School Health Services National Quality Initiative

About the School Health Services National Quality Initiative

In September 2014, the School-Based Health Alliance and the Center for School Mental Health (CSMH) were jointly awarded a four-year cooperative agreement from the Maternal and Child Health Bureau (MCHB), Division of Child, Adolescent, and Family Health, Adolescent Health Branch. This agreement will help expand the number of school-based health care (SBHC) centers and comprehensive school mental health programs (CSMHPs), improve the quality of services they provide, and strengthen their sustainability by developing a set of national standardized performance measures.

Historically, SBHC centers and CSMHPs have not documented or reported standardized performance measures at the national level.  However, several states have been required to report performance measurement data as a requirement of state government funding. Many of these state initiatives have been successful in driving quality improvement and supporting the sustainability of the model; but there is variability across states in the types of data being reported.

We think this work has the potential to transform SBHC: standardized measures will allow health centers to compare themselves nationally and statewide, which in turn will drive quality improvements and, ultimately, the sustainability of the model. – John Schlitt, President


We aim to see a minimum of 50% of all SBHC centers and CSMHPs voluntarily contributing performance measurement data across the United States by the end of the second and fourth year of the project, respectively. Additionally, by the end of the fourth year of grant, our goal is to increase the numbers of SBHC centers and CSMHPs by 30%.

Project Description

The School-Based Health Alliance and CSMH will lead a group of project advisors and key stakeholders through a process to establish consensus on a set of national performance measures that capture the services being delivered by SBHC and CSMHPs. Both of the partner organizations will lead two cohorts of SBHC centers or CSMHPs, each completing a 15- to 18-month cycle.

Project Updates

Get Ready! SBHC Offered Opportunity to Practice Reporting Performance Measures (Winter 2017)

From mid-January to mid-February 2017, the School-Based Health Alliance will offer school-based health care (SBHC) centers the opportunity to practice reporting the five performance measures for SBHC through its Quality Counts data portal.

Read more about reporting the performance measures .

To learn more, please join the webinar “Quality Counts: Practice Reporting the Five Performance Measures for SBHC,” scheduled for 2:00pm Eastern on January 12, 2017. Presenters from the School-Based Health Alliance will discuss the importance of Quality Counts and what the initiative makes possible for the field as well as the nuts and bolts of entering data into the Alliance’s Quality Counts data portal.

Alliance to Host Webinar Series to Help Prepare SBHC Centers for Reporting the Performance Measures (Fall 2016)

The School-Based Health Alliance will host a series of webinars starting in September 2016 to help school-based health care (SBHC) centers adopt and report the performance measures. During these webinars, attendees will have the opportunity to ask questions and share successes and challenges with one another. This sharing it essential to helping us improve.

Read more about the webinar series.

Join us for a series of webinars in the fall of 2016 to learn about:

  • The five performance measures for SBHC and promising strategies to improve the care being delivered.
  • Tips on how to set up your electronic health record (EHR) to collect data and how to report data to the School-Based Health Alliance.
  • Understand what data is being collected and when as well as how data will be used and how privacy will be protected.

SBHC Call to Action: Join the Quality Counts Movement! (Summer 2016)

We are challenging the school-based health care (SBHC) field to join the “Quality Counts” movement and voluntarily adopt and report the five performance measures for SBHC.

Learn more about the Quality Counts movement.

Central to the School Health Services National Quality Initiative (NQI) is the adoption of the first-ever set of standardized performance measures by SBHC providers. Collecting standardized data from SBHC providers nationwide will help to describe the quality of care being delivered in SBHC at the national level and demonstrate our collective impact to advocate for increased support of the model.

For this initiative to be successful, we need your participation. All SBHC centers are encouraged to begin planning for performance measure reporting. As a first step, we created “Quality Counts,” an online guide providing background information and resources to help set your plans in motion. Access it to:

  • review of the five core performance measures for SBHC;
  • learn about promising strategies to improve the care being delivered;
  • view tips on how to set up your EHR to collect data and how to report data to the Alliance;
  • understand what data is being collected and when;
  • how data will be used and how privacy will be protected; and
  • register for upcoming Quality Counts webinars or view archived webinars.

Use the “Quality Counts” menu located at the top right of this page to access the online guide.

Congratulations to the First Cohort of NQI CoIIN Teams! (Fall 2015)

We are excited to announce the eight teams selected to participate in the first cohort of the School Health Services National Quality Initiative (NQI) Collaborative Improvement and Innovation Network (CoIIN) learning collaborative!

Read more about the first cohort.

These teams will learn from each other and experts in the field to collectively make improvements in two focus areas:

  • Standardized Performance Measures: Building the capacity to document and report the first-ever standardized set of national performance measures for SBHC
  • Sustainable Business Practices: Improving how SBHC centers position themselves in today’s health care marketplace by implementing business-savvy practices

The eight participating teams represent two School-Based Health Alliance state affiliate organizations, four state or county departments of health and public health, 22 sponsoring organizations, and more than 60 participating school-based health care (SBHC) centers in eight different states. We are thrilled to be engaging such a diverse network of highly motivated individuals from across the country committed to achieving excellence in school health care.

Members of the Standardize Performance Measures Team include:

  • Colorado Department of Public Health and Environment
    Team Champion: Kristina Green
  • Public Health – Seattle and King County School-Based Partnership Program
    Team Champion: Sara Rigel
  • Connecticut Department of Public Health and Connecticut Association of School Based Health Centers
    Team Champions: Mark Keenan and Jesse White-Fresé
  • North Carolina School-Based Health Alliance
    Team Champion: Stephanie Daniel

Members of the Sustainable Business Practices Team include:

  • Bassett Healthcare Network, Cooperstown, New York
    Team Champion: Chris Kjolhede
  • Growing Well, Cincinnati, Ohio
    Team Champion: Francie Wolgin
  • YMCA of the East Bay, Richmond, California 
    Team Champion: Tracy Ward
  • Minnesota Department of Health, Child and Adolescent Health Section
    Team Champion: Julie Neitzel Carr

Thank you to all who applied to participate in the NQI CoIIN! Continue to watch for updates from cohort one and be sure to look for the opportunity to apply to participate in cohort two in spring 2016.

SBHC Performance Measures Selected (Spring 2015)

Listed below are the five performance measures for school-based health care (SBHC) centers. By reporting standardized data to the School-Based Health Alliance, SBHC centers will be able to compare themselves at local, state, and national levels and assess their strengths and areas for improvement.

Read more about the performance measures and the selection process.

Performance Measure #1: Annual well child visit.
Performance Measure #2: Annual risk assessment.
Performance Measure #3: Body Mass Index (BMI) screening and nutrition/physical activity counseling.
Performance Measure #4: Depression screening and follow-up.
Performance Measure #5: Chlamydia screening.

An explanation of each performance measure, including its definition, numerator and denominator, source of the definition, and relevant claim/encounter codes is now available. In addition, access this page to learn about promising strategies for centers to improve the care they deliver.

Performance Measure Selection Process
The process of selecting a set of standardized performance measures for SBHC evolved in two phases and engaged members of the SBHC field at every step.

First, Alliance staff conducted interviews with national child quality experts, reviewed current literature, and assessed measures with relevance to the populations served by SBHC within national measurement frameworks, including  and . Alliance staff also completed interviews with representatives from state governments that require funded SBHC centers to report performance measurement data. The types of measures required by state governments were compared with the types of measures included in the aforementioned national child health initiatives and narrowed down to eleven potential measures.

Second, in spring and summer 2015, 90 SBHC stakeholders used the Delphi method, an evidence informed process developed by the RAND Institute and University of California, Los Angeles, to gain consensus on a set of SBHC performance measures. Stakeholders included:

  • School-Based Health Alliance members, board, and staff;
  • NQI project advisory group members and expert faculty;
  • SBHC providers and administrators;
  • State affiliate organizations representatives;
  • State government offices that fund SBHC; and
  • Educators and payers.

During three consecutive rounds of scoring, participants were asked to prioritize the measures based on their importance, sensitivity, feasibility, and usability. Through this process, five measures were selected to document SBHC performance: well-child visits, risk assessments, body mass index assessments, depression screens, and chlamydia screens.

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number: U45MC27804 and title: State Adolescent and Young Adult Health Capacity Building Program for $2.8 million. 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.

Agency for Healthcare Research and Quality’s Children’s Health Insurance Program Reauthorization Act (CHIPRA) Core Set of Children’s Health Care Quality Measures 
National Committee for Quality Assurance’s Healthcare Effectiveness Data and Information Set