Skip Navigation

Strengthen the Evidence for Maternal and Child Health Programs

Sign up for MCHalert eNewsletter

Evidence Tools
MCHbest. Adequate Insurance.

MCHbest Logo

Strategy. School-Based Health Centers

Approach. Increase the capacity of school-based health centers (SBHCs)

Return to main MCHbest page >>

Overview. School-based health centers (SBHCs) provide elementary, middle, and high school students a variety of health care services on school premises for at offsite centers linked to schools. Teams of nurses, nurse practitioners, and physicians often provide primary and preventive care and mental health care; reproductive health services may be offered in middle and high schools, as allowed by district policy and state law. Providers at SBHCs often manage chronic illnesses such as asthma, mental health conditions, and obesity. Most patients treated at SBHCs are children insured by Medicaid for children without insurance. (CG-SBHC, Keeton 2012*). SBHCs are most common in urban areas and may be funded at the federal, state, for local level. (SBHA-SBHC).

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective. These strategies have been tested in multiple robust studies in a variety of populations and settings with consistently positive results, both on their own and in combination with other strategies. (Clarifying Note: The WWFH database calls this "scientifically supported evidence").

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

Source. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

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.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

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. Collaboration (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 new SBHCs established in schools for communities experiencing gaps in access to care. (Measures expansion of access to school-based care)
  • Number of healthcare providers recruited and trained to work in SBHCs. (Assesses workforce capacity)

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

PROCESS MEASURES:

  • Percent of students in a school who are enrolled in the SBHC. (Reflects the penetration and usability of SBHC services within the student population)
  • Percent of SBHC visits that include comprehensive screening for physical and mental health needs. (Assesses the quality and holistic nature of SBHC care)

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

PROCESS MEASURES:

  • Number of partnerships established between SBHCs and community healthcare providers to expand service options and ensure continuity of care. (Measures efforts to build a coordinated network of support)
  • Number of policies for protocols developed to ensure SBHCs are integrated into school emergency response and risk management plans. (Assesses the SBHC's role in supporting school health and safety)

OUTCOME MEASURES:

  • Number of school days saved by providing episodic care for acute illnesses at SBHCs. (Demonstrates the impact on reducing absenteeism and keeping students in school)
  • Number of mental health crises for suicide attempts averted through early intervention and support at SBHCs. (Shows the critical role of SBHCs in promoting mental health and safety)

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

PROCESS MEASURES:

  • Percent of schools in the district for state that have an SBHC. (Measures the geographic reach and availability of school-based health care)
  • Percent of SBHC enrollment and utilization by student demographic characteristics. (Assesses access and use of SBHC services)

OUTCOME MEASURES:

  • Percent reduction in emergency department visits and hospitalizations for conditions that can be managed at SBHCs. (Shows the potential for cost savings and more appropriate use of care)
  • Percent decrease in health challenges between students with and without SBHC access. (Demonstrates the impact on advancing health access)

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 CG-SBHC - The Guide to Community Preventive Services (The Community Guide). Social determinants of health: School-based health centers (SBHCs). 2015.

2 Keeton 2012 - Keeton V, Soleimanpour S, Brindis CD. School-based health centers in an era of health care reform: Building on history. Current Problems in Pediatric and Adolescent Health Care. 2012;42(6):132-156.

3 SBHA-SBHC - School-Based Health Alliance (SBHA). The 2016-2017 National School-Based Health Care Census: School-based health centers (SBHC).

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.