Skip to main content

A systematic review of the role of school-based healthcare in adolescent sexual, reproductive, and mental health

Abstract

Background

Accessible sexual, reproductive, and mental healthcare services are crucial for adolescent health and wellbeing. It has been reported that school-based healthcare (SBHC) has the potential to improve the availability of services particularly for young people who are normally underserved. Locating health services in schools has the potential to reduce transport costs, increase accessibility and provide links between schools and communities.

Methods

A systematic review of the literature was undertaken. Pubmed, Psychinfo, Psychnet, Cochrane CENTRAL, and Web of Science were searched for English language papers published between January 1990 and March 2012

Results

Twenty-seven studies were found which fitted the criteria, of which, all but one were from North America. Only three measured adolescent sexual, reproductive, or mental health outcomes related to SBHC and none of the studies were randomized controlled trials. The remaining studies explored accessibility of services and clinic utilization or described pertinent contextual factors.

Conclusions

There is a paucity of high quality research which evaluates SBHC and its effects on adolescent sexual, reproductive, and mental health. However, there is evidence that SBHC is popular with young people, and provides important mental and reproductive health services. Services also appear to have cost benefits in terms of adolescent health and society as a whole by reducing health disparities and attendance at secondary care facilities. However, clearer definitions of what constitutes SBHC and more high quality research is urgently needed.

Peer Review reports

Background

Access to healthcare, especially for adolescents, is a high priority policy objective in many countries and particularly for sexual and reproductive health [1] and mental healthcare [2]. In 2009 young people aged 15 to 19 years accounted for 41% of all new HIV infections globally and more than half of other sexually transmitted infections (STIs) [3]. It has also been estimated worldwide that 11% of those who give birth each year are adolescents [4]. Mental health problems are estimated to affect 10% to 25% of adolescents globally, yet their mental healthcare is often neglected [5, 6]. Clearly sexual and reproductive health services, and mental healthcare services need to be easily accessible to adolescents, and the barriers to access [7] overcome.

At the turn of the 20th century social activists in the US led the movement to serve the needs of young people living in disadvantaged communities by providing health and social services through schools, though service was often through voluntary efforts and rarely formally incorporated into wider health systems [8]. The impulse to provide such services emerged over the years from the realization that young people’s health status and their educational achievement are closely related [9] and from the need to provide an accessible consumer-oriented service [10]. The advantages of schools as a location for delivering healthcare services are clear: schools are where most young people are, they are accessible to families, can provide a comprehensive and non-stigmatizing health service and can provide links between schools and communities.

In recent years, formal health services have been developed in the school setting such that a ‘one-stop shop’ delivers a comprehensive, integrated preventative health service providing medical, nursing, and mental healthcare to young people [10, 11]. This model of healthcare delivery has gained popularity in the United States (US) particularly. The National Assembly on School-Based Health Care (http://www.nasbhc.org) found almost 2,000 school-based healthcare (SBHC) services being implemented country-wide in 2008. Nevertheless, despite their popularity in the US, the provision of services remains patchy with care provided to approximately 2% of young people enrolled in schools [12]. Evidence suggests that SBHC is also common in the UK, involving nursing services only, but services are unevenly distributed and outcomes rarely documented [13]. With regard to other countries, particularly middle and low income countries, there is virtually no documented information. South Africa, is currently embarking on the development of SBHC as part of its primary healthcare re-engineering program [14].

Known variously as ‘school-based health care (SBHC)’, ‘school-based health clinics’, or ‘school-based health centers’ (SBHCs), this way of delivering healthcare is considered to be one of the most effective strategies for delivering comprehensive primary and preventative health services to young people, especially those that are normally underserved by health services [1517]. Although they would not normally reach those young people who have already dropped out of school, are homeless, or incarcerated [18] there is evidence that they can prevent school-dropout and the development of risky behaviors [19, 20].

SBHC aims to provide essential primary care services, overcome barriers such as transport issues, limited community services, and inconvenient location or appointment systems, and can also act on the multiple determinants of health, including public health interventions and environmental change strategies [21], Provision can vary from fully equipped and permanently staffed centers with medical, nursing, and auxiliary staff [22] to clinics offering nursing services for only a few hours per week [23].

Although literature exists on school health services as a whole [13, 2426] which include comprehensive services based at schools, dedicated adolescent health services, school-linked services based at local health centers and servicing a number of schools and other outreach services there is, to our knowledge, no known existing review of the role of school-based healthcare, that is, located on the school grounds and serving the students therein. Specifically, we wanted to review the evidence of the effects and cost-effectiveness of SBHC on adolescent sexual and reproductive health and mental health; issues key at this age. We wanted to look at effectiveness of SBHC, to review factors influencing young people’s use of SBHC, and to describe pertinent contextual facilitating and impeding factors in the establishment of SBHC.

Methods

Pubmed, Psychinfo, Psychnet, Cochrane CENTRAL, and Web of Science were searched for English language papers published between January 1990 and March 2012 using the search terms ‘School-based health care’, ‘School-based health service’ and ‘School-based health clinic’, ‘school-based health centre’, with the addition of the subterms: adolescents, youth, high schools, health, prevention, HIV, mental health, reproductive health, and sexual health. We chose not to review studies from before 1990 as we wanted to review models of SBHC which were relevant to current health system provision.

Search strategy:

Databases: Pubmed, Psychinfo, Psychnet, Cochrane CENTRAL, Web of Science

Inclusion dates: 1 Jan 1990-31 March 2012

Language: English

Search terms:

#1“Adolescent/s”

OR

#2“Youth”

AND

#3 “School based health services”

OR

#4 “School based health care”

OR

#5“School based health centre”

OR

#6“School-based health clinic”

OR

#7 “Health services” AND “High schools” AND “Prevention” AND “HIV”

AND

#8 “Mental health”

OR

#9 “Reproductive Health”

OR

#10 “Sexual health”

OR

#11“Sexual and Reproductive Health”

Studies selected included any process and/or outcome studies using quantitative or qualitative methods that described evaluations of SBHC involving adolescents in secondary schools/high schools. Studies included evaluations of school-based health centers, school-based health clinics, or school-based healthcare. Evaluations of so-called ‘school-linked’ service evaluations were excluded if the school was not the primary location of the service. Primary outcomes included sexual and reproductive health and mental health outcomes and secondary outcomes included satisfaction with services, accessibility of services, measures of use, facilitating and impeding factors, and cost-related analyses. Titles of all possible papers and the abstracts were reviewed. Full papers of identified titles were screened by at least two of the reviewers to determine if they met the inclusion criteria (AMJ and either CM/MM/JK/PDK or CC). Data were extracted from reports that met the inclusion criteria using a piloted form and this was done by two of the review authors (AMJ and either CC or MM) independently.

Results

A total of 1,331 titles were identified through searching databases (n=1,315) and through other sources (n=16) of which 151 duplicates were removed. All titles were screened and 918 articles were excluded as they did not meet the inclusion criteria. Of these, 262 articles were identified and abstracts were screened as being potentially eligible for inclusion. However, at this stage 207 did not meet the inclusion criteria and 55 full text articles were assessed for eligibility. Of these, 28 articles were eventually excluded. In total, 27 studies were included in the final review (see Figure 1).

Figure 1
figure 1

Study flow diagram.

Characteristics of included studies and evaluation findings are shown in Table 1. Apart from one study that was conducted in the UK, all were conducted in North America (24 in the USA and two in Canada). Only three studies were impact evaluations reporting quantitative outcomes [22, 27, 28], and none of these were randomized controlled trials (RCTs). These evaluations included sexual and reproductive health outcomes such as use of contraceptives, pregnancy prevention, and screening for sexually transmitted infections [22, 27, 28]. None of these papers included mental health outcomes. The remainder of the studies retrieved were those evaluating accessibility of services and clinic utilization [1517, 23, 2943], only one of which, [33] used an experimental method with a comparison group and other studies which looked at contextual factors, including operational issues [12, 44, 45] and cost-effectiveness [46].

Table 1 Characteristics of studies

Discussion

School-based health clinics and adolescent sexual, reproductive, and mental health outcomes

Despite the relatively established precedent of SBHC in North America [25] there is surprisingly little robust scientific evidence of its effectiveness in terms of sexual and reproductive or mental health outcomes. There are no known randomized controlled trials and the results of studies that have used a comparison group have been mixed. Nevertheless, some studies have shown that students received more focused preventative healthcare. For example, Ethier and colleagues [27] found that girls at schools which provided school-based health centers had an increased odds of reporting having received pregnancy or disease prevention care (adjusted odds ratio, AOR=1.68, 95% CI, 1.16 to 1.80), having used hormonal contraceptives at last sex (AOR= 1.68, 95% CI, 1.24, 2.28) and were more likely to have been screened for sexually transmitted diseases (STDs) (AOR=1.85, 95% CI, 1.43, 2.40). Also, female students at schools with SBHC were more likely to have used emergency contraception at last sex (AOR=2.1, 95% CI 1.08, 4.22). However access to SBHC did not influence receipt of reproductive healthcare for boys. Kirby [22] reported mixed findings with regard to the role of SBHC in sexual and reproductive health outcomes in six intervention schools compared to four matched comparison schools. Overall there was no evidence that SBHC reduced pregnancy rate. However, the schools all offered slightly different services. For example only three of the six ‘intervention’ schools actually provided contraceptives on-site and only one of these schools reported a significantly increased use of contraceptives at last sex by young people in that school versus the comparison school (boys, 78% vs. 61%, P <0.001 and girls, 75% vs. 60%, P <0.001). Combining SBHC with an in-school educational program that focused on HIV in a community with high prevalence encouraged a sharp rise in reported condom use in another school (boys 61% vs. 41%, P <0.001). The authors suggest that focusing on issues which are priorities for specific school communities may have merit rather than a ‘blanket’ approach to provision. However this does make comparisons of school programs and measures of overall effectiveness of SBHC difficult. Kisker and colleagues’ study [28] compared outcomes of students attending 19 schools in the US with school-based health centers sponsored by a particular funding agency to a nationally representative sample of students. They reported mixed and inconsistent findings. For example they suggest that SBHC may have reduced initiation of sexual activity (67% vs. 70%, P=0.05) but that SBHC students were less likely to use contraceptives at last sex than the nationally representative sample (75% vs. 80%, P=0.05) and there were no differences in the rate of pregnancy (25% vs. 25%). They also reported that SBHC had reduced the number of students who had ever considered suicide (21% vs. 22%, P=0.01) yet there was no difference in those who had attempted suicide when compared with the national sample. One explanation for these inconsistent findings may be that there were quite substantial methodological issues with the study in that the comparison students may have had access to SBHC and therefore did not act as a true comparison group.

Access to and utilization of services

Much of the evidence about SBHC has come from descriptive studies which have examined access to and use of services and the vast majority of the papers retrieved were related to access and clinic utilization. It appears that overwhelmingly girls tend to use services more than boys [16, 17, 23, 24, 3032, 34, 3840, 42, 43, 47], and that students who reported experiencing the greatest level of mental health difficulties such as those who had considered suicide, had sleep disturbance and depression were more likely to use SBHC than those without such difficulties [17, 36, 47]. Some studies found that the more frequent users of SBHCs reported higher levels of mental health need than their peers [17, 30, 31, 36, 42] although one of the studies did not support this [40]. Jepson and colleagues found that the primary reason for using mental health services were for pregnancy and sexuality issues, depression or conflict, and violence [36]. Users of SBHC were also often described as exhibiting more high risk behaviors including unprotected sexual intercourse, substance usage, and suicidal behavior than non-users of services [12, 15, 17, 29, 38, 41, 43, 47]. Adolescents exposed to SBHC received more mental health services compared with those in schools without SBHC and there appeared to be a cost efficiency saving comparing them to those not exposed [35, 46]. It appears therefore, that SBHC can reach adolescents with the greatest level of need.

SBHC has been cited as being able to enhance adolescents’ access to care for medical, mental health, and substance abuse problems [16] but it appears that even then a significant proportion of students remain underserved particularly for mental health services such that many students despite having access to SBHC still reported not seeking the care that they needed [31, 33, 48]. School-based health services, therefore, do not always fully substitute as the primary source of healthcare and students still report having emergency department visits, although sometimes less often than those without access to SBHC [32]. It is therefore important to investigate methods to implement SBHC so that they maximize accessibility and capacity to provide such services.

Reasons for use and non-use of SBHC

A number of studies explored the reason for use and non-use of school-based healthcare. The most commonly cited reason for non-use was related to students’ perception of being healthy and therefore not requiring school-based health services; already having a physician and to a lesser degree, concerns about confidentiality and parental objections [15, 31, 34, 40]. Ease of access was the most frequently mentioned reason for use [31, 34]. Ninety-one per cent of students felt that they had got the service they wanted [23] and 92% were very or somewhat satisfied with the services [40]. Mental health services and reproductive health services and medical services were the most commonly reported reasons for using SBHC [37, 40, 47] and a high proportion of sexually experienced students reported they would use SBHC for reproductive health and STI services where available [34]. Moreover, these services appealed most to female students from lower socioeconomic backgrounds and girls who inconsistently used contraception [34], highlighting the potential of SBHC services to reach adolescents considered to be ‘high risk’, who would benefit the most from receiving such preventative and early interventions.

Whilst adults planning SBHC may feel that pregnancy prevention is the top priority it is also important to ensure that such clinics meet the needs of young people which often include the need to discuss physical body changes, relationships, family issues, and psychological wellbeing [47]. A study conducted in the UK that analyzed patterns of use, reasons for attendance, and views on services in 16 high schools found that the service attracted normally underserved students including boys, those less academically able and those engaging in sex at younger ages [23]. A wide range of sexual and reproductive health services were taken up. However barriers to services included embarrassment, cultural issues, and fears about confidentiality. Alternative ways need to be found to engage with non-users, particularly boys [47]. Interestingly, among all respondents in the UK study, a significant percentage reported most commonly seeking help from friends and family members, highlighting the potential value of peer-support and counselor training programs [23].

Contextual influences

Billy and colleagues [44] looked at contextual influences on the provision of SBHC and found, as one might expect, that those States in the US that had policies around school-based provision and had students enrolled who had health-related risk, were more likely to provide such services. Availability of accessible healthcare services within the local community tended to impede provision of school-based health services and in general more affluent communities tended to provide SBHC more than less affluent communities. The authors stated that highlighting the health concerns of students in specific communities can stimulate the provision of services needed.

The importance of well-trained staff who are able to communicate with adolescents, referral systems and adequate follow-on care, and collaboration between health service staff and schools can improve service delivery and effectiveness [8].

The importance of planning for the setting up of SBHC cannot be overemphasized [49]. If accessible and sensitive services are already available locally such a service may not be needed. It is also important to explore any sources of both resistance and support in the community. Often SBHC has been seen as ‘contraceptive clinics’ that will encourage young people to become prematurely sexually active, often resulting in school district policy restrictions [29]. However, such concerns are not supported by the evidence [22]. Nevertheless, planners must be ready to listen and ensure that comprehensive services are offered. This may also help in making visiting SBHC less stigmatizing for students. Schools and healthcare staff may also resist the setting up of SBHC due to the blurring of boundaries between professionals, increased responsibility, and workload. It is recommended that a representational advisory board is set up in the planning stages for each school so that the SBHC model adopted reflects the needs of the community in which it is based, and does not rely on a ‘one-size-fits-all’ approach. Another important consideration relates to the integration of SBHC services into existing systems of care. The location of SBHC in deprived communities may result in these centers becoming key primary care providers so effective coordination of referral systems to other sources of care is essential as it developing strong partnerships with communities [12, 32, 45].

The source of funding for SBHC is an issue that needs to be addressed because of the long-term needs of adolescents in schools. In most of the reported studies funding came centrally from government. Evaluation of cost-benefit of SBHC was undertaken by Guo and colleagues [46] using a quasi-experimental repeated measures design and using data from medical aid claims and parental reports. They found that SBHC was cost beneficial in terms of the medical aid system and argued that it is also cost beneficial to society in reducing health disparity gaps.

Limitations

Our search was limited to published English language peer-reviewed studies; there may be grey literature available which provides more evidence of effectiveness of school-based health centers for sexual, reproductive, and mental health of adolescents. However this was very difficult to identify, systematically. The authors also did not have access to the CINAHL database and there may have been nurse-led studies which have been missed. Most of the studies identified were descriptive. Only five studies employed a comparison group [22, 27, 28, 33, 35] but none were randomized controlled trials, hence comparisons between schools with and without SBHC may be biased. The review was therefore severely limited by the quality of the available studies. No formal risk of bias assessments were carried out which is also a potential limitation of the review. Most of the studies used self-reported measures of healthcare usage and health status or else used retrospective reviews of health records. Some of the studies [17, 28, 31, 34, 37, 44] mentioned other services young people utilized outside of school such as STI treatment, maternity, general practitioner, pharmacy, clergy, or alternative healing services, for example, that may have impacted on utilization as a whole and health outcomes in particular but none analyzed this in any depth. Also, reports of utilization were from students attending school. Their health needs and patterns of healthcare utilization are probably not representative of those who have dropped out who are more likely to have a higher burden of disease [18]. It is feasible that users of SBHC are different from non-users. In terms of analysis of studies, few authors employed rigorous statistical techniques to control for confounding factors such as age, gender, ethnicity, and health status.

Finally and most importantly, clearer definitions are needed of what SBHC actually is, as it is different in different contexts and countries. Currently the range of what constitutes SBHC makes comparisons across a range of settings difficult. For example, services could range from comprehensive primary care services provided Monday to Friday during school hours by a doctor, nurse, counselor/psychologist, social worker, and dentist providing screening, diagnosis, lab tests, treatment for minor illnesses and injuries, immunizations, gynecological examinations, STI treatment, and contraceptive advice and provision [22, 28], or a nurse and youth worker service operating for one lunchtime a week during term time [23].

Conclusions

It appears that SBHC can provide services for normally underserved young people particularly for mental health services. However, more high-quality research is urgently needed into the effectiveness of SBHC on sexual reproductive and mental health outcomes and especially on what encourages young people to use services and what prevents others, particularly boys, from not using services. Careful planning and collaboration with young people, parents, and local communities is clearly needed. School-based health services may not be the main source of healthcare due to their limited coverage of schools, services offered or opening times (that is, closed at weekends and during holidays) and health policy-makers need to ensure that there is a seamless provision between usual healthcare delivery networks. School-based health services should ideally form a complementary service and should not replace other community health provision [37].

Currently the evidence is both severely limited and equivocal on the effectiveness of SBHC on adolescent sexual, reproductive, and mental health. If further studies can begin to define what the minimum standards for comprehensive SBHC services are and can ascertain ‘what works’ using appropriate and rigorous research methodologies it could provide promise as an intervention for addressing key adolescent public health issues. But until that time, although intuitively and anecdotally it may seem to make good sense we do not have the evidence to be confident to make claims as to its effectiveness.

References

  1. Ralph L, Brindis C: Access to reproductive healthcare for adolescents: establishing healthy behaviours at a critical juncture in the lifecourse. Curr Opin Obstet Gynecol. 2012, 22: 369-374.

    Article  Google Scholar 

  2. World Health Organization: Caring for children and adolescents with mental disorders: Setting WHO directions. In Caring for children and adolescents with mental disorders: Setting WHO directions. 2003, Geneva: WHO

    Google Scholar 

  3. UNAIDS: Securing the future today: Synthesis of strategic information on HIV and Young People. In Securing the future today: Synthesis of strategic information on HIV and Young People. 2011, Geneva: UNAIDS

    Google Scholar 

  4. World Health Organization: Young people: health risks and solutions WHO Fact sheet N°345. In Young people: health risks and solutions WHO Fact sheet N°345. 2011, Geneva: WHO

    Google Scholar 

  5. Merikangas KR, He J-p, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J: Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010, 49: 980-989. 10.1016/j.jaac.2010.05.017.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kieling C, Baker-Henningham H, Belfer H, Conti G, Ertem I, Omigbodun O, Rohde L, Srinath S, Ulkuer N, Rahman A: Child and adolescent mental health worldwide: evidence for action. Lancet. 2011, 378: 1515-1525. 10.1016/S0140-6736(11)60827-1.

    Article  PubMed  Google Scholar 

  7. Lieu TA, Newacheck PW, McManus MA: Race, ethnicity, and access to ambulatory care among US adolescents. Am J Public Health. 1993, 83: 960-965. 10.2105/AJPH.83.7.960.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Dryfoos JG: Full service schools: revolution or Fad?. J Res Adolesc. 1995, 5: 147-172. 10.1207/s15327795jra0502_1.

    Article  Google Scholar 

  9. Richardson JW: Building bridges between school-based health clinics and schools. J Sch Health. 2007, 77: 337-343. 10.1111/j.1746-1561.2007.00217.x.

    Article  PubMed  Google Scholar 

  10. Dryfoos J: Full-service schools: A revolution in health and social services for children, youth and families. 1994, San Francisco, CA: Jossey-Bass

    Google Scholar 

  11. Bruininks R, Frenzel M, Kelly A: Integrating services: the case for better links to schools. J Sch Health. 1994, 64: 242-248. 10.1111/j.1746-1561.1994.tb06195.x.

    Article  CAS  PubMed  Google Scholar 

  12. Brindis CD, Klein J, Schlitt J, Santelli J, Juszczak L, Nystrom RJ: School-based health centers: accessibility and accountability. J Adolesc Health. 2003, 32: 98-107.

    Article  PubMed  Google Scholar 

  13. Owen J, Carroll C, Cooke J, Formby E, Hayter M, Hirst J, Lloyd Jones M, Stapleton H, Stevenson M, Sutton A: School-linked sexual health services for young people (SSHYP): a survey and systematic review concerning current models, effectiveness, cost-effectiveness and research opportunities. Health Technol Assess. 2010, 14: 1-228.

    Article  CAS  PubMed  Google Scholar 

  14. Motsoaledi A: Health Budget Vote Policy Speech presented at the National Assembly by Minister of Health, Dr A Motsoaledi. In Health Budget Vote Policy Speech presented at the National Assembly by Minister of Health, Dr A Motsoaledi. Edited by: Cape T. 2011, Cape Town: Parliamentary Monitoring Group

    Google Scholar 

  15. Balassone ML, Bell M, Peterfreund N: A comparison of users and nonusers of a school-based health and mental health clinic. J Adolesc Health. 1991, 12: 240-246. 10.1016/0197-0070(91)90017-G.

    Article  CAS  PubMed  Google Scholar 

  16. Anglin TM, Naylor KE, Kaplan DW: Comprehensive school-based health care: high school students' use of medical, mental health, and substance abuse services. Pediatrics. 1996, 97: 318-330.

    CAS  PubMed  Google Scholar 

  17. Amaral G, Geierstanger S, Soleimanpour S, Brindis C: Mental health characteristics and health-seeking behaviors of adolescent school-based health center users and nonusers*. J Sch Health. 2011, 81: 138-145. 10.1111/j.1746-1561.2010.00572.x.

    Article  PubMed  Google Scholar 

  18. Freudenberg N, Ruglis J: Reframing school dropout as a public health issue. Prev Chronic Dis. 2007, 4: 1-5.

    Google Scholar 

  19. Kerns S, Pullmann M, Cusworth Walker S, Lyon A, Cosgrove T, Bruns E: Adolescent use of school-based health centers and high school dropout. Arch Pediatr Adolesc Med. 2011, 165: 617-623. 10.1001/archpediatrics.2011.10.

    Article  PubMed  Google Scholar 

  20. Van Cura M: The relationship between school-based health centers, rates of early dismissal from school, and loss of seat time. J Sch Health. 2010, 80: 371-377. 10.1111/j.1746-1561.2010.00516.x.

    Article  PubMed  Google Scholar 

  21. Clayton S, Chin T, Blackburn S, Echeverria C: Different setting, different care: integrating prevention and clinical care in school-based health centers. Am J Public Health. 2010, 100: 1592-1596. 10.2105/AJPH.2009.186668.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kirby D, Waszak C, Ziegler J: Six school-based clinics: their reproductive health services and impact on sexual behavior. Fam Plann Perspect. 1991, 23: 6-16. 10.2307/2135395.

    Article  CAS  PubMed  Google Scholar 

  23. Ingram J, Salmon D: Young people's use and views of a school-based sexual health drop-in service in areas of high deprivation. Health Educ J. 2010, 69: 227-235. 10.1177/0017896910364566.

    Article  Google Scholar 

  24. Fothergill K, Ballard E: The school-linked health center: A promising model of community-based care for adolescents. J Adolesc Health. 1998, 23: 29-38. 10.1016/S1054-139X(98)00012-3.

    Article  CAS  PubMed  Google Scholar 

  25. School-based health care, advancing educational success and public health. Edited by: Wright T, Richardson JW. 2012, Washington, DC: American Public Health Association

    Google Scholar 

  26. Peak GL, Hauser McKinney DL: Reproductive and sexual health at the school-based/school-linked health center: An analysis of services provided by 180 clinics. J Adolesc Health. 1996, 19: 276-281. 10.1016/S1054-139X(96)00039-0.

    Article  CAS  PubMed  Google Scholar 

  27. Ethier KA, Dittus PJ, DeRosa CJ, Chung EQ, Martinez E, Kerndt PR: School-based health center access, reproductive health care, and contraceptive use among sexually experienced high school students. J Adolesc Health. 2010, 48: 562-565.

    Article  Google Scholar 

  28. Kisker EE, Brown RS: Do school-based health centers improve adolescents' access to health care, health status, and risk-taking behavior?. J Adolesc Health. 1996, 18: 335-343. 10.1016/1054-139X(95)00236-L.

    Article  CAS  PubMed  Google Scholar 

  29. Santelli J, Nystrom RJ, Brindis C, Juszczak L, Klein J, Bearss N, Kaplan D, Hudson M, Schlitt J: Reproductive health in school-based health centers: findings from the 1988–99 census of school-based health centres. J Adolesc Health. 2003, 32: 443-451. 10.1016/S1054-139X(03)00063-6.

    Article  PubMed  Google Scholar 

  30. Harold R, Harold N: School-based clinics: a response to the physical and mental health needs of adolescents. Health Soc Work. 1993, 18: 65-74.

    CAS  PubMed  Google Scholar 

  31. Adelman HS, Barker LA, Nelson P: A study of a school-based clinic: who uses it and who doesn't?. J Clin Child Psychol. 1993, 22: 52-59. 10.1207/s15374424jccp2201_5.

    Article  Google Scholar 

  32. Allison M, Crane L, Beaty B, Davidson A, Melinkovich P, Kempe A: School-based health centers: improving access and quality of care for low income adolescents. Pediatrics. 2007, 120: e887-e894. 10.1542/peds.2006-2314.

    Article  PubMed  Google Scholar 

  33. Britto MT, Klostermann BK, Bonny AE, Altum SA, Hornung RW: Impact of a school-based intervention on access to healthcare for underserved youth. J Adolesc Health. 2001, 29: 116-124. 10.1016/S1054-139X(01)00196-3.

    Article  CAS  PubMed  Google Scholar 

  34. Coyne-Beasley T, Ford C, Waller M, Adimora A, Resnick M: Sexually active students' willingness to use school-based health centers for reproductive health care services in North Carolina. Ambul Pediatr. 2003, 3: 196-202. 10.1367/1539-4409(2003)003<0196:SASWTU>2.0.CO;2.

    Article  PubMed  Google Scholar 

  35. Guo J, Wade T, Keller K: Impact of school-based health centers on students with mental health problems. Public Health Rep. 2008, 123: 768-780.

    PubMed  PubMed Central  Google Scholar 

  36. Jepson L, Juszczak L, Fisher M: Mental health care in a high school based health service. Adolescence. 1998, 33: 1-15.

    CAS  PubMed  Google Scholar 

  37. Juszczak L, Melinkovich P, Kaplan D: Use of health and mental health services by adolescents across multiple delivery sites. J Adolesc Health. 2003, 32: 108-118. 10.1016/S1054-139X(03)00073-9.

    Article  PubMed  Google Scholar 

  38. Kaplan D, Calonge N, Guernsey B, Hanrahan M: Managed care and school-based health centres. Arch Pediatr Adolesc Med. 1998, 152: 25-33.

    Article  CAS  PubMed  Google Scholar 

  39. Langille D, Asbridge M, Kisely S, Leblanc M, Schaller E, Lynk A, Allen M: The relationship of sex and risk behaviours to students' use of school-based health centres in Cape Breton, Nova Scotia. Paediatr Child Health. 2008, 13: 605-609.

    PubMed  PubMed Central  Google Scholar 

  40. Pastore D, Techow B: Adolescent school-based health care: A description of two sites in their 20th year of service. Mt Sinai J Med. 2004, 71: 191-196.

    PubMed  Google Scholar 

  41. Walter H, Vaughan R, Armstrong B, Krakoff R, Tiezzi L, MccCarthy J: Characteristics of users and nonusers of health clinics in inner-city junior high schools. J Adolesc Health. 1996, 18: 344-348. 10.1016/1054-139X(95)00171-N.

    Article  CAS  PubMed  Google Scholar 

  42. Weist M, Proescher E, Freedman A, Paskewitz D, Flaherty L: School-based health services for urban adolescents: psychosocial characteristics of clinic users vs nonusers. J Youth Adolesc. 1995, 24: 251-265. 10.1007/BF01537152.

    Article  Google Scholar 

  43. Wolk LI, Rosenbaum R: The benefits of school-based condom availability: cross-sectional analysis of a comprehensive high school-based program. J Adolesc Health. 1995, 17: 184-188. 10.1016/1054-139X(95)00031-M.

    Article  CAS  PubMed  Google Scholar 

  44. Billy JOG, Grady WR, Wenzlow AT, Brener ND, Collins JL, Kann L: Contextual influences on school provision of health services. J Adolesc Health. 2000, 27: 12-24. 10.1016/S1054-139X(99)00123-8.

    Article  CAS  PubMed  Google Scholar 

  45. Bowlan N, Chevalier N, Gullo S, Lawrence L, Hinton Walker P: School-based care: clinical challenges and research opportunities. J Soc Pediatr Nurs. 1996, 1: 64-74. 10.1111/j.1744-6155.1996.tb00003.x.

    Article  Google Scholar 

  46. Guo JJ, Wade TJ, Pan W, Keller KN: School-based health centers: cost-benefit analysis and impact on health care disparities. Am J Public Health. 2010, 100: 1617-1623. 10.2105/AJPH.2009.185181.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Szumilas M, Kutcher S, LeBlanc JC, Langille DB: Use of school-based health centres for mental health support in Cape Breton, Nova Scotia. Can J Psychiatry. 2010, 55: 319-328.

    PubMed  Google Scholar 

  48. Soleimanpour S, Geierstanger SP, Kaller S, McCarter V, Brindis CD: The role of school health centers in health care access and client outcomes. Am J Public Health. 2010, 100: 1597-1603. 10.2105/AJPH.2009.186833.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Alexander E: School-based clinics: questions to be answered in planning stages. High Sch J. 1989, 73: 133-138.

    Google Scholar 

Download references

Acknowledgements

AMJ was previously funded by the South African MRC and the PREPARE PROJECT and is currently funded by the University of York. CC was funded by Brown University. MM, JK PDK and CM are funded by the PREPARE. “Promoting sexual and reproductive health among adolescents in southern and eastern Africa - mobilizing schools, parents and communities”. Acronym: PREPARE. The PREPARE study is funded by the EC Health research program (under the 7th Framework Program). Grant Agreement number: 241945. The partners and principal investigators include: University of Cape Town (Cathy Mathews), Muhimbili University College of Health Sciences (Sylvia Kaaya), University of Limpopo (Hans Onya), Makerere University (Anne Katahoire), Maastricht University (Hein de Vries), University of Exeter (Charles Abraham), University of Oslo (Knut-Inge Klepp), University of Bergen (Leif Edvard Aarø, coordinator). See also the project homepage http://prepare.b.uib.no/. CM is funded by the South African MRC.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Amanda J Mason-Jones.

Additional information

Competing interests

AMJ was previously funded by the South African MRC and the PREPARE PROJECT and is currently funded by the University of York. CC was funded by Brown University. MM, JK PDK and CM are funded by the PREPARE.

Authors’ contributions

AMJ designed and led the study, reviewed all included studies, and wrote the paper. CC completed the search, reviewed all studies, and co-wrote the paper. MM reviewed all studies and co-wrote the paper. CM, JK, and PDK reviewed a proportion of included studies and gave feedback on the manuscript. All authors have read and approved the final manuscript.

Authors’ original submitted files for images

Below are the links to the authors’ original submitted files for images.

Authors’ original file for figure 1

Rights and permissions

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and permissions

About this article

Cite this article

Mason-Jones, A.J., Crisp, C., Momberg, M. et al. A systematic review of the role of school-based healthcare in adolescent sexual, reproductive, and mental health. Syst Rev 1, 49 (2012). https://doi.org/10.1186/2046-4053-1-49

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/2046-4053-1-49

Keywords