Fresno OKs Six New SBHCs

The Fresno Unified School District Board of Supervisors on February 8, 2017, approved six new school-based health centers (SBHCs) to benefit nearly 7,000 students.

Fresno Unified School DistrictStudents “benefit from having quality health care, which keeps them in school longer, makes them more successful, and immediately impacts their learning,” Acting Fresno Unified Superintendent Bob Nelson said at a press event announcing the plans to build the new SBHCs.

Fresno opened its first school-based health center at Gaston Middle School in 2014. Kaiser Permanente Northern California Community Benefit provided generous support to facilitate the planning of the new SBHCs in partnership with Fresno Unified. The six new sites will be operated in partnership with Clinica Sierra Vista and Valley Children’s Healthcare and are planned for Addams and Bakman elementary schools; Tehipite and Sequoia middle schools; and Duncan Polytechnic and Sunnyside high schools. 

Fresno Unified School DistrictCalifornia School-Based Health Alliance Project Director Salina Mendoza provided Fresno Unified with background on the values of school-based health care, and partnered with Kaiser Permanente, Clinica Sierra Vista, and Valley Children’s Healthcare on planning the new sites.

Valley Children’s Healthcare CEO Todd Suntrapak outlined the fiscal and public health benefits of putting health care directly into Fresno’s schools:

Fresno Unified School District“Last year, we took care of 37,599 kids that were located within three miles of each one of these six clinics. We believe in partnering with Clinica Sierra Vista and Fresno Unified, we won’t just be committed to addressing episodic acute health care needs of kids, but we will be able to … improve and sustain the health and wellbeing of kids.”

See more in a video of the press event and on the Fresno Bee website.

School Health Care Remains Popular in CA

School-based health care is growing in California and providing more services and health care access for students.  There are now 246 school-based health centers (SBHCs) providing high-quality health care to students. Across California, more than 265,000 students attend a school that has a health center, and many more have access to other types of school health services.

This is more than double the number a decade ago. Of the 246 SBHCs, 159 offer mental health care, 69 offer dental treatment, and 129 offer youth engagement programs that keep kids engaged in school and thinking about their future.

SBHCs are so popular because they offer convenient health care for kids in a setting families already know and trust.

Students who utilize SBHCs are less likely to go to the emergency room or be hospitalized, keeping costs down. SBHCs also improve attendance, reduce dropout rates, improve school climate, and support students’ academic achievement. Schools and school districts partner with health service providers to finance SBHCs.

More Information on California’s SBHCs

There are 246 SBHCs serving more than 265,000 students across California. SBHCs are usually located directly on a school campus and provide primary care like any health clinic. Staff vary in size, and typically includes nurse practitioners, nurses, mental health providers, as well as part-time physicians and medical students. Services are provided at no or low cost. No one is refused service for inability to pay.

Services Offered

Service Number Percentage
Medical 213
Health Education 175 71%
Mental Health
159 64%
Reproductive Health – Screening & Education
150 60%
Reproductive Health – Clinical Care 140 56%
Youth Engagement 129 52%
Dental Prevention 123
Dental Treatment


Sponsoring Org Types

Type of Sponsoring Organization Number Percentage
Community Clinic 137 57%
School District 65 27%
Local Health Department 11 5%
Hospital 9 4%
Nonprofit Organization 7 2%
Mental Health Agency 8 3%
Tribal Government 1 .5%
Other 4 1.5%


Onsite SBHC Location Level 

School Level Number Percentage
High School  120  49%
Elementary School  60  24%
Middle School  27  11%
Other (school-linked/mobile/combined levels)  39  16%



Moving Forward, No Matter What

School-based health care providers and those who advocate for the well-being of children and teens help hold our community.

This election has been a particularly divisive time, and as you work to care for students and their families, we will continue to support you and your work. We will work hard to uphold the gains we have made and build on them.

There is some really good news to share: the following key ballot measures passed that will provide critical support to our school children.

  • Proposition 55 will raise billions every year to fund K-12 schools.
  • Proposition 51 will bring in billions to fund school renovations and facilities upgrades.
  • Proposition 56 will tax tobacco sales and bring in extra revenue for Medi-Cal.
  • Proposition 57 will decrease the ability to try juveniles as adults in court.
  • Local soda tax measures prevailed in communities in the San Francisco Bay Area.

These are all wins for promoting student health and success in our state and we are hopeful that school-based health services will benefit from these new sources of funding.

We still don’t know what this week’s presidential election will mean for the federal policies that have improved the lives of children and families in our state.

Let’s remember that emotions may be running high among families of the children whose lives are changed by school-based health services. Students in our schools are fortunate to have you to help them address any possible stress. And again, as you support them, we are here to support you.

We will not back down from our commitment to helping communities across California bring access to mental and physical health care for all students at school, no matter what.

#Health4All Brings Us Closer to Health Equity

By Lourdes Bernal
Lourdes at work

Lourdes helps parents understand eligibility for expanded Medi-Cal.

Getting health care has always been a battle for undocumented, low-income Californians. It has always meant waiting until the last minute to visit a provider, and trying to downplay pain and discomfort from illness or injuries.

The parents of undocumented children work extra hard to pay bills and put food on the table, and many young people are conscious of the added stress of paying for health care. Many undocumented children minimize care to maximize their family’s security.

Thanks to legislation enacted in 2012, many young people have become eligible for Deferred Action for Childhood Arrivals (DACA), which is a program that allows undocumented young people to be employed legally and be eligible to receive Medi-Cal, our state’s Medicaid assistance program for low-income Californians.  This helped a lot, but many young people who were ineligible for DACA were still left out.

This year Medi-Cal expanded to include all income-eligible children and youth under 19, regardless of immigration status. This historic expansion provides thousands of kids in California with access to previously restricted care. 

At the California School-Based Health Alliance, I work closely with schools in the Bay Area to spread awareness about this opportunity so more parents can enroll their kids in coverage. My goal is to create a pathway to access for the many students who feel  that health care is not an option for them because of the cost and because of where they were born.

I am proud I can help parents understand there are options for their children to access health care, and that doing so does not come at the risk of financial burdens, or worse, separation and deportation. I take pride in sharing new options for coverage with parents who are sacrificing so much so their children can thrive. 

Free resources on expanded Medi-Cal:

This outreach is personal to me because I understand the vital importance of having access to care. I’ve seen how access provides you with the opportunity to live better in this place we call home.

I am also proud to be working in partnership with school-based health centers because, in addition to providing vital access to care, they give children and youth a safe space to be themselves without fear. School-based health centers are an important part of an education system that makes it possible for young people to dream, thrive, and succeed.

I believe in expanded Medi-Cal and #Health4All because I know that California is stronger when we are all healthy.

Lourdes Bernal is the Communications Program Assistant at the California School-Based Health Alliance and is helping schools educate parents and students about expanded Medi-Cal for all kids.

State to Change School Medi-Cal Billing Program

We have very exciting news to share about the “free care rule” reversal that reopens a critical avenue of reimbursement for Local Education Agency (LEA) school health providers.

Learn More About the Free Care Rule

The Department of Health Care Services (DHCS) announced on August 29 that changes to the provider manual for the LEA Billing Option Program will reflect the most recent policy direction from the Centers for Medicare & Medicaid Services (CMS) regarding “free care.” The draft changes to the manual are available for review and should be officially published later in September.

This exciting anticipated change to the LEA Billing Option program ensures that Medi-Cal may reimburse LEA providers for services provided to Medi-Cal eligible students, even if they are not in special education.

We hope that everyone providing health services in schools will learn about this opportunity to draw down more revenue to create robust school health systems that include both school districts and community providers.

You can learn more about the “free care” policy, the LEA Billing Option program, and CMS’s policy change on our Free Care Rule page. We have been working closely with DHCS, LEAs, the California School Nurses Organization, and other advocates to make sure that our state makes changes to the LEA program to strengthen school-based health care.

Judy Appel Named Executive Director

Judy AppelThe California School-Based Health Alliance Board of Directors has named Judy Appel as the new executive director to lead our organization.

Judy starts on September 19 and is excited to join us at a moment of incredible opportunity to build more support for school-based health care. Our Board of Directors chose Judy after a comprehensive search process because of her strong experience leading a regional nonprofit to statewide and national prominence.

Judy has served since 2005 as the executive director of Our Family Coalition, which is based in the Bay Area and advances equity for lesbian, gay, bisexual, transgender, and queer (LGBTQ) families with children through support, education, and advocacy.

She has led policy victories for Our Family Coalition, including the Welcoming and Inclusive Schools Program that guides schools to create more welcoming environments for LGBTQ families, and LGBTQ inclusion in the new history-social science curriculum framework recently adopted by the State Board of Education. She is also involved in statewide policy efforts on ending the school-to-prison pipeline.

Judy serves on the Board of Education for the Berkeley Unified School District, where she oversees a complex budget of $135 million; guides policy direction for instruction and programs; supports physical and mental health services for students; and leads Board efforts to implement restorative justice, social emotional learning, and trauma-informed practices at school sites.

In addition, she is involved with numerous initiatives aimed at improving education and health equity for all students, including the Restorative Practices Advisory Committee, the Berkeley Unified 2020 Vision Leadership Team, and the Fix School Discipline Policy Coalition.

We are pleased to welcome Judy as we begin a new phase of growth for the California School-Based Health Alliance and school-based health care in California!

How Supreme Court Ruling Affects Health for All Kids

Health4AllKids-HHH-SBHCs-largeThe United States Supreme Court on June 23, 2016, issued a 4-4 split decision on President Obama’s executive immigration actions known as Deferred Action for Parental Accountability (DAPA) and the expansion of Deferred Action for Childhood Arrivals (DACA).

This leaves in place a lower court decision that blocks the implementation of these executive orders.You can read more about what this ruling means by reading statements from The California Endowment and the National Immigration Law Center.

School-based health centers have always been committed to providing health care for all students, regardless of immigration status. The California School-Based Health Alliance stands behind the work that all of you do to keep everyone in our state healthy and ready to learn. We will continue to advocate for health security for all children and families in California.

Today’s ruling does not affect the 2012 DACA program or California’s recent Medi-Cal expansion to undocumented children. We continue to ask schools and school-based health care partners to join us in sharing information on Medi-Cal for all kids in California.

  • You can download customizable flyers that you can print or post on your school’s website here. These flyers meet the state’s requirements for AB 2706, which requires schools to include information about health coverage at registration.
  • You can get more information and resources here.

You can see our health coverage outreach resources here.



A Note on Violence Affecting Bay Area Youth

By Juan Taizan

health-center-graffiti-450In the last two weeks three young men have been murdered in Richmond in the Bay Area. Xavier Mclanahan, 14, Malik Barnes, 15, and Joshmahl Russell, 21, were all shot to death, their lives ending far too soon.

While we did not know these young men directly, they were a part of our community through the school-based health centers and partners we know in Richmond. Their deaths also touch a nerve because of our work to support young men of color who have experienced violence.

I can’t help but feel frustration as I struggle with the question of what more any of us could have done to prevent these tragedies. It also makes me feel overwhelmed at how much more work we have to do to prevent future violence and death. It is important for us to take some time to pause, to reflect on the lives of these young men, to understand the pain of their loss, to feel the joy they brought to their friends and families, and to envision the lives they could have lived if they had more support and opportunity.

It is important that we take all of our feelings and remember this is why we do our work. School health staff regularly support young men and women who face the same challenges of Xavier, Malik, and Joshmahl. SBHCs and school health services play an important role in not only helping youth be healthy and succeed; they help many youth stay alive.

We have to continue to advocate for school health. We have to continue to find resources to help every young person who needs support. We have to continue working to honor the lives of every young person we have lost and to honor Xavier, Malik, and Joshmahl.

You can read more about Juan’s experiences helping students and schools through school-based health on the CSBA blog: Invest in Health to Improve School Climate & Student Engagement (Omar’s Story).

New Voices Bring Promise to Childhood Adversity Challenge

By Serena Clayton

This post originally appeared on The Chronicle of Social Change.

At the Center for Youth Wellness policy convening on childhood adversity recently, I kept asking myself if we were having a new conversation or an old conversation but with different people at the table.

The fact that children who experience adverse events (e.g., domestic violence, or a mentally ill or incarcerated parent) have worse health outcomes hardly seems like news. In public health, we know that environmental, economic, and social factors lead to health disparities. In education, we know that poverty is connected to lower achievement, and there is a strong correlation between poverty and adverse childhood experiences (ACEs).

To address ACEs, new “trauma-informed practices” are moving the focus off of “fixing” individuals to understanding their experiences and building resiliency and safe, supportive environments. All of this sounds a lot like youth development, protective factors, and strength-based approaches.

There is no doubt that we are seeing some of the same ideas come back in a new package. But something is different now, and it is the very fact that different people are at the table. The concept of childhood trauma has succeeded in uniting various sectors in a way that I have not seen before.

Juvenile and criminal justice advocates see themselves in this issue because so many youth who have experienced trauma end up in the correctional system. Educators have a stake because childhood trauma shows up in the classroom in the form of poor attendance, behavioral challenges, or learning difficulties.

Even the health care industry is beginning to take note. We now have not only epidemiological evidence of the impact of social stressors on health, but also biological evidence. ACEs or chronic stress raise the level of cortisol in the body which affects many physiological processes and, ultimately, increases the risk of poor health outcomes. Just like poor diet or physical inactivity, ACEs are a risk factor that can to increased health care costs down the road.

As a public health professional with 20 years in various aspects of adolescent health, I am encouraged by the way that new science is creating new bedfellows. The concept of adverse childhood experiences provides an explanation for so many outcomes in different sectors: health disparities, the achievement gap, multi-generational poverty, cycles of violence.

As a school-based health advocate, I am intrigued by the possibilities. How can school-based health providers best use their unique position at the intersection of health and education to respond to childhood adversity, or to prevent it in the first place? As health care (slowly) begins to take prevention more seriously, what approaches to childhood trauma could become part of pediatric care or patient-centered health homes?

As educators strive to improve school climate, what alternatives to suspension will become standard practice? How can the public health and educator sectors support criminal justice reform as a health issue? And how can justice reform advocates help increase resources for health and education?

Thank you to the Center for Youth Wellness for a thought-provoking day. I look forward to our next steps!

Serena Clayton is the Executive Director of the California School-Based Health Alliance.

Safety, Justice, Equity, & Our Work in School-Based Health

By Serena Clayton

This post originally appeared on the Voices for Health Equity blog.

On November 4, 2015, I attended “Smart on Safety,” an invitational summit to examine how California can reform the criminal justice system and transform communities to prioritize prevention over punishment.

As Adam Kruggel, Director of Organizing for PICO California, stated, “mass incarceration creates a legitimacy crisis for some of our most deeply held values – that everyone has a right to be a human being.” Harsh sentences, three strikes, mandatory minimums, racial profiling, gang injunctions, and transfer of juveniles to adult courts have demonized poor black and brown males as less deserving “others” – predators who are beyond redemption.

Anyone who works in marginalized communities knows the toll that these policies take on the health and life prospects of their teen patients. Although one would hope that the appalling scene in South Carolina is not the norm, it has been well documented that black students are three times more likely to be suspended than white students. Suspension is a gateway to dropout, economic instability, crime and incarceration. And we don’t need to look only at teens to see how “tough on crime” affects children’s health. Tamir Rice, a 12 year old who was playing with a toy gun in a park, is dead. The children of Eric Gardner and Walter Scott are fatherless. Approximately 2.7 million children have a parent in prison – a vastly disproportionate number of whom are poor and black. Millions more children experience post-traumatic stress disorder from extended exposure to violent encounters between citizens and law enforcement in their communities.

Speakers at Smart on Safety celebrated the one year anniversary of the passage of Prop 47, a huge step forward in turning the tide on mass incarceration. That this victory took place in California was significant. California has been among the states with the dubious distinction of leading the nation in mass incarceration. Prop 47 changed nine felonies to misdemeanors and gave thousands of low level offenders the opportunity to be resentenced, released, and have felonies wiped off their records. With this law, California takes on a new role as a leader in the national outcry against punitive policing and correctional policies that demonize communities of color.

As a professional from the worlds of health and education, I often felt like a fish out of water at this gathering of activists for social justice, racial equality, and criminal justice reform. But I appreciated the opportunity to attend and understand how our work in school-based health connects with this broader movement.

At this meeting schools were mentioned frequently as a key element in reversing our priorities so that we invest in prevention rather than in punishment. We heard calls for increased school funding, improved school climate, changes in school discipline, reduced school policing, and improved mental health services.

Jeff Rosen, Santa Clara’s district attorney, pointed out that many of today’s offenders were victims earlier in their lives. If we did a better job of attending to the needs of victims, might we have fewer offenders down the line? What school experiences would help children and families who have been victims of violence heal, stay engaged in school, and graduate?

School-based health centers have a critical role to play in this picture. They are part of a movement to transform education to encompass the support, the environment, and the services that students need to enable them to stay in class and concentrate on learning. For many students this includes approaches that address the trauma they experience as victims or witnesses to violence. I am proud that we are working with school-based health centers in Oakland and West Contra Costa specifically on this issue and hope that we can find more ways to strengthen the role of school-based health in promoting safety and justice.

Serena Clayton is the Executive Director of the California School-Based Health Alliance.