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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. Adapted Healthcare

Approach. Support adapted healthcare to families of children with special healthcare needs to better coordinate their care.

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Overview. Adapted healthcare tailors care to patients’ norms, backgrounds, beliefs, values, language, and literacy skills.[1, 2] Care may delve more deeply into considerations such as social, psychological, economic factors, and place of family origin.[2] Adapted healthcare can include: matching specialists to patients by background or place of family origin;[3] adapting patient materials to reflect patients’ customs, language, or literacy skills;[1] offering education via community-based health supporters;[4] incorporating norms about faith, food, family, or self-image into patient care; and implementing patient involvement strategies.[5]

Evidence. Scientifically Rigorous Evidence. Strategies based on scientifically rigorous evidence are proven effective across multiple robust studies. While success is highly likely, local impact may vary. Monitor outcomes and use data to tailor these strategies to the community's unique needs.

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:

  • Care coordination service logs
  • Family experience of care coordination surveys
  • Care coordination training and professional development data

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.
  • Community Health Factors.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.

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

Intervention Level. Individual/Family-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 healthcare providers trained in delivering adapted care to families of children with special healthcare needs. (Shows the capacity building efforts to support the implementation of adapted care)
  • Number of community-based health supporters engaged to support families in navigating and coordinating adapted care for their children with special healthcare needs. (Indicates the involvement of congruent support personnel in facilitating care coordination)

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

  • Percent of healthcare organizations serving children with special healthcare needs that have policies and protocols led by Title V in place to support the delivery of adapted care coordination. (Shows the institutional commitment and readiness to implement adapted care)
  • Percent of families of children with special healthcare needs who rate the responsiveness and appropriateness of the care coordination services they receive as high. (Indicates the family-reported quality and relevance of adapted care)

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

  • Number of partnerships convened by Title V established between healthcare organizations and community-based entities (e.g., faith-based organizations, community-specific centers) to support the delivery of adapted care coordination to families of children with special healthcare needs. (Shows the multi-sector collaboration and community engagement efforts to enhance adapted care)
  • Number of quality improvement initiatives or learning collaboratives led by Title V focused on enhancing the delivery of adapted care coordination to families of children with special healthcare needs. (Indicates the commitment to continuous improvement and shared learning in advancing adapted care practices)
  • Number of emergency department visits or hospitalizations prevented among children with special healthcare needs as a result of receiving adapted, proactive care coordination delivered by Title V. (Shows the impact of adapted care on reducing adverse health events and costly care utilization)
  • Number of successful policy changes to support the sustainable financing and delivery of adapted care coordination for children with special healthcare needs and their families. (Indicates the systems-level impact and sustainability of adapted care approaches)

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

  • Percent of healthcare organizations serving children with special healthcare needs that have dedicated funding and resources allocated to support the ongoing delivery of care coordination. (Shows the institutional investment and prioritization of adapted care approaches)
  • Percent of adapted care coordination initiatives for children with special healthcare needs that include a focus on addressing health outcomes. (Indicates the explicit integration of goals and practices within adapted care delivery)
  • Percent of families of children with special healthcare needs who report feeling affirmed, respected, and valued in their interactions with the healthcare system as a result of receiving care coordination. (Shows the family-reported experiences of safety and humility within the care delivery process)
  • Percent of healthcare payment models and policies that incentivize and reward the delivery of care coordination to children with special healthcare needs and their families. (Indicates the broader systems-level recognition and prioritization of care approaches as a standard of quality 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] Pottie 2013 - Pottie K, Hadi A, Chen J, Welch V, Hawthorne K. Realist review to understand the efficacy of culturally appropriate diabetes education programmes. Diabetic Medicine. 2013;30(9):1017-25.

2 Hodge 2010 - Hodge DR, Jackson KF, Vaughn MG. Culturally sensitive interventions and health and behavioral health youth outcomes: A meta-analytic review. Social Work in Health Care. 2010;49(5):401-23.

3 Chowdhary 2014 - Chowdhary N, Jotheeswaran AT, Nadkarni A, et al. The methods and outcomes of cultural adaptations of psychological treatments for depressive disorders: A systematic review. Psychological Medicine. 2014;44(6):1131-46.

4 Cochrane-Attridge 2014 - Attridge M, Creamer J, Ramsden M, Hawthorne K. Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus: Review. The Cochrane Database of Systematic Reviews. 2014;(9):CD006424.

5 Kong 2014 - Kong A, Tussing-Humphreys LM, Odoms-Young AM, Stolley MR, Fitzgibbon ML. Systematic review of behavioural interventions with culturally adapted strategies to improve diet and weight outcomes in African American women. Obesity Reviews. 2014;15(S4):62-92.

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.