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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Developmental Screening.

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Strategy. Home Visiting Programs

Approach. Utilize Home Visiting/MIECHV programs to provide the Ages and Stages Developmental Screening tool to clients

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Overview. There is growing evidence that using home visiting sessions to encourage parents to use the Ages and Stages tool may increase developmental screening rates. While there are limited number of studies that examine this intervention, it appears to be effective in this setting.[1,2]

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some 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):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.

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

Intervention Level. Community-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 home visitors trained to administer and interpret the Ages and Stages Developmental Screening tool. (Measures capacity building efforts to support the intervention)
  • Number of Ages and Stages Developmental Screening kits distributed to home visiting programs. (Measures the dissemination of the key resource needed for the intervention)

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

PROCESS MEASURES:

  • Percent of home visitors who demonstrate proficiency in administering and interpreting the Ages and Stages tool after training. (Assesses the quality and effectiveness of staff training efforts)
  • Percent of home visiting programs that have a written protocol for follow-up and referral after an Ages and Stages screening indicates a concern. (Measures the standardization and quality of post-screening process)

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

PROCESS MEASURES:

  • Number of community partners (e.g., early intervention, pediatricians) engaged by home visiting programs to support the use of the Ages and Stages tool and follow-up. (Measures the level of cross-sector collaboration and care coordination)
  • Number of state for local policies and funding streams that support the use of the Ages and Stages tool in home visiting programs. (Measures the degree of institutional and financial support for the intervention)

OUTCOME MEASURES:

  • Number of children who receive early intervention for disability support services as a result of being screened with the Ages and Stages tool in home visiting. (Measures the connection between screening and receipt of needed services)
  • Number of communities that show improved rates of school readiness and academic success after implementing the Ages and Stages screening in home visiting programs. (Shows the long-range, population-level impact of the early detection intervention)

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

PROCESS MEASURES:

  • Percent of home visiting programs using the Ages and Stages tool that serve high proportions of families experiencing socioeconomic challenges. (Assesses the focus and reach of the intervention)
  • Percent of home visitors trained on the Ages and Stages tool who reflect key characteristics of the clients they serve. (Measures the congruence and representation of the screening workforce)

OUTCOME MEASURES:

  • Percent reduction in gaps in developmental screening and early intervention rates between different subpopulations of children in home visiting after implementing the Ages and Stages tool. (Measures the intervention's impact on advancing access and reach)
  • Percent of all children in the communities who have access to developmental screening and follow-up through the Ages and Stages tool in home visiting for other delivery mechanisms. (Assesses the universality and reach of the early detection intervention)

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

1,3 Green B, Tarte JM, Harrison PM, Nygren M, Sanders M. Results from a randomized trial of the Healthy Families Oregon accredited statewide program: early program impacts on parenting. Child Youth Serv Rev. 2014;44:288-298.

2 Garcia S, Brown E, Strobino D, & Minokovitz C. National Performance Measure 6 Developmental Screening Evidence Review. Strengthen the Evidence for Maternal and Child Health Programs. 2018. Women's and Children's Health Policy Center, John Hopkins University, Baltimore, MD.

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.