In a Nutshell:

• Attention to hiring more school counselors, nurses, social workers, and psychologists is long overdue.
• School-based health centers provide a complementary approach to improve students’ health.
• Student mental health needs must be met, but they should be approached from the perspective that recognizes that health is a state of physical, mental, behavioral, social, and spiritual well-being; school-based health centers may help facilitate this holistic approach to student wellness.

After years of falling short on behavioral health services, much attention has been focused on the mental health of Michiganders in recent months. While it is encouraging to see new investments directed at long-standing shortcomings in Michigan’s mental health system and school-based health professionals, the scope of the problem is immense after decades of neglect.

As advocates push for increased investment in school-based health centers, it is important for policymakers to understand that these centers are not duplicative investments alongside funding for school health professionals; rather, school-based health centers provide complementary, overlapping support to the services provided by school nurses and social workers.

What are School-Based Health Centers

School-based health centers (SBHCs) are clinics located within or adjacent to schools that provide a wide array of medical and behavioral health services. They arose during the 1970s in elementary schools as a way to provide services to those who could not afford or access primary health care. Over the past 50 years, the school-based health model has expanded to provide a range of services in school and community settings. While SBHCs continue to focus on providing services in at-risk and/or medically-underserved communities, the model holds promise to help a growing number of children and adolescents with increasingly complex health challenges and needs.

SBHCs provide affordable services conveniently located where youth spend much of their day, helping to remove numerous barriers to access. They provide a full range of primary care services, including behavioral health and dental care. SBHCs are typically partnered with outside health providers for staffing and other needs. In Michigan, they collaborate with health systems, local health departments, and federally qualified health centers in relatively equal proportion. They are located throughout the state, but predominantly in the Detroit and Grand Rapids metropolitan areas.

Locating SBHCs within the schools allows students to access healthcare services during the school day, as well as before or after school. These centers reduce barriers to behavioral health care for students such as transportation and/or scheduling difficulties, uncertainty of where to go for help, and delays between referral and treatment. Moreover, by integrating behavioral health and wellness within a school setting, opportunities are created to normalize treatment seeking behaviors and reduce stigma, making it more likely that people will be willing and able to seek care during their school years and throughout life.

Social and emotional well-being counseling and crisis intervention are the most common behavioral health services provided by SBHCs. SBHCs also efficiently and effectively provide screening and early identification of various behavioral health conditions. Evidence suggests services provided through SBHCs also increase the proportion of students who receive mental health care, by facilitating access and removing barriers to treatment. There is also evidence that SBHCs improve attendance and academic performance, particularly for high-risk groups.

Duplicative vs. Complementary Spending

It is important to recognize that SBHCs do not eliminate the need for school nurses, social workers, or psychologists. Ideally, school-based health centers communicate, cooperate, and collaborate with school personnel. An individual’s health is often determined by the intersection of complex social, environmental, physical, mental, and emotional factors; SBHCs complement the work of school health personnel by providing services for students in need of more complex care and enabling school health personnel to focus on population health efforts. In an ideal situation, SBHCs can provide holistic, individualized primary care to students while school nurses, counselors, social workers, and psychologists work within their respective disciplines to provide classroom and building-level health interventions. Through a multitiered and multilevel approach, the focus can be proactive attention to health promotion and disease prevention rather than merely reactive treatment.

Legislators have a difficult job of appropriating scarce resources among many worthy uses. Duplicative efforts and programs are often evidence of inefficient budgeting. On the other hand, complementary investments often extend the impact of each public dollar spent. School-based health centers should be viewed as the latter.