"Sacred ground for kids": Institutional perspectives on rural school-based health centers as patient-centered medical homes.

BACKGROUND: School-based health centers (SBHCs) can function as patient-centered medical homes (PCMHs), but few studies examine how SBHCs fit the PCMH definition and address the challenges of rural health disparities among children and adolescents. METHODS: Note that 12 semi-structured interviews were conducted in four rural counties in New York State with school superintendents, SBHCs medical providers, and health care network administrators and between January 2024 and April 2024. Participants were identified using snowball sampling. Interviews were transcribed. Framework analysis was applied with thematic coding based on the PCMH framework. NVivo 14 was used to generate the final set of themes. FINDINGS: Our analysis confirms SBHCs fit the PCMH model-accessibility, comprehensive, family-centered, coordinated, continuous, and compassionate care-to improve health care access for rural children and empower children to advocate for their own health. We identify privacy and confidentiality as additional important elements in the PCMH model, which ensure children's empowerment. However, they present special challenges for rural SBHCs. Addressing these challenges requires attention to information sharing between SBHCs and schools and the need for trust and communication to empower children, while not alienating school partners and parents. This may explain why so few rural SBHCs are PCMH. CONCLUSIONS: This qualitative thematic analysis shows SBHCs can serve as PCMHs in rural communities. It also highlights the importance of privacy, confidentiality, trust, and communication between SBHCs, schools, parents, and children.