Taking the "guest" work out of school-health interagency partnerships

School-based health centers (SBHCs) have proliferated rapidly, demonstrated success in health outcomes and access, and gained national recognition. Despite these accomplishments, organizational dissimilarities exist among health and school systems that are potentially leading to SBHC partnership barriers. This study sought to determine how partnering agencies promote cooperation and manage conflict across institutional boundaries.

Utilizing case study methods, we conducted semistructured interviews of 55 stakeholders involved in program operations from four Massachusetts SBHCs. All had similar characteristics, yet based on a state-level rating system, two had successful interagency partnerships and two were experiencing difficulties.

Success designation played a role in how sites managed conflict and promoted understanding and cooperation. Data also revealed similarities such as frequent use of the term "guest" by all study subjects when describing SBHCs. School representatives stated that as guests, SBHCs should adhere to school rules. Health representatives assumed that as guests, they were not full partners and could be asked to leave. Successful sites were less likely to perceive themselves as guests. At successful sites, guest terminology also dissipated over time and evolved into interdependence and cooperation among school-health interagency partners.

Viewing SBHCs as guests creates a tenuous partnership that may be counterproductive to SBHC growth and sustainability. Given current levels of public interest in education, SBHCs may afford enhanced attention to youth health. Additional financial and training resources are needed to build the common purpose that will encourage the formation and sustainability of strong, interdependent school-health partnerships.