School-based health centers

School-based health centers (SBHCs) provide elementary, middle, and high school students a variety of health care services on school premises or at offsite centers linked to schools. Teams of nurses, nurse practitioners, and physicians often provide primary and preventive care and mental health care; reproductive health services may be offered in middle and high schools, as allowed by district policy and state law. Providers at SBHCs often manage chronic illnesses such as asthma, mental health conditions, and obesity. Most patients treated at SBHCs are children insured by Medicaid or children without insurance (CG-SBHC, Keeton 2012*). SBHCs are most common in urban areas and may be funded at the federal, state, or local level (SBHA-SBHC).

Expected Beneficial Outcomes (Rated)

  • Increased access to care

  • Improved health outcomes

  • Increased academic achievement

Other Potential Beneficial Outcomes

  • Improved quality of care

  • Reduced emergency room visits

  • Reduced hospital utilization

  • Increased vaccination

  • Reduced health care costs

Evidence of Effectiveness

There is strong evidence that school-based health centers (SBHCs) increase access to care (Bains 2016*, Mason-Jones 2012, Guo 2010a*, Wade 2008*, Kisker 1996*, Anyon 2013*, Albright 2016*), improve health outcomes (CG-SBHC, Kong 2013, McNall 2010*, Guo 2008), and increase academic achievement (CG-SBHC, Wade 2008*, Strolin-Goltzman 2014*, Walker 2010*) for participating children.

SBHCs are associated with improved quality of care (CG-SBHC, Riley 2016*), fewer emergency room visits, reduced hospital utilization (CG-SBHC, Guo 2005*), and increased immunization rates (CG-SBHC, Federico 2010*). SBHCs have been shown to improve students’ health behaviors including physical activity and consumption of healthy foods (McNall 2010*), and may reduce barriers to mental health services (Bains 2016*, Mason-Jones 2012, Guo 2008).

SBHCs have been shown to reduce absenteeism (Walker 2010*, Strunk 2008*), increase graduation rates, reduce dropout rates (CG-SBHC, Strunk 2008*), and increase students’ connectedness to school (Strolin-Goltzman 2014*). Children who receive mental health services at their school’s SBHC may have higher GPAs than peers who do not receive services (Walker 2010*). SBHCs that offer reproductive health services can reduce rates of teen pregnancy (NBER-Lovenheim 2016, Strunk 2008*) and improve educational outcomes for pregnant or parenting teens (Strunk 2008*).

SBHCs have been shown to increase access to care for minority students (CG-SBHC, Guo 2010a*), particularly black and Latino students (Anyon 2013*), students with disabilities (Guo 2010a*), and underserved urban youth (Kisker 1996*), and to reduce disparities in academic achievement (Kerns 2011*).

SBHCs have been shown to reduce health care costs, particularly costs to Medicaid (Guo 2010a*, Guo 2008, Wade 2010*) and costs from asthma-related hospitalizations (Guo 2010a*).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

As of 2016, there are 2,584 school-based health centers (SBHCs) in 48 states and Washington DC (SBHA-SBHC). Oregon, for example, operates a statewide network of SBHCs, with 68 certified SBHCs as of 2015. SBHCs have operated in Oregon since 1986 through partnerships between the Oregon Public Health Division, county public health departments, school districts, public and private practitioners, students, parents, and community members (OSBHA-SBHC report 2015). Hospitals may also create and manage SBHCs: Mount Sinai Hospital in New York City, for example, operates six adolescent SBHCs, caring for over 2,000 students each school year (MSH-SBHC).

Implementation Resources

SBHA-SBHC - School-Based Health Alliance (SBHA). The 2016-2017 National School-Based Health Care Census: School-based health centers (SBHC).

OSBHA - Oregon School-Based Health Alliance (OSBHA). Promote the health and academic success of children and youth through sustaining, strengthening, and expanding school-based health centers (SBHCs).

CASBHC - Colorado Association for School-Based Health Care (CASBHC). Managing a school-based health center: tools and models to create, manage, recruit providers, and maintain SBHCs.

Citations - Evidence

* Journal subscription may be required for access.

Bains 2016* - Bains RM, Diallo AF. Mental health services in school-based health centers: Systematic review. The Journal of School Nursing. 2016;32(1):8–19.

Mason-Jones 2012 - Mason-Jones AJ, Crisp C, Momberg M, et al. A systematic review of the role of school-based healthcare in adolescent sexual, reproductive, and mental health. Systematic Reviews. 2012;1:49.

Guo 2010a* - Guo JJ, Wade TJ, Pan W, Keller KN. School-based health centers: Cost-benefit analysis and impact on health care disparities. American Journal of Public Health. 2010;100(9):1617-1623.

Wade 2008* - Wade TJ, Mansour ME, Line K, Huentelman T, Keller KN. Improvements in health-related quality of life among school-based health center users in elementary and middle school. Ambulatory Pediatrics. 2008;8(4):241–249.

Kisker 1996* - Kisker EE, Brown RS. Do school-based health centers improve adolescents’ access to health care, health status, and risk-taking behavior? Journal of Adolescent Health. 1996;18(5):335–343.

Anyon 2013* - Anyon Y, Moore M, Horevitz E, et al. Health risks, race, and adolescents’ use of school-based health centers: Policy and service recommendations. The Journal of Behavioral Health Services & Research. 2013;40(4):457-468.

Albright 2016* - Albright K, Barnard J, O’Leary S, et al. School-based health centers as medical homes: Parents’ and adolescents’ perspectives. Academic Pediatrics. 2016;16(4):381-386.

CG-SBHC - The Guide to Community Preventive Services (The Community Guide). Health Equity: School-Based Health Centers (SBHC). 2015.

Kong 2013 - Kong S, Sussman AL, Yahne C, et al. School-based health center intervention improves body mass index in overweight and obese adolescents. Journal of Obesity. 2013;2013:Article ID 575026.

McNall 2010* - McNall MA, Lichty LF, Mavis B. The impact of school-based health centers on the health outcomes of middle school and high school students. American Journal of Public Health. 2010;100(9):1604-1610.

Guo 2008 - Guo JJ, Wade TJ, Keller KN. Impact of school-based health centers on students with mental health problems. Public Health Reports. 2008;123(6):768-780.

Strolin-Goltzman 2014* - Strolin-Goltzman J, Sisselman A, Melekis K, Auerbach C. Understanding the relationship between school-based health center use, school connection, and academic performance. Health & Social Work. 2014;39(2):83-91.

Walker 2010* - Walker SC, Kerns SEU, Lyon AR, Bruns EJ, Cosgrove TJ. Impact of school-based health center use on academic outcomes. Journal of Adolescent Health. 2010;46(3):251–257.

Riley 2016* - Riley M, Laurie AR, Plegue MA, Richardson CR. The adolescent “expanded medical home”: School-based health centers partner with a primary care clinic to improve population health and mitigate social determinants of health. The Journal of the American Board of Family Medicine. 2016;29(3):339-347.

Guo 2005* - Guo JJ, Jang R, Keller KN, et al. Impact of school-based health centers on children with asthma. Journal of Adolescent Health. 2005;37(4):266–274.

Federico 2010* - Federico SG, Abrams L, Everhart RM, Melinkovich P, Hambidge SJ. Addressing adolescent immunization disparities: A retrospective analysis of school-based health center immunization delivery. American Journal of Public Health. 2010;100(9):1630-1634.

Strunk 2008* - Strunk JA. The effect of school-based health clinics on teenage pregnancy and parenting outcomes: An integrated literature review. The Journal of School Nursing. 2008;24(1):13-20.

NBER-Lovenheim 2016 - Lovenheim M, Reback R, Wedenoja L. How does access to health care affect teen fertility and high school dropout rates? Evidence from school-based health centers. National Bureau of Economic Research (NBER). 2016: Working Paper 22030.

Kerns 2011* - Kerns SEU, Pullman MD, Walker SC, et al. Adolescent use of school-based health centers and high school dropout. Archives of Pediatrics & Adolescent Medicine. 2011;165(7):617-623.

Wade 2010* - Wade TJ, Guo JJ. Linking improvements in health-related quality of life to reductions in Medicaid costs among students who use school-based health centers. American Journal of Public Health. 2010;100(9):1611-1616.

Citations - Implementation Examples

* Journal subscription may be required for access.

SBHA-SBHC - School-Based Health Alliance (SBHA). The 2016-2017 National School-Based Health Care Census: School-based health centers (SBHC).

OSBHA-SBHC report 2015 - Oregon School-Based Health Alliance (OSBHA). A defining year: Expansion, partnerships, and evolution of school-based health centers (SBHCs) in Oregon. Oregon school-based health centers status report 2015. Oregon Health Authority, Public Health Division, School-Based Health Center Program. Oregon School-Based Health Centers.

MSH-SBHC - Mount Sinai Hospital (MSH). School-based health centers (SBHC).

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