Create a Blueprint for Collaboration

Stakeholders’ first collaborative effort should be to develop a mutual understanding of their shared work.

This “blueprint for collaboration” should include:

• a vision and mission for the SBHC
• partners’ common interests and goals for SBHC services
• clearly defined roles and responsibilities for all partners
• decision-making and/or operational protocols for areas of intersection, such as:
  • information sharing
  • equipment and facilities sharing
  • student access to the health center
  • community access to the health center
• systems for regularly scheduled and ad hoc communication

As early as possible, it should be formalized into a Letter of Agreement to which all partners can be held accountable.

Foster a Strong, Ongoing Relationship

Creating a “blueprint for collaboration” is only the first step in an ongoing process.

Stakeholders can continue to foster a strong relationship by taking important next steps:

• Identify liaisons representing the school, the SBHC, and any other key partners.
• Include at least one school representative on the SBHC advisory board.
• Form a Coordination of Services Team (COST), including school and SBHC representatives, as well as any other student support services providers.
• Ensure that the school and SBHC calendars are shared and kept updated.
• Schedule regular, standing meetings between school and SBHC partners as a forum for discussing accomplishments, as well as for noting challenges (before they become full-on problems!) and finding mutually acceptable solutions.
• Ensure that SBHC representatives attend school staff meetings and/or professional development sessions so they can give teachers and other personnel information about the SBHC, and about relevant medical and mental health issues.

Topics for Discussion

A “blueprint for collaboration” should include decision-making and/or operational protocols for areas of intersection.¹

These questions can help guide your conversation:

• Where on campus is the SBHC housed? How much space does it need?

• Who provides custodial services for the SBHC? Who pays for them?

• Who provides phone and internet access at the SBHC? Who pays for them?

• Can students and other clients come to the SBHC before school, after school, on weekends, and during holidays? If a student must be seen in the SBHC during the school day, what is the best time? Are there specific classes that should only be missed in an emergency? How shall students be called from class to the SBHC?

• How do school health staff—such as school nurses or counselors—partner with SBHC staff?

• If a student is perceived to be under the influence of alcohol or drugs, does s/he go to the SBHC or to the disciplinary office? If s/he is sent first to the SBHC, will the school administration also impose any disciplinary consequences?

• When do we inform parents or guardians about a student’s SBHC visit?

The Role of School and District Staff in Promoting Health

A school-based health center can more effectively promote student health when it is truly integrated into the broader school campus. School and district staff play an important role in facilitating this integration and can maximize the SBHC’s impact on learning by:

• Establishing and maintaining strong relationships with SBHC staff.

• Reaching out to SBHC staff with health questions and specific student concerns.

• Reinforcing the importance of health and wellness with students during class and at school-wide events.

• Referring students to the SBHC and encouraging them to use its services.

• Communicating the benefits of the SBHC to colleagues and families.

• Giving feedback to the SBHC on strengths and opportunities for improvement.

All school district employees—including teachers, psychologists, custodians, and board members— can support the SBHC. Here is a position-specific list of responsibilities.

School Board and Central Office Staff

• Establish a contract with the SBHC sponsoring organization to deliver services at the appointed school.

• Provide the SBHC with space at no cost to the SBHC.

• Provide heating, cooling, ventilation, water, and electricity at no cost to the SBHC.

• Provide internal school phone line at no cost to the SBHC.

• If privacy can be ensured, provide computer line at no cost to the SBHC.

• Permit SBHC to place signage both within the school and on school exterior.

School Administration and Principal

• Work with the SBHC sponsoring organization to set vision, mission and services.

• Build relationships with SBHC coordinator and staff.

• Invite SBHC coordinator to participate in school site leadership team or advisory council.

• Be knowledgeable about and supportive of SBHC services.

• Be knowledgeable about and respect SBHC policies and procedures.

• Work with the SBHC to coordinate emergency roles and responsibilities.

• Provide SBHC staff and clients with appropriate access to the SBHC, which may include providing access during evenings, weekends, holidays, and vacations.

• Facilitate sharing of SBHC information/consent forms with students and families at in-person school registration events, in school information and enrollment packets sent home, and at back-to-school nights.

• Ensure SBHC staff are given adequate time during at least one school staff meeting per year to provide information on the SBHC and how to access services.

• Invite SBHC staff to participate in planning and implementing student support programs.

• Cooperate with the SBHC in its efforts to secure funding and hold special events.

Custodial Staff

• Build relationships with SBHC coordinator and staff.

• Empty SBHC trash as required for all other areas of the school.

• Clean SBHC floors, toilets, and sinks as required for all other areas of the school.

• Shampoo carpeting as required for all other areas of the school.

• Keep the SBHC stocked with toilet paper, paper towels, and soap.

• Replace all light bulbs in the SBHC, as needed.

• Repair outlets, sinks, and toilets in the SBHC, as needed.

• Touch up paint and remove graffiti in the SBHC, as needed.

School Nurse

• Build relationships with SBHC coordinator and staff.

• Be knowledgeable about and supportive of SBHC services.

• Be knowledgeable about and respect SBHC policies and procedures.

• Assist with the distribution of SBHC consent forms.

• Refer students and families to the SBHC.

• Communicate regularly with SBHC staff about students with chronic health conditions, Individualized Education Programs (IEPs) and Individualized Health Plans (IHPs).

• If school requests assistance from SBHC with medical compliance, ensure that SBHC has past vaccination records for enrolled students registered at the SBHC.

• Make sure SBHC staff are familiar with emergency roles and responsibilities.

School Counselor/Psychologist/Social Worker/Case Manager

• Build relationships with SBHC coordinator and staff.

• Be knowledgeable about and supportive of SBHC services.

• Be knowledgeable about and respect SBHC policies and procedures.

• Invite SBHC mental health professionals to behavioral health meetings.

• Make sure SBHC staff are familiar with crisis response roles and responsibilities.

Teachers and Classroom Aides

• Build relationships with SBHC coordinator and staff.

• Be knowledgeable about and supportive of SBHC services.

• Know how to refer a student for SBHC services.

• Know how to communicate with SBHC staff.

• Know how to use the SBHC as a resource for health information and resources.

• As appropriate to topic and content standards, work with SBHC or other partner agency staff to deliver mandated or recommended health education in the classroom (e.g., mandated HIV/AIDS prevention education).

Security Staff

• Build relationships with SBHC coordinator and staff.

• Be familiar with SBHC services.

• Provide security at the SBHC, based on its hours of operation and the school’s emergency plan, as well as on the school administration’s guidelines for SBHC security.

• Support the policies/procedures for accessing the SBHC (e.g., escorts, hall passes).

Food Service Staff

• Build relationships with SBHC coordinator and staff.

• Be familiar with SBHC services.

• Support SBHC efforts to provide healthy nutrition programs in the school.

School-based health centers offer more than health interventions—they may also support academic interventions. In addition to their primary clinical roles, SBHC staff can actively promote student learning, improve student attendance, and prevent school drop-out. To have the greatest impact on student learning, SBHC staff should:

• Establish and maintain close relationships with school administration.

• Provide active teacher support.

• Identify and intervene with chronically absent students.

• Address behavior problems and foster positive school climate.

Ready, Set, Success! compiles information on all of the above topics into one toolkit.

How SBHC Staff can Build Partnerships with School Personnel

By conducting the following activities, SBHC employees can contribute to the SBHC’s overall efforts to support the school’s academic mission.

SBHC Sponsoring Organization Leadership

• work with school administration to set vision, mission and services
• coordinate and oversee the delivery of health services on the school campus
• take the lead in securing the funding necessary to deliver health services on the school campus, in collaboration with other partners (who may contribute in-kind space, services, or equipment, sign-on to grant proposals, submit grant proposals for supplemental services, etc.)

SBHC Coordinator

• build relationships with school administration and staff
• be knowledgeable about and supportive of school’s mission and approach
• be knowledgeable about and respect school policies and procedures
• inform school administration and staff about HIPAA regulations
• solicit school administration’s input on SBHC policies and procedures (including those related to student access to the SBHC and patient referral and follow-up)
• design and implement a system for school staff to provide feedback to the SBHC
• invite school administration and staff to participate in SBHC advisory board
• choose SBHC staff to participate on school’s Coordination of Services Team (COST)
• keep school administration informed of SBHC services and programs
• attend school meetings to share SBHC information with teachers and others
• coordinate with relevant school staff on school-wide student support initiatives

SBHC Clinicians

• build relationships with school administration and staff
• be knowledgeable about and supportive of school’s mission and approach
• be knowledgeable about and respect school policies and procedures
• work closely with school health personnel (e.g., school nurse or social worker)
• provide school staff with information and resources on relevant health topics
• consult with school staff members on specific students or topics, and participate in Student Success Team (SST) or Individualized Education Program (IEP) meetings as requested and appropriate (while maintaining patient confidentiality as required by federal FERPA/HIPAA regulations and California’s minor consent laws)
• contribute to school-wide health promotion initiatives as appropriate

Youth Development Staff

• build relationships with school administration and staff
• be knowledgeable about and supportive of school’s mission and approach
• be knowledgeable about and respect school policies and procedures
• coordinate youth development activities with school and after-school initiatives
• contribute to school-wide student support initiatives, including youth leadership programs

SBHC Support Staff

• build relationships with school administration and staff, particularly attendance secretary
• be knowledgeable about and supportive of school’s mission and approach
• be knowledgeable about and respect school policies and procedures

Building a strong relationship with school administrators lets a school health center dramatically increase its impact on student success. Administrators are experts on a school’s academic priorities and programming and can be invaluable allies as a school health center works to maximize its influence on student learning. Administrators also wield great influence, both with their teachers and with the district. When a principal is invested in a school health center, she can help students by committing resources, facilitating referrals, and rallying district support. Finally, we know that collaborative, holistic efforts meet students’ needs more effectively than isolated interventions. If school health center staff and administrators have strong relationships, trust each other, and agree on decision-making protocols, they can work together to develop and implement school-wide strategies to promote student success. School health centers can influence a school’s overall approach, but only if the principal is on board!

Tips for School Health Centers

1. Assign a “point person” for communication with school administrators; usually, the “point person” will be the school health center coordinator/director, but some school health centers do things differently!
2. Create systems for regular—as well as emergency—communication with school administrators. For example, you might set up weekly or monthly meetings, establish shared email expectations, or join a walkie-talkie team for campus crisis situations.
3. Define and follow a clear decision-making protocol between school health center leadership, other student support services providers, and school administrators.
4. Disseminate information about new services and upcoming events to school administrators to keep them informed and connected to the school health center.
5. Share service and outcomes data with school administrators so they understand the positive impact of school health center programs and services, using a variety of methods—including meetings, calls, emails, text messages, newsletters, bulletin boards, and student presentations.
6. Engage administrators in ongoing conversations about how the school health center can best support academic achievement (e.g., through targeted intervention for at-risk students, contributions to anti-absence efforts, efforts to improve school climate).

Case Studies

Columbus Middle School, Canoga, CA

School health center leaders at Columbus Middle School in Canoga believe that a strong relationship with school administrators is vital to their center’s success. They therefore put significant effort into proactively building that relationship. School health center staff make time to get to know administrators both individually and through regular attendance at key gatherings, such as staff meetings, back to school nights, coffee-with-the-principal conversations, and PTA, School Site Council, and Resource Coordination Team meetings. They invite administrators to attend health center events, making sure to schedule them at convenient times. They provide the principal with a list of current clinic staff and their areas of expertise, along with a menu of professional development topics and presentations that the health center can provide for parents or staff. Health center staff also regularly acknowledge administrators for their hard work and support of the health center, and share with school district directors and the superintendent the positive contributions and dedicated leadership that school administrators provide.

School health center staff also build strong relationships with other members of the school community, including parents, teachers, the custodial team, the attendance office staff, and the principal’s administrative assistant. They invite all staff to hold their meetings inside the health center’s large conference room. They also provide some services, such as flu shots and health screenings, to staff and parents at no cost. Recently, when health center staff wanted to evaluate the impact of their immunization program on student attendance, they asked the attendance office to compile the relevant reports. Because they knew that this request took time—and because it went above and beyond the attendance office’s regular responsibilities—health center staff not only personally thanked their colleagues but also let the principal know how helpful and responsive clerical staff had been.

School health center leaders are careful neither to be seen as—nor to operate as—a “separate entity.” As a result, the Columbus Middle School health center is truly integrated into the campus and visible at all campus events. This integration enhances the health center’s impact: with the entire school community supporting the health center’s efforts, more students are referred for critical services and receive the individualized support necessary for long-term success.

Richmond High School, Richmond, CA

After a brutal sexual assault on campus, the school health center at Richmond High School was able to work more closely with administrators to try to meet students’ immediate needs, improve school climate, and prevent future violence. This tragic event brought the health center closer to school leadership and campus security.

Now, school health center leaders meet monthly with the principal and vice principals. These meetings foster collaborative problem-solving to address student disciplinary and health issues, and provide opportunities to share information about program implementation and impact. The health center has recently been given a walkie-talkie—allowing the health center coordinator to stay in close contact with site administrators and security, and to respond directly to crises. In addition, as part of a district initiative to help centralize community partners and health services on campus, site administration asked the health center to coordinate all student support services on campus. This allows the school health center to ensure that multiple providers work together in effective, efficient ways. A new full-time case manager is now co-funded by the school district and the Y-Team, a local community-based mental health services provider. The case manager works with students who are ineligible for Medi-Cal—meaning that the school health center can serve more youth.

The school health center begins each year with a school staff event that includes a health center orientation and open house, food, staff appreciations, and an open dialogue to ask questions and learn more about the health center. The health center has been sending out an annual newsletter that highlights health center successes; this will be increased to a quarterly release to keep staff informed about services and resources in the health center.

Because of its closer relationship with the administration, the school health center is better integrated into the school and able to respond to student health and safety needs. School administrators and staff are working more closely with the health center and are referring more students for services. By helping shape the school’s student support policies, the school health center staff is working to ensure that all students have the services that they need to be successful in school.

Teachers work hard to promote the academic success of their students. By actively supporting teachers, school health center staff can help teachers reach all students, while also increasing the health center’s impact on learning.

First, school health center staff have valuable insight and expertise to share. Individual consultations and targeted professional development opportunities can build teachers’ capacity to respond effectively to students’ needs in the classroom context. Teachers supported by school health center staff are better teachers.

Second, teacher allies and champions can advance the school health center’s mission, indirectly contributing to academic success. Teachers know best the strengths and needs of their students and can help school health center staff develop high-quality interventions. Teachers can also be a key referral source. Not surprisingly, the more invested they are in the school health center, the more students they will refer for its services. Finally, teachers can be important advocates with administrators and districts. Ultimately, school health centers supported by teachers are better school health centers.

Many teachers immediately embrace school health centers. Others, however, have legitimate questions and concerns about a health center’s role on a school campus. It’s therefore imperative that school health center staff actively reach out to teacher colleagues.

Tips for School Health Centers

• Build personal relationships with teachers and show appreciation for their hard work.
• Communicate with teachers in consistent, convenient, and natural ways. Consider attending regularly scheduled staff, department or committee meetings, and find out how each teacher prefers to communicate with you (e-mail, in-person, phone calls, etc.).
• Provide an annual teacher orientation to your school health center, as well as ongoing opportunities for teachers to visit and learn more. Include a school health center tour in your orientation, and cover topics such as how to refer students to the school health center, school health center programs and services, and any available services for staff (e.g., flu shots, tuberculosis tests). Talk with teachers about how you will work together to minimize instructional disruptions while also effectively meeting students’ needs.
• Offer individual consultation to teachers. This might mean supporting a teacher in developing strategies for working with challenging or disruptive students, including those with special needs. (You might suggest classroom modifications for a student with ADHD after carefully observing him in class, in the hallway, at lunch, and during P.E.). This might mean educating teachers about a student’s medical condition, particularly if it is rare or requires in-class monitoring. This might also mean helping a teacher prepare to talk to a parent about a student’s health-related challenges. Of course, individual teacher consultation is individualized, and it might mean anything!
• Provide professional development to teachers on health topics that they are interested in, possibly including asthma/allergy triggers, bloodborne pathogens and universal precautions, healthy eating and physical activity, health education delivery, etc.
• Invite teachers to participate in your school health center’s advisory board (or planning committee, if you are in the “start-up” phase). Think about inviting teachers who are already committed to your center, as well as some who want to learn more.

Case Study

The James Morehouse Project, El Cerrito High School, El Cerrito, CA

The James Morehouse Project was started by an El Cerrito High School teacher who saw unaddressed health and mental health needs impeding student learning and overall wellbeing. She and other health center staff prioritize strong personal and professional relationships with teachers. Teachers who are knowledgeable about and invested in the James Morehouse Project are more likely to make referrals and reach out for consultation.

At the beginning of each year, James Morehouse Project staff introduce themselves and health center services at a schoolwide staff meeting. They then foster ongoing communication by regularly attending meetings, distributing flyers, organizing student presentations, talking with individual teachers, and participating in a staff listserv that facilitates open dialogue about student support policies and procedures. Health center staff are committed to following up with teachers who refer students to the James Morehouse Project to ensure continued collaboration and information sharing. In addition, health center staff are sometimes called to participate in Student Support Team meetings for students with whom they are working, collaborating closely with teachers and administrators in planning and implementing interventions. Finally, the health center hosts teacher appreciation events—sometimes even providing much-needed massages!

Ultimately, strong relationships between teachers and school health center staff impact student success in positive ways. When teachers at El Cerrito High School were worried about the frequency with which certain students were being pulled out of class for health and mental health services, James Morehouse Project staff were receptive to their concerns. They worked closely with teachers and administrators to minimize learning disruptions, successfully creating flexible schedules that effectively balanced students’ academic, health, and mental health needs. And, when teachers identify specific students in need of services, they feel comfortable reaching out to health center staff to initiate collaborative solutions. According to one teacher, “I and my students have benefited from the James Morehouse Project. It’s a total package. I feel sorry for teachers who don’t have it – it’s a crown jewel.”

The Role of Other Partners in Promoting Health and Learning

Many school-based health centers partner with community-based organizations to bring additional support services—such as youth development programs—to schools. Other SBHCs work closely with local government, including with public health and mental health departments and social service agencies. Together, these other partners play an essential role in ensuring that SBHCs are meeting students’ health and mental health needs. Just as for the school and the SBHC, the roles and responsibilities of any other partners must also be clearly defined.

Responsibilities for Other Partners

Overall, other partners need to:

• develop Memoranda of Understanding/Letters of Agreement with the school and SBHC
• build relationships with school administration and staff
• be knowledgeable about and supportive of school’s mission and approach
• be knowledgeable about and respect school policies and procedures
• build relationships with SBHC coordinator and staff
• be knowledgeable about and supportive of SBHC services
• be knowledgeable about and respect SBHC policies and procedures
• participate on school’s Coordination of Services Team (COST)
• refer students and families to the SBHC
• conduct case management services in partnership with school and SBHC personnel

Of course, more specific roles and responsibilities will depend on who the partners are and what services they provide. The Letter of Agreement should outline them in greater detail.

Partner Build Grow Toolkit

Want to implement new partnership and collaboration strategies to improve the sustainability of your SBHC? The Center for Health and Health Care in Schools (CHHCS) has an Action Guide that uses an evidence-based approach to assist in the advancement and sustainability of school-based child development and behavioral health services. Their advocacy steps are broken down into four interconnected prongs: Mapping Assets, Building an Action Team, Connection with the Policy Environment, and Communications. Each section comes with guiding questions and a list of key actions to help facilitate the planning process. Use this toolkit to review and adapt these strategies to develop a plan that helps you take advantage of resources and collaboration opportunities in your environment.