Making the Grade: State and Local Partnerships to Establish School-Based Health Centers

An RWJF National Program

Field of Work: Expanding comprehensive school-based health services for children and adolescents.

Problem Synopsis: Among the 41 million people without health insurance in the United States are millions of school-age children, and multiple barriers keep many additional children who are insured from getting the care and preventive health services they need. To deliver vital care, the health system needs access to children and adolescents, who spend much of their time in schools.

Synopsis of the Work: Making the Grade: State and Local Partnerships to Establish School-Based Health Centers (operational from 1994 to 2001) helped funded states and their local partners establish new school-based health centers (SBHCs) and promote policies to sustain the centers over the long term.

Key Results

  • According to the national program office, Making the Grade:

    • Helped expand the total number of school-based health centers in the funded states from 278 in 1994 to 442 in 2000, an increase of 59 percent.
    • Brought about more stable state financing, primarily from state general funds.
    • Stimulated more favorable state policies, including expanding centers' eligibility to participate in Medicaid and managed care programs.
    • Strengthened quality improvement practices in SBHCs and created a specialized continuous quality improvement tool.
    • Established the comprehensive SBHC model as the gold standard for school-based health care.
    • Helped launch the National Assembly on School-Based Health Care, with state chapters in eight Making the Grade states and many others.

Evaluation Findings

  • The Barents Group of KPMG Consulting in Washington conducted an evaluation of the program. Among its key findings:

    • School-based health centers have become an established, permanent and respected part of the publicly supported health system infrastructure.
    • Although school-based health centers have not achieved widespread penetration through the public school systems of this country, there is continued momentum toward program growth, even in states nurturing new and fragile programs.
    • School-based health centers need mixed financing strategies involving federal, state and local sources in both the private and public sectors.
    • The political environment and political support for school-based health centers are of fundamental importance to the long-run sustainability of SBHCs.