The Mission Creep of Public Schools

Parents, educators, and policy makers throughout the country were dismayed in September to see the latest scores from the National Assessment of Educational Progress (NAEP). The NAEP scores, known as “The Nation’s Report Card,” paint a bleak picture: In 2024, only 35% of 12th graders, 38% of 8th graders, and 31% of 4th graders were deemed proficient in reading, while only 22% of 12th graders, 28% of 8th graders, and 39% of 4th graders were deemed proficient in mathematics. These scores have added to growing concerns over the quality of public education. At the same time, there is a concerted effort to have public schools provide many things other than education, including health care.

Last year, Rockingham County in Virginia launched its first School-Based Health Center (SBHC), establishing health care clinics at a public middle school and high school. The program is meant to increase healthcare access to underserved populations, improve school attendance (a serious and lingering problem since Covid-school closures), and offer relief to busy parents.

Rockingham County’s program is part of a larger movement to provide healthcare at public schools: according to a 2022 census, there are approximately 3900 SBHCs across the United States, with New York and California paving the way with extensive SBHC networks. For example, New York City’s SBHCs provide the following:

• Physical exams (including for sports, working papers, and new admissions)
• Vaccinations
• Health education
• Mental health counseling and treatment (including crisis intervention) 
• Reproductive health services for adolescents

A Harmful Paradigm Shift

Proponents of this model argue that it is family-friendly because it is more convenient for parents. Some go further to suggest that SBHCs benefit not only children and parents, but the entire community. The American Federation of Teachers (AFT), the teachers union led by Randi Weingarten, boasts of NYC’s “community schools”:

These schools become the center of their communities by providing the services to students, families and neighbors that best serve their needs, while at the same time promoting stable, healthy neighborhoods. This isn’t just another program: It’s a paradigm shift in the way we think about schools that goes well beyond just providing supports and services for students.

“Paradigm shift” is an understatement. Schools providing health care services strays so far from the original purpose of public education that it is almost unrecognizable. Schools are no longer expected only to educate children, but to provide the basic care once expected of the family. This “paradigm shift” is harmful to children, families, and society for the following three reasons.  1) SBHCs have not been shown to improve educational outcomes; 2) SBHCs risk replacing parents as the primary caregivers for their own children; and 3) SBHCs represent a mission creep that compromises the vital role of the family in society.

1. SBHCs don't improve educational outcomes.

The first point to consider is whether SBHCs contribute positively to the education of children, which is, of course, the purpose of public schools. After all, public schools’ foray into offering physical, dental, and mental health care comes while we are seeing math, reading, and science scores throughout the country drop to some of the lowest levels ever recorded. While SBHCs have been shown to improve students’ attendance and access to care, they have not been shown to improve academic outcomes. Therefore, these programs do not deliver on the first goal of public education: improving education. Thankfully, there is one thing we know to be the biggest predictor of academic growth: strong parental involvement.

2. SBHCs risk replacing parents as the primary caregivers for their own children.

It is also important to consider type of “care” that children may receive in SBHCs without their parents’ presence. The most basic care offered involves well-child visits and sports physicals, which some may argue are harmless evaluations—not treatments—and therefore do not require parental oversight. However, what is considered a “standard evaluation” is increasingly invasive and potentially harmful. For example, it is now standard protocol for a child to be asked any/all of the following during a pediatric well-visit:

• Do you ever have thoughts that you would be better off dead?
• In the past week, have you been having thoughts about killing yourself?
• Have you ever tried to kill yourself?
• Are you having thoughts of killing yourself right now? 

Despite little evidence that they improve mental health, these mental health screeners have become commonplace. In my daughter’s most recent check-up and sports physical, she was given (and I intercepted) three different questionnaires asking whether she had considered killing herself. Illinois Governor JB Pritzker (D)  recently announced that his state will be implementing universal mental health screening of every student beginning in third grade. We should not accept these screenings as benign. Repeatedly asking a child probing questions about suicide is not a careful approach to mental health care and may have unintended consequences. Parents must be aware that if they entrust SBHCs to conduct even the most banal of health services, such as a sports physical, they still risk exposing their children to harmful interventions.

Every time we absolve parents of a traditional responsibility, we degrade the role of the family.

In addition to well visits and sports physicals, some SBHCs offer more extensive care, including reproductive health services. While parental involvement in this care is “encouraged,” it is often not required. New York City Public Schools explain:

 [SBHCs] encourage parental involvement in a student’s use of reproductive health services. However, as per NY State law, minors are legally allowed to consent to their own care for reproductive health services, including pregnancy prevention, prenatal care, and testing for and treatment of sexually transmitted infections (STIs), including HIV. 

Parents are right to be alarmed because parents have the right to know if their child is seeking prenatal care or treatment for an STI—not only so that they can manage the child’s medical care, but also so they may protect the child from unhealthy and potentially abusive sexual relationships. Schools providing children opportunities to hide their sexual activity from their parents is dangerous; it puts those children at risk and violates a parent's right to protect them. This concern is underscored by a recent case in Fairfax County, VA, where there is now a criminal investigation into school employees suspected of arranging and funding a minor student’s abortion without parental consent. It is not unreasonable to expect similar overreach and threats to parental rights in school divisions where SBHCs are more extensive, and where minors have more autonomy by law.

3. SBHCs represent a mission creep that compromises the vital role of the family in society.

Lastly, we should all be wary of a program that promises to ease parents’ burden by relieving them of their obligations as parents. Yes, most parents are busy. However, we should be the ones seeing to the care of our children. Outsourcing our children’s health care to public schools—that is, to the government—ought to be an unwelcome development because it degrades the role of the family in society and represents government overreach. Families have traditionally served the role of socializing children, and providing for their care (food, housing, and health). The more we abandon these norms, the more society will suffer. The AFT’s boasting that SBHCs become the backbone of a community should be alarming because it is families who should be the backbone of a community. We should reject a reorganization of society that demotes the family.

It is a devastating reality that many children grow up without a solid family support structure. The best way to help those children is to develop the parents’ role in the child’s life. Rendering the parents increasingly unnecessary is bad for the child and bad for all of us. Parents should be on the hook for their children’s overall well-being. When parents are struggling to bear that responsibility, we should help them get back to the point where they can do it themselves; we should not build an entire government system to relieve them of the responsibility.

A truly family-friendly program is one that strengthens the relationship between parents and children, and it does so by honoring the traditional role of parents as their children’s primary caregivers and protectors. Every time we absolve parents of a traditional responsibility, we degrade the role of the family. And every time we degrade the role of the family, we degrade society.

Meg Scalia Bryce is a wife and a mother of four. She currently serves on the Board of the School Board Member Alliance.