School-Based Health Centers: Impact Beyond the Clinic Walls

Nov 2, 2012, 10:48 AM

file Scene from a California School Health Centers Association clinic

The use of school-based health services has gained momentum and recognition across the United States as a unique tool in the fight to prevent poor outcomes in both health and education, especially among vulnerable populations. When last surveyed in 2008, the number of school-based or school-linked health clinics in the U.S. had surpassed 1,900. Recently, the federal government has acknowledged their potential, too, creating a distinct grant program for school-based health centers as part of ACA and recognizing them as providers in the Children’s Health Insurance Program Reauthorization Act. [Read more on school-based health center policy developments.]

The typical school-based health center (SBHC) provides free or low-cost basic physical and mental health services, and sometimes oral and vision care. They’ve been shown to reduce asthma-related ER visits and hospitalization costs; reach greater numbers of racial minorities, especially young men; and increase the likelihood by 10 to 20 times that a student uses mental health services. But, the conversation at the American Public Health Association annual meetings was focused on the unique effects these centers are having on students and communities beyond the clinic walls.

Youth Successfully Influencing Their Peers

One session on youth as public health champions covered how receiving services directly on campus involves youth in their own health and the health of their peers in a powerful way. Kathleen Gutierrez from the California School Health Centers Association highlighted innovative ways in which California’s SBHCs are utilizing youth as messengers. 

  • Students in Tulare County, home to California’s highest teen pregnancy rate, are acting as “promotoras” by teaching peers how to practice safe sex in an accessible way.
  • In San Francisco Unified School District, students successfully advocated for a change to laws limiting the education that minors receive about their consent rights.

Gutierrez also shared examples of how care becomes more accessible and frequently used by students when they have a say in how it’s delivered – something that many SBHCs encourage.

  • At Life Academy High School in Oakland, interested students learned basic survey methods, and then polled their peers on what would make them more likely to use the SBHC. The center learned from the survey, among other things, that its appointment-only policy discouraged students from coming in to ask simple health questions and that its condom supply would be used if they simply changed to the brand that students saw advertised everywhere.
  • A Richmond high school plagued by youth violence had tried to make mental health a priority by using more social workers, but students informed them they were doing it wrong. Students recommended more socializing with the social workers at the beginning of the year, so that the first time they met one another wasn’t when the youth had just experienced a traumatic event and lacked trust.

[Find examples of what other innovative California SBHCs are doing from the California School Health Centers Association.]

At the same session, Dale Maglalang, a young man on the Youth Board of the California School Health Centers Association applauded SBHCs for seeding inspiration and good health behaviors among youth of color like him early in life. Through his SBHC, he gained community outreach and leadership experience and access to mentors, which inspired him to stay involved in health advocacy work, a field short on young men of color. Maglalang also noted that his health center’s yoga and other wellness activities introduced many students to a holistic understanding of health that will stay with them as adults.

Encouraging Lifelong Health and Success

In another session, Dr. Terri Wright of the Center for School, Health and Education noted that SBHCs also introduce important, basic health habits, like regular preventative check-ups, at an age when young people are forming the behaviors they carry into adulthood. Reinforcing and supporting those behaviors is especially important among vulnerable populations who historically do not access preventative care.

Dr. Wright’s session focused on another key effect that SBHCs could have on students and school climate: improved educational achievement and decreased dropout rates. Wright and her colleague Leslie Sessom-Parks noted that, although SBHCs force the health and education sectors to collaborate to an extent, they would both benefit from a much stronger partnership. They emphasized the special ability that SBHCs have to identify and address social determinants of health, whose causes and effects often bleed between the clinic and the classroom.

Wright presented some early but promising data about the potential that SBHCs have to stem the dropout crisis. One study showed that SBHCs decrease absenteeism by 50 percent and make black males three times more likely to stay in school. She suggested that part of their success comes from the unique ways in which SBHCs can use risk assessment tools early on in students’ lives and act on those indicators in a multifaceted way. Wright concluded her session by asking the audience to imagine the vast effects SBHCs could have if educators were to actually use them in an intentional, deliberate way.

>>Dive into the Center for School, Health and Education’s research and resources on the intersection of SBHCs and dropout prevention.

This commentary originally appeared on the RWJF New Public Health blog.