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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Postpartum Visit.

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Strategy. Mother-Infant Dyad Programs

Approach. Support primary- and pediatric-care partnerships that enable concurrent (co-located and co-timed) mother/infant preventive checkups

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Overview. Mother-Infant Dyad programs can link well-child visits with postpartum primary care visits, increasing clinical interactions that promote longitudinal care, including screening for complications of pregnancy such as gestational diabetes mellitus.[1] Co-timed and co-located maternal-newborn visits may be more feasible and acceptable as a health service intervention in settings where pediatricians and obstetric providers are able to coordinate care and work in tandem.[2] Evidence suggests that mother-infant dyad programs can increase the likelihood that both postpartum women and their newborns will receive primary preventive care.

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):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.

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. Direct Care (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. 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 postpartum individuals and their infants who participate in co-located and co-timed preventive care visits through mother-infant dyad programs. (Measures the reach and engagement of the focus population)
  • Number of primary care and pediatric providers trained and supported to deliver coordinated, team-based care through mother-infant dyad programs. (Assesses the workforce capacity and readiness for the strategy)

OUTCOME MEASURES:

  • Number of infants who receive recommended well-child care, immunizations, and developmental screenings through mother-infant dyad programs. (Measures the impact of the strategy on infant preventive care and early intervention)
  • Number of postpartum complications, chronic conditions, and adverse health outcomes prevented or managed through the early detection and longitudinal care enabled by mother-infant dyad programs. (Assesses the health impact and cost-saving potential of the strategy)

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

PROCESS MEASURES:

  • Percent of postpartum individuals and infants who complete all recommended preventive care visits and screenings through mother-infant dyad programs. (Measures the retention and adherence to care of the focus population)
  • Percent of mother-infant dyad program providers and staff who demonstrate cultural humility, patient-centered communication skills, and trauma-informed practices. (Assesses the competency and responsiveness of the workforce to the diverse needs of families)

OUTCOME MEASURES:

  • Percent of infants who achieve key health and developmental milestones, such as healthy growth, up-to-date immunizations, and positive parent-child interactions, through participation in mother-infant dyad programs. (Measures the short- and long-term benefits of the strategy for child health and well-being)
  • Percent reduction in disparities in postpartum and well-child preventive care access, utilization, and outcomes between families participating in mother-infant dyad programs and those receiving usual care, stratified by race, ethnicity, income, and other equity dimensions. (Assesses the health equity impact of the strategy)

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

PROCESS MEASURES:

  • Number of policies, payment models, and quality improvement initiatives developed to incentivize and sustain the implementation of mother-infant dyad programs. (Measures the enabling environment and systems change efforts for the strategy)
  • Number of research studies, evaluations, and dissemination activities conducted to build the evidence base and spread best practices for mother-infant dyad programs. (Assesses the knowledge generation and translation efforts to improve and scale the strategy)

OUTCOME MEASURES:

  • Number of communities and states that adopt and scale mother-infant dyad programs as a standard of care and best practice for advancing postpartum and well-child preventive care. (Measures the population-level impact and spread of the strategy)
  • Number of families, particularly those from communities facing economic or social barriers, who experience improved health, well-being, and equity through the access, quality, and coordination of care provided by mother-infant dyad programs. (Assesses the family and community-level impact and value of the strategy)

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

PROCESS MEASURES:

  • Percent of mother-infant dyad program resources and funding allocated to address social determinants of health and upstream drivers of maternal and child health inequities, such as economic instability, discrimination, and access barriers. (Measures the health equity and social justice orientation of the strategy)
  • Percent of mother-infant dyad program performance measures and accountability systems that prioritize patient-reported outcomes, family-centered care experiences, and equity indicators. (Assesses the responsiveness and continuous improvement focus of the strategy)

OUTCOME MEASURES:

  • Percent reduction in structural and systemic barriers to accessing and benefiting from postpartum and well-child preventive care, such as transportation, language, and discrimination, through the tailored design and implementation of mother-infant dyad programs. (Measures the social determinants and health equity outcomes of the strategy)
  • Percent of overall maternal and child health and well-being indicators, such as maternal morbidity, infant mortality, and kindergarten readiness, that improve at the population level as a result of the widespread adoption and sustainment of mother-infant dyad programs. (Assesses the long-term, intergenerational impact of the strategy on health and equity)

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] Bose Brill, S., May, S., Lorenz, A. M., Spence, D., Prater, L., Shellhaas, C., Otsubo, M., Mao, S., Flanigan, M., Thung, S., Leonard, M., Jiang, F., & Oza-Frank, R. (2022). Mother-Infant Dyad program in primary care: evidence-based postpartum care following gestational diabetes. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 35(25), 9336–9341.
[2] Polk, S., Edwardson, J., Lawson, S., Valenzuela, D., Hobbins, E., Prichett, L., & Bennett, W. L. (2021). Bridging the Postpartum Gap: A Randomized Controlled Trial to Improve Postpartum Visit Attendance Among Low-Income Women with Limited English Proficiency. Women's health reports (New Rochelle, N.Y.), 2(1), 381–388. https://doi.org/10.1089/whr.2020.0123.

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.