $2.65 million direct allocation to schools that had been recommended for school-based health centers. I was very involved in encouraging the governor not to veto this legislation, and he was very willing to consider the facts. I believe that providing health care to students who would not otherwise have an opportunity to receive care is critical.”

Senator Jay Dardenne, Louisiana State Legislature

Health Care Providers are Making it Happen

School-based health centers are staffed by a multi-disciplinary team of health care professionals, each of whom can address a broad range of problems. The full-time staff typically includes a nurse practitioner or physician assistant, a medical assistant, a social worker, and administrative personnel. In addition, a part-time pediatrician or family practitioner may be augmented by a part-time nutritionist, dental hygienist, substance abuse counselor, or conflict resolution counselor.

This team is responsible not only for providing medical and mental health services, but also for coordinating care with students’ personal physicians and/or managed care plans; serving as liaisons between parents, teachers, and students; acting as community advocates for children; conducting health promotion activities at school and in the community; and much more. As school-based providers, they have assumed responsibility for the overall well-being of their patients – a much broader role than is typical of most health care practitioners.

More than one-third of the problems that students bring to school-based health centers are related to mental health. Prevention and early intervention for these problems are critical to helping students become successful learners. The centers provide continuity of care and coordination of a full range of services. School administrators, teachers, counselors, social workers, nurses, and other professionals work in concert with community providers to make sure students get the best possible care.”

Steve Adelsheim, MD, Director of School Mental Health Initiative, New Mexico Department of Health

School-based health centers are an important way for managed care organizations to reach teens. Kaiser has helped support two school-based health centers in the Denver area, and now we’re looking at a third. In a study of how adolescents used school-based health centers, we learned that our teens with access to the school-based health centers used emergency rooms and other hospital services less than those who did not have access to the school services.”

Maureen Hanrahan, Director of Community Medicine, Kaiser Permanente, Colorado Region

With a 27-year career in school nursing, I have seen many missed opportunities for preventive health: hearing problems were detected but kids weren’t getting treatment; asthmatics without access to a physician used the emergency room rather than get preventive services. We created the Sunshine Health Center in a large middle school to improve our students’ health regardless of their ability to pay for care.”

Phyllis F. Bricker, RN, BSN, Certified School Nurse, Supervisor of Medical Services, Portsmouth City Schools, Portsmouth, Virginia

I serve on the advisory board for the Asheville High School health center. To my knowledge, there’s been no concern among local doctors about the center’s effect on access to patients or referrals. First, the health of these kids is significantly enhanced by school-based health care. Second, the clinic’s discovery of complicated illnesses and problems and the referral of those problems to community physicians mean there is a partnership in care. And, third, these kids were not being seen by any health care provider so it’s not like the doctors are losing anything.”

Olson Huff, MD, President, North Carolina Chapter, American Academy of Pediatrics

Our school-based health center provides an invaluable service to a lot of kids who would not otherwise have access to health care. We provide medical care, but we also provide treatment for mental health problems. This includes counseling for family problems, abuse, and behavioral issues. The students really appreciate the care they receive and they keep coming back.”

Stacy Bower, CNP, Nurse Practitioner, San Fernando High School, California


Educators are Making it Happen

Thirty years ago, pioneering educators and health professionals began to team up to develop new ways to help students overcome the health and social problems that create barriers to learning. One innovation that emerged from these education/health partnerships is the school-based health center. Working with teachers, school administrators, and, if they are on staff, school nurses and counselors, the centers are helping students remain healthy so that they stay in school and learn to become productive members of their community. This is why school faculty and staff account for more than half of all patient referrals to school-based health centers.

From an educator’s perspective, it’s important for schools to be concerned with a child’s health because healthy children are more effective learners. For parents, it is very reassuring to know that their local school is concerned not only with reading and writing, but is also looking out for their child’s health and well-being. In my school district, there are now 12 school-based health centers serving approximately 9,800 students.”

William Casey, Superintendent, Community School District 15, Brooklyn, New York

Our school-based health center is one of the things that I’ve been most excited about in 33 years of teaching. This is something that is changing lives. I became involved with the center a few years ago as a volunteer, doing office work or whatever was needed. Now, I teach parenting classes at the clinic two nights a week. We’re helping parents to teach their children to be responsible.”

Carolyn Brooks, First Grade Teacher, Edwin J. Kiest Elementary School, Dallas, Texas

Our Wellness Center offers a variety of beneficial services to students. Preventive health programs are cost-effective, especially at the community level.”

Margaret Sparks, Guidance Counselor, Lake Forest High School, Felton, Delaware

In 1986, when the Dade County school board approved the opening of a health center in a high school, it was so controversial that our school board auditorium was searched for bombs on the day we took our final vote. Despite the controversy, the health center was successful and we now have health centers in 11 Dade County schools. School-based health care is so established that private companies and public agencies throughout the county see this as a way to make a positive impact on their community.”

Janet McAliley, School Board Member, Dade County, Florida

Our school asked the city and a local hospital to join us in an unprecedented partnership to create a school-based health center. Our success has come from the willingness of all of the partners to lend resources and expertise – particularly the hospital, which has taken responsibility for almost all of the health center’s medical providers and makes sure they become part of the hospital family.”

Jason Edgecombe, Assistant to the Superintendent, Evanston Township High School, Evanston, Illinois

For more information, please contact:

Making the Grade
The School of Public Health and Health Services
The George Washington University
1350 Connecticut Avenue, NW #505
Washington, DC 20036

Phone: 202-466-3396
Fax: 202-466-3467