Applying a Global Perspective to School-Based Health Centers in New York City

Background Since the 1960s, school-based health centers (SBHC) in the United States have emerged and grown with the mission of providing primary medical, reproductive, and mental health services, as well as comprehensive health education, to all students who are enrolled in the participating school. SBHCs have demonstrated a unique ability to reduce barriers to medical care for underserved populations in New York City, including undocumented immigrants and those who are of lower income status. Methods The Mount Sinai Adolescent Health Center School-Based Health Program (MSAHC SBHP) was established in 1985 in order to increase access to care for New York City teens. After a change of physical location, one particular site of the MSAHC SBHP had a significant decrease in clinic visits and enrollment. Traditional outreach strategies were utilized, but the results of the efforts were disappointing. Applying the Community Health Worker model, as defined by the World Health Organization (WHO), the MSAHC SBHP developed the Student Ambassador Program, a student-organized community-engagement initiative. The program is based on the premise that youth can be effective at outreach and serving as community liaisons to increase awareness and use of the SBHC. The SBH staff provided recruitment, training, and support. The student ambassadors initiated peer-informed outreach projects to appeal to the student body. Upon completion of the Student Ambassador projects, clinic enrollment increased 4.3% and visits increased 32% over the prior year. Conclusions School-based health centers in the United States have helped to provide comprehensive, multidisciplinary care to many children who would otherwise not be able to access care, but community engagement is critical to their success. Applying the WHO Community Health Worker Model to utilize school students for outreach to their school community is an effective way to increase utilization.