School-based health centers (SBHCs) throughout California are continually working to evolve their practices to better serve students. One of the best practices identified by the California School-Based Health Alliance (CSHA) is the use of schoolwide or grade level screenings, which allow SBHCs to use their unique location on the school campus to provide education, population health, and prevention.
This toolkit is designed to help SBHCs implement a schoolwide or grade-level screening.
Benefits of Conducting Schoolwide Screening
Schoolwide screenings conducted in SBHCs can be used to screen large populations of students and provide an opportunity to expand reach to new students, enhance collaboration between SBHCs and schools, increase student awareness of SBHCs, and support the financial stability of SBHCs.
Schoolwide screenings are a good way to get students in the health center; they can be used as an outreach mechanism and can increase the percentage of the student body that the health center serves.
Schoolwide screenings improve access to care by allowing health center staff to reach out proactively to students rather than waiting for students to walk in. Some students are less willing or even fearful of seeking help in a clinical setting, so it’s important for SBHCs to establish connections with students.
Schoolwide screenings can be conducted to identify students that would benefit the most from SBHC programs. Some examples include obesity, sexually transmitted infections, asthma, oral health, and mental health. Screenings can also be used as a means to register new students. Often these screenings are done with the incoming grade, such as kindergarten, 6th, or 9th, and are used as a way to register new students.
Schools and SBHCs have common goals: the health, wellbeing, and academic success of students. By participating in mandated and other important screenings across schools, grades, or classes, SBHCs can strengthen this natural collaboration.
In addition to screenings discussed above, SBHCs could participate in traditionally mandated screenings such as visual acuity, possibly conducting additional screenings and assisting with follow-up. Joint screening projects can strengthen the relationship between school and clinic personnel, and children and youth can benefit.
Young people who attend SBHC consistently express satisfaction with the services they receive, and find their SBHC providers to be more approachable than providers in traditional health centers.
In our experience, some youth, especially those in middle school and younger grades, may have fears and misconceptions about the services provided and may not come in for care on their own. Screening programs can serve as an excellent entry point to the SBHC for students who otherwise may not be aware of the clinic’s services, or are hesitant to come in for a visit.
Presenting opportunities for students to access the clinic along with their peers may create a safe space for learning about what the clinic has to offer while also dispelling misconceptions that may exist about becoming a clinic patient.
Schoolwide screenings may also benefit the financial sustainability of an SBHC. If your screening campaign can be structured in a way that includes billable visits or procedures, it can be an instrumental way to increase opportunities for revenue.
In the following section we discuss two of these strategies: bringing in staff from other centers for a concentrated and streamlined clinic day, and incorporating nursing and other health science student volunteers who can increase clinic capacity while engaging in the screenings as a service learning project.
Follow-up visits generated from screening campaigns can also increase opportunities for future billable visits. Screening campaigns can be part of a “smart financing” strategy to leverage multiple resources.
Goal of Screening
Identifying the goal for implementing a schoolwide screening program at a SBHC during the planning phase is essential to success. Consider the following potential goals for implementing a screening program.
Consideration of which health indicators you seek to impact with the screening is essential. The goals of the screening can range from Healthy People goals, to site-specific areas you have identified as a need in your clinic or organization. Consider performing a needs assessment at your site before developing your screening program. This can not only help you determine how to best target your program, but also give you some baseline data to use later to evaluate its success.
Ideally, the screening program will include or lead to patient enrollment and future visits. Build in an opportunity for students to become more familiar with the SBHC and its services in a more comfortable way, such as in the company of classmates and friends.
After clarifying the Goals and Objectives of your screening program, the population you intend to reach should be defined.
Consider realistically what your clinic can handle based on your resources. If your school has a large student body, identify ways to reduce numbers either by only targeting specific grade levels and/or groups that are at highest risk. Develop a plan for whether and how to include students who are absent on the day of your program and how that follow-up will occur. If your aim is to reach the entire student body, consider spreading out the campaign so that smaller groups are screened at multiple times during the school year, rather than all at once.
Determine whether consent should be provided by the parent and/or student, and whether written or “opt-out” consent is most appropriate.
Students may sign their own consent for services covered under minor consent laws, whereas general medical and dental care must be done with parent or guardian consent. For a guide to minor consent laws in your area, consult an adolescent health law resource, such as the National Center for Youth Law.
School districts often have specific policies about whether and under what circumstances they allow “opt-out” consents: parents are notified and consent is implied unless parents specifically return the opt-out form. Save time by noting which students are already enrolled as patients of the SBHC, and thus may already have consents on file. When possible, attempt to obtain consent and/or patient registration forms before the day of the screening event, as this will speed up flow.
Universal screening can identify many diseases and health conditions in children. Survey tools may vary.
|Social Determinants of Health||National School-Based Health Alliance Toolkit|
|Immunizations||Immunization Record Review|
|Oral Health||Oral Health Risk Assessment Tool|
|Distance Vision||Optotype Charts|
|Tuberculosis||CA Pediatric TB Risk Assessment, then skin test or blood|
|Suicide||Ask Suicide-Screening Questions (ASQ)|
|Trauma*||Not recommended for population level screen|
|Chlamydia and Gonorrhea||Urine|
|Intimate Partner Violence||Universal education recommended instead of population level screen|
|Major Depressive Disorder||Patient Health Questionnaire for Adolescents (PHQ-A)|
|Sexual Exploitation||Commercially Sexually Exploited Children Screener|
|HIV||Oral swab or blood|
|Anxiety*||Generalized Anxiety Disorder (GAD-7)|
* Screening start age can vary
The information in this online toolkit is adapted from the Population-Wide Screenings in Schools Guide: A publication of UCSF and Family Health Together. We are grateful to our partners at ETR for funding and the UCSF School of Nursing for creating this content: Naomi Schapiro, RN, PhD, CPNP; Emily Green, RN, PhD; Victoria F. Keeton, PhD, RN, CPNP-PC; and Ivette Gutierrez, M.A.
We would like to also acknowledge Alameda County Center for Healthy Schools and Communities, Oakland Unified School District, La Clínica de la Raza, Native American Health Center, Lifelong Medical, Karen Gersten-Rothenberg, and Joanna Bauer for their contributions to this toolkit.
The photos used throughout the toolkit were taken by Randall Ann Homan.