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Strengthening the evidence base for maternal and child health programs

New: MCH Best strategies database for sample ESMs

Evidence Tools
MCH Best: Bank of Evidence-linked Strategies and Tools

The MCH Evidence Center is pleased to share Phase 1 of the MCH Best 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). It's as easy as Ready, Set, Go. Read the following guidance and then access the strategies below.

Instructions

Ready: Read About the Database

Comprehensive Tool. This new tool addresses the three components of the MCH Evidence project:

  1. Evidence Base. It links the evidence to concrete strategies (interventions) that can be used by Title V programs to address their MCH priorities.
  2. Structured Planning Process. It provides suggestions for measurement of your strategies (interventions) by providing sample Evidence-based/informed Strategy Measures (ESMs) as seen through a Results-Based Accountability framework.
  3. Title V Implementation Tools. It provides information on additional MCH resources to support specific strategies.

Expanding Strategies. Check back often as we add new strategies to the database:

  • Phase 1 (available now). We present 85 strategies that are most based in the scientific evidence. Note that often the strategies that are most based in the evidence are often those that are more clinical in nature. We have given examples on how to adapt these strategies in the Sample ESM section. In addition, please see the resource, The Role of Title V, for tips on how to adapt the strategy for work in your state or jurisdiction.
  • Phase 2 (coming Summer 2020). We will incorporate additional strategies based on promising practice and expert/consensus opinion. We will also be adding strategies pulled from other evidence-based sources.
  • Phase 3 (coming Fall 2020). We will add strategies based on programs showing promise in the field with a wide range of MCH population groups.

Acknowledgments. Many people were involved in the creation and review of this database. We would like to make acknowledgment of their tireless and insightful contributions.

Set: Learn How to Use the Database

Two Complemenatry Tools. Use this database in combination with: the ESM Development Guide. The guide provides the entire framework you need to develop strong ESMs, including:
  • An Overview of the Evidence Base. Understanding the evidence continuum, tools to ensure health equity, and ESM development tips.
  • A Structured Planning Process. A summary of the Results-Based Accountability (RBA) process you can use to develop and measure ESMs based on data.
  • Title V Implementation Tools. Tools from the MCH Library on social determinants of health and health equity.

Technical Package Approach. Strategies in the MCH Best database are based on the most current evidence and are presented in the Center for Disease Control and Preventtion's (CDC's) technical package approach — a simple way to link strategies to science. CDC’s former Director, Dr. Tom Frieden named technical packages as one of the six key components for effective public health program implementation:

“The most effective public health programs are based on an evidence-based technical package…A technical package of proven interventions sharpens and focuses what otherwise might be vague commitments to “action” by committing to implementation of specific interventions known to be effective.”

A technical package has three parts:

  • The strategy lays out the direction or actions to achieve the goal of preventing violence.
  • The approach includes the specific ways to advance the strategy. This can be accomplished through programs, policies, and practices.
  • The evidence for each of the approaches in preventing violence or its associated risk factors is included as the third component.

Strategic ESM Development. Strategy is required to develop strong ESMs. One must consider the eventual goal of the strategy, the data and need that the strategy will address, underlying/root causes, potential partners, barriers and competing factors, motivating factors along with intent to change behavior, and the needed scale for the strategy to work. One must also develop the strategy so that it's effective to the needed population groups, relates with social determinants of health, and advances health equity. All while fiting within the capacity and budget of the Title V program.

It's no surprise that measurable impact will take time. That's one reason why it's so important to develop ESMs strategically. The flexibility of ESMs is that they can be modified over time to continually impact NPMs in meaningful ways. By using these tools to develop meaningful, measurable, and moveable ESMs, we have the greatest chance of making significant change to the women, infants, children, adolescents, youth, and families we serve.

Go: Access Additional Tools

Additional Resources. To assist you in developing/strengthening ESMs, you may want to use:

Feedback and Suggest a Strategy: We Want To Hear from You

We are always looking for ways to improve the MCH Best database and to add to our collection of strategies. Please take a few minutes to share your thoughts with us.

  • Feedback. Answer a few short questions to help us improve the database and strategies.
  • Suggest a Strategy. Do you have a strategy that you would like to add? Send us your ideas, and we'll investigate the evidence base to see how they might fit into MCH Best.

Strategies

Access MCH Best strategies below by NPM topic area. You can use the examples within these strategies to develop/update your ESMs. Don't forget to use the ESM Development Guide and the Role of Title V to provide the structure for your ESM work.

Sort each set of strategies by: Evidence Level* | Target Audience

NPM 1: Well-Woman Visit

These strategies have been proven effective in addressing NPM 1: Percent of women, ages 18 through 44, with a preventive medial visit in the past year. They can be adapted for your program needs.

Scientifically Rigorous Evidence:

  • Patient Reminders: Support providers in disseminating reminders (e.g., postcard, text, email, phone) to women about scheduling annual preventive visit.

Moderate Evidence:

Additional Resources:

  • Well-Woman Visit: Resource Overview: The American College of Obstetricians and Gynecologists (ACOG) has identified the following resources that may be helpful for ob-gyns, other health care providers, and patients related to the well-woman visit.
  • AMCHP Resources:
    • Health for Every Mother: A Maternal Health Resource and Planning Guide for States. This guide for Title V programs and their partners provides a synthesis of program and policy recommendations and offers a framework to support states in identifying next steps. Contents include strategies and planning tools for strengthening maternal data systems, increasing the value of an investment in maternal health, enabling healthy living, improving access to care, ensuring high quality health care for women, and ensuring readiness and response to obstetric emergencies.
    • Implementation Toolkit for National Performance Measure 1. This toolkit contains examples of state strategies being used to address NPM 1 in Title V programs.
  • For a comprehensive summary of the evidence, promising practices, additional sample ESMs, and additional learning and resources, access the Well-Woman Visit Evidence Toolkit.

NPM 2: Low-Risk Cesarean Delivery

These strategies have been proven effective in addressing NPM 2: Percent of cesarean deliveries among low-risk first births. They can be adapted for your program needs.

Emerging Evidence:

Mixed Evidence:

Additional Resources:

  • Access ESMs from other Title V programs that can serve as examples and models.
  • For a comprehensive summary of the evidence, promising practices, additional sample ESMs, and additional learning and resources, access the Low-Risk Cesarean Deliveries Toolkit.

NPM 3: Risk-Appropriate Perinatal Care (Perinatal Regionalization)

These strategies have been proven effective in addressing NPM 3: Percent of very low birth weight (VLBW) infants born in a hospital with a Level III+ Neonatal Intensive Care Unit (NICU). They can be adapted for your program needs.

Moderate Evidence:

Emerging Evidence:

Additional Resources:

  • Access ESMs from other Title V programs that can serve as examples and models.
  • For a comprehensive summary of the evidence, promising practices, additional sample ESMs, and additional learning and resources, access the Perinatal Regionalization Toolkit.

NPM 4: Breastfeeding

These strategies have been proven effective in addressing NPM 4A: Percent of infants who are ever breastfed and NPM 4B: Percent of infants breastfed exclusively through 6 months. They can be adapted for your program needs.

Moderate Evidence:

  • Home Visits: Provide training and coaching to MIECHV home visiting staff to promote breastfeeding best practices.
  • Lactation Consultants: Maintain a 24-hour breastfeeding hotline staffed by a bilingual certified lactation consultant.
  • Peer Counselors: Utilize breastfeeding peer counselors through WIC programs.

Emerging Evidence:

  • Family Leave, Workplace Policies, State Laws: Provide trainings and other supports on workplace Mother-Friendly breastfeeding support policies (e.g., employer-provided break time and private space to breastfeed) across the state/jurisdiction.
  • Provider Training: Provide training to health care providers around breastfeeding best practices.

Mixed Evidence:

  • Group Education: Promote the use of group education for pregnant women around breastfeeding practices in the hospital setting.
  • Hospital Policies: Promote Baby Friendly policies for hospital systems across the state/jurisdiction.
  • WIC Food Package Change: Enhance the number of families participating in the fully-breastfed WIC food package change.

Additional Resources:

NPM 5: Safe Sleep

These strategies have been proven effective in addressing NPM 5A: Percent of infants placed to sleep on their backs, NPM 5B: Percent of infants placed to sleep on a separate approved sleep surface, and NPM 5C: Percent of infants placed to sleep without soft objects or loose bedding. They can be adapted for your program needs.

Note: The most effective efforts in lowering SUID/SIDS should include NPM 4: Breastfeeding and NPM 14: Smoking (Moon R,Darnall RA, Feldman-Winter L, Goodstein M, Hauck FR. (2016). SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics. 138. 10.1542/peds.2016-2938).

  • The protective role of breastfeeding on SIDS is enhanced when breastfeeding is exclusive and without formula introduction. In addition, maternal smoking during pregnancy has been identified as a major risk factor in almost every epidemiologic study of SIDS.
  • Smoke exposure adversely affects infant arousal; in addition, smoke exposure increases the risk of preterm birth and low birth weight, both risk factors for SIDS. It is estimated that one-third of SIDS deaths could be prevented if all maternal smoking during pregnancy was eliminated.

Moderate Evidence:

Expert Opinion:

Emerging Evidence:

Additional Resources:

NPM 6: Developmental Screening

These strategies have been proven effective in addressing NPM 6: Percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year. They can be adapted for your program needs.

Moderate Evidence:

Additional Resources:

NPM 7: Injury Hospitilization

These strategies have been proven effective in addressing NPM 7.1: Rate of hospitalization for non-fatal injury per 100,000 children, ages 0 through 9 and 7.2: Rate of hospitalization for non-fatal injury per 100,000 adolescents, ages 10 through 19. They can be adapted for your program needs.

Moderate Evidence:

Additional Resources:

NPM 8: Physical Activity

These strategies have been proven effective in addressing NPM 8.1: Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day and 8.2: Percent of adolescents, ages 12 through 17, who are physically active at least 60 minutes per day. They can be adapted for your program needs.

Moderate Evidence:

Mixed Evidence:

Additional Resources:

NPM 9: Bullying

These strategies have been proven effective in addressing NPM 9: Percent of adolescents, ages 12 through 17, who are bullied or who bully others. They can be adapted for your program needs.

Multi-tiered approaches have been shown to be the most effective approach in addressing bullying. It is critical to combine youth-targeted interventions with universal programs (e.g., classroom or school-based). Likewise, combining classroom and school level interventions appears to be more effective than implementing either alone. Findings suggest that students involved in extracurricular activities have more favorable perceptions of social-emotional security, adult support, student support, and school connectedness. In addition, classroom discussions to elicit views on what rules should govern the way people treat others are thought to increase the likelihood of disciplinary actions for infractions of school rules being effective.

Moderate Evidence:

  • Combining classroom and school level interventions appears to be more effective than implementing either alone (see below).

Emerging Evidence:

Additional Resources:

NPM 10: Adolescent Well-Visit

These strategies have been proven effective in addressing NPM 10: Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year. They can be adapted for your program needs.

Moderate Evidence:

  • Expanded Insurance Coverage: Adopt a protocol to ensure that all persons in adolescent health programs are referred for enrollment in a health insurance program.

Emerging Evidence:

Additional Resources:

NPM 11: Medical Home

These strategies have been proven effective in addressing NPM 11: Percent of children with and without special health care needs, ages 0 through 17, who have a medical home. They can be adapted for your program needs.

Emerging Evidence:

  • Dedicated Care Coordinators: Use dedicated care coordinators to develop relationships with families to increase timely attendance of well-child visits and respond to the needs of families.
  • Provider Alliance and Mid-Level Providers: Use a provider alliance and mid-level providers to create a “one-stop” medical home model to provide community outreach and coordination of services.
  • Provider-School Partnerships: Develop partnerships between primary care providers (PCPs) and school-based health centers (SBHC) to create an expanded medical home model based on care coordination.
  • Shared Care Coordination with Home Visiting: Develop early connections to a medical home model through care coordination and collaboration with home visiting.

Additional Resources:

NPM 12: Health Care Transition

These strategies have been proven effective in addressing NPM 12: Percent of adolescents with and without special health care needs, ages 12 through 17, who received services necessary to make transitions to adult health care. They can be adapted for your program needs.

Moderate Evidence:

Expert Opinion:

State Policy/System Development: Partner with organizations to encourage adoption of evidence-driven health care transition (HCT) practices and policies.

Emerging Evidence:

Additional Resources:

NPM 13: Preventive Dental Visit (Oral Health)

These strategies have been proven effective in addressing NPM 13.1: Percent of women who had a preventive dental visit during pregnancy and 13.2: Percent of children, ages 1 through 17, who had a preventive dental visit in the past year. Examples of preventive oral health services include screenings, anticipatory guidance and education (oral hygiene and eating practices), dental sealants applications, fluoride varnish applications, mouthguards, prophylaxis, and silver diamine fluoride).

These strategies can be adapted for your program needs.

13.1: Percent of women who had a preventive dental visit during pregnancy

Expert Opinion:

  • Provider Education (13.1): Collaborate with Early Head Start programs, home visiting programs, and/or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics to train staff to conduct oral health risk assessments, provide preventive oral health care, and refer pregnant women for dental visits.
  • Provider Education (13.1): Collaborate with obstetrical and/or nurse midwifery associations to train their members to conduct oral health risk assessments, provide preventive oral health care, and make referrals.
  • Provision of Information about Teledentistry (13.1): Provide information about opportunities and barriers related to teledentistry (e.g., state statutes, practice acts, reimbursement policies) to key state and/or local oral health stakeholders.
  • Teledentistry: Provider Education and Promotion/Provision of Services (13.1): Develop and provide training (or professional development) for oral health professionals at the state and/or local level about teledentistry (including state practice acts and reimbursement policies), and provide teledentistry services for pregnant women.

Emerging Evidence:

13.2: Percent of children, ages 1 through 17, who had a preventive dental visit in the past year

Moderate Evidence:

  • Medicaid Reforms (13.2): Increase the number of dental providers who accept Medicaid through activities such as provider training, increased reimbursements, and other incentives.
  • Public Insurance Coverage (13.2): Collaborate with Medicaid to increase the number of children and youth who have had a preventive dental visit in the past year.
  • School/Preschool Interventions (13.2): School-Based Dental Services/Head Start Participation: Increase oral health referrals among children and youth through School Based Health Centers (SBHCs).

Expert Opinion:

Emerging Evidence:

Additional Resources:

NPM 14: Smoking

These strategies have been proven effective in addressing NPM 14: 14.1 Percent of women who smoke during pregnancy and 14.2 Percent of children, ages 0 through 17, who live in households where someone smokes. They can be adapted for your program needs.

14.1 Percent of women who smoke during pregnancy

Moderate Evidence:

  • Incentives: Provide incentives to reduce smoking during pregnancy.

Emerging Evidence:

  • Counseling: Provide counseling to reduce smoking during pregnancy.
  • Feedback: Provide feedback to support reduction or smoking cessation behaviors.
  • Health Education: Provide health education to reduce smoking during pregnancy.

14.2 Percent of children, ages 0 through 17, who live in households where someone smokes

Note: the research for smoking in the household has focused almost exclusively on multicomponent interventions. Combining strategies appears to increase effectiveness; however, single component interventions also trend positive in many situations.

Moderate Evidence:

Emerging Evidence:

Additional Resources:

  • NPM 14.2 Smoking in the Household - Evidence Review: Brief. A summary of report methodologies, results, key findings, and implications.
  • NPM 14.2 Smoking in the Household - Evidence Review: Full Report. A critical analysis and synthesis of the effectiveness of strategies that might be applied to address NPM 11 to serve as the foundation for accountability across all states and jurisdictions.
  • Smoking Timeline. With widespread documentation of the adverse health effects of active smoking in the 1960s, attention turned to the exposure of nonsmokers and the possibility of serious health effects. This timeline traces the public health response to the smoking crisis.
  • For a comprehensive summary of the evidence, promising practices, additional sample ESMs, and additional learning and resources, access the Smoking Toolkit.

NPM 15: Continuous and Adequate Insurance

These strategies have been proven effective in addressing NPM 15: Percent of children, ages 0 through 17, who are continuously and adequately insured. They can be adapted for your program needs.

Moderate Evidence:

Emerging Evidence:

Additional Resources:

* Read more about understanding evidence ratings.

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.