Teachers, administrators, school board members or other educators are often the drivers in bringing more health services to schools. This section is designed to help you get started in this important endeavor!
Refer to our toolkit – From Vision to Reality: How to Build a School-Based Health Center from the Ground Up – to get more details on any of the sections below.
There are many paths to developing or expanding your school’s health services or center, and there is no one “right” way. We suggest that you begin by considering the following questions:
- What is your school doing well?
- What do your students need that your school doesn’t currently offer?
- How can you build on existing programs, staff expertise, and established partnerships?
Key Start-Up Activities
Below, you will find a list of key start-up activities that have helped many schools and districts develop strong, sustainable school health programs. These start-up activities can happen in different orders, depending upon your school’s context and resources. You may also want to start by reviewing these Key Steps in Planning an SBHC.
All school health services should respond to the needs of students, families, and the community. A key step in expanding school health services is to bring together interested parties to assess community needs and map existing resources. This will guide you and other stakeholders as you decide what new services to offer, who will be eligible to receive them, and where to locate them.
When youth, families, and community members are engaged in the planning process, they are able to establish a clear vision for student health services, identify concerns about certain services before they become crises, and determine how to address possible future opposition. Also, by engaging youth and families, you will likely increase utilization of existing and new services. Be sure to draw on expertise from diverse individuals and groups and to involve key community decision makers—some of whom may become school health services “champions.”
Stakeholders to Engage
- School Board Member(s)
- School Health Services Staff
- Community Health Services Providers
- Local Elected Officials
- Other Interested Partners
Case Study – Riverbank High School
The health center at Riverbank High School was spearheaded by both youth and parents, all of whom were involved from the very start. A social worker at the high school had been working with a group of students interested in developing peer programs. The idea of a campus/community health center grew out of student organizing and from the results of a survey that students conducted with their peers and community members. From the beginning, youth were the ‘face’ of the initiative and spread the word about the center to their parents and with the larger community. The Family Resource Center, which recognized parents as experts in the health of their children, was also instrumental in engaging family members in the start-up. Ultimately, parents acted as vocal advocates for the health center when it came time to solicit support from key education stakeholders. Read more about Riverbank High School’s health center.
School health services are provided by a diverse set of organizations, including clinics, hospitals, and public health departments. Although some services are provided directly by school district employees, many service providers are independent organizations that agree to partner with a school and provide health services on or near campus. Medical, mental and oral health providers are often able to provide services at no cost to the school—either because they can bill insurance carriers for their services or because they have grant funding to support their work.
As an educator, your role is to reach out to potential partners and talk to them about whether they might be interested in providing school health services. You should find out which organizations provide school health services in your district; if there are any school health centers, you should find out which organizations “sponsor” them. You should also talk to staff at schools with health services or centers to learn more about their partnerships. Finally, you should reach out to potential partners to discuss collaboration opportunities.
- Community Clinics
- Community Mental Health Agencies
- County Mental Health and Public Health Departments
- Non-Profit Community-Based Organizations (e.g., youth development, mentoring, sports and recreation)
You can find potential partners by:
- Visiting the California Primary Care Association’s Californiahealth+ website and locate community clinics in your city or county.
- Visiting the California Council of Community Mental Health Agencies’ website and seeing whether any of its member agencies are located in your area.
- Visiting your county behavioral health department’s website and locating program and contact information for children’s behavioral health services and/or children’s system of care.
- Visiting the California Department of Public Health’s website and using its Local Health Services page to find information about your county’s public health department.
You can also contact us for assistance in finding partners. Call (510) 268-1260 or email us at firstname.lastname@example.org.
Often, various community partners work with a single school: for example, a community clinic may provide medical services; a community mental health agency may deliver behavioral health services; and a school nurse may perform school wide health screenings. In order to effectively coordinate services, there must be strong collaboration between provider organizations, including the school itself. Educators and their partners should determine how they will share information and space, handle case management, and raise funds, among other considerations.
It is important to develop a formal memorandum of understanding (MOU) between the school district and community health services providers, outlining roles and responsibilities, services, hours of operation, and protocols for sharing information. In addition, many schools have found it helpful to establish a Coordination of Services Team that brings partners together regularly for collaborative planning and to make sure that individual student needs are being met.
Key Stakeholders to Engage in Service Coordination
- District Student Support and Health Staff
- Community Health Services Provider(s)
- County Mental Health and Public Health Department Staff
- Other Agencies that Deliver Health Services on Campus.
Case Study – Kennedy Health Center in Richmond
Read about the coordination of services at Kennedy Health Center in Richmond.
You will need to think carefully about where health services will be provided at the school. Mental health services need only very basic facilities: it is important to have a private, soundproof space, preferably with a phone line—but typically there are no other facilities requirements for mental health. Medical and oral health services need more complex facilities and equipment. Ultimately, facilities design must reflect your school’s health services program.
School health services are housed in a wide variety of spaces, ranging from converted classrooms to on-site portables to buildings near the school. Some schools are not able to build a fixed site and therefore have services delivered from a mobile van or using telehealth technology. As you begin to think about facilities, an important first step is to reach out to district administration and facilities personnel. Also, community health partners are typically knowledgeable about facilities requirements and can help schools and school districts make a plan for building, purchasing, renovating and equipping the necessary facilities.
While some school health facilities require substantial capital investment others are much more affordable. School health centers can seek federal, state and local funding, including: federal grants for school health center equipment/facilities; school modernization or new construction grants; local bond measures with school construction project allocations; community development block grants; and facilities grants to community clinics and hospitals. Joint-use agreements between cities and school districts can also open up space for school health centers.
Key Stakeholders to Engage in Facilities Planning
- District Facilities Managers
- School Health Personnel
- Relevant Staff from Medical, Mental, and Oral Health Agencies
Accessing the School-Based Health Center
How do students register with an SBHC?
For a student to enroll in an SBHC, a parent or legal guardian must complete and return a consent form. Although each SBHC handles this process slightly differently, many find that in-person SBHC outreach to secure parental consent works best, such as at school registration, back-to-school night, or new student orientation events. Some SBHCs also send home parent/guardian consent forms at the start of the school year. Have interpreters present who can help families complete the forms in their native language. Raffles or other incentives for those that complete SBHC registration forms are always fun!
Are students required to register with an SBHC?
Students are not required to enroll in an SBHC. That said, SBHC enrollment is strongly encouraged so that students can take advantage of the wide range of services offered on campus. Depending on the SBHC, school-based services may include: comprehensive physical examinations, immunizations, diagnosis and treatment of illnesses and injuries, mental health counseling, dental services, and more. If a student is not enrolled in the SBHC, the only types of care that the SBHC can provide are emergency first aid and those services for which minors may consent to their own treatment (see below).
Do students need to have parental permission to be seen at an SBHC?
For a student to be seen at an SBHC for general medical care, a parent or legal guardian must give consent. However, under California law, children of any age can receive emergency medical care and pregnancy related services without parental consent. Students 12 years and over may receive additional services without parent/guardian consent, including prevention and treatment for STDs, HIV counseling and testing, outpatient mental health services, substance abuse treatment, and rape services. All students receiving these services get counseling, which includes guidance on discussing health concerns with parents and guardians whenever it is appropriate and safe to do so.
Do students need to have health insurance to be seen at an SBHC?
No. Uninsured students can always receive services at an SBHC. That said, some SBHCs will ask students whether they have health insurance and, if they do, will collect insurance information. This information is useful for an SBHC for two reasons. First, it allows the SBHC to refer the student for follow-up care within the appropriate provider network. Second, it may allow the SBHC to bill the student’s health insurance for the services provided. Doing so will bring revenue to the SBHC and make it more financially sustainable. It is important to emphasize that SBHCs will not collect insurance information or bill an insurance carrier if doing so would breach student confidentiality. (Note that some SBHCs do not serve privately insured students.)
If a student already has a doctor, can s/he be seen at the SBHC?
Usually, yes. There are a small number of SBHCs that do not serve privately insured students, but almost all SBHCs serve all students, even if they already have a doctor or primary care provider. In many cases, the SBHC will encourage students to see their primary care provider, if possible, for improved continuity of care.
Can school staff receive services at the SBHC?
As SBHCs decide whether to offer services to school staff, they consider issues such as their ability to bill health insurance carriers for services provided, and the need to ensure student privacy. Since school staff usually have health insurance and an assigned primary care provider outside the SBHC, most SBHCs provide limited or no clinical services to staff. Common staff services include flu vaccines, TB tests, and minor first aid. Some SBHCs also promote staff wellness through health education, healthy snacks at staff events, or even yoga classes.
In the event of an emergency, SBHC staff should respond to all people in the building. School administrators are encouraged to include SBHC staff in their school safety planning, on their health and safety committees, and as part of their emergency response team. In addition, the SBHC should serve school staff as an expert source of health information and consultation related to student health issues.
Can community members receive services at the SBHC?
Some SBHCs do offer services to students’ family members, or even to the community at large. As SBHCs decide whether to offer services to community members, they consider a range of factors, including, but not limited to: the security arrangements in the school; the type of sponsoring agency that operates the SBHC; the SBHC’s ability to bill health insurance carriers for services provided; and the expressed desires of the students, school, and local community. If an SBHC is open to the community, it is critical that systems are in place to ensure adolescents’ confidentiality and privacy. Often, SBHCs serving community members have two entrances—one inside and one exterior to the school.
Integrating the SBHC into the School
What is the difference between SBHC staff and school clinical staff?
School clinical staff, including school nurses, school psychologists, and school social workers, are school district employees, and their work is governed by the California Education Code, the California Health and Safety Code, and the federal Individuals with Disabilities Education Act (IDEA). Their primary responsibility is to provide a core set of mandated school health services, which include hearing, vision, and scoliosis screenings, as well as health-related special education services. School nurses can provide first aid, as well as dispense or administer prescription medications with orders from the primary care provider, but they cannot diagnose conditions or write prescriptions.
SBHC staff are licensed to provide a broader range of health services. Advanced practice clinicians, such as nurse practitioners and physician assistants, provide primary care services, including routine check-ups, diagnosis and treatment for illness or injury, and, at some SBHCs, certain reproductive health services, such as contraception, pregnancy testing, and STD testing and treatment. Dentists and dental hygienists provide oral health services. At some SBHCs, oral health services are limited to preventive care (for example, cleanings, sealants, and varnishes), while, at others, restorative therapies are also available (for example, fillings).
Both school clinical staff and SBHC staff contribute to student health, academic success, and overall wellbeing, but they do play distinct roles. Clear written policies outlining position-specific responsibilities are helpful in ensuring the best possible partnerships. That said, and as always, the more collaboration the better! To this end, policies should include thoughtful communication systems and jointly determined collaboration norms.
Can students visit the SBHC during class time?
SBHCs are focused on supporting student success in school, which means addressing absenteeism and minimizing missed classes. Every effort is made to schedule SBHC appointments so that students do not miss core classes. In the rare instances when students do need to miss class for appointments, school and SBHC staff work together to create a schedule that poses the fewest problems for students and teachers.
What information can school staff and SBHC staff share with each other?
Educational information is protected by the Family Educational Rights and Privacy Act (FERPA), while health information is protected by the Health Insurance Portability and Accountability Act (HIPAA). These two pieces of federal legislation are extremely complicated and extremely important. Comprehensive guidance can be found on our Consent and Confidentiality web page.
In brief, school district employees, including school nurses, cannot share most individual student record information with SBHC staff not employed by the school district (under most circumstances), unless they have parent/guardian authorization allowing them to do so. Schools may ask parents/guardians to complete an “authorization for release of information” to the SBHC so the school can share relevant student health, attendance, and/or academic data. This will allow the SBHC to better serve students’ health and academic needs in partnership with the school. SBHC staff employed by the district may share health information with other district employees, if they determine these staff have a “legitimate educational interest” in the student’s health information.
SBHC staff not employed by the school, on the other hand, cannot share students’ health record information with school staff without parent/guardian consent (or, for minor consent services, without student consent). This means that even if a teacher refers a student to the SBHC, the SBHC staff cannot report back to the teacher on the student’s condition, diagnosis, or treatment plan. Again, SBHCs can solicit permission from students, parents, or guardians to allow them to share health information with school staff if appropriate. Doing so can often be helpful in ensuring that students’ holistic needs are being met, through a diverse set of supports.
Regardless of sponsoring agency, SBHC staff can always provide school staff with general information and resources on relevant health issues and usage trends. In turn, school staff can freely share school-wide aggregated data on attendance, behavior and achievement.
What information can SBHC staff share with parents and guardians?
Under HIPAA, health information-sharing generally follows consent. SBHCs not run by the school district (operating under HIPAA) can share general medical information with parents and guardians, for all the services that the parent/guardian consented to. If the student consented to confidential services, including those services referred to in the section above on parental permission, then only the student can share the related health information with the parent/guardian. SBHC staff can, however, help foster improved communication between adolescent students and their family members, thus helping adolescents share their more personal health issues directly with their parents/guardians.
Under FERPA, different rules apply, as parents may access their child’s school records at anytime, including those health records created by school district-run SBHCs. This means that while minors may consent to certain services as outlined above, if the provider is employed by the district, the parent/guardian will have access to the minor’s records and may learn about “minor consent” services provided.
This FAQ is adapted from Partnering with School-Based Health Centers: What Schools Need to Know, a toolkit developed for the National Assembly on School-Based Health Care by the Illinois Coalition for School Health Centers, in collaboration with Chicago Public Schools and the Illinois Department of Human Services, with funding from the Atlantic Philanthropies.