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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Medical Home: Referrals.

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Strategy. School-Based Health Centers

Approach. Support School-Based Health Centers (SBHCs) 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] Research suggests that SBHCs can improve population health by addressing challenges to healthcare access and supporting academic outcomes.[5] A recent study found that a combined in-person and tele-delivered mobile school clinic is a novel innovation that increases access to acute care and reduces school absenteeism.[6]

Evidence. Scientifically Rigorous Evidence. Strategies based on scientifically rigorous evidence are proven effective across multiple robust studies. While success is highly likely, local impact may vary. Monitor outcomes and use data to tailor these strategies to the community's unique needs.

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:

  • Student and parent/caregiver satisfaction surveys
  • Student-reported measures on quality of care
  • SBHC activity 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. 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 establish formal referral protocols and agreements with community providers and specialists. (Measures development of referral infrastructure)
  • Number of SBHC staff trained on effective referral practices, including identifying needs, coordinating care, and facilitating transitions. (Measures workforce capacity for referral management)

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

  • Percent of SBHCs that use standardized referral forms and tracking systems to ensure clarity and accountability in the referral process. (Measures consistency and quality of referral practices)
  • Percent of families who report receiving clear and timely information about SBHC referrals, including the purpose, expectations, and follow-up plans. (Measures family engagement in referral process)

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

  • Number of SBHCs that implement electronic referral systems and health information exchange platforms to facilitate seamless care coordination. (Measures adoption of enabling technology for referrals)
  • Number of community coalitions and partnerships formed to strengthen referral networks and resources for children served by SBHCs. (Measures collaboration and collective action for improving referrals)
  • Number of communities that demonstrate increased utilization of preventive services, reduced duplication of care, and improved health outcomes through coordinated SBHC referral networks. (Measures population health impact of optimized referrals)
  • Number of states and payers that realize cost savings and efficiency gains by investing in SBHC referral management and care coordination infrastructure. (Measures economic and system-level impact of referral improvements)

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

  • Percent of SBHCs that implement electronic referral systems and health information exchange platforms to facilitate seamless care coordination. (Measures adoption of enabling technology for referrals)
  • Percent of community coalitions and partnerships formed to strengthen referral networks and resources for children served by SBHCs. (Measures collaboration and collective action for improving referrals)
  • Percent of communities that demonstrate increased utilization of preventive services, reduced duplication of care, and improved health outcomes through coordinated SBHC referral networks. (Measures population health impact of optimized referrals)
  • Percent of states and payers that realize cost savings and efficiency gains by investing in SBHC referral management and care coordination infrastructure. (Measures economic and system-level impact of referral improvements)

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.
[5] Lim, C., Chung, P. J., Biely, C., Jackson, N. J., Puffer, M., Zepeda, A., Anton, P., Leifheit, K. M., & Dudovitz, R. (2023). School Attendance Following Receipt of Care From a School-Based Health Center. The Journal of adolescent health, 73(6), 1125–1131.
[6] Nelson, R., Bhattacharya, S. D., & Hart, S. (2022). Combined in-person and tele-delivered mobile school clinic: A novel approach for improving access to healthcare during school hours. Journal of telemedicine and telecare, 28(2), 146–155.

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.