Setting up a School Based Health Service

Health and education are intrinsically linked. Good education promotes better health and health is a precondition for reaching educational goals. As such, both education and health could be described as resources which contribute to better outcomes across the lifespan.

Schools play an important role in healthy development through the period of adolescence. The value of schools as a setting in which to provide universal healthy lifestyle education and skill development is being recognised and increasingly schools are building community partnerships to develop this aspect of the formal and informal curriculum.

Universally, however, adolescents frequently miss out on health care. As a group, they are the least likely of all age groups to access care, and socio-economic disadvantage and factors relating to minority cultural status compounds this risk. In the community, young people face recognised barriers in accessing health care due to:

  • Not knowing where to go
  • Not knowing when to go
  • Fears about confidentiality
  • Concerns about stigma
  • Cost to themselves or their family
  • Inconvenient appointment times
  • Scarcity of clinicians trained specifically in working with young people
  • Not having parental/carer support to attend

Promisingly, however, there is a growing body of evidence around the value and effectiveness of School Based Health Services (SBHS) suggesting:

  • Adolescents are more likely to present to a SBHS than any other health service
  • SBHSs provide:
    • Increased access to mental health care (esp. disadvantaged; male)
    • Improvements in psychosocial and physical health
    • Reduction in ED presentations/ hospitalisations
    • Increased school attendance for SBHS users

The World Health Organisation (WHO) has developed the Adolescent-Friendly Health Services framework to describe a model of care that seeks to address and overcome these recognised barriers.1 Youth Friendly health services need to be equitable, accessible, acceptable, appropriate, comprehensive, effective and efficient. The DiSS program model of care adopts the WHO Adolescent-Friendly health service approach (described here as Youth-Friendly services) as an evidence-based and best practice approach to providing high quality care in combination with qualities that young people demand. Furthermore, through wide stakeholder consultation, we have learned that much of what is desired in the school setting is represented by this approach.  Ideally, DiSS Clinics should aspire to become Youth Friendly, and even if these key characteristics cannot be reached immediately, improvements will bring better outcomes over time.

Key stages of the DiSS Program Implementation -Overview

The program moves through a number of phases from conceptual design and clinic construction, getting started, establishing initial services through to embedding the service into the life of the school and integrating it within the community.

Through the conceptual planning phase, we sought to understand how this program could work through consultation with clinicians, students, school staff (i.e. SPL, Health and Wellbeing staff, School Nurses), the Primary Health Networks (PHN), and the Department of Education and Training (DET) all of whom have had to consider how their diverse roles and skills would interact in this new program environment. A literature review was conducted to better understand the evidence base and best practice recommendations for School Based Health Services (SBHS) in the Victorian context, and the DiSS Program model of care was developed. This all occurred whilst the schools were selected and facilities were under construction.

Selected Schools got started once they made a commitment to the program and received induction training and operational guidance, whilst clinical staff went through similar parallel processes. Clinicians received face-to-face training which covered aspects of adolescent health care in the school setting and relevant medico-legal responsibilities and duties when caring for young people, their families and carers.

In the establishment phase, clinicians provided feedback on the important activities involved in preparing to conduct direct clinical care and work with key school partners. Similar feedback was obtained from school staff through the initial phases of DiSS clinic establishment. The process of embedding the program within the schools is a complex task and as such, we sought wide stakeholder consultation with over 480 professionals working in the DiSS program in order to better understand their collective vision for the program and to set an agenda for change. Stakeholders included teachers, wellbeing officers, members of the Principal class, General Practitioners (GPs), Practice Nurses (PNs), Secondary School Nurses (SSNs) and Registered Nurses (RNs) and these conversations have contributed to the strategies described in this section of the guide.

1 WHO. Adolescent Friendly Health Services — An Agenda for Change. 2002; Available from:;jsessionid=415BD90B21951BEFEA555B3C49E0B3A2?sequence=1