The “State of the State” of School-Based Health Centers

For more than 40 years, there has been national interest in the school-based health center (SBHC) model and its ability to create linkages between health, both physical and mental, and education systems to help ensure that students are healthy and ready to learn, achieving both health and educational milestones. Although there is great variation across the country, often reflecting community need and resources, SBHCs generally share common elements, including location on or inside of school groups, the delivery of comprehensive services often provided by a nurse practitioner or physician assistant and enhanced by a multidisciplinary team, and integration with the mission and activities of the school community. Though they represent a relatively small number of clinics, approximately 2,300 across the country, their growth and scope of activities have been followed closely by different stakeholders, accompanied by a high level of interest in what they accomplish, particularly in the area of prevention and early intervention. It is a “double-edged sword” that SBHCs’ placement in schools has resulted in their higher burden of proof, being held to a far greater expectation that they demonstrate their effectiveness both in terms of health and educational outcomes. As a result, clinics have often been examined under a far stronger lens of accountability, as compared with traditional pediatric and primary care programs. This “high bar,” given the types of resources and the complexity of providing care in often low-resourced schools, has often contributed to the ongoing struggle to effectively tell their outcome “story” as well as having sufficient resources to keep the clinic doors open.