Evaluating the Sustainability of School-Based Health Centers.

BACKGROUND: The United States is facing a surge in the number of school-based health centers (SBHCs) owing to their success in delivering positive health outcomes and increasing access to care. To preserve this success, experts have developed frameworks for creating sustainable SBHCs; however, little research has affirmed or added to these models. OBJECTIVES: This research seeks to analyze elements of sustainability in a case study of three SBHCs in San Diego, California, with the purpose of creating a research-based framework of SBHC sustainability to supplement expertly derived models. METHODS: Using a mixed methods study design, data were collected from interviews with SBHC stakeholders, observations in SBHCs, and SBHC budgets. A grounded theory qualitative analysis and a quantitative budget analysis were completed to develop a theoretical framework for the sustainability of SBHCs. RESULTS: Forty-one interviews were conducted, 6 hours of observations were completed, and 3 years of SBHC budgets were analyzed to identify care coordination, community buy-in, community awareness, and SBHC partner cooperation as key themes of sustainability promoting patient retention for sustainable billing and reimbursement levels. CONCLUSIONS: These findings highlight the unique ways in which SBHCs gain community buy-in and awareness by becoming trusted sources of comprehensive and coordinated care within communities and among vulnerable populations. Findings also support ideas from expert models of SBHC sustainability calling for well-defined and executed community partnerships and quality coordinated care in the procurement of sustainable SBHC funding.

Program self-evaluation: the evolution of an injury prevention foundation.

OBJECT: Injuries are a leading cause of morbidity and mortality in the US. The authors provide a brief discussion of a national injury prevention foundation's self-evaluation of its efforts to decrease the incidence of traumatic injuries through educational programs, legislative efforts, and community programming. METHODS: The authors performed a literature review of evaluation studies and activities of the Think First National Injury Prevention Foundation accomplished between 1986 and 2002 and summarized their findings. Suggestions generated from research studies were incorporated into the foundation's programs. Efficacy studies show that the injury prevention programs have a significant impact on knowledge, attitudes, and practice, and demonstrate the need for injury prevention to be recognized as a valuable component of the US medical system. CONCLUSIONS: After a self-evaluation, the Think First National Injury Prevention Foundation has made strides in developing a multilevel approach to injury prevention by combining education with legislative initiatives, community-wide safety programming, and a large public presence, similar to what has been accomplished with successful smoking cessation programs and seat-belt use campaigns.