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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
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Strategy. Paid Sick Leave Laws

Approach. Establish paid sick leave laws so parents can have the time to take their children to the doctor

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Overview. Paid sick leave laws require employers in the affected jurisdictions to provide paid time off to employees for use when ill or injured. Sick employees may use the time to care for themselves by seeing a health care provider or stay home until they are healthy enough to work again, without concern for lost wages. In some cases, sick leave can be used to provide care to a sick child, or for instances related to domestic violence. As of 2022, the U.S. Bureau of Labor Statistics estimates that 21% of civilian workers in the U.S. do not have paid sick leave.[1] Women, Hispanic individuals, workers experiencing economic challenges, and employees with lower levels of education are less likely to have paid sick leave than their counterparts.[2, 3, 4] Individuals with paid sick leave also tend to have higher incomes[5, 6, 7] while those without it are more likely to have income below the poverty line[8] and receive safety net services.[9] Some local governments cannot enact paid sick leave measures due to state preemption legislation.[10]

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. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

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.
  • Policy. This strategy helps to promote decisions, laws, and regulations that promote public health practices and interventions.

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. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

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 advocacy campaigns or initiatives launched to promote paid sick leave laws. (Indicates efforts to build support for the policy)
  • Number of partners (e.g., legislators, businesses, community organizations) engaged in discussions or collaborations to advance paid sick leave policies. (Shows the breadth of partnership-building for policy change)

OUTCOME MEASURES:

  • Number of paid sick leave laws or policies enacted at the local, state, or federal level. (Indicates the success of the strategy in achieving policy adoption)
  • Number of workers, particularly parents, who gain access to paid sick leave as a result of newly enacted laws or policies. (Shows the reach and impact of the policy change)

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

PROCESS MEASURES:

  • Percent of educational materials or resources on paid sick leave that are culturally and linguistically appropriate for diverse audiences. (Indicates the inclusivity and accessibility of awareness-raising efforts)
  • Percent of employers that provide training or guidance to their employees on their rights and benefits under newly enacted paid sick leave laws. (Shows employer compliance and proactive communication efforts)

OUTCOME MEASURES:

  • Percent of parents who report increased ability to take their children to medical appointments or provide care during illness due to paid sick leave access. (Indicates the policy's impact on parental capacity to meet children's health needs)
  • Percent of parents who report reduced stress, improved work-life balance, or increased job satisfaction as a result of having access to paid sick leave. (Shows the broader well-being and economic security benefits of the policy)

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

PROCESS MEASURES:

  • Number of partnerships formed between government agencies, community organizations, and healthcare providers to promote awareness and utilization of paid sick leave for children's health needs. (Indicates cross-sector collaboration to maximize policy impact)
  • Number of data collection or research initiatives undertaken to monitor and evaluate the implementation and outcomes of paid sick leave laws. (Shows investments in continuous learning and improvement)

OUTCOME MEASURES:

  • Number of children who receive timely and appropriate medical care or treatment as a result of their parents having access to paid sick leave. (Indicates the policy's impact on children's healthcare utilization and outcomes)
  • Number of parents who report improved ability to manage and coordinate their children's chronic health conditions or special healthcare needs due to paid sick leave access. (Shows the policy's impact on care management for children with complex needs)

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

PROCESS MEASURES:

  • Percent of paid sick leave laws or policies that include provisions for job protection and non-retaliation to ensure workers feel safe using their benefits. (Indicates the comprehensiveness and worker-friendliness of the policy design)
  • Percent of paid sick leave outreach and education efforts that focus on workers with lower wages, communities of color, and other populations facing disproportionate barriers to healthcare access. (Shows the equity focus of policy awareness-building)

OUTCOME MEASURES:

  • Percent reduction in racial, ethnic, or socioeconomic disparities in children's receipt of timely and needed healthcare services following the implementation of paid sick leave laws. (Indicates the policy's impact on health equity)
  • Percent of children in the state and jurisdictions covered by paid sick leave laws who experience improved health outcomes and reduced complications from common illnesses or conditions. (Shows the population-level health impact of the policy over time)

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] US DOL-PSL - US Department of Labor (US DOL), Bureau of Labor Statistics (BLS). Employee benefits in the United States - March 2017.

2 BLS-Bartel 2019 - Bartel AP, Kim S, Nam J. Racial and ethnic disparities in access to and use of paid family and medical leave: Evidence from four nationally representative datasets. Monthly Labor Review. US Bureau of Labor and Statistics (BLS); 2019.

3 Zhai 2018 - Zhai Y, Santibanez TA, Kahn KE, Black CL, de Perio MA. Paid sick leave benefits, influenza vaccination, and taking sick days due to influenza-like illness among US workers. Vaccine. 2018;36(48):7316-7323.

4 Chen 2016 - Chen ML. The growing costs and burden of family caregiving of older adults: A review of paid sick leave and family leave policies. The Gerontologist. 2016;56(3):391-396.

5 Cook 201[1] - Cook WK. Paid sick days and health care use: An analysis of the 2007 National Health Interview Survey data. American Journal of Industrial Medicine. 2011;54(10):771-779.

6 Clemans-Cope 2008 - Clemans-Cope L, Perry CD, Kenney GM, Pelletier JE, Pantell MS. Access to and use of paid sick leave among low-income families with children. Pediatrics. 2008;122(2):e480-6.

7 CWF-Collins 2004 - Collins SR, Davis K, Doty MM, Ho A. Wages, health benefits, and workers’ health. New York: The Commonwealth Fund (CWF); 2004: Issue Brief #788.

8 Stoddard-Dare 2018b - Stoddard-Dare P, DeRigne LA, Mallett C, Quinn L. How does paid sick leave relate to health care affordability and poverty among US workers? Social Work in Health Care. 2018;57(5):376-392.

9 Stoddard-Dare 2018a - Stoddard-Dare P, Quinn L, Mallett C. Paid sick leave status in relation to government sponsored welfare utilization. American Journal of Orthopsychiatry. 2018;88(5):608-615.

10 Grassroots Change - Grassroots Change: Connecting for better health. Preemption Watch.

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.