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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. Women Infants and Children. (WIC) Nutrition Programs

Approach. Utilize WIC clinics to provide developmental monitoring and referral

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Overview. Based on Centers for Disease Control and Prevention’s Learn the Signs. Act Early. campaign, the program was developed and replicated in two phases at 20 different WIC clinics in eastern Missouri. Parents were asked to complete developmental milestone checklists for their children, ages 2 months to 4 years, during WIC eligibility recertification visits; WIC staff referred children with potential concerns to their healthcare providers for developmental screening. WIC staff surveys and focus groups were used to assess initial implementation outcomes.[1]

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):

  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Quality of Care. This strategy promotes the degree to which healthcare services meet established standards aimed at achieving optimal health outcomes.

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. Referral and Follow-Up (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 WIC clinics implementing the Learn the Signs. Act Early (LTSAE) developmental monitoring and referral program. (Measures the adoption and spread of the intervention)
  • Number of developmental milestone checklists distributed to parents during WIC recertification visits. (Measures the reach and scale of the intervention with the focus population)

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

PROCESS MEASURES:

  • Percent of WIC staff who demonstrate proficiency in using LTSAE materials and protocols after training. (Assesses the effectiveness of staff training and preparation)
  • Percent of WIC recertification visits where parents are offered and complete LTSAE developmental milestone checklists. (Measures the consistency and reliability of intervention delivery)

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

PROCESS MEASURES:

  • Number of partnerships established between WIC clinics and local early intervention, pediatric healthcare, and family support providers to facilitate developmental screening and service linkages. (Measures the level of cross-sector collaboration and care coordination)
  • Number of WIC agencies that integrate LTSAE developmental monitoring into their clinic policies, data systems, and continuous quality improvement efforts. (Assesses the systemization and institutionalization of the practice)

OUTCOME MEASURES:

  • Number of communities that demonstrate increased early identification and intervention rates for developmental delays after implementing LTSAE in WIC clinics, compared to baseline. (Shows the population health impact of the WIC-based intervention)
  • Number of states that adopt policies for provide funding to support the integration of LTSAE developmental monitoring in WIC clinics statewide. (Measures progress toward institutionalizing and sustaining the practice through policy levers)

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

PROCESS MEASURES:

  • Percent of WIC clinics implementing LTSAE developmental monitoring that serve predominantly families experiencing socioeconomic challenges. (Measures the focus on reaching focus populations)
  • Percent of LTSAE materials and referral resources adapted to be relevant and responsive to the needs and strengths of various WIC families. (Assesses the tailoring of the intervention)

OUTCOME MEASURES:

  • Percent reduction in gaps in developmental monitoring and early intervention rates between WIC-enrolled children and other children after LTSAE implementation. (Measures the intervention's impact on promoting early identification)
  • Percent increase in the proportion of all young children in the community who receive developmental monitoring and timely intervention through universal implementation of LTSAE in WIC and other settings. (Measures progress toward population-level access of early detection and support)

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 Farmer, J.E., Falk, L.W., Clark, M.J. et al. Developmental Monitoring and Referral for Low-Income Children Served by WIC: Program Development and Implementation Outcomes. Materal Child Health J 26, 230–241 (2022). https://doi.org/10.1007/s10995-021-03319-9.

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.