Youth in underserved communities lack access to consistent sources of high-quality health care. School-based health centers (SBHCs) address this challenge through the provision of primary care, mental health care, and other health services in schools. This article describes the current status of SBHCs nationally, including changes over the past twenty years. Data were collected through the School-Based Health Alliance's National School-Based Health Care Census. The number of SBHCs doubled from 1,135 in 1998-99 to 2,584 in 2016-17. During this time they adapted to the changing health care landscape and community needs. Sponsorship shifted predominantly to federally qualified health centers, and SBHCs provided access to primary care and, often, to mental, oral, and other health services to 10,629 schools and over 6.3 million students. SBHCs have grown steadily since 1998, and recent expansion through federally qualified health centers and telehealth technology forecasts even greater growth, innovation, and access for underserved communities. E ach day in the US, millions of children and adolescents-especially those of color and those who live in underserved communities-go to school with physical and mental health concerns that threaten their well-being and educational performance. 1 Youth living in impoverished communities have higher rates of asthma, substance use, anxiety and depression, and obesity and are at elevated risk of not having regular health maintenance visits. 2 Adolescents cite lack of access, concerns about confidentiality, and inconvenience as reasons for not using the health care system. 3 When adolescents seek health services, they often access care in multiple settings (schools, medical offices, family planning centers, mental health clinics, and emergency departments), with little continuity of care. 3 This fragmentation has farreaching consequences. In the short term, young people with unmet or poorly managed health care needs are more likely to be chronically absent from school, experience suspension, and drop out. 1,4 In the longer term, they are more likely to be underemployed and financially unstable. 5 There are costs to the health care system associated with fragmented and forgone care, overuse of the emergency department, and duplicated care-as well as costs to the education, welfare, and juvenile justice systems when health care needs are not met. 1 School-based health centers (SBHCs) are a logical response to the challenges that underserved youth face in health care access and use. The centers represent a shared commitment by a community's schools and health care organizations to address health care access and use among the nation's underserved communities and aim to support children's and adolescents' health, well-being, and academic success. The centers help youth and their families overcome access barriers-including transportation, time,

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Telehealth is a growing model of delivering health care. School-based health centers (SBHCs) provide access to health care for youth in schools and increasingly use telehealth in care delivery. This article examines the recent growth of telehealth use in SBHCs, and characteristics of SBHCs using telehealth, including provider types, operational characteristics, and schools and students served. The percentage of SBHCs using telehealth grew from 7% in 2007-2008 to 19% in 2016-2017. Over 1 million students in over 1800 public schools have access to an SBHC using telehealth, which represents 2% of students and nearly 2% of public schools in the United States. These SBHCs are primarily in rural communities and sponsored by hospitals. This growing model presents an opportunity to expand health care access to youth, particularly in underserved areas in the United States and globally. Further research is needed to fully describe how telehealth programs are implemented in school settings and their potential impacts.

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SYNOPSISObjectives. This study explored the current status of the role of state schoolbased health center (SBHC) initiatives, their evolution over the last two decades, and their expected impact on SBHCs' long-term sustainability.Methods. A national survey of states was conducted to determine (1) the amount and source of funding dedicated by the state directly for SBHCs, (2) criteria for funding distribution, (3) designation of staff/office to administer the program, (4) provision of technical assistance by the state program office, (5) types of performance data collected by the program office, (6) state perspective on future outlook for long-term sustainability, and (7) Medicaid and the State Children's Health Insurance Program (SCHIP) policies for reimbursement to SBHCs.Results. Nineteen states reported allocating a total of $55.7 million to 612 SBHCs in school year [2004][2005]. The two most common sources of statedirected funding for SBHCs were state general revenue ($27 million) and Title V of the Social Security Act ($7 million). All but one of the 19 states have a program office dedicated to administering and overseeing the grants, and all mandate data reporting by their SBHCs. Sixteen states have established operating standards for SBHCs. Eleven states define SBHCs as a unique provider type for Medicaid; only six do so for SCHIP.Conclusions. In 20 years, the number of state SBHC initiatives has increased from five to 19. Over time, these initiatives have played a significant role in the expansion of SBHCs by earmarking state and federal public health funding for SBHCS, setting program standards, collecting evaluation data to demonstrate impact, and advocating for long-term sustainable resources.