Setting up a School-Based Health Service (SBHS)

This section provides information and recommendations about setting up a School-Based Health Service (SBHS).

Health and education are intrinsically linked. Good education promotes better health and health is a precondition for reaching educational goals. While most respondents in the nationwide survey Young Australians: their health and well-being (AIHW 2011) rate their health as ‘good’, ‘very good’ or ‘excellent’, there remain concerning trends in ill health, risk-taking behaviours, and health inequalities for groups of disadvantaged young people. Rates of diabetes and STIs are rising, mental disorders are common in secondary school-age students and accidental and non-accidental injuries and death remain unacceptably high. (AIHW 2011) Too many young people are overweight or obese, not meeting physical activity or fruit and vegetable intake guidelines, are drinking at risky or high-risk levels, and are victims of alcohol or drug-related violence. These manifest health conditions and health risk behaviours not only have a negative impact on the day-to-day life and goal attainment of young people but contribute to poorer health and quality of life across their lifespan.

Schools play an important role in healthy development through adolescence. Increasingly the value of schools as a setting to provide near-universal education about healthy lifestyles and skill development is being recognised and increasingly schools are building community partnerships to develop this aspect of the curriculum. Furthermore, education itself promotes better health outcomes for young Australians.

Author: Dr Bianca Forrester, 2018

Setting up a School-Based Health Service

Step 1: A ‘champion team’ for young people

In the school setting, identify one person to act as the link between your school and the health professionals providing services. They will work alongside the clinicians and act as liaisons for the SBHS or clinic. They will lead the set-up (or ongoing improvement) of the clinic in the school, explain what is happening and why, and be responsible for introducing the clinicians to the school community. While they won’t be responsible for all the changes, as the school leadership and or lead teacher will support them, they will play a crucial role in the ‘champion team’.

The General Practitioner (GP) and Practice Nurse (PN) working in the SBHS clinic will also be part of the SBHS clinic ‘champion team’. They will lead the clinic set-up with the support of their practice manager and work to build relationships with the students and staff within the school. Consider who else in the home clinic, broader health administration and school community should be part of the champion team. Is there a school nurse or well-being team member who could play a role in championing the SBHS clinic?

Step 2: Get the team together

Get the team together through an orientation meeting. Create an agenda of things to discuss, such as how to book appointments, how to communicate outside clinic times, how you will manage privacy and confidentiality. Sometimes these processes can appear daunting, on both sides of the program, and we can feel a little unsure of what to expect and how it’s all going to work. Sitting down to communicate early and often is a useful strategy as most issues, problems and questions can be resolved through regular communication between school and clinic team members. Take some time to learn about one another’s roles, settings, hopes and expectations of the SBHS and try to establish common goals.

Step 3: Familiarise yourselves with relevant guidelines

Seek out operational guidelines for your program or reach out to the Australasian School Based Health Association (ASBHA) for advice in accessing policies and guidelines for SBHS.

Step 4: Get feedback

Put out a suggestion/feedback box for students. Invite them to give anonymous feedback about the service – what they like, don’t like, and how they would like things to change. Some clinics have placed this in the waiting room of the SBHS clinic, others in the well-being area. Perhaps you have other ideas for gathering feedback in the early stages?

Step 5: Feel comfortable around confidentiality

Young people have the right to access confidential healthcare and clinicians must be aware of how they can uphold this right alongside their medicolegal duties of care. Ensure that your clinic has a confidentiality policy that is in line with Australian standards. Circulate these policies to all staff. Ensure that all teachers, reception staff and other staff members are aware of the confidentiality policy for the SBHS program and then make sure that your policy is displayed. For more information, visit the Department of Education website.

Step 6: A welcoming place to be

Refresh the SBHS clinic waiting area. Are there ways to make it less intimidating and more relaxed? Consider some games, mindfulness activities, resources, or magazines appropriate for teenagers. Will you provide fruit or tea and coffee? Can you engage students to decorate the space?

Step 7: What exactly are we doing for young people?

Think through various aspects of your provision and identify different services that are relevant to young people. Are there any barriers to offering certain services? What extra equipment will you need? What services can your clinic offer on an in-reach/ outreach basis? Consider creating a ‘Did you know….’ Poster for the waiting area listing all these services. Consider holding a student and parent information night.

Step 8: Experiencing working in the DiSS clinic

For the health sector, if your clinic doesn’t usually work with young people, talk with all your staff about working with young people. Find out what experience staff have with working with young people. Are there any positive/negative stories that can be learnt from? What do staff feel are barriers to engaging positively and productively with young people? Bring interested staff members out to the school clinic to get a sense of the school environment and the SBHS clinic space and possibilities.

For the education sector, if your school doesn’t usually provide health services, talk with teachers about their understanding of the health needs of adolescents. Find out what experiences they have had with students requiring health care. Are there any positive/negative stories that can be learnt from? What do staff feel are barriers to referring students to health services within the school setting? Take interested staff through the clinic and introduce them to clinicians.

Step 9: Find out who else is out there

Sit down as a ‘champion team’ to discuss services that each of you might offer in your unique settings. Schools will have a host of programs, activities, and services available as well as dedicated health, social care, and wellbeing team members on-site throughout the school week. Make a point of getting acquainted with these other key stakeholders in schools. Do some research or consider other services in the area that support young people’s health and well-being. Is there a psychologist in your area that could establish a practice in the clinic rooms on alternate days? Would dieticians offer Telehealth? Would a youth team or special services support worker use the space on non-SBHS days?

Step 10: How do young people access the SBHS Clinic?

Make sure that all staff are clear about when young people can access services on their own. When is the SBHS clinic going to be open? How can students make a booking, and do they require support to access the service? Make this information available to students and their families through your usual channels for communication. Sit down as a champion team to create a referral process, booking system and processes for managing on the day appointments, cancellations, or no shows. Understand how young people want to be communicated with and what they might need in regard to support in attending appointments.

Dr Bianca Forrester 2018 / updated 2023
Acknowledgement- This section was based on You’re Welcome Pilot 2017; Quality criteria for making health services young people friendly. British Youth Council