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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Adolescent Well-Visit.

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Strategy. Federally Qualified Health Centers. (FQHCs)

Approach. Support the provision of adolescent well-visit services at FQHCs

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Overview. Federally qualified health centers. (FQHCs) are public and private non-profit healthcare organizations that receive federal funding under Section 330 of the Public Health Service Act. Governed by a community board, FQHCs deliver comprehensive care to uninsured, underinsured, and patients who may need additional support regardless of ability to pay. FQHCs are located in high need communities in urban and rural areas. (HRSA-Health centers). Often called Community Health Centers. (CHCs), FQHCs can also include migrant health centers, health care for the homeless centers, public housing primary care centers, and outpatient health programs for facilities operated by a tribe for tribal organization. (CMS-FQHC).

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):

  • 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.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.

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. Direct Care (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 adolescent-focused health promotion and outreach events conducted by funded FQHCs to raise awareness and engagement in well-visit services among youth and families in their communities. (Measures the efforts to increase demand and utilization of adolescent well-visits)
  • Number of FQHC providers and staff trained on best practices for delivering trauma-informed and developmentally appropriate adolescent well-visit services. (Measures the workforce development activities to improve the quality of care for adolescents)

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

PROCESS MEASURES:

  • Percent of funded FQHCs that have integrated evidence-based practices and quality improvement strategies to optimize the delivery of adolescent well-visit services. (Measures the adoption of best practices and commitment to continuous improvement)
  • Percent of FQHC providers and staff who demonstrate increased knowledge, skills, and confidence in providing high-quality adolescent well-visit services as a result of Title V-supported training and technical assistance. (Measures the effectiveness of capacity building efforts)

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

PROCESS MEASURES:

  • Number of community partnerships and collaborations established by funded FQHCs to promote adolescent well-visits, such as partnerships with schools, youth organizations, and social service agencies. (Measures the level of multi-sector engagement and collective impact)
  • Number of quality improvement projects and data-driven initiatives implemented by funded FQHCs to identify and address gaps in adolescent well-visit utilization and outcomes. (Measures the use of data and continuous improvement to advance health)

OUTCOME MEASURES:

  • Number of adolescents at funded FQHCs who receive early intervention and treatment for physical, behavioral, for developmental health issues identified during well-visits. (Measures the impact on secondary and tertiary prevention)
  • Number of FQHCs and primary care practices that adopt for expand adolescent well-visit services based on the best practices, tools, and learnings disseminated from the Title V-funded FQHC initiative. (Measures the spread and replication of the FQHC model for adolescent preventive care)

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

PROCESS MEASURES:

  • Percent of funded FQHCs that have implemented appropriate services, materials, and environments to ensure the usability and acceptability of adolescent well-visits for youth populations. (Measures the health literacy of FQHC well-visit services)
  • Percent of funded FQHCs that engage youth and families from the community in the planning, implementation, and evaluation of adolescent well-visit services. (Measures the level of community ownership and patient-centered design)

OUTCOME MEASURES:

  • Percent of adolescents served by funded FQHCs who demonstrate increased health literacy, self-efficacy, and activation in managing their own health and healthcare as a result of the well-visit services and support received. (Measures the impact on empowering and engaging youth as active partners in their care)
  • Percent of overall adolescent healthcare spending in the community that is shifted from costly emergency and tertiary care to preventive and primary care services as a result of increased adolescent well-visit utilization at funded FQHCs. (Measures the long-term financial and system-level impact of investing in FQHC adolescent well-visit services)

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.

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.