The growth of school-based health centers and the role of state policies: results of a national survey.

OBJECTIVES To document recent growth among school-based health centers across the United States and identify state policies that may be facilitating that growth, using a nationwide survey. This was the fourth in a series of surveys undertaken by the Making the Grade office, Washington, DC. DESIGN During the period from July to September 1998, a written survey instrument was sent to 50 state governments plus the District of Columbia requesting data on numbers of school-based health centers as well as their basic characteristics and a description of state funding and other policies as they relate to the centers. Follow-up telephone calls and additional mailings secured a 100% completion rate. MAIN OUTCOME MEASURES The numbers of centers by state and region, basic health center characteristics, levels of state financial support, and numbers of states implementing specific policies to sustain and replicate the centers. RESULTS School-based health centers increased from 900 during school year 1995-1996 to 1157 in 1997-1998, a 29% gain. Mid-Atlantic and New England states continue to lead the regions with 37% of the total. The fastest growth occurred in the Midwest and the Southwestern/Rocky Mountain states. State grant funding of centers decreased slightly during this period. Other policies, including support from Medicaid and the State Child Health Insurance Program, are increasing third-party revenues. CONCLUSIONS The spread of school-based health centers into the Southwest and Rocky Mountain states is increasing the importance of the centers to rural communities. Because these areas are generally more conservative than either coast, these developments suggest a continued migration of school-based health centers from the political margins into the mainstream. The growth of the centers during a period of stagnation in state grant funding may also suggest that other sources of support, including third-party payments and support from private institutions, are becoming more significant.