Introduction
School-based health centres (SBHCs) are crucial in providing healthcare services to underserved youth in the United States. These centres provide essential healthcare services directly within schools, ensuring that students have easy access to medical care. Located in elementary, middle, and high schools, SBHCs primarily serve low-income communities, offering primary care, reproductive health, mental health, dental, vision, and nutrition services. These centres are staffed by a multidisciplinary team, including physicians, nurse practitioners, mental health providers. SBHCs improve both health and educational outcomes by increasing access to care and partnering with schools and paediatric healthcare providers. They play an important role in both advancing health equity and enhancing educational outcomes.
Background and Current State
The origins of SBHCs date back to the 1960s and 1970s. These early centres aimed to enhance care for underserved students and improve prenatal care for teen mothers. As of the 2016-2017 Census by the School-Based Health Alliance (SBHA), there are 2,584 SBHCs across 48 states, Puerto Rico, and the District of Columbia. These centres serve over 6 million students in various communities. Most SBHCs are located on school campuses, while others are mobile or telehealth-exclusive. Federally qualified health centres sponsor 51% of SBHCs, and all provide primary care services.
SBHCs and Access to Care
SBHCs are instrumental in bridging gaps in care for underserved youth, particularly those who are uninsured or underinsured. These centres offer comprehensive medical services, including preventive care, management of chronic conditions, and reproductive health services. By providing care on-site, SBHCs reduce the need for travel and ensure that students miss less school. Confidentiality is maintained, allowing adolescents to seek care without parental involvement.
Management of Chronic Health Conditions
SBHCs play a crucial role in managing chronic health conditions like asthma and obesity. Asthma is the most common chronic illness in children. SBHCs can initiate treatment, provide urgent care, and promote medication adherence. Studies have shown that SBHCs reduce asthma-related hospitalisations and improve school attendance.
Childhood obesity is another significant concern, particularly those from low-income households. SBHCs screen for obesity and related conditions and offer educational interventions. A study in New Mexico found that a SBHC weight management program led to improvements in body mass index (BMI) and waist circumference.
The Role of SBHCs in Advancing Health Equity
A Community Guide systematic review in 2016 highlighted the effectiveness of SBHCs in improving educational and health-related outcomes. According to this review, SBHCs were associated with higher grade point average (GPA), grade promotion, and reduced school suspensions. Health outcomes improved as well, with increased immunisation rates, reduced asthma-related hospitalisations, and better reproductive health indicators.
Educational Outcomes
SBHCs positively impact educational outcomes by reducing absenteeism and improving academic performance. Studies have shown that SBHC users have higher GPAs and are more likely to be promoted to the next grade. One study found that SBHC use was associated with a 33% reduction in school dropout rates, particularly among high-risk students. SBHCs also support pregnant adolescents, helping them stay in school and achieve better educational outcomes.
Cost Effectiveness of SBHCs
SBHCs are not only beneficial for students but also cost-effective, reducing healthcare and societal costs. They decrease emergency department visits, hospitalisations, and missed time from work and school, providing a high return on investment. Wade and Guo demonstrated that SBHCs reduce Medicaid costs by improving students’ health-related quality of life (HRQoL). Moreover, a systematic review found that the societal benefit of SBHCs ranged from $15,028 to $912,878 annually. Another study in Ohio reported a net social benefit of $1.35 million over three years of SBHC operation.
Conclusion
SBHCs are important healthcare facilities that promote health equity among youth and improve their educational outcomes. They reduce health disparities, offer cost-effective care, and support the academic success of students. However, there are several challenges that SBHCs face. Many SBHCs rely on grants and external funding, which can be unpredictable. Moreover, there is a need for better integration with primary care providers to ensure continuity of care. Future efforts should focus on securing stable funding sources and enhancing collaboration between SBHCs and other healthcare providers.
