Date of Award


Document Type

Honors Thesis (Open Access)


Colby College. Sociology Dept.


Karen E. Macke

Second Advisor

Matthew E. Archibald


The rising costs of healthcare and increasing awareness about poor health outcomes in the United States has brought the issue of access to primary and preventative care to the forefront of the national public health agenda in recent years. While still a relatively small part of the U.S. health care delivery system, the integral place of school-based health centers is becoming increasingly apparent, particularly in low-income, medically underserved communities. Previous scholarship that using quantitative measures demonstrates that school-based health centers are effective and address the stark racial and socioeconomic health disparities that persist. Yet, this work neglects many of the local, contextual factors that impact care. The purpose of this study is to gain perspectives of those working on the ground in the field of school-based health in Maine to supplement the plethora of quantitative data on school-based health outcome measures. Data from in-depth, semi-structured interviews explores the perspectives of those working in school-based health care in Maine. Through the framework of “negotiated order,” this paper unpacks the workings of school-based health centers in Maine in order to uncover the structures shaping organizational relations and the provision of school-based health services. Differences reflected at the level of sponsoring agency were the most salient factors shaping care- the ways in which these differences mattered is the focus of this paper. Findings presented illuminate the salience of the centers’ sponsoring agency in shaping organizational arrangements and how decisions are made regarding issues of stability, value negotiations, sustainability, and best practices.


Negotiated Order, School-Based Health Center, School Health, Sponsoring Agency, Inter-organizational Relations, Standpoint