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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
NPM 7

mother and young girl in pajamas holding handsInjury Hospitilization (Child Safety)

Significance

The Title V Maternal and Child Health Services Block Grant to States Program guidance defines the significance of this goal as follows:

Injury is the leading cause of child mortality. For those who suffer non-fatal severe injuries, many will become children with special health care needs. Effective interventions to reduce injury exist but are not fully implemented in systems of care that serve children and their families. Reducing the burden of nonfatal injury can greatly improve the life course trajectory of infants, children, and adolescents resulting in improved quality of life and cost savings.

NPM 7 Tools

MCHbest LogoNEW! The MCH Evidence Center is pleased to share Phase 1 of the MCHbest database: the Bank of Evidence-linked Strategies and Tools.

The database aggregates sample evidence-based/informed strategies that can be used as-is or adapted to develop Evidence-based or informed Strategy Measures (ESMs) for each of the MCH National Performance Measures (NPMs). Use the database along with the ESM Development Guide to work through the entire ESM process.

Other New Resources:

Strategy Video

Presented by Jennifer Leonardo, Children’s Safety Network

 

Introductory Resources

Summary of the Evidence

Evidence, summarized by the CDC, finds that the most effective injury prevention efforts use a combination of strategies

The following trends emerged from analysis of peer-reviewed evidence. While findings might not completely align with your ESM, they can serve as ideas for future expansion.

Key Findings for NPM 7.1: Injury Hospialization (Ages 0-9)

Injury Area Intervention Type Intervention Strategy Evidence Rating
General Home Safety Education + Environment/ Engineering + Enforcement Home visiting with safety education, the provision of safety equipment, and enforcement of a safety checklist Moderate evidence
Education +Environment/ Engineering Mobile safety center with safety education and reduced cost safety equipment Moderate evidence
Education Clinic-based home safety education (e.g., computer assessment with tailored injury prevention information during well-baby visit with follow-up assessment by telephone 1 month later to adopt new injury prevention behaviors) Moderate/Emerging evidence
Infant Suffocation Education + Environment/ Engineering + Enforcement Multicomponent interventions in the neonatal intensive care unit (NICU) (e.g., revision of hospital policies and practices, use of quality improvement framework, training of nurses, parent education, discharge instructions and checklists, education materials (e.g., video/DVD), computerized teaching tool, crib card, crib audit tool, family education plan, wearable blankets/ sleep sacks, and post-discharge telephone call) Moderate evidence
Multicomponent interventions in maternity ward (e.g., revision of hospital policies/practices, training of nurses, parent education, teaching tools and education materials (e.g., video), posters, use of quality improvement framework, parental signature on an acknowledgement form, and nurse signature on Declaration of Safe Sleep Practice, indicating nurse had read information and agreed to practice safe sleep for her patients) Moderate evidence
Education + Environment/ Engineering Distribution of cribs and safe sleep education at agencies Moderate evidence
Drowning Environment/
Engineering + Enforcement
Water safety legislation promoting barrier isolation to protect young children Moderate evidence
Fires, Burns, and Scalds Education Educational workshop and home visiting on fire prevention Moderate evidence
Poisoning Education + Environment/ Engineering + Enforcement Home visiting with safety education, the provision of safety equipment, and enforcement of a safety checklist Moderate evidence
Child Pedestrian- related Environment/Engineering Infrastructure changes to increase pedestrian safety (e.g., installing new traffic and pedestrian signals; adding exclusive pedestrian crossing times; installing speed bumps, speed boards (radar-equipped digital signs that tell drivers how fast they are moving), and high-visibility crosswalks; and enforcing new parking regulations) Moderate/Emerging evidence
Firearm-related

Environment/
Engineering + Enforcement

Child access prevention (CAP) laws for safer storage of firearms Moderate evidence
Alcohol and Drug Use Education

Universal, multicomponent school-based social and character development program

Moderate evidence

Classroom behavior management program (e.g., Good Behavior Game introduced in 1st and 2nd grades aimed at socializing children to the role of being a student and reducing aggressive, disruptive behavior; same students were followed up at ages 19-21) Moderate/Emerging evidence
Child Maltreatment Education Home visiting for Early Head Start (e.g., a dual generational program serving low-income families with children prenatally through 3 years of age, with home visits, group socialization activities, and/or center-based child development activities with at least 2 home visits per year) Moderate/Emerging evidence
Home visiting for young disadvantaged moms (e.g., improve parental responsiveness and developmental knowledge, reinforce parenting skills and strengthen relationships, improve parenting competence and lead to positive changes in the behavior of mothers and children)
Home visiting for families at risk of child abuse (e.g., promote positive parenting skills and prevent child maltreatment with trained paraprofessionals, increase child safety in the home, strengthen parenting skills, build problem-solving skills, and increase parents’ social support)
Home visiting for families of infants with medical risk/children with disabilities (e.g., positive parenting for parents of preadolescent children with disabilities to target problem behaviors)
Group-based parenting programs (e.g., to build attachment, improve parenting skills, improve parenting stress, and improve child behaviors) Moderate/Emerging evidence
Education + Enforcement

Remediation for families involved with Child Protection Services
(e.g., solution-based casework, interactive violence prevention program, social interaction learning theory based program to improve parenting skills, parenting stress, and child behaviors)

Moderate/Emerging evidence
Remediation for mothers at risk for child maltreatment (e.g., parent-child interaction therapy for mothers at risk or with a history of maltreating their children)
Remediation for mothers in drug court (e.g., integration of child welfare services and substance abuse treatment to address child neglect and substance abuse)
Remediation for fathers in rehabilitation for alcohol use (e.g., parenting skills with behavioral couples therapy or individual-based treatment)
Remediation for children referred due to child maltreatment (e.g., family group decision making to encourage shared responsibility to protect children)
Bullying Education + Environment/ Engineering + Enforcement Multicomponent universal prevention programs (e.g., multi-tiered school- wide intervention to improve environment; bystander intervention with curriculum, parental involvement, and individual interventions) Scientifically rigorous/Moderate evidence
Education Multicomponent selective prevention programs (e.g., cognitive behavioral therapy for victims of bullying with behavioral management training for teachers and parents) Moderate evidence

Key Findings for NPM 7.2: Injury Hospialization (Ages 10-19)

Injury Area Intervention Type Intervention Strategy Evidence Rating
General Home Safety Education + Environment/ Engineering + Enforcement Home visiting with safety education, the provision of safety equipment, and enforcement of a safety checklist Moderate evidence
Poisoning

Education + Environment/ Engineering + Enforcement

Home visiting with safety education, the provision of safety equipment, and enforcement of a safety checklist

Moderate evidence

Fires, Burns, and Scalds

Education + Environment/ Engineering Home visiting with fire safety education and installation of smoke alarms Moderate evidence
Sports and Recreation Education Educational materials on sports-related safety (e.g., safety video and brochure) Moderate evidence

Injury prevention warm-up program (e.g., FIFA 11+ injury prevention complete warm-up program for female soccer players)

Moderate evidence

Child Pedestrian- related

Environment/Engineering Infrastructure changes to increase pedestrian safety (e.g., installing new traffic and pedestrian signals; adding exclusive pedestrian crossing times; installing speed bumps, speed boards (radar-equipped digital signs that tell drivers how fast they are moving), and high-visibility crosswalks; and enforcing new parking regulations) Moderate/Emerging evidence
Firearm-related Environment/ Engineering + Enforcement Child access prevention (CAP) laws for safer storage of firearms Moderate evidence
Underage Alcohol Use Education Universal, multicomponent school-based social and character development programs Scientifically rigorous/ Moderate evidence
Personality-targeted programs for students with high-risk personality traits (e.g., anxiety sensitivity, hopelessness, impulsivity, and sensation seeking)

Scientifically rigorous/ Moderate evidence

Community-wide anti-binge drinking intervention Moderate evidence
School-based programs focused on social influence and harm minimization Moderate/Emerging evidence
Illegal Drug Use Education Universal, multicomponent school-based social and character development program (e.g., health motivation, social skills, social influence recognition, and knowledge development) Scientifically rigorous/ Moderate evidence
Multi-year, motivational interviewing-based program Moderate/Emerging evidence
Classroom behavior management program (e.g., Good Behavior Game introduced in 1st and 2nd grades aimed at socializing children to the role of being a student and reducing aggressive, disruptive behavior; same students were followed up at ages 19-21) Moderate/Emerging evidence
School-based curriculum focused on social influence and harm minimization Moderate/Emerging evidence
Bullying Education Single-component universal prevention programs (e.g., coaches organize structured activities during recess and game times in classrooms) Moderate evidence
Single-component selective prevention programs (e.g., lunchtime mentoring program) Moderate evidence
Education + Environment/ Engineering + Enforcement Multicomponent universal prevention programs (e.g., a school-wide program with a bystander-type intervention intended to raise awareness of the group’s role, increase empathy for victims, promote strategies and self-efficacy to support victims, and increase coping skills for those who are bullied, with an anti-bullying computer game for primary school students, internet forum for secondary school students, environmental changes such as posters and brightly colored vests to increase teacher visibility in hallways, playgrounds, etc., direct interventions with students involved in bullying incidents (both children and youth who are bullied and children and youth who bully), and parents’ guides) Scientifically rigorous/ Moderate evidence
Education Multicomponent selective prevention programs (e.g., cognitive behavioral skills building with 8 weekly hour-long group sessions of cognitive therapy using role play and group discussions, education on bullying behaviors and adaptive coping strategies, and parental group meetings) Moderate/Emerging evidence
Youth Violence Education Intensive residential military-styled programs (e.g., intensive 17-month residential program divided into three phases: 1) a two-week orientation and assessment period, 2) a 20-week residential phase built around eight core components designed to promote positive youth development, and 3) a one-year post- residential phase featuring a structured mentoring program) Moderate evidence
Dating Violence Education Standard educational program (e.g., curriculum including lessons on healthy relationships, sexual health, and substance use prevention) Moderate evidence
Social norms theory interventions (e.g., intensive bystander training for students who were considered popular opinion leaders taught by rape crisis center personnel) Moderate evidence
Bystander interventions focused on dating violence (e.g., traditional dating violence awareness program for undergraduate students) Moderate evidence
Bystander interventions focused on sexual assault (e.g., 20-minute video on changing attitudes and positive bystander behaviors viewed in regular high school classrooms by the entire class with vignettes on dating violence and sexual assault) Moderate evidence
Suicide Education + Environment/ Engineering Selective/Indicated interventions targeted to suicidal adolescents and their families (e.g., individual and family therapy sessions, based on family interaction theory; comprehensive school- and home-based suicide prevention program for youth identified as at risk for suicide) Moderate evidence
Education Classroom behavior management program (e.g., Good Behavior Game introduced in 1st and 2nd grades aimed at socializing children to the role of being a student and reducing aggressive, disruptive behavior; same students were followed up at ages 19-21) Moderate/Emerging evidence

Children's Safety Network has also developed the resource Evidence-based and Evidence-informed Strategies for Child and Adolescent Injury Prevention. See p. 29 for a summary of findings.

Evidence Analysis Reports

Promising Practices

You can access strategies from AMCHP’s Innovation Station that have shown promise in advancing your NPM below. While these strategies may not completely align with your current activities, they can be used to help guide further development and measurement of your ESM.

Practice Name Primary Interest State Level of Evidence
Teen Driving Safety Task Force Adolescent Health UT Emerging
Boys' Health Advocacy Program Child Health SD Promising
Every Child Succeeds Child Health OH Best
Nurse Family Partnership Home Visiting National Best
Graduated License Education Injury Prevention NE Cutting Edge
e Submissions of Car Seat Inspections Injury Prevention IN Cutting Edge
Safe Stars Injury Prevention TN Cutting Edge

Sample ESMs

Domain and National Performance Measure: Rate of hospitalization for non-fatal injury per 100,000 children ages 0 through 9 and adolescents ages 10 through 19

Strategy [Source] Evidence-based/-informed Strategy Measure (ESM)
Provide training for home visitors on assessing home safety [3] Increase knowledge of best practices among home visitors as assessed at annual cross-model training
Link with schools to promote safe behaviors through comprehensive parent/student education campaigns [3] % of middle schools implementing comprehensive injury prevention education campaigns
Support local health departments in offering free car seat safety inspections and distributing care seats [3,4] # of inspections completed and car seats distributed in past year by health department
Encourage school districts to require helmet use when riding to school [3] % of schools with policies requiring helmet use

[3] Women’s and Children’s Health Policy Center, Johns Hopkins Bloomberg School of Public Health. Environmental Scans.
[4] Association of Maternal and Child Health Programs & Johns Hopkins Bloomberg School of Public Health. Taking Action with Evidence: Implementation Roadmap Webinars.

Source: Sample Strategies and Evidence-based/informed Strategy Measures (ESMs) (WCHPC). A list of sample strategies and ESMs for each of the 15 NPMs. Sources are provided at the end of the document. 


Related ESMs. Access ESMs being implemented by other states/jurisdictions that may serve as models for future work with NPM 7.

Additional Learning

  • NPM 7 Transformation Tools (MCH Navigator and National MCH Workforce Development Center). Learning resources, implementation strategies, and links to the evidence base for the competencies needed to carry out NPM 7 activities.
  • Taking Action with Evidence Implementation Roadmap (Association of MCH Programs (AMCHP) and WCHPC). Archived webinars and additional learning and implementation resources.
  • Historical Resources from the MCH Digital Library (NCEMCH). This bibliography is automatically generated to pull resources from MCHLine, the MCH Library's online catalog of seminal resources, in support of NPM 7. Coming soon.

Additional Resources

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.