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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
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Strategy. School-Based Health Centers

Approach. Establish school-based health clinics that provide education and comprehensive healthcare services on school campuses

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Overview. School-based health clinics that provide comprehensive healthcare services on school campuses can offer education on healthy behaviors, nutrition, and mental health as well as preventive services such as vaccinations, vision and hearing screenings, and dental checkups. The increased access to routine care can lead to increased receipt of essential health services, including reproductive health services, and improved management of disease conditions, such as asthma, for children and youth with unmet health needs who may not have otherwise accessed care.[1,2,3,4] Evidence suggests that school-based programs are an effective way to provide educational information, preventive services, and disease management for children and youth in need of care.

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. Peer-Reviewed Literature

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.

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. Individual/Family-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) established on school campuses. (Measures availability and access to services)
  • Number of SBHC staff trained to provide comprehensive care, health education, and vaccination services to students. (Assesses workforce capacity)

OUTCOME MEASURES:

  • Number of students who receive recommended vaccinations through SBHCs. (Measures impact on vaccination rates)
  • Number of students who access preventive care, health screenings, and management of chronic conditions through SBHCs. (Shows impact on comprehensive care)

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

PROCESS MEASURES:

  • Percent of SBHCs that meet national standards for quality and comprehensive service delivery. (Assesses adherence to best practices)
  • Percent of SBHC staff who demonstrate cultural competence and provide care in a trauma-informed manner. (Shows culturally responsive care)

OUTCOME MEASURES:

  • Percent of students with up-to-date vaccinations as a result of SBHC-based immunization programs. (Measures vaccination coverage impact)
  • Percent of students with chronic conditions who achieve better management and control through SBHC services. (Assesses impact on chronic disease outcomes)

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

PROCESS MEASURES:

  • Number of partnerships established between SBHCs, local health departments, and community healthcare providers to support care coordination. (Measures collaborative infrastructure)
  • Number of policies and funding mechanisms secured to sustain and expand SBHC operations. (Shows sustainability efforts)

OUTCOME MEASURES:

  • Number of schools that demonstrate improved student attendance, academic performance, and health outcomes as a result of SBHC services. (Shows education and whole child impact)
  • Number of communities that show increased vaccination rates and reduced disparities among school-aged children due to SBHC-based immunization programs. (Measures population health impact)

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

PROCESS MEASURES:

  • Percent of SBHCs located in schools serving predominantly students from backgrounds facing economic challenges and historically underserved communities. (Measures equity focus)
  • Percent of SBHCs that use data to identify and address health disparities among student subpopulations. (Shows data-driven equity practices)

OUTCOME MEASURES:

  • Percent reduction in vaccination coverage disparities between students from different socioeconomic backgrounds as a result of SBHC immunization efforts. (Measures equity impact)
  • Percent decrease in absenteeism and missed instructional time due to preventable illnesses among students utilizing SBHC services. (Shows impact on attendance equity)

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] Adams, E. K., Strahan, A. E., Joski, P. J., Hawley, J. N., Johnson, V. C., & Hogue, C. J. (2020). Effect of Elementary School-Based Health Centers in Georgia on the Use of Preventive Services. American journal of preventive medicine, 59(4), 504–512.

[2] Cicutto, L., Gleason, M., Haas-Howard, C., White, M., Hollenbach, J. P., Williams, S., McGinn, M., Villarreal, M., Mitchell, H., Cloutier, M. M., Vinick, C., Langton, C., Shocks, D. J., Stempel, D. A., & Szefler, S. J. (2020). Building Bridges for Asthma Care Program: A School-Centered Program Connecting Schools, Families, and Community Health-Care Providers. The Journal of school nursing : the official publication of the National Association of School Nurses, 36(3), 168–180.

[3] McCann, H., Moore, M. J., Barr, E. M., & Wilson, K. (2021). Sexual Health Services in Schools: A Successful Community Collaborative. Health promotion practice, 22(3), 349–357. [4] Dittus, P. J., Harper, C. R., Becasen, J. S., Donatello, R. A., & Ethier, K. A. (2018). Structural Intervention With School Nurses Increases Receipt of Sexual Health Care Among Male High School Students. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 62(1), 52–58.

[4] Dittus, P. J., Harper, C. R., Becasen, J. S., Donatello, R. A., & Ethier, K. A. (2018). Structural Intervention With School Nurses Increases Receipt of Sexual Health Care Among Male High School Students. The Journal of adolescent health: official publication of the Society for Adolescent Medicine, 62(1), 52–58.

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.