Strategy overview

  • Addressing student health and wellbeing needs at school: School-based supports for child health and wellbeing aim to help students be physically and emotionally ready to learn. Supports can include a wide range of medical services (including physicals, vaccinations, STI tests, and more); dental and vision care; therapy and other mental health services; and school-wide programming, including sexual health education, social-emotional instruction, and trauma-informed school reform.

  • Delivering support services in a school setting: A core tenant of many evidence-based supports is that they are delivered by external partners at school, either in permanent offices (like a school-based health clinic) or temporarily (i.e. a mobile dentist’s office). Locating support services in schools addresses several major barriers. First, physical proximity to such services minimizes transportation and time costs. Second, many services are delivered for free, eliminating a financial barrier. Third, by integrating support services into school operations, student and family awareness is significantly increased, further raising the chances they will participate.

  • Bringing the community into school: In many jurisdictions, community groups and residents play a major role in supporting student needs. Furthermore, some school-based services, like dentistry or vision care, may also be made available to the broader community. In some cases, a full-time community liaison is hired to identify and connect students and their families to key services that are available both in school and in the community and to manage partnerships with service providers.

  • Taking a whole-school approach: While many supports are delivered directly and privately to individual students, some comprehensive approaches, especially those associated with behavioral health, include school-wide reform and/or programming. For instance, community schools set school-wide goals and work with families and other partners to achieve them, like increased attendance. The trauma-informed school model provides training to staff to better support students who have experienced trauma, and also is used to shape discipline policies and curricula. Some individual care models also include school-wide workshops or courses on a range of health and wellbeing issues, such as reproductive health, mental health, and social-emotional skills.

Multiple rigorous systematic reviews and research syntheses of various school-based supports for child health and wellbeing found strong evidence that this strategy is associated with significant improvements in health and academic outcomes.

  • A 2019 research synthesis of community schools, which integrate school-based supports for child health and wellbeing into school operations, can be associated with improved academic performance, increased attendance, and a reduction in risky behavior.

  • A 2015 systematic review of rigorous evaluations of school-based health centers found that they are associated with improvements in a range of academic outcomes, including higher grade point average and high school graduation rates, and health outcomes, like increased use of contraception and preventative medicine, and reduced consumption of tobacco and alcohol.

  • A 2019 systematic review of school-based cognitive behavioral therapy found robust evidence that the practice is associated with reductions in student anxiety and depression, especially when treatment is delivered by mental health professionals instead of school staff.

  • A 2017 research synthesis found that school dental programs can reduce instances of cavities for all students, especially among low-income students and students in rural areas.

Before making investments in school-based supports for child health and well-being, city and county leaders should ensure this strategy addresses local needs.

The Urban Institute and Mathematica have developed indicator frameworks to help local leaders assess conditions related to upward mobility, identify barriers, and guide investments to address these challenges. These indicator frameworks can serve as a starting point for self-assessment, not as a comprehensive evaluation, and should be complemented by other forms of local knowledge.

The Urban Institute's Upward Mobility Framework identifies a set of key local conditions that shape communities’ ability to advance upward mobility and racial equity. Local leaders can use the Upward Mobility Framework to better understand the factors that improve upward mobility and prioritize areas of focus. Data reports for cities and counties can be created here.

Several indicators in the Upward Mobility Framework may be improved with investments in high-quality school-based supports programs. To measure these indicators and determine if investments in this strategy could help, examine the following:

Mathematica's Education-to-Workforce (E-W) Indicator Framework helps local leaders identify the data that matter most in helping students and young adults succeed. Local leaders can use the E-W framework to better understand education and workforce conditions in their communities and to identify strategies that can improve outcomes in these areas.

Several indicators in the E-W Framework may be improved with investments in high-quality school-based supports programs. To measure these indicators and determine if investments in this strategy could help, examine the following:

  • 6th grade on track: Percentage of students in grade 6 with passing grades in English language arts and math, attendance of 90 percent or higher, and no in- or out-of-school suspensions or expulsions.
  • 8th grade on track: Percentage of students in grade 8 with a GPA of 2.5 or higher, no Ds or Fs in English language arts or math, attendance of 96 percent or higher, and no in- or out-of-school suspensions or expulsions.
  • 9th grade on track: Percentage of students in grade 9 with a GPA of 3.0 or higher, no Ds or Fs in English language arts or math, attendance of 96 percent or higher, and no in- or out-of-school suspensions or expulsions.
  • Access to early intervention screening: Percentage of children with identified concerns who are connected to services or percentage of children needing selected special education services in kindergarten who were not identified and connected to services before kindergarten.
  • Access to health, mental health and social supports: Ratio of number workers or students to number of health, mental health, and social services FTE staff (for example, school nurses, psychologists, and social workers).
  • Mental and emotional well-being: Percentage of youth with mental or emotional health needs as identified by a universal screening tool.
  • Physical development and well-being: Percentage of students meeting benchmarks on self-rated surveys of physical health, such as the California Healthy Kids Survey Physical Health & Nutrition module.
  • Dedicated staff: Successful provision of school-based supports requires a staff member whose time is dedicated, at least in part, to the coordination of support services and to ensuring that the right student is receiving the right services at the right time. This may include leading processes to identify student needs, building partnerships with community organizations or external providers, engaging parents and guardians, and coordinating logistics. They may be employed by the school directly, or by the local government, district or a community-based organization and assigned to one or several schools. Ideally this coordinator has experience tailored to the environment of the school. For example, a school located in an area with a high prevalence of violence may seek coordinators with experience in trauma-informed practices or restorative justice.

  • Active family and community engagement: Seamless communication processes with community, family members and caregivers is imperative, particularly because services may be provided to the child at school for which a parent may normally be present if received outside of school, like visits to doctors or dentists. Efforts should build in processes to educate parents on services provided and receive consent. Processes and structures may be defined in order to enable the identification of needs and partnerships with new types of service providers. Ideally, families and community organizations can be involved in determining needs, allowing for hyper-local decision-making and allocation of resources.

  • Appropriate training and services for staff: Teachers and school staff should have proper certifications or be trained adequately for their role in providing services, in line with external standards for service providers like therapists, counselors, or registered nurses. It is also vital that staff members themselves are provided appropriate support and services to ensure their needs are met. Many evidence-based interventions require that educators and staff participate in the program–whether it be mindfulness training, group therapy sessions, or otherwise–before delivering to students. Others encourage staff to take advantage of mental health benefits, or provide other services to support the well-being of staff. Furthermore, schools should provide staff with adequate, paid time to complete training or carry out other required duties, such as collaborating with other staff on issues that arise with students.

  • Referral mechanisms for complex or long-term care: Some students may be in need of more extensive or ongoing services related to needs such as physical or mental health, housing insecurity, or family instability, than can be provided through the scope of the in-school program. Schools should establish processes to refer students to external doctors, dentists, or other support services to ensure continuity of care. This might include healthcare navigator programs, federally qualified health centers, or local nonprofits.

  • Services delivered during the school day: Providing access to services during the school day increases accessibility for students who may face barriers to participating at other times and frames supports, like group therapy, as a priority alongside academic classes. However, participation must be voluntary and disconnected from grades or mandatory academic evaluations to eliminate pressures students feel in other settings.

  • Small group sizes: Group-oriented interventions, like group therapy or leadership development, should maintain small group sizes in order to foster an environment where each student feels like they have space to contribute. Expert practitioners recommend no more than fifteen students per staff member.

  • Prioritize understanding and addressing individual needs: Centering equity requires a nuanced understanding of the context of individuals or specific groups of students. School-based supports should address needs revealed by examining school data and via direct engagement with students, teachers, families, and community organizations. In fully mature and operationalized Community School, for example, staff may recognize a specific need of an individual student and enlist community-based providers to ensure those needs are met.

  • Focus on opportunities and growth, not only basic needs: An unintended consequence of a hyper-focus on ensuring basic needs are met is that it can forestall necessary attention on providing students in under-resourced environments stretch opportunities in which they can grow. Dedicated effort should be made to ensure resources are allocated both to providing such opportunities, while still targeting resources at students with the greatest needs.

  • Ensure communications to students and families are accessible and thorough: A greater level of information and engagement may be required with students and families who are unfamiliar with the services being provided in school. Staff should be hired that speaks the same primary language of the broader community, and informational brochures and consent forms should be made available in the appropriate languages, as well as in both physical and digital forms. Students who are recent immigrants may need additional context on how medical or mental health processes work in the U.S. context. It may be required to account for longer appointment times for students to whom certain medical or dental services are new.

  • Minimize unnecessary information requests: Undocumented students and their families face particular barriers to receiving public services provided in other contexts. Healthcare, in particular, is a challenge, as they are ineligible to participate in the Affordable Care Act exchange, and may fear visiting other institutions due to the nature of information collected by providers. Schools have the advantage of generally being a trusted institution within communities. They should minimize the information collected when providing support services like healthcare to only information that is necessary to carry out care. Expert practitioners, for example, advise against requesting any type of identification numbers when providing services.

  • District leadership: Principals, superintendents, and other school officials play a vital role in establishing school-based supports as a priority and cultivating partnerships with community based organizations and other external partners that may provide services in the school setting. They are also critical in granting partner organizations access to facilities, data, and time during the school day to provide services to students.

  • School coordinators and liaisons: Parent liaisons, community school coordinators, and other school operations staff may be key partners in helping to facilitate the coordination of schedules across classrooms and service providers.

  • Teachers: Teachers often have the closest direct relationships with students and can play a critical role in identifying the needs of students. Their flexibility is also required when the provision of support services occurs during class time.

  • Community-based organizations and service providers: Nonprofits, government agencies, businesses, hospitals, universities and other types of institutions can all be valuable partners to provide in-school supports for students. Beyond the provision of services, community-based organizations can also serve as the link between the school and the community at large–helping ensure communication flows to school leadership and teachers about events that occur in the community that may affect students’ wellbeing.

  • Parents: Parental input and consent is a key aspect of providing support in-school to meet students’ needs. In some models, like Community Schools, they can also play a central role in identifying needs, establishing partnerships with providers, and coordinating support services.

  • Local healthcare providers: In some cases, students may require ongoing or advanced care that exceeds the scope of the services provided in-school. Schools and their partners should foster relationships with long-term providers, such as Federally Qualified Health Centers, primary care physicians, and others, in order to link students to needed services.

  • Utilize familiar channels to inform families of services and encourage participation: Existing channels, like parent-teacher conferences, may serve as effective opportunities to inform families about services that are available in-school. Schools can also leverage existing relationships between staff such as parent engagement coordinators, for example, to reach families. Channeling communications through organizations that are embedded within the community, like local nonprofits or faith-based institutions can also help increase awareness and utilization of services.

  • Cultivate teacher buy-in: Given the critical role of teachers, it is important that they are on-board and well-supported in participating in school-based supports efforts. Schools can use existing staff meeting time to conduct training and inform staff about services and processes rather than adding additional meeting time. Teacher voice should also be included in the design of logistics to ensure classroom disruption is minimized. Additionally, teachers should be allowed to use existing work hours to complete necessary training or participate in services themselves.

  • Seek blended funding sources: Funding for in-school services may come from a variety of sources, including district or municipal budgets, philanthropy, local nonprofits, or businesses that may provide services pro bono. School leadership or school coordinators may be responsible for seeking funding and resources from external sources, or for building relationships with local community organizing leaders who can facilitate relationships with the broader community.

  • Plan for expected attendance: For enrollment-based programs, plan for attrition and absences to maximize program utilization. Some experts recommend over-enrolling by roughly 20% to account for inevitable attrition. It is also important to align services to be compatible with the existing academic calendar or state-mandated testing schedule.

  • Enrollment, attendance, or number of students served: Metrics tied to achievement and well-being often take longer periods of time to show improvement, and outcomes related to well-being can be very difficult to measure. Schools that are earlier in their journey to provide support services in school should look to output metrics that indicate how well-utilized the provided services are. Attendance can be viewed both in terms of program attendance, for interventions like weekly group therapy programs, or general school attendance, which may be an indicator that students need support or have unmet needs.

  • Staff participation: Some school-based supports, like trauma-informed schools, require staff participation both to implement the intervention with students, but also as participants and recipients of services themselves. Staff participation in training, mindfulness or group therapy sessions, may be critical to the overall success.

  • Social-emotional learning indicators or holistic student assessment: Assessments that measure indicators like action orientation, perseverance, critical thinking, empathy, and learning interest can give a holistic picture on student well-being. Assessment tools that may be employed include the Survey for Academics and Youth Outcomes and Holistic Student Assessment.

  • School health assessments: In addition to collaborative needs identification with families and caregivers, schools can also utilize assessments to identify opportunities to improve school health programs and policies, such as the CDC’s School Health Index self assessment tool.

  • Grades: One goal of school-based supports is to enable academic achievement. Grades may serve as a measure of how successfully a student is participating in class, and they are also a strong predictor of high school graduation. They may be a more effective indicator than standardized test scores, which measure attainment of specific academic material. Experts caution that it may take time for grade improvement to occur.

Evidence-based examples

Individual-, group-, and community-level programming promoting healthy sexual behavior
Stable and healthy families

Evidence varies across specific models

Check & Connect (C&C) is a school-based, student engagement and mentoring program that aims to increase attendance and reduce dropout for K-12 students.
Elementary and middle school success High school graduation
Holistic approach leveraging community partnerships to support student well-being
Elementary and middle school success High school graduation
Community- or school-based programming on protection against sexually transmitted infections (STIs)
Stable and healthy families

Evidence varies across specific models

Diplomas Now is a school reform model that seeks to improve student attendance, behavior, and academic performance.
Elementary and middle school success High school graduation Post-secondary enrollment and graduation
Clinic- or school-based short-term intervention program for youth who have been referred by juvenile justice, mental health, school, or child welfare systems
Stable and healthy families
Helping children and adults build behavioral skills and social support systems to encourage physical activity
Stable and healthy families
Healthy living and nutrition education classes, increased physical activity opportunities, and school-wide promotion of healthy food options
Elementary and middle school success High school graduation Stable and healthy families

Evidence varies across specific models

Fully-subsidized and nutritious breakfast at school, often involving culturally relevant practices and food options
Kindergarten readiness Elementary and middle school success High school graduation Stable and healthy families
On-site clinics or partnerships that provide dental care to students
Kindergarten readiness Elementary and middle school success High school graduation
School-based gardens that host programming including nutrition education, food preparation lessons, and tasting opportunities
Elementary and middle school success High school graduation Stable and healthy families
Health care services provided on school premises
Kindergarten readiness Elementary and middle school success High school graduation
Curriculum and activities that focus on students' social-emotional development
Elementary and middle school success High school graduation

Evidence varies across specific models

Teaching self-awareness, improving emotional self-control, building self-esteem, and more
High school graduation Elementary and middle school success Stable and healthy families Supportive neighborhoods

Evidence varies across specific models

Providing free comprehensive vision screenings and eyeglasses in K-12 schools.
Elementary and middle school success High school graduation
Curriculum to develop social skills, positive character traits, and nonviolent and drug-free norms among K-12 students
High school graduation Supportive neighborhoods
School culture and climate reforms to ensure safe learning environments
High school graduation Elementary and middle school success

Evidence varies across specific models


Results for America would like to thank the following contributors who lent their expertise to the creation of this resource:

  • Dr. Micere Keels: Dr. Micere Keels is a professor in the Department of Comparative Human Development at the University of Chicago. Her research focuses on understanding how sociodemographic characteristics (race-ethnicity and poverty, in particular) structure the supports and challenges that individuals experience. She is particularly invested in systems-change interventions.
  • Julian Huerta: Julian Huerta is the Vice President of Community Programs at St. David’s Foundation. Julian develops and implements the Foundation’s portfolio of direct service programs, including the Mobile Dental Program. Julian previously served as Deputy Executive Director at Foundation Communities, Central Texas’ largest nonprofit provider of affordable housing with supportive services. Julian received his Bachelor of Arts from the University of the Incarnate Word, and he has also completed the NeighborWorks Achieving Excellence Program at Harvard University.
  • José Munoz: José Muñoz joined IEL as the director of its Coalition for Community Schools initiative in 2017. He brings over 25 years of cross-sector partnership experience for youth, family, and community development across the US. Before IEL, he was the ABC Community School Partnership executive director. In this role, José strategically scaled up the community schools strategy from 4 to 26 schools in five years, securing over $3M through successful policy advocacy. In 2014, José won the first Community Schools Initiative Leadership Award.
  • Dr. Katheleen Provinzano: Kathleen Provinzano (she/her) is an Associate Professor in the College of Community and Public Affairs at State University of New York - Binghamton University,Her research interests are associated with urban comprehensive school transformation, specifically, full-service community school strategies. Resultantly, she studies leadership dynamics in full-service community schools, the impact of integrated student supports on student learning and behavior outcomes in community schools, and the reciprocal influence of community school programming on local neighborhoods.
  • Garrett Webster, Sr.: Garrett Webster is the Executive Director of Youth Guidance in Kansas City. He leads the implementation of Becoming a Man (BAM) and Working on Womanhood (WOW), school-based group counseling and mentoring programs with multiple school districts across the metro area. The evidence-based programs target students in grades 6-12 who have been exposed to traumatic stressors and who face social, behavioral, cognitive, or emotional challenges. Youth Guidance serves over 13,000 youth across 9 states and the United Kingdom. His leadership opens doors for students and families to access quality education and sets the stage to prepare for college, career and life.