School-based health: an area of opportunity to address challenges in management of pediatric obesity and type 2 diabetes

Abstract

Purpose of review: Obesity and type 2 diabetes (T2D) are increasingly common, chronic, and complex and disproportionally affect systemically under-resourced communities negatively impacted by social determinants of health. The primary goals of management for both conditions are improvement of medical and psychosocial well being and prevention of secondary complications. The advent of pediatric specific multidisciplinary weight management programs, bariatric surgery, and recent FDA approved medications have provided clinicians with tools to improve patient outcomes. However, implementation remains a challenge.

Recent findings: The Chronic Care Model proposes utilization of community-based interventions to support children and families in managing chronic disease The CDC's Whole School, Whole Community, Whole Child Model provides a framework for schools to engage in this role. School-Based Health Centers (SBHCs) utilize a child-focused, multidisciplinary approach to support the medical home and overcome barriers to routine primary care, medical screenings and successful care plans for management of chronic disease. SBHCs and school-based programs have proven sustainable and effective in addressing obesity and T2D in youth, however recent studies are limited and more research evaluating impact are needed.

Summary: School-based health offers an evidence-based solution to ensuring equitable and comprehensive care for obesity and T2D, particularly among at-risk communities.

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FIGURE 1

School based Health and the chronic care model. School-based health provides a framework for collaborative community-based interventions within the chronic care model. This includes education, appropriate and timely communication, equitable healthcare delivery, implementation of medical care plans, and support for self-management of chronic conditions. The figure demonstrates the intersecting roles and responsibilities of patients, families, schools and the clinical team within this model. School based interventions have the capacity to unite stakeholders with a child focused approach and provide additional supports for pediatric chronic care outside of the medical home.

FIGURE 2

Evolution of SBHCs in the United States. SBHCs emerged in the 1960s and 1970s and were focused on mitigating increasing rates of pregnancy among adolescents, particularly in urban areas. Though there were only a handful of fully operational SBHCs by 1985, early recognition of value and impact resulted in exponential increase. By 1988, there were 138 SBHCs across 30 states and the District of Columbia, at least 65 new SHBCs in development and increased state funding to support local public health departments in establishing new centers. By 1998 there were over 1000 SBHCs in elementary, middle and high schools in rural, suburban and urban communities in nearly all 48 continuous states. This was also the year of the establishment of the School Based Health Alliance (SBHA), the premiere national membership organization for SBHCs. By 2017 more than 50% of SBHCs were federally funded and there were over 2580 unique clinics utilizing all school-based health models. AP, advanced practitioner; CPO, Center for Population Options; ES, elementary school; HS, high School; MS, middle school; PA, physician assistant; RWJF, Robert Wood Johnson Foundation.