School-Based Health Centers

 School-Based Health Centers (SBHC) play an important role in overcoming health disparities for low-income students due to accessibility to services and reducing barriers to student learning.  Teachers and primary care and behavioral health providers work collaboratively to integrate the two disciplines and to identify school-age children at risk, the latter which is accomplished thru screening and assessment. Students and their families rely on SBHCs to meet their needs for a full range of age-appropriate health care services, including: 

  • Primary medical care
  • Mental/behavioral health care
  • Dental/oral health care
  • Health education and promotion
  • Substance abuse counseling
  • Case management
  • Nutrition education 

Healthy children make better students and better students make healthier communities. Contemporary Health Care, Inc. (EXEC) recognizes that the many deterrents to learning (poverty, poor health, uninsured and underinsured, exposure to violence, ethnic/racial minority and learning disabilities) must be counteracted by protective factors in order to produce resilience and healthy children ready to learn. 

CHCI assists organizations to continue, expand, and introduce the protective factors—access to medical care, early identification of behavioral and mental health issues, as well as acute or chronic physical illness, health education, and relationships with caring adults. With our guidance organizations can contribute to acute and preventative behavioral and physical health care and student/adult relationship-building that begins to move high-risk youth from their specific deterrents to resilience and an ability to learn and contribute productively to the community at large. 

Since SBHCs are often operated as partnerships and/or sponsorships, CHCI assists with the collaboration fine points and helps tailor the specific services provided by SBHCs based on the specific community needs and resources.  Services can be provided by CHCI to the school, charter school association, school board, school district, SBHC sponsor, Federally Qualified Health Center (FQHC) or any combination thereof. As an example, CHCI could: 

·         Initiate the collaboration between organizations to start a successful integrated primary care and behavioral health linkage;

·         Work collaboratively to integrate disciplines and to identify school-age children at risk, the latter which is accomplished thru screening and assessment; 

·         Continue primary care and behavioral health development of schools’ SBHCs; Further the dialogue/operationalization with interested parties to comply with the Change in Scope (CIS) applications submitted that are approved by HRSA (such as what we have performed for our clients in 2012-2015) regarding SBHCs;

·         Assist with revenue cycle issues i.e. Medicaid/Medicaid HMO provider numbers and Medicaid FQHC provider number linkage based on CIS approval by HRSA to ensure financial sustainability for existing partners, inclusive of billing and collection methodologies beneficial to garner additional reimbursement/revenue and mitigate cost;

·         Assist with reimbursement issues relative to Medicaid, Medicaid HMOs, and other payors impacting SBHC governance and operation and under health reform;

·         Continue analysis of primary care development of SBHCs, including financial analysis of all SBHC services transitioned;

·         Explore privatization of SBHCs as needed, based on potential transition and conversion of entire operations, including staffing;

·         Continue to explore other opportunities and collaboration with other agencies and organizations to provide primary medical care, behavioral health care, and oral health care to school age children and adolescents of schools;

·         With SBHC continued development for potential linkage and potential privatization, the objective may include, but not be limited to the tasks/subtasks delineated as follows:

§  Review selected school SBHC financial and student/patient data;

§  Review schools’ SBHC operations, programs and services, contracts, etc.;

§  Review SBHC specific utilization in total and on a monthly basis by payor for total direct face-to-face visits by provider and visits by LCSW, LPC, and/or psychologist/psychiatrist (mental health) and by NP, MD/DO, and RN (primary medical care);

§  Review data for multiple years – total students, male/female, free and reduced lunch, SBHC programs and services, and other criteria for potential linkage consideration;

§  Review population and population subset information – base or current year and future year to project potential SBHC utilization;

§  Review current operational staffing – provider and non-providers by type, along with other support personnel;

§  Review current operational salary structure and operational expenses by individual line item – prior years, budget for current year;

§  Review facility/overhead/indirect expenses and staffing (if appropriate) supported by SBHC;

§  Analyze and project utilization, revenue/reimbursement, payor mix, staffing, operational expenses, and facility/overhead expenses based on current governance and operating structure – non-FQHC model;

§  Analyze and project utilization, revenue/reimbursement, payor mix, staffing, operational expenses, and facility/overhead expenses based on linkage;

§  Develop assumptions and prepare P&L and impact study based on current governance and operating structure compared to linkage to FQHC, determine any subsidy if needed;

§  Assist in review of Medicaid and other billings and collections;

§  Determine revenue per SBHC encounter, determine cost per SBHC encounter (primary care and mental health), and determine proration of SBHC-sponsored expense to total expense to be allocated to FQHC Medicaid reimbursement per encounter rate (assumed as statewide rate);

§  Attend conference calls and meetings among SBHC interested parties;

§  Review current staffing and other costs at SBHC for compliance to HRSA Policy Information Notices (PIN) and state Department of Health Medicaid relative to reimbursement;

§  Review appropriate state Department of Health and HRSA guidance along with literary research relative to SBHCs; and

§  Perform other tasks as required for the project.


As a result of such SBHC collaborations the following will be realized: 

·       Optimal use of the schools’ SBHCs as an entry point for integration of primary care and behavioral health services.

·    Overall health will be served and the ability to achieve positive health outcomes will increase.

·  Different factors affect the health and well-being of students, including the physical condition of home; school and community; the availability of quality health services; economic and social conditions; and the quality and impact of health promotion.  As a result, the SBHC will encourage and depend on active partnerships among all of those who can and should contribute to the well-being of students.

·   Studies of school-based programs show that health instruction is effective in changing health attitudes and behaviors - by combining instruction with environmental, social and service support, The SBHC aims to assure pro-health attitudes and behaviors endure. 

·   SBHC services are designed to keep students in schools, keep parents at work, promote preventative care, change student behavior, and treat physical and mental health issues earlier and more cost effectively. 

·     Added benefits are decreased absenteeism, reduced suspensions, expulsions and dropout rates, increased education hours, reduced emergency room visits, coordination of health and wellness activities, and individual guidance as students work through adolescent challenges. 

Please contact CHCI to discuss the ways we can assist you with a SBHC collaboration, partnership, and linkage and to address the root causes of health disparities and ultimately reduce the health disparities experienced.

Contact us, and we'll be happy to tell you exactly how we can address your particular institutional situation.