School-based supports for child health and well-being
Strategy overview
- Addressing student health and wellbeing needs at school: School-based supports for child health and wellbeing help position students to be physically and emotionally ready to learn. Supports can include a wide range of medical services (including physicals, vaccinations, STI tests, and more); dental and vision care; therapy and other mental health services; and school-wide programming, including sexual health education, social-emotional instruction, and trauma-informed school reform.
- Delivering support services in a school setting: A core tenant of many evidence-based supports is that they are delivered by external partners at school, either in permanent offices (like a school-based health clinic) or temporarily (i.e. a mobile dentist’s office). Locating support services in schools addresses several major barriers. First, physical proximity to such services minimizes transportation and time costs. Second, many services are delivered for free, eliminating a financial barrier. Third, by integrating support services into school operations, student awareness is significantly increased, further raising the chances they will participate.
- Bringing the community into school: In many jurisdictions, community groups and residents play a major role in supporting student needs. This can include partnerships with schools for clothing drives, providing free holiday meals, and hosting recreational events. Meanwhile, some school-based services, like dentistry or vision care, may also be made available to the broader community. In some cases, a full-time community liaison is hired to identify and connect students and their families to key services that are available both in school and in the community and to manage partnerships with service providers.
- Taking a whole-school approach: While many supports are delivered directly and privately to students, some comprehensive approaches include school-wide reform and/or programming. For instance, community schools include setting school-wide goals and working with families and other partners to achieve them, like increased attendance; the trauma-informed school model, meanwhile, provides training to staff to better support students who have experienced trauma, and also is used to shape discipline policies and curricula. Some individual care models also include school-wide workshops or courses on a range of health and wellbeing issues, such as reproductive health, mental health, and social-emotional skills.
What evidence supports this strategy?
Multiple rigorous systematic reviews and research syntheses of various school-based supports for child health and wellbeing found strong evidence that the strategy is associated with significant improvements in health and academic outcomes.
A 2019 research synthesis of community schools, which integrate school-based supports for child health and wellbeing into school operations, can be associated with improved academic performance, increased attendance, and a reduction in risky behavior.
A 2015 systematic review of rigorous evaluations of school-based health centers found that they are associated with improvements in a range of academic outcomes, including higher grade point average and high school graduation rates, and health outcomes, like increased use of contraception and preventative medicine, and reduced consumption of tobacco and alcohol.
A 2019 systematic review of school-based cognitive behavioral therapy found robust evidence that the practice is associated with reductions in student anxiety and depression, especially when treatment is delivered by mental health professionals instead of school staff.
A 2017 research synthesis found that school dental programs can reduce instances of cavities for all students, especially among low-income students and students in rural areas.
Is this strategy right for my community?
Providing school-based supports for child health and well-being has been shown to improve outcomes predictive of upward mobility. These outcomes, identified by the Urban Institute, are effective public education, preparation for college, access to health services, and safety from trauma.
City and county leaders can assess local conditions for each of these outcomes using the metrics below, identified by the Urban Institute. This assessment can be used to determine whether this strategy is appropriate for their community. (Note: these metrics are a starting point for self-assessment and are not intended to be comprehensive.)
All cities and counties with populations over 75,000 can receive a customized data sheet here.
-
Measuring the effectiveness of public education in your community: Examine the average per-grade change in English Language Arts achievement between the third and eighth grades. These data are available from Stanford University’s Education Data Archive.
-
Measuring preparation for college in your community: Examine the share of 19- and 20-year-olds with a high school degree. These data are available from the Census Bureau’s American Community Survey.
-
Measuring access to health services in your community: Examine the ratio of residents to primary care physicians. These data are available from the U.S. Department of Health and Human Services’ Area Health Resource File.
-
Measuring safety from trauma in your community: Examine the number of deaths due to injury per 100,000 people. These data are available from the National Center for Health Statistics’ Mortality File and the CDC’s WONDER database.
Best practices in implementation
- Identify and match supports to student, family needs: During the initial planning phase, conduct a needs assessment in close consultation with school staff and families. Given the wide range of supports and their variance in intensity, a robust, community-informed planning process will help determine which interventions and models have the highest value given local conditions and contexts. This is especially important when implementing a school-wide reform model like trauma-informed or community schools, which can be used to shape curricula, school discipline models, approaches to family engagement, and more.
- Integrate service providers into school facilities and operations: Many support models require external service providers (like nurses or counselors) to work on-site on a regular basis. To help them reach more students, ensure that external staff are given frequent opportunities to engage with students and teachers (such as during recess or lunch). This can also extend to thoughtful assignment of office space, such as in a high-traffic area that can serve as a physical reminder to students. Lighter-touch efforts, like inviting service providers to speak at school-wide invites and listing them in school directories, can further facilitate a strong working partnership.
- Dedicate staff capacity to managing partnerships: Many services, like physical health or dental care, are not core competencies for a school or district. As a result, external partnerships take on a particularly important role. Especially for comprehensive approaches that include multiple partners, effective model delivery often requires a dedicated, school-based staff member with a mandate to engage deeply with students, families, service providers, and community members alike.
- Promote services to students and families: The impact of any given support is reliant on student uptake. To address this dynamic, school and district leaders should proactively promote and market supports throughout the school year, both during in-person events like student orientation or back-to-school nights, and in written communications. Promotion should also include messaging aiming to de-stigmatize student use of services; stigma remains a persistent barrier for student access to services including free meals, therapy, sexual health care, and more.
Resources
Evidence-based examples
|
Outcome Area |
This ranking reflects how these approaches are scored in one of the major government- or philanthropy-led clearinghouse resources. For more: https://catalog.results4americ... |
---|---|---|
Individual-, group-, and community-level programming promoting healthy sexual behavior
|
Stable and healthy families |
|
Holistic approach leveraging community partnerships to support student well-being
|
Elementary and middle school success High school graduation |
|
Community- or school-based programming on protection against sexually transmitted infections (STIs)
|
Stable and healthy families |
|
Clinic- or school-based short-term intervention program for youth who have been referred by juvenile justice, mental health, school, or child welfare systems
|
Stable and healthy families |
|
Helping children and adults build behavioral skills and social support systems to encourage physical activity
|
Stable and healthy families |
|
Healthy living and nutrition education classes, increased physical activity opportunities, and school-wide promotion of healthy food options
|
Elementary and middle school success High school graduation Stable and healthy families |
|
Fully-subsidized and nutritious breakfast at school, often involving culturally relevant practices and food options
|
Kindergarten readiness Elementary and middle school success High school graduation Stable and healthy families |
|
On-site clinics or partnerships that provide dental care to students
|
Kindergarten readiness Elementary and middle school success High school graduation |
|
School-based gardens that host programming including nutrition education, food preparation lessons, and tasting opportunities
|
Elementary and middle school success High school graduation Stable and healthy families |
|
Health care services provided on school premises
|
Kindergarten readiness Elementary and middle school success High school graduation |
|
Curriculum and activities that focus on students' social-emotional development
|
Elementary and middle school success High school graduation |
|
Teaching self-awareness, improving emotional self-control, building self-esteem, and more
|
High school graduation Elementary and middle school success Stable and healthy families Supportive neighborhoods |
|
Curriculum to develop social skills, positive character traits, and nonviolent and drug-free norms among K-12 students
|
High school graduation Supportive neighborhoods |
|
School culture and climate reforms to ensure safe learning environments
|
High school graduation Elementary and middle school success |
|