Who Staffs The Clinic? Analyzing Workforce Roles and Challenges in School Health Settings

June 3, 2026

By Sahana Srikanth, Youth Advisory Council member.

The following reflects Sahana’s lived experiences, thoughts, and opinions.

So, who actually works in an SBHC, and what do their roles entail?

Across the United States, there are over 3,900 school-based health centers (SBHCs) currently in operation [1]. When we talk about these SBHCs, we often focus on the experiences of youth who use the center’s services. However, it’s equally important to discuss the experiences of the staff who make those services possible.

Each SBHC is staffed by health and non-health workers who support its operations. Generally, an SBHC will include the health-related roles of a primary care provider, a mental health professional, a nutritionist, a dentist, and/or an optometrist [2] [3]. Outside of health-related positions, most SBHCs also require program managers, custodial operators, billing staff, educators, and/or patient navigators as well [4]. SBHC Program Managers typically develop operational plans, policies, and procedures to ensure the SBHC can achieve its goals. Program Managers may also meet with the SBHC’s partner organizations, support the SBHC’s expansion, and handle the SBHC’s community outreach [5]. The SBHC ‘s billing staff would be responsible for submitting claims for payment to a patient’s health plan, checking students’ insurance status, and managing the revenue cycle [4]. Some SBHCs employ health educators, who can work closely with teachers to develop age-appropriate curricula on prevention, nutrition, and/or reproductive health. The importance of SBHC health educators was confirmed by a study of SBHCs in Seattle, which found that introducing a health educator to the SBHC allowed the medical provider to see two additional patients each day [6].

Yet recently, SBHCs across the country have faced challenges in filling many of these staff positions. Data from 2021-2022 reveals the significant areas of hiring concern for SBHCs. In terms of behavioral health, even though 71% of SBHCs offer expanded care models (primary care + behavioral health + other services), we still see that 17% of SBHCs do not offer behavioral health services at all [7]. Oral health and vision care face the most acute gaps, with 63% and 73% of SBHCs, respectively, reporting no service delivery in those areas. And when it comes to mental health specifically, challenges remain persistent even in recent years. In the 2024-2025 school year, only half of public schools said they could effectively offer mental health services to students in need [8].

As a student, I feel like these employment gaps should be a red flag for policymakers to act on. When SBHCs aren’t staffed with behavioral, oral, or vision care services, that means students can’t access these services. I know peers in nearby school districts who rely on the care offerings of an SBHC for their healthcare needs. So, if SBHCs cannot hire across a diverse range of roles, then students might have to find more expensive healthcare alternatives – or simply forgo receiving care altogether.

But what causes these employment challenges in the first place? Primarily, policy. For one, there is the issue of scope of practice. Across the country, a nurse practitioner’s ability to practice independently (see patients, diagnose, and prescribe treatment without supervision) depends on the state in which they work. Some states grant full autonomy, while others require a physician to be present for oversight, adding an administrative and financial burden that SBHCs may not be equipped to bear. For example, in Ohio, nurse practitioners (NPs) in school-based health centers (SBHCs) cannot practice independently and must have a formal, mandated Standard Care Arrangement (SCA) with a collaborating physician [9]. This requires collaborative prescribing and chart reviews. In contrast, over 27 states, including nearby states, grant full practice authority, allowing NPs to evaluate, diagnose, and treat without physician oversight [10]. Consider an SBHC in a rural community with a limited hospital partnership. A supervision requirement could thus make hiring an NP not feasible for that SBHC.

Furthermore, policy barriers often lead to funding barriers too – especially with compensation. Since State Medicaid agencies determine which behavioral health services to cover, they may not cover certain services that SBHCs provide [11]. These state coverage policies can create challenges in providing and billing for services like group therapy. In fact, in one study, providers in SBHCs noted they do not receive sufficient reimbursement for the amount of time they spend managing group services, including time spent completing required documentation and billing processes. When pay for SBHC work is already lower than comparable hospital or private practice roles, this administrative burden becomes a massive retention problem for SBHCs.

These staffing shortages are an especially critical problem right now – and that’s because of Medicaid. Due to recent federal law, State Medicaid Budgets could be cut by nearly $665 billion [12]. This is a direct threat to virtually every SBHC’s organizational chart. Eighty-six percent of school districts use Medicaid reimbursements to cover the salaries of school health staff [13]. School-age youth make up roughly one-third of all Medicaid enrollees, and Medicaid is the fourth-largest funding source for K-12 schools, covering physical, mental, and behavioral health services. When Medicaid gets cut, SBHCs lose the staffing budgets that keep their doors open. And as a student, I believe these Medicaid cuts are more than just a hiring threat – they’re a threat to youth well-being too.

So, how can we strengthen the SBHC workforce to better meet the growing needs of students? To start, youth can use their voices to advocate for change. I believe that students and districts can work together to advocate for increased compensation for SBHC staff. As students, we see how hard school healthcare professionals work to help us thrive academically, and thus our experiences can inform policymakers’ perspectives on the crucial role of SBHC staff. To advocate, students could create an advocacy campaign involving petitions or sign-on forms, and acquire the signatures of Staff to demonstrate support. Youth can also contact their local State Representative or Senator to increase awareness of SBHCs in legislative decisions. In my experience advocating for health policies, I’ve also found that writing and publishing op-eds can help policymakers (and even community members!) understand my perspective.

Ultimately, an SBHC’s strength in serving youth comes directly from the team that staffs it. When policy restrictions and funding shortfalls leave clinics without mental health professionals, dentists, or vision specialists, it is the students who pay the price—either by facing costly medical bills outside of school or by forcing them to forgo essential care altogether. With imminent Medicaid cuts threatening the budgets that fund these positions, it becomes the community’s responsibility to save SBHCs before youth face the consequences. Policymakers can modernize scope-of-practice laws for nurse practitioners and ensure that state Medicaid reimbursements accurately reflect the time staff spend on student care. As students, we can use social media, contact legislators, and share our stories to bridge the gap between policy and reality. Investing in the SBHC workforce must become a policy priority – after all, it’s an investment in the health, equity, and future of our generation.

Sources:

Who Staffs The Clinic? Analyzing Workforce Roles and Challenges in School Health Settings

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