School-Friendly Health Systems Framework FAQs

In mid-2021, Children’s National Hospital first released the 5 Core Principles of a SFHS and updated the framework and case examples in 2023. The SFHS framework builds upon lessons learned from other “friendly” initiatives that help health systems meet the needs of specific populations, such as the nationally recognized baby-friendly hospitals and age-friendly health systems initiatives. These efforts have shown that guiding, organizational frameworks can have significant, positive impact on patient and family experience, health care costs, and health outcomes.

The SFHS framework consists of five principles, each accompanied by practices that help illuminate how a health system — from the systems level to individual providers — can support children’s health and learning. These are practices that professionals working at the intersection of healthcare and education view as emblematic of an SFHS, some already put into practice and some aspirational:

• Awareness. Be familiar with, and responsive to the culture, policies and needs of the school systems and student populations they serve.
  
• Alignment. Have a cohesive strategy for collaborating with schools and communities that aligns with those partners’ needs and goals.
  
• Accessibility. Make themselves accessible to school partners and collaborate with those partners to optimize students’ learning experience.
• Accountability. Set organizational goals that support children’s academic experience and set metrics and incentives that reinforce those priorities.
  
• Family Engagement. Collaborate and share power with families, understanding that they are the most important conduits between health systems and schools.

We recognize that how a health system can most effectively embody each SFHS principle will depend on its unique context and that of the surrounding community.

The SFHS framework is intended primarily as a tool for health systems, focusing on how they can contribute to improving children’s health and academic experience, including by better positioning themselves as school partners. An SFHS is any entity that manages or provides health care services or programs, including hospitals, clinics and health centers. School health is an interdisciplinary field and requires involvement from broad professional roles including but not limited to clinical care, administration, family support, advocacy, and research. This framework could be applied to diverse settings, such as hospital-based education settings, primary and specialty care clinics and school-based health centers. The framework encourages there to be diverse teams of health and education professionals working in collaboration, with input from students and family, to ensure all children achieve optimal health and reach their full academic potential.

Between 2019 and 2021, the project team assembled expert input from physicians, educators, school nurses, parents, health system and school administrators and others at the intersection of health and education to articulate 5 Core Principles of a SFHS. Specific organizations engaged through meetings and presentations include:

• American Academy of Pediatrics
• American Federation of Teachers
• American School Health Association
• Association of American Medical Colleges
• Center for Health and Health Care in Schools at the George Washington University Milken Institute School of Public Health
• Children’s Hospital Association,
• Children’s National Hospital School Health Collaborative and School Health Advisory Committee
• Healthy Schools Campaign
• Kaiser Permanente
• National Center for School Mental Health
• School Partnerships in Pediatric Settings Project.

The SFHS framework is meant to complement frameworks like the Center for Disease Control and Prevention’s Whole School, Whole Community, Whole Child (WSCC) model, which focus primarily on actions in the school setting. The WSCC model is a student-centered framework emphasizing the role of the community in supporting the school’s efforts to advance health and learning outcomes through 10 school health components. In developing principles of a SFHS, Children’s National conducted a crosswalk of leading school health frameworks, including the WSCC, to see where there is alignment and understand how this framework could support existing efforts. As students, educators, parents, and pediatricians face the ongoing challenges from the COVID-19 pandemic, it is critical for the health and education sectors to align efforts to address the needs of children. Recognizing that supporting children’s health and learning is a multi-disciplinary, multi-institutional endeavor, this framework is geared specifically for hospitals and health systems. The SFHS framework provides the needed direction for hospitals and health systems to become “school-friendly” through personal interactions, programmatic efforts, and organizational structures. The SFHS initiative seeks to provide hospitals and health systems, including ambulatory settings, with a framework to better position themselves to support children’s educational experience in partnership with schools and families. The framework is intended to guide any health system engagement with a student or family and a school/school district that may occur in a clinical setting, at a school or in the community. Long-term, we believe broad adoption of the SFHS framework, and implementation of strategies that align with the principles, can strengthen partnerships, and drive meaningful population-level improvements in health and education outcomes. 

Children’s National and RESOLVE are supporting a SFHS Learning Collaborative, a national cohort of hospitals, health systems, and health clinics piloting the SFHS framework, putting the principles into practice. Each participating organization is developing and implementing plans to institutionalize one or more of the SFHS principles using shared planning, evaluation, and documentation tools. The SFHS Learning Collaborative participants convene at least quarterly to exchange experiences, challenges, and solutions and learn from independent experts. The anticipated outcomes of the learning collaborative include implementation tools jointly developed by the group as well as case studies on each participant’s experience.

Seven hospitals are current members of the SFHS Learning Collaborative, including, Children’s Health Orange County (Orange, CA), Children’s Hospital & Medical Center (Omaha, NE), Children’s Mercy (Kansas City, MO), Children’s National (Washington, DC), Children’s Wisconsin (Milwaukee, WI), Cincinnati Children’s Hospital Medical Center (Cincinnati, OH), and St. Luke’s Children’s Hospital (Boise, ID). The Center for Health and Health Care in Schools (CHHCS) at the George Washington University Milken Institute School of Public Health has been identified as a lead monitoring and evaluation partner for this initiative. CHHCS is a nonpartisan policy, resource, and technical assistance center with a history of developing school-connected strategies for better health and education outcomes for children. This effort has also been supported by a SFHS Family Advisor and other national partners.

Children’s National secured initial resources through its hospital foundation and has been supporting efforts through staff time lead by the Child Health Advocacy Institute school health team staff and hospital operational dollars. In 2022, the SFHS Learning Collaborative was launched by Children’s National and RESOLVE through a Kaiser Permanente grant. The SFHS Learning Collaborative is seeking additional funding to continue to support its implementation and evaluation efforts.

For more information and additional questions, please email us.