Productive Partners: Schools and Health Care Organizations

Wellness Centers Deliver Even When Schooling Is Remote

By Rebecca Dudovitz, Alex Zepeda and Maryjane Puffer

School-based health centers in Los Angeles are using a collective impact model to support students’ health and well-being alongside academic achievement. The Los Angeles Unified School District established 20 full-scope wellness centers in schools over a 10-year period.

These clinics are sponsored by federally qualified health centers, which also operate community clinics in surrounding neighborhoods and provide comprehensive physical, mental and dental health care, all in one location. The clinics were designed as an access point for students within the campus and for community members. This means students and families can visit the clinics, even when the school is closed. This design allows the clinics to serve as a medical home, which proved extremely valuable during pandemic-related school closures.

A study published in the November 2022 issue of the Journal of School Health found that, even when school campuses were closed to in-person learning, clinic use remained the same. This was especially true for preventive health visits, which is surprising as many families were avoiding other health care sites at the time.

In addition, the study reported, mental health encounters at wellness centers increased for all age groups during the pandemic. This suggests school-based health clinics are meeting a critical need for students and their value extends beyond the convenience of being on a school campus.

A Backbone Group

The collective impact model includes a collaborative network that works together to promote equity through shared learning, alignment and integration of their efforts for population and systems change. The Collective Impact Framework consists of five conditions to be effective: (1) a common agenda; (2) coordination of mutually reinforcing activities; (3) a shared measurement system; (4) continuous communication; and (5) a backbone organization to support these efforts.

The Los Angeles Trust for Children’s Health serves as a backbone organization, bringing clinic and school staff together. Both partners agree to work toward shared outcomes that include both student wellness and academic success. In addition, both entities contribute to a data system, the Data xChange, which links students’ clinic data to academic data from the school district.

Data reports help partners remain accountable to each other and their shared goals and drive quality improvement efforts. These efforts take place three times a year at Learning Collaborative meetings, led by the Los Angeles Trust. Here, clinic and school staff can compare their site’s performance to others and share best practices.

Finally, each has a student advisory board to ensure the clinic is meeting students’ needs. Student advisory boards meet weekly to review their site’s data, plan health and wellness events on their campus and provide feedback to the clinic and school administration about how to deliver teen-friendly services.

The success of the model is supported by a research study in the Journal of Adolescent Health’s September 2023 issue showing that students who visited the wellness centers saw improved attendance over time, especially when visiting for a mental health problem. This is powerful data that shows the importance of investing in student wellness as a key component of a successful school.

Rebecca Dudovitz is a pediatrician and director of pediatric health services research for the Department of Pediatrics at the David Geffen School of Medicine at UCLA in Los Angeles. ALEX ZEPEDA is senior research and data analyst at the Los Angeles Trust for Children’s Health, where MARYJANE PUFFER is executive director.