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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. 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 Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Health Outcomes. This strategy helps contribute to reducing avoidable differences among socioeconomic and demographic groups or geographical areas in health status and health outcomes such as disease, disability, or mortality.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Outreach (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

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. Here are sample ESMs to use as models 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?")

PROCESS MEASURES:

  • Number of health navigators for child benefit advisors hired and trained. (Measures workforce capacity for implementing the multicomponent approach)
  • Number of collaborative partnerships established with health care providers, community organizations, and early intervention programs. (Assesses breadth of community partner engagement)

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

PROCESS MEASURES:

  • Percent of health navigators for benefit advisors who achieve defined competency standards. (Evaluates workforce readiness to implement the approach effectively)
  • Percent of focus population reached through the collaborative partnerships. (Measures penetration of the intervention among those who need it most)

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

PROCESS MEASURES:

  • Number of referrals to the program generated by collaborative partners in health care and early intervention. (Measures effective activation of partnerships)
  • Number of policy barriers to enrollment identified and addressed through the intervention. (Demonstrates systems-level problem-solving)

OUTCOME MEASURES:

  • Number of children who maintain continuous insurance coverage for 12 months after enrollment. (Reflects impact on retention and reducing churning)
  • Number of well-child visits and developmental screenings received by children after gaining coverage. (Measures health care access and utilization)

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

PROCESS MEASURES:

  • Percent of uninsured children in the community who are reached by the multicomponent intervention. (Assesses population coverage of the approach)
  • Percent of collaborative partners who report strengthened capacity to support insurance enrollment. (Measures systems-level impact and sustainability)

OUTCOME MEASURES:

  • Percent reduction in emergency department visits for conditions that could have been managed in primary care after children gain coverage. (Reflects improved care management)
  • Percent of newly enrolled children who access preventive care within 6 months of gaining coverage. (Shows initial health care utilization enabled by insurance)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 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.