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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest: Bank of Evidence-linked Strategies and Tools

Strategies by Evidence Level*

Access MCHbest strategies below for each NPM topic area. You can use the examples within these strategies to develop/update your ESMs. Don't forget to use the ESM Development Guide and the Role of Title V to provide the structure for your ESM work.

You can also sort each set of strategies by: Target Audience | Advanced Search

NPM 1: Well-Woman Visit

These strategies have been proven effective in addressing NPM 1: Percent of women, ages 18 through 44, with a preventive medial visit in the past year. They can be adapted for your program needs.

Scientifically Rigorous Evidence:

Moderate Evidence:

Expert Opinion:

Emerging Evidence:

  • Home Visiting: Support home visiting programs that promote annual well-woman visits and preventive cancer screenings.
  • Nurse-Led Multicomponent Interventions: Support multicomponent interventions led by nurse practitioners to improve access to preventive services for women in health care settings.

Additional Resources:

  • Well-Woman Visit: Resource Overview: The American College of Obstetricians and Gynecologists (ACOG) has identified the following resources that may be helpful for ob-gyns, other health care providers, and patients related to the well-woman visit.
  • AMCHP Resources:
    • Health for Every Mother: A Maternal Health Resource and Planning Guide for States. This guide for Title V programs and their partners provides a synthesis of program and policy recommendations and offers a framework to support states in identifying next steps. Contents include strategies and planning tools for strengthening maternal data systems, increasing the value of an investment in maternal health, enabling healthy living, improving access to care, ensuring high quality health care for women, and ensuring readiness and response to obstetric emergencies.
    • Implementation Toolkit for National Performance Measure 1. This toolkit contains examples of state strategies being used to address NPM 1 in Title V programs.
  • For a comprehensive summary of the evidence, promising practices, additional sample ESMs, and additional learning and resources, access the Well-Woman Visit Evidence Toolkit.

NPM 2: Low-Risk Cesarean Delivery

These strategies have been proven effective in addressing NPM 2: Percent of cesarean deliveries among low-risk first births. They can be adapted for your program needs.

Emerging Evidence:

Mixed Evidence:

Additional Resources:

  • Access ESMs from other Title V programs that can serve as examples and models.
  • For a comprehensive summary of the evidence, promising practices, additional sample ESMs, and additional learning and resources, access the Low-Risk Cesarean Deliveries Toolkit.

NPM 3: Risk-Appropriate Perinatal Care (Perinatal Regionalization)

These strategies have been proven effective in addressing NPM 3: Percent of very low birth weight (VLBW) infants born in a hospital with a Level III+ Neonatal Intensive Care Unit (NICU). They can be adapted for your program needs.

Scientifically Rigorous Evidence:

  • Telemedicine: Support the use of telemedicine to establish need for referral and transfer of high-risk mothers with VLBW neonates.

Moderate Evidence:

Expert Opinion:

Emerging Evidence:

Additional Resources:

  • Access ESMs from other Title V programs that can serve as examples and models.
  • For a comprehensive summary of the evidence, promising practices, additional sample ESMs, and additional learning and resources, access the Perinatal Regionalization Toolkit.

NPM 4: Breastfeeding

These strategies have been proven effective in addressing NPM 4A: Percent of infants who are ever breastfed and NPM 4B: Percent of infants breastfed exclusively through 6 months. They can be adapted for your program needs.

Moderate Evidence:

  • Home Visits: Provide training and coaching to MIECHV home visiting staff to promote breastfeeding best practices.
  • Lactation Consultants: Maintain a 24-hour breastfeeding hotline staffed by a bilingual certified lactation consultant.
  • Peer Counselors: Utilize breastfeeding peer counselors through WIC programs.

Emerging Evidence:

  • Family Leave, Workplace Policies, State Laws: Provide trainings and other supports on workplace Mother-Friendly breastfeeding support policies (e.g., employer-provided break time and private space to breastfeed) across the state/jurisdiction.
  • Provider Training: Provide training to health care providers around breastfeeding best practices.

Mixed Evidence:

  • Group Education: Promote the use of group education for pregnant women around breastfeeding practices in the hospital setting.
  • Hospital Policies: Promote Baby Friendly policies for hospital systems across the state/jurisdiction.
  • WIC Food Package Change: Enhance the number of families participating in the fully-breastfed WIC food package change.

Additional Resources:

NPM 5: Safe Sleep

These strategies have been proven effective in addressing NPM 5A: Percent of infants placed to sleep on their backs, NPM 5B: Percent of infants placed to sleep on a separate approved sleep surface, and NPM 5C: Percent of infants placed to sleep without soft objects or loose bedding. They can be adapted for your program needs.

Note: The most effective efforts in lowering SUID/SIDS should include NPM 4: Breastfeeding and NPM 14: Smoking (Moon R,Darnall RA, Feldman-Winter L, Goodstein M, Hauck FR. (2016). SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics. 138. 10.1542/peds.2016-2938).

  • The protective role of breastfeeding on SIDS is enhanced when breastfeeding is exclusive and without formula introduction. In addition, maternal smoking during pregnancy has been identified as a major risk factor in almost every epidemiologic study of SIDS.
  • Smoke exposure adversely affects infant arousal; in addition, smoke exposure increases the risk of preterm birth and low birth weight, both risk factors for SIDS. It is estimated that one-third of SIDS deaths could be prevented if all maternal smoking during pregnancy was eliminated.

Moderate Evidence:

Expert Opinion:

Emerging Evidence:

Additional Resources:

NPM 6: Developmental Screening

These strategies have been proven effective in addressing NPM 6: Percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year. They can be adapted for your program needs.

Moderate Evidence:

Additional Resources:

NPM 7: Injury Hospitilization

These strategies have been proven effective in addressing NPM 7.1: Rate of hospitalization for non-fatal injury per 100,000 children, ages 0 through 9 and 7.2: Rate of hospitalization for non-fatal injury per 100,000 adolescents, ages 10 through 19. They can be adapted for your program needs.

Scientifically Rigorous Evidence:

Moderate Evidence:

Expert Opinion:

Emerging Evidence:

Additional Resources:

NPM 8: Physical Activity

These strategies have been proven effective in addressing NPM 8.1: Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day and 8.2: Percent of adolescents, ages 12 through 17, who are physically active at least 60 minutes per day. They can be adapted for your program needs.

Scientifically Rigorous Evidence:

Moderate Evidence:

Emerging Evidence:

Mixed Evidence:

Additional Resources:

NPM 9: Bullying

These strategies have been proven effective in addressing NPM 9: Percent of adolescents, ages 12 through 17, who are bullied or who bully others. They can be adapted for your program needs.

Multi-tiered approaches have been shown to be the most effective approach in addressing bullying. It is critical to combine youth-targeted interventions with universal programs (e.g., classroom or school-based). Likewise, combining classroom and school level interventions appears to be more effective than implementing either alone. Findings suggest that students involved in extracurricular activities have more favorable perceptions of social-emotional security, adult support, student support, and school connectedness. In addition, classroom discussions to elicit views on what rules should govern the way people treat others are thought to increase the likelihood of disciplinary actions for infractions of school rules being effective.

Moderate Evidence:

Emerging Evidence:

Additional Resources:

NPM 10: Adolescent Well-Visit

These strategies have been proven effective in addressing NPM 10: Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year. They can be adapted for your program needs.

Scientifically Rigorous Evidence:

Moderate Evidence:

Emerging Evidence:

Emerging Evidence/Expert Opinion:

Additional Resources:

NPM 11: Medical Home

These strategies have been proven effective in addressing NPM 11: Percent of children with and without special health care needs, ages 0 through 17, who have a medical home. They can be adapted for your program needs.

Emerging Evidence:

  • Dedicated Care Coordinators: Use dedicated care coordinators to develop relationships with families to increase timely attendance of well-child visits and respond to the needs of families.
  • Provider Alliance and Mid-Level Providers: Use a provider alliance and mid-level providers to create a “one-stop” medical home model to provide community outreach and coordination of services.
  • Provider-School Partnerships: Develop partnerships between primary care providers (PCPs) and school-based health centers (SBHC) to create an expanded medical home model based on care coordination.
  • Shared Care Coordination with Home Visiting: Develop early connections to a medical home model through care coordination and collaboration with home visiting.

Additional Resources:

NPM 12: Health Care Transition

These strategies have been proven effective in addressing NPM 12: Percent of adolescents with and without special health care needs, ages 12 through 17, who received services necessary to make transitions to adult health care. They can be adapted for your program needs.

Moderate Evidence:

Expert Opinion:

Emerging Evidence:

Mixed Evidence:

  • Planning for Transition + Transfer Assistance: Provide planning activities and transfer assistance to increase the percent of adolescents who received services to prepare for the transition from pediatric to adult health care.

Additional Resources:

NPM 13: Preventive Dental Visit (Oral Health)

These strategies have been proven effective in addressing NPM 13.1: Percent of women who had a preventive dental visit during pregnancy and 13.2: Percent of children, ages 1 through 17, who had a preventive dental visit in the past year. Examples of preventive oral health services include screenings, anticipatory guidance and education (oral hygiene and eating practices), dental sealants applications, fluoride varnish applications, mouthguards, prophylaxis, and silver diamine fluoride).

These strategies can be adapted for your program needs.

13.1: Percent of women who had a preventive dental visit during pregnancy

Moderate Evidence:

  • Medicaid Reforms: Provide comprehensive dental coverage for Medicaid-enrolled pregnant women during pregnancy and postpartum.

Expert Opinion:

  • Information about Teledentistry: Provide information about opportunities and barriers related to teledentistry (e.g., state statutes, practice acts, reimbursement policies) to key state and/or local oral health stakeholders.
  • Provider Education (Early Head Start, Home Visiting, WIC): Collaborate with Early Head Start programs, home visiting programs, and/or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics to train staff to conduct oral health risk assessments, provide preventive oral health care, and refer pregnant women for dental visits.
  • Provider Education (National Organizations): Collaborate with national, obstetrical and/or nurse midwifery associations to train their members to conduct oral health risk assessments, provide preventive oral health care, and make referrals.
  • Teledentistry: Develop and provide training (or professional development) for oral health professionals at the state and/or local level about teledentistry (including state practice acts and reimbursement policies), and provide teledentistry services for pregnant women.

Emerging Evidence:

  • Patient Education/Counseling: Integrate oral health messages and strategies within existing community-based maternal and infant health programs.
  • Quality Improvement Collaboratives: Collaborate with safety net dental clinics to integrate business assessment, quality improvement, and education on appropriate dental care for pregnant people.

13.2: Percent of children, ages 1 through 17, who had a preventive dental visit in the past year

Scientifically Rigorous Evidence:

  • School-Based Dental Programs: Provide school oral health programs, School Based Health Centers (SBHCs), and Title V local grantees with technical assistance to enhance the quality of oral health services and increase oral health visits.

Moderate Evidence:

  • Community School Partnerships: Facilitate partnerships between community schools and pediatric oral health services.
  • Medicaid Reforms: Increase the number of dental providers who accept Medicaid through activities such as provider training, increased reimbursements, and other incentives.
  • Public Insurance Coverage: Collaborate with Medicaid to increase the number of children and youth who have had a preventive dental visit in the past year.

Expert Opinion:

  • Information about Teledentistry: Provide information about opportunities and barriers related to teledentistry (e.g., state statutes, practice acts, reimbursement policies) to key state and/or local oral health stakeholders.
  • Teledentistry: Develop and provide training (or professional development) for oral health professionals at the state and/or local level about teledentistry (including state practice acts and reimbursement policies), and provide teledentistry services for children and adolescents.

Emerging Evidence:

  • Caregiver/Parent Education and/or Counseling: Share postcards or conduct motivational interviews with families that focus on the importance of dental enrollment and how to set up appointments.
  • Early Head Start Integration: Integrate oral health activities into Early Head Start Programs.
  • Mobile Dental Care Programs: Use mobile dental clinics to perform preventive care for individuals who otherwise would not have access to services.
  • Preventive Oral Care Outreach: Collaborate with Early Head Start and Head Start programs, home visiting programs, and/or WIC clinics to train staff to provide preventive oral health care and referrals to oral health professionals for dental visits.

Mixed Evidence:

Additional Resources:

NPM 14: Smoking

These strategies have been proven effective in addressing NPM 14: 14.1 Percent of women who smoke during pregnancy and 14.2 Percent of children, ages 0 through 17, who live in households where someone smokes. They can be adapted for your program needs.

14.1 Percent of women who smoke during pregnancy

Moderate Evidence:

  • Incentives: Provide incentives to reduce smoking during pregnancy.

Emerging Evidence:

  • Counseling: Provide counseling to reduce smoking during pregnancy.
  • Feedback: Provide feedback to support reduction or smoking cessation behaviors.
  • Health Education: Provide health education to reduce smoking during pregnancy.

14.2 Percent of children, ages 0 through 17, who live in households where someone smokes

Note: the research for smoking in the household has focused almost exclusively on multicomponent interventions. Combining strategies appears to increase effectiveness; however, single component interventions also trend positive in many situations.

Moderate Evidence:

Emerging Evidence:

Additional Resources:

  • NPM 14.2 Smoking in the Household - Evidence Review: Brief. A summary of report methodologies, results, key findings, and implications.
  • NPM 14.2 Smoking in the Household - Evidence Review: Full Report. A critical analysis and synthesis of the effectiveness of strategies that might be applied to address NPM 11 to serve as the foundation for accountability across all states and jurisdictions.
  • Smoking Timeline. With widespread documentation of the adverse health effects of active smoking in the 1960s, attention turned to the exposure of nonsmokers and the possibility of serious health effects. This timeline traces the public health response to the smoking crisis.
  • For a comprehensive summary of the evidence, promising practices, additional sample ESMs, and additional learning and resources, access the Smoking Toolkit.

NPM 15: Continuous and Adequate Insurance

These strategies have been proven effective in addressing NPM 15: Percent of children, ages 0 through 17, who are continuously and adequately insured. They can be adapted for your program needs.

Scientifically Rigorous Evidence:

Moderate Evidence:

Expert Opinion:

  • Behavior Health Programs: Support state agencies to identify eligibility and connect children to appropriate behavioral health services.
  • CHIP: Support the enrollment of children in the Children’s Health Insurance Program (CHIP) across the state.
  • EPSDT: Expand access to EPSDT benefits for children enrolled in Medicaid.
  • Family Supports: Work collaboratively with Family-to-Family Health Information Centers.
  • Foster Care: Implement programs within Medicaid agencies to support children in the foster care system in establishing health insurance.
  • Managed Care: Create or implement specifications within specialty managed care plans to capitate rates for CYSHCN.
  • Mandated Benefits: Implement mandated (state-required) benefits to include specific services for children covered by private health insurers.
  • Medicaid Waivers: Implement protocol to waive federal regulations to ensure health insurance coverage for CYSHCN.
  • Outreach to Communities Experiencing Inequities: Support outreach to communities experiencing inequalities in health insurance coverage.
  • Premium Assistance: Support the development of a premium assistance program for low-income working families.
  • Relief Funds: Establish a state relief fund to support families of CYSHCN with financial burdens.
  • TEFRA (Katie Beckett Option): Support the implementation of the Tax Equity and Fiscal Responsibility Act.

Emerging Evidence:

Additional Resources:

* Read more about understanding evidence ratings.

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.