School-Based Health Centers: Implications for Counselors.

There are increasing numbers of children and adolescents who are affected by chronic health or emotional problems. Many children and adolescents do not receive adequate services in the community, and, untreated, these problems often become a barrier for success in school (Adelman & Taylor, 1998). Meeting the physical and mental health needs of these children and their families presents a formidable professional challenge that requires the coordinated efforts of many disciplines, including health education, nursing, nutrition, school counseling, and school psychology (Zins & Wagner, 1997). School-based health centers (SBHCs) are one example of interdisciplinary efforts to provide comprehensive physical and mental health care for children and adolescents. Most SBHCs have adopted a primary care orientation and offer physicals, acute care treatment for illnesses and minor injuries, and often provide ongoing care for chronic illnesses. Some provide dental care, and many provide preventive and health promotion programs. Originally established in urban areas, they are quickly developing in rural and suburban areas as well because they provide enhanced access to a variety of services in one convenient location. There is a growing body of evidence that SBHCs have positive effects for students. Children using SBHCs have a net gain in their number of health care visits and are much more likely to access mental health services when an SBHC is available in their school. This is especially true for children who are typically underserved: children in rural areas, minority youth, and homeless children. SBHC services also have been shown to result in a decrease in emergency room visits and referrals for specialty treatment. Students receiving school-based mental health care have an increase in academic achievement, reduced disciplinary problems, and fewer absences from school. Consumer satisfaction studies have found that students are very satisfied with SBHC services, are comfortable being seen in a center, and find the range of services acceptable. SBHCs are being established at an increasing rate, and they are becoming a part of mainstream health care in the United States (Koppelman & Lear, 2000). Although in operation for 25 years, SBHCs have received little attention in the counseling literature. Many school practitioners are not familiar with these centers and issues related to providing full-service health care through the schools. This article reviews one of the few special journal issues on SBHCs that have focused on school mental health providers. * Article Reviews The May 2003 issue of Psychology in the Schools presented a series of articles on the issues involved in the implementation of SBHCs. Although many of the articles were written from the perspective of school psychologists, the information in the issue is applicable to other school and community mental health practitioners. Several articles from this issue are reviewed, followed by a discussion of the implications for counseling practice and counselor education. Development of SBHCs Meyers and Swerdlik (2003) described the barriers and opportunities affecting the development of SBHCs in their article "School-Based Health Centers: Opportunities and Challenges for School Psychologists." They discussed the influence of various factors on the establishment of SBHCs, such as system reforms, school system governance, the importance of SBHC to stakeholders, and availability of funding. They reviewed some of the factors that may impede the development of SBHCs, including definitional confusion, community stigma, limited resources, lack of integration and coordination of services, and an emphasis on a narrow role of medical services. There are a number of strategies that were suggested by Meyers and Swerdlik (2003) to overcome the formidable challenges in the development of SBHCs. Many solutions can be implemented during program establishment by approaching development as system-level reform and by becoming a "player at the table," educating stakeholders, and conducting effective needs assessments. …