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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. 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 Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Health Outcomes. This strategy helps contribute to reducing avoidable differences among socioeconomic and demographic groups or geographical areas in health status and health outcomes such as disease, disability, or mortality.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Outreach (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

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. Here are sample ESMs to use as models 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?")

PROCESS MEASURES:

  • Number of schools that include health insurance status forms in registration packets and other materials. (Measures adoption of the outreach strategy)
  • Number of outreach materials on health insurance distributed to families through school communication channels. (Measures dissemination of enrollment information)

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

PROCESS MEASURES:

  • Percent of schools that use a standardized health insurance status form in their registration materials. (Evaluates consistency of the strategy across sites)
  • Percent of outreach materials that are appropriate for the school community. (Reflects tailoring of messages to the audience)

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

PROCESS MEASURES:

  • Number of community partners engaged by schools to support health insurance outreach and enrollment. (Leverages external resources to enhance impact)
  • Number of school-based events held to provide in-person assistance with insurance applications. (Creates additional opportunities for enrollment support)

OUTCOME MEASURES:

  • Number of students who gain access to school-based health services after enrolling in insurance. (Reflects integration of coverage and care delivery)
  • Number of families who report reduced financial stress and improved wellbeing after gaining insurance through school outreach. (Shows broader family impact)

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

PROCESS MEASURES:

  • Percent of uninsured students in the school district who are identified and contacted through school-based outreach. (Measures penetration of the strategy)
  • Percent of school districts in the state that adopt health insurance status forms and related practices. (Shows spread and scale of the approach)

OUTCOME MEASURES:

  • Percent reduction in the uninsured rate among school-age children in communities implementing the strategy. (Evaluates population-level coverage impact)
  • Percent decrease in missed school days due to untreated health conditions among students gaining coverage. (Measures health-related educational outcomes)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

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

References

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.