Snapshot: Youth Transform School-Based Health Centers in Oregon

December 4, 2013

If you build it, and they don’t come, what do you do? In Oregon, when school-based health clinics faced this dilemma, county officials turned to youth for the solution.

For over 25 years, Multnomah County has had school-based health centers—comprehensive health clinics located in 13 elementary, middle and high schools that provide physical and mental health care services to thousands of children, teens and families each year.

Yet in 2008, these health centers weren’t seeing as much use as they knew they should be, given insurance rates and students’ health concerns.

“Administrators were scratching their heads,” says Marc Fernandes, Youth Development Coordinator with the Multnomah County Office of Diversity and Equity, who coordinates the Multnomah Youth Commission. “They were in the schools, where the young people were and access was easy, so more youth should have been using the centers.”

Data show that school-based health centers are a powerful system that can help young people and families stay healthy. They offer mental health services, dental care, physical exams for sports, vaccinations and plenty of prevention services—all confidentially and without the need to arrange transportation. Several studies have shown that students who use these centers are more likely to have positive health outcomes, rely on emergency rooms far more frequently and are even more likely to graduate on time than those who don’t. 

Further confounding local administrators was the fact that the Multnomah Youth Commission (MYC)—a group of young people ages 13 to 21 who advise government in the county and the city of Portland—had in their own work identified access to free or affordable health care as a priority need for local youth.

So what was causing this disconnect? To help shed some light, the MYC held focus groups where students shared their feelings about the centers and why they did or didn’t use them. The discussions uncovered a “real chasm” between health care staff, students and school personnel. There was also stigma attached to visiting the school-based clinics: it was often assumed that students were there because of STDs or other reproductive issues.

“Unfortunately many students assumed the centers only offered birth control and sports physicals because they didn’t know what all the health centers offered,” says Chris Edmonds, MYC alum and former co-chair of the MYC School-Based Health Center Committee.

The Youth Commission members compiled the feedback into a report and presented it to health center staff. They also launched annual Awareness Weeks at the schools with clinics.

One of the main problems that came up in the youth surveys was that health center staff were not always responsive to young people’s needs. In 2011, youth commission members recommended the creation of smaller Youth Advisory Councils in each of the nine school-based health centers located in county high schools. They arranged for AmeriCorps members to oversee each program.

“The youth were instrumental in busting the myths and creating more inviting environments for students,” says Fernandes. “They’re working alongside clinics and education leaders to change the culture of how staff treat youth and what sites look like, making them more youth-friendly.”

Now, two years on, these youth advisory councils remain active and have been officially adopted by the county health commission—a direct result of the Youth Commission requesting that they be housed there to ensure stability.

In 2012-13, the Youth Commission held another round of focus groups and used this input to modify the internal customer satisfaction survey at the clinics. They also recommend some clinics stay open during the summer in order to serve student athletes and those with no other access to medical care.

In 2012, the most recent year for which county data are available, the 13 school-based health centers served 6,000 young people.

“School-Based Health Centers are incredibly important and helpful in my community. They not only allow youth to take responsibility for their own health, but they also make it easy for us to access health care. I know I can go to my health center when I have any type of health concern," says Daisy Quinonez, MYC alum and former MYC Co-Chair.

Ensuring that school-based health centers are not only open but are truly meeting the needs of youth is important not just to individual students’ well-being: higher usage and success rates mean a stronger argument for adequate funding in state and federal budgeting processes.

November 2013 update: sustaining the impacts have proven challenging now that the Multnomah Youth Commission is no longer focusing on school-based health centers. This underscores the need for a strong backbone of support for youth input.

About the Multnomah Youth Commission

The Multnomah Youth Commission (MYC) is the official youth policy body for Multnomah County and the City of Portland, Oregon, comprising young people ages 13 to 21. It started in 1996 as a small Multnomah County Youth Advisory Board to advise the county’s Commission on Children, Youth, Families & Community on issues that policymakers identified as priorities.  In 2002, youth members developed bylaws that shifted the group from an advisory board to a commission; the County Board approved the shift and the Multnomah Youth Commission was officially launched. Now, instead of reacting to policymakers’ goals, the members identify their own priorities and build campaigns to inform local policy.

Staffing: The MYC can have a maximum of 42 youth across the city and county. For the 2013-2014 session, the Commission includes 27 youth commissioners, supported by a full-time adult youth development coordinator, Marc Fernandes, a full-time AmeriCorps Vista worker, two part-time college students, and a part-time high school-age staff member. Official by-laws define the structure and function of the MYC.

Funding: The Youth Commission operates as a partnership between the county and the city of Portland under an intergovernmental agreement. It receives some county funds and has also raised over $300,000 in grants funders like the Penney Family Fund and StateFarm.

See also:  

This snapshot is part of SparkAction's Youth Impact series, short profiles of youth councils and commissions that are influencing local and state policies and practices. SparkAction is producing this series in partnership with the youth-led Campaign for a Presidential Youth Council and with support from the John S. and James L. Knight Foundation.

To suggest an impact story, please contact Caitlin Johnson, managing editor, at