In order to best support students’ health, well-being, and academic success, school-based telehealth (SBTH) partnerships need a shared commitment between a community’s schools and health care organizations. Built on two frameworks for school-based health care excellence—SBHC Core Competencies and SBHC Sustainability—the partnerships cultivated throughout your SBTH program drive operations and utilization, fostering student wellness and a culture of health that extends beyond the telehealth visit. Whether you are new or expanding services, your SBTH program’s success depends on strong partnerships to support planning, marketing, day-to-day operations, care coordination, evaluation, and quality improvement.

Key Considerations

SBTH program partnerships navigate barriers to successful implementation and gain program buy-in from inception. Each key stakeholder from the community brings a unique perspective to the table. Whether adding telehealth to an existing SBHC, or SBTH is your entry to school-based health care, collaborating with organizations—especially those with established relationships with school and community organizations—can help build trust, increase awareness, and improve program enrollment.  

SBTH programs require a multidisciplinary approach. Successful programs often have the following elements: Planning Group, Advisory Committee, and Program Champions.

Planning Group

Advisory Committee

Champions

The first step is convening a planning group. This group will likely be the start of your SBTH team (hyperlink to Program Models).   Group members may include representatives from the school and school district, a champion, caregivers, students, a medical sponsor, the local medical community (such as a pediatrician or family practice physician, mental health professional, or dental health professional), and community-based and faith-based organizations. 

In addition to the planning group, an advisory committee supports the completion of your needs assessment (hyperlink to Assessing Needs and Readiness)) as well as ongoing program development. Advisory committee members include representatives from the planning group and, at a minimum,  a public health professional, school health service providers (including a school nurse), and representatives from the community, student body, and a caregiver group. 

The most successful programs identify a champion(s) (e.g., school-level and community-level) to facilitate multi-level collaboration between all SBTH program partners and stakeholders. With strong community ties, connections for relationship building, and opportunities to diversify funding streams, the champion organizes and convenes the partnerships. Any health, school, or community partner can assume this role, but note it requires commitment to overseeing the program’s growth. 

Sustainable SBTH programs develop and nurture partnerships with stakeholders such as school leadership, local health care providers, students, and families. This is not an exhaustive list of stakeholders, but they are priorities. Each partner or stakeholder group has its own language, priorities, and definitions related to health, school health, and student success and well-being. Establishing and sustaining partnerships begins with relatable messaging (e.g. the email, introductory meeting, community focus groups, etc.) that will resonate with your audience. Work with each potential partner to answer all of the following questions:  

  • Who are we primarily trying to reach with our efforts? 
  • Who has the most influence over our target audience, students? 
  • What messages will resonate with this audience? 
  • What types of materials and marketing vehicles will best convey our message(s)? 
  • How will we reach individuals from different backgrounds, generations, etc. with our message(s)?

Successful SBTH programs integrate into a school environment with support from multiple tiers including the school nurse and other school health professionals, teaching staff, principal, director of special services, and superintendent.

Successful programs also prioritize school integration; they build on the foundation of and integrate with existing school health services, and actively engage students, caregivers, and communities.  To ensure this partnership’s success, school leadership and personnel can collaborate to identify services based on the greatest needs, as well as identify outcomes that are meaningful such as reducing absenteeism.  

Partnership with the school nurse, whose knowledge of school operations and students’ and families’ needs, is invaluable. School nurses serve a pivotal role between students, the school, caregivers, and the community,

  • providing direct care to students; oversee the policies, programs, and provision of school health services;  
  • promoting a healthy school environment; provide health education, screenings, and referrals for health conditions; and  
  • coordinating care among schools, medical homes, and families.  

School nurses often increase awareness of the program among parents, referring students who could benefit from a telehealth visit, and using the equipment to telepresent a student to a connecting provider. Additionally, school nurses complement and expand (not duplicate) health care access by offering guidance towards smooth SBTH integration.  

School Partnership Tips 

Increase Awareness  

Utilize multiple marketing avenues to generate awareness of the SBTH program. Collaborate with the school district to send email blasts and social media posts with information about the program and its staffing. Advertise services through school lunch programs, and offer that SBTH staff can participate in school initiatives, such as meal distributions and the school health wellness committee. 

Many school district partners advertise telehealth services by sharing information on the district website and in school registration packets. SBTH staff and school nurses can reach out to students enrolled in the program who are due for services to schedule visits (such as students with asthma). School nurses can also reach out to the caregivers of unenrolled students about the benefits of the program.  

Prevent and Prepare for Delays 

If the superintendent and members of the school board are not already members of your planning group or advisory committee, engage with them early and often in the planning process.  Efforts in planning and implementation can stall if the enthusiasm and momentum from partners at the school-level is circumvented by concerns and reservations from district-level leadership. 

Also, plan for school turnover; this could be a school nurse, the champion, an administrator, or the superintendent. Have materials and information about the SBTH program ready and up-to-date with testimonials, outcomes, etc. to on-board new school stakeholders and get their buy-in quickly. Also, be prepared for possible delays during turnover by including alternate care contingency plans in your business case, policies, procedures, and workflows.

Adapted from the School-Based Health Care Core Competencies: The SBTH program, although governed and administered separately from the school, integrates into the education and environment to support the school’s mission of student success.

School Health Services are services traditionally provided by the school system (e.g.,IEPs, 504s, nursing care plans, and first aid) via the school nurse and other school-employed health professionals.

As the target audience and primary focus for your SBTH program, student voices and representation are essential elements that require intentional and consistent development. In line with Student Focus:

  • Connect with and engage students to ensure your program components match the individual needs, experiences, and circumstances of each student.  
  • Ensure SBTH services and delivery are developmentally appropriate, respectful of cultural and linguistic diversity, and include accessibility training, aids, and services.  
  • Encourage students (as age-appropriate) to be effective advocates and consumers of their health care by encouraging them to schedule their appointments, manage medications, ask questions about their care, and improve their health literacy.  

Students can serve as youth advisors (starting with your SBTH advisory committee) and contribute to or lead various functions. Asset mapping and needs assessment, evaluation of services and visit experience, youth-led outreach and promotion, and peer-to-peer health education are just a few opportunities for meaningful engagement and development. 

Student Partnership Tips 

Expand Communication Avenues  

Think beyond using telehealth solely for appointments. Develop a website for students to access crisis information, health education, and counselors. Host virtual sessions (e.g., bi-weekly Zooms or Instagram live) for students to discuss health and wellness topics. Use the school digital learning platform (e.g., Schoology or Google Classroom) to offer “daily surprises,” engaging students with quotes, coping skills, silly videos, meditation, etc. 

Work with youth to connect with their peers. Youth advisory councils (YACs) can advertise the SBTH’s services via word-of-mouth and use social media to facilitate peer-to-peer engagement. 

Maintain Confidentiality, Privacy, and Respect  

Recognize that it is important to demonstrate and maintain confidentiality at all times. For visits where the student and/or the provider is in a non-school or clinic setting (e.g., the home), start by showing the surrounding area to the student and ask that they do the same.  

Designate the student’s cell phone number and caregiver’s cell phone number in electronic health records (EHR) rather than collecting one general contact number. SBHCs can text (without including PHI) and call students directly to schedule confidential visits. 

Additional ways adolescents are addressing privacy concerns include making connections to the virtual visit from a parked car, on a walk, or finding other ways to distance themselves to ensure privacy.  

Adapted from the School-Based Health Care Core Competencies: The SBTH team and services are organized explicitly around relevant health issues that affect student well-being and academic success.

Caregivers are vital partners for SBTH and for achieving systems coordination. They are the prime decision-makers for where, when, and how children and youth access health care. While telehealth can present additional family engagement opportunities to meet with students and caregivers together, the SBTH team must address concerns about virtual care and to gain caregivers’ trust and support of the program. The SBTH team should inform caregivers about the telehealth services and benefits, partner agencies and schools, billing, patient confidentiality, and HIPPA regulations (see the Special Consideration below). Additionally, invite caregivers to participate in the visits by connecting via audio and/or video. 

Special Considerations for Adolescents: Most SBTH programs have a parental consent policy. Health centers must also protect patient information confidentiality—as required by state and federal law—when transmitted through telehealth visits, communication, billing activity, or health records release, just as they would for in-person visits. Many states’ minor consent laws permit adolescents to self-consent, based on status—such as emancipation or living apart from their caregivers—or specific services, such as mental health, sexual/reproductive health, and substance use. This self-consent may also extend to their health information and restrictions on information sharing without the adolescent’s authorization. 

Caregiver Partnership Tips 

Outreach and Education 

To orient caregivers to school-based telehealth, school and SBTH staff can provide education on the program in multiple ways such as participating in back-to-school nights, awards nights, etc. and offer live demonstrations of the equipment. Another strategy hosting virtual “office hours” to educate caregivers about the program, engage in peer-to-peer discussions with caregivers experienced with telehealth, and answer questions. 

To make it easier on caregivers, develop an electronic consent process and paths for alleviating accessibility issues. For example, one SBTH program that offers online consent forms has extended wireless internet access into its clinics’ parking lots. Families who do not have internet access at home can come to the parking lot to complete their enrollment paperwork. Another SBTH has a staff member reach out to families struggling to complete the online consent to walk them through it. 

Engage Caregivers during Telehealth Visits 

Some SBTH programs extend the availability of services–such as over the summer–by connecting directly to the student at home for a virtual visit. Often, telehealth provided to younger students during an at-home visit will require a family member’s assistance. In such cases, caregivers may serve as telepresenters in a variety of ways. Caregivers may use different phone applications to assist, such as the phone camera for assessments or at-home thermometers and scales to report vital signs. Caregivers can also help count respirations for providers and use flashlights to illuminate the oropharynx. SBTH programs vary in their policies around requiring a caregiver’s presence for appointments. Regardless, it is fundamental that, when permitted, providers communicate with caregivers before and after the telehealth visit and help caregivers access any needed follow-up care for their student.  

Adapted from the School-Based Health Care Core Competencies: The SBTH program coordinates across relevant systems of care that share in the well-being of its patients.

The central tenet of Systems Coordination is partnerships with local health care and social services providers (e.g., dentists, food assistance, community health centers, housing authority, behavioral health agencies, medical-legal partnerships, pediatricians, outofschool time programs, and hospitals) to ensure health care coverage is available outside of the SBTH program. SBTH programs promote continuity of care and, when possible, establish a referral system with the student’s primary care provider to coordinate and integrate efforts (including warm hand-off, scheduling on-site preventive visits, exchange of health information as appropriate, and follow-up communication) with existing systems. 

Adapted from the School-Based Health Care Core Competencies: The SBTH program coordinates across relevant systems of care that share in the well-being of its patients.

Examples from the Field