The rapid rise of school-based health centers

A student visit at a school-based health center in St. Paul, Minnesota.Gary Hough, superintendent of Fayette County Schools in West Virginia, has witnessed the profound impact of school-based health centers (SBHCs) over his 45 years in education. In the early 1990s, as a middle school principal, Hough collaborated with local nonprofit healthcare provider New River Health to offer sports physicals for low-income students who didn’t have access to exams. That partnership grew into the district’s first full-fledged SBHC, and today there are several school-based clinics providing comprehensive health services to the district’s 5,600 students. 

A health center serving students in the Fayetteville County Schools in West Virginia. The superintendent says the center is critically important, as many students in the district lack access to health services.“Many of our students live in poverty and don’t have strong home environments. SBHCs have become critical in providing physical, dental, and mental health care, especially in recent years,” Hough explains. Today, all schools in his district have access to SBHC services, and some centers serve the broader community. New River Health now operates nine school-based health centers in the area. 

Many positive impacts 

Today there are an estimated 3,900 SBHCs in districts across the country, up from less than 2,600 in 2017, according to the School-Based Health Alliance, a national nonprofit organization that supports SBHCs through advocacy, research, and training. [See Resources box below for more information] 

SBHC’s are designed to make healthcare more accessible to students by providing services directly on school campuses or nearby, including primary and preventive care, such as vaccinations, physical exams, and mental health services. 

SBHCs may receive funding from federal, state, or local sources, and typically operate through partnerships between health care organizations, school communities, and community-based organizations.  

These centers can have a significant impact on attendance and academic outcomes, according to John G. Kennedy, director of school-based and behavioral health services for the West Virginia Primary Care Association. In West Virginia alone, 240 SBHCs serve 100,000 students. By addressing health needs early, Kennedy says that SBHCs reduce student absenteeism and prevent the need for parents to take time off work for medical appointments. 

 West Virginia’s SBHCs are expanding their reach by using mobile health units and telehealth services to serve students in rural areas. These mobile units deliver healthcare directly to communities, ensuring that even students with limited broadband or transportation have access to essential services. 

Telehealth also allows schools to launch SBHCs with a lower upfront investment. Kennedy says the state will begin using equipment from 19Labs early next year that enables trained professionals to use smart diagnostic devices including stethoscopes, glucometers, and blood-pressure cuffs in a school health center remotely, to meet the needs of rural students who live far from a doctor’s office.  

Keeping students in school and healthy 

Erica Drake, APRN, CNP, is the medical director of Health Start Clinics in St. Paul, Minnesota, home to the first SBHC in the U.S., established in 1973. The state’s SBHCs offer everything from asthma management to reproductive healthcare, with state laws allowing adolescents to receive reproductive services without parental consent. 

A health clinic at Washington Technology High School in the St. Paul Public Schools in Minnesota, where the first school-based health center in the country was established in 1973.Drake emphasizes how SBHCs keep students in school by providing on-site care for common health needs. In 2023-24, the St. Paul district’s clinics recorded 13,853 visits and administered 3,500 immunizations. 

Because these clinics are part of a federally qualified health center, they can offer medications, including birth control, at reduced rates. “We build relationships with students, ensuring they know how to properly use their medications,” Drake says. “It’s not just about handing out prescriptions; it’s about follow-up and ensuring their needs are met.” 

The state of Minnesota has some 29 health centers in schools, serving 9,000 students annually. In addition to physical health services, Minnesota’s SBHCs lead student discussion groups raising awareness about topics such as vaping and mental health. 

Taking on an expanded role 

School-based health centers have evolved significantly in recent years, according to Laura Brey, chief operating officer of the School-Based Health Alliance. “Today, SBHCs offer a mix of in-person, virtual, and hybrid care through telehealth and mobile services,” Brey says. “In rural areas, mobile health units are especially valuable.” 

Many SBHCs have expanded to include food pantries and clothing closets, while others partner with public housing agencies or connect students to legal services.  

In addition to care coordination, youth advocacy is becoming a larger focus. “Students are speaking up about their needs, such as requesting substance-abuse counseling services,” Brey explains. “They’re driving some of the changes we’re seeing.” 

Building a healthier future 

SBHCs have been found to have wide ranging impacts in schools, communities and states. A study by Education Plus Health, a nonprofit organization serving 7,000 students in 15 school-based health centers in Philadelphia, found that 60 percent of students with access to SBHCs improved their attendance during the 2022-23 school year, and states with robust health services in schools have higher test scores and lower dropout rates. 

In California’s Oakland Unified School District, SBHCs offer medical, dental, and behavioral care at 23 schools. A student survey found that 94 percent of students feel that SBHCs provide a caring adult presence, and 98 percent of students return to class after their visits. As one high school student said, “It’s a good place to find help. If you need something, you can always come here, feel safe, and not be judged.”