Supports and barriers associated with the provision of health care in schools: Results from a national census of school-based health centers

School-based health centers (SBHCs) provide comprehensive, accessible health care to children and adolescents in a familiar setting: their schools. Most SBHCs offer primary and mental health care, while a growing number also provide expanded services, such as health education and dental care. Despite continued growth of the model nationwide, many SBHCs face challenges in delivering care in their communities. Using data from the 2010/11 national census of SBHCs (n=1,381), this study examines supports and barriers associated with provision of specific types of services in the school setting, such as years in operation, funding, provider availability, and geographic location. For example, while 71% of SBHCs offer mental health services, those that have been open for ten or more years were more likely to offer these services. Barriers to provision of mental health care included lack of reimbursement (41%), availability of qualified providers (34%), and consent policies (19%). Furthermore, the number of SBHCs providing HIV testing varied dramatically by geographic setting, with SBHCs in urban settings being more likely to provide testing on-site. Although the majority of SBHCs provide oral health education (84%) and dental screenings (73%), only 39% provided dental examinations by a dentist or dental hygienist. Among SBHCs that did not have an oral health provider, barriers to provision of care on-site included costs (73%) and provider availability (71%). Understanding the supports and barriers associated with provision of specific types of services in the school setting can help to inform future SBHC planning and advocacy efforts.