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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Medical Home: Personal Doctor or Nurse.

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Strategy. School-Based Health Centers

Approach. Support School-based health centers in increasing access of care for children.

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Overview. School-based health centers (SBHCs) provide elementary, middle, and high school students a variety of healthcare services on school premises or at off-site centers linked to schools. Teams of nurses, nurse practitioners, and physicians often provide primary and preventive care, including well-child visits, vaccinations, and sports physicals, along with mental healthcare, sick visits, and sexual health education.[1] 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, diabetes, and obesity. Most patients treated at SBHCs are children insured by Medicaid or children without insurance.[2, 3] SBHCs are most common in urban areas and may be funded at the federal, state, or local level.[4] State policies vary regarding which services may be provided to a student without a parent or guardian present.[1]

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective...

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

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 Outcomes. This strategy helps contribute to reducing avoidable differences among socioeconomic and demographic groups or geographical areas in health status and health outcomes such as disease, disability, or mortality.

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. 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 SBHCs that offer comprehensive primary care services provided by a consistent doctor or nurse. (Measures availability of personal care providers in SBHCs) Number of SBHC staff trained in providing patient-centered, relationship-based care as personal providers. (Measures workforce capacity for personal care in SBHCs)

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

  • Percent of SBHCs that have a defined process for assigning and introducing children to their personal doctor or nurse. (Measures systematic implementation of personal care model) Percent of children and families who are aware of and understand the role and benefits of having a personal provider at SBHCs. (Measures patient and family engagement in personal care model)

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

  • Number of schools and districts that integrate personal provider assignments and communications into their student information and family engagement systems. (Measures cross-sector coordination to reinforce personal care model) Number of community providers and specialists who establish collaborative agreements led by Title V with SBHC personal providers to ensure coordinated care for children. (Measures development of personal care networks and teams) Number of schools that experience improved student health, attendance, and academic performance as a result of SBHC personal provider programs. (Measures impact on school and student outcomes) Number of communities that strengthen their primary care and public health systems by leveraging SBHCs as reachable, trusted sites for personal care delivery. (Measures broader population health impact of personal care in SBHCs)

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

  • Percent of SBHC personal providers who reflect the linguistic and socioeconomic makeup of the student populations served. (Measures workforce representation) Percent of students and families who are actively engaged in designing and improving personal care delivery at SBHCs. (Measures participatory approaches to personal care) Percent reduction in health differences between student populations with differing levels of healthcare access through personal care delivery at SBHCs. (Measures impact on personal care) Percent of SBHC personal providers who consistently demonstrate sensitive, trauma-informed practices. (Measures workforce capacity)

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] Zwiebel 2022 - Zwiebel H, Thompson LA. What are school-based health clinics? JAMA Pediatrics. 2022;176(4):428.

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

3 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.

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.