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.
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.
- 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.
- Designated Clinics/Extended Hours: Increase access and visibility to clinics that offer extended hours of service within close proximity to MCH populations.
- Engagement of Other MCH Programs to Disseminate Information and Make Referrals for Well-Woman Visit: Provide education on the importance of the Well-Woman Visit to other MCH programs such as WIC, Healthy Start, MIECHV and other home visiting programs; encourage these programs to make referrals for visits.
- Nurse-Led Multicomponent Interventions: Support multicomponent interventions led by nurse practitioners to improve access to preventive services for women in health care settings.
- Provider Education: Host an onsite or online educational series about annual preventive visits and strategies to help providers address missed opportunities.
- Eligibility Expanded Insurance Coverage/Medicaid Eligibility : Adopt a protocol to ensure that all persons in maternal, child, and adolescent health programs are referred for enrollment in health insurance.
Schools; Provider/System; Patient/Consumers:
- Engagement of Other MCH Programs to Disseminate Information and Make Referrals: Provide education on the importance of the Well-Woman Visit to other MCH programs.
- Federally Qualified Health Centers (FQHCs): Expand the number of FQHCs in the state to provide preventive care services to the underinsured.
- Medical Homes: Support the development of a medical home care model to be implemented within clinics statewide.
- Practice Facilitation for Primary Care: Develop a practice facilitation program to connect practice coaches with primary care clinics.
- Professionally Trained Medical Interpreters: Support the development of a training program for medical interpreters.
- University-Based Quality Improvement Initiatives: Work with academic institutions to develop and adopt multicomponent QI initiatives to increase annual well-woman visits and preventive screening on college campuses.
- Value-Based Insurance Design: Support the shift to value-based insurance design for all health insurance models within the state.
- Media Campaigns: Utilize media outlets to promote preventive medical visits.
- 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.
- Childbirth Education Classes: Support the development of a community-based childbirth education class.
- Nutrition Education for Expectant Mothers: Provide educational materials or trainings that increase awareness and identify risk factors for nutrition-related indicators that have been shown to increase cesarean deliveries.
- Multicomponent: Childbirth Education Classes + Active Management of Labor: Support the development of a statewide community-based childbirth education class + support providers in active management of labor using oxytocin infusion.
- Programs to Promote Active Management of Labor: Promote the initiation by providers of oxytocin infusion.
- Supportive Care from Lay Doulas: Implement a statewide community-based doula program which contracts to local hospitals.
- Elective Induction Policy: Support the development of an elective induction policy.
- Multicomponent: Chart Audit and Feedback + State/National Guidelines: Support the development of an elective induction policy + develop state goal for low-risk cesarean section rate.
- Multicomponent: Active Management of Labor + Chart Audit and Feedback + State/National Guidelines: Support providers in active management of labor using oxytocin infusion + support the development of an elective induction policy + develop state goal for low-risk cesarean section rate.
- Multicomponent: Active Management of Labor + Use of State/National Guidelines: Support providers in active management of labor using oxytocin infusion + develop state goal for low-risk cesarean section rate.
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.
- Adopt Standard Definitions for Hospital Level of Care: Define Hospital Levels of Neonatal care and Levels of Maternal Care using AAP and ACOG/SMFM guidelines.
- Continuing Education of Hospital Providers: Develop CME module on transport guidelines of high-risk pregnant women.
- Statewide Assessment of Personnel, Resources, and Capabilities of Birthing Facilities: Implement a statewide assessment of the personnel and capabilities of maternity hospitals using CDC’s Level of Care Assessment Tool (LOCATe).
- Home Visiting Program/Healthy Families America: Establish a family home visiting program beginning in the prenatal period.
- Multicomponent: Access to Providers through Hotline + Continuing Education of Hospital Providers + State Policies/Guidelines: Support development of a 3-pronged approach by developing a 24-hour hotline, support establishment of intra-hospital transport system, and develop an educational CME module.
- Multicomponent: Continuing Education of Hospital Providers + State Policies/Guidelines: Support establishment of intra-hospital transportation system and develop educational CME module.
- 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.
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.
- 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.
- AMCHP Resources:
- For a comprehensive summary of the evidence, promising practices, additional sample ESMs, and additional learning and resources, access the Breastfeeding Evidence Toolkit.
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:
- Child Care Provider Education: Enforce laws regarding mandatory training for childcare providers on infant safe sleep practices.
- Caregiver Education (e.g., mothers, family members): Partner with WIC, home visiting, and other programs to provide safe sleep education and counseling to new caregivers.
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:
- Health Care Provider Education: Provide staff of birthing hospitals with training on infant safe sleep.
- Building on Campaigns with Conversations: Provide training to professionals who interact with expecting and new mothers and families that emphasize a nuanced approach.
- Multicomponent Strategy: Caregiver Education + Health Care Provider Education + Hospital Safe Sleep Policy: Implement a multicomponent strategy that targets caregivers, child care providers, health care providers, and hospital systems (not including quality improvement components).
- Multicomponent Strategy: Caregiver Education + Health Care Provider Education + Hospital Safe Sleep Policy + Quality Improvement: Implement a multicomponent strategy that targets caregivers, child care providers, health care providers, and hospital systems with built-in quality improvement components.
- Promising Practices for Safe Sleep to Inform the Missouri Safe Sleep Strategic Plan.
- Successful Strategies Hospitals Can Use to Support Safe Sleep.
- For a comprehensive summary of the evidence, promising practices, additional sample ESMs, and additional learning and resources, access the Safe Sleep Evidence Toolkit.
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.
- Home Visiting Programs: Utilize Home Visiting/MIECHV programs to provide Ages and Stages Developmental Screening tool with clients.
Health Care Practice:
- Quality Improvement Programs in Health Care Settings: Support practice-based learning collaborative for primary care practices.
- Provider Training: Train medical, social service, childcare providers, and home visitorson the importance of utilizing validated developmental screening tools.
- Implementation of Quality Standards: Support statewide learning collaborative for primary care practices with enhanced reimbursement for developmental screening and collaboration with local agencies.
- AMCHP Resources:
- Early Childhood Developmental Screening and Title V: Building Better Systems—An Issue Brief sharing Title V Strategies and Measures on National Performance Measure 6: Developmental Screening
- Implementation Toolkit for National Performance Measure 6. This toolkit contains examples of state strategies being used to address NPM 6 in Title V programs.
- For a comprehensive summary of the evidence, promising practices, additional sample ESMs, and additional learning and resources, access the Developmental Screening Evidence Toolkit.
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.
- Clinic-Based Interventions to Prevent Child Maltreatment: Conduct parent education during prenatal care and/or well-child visits to reduce child maltreatment.
- Collaboration with Existing Evidence-based/informed Programs: Disseminate injury prevention and safe behavior information through existing evidence-based/informed home visiting, caregiver education, and school-based outreach programs
- Community-Based Distribution of Cribs and Safe Sleep Education to Prevent Infant Suffocation: Provide safe sleep education and distribute cribs at community baby showers to promote safe sleep.
- Education During Home Visiting Programs: Provide injury prevention education for families participating in home visiting programs.
- Home Visiting Interventions to Prevent Child Injury: Conduct home visiting programs that include safety discussions, informational materials, and free safety devices to reduce household hazards.
- Home Visiting Interventions to Prevent Child Maltreatment: Conduct home visiting programs that promote positive parenting skills.
- Hospital-Based Multi-Component Safe Sleep Training to Prevent Infant Suffocation: Conduct safe sleep training for nurses and/or mothers in maternity wards/neonatal intensive care units.
- Parent Group Programs to Prevent Child Maltreatment: Conduct group-based parenting programs to improve parenting skills.
- Person-to-Person Interventions Outside the Clinical Setting: Adopt person-to-person interventions such as the drug disposal program, Count it! Drop it! Lock it!
- Well-Child Visits to Deliver Safety Education: Provide safety advice + counseling at well-child visits.
Children and Adolescents:
- Implementation of Established, Evidence-based or Informed Suicide Prevention Programs: Apply implementation science and quality improvement for testing, adapting, sustainably implementing, and widely spreading established suicide prevention programs.
- Multicomponent Selective/Indicated Programs Targeted to Suicidal Adolescents and their Families: Conduct multicomponent selective/indicated programs that are targeted to suicidal adolescents and their families to prevent suicide.
- School-Based Educational Programs to Promote Safety on the Road: Conduct educational programs with curricula that focus on bicycle safety and on safe driving skills.
- School-Based Interventions: Conduct outreach, education campaigns, and trainings in school-based settings.
- School-Based Multicomponent Educational Programs to Prevent Suicide: Conduct school-based multicomponent educational programs with curricula focused on increasing knowledge of risk factors and strengthening social support.
- School-Based Multicomponent Programs to Prevent Bullying: Conduct multi-tiered school-wide intervention to improve school environment, encourage positive bystander behaviors, provide education on bullying, and include parental involvement and individual interventions.
- School-Based Multicomponent Programs to Prevent Underage Alcohol Use and Illegal Drug Use: Conduct multicomponent educational programs using curricula based on social and character development and focused on health motivation, social skills, social influence recognition, and knowledge development.
- School-Based Programs to Prevent Dating Violence and Sexual Assault: Conduct educational programs including curriculum on healthy relationships, social norms training, and improved bystander awareness and behaviors, and increase surveillance and teacher/staff visibility in violence ‘hot spots’ in the school environment.
- School Program Using Motivational Interviewing to Prevent Underage Alcohol Use and Illegal Drug Use: Conduct motivational interview-based educational program to prevent underage alcohol use and illegal drug use.
Adolescents and Youth:
- College Campus-Based Programs to Prevent Dating Violence and Sexual Assault: Conduct educational programs including curriculum on healthy relationships, social norms training, and improved bystander awareness and behaviors.
- Intensive Residential Program + Mentoring to Decrease Youth Violence: Implement residential program with mentoring to decrease youth violence.
- Personality-Targeted School Program Aimed to Prevent Underage Alcohol Use and Illegal Drug Use: Conduct targeted educational program for students with high-risk personality traits to prevent underage alcohol use and illegal drug use.
Schools and Community:
- School-Based Educational Programs to Promote Safety on the Road: Conduct educational programs with curricula that focus on bicycle safety and on safe driving skills.
- Modification of Infrastructure to Enhance Pedestrian Safety: Modify the infrastructure around schools.
- Training + Equipment Upgrades to Increase Playground Safety: Provide staff training + upgrades to playground equipment to reduce falls and increase playground safety.
- Legislation that Promotes and Enforces Teen Driver/Passenger and Bicycle Safety: Pass and enforce legislation that promotes and enforces safety for teen drivers and their passengers and for bicycle riders.
- Legislation to Prevent Drowning and Other Injuries: Support policies and legislation promoting barrier-isolation to protect young children from drowning and other injuries.
- Oversight and Regulation of Innovative Programs: Provide oversight and regulation of innovative programs such as comprehensive home safety assessments.
- Partnerships to Scale Evidence-based Programs and Practices: Align and mobilize traditional and non-traditional partners to sustainably implement and widely spread child safety programs and strategies.
- You can access strategies from the Children's Safety Network's resource, Evidence-based and Evidence-informed Strategies for Child and Adolescent Injury Prevention. See p. 29 for a summary of findings.
- For a comprehensive summary of the evidence, promising practices, additional sample ESMs, and additional learning and resources, access the Child Safety/Injury Evidence Toolkit.
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.
- Comprehensive School Physical Activity Programs: Implement a comprehensive school physical activity program with a combination of strategies to increase physical activity before, during, and after school.
- Extracurricular Activities for Physical Activity: Provide students with opportunities to participate in sports or other athletic activities before or after school.
- Homework or Extra Credit for Physical Education Class: Assign physical activity requirements outside of school for homework or extra credit.
- Physically Active Classrooms: Incorporate physical activity in the lesson plan or include classroom energizers during academic lessons.
- Physical Education Enhancement: Expand and strengthen physical education (PE) efforts.
- Social Network/Peer Influence in School: Use in-person or technology-based social influence student groups (e.g., peer mentoring, peer leadership) to encourage and increase physical activity in or out-of-school.
- Access to Places for Physical Activity: Support increased access to places for physical activity, or decreased financial barriers to places for physical activity.
- Activity-Friendly Routes to Everyday Destinations: Use built environment approaches to create or enhance community characteristics to make physical activity easier, more appealing, and more accessible.
- Community-Wide Campaigns: Implement community-wide campaigns to increase physical activity and improve fitness among children and adults.
- Green Space and Parks: Create new parks and green space or rehabilitate empty or under-utilized public areas to promote physical activity.
- Infrastructure and Environmental Supports for Physical Activity: Promote the development and use of infrastructure that facilitates physical activity (e.g., walking trails, sidewalks, playgrounds, parks).
- Mass Communication Strategies Combined with Other Efforts: Use Mass Media Strategies (e.g., Posters, Flyers, Websites) in Conjunction with Other Strategies to Promote Physical Activity.
- Policies Regarding the Use and Promotion of Local Locations and Resources: Develop policies for the use of local locations and resources (e.g., sporting clubs, community centers, shopping malls, schools) and promote physical activity events at these locations.
- Prompts to Encourage Physical Activity: Use signage or other prompts located at points where people make decisions about being active to increase physical activity.
- MCH Navigator's NPM 8 Transformation Tools.
- Taking Action with Evidence Implementation Roadmap -- Webinar.
- For a comprehensive summary of the evidence, promising practices, additional sample ESMs, and additional learning and resources, access the Physical Activity Evidence Toolkit.
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)
- Multi-Tiered Bullying Program that Engages Youth, Classrooms, and Schools. Develop community-wide support for anti-bullying activities by promoting the spread of a comprehensive bullying program.
- Adult-Led Counseling, Mentoring, and Support: Increase youth participation in evidence-based mentoring, counseling, or adult supervision programs.
- Peer-Led Counseling, Mentoring, and Support: Promote a peer-led, counseling, mentoring, and support group to provide strengths-based skills in dealing with cyberbullying.
Multi-Tiered Universal (Classroom+ School)
- Multi-Tiered Approach: Classroom and School-Based Bullying Efforts. Combine classroom-based and school-level interventions together to be more effective than implementing either alone.
- Strengths-Based Classroom Training: Provide classroom training for students on positive youth development and non-violence intervention skills.
- 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.
- You can access strategies from HRSA’s document, Assessing Prevention Capacity & Implementing Change: An Evidence-informed and Evidenced-based Bullying Prevention Capacity Assessment and Change Package.
- Implementation Toolkit for National Performance Measure 9 (AMCHP). This toolkit contains examples of state strategies being used to address NPM 9 in Title V programs.
- For a comprehensive summary of the evidence, promising practices, additional sample ESMs, and additional learning and resources, access the Bullying Evidence Toolkit.
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.
- School-Based Health Centers: Support partnerships between primary care clinics and local school-based health centers.
- Patient Reminders/Navigator Program: Support a patient reminder program that includes telephone and mailed reminders with transportation services.
- Expanded Insurance Coverage: Adopt a protocol to ensure that all persons in adolescent health programs are referred for enrollment in a health insurance program.
- Improve State/Systems-Level Policies and Practices: Partner with Medicaid and private payers to encourage adoption of annual well-visits standards and offer incentives.
- Federally Qualified Health Centers (FQHCs): Support the provision of adolescent well-visit services at FQHCs.
- Quality Improvement (QI) Initiatives to Increase Adolescent Well-Visits: Develop and adopt multicomponent QI initiatives within pediatric practices to increase annual well-visits for adolescents.
- Support Clinic Systems in Promoting Attendance of Well-Visits: Provide information and guidance to actively schedule, code, and remind patients about the adolescent well-visit.
- Telemedicine: Promote and support telemedicine in pediatric and family medicine practices.
- National Adolescent and Young Adult Health National Resource Center (AYAH Center):
- Improving Young Adult Health: State and Local Strategies for Success. This guide outlines five key strategies that Title V programs can adopt to improve young adult health. The report includes real-world examples, resources with links, and lessons learned from Title V programs. The strategies consist of:
- Increasing Delivery of Preventive Services to Adolescents and Young Adults: Does the Preventive Visit Help?
- Change Package: A change package is a set of materials and ideas that guide and enable improvement teams to implement change in their settings. “Transforming Health Care for Adolescents and Young Adults” is an interactive module, housed by the Association of Maternal & Child Health Programs (AMCHP), that features three change packages on increasing the receipt of quality preventive visits for adolescents and young adults. The change package to "Increase Access and Utilization of AYA Preventive Services" contains the following resources relevant to NPM 10.
- Implementation Toolkit for National Performance Measure 10 (AMCHP). This toolkit contains examples of state strategies being used to address NPM 10 in Title V programs.
- For a comprehensive summary of the evidence, promising practices, additional sample ESMs, and additional learning and resources, access the Adolescent Well-Visit Evidence Toolkit.
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.
- 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/Practice with Home Visiting Program:
- 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.
- Shared Care Coordination with Home Visiting: Develop early connections to a medical home model through care coordination and collaboration with home visiting.
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.
- National Resource Center for Patient/Family-Centered Medical Home Promising Practices:
- Access promising practices that have been selected by an expert work-group as innovative and promising in pediatric medical home implementation.
- Access additional Tools and Resources for Medical Home Implementation.
- Access customizable Essential Data for Pediatricians on National Performance Measure 11 (Medical Home) template.
- For a comprehensive summary of the evidence, promising practices, additional sample ESMs, and additional learning and resources, access the Medical Home Evidence Toolkit.
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:
- Peer Support and Mentorship: Create a peer support and mentorship program or adolescent advisory council to discuss issues around health care transition.
- Planning for Transition + Training/Educating Youth: Provide planning services, including training and educating youth with and without special health care needs, who are ready for transition to adult care.
- 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.
- Planning for Transition + Transfer Assistance + Care Coordination: Provide planning, transfer assistance, and care coordination to prepare adolescents for the transition from pediatric to adult health care services.
- Planning for Transition + Transfer Assistance + Integration into Adult Care: Provide planning, transfer assistance, and integration into adult care activities to increase the percent of adolescents who received services to prepare for the transition from pediatric to adult health care.
- Planning for Transition + Transfer Assistance + Integration into Adult Care + Care Coordination: Provide planning activities, transfer assistance, integration into adult care, and care coordination to increase the percent of adolescents who received services to prepare for the transition from pediatric to adult health care.
- Transfer Assistance + Integration into Adult Care: Provide transfer assistance and integration into adult care to increase the percent of adolescents who received services to prepare for the transition from pediatric to adult health care.
Health Care Practices and Systems:
- Medical Home Integration: Incorporate transition strategies and billing codes into medical home systems.
- Provider Training/Workforce Development: Provide transition training modules to health care professionals.
- Six Core Elements Adaptation with Quality Improvement (QI): Incorporate the Six Core Elements in a learning collaborative or medical center/hospital system with built-in QI activities.
- State Policy/System Development: Partner with organizations to encourage adoption of evidence-driven health care transition (HCT) practices and policies.
- Transition Care Coordinaton Services: Use care coordinators at clinics to help with appointments, scheduling, education, and other health care transition services.
- Got Transition/Center for Health Care Transition Improvement:
- Health Care Transition in State Title V Programs: A Review of 2021 Block Grant Applications/ 2019 Annual Reports and Recommendations
- Updated Six Core Elements of Health Care Transition™ 3.0
- Implementation Guides and additional information
- Six Core Elements of Health Care Transition
- Transitioning Youth to Adult Health Care Services
- Transitioning to Adult Approach to Health Care Without Changing Providers
- Integrating Young Adults in Adult Health Care
- Validated Transition Tools
- Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home
- State Transition Information:
- Baseline Assessment of Health Care Transition Implementation in Title V Care Coordination Programs
- Health Care Transition in State Title V Program: A Review of 2018 Block Grant Applications & Recommendations for 2020
- State Title V Health Care Transition Performance Objectives and Strategies: Current Snapshots and Suggestions
- Implementation Toolkit for National Performance Measure 12 (AMCHP). This toolkit contains examples of state strategies being used to address NPM 12 in Title V programs.
- For a comprehensive summary of the evidence, promising practices, additional sample ESMs, and additional learning and resources, access the Transition Evidence Toolkit.
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 Education/Counseling: Integrate oral health messages and strategies within existing community-based maternal and infant health programs.
- 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 provide preventive oral health care to pregnant women and referrals to oral health professionals 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.
- Medicaid Reforms: Provide comprehensive dental coverage for Medicaid-enrolled pregnant women during pregnancy and postpartum.
- 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
- 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.
- 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.
- 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.
- 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.
- Community School Partnerships: Facilitate partnerships between community schools and pediatric oral health services.
- Early Head Start Integration: Integrate oral health activities into Early Head Start Programs.
- 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.
- School-Based Screenings and Follow-Up: Utilize school-based dental screenings to improve children’s oral health status and the use of dental services.
- Medicaid Reforms: Increase the number of dental providers who accept Medicaid through activities such as provider training, increased reimbursements, and other incentives.
- Mobile Dental Care Programs: Use mobile dental clinics to perform preventive care for individuals who otherwise would not have access to services.
- 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.
- Strengthening State Efforts Related to Title V Maternal and Child Health National Performance Measure 13 (Oral Health)
- Implementation Toolkit for National Performance Measure 13 (AMCHP). This toolkit contains examples of state strategies being used to address NPM 13 in Title V programs.
- For a comprehensive summary of the evidence, promising practices, additional sample ESMs, and additional learning and resources, access the Oral Health Evidence Toolkit.
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
- Feedback: Provide feedback to support reduction or smoking cessation behaviors.
- Health Education: Provide health education to reduce smoking during pregnancy.
- Incentives: Provide incentives to reduce smoking during pregnancy.
Pregnant Women/Health Care Providers:
- Counseling: Provide counseling 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.
- Clinic-based Counseling + Education Materials: Provide in-person counseling + educational materials during visits with a health care provider to reduce child exposure to secondhand smoke in the home.
- Home Visits + Education Materials + Telephone Counseling: Provide in-person counseling via home visits + educational materials + telephone counseling to reduce child exposure to secondhand smoke in the home.
- Telephone Counseling + Education Materials: Provide telephone counseling + educational materials to reduce children’s exposure to secondhand smoke in the home.
Parents/Caregivers or Parent/Child Dyads:
- School-based Counseling + Education Materials: Provide in-person counseling in a school setting + educational materials to reduce child exposure to secondhand smoke in the home.
- Smoking Policies/Bans/Legislation: Support policies/legislation to establish smoking bans in homes, cars, and other family spaces.
- 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.
- Health Insurance Enrollment Outreach and Support Health Care Entities: Community-based case managers offer health insurance information and application support.
- Insurance Enrollment Helpline (Benefits Counseling): 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.
- On-Site Medical Practice Care Coordination Services: Support the development of a care coordination plan by clinics.
- Outreach Using Enrollment Assistants: Use enrollment assistants in community health centers to help patients navigate the public health insurance process.
- Outreach Using School-Based Communication Tools: Use school-based outreach tools to promote enrollment among children and families.
- Outreach Using School Staff: Use trained school staff to assist families in getting insurance coverage.
- School-Based Health Centers: Increase the capacity of school-based health centers (SBHCs).
- 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.
- 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.
- Mental Health Benefits Legislation: Promote state policy mandating mental health coverage.
- 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.
- Patient Navigators: Promote the use of family navigator programs.
- Premium Assistance: Support the development of a premium assistance program for low-income working families.
- Price Transparency Initiatives for Patients: Create a web-based system to inform potential patients of the price of medical procedures.
- Public Reporting of Health Care Quality Performance: Display quality scores alongside insurance plans or options to help consumers choose better plans.
- 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.
- The Catalyst Center/National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs (CYSHCN): An MCHB-funded technical assistance resource center, this project supports NPM 13 topic areas.
- Data Resource Center for Child and Adolescent Health (DRC): A project of the Child and Adolescent Health Measurement Initiative, the DRC is a national data resource providing easy access to children’s health data on a variety of important topics, including the health and well-being of children and access to quality care.
- For a comprehensive summary of the evidence, promising practices, additional sample ESMs, and additional learning and resources, access the Adequate Insurance Coverage Toolkit.