School-Based Health Centers
School-Based Health Centers
School-based Health Centers provide comprehensive health services in school buildings where students spend significant amounts of time. This innovative approach is accomplished through schools and local healthcare partnerships and is based on the belief that a student’s physical, mental and emotional needs must be met for them to learn and thrive. According to the Ohio School-Based Health Alliance, programming and services that may be offered through school-based health centers can include:
- Preventive care, including annual physicals and immunizations;
- Acute illness;
- Mental health and behavioral health services and supports;
- Oral health and vision services; and
- Chronic disease management.
School-based health centers work to ensure that every student, family and community has the health services, supports and systems they need to achieve optimal health and education outcomes.
Educators and health professionals can help reduce chronic absenteeism and promote healthy schools by:
- Supporting each student so health issues do not interfere with learning;
- Utilizing existing school health care providers in a more efficient manner to ensure more students are treated for health problems;
- Creating a convenient and consistent way for students to receive needed care and maximize class time; and
- Ensuring all students have greater access to external clinicians, thereby increasing efficacy of treatment.
Ohio’s Investment in School-based Health Centers
Governor Mike DeWine and Ohio’s General Assembly continue to support the physical and mental health of Ohio’s youth through their on-going investment in school-based health centers.
In 2022, Ohio invested in school-based health centers utilizing the Governor’s Emergency Education Relief Funding. The Governor’s Office and Ohio Departments of Education and Workforce and Health collaborated with Nationwide Children’s Hospital and awarded funds to local education agencies to create and enhance school-based health centers in Ohio.
In 2023, the Governor’s Office of Appalachia began funding the Appalachian Community Grant Program, which allows for establishment of school-based health clinics in Appalachian communities. The most recent fiscal year 2024-2025 state budget allocated $7.5 million for the development and expansion of school-based health centers across Ohio.
School-Based Health Center Toolkit
Click on the quick-links below to go directly to the section of the toolkit.
Schools and districts can start by identifying the needs of the school, students, families and community and assess current resources. It is best practice to identify an individual or small team who can dedicate time to the activities below.
- Form an advisory council. Involve a diverse group of stakeholders, including, but not limited to, administrators, board members, staff, students, families and parent teacher association members, healthcare providers, public health officials and community leaders. This group may support school programs, review budgets and ensure alignment with health goals. Learn more about creating an effective advisory council here.
- Conduct needs and readiness assessments. Needs assessments may include questions about academic, health and community access, while readiness assessments may explore potential providers, community interest, available resources and survey data. Consider using publicly available data when planning, including:
- Engage providers. Share the advisory council’s goals for the implementation of a school-based health center with potential providers. Discuss school resources available and community interest in the project. When meeting with providers be sure to explore:
- The provider’s role in development, construction and implementation;
- Care model preferences (school linked, mobile providers, mobile van, fixed site in the building, telehealth, hub and spoke);
- The provider’s experience and resources;
- Benefits such as access to patients, convenience and reduced treatment stigma;
- Collaboration and privacy compliance with treatment plans, health monitoring and referrals; and
- What agreement will outline the partnership. Sample contracts, memorandums of understanding and strategic plans are available here
Schools and districts identify and operationalize partnerships to provide effective school-based health services.
In a school-provider partnership, key roles and responsibilities include:
- Clinicians who treat students in the school setting with family consent, make referrals when necessary, coordinate care with community clinicians and conduct informative sessions for families, teachers and the community.
- School Health Care Providers, such as school nurses, psychologists, physical therapist, occupational therapists and social workers who serve as the initial point of care for students and collaborate with partner clinicians to refer high-need cases. They triage referrals as needed, ensure treatment compliance and provide follow-up care for students with chronic conditions.
- Resource Coordinators who serve as liaisons between school and clinical partners and the community, overseeing consent, insurance logistics, information dissemination and sustainability efforts.
- Principal and Administrators who make operational decisions and foster buy-in among internal and external stakeholders. They organize funding for space and personnel, establish guidelines for on-campus treatment and facilitate integration of partner clinicians with school staff.
- Teachers and School Personnel who collaborate with clinicians by relaying relevant academic information and support early health intervention, share pertinent health and academic observations and work to minimize classroom disruptions caused by health efforts.
- Students who can provide ideas, input and information that is vital to decision making.
- Parents and caregivers. All parties can work to build trusting relationships between students, families, schools and health professionals. Open communication and engagement with parents and caregivers ensures that school-based health programs effectively meet the needs of the students they serve.
Developing an internal and external referral process between the school, health center and medical specialists prior to opening the health center is essential to the success of the health center. Below are suggestions for schools and health centers when developing the referral plan:
- Develop a plan that is agreed upon by school nurse, school administrator and health center staff;
- Escorting students to and from health center and facilitating appointment scheduling will help to emphasize access to care in the referral process;
- Define roles and permissions for sharing medical information between school and medical provider;
- Integrate treatment plans when students are seeing behavioral health providers from both the school and health center;
- Maintain communication between provider partners and external providers to ensure care continuity, coordination, collaboration and confidentiality protection.
The Health Insurance Portability and Accountability Act (HIPAA) and the Family and Educational Rights Privacy Act (FERPA) both require that data sharing arrangements between educational systems and healthcare providers involve parents and guardians. HIPAA mandates that providers obtain consent, while FERPA mandates that school staff need consent for sharing FERPA-protected data.
Consent may be broad for healthcare services over time or specific per encounter. For insurance beyond basic coverage, providers should discuss out-of-pocket expenses with families, requiring consent for third-party insurance access.
Prioritize privacy, confidentiality and safety by using secluded rooms, securing medications and files, addressing infrastructure needs and complying with Americans with Disabilities Act (ADA) standards and fire safety requirements. Educate providers on school safety, establish clear communication and harmonize emergency procedures. If allowing non-student visitors, consider separate entrances and safety protocols.
It is necessary to engage the right members of the school community to achieve success. Consider the following:
- General outreach. Share information with the school and community regularly to gain support. Outreach materials can answer questions about services, benefits, operations, enrollment and contact information. For wider reach, distribute materials during school- or community-based events.
- Engage with families. Highlight how access to a school-based health center could eliminate several barriers to their child’s health care plans, like finding providers in insurance networks, scheduling and keeping appointments and taking leave from work. Emphasize that the goal is to minimize their child’s time out of class and maximize their learning.
- Engage with teachers and school personnel. Communicate with teachers and other school personnel (such as school social workers or counselors, school nurses, paraprofessionals, athletic trainers and coaches) that school-based health care minimizes disruptions to student learning and positively impact graduation rates, absenteeism, tardiness, grade promotion and behavioral issues.
- Engage with the community. Emphasize the pivotal role of school-based health in bolstering community strength by providing dependable and convenient access to care, resulting in improved overall health with reduced hospitalizations and emergency room visits. Highlight its role in mitigating health disparities by ensuring that every student has access to high-quality healthcare.
Schools and districts can create an effective evaluation process that is based on continuous improvement for the school-based health center and involves the following:
- Model Design. Align the school-based health center model with school needs and objectives, focusing on essential academic and health metrics (such as reduced chronic absenteeism, fewer hospitalizations or improved student behavior).
- Data collection and evaluation. Use data to demonstrate the effectiveness of school-based care for both internal and external stakeholders and refine service delivery models. Consider tracking data such as demographics, insurance, enrollment status and seat time saved to help in the evaluation process. Consider gathering additional data through client satisfaction surveys or focus groups to use for continuous refinement and enhancement of the model.
Schools and districts may consider various ways to build financial and operational capacity to sustain funding. Some considerations include:
- Utilizing state and federal allocations;
- Applying for competitive grants from state, federal and private or nonprofit funding sources;
- Applying for non-competitive grants from state and federal funding sources;
- Building operational capacity through attracting high-quality practitioners and community partners;
- Implementing a robust medical billing system which includes billing insurance, Medicaid and Medicare if seeing older adults; or
- Expand patient caseload by seeing students, staff and community members at the health center.
The Ohio Medicaid Schools Program is a reimbursement strategy designed to assist schools in offsetting costs associated with the Individuals with Disabilities Education Act (IDEA). The program primarily covers therapy services indicated on a student's Individualized Education Plan (IEP) and transportation services for Medicaid-enrolled students to access healthcare.
Note that this program is different than school-based health care, which is a model aimed at connecting all students, regardless of insurance type or IEP status, with external health providers to improve access to quality healthcare within the educational setting.
Last Modified: 12/5/2023 8:51:30 AM