No Strangers Here: School Based Health Centers Connect Youth to Caring Adults

School-based health centers (SBHCs) have emerged as a model of care that enhances utilization of health services for U.S. adolescents.  Staffed by interdisciplinary teams, physicians play a largely supervisory role in these centers, where nurses, nurse practitioners and social workers play critical roles.  Yet the model is unfamiliar to many school health professionals. The passage of comprehensive national health care reform included dedicated funding for SBHCs, so this model is expanding. The primary purpose of this study was to better understand the mechanism of how and why a SBHC succeeds in improving the health and well-being of adolescent users.  This research used case study methodology to examine provider working relationships, motivations, and structure in a mature health center, as well as its effect on student risk and protective factors. An adaptation of Bronfenbrenner’s ecological model of multiple influencers was the theoretical framework that guided interviews and data analysis.  Findings included the overarching theme of the creation of a student centered community of care with sub-themes of immediate access to adolescent friendly care, providers as connectors and care of the whole adolescent. This SBHC was able to construct a robust nexus of care that fit the needs of adolescents, creating a complex network of partnerships with the school and local community. Accessing SBHC care may create opportunities for youth to establish connections to caring adults and for providers to identify students at highest risk.