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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Medical Home: Care Coordination.

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Strategy. Community Health Workers

Approach. Establish a community health worker program to provide coordination of healthcare for children with medical complexities to improve outcomes for pediatric asthma patients in low income populations.

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Overview. Involving community health workers (CHWs) to support pediatricians, subspecialists, behavioral health providers, and legal experts, may offer potential pathways to improve pediatric asthma outcomes in low-income populations.[1] Implementing the evidence-based program Coordination of Healthcare for Complex Kids. (CHECK) is associated with improved healthcare utilization and controller prescriptions for these patients.[1] Engaged children experienced a reduction in emergency department visits from 68.1% at baseline to 49.5% after the first year.[1]

Evidence. Emerging Evidence. Strategies based on emerging evidence show promise but have not undergone extensive testing. While these approaches demonstrate potential, their effectiveness remains unconfirmed. Prioritize rigorous monitoring to ensure they achieve desired outcomes for all MCH populations.

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

Potential Data Sources. Data to support this strategy can be accessed through:

  • Parent/caregiver-reported satisfaction measures on asthma control
  • Community health worker activity logs
  • Patient and family satisfaction surveys

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

  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • Health Care Access for All MCH Populations.
  • 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).

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

Intervention Level. Community-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 community health workers (CHWs) deployed to support children with medical complexities, particularly those with asthma from communities facing economic challenges. (Measures CHW workforce capacity)
  • Number of children with medical complexities receiving care coordination services from CHWs. (Assesses reach of CHW intervention)

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

  • Percent of CHWs who are representative of the communities they serve. (Measures concordance of CHW workforce)
  • Percent of children receiving CHW services tailored to their unique needs. (Assesses person-centeredness of CHW intervention)

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

  • Number of children with asthma demonstrating sustained self-management skills after CHW engagement. (Measures behavior change impact of CHW intervention)
  • Number of families reporting high levels of trust and shared decision-making with CHWs. (Assesses relational outcomes of CHW coordination)
  • Number of healthcare systems adopting CHW models for children with medical complexities. (Measures uptake of CHW care coordination model)
  • Number of communities achieving reductions in negative health outcomes through CHW interventions for children with medical complexities. (Assesses population health impact)

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

  • Percent of children with asthma demonstrating sustained self-management skills after CHW engagement. (Measures behavior change impact of CHW intervention)
  • Percent of families reporting high levels of trust and shared decision-making with CHWs. (Assesses relational outcomes of CHW coordination)
  • Percent of healthcare systems adopting CHW models for children with medical complexities. (Measures uptake of CHW care coordination model)
  • Percent of communities achieving reductions in negative health outcomes through CHW interventions for children with medical complexities. (Assesses population health impact)

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] Pappalardo, A., Wang, T., & Martin, M. A. (2022). CHECK – multilevel real-world pediatric asthma care coordination: results and lessons learned. Journal of Asthma, 60(6), 1061–1071. https://doi.org/10.1080/02770903.2022.2129063

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.