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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Medical Home: Usual Source of Sick Care.

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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 with this rating are most likely to be effective...

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 are recognized and promoted as a usual source of care for enrolled students. (Measures establishment of SBHCs as medical homes)
  • Number of children who identify SBHCs as their primary and usual source of preventive, acute, and chronic care. (Measures patient attribution to SBHCs for usual care)

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

  • Percent of SBHCs that meet state and national standards for medical home recognition and certification. (Measures quality and fidelity to usual source of care model)
  • Percent of SBHC visits and interactions that include comprehensive assessments, care planning, and follow-up consistent with medical home practices. (Measures adherence to usual care process)

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

  • Number of schools and districts partnered with Title V that adopt policies and budgets to sustain SBHCs as a long-term source of comprehensive student health services. (Measures institutionalization of SBHCs as usual source of care)
  • Number of cross-sector partnerships led by Title V (e.g., healthcare, public health, education) formed to support and integrate SBHCs as critical community resources for child health that report high levels of engagement. (Measures multi-partner investment in SBHCs as usual source of care)
  • Number of schools and communities that achieve sustained improvements in child health outcomes and resource utilization through SBHC medical home initiatives. (Measures long-term population health impact of SBHCs as usual source of care)
  • Number of states that reduce preventable ED visits, hospitalizations, and healthcare costs among children by investing in SBHCs as reachable medical homes. (Measures impact on healthcare utilization and spending)

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

  • Percent of schools and districts partnered with Title V that adopt policies and budgets to sustain SBHCs as a long-term source of comprehensive student health services. (Measures institutionalization of SBHCs as usual source of care)
  • Percent of cross-sector partnerships led by Title V (e.g., healthcare, public health, education) formed to support and integrate SBHCs as critical community resources for child health that report high levels of engagement. (Measures multi-partner investment in SBHCs as usual source of care)
  • Percent of schools and communities that achieve sustained improvements in child health outcomes and resource utilization through SBHC medical home initiatives. (Measures long-term population health impact of SBHCs as usual source of care)
  • Percent of states that reduce preventable ED visits, hospitalizations, and healthcare costs among children by investing in SBHCs as reachable medical homes. (Measures impact on healthcare utilization and spending)

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.