Figure 1  National Survey of State SBHC Initiatives
School Year 1999-2000
chhcs_map2
 Figure 2  Top Ten States with School-Based Health Centers
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 Figure 3   States with significant growth
 State 2000 1998 Growth
 Mississippi
Illinois
Ohio
Maine
Wisconsin
California
Iowa
Arizona
Maryland
Louisiana
Florida
Massachusetts
32
43
20
17
38
102
26
116
59
40
80
44
13
18
10
10
23
64
18
82
43
30
64
36
146%
139%
100%
70%
65%
59%
44%
41%
37%
33%
25%
22%
 Figure 4  Location of School-Based Health Centers
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 Figure 5  Type of Schools Housing SBHCs
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 Figure 6  State Dollars Supporting SBHCs
 Source of state dollars Amount
Title V MCH Block Grant (state-directed dollars)
(N=15)
$ 8,156,165
Title V MCH Block Grant (local-directed dollars)
(N=4)
$ 1,970,161
Title XX Social Service Block Grant (N=1) $ 788,300
State General Funds (N=18) $ 31,978,697
Preventive Health and Health Services
Block Grant (N=2)
$ 250,500
Tobacco Tax Dollars (N=2) $ 7,950,000
Tobacco Settlement Dollars (N=3) $ 5,583,457
Other** (N=12) $ 5,269,154
Total $ 61,946,434

**Other includes: Juvenile Justice Funds, STD Training Dollars, Special Education Funds, Department of Education, EPSTD, and Making the Grade dollars.

*Note: The survey was conducted in the summer of 2000 by Making the Grade, a national program of The Robert Wood Johnson Foundation. In February 2001, Making the Grade became The Center for Health and Health Care in Schools. The Center remains at The George Washington University and is co-sponsored by the School of Public Health and Health Services and the Graduate School of Education and Human Development.

Growth and Location
School-based health centers (SBHCs) have grown rapidly over the past decade, from 200 in 1990 to 1,380 in 2000-an increase of almost 600 percent. SBHCs are found in 45 states plus the District of Columbia. Only Idaho, Nevada, North and South Dakota, and Wyoming report no centers (see figure 1).

Top Ten States
In 2000, the states with the largest number of centers included: New York (159), Arizona (116), California (102), Florida (80), Texas (70), Maryland (59), Connecticut (56), Massachusetts (44), Oregon (44), and Illinois (43)
(see figure 2).

States with Significant Growth
Rapid expansion has occurred in historically liberal and conservative states across most regions of the country. Since 1998, the number of centers in Mississippi and Illinois more than doubled. The number of centers in Wisconsin rose by 65%, in California by nearly 60%, in Arizona by more than 40%, and in Maryland by 37%
(see figure 3).

Rural, Urban, Suburban
School-based health centers are located in urban, rural and suburban communities. Since 1998, the largest increases have been in suburban areas (see figure 4).

Types of Schools Housing
School-Based Health Centers SBHCs are in elementary schools (38%), middle schools (17%), high schools (34%), k-12 schools (5%), and a mix of other schools (6%) (see figure 5). Since 1998, of all schools, elementary schools have seen the largest growth in centers.

Part-Time vs. Full-Time
Health care providers-usually a nurse practitioner or a physician assistant -work full time in 60% of the centers and 25 hours per week or less in the remaining 40% of SBHCs.

Community Support for School-Based Health Centers
Communities across the country are asking their states about launching school-based health centers. Thirty-six of 43 states responding reported they had been asked to provide information on how to start, operate, or fund a SBHC. Only 13 states reported they had been contacted by anyone who opposed the opening of an SBHC in their state.

State Dollars
State funding for SBHCs increased from $46.1 million in 1997/1998 to $61.9 million in 1999/2000.

In school year 1999/2000, 33 states funded school-based health centers. Eighteen states spent a combined $32 million in general fund dollars, and 15 states earmarked over $8 million from their Maternal and Child Health (MCH) Block Grants. Most of the remaining state funding came from either tobacco taxes or tobacco settlement funds (see figure 6).

Federal Dollars
Federal funds for school-based health centers primarily flow from two sources: the MCH Block Grant, in which states choose how their dollars are distributed; and the Healthy Schools, Healthy Communities grant program, administered by the Bureau of Primary Health Care, DHHS. In FY 2000, this program allocated $14.4 million to SBHCs.