Stayin' Alive and Thriving: Exploring Multiple Dimensions of SBHC Sustainability

Despite their proven success, School Based Health Centers (SBHCs) face sustainability challenges, primarily revolving around operational funding and developing systems to collect for billable services. In June 2009, the Colorado Health Foundation launched a School-Based Health Care Initiative to support the planning and implementation of more than 20 new or expanded SBHCs over four years. Our evaluation is working to determine if the initiative process is effective in driving Colorado SBHCs toward increased self-sustainability. Data collection methods included 17 Sustainability Self-Assessments completed by grantees and 23 interviews with grantees and key stakeholders representing national and state level policy and program perspectives. Interview respondents described numerous challenges in sustaining SBHCs, including billing for integrated services, lack of billing infrastructure, and resistance from other providers and FQHCs. Several factors were described as promoting sustainability: diversified funding sources; stable core operational funding; maximized billing revenue; staff and program consistency; school community support and integration with an emphasis on the impact on academics; and data systems to demonstrate their impact. Preliminary results from grantee Sustainability Self-Assessments indicate funded programs show strengths in the areas of staffing, services and community partnerships. Identified areas of improvement include the need for better school integration, marketing and outreach, and billing systems. SBHCs must continue to demonstrate themselves to be viable healthcare providers with high measures of quality of care and effective financial and billing systems. In addition, they must be well-grounded and supported in their schools and communities.