School-based health centers (SBHCs) positively influence student health. However, the extent to which these benefits are actualized varies across sites. We conducted focus groups with high school students and teachers at an underperforming SBHC to identify facilitators and barriers to student access to SBHC services. Our qualitative analysis revealed four main emergent categories: (1) students' knowledge of SBHC services; (2) teachers' perceptions of, and experiences with, the SBHC; (3) accessing and utilizing SBHC services; and (4) student and teacher suggestions to improve the school–SBHC relationship. Our findings suggest that the relationships between health center staff and teachers are crucial and can be damaged with poor implementation. Additionally, there was a general lack of knowledge about the procedures for accessing services at the SBHC. Participants provided recommendations, including strategies for better outreach and engagement with teachers and students, as well as operational strategies to enhance communication systems and the physical environment.
AbrishamiD. (2018). The need for cultural competency in health care. Radiologic Technology, 89(5), 441–448. http://www.radiologictechnology.org/
2.
AlbrightK.BarnardJ.O’LearyS.FedericoS.SavilleA.LockhartS.LeeM. (2016). School-based health centers as medical homes: Parents’ and adolescents’ perspectives. Academic Pediatrics, 16(4), 381–386. https://doi.org/10.1016/j.acap.2015.06.004
3.
AllisonM. A.CraneL. A.BeatyB. L.DavidsonA. J.MelinkovichP.KempeA. (2007). School-based health centers: Improving access and quality of care for low-income adolescents. Pediatrics, 120(4), e887–e894. 10.1542/peds.2006-2314
4.
AndersonJ. K.HowarthE.VainreM.JonesP. B.HumphreyA. (2017). A scoping literature review of service-level barriers for access and engagement with mental health services for children and young people. Children and Youth Services Review, 77(November 2016), 164–176. https://doi.org/10.1016/j.childyouth.2017.04.017
5.
ArensonM.HudsonP. J.LeeN.LaiB. (2019). The evidence on school-based health centers: A review. Global Pediatric Health, 6, 1–10. 10.1177/2333794X19828745
6.
BainsR. M.DialloA. F. (2016). Mental health services in school-based health centers: Systematic review. Journal of School Nursing, 32(1), 8–19. https://doi.org/10.1177/1059840515590607
7.
BainsR. M.FranzenC. W.White-Frese’J. (2014). Engaging African American and Latino adolescent males through school-based health centers. Journal of School Nursing, 30(6), 411–419. https://doi.org/10.1177/1059840514521241
8.
BeemA. A.BatlivalaC.NorwoodA. A. (2019). School-based health centers as the pediatric expanded medical home. Journal of School Health, 89(11), 934–937. https://doi.org/10.1111/josh.12825
9.
BenkertR.GeorgeN.TannerC.BarkauskasV. H.PohlJ. M.MarszalekA. (2007). Satisfaction with a school-based teen health center: A report card on care. Pediatric Nursing, 33(2), 103–109. http://www.pediatricnursing.net/
10.
BersaminM.PaschallM. J.FisherD. A. (2017). School-based health centers and adolescent substance use: Moderating effects of race/ethnicity and socioeconomic status. Journal of School Health, 87(11), 850–857. 10.1111/josh.12559
11.
BlacksinB. A.KellyP. J. (2015). Connecting teens to caring adults in a school-based health center: A case study. Journal of Community Health Nursing, 32(2), 89–103. https://doi.org/10.1080/07370016.2015.1024543
12.
BrindisC. D.KleinJ.SchlittJ.SantelliJ.JuszczakL.NystromR. J. (2003). School-based health centers: Accessibility and accountability. Journal of Adolescent Health, 32(6 Suppl.), 98–107. https://doi.org/10.1016/S1054-139X(03)00069-7
DaleyA. M.PolifroniE. C.SadlerL. S. (2019). The essential elements of adolescent-friendly care in school-based health centers: A mixed methods study of the perspectives of nurse practitioners and adolescents. Journal of Pediatric Nursing, 47, 7–17. https://doi.org/10.1016/j.pedn.2019.03.005
15.
FastJ. D. (2003). An in-law comes to stay: Examination of interdisciplinary conflict in a school-based health center. Social Work, 48(1), 45–50. https://doi.org/10.1093/sw/48.1.45
16.
GarbersS.HeckC. J.GoldM. A.SantelliJ. S.BersaminM. (2018). Providing culturally competent care for LGBTQ youth in school-based health centers: A needs assessment to guide quality of care improvements. Journal of School Nursing, 34(6), 424–429. 10.1177/1059840517727335
17.
GibsonE. J.SantelliJ. S.MinguezM.LordA.SchuylerA. C. (2013). Measuring school health center impact on access to and quality of primary care. Journal of Adolescent Health, 53(6), 699–705. https://doi.org/10.1016/j.jadohealth.2013.06.021
18.
GlissonC. (2002). The organizational context of children’s mental health services. Clinical Child and Family Psychology Review, 5(4), 233–253. https://doi.org/10.1023/A:1020972906177
19.
GraneheimU. H.LundmanB. (2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24(2), 105–112. https://doi.org/10.1016/j.nedt.2003.10.001
20.
GuoJ. J.JangR.KellerK. N.McCrackenA. L.PanW.CluxtonR. J. (2005). Impact of school-based health centers on children with asthma. Journal of Adolescent Health, 37(4), 266–274. https://doi.org/10.1016/j.jadohealth.2004.09.006
21.
HackerK.WesselG. L. (1998). School-based health centers and school nurses: Cementing the collaboration. Journal of School Health, 68(10), 409–414. https://doi.org/10.1111/j.1746-1561.1998.tb06318.x
22.
HemmelgarnA. L.GlissonC.JamesL. R. (2006). Organizational culture and climate: Implications for services and interventions research. Clinical Psychology: Science and Practice, 13(1), 73–89. https://doi.org/10.1111/j.1468-2850.2006.00008.x
23.
Ijadi-MaghsoodiR.BonnetK.FellerS.NagaranK.PufferM.KataokaS. (2018). Voices from minority youth on help-seeking and barriers to mental health services: Partnering with school-based health centers. Ethnicity and Disease, 28(2, Suppl.), S437–S444. 10.18865/ed.28.S2.437
24.
JuszczakL.MelinkovichP.KaplanD. (2003). Use of health and mental health services by adolescents across multiple delivery sites. Journal of Adolescent Health, 32(6 Suppl.), 108–118. https://doi.org/10.1016/S1054-139X(03)00073-9
25.
KaplanD. W.BrindisC. D.PhibbsS. L.MelinkovichP.NaylorK.AhlstrandK. (1999). A comparison study of an elementary school-based health center: Effects on health care access and use. Archives of Pediatrics and Adolescent Medicine, 153(3), 235–243. https://doi.org/10.1001/archpedi.153.3.235
26.
KeyJ. D.WashingtonE. C.HulseyT. C. (2002). Reduced emergency department utilization associated with school-based clinic enrollment. Journal of Adolescent Health, 30(4), 273–278. https://doi.org/10.1016/S1054-139X(01)00390-1
27.
KingL.AppletonJ. V. (1999). Pearls, pith, and provocation fourth generation evaluation of health services: Exploring a methodology that offers equal voice to consumer and professional stakeholders.
28.
KleinJ. D.HandwerkerL.SesselbergT. S.SutterE.FlanaganE.GawronskiB. (2007). Measuring quality of adolescent preventive services of health plan enrollees and school-based health center users. Journal of Adolescent Health, 41(2), 153–160. 10.1016/j.jadohealth.2007.03.012
29.
KnopfJ. A.FinnieR. K. C.PengY.HahnR. A.TrumanB. I.Vernon-SmileyM.JohnsonV. C. (2016). School-based health centers to advance health equity: A community guide systematic review. American Journal of Preventive Medicine, 51(1), 114–126. https://doi.org/10.1016/j.amepre.2016.01.009
30.
LaiK.GuoS.Ijadi-MaghsoodiR.PufferM.KataokaS. H. (2016). Bringing wellness to schools: Opportunities for and challenges to mental health integration in school-based health centers. Psychiatric Services, 67(12), 1328–1333. https://doi.org/10.1176/appi.ps.201500401
31.
LofinkH.KueblerJ.JuszczakL.SchlittJ.EvenM.RosenbergJ.WhiteI. (2013). 2010–2011 Census Report of School-Based Health Centers.
32.
LoveH.SoleimanpourS.PanchalN.SchlittJ.BehrC.EvenM. (2018). 2016–17 National School-Based Health Care Census.
33.
MandelL. A.QazilbashJ. (2005). Youth voices as change agents: Moving beyond the medical model in school-based health center practice. Journal of School Health, 75(7), 239–242. https://doi.org/10.1111/j.1746-1561.2005.tb06682.x
34.
MikesellL.BromleyE.KhodyakovD. (2013). Ethical community-engaged research: A literature review. American Journal of Public Health, 103(12), e7. https://doi.org/10.2105/AJPH.2013.301605
ParasuramanS. R.ShiL. (2014). The role of school-based health centers in increasing universal and targeted delivery of primary and preventive care among adolescents. Journal of School Health, 84(8), 524–532. https://doi.org/10.1111/josh.12178
37.
PowerT. J.EiraldiR. B.ClarkeA. T.MazzucaL. B.KrainA. L. (2005). Improving mental health service utilization for children and adolescents. School Psychology Quarterly, 20(2), 187–205. https://doi.org/10.1521/scpq.20.2.187.66510
38.
SchwartzK. E.MonieD.ScribaniM. B.KrupaN. L.JenkinsP.LeinhartA.KjolhedeC. L. (2016). Opening school-based health centers in a rural setting: Effects on emergency department use. Journal of School Health, 86(4), 242–249. https://doi.org/10.1111/josh.12375
39.
SeawrightJ.GerringJ. (2008). Case selection techniques in case study research: A menu of qualitative and quantitative options. Political Research Quarterly, 61(2), 294–308. https://doi.org/10.1177/1065912907313077
40.
ShinK. R.KimM. Y.ChungS. E. (2009). Methods and strategies utilized in published qualitative research. Qualitative Health Research, 19(6), 850–858. https://doi.org/10.1177/1049732309335857
41.
SoleimanpourS.GeierstangerS. P.KallerS.McCarterV.BrindisC. D. (2010). The role of school health centers in health care access and client outcomes. American Journal of Public Health, 100(9), 1597–1603. https://doi.org/10.2105/AJPH.2009.186833
42.
SummachA. H. (2011). Facilitating trust engenderment in secondary school nurse interactions with students. The Journal of School Nursing, 27(2), 129–138. https://doi.org/10.1177/1059840510392786
43.
WebbC. (1992). The use of the first person in academic writing: Objectivity, language and gatekeeping. Journal of Advanced Nursing, 17(6), 747–752. https://doi.org/10.1111/j.1365-2648.1992.tb01974.x
44.
WhitakerK.StoneS. I.AnyonY.BlankenbakerS.RozumA. (2019). Academic, psychosocial, and demographic correlates of school-based health center utilization: Patterns by service type. Child and Youth Care Forum, 48(4), 545–562. https://doi.org/10.1007/s10566-019-09495-8
45.
World Health Organization. (2015). People-centred and integrated health services: An overview of the evidence: Interim report. https://doi.org/No.WHO/HIS/SDS/2015.7
46.
ZhangL.FinanL. J.BersaminM.FisherD. A. (2020). Sexual orientation-based depression and suicidality health disparities: The protective role of school-based health centers. Journal of Research on Adolescence, 30(1, Suppl.), S134–S142.
