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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Work Together with Equity Tools

MCH Best LogoThe third component of the MCH Evidence Center conceptual model calls us to work together to ensure that programs are moveable within the realities of Title V programs and lead to health equity for all people. This strengths-based approach draws on implementation tools designed for MCH populations. Use this page to access specific approaches and tools that the Evidence Center uses to advance health equity and address social determinants of health (SDOH) through our Ready, Set, Go approach.

1. READY: Learn the basics to address health equity and SDOH.

Video. Start here to learn about specific tools and approaches used by Title V agencies.

Resources to Accompany Video. Access the following resources referenced in the video:

Trainings. The MCH Navigator, the National MCH Workforce Development Center, and the MCH Digital Library have aggregated learning opportunities that conceptualize health equity and SDOH and provide actionable steps to integrate into Title V programs.

Strategies for Promoting Health Equity in Your State: Ten Steps and Examples from the MCH Workforce Development Center

Strategies for Promoting Health Equity in Your State. A commonly asked question across states is “What strategic steps can we take to advance health equity at our health department?” In response to this need in the field the MCH Navigator in collaboration with the National MCH Workforce Development Center (WDC) created this learning opportunity to assist MCH professionals in answering that question. Originally several presentations focused on health equity conducted by the WDC, we have separated them into multiple sections for easier access and the ability for learners to quickly locate specific sections of interest. This resource is formatted to include the following "Health Equity Strategies" section: an introduction and 10 individual strategies to achieve health equity.

In addition, the WDC has developed a portal on health equity. Goal Two of MCHB's Division of MCH Workforce Development focuses on Diversity and Health Equity - Prepare and empower MCH leaders from diverse communities to promote health equity, wellness, and reduce disparities in health and health care. This includes: (1) recruitment and retention of faculty, trainees and program staff from racial and ethnically diverse and underserved backgrounds; (2) training awareness of disparities and inequities through curricula, research, learning, practice and service environments; and (3) integration of cultural and linguistic competence in all aspects of training, learning, practice and service. The Center includes a focus on health equity in all of its work and resources. The following are some online resources to guide your work to include health equity into your daily work.

Diversity and Health Equity Learning Spotlight: Through the Lens of the MCH Leadership Competencies

Diversity and Health Equity Learning Spotlight. Issues focused on diversity and health equity are woven into the MCH Leadership competencies, which form the structure of the trainings collected in this resource. These approaches augment the HHS Action Plan to Reduce Racial and Ethnic Health Disparities, which promotes integrated approaches, evidence-based programs, and best practices to reduce these disparities in the context of Healthy People 2030 and other national initiatives to improve health equity.

MCH Digital Library Resources: A Repository of Online Resources for Professionals and Families

2. SET: Utilize tools to integrate health equity and SDOH into your work.

The MCH Evidence Center uses the Hays Addressing Model in focusing our health equity work and in choosing tools from the field that are easy to use and address the diversity of MCH populations.

Hays Model - described in text

Tools. The Center has identified and uses the following tools in work with Title V agencies to ensure that new and ongoing strategies reflect the needs of all populations, advance health equity, and address SDOH.

Collaborating for Equity and Justice Toolkit: Case Studies, Resources, and Tools

Collaborating for Equity and Justice Toolkit. This toolkit includes case studies, resources, and tools related to the 6 core equity principles. The Community Tool Box has also created a Data Collection for Implementation Equity assessment form that asks 5 questions to consider when deploying new strategies. Do your strategies, outcomes, and determinants:

  • Explicitly address issues of social and economic injustice and structural racism?
  • Employ a community development approach in which residents have equal power in determining the coalition or collaborative’s agenda and resource allocation?
  • Employ community organizing as an intentional strategy and as part of the process?
  • Build on community-engaged scholarship and research that shows what works, acknowledges its complexity, and evaluates it appropriately?
  • Build core functions for the collaborative base on equity and justice that provide basic facilitating structures and build member ownership and leadership?
  • The process is outlined in this presentation: Using Data to Promote Equitable Implementation: Decision-Making, Data, and Uncertainty in Complex Systems.

Community Commons: Our Favorite Equity Data Tools

Our Favorite Equity Data Tools (Community Commons). The resources required for a healthy life are not distributed equally within or between communities. The Community Commons believes that through data we can better understand our community conditions and opportunities to advance equity.  This resource aggregates data tools across SDOH.

Cultural Competence: Tools from the National Center for Cultural Competence

Disparities Impact Statement: A Five-Step Worksheet from CMS

Disparities Impact Statement (Centers for Medicare and Medicaid Services). This tool can be used by all health care stakeholders to achieve health equity for racial and ethnic minorities, people with disabilities, sexual and gender minorities, individuals with limited English proficiency, and rural populations. The worksheet has five steps: (1) identify health disparities and priority populations; (2) define your goals; (3) establish your organization's health equity strategy; (4) determine what your organization needs to implement its strategy; and (5) monitor and evaluate your progress.

Family Engagement: A Systems Assessment Tool

Family Engagement Systems Assessment Tools (Family Voices). This assessment tool tracks family engagement in health care systems and created supporting materials to assist in the recruitment of and meaningful engagement with families to improve systems of care, programs, and policies. The toolkit includes the assessment tool, instructions, score sheet, and related resources. Users can contact Beth Dworetzky for technical support around the use of the tools.

Health Equity Report Card: Create Your Local Report

Health Equity Report Card. (Salud America!). By using this interactive guide, users can pull county data on a variety of health-related conditions compared to the rest of one's state and the nation. The data show how each area ranks up in housing, transportation, poverty, healthcare, mental health, environmental issues, and access to healthy food and active spaces.

Hexagon Tool: A Six-Step Process

Hexagon Tool. This planning and evaluation tool guides the selection of the appropriate, evidence-based/informed strategies through a six-step exploration process. It can be used in collaboration with your partners to better understand how a new or existing program fits into your existing work, context, and health equity priorities.

Is My Implementation Practice Culturally Responsive: A 38-Question Assessment

Is My Implementation Practice Culturally Responsive? This instrument is designed to provide implementation science practitioners with a point-in-time assessment of the degree to which their current practice incorporates the principles and methods for conducting work using a cultural responsive and racial equity lens. Because the utilization of this lens requires an ongoing process of learning, reflecting, and adjusting, the instrument is intended to provide the greatest insight when repeated at regular intervals to identify changes in areas of strength, as well as targets for growth. The assessment consists of 38 statements describing tasks that support the core tenants related to conducting work using a cultural responsive and racial equity lens. For each task statement, indicate how often your implementation work over the past year incorporated the activity described.

People with Lived Experience: Six Considerations when Making Evidence-Based Decisions

Six Considerations for Centering People with Lived Experience When Making Evidence-Based Decisions: Planning Tool (AMCHP). This tool supports individuals and teams to intentionally center and partner with people with lived experience (PWLE) during initial conversations related to the evidence-based decision making (EBDM) process.  This ensures that decision making processes guided by those directly impacted by the outcomes of these decisions. Learn how to use the planning tool through this online training: Shifting Power in Practice: Strategies for Centering People with Lived Experience When Making Evidence-Based Decisions e-Learning Module.

Promoting Health Equity: A Resource to Help Communities Address SDOH

Promoting Health Equity: A Resource to Help Communities Address SDOH (CDC). This workbook was created to encourage and support the development of new and the expansion of existing, initiatives and partnerships to address SDOH. It reflects the views of experts from multiple arenas, including local community knowledge, public health, medicine, social work, sociology, psychology, urban planning, community economic development, environmental sciences, and housing. It is designed for a wide range of users interested in developing initiatives to increase health equity in their communities.

REIA: Race Equity Impact Assessment Tool

Race Equity Impact Assessment (REIA) Tool (MPHI and the Implementation Group). A systematic examination of how different racial and ethnic groups will likely be affected by a proposed action or decision. REIAs are used to minimize unanticipated adverse consequences in a variety of contexts, including the analysis of proposed policies, institutional practices, programs, plans and budgetary decisions. The REIA can be a vital tool for preventing institutional racism and for identifying new options to remedy long-standing inequities. Race Forward summarizes the REIA process that includes five questions:

  • Are all racial/ethnic groups who are affected by the strategy at the table?
  • How will the proposed strategy affect each group?
  • How will the proposed strategy be perceived by each group?
  • Think about how the strategy affects existing disparities. Does the strategy ignore existing disparities? Could it possibly worsen existing disparities?
  • Based on the above responses, what revisions are needed in the strategy under discussion? Don’t be afraid to re-think the strategy in light of addressing disparities – it’s worth it!

SDOH Crosswalks: Linking the Ten Essential Public Health Services to Addressing SDOH

Resources Linking the Ten Essential Public Health Services to Addressing Social Determinants of Health. This factsheet summarizes SDOH and updates the CDC document below in presenting examples of addressing SDOH related to each of the essential public health services. It also includes evidence-based resources from the field.

At-A-Glance: Ten Essential Public Health Services and How they Can Include Addressing SDOH. This brief document is intended to help public health agencies embed SDOH efforts as part of their portfolio in protecting the health of communities that they serve. A simple two-column table helps illustrate the relationship between addressing SDOH inequities and the Ten Essential Public Health Services.

SDOH Screening and Policy Tools: Multiple Tools with Common Goals

HealthBegins screening tool from the Association of American Medical Colleges is designed to spark discussions among healthcare providers about incorporating SDOH data to better inform patient care. The tool consists of questions on topics such as education, employment, social support, immigration, and violence.

Health-Related Social Needs Screening Tool (AHC-HRSN) from the Centers for Medicare & Medicaid Services is meant to be used for individual respondents who answer the questions themselves. A parent or caregiver can answer for an individual, too, if that makes more sense. Clinicians and their staff can easily use this short tool as part of their busy clinical workflows with people of all different ages, backgrounds, and settings.

Leveraging Evidence-Based Policies to Improve Health, Control Costs, and Create Health Equity from the Trust for America's Health outlines role of social determinants in Americans’ health and calls for adoption of policies to improve health outcomes, control healthcare spending, and create health equity.

Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences tool (PRAPARE) from the National Association of Community Health Centers includes 15 core questions and 5 supplemental questions. The data can be directly uploaded into many electronic health records as structured data. It is generally administered by clinical or non-clinical staff at the time of the visit, but a paper version can be given to the patient to self-administer.

Social Determinant of Health Screening Tools with Validity-Related Data from the University of North Carolina includes descriptions and links to SDOH screening tools that address both single and multiple domains. The tools can be used to identify adult SDOH questions that produce consistent, true, and correct results as verified by validity-related data.

Social Needs Screening Tool/EveryONE Project from the American Academy of Family Physicians offers short- and long-form in English and Spanish, The short-form  includes 11 questions. It can be self-administered or administered by clinical or non-clinical staff.

Systems Change: "The Water of Systems Change" Approach

The Water of Systems Change Action Learning Exercise from FSG Consulting is designed to help individuals think systemically about social change, explore what is happening below the surface, and determine how they and their organizations can pursue large-scale change in a disciplined and holistic manner. The exercise is divided into three parts: Part I performs an external assessment of opportunities; Part II uses the same framework to consider internal conditions; Part III looks at “What to do next?”

Prior to engaging in this exercise, all participants are encouraged to read the article The Water of Systems Change by John Kania, Mark Kramer, and Peter Senge.

3. GO: Integrate health equity and SDOH into RBA planning.

The MCH Evidence Center uses the Results-Based Accountability (RBA) as one way to identify root causes of population-based issues, develop responsive strategies to bring about change, and establish measures that can be quantified, brought to scale, and replicated across population groups. These tools integrate health equity considerations into RBA processes.

RBA Tools - Decorative

Turn-the-Curve Tool: Developing Population-Level Strategies

Turn-the-Curve (TTC) Strategy Tool. Use this tool to develop new strategies that align with your population needs and advance each NPM. TTC is a quick method to strategically think about your needs assessment data and develop strong measures to assess progress we make in changing the trajectory of your work. There are five basic steps to the TTC activity that can be adapted to meet your team’s needs:

  1. Graph or describe the trend of data associated with your outcome.
  2. Analyze and describe the story behind the curve to give your outcome some background and context.
  3. Identify existing and new partners who have a role to play in improving the data.
  4. Brainstorm what works to address the contributing factors and turn the curve.
  5. Develop and implement a comprehensive action plan that includes strong measures.

ESM Quadrant Measurement Tool: Assessing Performance-Level Strategies

ESM Quadrant Measurement Tool. Use this tool to develop strong ESMs to measure your strategies.

Results-Based Accountability (RBA) provides an intuitive framework to help you move from reporting "what did we do?" to "how well did we do it?" and eventually to "is anyone better off from our efforts" and"“how are they better off?." Measuring "what did we do" is the simplest form of measurement and should be avoided as much as possible. Measuring how MCH populations are "better off" is the desired goal of ESMs and leads to reporting impact. RBA provides four quadrants of measurement when you look at effort and effect across quantity and quality.

4 quadrants of RBA

Once you have identified strategies to use as your ESMs and SPMs, map them across these four quadrants. Think of how you might strengthen your strategies by moving from quadrant 1 to 2 and from 3 to 4, knowing that it’s not always feasible to move up based on data and resources available. However, measurement is important! Spend some time strategizing how to report stronger measures in your MCH Block Grant report and application. Tell the Title V story as having a quantifiable and qualifiable effect on your MCH populations.

Goals in Strengthening Your Measures. When looking at your ESMs, SPMs, or other strategies:
  • Move from measuring quantity to quality.
  • Eventually move from measuring effort to effect.
  • Quadrant 1 strategies should be used sparingly, when no other data exists. Challenge yourself to find ways to report more meaningful accomplishments.
  • The most effective measurement combines strategies in all levels, with most in quadrants 2 and 4.
  • Use all the tools at your fingertips to double-check your strategies.
  • You can also read about the entire process in the ESM Development Guide.

Need more help? Request technical assistance (TA).

We are eager to talk with you further about your ESMs. We provide TA that is customized to your needs and the time you have.

Addressing complex, systems-based issues is strengthened by a team approach. We collaborate with Evidence-Based Decision Making team of the National MCH Workforce Development Center to identify, develop, measure, and improve your ESMs.

We also collaborate with the Association of Maternal and Child Health Programs (AMCHP) to ensure that you have access to promising practices and tools from other Title V programs across the country. Finally, we coordinate with a wide array of MCHB-funded topical TA centers to make sure you have access to cutting-edge knowledge and resources from the experts.

SMARTIE TA: An Equity-Centric Approach to Our Work

Specifically, we provide SMARTIE TA that leads to:

  • Sharp, Specific, and Systems-based ESMs. We help sharpen ESM goals to more fully advance NPM topics and utilize systems to sustain these strategies.
  • Measurable and Meaningful ESMs. We ensure that your ESMs are measurable and in line with related projects in other states and jurisdictions.
  • Actionable, Achievable, and Aligned ESMs. We ensure that your ESMs inform your actions, are aligned with your needs assessment, and flow from your State Action Plan.
  • Relevant and Research-based ESMs. We connect your ESMs with the published evidence, emerging promising practices, and what other states are currently doing.
  • Translatable, Targeted, and Time-phased ESMs. We engage your team in developing sustained approaches to address specific needs of your populations, including Children and Youth with Special Health Care Needs (CYSHCN).
  • Inclusive and Integrated ESMs. We encourage you to work with all population groups as decision makers in every step of the process to ensure a meaningful partnership draws on the strengths of your communities.
  • Equitable ESMs. We continually ask the tough questions to address disparities, gaps, and issues of equity.

Read about our TA in our brochure | Read about how our TA promotes implementation science

How To Request TA: Three Easy Ways

It’s easy to connect with us. We work closely with regional project officers to provide the most appropriate assistance. You can:

  • Email us at with specific questions or to set up a time to talk. We will get right back with you to get the process started.
  • Use our online form to choose from several different types of TA.
  • Talk with your regional project officer who will contact us to arrange for TA, either for your group individually or as part of a group Title V programs.

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.