Abstract
BACKGROUND: This study examines how school-based health centers (SBHCs) are implemented and sustained through schools and a healthcare system in a four-county rural region in New York State. METHODS: Twelve semi-structured interviews were conducted with school superintendents and employees of the healthcare system, including SBHC medical providers (physician assistant, mental health therapist, nurse), SBHC manager, care coordinator, Chief of Pediatrics, and executive leader between January and April 2024. Interviews were thematically coded using collective impact and collective action frameworks. RESULTS: SBHCs are implemented and sustained through a strong collaborative culture, shared financial, physical, and human resources, and a common agenda for student well-being. Trust and open communication were essential in clarifying roles and overcoming institutional challenges. Key barriers included funding for startup costs, challenges in data sharing and confidentiality, and different institutional priorities. Regular communication, local governmental support, and community trust helped mitigate these challenges. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Policies should support schools and healthcare systems as equal partners, ensure sustainable funding, and provide clearer guidance on data sharing to advance health equity in rural areas. CONCLUSIONS: Collaborative partnerships, trust, and open communication between schools and healthcare systems are essential to support SBHCs in rural communities.