Access to Contraceptives in School-Based Health Centers: Progress and Opportunities.

INTRODUCTION: The U.S. has a higher adolescent pregnancy rate than other industrialized countries. School-based health centers can improve access to contraceptives among youth, which can prevent unplanned pregnancies. This cross-sectional study examines the characteristics and predictors of contraceptive provision at school-based health centers in 2016-2017 and changes in and barriers to provision between 2001 and 2017. METHODS: In 2020-2021, the authors conducted analyses of the National School-Based Health Care Census data collected from 2001 to 2017. The primary outcome of interest was whether adolescent-serving school-based health centers dispense contraceptives, and a secondary outcome of interest was the policies that prohibit school-based health centers from dispensing contraceptives. A multivariate regression analysis examined the associations between contraceptive provision and various covariates, including geographic region, years of operation, and provider team composition. RESULTS: Less than half of adolescent-serving school-based health centers reported providing contraceptives on site. Those that provided contraceptives were more likely located in the Western and Northeastern regions of the U.S., older in terms of years of operation, and staffed by a wide variety of health provider types. Among school-based health centers that experienced policy barriers to providing access to contraceptive methods, most attributed the source to the school or school district where the school-based health center was located. CONCLUSIONS: School-based health centers are an evidence-based model for providing contraceptives to adolescents but not enough are providing direct access. Understanding the predictors, characteristics, and barriers influencing the provision of contraceptives at school-based health centers may help to expand the number doing so.

Current status of state policies that support school-based health centers.

OBJECTIVES: This study explored the current status of the role of state school-based health center (SBHC) initiatives, their evolution over the last two decades, and their expected impact on SBHCs' long-term sustainability. METHODS: A national survey of states was conducted to determine (1) the amount and source of funding dedicated by the state directly for SBHCs, (2) criteria for funding distribution, (3) designation of staff/office to administer the program, (4) provision of technical assistance by the state program office, (5) types of performance data collected by the program office, (6) state perspective on future outlook for long-term sustainability, and (7) Medicaid and the State Children's Health Insurance Program (SCHIP) policies for reimbursement to SBHCs. RESULTS: Nineteen states reported allocating a total of $55.7 million to 612 SBHCs in school year 2004-2005. The two most common sources of state-directed funding for SBHCs were state general revenue ($27 million) and Title V of the Social Security Act ($7 million). All but one of the 19 states have a program office dedicated to administering and overseeing the grants, and all mandate data reporting by their SBHCs. Sixteen states have established operating standards for SBHCs. Eleven states define SBHCs as a unique provider type for Medicaid; only six do so for SCHIP. CONCLUSIONS: In 20 years, the number of state SBHC initiatives has increased from five to 19. Over time, these initiatives have played a significant role in the expansion of SBHCs by earmarking state and federal public health funding for SBHCS, setting program standards, collecting evaluation data to demonstrate impact, and advocating for long-term sustainable resources.