Community health providers can deliver primary health care to students, and sometimes families, through school-based health centers (SBHCs). This section is designed to help you understand how to bring your important medical, dental, and/or mental health services to under-served children, adolescents, and/or adults through an SBHC in your community!
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 clinical health services in schools: there is no one “right” way. We suggest that you begin by considering the following questions:
- What health services can you bring to a school?
- What kinds of clinical care do students need that the school/existing health provider doesn’t currently offer?
- How can you build on your existing clinical services, staff expertise, and established partnerships to bring clinical care to one or more schools?
There are many reasons a health care agency such as a Federally Qualified Health Center (FQHC) or hospital might consider opening and operating a SBHC. These range from mission-focused values to smart business practice.
Research shows that SBHCs:
- Have a positive impact on health and education outcomes and equity
- Increase the use of cost-effective preventive care
- Help health care agencies improve clinical quality scores.
- Increase a lead agency’s base of patients/clients
- Support workforce development
Download our white paper on Navigating the Promise of SBHCs: A Guide for Health Care Leaders to get more information on how the SBHC model is different from traditional health care settings, and how medical providers can be successful in this alternative setting.
Key Start-Up Activities
Below, you will find a list of key planning activities that have helped many health care providers develop strong, sustainable school health programs. These start-up activities can happen in different orders, depending upon the school’s context and resources. You may also want to start by reviewing these Key Steps in Planning an SBHC.
Get advice on establishing strong partner collaboration as well as information on the important role of school-based health center staff in maximizing the impact of the SBHC on student success in school.
If you want resources on how to apply for your community clinic to become a Federally Qualified Health Center (FQHC), please contact the National Association of Community Health Centers. FQHCs enjoy a higher Medi-Cal reimbursement rate and federal grant to provide services to the uninsured.
There are many entry points to working with schools. If a school district doesn’t approach you to bring clinical care to their students, you can do outreach to schools within an area to which you would like to deliver care. Sometimes health care providers must first build trust with a school district by demonstrating their commitment to improving student health. Some health providers do this by initiating needed services that don’t require special facilities, such as participating in a school-based immunization clinic, conducting classroom health education, or consulting with the school nurse on students with medical or behavioral problems.
There are many school stakeholders you might approach about starting an SBHC. While you can go directly to top district leadership, such as the superintendent, school board, or a school principal, you might first want to identify a health champion within the school or district, who will help build internal buy-in for the concept of an SBHC. This might be a school nurse, a counselor, or a health professional serving on the school board. You should also talk to local SBHC providers to learn more about how they formed their school partnership.
You can also contact us for assistance in finding a school district interested in an SBHC. We maintain a database of school districts interested in partnering to bring health care to their schools. Call (510) 268-1260 or email us at email@example.com.
All school health services should respond to the needs of students, families, school staff, 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, school staff, 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, families, and school personnel, 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 school leaders—some of whom may become school health services “champions.”
Stakeholders to Engage
- School Board Member(s)
- School Health Services Staff
- Other 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 and to seek a community health provider to deliver services at the SBHC.
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, especially the sponsoring agency. Whether your health organization will sponsor the SBHC or deliver clinical services, you should determine how you will share information and space with school personnel and other onsite community providers, handle case management, and raise funds, among other considerations.
It is important to develop a formal memorandum of understanding (MOU) between community health services providers and the school district, outlining your 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 (e.g., School Nurse, Counselor, Special Education Personnel)
- Other Community Health Services Provider(s)
- County Mental Health and Public Health Department Staff
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 and what clinical services will be provided at the school. If your goal is to serve the entire community, you will want to ensure public as well as student access to the SBHC. If your primary client base will be adolescents, you will need to find a location that ensures confidentiality as well as accessibility for teen students. If your SBHC will function as a satellite or intermittent clinic, you may more easily extend your license to the SBHC, but if you plan to operate the SBHC for more than 20 hours a week, it will undergo a facility site review.
Often, schools will provide in-kind space to the health care provider to house the SBHC. Some schools may have money to help build a clinical facility within existing or new school buildings, while others will not. SBHCs are housed in a wide variety of spaces, ranging from converted classrooms to on-site portables to buildings near the school. Some providers opt to deliver services from a mobile van or using telehealth technology. As you begin to think about facilities, an important first step is to reach out to school district administration and school facilities personnel. While they will rely on your knowledge about medical and dental facilities requirements, they will be your close partners in making a plan for building, purchasing, or renovating and equipping the necessary facilities on their school campus. Ultimately, facilities design must reflect both your scope of clinical services as well as the interests of the school and your target population.
While some SBHC facilities require substantial capital investment, others are much more affordable. SBHCs can seek federal, state and local funding, including: federal grants for SBHC equipment/facilities; school modernization or new construction grants; local bond measures with school construction project allocations; and facilities grants for community clinics and hospitals. Joint-use agreements between cities, counties, and school districts can also fund SBHC construction.
Key Stakeholders to Engage in Facilities Planning
- District Facilities Managers
- School Health Personnel
- Your Own Project Planning/Clinic Construction Staff
Ensuring Utilization of the School-Based Health Center
What’s the best way to get students registered with your SBHC?
Most health care providers prefer written parent or legal guardian consent before they will see a student for general medical care. While you can try sending consents and medical history forms home for parental completion, very few will students will get registered this way. Many SBHCs do outreach and have parents/guardians complete the forms at in-person school registration, back-to-school nights or open houses, and any other school events that families are likely to attend. Work within your own and school staff to identify interpreters who can help families complete the forms in their native language. Raffles or other incentives for those that complete registration forms are always fun!
Should you register students for whom you are not the primary care provider?
The philosophy and spirit of school-based health care is to serve all students on campus. We strongly encourage you to register all students who are interested, as their families may choose for them to well become your “assigned” patients under managed care as a result of your presence in their school community. In addition, many students may not yet be enrolled in Medi-Cal or health insurance, or they may need to be re-enrolled. In either case, you may become their selected primary care provider if you demonstrate an “open door” policy for all students. That said, some SBHCs will only provide limited services to students who are well-established with another primary care provider. These services might include immunizations, urgent care, acute exacerbation of chronic illness, and sometimes management of a condition requiring daily treatment at school, such as asthma or insulin-dependent diabetes. In all cases, it is essential to coordinate care with the primary care and/or any specialty care providers of your SBHC patients.
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.
Should you provide school staff 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 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 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; your agency’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—once inside and one exterior to the school.
FAQ: 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.
Both school clinical staff and SBHC staff contribute to student health, academic success, and overall well-being, 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.