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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 15: Continuous and Adequate Insurance

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Strategy. Multicomponent Approach

Approach. Use a multicomponent approach (e.g. care management + education/parent engagement + collaborative partnerships; educational messaging + data from program databases + individual counseling) to facilitate enrollment of uninsured and underinsured children.

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Overview. Some interventions used a combination of strategies to connect children and families to health insurance and overcome enrollment barriers. In one study, a registered nurse, also known as a health navigator, supports parents by teaching team how to work with health care professionals. The main components of this study are care management + education and parent engagement + collaborative partnerships.1 In another study, child benefit advisors work directly with parents of children in the Early Intervention Program to facilitate enrollment and renewal of coverage. The 3 key components of this study are educational messaging + data from program databases + individual counseling using program staff.2

Evidence. Emerging. Initial research showed positive results for this strategy, but further research is needed to confirm effects. This strategy has been tested more than once and results trend positive overall. This strategy has been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. Caregivers and children; young children with special health care needs.

Outcome.  Improve health insurance enrollment and renewal for children and self-efficacy for parents. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the “Intervention Results” for each study.

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Use a combined approach to facilitate enrollment of uninsured and underinsured children,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

  • Number of health navigators or child benefit advisors trained to assist families.

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

  • Percent of families receiving support (e.g., care management, education) for enrollment and renewal of health coverage.
  • Percent of parents reporting satisfaction with the support services.

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

  • Number of families receiving support (e.g., education and parent engagement, counseling) to enhance utilization of services and adequacy of coverage.

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

  • Percent of families reporting increased knowledge, enhanced engagement, and greater adequacy of coverage.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4):

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References:

1 Chao R, Bertonaschi S, Gazmararian J. Healthy beginnings: A system of care for children in Atlanta; Fuld J, Farag M, Weinstein J, Gale LB. Enrolling and retaining uninsured and underinsured populations in public health insurance through a service integration model in New York City. American journal of public health. 2013 Feb;103(2):202-5

2 Fuld J, Farag M, Weinstein J, Gale LB. Enrolling and retaining uninsured and underinsured populations in public health insurance through a service integration model in New York City. American journal of public health. 2013 Feb;103(2):202-5

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.