The MCH Evidence Framework

The MCH Evidence Center’s process in working with Title V agencies to develop new ESMs or strengthen current measures has been based on a modified Richmond/ Kotelchuck model of systems impact. According to this model, the components required for developing, implementing, and measuring effective evidence-based/informed programs are (1) integration of established/emerging evidence (to ensure strategies have the potential to affect change), (2) utilization of an established planning process (to align performance-based strategies with population goals), and (3) guidelines and resources specific to Title V MCH programs to implement change.

It is important to note that states/jurisdictions are on a spectrum when it comes to understanding how to create and measure programs that have significant effect on advancing National Performance Measures (NPMs) and National Outcome Measures (NOMs).

How it Works: To meet today’s complex needs, effective programs must be meaningful, measurable, and moveable…

1. Accelerate with Evidence. To ensure that programs/interventions are meaningful and have the greatest potential to affect a desired change, it’s critical that they are unbiased, significant to public health, and rooted in science, experience, and policy. By understanding what has worked in the past, we can build programs on proven successes. The evidence base includes peer-reviewed findings, promising practices, other state ESMs currently in use, and identification of the corresponding science that support ESMs.

Tool. We use the Science-Based Intervention approach (Harvard University) to ensure that a program is effective with MCH population groups by asking:

• What about it works? If we understand the key ingredients, we can replicate them.
• How does it work? Being specific about the underlying mechanisms can help us increase the impact.
• For whom does it work, and for whom does it not work? When we know who is and isn’t responding, we can make targeted adaptations to improve outcomes.
• In what contexts does it work? By evaluating the context in which a program is implemented, we can adapt it for other settings.

2. Think Upstream with a Structured Planning Process. To ensure that programs/interventions address issues early and are measurable in “turning the curve” on big issues that face MCH populations, a system of shifting the evidence into practice is needed. Implementation science uses the foundational building blocks of evidence to translate root causes of population-based issues into responsive programs that bring about change that can be quantified, brought to scale, and replicated across population groups.

Tool. We use Results-Based Accountability (RBA) (Clear Impact) to align program performance (measurement of ESMs) with population goals (achievement of NPMs & NOMs).

• RBA helps ensure that ESMs align with and advance NPMs. A set of seven performance accountability questions require programs to consider:
• Desired impact change on a targeted group.
• Mechanisms to deliver services effectively.
• Ways to address barriers, identify resources, and engage appropriate partners.
• Identification of what specifically works to produce measurable outcomes.
• RBA strengthens measurement of ESMs. A four-quadrant measurement matrix assists programs to move from tracking effort to assessing effect:
• Quantity of the effort (What/how much did we do? – most basic measure).
• Quality of the effort (How well did we do it?).
• Quantity of the effect (Is anyone better off?).
• Quality of the effect (How are they better off?).

3. Work Together to Implement within a Title V Focus. To ensure that programs/interventions are moveable within the realities of Title V programs and lead to health equity for all people, a strengths-based MCH approach draws on: (1) field-generated resources  – the MCH Library serves as a gateway to electronic resources across all topic areas addressed by Title V programs; (2) communal, MCH-driven learning – short, competency-based bursts of learning give professionals the tools to implement this work quickly; and (3) MCH-focused technical assistance that addresses the needs of all programs and populations  – MCH Evidence Center staff are available for ongoing TA opportunities.

Tool. We use the Hexagon Tool (National Implementation Research Network) to systematically evaluate effectiveness of a program/intervention via six factors:

• Need. Asks how well the program/intervention will meet target population needs while addressing service and systems gaps.
• Fit. Looks for alignment with family/community culture and values, current initiatives, priorities, structures, and supports.
• Capacity. Ensures the cultural responsivity, financial, and structural ability to build systems that meet needs of practitioners and families.
• Evidence. Analyzes the strength and effectiveness for diverse cultural groups, scalability, and cost-effectiveness of programs.
• Usability. Determines the readiness for replication, including models for comparison and fidelity of content adaptations.
• Supports. Reviews the capacity to implement program, including expert assistance, staffing, training, and ability to sustain the program over time.

The Evidence Center provides a scaffold of support to Title V programs to integrate these components into their work through our evidence tools, TA, learning resources, and team of experts. The process is cyclic in that data from ESMs will eventually lead to a greater understanding of the evidence/interventions that are effective in advancing NPMs.