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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 Staff

Approach. Use trained school staff to assist families in getting insurance coverage.

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Overview. Schools can be a point of intervention for enrolling young children in public health insurance and as a source of trusted information for parents from low-income backgrounds. In one study, school nurses and administrative staff attend regional trainings on how to use a required health assessment form, submitted at school entry, to identify uninsured children who could be eligible but are not enrolled in public insurance.1

Evidence. Emerging. There is some evidence that outreach using school staff increases enrollment rates and well-child exams, 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 staff.

Outcome. Increase enrollment in public health 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 trained school staff to assist families in getting insurance coverage,” 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 participating in CHIP and Medicaid outreach.
  • Number of school staff trained to identify and enroll eligible children in public insurance.

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

  • Percent of eligible children identified by school staff for public insurance.

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

  • Number of families who worked with school staff to gain coverage for their children.

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

  • Percent of children enrolled in public insurance as a result of school-based outreach.

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 Jenkins JM. Healthy and Ready to Learn: Effects of a school‐based public health insurance outreach program for kindergarten‐aged children. Journal of School Health. 2018 Jan;88(1):44-53.

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.