Literature Review
SBHC Literature Review
One size doesn't fit all.
There are many models and configurations to SBHCs: traditional, offsite, satellite, mobile, etc. Services can be any combination of health services but must include primary care. Communities can tailor the SBHC model best to meet the needs of local youth using their community infrastructure.
Funding SBHCs can look different depending on the location and needs (The Community Preventative Service Task Force, 2015; Moore & Johnson, 2015).
Some common funding streams are private, government, in-kind, foundation, and Medicaid; however, rural communities with high insurance rates can strongly benefit (Moore & Johnson, 2015).
Massachusetts is committed, as is the U.S. government, to funding school-based health due to the positive outcomes associated with youth wellbeing. However, funding can be unstable and SBHCs can be costly to run*.
Between 2014 and 2017, Massachusetts dedicated $2.9M annually to fund SBHCs (SBHC, 2017).
Affordable Healthcare Act (ACA) appropriated between 2010 and 2013 a total of $200M for improvement and expansion of SBHCs.
September 30, 2020: Passage of H.R. 2075, the School-Based Health Centers Reauthorization Act of 2020 in the U.S. House of Representatives; extends the authorization for federal funding of school-based health centers through 2025, helps provide vital, affordable health care for our nation’s students and families at over 2,500 SBHCs.
School-based health centers can help to bridge the school-family relationship, and save families time and resources.
Some parents whose children had access to school-based tele-health services at childcare centers reported almost unanimously that they would choose a program with telemedicine over one that did not (Kenneth et al., 2009).
Parents whose children had access to school-based tele-health services reported on average 4.5 hours saved compared to in-person healthcare visits (Kenneth et al., 2009).
The research on SBHCs reports that parents whose children attend schools with SBHCs request less time-off from work (Lofink et al., 2013).
*Telehealth and ECHO models of healthcare show promise for reducing the cost of running/staffing SBHCs. The upstart of a school tele-health model can be quite cost effective due to the limited need for equipment and supplies (Moore & Johnson, 2015).
What we know
School-based health centers relate to academic achievement, student engagement, and students' positive perceptions of school.
By offering a safe place to receive needed services from a trusted adult, 97% of visits result in students returning to class and maximizing time in learning (mass.gov).
Decreases in absences and discipline referrals are linked to student users of SBHCs (Gall et al., 2000; Hall, 2001; Kenneth et al., 2009; Webber et al., 2003).
Providing access to school-based health services communicates to youth that the school cares about their wellbeing (Strolin-Goltzman, 2010).
School-based health centers promote positive health behaviors and increased access to healthcare for adolescents.
Schools present the most accessible environment to provide youth equitable healthcare (CDC Policy Brief; )
Adolescents are 10-21 times more likely to come to a SBHC for mental health services than the community health center network (Juszczak L., et al., 2003).
Youth in poverty and uninsured youth are less likely to have a routine place for preventive care and less likely to have had a well-child visit in the past year (Katz, 2020).
Studies show strong/sufficient evidence for SBHCs as an effective intervention strategy that promotes health equity for youth (delivery of vaccinations and preventative services), school performance, grade promotion and high school completion, and lower asthma morbidity and emergency department/hospital admission rates (The Community Preventative Service Task Force, 2015; Kenneth et al., 2009).
Adolescence is a key time to make an impact on student's future health behaviors that prevent chronic disease: heart disease, cancer, and diabetes (Ruglis &Freudenberg, 2010).
School-based health centers prove promising for the future of youth healthcare access.
COVID-19 has brought about changes in healthcare that may benefit SBHCs: ease of access to clinicians via Telehealth, reduced costs, stronger partnerships with community clinicians, and community value as a healthcare hub (MacLean, 2020).
School-based health centers benefit their surrounding communities and society as well.
Cost benefit studies show:
that societal benefits range between $15,028 to $912,878 in averted costs per SBHC per year (due to treatment, productivity loss, and transportation);
a net savings to Medicaid ranging from $30 to $969 per visit, or $46 to $1,166 per user; and
patient/parent-reported savings of $90 per visit and $23,592 per user.
"Here for the Kids"
(1) ACCESS: School-based health center (SBHC) services are easily accessible and designed to eliminate or diminish barriers to care and participation by students and their families (availability of services and physical plant).
(2) PROFESSIONAL QUALIFICATIONS: SBHC services are delivered in accordance with professional standards and by qualified licensed and/or registered staff.
(3) MANAGEMENT AND CLINICAL STRUCTURE: The SBHC operates according to written management and clinical protocols that ensure that health services are delivered to students in an organized manner and in accordance with evidence-based medical practices.
(4) CONTINUITY OF CARE: The SBHC develops a collaborative relationship with the students, his/her parent or guardian, the school health program, and other health care providers in the child's community.
(5) QUALITY MEASUREMENT: The SBHC complies with a program that monitors and evaluates the appropriateness and effectiveness of the services provided.
(6) MEDICAL RECORDS: The SBHC establishes a record-keeping system that provides for consistency, confidentiality, and security of records in documenting significant student health information and the delivery of health care services.
Things to Consider
Understanding-Social-Influencers-of-Health-and-Education.pdf
Rural Student and School Community Health Needs & Health Behaviors-SDOH
Insurance
Uninsured rates of children has increased since 2018: "The changes in uninsured status between 2018 and 2020 affected children in poverty more than those living above the poverty level" (Census, 2020).
Physical Plant
Data Sharing
MV Community Healthcare Capital & Shortages
Existing School-Clinical Partnerships
Public Policy
SBHArecommendationstoBidenHarrisTransitionTeam.pdf