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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Early Prenatal Care.

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Strategy. School-Based Health Centers with Reproductive Health Services

Approach. Collaborate with School-Based Health Centers. (SBHC) with reproductive health services to increase prenatal care visits to pregnant teens.

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Overview. School-Based Health Centers (SBHCs) provide a variety of healthcare services to students. Many middle and high school-based clinics offer reproductive services, which generally include abstinence and contraception counseling, pregnancy and sexually transmitted infections. (STIs) testing, and may also include distributing contraceptives. Some clinics offer prenatal care.[1] SBHCs are most frequently located in urban and rural neighborhoods with residents of lower socioeconomic status;[2, 3] in 2022, about 70% of students attending schools with SBHCs were ethnic nationalities.[4]

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some 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.
  • Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
  • 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. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

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 School-Based Health Centers (SBHCs) staff trained on providing or referring pregnant teens to prenatal care services. (Indicates capacity building for coordinated care)
  • Number of outreach events or campaigns conducted by SBHCs partnered with Title V to raise awareness about the importance of early and regular prenatal care for pregnant teens. (Shows efforts to promote prenatal care utilization)

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

PROCESS MEASURES:

  • Percent of School-Based Health Centers (SBHCs) staff trained on providing or referring pregnant teens to prenatal care services. (Indicates capacity building for coordinated care)
  • Percent of partnerships convened by Title V between community organizations and SBHCs to provide comprehensive support services for pregnant teens. (Shows the breadth of multi-sector partnerships for holistic care)

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

PROCESS MEASURES:

  • Number of School-Based Health Centers (SBHCs) staff who report increased knowledge and skills in supporting pregnant teens to access prenatal care. (Indicates the impact of training and capacity building efforts)
  • Number of referrals to prenatal care services made by SBHCs partnered with Title V that result in prenatal care initiation by pregnant teens. (Shows the effectiveness of referral and care coordination process)

OUTCOME MEASURES:

  • Number of pregnant and parenting teens who remain engaged in school or graduate as a result of support received through School-Based Health Centers (SBHCs) prenatal care collaborations convened by Title V. (Indicates the approach's impact on educational attainment)
  • Number of pregnant teens identified and served by School-Based Health Centers (SBHCs) through prenatal care collaborations conveneded. (Indicates the reach and scale of the approach)

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

PROCESS MEASURES:

  • Percent of prenatal care services and resources provided through School-Based Health Centers (SBHCs) collaborations convened by Title V that are appropriate for all teen populations served. (Indicates the responsiveness of care)
  • Percent of SBHC prenatal care collaborations that include sustainable funding mechanisms and resource-sharing agreements. (Shows the long-term viability and institutional commitment to the approach)

OUTCOME MEASURES:

  • Percent of pregnant and parenting teens who remain engaged in school or graduate as a result of support received through School-Based Health Centers (SBHCs) prenatal care collaborations convened by Title V. (Indicates the approach's impact on educational attainment)
  • Percent of pregnant teens identified and served by School-Based Health Centers (SBHCs) through prenatal care collaborations conveneded. (Indicates the reach and scale of the approach)

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] Strunk 2008 - Strunk JA. The effect of school-based health clinics on teenage pregnancy and parenting outcomes: An integrated literature review. The Journal of School Nursing. 2008;24(1):13-20.

2 NBER-Lovenheim 2016 - Lovenheim M, Reback R, Wedenoja L. How does access to health care affect teen fertility and high school dropout rates? Evidence from school-based health centers. National Bureau of Economic Research (NBER). 2016: Working Paper 22030.

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

4 SBHA-SBHC - School-Based Health Alliance (SBHA). Findings from the 2022 national census of school-based health centers (SBHCs). 2023.

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.