ABSTRACT
This chapter discusses important barriers to the establishment and growth of school-based health centers (SBHCs). It also explores the underlying conditions or more fundamental problems that plague school clinics. The chapter looks at three school districts where school health centers either proved to be less than successful over time. School health centers have received broad support from almost every national health and social service organization, the collaborative arrangements necessary to establish and maintain SBHCs are not easily achieved. The most frequently listed were lack of funding, including problems with third-party reimbursement and managed care organizations; political opposition from conservative groups; staff shortages and lack of trained personnel; general ignorance of and false beliefs about clinic services; lack of state support; competition from other health and human service providers; lack of parental awareness and support, as well as parents' concerns about reproductive services; and insufficient support from school boards and school personnel.
