Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Prenatal Care Access Access Provider Training/Education Telehealth/Virtual Care

Intervention Description: The intervention in the study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City was the adoption and utilization of telehealth for prenatal care visits. The study aimed to evaluate the feasibility and effectiveness of telehealth for prenatal care during the COVID-19 pandemic, which necessitated a shift away from in-person visits to minimize the risk of viral transmission. The telehealth intervention involved the use of video conferencing technology to conduct prenatal care visits remotely. Patients were able to connect with their healthcare providers via video conferencing software, such as Zoom or Skype, to receive prenatal care services. The study analyzed the proportion of prenatal care visits that were conducted via telehealth compared to in-person visits over a 5-week period from March 9 to April 12, 2020, at Columbia University Irving Medical Center (CUIMC)-affiliated prenatal practices in New York City . The study also evaluated the challenges and successes associated with the adoption of telehealth for prenatal care, including provider attitudes towards telehealth, patient barriers to accessing telehealth, and operational considerations for clinics and healthcare systems . Overall, the intervention involved the rapid adoption and utilization of telehealth for prenatal care during the COVID-19 pandemic, with the aim of maintaining access to essential prenatal care services while minimizing the risk of viral transmission.

Intervention Results: The study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City found that telehealth was rapidly adopted and utilized for prenatal care during the study period. The study analyzed 4,248 prenatal care visits over a 5-week period, of which approximately one-third were conducted via telehealth (n=1,352, 31.8%). By the fifth week, 56.1% of generalist visits, 61.5% of maternal-fetal medicine (MFM) visits, and 41.5% of clinic visits were conducted via telehealth . The study also found that providers generally had positive attitudes towards telehealth visits, and accessing technology and performing visits, documentation, and follow-up using the telehealth electronic medical record were all viewed favorably by providers . However, the study identified significant barriers to telehealth and in-person visits, including patient fear of COVID-19 infection, limited access to technology and connectivity, and language barriers . The study also found that the transition to virtual prenatal care was more challenging for patients with Medicaid insurance receiving care at health clinics than for women with commercial insurance in generalist and maternal-fetal medicine faculty practices. Factors related to differential care attendance included operational considerations such as requiring increased staffing in clinics and patient factors related to technological proficiency, language barriers, Wi-Fi and data access, child care, and fear of infection. Additional patient-level and operational supports were required to optimize access for patients with Medicaid . Overall, the study suggests that telehealth was feasible and associated with provider satisfaction for prenatal care during the COVID-19 pandemic. However, significant barriers to telehealth may be present for patients with Medicaid insurance, which may require additional support to resolve .

Conclusion: The conclusions drawn from the study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City are as follows: 1. Rapid Transition Feasibility: The study demonstrated that a rapid transition to telehealth for prenatal care was feasible and associated with provider satisfaction. The adoption and utilization of telehealth for prenatal care were viewed favorably by healthcare providers . 2. Differential Uptake Based on Insurance: The study highlighted that telehealth uptake differed based on insurance, with patients with Medicaid insurance experiencing more challenges and barriers to accessing telehealth compared to those with commercial insurance. This finding underscores the need for additional patient-level and operational supports to optimize access for patients with Medicaid . 3. Operational Challenges: The transition to virtual prenatal care was more challenging for patients with Medicaid insurance receiving care at health clinics than for women with commercial insurance in generalist and maternal-fetal medicine faculty practices. Operational considerations, such as requiring increased staffing in clinics, were identified as significant barriers to the adoption of telehealth for prenatal care . 4. Patient Barriers: The study identified various patient-related barriers to telehealth, including technological proficiency, language barriers, Wi-Fi and data access, child care responsibilities, and fear of infection. These barriers need to be addressed to optimize access to telehealth for prenatal care, particularly for patients with Medicaid insurance . In summary, the study underscores the feasibility of rapid transition to telehealth for prenatal care and the need for additional support to address barriers faced by patients with Medicaid insurance. It emphasizes the importance of addressing operational challenges and patient-related barriers to ensure equitable access to telehealth for prenatal care during public health crises such as the COVID-19 pandemic .

Study Design: The study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City utilized a mixed-methods approach, combining quantitative analysis and qualitative assessment. Quantitative Analysis: The study analyzed trends in whether prenatal care visits were conducted in-person or via telehealth over a 5-week period from March 9 to April 12 at Columbia University Irving Medical Center (CUIMC)-affiliated prenatal practices in New York City during the COVID-19 pandemic. The proportion of visits that were conducted via telehealth was analyzed by visit type by week . This quantitative analysis provided insights into the adoption and utilization of telehealth for prenatal care during the specified period. Qualitative Assessment: In addition to the quantitative analysis, the study conducted a survey and semistructured interviews of healthcare providers to evaluate resources and obstacles in the uptake of telehealth. The survey and interviews aimed to understand provider experiences, satisfaction, and challenges associated with the integration of telehealth into prenatal care. The qualitative assessment provided in-depth insights into the operational challenges and barriers faced by healthcare providers and clinics during the transition to telehealth for prenatal care . By employing both quantitative and qualitative methods, the study aimed to comprehensively assess the transition to telehealth for prenatal care during the COVID-19 pandemic, providing a multifaceted understanding of the challenges, successes, and provider attitudes related to this transition.

Setting: The setting for the study on the transition of prenatal care to telehealth during the COVID-19 pandemic is New York City. Specifically, the study focuses on the prenatal care facilities affiliated with the Columbia University Irving Medical Center (CUIMC) located in midtown Manhattan, Washington Heights in Upper Manhattan, Rockland County, and Westchester . These facilities provide care for patients with both Medicaid and commercial insurance, and the patients accessing prenatal care at these sites primarily deliver at NewYork Presbyterian Morgan Stanley Children’s Hospital of New York and NewYork Presbyterian/The Allen Hospital . The study provides insights into the adoption of telehealth for obstetric patients in a tertiary referral hospital and clinic system in New York City, offering valuable information on the implementation of telehealth in an urban setting during the COVID-19 pandemic.

Population of Focus: The target audience for the study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City includes a wide range of stakeholders involved in maternal-fetal medicine, obstetrics and gynecology, public health, healthcare administration, and telehealth implementation. This may encompass: 1. Healthcare Providers: Obstetricians, gynecologists, maternal-fetal medicine specialists, and other healthcare professionals involved in prenatal care. 2. Healthcare Administrators: Hospital administrators, clinic managers, and healthcare system leaders responsible for implementing telehealth services and optimizing prenatal care delivery. 3. Public Health Officials: Professionals involved in public health policy, maternal and child health, and healthcare access initiatives. 4. Telehealth Practitioners: Individuals and organizations involved in the provision of telehealth services, including telemedicine companies and technology developers. 5. Researchers and Academics: Scholars and researchers interested in the impact of telehealth on prenatal care, healthcare delivery during crises, and healthcare disparities. 6. Policymakers: Government officials and policymakers involved in shaping healthcare regulations, reimbursement policies, and telehealth legislation. 7. Patient Advocacy Groups: Organizations advocating for improved access to prenatal care and maternal healthcare services. The study's findings are relevant to these stakeholders as they provide insights into the feasibility, challenges, and benefits of transitioning prenatal care to telehealth, particularly in an urban setting during a public health crisis. Additionally, the study's focus on provider attitudes and patient access issues makes it valuable for those interested in improving maternal healthcare delivery and access to early prenatal care.

Sample Size: Specifically, the study surveyed 36 healthcare providers and conducted interviews with 11 of them 8. While the exact sample size for the patient population is not provided, the study analyzed prenatal visits over a 5-week period from March 9, 2020, to April 12, 2020, during which time telehealth was adopted across clinical sites

Age Range: the study focused on prenatal care for pregnant individuals accessing care at the Columbia University Irving Medical Center (CUIMC)-affiliated obstetric ambulatory prenatal care facilities in New York City. As such, the patient population likely consisted of pregnant individuals of reproductive age, typically ranging from late teens to early 40s. Given the focus on prenatal care, the study's patient population would primarily include pregnant individuals seeking obstetric and gynecological care during the COVID-19 pandemic. The specific age range of these individuals was not explicitly stated in the available information.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Peer Counselor Telephone Support Educational Material PROVIDER/PRACTICE Community Health Workers (CHWs)

Intervention Description: To assess whether a theory-based, community health worker–delivered intervention for household smokers will lead to reduced secondhand smoke exposure to children in Chinese families.

Intervention Results: Of the 318 families randomized, 98 (60%) of 164 intervention group and 82 (53%) of 154 of controls completed 6-month follow-up assessment. At the 6-month follow-up, 62% of intervention and 45% of comparison group households adopted complete smoking restrictions at home (P = .022); total exposure (mean number of cigarettes per week ± standard deviation) from all smokers at home in the past 7 days was significantly lower among children in the intervention (3.29 ± 9.06) than the comparison (7.41 ± 14.63) group (P = .021); and mean urine cotinine level (ng/mL) was significantly lower in the intervention (0.030 ± .065) than the comparison (0.087 ± .027) group, P < .001). Participants rating of the overall usefulness of the intervention was 4.8 + 0.8 (1 standard deviation) on the 5 point scale (1 not at all and 5 = very useful). Conclusions

Conclusion: The findings of this very first study in China showed that smoking hygiene intervention was effective in reducing children's exposure to secondhand smoke. These findings have implications for the development of primary health care–based secondhand smoke exposure reduction and family oriented smoking cessation interventions as China moves toward a smoke-free society.

Study Design: RCT

Setting: Community (households)

Population of Focus: Smoking parents or caregivers who had a child aged 5 years or younger

Data Source: Health center records and parent selfreport.

Sample Size: 318 families

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Quality Improvement EMR Reminder

Intervention Description: The interventions included nurse-champion training, standardized screening using the Patient Health Questionnaire-9 (PHQ-9), a reminder system for nurses to conduct screenings, and a video training program for nursing staff. These interventions align with a discernable strategy of implementing evidence-based screening tools and providing education and training to healthcare providers to improve their knowledge and comfort level in addressing perinatal mood and anxiety disorders. The study analyzes a multicomponent intervention that includes the four interventions mentioned above. The study aimed to determine if these interventions improved the PPD screening rate, PPD screening positive rate, and related social work referrals and consultation rates at Cedars-Sinai’s postpartum and maternal-fetal care units. The study found that all four interventions were successful in achieving the main outcomes, and the program has improved depression screening and increased social work referral rates at Cedars-Sinai.

Intervention Results: The four interventions increased nurse-champion screening comfort and perinatal mood and anxiety disorder knowledge, PHQ-9 screening rates from 10% to 99%, and screen-positive rates from 0.04% to 2.9%, and rates of social work consultation from 1.7% to 8.4% . Before training, 43% of surveyed nurses felt “very comfortable” screening patients for depression. After training, overall comfort increased to 73%. Nurse champions showed increased comfort discussing perinatal mental health, facilitating mental health referrals, and providing information to patients . After completion of 5 months of video training, the screening rate remained at 99%. Of those screened, 19% screened positive and as many as 39% of them consulted with social work . The SPC chart showed that screening rates had a sharp increase between March 2017 and June 2017 from 0.01% to 59.54% . The program sustained progress achieved by the first 4 interventions detailed in the report, and data from the next 4 interventions are currently being analyzed.

Conclusion: Quality improvement results from the first 3 years of the program suggest that 4 interventions improved screening rates, screen-positive rates, and social work consultation rates. Future work will focus on method of screening, patients at highest risk of perinatal mood and anxiety disorders, and ongoing nurse training.

Study Design: The study design used the Standards for QUality Improvement Reporting Excellence 2.0 guidelines to report outcomes from the four interventions. The study aimed to evaluate the impact of the interventions on the postpartum depression screening, education, and referral program at Cedars-Sinai. The interventions included nurse-champion training, use of the 9-item Patient Health Questionnaire-9 in the postpartum unit, a series of brief in-service trainings, and a 10-minute video training. The study collected data including nurse feedback, screening rates, screen-positive rates, and social work consultation rates

Setting: The study was conducted at Cedars-Sinai, a nonprofit hospital located in Beverly Hills, California. The hospital has a postpartum and maternal-fetal care unit where the interventions were implemented to improve the screening, education, and referral program for postpartum depression. The study included a sample of 19,564 women who delivered their babies at Cedars-Sinai over the course of two years

Population of Focus: The target audience of this study appears to be healthcare professionals, specifically those working in the postpartum and maternal-fetal care units at Cedars-Sinai. The study aimed to improve the screening, education, and referral program for postpartum depression at Cedars-Sinai, and the interventions were targeted towards nursing staff and social workers. The study also reported on the outcomes of the interventions, including nurse feedback, screening rates, screen-positive rates, and social work consultation rates, which may be of interest to healthcare professionals working in similar settings.

Sample Size: The sample size for the study was 19,564 women who delivered their babies at Cedars-Sinai over the course of two years. This sample size was used to evaluate the outcomes of the interventions aimed at improving the screening, education, and referral program for postpartum depression at the hospital

Age Range: The study did not report a specific age range for the sample of women who delivered their babies at Cedars-Sinai. However, the study did report that the average patient age was 33.95 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention Provider Training/Education Guideline Change and Implementation Provider Tools

Intervention Description: Parents were interviewed and instructed on creating a care map. That map was then shared with HCP. Both parents and HCP were intereviewed to learn what their thoughts were about implementing both care maps and care plans.

Intervention Results: Two themes reflected two primary categories: (a) the utility of care plans and care maps, and (b) the intersection of care plans and care maps. results indicated that care maps are useful and should be created and discussed with HCP prior to creating a care plan.

Conclusion: No Conclusion: Results: Data analysis exploring the relationship and utility of care plans and care maps revealed six primary themes related to using care plans and care maps that were grouped into two primary categories: (a) utility of care plans and maps; and (b) intersection of care plans and care maps. Discussion: Care plans and care maps were identified as valuable complementary documents. Their integration offers context about family experience and respects the parents' experiential wisdom in a standard patient care document, thus promoting improved understanding and integration of the family experience into care decision making

Study Design: A qualitative design with thematic analysis

Setting: CMC: Hospital/Clinic - tertiary pediatric academic health sciences center, The Hospital for Sick Children (SickKids), and at a community hospital, North York General Hospital (NYGH), both located in Ontario, Canada.

Population of Focus: CMC - healthcare providers, including pediatricians, pediatric subspecialists, pediatric nurse practitioners, social workers, occupational and physiotherapists, pharmacists, and community nurses, who provide care for children with medical complexity.

Sample Size: 15 parents, 30 HCP - 15 parents of children with medical complexity who created care maps, and 30 healthcare providers who provided care to children with medical complexity.

Age Range: 1/17/2024

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Technology-Based Support

Intervention Description: In the US, many individuals with diabetes do not have consistent access to endocrinologists and therefore rely on primary care providers (PCPs) for their diabetes management. Project ECHO (Extension for Community Healthcare Outcomes) Diabetes, a tele-education model, was developed to empower PCPs to independently manage diabetes, including education on diabetes technology initiation and use, to bridge disparities in diabetes.

Intervention Results: PCPs reported improvement in all domains of diabetes education and management. From baseline, PCPs reported improvement in their confidence to serve as the T1D provider for their community (pre vs post: 43.8% vs 68.8%, p=0.005), manage insulin therapy (pre vs post: 62.8% vs 84.3%, p=0.002), and identify symptoms of diabetes distress (pre vs post: 62.8% vs 84.3%, p=0.002) post-intervention. Compared to pre-intervention, providers reported significant improvement in their confidence in all aspects of diabetes technology including prescribing technology (41.2% vs 68.6%, p=0.001), managing insulin pumps (41.2% vs 68.6%, p=0.001) and hybrid closed loop (10.2% vs 26.5%, p=0.033), and interpreting sensor data (41.2% vs 68.6%, p=0.001) post-intervention.

Conclusion: PCPs who participated in Project ECHO Diabetes reported increased confidence in diabetes management, with notable improvement in their ability to prescribe, manage, and troubleshoot diabetes technology. These data support the use of tele-education of PCPs to increase confidence in diabetes technology management as a feasible strategy to advance equity in diabetes management and outcomes.

Study Design: Pre-post study

Setting: Health centers in underserved areas of California and Florida

Population of Focus: Primary care providers (PCPs) who were recruited from federally qualifying health centers and community health centers in underserved areas of California and Florida. The participants included physicians and advanced practice providers, with a focus on those who were responsible for managing diabetes care in these settings

Sample Size: 116 providers

Age Range: Adult providers serving pediatric populations

Intervention Components (click on component to see a list of all articles that use that intervention): Provider, Education; Hospital, Chart audit and feedback, Elective induction policy, Guideline change and implementation, Quality improvement HEALTH_CARE_PROVIDER_PRACTICE Provider Training/Education HOSPITAL Chart Audit and Feedback Elective Induction Policy Guideline Change and Implementation Quality Improvement

Intervention Description: At a large Southern US women's hospital, new measures were made to reduce the rates of cesarian delivery at the facility. Endeavors were led by nurse / doctor leaders (VP & chief of staff). These included monitoring, benchmarking & disseminating information about CD at the facility; new protocols for oxytocin administration; Bishop's score assessment; elective CD performed only at 39 weeks; new protocols and intrapartum alternative positioning devices, the process of laboring down, and closed glottis pushing attempts in second-stage labor.

Intervention Results: Collectively, these interdisciplinary interventions have resulted in significant decreases in overall cesarean birth rates and comparable significant reductions in the NTSV cesarean rates.

Conclusion: Concerted efforts to reduce rates of nonmedically indicated cesarean birth have resulted in the development and implementation of comprehensive action plans aimed at effecting reductions and enhancing overall obstetric quality care.

Setting: One large obstetric hospital in the Southern USA

Population of Focus: NTSV births

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE Provider Training/Education PROFESSIONAL_CAREGIVER Education/Training (caregiver) COMMUNITY Presentation

Intervention Description: This study assessed the impact of the two-day Kansas Infant Death and SIDS (KIDS) Network Safe Sleep Instructor (SSI) train-the-trainer program on CPS staffs' knowledge of the American Academy of Pediatrics safe sleep recommendations. Training was attended by 43 participants, 27 (63%) of whom were employed by CPS. All participants completed a 10-item pre- and post-training knowledge assessment at the beginning of the training and immediately following the training, respectively. Following training, SSIs were certified to educate parents/caregivers, childcare providers, health care providers, and other members of their communities about safe sleep practices. SSIs were tasked with providing safe sleep training to at least 10 professionals and with hosting one Safe Sleep Community Baby Shower or Crib Clinic within 9 months of certification.

Intervention Results: Following SSI certification, CPS SSIs provided more safe sleep training to professionals than other SSIs (1051 vs. 165, respectively), and both groups of SSIs were able to significantly increase the knowledge of their trainees.

Conclusion: Overall, the KIDS Network SSI training was successful. The innovative partnership with CPS allowed for provision of training to a group not historically targeted for safe sleep education.

Setting: Kansas Department of Children and Families Child Protective Services (CPS)

Population of Focus: Child Protective Services staff

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Patient-Centered Medical Home Quality Improvement/Practice-Wide Intervention

Intervention Description: pre-test, training intervention and tool guide, post test

Intervention Results: After completing the educational intervention to promote family and sibling adaptation in the NICU, the nurses' knowledge and perceptions were more favorable, and they implemented more nursing practices.

Conclusion: Based on the findings of our quality improvement project, the educational intervention could be offered to all NICU nurses working with families, as the positive attitudes of nurses are central to the implementation of FCC (Maree & Downes, 2016). FCC should be encouraged in NICUs as parental presence, educational sessions and participating actively in the care of preterm infants have been recently reported to improve both infant and parental outcomes (O'Brien et al., 2018), as well as the infants' medical outcomes (Lv et al., 2019). Visitors' programs in hospital centers to support FCC have reported significant results for parents (Lee et al., 2014). Policies in the NICU should encourage the parents' presence and participation in care and also include siblings and extended families, such as grandparents (Craig et al., 2015; Lee et al., 2014). If necessary, the visitation policy could be modified to promote parental presence, participation and partnership in FCC (Griffin, 2013). The design of the NICU can also support FCC (Maree & Downes, 2016). With the goal of expanding the reach of our training intervention, this quality improvement project is currently being turned into an online training program in order to be offered to all NICU nurses across the province. This project should be replicated with a larger sample of NICU nurses. Future research could also evaluate the parents' satisfaction with the FCC in the NICU using an instrument that includes all FCC principles (Dall'Oglio et al., 2018). Using FCC guidelines, the effect of training or educational programs on the family members' psychological and wellness outcomes should be evaluated (Davidson et al., 2017). Comparing the effect of FCC on the adaptation of different sibling age groups (i.e., 3 to 8 years old vs. 12 to 16 years old), as well as grandparents or even others deemed to be significant others by families during NICU hospitalization, would also contribute to the body of knowledge about FCC. Finally, nurses' perceptions of the benefits of implementing FCC in their practice could be further explored through a qualitative study. The findings of our project reinforce the importance of offering NICU nurses educational training programs to support them in their practice, as part of quality improvement processes. Our results support the main objective of the educational intervention, which was to develop the nurses' competencies in intervening with siblings and families in the NICU. This FCC educational intervention can significantly contribute to the quality of care offered to family members, including siblings, who have a preterm infant hospitalized at the NICU

Study Design: quality improvement project

Setting: NICU: a level III NICU in Montreal, Canada, with a capacity of 40 beds designed in pods - a level III NICU in Montreal, Canada, with a capacity of 40 beds designed in pods (intermediate and intensive care) and single-family rooms, where approximately 110 nurses work

Population of Focus: NICU Nurses - the nurses working in the NICU. A convenience sample of 20 nurses initially participated in the project, and 13 completed the post-intervention evaluation .

Sample Size: 20 nurses

Age Range: 23-44

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Provider Training/Education Educational Material (Provider) Expert Support (Provider)

Intervention Description: To increase primary care providers' use of validated tools for developmental, social/emotional, maternal depression, and domestic violence screening and to increase early awareness of autism symptoms during pediatric well-child visits in children aged 0 to 3 years.

Intervention Results: Percentage of sites screening 85% of children by 12-month well-child visit increased from 0% at baseline to 68.8% at follow-up. Sites not reaching 85% screening screened 48-83% of children at follow-up. Percentage of sites conducting social/emotional screening for 85% of children by 18-month well-child visit increased from 6% at baseline to 46.7% at follow-up. Sites not reaching 85% screening screened 5-81% of children at follow-up. Percentage of sites screening 85% of children by 24-month well-child visit increased from 0% at baseline to 68.8% at follow-up. Sites not reaching 85% screening screened 18-84% of children at follow-up.

Conclusion: The Enhancing Developmentally Oriented Primary Care (EDOPC) project enhanced confidence and intent to screen among a large group of Illinois primary health care providers. Among a sample of primary care sites at which chart reviews were conducted, the EDOPC project increased developmental screening rates to the target of 85% of patients at most sites and increased social/emotional screening rates to the same target rate in nearly half of the participating practices.

Study Design: QE: pretest-posttest

Setting: Primary care medical homes (federally qualified health centers, residency training programs, private practices) primarily in Chicago, Illinois, metropolitan area

Population of Focus: Children ages 4 to 24 months

Data Source: Child medical record

Sample Size: Chart audits at 16 sites (n=25 per site)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Outreach (School Staff) Educational Material (Provider) Patient Navigation

Intervention Description: The intervention in the study is described as a school-based outreach pilot program aimed at increasing access and participation in State-subsidized health insurance. The specific activities of the intervention include including State-subsidized insurance marketing material in the student registration packet and providing outreach material to develop sustainable strategies for identifying uninsured children and systematically incorporating child health outreach into routine school district operations

Intervention Results: The study's results indicate that the school-based outreach program was effective in identifying uninsured children and facilitating their enrollment in State-subsidized health insurance programs. The outreach efforts resulted in a significant response rate, with a notable number of children enrolled in the program as a result of the intervention. These findings suggest that incorporating health insurance outreach into routine school district operations can be a successful strategy for reaching uninsured children and increasing their access to State-subsidized health insurance

Conclusion: The conclusion of the study suggests that integrating the collection of health insurance status into routine school communication channels is an effective way to identify uninsured children who may be eligible for State subsidized benefits. The research, conducted in Van Buren County, MI, estimates that 70% of the 1,211 uninsured children are eligible for State subsidized health insurance. A survey distributed with free and reduced lunch applications and school registration identified 156 uninsured children, raising questions about the external validity of the research. The study proposes the extrapolation of results to the entire county or even the state, emphasizing the simplicity of the survey and the statewide management of the Free and Reduced Lunch Program. The approach, already successful in several states, could provide a sustainable and everyday method for effective outreach to identify uninsured children. Additionally, the study rejects Ho2, stating there is a statistical difference in the number of applications received from a school-based outreach program during the pilot period. The analysis of application data shows a positive relationship between time and the number of applications received, with a predicted increase of 5.6593 applications in each subsequent period. The model's strength is supported by a relatively strong R² of 77.58%. However, the study acknowledges that 23% of the error remains unexplained, possibly due to factors such as the pilot outreach intervention. The actual number of applications in May 2013 exceeded the predicted range, suggesting factors not accounted for in the model.

Study Design: The study is described as a cross-sectional pilot study designed to employ a school-based outreach effort utilizing existing school communications to identify children who are currently uninsured and may be eligible for State subsidized health insurance.

Setting: State of Michigan schools

Population of Focus: The target audience for the study includes K-12 students and their families, particularly those who are currently uninsured and may be eligible for State subsidized health insurance.

Sample Size: The study identifies 156 children as not having health insurance, representing more than 44% of the 358 children who are eligible for State subsidized health insurance in the participating school districts

Age Range: The age range of the children involved in the study is K-12, which typically includes children between the ages of 5 and 18 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement Educational Material (Provider)

Intervention Description: Increasing women's access to nonmedical interventions during labor, such as continuous labor support, also has been shown to reduce cesarean birth rates. External cephalic version for breech presentation and a trial of labor for women with twin gestations when the first twin is in cephalic presentation also can contribute to the safe lowering of the primary cesarean delivery rate.

Intervention Results: Variation in the rates of nulliparous, term, singleton, vertex cesarean births also indicates that clinical practice patterns affect the number of cesarean births performed. The most common indications for primary cesarean delivery include, in order of frequency, labor dystocia, abnormal or indeterminate (formerly, nonreassuring) fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia.

Conclusion: Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. A Cochrane metaanalysis of 12 trials and >15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery.111 Given that there are no associated measurable harms, this resource is probably underutilized.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention Provider Training/Education Referrals

Intervention Description: Due to the pervasive shortage of behavioral health (BH) specialists, collaborative partnerships between pediatric primary care practitioners (PPCPs) and BH specialists can enhance provision of BH services by PPCPs. We aimed to create a new model of collaborative care that was mostly virtual, affordable, and scalable. The pilot program was implemented in 18 practices (48 PPCPs serving approximately 150 000 patients) in 2 consecutive cohorts. Outcomes were assessed by administering pre-program and post-program surveys.

Intervention Results: Across the 18 practices, PPCPs reported significantly increased confidence in their BH knowledge and skills, and significantly increased their provision of target BH services. Barriers to BH service provision (resources, time, and staff) were unchanged.

Conclusion: This compact, mostly virtual model of BH collaboration appears to be beneficial to PPCPs while also offering convenience to patients and affordability and scalability to the practice network.

Study Design: Pre-post observational study

Setting: 18 clinical practices (48 PPCPs serving approximately 150000 patients) in CA.

Population of Focus: Pediatric primary care provicers in clinic-based practices. The eligible population comprises approximately 200 PPCPs in 65 practices in a pediatric network affiliated with an academic medical center in Southern California. This report presents the findings from the first 2 groups of practices to enroll (cohorts 1 [7 practices, 23 PPCPs] and 2 [11 practices, 25 PPCPs]).

Sample Size: 18 practices, 48 pediatric primary care providers

Age Range: Providers seeing pediatric patients 0-17 years

Intervention Components (click on component to see a list of all articles that use that intervention): Enabling Services Provider Training/Education Patient-Centered Medical Home PATIENT_CONSUMER HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The Colorado Adolescent Maternity Program (CAMP) is an obstetric and pediatric medical home for pregnant and parenting adolescent girls through age 22 and their children located within Children’s Hospital Colorado. With the integration of behavioral health into CAMP, and given the prevalence of trauma histories among adolescent mothers reported in the literature, programmatic and operational changes to clinical care were made using the Substance Abuse and Mental Health Services Administration’s six key principles of a trauma-informed approach.

Intervention Results: Data showed that nearly 30% of participants reported a history of trauma. Following the inclusion of trauma-informed principles, patients had significantly higher rates of attendance at prenatal appointments (p < .001) and significantly lower rates of low birthweight babies (p = .02).

Conclusion: Future programmatic changes and long-term assessment outcomes of this trauma-informed approach in a PCMH are also discussed.

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE Provider Training/Education Expert Support (Provider)

Intervention Description: The City of Dallas, TA, WIC program collaborated with 3 urban hospitals and developed a training of practical techniques and information for staff to use while working with breastfeeding patients. It recognizes the powerful role that health care workers have in successful BF and the need for competent, hands-on skills to support lactation. The goals of the new collaboration with WIC were to provide staff a supervised clinical experience in a workshop format and provide a venue to practice the information they gained from the didactic education.

Intervention Results: Since implementation, 1,600 workers were trained, 1 hospital achieved Baby-Friendly designation, and all have increased BF rates by 10%.

Conclusion: The City of Dallas, TX, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program collaborated with 3 urban hospitals and developed a training of practical techniques and information for staff to use while working with BF patients. Since implementation, 1,600 workers were trained, 1 hospital achieved Baby-Friendly designation, and all have increased BF rates by 10%.

Study Design: Evaluation data

Setting: Three hospitals in Dallas, TX, and the City of Dallas WIC program

Population of Focus: Physicians, midwives, dietitians, and staff from area hospitals and clinics

Sample Size: 1600 people over three years

Age Range: Adults

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention Development/Improvement of Services Continuing Education of Hospital Providers HOSPITAL HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: Creation of a small baby program requires special resources and multidisciplinary engagement.

Intervention Results: While it took pre-planning to time routine exams with cares, this approach resulted in a significant decrease in apnea, bradycardia, and desaturation events than previously observed.

Conclusion: We have described benefits, challenges, and practical approaches to creating and maintaining a small baby program that could be a model for the development of special programs for other sub-populations within in the NICU.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Residents/Medical Students HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: Six obstetricians with significant experience in operative deliveries supervised and taught residents on labor and delivery, including the use of forceps

Intervention Results: There were 5,201 live, term, singleton, vertex deliveries under the care of residents, 1,919 (36.9%) before December 2012 and 3,282 (63.1%) December 2012 or later. The rate of forceps deliveries significantly increased from 0.6% to 2.6% (adjusted odds ratio [OR] 8.44, 95% confidence interval [CI] 3.1–23.1), and the rate of cesarean deliveries significantly decreased from 27.3% to 24.5% (adjusted OR 0.68, 95% CI 0.55–0.83). There were no statistically significant differences in the rates of third- or fourth-degree lacerations or 5-minute Apgar scores less than 7. Among nulliparous women, the forceps rate increased from 1.0% to 3.4% (adjusted OR 4.87, 95% CI 1.74–13.63) and the cesarean delivery rate decreased from 25.6% to 22.7% (adjusted OR 0.69, 95% CI 0.53–0.89). The increase in forceps deliveries

Conclusion: Having senior obstetricians supervise resident deliveries is significantly associated with an increased rate of forceps deliveries and a decreased rate of cesarean deliveries.

Setting: Mt. Sinai Hospital

Population of Focus: All patients with term singleton vertex gestrations

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Provider Training/Education Educational Material (Provider) Participation Incentives Quality Improvement/Practice-Wide Intervention Expert Support (Provider) Modified Billing Practices Data Collection Training for Staff Screening Tool Implementation Training Office Systems Assessments and Implementation Training Expert Feedback Using the Plan-Do-Study-Act-Tool Collaboration with Local Agencies (State) Collaboration with Local Agencies (Health Care Provider/Practice) Engagement with Payers STATE POPULATION-BASED SYSTEMS Audit/Attestation HEALTH_CARE_PROVIDER_PRACTICE Audit/Attestation (Provider)

Intervention Description: The Vermont Child Health Improvement Program (VCHIP) at the University of Vermont collaborated with state agencies and professional societies to conduct a survey of Vermont pediatric and family medicine practices regarding their developmental screening and autism screening processes, referral patterns, and barriers. The survey was administered in 2009 to 103 primary care practices, with a 65% response rate (89% for pediatric practices, 53% for family medicine practices).

Intervention Results: The survey results revealed that while 88% of practices have a specific approach to developmental surveillance and 87% perform developmental screening, only 1 in 4 use structured tools with good psychometric properties. Autism screening was performed by 59% of practices, with most using the M-CHAT or CHAT tool and screening most commonly at the 18-month visit. When concerns were identified, 72% referred to a developmental pediatrician and over 50% to early intervention. Key barriers to both developmental and autism screening were lack of time, staff, and training. Over 80% of practices used a note in the patient chart to track at-risk children, and most commonly referred to child development clinics, audiology, early intervention, and pediatric specialists.

Conclusion: The survey conducted by VCHIP revealed wide variation in developmental and autism screening practices among Vermont pediatric and family medicine practices. While most practices conduct some form of screening, there is room for improvement in the use of validated tools, adherence to recommended screening ages, and implementation of office systems for tracking at-risk children. The survey identified knowledge gaps and barriers that can be addressed through quality improvement initiatives, which most respondents expressed interest in participating in.

Study Design: QE: pretest-posttest

Setting: Pediatric and family medicine practices in Vermont

Population of Focus: Children up to age 3

Data Source: Child medical record; ProPHDS Survey

Sample Size: Chart audits at 37 baseline and 35 follow-up sites (n=30 per site) Baseline charts (n=1381) - Children 19-23 months (n=697) - Children 31-35 months (n=684) Follow-up charts (n=1301) - Children 19-23 months (n=646) - Children 31-35 months (n=655)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Educational Material PROVIDER/PRACTICE Provider Education Provider Audit/Practice Audit Quality Improvement/Practice-Wide Intervention Designated Clinic/Extended Hours

Intervention Description: Evaluation of a 5-year demonstration project testing a multicomponent (provider, system, and patient) intervention to increase cervical cancer screening among women who receive their health care through the Los Angeles County Department of Health Services, the second largest County Health Department in the nation.

Intervention Results: At the Hospital and Comprehensive Health Center (CHC) levels a statistically significant intervention effect was observed after controlling for baseline screening rates and case mix. No intervention effect was observed at the Public Health Center (PHC) level.

Conclusion: An intensive multicomponent intervention can increase cervical cancer screening in a large, urban, County health system serving a low-income minority population of under screened women.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Los Angeles County Department of Health Services (LACDHS) facilities: 2 large hospitals, 2 feeder Comprehensive Health Centers, and 6 of the health center’s feeder Public Health Centers

Population of Focus: Women attending LACDHS facilities

Data Source: Medical records and computerized databases held by the Los Angeles County Department of Health Services

Sample Size: Total (N=18,642) Intervention (n=9,492); Control (n=9,150) Baseline (n=5,249) Year 2 (n=5,470) Year 3 (n=5,365) First 6 months of Year 4 (n=2,558)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE Provider Training/Education HOSPITAL Quality Improvement

Intervention Description: A hospital-wide safe sleep bundle, based on a hospital-acquired conditions (HAC) model, was implemented in September 2017. Interventions were chosen by team members during multidisciplinary team meetings. Four key time points and/or interventions across the study period were (1) nursing education on the safe sleep bundle; 2) policy update and implementation; (3) collection and sharing of audit data; and (4) peer-to-peer bundle checklist reviews during registered nurse shift handoffs and electronic medical record (EMR) input. Other notable education interventions included subject matter expert training by guest speakers from the University of Pennsylvania and education to parents through updating newborn video instruction and increased exposure to appropriate safe sleep modeling.

Intervention Results: Overall compliance improved from 9% to 72%. Head of bed flat increased from 62% to 93%, sleep space free of extra items increased from 52% to 81%, and caregiver education completed increased from 10% to 84%. The centerline for infant in supine position remained stable at 81%.

Conclusion: Using an HAC bundle safety prevention model to improve adherence to infant safe sleep guidelines is a feasible and effective method to improve the sleep environment for infants in all areas of a children's hospital.

Setting: Penn State Children's Hospital

Population of Focus: Hospital healthcare providers

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Provider Training/Education Educational Material (Provider)

Intervention Description: We modified the Enhancing Developmentally Oriented Primary Care (EDOPC) program to provide a formal curriculum to pediatric residents serving children in distressed neighborhoods.

Intervention Results: Percentage of ASQ screening at 12-month well-child visits increased from 11% at baseline to 100% at follow-up. Percentage of ASQ:SE screening at 18-month well-child visits increased from 0% at baseline to 95% in June 2008 and declined to 58% at last follow-up in Jan 2009. Percentage of ASQ screening at 24-month well-child visits increased from 0% at baseline to 88% at follow-up.

Conclusion: Chart audits 1 year after the intervention demonstrated increased use of screening tools and more referrals to community services. This article will discuss lessons about facilitators and barriers to teaching residents about vulnerable preschool children.

Study Design: QE: pretest-posttest

Setting: University of Chicago Pediatric Residency Program in Chicago, Illinois

Population of Focus: Children ages 6 to 24 months

Data Source: Child medical record

Sample Size: Chart audits - Baseline (n=27 of 50 selected) - Follow-up 1: (n=61 of 100 selected) - Follow-up 2: (n=82 of 100 selected) - Follow-up 3: (n=94 of 100 selected) - Follow-up 4: (n=74 of 100 selected)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Reminder/Recall Systems Education/Training (caregiver) Social Media

Intervention Description: Based on the concerns parents expressed through the survey, a program was designed and implemented that included reminder calls, parent education, proactive appointment scheduling, and social media reminders.

Intervention Results: After implementing a parent-driven quality-improvement program for 6 months during influenza season, the health center's pediatric influenza immunization rates rose to 57% compared with 44% during the year before.

Conclusion: Childhood immunization is a critical priority to protect the health and wellness of children. Increasing parent engagement in discussions about increasing immunization rates not only promotes awareness surrounding vaccines but also allows primary care providers to learn from parents to create a patient-centered immunization program. Programs that specifically target immunization efforts toward parental concerns have the potential for increased vaccine acceptance and improved health outcomes.

Study Design: The study utilized a randomized sampling method and conducted open-ended telephone surveys with parents of young children to identify key barriers to influenza immunization

Setting: a diverse, urban family health center

Population of Focus: The target audience for the study is parents of children aged 6 through 24 months at the urban family health center

Sample Size: The sample size is not explicitly mentioned in the provided text

Age Range: The age range of the children involved in the study is 6 through 24 months

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Educational Material (Provider) Residents/Medical Students

Intervention Description: The intervention described by the article to increase postpartum screening was a 15-minute slide presentation with essential topics, including content on antepartum and postpartum depression focusing on signs, symptoms, screening, and treatment as well as antepartum maternal depression education highlighting the importance of understanding health literacy

Intervention Results: The results of the study showed that there was an increase in mean change over time for knowledge, self-efficacy, and motivation among medical and nurse practitioner students. The second null hypothesis was rejected, indicating that there was a significant increase in motivation levels from before to after the intervention. However, there was no significant difference between medical and nurse practitioner students, and student profession did not moderate the outcome effect

Conclusion: An intervention to influence health care students' knowledge, self-efficacy, and motivation for antepartum depression screening can be included in medical and nursing curricula and can also be used with currently practicing health care providers. Doing so could possibly benefit pregnant women by enhancing the antepartum care that they receive.

Study Design: The study design/type is a quasi-experimental study design

Setting: University of South Florida, College of Nursing and College of Medicine

Population of Focus: he target audience for the study was medical and nurse practitioner students who had completed the women's health/obstetric course within the curriculum, had self-identified ability to use the online technology platform/intervention, had access to an Internet-enabled device capable of accessing the online intervention, and were fluent in the English language

Sample Size: The sample size of this study was 71 participants, including 19 medical students and 52 nurse practitioner students

Age Range: The age group of the participants is not explicitly mentioned in the given texts. However, it is stated that medical students tended to be younger than nurse practitioner students

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Quality Improvement/Practice-Wide Intervention Provider Training/Education Assessment (Provider)

Intervention Description: To evaluate the effectiveness of a complex intervention to improve referral and treatment of pregnant smokers in routine practice, and to assess the incremental costs to the National Health Service (NHS) per additional woman quitting smoking.

Intervention Results: After introduction of the intervention, the referral rate increased more than twofold (incidence rate ratio=2.47, 95% CI 2.16 to 2.81) and the probability of quitting by delivery increased (adjusted OR=1.81, 95% CI 1.54 to 2.12). The additional cost per delivery was £31 and the incremental cost per additional quit was £952; 31 pregnant women needed to be treated for each additional quitter.

Conclusion: The implementation of a system-wide complex healthcare intervention was associated with significant increase in rates of quitting by delivery.

Study Design: Quasi experimental Crosssectional and Cost-benefit analysis

Setting: National Health Service(NHS) antenatal clinics

Population of Focus: Health records of singleton births to mothers who smoked and did not smoke

Data Source: Electronic health records

Sample Size: 37726

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE Provider Training/Education HOSPITAL Guideline Change and Implementation Quality Improvement

Intervention Description: This quality improvement initiative used a systematic approach to reduce nulliparous cesarean birth rates, aligning with recommendations developed by the Council on Patient Safety in Women's Health Care: Patient Safety Bundle on the Safe Reduction of Primary Cesarean Births. Health care providers and nurses received education on contemporary labor management guidelines developed by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine Obstetric Care Consensus regarding safe prevention of primary cesarean deliveries and nurses were instructed on labor support techniques. The preguideline implementation period was January 1, 2015, to June 30, 2015. The postguideline implementation period was July 1, 2016, to December 31, 2016. The primary outcome measured was the nulliparous, term, singleton, vertex cesarean birth rate.

Intervention Results: There were 434 women identified in the preguideline period and 401 women in the postguideline period. The nulliparous, term, singleton, vertex cesarean birth rate decreased from 27.9% to 19.7% [odds ratio (OR) 0.63, CI 0.46-0.88]. There were improvements in health care provider compliance with following the labor management guidelines from 86.2% to 91.5% (OR 1.73, 95% CI 1.11-2.70), the use of maternal position changes from 78.7% to 87.5% (OR 1.86, 95% CI 1.29-2.68), and use of the peanut birthing ball from 16.8% to 45.2% (OR 3.83, 95% CI 2.84-5.16) as provisions for labor support.

Conclusion: Implementing a systematic approach for care of nulliparous women is associated with a decrease in term, singleton, vertex cesarean birth rates.

Setting: Two rural community hospitals and one urban community hospital in North Carolina

Population of Focus: Nulliparous women with term singleton vertex gestations

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention HEALTH_CARE_PROVIDER_PRACTICE Data Collection Training for Staff Provider Training/Education Audit/Attestation (Provider)

Intervention Description: Quality improvement (QI) methodology was used to implement routine screening using an adapted version of the Survey of Well Being of Young Children (SWYC), a child behavior and social screen, for all children ages 6 months to 10 years. Rates of screen administration and documentation were assessed for 18 months. Medical records of a convenience sample (N=349) were reviewed to track referrals and follow-up for positive screens.

Intervention Results: Over 18 months, 2028 screens were administered. Screening rates reached 90% after introducing a tablet for screening. Provider documentation of screens averaged 62%. In the convenience sample, 28% scored positive for a behavioral problem, and 25% reported at least 1 social stressor. Of those with positive child behavior or social stressor screens, approximately 80% followed up with their primary medical doctor, and approximately 50% completed referrals to the clinic social worker. Further analysis indicated that referral and follow-up rates varied depending on whether the family identified child behavior or social issues. Logistic regression revealed that parental concern was independently associated with child behavior symptoms (p = 0.001) and social stressors (p = 0.002).

Conclusion: Implementing a comprehensive psychosocial screen is feasible in pediatric primary care and may help target referrals to address psychosocial health needs.

Setting: Community health center

Population of Focus: Primary care peditricians

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention Provider Training/Education Screening Tool Implementation

Intervention Description: The intervention is the implementation of a screening protocol for postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS) and referral to a licensed professional clinical counselor for mothers who score 10 or higher on the EPDS . The intervention aligns with a discernable strategy of using the Institute for Healthcare Improvement’s (IHI) Plan-Do-Study-Act cycle as a guiding framework to plan, implement, evaluate, and modify changes to achieve outcome objectives .

Intervention Results: The study found that the implementation of the PPD screening and referral process resulted in a 24% detection rate for postpartum depression, which is approximately double that of the general population . The project reduced common barriers to PPD treatment, such as cost, transportation, and childcare issues . The RNs who participated in the project reported that the educational content provided them with the necessary information to successfully implement the PPD screening and referral process . The study also found that 80% of RNs reviewed the slide presentation by the project start date .

Conclusion: This project recognizes the importance of an interdisciplinary care approach and highlights the need for early identification and treatment for PPD among mothers with babies in the NICU. The project can guide future initiatives to increase the use of screening in the inpatient setting, to detect PPD during its early and more treatable stages.

Study Design: The study design used in the research is not explicitly stated, but it appears to be a quality improvement project aimed at implementing a routine postpartum depression (PPD) screening protocol in the Neonatal Intensive Care Unit (NICU) . The study used a one-group, posttest-only design to evaluate outcome objectives

Setting: The setting for the study is not explicitly stated in any of the given texts. However, it is mentioned that IRB review and waiver were obtained from both the academic institution and the hospital site . Additionally, the study focuses on screening mothers of babies in the Neonatal Intensive Care Unit (NICU)

Population of Focus: The target audience for the study appears to be healthcare providers who work with mothers of babies in the Neonatal Intensive Care Unit (NICU) and are interested in implementing a routine postpartum depression (PPD) screening protocol. The study provides information on the use of the Edinburgh Postnatal Depression Scale (EPDS) for identifying mothers at risk for PPD, as well as recommendations for education and referral to licensed professional clinical counselors

Sample Size: The sample size for the study is 25 mothers who received the screening

Age Range: The age group of the mothers who received the screening is not mentioned in the given texts

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This case study describes an innovative practice model informed by the Collective Impact Model (CIM) designed to promote breastfeeding continuity of care and community support in Central Illinois.

Intervention Results: Numerous breastfeeding support improvements were made at and between CIBPN sites. Breastfeeding rates at the birthing hospital and health center were stable, including during the COVID-19 pandemic.

Conclusion: This article contributes to the practice-based evidence for breastfeeding support by strengthening continuity of care through a successful application of the CIM by public health practitioners.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Hospital Policies Provider Training/Education

Intervention Description: Despite policy and guideline recommendations to support planned, effective postnatal care, national surveys of women's views of maternity care have consistently found in-patient postnatal care, including support for breastfeeding, is poorly rated.

Intervention Results: Post intervention there were statistically significant differences in the initiation (p = 0.050), duration of any breastfeeding (p = 0.020) and duration of exclusive breastfeeding to 10 days (p = 0.038) and duration of any breastfeeding to three months (p = 0.016). Post intervention, women were less likely to report physical morbidity within the first 10 days of birth, and were more positive about their in-patient care.

Conclusion: It is possible to improve outcomes of routine in-patient care within current resources through continuous quality improvement.

Study Design: QE: pretest-posttest

Setting: Large maternity unit in the south of England

Population of Focus: Women on the postnatal ward who were >16 years old, able to speak and read English, and who had not experienced a stillbirth or neonatal death

Data Source: Mother self-report

Sample Size: Pretest (n=751/741)3 Posttest (n=725/725)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER Home Visit (caregiver) Educational Material (caregiver) Oral Health Product Patient Navigation (Assistance) PROVIDER/PRACTICE Outreach (Provider) Education/Training (caregiver)

Intervention Description: The aim of this study was to determine the effect of a dental care coordinator intervention on increasing dental utilization by Medicaid-eligible children compared with a control group.

Intervention Results: Dental utilization during the study period was significantly higher in the intervention group (43 percent) than in the control group (26 percent). The effect was even more significant among children living in households well below the Federal Poverty Level. The intervention was effective regardless of whether the coordinator was able to provide services in person or via telephone and mail.

Conclusion: The dental care coordinator intervention significantly increased dental utilization compared with similar children who received routine Medicaid member services. Public health programs and communities endeavoring to reduce oral health disparities may want to consider incorporating a dental care coordinator along with other initiatives to increase dental utilization by disadvantaged children.

Study Design: RCT

Setting: Jefferson County in Louisville, KY

Population of Focus: Children aged 4-15 years who currently or for 2 years prior had Medicaid insurance but have not had Medicaid dental claims filed for the previous 2 years

Data Source: Medicaid claims

Sample Size: Intervention (n=68) Control (n=68)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Patient-Centered Medical Home Provider Training/Education Quality Improvement/Practice-Wide Intervention

Intervention Description: The survey instrument, “Caring for Children with Complex Chronic Conditions,” was adapted from a previously validated instrument (20). The survey consisted of 183-items, including 21 open-ended response items

Intervention Results: Informational themes included providing clear communication, with subthemes of: 1) be honest and open and 2) coordinate interdisciplinary care and provide consistent messaging with other clinicians working with our family. Relational themes were as follows: 1) include parents’ experiences and recognize their expertise about their children, with subthemes of: a) be caring and sensitive toward parents and b) be accommodating and flexible to demonstrate respect and provide comfort and 2) maintain relationships with families throughout their child’s medical journey and into bereavement.

Conclusion: Clinical care strategies that support parents of children with complex chronic conditions reflect the unique needs of this group of children. Relational strategies such as including parents as experts in their child’s care were paramount to parents of children with complex chronic conditions throughout their child’s medical journey and at end of life.

Study Design: This study reports findings from a cross-sectional survey of bereaved parents of children with CCCs.

Setting: CMC: Hospital - a single children's hospital

Population of Focus: CMC - bereaved parents of children with complex chronic conditions (CCCs) who had received care at Boston Children's Hospital (BCH) and had passed away between January 2006 and December 2015.

Sample Size: 110 - The study had a total of 211 eligible participants, and 110 of those eligible parents completed the survey and at least one open-response item, yielding a 52% participation rate.

Age Range: 1.9–20.3 - children

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement Provider Training/Education

Intervention Description: The intervention involved a QI program that included teaching essential QI principles, providing strategies to deliver a strong provider vaccine recommendation, reviewing system changes to facilitate vaccination, and engaging all office staff in the effort

Intervention Results: The QI program resulted in increases in HPV vaccine series initiation and completion rates among children aged 11–12 years, well above the goal of 10%, even when replicated with a second group of practices

Conclusion: The conclusion highlighted the success of the QI program in optimizing patient care and workflow efficiency in busy primary care practices, emphasizing the importance of basic quality improvement education and strategies to deliver a strong provider vaccine recommendation

Study Design: The study design involved a Quality Improvement (QI) program that included teaching essential QI principles and providing examples of workflow-focused strategies to improve HPV vaccination rates among children aged 11–12 years

Setting: The setting for the Quality Improvement (QI) initiative was pediatric practices in AAP NY Chapter 1, mostly large, private practices serving suburban communities

Population of Focus: The target audience included pediatric providers and staff from the participating practices in AAP NY Chapter 1

Sample Size: The article does not explicitly mention the sample size. However, it states that eight different pediatric practices from AAP NY Chapter 1, each employing between 1 and 10 providers, were recruited for participation in the QI initiative

Age Range: The age range targeted by the QI initiative was 11–12 years old

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL Continuing Education of Hospital Providers POPULATION-BASED SYSTEMS STATE Policy/Guideline (State) Funding Support Perinatal Committees/Councils

Intervention Description: Vital records data (1971 to 1978) were used to assess the change in neonatal and fetal mortality in Colorado in relationship to the regionalization of perinatal health care within the state.

Intervention Results: There has been a decrease in neonatal mortality rate from 13.4 to 6.9 during a period of time when there was a minimal decrease in the incidence of low-birth weight infants. The improved neonatal mortality has been associated with a shift in the frequency of birth of very low-birth weight (VLBW) infants to hospitals with level II and III perinatal services and relatively greater survival rates of VLBW infants born in these hospitals as compared to those born in level I hospitals. There was no decrease in fetal mortality in the same period of time.

Conclusion: These date suggest that outreach education in perinatal medicine should now emphasize current knowledge and methods for reducing antepartum deaths.

Study Design: QE: pretest-posttest

Setting: All Colorado hospitals Three level III, seven level II, remaining level I

Population of Focus: Infants born weighing greater than one lb.

Data Source: Data from the Bureau of Vital Records, Colorado State Health Department.

Sample Size: Pretest: 1.8% (n=2,818) Posttest: 1.8% (n=2,967) Infants born weighing one to four lbs.

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER Training/Education PROFESSIONAL_CAREGIVER Education/Training (caregiver) Educational Material (caregiver)

Intervention Description: A quality improvement project was implemented at a pediatric primary care practice to improve screening for infant safe sleep practices. The screening form was updated to include questions from the Pregnancy Risk Assessment Monitoring System (PRAMS) that better capture actual sleeping practices and allow for a more targeted response from providers. Based on individual survey responses, the providers offered and documented their specific educational feedback. Any changes/improvements reported during a 2-week callback were also documented. Study participation was encouraged by offering a chance to win a $50 Amazon gift card and a free board book, Sleep Baby, Safe and Snug, covering the basics of safe sleep in a format that can be read to the child (Charlie's Kids Foundation, 2017).

Intervention Results: This updated screening better captured actual sleeping practices, allowing for more targeted education.

Conclusion: This article describes a quality improvement project implemented at a pediatric primary care practice to improve screening for infant safe sleep.

Setting: A single pediatric primary care practice

Population of Focus: Parents/caregivers of infants 0-6 months

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Lactation Consultant PROVIDER/PRACTICE Provider Training/Education

Intervention Description: To evaluate the efficacy of an intervention program to increase breast-feeding in a low-income, inner-city population.

Intervention Results: There was a markedly higher incidence of breast-feeding in the intervention group, as compared with that of the control group (61% vs 32%, respectively; P = .002). The duration of breast-feeding was also significantly longer in the intervention group (P = .005).

Conclusion: This lactation program increased the incidence and duration of breast-feeding in our low-income cohort. We suggest that similar efforts that are applied to analogous populations may increase the incidence and duration of breast-feeding in low-income populations in the United States.

Study Design: RCT

Setting: Maternal-Infant Lactation Center of Pittsburgh (PA)

Population of Focus: Women attending the prenatal clinic of The Mercy Hospital of Pittsburgh, English-speaking, and nulliparous

Data Source: Mother self-report

Sample Size: Intervention (n=51) Control (n=57)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Health_Care_Provider_Practice Screening Tool Implementation Training Provider Training/Education

Intervention Description: Twenty-eight pediatricians completed an in-person meeting, monthly webinars, and individualized feedback from an Expert Work Group on progress across a 3-month action period.

Intervention Results: Statistically significant increases were observed in rates of autism screening, discussions of screening results with families, and referral following abnormal results. There was no statistically significant change in rates of general developmental screening. Comparing self-report with record review, pediatricians overestimated the extent to which they conducted discussion and referral.

Conclusion: Universal screening for all children has yet to be achieved. The current project supports that practice-based improvements can be made and delineates some of the routes to success.

Setting: Clinical practice

Population of Focus: Primary care peditricians

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Access to Provider through Hotline HOSPITAL Continuing Education of Hospital Providers POPULATION-BASED SYSTEMS INTER-HOSPITAL SYSTEMS Maternal/In-Utero Transport Systems STATE Policy/Guideline (State) Consultation Systems (Inter-Hospital Systems) Consultation Systems (Hospital) Telemedicine Systems (Inter-Hospital Systems) Telemedicine Systems (Hospital)

Intervention Description: To examine the factors associated with delivery of preterm infants at neonatal intensive care unit (NICU) hospitals in Arkansas during the period 2001–2006, with a focus on the impact of a Medicaid supported intervention, Antenatal and Neonatal Guidelines, Education, and Learning System (ANGELS), that expanded the consulting capacity of the academic medical center's maternal fetal medicine practice.

Intervention Results: Perceived risk, age, education, and prenatal care characteristics of women affected the likelihood of use of the NICU. The perceived availability of local expertise was associated with a lower likelihood that preterm infants would deliver at the NICU. ANGELS did not increase the overall use of NICU, but it did shift some deliveries to the academic setting.

Conclusion: Perinatal regionalization is the consequence of a complex set of provider and patient decisions, and it is difficult to alter with a voluntary program.

Study Design: Time trend analysis

Setting: All Arkansas hospitals Five level III hospitals from 2001- 2005, six in 2006

Population of Focus: Infants born at <35 weeks GA

Data Source: Data from Medicaid claims for pregnancy linked to birth certificates for women covered by Medicaid in Arkansas

Sample Size: Total (n= 5,150) 2001 (n= 812) 2002 (n= 1,105) 2003 (n= 824) 2004 (n= 824) 2005 (n= 887) 2006 (n= 698) Infants born at <35 weeks GA

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER Access to Provider through Hotline HOSPITAL Continuing Education of Hospital Providers STATE Policy/Guideline (State)

Intervention Description: In this longitudinal observational study, linked vital records and Medicaid claims records for 29,124 preterm births (April 2001–December 2012) to Medicaid covered women were used to examine factors predicting whether deliveries occurred at hospitals with neonatology-staffed NICUs. The factors associated with delivery are estimated and compared for baseline and three post-implementation periods.

Intervention Results: Rates for NICU preterm deliveries increased from 28 to 37% over the time period. Compared to baseline, adjusted NICU delivery rates in the middle and late implementation periods were statistically significant (p < 0.001). Negative impacts of long travel times were reduced, while impacts of obstetrician prenatal care changed from negative to positive association.

Conclusion: Findings validate the ANGELS initiative premise: academic specialists, working with community-based care providers, can improve perinatal regionalization.

Setting: Hospitals in Arkansas

Population of Focus: Medicaid-covered women in Arkansas

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Provider Reminder/Recall Systems Quality Improvement/Practice-Wide Intervention

Intervention Description: The study used a bundled measure that includes immunizations, lead screening, and use of screening tools to improve preventative care service delivery. The interventions included staff education on measure components, introduction of exam room-based phlebotomy to address lead screening completion rates, and population management strategies, including development of a patient registry and use of reminders and visit tracking to increase attendance at well-child visits.

Intervention Results: The percent of bundle completion by 14 months of age increased from a baseline of 58% to 77% following implementation of the QI initiatives. A mean shift was identified after the population manager began proactive targeted outreach for the 12-month visit.

Conclusion: Targeted systems for outreach aimed at bringing patients into the clinic and patient-centred strategies for visit completion are effective at ensuring timely delivery of comprehensive preventative care to an underserved paediatric population.

Study Design: The study is a quality improvement (QI) study that used plan-do-study-act (PDSA) cycles to optimize results.

Setting: The study was conducted at a community-based academic primary care clinic.

Population of Focus: Underserved pediatric patients under 2 years old.

Sample Size: The study does not provide a specific sample size.

Age Range: The target audience is pediatric patients under 2 years old.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Home Visits Other Person-to-Person Education CAREGIVER Education/Training (caregiver) PROVIDER/PRACTICE Nurse/Nurse Practitioner Motivational Interviewing Motivational Interviewing/Counseling

Intervention Description: Intervention (INT) was a home-based asthma follow-up after ED visit and two visits for an environmental control educational program delivered by trained nurses and nurse practitioners to the child and caregiver. For caregivers of children with positive cotinine results, brief motivational interviewing sessions were conducted to implement total home smoking ban.

Intervention Results: Over half of children in the study tested positive for SHS. Targeting SHS exposure was major component of the intervention [but] no significant reduction in cotinine exposures was associated with the intervention at 12 months.

Conclusion: In this study, a home-based EC intervention was not successful in reducing asthma ED revisits in children with poorly controlled asthma with SHS exposure. Allergic sensitization, young age, and increased controller medication use were important predictors of asthma ED visits.

Study Design: Prospective randomized controlled trial

Setting: Home-based (following ED visit)

Population of Focus: Children with physician diagnosed persistent asthma, having two or more ED asthma visits or more than one hospitalization over the past 12 months and residing in the Baltimore metropolitan area

Data Source: For SHS exposure, child saliva samples collected during the ED visit and at 6- and 12-month follow up visits.

Sample Size: 222 inner city children ages 3-12

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Other Education Provider Training/Education Development/Improvement of Services Patient Reminder/Invitation

Intervention Description: This intervention presents a toolkit developed by the March of Dimes, California Maternal Quality Care Collaborative, and the California Department of Public Health, aimed at eliminating non-medically indicated (elective) deliveries before 39 weeks of gestation. The toolkit provides guidance and strategies for healthcare providers, hospitals, and policymakers to reduce early elective deliveries (EEDs), which are associated with neonatal morbidities and increased healthcare costs. It identifies common barriers to reducing EEDs, such as lack of effective policies, provider resistance, lack of patient awareness, and data collection challenges. The toolkit offers recommendations to overcome these barriers through policy changes, hard-stop policies, provider and patient education, data collection guidance, and measurement strategies using The Joint Commission's PC-01 measure for EEDs.

Intervention Results: The toolkit highlights several successful quality improvement (QI) interventions implemented by healthcare organizations to reduce early elective deliveries. Intermountain Healthcare, through a multidisciplinary team approach, data-driven interventions, and strict enforcement of policies, reduced elective deliveries before 39 weeks from 28% to less than 3% within six years. Additionally, they observed a decrease in stillbirth rates and no significant increase in maternal morbidity. Magee Women's Hospital achieved a significant reduction in elective inductions before 39 weeks and lower cesarean section rates among nulliparous women after implementing induction guidelines, involving key physician and nursing leaders, and establishing a chain of support for enforcement. The Ohio Perinatal Quality Collaborative reported a decrease in elective deliveries from 25% to less than 5% within 14 months among participating hospitals, along with a decline in stillbirth rates and fewer NICU admissions for infants born between 36 and 38 weeks.

Conclusion: Despite efforts to curb early elective deliveries, the toolkit acknowledges that some areas still face difficulties in achieving desired results. It emphasizes the need for a coordinated effort from various stakeholders, including healthcare providers, hospitals, professional organizations, patient advocates, and policymakers. The toolkit serves as a comprehensive resource, offering evidence-based strategies, educational tools, and case studies to support the elimination of non-medically indicated deliveries before 39 weeks. By addressing barriers, promoting policy changes, enhancing data collection and measurement, and increasing awareness among providers and patients, the toolkit aims to facilitate sustainable improvements in maternal and neonatal health outcomes.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE Provider Training/Education HOSPITAL Chart Audit and Feedback Guideline Change and Implementation Quality Improvement Policy/Guideline (State) STATE Collaboration with Local Agencies (Health Care Provider/Practice) Collaboratives Policy/Guideline (Hospital)

Intervention Description: Hospitals participating in the MDPQC (Maryland Perinatal-Neonatal Quality Care Collaborative) agreed to implement practices from the "Safe Reduction of Primary Cesarean Births" patient safety bundle, developed by the Council on Patient Safety in Women's Health Care. As a requirement of participation, hospital teams sent at least one team member to each collaborative event. Activities included a June 2016 in-person kick off meeting for two to three representatives from each hospital to familiarize them with the cesarean delivery bundle and the requirements of participation, followed by conference calls that occurred every month in the first year and every 2 months in the second year. Additional in-person meetings for all hospital teams took place at 12 months and at the end of the collaborative (November 2018). Nice webinars on related clinical topics were presented throughout the 30-month period. The collaborative director provided facilitation support to site teams through calls and visits when requested by the site team or when site participation lapsed.

Intervention Results: Among the 26 bundle practices that were assessed, participating hospitals reported having a median of seven practices (range 0-23) already in place before the collaborative and implementing a median of four (range 0-17) new practices during the collaborative. Across the collaborative, the cesarean delivery rates decreased from 28.5% to 26.9% (P=.011) for all nulliparous term singleton vertex births and from 36.1% to 31.3% (P<.001) for nulliparous, term, singleton, vertex inductions. Five hospitals had a statistically significant decrease in nulliparous, term, singleton, vertex cesarean delivery rates and four had a significant increase. Nulliparous, term, singleton, vertex cesarean delivery rates were significantly lower across hospitals that implemented more practices in the "Response" domain of the bundle.

Conclusion: The MDPQC was associated with a statewide reduction in cesarean delivery rates for nulliparous, term, singleton, vertex births.

Setting: 31 Maryland birthing hospitals

Population of Focus: Among the 26 bundle practices that were assessed, participating hospitals reported having a median of seven practices (range 0–23) already in place before the collaborative and implementing a median of four (range 0–17) new practices during the collaborative. Across the collaborative, the cesarean delivery rates decreased from 28.5% to 26.9% (P5.011) for all nulliparous term singleton vertex births and from 36.1% to 31.3% (P,.001) for nulliparous, term, singleton, vertex inductions. Five hospitals had a statistically significant decrease in nulliparous, term, singleton, vertex cesarean delivery rates and four had a significant increase. Nulliparous, term, singleton, vertex cesarean delivery rates were significantly lower across hospitals that implemented more practices in the “Response” domain of the bundle.

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL Continuing Education of Hospital Providers POPULATION-BASED SYSTEMS INTER-HOSPITAL SYSTEMS Maternal/In-Utero Transport Systems Follow-Up Given On Transferred Patients STATE Perinatal Committees/Councils NICU Bed Registry/Electronic Bulletin Board

Intervention Description: To determine whether perinatal care in southwestern Ontario is regionalized, to identify trends over time in referral patterns, to quantify trends in perinatal death rates and to identify trends in perinatal death rates that give evidence of regionalization.

Intervention Results: Between 1982 and 1985 the antenatal transfer rate increased from 2.2% to 2.8% (p less than 0.003). The proportion of births of infants weighing 500 to 1499 g increased from 49% to 69% at the level III hospital. The neonatal transfer rate increased from 26.2% to 47.9% (p less than 0.05) for infants in this birth-weight category and decreased from 10.2% to 7.1% (p less than 0.03) for infants weighing 1500 to 2499 g. The death rate among infants of low birth weight was lowest among those born at the level III centre and decreased at all centres between 1982 and 1985.

Conclusion: Perinatal care in southwestern Ontario is regionalized and not centralized; regionalization in southwestern Ontario increased between 1982 and 1985.

Study Design: QE: pretest-posttest

Setting: Southwestern Ontario One level III, one modified level III and 30 level II or I

Population of Focus: Births greater than 500 gm

Data Source: Data obtained from hospital delivery room books and for 31 of the 32 hospitals, from hospital charts of women and neonates.

Sample Size: Pretest: 1.17% (n= 194) Posttest: 1.31% (n= 211) Infants born weighing 500-1499 gm

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE Provider Training/Education PROFESSIONAL_CAREGIVER Education/Training (caregiver)

Intervention Description: Research staff from a single maternity ward recruited 184 mothers and their term newborns to participate in this randomized controlled trial to assess whether a patient portal could be used to provide personalized safe sleep care. The portal is capable of supporting two-way information sharing and communication between providers and families. Feasibility of the study was measured by a) the proportion of consenting mothers who enrolled in the portal and b) maternal adherence to prompts to submit photographs of their infant sleeping to the research team through the patient portal. Efficacy was determined via research assistant review of submitted photographs. The assistants were trained to detect sudden unexplained infant death risk factors, including sleep position, based on AAP guidelines. Standardized feedback was returned to mothers through the patient portal.

Intervention Results: One hundred nine mothers (59%) enrolled in the patient portal and were randomized to intervention (N = 55) and control (N = 54) groups. 21 (38, 95% CI 25-52%) intervention group participants sent photographs at 1 month and received personalized feedback. Across both groups at 2 months, 40 (37, 95% CI 28-46%) sent photographs; 56% of intervention group participants who submitted photographs met all safe sleep criteria compared with 46% of controls (difference 0.10, 95% CI - 0.26 to 0.46, p = .75). Common reasons for guideline non-adherence were sleeping in a room without a caregiver (43%), loose bedding (15%) and objects (8%) on the sleep surface.

Conclusion: Utilizing the patient portal to individualize safe infant sleep is possible, however, we encountered numerous barriers in this trial to assess its effects on promoting safe infant sleep. Photographs of infants sleeping showed substantial non-adherence to AAP guidelines, suggesting further needs for improvement to promote safe infant sleep practices.

Setting: Single maternity ward, Penn State Milton S. Hershey Medical Center

Population of Focus: Mothers and their term newborns

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Hospital Policies POPULATION-BASED SYSTEMS COMMUNITY Community Health Services Policy Provider Training/Education

Intervention Description: To assess the effectiveness of the Baby Friendly Community Initiative (BFCI) on exclusive breast feeding at 6 months.

Intervention Results: The crude rates of exclusive breast feeding at discharge, 3 and 6 months, and of any breast feeding at 6 and 12 months increased at each round of data collection after baseline in the early and late intervention groups. At the end of the project, 10% of infants were exclusively breast fed at 6 months and 38% were continuing to breast feed at 12 months. However, the comparison by adjusted rates and logistic regression failed to show statistically significant differences between groups and rounds of data collection in the intention-to-treat analysis, as well as when compliance with the intervention and training coverage was taken into account.

Conclusion: The study failed to demonstrate an effect of the BFCI on the rates of breast feeding. This may be due, among other factors, to the time needed to observe an effect on breast feeding following this complex intervention.

Study Design: QE: pretest-posttest time-lagged nonequivalent control group

Setting: 18 Local Health Authorities (LHAs) in 9 regions of Italy

Population of Focus: Women living in the area covered by LHA, with infants > 2000g, who spoke Italian, English, French, or Spanish (or who had a relative who spoke these languages), and without a postpartum condition that required admission to the NICU

Data Source: Mother self-report

Sample Size: Early Intervention Group5 • Enrolled (n=2846) • 12-month follow-up (n=2474) Late Intervention Group • Enrolled (n=2248) • 12-month follow-up (n=1931)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Hospital Policies Baby Friendly Hospital Initiative Provider Training/Education

Intervention Description: Breastfeeding rates and related hospital practices need improvement in Italy and elsewhere.

Intervention Results: No statistically significant differences in both groups, before and after training, of exclusive breastfeeding at 6 months

Conclusion: Training for at least three days with a course including practical sessions and counselling skills is effective in changing hospital practices, knowledge of health workers, and breastfeeding rates.

Study Design: QE: pretest-posttest time-lagged nonequivalent control group

Setting: 8 hospitals (3 general hospitals and 1 teaching hospital in southern Italy, 3 general hospitals and 1 teaching hospital in central and northern Italy)

Population of Focus: Women with healthy infants > 2000g

Data Source: Mother self-report

Sample Size: Group 1 • Phase 1 (n=529) • Phase 2 (n=515) • Phase 3 (n=516) Group 2 • Phase 1 (n=483) • Phase 2 (n=342) • Phase 3 (n=284)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform Provider Training/Education Media Campaign (Print Materials, Public Address System, Social Media)

Intervention Description: We estimate the association of the Delaware Contraceptive Access Now (DelCAN) initiative with use of postpartum Long-Acting Reversible Contraception (LARC). DelCAN included Medicaid payment reform for immediate postpartum LARC use, provider training and technical assistance in LARC provision, and a public awareness campaign.

Intervention Results: Relative to the comparison states, postpartum LARC use in Delaware increased by 5.26 percentage points (95% CI 2.90-7.61, P < 0.001) during the 2015-2017 DelCAN implementation period. This increase was the largest among Medicaid-covered women, and grew over the first three implementation years. By the third year of the DelCAN initiative (2017), the relative increase in postpartum LARC use for Medicaid women exceeded that for non-Medicaid women by 7.24 percentage points (95% CI 0.12-14.37, P = 0.046).

Conclusion: The DelCAN initiative was associated with increased LARC use among postpartum women in Delaware. During the first 3 years of the initiative, LARC use increased progressively and to a greater extent among Medicaid-enrolled women. Comprehensive initiatives that combine Medicaid payment reforms, provider training, free contraceptive services, and public awareness efforts may reduce unmet demand for highly effective contraceptives in the postpartum months.

Study Design: Difference in differences design

Setting: Delaware (statewide compared to 15 other states)

Sample Size: 4815 women in Delaware; 88470 women in 15 comparison states

Age Range: 15-50

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Home Visit (caregiver) PROFESSIONAL_CAREGIVER HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This study evaluated the efficacy of a program to train home visitors to talk to clients about infant safe sleep using Motivational Interviewing and cultural sensitivity.

Intervention Results: Home visitors showed significant improvement in MI skill use and cultural sensitivity from pre- to post-test. Regarding client outcomes, our results indicate a significant group by time interaction when predicting changes in client knowledge such that the treatment group showed larger gains than the control group. There were no significant differences between groups when predicting changes in client attitudes or behavior.

Conclusion: MI may be an effective technique for home visitors to help increase families' safe sleep knowledge. Additional research is needed to examine whether such training can translate to changes in families' safe sleep behavior.

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE Provider Training/Education PROFESSIONAL_CAREGIVER Education/Training (caregiver) Home Visit (caregiver)

Intervention Description: This study evaluated the efficacy of a program to train home visitors to talk to clients about infant safe sleep using Motivational Interviewing and cultural sensitivity. Conducted as part of the initiative by Cradle Kalamazoo initiative to decrease racial disparities in infant mortality, home visitors attended a 2-day training that incorporated MI skills, cultural sensitivity, and safe sleep information. The MI training was conducted by a licensed Ph.D.-level psychologist as well as a second-year doctoral student in clinical psychology with 1 year of experience conducting clinical work. Home visitor outcomes were assessed using a pre-post design that included self reporting (based on a 16-question safe sleep knowledge questionnaire) and an observational rating by a paid “community mother.” When assessing client outcomes, a quasi-experimental design was used to examine changes in knowledge, attitudes, and safe sleep practices (Fig. 1). The home visitors administered the safe sleep survey to two different groups. The intervention group included 31 clients of home visitors who completed the training. The control group included 44 clients of home visitors who had not completed the training.

Intervention Results: Home visitors showed significant improvement in MI skill use and cultural sensitivity from pre- to post-test. Regarding client outcomes, our results indicate a significant group by time interaction when predicting changes in client knowledge such that the treatment group showed larger gains than the control group. There were no significant differences between groups when predicting changes in client attitudes or behavior.

Conclusion: MI may be an effective technique for home visitors to help increase families' safe sleep knowledge. Additional research is needed to examine whether such training can translate to changes in families' safe sleep behavior.

Setting: Cradle Kalamazoo initiative in Kalamazoo, Michigan

Population of Focus: Home visitors and their clients

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Nurse/Nurse Practitioner PATIENT/CONSUMER Patient Reminder/Invitation Educational Material CAREGIVER Educational Material (caregiver)

Intervention Description: The aim of this study was to evaluate the effectiveness of a nursing educational intervention with mothers of sick children to decrease passive smoking exposure.

Intervention Results: Baseline comparison showed no significant differences between the two groups in the mothers’ actions to protect the children from passive smoking exposure. More mothers in the intervention group than the control group had always moved the children away when they were exposed to the fathers’ smoke at home at 3‐month follow up (78·4% vs. 71·1%; P = 0·01) but became non‐significant at 6 and 12 months.

Conclusion: A simple health education intervention provided by nurses to the mothers in a busy clinical setting can be effective in the short-term to motivate the mothers to take actions to protect the children from exposure to passive smoking produced by the fathers.

Study Design: RCT

Setting: Hospital (pediatric ward/outpatient departments)

Population of Focus: Non-smoking mothers of sick children admitted to the pediatric ward/smoking husbands living in the same household

Data Source: Parental self-report.

Sample Size: 1483 mothers of sick children

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER Expanded Insurance Coverage HEALTH_CARE_PROVIDER_PRACTICE Public Insurance (Health Care Provider/Practice) Educational Material (Provider) Collaboration with Local Agencies (State) Collaboration with Local Agencies (Health Care Provider/Practice) Nurse/Nurse Practitioner PROFESSIONAL_CAREGIVER Patient Navigation (Assistance) Care Coordination STATE Multicomponent Approach

Intervention Description: The Healthy Beginnings system of care in Atlanta, GA connects children and their families to health insurance and a medical home model of care to support children’s health and development. The main components are care management + education and parent engagement + collaborative partnerships. A registered nurse, known as the health navigator, supports parents and helps them learn how to work with health care professionals on behalf of their children; they also connect parents to the Center for Working Families to ensure that they receive public benefits for which they are eligible.

Intervention Results: Healthy Beginnings coordinated care approach has ensured that participating children and families have health insurance (97%) and receive regular immunizations (92%), ongoing health care from a primary care physician and dental health provider, and regular developmental screenings (98%) and follow-up care. Healthy Beginnings has dramatically increased children’s access to health care and forms the basis for a cost-effective approach that can be replicated in other communities.

Conclusion: By building upon the partnerships formed through the foundation’s community change effort, Healthy Beginnings has dramatically increased neighborhood children’s access to health care and forms the basis for a cost-effective approach that can be replicated in other communities.

Study Design: Program evaluation

Setting: Community (Community-based organizations in Atlanta, Georgia)

Population of Focus: Low-income young children and families

Data Source: Questionnaire data

Sample Size: 279 children

Age Range: 0-10 years

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education

Intervention Description: The intervention in the study was the "Watch Me!" training program, which aimed to increase childcare providers' knowledge and impact attitudes related to developmental monitoring and referral practices. The "Watch Me!" training program is designed to provide childcare providers with the necessary knowledge and tools to conduct developmental monitoring and make recommended referrals when there is a concern about a child's development. The training program covers five key components of developmental monitoring, including tracking development, recognizing delays, talking to parents about development, talking to parents about concerns, and making referrals. The program is designed to equip childcare providers with the knowledge and skills to effectively carry out these components of developmental monitoring and referral practices. The training program utilizes web-based surveys to assess the impact of the training on knowledge and attitudes related to developmental monitoring and referral practices. It also includes pretest-posttest design to evaluate the effectiveness of the training program in improving childcare providers' knowledge and attitudes. Overall, the "Watch Me!" training program is designed to increase awareness, knowledge, and skills among childcare providers to support early identification and intervention for children with developmental concerns.

Intervention Results: Childcare providers demonstrated a significant pre-post increase in perceived knowledge and access to the tools to engage in five core components of developmental monitoring after completing "Watch Me!" training. There was also a significant pre-post increase in childcare providers' ability to list the child's doctor as an appropriate referral (39 pre-63% post), but not in the ability to list Part C/Part B programs as an appropriate referral (56 pre-58% post). CONCLUSIONS FOR PRACTICE: "Watch Me!" training may be effective at impacting targeted areas of knowledge and attitude about developmental monitoring among childcare providers in the short term.

Conclusion: Yes, the study found statistically significant findings related to the impact of the "Watch Me!" training program on childcare providers' knowledge and attitudes related to developmental monitoring and referral practices. The study found that completing the training program had a significant immediate impact on childcare providers' perception that they had the knowledge and could access tools needed to carry out the five components of developmental monitoring, including tracking development, recognizing developmental delays, talking to parents about development, talking to parents about developmental concerns, and making referrals when there was a concern about a child's development. The study also found that there was a significant pre-post increase in childcare providers' ability to list the child's doctor as an appropriate referral when there was a concern about their development. However, there was no significant pre-post increase in the ability to list Part C/Part B programs as an appropriate referral. Overall, the study suggests that the "Watch Me!" training program may be effective at impacting targeted areas of knowledge and attitude about developmental monitoring among childcare providers in the short term.

Study Design: The study design used in this research is a pretest-posttest design. The study aimed to evaluate the impact of the "Watch Me!" training program on childcare providers' knowledge and attitudes related to developmental monitoring and referral practices. The participants completed a web-based pretest before the training program and a web-based posttest after completing the training program. The study used a purposeful sampling strategy to recruit childcare programs for program-wide implementation to ensure participation of programs representing the following predetermined important criteria: geographic diversity, center- and home-based, regulated and unregulated, national accreditation status, and QRIS participation and rating level. The data collected from the pretest and posttest were analyzed using generalized linear mixed models.

Setting: The study was conducted in childcare settings, specifically targeting childcare providers. The "Watch Me!" training program was implemented to assess its impact on childcare providers' knowledge and attitudes related to developmental monitoring and referral practices. The participants in the study were childcare providers who completed the "Watch Me!" training program, and the data collection involved web-based surveys to evaluate the impact of the training on the participants' knowledge and attitudes. The study aimed to assess the effectiveness of the training program in increasing knowledge and changing attitudes related to developmental monitoring and referral practices among childcare providers. Therefore, the setting for the study was within the context of childcare facilities and providers who play a crucial role in early childhood development and care.

Population of Focus: The target audience for the study is childcare providers who work in childcare settings. The study aimed to evaluate the impact of the "Watch Me!" training program on childcare providers' knowledge and attitudes related to developmental monitoring and referral practices. The participants in the study were childcare providers who completed the "Watch Me!" training program, and the data collection involved web-based surveys to evaluate the impact of the training on the participants' knowledge and attitudes. The study's findings suggest that the "Watch Me!" training program may be effective at impacting targeted areas of knowledge and attitude about developmental monitoring among childcare providers in the short term. Therefore, the study's target audience is childcare providers who play a crucial role in early childhood development and care and can benefit from the "Watch Me!" training program to improve their knowledge and attitudes related to developmental monitoring and referral practices.

Sample Size: The sample size for the study was 127 childcare providers who completed the "Watch Me!" training program and participated in the web-based surveys to evaluate the impact of the training on their knowledge and attitudes related to developmental monitoring and referral practices. The participants were from various types of childcare programs, including Head Start/Early Head Start, regulated centers, regulated homes, unregulated centers, and other/unknown programs. The study used a pretest-posttest design to assess the impact of the training program on the participants' knowledge and attitudes, and the data were analyzed using generalized linear mixed models.

Age Range: The study did not focus on a specific age range of children. Instead, the study aimed to evaluate the impact of the "Watch Me!" training program on childcare providers' knowledge and attitudes related to developmental monitoring and referral practices. The training program focuses on five key components of developmental monitoring, including tracking development, recognizing delays, talking to parents about development, talking to parents about concerns, and making referrals. These components are relevant for children of all ages, from infancy to early childhood. Therefore, the study's findings are applicable to childcare providers who work with children of all ages and can benefit from the "Watch Me!" training program to improve their knowledge and attitudes related to developmental monitoring and referral practices.

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material PATIENT_CONSUMER Community Events COMMUNITY Nurse/Nurse Practitioner HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The study aimed to evaluate the effectiveness of a cervical cancer prevention education program for rural Korean immigrant women. A total of 46 Korean immigrant women who had not been screened in the past three years participated. The experimental group participated in the intervention program once a week for four weeks and completed a post-program survey in week 12.

Intervention Results: The experimental group participated in the intervention program once a week for four weeks and completed a post-program survey in week 12. Compared to the control group, significant increases were detected in level of knowledge of cervical cancer prevention (p = .001), behavioral attitude toward cervical cancer prevention (p = .029) and behavioral intention regarding cervical cancer prevention (p = .005) in the experimental group. Pap screening rate of the experimental group was significantly increased (p = .029), but the rate of change in the selection of primary care providers was not significant.

Conclusion: The results suggest the need for a multilevel approach to address cultural and systemic barriers to Korean immigrant women in promotion of cervical cancer prevention behavior.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Educational Material (Provider)

Intervention Description: Training health professionals for the skills and capacity to respond adequately to children and adults who have been exposed to adverse childhood experiences is recognized as an essential need in health care. Accessible opportunities to educate physicians and physician-trainees are limited. Four computer-based e-modules were created focusing on addressing childhood adversity and implementing trauma-informed care in the pediatric primary care setting. These childhood adversity and trauma-informed care (CA-TIC) e-modules were designed as an individualized, self-directed experience to allow for distance learning with flexibility to be embedded into existing coursework. To foster an engaging learning environment, we narrated the modules, prioritized images, and included the opportunity for participant interaction via multiple-choice and short-answer questions. Twenty-eight pediatric residents, two medical students, four attending physicians, and one fellow at Children's National Hospital completed the e-modules.

Intervention Results: Overall, participants rated the CA-TIC e-modules 4.6 (SD = 0.5) out of 5 for design and quality. Using paired t tests and Wilcoxon signed rank tests, we found statistically significant score increases from presession to postsession for participants' knowledge, attitudes, practice, and confidence related to CA-TIC. The most commonly cited learning points and practice changes included asking about trauma in practice and the seven C's of resilience.

Conclusion: A trauma-informed, strengths-based approach to care can assist health care providers in mitigating the link between adversity and related poor health outcomes. The CA-TIC e-modules provide an opportunity to train health professionals using an innovative, self-directed, and low-resource mechanism.

Study Design: Pre-post study

Setting: Pediatric primary care practices in connection with Children’s National Hospital

Population of Focus: Pediatric health care providers (pediatric residents, medical students, attending physicians, and fellows)

Sample Size: 35 pediatric health care providers 28 pediatric residents, 2 medical students, 4 attending physicians, and 1 fellow

Age Range: Adults who take care of pediatric populations

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention Provider Training/Education

Intervention Description: The model for the Extension for Community Healthcare Outcomes (Project ECHO®) was used to extend specialist support to the pediatric medical home for the treatment of adolescent depression by taking a comprehensive, disease-specific approach. Child and adolescent psychiatrists constructed a course to train community pediatric primary care providers (PCPs) to screen patients for depression, initiate evidence-based interventions, and provide ongoing management. Participants were assessed for changes in clinical knowledge and self-efficacy. Secondary measures included self-reported practice change and emergency department (ED) mental health referrals 12 months pre- and post-course completion.

Intervention Results: Sixteen out of 18 participants in cohort 1 and 21 out of 23 participants in cohort 2 completed the pre- and post-assessments. Clinical knowledge and self-efficacy showed statistically significant improvement pre- and post-course completion. ED mental health referrals from participant PCPs decreased by 34% (cohort 1) and 17% (cohort 2) after course completion.

Conclusion: These findings indicate that utilizing the Project ECHO format to provide subspecialist support and education on the treatment of depression can improve pediatric PCPs' clinical knowledge and confidence in their ability to independently treat depression. Secondary measures suggest that this can translate into practice change and improved treatment access with decreased ED referrals for mental health assessments by participant PCPs. Future directions include more robust outcomes measurement and developing more courses with an in-depth approach to a single or similar cluster of mental health diagnoses such as anxiety disorders.

Study Design: Pre-post study

Setting: Pediatric primary care offices connected to a large midwestern academic children's hospital

Population of Focus: Pediatric primary care providers, including medical doctors, nurse practitioners, and other healthcare professionals working in pediatric primary care settings

Sample Size: 41 providers

Age Range: Primary care providers serving pediatrics patients 0-17

Intervention Components (click on component to see a list of all articles that use that intervention): Notification/Information Materials (Online Resources, Information Guide) Other Education Patient-Centered Medical Home PATIENT_CONSUMER PARENT_FAMILY HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The purpose of this study was to establish a healthy weight management support group in a pediatric patient-centered medical home.

Intervention Results: There was a significant improvement in fruit and vegetable intake and dining out (p = <.05), and a clinical improvement in physical activity and sugar sweetened beverage intake.

Conclusion: Setting Kids Up For Success provides a framework for patient-centered medical home's to provide a healthy lifestyle support group for SA children and their families.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Technology-Based Support

Intervention Description: The intervention involved an educational intervention for providers and the integration of an MI-based communication tool called MOTIVE (MOtivational Interviewing Tool to Improve Vaccine AcceptancE)

Intervention Results: Statistically significant differences were observed between the groups for age and ethnicity, with a larger proportion of younger age groups and more patients of Hispanic/Latino ethnicity in the intervention period

Conclusion: Use of an MI-based communication tool may decrease vaccine refusals and improve childhood vaccination coverage rates, particularly for IIV.

Study Design: The study utilized a pre-post intervention design, with data collected retrospectively from the electronic health record (EHR) during two time periods: a baseline period and an intervention perio

Setting: the Rocking Horse Community Health Center (RHCHC) in the United States

Population of Focus: Children aged 0–6 years and their parents or guardians

Sample Size: A total of 2504 patients were included in the baseline period, and 1954 patients were included in the intervention period

Age Range: Children aged 0–6 years

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Quality Improvement/Practice-Wide Intervention Patient-Centered Medical Home

Intervention Description: To evaluate the impact of TEAM UP-an initiative that fully integrates behavioral health services into pediatric primary care in three Boston-area Community Health Centers (CHCs)-on health care utilization and costs.

Intervention Results: After 1.5 years, TEAM UP was associated with a relative increase in the rate of primary care visits (IRR = 1.15, 95% CI 1.04-1.27, or 115 additional visits/1000 patients/quarter), driven by children with a MH diagnosis at baseline. There was no significant change in avoidable health care utilization or cost.

Conclusion: Expanding the TEAM UP behavioral health integration model to other sites has the potential to improve primary care engagement in low-income children with MH needs.

Study Design: Difference in difference approach

Setting: Three Boston-area pediatric medical home community health center (CHC) sites that serve low-income and demographically diverse patient populations.

Population of Focus: Children age 17 and younger with Medicaid coverage, who were enrolled in BMC HealthNet, and who had a PCP visit within the last 18 months

Sample Size: 2,616 children

Age Range: Children ages 17 and younger

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Provider Training/Education HOSPITAL Continuing Education of Hospital Providers Policy/Guideline (Hospital) Educational Material (Provider) Guideline Change and Implementation

Intervention Description: We hypothesized that a pragmatic, multilevel treatment model including (ask, advise, refer [AAR]) coupled with individualized, telephone-based behavioral counseling promoting child tobacco smoke exposure (TSE) reduction would demonstrate greater child TSE reduction than would standard AAR.

Intervention Results: Complete case analysis demonstrated that compared with control parents (29.9%), significantly more parents in the experimental condition (45.8%) eliminated their children’s exposure to all sources of tobacco smoke both inside and outside their homes at 3-month follow-up. In addition, more parents in AAR/counseling than in AAR/attention control eliminated all sources of TSE (45.8% vs. 29.9%) and quit smoking (28.2% vs. 8.2%).

Conclusion: The results indicate that the integration of clinic- and individual-level smoking interventions produces improved TSE and cessation outcomes relative to standalone clinic AAR intervention. Moreover, this study was among the first in which researchers demonstrated success in embedding AAR decision aids into electronic health records and seamlessly facilitated TSE intervention into routine clinic practice.

Study Design: RCT

Setting: Community (home)

Population of Focus: Tobacco-smoking parents living in low-income, urban communities with children <11 years old exposed daily to tobacco smoke in the home. Additional inclusion criteria: daily smoker, >17 years old, and speaking English

Data Source: Structured telephone interviews for baseline data collection and 3-month follow-up.

Sample Size: 334 providers. 327 participants (n=163 AAR and counseling, n=164 AAR and control)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Provider Training/Education

Intervention Description: To determine whether an educational intervention to change nursery practice would result in more inner-city parents placing their infants in the supine position for sleep.

Intervention Results: Infant observations showed that 20% and 99% of the infants in the well-newborn nursery were placed in the supine position before and after the intervention respectively (p<0.05). Parents reported that 37% and 88% of nursery staff exclusively placed infants to sleep in the supine position before and after the intervention respectively (OR=12.5, 95% CI: 5.7-27.7). Parent report showed that 42% and 75% of parents usually placed infants to sleep in the supine position at home before and after the intervention respectively (OR=4.2, 95% CI: 2.1-7.9).

Conclusion: After an educational intervention to change practice in a well-newborn nursery, many more parents reported placing their infants in the supine position for sleep,

Study Design: QE: pretest-posttest

Setting: Yale-New Haven Hospital (New Haven, CT); Pediatric Primary Care center of the Yale-New Haven Hospital

Population of Focus: Infants in the well-newborn nursery during the postpartum stay; Parents of infants at the infants’ 2-week health supervision visit

Data Source: Infant observation and Parent report

Sample Size: Baseline (n=100) Follow-up (n=100)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: To increase consistency of breastfeeding care and interventions across a large primary care network, we established an Ambulatory Breastfeeding Consortium (ABC) focused on information sharing and discussion centered on care of breastfeeding and lactating families.

Intervention Results: The ABC has been effective in engaging primary care nurses and other clinicians and disseminating information while encouraging discussion on the importance of providing informed care to breastfeeding families.

Conclusion: Although more breastfeeding-specific education is recommended for clinicians, the ABC serves as a model for primary care clinicians to improve their knowledge and provide support for families through education, shared experience, and awareness across many pediatric primary care network sites.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Enabling Services Expert Support (Provider) HEALTH_CARE_PROVIDER_PRACTICE PATIENT_CONSUMER

Intervention Description: This study sought to describe the PPCC's approach to care, their guiding principles and the roles, knowledge and skills that enable them to provide exemplary care.

Intervention Results: Findings include the PPCC's position within the healthcare system, guiding principles, goals, roles and responsibilities, and knowledge and skills. Two figures enhance the understanding of the PPCCs approach to creating a safe space for the family, supporting the interdisciplinary team and facilitating coordinated birth planning.

Conclusion: Every perinatal palliative care programme should include a PPCC. Future research on clinical training could examine the effectiveness of an educational intervention, using the detailed knowledge and skills learned in this study as a curriculum.

Intervention Components (click on component to see a list of all articles that use that intervention): Education on Disease/Condition Planning for Transition HEALTH_CARE_PROVIDER_PRACTICE YOUTH

Intervention Description: This study aimed to evaluate the transition to adult care program instituted for liver transplant recipients (LTRs) at a large tertiary pediatric hospital in Melbourne, Australia.

Intervention Results: Twenty-eight LTRs participated in the study; 20 received the transition intervention and 8 served as controls. Within the intervention group, all domains of transition competency and reported anxiety regarding transferring had significantly improved at the conclusion of the intervention and all reported satisfaction with the transition program with most (81%) reporting readiness to transfer. There were no significant differences in rejection rates or failure to attend rates between those who did and did not receive the transition intervention.

Conclusion: A longitudinal holistic transition program has the potential to positively impact the competencies and readiness of LTRs to successful transition and transfer to adult care.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Nurse/Nurse Practitioner CAREGIVER Motivational Interviewing/Counseling Assessment (caregiver) PATIENT/CONSUMER Educational Material Online Material/Education/Blogging Motivational Interviewing PARENT/FAMILY Consultation (Parent/Family) Notification/Information Materials (Online Resources, Information Guide)

Intervention Description: A study was undertaken to determine the effectiveness of two brief multi-strategic child health nurse delivered interventions in: decreasing the prevalence of infants exposed to SHS; decreasing the prevalence of smoking amongst parent/carers of infants and increasing the prevalence of household smoking bans.

Intervention Results: When compared to the Control group at 12 months, no significant differences in the prevalence of infant exposure to SHS were detected from baseline to follow-up for Treatment condition 1 or Treatment condition 2. Similarly, no significant differences were detected in the proportion of parent/care givers who reported that they were smokers, or in the proportion of households reported to have a complete smoking ban.

Conclusion: Further research is required to identify effective interventions that can be consistently provided by child health nurses if the potential of such settings to contribute to reductions in child SHS exposure is to be realised.

Study Design: Cluster randomized controlled trial

Setting: Community well-child health clinics

Population of Focus: s Infants exposed to second hand smoke

Data Source: Data was collected via computer during the visit, child health clinic records

Sample Size: 1424 parents of children aged 0 to 4 years attending well-child health checks

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Patient Reminder/Invitation Educational Material PROVIDER/PRACTICE Designated Clinic/Extended Hours

Intervention Description: Evaluate the effectiveness of an invitation letter on cervical screening participation among unscreened women 30 to 69 years of age.

Intervention Results: Women who were sent an invitation letter were significantly more likely to have had a Pap test in the next 6 months compared with women who were not sent an invitation letter (odds ratio [OR]=2.60, 95% confidence interval [CI] 2.09-3.35, p<0.001).

Conclusion: Sending invitation letters increased cervical screening participation but because the overall effect was small, additional strategies that remove barriers to screening for unscreened women are also necessary.

Study Design: Cluster RCT

Setting: Manitoba

Population of Focus: Women who had no Pap smear reported since 2001 and had been registered in the screening registry for at least 5 years (as of June 2010), with no history of gynecological cancer or hysterectomy, and who were covered by provincial health care insurance

Data Source: Cervical cancer screening registry

Sample Size: Total (N=31,452) Intervention (n=17,068); Control (n=14,384)

Age Range: 30-69

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Patient-Centered Medical Home Quality Improvement/Practice-Wide Intervention

Intervention Description: common reading program in their first year. 12-16 months later, participate in focus groups discussions

Intervention Results: 5 primary themes - seeing family members as stakeholders, establishing common ground with peers and affirming the larger reason for graduate school, applying lessons from clinical practice that see the parient as a person, experiencing an emotional connections with a story and its characters, taking alternative perspectives/stepping into the shoes of the patient

Conclusion: Story can be a global way to construct meaning. In health care, health professionals must piece together the illness narrative to fully appreciate their client’s illness experience (Clark, 2014; Kleinman, 1988). A common reading program provides a means for helping interprofessional learners construct this narrative. Through shared reading and reflection on a fictional account, health professions students better understand the dimensions of illness, what it means to give and receive care, and the uncertainty of the human condition. This narrative, experiential approach for socializing entering graduate students to the health professions can serve to impart the values of patient-centered care from day one. When implemented in an integrative and comprehensive inter-professional education curriculum, it has the potential to encourage students to embrace the dual identity entailed by interprofessional professionalism. Facilitation of a common reading follows best practices in interprofessional learning by creating and sustaining group culture and role modeling reflection, values, and challenges to stereotypes (Barr, 2013; Bridges, Davidson, Odegard, Maki, & Tomkowiak, 2011; Carpenter & Dickerson, 2016; Interprofessional Education Collaborative, 2016; Institute of Medicine, 2015; Oandasan & Reeves, 2005). Although no known studies to date have evaluated the staying power of common reading programs, our findings mirror research in liberal arts education that suggest first-year seminars are best practice in the development of a holistic student, citizen, and lifelong learner (Association of American Colleges and Universities, 2007; Padgett, Keup, & Pascarella, 2013). A common reading appears to be a relatively low-cost, high-yield interprofessional educational activity that serves to develop health professions students’ knowledge, attitudes, and behaviors in patient-centered care. It is easily introduced into educational programs and bridges both uniprofessional and interprofessional learning. A common reading program can curtail typical alignment challenges between programs, timetables, and faculty (Barr, Helme, & D’Avray, 2014) since students complete the reading pre-matriculation and reflect on the reading during program orientation. It facilitates meaningful conversations across a variety of backgrounds and experiences, and translates contexts from academic to clinical education settings along the continuum of learning. A common reading may be an effective and lasting way for educators to establish a patient-centered, perspective-taking approach to care in pre-licensure health professions students. Assigning and facilitating discussion on a common reading imparts the message to students that the institution values the human aspects of care. It is an effective way to foster interprofessionalism and make patient-centered care explicit for novice health professionals. Themes elicited from this research suggest the staying power of this pedagogy in regard to perspective-taking, understanding family as stakeholders, and the importance of seeing the patient as a person. A common reading program allows the learner to engage with an illness narrative, connecting learner to patient and preparing students for collaborative practice.

Study Design: An exploratory case study approach using focus groups and thematic analysis was used to evaluate whether students’ attitudes about a literary account of illness endured a year after clinical and professional education

Setting: MGH Institute of Health Professions, an independent graduate school in Boston, Massachusetts, - second-year students in nursing, physical therapy, occupational therapy, and communication sciences and disorders (i.e., speech-language pathology) entry-level programs .

Population of Focus: second-year students in nursing, occupational therapy, physical therapy, and speech-language pathology - second-year students in nursing, physical therapy, occupational therapy, and communication sciences and disorders (i.e., speech-language pathology) entry-level programs .

Sample Size: 316 students from the four participating health professions programs, with representation from nursing, physical therapy, occupational therapy, and speech-language pathology . Additionally, 24 students agreed to participate in the focus group discussions, with the four professions represented as follows: nursing (n = 4), occupational therapy (n = 5), physical therapy (n = 8), and speech-language pathology (n = 7) .

Age Range: college students

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Patient Reminder/Invitation Educational Material PROVIDER/PRACTICE Provider Reminder/Recall Systems Quality Improvement/Practice-Wide Intervention Designated Clinic/Extended Hours Female Provider Needs Assessment PATIENT_CONSUMER HOSPITAL

Intervention Description: Translational research (TR) and continuous quality improvement (CQI) processes used to identify and address barriers and facilitators to Pap smear screening within an urban Aboriginal Community Controlled Health Service (ACCHS).

Intervention Results: There was a statistically significant increase in Pap smear numbers during Plan-Do-Study-Act (PDSA) cycles, continuing at 10 months follow up.

Conclusion: he use of TR with CQI appears to be an effective and acceptable way to affect Pap smear screening. This model is transferrable to other settings and other health issues.

Study Design: QE: pretest-posttest

Setting: An urban Aboriginal Community Controlled Health Service (ACCHS)

Population of Focus: All women within eligible age range

Data Source: Electronic medical records

Sample Size: Total (N=213)

Age Range: 18-70

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Provider Training/Education Educational Material (Provider) Expert Support (Provider) Participation Incentives Modified Billing Practices Data Collection Training for Staff Screening Tool Implementation Training Office Systems Assessments and Implementation Training Expert Feedback Using the Plan-Do-Study-Act-Tool Collaboration with Local Agencies (State) Collaboration with Local Agencies (Health Care Provider/Practice) Engagement with Payers STATE POPULATION-BASED SYSTEMS Audit/Attestation HEALTH_CARE_PROVIDER_PRACTICE Audit/Attestation (Provider)

Intervention Description: Early identification of children with developmental and behavioral delays is important in primary care practice, and well-child visits provide an ideal opportunity to engage parents and perform periodic screening. Integration of this activity into office process and flow is necessary for making screening a routine and consistent part of primary care practice.

Intervention Results: In the North Carolina Assuring Better Child Health and Development Project, careful attention to and training for office process has resulted in a significant increase in screening rates to >70% of the designated well-child visits. The data from the project prompted a change in Medicaid policy, and screening is now statewide in primary practices that perform Early Periodic Screening, Diagnosis, and Treatment examinations.

Conclusion: Although there are features of the project that are unique to North Carolina, there are also elements that are transferable to any practice or state interested in integrating child development services into the medical home.

Study Design: QE: pretest-posttest

Setting: Partnership for Health Management, a network within Community Care of North Carolina

Population of Focus: Children ages 6 to 60 months receiving Early Periodic Screening, Diagnosis, and Treatment services

Data Source: Child medical record

Sample Size: Unknown number of charts – screening rates tracked in 2 counties (>20,000 screens by 2004)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL Continuing Education of Hospital Providers Development/Improvement of Services

Intervention Description: In the Thames Valley region of the UK in 2012-2014, covering 27 000 births per annum, about 50% of extremely premature babies were born in a specialist centre. Audit showed a number of potential areas for improvement. We used regional place of birth data and compared the place of birth of extremely premature babies for 2 years before our intervention and for 4 years (2014-2018) after we started. We aimed to improve the proportion of neonates born in a specialist centre with three interventions: increasing awareness and education across the region, by improving and simplifying the referral pathway to the local specialised centre, and by developing region-wide guidelines on the principal precursors to preterm birth: preterm labour and expedited delivery for fetal growth restriction.

Intervention Results: There were 147 eligible neonates born within the network in the 2 years before the intervention and 80 (54.4%) were inborn in a specialised centre. In the 4 years of and following the intervention, there were 334 neonates of whom 255 were inborn (76.3%) (relative risk of non-transfer 0.50 (95% CI 0.39 to 0.65), p<0.001). Rates showed a sustained improvement.

Conclusion: The proportion of extremely premature babies born in specialist centres can be significantly improved by a region-wide quality improvement programme. The interventions and lessons could be used for other areas and specialties.

Setting: Network of hospitals in the Thames Valley region of UK

Population of Focus: Extremely premature babies born within network

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Provider Training/Education

Intervention Description: The aim of the study was to evaluate the effects of process-oriented training in supportive breastfeeding counseling for midwives and postnatal nurses on the time lapse between the initial breastfeeding session, introduction of breastmilk substitutes and solids, and the duration of breastfeeding.

Intervention Results: The IG mothers had a significantly longer duration of exclusive breastfeeding, even if the initial breastfeeding session did not occur within 2 hours after birth, than the corresponding group of CGA mothers (p=0.01). Fewer infants in the IG received breastmilk substitutes (in the first week of life) without medical reasons compared with the control groups (p=0.01). The IG infants were significantly older (3.8 months) when breastmilk substitutes were introduced (after discharge from the hospital) compared with the infants in the control groups (CGA, 2.3 months, p=0.01; CGB, 2.5 months, p=0.03).

Conclusion: A process-oriented training program for midwives and postnatal nurses was associated with a reduced number of infants being given breastmilk substitutes during the 1st week without medical reasons and delayed the introduction of breastmilk substitutes after discharge from the hospital.

Study Design: Cluster RCT

Setting: 10 municipalities in southwest Sweden

Population of Focus: First time, Swedish-speaking mothers with singleton, healthy, full-term births delivered spontaneously, by vacuum extraction, or by cesarean section, and who had been cared for by a healthcare professional in one of 10 municipalities

Data Source: Mother self-report

Sample Size: 3 Days Postpartum3 • Intervention (n=206/172) • Control Group A (n=162/148) • Control Group B (n=172/160)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE Training/Education Educational Material (provider) Audit/Attestation (provider) PROFESSIONAL_CAREGIVER Education/Training (caregiver) HOSPITAL Quality Improvement Crib Card

Intervention Description: This quality improvement project used an interprofessional, multimodal approach to improve sleep safety for hospitalized infants. The working group for this project included the Director of Quality Improvement for the Department of Pediatrics, a Pediatric Hospitalist, a Senior Advanced Practice Nurse in Pediatrics, Senior Associate Counsel for the Office of Counsel, and a medical student with a background in social work. The interdisciplinary group met to review and discuss improvements to communication and facilitated the development of five family interventions: a designated safe sleep web page, a clear bedside guide to safe sleep, additional training for nursing staff in motivational interviewing, a card audit system, and electronic health record smart phrases. A short survey was conducted to assess how the safe sleep toolkit has been useful to care providers in the Children’s Hospital. 

Intervention Results: With the initial pilot implementation of the K-cards, staff reported increased ease of audits. Adherence to recommended safer sleep measures was a major barrier in previous attempts to improve institutional sleep safety (1). By making adherence easier, providers may be more likely to both participate in quality improvement tracking measures and follow-up with families directly.

Conclusion: These coordinated interventions reflect advantages of an interprofessional and family-centered approach: building rapport and achieving improvements to infant sleep safety.

Setting: Golisano Children’s Hospital

Population of Focus: Hospital healthcare providers

Intervention Components (click on component to see a list of all articles that use that intervention): Other Person-to-Person Education PATIENT_CONSUMER Educational Material Provider Training/Education HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This study was a controlled trial study with longitudinal design. The sample consisted of 156 women (intervention = 78, control = 78) who registered in hearing-impaired associations in Izmir, Turkey. The education about cervical cancer and Pap smear test was given to intervention group with face-to-face interviews by using Turkish sign language. Three months later, the women were contacted and asked whether they have had a Pap smear test, and the total knowledge score of intervention groups was evaluated.

Intervention Results: There was not a statistically significant difference between the mean total score of knowledge about cervical cancer and Pap smear test in intervention (0.6 ± 1.6) and control (1.1 ± 1.9) groups. After 3 months, having a Pap smear test was found to be statistically significantly higher between groups (intervention = 29.5%, control = %1.2), and the mean cervical cancer and Pap smear knowledge score of the intervention group (9.2 ± 1.4) was found to be statistically significantly higher than the score before education (0.6 ± 1.6).

Conclusion: Education of cervical cancer and Pap smear test increased knowledge level and behaviour of Pap smear test of the women.

Intervention Components (click on component to see a list of all articles that use that intervention): Enabling Services Provider Training/Education Patient-Centered Medical Home HEALTH_CARE_PROVIDER_PRACTICE PATIENT_CONSUMER

Intervention Description: This article provides recommendations for adapting the pediatric medical home (PMH) model for health care needs of youth in foster care.

Intervention Results: Preliminary evidence suggests that the PMH model of care may be ideal for addressing the complex and often underserved needs of youth in foster care and their families. The present recommendations provide a logistical framework for establishing a clinic that thoughtfully considers the unique needs of this population.

Conclusion: Future research is needed to examine best practices for implementation.

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation  Referrals PATIENT_CONSUMER Educational Material (Provider) HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: We pilot tested a Perinatal Wellness Navigator (PWN) program for a group of high-risk perinatal women (N = 50; n = 42 with OUD) that consisted of (a) one-on-one tobacco treatment, (b) comprehensive assessment of cessation barriers, and (c) linkage to clinical/social services.

Intervention Results: Outcome measures were assessed at baseline and postintervention. Participants smoked 10 fewer cigarettes per day (p = .05) at postintervention and were less dependent on nicotine (p < .01). Mean postnatal depression scores (p = .03) and perceived stress (p = .03) decreased postintervention. Participants received at least one referral at baseline (n = 106 total), and 10 participants received an additional 18 referrals at postintervention to address cessation barriers.

Conclusion: The PWN program was minimally effective in promoting total tobacco abstinence in a high-risk group of perinatal women, but participants experienced reductions in cigarettes smoked per day, nicotine dependence, stress, and depression.

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment Referrals YOUTH PATIENT_CONSUMER Educational Material (Provider) HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: To develop, implement, and assess implementation outcomes for a developmental monitoring and referral program for children in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Intervention Results: In both phases, all surveyed staff (n = 46) agreed the program was easy to use. Most (≥ 80%) agreed that checklists fit easily into clinic workflow and required ≤ 5 min to complete. Staff (≥ 55%) indicated using checklists with ≥ 75% of their clients. 92% or more reported referring one or more children with potential developmental concerns. According to 80% of staff, parents indicated checklists helped them learn about development and planned to share them with healthcare providers. During the second phase, 18 of 20 staff surveyed indicated the program helped them learn when to refer children and how to support parents, and 19 felt the program promoted healthy development. Focus groups supported survey findings, and all clinics planned to sustain the program.

Conclusion: Initial implementation outcomes supported this approach to developmental monitoring and referral in WIC. The program has potential to help low-income parents identify possible concerns and access support.

Intervention Components (click on component to see a list of all articles that use that intervention): Enabling Services Expert Support (Provider) Provider Training/Education HEALTH_CARE_PROVIDER_PRACTICE PATIENT_CONSUMER

Intervention Description: This article discusses a multidisciplinary, family-centered medical home designed to address the needs of this special population.

Intervention Results: The NSP has become a primary referral source for local NICUs, with a total of 549 medically fragile infants enrolled from its inception in 2011 through 2016. Caregivers and patients experience psychosocial stressors at averages statistically significantly higher than the rest of the Commonwealth of Pennsylvania and the US. Although patients in the program use medical resources beyond that of typically developing infants, hospital utilization among this patient cohort is trending down.

Conclusion: Caring for medically fragile NICU graduates can be daunting for families given the array of necessary services, supports, and resources to maximize their potential. A multidisciplinary primary care medical home, such as the NSP, is a successful model of patient care demonstrating favorable associations with health care utilization, care coordination, and addressing/improving family functioning and their experience.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Baby Friendly Hospital Initiative Quality Improvement/Practice-Wide Intervention Hospital Policies Provider Training/Education

Intervention Description: To conduct a national quality improvement initiative between 2011 and 2015. The initiative was entitled Best Fed Beginnings and enrolled 90 hospitals in a nationwide initiative to increase breastfeeding and achieve Baby-Friendly designation.

Intervention Results: Overall breastfeeding increased from 79% to 83% (t = 1.93; P = .057), and exclusive breastfeeding increased from 39% to 61% (t = 9.72; P < .001).

Conclusion: A nationwide initiative of maternity care hospitals accomplished rapid transformative changes to achieve Baby-Friendly designation. These changes were accompanied by a significant increase in exclusive breastfeeding.

Study Design: QE: pretest-posttest

Setting: 90 hospitals from 3 geographic regions

Population of Focus: Hospitals with low breastfeeding rates, readiness for change, establishment of a BabyFriendly/breastfeeding steering committee, data about sociodemographic characteristics of population served, geographic location based on regions with low breastfeeding rates and BFHI accreditation, commitment of senior leadership, and experience with quality improvement methods

Data Source: Medical record review

Sample Size: Intervention (N=89) N=hospitals

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE Provider Training/Education Quality Improvement/Practice-Wide Intervention Baby Friendly Hospital Initiative

Intervention Description: The Best Fed Beginnings (BFB) initiative was specifically aimed to enable 90 hospitals to earn Baby-Friendly USA assessment scheduled by the end of the collaborative project. Given the size of this initiative, BFB was conducted as 3 simultaneous Breakthrough Series collaborative projects comprising hospitals from 3 geographic regions. Hospitals assembled multidisciplinary teams that included parent partners and community representatives. Three in-person learning sessions were interspersed with remote learning and tests of change, and a Web-based platform housed resources and data for widespread sharing.

Intervention Results: By April 2016, a total of 72 (80%) of the 90 hospitals received the Baby-Friendly designation, nearly doubling the number of designated hospitals in the United States. Participation in the Best Fed Beginnings initiative had significantly high correlation with designation compared with hospital applicants not in the program (Pearson’s r [235]: 0.80; P < .01). Overall breastfeeding increased from 79% to 83% (t = 1.93; P = .057), and exclusive breastfeeding increased from 39% to 61% (t = 9.72; P < .001).

Conclusion: A nationwide initiative of maternity care hospitals accomplished rapid transformative changes to achieve Baby-Friendly designation. These changes were accompanied by a significant increase in exclusive breastfeeding.

Study Design: Evaluation data

Setting: Hospitals nationwide

Population of Focus: Hospitals across the country seeking to achieve Baby-Friendly designation

Sample Size: 90 Baby-Friendly Hospitals

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment (patient/consumer) Assessment (Provider) Education on Disease/Condition

Intervention Description: The study evaluated the impact of a community-based mobile crisis service intervention in Connecticut, which provides crisis stabilization and support, screening and assessment, suicide assessment and prevention, brief, solution-focused interventions, and referral and linkage to ongoing care.

Intervention Results: Youths who received mobile crisis services had a significant reduction in odds of a subsequent behavioral health ED visit compared with those who did not receive mobile crisis services.

Conclusion: The study provides evidence suggesting that community-based mobile crisis services, such as Mobile Crisis, reduce ED use among youths with behavioral health service needs.

Study Design: Quasi-experimental study

Setting: Connecticut, United States

Population of Focus: Healthcare providers, policymakers, and researchers interested in improving behavioral health services for youths.

Sample Size: Not specified

Age Range: Youths who were age 18 and younger, as well as older youths who were still attending high school.

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER Expanded Insurance Coverage HEALTH_CARE_PROVIDER_PRACTICE Public Insurance (Health Care Provider/Practice) Educational Material (Provider) PARENT_FAMILY Training (Parent/Family) PROFESSIONAL_CAREGIVER Outreach (caregiver) PATIENT_CONSUMER Peer Counselor Parent Mentors

Intervention Description: The aim of the Kids’ Health Insurance by Educating Lots of Parents (Kids’ HELP) study was to evaluate the effects of parent mentors – Latino parents with children covered by Medicaid or the Children’s Health Insurance Program (CHIP) – on insuring Latino children in a community-based trial of uninsured children from 2011-2015. Parent mentors were trained to assist families in getting insurance coverage, accessing health care, and addressing social determinants of health. The intervention group was assigned parent mentors – trained, fluently bilingual Latino parents who had at least one child insured by Medicaid or CHIP for at least one year. Parent mentors attended a two-day training and received training manuals in English and Spanish with 9 training topics and one on sharing experiences. Parents mentors provided 8 services to intervention children and families (e.g., teaching about types of insurance programs and application processes; helping parents complete and submit children’s insurance applications; acting as family advocates by liaising between families and Medicaid or CHIP agencies; and helping parents complete and submit applications for coverage renewal).

Intervention Results: The study found that parent mentors were more effective than traditional methods in insuring children (95% vs. 69%), achieving faster coverage and greater parental satisfaction, reducing unmet health care needs, providing children with primary care providers, and improving the quality of well-child and subspecialty care. Children in the parent-mentor group had higher quality of overall and specialty care, lower out-of-pocket spending, and higher rates of coverage two years after the end of the intervention (100% vs. 70%). Parent mentors are highly effective in insuring uninsured Latino children and eliminating disparities. Parent mentors, as a special category of community health workers, could be an excellent fit with and complement to current state community health worker models. This RCT documented that the Kids’ HELP intervention is significantly more efficacious than traditional Medicaid and CHIP methods of insuring Latino children. Kids’ HELP eliminates coverage disparities for Latino children, insures children more quickly and with greater parental satisfaction than among control parents, enhances health care access, reduces unmet needs, improves the quality of well-child and subspecialty care, reduces out-of-pocket spending and family financial burden, empowers parents, ad creates jobs.

Conclusion: Parent mentors are highly effective in insuring uninsured Latino children and eliminating disparities.

Study Design: RCT

Setting: Community (Communities in Dallas County, Texas with the highest proportions of uninsured and low-income minority children)

Population of Focus: Uninsured children 0-18 years old whose primary caregiver identified them as Latino and uninsured and reported meeting Medicaid/CHIP eligibility criteria for the child

Data Source: Kids’ HELP trial data; questionnaires

Sample Size: 155 subjects (children and parents); 75 in the control group and 80 in the intervention group

Age Range: 0-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER Expanded Insurance Coverage HEALTH_CARE_PROVIDER_PRACTICE Public Insurance (Health Care Provider/Practice) Educational Material (Provider) PARENT_FAMILY Training (Parent/Family) PROFESSIONAL_CAREGIVER Outreach (caregiver) PATIENT_CONSUMER Peer Counselor Parent Mentors

Intervention Description: This study examined the effects of parent mentors on insuring minority children in the Kids’ Health Insurance by Educating Lots of Parents (Kids’ HELP) program. Parent mentors were experienced parents with ≥1 Medicaid/CHIP-covered child who received 2 days of training, then assisted families for 1 year with insurance applications, retaining coverage, medical homes, and social needs; controls received traditional Medicaid/CHIP outreach. Parent mentors received monthly stipends for each family mentored. Parents mentors and intervention participants were matched by race/ethnicity and zip code, whenever possible. Latino families were matched with fluently bilingual Latino parent mentors. Session content for the 2-day training was based on training provided to community case managers in the research team’s previous successful RCT and addressed 9 topics (e.g., why health insurance is so important; being a successful parent mentor; parent mentor responsibilities; Medicaid and CHIP programs and the application process; the importance of medical homes).

Intervention Results: In the Kids’ HELP trial, the intervention was more effective than traditional outreach/enrollment in insuring uninsured minority children, resulting in 95% of children obtaining insurance vs. 68% of controls. The intervention also insured children faster, and was more effective in renewing coverage, improving access to medical and dental care, reducing out-of-pocket costs, achieving parental satisfaction and quality of care, and sustaining insurance after intervention cessation. This is the first RCT to evaluate the effectiveness of parent mentors in insuring uninsured children. Kids’ HELP could possibly save $12.1 to $14.1 billion. Parent mentors were more effective in improving access to primary, dental, and specialty care; reducing unmet needs, achieving parental satisfaction with care, and sustaining long-term coverage. Parent mentors resulted in lower out-of-pocket costs for doctor and sick visits, higher well-child care quality ratings, and higher levels of parental satisfaction and respect from children’s physicians.

Conclusion: PMs are more effective than traditional Medicaid/CHIP methods in insuring uninsured minority children, improving health care access, and achieving parental satisfaction, but are inexpensive and highly cost-effective.

Study Design: RCT

Setting: Community (Communities in Dallas County, Texas with the highest proportions of uninsured and low-income minority children)

Population of Focus: Primary caregiver had ≥1 child 0 to 18 years old who lacked health insurance but was Medicaid/CHIP eligible, and the primary caregiver self-identified the child as Latino/Hispanic or African-American

Data Source: Kids’ HELP trial data; questionnaires; national, state, and regional surveys

Sample Size: 237 participants; 114 in the control group and 123 in the intervention group

Age Range: 0-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention Office Systems Assessments And Implementation Training HEALTH_CARE_PROVIDER_PRACTICE Audit/Attestation (Provider) Data Collection Training for Staff Provider Training/Education

Intervention Description: This 1-year national quality improvement collaborative involved 19 pediatric primary care practices. Supported by virtual and in-person learning opportunities, practice teams implemented changes to early childhood screening. Monthly chart reviews were used to assess screening, discussion, referral, and follow-up for development, ASD, maternal depression, and SDoH. Parent surveys were used to assess parent-reported screening and referral and/or resource provision. Practice self-ratings and team surveys were used to assess practice-level changes.

Intervention Results: Participating practices included independent, academic, hospital-affiliated, and multispecialty group practices and community health centers in 12 states. The collaborative met development and ASD screening goals of >90%. Largest increases in screening occurred for maternal depression (27% to 87%; +222%; P < .001) and SDoH (26% to 76%; +231%; P < .001). Statistically significant increases in discussion of results occurred for all screening areas. For referral, significant increases were seen for development (53% to 86%; P < .001) and maternal depression (23% to 100%; P = .008). Parents also reported increased screening and referral and/or resource provision. Practice-level changes included improved systems to support screening.

Conclusion: Practices successfully implemented multiple screenings and demonstrated improvement in subsequent discussion, referral, and follow-up steps. Continued advocacy for adequate resources to support referral and follow-up is needed to translate increased screening into improved health outcomes.

Setting: Pediatric primary care practices

Population of Focus: Physician leader, staff and parent partner

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention Provider Training/Education Guideline Change and Implementation Provider Tools

Intervention Description: Participants were asked to complete the Family-Centered Care Questionnaire—Revised (FCCQ-R), a 45-item measure of healthcare professionals’ perceptions of the practice and importance of 9 core dimensions of family-centered care.

Intervention Results: Six main themes emerged from the analysis of the concerns and recommendations for family-centered care described in the comments: language translation; communication between staff and families; staffing and workflow; team culture and leadership; staff and parent education, and the NICU physical environment

Conclusion: No Conclusion: Implications for Practice: The NICU healthcare professionals identified a range of issues that support or impede delivery of family-centered care and provided actionable recommendations for improvement. Implications for Research: Future research should include economic analyses that will enable determination of the return on investment so that NICUs can better justify the human and capital resources needed to implement high-quality family-centered care.

Study Design: Data for this qualitative analysis were obtained from a multicenter survey of family-centered care practices completed by NICU healthcare professionals from 6 geographically and demographically diverse NICUs in California during the baseline (familycentered care) phase of a study comparing usual family-centered NICU care with mobile-enhanced family integrated care (mFICare) (NCT03418870)

Setting: NICU - six geographically and demographically diverse neonatal intensive care units (NICUs) in California

Population of Focus: NICU Professionals - NICU healthcare professionals, such as registered nurses, physicians, and neonatal nurse practitioners, who provided care in the NICUs involved in the study .

Sample Size: 382 NICU staff - The study involved 382 NICU healthcare providers from 6 NICUs who completed the survey, and 68 of them (18%) provided 89 free-text comments/recommendations about family-centered care , .

Age Range: adult professionals in NICU settings - The study reported that 65% of the sample were 50 years of age or younger, and 35% of the sample were older than 50 years .

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE Provider Training/Education HOSPITAL Quality Improvement Visual Display (Hospital)

Intervention Description: The purpose of this study was to improve safe sleep practice (SSP) adherence by healthcare providers working with infants admitted to an inpatient pediatric unit in an urban academic center, specifically increasing compliance on five core SSP (supine, alone in the crib, no objects in crib, appropriate bundling, and flat crib). Targeted pediatric hospitalists (attending physicians who exclusively work in the hospital setting), residents, and nurses working on the general pediatric wards were invited to complete a safe sleep survey prior to receiving a brief educational intervention tailored to their specific provider group. All participants received the same basic information on the current rates of SIDS, associated disparities, current hospital practices, AAP-endorsed safe sleep practices, and the impact of healthcare provider practices on caregivers. In-person presentations, handouts, posters, and “Ask me about safe sleep” buttons for nursing staff were among the teaching tools used. Efficacy of the intervention was assessed by comparing audits of sleeping infants in hospital rooms prior to (baseline) and following (post-intervention) the education sessions.

Intervention Results: This Quality Improvement project evaluated a staff education intervention using a pre- and post-design. Surveys of providers determined baseline SSP knowledge. Adherence to SSP in the hospital was audited before and after education. One hundred pre-intervention infant sleep placement observations were recorded and 123 were collected post-intervention.

Conclusion: This quality improvement project suggests that the inpatient setting provides opportunities for providers to demonstrate SSP but that healthcare providers often do not follow SSP in practice. Continued education can lead to improvements in SSP adherence ensuring that hospitals are modeling SSP for the families of infants.

Setting: The University of Chicago Medicine Comer Children’s Hospital

Population of Focus: Pediatric healthcare providers

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Childbirth Education Classes PROVIDER/PRACTICE Active Management of Labor Labor Support Midwifery

Intervention Description: Active management of labor is a multifaceted program that, as implemented at the National Maternity Hospital in Dublin, is associated with a lower rate of cesarean delivery than the rate usually found in the United States. We conducted a randomized trial to evaluate the efficacy of this approach in lowering the rate of cesarean section among women delivering their first babies.

Intervention Results: Rate of CS among protocol-eligible women lower in AMOL group vs. control group (10.9% vs. 11.5%; p>0.05) after adjustment for epidural use and adoption of final protocol (three hours for second stage of labor with epidural); (OR=0.9, 95% CI: 0.4–1.9)

Conclusion: Active management of labor did not reduce the rate of cesarean section in nulliparous women but was associated with a somewhat shorter duration of labor and less maternal fever.

Study Design: RCT

Setting: 1 women’s hospital

Population of Focus: Nulliparous women who gave birth between June 10, 1991 and October 17, 1993

Data Source: Not specified

Sample Size: Total (n=1,915) Intervention (n=1,009) Control (n=906)

Age Range: Not Specified

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE Provider Training/Education Quality Improvement/Practice-Wide Intervention

Intervention Description: Teams participated in a 7-month virtual learning collaborative to implement immunization delivery best practices at their SHCs. A pre-post-intervention design was used to compare vaccination coverage in May 2017 to May 2018 among students who were unvaccinated at the start of the academic year.

Intervention Results: Data were compared from 29 SHCs and 152,648 students (2017) and from 18 SHCs and 122,315 students (2018). Percent of newly vaccinated students increased for ≥1 dose of flu vaccine by 14.3 percentage points to 32.3% (p < .01), ≥1 dose of HPV vaccine by 3.9 points to 7.8% (p < .05) and ≥3 doses of HPV vaccine by 0.7 points to 1.5% (p < .05).

Conclusion: Participating in a learning collaborative may help SHCs improve vaccination delivery.

Setting: Student health clinics

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER Expanded Insurance Coverage HEALTH_CARE_PROVIDER_PRACTICE Public Insurance (Health Care Provider/Practice) PROFESSIONAL_CAREGIVER Education/Training (caregiver) Collaboration with Local Agencies (State) Educational Material (caregiver) STATE Multicomponent Approach

Intervention Description: In New York, to maximize comprehensive insurance coverage for CYSHCN, a Service Integration Model was formed between the Office of Health Insurance Services and the Early Intervention Program. The 3 key components include educational messaging (jointly prepared messages about health insurance benefits and enrollment assistance offered by the Office of Health Insurance Services through the Early Intervention Program) + data from program databases (data matching with the Early Intervention Program) + individual counseling using program staff (incorporation of the Office of Health Insurance Services program staff—child benefit advisors—to work directly with parents of children in the Early Intervention Program to facilitate enrollment and renewal. The model overcomes enrollment barriers by using consumer friendly enrollment materials and one-on-one assistance, and shows the benefits of a comprehensive and collaborative approach to assisting families with enrollment into public health insurance.

Intervention Results: Since 2008, more than 5,000 children in the Early Intervention Program have been successfully enrolled and coverage renewed in Medicaid through the Service Integration Model. In 2008, the study team found that children in the Early Intervention Program had a 34% churning rate for Medicaid because of enrollment barriers and misconception of the Early Intervention Program as a replacement for Medicaid. By 2010, the churning rate for clients assisted through Office of Health Insurance Services was reduced from 34% to 8%. The Office of Health Insurance Services will modify the Service Integration Model to respond to New York State’s implementation of the Health Insurance Exchange required by the 2010 ACA. Partnerships across government programs and agencies offer opportunities to enroll hard-to-reach populations into public health insurance. The model reflects how government programs can work together to improve rates of enrollment and retention in public health insurance. The key elements of integration of program messages, data matching, and staff involvement allow for the model to be tailored to the specific needs of other government programs.

Conclusion: The model overcomes enrollment barriers by using consumer-friendly enrollment materials and one-on-one assistance, and shows the benefits of a comprehensive and collaborative approach to assisting families with enrollment into public health insurance.

Study Design: Program evaluation

Setting: Community (New York City Department of Health and Mental Hygiene's Office of Health Insurance Services and the Early Intervention Program)

Population of Focus: Uninsured and underinsured young children with special health care needs in New York City participating in the Early Intervention Program

Data Source: Evaluation data

Sample Size: 6,500 children in early intervention with a Medicaid number

Age Range: 0-3 years

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Patient-Centered Medical Home Quality Improvement/Practice-Wide Intervention

Intervention Description: We developed BBetter Together on the basis of adult learning theory to prepare providers to implement best practices in FCC. The training was delivered as six consecutive in-person workshops (30-hr total over 10 wk).

Intervention Results: Observed changes included improved reports of FCC implementation and increased self-efficacy in all MPOC domains, with medium effect sizes. These outcomes were positively interrelated.

Conclusion: BT training can enhance health care providers’ perceptions of FCC implementation and self-efficacy and minimize differences in FCC implementation by providers across expertise levels and practice settings. This study can inform the development of future FCC training interventions for providers, managers, educators, and researchers

Setting: Continuing education centers in Israel - The research was conducted in northern Israel

Population of Focus: medical professionals - occupational therapists, speech-language pathologists, physical therapists, and art therapists working in outpatient or school-based pediatric practices in Israel

Sample Size: 82 providers - 82 participants, including 68 occupational therapists, 9 speech-language pathologists, 2 physical therapists, and 3 art therapists .

Age Range: adults who provided care to children - The participants had a mean age of 37.3 years, with a range from 24 to 55 years .

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Provider Training/Education Provision of Safe Sleep Item Assessment (Provider) HOSPITAL Quality Improvement Policy/Guideline (Hospital) Crib Card CAREGIVER Education/Training (caregiver) Assessment (caregiver) Educational Material (caregiver)

Intervention Description: The aims of this project were to increase the percentage of infants following safe sleep practices in the NICU before discharge and to determine if improving compliance with these practices would influence parent behavior at home.

Intervention Results: Audit data showed that there was a significant increase in the rate of supine positioning from 39% at baseline to 83% at follow-up (p<0.001). Parental surveys showed that there was a significant increase in the rate of supine position from 73% at baseline to 93% at follow-up (p<0.05).

Conclusion: Multifactorial interventions improved compliance with safe sleep practices in the NICU and at home.

Study Design: QE: pretest-posttest

Setting: Children’s Memorial Hermann Hospital NICU in Houston, TX

Population of Focus: Infants in open cribs eligible for safe sleep practices; Parents of infants after discharge

Data Source: Crib audit/infant observation; Parent report

Sample Size: Baseline (n=62) Follow-up (n=79); Baseline (n=66) Follow-up (n=98)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Provider Training/Education Educational Material (Provider)

Intervention Description: The aims of this project were to increase the percentage of infants following safe sleep practices in the NICU before discharge and to determine if improving compliance with these practices would influence parent behavior at home. An algorithm detailing when to start safe sleep practices, a "Back to Sleep" crib card, educational programs for nurses and parents, a crib audit tool, and postdischarge telephone reminders were developed as quality improvement intervention strategies.

Intervention Results: NICU compliance with supine positioning increased from 39% to 83% (P < .001), provision of a firm sleeping surface increased from 5% to 96% (P < .001), and the removal of soft objects from the bed improved from 45% to 75% (P = .001). Through the use of a postdischarge telephone survey, parental compliance with safe sleep practices was noted to improve from 23% to 82% (P < .001).

Conclusion: Multifactorial interventions improved compliance with safe sleep practices in the NICU and at home.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Provider Training/Education HOSPITAL Quality Improvement Policy/Guideline (Hospital) Crib Card Sleep Environment Modification Promotional Event POPULATION-BASED SYSTEMS COMMUNITY Social Media CAREGIVER Education/Training (caregiver) Educational Material (caregiver) Visual Display (Community)

Intervention Description: To improve sleep environment safety for inpatient infants.

Intervention Results: The proportion of infant cribs without loose objects in them increased (32-72%, p = .025), and safe sleep positioning remained stable (82% vs. 95%, p = .183).

Conclusion: Staff education, swaddle sleep sacks, and bedside storage containers were associated with improved sleep safety among pediatric inpatients at our institution and may help at other institutions.

Study Design: QE: pretest-posttest

Setting: University of Iowa Children’s Hospital

Population of Focus: Infants less than 1 year of age developmentally ready for a crib and asleep

Data Source: Crib audit/infant observation

Sample Size: Baseline (n=22) Follow-up 1 (not reported) Follow-up 2 (n=37) Follow-up 3 (n=18)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Provider Reminder/Recall Systems

Intervention Description: The multi-level, multi-component intervention included provider education, electronic health record (EHR) modifications, patient education, and reminder/recall systems. The intervention was designed to be practical and scalable, and strategies were implemented at multiple levels.

Intervention Results: The intervention was associated with a significant increase in HPV vaccine initiation (adjusted odds ratio [aOR] = 2.17, 95% confidence interval [CI] = 1.47-3.21) and completion (aOR = 2.23, 95% CI = 1.47-3.38) compared to the non-equivalent comparison group.

Conclusion: The multi-level, multi-component intervention was effective in improving HPV vaccine initiation and completion rates in a FQHC setting.

Study Design: The study used a quasi-experimental design with a non-equivalent comparison group.

Setting: The study was conducted in a Federally Qualified Health Center (FQHC) in Los Angeles, California, USA.

Population of Focus: The target audience of the study was primary care providers, nurses/medical assistants, and parents/patients.

Sample Size: The study included a total of 1,200 patients aged 9-26 years who were eligible for the human papillomavirus (HPV) vaccine.

Age Range: The study included patients aged 9-26 years

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Home Visits Other Person-to-Person Education PROVIDER/PRACTICE Outreach (Provider)

Intervention Description: This article describes the smoking behavior outcomes of a feasibility project testing a proactive approach, utilizing Māori voluntary community health workers to identify and reach Māori pregnant women who smoke and provide cessation support.

Intervention Results: The majority of women were Māori, 20-30 years old, had their first cigarette within 30 minutes of waking and 58% had not tried to quit during the current pregnancy. Of the participants who completed a follow-up interview 33% had stopped smoking while they were pregnant and 57% had cut down. There was an increase at follow-up of people who had used cessation support or products.

Conclusion: Aunties are well-placed to find pregnant women and provide cessation support and referral in a way consistent with traditional Māori knowledge and practices. This study suggests such an intervention could increase quit attempts and increase use of effective cessation methods. A more robust study is warranted to develop an enhanced Aunties intervention.

Study Design: Prospective intervention trial- evaluation

Setting: Home-based culturally tailored community health smoking cessation support

Population of Focus: Pregnant Māori women smokers

Data Source: In person questionnaires, interviews, and hospital birth records

Sample Size: 67

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Consultation Systems (Inter-Hospital Systems) Educational Material (Provider)

Intervention Description: The DC Mental Health Access in Pediatrics (DC MAP) program is a child psychiatry access program (CPAP) that provides telephonic consultation services to primary care providers (PCPs) in Washington, DC. The program aims to increase access to mental health services for children and adolescents by providing PCPs with real-time access to child psychiatry experts who can offer guidance on diagnosis, treatment, and care coordination. The program also provides PCPs with information about community resources and referral options available to their patients. The program is staffed by a team of child psychiatrists, psychologists, and social workers who provide consultation services to PCPs on a range of mental health concerns, including depression, anxiety, ADHD, and behavioral problems,.

Intervention Results: DC MAP consult volume increased 349.3% over the first 5 years. Services requested included care coordination (85.8%), psychiatric consultation (21.4%), and psychology/social work consultation (9.9%). Of psychiatry-involved consultations, PCPs managed patient medication care with DC MAP support 50.5% of the time. Most (94.1%) PCPs said they would recommend colleagues use DC MAP, and 29.6% reported diverting patients from the emergency departments using DC MAP.

Conclusion: Yes, the study reported statistically significant findings, including a significant increase in consultation volume over the first 5 years of the program, as well as a significant difference between baseline and 1 year of participation in PCPs' ability to receive more timely care coordination services for their patients with mental health needs,,. Additionally, paired t-tests were conducted to analyze self-report data about PCP beliefs related to mental health services collected at baseline and again 1 year later, indicating statistically significant changes in PCP beliefs over time.

Study Design: The study design is a retrospective analysis of data collected from the DC Mental Health Access in Pediatrics program between May 2015 and May 2020. The study used a mixed-methods approach, including descriptive statistics and paired t-tests to analyze self-report data about PCP beliefs related to mental health services collected at baseline and again 1 year later.

Setting: The study was conducted in the primary care setting, specifically in pediatric primary care practices in Washington, D.C.. The DC Mental Health Access in Pediatrics program was designed to provide consultation services to primary care providers in order to enhance their ability to meet the mental health needs of their pediatric patients.

Population of Focus: The target audience for the study includes primary care providers (PCPs) who care for pediatric patients, as well as professionals involved in pediatric mental health care, such as child psychiatrists, psychologists, and other mental health specialists. The study aims to evaluate the effectiveness of the Child Psychiatry Access Program (CPAP) in supporting PCPs in addressing the mental health needs of children and adolescents in the primary care setting.

Sample Size: The study received 3,389 consultation requests from primary care providers (PCPs) between May 2015 and May 2020. This indicates a substantial sample size for evaluating the effectiveness of the Child Psychiatry Access Program (CPAP) in Washington, D.C.

Age Range: According to the PDF file, the DC Mental Health Access in Pediatrics program provides mental health consultation services for youth aged 0-21 years.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Enabling Services Educational Material Community-Based Group Education Designated Clinic/Extended Hours PROVIDER/PRACTICE

Intervention Description: This paper summarizes impacts of a breast and cervical cancer screening intervention spearheaded by a Native Hawaiian community.

Intervention Results: Women in intervention community significantly more likely to be compliant with Pap smear guidelines than women in control community (X2=5.73. p=.02)

Conclusion: Positive changes in screening activities among women aware of the intervention support the importance of information diffusion by community consumers. Diffusion may occur beyond the boundaries of the community as defined.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Oahu, HI

Population of Focus: Native Hawaiian women

Data Source: Telephone survey

Sample Size: Total (N=1,260) Analysis (n=678) Intervention (n=318); Control (n=360)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): Notification/Information Materials (Online Resources, Information Guide) Referrals Educational Material (Provider) HEALTH_CARE_PROVIDER_PRACTICE PATIENT_CONSUMER

Intervention Description: To improve Early Head Start/Head Start (EHS/HS) screening, referral, and enrollment for children from diverse, low-income communities.

Intervention Results: The preintervention group included 223 patients. The postintervention group included 235 patients. EHS/HS screening improved significantly after the intervention, rising from 8% in the preintervention period to 46% in the postintervention period (odds ratio [OR] 10.5, 95% confidence interval [CI] [5.9, 19.4]). EHS/HS documented referral rates increased from 1% in the preintervention period to 20% in the postintervention period (OR 18.3, 95% CI [5.7, 93.6]). Thirty-two of the 42 patients in the postintervention group referred to EHS/HS were reached to determine enrollment status. Six children (14%) had enrolled in EHS/HS.

Conclusion: With use of existing resources, a medical home–Head Start partnership can build an integrated system that significantly improves screening and referral rates to early learning programs.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Provider Training/Education Expert Support (Provider) Modified Billing Practices Screening Tool Implementation Training Office Systems Assessments and Implementation Training Expert Feedback Using the Plan-Do-Study-Act-Tool Engagement with Payers STATE POPULATION-BASED SYSTEMS Collaboration with Local Agencies (State) Collaboration with Local Agencies (Health Care Provider/Practice) HEALTH_CARE_PROVIDER_PRACTICE Audit/Attestation (Provider)

Intervention Description: This report evaluates the impact of Phase II of Maine's First STEPS initiative

Intervention Results: Average percentage of documented use of a developmental screening tool increased substantially from baseline to followup for all three age groups (46% to 97% for children under one; 22% to 71% for children 18-23 months; and 22% to 58% for children 24-35 months). Rate of developmental screening based on MaineCare claims increased from the year prior to intervention implementation to the year after implementation for all three age groups (5.3% to 17.1% for children age one; 1.5% to 13.3% for children age two; and 1.2% to 3.3% for children age 3).

Conclusion: The authors summarize lessons learned in implementing changes in practices and challenges in using CHIPRA and IHOC developmental, autism, and lead screening measures at the practice-level to inform quality improvement.

Study Design: QE: pretest-posttest

Setting: Pediatric and family practices serving children with MaineCoverage

Population of Focus: Children ages 6 to 35 months

Data Source: Child medical record; MaineCare paid claims

Sample Size: Unknown number of chart reviews from 9 practice sites completing follow-up

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER Outreach (caregiver) PROVIDER/PRACTICE POPULATION-BASED SYSTEMS STATE Medicaid Reform Education/Training (caregiver) Provider Training/Education

Intervention Description: This study aimed to determine the Washington State's Access to Baby and Child Dent stry (ABCD) Program's effect on children's dental utilization and dental fear, and on parent satisfaction and knowledge.

Intervention Results: Children in the ABCD program had a mean of 10.27 preventive dental services compared to 0.24 among children not in the ABCD program (p=0.00).

Conclusion: The authors conclude that the ABCD Program was effective in increasing access for preschool children enrolled in Medicaid, reducing dental fear, and increasing parent satisfaction.

Study Design: QE: nonequivalent control group

Setting: Spokane County in WA

Population of Focus: Children aged 12-36 months enrolled in Medicaid as of August 31, 1997

Data Source: Parent survey

Sample Size: Intervention (n=228) Control (n=237)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Educational Material CAREGIVER Educational Material (caregiver) Motivational Interviewing/Counseling Motivational Interviewing Patient Reminder/Invitation PROVIDER/PRACTICE Nurse/Nurse Practitioner

Intervention Description: To determine if mothers receiving a smoking cessation intervention emphasizing health risks of environmental tobacco smoke (ETS) for their children have a higher quit rate than 1) mothers receiving routine smoking cessation advice or 2) a control group.

Intervention Results: Complete data (baseline and both follow-ups) were available for 166 subjects. There was no impact of group assignment on the quit rate, cigarettes/day, or stage of change. The Child Health Group intervention had a sustained effect on location where smoking reportedly occurred (usually outside) and on improved knowledge of ETS effects.

Conclusion: Further research is needed to devise more effective methods of using the pediatric health care setting to influence adult smoking behaviors.

Study Design: RCT

Setting: Primary care center in a large urban children’s hospital

Population of Focus: Female caregivers (16 years and older) who accompanied a child (under 12 years) to the Primary Care Center of Columbus Children’s Hospital for a health care visit for any chief complaint or well-child examination

Data Source: Baseline data on demographics and smoking topics collected by questionnaire; and 1- and 6-month follow-ups.

Sample Size: 479 mothers

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Provider Training/Education

Intervention Description: The purpose of this study was to determine whether educating practitioners affected breastfeeding initiation and exclusivity rates at hospitals with low breastfeeding rates.

Intervention Results: An overall increase in exclusive breastfeeding rates was not statistically significant. In multivariate logistic regression for all hospitals combined, infants born postintervention were significantly more likely to initiate breastfeeding than infants born preintervention (adjusted OR 1.32, 95% CI 1.03-1.69).

Conclusion: Intensive breastfeeding education for health care practitioners can increase breastfeeding initiation rates.

Study Design: QE: pretest-posttest

Setting: 4 MA hospitals

Population of Focus: Women with infants born 3-5 months before the intervention and women with infants born 2-4 months after the intervention7

Data Source: Medical record review

Sample Size: Preintervention (n=668) Postintervention (n=679)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Continuing Education of Hospital Providers Assessment

Intervention Description: To evaluate the effectiveness of a bespoke short training programme, which incorporated interactive and didactic teaching with printed and electronic resources.

Intervention Results: Training was associated with significant improvements in the specificity of depression judgements (52.0% for the intervention group and 47.2% for the control group, P = 0.039), and there was a non-significant increase in sensitivity (64.5% compared to 61.5% P = 0.25). Nurses’ knowledge about depression improved (standardised mean difference = 0.97 [95% CI 0.58 to 1.35], P < 0.001); and confidence about their professional role in relation to depression increased.

Conclusion: This school nurse development programme, designed to convey best practice for the identification and care of depression, delivered significant improvements in some aspects of depression recognition and understanding, and was associated with increased confidence in working with young people experiencing mental health problems.

Study Design: Cluster randomized controlled trial

Setting: School nurse services from 13 Primary Care Trusts in London

Population of Focus: School nurses

Sample Size: 146 school nurses

Age Range: School pupils (aligns with ages 12-17)