ADVOCATES FOR YOUTH

The Facts

School-Based Health Centers

School-based health centers (SBHCs) provide comprehensive medical and mental health screening and treatment for young people at their schools. SBHCs are designed to overcome barriers that inhibit young people from getting needed health care, including lack of confidentiality or fear that confidentiality will not be maintained, transportation problems, fear that parents will be notified by insurer, inconvenient appointment times, costs, and apprehension about discussing personal health problems.

Expanding Numbers of SBHCs Meet the Health Care Needs of Young People.

• The first SBHC was established in 1970 in Dallas, Texas. By 1984, 31 SBHCs were operating in the United States. In 1997, 948 SBHCs were operating in 42 states.^1,2
• According to Advocates for Youth's most recent biennial survey, urban areas host 59.0 percent of responding SBHCs, rural areas host 27.9 percent, and suburban areas host 13.1 percent.¹
• The mid-Atlantic region hosts 67 SBHCs; the Northeast, 292; the Southeast, 160; South central United States, 126; the Midwest, 136; the Southwest and Hawaii, 103; the Rocky Mountain region, 27; and the Pacific Northwest, 37.¹
• Of responding SBHCs, 45.6 percent operate in secondary schools (grades seven through 12); 12.6 percent are in primary schools (grades pre-kindergarten through six); and 41.8 percent serve students in all grades or in some different combination of grades. Most (63.1 percent) serve only one school.¹
• All SBHCs have sponsors that have administrative and fiscal responsibility. Sponsors of responding SBHCs include local public health departments (29.1 percent), hospitals and medical centers (27.2 percent), and community health centers (17.1 percent).¹

SBHCs Offer a Wide Range of Health Services that Meet Many Needs of Youth.

• Responding SBHCs report visits in the following diagnostic categories: acute medical care, 32.4 percent; preventive care, 26.3; mental health, 17.1 percent; injury prevention, 6.7 percent; care for chronic conditions, 5.9 percent; dental, 2.4 percent; and all other, including reproductive health services, 7.6 percent.¹
• Among responding SBHCs, staff are primarily nurse practitioners supported by physicians, registered nurses, and clinical assistants.¹
• Almost all of responding SBHCs offer treatment for minor acute illnesses (96.8 percent) and comprehensive health assessments (95.9 percent). Over 87 percent of centers offer anticipatory guidance, sports physicals, immunizations, and prescriptions.¹
• Most responding SBHCs offer counseling and mental health services: 80.3 percent offer crisis intervention; 69.8 percent offer comprehensive individual evaluation; 62.2 percent offer preventive mental health programs; 57.0 percent offer comprehensive individual treatment; 29.8 percent assess learning difficulties; and 20.1 percent treat learning difficulties.¹
• To meet the urgent needs of some students for food, shelter, and clothing, 49.3 percent of responding SBHCs provide assistance in obtaining social services such as Medicaid and WIC (Special Supplemental Food Program for Women, Infants, and Children).¹

SBHCs Offer Reproductive Health Services But Few Dispense Contraceptives.

• Among SBHCs serving secondary and combined schools, 74.2 percent offer pregnancy testing; 61.9 percent offer gynecological exams; 60.7 percent diagnose and treat sexually transmitted diseases (STDs); and 60.4 percent provide HIV/AIDS counseling.¹
• Among SBHCs serving secondary and combined schools, 28.7 percent prescribe oral contraceptives; 24.3 percent provide condoms; 15.5 percent provide birth control pills; and only 8.5 percent provide emergency contraception.¹

Providing Reproductive Health Services Reduces Students' Risk of Unintended Pregnancy.

• In one study, sexually active teenage women who used SBHCs frequently also used contraceptives more consistently than those who made fewer clinic visits.³
• One community reduced its adolescent pregnancy rate from 77 to 37 per 1,000 women ages 14 to 17 through a school- and community-based pregnancy prevention program. This significantly lower rate rose again to 66 per 1,000 after the state prohibited dispensing contraceptives on school grounds.⁴
• In a study comparing schools with and without SBHCs, students in schools with SBHCs report no more sexual activity and no increased frequency of sexual intercourse compared to students in schools without health centers.⁵

SBHCs Can Improve Students' Health and Achievement.

• In one study at an alternative school, SBHC users were less likely to be absent and significantly more likely to graduate or be promoted than students not using the SBHC.⁶
• A study of students in schools with and without SBHCs found that SBHCs improved students' health knowledge and increased students' use of health care, especially among students with little access to other health care or with greater need for health care.⁷
• One study found that having health insurance did not affect whether students used SBHCs and that a significantly greater proportion of students with Medicaid used SBHC mental health services.⁸
• One evaluation found that students who attend SBHCs decrease their use of hospital emergency rooms for routine health care—at significant cost savings to local and state governments.⁹
• A study in nine SBHCs found that providing teens with school-based primary care results in increased use of some health services, including sports physicals, treatment for minor illnesses, and counseling, decreased use of emergency rooms, and fewer hospitalizations.¹⁰
• In another study comparing groups of HMO-enrolled teens, those with access to an SBHC were over 10 times more likely to make a mental health or substance abuse visit than teens without access. Moreover, SBHCs received 98 percent of those visits, and teens with access reported 38 to 55 percent fewer after-hours emergency room visits than teens without access.¹¹
• In one study, 93 percent of a clinic's enrollees reported no other source of medical care.¹² Among surveyed SBHCs, on average, 28.1 percent of enrolled users have Medicaid coverage.¹

SBHCs Depend on Public and Private Funding.

• In 1997, the median cost of operating an SBHC was $213,097.¹
• Nearly 45 percent of responding SBHCs receive funds from Medicaid; 25.7 percent receive funds from Title V, the Maternal and Child Health Block Grant; 21.7 percent receive payments from students; and 20.0 percent report grants from private foundations.¹

SBHCs Have Significant Support.

• The American Medical Association, the American Academy of Pediatrics, the Society for Adolescent Medicine, the American School Health Association, the Inspector General of the Department of Health and Human Services, the National Association of State Boards of Education, and Congress' Office of Technology Assessment all affirm the unique potential of SBHCs to address teens' unmet health care needs.^13,14,15,16
• Students and parents support SBHCs. One study showed that 91 percent of SBHC enrollees and 89 percent of unenrolled students support SBHCs.¹⁷ In another study, parents signed consent forms for 71 percent of students to use SBHCs and more than 90 percent of signing parents requested that their children have unlimited access to care.¹⁶

References

1. Fothergill K. Update 1997: School-Based Health Centers. Washington, DC: Advocates for Youth, 1998.
2. Kirby D. School-Based Health Clinics: an Emerging Approach to Improving Adolescent Health and Addressing Teenage Pregnancy. Washington, DC: Center for Population Options/Advocates for Youth, 1985.
3. Brindis C, Starbuck-Morales S, Wolfe AL, et al. Characteristics associated with contraceptive use among adolescent females in school-based family planning programs. Fam Plann Perspect 1994; 26:160-164.
4. Koo HP, Dunteman GH, Green C, et al. Reducing adolescent pregnancy through a school- and community-based intervention: Denmark, South Carolina, revisited. Fam Plann Perspect 1994; 26:206-211+.
5. Kirby D, Waszak C, Ziegler J. Six school-based clinics: their reproductive health services and impact on sexual behavior. Fam Plann Perspect 1991; 23:6-16.
6. McCord MT, Klein JD, Foy JM, et al. School-based clinic use and school performance. J Adolesc Health 1993; 14:91-98.
7. Kisker EE, Brown RS. Do school-based health centers improve adolescents' access to health care, health status, and risk-taking behavior? J Adolesc Health 1996; 18:335-343.
8. Brindis C, Kapphahn C, McCarter V, et al. The impact of health insurance status on adolescents' utilization of school- based clinic services: implications for health care reform. J Adolesc Health 1995; 16:18-25.
9. Center for Reproductive Health Policy Research. Evaluation of School-Based Health Centers in California, 1991- 1992: Annual Report to the Carnegie Corporation of New York and The Stuart Foundations. [s.l.]: The Center, 1993.
10. Santelli J, Kouzis A, Newcomer S. School-based health centers and adolescent use of primary care and hospital care. J Adolesc Health 1996; 19:267-275.
11. Kaplan DW, Calonge BM, Guernsey BP, et al. Managed care and school-based health centers. Arch Pedatri Adolesc Med 1998; 152:25-33.
12. Bureau of Primary Health Care. School-Based Clinics that Work. {Washington, DC]: U.S. Dept. of Health & Human Services, Health Resources & Services Administration, 1994.
13. Office of Inspector General. School-Based Health Centers and Managed Care: Examples of Coordination. [Washington, DC]: U.S. Dept. of Health & Human Services, The Office, 1993.
14. National Commission on the Role of the School and the Community in Improving Adolescent Health. Code Blue: Uniting for Healthier Youth. Chicago, IL: American Medical Association ; Alexandria, VA: National Association of State Boards of Education, 1990.
15. Office of Technology Assessment. Adolescent Health. Vol I: Summary and Policy Options. Washington, DC: U.S. Government Printing Office, 1991.
16. Lear JG, Gleicher HB, St. Germaine A, et al. Reorganizing health care for adolescents: the experience of the school-based adolescent health care program. J Adolesc Health 1991; 12:450-458.
17. Santelli J, Couzis A, Newcomer S. Student attitudes toward school-based health centers. J Adolesc Health 1996; 18:340-356.

Compiled by Nicole Foster
February 1999 © Advocates for Youth

Click here to view the Publications Catalog and/or to order this publication.