School Based Health Clinics

What is a School Based Health Clinic?

A School Based Health Clinic (SBHC) is a medical clinic in the school, or attached to the school, that is managed by a third party. Most often, the third party is a local Hospital, but it can also be a pediatrician’s practice as well.

But wait, doesn’t the school already have a nurse on staff?

It varies by school. School nurses have been a growing investment in schools since 1904, when Lina Rogers Struthers was appointed to support over 8,000 students across 4 separate schools in New York City. She was so effective that within a year a dozen more nurses were hired. 120 years later, there is no actual law requiring a school to have a nurse. According to National Association of School Nurses (NASN), only about 40 percent of all U.S. schools have a full-time nurse; just 35 percent have a part-time nurse, and 25 percent have no nurse at all. We have often found that in schools with a nurse, the nurses are often a pillar of the school. Which just makes this all the more maddening that we don’t even have a nurse in all of our schools, but hundreds of millions of dollars are being used to open fully functioning medical clinics.

Where is that money coming from?

There is an array of grant options being utilized that help pay for the initial cost of opening a clinic, and grants that can help cover a portion of the annual operating cost of the clinic. The grants can change, as some expire others are created. Some grants are renewed annually, while others are renewed every couple of years.

These grants can be broken down into two primary categories, State, and Federal, with some overlap between the two.

Some Federal Examples:

In 2021 the American Rescue Plan passed. Included was funding for 2 years to enhance healthcare infrastructure.

In 2022, Health and Human Services awarded $25 million through the Health Resources and Services Admin (HSRA) to expand SBHCs. Five centers in Maine were awarded just shy of $1 million dollars for SBHCs.

Some State Examples:

The Maine CDC manages an annual grant for SBHCs. The School Based Health Center Services Grant awards funds annually depending on factors such as the size of the school, and how rural the school is.

The Fund for Healthy Maine has allocated $600,000 each year, for two years, for the express purpose of expanding the number of SBHCs in Maine.

There are a few clinics that are fully funded by grants or donations, and that do not accept any form of payment. So far, these particular clinics we have found only offer a few services and are not fully functional medical clinics.

Most of these clinics we have reviewed so far, do bill for services, and they have a varying range of services they offer.

Where is this coming from?

Public health officials have had an interest in schools for over 100 years, that part is not new. Actually, even as the first vaccines became available, schools were used as a tool to get them into children. In 1954, the public school system was even used to conduct a pharmaceutical safety study for the first polio vaccine. At that time, 623 ,972 schoolchildren were injected with the vaccine or placebo, and more than a million others were used as “observed” controls. School Nurses monitored the children and provided the details to Dr. Salk.

Actual school-based health clinics, however, were first developed as the focus of “school health” began to expand beyond just education. The first school-based health centers opened in Cambridge, Massachusetts (1967), Dallas, Texas (1970), and St. Paul, Minnesota (1973).

Then in 1978 the Robert Wood Johnson Foundation helped pave the way for the development of this model, and still today funds the Center for Health and Health Care in Schools. 

By 1985, there were 31 SBHCs in the Country. By the 1990s, there were over 1,000, as a result of multiple lobbies that had taken up the issue in Government. But it was the acknowledgements from the Obama Administration, and the inclusion of SBHCs in their healthcare reform efforts that really changed the landscape. Thanks to ample funding included in The Affordable Care Act, the number of SBHCs more than doubled throughout the 2010s. By 2020 there were 2,500, and that number is set to skyrocket again as the Biden Administration has renewed the Obama era interest in SBHCs. The Biden Admin has not only renewed interest but has prioritized SBHCs as a key opportunity to access children during the day, with no parental intervention. 

In 2022, the Safer Communities Act was passed and signed into law. Within this legislation, there was an emphasis on mental health services which provided for Medicare to support States in creating mental health programs in schools. It also required CMS to provide guidance to States in order to provide mental health services explicitly in school. It also reauthorized the Pediatric Mental Health Care grant for five years. In total, $1 Billion dollars was allocated for the purpose of expanding School-Based Health Services.

In 2023 each State qualified for up to $50 million in grants for the express purpose of opening new SBHCs in public school, with again, an emphasis on equity.

For decades, there has been little criticism towards this use of schools. In fact, prior to the development of all of the social programs we have today that make routine medical care accessible to impoverished populations, the medical programs offered at some schools were important. Some of these programs were the only way some children had access to basic healthcare. And it is important that we acknowledge that historically, there have been benefits to offering limited healthcare supports in schools.

However, it is equally important to recognize that the factors that limited access to healthcare in the 1970s are vastly different today.

Check our ongoing list of SBHCs in Maine to find out if there is a clinic at your child’s school here.

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