The Michigan Evaluation of School-based Health (MESH) Project

The state of Michigan funds 45 clinical school-based and school-linked health centers, known as Child and Adolescent Health Centers, to provide a wide range of primary care, preventative, and early intervention services to more than 30,000 children at all grade levels throughout the State of Michigan. To date, there has been no state-wide evaluation to assess the impact of these centers on the health outcomes and health care costs of the children they serve.

The primary purpose of the Michigan Evaluation of School-based Health (MESH) Project is to evaluate the impact of state-funded clinical school-based health centers (SBHCs) on the health outcomes, school attendance, and healthcare costs of children attending the schools in which they are located. The evaluation is based on a sample of children in 16 middle and high schools both with and without SBHCs throughout the state of Michigan. The overall aim of the evaluation is to determine if students attending schools with health centers experience better outcomes and lower healthcare costs in the area of emergent care.

The MESH Project has three components:

  • An outcomes evaluation that assesses the impact of SBHCs on the health outcomes and school attendance of children
  • A process evaluation that documents the numbers and types of services that SBHCs deliver to middle and high school students in Michigan and the characteristics of the children served by SBHCs
  • A cost evaluation that assesses the impact of SBHCs on the health care costs of Medicaid-enrolled children

The outcomes evaluation uses a comparison group design in which the health outcomes and school attendance of children attending schools with SBHCs (intervention group) are compared to the outcomes of children attending matched schools without SBHCs (comparison group). Comparison schools were matched to intervention schools based on three criteria: racial and ethnic composition of the student body, number of students receiving free and reduced price lunch (a proxy for socioeconomic status), and school size.

The data sources for this study include:

  • Quantitative child survey (self-report of health status)
  • Quantitative parent survey (self-report of access to healthcare and child’s health status)
  • Qualitative interviews of school and clinic staff
  • Clinic service records
  • School attendance records
  • Medicaid claims records