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MCHbest. NPM 3: Risk-Appropriate Perinatal Care

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Strategy. Home Visiting Program/Healthy Families America

Approach. Establish a family home visiting program beginning in the prenatal period.

Source. Robert Wood Johnson Foundation's What Works for Health (WWFH) Database

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Overview. A home visiting model - HFA services begin prenatally or right after birth. Family support workers provide voluntary, intensive services for 3 to 5 years (HFA).

Evidence. Moderate.1 Mothers participating in Healthy Families New York (HFNY) are less likely to deliver low birthweight (LBW) babies than non-participants; positive effects are more likely for mothers who participate in the program earlier in their pregnancies. Decreases in LBW babies have also been shown in Virginia, Florida, and Washington DC implementations of HFA (Harding 2007*). Additional evidence is needed to confirm effects and determine the characteristics of the most successful programs. Read more in the WWFH database report. Read more about WWFH's evidence ratings. (*Links to citations can be accessed through the WWFH database).

Target Audience. Patients.

Outcome. Percent of very low birth weight (VLBW) infants born in a hospital with a Level III+ Neonatal Intensive Care Unit (NICU).

Examples from the Field. Access descriptions of ESMs from across all states/jurisdictions 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 “Establish a family home visiting program beginning in the prenatal period,” 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 families enrolled in home visiting program.

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

  • Percent of families enrolled in home visiting program.

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

  • Number of pregnant women in program who report increase in knowledge related to risk factors associated with low birthweight babies.

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

  • Percent of pregnant women in program who report increase in knowledge related to risk factors associated with low birthweight babies.

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.


Note:

1 RWJ rated this approach as "some evidence," which is equivalent to the MCH Evidence "moderate evidence" rating.

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.