This program uses MCH Navigator strategies to develop tools to aid in the translation and understanding of Evidence-based/informed Strategy Measures (ESMs) based on an expanded version of the Integrated Model for Outcome-Based Workforce Development (see figure).
This methodology posits successful outcome-based workforce development integrates five key components: (1) evidence-based education, (2) adult learning theory, (3) an expanded version of the Dreyfus Model of addressing educational needs with the right methodology and content at the right time, (4) quality standards, and (5) a collaborative environment.
The project will use this methodology to develop:
- Choose-and-Use guides to identify effective ESMs.
- Microlearning programs to promote learning in short, weekly segments for incremental, paced, and communal acquisition of skills and knowledge.
- Listen-and-Learn sessions to to ensure that the program adapts to the needs of the field.
NPM Webinar Series
As our Title V colleauges look forward to the development of their Five-Year State Action Plans to address the priority needs identified through 2020 Five-Year Needs Assessment, the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) hosted five webinars on evidence-based/informed strategies for addressing each of the 15 National Performance Measure (NPMs). Subject matter experts (SMEs) presented on evidence-based/informed strategies, which are oriented to public health and relevant to the role and services provided by Title V.
These webinars are intended to provide Title V program staff with additional assistance in selecting evidence-based or informed strategies. For each NPM, the SME presenedt for approximately 10 minutes. Five minutes were allocated for questions from participating States and Jurisdictions. In addition, staff from the MCH Evidence Center at Georgetown University introduced the webinars, explained the foundations for evidence, and highlighted the growing list of available evidence resources that Title V agencies can access. Each webinar covers three NPMs:
- NPM 1 (Well-Woman Visit) – Arden Handler, University of Illinois at Chicago, School of Public Health
- NPM 2 (Low-Risk Cesarean) – Deborah F. Perry, GU Center for Child and Human Development
- NPM 3 (Perinatal Regionalization) – Kate Menard, University of North Carolina
- NPM 7 (Child Safety/Injury) – Jennifer Leonardo, Children’s Safety Network
- NPM 8 (Physical Activity) – Rachel Brady, GU Center for Child and Human Development
- NPM 9 (Bullying) – Sue Limber, Clemson University
- NPM 4 (Breastfeeding) – Barb Himes, First Candle
- NPM 5 (Safe Sleep) – Suzanne Bronheim, Georgetown University
- NPM 6 (Developmental Screening) – Sarah Riehl, Georgetown University Medical Center
- NPM 10 (Adolescent Well-Visit) – Charles Irwin, Adolescent and Young Adult Health National Resource Center
- NPM 13 (Oral Health) – Katrina Holt, National Maternal and Child Oral Health Resource Center
- NPM 14 (Smoking) – Beth DeFrancis, American College of Obstetricians and Gynecologists
- NPM 11 (Medical Home) – Christina Boothby, National Resource Center for Patient/Family-Centered Medical Home
- NPM 12 (Health Care Transition) – Peggy McManus and Patience White, Got Transition
- NPM 15 (Adequate Insurance Coverage) – Allyson Baughman, Catalyst Center and Elisabeth Burak, Center for Children and Families
Questions Answered After Webinar Series
1. Have you seen a difference between the results from “2A’s and an R” vs. the “5A’s”?
The Evidence Analysis Report for NPM 14.1 states that "although some professional organizations endorse a modified three-step process “Ask, advise, and refer,” this method has not been proven to be effective in pregnancy." But that doesn't mean it's not effective; it just means that there haven't been studies that focus specifically on the effectiveness of AA+R in pregnancy women. And I'm unaware of any studies that compare the 5A approach with the AA+R approach. ACOG mentions various forms of counseling in its committee opinion on smoking cessation during pregnancy at https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/10/smoking-cessation-during-pregnancy.
2. Are there good resources for pregnancy and cessation of vaping via quitlines or other methods?
Our evidence report for NPM 14 didn't specifically address vaping or e-cigarette smoking, so it's hard to say which cessation techniques would be most effective and safe for use with pregnant women. The "Incentives" strategy I mentioned during the Smoking webinar is not only effective in reducing the number of pregnant women who smoke, but it's one of the only interventions that has been effective with pregnant women who abuse drugs. So it's probably safe to assume that it would be an effective strategy in reducing the number of pregnant women who vape or use e-cigarettes. The CDC website offers quitting advice for teens. And you might also want to look at what ACOG has to say about vaping and e-cigarette use among pregnant women.
Note from the speaker: I just wanted to mention that ACOG just released a new committee opinion (dated May 2020) on tobacco and nicotine cessation during pregnancy. It includes information and guidance on alternate forms of nicotine delivery, including e-cigarettes and vaping. Although it's geared towards Ob-Gyns, it has some solid information that will likely be useful to non-clinicians.
1. Does anyone’s Medicaid agency include the CYSHCN screener items to identify CYSHCN when children/families apply for Medicaid?
Answer coming soon.
2. Can you address the significantly lower payment rates for Medicaid compared to Medicare or commercial insurance?
Assuming this refers to enrolled families, federal Medicaid law has protections that limit premiums and co-pays, making the coverage most affordable compared to others. Total premiums and cost-sharing (co-pays or coinsurance, etc) may not exceed 5% of family income for all family members enrolled. States may not charge any premiums or cost-sharing on the lowest income children and adults and amounts are loosened as income rises above 133% for some services (e.g. never preventive care), but never to exceed the annual 5% income cap. Details on Medicaid premiums or cost-sharing for each state can be found in this survey we do with Kaiser annually. Many states have waived or suspended premiums and cost-sharing during the COVID emergency.
Assuming this question refers to provider payments, it's true that in most cases, Medicaid reimbursement rates to primary care providers and specialists are woefully below those paid by Medicare and private plans. States, and, where applicable, Medicaid managed care organizations (MCOs) set payment rates through contracts with providers. These lower reimbursement rates are of grave concern, especially now as we see fewer kids getting well-child care and challenging practice solvency. Yet another health care infrastructure challenge that could have ripple effects. Title V is in a great position to learn and report trends from the Medicaid practice community about what resources-- monetary and otherwise-- will be needed to continue ensuring children's access to health care can be (at least!) maintained, or better yet, improved. (Folks are likely well aware that the ACA provided a temporary primary care bump that phased out after 2 years, but showed some important improvements leading a number of states to maintain increases on their own.)
MCH Navigator Learing Tools
- Identifying and Using Evidence-Based/Informed Resources to Address MCH Issues Learning Brief provides links to selected trainings and related tools on the topic of evidence-based and informed resources to address MCH issues
- Title V Transformation Tools provide online learning materials, resources, and evidence-based strategies and programs that support knowledge sets and skills needed to advance each National Performance Measure (NPM) topic area.