Service Guidelines

Definition“A school-based health center (Center) is a primary care program offering medical, mental health, substance abuse treatment and health promotion and disease prevention services in a school building, where most children spend a great deal of time. The Center offers a comprehensive range of preventive and primary care services.”(Quality Standards)
Services School-Based Health Center (SBHC)
Medical Care
  • Well-child or adolescent exams (comprehensive health history, physical assessment, and screening procedures); immunizations; Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program;
  • Services as specified by the Guidelines for Adolescent Preventive Services (GAPS) prepared by the American Medical Association; as appropriate;
  • Diagnosis and treatment of acute illness and injury;
  • Prescribing and/or dispensing commonly used medications for identified health conditions;
  • Individual health education and anticipatory guidance for students and parents;
  • Acute management and on-going monitoring of chronic conditions, in conjunction with a student’s regular doctor, such as asthma, diabetes, and seizure disorder;
  • Individual health education and anticipatory guidance for students and parents.
Mental Health
  • Mental health assessment;
  • Individual, group, and family counseling;
  • Consultation with school administrators, parents, teachers, and students.
Laboratory Testing
  • Basic public health laboratory tests, including pregnancy tests.
Reproductive Health Care
Based upon local planning, if offered, may include any or all of the following:

  • Information on human sexuality with an emphasis on abstinence;
  • Pelvic exams;
  • Diagnosis and treatment of sexually transmitted diseases;
  • Testing and counseling for HIV/AIDS;
  • Prescribing, dispensing, or referring for birth control, including condoms.
Drug and Alcohol If offered:

  • Assessment of student substance abuse problems;
  • Prevention, intervention, and treatment services.
Other Services
  • Specific to adolescents: treatment of acne, weight management, and other common adolescent concerns.
  • Violence prevention and intervention services utilizing assessment and direct counseling.


Operating Guidelines

Operating Guidelines School-Based Health Center (SBHC)
Facility Requirements
  • 1,500 to 2,000 square feet is recommended per 700 students;
  • Must be accessible to individuals with disabilities and conform to the Americans with Disabilities Act requirements;
  • Private examination and treatment room(s) with sinks;
  • Adequate waiting and reception areas;
  • Counseling room(s);
  • Bathroom(s);
  • Secure storage area(s) for pharmaceuticals and center health records;
  • Laboratory space, and utility area;
  • Center adheres to OSHA guidelines re: environmental sanitation, cleaning and sterilization equipment and supplies, and the disposal of hazardous and medical waste;
  • Center complies with laws and regulations regarding:- Reportable diseases and conditions and employee health policies;
    – CLIA regulations for laboratory operations;
  • Center is equipped with sufficient computer, telephone, photocopy, and fax capabilities;
  • Translation services are required for major populations served.
Staffing Requirements
  • Staff should be educated in cultural diversity;
  • Staff must be licensed, registered, and/or certified health professionals;
  • Staffing may include but is not limited to nurse practitioners, physician assistants, nurses, mental health providers, and physicians, who are educated and experienced in community and school health, and who have a knowledge of health promotion and disease prevention strategies for children and adolescents.
Health Care Access
  • Services should be accessible either on-site or through formal referral;
  • Schedule should include before or after school hours at least one day a week;
  • Appointments are convenient and appropriate to medical situation(s):- Emergency appointments are immediate;
    – Urgent appointments are scheduled same day or following day after request;
    – Non-urgent appointments offered within seven calendar days or referred to a more readily available provider;
  • 24-hour access to medical, mental health, and social services when Center is closed;
  • Parental consent must be given before a student receives primary care services from SBHC.
Quality Management and Improvement Requires a Quality Management and Improvement program that monitors and evaluates the appropriateness and effectiveness of the services provided.

  • Quality Management and Improvement program is consistent with NCQA guidelines and of the sponsoring agency regarding the following:- Data collected on student demographics, service utilization, diagnosis, and health status;
    – Center monitors and evaluates a minimum of two preventive services (e.g., immunizations, nutrition, weight, sexually transmitted diseases, etc.) to improve the use of preventive services and health outcomes for students;
    – Health record system established that is consistent and confidential;
    – Credentialing, confidentiality, and grievance policies and procedures.

Targeting Guidelines

Targeting Criteria School-Based Health Center (SBHC)
School and Community Support
  • Planning and program involvement by parents, health professionals, community leaders and educators.
Student Need
  • Free or reduced cost school lunch enrollment;
  • Population/primary care physician ratio;
  • Morbidity/mortality rates of target population;
  • Health status indicators (i.e., tobacco use, physical activity levels, obesity, STD rates);
  • Income and welfare assistance data, unemployment data;
  • Numbers of uninsured students in schools.
Sustainable Programs
  • Size of school population sufficient to generate adequate demand and volume;
  • Capacity of sponsoring organization;
  • Adequate funding sources.



Colorado Department of Public Health and Environment. Quality Standards for Colorado

School-Based Health Centers. Denver: Colorado Department of Public Health and

Environment, May 1, 1996. Third Draft

Colorado Department of Public Health and Environment. Summary Sheet: Application

Package: School-Based Health Center (SBHC) Planning Grants (Colorado RFP).

Denver: Colorado Department of Public Health and Environment, 1996.

Colorado’s School-Based Health Centers: Rationale, Current Capacity, and Goals for

Future Expansion. Presentation for the Making the Grade site visit to the Colorado

School-Based Health Center Initiative, February 27, 1997.

Primary sources for quality standards include: National Committee for Quality

Assurance’s (NCQA) Accreditation Standards; Massachusetts Department of Public

Health’s School-Based Health Center Quality Standards; Colorado Department of

Public Health and Environment’s Application Package for Assisted Planning for

School- Based Health Centers; New York Department of Health’s Standards for

School- Based Health Centers; and Minnesota HealthPartners’ School-Based Health

Center Medical Policy for Prepaid Medical Assistance in Ramsey County.