Linking School-Based Health Services and Community Schools to Address the Needs of Students and Families
Policy Brief by Sally Dreslin and Adrienne Anderson
Key Takeaways
By establishing schools as hubs of coordinated services, we build a safety net that can fundamentally enhance the health and well-being of students and their families.
In addition to the primary care-focused school-based health centers (SBHC), there are also SBHCs that provide only dental services (SBHC-D), and school-based mental health clinics (SBMHC) that provide assessment and mental health services.
Community Schools represent an integrated educational approach designed to transform traditional schools into community hubs by offering comprehensive services and supports to students and their families.
In NYC, approximately 420 out of the City’s 1,700 public schools are Community Schools. The NYS Basic Educational Data System (BEDS) survey identifies approximately 820 Community Schools statewide.
In NYC, 118 of the 421 Community Schools have access to a SBHC.
Outside of NYC, 41 of the 365 Community Schools have access to a SBHC.
We were not able to assess the overlap of Community Schools and SBMHCs because the data is not publicly available.
To enhance the linkages between school-based health services and Community Schools, it is important to
Make more Community Schools data publicly available
Establish a statewide office with resources dedicated to Community Schools
Ensure the sustainability of school-based health centers
Streamline the requirements to establish school-based health services
As NYC implements reduced class size requirements, it is essential that classroom space be preserved for school-based health services.
Given the current uncertainty of federal healthcare and education funding to states, it is more important than ever to maximize the value of State spending. Linking school-based health services and Community Schools is a low-barrier, high-impact approach to improving educational and health outcomes for students, and to better engaging families and the surrounding community in supporting student success.
Introduction
The Step Two Policy Project discussed school-based health centers (SBHCs), the opportunities, and the many challenges in a Policy Brief from December 2024. One of the opportunities identified was to strengthen the integration of SBHCs with Community Schools. This Policy Brief delves more deeply into 1) the background of Community Schools in New York, particularly in New York City, where there was a significant effort to expand their presence, and 2) what would be involved in strengthening the integration of SBHCs and other school-based health services, and Community Schools.
Integrating healthcare and access to social services is a vital strategy for addressing the multifaceted challenges faced by vulnerable populations, especially within school settings. Many students, particularly those in traditionally underserved communities, experience educational challenges in the context of existing health issues, such as acute and chronic illness. These challenges are often compounded by social needs like food insecurity and housing instability. Siloed service delivery systems often fail to address these intersecting challenges; however, efforts that merge the activities of disparate social service organizations with local healthcare providers can bridge the gaps. By establishing schools as hubs of coordinated services, we build a safety net that can fundamentally enhance the health and well-being of students and their families.
As the Step Two Policy Project discussed in our previous work, school-based health centers are located within the school building; they provide “… primary and preventive care, acute or first contact care, chronic care, and referral as needed. They provide services for children and adolescents within the context of their family, social/emotional, cultural, physical, and educational environment.”[1] Per the NYS Department of Health’s Principles and Guidelines, SBHCs across the state collaborate with hospitals, community clinics, community-based primary care providers, and local health departments to ensure the provision of coordinated healthcare for students.
Community Schools are focused on creating an environment that brings together educators, families, students, and community members to “strengthen the conditions for student learning and healthy development.”[2] Ensuring access to school-based health and mental health services for more Community Schools[3] provides an important opportunity to integrate the healthcare, social service, and education delivery systems to better meet the complex needs of vulnerable students and their families.
Background on School-Based Health Centers
School-based health centers are an important component of the healthcare safety net in New York. These health centers provide access to services for approximately 250,000 mostly low-income students in urban and rural areas, and areas where the majority of students’ health insurance coverage is Medicaid. SBHCs are technically extension clinics of hospitals or federally qualified health centers that are referred to as the SBHC’s “sponsors.” SBHCs often operate with a precarious financial status, even though they receive reimbursement for many of the services they provide, and many also receive capital and operating support from NYS and NYC, as applicable. Several elements contribute to the financial instability of SBHCs – they are required to treat all students who present to the health center, whether or not they have health insurance; they are not permitted to charge students out-of-pocket for services provided; reimbursement for primary care services in general is often lower than the cost for providing the care; many of the services provided by SBHC are not reimbursable, e.g., nutritional counseling, care coordination, health promotion; and SBHCs often require costly capital improvements to the clinic space provided by the school.
In addition to the primary care-focused SBHCs, there are also SBHCs that provide only dental services (SBHC-D) and school-based mental health clinics (SBMHC) that provide assessment and mental health services. A SBMHC operates under NYS Office of Mental Health regulations as a satellite clinic of an existing behavioral health clinic located within the community. Additional services provided on-site or arranged by the SBMHC may include peer support, psychiatric assessment, medication treatment, and crisis intervention.[4]
Adding to the financial concern for SBHCs is the direction by the NYS Department of Health (NYS DOH) requiring SBHCs to contract with managed care plans to receive Medicaid reimbursement, rather than the current Medicaid fee-for-service (FFS) payment model. In late September 2024, NYS DOH informed SBHCs that the long-delayed transition to managed care would take effect on April 1, 2025.[5] On March 31, 2025, the NYS DOH delayed the carve-in until May 1, 2025. Although the transition requires managed care plans to maintain current fee-for-service reimbursement rates for two years, after that period, the rates would need to be negotiated between the plan and the SBHC sponsor. These new administrative requirements (e.g., contracting with multiple managed care plans as well as their vendors for behavioral health and dental care, rate negotiations, and provider credentialing) for reimbursement by managed care organizations would need to be in place by the transition deadline for the SBHCs to receive payment by that date.
Some NYC SBHC sponsors have closed their health centers in recent years,[6] notably NYC Health and Hospitals Corporation (NYC H+H) closed 19 SBHCs between 4/2018 and 8/2023 that served 13,768 students in 44 schools.[7] The transition to managed care may lead to additional closures by hospital sponsors, whose FFS reimbursement rate is lower than the FQHC sponsors' rate. Even FQHC sponsors are closing their SBHCs, though, due to financial pressures related to reimbursement for their core services. The SBHC sector, particularly in NYC, and its supporters, believe that a carve-in to Medicaid managed care will increase their administrative costs (due to contracting, credentialling, and billing processes with multiple plans and subcontractors), while reducing revenue due to either lower reimbursement rates (after the transition period) or the elimination altogether of reimbursement due to being designated as out-of-network providers, when not contracted. SBHCs fear that this policy change has the potential to decrease access to primary care services if, as a result, some SBHCs close due to financial unsustainability or an unsupportable level of administrative burden. The NYS OMH-regulated school-based mental health clinics currently operate in managed care, although they receive an enhanced reimbursement rate to support the delivery of services that are not reimbursable.[8]
Background on Community Schools
Community Schools represent an integrated educational approach designed to transform traditional schools into community hubs by offering comprehensive services and supports to students and their families. These schools go beyond a focus strictly on academics, addressing a wide array of needs through health, social, emotional, and family services, leveraging partnerships with the community.
The foundational elements of Community Schools are 1) active student and family engagement, 2) expanded and extended learning opportunities, 3) collaborative leadership and shared governance practices, and 4) student and family supports, including health and wellness, in a culture of belonging and safety.[9],[10]
In NYC, approximately 420 out of the City’s 1,700 public schools are designated as Community Schools.[11] The data for the rest-of-state Community Schools is based on a self-designation process. The NYS Basic Educational Data System (BEDS) survey identifies approximately 820 Community Schools statewide.[12] Each Community School typically employs a dedicated Director or Coordinator (we use the term “Coordinator”). The Coordinator role involves aligning services to local needs, as identified through a needs assessment process, and facilitating collaboration among school leadership, community stakeholders, students, and families. Community Schools across New York have access to Technical Assistance Centers to support their efforts.
The concept of bringing community resources into schools in New York was first implemented in NYC in 1977. There was a period of NYC activity in the early 1990s, but the real expansion of Community Schools in NYC and the rest of the state began in 2012 and 2013.
In 2014, NYC Mayor de Blasio's administration launched the Community Schools Initiative (NYC-CS), with the goal of transforming public schools into community hubs that provide services that support students and families. The initiative began with a $52 million investment to establish 45 Community Schools in high-need neighborhoods, integrating social services like mental health support, vision testing, tutoring, job training, and family counseling directly into the school environment.[13]
The NYC program expanded over the years, surpassing the initial goal of ‘100 Community Schools by 2017.’ By 2020, there were 267 Community Schools serving approximately 135,000 students and families citywide, making it one of the largest Community Schools initiatives in the US. And by 2023, there were approximately 420 Community Schools serving approximately 191,000 NYC students.
The RAND Corporation conducted evaluations of the NYC Community Schools initiative in 2017 and 2020 to assess its implementation and impact. Their 2017 report, focused on implementation, found that virtually all participating schools had successfully implemented core components of the community school model, including forming partnerships with community-based organizations, providing expanded learning opportunities, and offering mental health services.[14] The 2020 assessment focused on specific outcomes and identified positive impacts on student attendance across all grades, improved on-time grade progression, and increased graduation rates in high schools. There was also a reduction in disciplinary incidents among elementary and middle school students, and a positive impact on math achievement in the third year of the study.[15] A follow-up evaluation conducted by RAND and Vanderbilt University, published in 2022, examined the impact of NYC Community Schools on elementary and middle school students’ attendance and academic achievement. They found,
“… an immediate reduction in chronic absenteeism of 5.6 percentage points, which persists over the following three years. We also find large improvements in math and ELA test scores – an increase of 0.26 and 0.16 standard deviations by the third year after implementation – although these effects took longer to manifest than the effects on attendance. Our findings suggest that improved attendance is a leading indicator of success of this model and may be followed by longer-run improvements in academic achievement, which has important implications for how community school programs should be evaluated.”
At the State level, $15 million was included in each of the FY 14 and the FY 15 Enacted Budgets for a NYC-only, three-year funded, competitive Community Schools Grant Initiative. In 2015, a new section of Education Law established a “Superintendent Receivership” program that permitted “failing” or “persistently failing schools” to convert to a Community School as part of their School Intervention Plan.[16] In 2016, Governor Cuomo included proposals to expand Community Schools in the State of the State, and the FY 16 Enacted Budget included $75 million to support the transformation of struggling schools into Community Schools. In FY 17, funding for Community Schools was included in the Foundation Aid formula. Funding is discussed in more detail below.
Community Schools Operations
In NYC, Community Schools operate as a partnership between a community-based organization (CBO), such as the Children’s Aid Society, or with a union, such as the United Federation of Teachers, and the school. The Community School ecosystem is managed by a Coordinator who is located within the school and employed by the designated community-based partner organization. There are, however, several operating models for Community Schools across New York.[17]
Outside of NYC, Community Schools operate using several additional models. These include partnerships with school districts or universities, such as Binghamton University. The university-assisted Community School approach incorporates a college or university into partnerships between the school, school district, families, and communities. The Community School can leverage the resources of the university, and the university can align university student internships and learning experiences with opportunities at the Community School. Binghamton University, in partnership with the National Center for Community Schools, also offers a certificate program that prepares students to become Community School Coordinators.
The Massena Central School District in St. Lawrence County, NY, is an example of a district-led Community School model. The following is how the district describes its Community School approach:
“Building a strong partnership between the school district and the surrounding community. This includes working with community partners such as law enforcement, local firefighters, not for profits, faith-based organizations, and colleges. Through this network, there are accessible resources for students and families in need of basic necessities such as clothing, shelter, or food. As a result, this relationship helps to promote the local organization when they meet a student or family’s need.”
An emerging operating model for Community Schools outside of NYC is a county-led model. Wayne County, NY, is an example of this approach, and they describe their Community School strategy as one that is “person-centered and place-based” with the goal of “weaving [service providers] into the fabric of the students’, families’, and community’s daily lives.”
There is no “right” approach, beyond the presence of a Coordinator to facilitate alignment and engagement, and an adherence to the essential elements described above. Each of the Community School operating approaches reflects local needs, priorities, and resource availability, focused on the goal of creating a “safe and supportive environment where children can learn and grow.”[18]
Funding
State funding for Community Schools is primarily through a NYS Education Department Foundation Aid Set-Aside and a separate allocation for the Community Schools Technical Assistance Centers.
The Community Schools Foundation Aid, which in recent years has been a Set-Aside of $250 million,[19] does not require the funding to be used strictly for Community Schools-oriented expenses only. The funding for “high-need” schools districts may be used for a wide range of categories, including academics, health/mental health and counseling/dental care, trauma-informed support, after-schools programming, dual language programs, nutrition, legal services, salary/benefits for a Community School Site Coordinator, costs for service coordination, transportation costs under the Community Schools Plan, and other costs related to maximizing student achievement.[20]
The NYS Community Schools Network examined the Foundation Aid Set-Aside spending by the school districts for the school years 2020-21 through 2022-23. The top three reported uses of the funding by school districts were for “allowable academic services,” “allowable health, mental health and counseling, and dental services,” and “after-school programs.” While coordination plays a critical role in the success of Community School implementation, in the 2022-23 school year, just 6.57% of districts reported using the funding for a Community School site coordinator, and 3.39% of school districts reported using the funding for coordination between schools and social service agencies.[21]
State funding for SBHCs through FY 25 was presented by the Step Two Policy Project in our Policy Brief from December 2024. Separate from health insurance reimbursement, the State provides approximately $22 million in grants to support the operations of SBHCs across the State.
New York City provided $70 million to Community Schools in the FY 25[22] NYC Budget. The Mayor’s proposed funding had been $56 million, but following negotiations with the NYC Council, the adopted FY 25 NYC Budget funding was increased by $14 million. Several different NYC and federal school funding streams may flow into Community Schools in NYC. The NYC funding for Community Schools is partially a pass-through of the State Foundation Aid Set-Aside for high needs schools, partially funding from the City Tax Levy, and partially from other State and federal education funding pools, such as the 21st Century Community Learning Centers and others.
New York City also provides separate funding from the State for SBHCs. Beginning with Mayor Koch’s administration in the early 1980s, the NYC Department of Health and Mental Hygiene (DOHMH) began to use City Tax Levy funds to support the establishment of new SBHCs. This funding for SBHCs expanded with the Dinkins administration and with the Bloomberg administration, following the recommendation to expand school-based health and reproductive health services in the 2006 report on Increasing Opportunity and Reducing Poverty in NYC,[23] there was a ramp-up of capital funding. Mayor de Blasio’s administration continued funding to establish new SBHCs, in addition to providing operations funding. As of FY 24, NYC provided $7.8 million to support 35 SBHCs with operational expenses and $734,000 for their contraceptive health services expenses.[24]
Linkages Between SBHCs, SBMHCs, and Community Schools
The presence of a SBHC within a Community School increases student enrollment in and utilization of the SBHC because the Community School Coordinator engages directly with families to enroll their students in the health center. The Community School Coordinator meets regularly with school leadership and ensures ongoing communication to make access to health and social services seamless for the students and families. This engagement with the SBHC not only helps to generate reimbursement revenue but also supports improved health and educational student outcomes. This case study video from NYC Public Schools describes the benefits of linking SBHCs and other health-related services to a Community School. Despite these natural advantages, however, the integration and maintenance of SBHCs face several challenges.
One operational challenge within NYC's Community Schools is coordination among multiple CBOs within single school buildings, especially when multiple Community Schools operate under different organizations. This can result in inefficiencies, redundancy, or conflicts related to service delivery for students in the building who attend different schools. As mentioned earlier, it is not uncommon in NYC for several distinct public or charter schools to be located in the same building, also referred to as a campus.
School buildings often have limited space for health clinics, which may require locked rooms for securing records and equipment and adequate private space for conversations and care. School rooms are often multi-purpose throughout the day, and dedicating a full classroom or more, away from learning or other educational activities, can be challenging. This challenge will likely be exacerbated as NYC works to implement the State law requiring reduced class size in the City by September 2028. It is essential, however, that space to provide health services be preserved.
Data on School-Based Health Centers and Community Schools
Sources and Methods
Note: NYS DOH often cites 252 as the number of SBHCs statewide. We consider this approach to counting SBHCs as counting the number of SBHC “campuses” because many SBHCs serve more than one school in the same building,[25] so the total number of schools that can access SBHC services is much higher than the number of health centers. Further, if a SBHC (i.e., campus) serves multiple schools, none or any number of them may be Community Schools. We were not able to locate a public list of NYS OMH-approved SBMHC locations, so we could not determine overlap between Community Schools and SBMHCs.
Relevant data is hosted in several places under different stewards, and has been updated at different times:
New York City: DOHMH shared NYC-specific lists of 1) Community Schools and 2) SBHCs that were recent as of March 2025. In NYC, there are a number of special programs operated in or as schools (e.g., District 79 programs (LYFE, Pathways to Graduation, YABC, etc.) and District 75 schools (which have their own nurses assigned)), which serve adult or non-traditional students, or may have their own nurse.[26] Students in these programs may access services at the SBHC, but NYC DOHMH, as a practice, does not count these programs toward its list of 315 schools served.
Based on analysis of these 2025-dated sources, in New York City, there are,
421 Community Schools
423 schools (including the special programs mentioned above) served by 134 SBHCs
118 schools with SBHC access that are also Community Schools
Rest-of-State/Outside of NYC: A PDF hosted on the NYSED website, titled “New York State Community Schools Self-Reported via BEDS, 2023-2024,” provides a list of Community Schools statewide, with columns for the school type (public or charter), SED code, district name, and school name. Since this data source did not include counties, the NYSED spreadsheet “Public, Nonpublic & Charter Schools: Active Public, Nonpublic & Charter Schools CEO Info with Physical & Mailing addresses, Grades & Grade Orgs” was used to pull in bridge data necessary to connect schools across sources. The New York State School-Based Health Alliance provides a spreadsheet of SBHCs on its website, with one tab for NYC and one tab for statewide, dated August 2023. The statewide SBHC spreadsheet, which we filtered to rest-of-state (ROS) counties only, provides the address and county of each SBHC campus, but not the name of the school district; it also provides the name(s) of schools each SBHC campus serves, but these are aggregated in a single cell, rather than listed as one column per school served.
School names, like other institutions with multiple words and variable punctuation, are difficult to accurately and automatically cross-reference, so identifying overlaps between ROS SBHCs and Community Schools was manual. Counting how many SBHCs serve only one, versus two or three schools each, required an additional process of disaggregating the cells that list each campus’s schools served.
The analysis in this Policy Brief uses the statewide 2023-2024 NYSED Community Schools list for data on rest-of-state Community Schools, and the 08/2023 NYSBHA spreadsheet for the rest-of-state (ROS) SBHCs.
Based on analysis of these statewide sources from 2023-24, outside of NYC, there are approximately,
365 Community Schools
118 schools served by 102 SBHCs
41 schools with SBHC access that are also Community Schools
Visualizations
Note: It is coincidental that the total number of Community Schools (n=421) is so close to the total number of SBHCs below (n=423), in NYC.
Note: The total number of campuses here (134+102) does not match the number posted by the NYS DOH (i.e., n=252, with 146 in NYC and 106 in ROS) because our source data for the NYC region is more recent than both our source data for ROS and the DOH total, both of which are from 2023.
Fostering Linkages Between School-Based Health Services and Community Schools
Make More Community Schools Data Publicly Available
The BEDS survey includes questions identifying whether a school 1) considers itself a Community School, 2) is working to employ the practices of a Community School, 3) receives Community Schools Foundation Aid Set-Aside funds, 4) includes a NYS DOH-approved SBHC at its location, 5) includes a NYS DOH SBHC Dental Program serving the students, and 6) includes a NYS OMH-approved School-Based Mental Health Clinic or satellite provider operating at its location. Apart from whether a school self-identifies as a Community School, none of the other information is available publicly.[27] Publicly available information related to the spending categories that school districts spent their Foundation Aid Set-Aside on and the overlap of Community Schools and school-based health, dental, and mental health services are important in program development and evaluation, policy-making, and population health analyses.
Establish a Statewide Office with Resources Dedicated to Community Schools
The NYC Office of Community Schools within the NYC Department of Education was established in 2014. Its mission is to “… create and sustain school and CBO Partnerships through intentional collaborative leadership that empower students, families, and communities to thrive.” The State, however, does not have an office solely dedicated to the implementation and support of the Community School approach. The Foundation Aid Set-Aside is significant, but as mentioned above, there is discretion in how the high-needs school districts spend the funding. Consolidating staff expertise and targeted funding for Community School coordination and alignment activities in a dedicated State office responsible for managing statewide technical assistance would benefit Community Schools, their partners, students, and families.
Ensure the Sustainability of School-Based Health Centers
We presented several recommendations in our December 2024 Policy Brief on SBHCs. Among them,
Improve the publicly available data and information about SBHCs
Make it easier for SBHCs to navigate Medicaid Managed Care
Increase reimbursement rates for services, including dental
Establish an optional expansion of the populations that SBHC can serve
Streamline the Requirements to Establish and Operate School-Based Health Services
NYS DOH and NYS OMH each have comprehensive information and documents that provide guidance on establishing SBHCs and SBMHCs. Anecdotally, several themes related to the challenges of establishing school-based health services emerged in our discussions with stakeholders. One was that the SBHC requirement for a locked space, even when the SBHC is not conducting clinical activities, presents a barrier to establishing health centers in schools that, in many cases, are short on classroom and activity space. A second theme that emerged was that while the NYS OMH provides support and start-up funding to establish new SBMHCs, it often takes as long as two years to complete the process to be able to provide services. And a third theme related specifically to NYC was that renovations to school-provided space, which are often necessary for SBHCs and SBMHCs, are all required to be accomplished through the NYC School Construction Authority, which often prolongs the duration and increases the costs.
Conclusion
Given the current uncertainty of federal healthcare and education funding to states, it is more important than ever to maximize the value of State spending. Establishing a matrix of educational, health, mental health, and social services to wrap around vulnerable youth and their families in the school setting is a low-barrier, high-impact approach to improving educational and health outcomes for students and to better engaging families and the surrounding community in supporting student success.
Endnotes:
[1] NYS DOH Principles & Guidelines for School Based Health Centers in New York State
[2] NYSED, Student Support Services, Community Schools.
[3] In NYC, for example, there are sometimes multiple schools in one building that can be served by one SBHC site.
[4] School-Based Mental Health Satellite Clinic, FAQs for Schools, NYS OMH.
[5] Both the NYS Senate and Assembly included proposals to maintain FFS reimbursement for SBHCs in their one-house budget proposals released on March 10 and 11, 2025. As of this writing, the NYS FY 26 Budget has not yet been enacted.
[6] Between 2018 and 2024, seven sponsors closed 39 SBHC sites that were accessed by 26,673 students in 81 schools.
[7] Personal communication with NYC DOHMH. The NYC Mayor did recently announce the opening of 16 SBMHCs to be operated by NYC H+H.
[8] School-Based Mental Health Satellite Clinic, FAQs for Schools, NYS OMH.
[9] NYSUT, Fact Sheet 21-16: Community Schools in New York State, 2021.
[10] NYSED, Student Support Services, Community Schools.
[11] NYC Community Schools, Our Schools
[12] New York State Community Schools Self-Reported via BEDS, 2023-2024
[13] RAND Corporation, Illustrating the Promise of Community Schools: An Assessment of the Impact of the New York City Community Schools Initiative, 2020.
[14] NYC Public Schools InfoHub, NYC Community Schools: Our Results.
[15] RAND Corporation, Illustrating the Promise of Community Schools: An Assessment of the Impact of the New York City Community Schools Initiative, 2020.
[16] engageny, Intervention in Struggling Schools Through Receivership – New York State, May 2015; New York Consolidated Laws, Education Law - EDN § 211-f. Takeover and restructuring failing schools.
[17] NYSUT, Fact Sheet 21-16: Community Schools in New York State, 2021.
[18] NYS Community Schools Network, Community Schools Messaging Toolkit for Schools & Partners, 2025.
[19] For the 2022-23 school year, the NYC Department of Education received $117,696,335.
[20] Foundation Aid: Community Schools Set-Aside Guidance
[21] Personal Communication with NYS Community Schools Network
[22] NYC FY 25 = July 1, 2024, to June 30, 2025.
[23] “Expand school-based health and reproductive health services. School-based health and reproductive health programs provide confidential reproductive health services including counseling, education, referrals for additional services, and the reinforcement of activities aimed at reducing teen pregnancy. Studies have shown decreased rates of pregnancy when school-based or school-linked health programs include reproductive health services (including educational materials, one-on-one counseling, and the provision of contraceptives). To ensure better access to these health services, the City should expand school-based reproductive health services in high schools.” P. 30.
[24] Personal communications with NYC DOHMH.
[25] This is more often the case in New York City than in the rest of the state.
[26] Only one of these is also a Community School.
[27] There is no publicly available data on the location of the NYS OMH-approved SBMHCs.