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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Medical Home: Care Coordination.

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Strategy. School Nurses

Approach. Implementing full-time nurses in schools can increase follow-up for treatment after vision screening and improve medical care coordination for children in the school environment.

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Overview. When schools have full-time nurses, a higher Percent of students are referred for possible vision problems and examined by a healthcare provider compared to schools with part-time nurses.[1] Teachers in schools with full-time nurses reported that follow-up of vision problems and getting glasses for students was the most beneficial activity performed by the nurses.[1]

Evidence. Emerging Evidence. Strategies based on emerging evidence show promise but have not undergone extensive testing. While these approaches demonstrate potential, their effectiveness remains unconfirmed. Prioritize rigorous monitoring to ensure they achieve desired outcomes for all MCH populations.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Parent/caregiver and teacher satisfaction surveys
  • School nurse activity logs
  • Vision screening follow-up and referral logs

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.
  • Health Care Access for All MCH Populations.

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. Referral and Follow-Up (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. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of schools implementing full-time nursing positions, particularly in under resourced communities. (Measures adoption of school nursing intervention)
  • Number of children receiving health screenings and care coordination from school nurses. (Assesses service delivery by school nurses)

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

  • Percent of school-based vision screenings adhering to evidence-based guidelines. (Measures fidelity of school nursing practice)
  • Percent of care coordination encounters involving clear communication between school nurses and medical providers. (Assesses effectiveness of care coordination process)

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

  • Number of school districts establishing policies to support full-time school nursing positions. (Assesses enabling systems for school nursing sustainability)
  • Percent of parents reporting high satisfaction with school nurses in managing their children's health needs after receiving training from Title V. (Shows family experience outcomes of school nursing)
  • Number of education agencies integrating school nursing into improvement plans and resource allocations. (Measures institutionalization of school nursing within education systems)
  • Number of healthcare payers establishing reimbursement models for school nursing services. (Assesses financing mechanisms for school nursing)

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

  • Percent of school nursing positions filled by nurses reflecting the composition of the student population. (Measures workforce composition in school nursing)
  • Percent of school nurses receiving training in care coordination who report increase in knowledge and/or skill. (Shows capacity-building in school nursing practice)
  • Percent decrease in health and educational opportunity gaps through tailored school nursing interventions. (Measures impact on advancing health)
  • Percent of students from multiple backgrounds feeling respected and supported in interactions with school nurses. (Assesses relational outcomes of school nursing)

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] Duff, C. L., & Poole, C. R. (2016). School Nurses: Coordinating Care Through a Community/School Health Partnership. NASN school nurse (Print), 31(6), 342–346. https://doi.org/10.1177/1942602X16639379

[2] Rodríguez, E., Srivastava, A., & Landau, M. (2018). Increasing Screening Follow-Up for Vulnerable Children: A Partnership with School Nurses. International Journal of Environmental Research and Public Health, 15(8), 1572. https://doi.org/10.3390/ijerph15081572

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.