School-Based Health Centers: A Solution for Improving Student Health and Learning

When a student misses a day of school for a doctor’s appointment across town or a parent postpones preventive care for their child because they can’t afford to take time off work, these aren’t just healthcare access problems. They are healthcare access problems that can disrupt education, and school facilities planners, designers, and administrators are uniquely positioned to help address them.

One way to improve health care access and minimize disruptions to student learning simultaneously is to co-locate health services in, or very near, to schools. School-based health centers (SBHCs) — comprehensive primary care clinics located within or near school buildings — do just that. SBHCs provide medical, dental, and mental health services to students and sometimes to community members. They are staffed by medical professionals who may coordinate with education staff to ensure that students’ health and learning needs are being met holistically.

Co-locating healthcare services in schools has a number of benefits:

• Academic: SBHC utilization has been associated with improved academic outcomes, such as improved grade-point averages (GPAs), attendance, grade promotion, college preparation, and reduced rates of suspension. 
• Health: SBHCs improve access to needed healthcare services, which is particularly critical for the nearly 40% of school-aged children who, the CDC tells us, live with a chronic health condition.
• Economic: An economic evaluation of SBHCs conducted by the Centers for Disease Control and Prevention (CDC) found cost-benefit ratios ranging from 1.38 to 3.05, largely because of reductions to costly emergency department care and parents’ time away from work.

While it makes a lot of sense to locate healthcare services for young people in the schools where they spend much of their time, academic instruction and healthcare provision are two very different activities that require different types of physical infrastructure. School buildings are typically designed to maximize instructional space, while health care settings require features such as private waiting areas, appropriate ventilation systems, and spaces that support confidential care. Thoughtful design is key—not only in configuring SBHC spaces, but also in considering how these spaces operate within the broader school environment. 

The following principles can help ensure that SBHCs deliver appropriate and accessible care to students and communities:

• Purpose-driven design. Healthcare spaces have different requirements than educational spaces. While some healthcare providers successfully work with schools to retrofit existing spaces for SBHCs, meeting healthcare facility requirements for HVAC, plumbing, electrical, and data infrastructure requirements can be challenging. Plans for new buildings or building renovations present opportunities to create healthcare spaces that are built with healthcare delivery in mind.
  
• Ensure access outside of the school’s instructional calendar.  Students don’t stop needing health care when school ends. SBHCs operated by healthcare partners usually provide services outside of traditional school hours and often year-round, both to meet ongoing needs and because  financial viability and staff retention depend on continuity of operations.  Facility design should therefore support access to the SBHC independent of the school’s instructional calendar — for example, by locating the clinic near an exterior entrance so it can operate on evenings, weekends, and school breaks without requiring access to the rest of the building.”
  
• Keep flexibility in mind. There is not a one-size-fits-all model for SBHCs, as funding availability, partnership opportunities, and healthcare needs vary across communities.. Designing clinic space with an eye towards flexibility can make it easier for clinic space to accommodate the types of services that align with the unique circumstances in your community over time.
  
• Design for telehealth. Telehealth is an increasingly important strategy for ensuring access to healthcare, especially in rural communities and other areas with provider shortages. Telehealth can also facilitate access to specialty care. Key considerations include information technology infrastructure and private spaces for telehealth sessions.
• Engage healthcare providers and community members in planning. Designing for SBHCs will benefit from engagement with school staff, healthcare providers, and community members. The School-Based Health Alliance and the National Association of School Nurses note that SBHCs and school nurses provide complementary services benefitting students; involving school nurses in the design process ensures plans promote care coordination. If the SBHC will be run by an external healthcare provider—as opposed to the school district—it is helpful to involve them early on in planning and design conversations, including logistical and cost considerations related to equipping and maintaining a health clinic.

There are many roads to success, and many different ways that school districts can work with healthcare partners and design firms to reduce barriers to healthcare for students and families in their communities.

Leaning into partnership and interactive design to transform an existing space

Mount Vernon (OH) City Schools worked with an architecture firm to transform an unused industrial arts space into a modern health center. Nationwide Children’s Hospital—the healthcare partner—provided specific requirements for the medical facility’s layout, including five dedicated exam rooms.

The design team explored multiple layout options, carefully considering how to best use the 4,200 square feet of available space. Through an iterative design process, they discovered additional needs beyond the initial plan, such as incorporating appropriate restroom facilities for both staff and students. This collaborative approach ensured the health center would be both functional and responsive to the school’s specific requirements.

By repurposing an existing space within the school, the project demonstrated an innovative approach to creating accessible healthcare services for students, maximizing existing resources while meeting the precise needs of both the school and the healthcare provider.

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A modular solution to achieve a tight project timeline

The local health department and school district in St. Mary’s County (Maryland) worked together to create new medical facilities located on school campuses. To meet tight project timelines, they selected a modular construction strategy that would allow rapid deployment of a comprehensive healthcare space.

A new clinic, spanning nearly 3,000 square feet, was designed to provide comprehensive medical services for students. The facility included a mix of spaces: private examination rooms, staff offices, employee break areas, essential storage, and a dedicated laboratory space. Careful attention was paid to accessibility, with compliant entrance ramps and steps ensuring the clinic could serve all students.

By utilizing modular construction techniques, the project team dramatically compressed the typical construction timeline. The entire process—from initial contract to fully operational clinic—was completed in just over seven weeks.

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Purpose-driven design elements for a brand-new building

The Gresham-Barlow School District in Oregon worked with an architecture firm to build a brand new building to house an SBHC. The project brought together K-12 infrastructure experts, healthcare professionals, and community stakeholders to create a purpose-built student health facility that redefines healthcare delivery in educational settings. In addition to stakeholders from the school district, the planning discussions also included the Oregon School-Based Health Alliance and Wallace Medical Concern—the nonprofit medical provider.

Working within a compact 2,400 square feet, the design team created a healthcare space that included three exam rooms, dedicated behavioral health space, a laboratory, and staff areas. The building includes a lobby with comfortable seating, an area where students can plug in their devices, and a large interactive magnetic mural designed by students. Exam rooms were strategically positioned away from busy street-facing areas, ensuring student confidentiality and comfort. Biophilic design principles were applied, including the use of soothing colors, abundant natural light, and wood-inspired elements to a welcoming clinical space. A courtyard serves as a calming intervention, providing a restorative space for students seeking medical care. 

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The educational and community benefits of SBHCs are profound. However, school communities can only experience those benefits when adequate facility infrastructure is in place. By prioritizing purposeful design, school facilities leaders can play a key role in making SBHCs successful long-term community health infrastructure.

Resources from national organizations

Vision to Reality: School-Based Health Center Implementation Toolkit 

A comprehensive guide providing step-by-step strategies for developing, implementing, and sustaining school-based health centers. The toolkit offers practical resources, planning tools, and best practices to help communities transform the vision of comprehensive student healthcare into a functional reality.

School-Based Health Center (SBHC) Planning Checklist

A comprehensive planning resource that provides step-by-step guidance for developing and implementing school-based health centers. The checklist offers school infrastructure professionals a systematic approach to navigating the complex process of establishing effective, sustainable healthcare services within educational settings.

Examples of state guidance for SBHCs

School-Based Health Centers in Arkansas: A Practical Guide 

A comprehensive planning resource outlining the strategic implementation of school-based health centers in Arkansas. The guide provides practical insights into establishing, operating, and sustaining school-based health centers, with a focus on meeting the unique healthcare needs of students.

Standards For School-Based Health Centers In the Maryland School-Based Health Center Program 

A comprehensive set of standards and guidelines for implementing and maintaining school-based health centers in Maryland. The document provides detailed requirements for program operations, facility design, clinical services, and quality assurance to ensure effective and high-quality healthcare delivery in school settings.

Oklahoma School-Based Health Center Toolkit

A comprehensive toolkit providing detailed guidance for establishing and maintaining school-based health centers in Oklahoma. The resource offers practical strategies, implementation guidelines, and essential considerations for developing effective healthcare services within educational settings.

Oregon School-Based Health Center Standards for Certification

A detailed certification framework for school-based health centers that outlines comprehensive standards for program quality, clinical services, and operational requirements. The document provides a structured approach to ensuring school-based health centers meet rigorous healthcare and educational support standards.

New York State School-Based Health Center Program

A comprehensive resource detailing the state’s approach to school-based health centers, including guidelines for establishment, operation, and support of healthcare services within educational settings. The webpage provides information on program implementation, regulations, and the critical role of SBHCs in supporting student health and academic success.

Find more SBHC resources in NCSI’s library.