School-based health centers: accessibility and accountability.
OBJECTIVE
To examine the current experience of school-based health centers (SBHCs) in meeting the needs of children and adolescents, changes over time in services provided and program sponsorship, and program adaptations to the changing medical marketplace.


METHODS
Information for the 1998-1999 Census of School-Based Health Centers was collected through a questionnaire mailed to health centers in December 1998. A total of 806 SBHCs operating in schools or on school property responded, representing a 70% response rate. Descriptive statistics and cross-tab analyses were conducted.


RESULTS
The number of SBHCs grew from 120 in 1988 to nearly 1200 in 1998, serving an estimated 1.1 million students. No longer primarily in urban high schools, health centers now operate in diverse areas in 45 states, serving students from kindergarten through high school. Sponsorship has shifted from community-based clinics to hospitals, local health departments, and community health centers, which represent 73% of all sponsors. Most use computer-based patient-tracking systems (88%), and 73% bill Medicaid and other third-party insurers for student-patient encounters.


CONCLUSIONS
SBHCs have demonstrated leadership by implementing medical standards of care and providing accountable sources of health care. Although the SBHC model is responsive to local community needs, centers provide care for only 2% of children enrolled in U.S. schools. A lack of stable financing streams continues to challenge sustainability. As communities seek to meet the needs of this population, they are learning important lessons about providing acceptable, accessible, and comprehensive services and about implementing quality assurance mechanisms.
Brindis
Claire D
CD
Department of Pediatrics, Division of Adolescent Medicine, University of California-San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94143-0936, USA.
Klein
Jonathan
J
Schlitt
John
J
Santelli
John
J
Juszczak
Linda
L
Nystrom
Robert J
RJ
D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration; D001294:Attitude to Health; D019352:Censuses; D002648:Child; D002662:Child Health Services / Q000458:organization & administration; D002675:Child, Preschool; D004059:Diffusion of Innovation; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D011785:Quality Assurance, Health Care / Q000592:standards; D012572:School Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data / Q000639:trends; D012941:Social Responsibility; D011795:Surveys and Questionnaires; D014481:United States