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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 15: Continuous and Adequate Insurance

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Strategy. Outreach Using School-Based Communication Tools

Approach. Use school-based outreach tools to promote enrollment among children and families.

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Overview. Routine school communication tools can be used to help identify and enroll children who are uninsured but may be eligible for state-subsidized health insurance programs. One study included health-insurance status forms in school registration packets, welcome materials, and free and reduced lunch application forms.1

Evidence. Emerging. Initial research showed positive results for this strategy, but further research is needed to confirm effects. This strategy has been tested more than once and results trend positive overall. This strategy has been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. School settings.

Outcome. Increase enrollment in public insurance for eligible children. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the “Intervention Results” for each study.

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Use school-based outreach tools to promote enrollment among children and families,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of schools using communication packets to outreach to families regarding state-subsidized health insurance programs.
  • Number of families receiving health insurance status forms.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of families who learned about their health coverage eligibility through school communication packets.
  • Percent of families who reported satisfaction with the school’s outreach efforts.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of families who received assistance to enroll their children in a public insurance option.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of uninsured children who enrolled in public health insurance as a result of school-based communication tools.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4):

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


1 Aller, J. Enrolling eligible but uninsured children in Medicaid and the State Children's Health Insurance Program (SCHIP): A multi-district pilot program in Michigan schools (Doctoral dissertation, Central Michigan University.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.