Andrea is a 14-year-old who lives with her mother. She started at a new school six months ago. At her annual well visit at the school-based health center (SBHC), she scored high on the Patient Health Questionnaire-9 and reported cutting. She said she has no friends and does not fit in at her new school. The supervising pediatrician recommended a selective serotonin reuptake inhibitor (SSRI), and Andrea and her mother agreed. Ongoing therapy was arranged with the mental health care provider at the SBHC, which also has daily access to a nurse practitioner. The therapist, nurse practitioner and pediatrician coordinate and share in the care of this teen within the SBHC.
SBHCs provide primary care services and address the physical and mental health needs of students in a convenient and confidential location. SBHCs have been shown to improve access to care and health outcomes and reduce health disparities.
An updated AAP policy statement provides an overview of SBHCs, including benefits and challenges. It also reviews their role in working with pediatric medical homes and offers recommendations that support coordination with pediatric primary care clinicians.
The policy School-Based Health Centers and Pediatric Practice, from the Council on School Health, is available at https://doi.org/10.1542/peds.2021-053758 and will be published in the October issue of Pediatrics.
Significant growth, benefits
The number of SBHCs across the country has doubled since 1998. Currently, 64% of SBHCs are in urban or suburban communities, while over a third are in rural school districts. SBHCs are located in high schools, middle schools and elementary schools.
Increasing access to health care is a primary role of SBHCs. They can decrease geographic or transportation barriers to health care, especially in rural areas.
They can provide quality, comprehensive and coordinated primary care, particularly among underserved, at-risk and stressed children and adolescents.
The effectiveness of SBHCs can be seen by improvements in health outcomes. SBHCs reduce health disparities and increase access to mental health services. Immunization rates are increased, and access to reproductive health services for adolescents is improved. Some chronic conditions such as asthma and obesity can be addressed with novel treatments by the SBHC team of caregivers. And, by reducing barriers to health care, SBHCs decrease school absenteeism.
Pediatricians’ role
The updated policy promotes a more active role of community pediatricians in establishing and collaborating with SBHCs. Additionally, pediatricians can oversee school health services and can guide school wellness programs.
Lastly, if a student does not have a medical home, an involved pediatrician can serve as the medical home or provide support for the SBHC to become a certified patient-centered medical home site.
Recommendations
The policy statement includes the following guidance for pediatricians:
- Promote patient access to a medical home and communication between health care providers across settings.
- Recommend care coordination practices between SBHCs and community primary care providers to avoid duplication and fragmentation of care. This may include promoting forms that are compatible with electronic health records.
- Support SBHCs and community schools by increased involvement, including by providing clinical services and serving as an SBHC consultant or medical director.
- Promote school health advisory councils to review health policy and analyze emerging health trends that might influence student health and academic success.
- Advocate for better funding for SBHCs from national, state and local sources.
- Advocate for programs that reduce health disparities and advance health equities for children and adolescents.
Dr. Kjolhede is a lead author of the policy statement and a former member of the Council on School Health Executive Committee.
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