School-based health centers (SBHCs) provide a variety of health care services to youth in a convenient and accessible environment. Over the past 40 years, the growth of SBHCs evolved from various public health needs to the development of a specific collaborative model of care that is sensitive to the unique needs of children and youth, as well as to vulnerable populations facing significant barriers to access. The SBHC model of health care comprises of on-school site health care delivery by an interdisciplinary team of health professionals, which can include primary care and mental health clinicians. Research has demonstrated the SBHCs’ impacts on delivering preventive care, such as immunizations; managing chronic illnesses, such as asthma, obesity, and mental health conditions; providing reproductive health services for adolescents; and even improving youths’ academic performance. Although evaluation of the SBHC model of care has been complicated, results have thus far demonstrated increased access to care, improved health and education outcomes, and high levels of satisfaction. Despite their proven success, SBHCs have consistently faced challenges in securing adequate funding for operations and developing effective financial systems for billing and reimbursement. Implementation of health care reform (The Patient Protection and Affordable Care Act [P.L. 111-148]) will profoundly affect the health care access and outcomes of children and youth, particularly vulnerable populations. The inclusion of funding for SBHCs in this legislation is momentous, as there continues to be increased demand and limited funding for affordable services. To better understand how this model of care has and could further help promote the health of our nation’s youth, a review is presented of the history and growth of SBHCs and the literature demonstrating their impacts. It may not be feasible for SBHCs to be established in every school campus in the country. However, the lessons learned from the synergy of the health and school settings have major implications for the delivery of care for all providers concerned with improving the health and well-being of children and adolescents.

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,

School health centers increase access to care and improve mental health, resiliency, and contraceptive use.

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BACKGROUND:The purpose of this study is to compare the mental health risk profile and health utilization behaviors of