ABSTRACT
Instituting school reform, such as school-based health centers (SBHCs), directly involves the politics of making structural changes in the educational system. Such changes affect school governance and personnel, school relations with the larger community and even the state government, and the integration of health services into the overall educational program. School district officials and personnel comprise the inner circle of support critical to the successful implementation and sustenance of school-based health centers. From the inception, officials at the highest levels, the superintendent and the school board, must be involved as equal partners with the community agency representatives sponsoring the SBHC. The success of school health clinics is crucially dependent upon support and alliances with a host of organizations and governmental structures beyond the confines of the school system. A 'coordinator of planning' or clinic director generally holds the responsibility for generating and sustaining these inner and outer circles that comprise the fundamental sources of support for SBHCs.
