In Colorado, 73% of landmass is considered rural or frontier, and more than 750,000 Coloradans call these areas home. Eleven of these rural or frontier counties do not have a hospital, and there are fewer physicians per capita compared to urban areas. Thus, rural residents often face the greatest barriers to comprehensive and affordable health care.¹ How far is it to the nearest clinic or hospital? Is there public transportation I can take there? Will the provider accept my health insurance? What if I don’t have health insurance? How can my children receive care if I cannot leave work?

School-based health centers (SBHCs) remove barriers to health care for children and young people in rural areas. A SBHC is a health care facility located inside a school or on school grounds. It is staffed by a multi-disciplinary team of medical and behavioral health specialists. At some locations, dental professionals, health educators and/or health insurance enrollment specialists are also on the team. SBHCs serve students whose access to health care is limited.

Colorado currently has 17 rural SBHCs, 14 of which were opened in the last decade in locations like Cortez, Delta, Leadville and Parachute. In the 2015-16 school year, these SBHCs served 7,121 users: 40.8% were covered by Medicaid, and 30.2% were uninsured.² Although only 2.5% of children and youths in Colorado were uninsured in 2015, the rate of uninsured in rural SBHCs was more than 12 times higher than the statewide.

This fact supports the mission of Colorado’s SBHCs: to serve Colorado’s most vulnerable populations and ensure that health and academic outcomes for kids are no longer predicted by circumstance. Major findings from the Community Preventive Services Task Force³ demonstrate that SBHCs led to improved academic outcomes — including school performance, grade promotion, and high school completion — as well as marked improvements in health outcomes including preventative services, asthma morbidity and emergency room utilization rates.

The stories supporting the importance of SBHCs in rural communities are even more compelling than the numbers. Take Blake, for example. Blake is a four-year-old living in a rural Colorado town without a health clinic. Blake’s mother, a Medicaid client, drove Blake to the nearest SBHC for a physical because it was the closest place to receive care. She told the primary care provider that Blake bruised easily. Blood tests later confirmed a critically low platelet count; after further tests, Blake was diagnosed with aplastic anemia. Through the SBHC, Blake received the therapy needed to manage his condition. If Blake had not been diagnosed and treated properly, he could have died from any mild infection or virus.

Nearly 80% of the users at Blake’s SBHC are covered by Medicaid. SBHCs allow parents in rural communities with limited access to care, health insurance, transportation or work flexibility to ensure their children receive effective health care.

And Principals understand the importance of that added value. Where Blake received care, the principal said “knowing that I can bring them [students] next door, get the treatment they need, and get them back in class, helps us meet all of our goals.”

The link between health and academic achievement is no longer disputable – health issues are the leading cause of chronic absenteeism, and chronic absenteeism can have devastating effects on early learning milestones, high school graduation, and quality of life in adulthood.⁴ Sustainable systems that support health equity and academic achievement for children and youths are essential factors for positive community development. The Colorado Alliance for School Health is committed to fostering, supporting and advocating for these collaborative partnerships between health and academics.

¹ Snapshot of Rural Health in Colorado, 2018. Colorado Rural Health Center.
² Mountains, Plains, Cities, Schools: An Analysis of Colorado’s Rural and Urban School-Based Health Centers. Colorado Health Institute.
³ School-Based Health Centers. The Community Guide.
⁴ Chronic Absenteeism in the Nation’ Schools. United States Department of Education.