School-based health services expanding as need grows

Millions of students receive school-based health services, and for many, schools are their first — and sometimes only — option to receive health care. At least 70 percent of students who access mental health services begin doing so in a school-based setting, which makes expanding access that much more critical as demand continues to rise, according to a new brief.

Published Feb. 24 by the Education Commission of the States, Addressing Health Disparities Through School-Based Health Services explores legislative and programmatic examples in 17 states that are focused on improving equitable access to these services.

“Decades of research have highlighted the many ways in which healthier students are better equipped for learning,” researchers wrote. “As a result, many states have focused efforts on strategies that provide school-based health services with greater levels of engagement and outreach to students, families and local communities to increase equitable access to health and wellness.”

There were more than 300 bills addressing student wellness in state legislatures in 2022. Of those, 188 bills were enacted in 45 states and the District of Columbia that address a full range of student health and wellness elements in state policy.

Common themes emerged, including using Medicaid and federal funds to expand school health services, increasing investments in telehealth and recruitment efforts for providers, and implementation of policies that promote school-based health centers and community schools to provide equitable access to physical and mental health services for all students.

School-based health centers

At least 18 states and the District of Columbia formally address on-campus health centers or clinics in statute or regulation. School-based health centers offer a variety of services delivered by multidisciplinary teams, depending on implementation and local needs. Centers may provide primary care, mental health care, social services, oral health care, reproductive health care, nutrition education, vision services and more.

School-based health centers have been recognized for increasing access to care among underserved communities and in rural areas. Some states have emphasized promoting family engagement strategies to increase access and reduce barriers for students to receive care.

States have different approaches to using Medicaid in school-based health centers as well as different approaches to funding them through grants from local, state and federal governments, which researchers noted provides many examples for policymakers to consider in their own states or communities.

Community schools

Since 2020, policies supporting community schools have been adopted in at least 37 states as another way of expanding equitable access to care and resources for students and their families. Some states have taken steps toward removing language barriers and providing culturally responsive support to better serve all families and communities, the brief notes.

“Active family and community engagement strategies are essential to community schools,” researchers wrote. “Before establishing a community school, a community must conduct a needs assessment or audit to capture the services families and children need. The needs assessment can help identify the potential barriers and capture the specific community needs.”

In Maryland, for example, community needs assessments identified a broad range of needed health services — from home visitation, safe opportunities for physical activity, food pantries, primary health and dental care to mental health and counseling services.

Maryland community schools also offer academic services such as counseling, job training, internship opportunities, postsecondary advising and career, apprenticeship and employment opportunities for older students. And for parents, community schools provide programs that promote parental involvement and family literacy, parent leadership development and advocacy activities, as well as parenting courses, adult English language courses for non-native speakers and other courses on homelessness prevention and guidance on obtaining housing services.

In an effort to expand access in the highest-need areas, states like California have placed a priority on creating community schools in areas that have historically struggled with access to health and wellness services.

The California Community Schools Partnerships Act specifies that the superintendent should prioritize grant funding to schools where at least 80 percent of students are classified as an emerging bilingual learner, eligible for free or reduced-price meals, or are in the foster care system. The grant recipient must commit to providing trauma-informed health, mental health and social services for students at the school site.

The California Department of Education in 2021 launched the California Community Schools Partnership Program (CCSPP), which supports schools’ efforts to partner with community agencies and local government to align community resources to improve student outcomes. In 2022, legislators passed a bill that added funding and expanded the program through 2031.