46 MONITOR ON PSYCHOLOGY • SEPTEMBER 2013
care programs. It is the first time that federal funding has been
specifically allocated for school-based health centers, although
the centers have been eligible to apply for other federal health-care grants.
The money will help provide more solid financial footing
for school-based health centers, which rely on a mix of grants
and government funds. Even though the Affordable Care Act
funding is geared toward construction and equipment, it will
free up other funds to hire new staff, says Ronald S. Palomares,
PhD, assistant executive director of APA’s Practice Directorate.
“It has a tremendous impact, on school-based health centers
and for children, to break down barriers to access for health
care,” says Palomares, who previously worked in school-based
health centers in Dallas.
Nearly 2,000 school-based health centers operate
nationwide, with 75 percent employing a mental health
provider, according to the National Assembly on School-Based Health Care. The centers serve approximately 2 million
students, and mental health counseling is the leading cause
for visits by students, according to several surveys. The centers
typically provide primary and mental health care, substance
abuse counseling, case management and health education.
Some clinics also offer dental exams and pregnancy prevention
programs, and they often are operated as a partnership between
a school district and a local community health organization.
Improving access to care
Psychologists in school-based health centers provide counseling
for students with mental health problems, such as depression or
anxiety. They also address behavioral issues related to treatment
plans or lifestyle choices that affect chronic conditions,
including asthma, diabetes and obesity. Psychologists also may
lead group sessions on pregnancy prevention or substance
abuse, and they work with school psychologists and teachers
to address issues that may arise in the classroom because of a
child’s mental illness or learning disability.
Licensed psychologists who work in school-based health
centers don’t need to be credentialed as school psychologists
as long as they have relevant education, training or experience
working with children and adolescents, Palomares says. A
psychologist also could enlist the help of a more experienced
colleague as a mentor at a school-based health center.
School psychologists who work for local school districts
may perform some of the same services as health center
psychologists, such as leading group sessions, but their main
focus is academics, primarily evaluating students with learning
or developmental disabilities and providing services based on a
student’s individual education plan as mandated under federal
law, Palomares says.
The services at school-based health centers often are free
to students, thanks to grant funding, private insurance or
Medicaid. As a result, they offer a critical resource for low-income students to access mental health care, Alfonso says.
Research has shown that school-based health centers can
help reduce absenteeism and costly emergency room visits.
One study showed that inner-city students were 21 times more
likely to make mental health-related visits to school-based
health centers than to facilities outside their schools (Journal
of Adolescent Health, 2003). Another study found that students
served by health centers had fewer discipline problems, course
failures and school absences (Journal of School Health, 2000).
Health centers inside schools also can save tax dollars,
according to a study by University of Cincinnati researchers
(American Journal of Public Health, 2010). The study analyzed
Medicaid reimbursement costs for more than 5,000 students
in seven schools with health centers and six schools without
in the Cincinnati area. The estimated savings in the schools
with health centers totaled more than $1.35 million over
three years, or approximately $35 per student per year, the
By serving students in schools, health centers also eliminate
transportation costs for parents along with the time and wages
they might lose if they had to take their children to health-care
appointments outside school, Palomares says. Students also may
refer their friends if they notice problems, which increases the
reach of the health center as the staff becomes part of the school
community, he says.
‘Whatever the kids need’
In Snow Hill, N.C., that sense of school community led
psychologists and doctoral students from nearby East Carolina
University to help students and teachers when a tornado ripped
through the small town in 2011, destroying many homes along
with the middle school.
“We were out in the parking lot while the teachers were
cleaning out their classrooms,” says Jeannie Golden, PhD, an
associate professor of psychology at East Carolina University.
“Some of them were bursting into tears. We did on-the-spot
Golden supervises doctoral students who specialize in
pediatric school psychology and provide mental health
counseling at two local middle schools and Greene Central
High School in Snow Hill. Located in a trailer on the high
school grounds, the health center employs a nurse practitioner
and offers a pregnancy prevention program in addition to
primary and mental health care. The doctoral students receive
clinical experience and firsthand exposure to the challenges
faced by many of the 850 high school students, including
poverty, domestic violence, substance abuse and teen pregnancy.
One in four children in Greene County lives below the national
poverty level, and 71 percent of children qualify for free or
reduced-price school meals, according to county statistics.
Depression, anxiety and suicidal ideation are common
problems for the high school students, and some are
undocumented immigrants who have no access to health care
except at the school clinic, Golden says. Parental resistance and