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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. Policy and Support

Approach. Utilize Health Services Initiatives (HSI) funding to expand programs and increase developmental screening rates

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Overview. States seeking to improve quality metrics in pediatric primary care, specifically developmental screening and comprehensive well-child visit (WCV) completion, can leverage federal State Children’s Health Insurance Program (CHIP) Health Services Initiatives (HSIs). HSIs allow states to use up to 10% of their CHIP funding to implement programs aimed at improving the health of eligible children, offering flexibility in scope and design. [1] This funding mechanism provides significant federal dollars by utilizing state or private matching funds, which supports infrastructure for evidence-based strategies in maternal and child health. [1] The goal of this leverage is to improve the quality of the WCVs, known as Early and Periodic Screening, Diagnostic and Treatment (EPSDT) visits. [1] Evidence from one state’s implementation showed that leveraging HSI funds to support a high-quality pediatric intervention significantly improved results: participating clinics had significantly higher rates of developmental screening (48% versus 36% at non-participating sites in SFY 2019) and showed higher percentages of completed WCVs (72% versus 51% at non-participating sites in SFY 2019). [1] This model helps meet the requirement that HSI funding is intended to directly improve the health of children in low-income households, and it can also serve children who are eligible for but not enrolled in Medicaid or CHIP. [1]

Evidence. Moderate Evidence. Strategies with this rating are likely to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

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.
  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).
  • 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. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

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

  • Number of state agencies (e.g., Medicaid/CHIP), universities, and non-profit organizations formally partnering to secure and administer HSI funding for quality improvement program expansion. (Measures the breadth of multi-sector collaboration required to launch the funding strategy)
  • Number of primary care clinics or healthcare systems newly implementing evidence-based quality improvement programs through HSI financial support. (Measures the adoption and spread of the strategy across delivery systems)

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

  • Percent of newly trained clinical providers and staff who achieve competency standards in delivering developmental surveillance and utilizing standardized screening tools. (Assesses the fidelity and quality of workforce capacity development)
  • Percent of available federal CHIP Health Services Initiative funds utilized by the state to support evidence-based MCH strategies that target developmental screening and well-child visits. (Measures the optimization of federal funding mechanisms toward key MCH outcomes)

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

  • Number of children enrolled in Medicaid/CHIP who receive a well-child visit (EPSDT) at a clinic participating in the HSI-funded quality improvement program, indicating increased access to preventive care. (Measures improved utilization of essential pediatric services)
  • Number of formal interagency agreements, policies, or sustainable financing models established to ensure the continuation of HSI-funded program infrastructure and activities beyond the initial project term. (Measures the enabling environment and systems change efforts for the strategy)
  • Number of parents/caregivers receiving services through the HSI-funded program who report increasing positive parent-child interaction behaviors. (Measures positive health behavior change among the target population)
  • Number of participating primary care sites where the observed developmental screening rate for children aged 9 to 36 months meets or exceeds the statewide developmental screening goal. (Measures improved compliance with standard clinical practice guidelines)

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

  • Percent increase in the standardized developmental screening rate for eligible children within HSI-participating sites compared to non-participating sites over a two-year period following HSI implementation. (Measures the differential impact and effectiveness of the strategy)
  • Percent of Well-Child Visits delivered at HSI-participating clinics that are categorized as high quality based on full completion of all recommended Early and Periodic Screening, Diagnostic and Treatment (EPSDT) components. (Measures the improvement in the overall quality of care delivery)
  • Percent of parents and caregivers served by HSI-funded programs who report high satisfaction with the personalized guidance provided by their healthcare provider. (Measures the improvement in the patient experience of care and communication)
  • Percent of Medicaid/CHIP-eligible young children served by HSI-funded programs who are screened and referred for early intervention services, when necessary, in a timely manner. (Measures the effectiveness of the strategy in achieving timely intervention and continuum of care)

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] Dunlap, M., Lake, L., Patterson, S., Perdue, B., & Caldwell, A. (2021). Reach Out and Read and developmental screening: using federal dollars through a health services initiative. J Investig Med, 69(5), 897–900.

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.