Supporting Adolescent Health Through School-Based Health Programs

May 21, 2025 | Lexa Giragosian

Adolescence is a critical stage of the life course that can influence long-term health outcomes, making it a key public health priority for jurisdictions. According to the Youth Risk Behavior Survey Data Summary & Trends Report: 2013-2023, high school students reported increased experiences of violence, indicators of poor mental health, and suicidal thoughts and behaviors. Engaging adolescents through school-based health programs can be effective in addressing these concerns — as schools reach 95% of youth in the United States, creating a pathway to assess student health and implement evidence-based initiatives to promote overall well-being.

Coordinated collaboration between education and health agencies is a successful method for developing or maintaining the school-based health infrastructure and providing research-backed resources and tools; Florida, Maine, Texas, and other states exemplify this approach. School-based health centers (SBHCs) are also an effective avenue for health departments to support adolescent well-being, leading to improved health outcomes, positive learning environments, and better student behavior. Washington and Illinois enacted legislation empowering their Departments of Health to lead SBHC programs in their jurisdictions.

Strategies Aiding School-Based Health Programs

Family Engagement

Family engagement in schools improves student academic success, social skills, motivation, and self-confidence. Effective engagement strategies are socially informed, connect families with essential resources, promote community involvement, meet basic needs, and encourage participation in educational journeys. Two-way communication between families and schools, either in person or through digital formats, is important to ensure collaboration and provide personalized student support. Chicago Public Schools’ Healthy CPS Office created a toolkit for educators on how to support school-to-home communications, specifically on personal health and safety, and sexual health education.

Health departments are key partners as schools enhance family engagement strategies. For example, schools can partner with health departments to host workshops or seminars for parents on health topics their children are learning in school as well as provide resources about adolescent and family issues. To advance these high-impact family engagement strategies, Michigan’s Department of Education and Department of Lifelong Education, Advancement, and Potential leveraged stakeholders, including the Department of Health, to develop a Family Engagement Framework. This framework supports Michigan school districts expand their home-school partnerships by defining student impact levels and guiding principles for engaging families.

School Health Screenings

Effective implementation of mental and behavioral health screening in schools requires the involvement of students and families, maintains resources and an active referral system, and utilizes an appropriate and flexible screening tool that assesses the proper determinants. Incorporating universal screenings of student mental and behavioral health is an important aspect of school behavioral health programs for early identification and connection to services as well as collection of essential data; however, research suggests that only 20% of schools implement universal verbal screening for mental and behavioral health. Universal screenings play a crucial role in preventing students from falling through the cracks. This is especially important as stigma about mental and behavioral health remains a major barrier for adolescents seeking care.

Health departments, in conjunction with education departments, are valuable leaders in identifying and implementing effective tools for school health screenings as well as supporting school health screening policies. Massachusetts legislation requires verbal substance use disorder screenings in schools. The policy ensures that screenings occur annually at two different grade levels, while also granting parents the right to opt out. The Massachusetts Department of Public Health and Department of Elementary and Secondary Education collaborated to select and implement an effective tool (Screening Brief Intervention and Referral to Treatment) for the required screenings.

Health Education

Effective, evidence-based health education is important for adolescent development and should include information about various topics such as mental health, sexual health, substance use, violence, dietary patterns, and physical activity. When updating health education standards, state education departments collaborate with health departments to develop accurate and appropriate curricula, as seen in Minnesota. Health departments are also key partners in the development and implementation of new policies expanding health education curricula to better represent current adolescent issues, like the addition of dating violence and opioid abuse prevention in Ohio.

Health educators must reframe messages, leverage social media, and involve youth voices to build trust and ensure a safe, empowering environment. Interactive learning — through technology, role-playing, peer education, and games — actively engages adolescents and reinforces skills to make evidence-informed health decisions.

Safe and Supportive School Environments

Establishing safe and supportive school environments fosters safety, trust, respect, positive relationships, and open communication while reducing violent behavior, health risk behaviors, and poor mental health and loneliness. Positive school environments are also associated with reductions in bullying. Emphasizing student engagement in schools and promoting positive relationships between students and important adults in their lives can help achieve this.

Health departments can promote safe and supportive school environments through various methods, such as implementing youth development programs, sharing resources on positive parenting interactions, and providing professional development opportunities for school health workers. School nurses are important leaders in fostering positive school climates as their focus is on the interconnection between student health and the overall well-being of the school community. Health departments can provide development opportunities and training/technical assistance to expand the impact of school nurses. Indiana, North Carolina, and Arizona have leveraged health department partnerships to strengthen their school nursing supports.