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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCH Best: Bank of Evidence-linked Strategies and Tools

Strategies by Target Audience

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: Evidence Level* | 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.

Patient/Consumer:

  • Community-Based Group Education: Support community-based education that promotes annual preventive visits.
  • Community Health Workers: Establish a network of community health workers within communities of low preventive care service utilization.
  • Faith Community Nursing: Establish a program to connect a registered nurse with a faith community to serve as a health liaison.
  • Health Literacy Interventions: Develop patient education videos to improve health literacy surrounding use of preventive care services.
  • Home Visiting: Support home visiting programs that promote annual well-woman visits and preventive cancer screenings.
  • Patient Financial Incentives for Preventive Care: Support the use of patient financial incentives for preventive care.
  • Patient Navigation: Support programs and adapt clinical protocols that assist women in scheduling preventing visits using patient navigators.
  • Patient Reminders: Support providers in disseminating reminders (e.g., postcard, text, email, phone calls, or a step-by-step combination) to women about scheduling an annual preventive visit.

Provider/Practice:

Payer:

Schools; Provider/System; Patient/Consumers:

Community:

  • Media Campaigns: Utilize media outlets to promote preventive medical visits.

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.

Patient:

Patient/Provider:

Provider:

Hospital:

Hospital/State/National:

Provider/Hospital/State/National:

Provider/State/National:

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.

Hospital:

Patient:

Providers:

Systems/State/National:

  • Rural Transportation Services: Establish a transportation system for pregnant women and VLBW neonates requiring higher level care.
  • State Policies/Guidelines: Strengthen statewide intra-hospital transportation systems for transport of high-risk mothers and newborns.
  • Telemedicine: Support the use of telemedicine to establish need for referral and transfer of high-risk mothers with VLBW neonates.

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.

Mother/Family (through home visitors, community health workers, and health care providers):

  • Group Education: Promote the use of group education for pregnant women around breastfeeding practices in the hospital setting.
  • 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.

Provider/Practice:

  • Hospital Policies: Promote Baby Friendly policies for hospital systems across the state/jurisdiction.
  • Provider Training: Provide training to health care providers around breastfeeding best practices.

State/National and Employer/Workplace:

  • 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.
  • 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.

Child Care Provider:

Parent/Caregiver:

Professional (Other than Health Care Provider):

  • Mass Media: National Campaign: Promote the national Safe to Sleep Campaign locally by providing professionals (e.g., first responders) with safe sleep kits. .

Health Care Provider:

Multiple Audiences:

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.

Patient/Caregiver:

  • Home Visiting Programs: Utilize Home Visiting/MIECHV programs to provide Ages and Stages Developmental Screening tool with clients.

Health Care Practice:

Medical/Childcare Provider:

  • Provider Training: Train medical, social service, childcare providers, and home visitorson the importance of utilizing validated developmental screening tools.

Systems:

  • Implementation of Quality Standards: Support statewide learning collaborative for primary care practices with enhanced reimbursement for developmental screening and collaboration with local agencies.

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.

Patients/Consumers/Caregivers:

Children and Adolescents:

Adolescents and Youth:

Schools and Community:

State/National:

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.

Children and Adolescents:

  • Active Recess: Promote an active, semi-structured, or recess break from the school day, typically before lunch.
  • Electronic Physical Activity Intervention: Use electronic gaming or electronic equipment to provide physical activity opportunities in a home-setting.
  • Family-Based Physical Activity Interventions: Include families in physical activity interventions to encourage support for positive behavior for children and adolescents through educational sessions and role modeling.
  • Individual Counseling by Health Professionals: Promote physical activity counseling during well-child visits.
  • Individual Supports: Provide individually-catered behavior change strategies through counseling, goal setting, peer support, summer camps or community efforts, or virtual coaching.
  • Multicomponent School-Based Obesity Prevention: Provide a multifaceted method in a school-based setting to improve the overall health of students and prevent obesity.
  • School-Based Family Intervention: Provide a school-based family intervention with instruction and support in or outside of school to encourage physical activity.
  • Screen Time Interventions: Provide educational support and encouragement to children to decrease time on TV and other stationary screen media.
  • Self-Regulation Intervention: Use of self-regulation and behavioral interventions in or out-of-school to increase moderate-to-vigorous physical activity during leisure or out-of-school time.
  • Social Supports: Promote social networks, friendships, and community support groups to help maintain and encourage physical activity.

Schools:

Community:

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.

Combining classroom and school level interventions appears to be more effective than implementing either alone (see below).

Comprehensive (Targeted Youth + Classroom + School)

Targeted

Youth:

Universal

Multi-Tiered Universal (Classroom+ School)

Classroom:

School-Wide:

  • Ongoing Outreach at Schools: Collaborate with School Based Health Centers to conduct ongoing meetings, conferences, and webinars to address bullying.
  • Suicide Prevention In-Class Training: Provide learning opportunities and support to youth in the classroom regarding bullying and suicide prevention.
  • Trauma Training: Provide ongoing educational opportunities, such as trauma training, for school professionals as well as community leaders/workers who may interface with child populations.

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.

Patient/Consumer:

Payer:

Provider/System:

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.

General Provider/Practice:

Provider/Practice with Home Visiting Program:

Provider/Practice with School Systems:

  • 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.

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.

Adolescents/Youth (with and without Special Health Care Needs):

Adolescents/Youth with Special Health Care Needs:

Health Care Practices and Systems:

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

Patient:

Professionals:

  • Provider Education (13.1): 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 provide preventive oral health care to pregnant women and referrals to oral health professionals for dental visits.
  • Provider Education (13.1): Collaborate with obstetrical and/or nurse midwifery associations to train their members to conduct oral health risk assessments, provide preventive oral health care, and make referrals.
  • Provision of Information about Teledentistry (13.1): 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: Provider Education and Promotion/Provision of Services (13.1): 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.

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

Parent/Caregiver:

Professionals:

School:

  • School/Preschool Interventions (13.2): School-Based Dental Services/Head Start Participation: Increase oral health referrals among children and youth through School Based Health Centers (SBHCs).

State:

  • Medicaid Reforms (13.2): Increase the number of dental providers who accept Medicaid through activities such as provider training, increased reimbursements, and other incentives.
  • Public Insurance Coverage (13.2): Collaborate with Medicaid to increase the number of children and youth who have had a preventive dental visit in the past year.

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

Pregnant Women:

Pregnant Women/Health Care Providers:

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.

Parents/Caregivers:

Parents/Caregivers or Parent/Child Dyads:

State/National:

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.

Patient: Caregiver and Children:

  • Family Supports: Work collaboratively with Family-to-Family Health Information Centers.
  • Insurance Enrollment Helpline: Maintain a state-run helpline to assist with insurance enrollment navigation.
  • Outreach Using Parent Mentors: Use trained parent mentors to assist families with getting insurance coverage, accessing health care, and addressing social determinants of health.

Providers/Other Professionals:

Schools:

State/Systems/Community/National:

  • Behavior Health Programs: Support state agencies to identify eligibility and connect children to appropriate behavioral health services.
  • Care Coordination: Provide access to comprehensive care coordination for children with chronic diseases to ensure benefits adequacy and reasonable costs using community health workers.
  • CHIP: Support the enrollment of children in the Children’s Health Insurance Program (CHIP) across the state.
  • Dependent Coverage Expansion: Use dependent coverage expansion policies to prevent loss of insurance coverage among adolescents and young adults (AYA).
  • EPSDT: Expand access to EPSDT benefits for children enrolled in Medicaid.
  • Expansion of Access to Prenatal Care: Expand access to prenatal care to increase coverage and improve health outcomes for immigrant women and their infants.
  • Expansion of Coverage Eligibility (Partnerships with Medicaid): Promote expansion of Medicaid benefits; reduce barriers to Medicaid enrollments; leverage partnerships with 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.
  • Health Reform Legislation: Support legislative changes to reduce uninsurance and improve access to care for children.
  • 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 Buy-In Program: Adopt a Medicaid Buy-In program for children with disabilities to ensure adequate insurance coverage.
  • Medicaid Waivers: Implement protocol to waive federal regulations to ensure health insurance coverage for CYSHCN.
  • Multicomponent Approach: Use a multicomponent approach to facilitate enrollment of uninsured and underinsured children.
  • Outreach to Communities Experiencing Inequities: Support outreach to communities experiencing inequalities in health insurance coverage.
  • Outreach Using a Data Collection System: Develop a data collection system that can monitor and evaluate the effectiveness and success of enrollment and retention efforts.
  • Outreach Using Mini-Grant Opportunities: Provide small grants to community-based organizations to improve enrollment and utilization of Medicaid and CHIP.
  • Parental Health Insurance Expansions: Provide health insurance coverage for parents to increase the likelihood of insuring children.
  • 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.

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.