Source: National Survey of School-Based Health Centers, 1997-98, Making the Grade, The George Washington University, Washington, D.C.

Figure 2
Source: National Survey of School-Based Health Centers, 1997-98, Making the Grade, The George Washington University, Washington, D.C.

Figure 3
Source: National Survey of School-Based Health Centers, 1997-98, Making the Grade, The George Washington University, Washington, D.C.

Where are they?School-based health centers have grown rapidly during the 1990s, increasing from about 200 in 1990 to 1157 in 1998. They are found in every region of the country and are located in 45 states plus the District of Columbia. Only Idaho, Nevada, North and South Dakota, and Wyoming report no school-based health center. (Figure 1)

Which states lead the way?

In 1998, the states with the largest number of centers included: New York (158), Arizona (82), Texas (77), Florida (64), California (64), Connecticut (51), Maryland (43), Michigan (41), New Mexico (40), Oregon (39), and North Carolina (39).

Which regions host the largest number?

Mid-Atlantic and New England states continue to lead the regions with 37% of the total. However, the Southwestern/Rocky Mountain states and the Midwest, which house 20% and 15% of the total respectively, have seen the largest growth in the past two years. Eighteen percent are located in Southeast/South-central states, and 10% are found in the Pacific states.

Rural or Urban?

School-based health centers are located in urban, rural, and suburban communities, with the largest recent increases in rural areas. (Figure 2)

What types of schools house school-based health centers?

They are in elementary schools (33%), middle schools (16%), high schools (38%), K-12 schools (6%), and a mix of other schools (7%). (Figure 3)

How long are they open?

In 57% of the centers, medical services are available more than 25 hours per week; 43% of centers offer medical services less than 25 hours per week. (Figure 3)

 

 

 

Figure 4
VISITS BY DIAGNOSIS, 1997-98
Making the Grade local partners
Survey of 26 School-Based Health Centers

No. of
visits
% of
visits

Mental health
4,449
25.07%

Health supervision
3,589
20.22%

Pulmonary/respiratory
1,848
10.41%

Ear/nose/throat
1,308
7.37%

Skin & subcutaneous
981
5.53%

Symptons
825
4.65%

Reproductive health care
589
3.32%

Musculoskeletal trauma
551
3.10%

All other
3,615
20.37%

Total
17,749
100.00%
Source: Making the Grade quarterly data reports Oct-Dec, The George Washington University, Washington, D.C.
Figure 5
VISITS BY DIAGNOSIS, 1997-98
Connecticut school-based health centers
Survey of 45 School-Based Health Centers

No. of
visits
% of
visits

Mental Health/
Substance Abuse
24,523
34%

Acute Disease
18,046
25%

Reproductive Health
5,872
8%

General medical
examination
5,618
8%

Intentional/unintentional
injury and poisoning
4,660
6%

All Other
12,687
19%

Total
71,406
100.00%
Source: School Based Health Centers Annual Report, 1997-98, Connecticut Department of Public Health
Figure 6
SCHOOL-BASED HEALTH CENTER STAFF

Provider
Hours per week

Primary care providers:
NPs, PAs, MDs
25.35

Preventive care, health promotion:
RNs, LPNs, health educators
34.08

Mental health, substance abuse:
Clinical social workers, psychologists,
psychiatrists, other mental health
providers
18.81

Social Services
5.07

Adminstrative
16.09

Dental
1.70

All Other
13.32
Source: 1998 Census, National Assembly on School-Based Health Care, Washington, D.C.

What kinds of services do they provide?
The services offered at each center are determined by each community in conformity with state laws. Surveys of students, parents and school staff frequently are used to assess student needs. While no nationwide data are available to describe all services provided by the 1157 centers, two recent reports suggest the breadth of services:

  • In a survey of 26 school-based health centers, mental health was reported as the leading service provided. Health supervision services (physical exams, behavior risk screenings, immunizations) followed closely. The 26 centers are from nine states participating in the Robert Wood Johnson Foundation grant program, Making the Grade. (Figure 4)
  • In Connecticut, 45 of the 51 health centers report that mental health was their leading service in the 1997-98 school year, followed by acute care, reproductive health care, and general health examinations. (Figure 5)

How are they staffed?

Nurses and health educators who provide preventive and health promotion services are on site most frequently (averaging 34 hours per week), according to a 1998 national survey of 621 school-based health centers. Next in line are primary care providers — physicians, nurse practitioners and physician assistants (about 25 hours per week). Mental health and substance abuse treatment professionals follow, and include clinical social workers, psychologists, and psychiatrists as well as other licensed mental health providers (nearly 19 hours per week). The survey was conducted by the National Assembly on School-based Health Care (NASBHC). (Figure 6)

Which institution sponsor the centers?

All school-based health centers are sponsored by a larger agency. Data from the same NASBHC survey reveal the following leading sponsors:

  • hospitals (29%)
  • health departments (22%)
  • community health centers (18%)
  • other non-profit health organizations (11%)
  • school systems (9%)
  • A miscellaneous group of institutions (11%)
    (Figure 7)
Figure 7
SPONSORS OF SCHOOL-BASED HEALTH CENTER STAFF

Hospitals/medical centers
29%

Health departments
22%

Community health centers
18%

Non-profit health organizations
11%

School systems
9%

Medical & nursing schools
6%

All Other
4%
Source: 1998 Census, National Assembly on School-Based Health Care, Washington, D.C.