School Health Services Best Practices
School health services — whether led by a nurse or approached as a school-based health center — help students assess their health, manage chronic illness, administer medication and provide health counseling. The payoff can be huge in terms of academic achievement. Better management of chronic illness, for example, increases attendance. And improved attendance increases the chances of academic success.
- Every school in our district provides health services by a licensed school nurse or a trained health services employee who is supervised by a school nurse. We maintain a school nurse-to-student ratio of one nurse per 750 students.
- Our students are routinely screened and referrals made for medical needs including vision, hearing, weight and dental problems as well as lack of health insurance.
- The health status of students with chronic illness (such as diabetes, asthma, allergies and seizures) is monitored routinely, and health care/emergency plans for these students are written by the school nurse.
- Student attendance records are monitored routinely to identify absences related to health concerns.
- Our schools have adequate health facilities including a sink with hot running water, a handicapped accessible restroom, a cot, a computer, a locked file cabinet and a secure medication cabinet.
- Our district has considered participating in the Medicaid School Health Services Program, and if we decide to participate, we will strategically spend reimbursed Medicaid dollars on sustaining long term school health efforts. View our webinar, Untapped Revenue Source – Is Your District Participating?.
- Our school ensures access to on site school social workers and psychologists who have adequate time in the building to meet the needs of individual students, but also to deliver school wide evidence-based programs that improve safety, social and emotional health and positive behaviors for all students.
“I truly believe school-based health clinics have improved our attendance rate. It’s critical that all school districts support school-based clinics. They improve the quality of students’ lives, the quality of their education and they have a huge, positive impact on the community.”
- Ensure schools have a designated faculty member or administrative personnel responsible for coordinating school health and safety programs and activities.
- Collect confidential student and school health indicator data at least once every two years. Consider that data carefully when determining strategic plan objectives and activities.
- Start or get new ideas for how to improve school-based Medicaid and CHP+ outreach to students. The Covering Kids and Families School-Based Enrollment Toolkit includes a step-by-step guide to help schools get started, a frequently asked questions document, a sample memorandum of understanding between a school district and an eligibility site, and contact information for schools already doing this work.
- Consider using free and reduced-price meal data to conduct outreach and enrollment services to students who may be eligible but are not enrolled in public health insurance programs.
- Ensure all schools have a school health team that helps plan and implement school health programs, with suggested representation from the following stakeholders:
- School principal
- Health education teachers
- Physical education teachers
- Mental health or social services staff
- Nutrition or food service staff
- Health services staff (e.g., school nurse)
- Maintenance and transportation staff
- Student body
- Local health departments, agencies or organizations
- Faith-based organizations
- Local government
- Consider conducting a community readiness assessment to determine the need for physical, mental and dental health services that could be provided through a school-based health center. Access The Colorado Health Foundation’s community readiness assessment and information on their School-Based Health Center funding initiative by clicking here.
- Develop a board policy that underscores the importance of providing students with access to quality school health services.
- Build awareness among constituents about why quality school health services are relevant to student achievement.
- Help district leaders develop partnerships with community partners to provide additional health services to students.
- Advocate for school-based clinics and access to nurses in all schools.
- Build partnerships between schools and community health organizations for additional resources and referrals.
- Teach your child how to stay healthy and the importance of simple, but effective measures like washing hands.
- Become a leader or a supporter of increasing access to school health services in your school district.
- Participate in conversations led by administrators and school board members about how to provide better school health services to students. Help identify community issues, priorities and values.
- Partner with districts and schools to identify and secure access to additional health services in the community.
- Write letters to experts in the community, including doctors, public health, health systems, etc., and ask them to speak to your school, join your wellness teams and inform your messages, posters, and information given to all students and school staff.
- Make resources in health, science or family and consumer sciences classes to display in hallways, such as good health and hygiene practices and techniques.
- Be an example to your peers of proper health actions and healthy behaviors.
- Create a student-led board of health. Give awards to students and staff who are “Caught in the Act” of exemplifying healthy behavior.
- Help ensure that the student body knows the school staff that is responsible for physical, mental and emotional health.
- Work with teachers and other school staff to create wellness days, once per week, involving activities during school and after school.
This is a remarkable school overcoming some remarkable hurdles. Located in Denver Public Schools, PLACE Bridge Academy is a magnet school for refugees, enrolling over 1,000 students who speak 52 different languages and come from over 60 different countries. The average income of students’ families is $20,000, and 96% of students qualify for free and reduced lunch. Some students spend two hours a day on a bus to get to the school. The Principal, Brenda Kazin, recognized the educational challenges the students faced, and she knew that for them to grow academically, their physical needs must be met first.
Partnering with Denver Health, The Denver Health Foundation, and Community Health Services, the school took advantage of federal, state, and grant funding to provide students with a school based health center, staffed with either a physical assistant or nurse practitioner who provide primary care for the students at PLACE Bridge. Students who are in the 6th grade or above can visit the center without a parent, so students can stay in school and parents do not need to leave work. Students can receive vaccinations, vision and hearing screenings, well visits, and preventative medical and preventative dental care. The service is at no cost to the parent or child, and private insurance is not necessary. The center does, however, bill insurance companies and Medicaid, when possible.
The health efforts of this school also reach far beyond their school based health center and into the school’s systems, culture and community. Ms. Kazin uses Maslow’s Hierarchy of Needs and offers staff wellness, culturally responsive games during recess, and a safe space where her students learn skills to self-monitor behavior and handle conflict. They also offer a dinner service, a community garden, and a parent welcome center that offers nutrition education and classes in cooking, English and business.
PLACE Bridge leaders have used general school funds to hire their own wellness facilitator to coordinate this work and collect data on nursing visits, student discipline issues and parent/student perception surveys. They analyzed the data, identified the needs of their students and integrated a health and wellness related major improvement strategy into their school’s Unified Improvement Plan.
The school now boasts a 95% attendance rate and a declining mobility rate. As Ms. Kazin states, “It’s a moral imperative. Let us be the stability in the lives of our students.” Clearly, it’s a happy, healthy PLACE to be.”
Montrose County, located in Southwest Colorado, believes that public education is an equalizing opportunity and strives to ensure that its graduates are prepared for the workplace or post secondary education. The school district serving this agricultural hub of the western slope is home to 40,000 people and covers 2,200 square miles. The district faces unique challenges with 50% of its 6100 students participating in the federal free and reduced lunch program, and 90% that are Medicaid eligible.
School Based Health Centers (SBHC) have shown a great deal of promise in improving health outcomes for students, decreasing Medicaid costs and even potentially raising academic outcomes for low-income students. Montrose County School District’s first SBHC opened its doors in 2007 at Northside Elementary School. The center is part of a broader strategy to address the needs of the community and is staffed with a full time nurse practitioner, mental health therapist, family outreach coordinator and receptionist.
The SBHC’s nurse practitioner is also seen as a resource to the school and provides after school physical activity and health education classes, week long Healthy Kids Camps, and contraceptive and health education classes at the high school.
The district is using technology to streamline SBHC operations and data collection. For example, an Electronic Medical Referral system tracks referrals from many locations in the county, replacing an older paper-based system and helping to ensure follow up care. Thanks to the district’s Small Rural Hospital Improvement Program (SHIP), referrals are loaded on iPads and sync to data repositories for analysis.
Because the clinic is certified as a medical home, it is connected to other health care resources in the community such as pediatricians and hospitals. Also, the district understands that dental health is connected to general health and ability to learn; therefore, it participates in programs like “Cavity Free at 3” and “SKIPPY,” which provide cleanings and sealants to children and parents.
Through its commitment to its SBHC, the district is demonstrating to students, staff, and families that health and education are priorities—and attention to both makes a measurable difference in the ability of students to learn and the community to thrive.
There’s a wealth of resources available to get you started. Among the most relevant to school health services:
Campaign for Educational Equity
View Healthier Students are Better Learners: A Missing Link in School Reforms to Close the Achievement Gap to see how high-quality school health initiatives are part of the strategy to close achievement gaps.
Center for Disease Control and Prevention
Find research on the link between healthy students and positive academic outcomes.
Colorado Association for School-based Health Care
Learn more about what school-based health clinics do and see the resources page for more links.
National Association of School Nurses
Check out this website’s policy and advocacy section for information about why school nurses are critical to healthy schools.