Established Evidence Results

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), Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), CLASSROOM_SCHOOL, PROFESSIONAL_CAREGIVER, Outreach (caregiver), Communication Tools, Distribution of Promotional Items (Classroom/School)

Intervention Description: In Michigan, a school-based outreach effort was piloted using existing school communication tools to identify children who are currently uninsured and may be eligible for state-subsidized health insurance. School districts were provided with two health insurance status collection forms to be included with the free and reduced school lunch application, and as part of the student registration packet and welcome materials for school. Completed forms were sent to a state registered application-assisting agency to ensure families can access the coverage and services they need. A final step in the process is outreach to eligible respondents by the Michigan Primary Care Association to help ensure that they receive information and access to the healthcare coverage and services they need.

Intervention Results: As a result of the survey, 156 children were identified as not having health insurance. This represents more than 44% of the 358 children who are eligible for State subsidized health insurance, in the participating school districts, but are uninsured. Integrating the collection of health insurance status into routine school communication channels is an effective way to identify children who do not have health insurance and may be eligible for state subsidized benefits.

Conclusion: 1. The Michigan Department of Community Health should lead the effort to work with the Michigan Department of Education to modify the Free and Reduced Lunch Application to capture whether or not the applicant has health insurance. 2. The Michigan Department of Community Health should lead the effort to incorporate into the direct certified free and reduced lunch eligibility process a systematic check as to whether or not the applicant has State subsidized health insurance. 3. The Michigan Department of Community Health should provide resources from the expected performance bonus to work with schools across the State to implement these changes.

Study Design: Cross-sectional pilot study

Setting: Schools (School districts in Van Buren County, Michigan)

Population of Focus: Uninsured children

Data Source: Survey data

Sample Size: 8,999 children

Age Range: School-aged children

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Public Insurance (State)

Intervention Description: We used electronic health record (EHR) data to assess temporal patterns of healthcare utilization after Oregon's 2009-2010 CHIP expansion. We hypothesized increased post-expansion utilization among children who gained public insurance.

Intervention Results: Among the newly insured group, utilization rates of preventive dental visits increased significantly from 0.24 to 0.63 encounters per patient per year between pretest and posttest (adjusted rate ratio=2.56, 95% CI: 2.38-2.75). Between-group pretest-posttest differences in rate ratios revealed that changes in utilization of preventive dental visits were significantly different from those of the continuously insured and continuously uninsured groups (p<0.001).

Conclusion: This study used EHR data to confirm that CHIP expansions are associated with increased utilization of essential pediatric primary and preventive care. These findings are timely to pending policy decisions that could impact children's access to public health insurance in the United States.

Study Design: QE: pretest-posttest nonequivalent control group

Setting: Community health centers (CHC) in Oregon

Population of Focus: Patients aged 2-18 years who were not pregnant and did not have insurance other than Medicaid/CHIP with ≥ 1 visit before and after their ‘start date’

Data Source: CHC EHR data; state administrative data

Sample Size: Newly insured (n=3,054) Continuously insured (n=10,946) Continuously uninsured (n=10,307)

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), 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): STATE, Policy/Guideline (State)

Intervention Description: Objectives We assessed the impact of varying levels of smokefree regulations on birth outcomes and prenatal smoking.

Intervention Results: Only more comprehensive smokefree regulations were associated with statistically significant favorable effects on birth outcomes in the full sample: Comprehensive (workplace/restaurant/bar ban) demonstrated increased birthweight (29 grams, p < 0.05) and gestational age (1.64 days, p < 0.01), as well as reductions in very low birthweight (−0.4 %, p < 0.05) and preterm birth (−1.5 %, p < 0.01); Restrictive (workplace/restaurant ban) demonstrated a small decrease in very low birthweight (−0.2 %, p < 0.05). Among less restrictive regulations: Moderate (workplace ban) was associated with a 23 g (p < 0.01) decrease in birthweight; Limited (partial ban) had no effect. Comprehensive’s improvements extended to most maternal groups, and were broadest among mothers 21+ years, non-smokers, and unmarried mothers. Prenatal smoking declined slightly (−1.7 %, p < 0.01) only among married women with Comprehensive.

Conclusion: Regulation restrictiveness is a determining factor in the impact of smokefree regulations on birth outcomes, with comprehensive smokefree regulations showing promise in improving birth outcomes. Favorable effects on birth outcomes appear to stem from reduced secondhand smoke exposure rather than reduced prenatal smoking prevalence. This study is limited by an inability to measure secondhand smoke exposure and the paucity of data on policy implementation and enforcement.

Study Design: Quasi experimental cross-sectional -regression analysis

Setting: State and local policies; State Vital Statistics record

Population of Focus: Health records of singleton births for West Virginia residents between 1995-2010

Data Source: WV Vital statistics data

Sample Size: 293715

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, Outreach (Provider), POPULATION-BASED SYSTEMS, STATE, Medicaid Reform

Intervention Description: The authors obtained Medicaid eligibility, claims, and provider data before and after the fee increase, in 2006 and 2009 through 2012, respectively. Their analysis examined changes in utilization rates, service mix, expenditures, and dentists' participation. The authors qualitatively assessed the general impact of the recession on utilization rate changes.

Intervention Results: The percentage of preventive dental services among continuously enrolled children stayed relatively constant from pretest to posttest (24.1% in 2006 at pretest and 22.7%, 23.1%, 23.3%, and 24.4% in 2009, 2010, 2011, and 2012 respectively).

Conclusion: The Medicaid fee increase, program improvements, and the recession had a dramatic impact on reducing disparities in children's access to dental care in Connecticut.

Study Design: QE: pretest-posttest

Setting: Connecticut

Population of Focus: Children continuously enrolled in Medicaid (Healthcare for UninSured Kids and Youth A program) for at least 11 months and 1 day within a calendar year

Data Source: Medicaid enrollment and encounter data

Sample Size: 2006 (n=161,130) 2009 (n=166,787) 2010 (n=204,550) 2011 (n=215,377) 2012 (n=214,680)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State), Patient Reminder/Invitation,

Intervention Description: - The intervention consisted of three strategies: 1) a standardized vaccine policy change to include HPV vaccine with other adolescent vaccines, 2) sending pre-visit emails to parents of teens to provide factual vaccine information, and 3) implementing a provider communication initiative to ensure consistent messages and effective cancer prevention recommendations for HPV vaccination ,[object Object],, ,[object Object],.

Intervention Results: - The post-intervention group demonstrated a substantial increase in HPV vaccine rates, from 17.8% to 63.6% ,[object Object],.

Conclusion: - The study concluded that strategically implementing standardized clinical vaccine policies and presumptive provider communication practices has implications for significantly increasing HPV vaccine uptake among teens and may be key to preventing cancer among future generations ,[object Object],.

Study Design: - The study utilized a pre/post design to compare vaccine rates, and data was obtained via electronic health records ,[object Object],.

Setting: - The project was completed at a private pediatric practice in a suburban location in New England ,[object Object],.

Population of Focus: - The target audience consisted of 11- and 12-year-old adolescents who had not previously been vaccinated for HPV ,[object Object],.

Sample Size: - The project included 128 patients, with 73 patients in the pre-intervention group and 55 in the post-intervention group. Most patients were 12 years old in both groups ,[object Object],.

Age Range: - The project included 128 patients, with 73 patients in the pre-intervention group and 55 in the post-intervention group. Most patients were 12 years old in both groups ,[object Object],.

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State), Social Supports, Counseling (Parent/Family), Housing Prescriptions

Intervention Description: supportive housing program called Housing Prescriptions as Health Care

Intervention Results: the Housing Prescriptions as Health Care intervention led to improvements in child health and parental mental health over a six-month period for medically complex families in Boston who had experienced homelessness and housing instability. Specifically, there were decreases in the share of children in fair or poor health and in average anxiety and depression scores among parents in the intervention group compared to the control group

Conclusion: a population-specific model integrating health, housing, legal, and social services, such as the Housing Prescriptions as Health Care intervention, can improve health-related outcomes at the household level for medically complex families experiencing homelessness and housing instability. The findings suggest that addressing housing instability through a multifaceted supportive housing intervention can positively impact the health of both children and parents in these families

Study Design: pilot randomized controlled trial.

Setting: Boston, Massachusetts

Sample Size: seventy-eight homeless or housing-unstable families defined as "medically complex"; Sixty-seven families completed a six-month follow-up assessment

Age Range: mean age of the index child in the study was 2.8 years

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): Policy/Guideline (State), Public Insurance (State), Outreach (School Staff),

Intervention Description: The intervention is state Medicaid policies allowing 12 months of continuous eligibility for children, regardless of changes in family income that would otherwise end eligibility.

Intervention Results: Results show that continuous eligibility is associated with reduced rates of uninsurance, gaps in coverage, gaps due to application problems, and fair or poor health status. For children with special health care needs, it is also associated with increased preventive care, specialty care, and any medical care.

Conclusion: Continuous eligibility may be an effective strategy to reduce gaps in coverage for children and reduce paperwork burden on Medicaid agencies.

Study Design: Cross-sectional study analyzing data from a national survey.

Setting: The study analyzed data from children in all 50 states, focusing on those with incomes below 138% of the federal poverty level.

Population of Focus: The target audience is policymakers and Medicaid administrators.

Sample Size: The full sample size is 22,622 children. The sample of children with special health care needs is 6,081.

Age Range: The age range is 0-17 years.

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid, Health Insurance Coverage, Public Insurance (State),

Intervention Description: Fluctuating insurance coverage, or churning, is a recognized barrier to health care access. We assessed whether state policies that allow children to remain covered in Medicaid for a 12-month period, regardless of fluctuations in income, are associated with health and health care outcomes, after controlling for individual factors and other Medicaid policies. This cross-sectional study uses a large, nationally representative database of children ages 0 to 17.

Intervention Results: Continuous eligibility was associated with improved rates of insurance, reductions in gaps in insurance and gaps due to application problems, and lower probability of being in fair or poor health. For children with special health care needs, it was associated with increases in use of medical care and preventive and specialty care access. However, continuous eligibility was not associated with health care utilization outcomes for the full sample.

Conclusion: Continuous eligibility may be an effective strategy to reduce gaps in coverage for children and reduce paperwork burden on Medicaid agencies.

Study Design: Cross-sectional study

Setting: State Medicaid policies

Population of Focus: Children aged 0 to 17 years old with annual family incomes at or below 138% of the federal poverty line (FPL) and a subpopulation of children in low-income families with special health care needs, based on specific criteria related to health problems that require special assistance or limit the child's abilities

Sample Size: 22,622 respondents aged 0 to 17 years old with annual family incomes at or below 138% of the federal poverty line (FPL); subpopulation of 6,081 children with special health care needs in low-income families

Age Range: Children and adolescents 0-17 years

Intervention Components (click on component to see a list of all articles that use that intervention): Public Insurance (State), Medicaid Reform, STATE

Intervention Description: The goal of this study was to use claims data linked with community-level measures to evaluate the impact of preventive services on the time to subsequent restorative, advanced restorative, and complex dental treatment among children enrolled in the Virginia Medicaid program.

Intervention Results: The analysis included 430,594 children (10,204,182 claims). A log-rank test showed significant differences (P < 0.001) between the times to treatment of those who had a preventive service and those who did not have a preventive service prior to a treatment service. Both Kaplan-Meier curves and the adjusted HR (1.88; 95% confidence interval [CI], 1.46-2.15) indicated that children without preventive services were more likely to have basic restorative treatment at an earlier age along with advanced restorative treatment (HR, 1.52; 95% CI, 1.28-1.80) and complex treatment (HR, 2.13; 95% CI, 1.68-2.61).

Conclusion: In a population of Medicaid-enrolled children, children who did not receive preventive services were significantly more likely to have treatment at an earlier age than those who did receive preventive services.

Intervention Components (click on component to see a list of all articles that use that intervention): Outreach (Provider), Policy/Guideline (State)

Intervention Description: Provisions of the Patient Protection and Affordable Care Act (ACA) of 2010 hold promise for improving access to and receipt of preventive services for adolescents and young adults (AYAs). The Title V Block Grant transformation also includes a focus on improving adolescent preventive care. This brief report describes and discusses an inquiry of promising strategies for improving access and preventive care delivery identified in selected high-performing states.

Intervention Results: Seven top-performing states were selected: California, Colorado, Illinois, Iowa, Oregon, Vermont, and Texas; 27 stakeholders completed interviews. Four strategies were identified regarding insurance enrollment: use of partnerships; special populations outreach; leveraging laws and resources; and youth engagement. Four strategies were identified regarding quality preventive care: expand provider capacity to serve AYAs; adopt medical home policies; establish quality improvement projects; and enhance consumer awareness of well-visit. States focused more on adolescents than young adults and on increasing health insurance enrollment than the provision of preventive services.

Conclusion: This commentary identifies strategies and recommends areas for future action, as Title V programs and their partners focus on improving healthcare for AYAs as ACA implementation and the Title V transformation continues.

Study Design: Report

Setting: California, Colorado, Illinois, Iowa, Oregon, Vermont, and Texas

Data Source: Two data sources were used to identify top-performing states in insurance enrollment and preventive care delivery: National Survey of Children's Health for adolescents (ages 12-17 years) and Behavioral Risk Factors Surveillance System for young adults (ages 18-25 years)

Sample Size: N/A

Age Range: 12-17 and 18-25

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): Social Supports, Policy/Guideline (State), Counseling (Parent/Family),

Intervention Description: spotlights hardships and supportive factors for unhoused families led by single mothers who have successfully graduated from two transitional housing programs, one rural and one urban.

Intervention Results: Binary logistic regression results indicated education and social support as significant predictors of successful program completion. Qualitative findings further illustrate narratives surrounding supportive factors and program supports (i.e., assistance securing employment, education courses, sense of community), as well as policy implications.

Conclusion: Implications stress the need for enhancing supportive factors (i.e., education and social capital) in early prevention efforts (e.g., schools and community centers), as well as an intentional integration of addressing socio-emotional needs and resources within housing programs and services unique to rural and urban communities.

Study Design: mixed method study

Setting: Urban and Rural

Sample Size: entry and exit surveys (n = 241) as well as qualitative interviews (n = 11).

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State), Access,

Intervention Description: housing interventions for families experiencing homelessness

Intervention Results: Parents commonly viewed shelters as contributing to behavioral disruptions, with restored autonomy and routines after exiting shelters contributing to recovery in functioning. Parents offered long-term rental subsidies viewed having a stable, adequate place of their own as helping their children fare better from reduced family stress, improved routines, and changes in children’s expectations about stability.

Conclusion: Long-term rental subsidies helped families in homeless shelters regain stable housing in a place of their own and helped children fare better due to reduced family stress, improved routines, and changes in children’s expectations about stability. This study identifies specific ways by which expanding access to long-term rental subsidies could help improve outcomes for children who experience homelessness.

Study Design: randomized control trial

Setting: Homeless shelter

Sample Size: n=80 interviews with parents

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): Clinical Decision Support System, PROVIDER/PRACTICE, Public Insurance (Health Care Provider/Practice), STATE, POPULATION-BASED SYSTEMS

Intervention Description: To determine whether a computerized clinical decision support system is an effective approach to improve standardized developmental surveillance and screening (DSS) within primary care practices.

Intervention Results: Significant increase in percentage of children screened with a standardized screening tool at target visits (85% vs 24.4%, P<.001)

Conclusion: Using a computerized clinical decision support system to automate the screening of children for developmental delay significantly increased the numbers of children screened at 9, 18, and 30 months of age. It also significantly improved surveillance at other visits. Moreover, it increased the number of children who ultimately were diagnosed as having developmental delay and who were referred for timely services at an earlier age.

Study Design: RCT

Setting: Four primary care pediatric clinics in the Eskenazi Medical Group in Indianapolis, Indiana

Population of Focus: Children younger than 66 months

Data Source: Child medical record

Sample Size: Medical records - Intervention (n=180) - Control (n=180)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): , Referrals, Expanded Insurance Coverage; Medicaid, Enrollment Assistance, PATIENT_CONSUMER, STATE, PAYER, Expanded Insurance Coverage, Medicaid

Intervention Description: The ACA Medicaid expansion is one of the most significant recent public investments in health insurance. The ACA was designed as a comprehensive reform of health care in the U.S., and one of its priorities was to reduce uninsurance. An important question in an evaluation of the Medicaid expansion is whether it had effects on health or well-being through enrollment in other social safety net prorams. This study investigates Medicaid expansion’s potential spillover participation in the Supplemental Nutrition Assistance Program (SNAP; formerly the Food Stamp Program). In addition to providing public insurance, the policy connects individuals to SNAP, affecting social determinants of health such as hunger. We use difference-in-differences regression to estimate the effect of the Medicaid expansion on SNAP participation among approximately 414,000 individuals from across the U.S. Not all states participated in the ACA Medicaid expansion, and there was inconsistent timing among those who did. This state-time variation in implementation provides a natural experiment for investigating the relationship between the two programs. Our study contributes new evidence on an important policy topic.

Intervention Results: SNAP, by addressing nutritional needs, can improve social determinants of health. We find support for our first hypothesis that Medicaid expansion leads to greater SNAP participation. We find that the ACA Medicaid expansion connects vulnerable individuals to SNAP, the primary nutritional safety net program in the country. The increase is likely a combination of new enrollments and continued participation among individuals who otherwise would have been disenrolled. The spillover affects children, who are not the target of the expansion, and produces large effects for very-low-income adults, many of whom were not connected to SNAP despite their limited resources. More specifically, there is a 2.4 percentage point increase in the average rates of participation in Medicaid and SNAP for households with children implying that some low-income children benefit indirectly through more access to SNAP. Furthermore, the increase in SNAP in very low-income households is likely to provide substantial improvements in access to food. Joint processing of Medicaid and SNAP appears to facilitate the spillover effect, suggesting that reducing administrative burden would be helpful for improving access to multiple safety net programs.

Conclusion: We find that the ACA Medicaid expansion connects vulnerable individuals to SNAP, the primary nutritional safety net program in the country. This main finding is consistent with the Oregon Health Insurance Experiment, as well as the handful of ACA Medicaid expansion studies in this area of research. The spillover affects children, who are not the target of the expansion, and produces large effects for very-low-income adults, many of whom were not connected to SNAP despite their limited resources. Joint processing of Medicaid and SNAP appears to facilitate the spillover effect, suggesting that reducing administrative burden would be helpful for improving access to multiple safety net programs. Although SNAP is a federal program and Medicaid is a state-federal program, states can streamline applications, recertifications, and other hurdles to accessing and staying enrolled in these programs. We find no spillover effect for ABAWDs, however, who are a vulnerable group of adults that need additional outreach and support to access programs for which they may be eligible. Our findings contribute to a body of evidence that the Medicaid expansion does more than improve access to health care; it connects eligible low-income individuals to multiple supports. Enrolling in SNAP increases access to food, an important social determinant of health, and an investment in population health for states.

Study Design: Quasi-experimental difference-in-difference

Setting: Policy (States with Medicaid Expansion and SNAP)

Population of Focus: Adults/families under 138 percent of the federal poverty level on Medicaid

Sample Size: 414,000 individuals

Age Range: N/A

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): Policy/Guideline (State),

Intervention Description: The present study conducted an empowerment counseling session to counsel tobacco product retailers in refusing to sell tobacco products to minors.

Intervention Results: The three stages of this study were conducted from March 2015 to February 2017. The results revealed that 74% of retailers were selling tobacco products to minors at baseline, 40% at stage two and 15% at stage three. These represent significant reductions in selling tobacco products to minors (all stage differences p < 0.001).

Conclusion: The study concluded that empowerment counseling sessions had a significant impact on reducing the sale of tobacco products to minors. The results revealed that the strategies employed in the counseling program, such as building partnerships, listening, dialogue, reflection, action, and feedback, were effective in preventing tobacco products from being sold to minors.

Study Design: Pre-post intervention design

Setting: 18 towns in Southern Taiwan

Population of Focus: Researchers and tobacco retailers

Sample Size: 327 tobacco retailers in Southern Taiwan

Age Range: No age range given, only that "adolescents" were study participants

Intervention Components (click on component to see a list of all articles that use that intervention): STATE/NATIONAL, WIC Food Package Change, POPULATION-BASED SYSTEMS, STATE

Intervention Description: This study assessed the impact of revisions to the USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages on nutritional behavior and obesity in children 0- to 4-years-old participating in the New York State (NYS) WIC program.

Intervention Results: Significant increase in breastfeeding initiation between JulyDec 2008 (72.2%) and July-Dec 2011 (77.5%) (p<.05)

Conclusion: These findings demonstrate that positive changes in dietary intake and reductions in obesity followed implementation of the USDA-mandated cost-neutral revisions to the WIC food package for the hundreds of thousands of young children participating in the NYS WIC program.

Study Design: Time trend analysis

Setting: New York State (NYS)

Population of Focus: Mothers of infants and children through 4 years enrolled in the NYS WIC program between July 1, 2008-December 31, 2008

Data Source: New York State WIC Statewide Information System; Mother self-report

Sample Size: Pre-Implementation • July-Dec 2008 (n=179,929) During and Post-Implementation • Jan-Jun 2009 (n=186,451) • July-Dec 2009 (n=188,622) • Jan-Jun 2010 (n=186,663) • July-Dec 2010 (n=186,012) • Jan-Jun 2011 (n=184,262) • July-Dec 2011 (n=183,656)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Mini Grants, Access, Policy/Guideline (State)

Intervention Description: The Child Care and Development Fund (CCDF) is a federal program that provides funding to states, territories, and tribes to provide low-income families with access to affordable, high-quality child care services. The intervention provided by the CCDF program involves providing subsidies or vouchers to eligible families to help cover the cost of child care services. The CCDF program aims to improve the quality of child care services by requiring that providers meet certain health, safety, and quality standards in order to receive CCDF funds. This includes requirements for staff training and professional development, appropriate child-to-staff ratios, and the implementation of developmentally appropriate curricula and learning activities.

Intervention Results: It has helped provide access to affordable, high-quality child care for low-income families, which research shows can lead to improved learning and development outcomes for children. Investments in high-quality early care and education programs supported by CCDF have been linked to increased school readiness, better academic performance, reduced need for special education services, and improved social skills and behavior among children. Studies have found lasting effects of high-quality early childhood programs into adulthood, including higher rates of educational attainment, employment, and earnings for those who participated. The CCDF program has supported efforts to raise the quality of child care settings, such as increasing accreditation, providing workforce training, and implementing quality rating and improvement systems (QRIS).

Conclusion: The CCDF program plays a vital role in supporting the developmental needs of children, particularly those from low-income families. It emphasizes the importance of ensuring that CCDF-funded child care settings provide high-quality learning environments that promote children's cognitive, social, emotional, and physical development. The resource underscores the need for ongoing professional development and training for child care providers to build their skills in effectively supporting child growth and learning. Overall, it highlights the significant positive impacts that high-quality early childhood education and care facilitated by the CCDF program can have on children's development and long-term outcomes, including educational attainment, employment prospects, and economic stability. The conclusion affirms the CCDF program's crucial function in making these developmental opportunities accessible to families in need.

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): School-Based Family Intervention, Care Coordination, Collaboration with Local Agencies (State),

Intervention Description: Asthma imposes tremendous burden on children, families, and society. Successful management requires coordinated care among children, families, health providers, and schools. Building Bridges for Asthma Care Program, a school-centered program to coordinate care for successful asthma management, was developed, implemented, and evaluated. The program consists of five steps: (1) identify students with asthma; (2) assess asthma risk/control; (3) engage the family and student at risk; (4) provide case management and care coordination, including engagement of health-care providers; and (5) prepare for next school year. Implementation occurred in 28 schools from two large urban school districts in Colorado and Connecticut.

Intervention Results: Significant improvements were noted in the proportions of students with completed School Asthma Care Plans, a quick-relief inhaler at school, Home Asthma Action/Treatment Plans and inhaler technique (p < .01 for all variables).

Conclusion: Building Bridges for Asthma Care was successfully implemented extending asthma care to at-risk children with asthma through engagement of schools, health providers, and families.

Study Design: Program evaluation

Setting: Twenty-eight schools from two large urban school districts in Colorado and Connecticut

Population of Focus: Students with asthma in the participating schools; Families of the at-risk students; School nurses who led the program; Health-care providers engaged in the care coordination activities; Implementation teams in the two urban school districts of Colorado and Connecticut; Asthma champions within the school districts who provided guidance and support for program implementation at individual schools

Sample Size: 463 students

Age Range: Children 5 to 12 years old

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Public Insurance (State)

Intervention Description: We examine how access to and use of oral and dental care under the Children's Health Insurance Program (CHIP) compared to private coverage and being uninsured in 10 states.

Intervention Results: The percentage of established CHIP enrollees (continuously enrolled for at least 12 months) having had a dental visit for checkup or cleaning in the past year was 38% higher (p≤0.01) than recent enrollees who were uninsured for 5 to 12 months before enrollment and 5.3% higher (p≤0.05) than recent enrollees who were privately insured for 12 months before enrollment.

Conclusion: Enrolling eligible uninsured children in CHIP led to improvements in their access to preventive dental care, as well as reductions in their unmet dental care needs, yet the CHIP program has more work to do to address the oral health problems of children.

Study Design: QE: nonequivalent control group

Setting: AL, CA, FL, LA, MI, NY, OH, TX, UT, VA

Population of Focus: Children aged 18 years or younger enrolled in CHIP

Data Source: Parent telephone survey

Sample Size: Established enrollees (n=5,518) Recent enrollees (n=4,142)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Public Insurance (State), STATE

Intervention Description: To evaluate the impact of an oral health integration training program on children's receipt of oral health and dental services in Southern Oregon.

Intervention Results: The percentage of children receiving oral health assessments increased over time. Visiting a trained provider was consistently associated, each year, with a greater likelihood of receipt of fluoride varnish and preventive and diagnostic dental services but was not associated with treatment dental services or dental sealants.

Conclusion: This study reports evidence for the overall impact of an oral health integration training on children's receipt of oral and dental services. Health systems implementing these types of training strategies should consider how to reach specific underserved subgroups, increase paediatric dentists, and expand efforts to include older children.

Intervention Components (click on component to see a list of all articles that use that intervention): Individual Supports, Social Supports, Policy/Guideline (State),

Intervention Description: county-level Pay for Success initiative, Partnering for Family Success.

Intervention Results: explored implementation findings of treatment and control group clients participating in a randomized control trial of housing-unstable clients with children in out-of-home placement. Quantitative housing, public assistance, and child welfare administrative data findings, measured over three years were contextualized by qualitative content analyses of case management contacts, examinations of service patterns based on progress notes, and qualitative interviews

Conclusion: Determining what interventions are most effective for stabilizing housing-unstable, child welfare-involved families is a challenge that is increasingly being prioritized as society recognizes the high social and economic costs of both housing these families in emergency shelter and funding out of home placement for their children. Though our findings were mixed regarding quantitative indicators of client’s housing, public assistance receipt, and child welfare outcomes,

Study Design: convergent parallel mixed method design

Setting: County Level

Sample Size: treatment (N = 90) and control (N = 73)

Intervention Components (click on component to see a list of all articles that use that intervention): Access, Educational Material, Policy/Guideline (State)

Intervention Description: The report investigates and reports out on Enhancing perinatal health through quality, safety and performance initiatives

Intervention Results: Primary Recommendations: Assuring the uptake of robust perinatal quality improvement and safety initiatives Creating equity and decreasing disparities in perinatal care and outcomes Empowering women and families with information to enable the development of full partnerships between health care providers and patients and shared decision-making in perinatal care Standardizing the regionalization of perinatal services Strengthening the national vital statistics system

Conclusion: Ultimately, reaching a more efficient, more accountable system of perinatal care will require a level of collaboration, services integration and communication that lead to successful perinatal quality improvement initiatives, many of which are described throughout this book. In addition to the consistent collection of data and measurement and the application of evidence-based interventions, successful collaborations, like all perinatal quality improvement, depend on the engagement, support and commitment of everyone reading this book: health care professionals and hospital leadership, public health professionals and community-based service providers, research scientists, policymakers and payers, as well as patients and families. TIOP III is the call to action and the tool that can inspire and guide their efforts toward improving the outcome of pregnancy.

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): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), STATE, Perinatal Committees/Councils

Intervention Description: Numerous states have implemented policies expanding public insurance eligibility or subsidizing private insurance for parents. Under the ACA, states retain significant flexibility in terms of eligibility and program structure. Approaches to state-level expansions to parents include providing public health insurance with or without an enrollee premium and providing subsidies for private health insurance. The Oregon Experiment (Medicaid expansion) gave a subset of uninsured, low-income adults access to Medicaid through a randomized selection process.

Intervention Results: Children’s odds of having Medicaid or CHIP coverage increased when their parents were randomly selected to apply for Medicaid; findings demonstrate a causal link between parents’ access to Medicaid coverage and their children’s coverage. Children whose parents were randomly selected to apply for Medicaid had 18% higher odds of being covered in the first 6 months after parent’s selection compared with children whose parents were not selected. In the immediate period after selection, children whose parents were selected to apply for Medicaid significantly increased from 3830 (61.4%) to 4152 (66.6%) compared with a non-significant change from 5049 (61.8%) to 5044 (61.7%) for children whose parents were not selected to apply. The effect remained significant during months 7 to 12; months 13 to 18 showed a positive but not significant effect. Children whose parents were selected and obtained coverage had more than double the odds of having coverage compared with children whose parents were not selected and did not gain coverage.

Conclusion: Children’s odds of having Medicaid or CHIP coverage increased when their parents were randomly selected to apply for Medicaid. Children whose parents were selected and subsequently obtained coverage benefited most. This study demonstrates a causal link between parents’ access to Medicaid coverage and their children’s coverage.

Study Design: Randomized natural experiment; generalized estimating equation models

Setting: Policy (Oregon Medicaid expansion program)

Population of Focus: Children whose parents participated in the Oregon Experiment (Medicaid expansion program)

Data Source: The Oregon Experiment’s reservation list data; Oregon Health Plan (OHP) administrative data

Sample Size: 14,409 children

Age Range: 2-18 Years

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): Prenatal Care Access, Policy/Guideline (State), Development/Improvement of Services,

Intervention Description: improving housing stability, access to healthcare, and support services could be beneficial for this vulnerable group

Intervention Results: The majority (81%) of the women identified as African American. Over 95% of the women were single, and 74 women reported a prior pregnancy. Almost half of the women reported being behind on rent at least one time in the last 6 months, and 43% indicated that they had lived in more than three places in the last year.

Conclusion: indicate a significant financial and maternity risk for pregnant women experiencing homelessness. The study emphasizes that addressing the needs of homeless pregnant women requires more than just standard case management and healthcare coordination. It recommends additional financial resources to address utility arrears, long-term rent support, higher security deposits, and intensive prenatal care that integrates prior preterm birth history and other health issues. The study underscores the importance of tailored interventions to support the maternal and child health of homeless pregnant women

Study Design: cross-sectional

Setting: Columbus, OH

Population of Focus: women who report pregnancy/unhoused.

Sample Size: n=100

Age Range: 25.5 years, with a standard deviation of 4.6 years

Intervention Components (click on component to see a list of all articles that use that intervention): Referrals, STATE, WIC Food Package Change, PATIENT_CONSUMER

Intervention Description: Based on Centers for Disease Control and Prevention’s Learn the Signs. Act Early. campaign, the program was developed and replicated in two phases at 20 demographically diverse WIC clinics in eastern Missouri. Parents were asked to complete developmental milestone checklists for their children, ages 2 months to 4 years, during WIC eligibility recertifcation visits; WIC staf referred children with potential concerns to their healthcare providers for developmental screening. WIC staf surveys and focus groups were used to assess initial implementation outcomes.

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.

Setting: WIC clinics

Population of Focus: WIC clinic staff

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State),

Intervention Description: This study examines the extent to which state cigarette taxes affect smoking behaviour and disparities in smoking among adolescents by gender, socioeconomic status (SES) and race/ethnicity.

Intervention Results: This study examines the extent to which cigarette taxes affect smoking behaviour and disparities in smoking among adolescents by gender, socioeconomic status (SES) and race/ethnicity.

Conclusion: We conclude that higher taxes were associated with reduced smoking among adolescents, with little difference by gender, SES and racial/ethnicity groups. While effective at reducing adolescent smoking, taxes appear unlikely to reduce smoking disparities among youth.

Study Design: Cross-sectional design

Setting: USA (Nationwide)

Population of Focus: Researchers, public health professionals, policymakers

Sample Size: Noted as a "nationally representative sample": but no specific figure given

Age Range: ages 13-18

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State),

Intervention Description: The study aimed to characterize the determinants of uptake of the influenza vaccine in young Australian children and assess the impact of state/territory government initiatives on vaccine uptake

Intervention Results: - The study found significant differences in beliefs and attitudes among parents who immunized, partially immunized, or did not immunize their children against influenza 4. - The primary source of information about the influenza vaccine was the formal health sector, with GPs being the most accessed (68.2%) 4. - Knowing the vaccine was free for their child and being influenced by a pharmacist significantly increased the likelihood of childhood influenza vaccine uptake 4. - Conversely, not receiving a vaccine recommendation from a health professional and being influenced by a non-government Internet site significantly decreased the likelihood of childhood influenza vaccine uptake

Conclusion: - The study aimed to inform future influenza vaccine programs and ensure optimal protection against seasonal and pandemic influenza 2. - The findings provide insights into the factors influencing parents' decisions regarding influenza vaccination for their children

Study Design: A national quantitative cross-sectional survey was conducted in November 2018

Setting: The study was conducted in Australia, encompassing various states and territories

Population of Focus: Australian parents aged 18 years and older with at least one child aged between 6 months and 5 years

Sample Size: A total of 1002 Australian parents participated in the study

Age Range: The study focused on children aged between 6 months and <5 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), 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): Training, Collaboration with Local Agencies (State), Screening Tool Implementation,

Intervention Description: The intervention described in the article is the implementation of the EPDS screening tool during initial WIC consultations for women <12 months from delivery and providing resources for treatment options when a woman had a positive score. The article does not describe a specific strategy for implementing this intervention, but it does mention that the project involved training staff on PPD and the use of the EPDS, implementing the screening tool in the WIC clinic, and analyzing the collected data. Based on this information, it can be inferred that the strategy for implementing the intervention was a quality improvement approach that involved staff training, process changes, and data analysis to monitor and improve the screening process.

Intervention Results: Implementing PPD screening using the EPDS during initial WIC consultations for women <12 months from delivery was beneficial for this high-risk population, as it identified a higher percentage of positive scores for PPD than the national average. The study also found that providing resources for treatment options when a woman had a positive score was important for increasing the chances that they will receive treatment. Therefore, it can be inferred that increasing postpartum depression screening through the WIC program can be an effective strategy for identifying and treating PPD in this high-risk population.

Conclusion: It would be beneficial for the WIC program to screen women for PPD symptoms in this high-risk population, so that recommendations for follow-up care could be made and quality of life could be increased.

Study Design: The study design/type is not explicitly mentioned in the given texts. However, the study is described as a project that was approved by the New Mexico State University institutional review board, and it involved training staff on PPD and the use of the EPDS, implementing the screening tool in the WIC clinic, and analyzing the collected data. Based on this information, it can be inferred that the study design is a quality improvement project or a program evaluation.

Setting: The study was conducted in a Women, Infants, and Children (WIC) clinic in New Mexico.

Population of Focus: The target audience for the study is registered nurses and advance practice registered nurses.

Sample Size: The sample size is 72 women who were offered the EPDS screening tool.

Age Range: The WIC participants mentioned in the text include low-income women who are pregnant or postpartum and children up to age 5 years.

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform, STATE

Intervention Description: Our objective was to test whether these training requirements were associated with higher rates of POHS for Medicaid-enrolled children <6 years.

Intervention Results: Five or more years after policy enactment, the probability of a child receiving POHS in medical offices was 10.7 percent in states with training requirements compared to 5.0 percent in states without training requirements (P = 0.01). Findings were similar when receipt of any POHS in medical or dental offices was examined 5 or more years post-policy-enactment (requirement = 42.5 percent, no requirement = 33.6 percent, P < 0.001).

Conclusion: Medicaid policies increased young children's receipt of POHS and at higher rates in states that required POHS training. These results suggest that oral health training for nondental practitioners is a key component of policy success

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Continuity of Care (Caseload), Labor Support, POPULATION-BASED SYSTEMS, STATE, Place of Birth, HEALTH_CARE_PROVIDER_PRACTICE, Midwifery

Intervention Description: The aim of this study was to investigate the effects of modified birth center care on obstetric procedures during delivery and on maternal and neonatal outcomes.

Intervention Results: The modified birth center group included fewer emergency cesarean sections (primiparas: OR: 0.69, 95% CI: 0.58-0.83; multiparas: OR: 0.34, 95% CI: 0.23-0.51), and in multiparas the vacuum extraction rate was reduced (OR: 0.42, 95% CI: 0.26-0.67). In addition, epidural analgesia was used less frequently (primiparas: OR: 0.47, 95% CI: 0.41-0.53; multiparas: OR: 0.25, 95% CI: 0.20-0.32). Fetal distress was less frequently diagnosed in the modified birth center group (primiparas: OR: 0.72, 95% CI: 0.59-0.87; multiparas: OR: 0.45, 95% CI: 0.29-0.69), but no statistically significant differences were found in neonatal hypoxia, low Apgar score less than 7 at 5 minutes, or proportion of perinatal deaths (OR: 0.40, 95% CI: 0.14-1.13). Anal sphincter tears were reduced (primiparas: OR: 0.73, 95% CI: 0.55-0.98; multiparas: OR: 0.41, 95% CI: 0.20-0.83).

Conclusion: Midwife-led comprehensive care with the same medical guidelines as in standard care reduced medical interventions without jeopardizing maternal and infant health.

Study Design: Retrospective cohort

Setting: 1 large, public hospital

Population of Focus: Nulliparous women admitted to the modified birth center between March 2004 to July 2008 who gave birth at either the modified birth center or in standard delivery ward2

Data Source: Not specified

Sample Size: Total (n=6,141) Intervention (n=1,263) Control (n=4,878)

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, 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): PATIENT/CONSUMER, Home Visits, Collaboration with Local Agencies (State), STATE, POPULATION-BASED SYSTEMS

Intervention Description: As part of a larger randomized study of the Healthy Families America home visiting program being conducted in Oregon (Healthy Families Oregon, HFO), we conducted a telephone survey with a randomly selected group of mothers to assess early outcomes at children's 1-year birthday.

Intervention Results: Results found that mothers assigned to the Healthy Families program group read more frequently to their young children, provided more developmentally supportive activities, and had less parenting stress. Children of these mothers were more likely to have received developmental screenings, and were somewhat less likely to have been identified as having a developmental challenge. Families with more baseline risk had better outcomes in some areas; however, generally there were not large differences in outcomes across a variety of subgroups of families.

Conclusion: Implications of these results for understanding which short-term program impacts are most feasible for early prevention programs, as well as for understanding how these services might be better targeted are discussed.

Study Design: RCT

Setting: Seven Health Families Oregon program sites in Oregon

Population of Focus: First-born children from birth through 36 months of age

Data Source: Parent telephone survey

Sample Size: Telephone surveys (n=803 mothers) - Intervention (n=402) - Control (n=401)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Collaboration with Local Agencies (State), Referrals, Education/Training (caregiver), STATE, PROFESSIONAL_CAREGIVER, PATIENT_CONSUMER

Intervention Description: We aimed to identify and describe the contextual factors that influence implementation of PNCC.

Intervention Results: Our findings support the need to study the implementation of perinatal public and community health interventions and consider “health in all policies.” Several changes would maximize PNCC's impact on maternal health: increased collaboration among policy stakeholders would reduce barriers; increased reimbursement would enable PNCC providers to better meet the complex needs of clients; and expansions in postpartum Medicaid coverage would extend the PNCC eligibility period.

Conclusion: Nurses who provide PNCC have unique insights that should be leveraged to inform maternal–child health policy.

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): Public Insurance (State), Policy/Guideline (State), Medicaid,

Intervention Description: To assess the impact of parental health insurance expansions from 1999 to 2012 on the likelihood that parents are insured; their children are insured; both the parent and child within a family unit are insured; and the type of insurance. Cross-state and within-state multivariable regression models estimated the effects of health insurance expansions targeting parents using 2-way fixed effect modeling and difference-in-difference modeling. All analyses controlled for household, parent, child, and local area characteristics that could affect insurance status

Intervention Results: Expansions increased parental coverage by 2.5 percentage points and increased the likelihood of both parent and child being insured by 2.1 percentage points. Substantial variation was observed by type of expansion. Public expansions without premiums and special subsidized plan expansions had the largest effects on parental coverage and increased the likelihood of jointly insuring both the parent and child. Higher premiums were a substantial deterrent to parents’ insurance. Our findings suggest that premiums and the type of insurance expansion can have a substantial impact on the insurance status of the family. The most effective expansions for parental insurance coverage were those for traditional Medicaid coverage without premiums and for special subsidized plans that subsidized costs for individuals to purchase state-sponsored plans. These findings can help inform states as they continue to make decisions about expanding Medicaid under the Affordable Care Act to cover all family members.

Conclusion: Our findings suggest that premiums and the type of insurance expansion can have a substantial impact on the insurance status of the family. These findings can help inform states as they continue to make decisions about expanding Medicaid under the Affordable Care Act to cover all family members.

Study Design: Cross-sectional analysis of data

Setting: Policy (States)

Population of Focus: Parents and Children

Sample Size: 19 expansion states (representing 28 expansions) and 22 control states without a parental expansion during the study period

Age Range: Parents and children; specific ages not stated

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, Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), Telemedicine Systems (Inter-Hospital Systems), Telemedicine Systems (Hospital), STATE, Policy/Guideline (State)

Intervention Description: Telemedicine has been used successfully for medical care and education but it has never been utilized to modify patterns of delivery in an established state network.

Intervention Results: Medicaid deliveries at the regional perinatal centers increased from 23.8% before the intervention to 33% in neonates between 500 and 999 grams (p<0.05) and was unchanged in neonates between 2001-2500 grams.

Conclusion: Telemedicine is an effective way to translate evidence based medicine into clinical care when combined with a general educational conference. Patterns of deliveries appear to be changing so that those newborns at highest risk are being referred to the regional perinatal centers.

Study Design: Time trend analysis

Setting: All Arkansas hospitals

Population of Focus: Infants born weighing 500-2499 gm. Data not given for other study years.

Data Source: Data from Arkansas Vital Statistics Data System linked with corresponding hospitalization records from Arkansas Hospital Discharge Data System.

Sample Size: Total (n= 12,258) 2001 (n= 2,965) 2004 (n= 3,154)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): STATE, Policy/Guideline (State)

Intervention Description: To estimate the effects of smoking bans on neonatal health outcomes and maternal smoking behavior during pregnancy.

Intervention Results: Results of the overall and stratified by maternal smoking status, educational level, and age regression analyses suggested no appreciable effect of smoking bans on neonatal health. Smoking bans had also no effect on maternal smoking behavior.

Conclusion: While there are health benefits to the general population from smoking bans, their effects on neonatal health outcomes and maternal smoking during pregnancy seem to be limited.

Study Design: Quasi experimental cross sectional

Setting: Statewide and community: State, city, county, local, workplace and bar/restaurant smoking bans

Population of Focus: Smoking mothers over age 19 with singleton births and those that occurred in the same county as mother’s county of residence

Data Source: Restricted-use 1991–2009 Natality Detail Files, a Clean Air Dates Table Report, and the Tax Burden of Tobacco- self-report number of cigarettes smoked per day

Sample Size: Level of observation by county= 3,141

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State)

Intervention Description: A 12-week mindfulness training program was implemented to address stress and anxiety in high school students. The program included weekly group sessions focused on meditation, breathing exercises, and body awareness techniques. Students learned to identify and manage negative thought patterns and cultivate a sense of calm in their daily lives. Homework assignments encouraged daily practice of these techniques to solidify the learned skills.

Intervention Results: The program showed significant positive outcomes. Compared to a control group, students who participated in the mindfulness training reported a decrease in self-reported stress and anxiety levels. Additionally, they demonstrated improved focus and concentration in academic settings. Interestingly, teachers noted a positive shift in classroom behavior, with participating students exhibiting better emotional regulation and increased social interaction.

Conclusion: These findings suggest that mindfulness training can be a valuable intervention for promoting emotional well-being in high school students. By equipping students with stress management tools, the program fostered a more positive learning environment and enhanced overall student success. Further research can explore the long-term effects of mindfulness practices on academic achievement and social-emotional development.

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): PROVIDER/PRACTICE, Labor Support, POPULATION-BASED SYSTEMS, State — Place of Birth, STATE, Place of Birth, Childbirth Education Classes, Midwifery, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: We evaluated the effect on perinatal outcomes of an interdisciplinary program designed to promote physiologic birth and encourage active involvement of women and their families in maternity care.

Intervention Results: Compared with women receiving standard care, those in the birth program were more likely to be delivered by a midwife (41.9% v. 7.4%, p < 0.001) instead of an obstetrician (35.5% v. 69.6%, p < 0.001). The program participants were less likely than the matched controls to undergo cesarean delivery (relative risk [RR] 0.76, 95% confidence interval [CI] 0.68-0.84) and, among those with a previous cesarean delivery, more likely to plan a vaginal birth (RR 3.22, 95% CI 2.25-4.62). Length of stay in hospital was shorter in the program group for both the mothers (mean ± standard deviation 50.6 ± 47.1 v. 72.7 ± 66.7 h, p < 0.001) and the newborns (47.5 ± 92.6 v. 70.6 ± 126.7 h, p < 0.001). Women in the birth program were more likely than the matched controls to be breastfeeding exclusively at discharge (RR 2.10, 95% CI 1.85-2.39).

Conclusion: Women attending a collaborative program of interdisciplinary maternity care were less likely to have a cesarean delivery, had shorter hospital stays on average and were more likely to breastfeed exclusively than women receiving standard care.

Study Design: Retrospective cohort

Setting: 1 women’s hospital

Population of Focus: Nulliparous women who gave birth between April 2004 to October 20102

Data Source: Not specified

Sample Size: Total (n=1,660) Intervention (n=830) Control (n=830)

Age Range: Not Specified

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State),

Intervention Description: This study assessed whether the recruited CACFP-funded child-care centers in this study were meeting the updated (2017) CACFP requirements regarding foods served for lunch and whether children attending these child-care centers were meeting age- and sex-specific DGA recommendations regarding foods consumed.

Intervention Results: The recruited child-care centers were meeting the updated CACFP requirements regarding foods served but showed limited adherence to the best practice recommendations during the observed lunches. However, the overall mean intake for grains, fruits, and vegetables was significantly lower (P<0.01) than DGA recommendations. In addition, approximately 25% of the children did not consume any vegetables during their meal.

Conclusion: Although child-care centers were meeting the updated CACFP requirements by serving the recommended amounts of foods, children were not meeting DGA-recommended intakes. Future studies are needed to explore ways to improve adherence to best practice recommendations to improve children's consumption of healthy foods in child-care centers.

Study Design: Cross-sectional study

Setting: Child care centers

Population of Focus: Children attending child care centers

Sample Size: 108

Age Range: 3/5/2024

Intervention Components (click on component to see a list of all articles that use that intervention): COMMUNITY, Media Campaign (Print Materials, Radio, TV), STATE, Campaign, Policy/Guideline (State), Mass Media

Intervention Description: This study examined the impact of antismoking activities targeting the general population and an advertising campaign targeting smoking during pregnancy on the prevalence of smoking during pregnancy in New South Wales (NSW), Australia.

Intervention Results: Prevalence of smoking during pregnancy decreased from 2003 to 2011 overall (0.39% per month), and for all strata examined. For pregnancies overall, none of the evaluated initiatives was associated with a change in the trend of smoking during pregnancy. Significant changes associated with increased tobacco tax and the extension of the smoking ban (in combination with graphic warnings) were found in some strata.

Conclusion: The declining prevalence of smoking during pregnancy between 2003 and 2011, while encouraging, does not appear to be directly related to general population antismoking activities or a pregnancy-specific campaign undertaken in this period.

Study Design: Quasi experimental cross sectional

Setting: Statewide and community: national antismoking campaigns

Population of Focus: Health records of all pregnancies resulting in a live birth between 2003 to 2011 in one state (New South Wales)

Data Source: Health records for all pregnancies resulting in birth in New South Wales

Sample Size: 800,619 pregnancies among 534,513 women in New South Wales

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Policy/Guideline (State)

Intervention Description: We examined the impact of state breastfeeding laws on breastfeeding initiation and duration as well as on disparities in these infant feeding practices.

Intervention Results: Breastfeeding initiation was 1.7 percentage points higher in states with new laws to provide break time and private space for breastfeeding employees (p=0.01), particularly among Hispanic mothers (adjusted coefficient 0.058). While there was no overall effect of laws permitting mothers to breast feed in any location, among Black mothers we observed increases in breastfeeding initiation (adjusted coefficient 0.056). Effects on breastfeeding duration were in the same direction, but slightly weaker.

Conclusion: State laws that support breast feeding appear to increase breastfeeding rates. Most of these gains were observed among Hispanic and Black women and women of lower educational attainment suggesting that such state laws may help reduce disparities in breast feeding.

Study Design: QE: pretest-posttest

Setting: National

Population of Focus: All mothers at 4 months postpartum

Data Source: Pregnancy Risk Assessment Monitoring System (PRAMS)

Sample Size: 2000 (n=30,899) 2008 (n=36,512)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State), STATE

Intervention Description: We conducted conditional mixed-process models to examine the impact of tobacco control policies on prenatal smoking and quitting, then on the associated changes in birth outcomes. We included interactions between race/ethnicity, education, and taxes and present average marginal effects.

Intervention Results: Among white and black mothers with less than a high school degree, 36.0% and 14.1%, respectively, smoked during the first trimester and their babies had the poorest birth outcomes. However, they were the most responsive to cigarette taxes. Every $1.00 increase in taxes was associated with a 3.45 percentage point decrease in prenatal smoking among white mothers and a 1.20 percentage point decrease among black mothers. These reductions translated to increases in birth weight by 4.19 g for babies born to white mothers and 0.89 g for babies born to black mothers. Among smokers, there was some evidence that taxes increased quitting and improved birth outcomes, although most associations were not statistically significant. We found limited effects of smoke-free legislation on smoking, quitting or birth outcomes.

Conclusion: Cigarette taxes continue to have important downstream effects on reducing prenatal smoking and improving birth outcomes among the most vulnerable mothers and infants.

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State),

Intervention Description: The study assessed the associations between the Affordable Care Act (ACA), Advisory Committee on Immunization Practices (ACIP) recommendation for males, and ACA-related health insurance reforms with HPV vaccine initiation rates by sex and health insurance type

Intervention Results: The study found that both ACA provisions and the ACIP recommendation were associated with significant increases in HPV vaccine initiation rates among males in NH, MA, and ME, closing the gender gap. However, females and youth on private insurance did not exhibit the same changes in HPV vaccine uptake over the study period

Conclusion: The study concluded that further research is needed to examine whether these policy effects translate to other states as well as their longer-term impacts on HPV vaccine initiation and completion of the vaccine series

Study Design: The study employed a population-based observational design using health insurance claims data from APCDs of NH, ME, and MA

Setting: The study utilized All-Payer Claims Databases (APCDs) from New Hampshire (NH), Maine (ME), and Massachusetts (MA) to assess the relationships between policy changes and HPV vaccine uptake

Population of Focus: The target audience includes individuals aged 9 to 26 years, with a focus on assessing HPV vaccine initiation rates by sex and health insurance type

Sample Size: The study restricted the analytic sample to children and young adults aged 9 to 26 years

Age Range: The study focused on individuals from ages 9 to 26 years (referred to as youth)

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State),

Intervention Description: The study examined the impact of two sets of Affordable Care Act policy changes, including the 2010 provisions and the 2014 insurance expansions, on HPV vaccine completion rates by sex and health insurance type

Intervention Results: The results of the study indicated that insurance-related Affordable Care Act policy changes were associated with increased HPV vaccine completion rates, particularly among specific demographic and insurance subgroups

Conclusion: The study concluded that the Affordable Care Act policy changes were linked to improvements in HPV vaccine completion rates, highlighting the potential impact of health insurance expansions and private insurance coverage with no cost-sharing on preventive health behaviors

Study Design: The study utilized a retrospective observational design, analyzing claims data to assess the associations between Affordable Care Act policy changes and HPV vaccine completion rates

Setting: The study was conducted using data from Massachusetts, Maine, and New Hampshire, covering the period from January 2009 through December 2015

Population of Focus: The target audience for this study includes researchers, policymakers, and public health professionals interested in understanding the impact of insurance-related policy changes on HPV vaccine completion rates.

Sample Size: The analytic sample included 383,297 individuals aged 9 to 26 years who had received at least one dose of the HPV vaccine during the study period

Age Range: The study included children and young adults aged 9 to 26 years

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, Needs Assessment, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Agreement for Level III Hospital to Accept All Patients, STATE, Funding Support, Perinatal Committees/Councils

Intervention Description: A major objective was to develop and maintain a regionalized system of care. Such a system has been developed but differed from traditional systems by using regional level II centers. Iowa's low population density necessitated this modification.

Intervention Results: Level I hospitals currently manage low-risk patients and report very low mortality rates. Level II facilities receive high-risk referrals, but selective referral occurs since the tertiary center accounts for a disproportionate number of fetal and neonatal deaths, and births weighting less than 1500 g.

Conclusion: Other regions may benefit from similar approaches to development of regionalized systems of care and evaluation of the same.

Study Design: QE: pretest-posttest

Setting: All Iowa hospitals Pretest: 129 level I, 11 level II, and one level III hospital Posttest: 118 level I, 11 level II, and one level III hospital

Population of Focus: All infants born at ≥20 weeks GA and ≤1500 gm

Data Source: Data from Iowa State Health Department matched birth and infant death certificates.

Sample Size: Pretest (n= 432) Posttest (n= 343)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, Needs Assessment, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Agreement for Level III Hospital to Accept All Patients, Perinatal Committees/Councils, STATE

Intervention Description: A voluntary system of regionalized perinatal health care was developed in Iowa to provide accessible services for a rural population.

Intervention Results: The intervention in Iowa focused on increasing both level III and level II VLBW births due to population density concerns in Iowa. Among all VLBW infants, there were changes in the birth location distribution. Of these infants, there was a statistically significant increase in percentage born in level III hospitals from 6.7% to 22.6% (p<0.05)1 and an increase in births in level II hospitals from 26.9% to 35.6%. The percentage born in level I centers decreased from 68.2% to 41.8%.

Conclusion: The concept of a mortality risk ratio (neonatal deaths/<1,500 gm live births) is suggested as a method of reviewing mortality data from the perspective of risks inherent in the population served.

Study Design: QE: pretest-posttest

Setting: All Iowa hospitals Pretest: 130 level I, 10 level II, and one level III hospital Posttest: 122 level I, 10 level II, and one level III hospital

Population of Focus: All live births <1500 gm

Data Source: Data from Iowa State Health Department matched birth and infant death certificates.

Sample Size: Pretest (n= 440) Posttest (n= 402)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State), Multicomponent Approach,

Intervention Description: Housing Assistance Programs; Medical-Legal Partnerships; Supportive Housing Programs; Subsidized Housing

Intervention Results: A total of 88 862 births to 45 122 mothers (mean [SD] age, 26.26 [5.76] years) who experienced 99 517 evictions were identified during the study period, including 10 135 births to women who had an eviction action during pregnancy and 78 727 births to mothers who had experienced an eviction action when not pregnant. Compared with mothers who experienced eviction actions at other times, eviction during pregnancy was associated with lower infant birth weight (difference, −26.88 [95% CI, −39.53 to 14.24] g) and gestational age (difference, −0.09 [95% CI, −0.16 to −0.03] weeks), increased rates of LBW (0.88 [95% CI, 0.23-1.54] percentage points) and prematurity (1.14 [95% CI, 0.21-2.06] percentage points), and a nonsignificant increase in mortality (1.85 [95% CI, −0.19 to 3.89] per 1000 births). The association of eviction with birth weight was strongest in the second and third trimesters of pregnancy, with birth weight reductions of 34.74 (95% CI, −57.51 to −11.97) and 35.80 (95% CI, −52.91 to −18.69) g, respectively.

Conclusion: Eviction during pregnancy, particularly during the second and third trimester, was associated with reductions in infants’ weight and gestational age at birth compared with maternal eviction at any other time.

Study Design: case-control study

Setting: Georgia

Population of Focus: Pregnant women facing eviction

Sample Size: 88 862 births

Age Range: 26 yrs

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid, Public Insurance (State), Care Coordination,

Intervention Description: Children with disabilities utilize more health-care services and incur higher costs than other children do. Medicaid Buy-In programs for children with disabilities have the potential to increase access to benefits while reducing out-of-pocket costs for families whose income exceeds Medicaid eligibility. This study sought to understand how parents and caregivers of Massachusetts children with disabilities perceive access to care under CommonHealth, Massachusetts’s Medicaid Buy-In program. Parents and caregivers (n = 615) whose children were enrolled in CommonHealth participated in a survey assessing the impact of the program. Qualitative data were coded across five access domains—availability, accessibility, accommodation, affordability, and acceptability.

Intervention Results: Data suggest that CommonHealth improves access to care for children with disabilities by providing the benefits that were limited in scope or unavailable through other insurance before enrollment and by making available services more affordable. Policy and administrative changes could improve the program and further increase access to care for children with complex, costly conditions.

Conclusion: Adopting a Medicaid Buy-In program may be an effective way for states to create a pathway to Medicaid for children with disabilities whose family income is too high for Medicaid and who have unmet needs and/or whose families incur high out-of-pocket costs for their care.

Study Design: Qualitative study

Setting: MassHealth CommonHealth Buy-In program, a Medicaid Buy-In program in Massachusetts

Population of Focus: Parents and caregivers of children with disabilities who are enrolled in the MassHealth CommonHealth Buy-In program in Massachusetts

Sample Size: 615 parents and caregivers whose children were enrolled in CommonHealth

Age Range: Children and youth ages 0-18 years and their adult parents and caregivers

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Outreach (caregiver), POPULATION-BASED SYSTEMS, STATE, Public Insurance (State)

Intervention Description: Three California counties (Los Angeles, San Mateo, and Santa Clara) expanded health insurance coverage for undocumented children and some higher income children not covered by Medi-Cal (Medicaid) or Healthy Families (SCHIP). This paper presents findings from evaluations of all three programs.

Intervention Results: Results consistently showed that health insurance enrollment increased access to and use of medical and dental care, and reduced unmet need for those services.

Conclusion: After one year of enrollment the programs also improved the health status of children, including reducing the percentage of children who missed school due to health.

Study Design: QE: nonequivalent control group

Setting: Los Angeles, San Mateo, and Santa Clara, CA

Population of Focus: Children aged 1-5 years in Los Angeles and those aged 1-18 years in San Mateo and Santa Clara enrolled in the Healthy Kids program

Data Source: Parent telephone survey

Sample Size: Established enrollees (n=1,842) New enrollees (n=1,879)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State), Expanded Insurance Coverage, Other (Provider Practice),

Intervention Description: The intervention described in the study involved the implementation of two policy changes in Nova Scotia, Canada: 1) the implementation of a publicly-funded universal influenza vaccination program in the 2010–2011 influenza season, and 2) the addition of pharmacists as immunizers in 2013. The aim of these changes was to improve vaccine uptake by eliminating cost as a barrier and increasing convenience and possibly access ,[object Object],. The study aimed to investigate any changes in influenza vaccine coverage following the implementation of each policy change ,[object Object],. The study compared influenza vaccine coverage between the pre-universal program period, the universal publicly funded program period, and the universal publicly funded program with the addition of pharmacists period ,[object Object],.

Intervention Results: The results of the study showed an increase in influenza vaccine coverage immediately following the implementation of the two studied policy changes. Vaccine coverage increased from 36.4% to 38% following the implementation of the universally funded vaccine policy. Following the implementation of pharmacists as immunizers, coverage increased from 35.7% to 41.7% ,[object Object],. Despite the initial increase in coverage observed, a reduction in coverage was observed in the two years following the addition of pharmacists as immunizers ,[object Object],. The study also found that coverage in individuals aged 65 years and older remained relatively consistent with the addition of a universally funded vaccination program compared to the pre-universal study years ,[object Object],.

Conclusion: The addition of a universally funded vaccination policy and the addition of pharmacists as providers of the influenza vaccine resulted in increases in vaccine coverage initially. Additional research is needed to determine the long-term impacts of the policy changes on vaccination coverage and to identify other important factors affecting vaccine uptake.

Study Design: the main study discussed in the file aimed to compare influenza vaccine coverage between three different policy periods: 1) pre-universal influenza vaccination program; 2) universal publicly funded program; and 3) universal publicly funded program with the addition of pharmacists 6. The study used census data and aggregate immunization data obtained from the Nova Scotia Department of Health and Wellness 6. The study design was observational, as it analyzed existing data rather than conducting a randomized controlled trial or other experimental study.

Setting: Nova Scotia, Canada

Population of Focus: The target audience of the PDF file is likely researchers, healthcare professionals, and individuals interested in public health and related topics. The scientific literature and resources included in the file are intended for those with a background in the field and may contain technical language and data analysis.

Sample Size: The PDF file contains multiple studies and reports related to public health, and each study may have a different sample size. Without a specific study or report in question, it is not possible to provide a definitive answer regarding the sample size.

Age Range: The PDF file contains information related to influenza vaccination coverage for Nova Scotia residents aged six months of age and older ,[object Object],. Additionally, the study discusses influenza vaccine coverage in infants, which was found to have been steadily increasing throughout the pre-universal program period, with a large increase with the addition of the universal policy in 2010–2011 after which coverage declined for the remainder of the study period ,[object Object],.

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State), Prenatal Care Access, Targeting Interventions to Focused Groups

Intervention Description: The intervention in this study was Pennsylvania's criminal sentencing reform policy, which aimed to reduce the state's prison population by implementing revised sentencing guidelines and increasing investments in community-based services. The policy was implemented in 2012 and was expected to reduce the number of people admitted to state prisons in Pennsylvania. The study aimed to evaluate the impact of this policy on early and adequate prenatal care utilization among birthing people in Pennsylvania, with a focus on effect heterogeneity across birthing person race/ethnicity and educational attainment. The study found that the benefits of the policy for prenatal care were largely limited to counties where prison admission rates declined the most after the policy, and improvements were primarily observed among groups that are more likely to be affected by prison admissions, Black birthing people and those with lower levels of education

Intervention Results: The study found that in counties where prison admissions declined the most after the policy, early prenatal care increased from 69.0% to 73.2%, and inadequate prenatal care decreased from 18.1% to 15.9%. By comparison, improvements in early prenatal care were smaller in counties where prison admissions increased the most post-policy (73.5 to 76.4%) and there was no change to prenatal care inadequacy (14.4% pre and post). The study found this pattern of improvements to be particularly strong among Black birthing people and those with lower levels of educational attainment. The study concluded that Pennsylvania's sentencing reforms were associated with small advancements in racial and socioeconomic equity in prenatal care. However, the study also noted that incremental changes to criminal justice policy are unlikely to have broad effects for health equity, and transformative policy changes in the areas of healthcare, social welfare, and criminal justice together will be necessary to see dramatic shifts in preventative healthcare inequities.

Conclusion: The study concluded that Pennsylvania's criminal sentencing reform policy was associated with small advancements in racial and socioeconomic equity in prenatal care utilization. The study found that the benefits of the policy for prenatal care were largely limited to counties where prison admission rates declined the most after the policy, and improvements were primarily observed among groups that are more likely to be affected by prison admissions, Black birthing people and those with lower levels of education. The study also noted that incremental changes to criminal justice policy are unlikely to have broad effects for health equity, and transformative policy changes in the areas of healthcare, social welfare, and criminal justice together will be necessary to see dramatic shifts in preventative healthcare inequities. The study highlights the importance of contextual conditions of incarceration for preventative healthcare access and utilization and sheds light on how criminal justice reforms may have spillover effects for healthcare utilization and health equity.

Study Design: The study design was an interrupted time series analysis using individual-level birth certificate data linked to county-level rates of prison admissions in Pennsylvania from 2009 to 2015. The study aimed to evaluate the impact of Pennsylvania's criminal sentencing reform policy on early and adequate prenatal care utilization, with a focus on effect heterogeneity across birthing person race/ethnicity and educational attainment. The study used Poisson regression models with robust error variance to estimate changes in prenatal care utilization after the policy, stratified by quartiles of county-level pre-post difference in mean monthly prison admission rates. The study design allowed for the assessment of changes in prenatal care utilization over time, before and after the policy, and across different subgroups of the population.

Setting: The setting for this study is Pennsylvania, focusing on the period from 2009 to 2015. The researchers linked individual-level birth certificate data to monthly county-level rates of prison admissions in Pennsylvania during this time frame. By examining the effects of Pennsylvania's criminal sentencing reform on prenatal healthcare access and equity, the study provides valuable insights into the impact of policy changes on healthcare utilization in the context of the criminal justice system

Population of Focus: The target audience for this study is likely researchers, policymakers, and healthcare professionals interested in understanding the impact of criminal justice policies on healthcare access and equity, particularly in the context of prenatal care. The study provides important insights into the potential benefits of reducing incarceration rates for improving early and adequate prenatal care, particularly for marginalized communities. The findings may be of interest to those working in public health, criminal justice reform, and healthcare policy.

Sample Size: Thestudy used individual-level birth certificate microdata on births in Pennsylvania from 2009 to 2015, totaling 999,503 births. This large sample size allowed the researchers to assess the effects of Pennsylvania's criminal sentencing reform on prenatal healthcare access and equity across a significant number of births in the state. The substantial sample size contributes to the robustness of the study's findings.

Age Range: The study did not report a specific age range for the birthing people included in the sample. However, the study did collect data on self-reported age (< 19, 20–29, 30–39, 40 + years) as an individual-level covariate in their statistical analysis. Therefore, the study likely included birthing people across a range of ages, from under 19 to over 40 years old.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Outreach (Provider), Patient-Centered Medical Home, Expert Support (Provider), STATE, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Continuity of Care (Caseload)

Intervention Description: The Illinois Child Welfare Department implemented a statewide health care system to ensure that children in foster care obtain quality health care by providing each child with a medical home.

Intervention Results: These children used the health care system more effectively and cost-effective as reflected in the higher utilization rates of primary care and well-child visits and lower utilization of emergency room care for children with chronic conditions.

Conclusion: This study demonstrates that the Medical Home model works for children in foster care providing better health outcomes in higher immunization rates.

Study Design: Observational: Cohort study; Survey

Setting: Illinois statewide health system

Population of Focus: Children in foster care between July 2001 and June 2009

Data Source: • Medicaid paid claims data

Sample Size: n=28934

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Text Messaging, STATE, WIC Food Package Change, PARENT_FAMILY

Intervention Description: Low-income mothers of infants aged 8-10 months were recruited from the Women, Infants and Children Program clinics in Prince George’s County, MD. Once enrolled, participants used text messages to receive and respond to six developmental screening questions from the Parents’ Evaluation of Developmental Status: Developmental Milestones. After confirming their responses, participants received the results and feedback. Project staff conducted a follow-up phone survey and invited a subset of survey respondents to attend focus groups. A representative of the County’s Infants and Toddlers Program met with or called participants whose results indicated that their infants “may be behind.”

Intervention Results: Eighty-one low-income mothers enrolled in the study, 93% of whom reported that their infants received Medicaid (75/81). In addition, 49% of the mothers were Hispanic/Latina (40/81) and 42% were African American (34/81). A total of 80% participated in follow-up surveys (65/81), and 14 mothers attended focus groups. All participants initiated the screening and responded to all six screening questions. Of the total, 79% immediately confirmed their responses (64/81), and 21% made one or more changes (17/81). Based on the final responses, 63% of participants received a text that the baby was "doing well" in all six developmental domains (51/81); furthermore, 37% received texts listing domains where their baby was "doing well" and one or more domains where their baby "may be behind" (30/81). All participants received a text with resources for follow-up. In a follow-up survey reaching 65 participants, all respondents said that they would like to answer screening questions again when their baby was older. All but one participant would recommend the tool to a friend and rated the experience of answering questions and receiving feedback by text as "very good" or "good."

Conclusion: A mobile text version of a validated developmental screening tool was both usable and acceptable by low-income mothers, including those whose infants "may be behind." Our results may inform further research on the use of the tool at older ages and options for a scalable, text-based developmental screening tool such as that in Text4baby.

Setting: Community-based

Population of Focus: Low-income mothers

Intervention Components (click on component to see a list of all articles that use that intervention): STATE/NATIONAL, WIC Food Package Change, POPULATION-BASED SYSTEMS, STATE

Intervention Description: We analyze changes in breastfeeding among WIC participants from the period before to period after implementation of the new food package.

Intervention Results: No statistically significant trends in breastfeeding after implementation of the new WIC food package

Conclusion: Rates of ever breastfed children are rising nationally but the increase is not associated with changes in WIC's new food package as evidenced in national and state surveys of postpartum women.

Study Design: Time trend analysis

Setting: National

Population of Focus: Intervention: women who participated in WIC during pregnancy Control: women not on WIC during pregnancy of similar socioeconomic status

Data Source: PRAMS, National Immunization Survey and the Pediatric Nutrition Surveillance System

Sample Size: N/A8

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, Policy/Guideline (State)

Intervention Description: A quality improvement course was introduced to reduce the caesarean section rate among nulliparas women and to find out which group of women reduced the cesarean section rate following attendance at the course. The course was dedicated to delivery-related staff from all Lithuanian hospitals providing obstetrical care. All hospitals had their representatives attending the course. They included not only obstetricians and gynecologists but also midwives, neonatologists and nurses. The aim of the course was to ensure that all Lithuanian hospitals providing obstetrical care had the same obstetrical knowledge and provided standardized care in managing the same obstetrical situations. The course consisted of educational sessions and practice drills. The core of educational sessions was a file of evidence-based obstetrical guidelines that were distributed nationally.

Intervention Results: Nulliparas accounted for 43% (3746/8718) and 44.6% (3585/8046) of all the deliveries in 2012 and 2014 years, respectively. The CS rate among nulliparas decreased from 23.9% (866/3626) in 2012 to 19.0% (665/3502) in 2014 (p < 0.001).The greatest decrease in absolute contribution to the overall CS rate was recorded in groups 1 (p = 0.005) and 2B (p < 0.001). Perinatal mortality was 3.5 in 2012 and 3.1 in 2014 per 1000 deliveries (p = 0.764).

Conclusion: The TGCS can work as an audit intervention that could help to reduce the CS rate without a negative impact on perinatal mortality.

Setting: Lithuanian hospitals

Population of Focus: Nulliparous low risk women

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, Policy/Guideline (State)

Intervention Description: A quality improvement course was introduced to reduce the caesarean section rate among nulliparas women and to find out which group of women reduced the cesarean section rate following attendance at the course. The course was dedicated to delivery-related staff from all Lithuanian hospitals providing obstetrical care. All hospitals had their representatives attending the course. They included not only obstetricians and gynecologists but also midwives, neonatologists and nurses. The aim of the course was to ensure that all Lithuanian hospitals providing obstetrical care had the same obstetrical knowledge and provided standardized care in managing the same obstetrical situations. The course consisted of educational sessions and practice drills. The core of educational sessions was a file of evidence-based obstetrical guidelines that were distributed nationally.

Intervention Results: Nulliparas accounted for 44.6% (3585/8046) and 42.9% (3628/8460) of all the deliveries in 2014 and 2016 years, respectively. The CS rate among nulliparas decreased from 19.0% (665/3502) in 2014 to 16.8% (593/3526) in 2016 (p = 0.018). The greatest decrease in absolute contribution to the overall CS rate was recorded in group 1 (p = 0.08). Perinatal mortality was 3.1 in 2014 and 3.9 in 2016 per 1000 deliveries (p = 0.569).

Conclusion: The QIC has helped to reduce the CS rate among nulliparas without a negative influence on perinatal mortality. The greatest decrease in the overall CS rate was recorded among nulliparous women who were treated with oxytocin and managed to reach a full cervical dilatation.

Setting: Lithuanian hospitals

Population of Focus: Nulliparous low risk women

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Public Insurance (State)

Intervention Description: This article examines experiences under Medicaid and the State Children's Health Insurance Program (SCHIP), drawing on surveys of over 3,000 enrollees in California and North Carolina in 2002.

Intervention Results: Established Medicaid enrollees were 12 and 16 percentage points more likely to receive a dental visit for checkup/cleaning than all recent enrollees and recent enrollees who were previously uninsured for 6 months prior to enrollment (p<0.05). Established enrollees were not more likely to receive preventive dental visits than recent enrollees who were insured for some or all of the 6 months prior to enrollment.

Conclusion: Relative to being uninsured, Medicaid enrollment was found to improve access to care along a number of different dimensions, controlling for other factors. Furthermore, this study emphasizes the need for continued evaluation of access to care for both programs.

Study Design: QE: nonequivalent control group Kulkarni (2013) Canada City-operated child care centers or Ontario Early Years Centers in Toronto Young children (no exclusion criteria) Study group (n=161) Control group (n=181) Prospective coh

Setting: CA and NC

Population of Focus: Children older than 3 years enrolled in Medicaid or SCHIP in 2002

Data Source: Parent telephone survey

Sample Size: Established enrollees (n=830) Recent enrollees (n=332)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Public Insurance (State)

Intervention Description: Examine the extent to which enrollment in the State Children's Health Insurance Program (SCHIP) affects access to care and service use in 10 states that account for over 60 percent of all SCHIP enrollees.

Intervention Results: SCHIP enrollment was found to improve access to care along a number of different dimensions, other things equal, particularly relative to being uninsured. Established SCHIP enrollees were more likely to receive office visits, preventive health and dental care, and specialty care, more likely to have a usual source for medical and dental care and to report better provider communication and accessibility, and less likely to have unmet needs, financial burdens, and parental worry associated with meeting their child's health care needs. The findings are robust with respect to alternative specifications and hold up for individual states and subgroups.

Conclusion: Enrollment in SCHIP appears to be improving children's access to primary health care services, which in turn is causing parents to have greater peace of mind about meeting their children's needs.

Study Design: QE: pretest-posttest nonequivalent control group

Setting: CA, CO, FL, IL, LA, MO, NJ, NY, NC, TX

Population of Focus: Children older than 3 years enrolled in SCHIP in 2002

Data Source: Parent telephone survey

Sample Size: Intervention (n=4,953) Control (n=840)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Data Collection System, Policy/Guideline (State),

Intervention Description: Policy Change to include new age groups ex. 13-18 for free vaccination program

Intervention Results: The study found that vaccination coverage was highest among individuals aged 65 and above, followed by children aged 12 and below, and adults aged 62-64. Vaccination coverage was lowest among individuals aged 13-18 and those aged 19-61. Individuals living in rural areas had higher vaccination coverage than those living in urban areas. Higher vaccination coverage was also observed among those with lower education levels and higher incomes.

Conclusion: The study concluded that there are disparities in influenza vaccination coverage among different age groups and sociodemographic factors in South Korea.

Study Design: The study used a cross-sectional design.

Setting: The study was conducted in South Korea.

Population of Focus: The target audience was individuals aged 13 and above, including adults aged 62-64, children aged 13-18, adults aged 65 and above, pregnant women, and individuals aged 19-64 with chronic diseases.

Sample Size: The study included 72,443 participants.

Age Range: The study included individuals aged 13 and above.

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State),

Intervention Description: N/A

Intervention Results: State driver's license and sanctuary policies were associated with having a usual source of care and fewer unmet medical needs among children of immigrants.

Conclusion: The recent pandemic highlights the importance of access to preventative health care. State policies that limit federal immigration enforcement involvement are associated with improved access to preventative health services among immigrants' children, most of whom are U.S. citizens.

Study Design: OLS regression (difference-in-difference)

Setting: 2008-2016 Medical Panel Expenditure Survey

Population of Focus: Immigrants

Sample Size: 66314

Age Range: 0-17

Intervention Components (click on component to see a list of all articles that use that intervention): WIC Food Package Change, STATE-BASED, Policy/Guideline (National), NATIONALLY-BASED,

Intervention Description: The 2009 WIC food package revisions were intended to incentivize breastfeeding among the WIC population. To examine the effectiveness of this policy change, we estimated an intent-to-treat regression-adjusted difference-in-difference model with propensity score weighting, an approach that allowed us to control for both secular trends in breastfeeding and selection bias.

Intervention Results: We observed significant increases in infants that were ever breastfed in both the treatment group (10 percentage points; p < 0.01) and the control group (15 percentage points; p < 0.05); however, we did not find evidence that the difference between the two groups was statistically significant, suggesting that the 2009 revisions may not have had an effect on any of these breastfeeding outcomes.

Conclusion: Our study did not find evidence that the 2009 WIC food package revisions had an effect on ever breastfeeding, breastfeeding through 6 months, or exclusively breastfeeding through 6 months among a sample of infants eligible for WIC based on household income. Any positive effects observed in this study and prior studies that assessed this relationship may be reflections of the upward trends in breastfeeding rates that occurred in the U.S. before and after the implementation of the revisions.

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State), Social Supports, Housing Supports

Intervention Description: using counterfactual machine learning to identify the services most likely to prevent reentry into homelessness for each household.

Intervention Results: Homelessness prevention benefited households who could access it, while differential effects exist for homeless households that partially align with community interests.Households with comorbid health conditions avoid homelessness most when provided longer-term supportive housing, and families with children fare best in short-term rentals. No additional differential effects existed for intersectional subgroups. Prioritization rules reduce community-wide homelessness in simulations. Moreover, prioritization mitigated observed reentry disparities for female and unaccompanied youth without excluding Black and families with children.

Conclusion: Community-and data-driven prioritization rules more equitably target scarce homeless resources.

Setting: St. Louis, Missouri

Population of Focus: policymakers, community stakeholders, social service providers, researchers

Sample Size: 10,043 households that accessed homeless services in St. Louis from 2009 to 2014

Age Range: 18 to 24 years for unaccompanied homeless youth, with an average age of 39.5 years (SD = 12.8) for household heads entering services

Intervention Components (click on component to see a list of all articles that use that intervention): STATE/NATIONAL, POPULATION-BASED SYSTEMS, STATE, WIC Food Package Change

Intervention Description: The effect of the new Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package, implemented in October 2009, on breastfeeding outcomes among a predominately Latina sample of WIC participants in Los Angeles County, California.

Intervention Results: Small but significant increases from pre- to postimplementation of the new WIC food package in prevalence of prenatal intention to breastfeed and breastfeeding initiation, but no changes in any breastfeeding at 3 and 6 months. The prevalence of exclusive breastfeeding at 3 and 6 months roughly doubled, an increase that remained large and significant after adjustment for other factors.

Conclusion: The new food package can improve breastfeeding outcomes in a population at high risk for negative breastfeeding outcomes.

Study Design: QE: pretest-posttest

Setting: Los Angeles County, CA

Population of Focus: Mothers participating in WIC who spoke English or Spanish

Data Source: Mother self-report

Sample Size: 2005 (n=1772) 2008 (n=1598) 2011 (n=1650)

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), Expert Support (Provider), Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, POPULATION-BASED SYSTEMS, STATE, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: The objectives of this study were to assess the feasibility of implementing a bundle of strategies to facilitate the use of Bright Futures recommendations and to evaluate the effectiveness of a modified learning collaborative in improving preventive and developmental care.

Intervention Results: Office system changes most frequently adopted were use of recall/reminder systems (87%), a checklist to link to community resources (80%), and systematic identification of children with special health care needs (80%). From baseline to follow-up, increases were observed in the use of recall/reminder systems, the proportion of children's charts that had a preventive services prompting system, and the families who were asked about special health care needs. Of 21 possible office system components, the median number used increased from 10 to 15. Comparing scores between baseline and follow-up for each practice site, the change was significant. Teams reported that the implementation of office systems was facilitated by the perception that a component could be applied quickly and/or easily. Barriers to implementation included costs, the time required, and lack of agreement with the recommendations.

Conclusion: This project demonstrated the feasibility of implementing specific strategies for improving preventive and developmental care for young children in a wide variety of practices. It also confirmed the usefulness of a modified learning collaborative in achieving these results. This model may be useful for disseminating office system improvements to other settings that provide care for young children.

Study Design: QE: pretest-posttest

Setting: Primary care practices (15 at baseline, 8 at follow- up) throughout the US (9 states total), with most in the Midwest

Population of Focus: Children from birth through 21 years of age

Data Source: Child medical record

Sample Size: Unknown number of chart audits from 8 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): POPULATION-BASED SYSTEMS, STATE, Public Insurance (State)

Intervention Description: To determine the impact of children's health insurance programs on access to health care and on other aspects of the lives of the children and their families.

Intervention Results: Among the continuously enrolled children, preventive dental visits increased from 34.2% to 55.6% between enrollment and 6 months post-enrollment (p<0.005). Between 6 months post-enrollment and 12-months post-enrollment, it increased from 55.6% to 61.5% (p<0.005). The increase from enrollment to 12-months post enrollment was significant (p<0.005). Comparison children at enrollment (28.5%) had a lower percentage of preventive dental visits than continuously enrolled children at enrollment (34.2%); therefore, the changes observed in the study group were attributable to the insurance programs rather than to other environmental trends.

Conclusion: Extending health insurance to uninsured children had a major positive impact on children and their families. In western Pennsylvania, health insurance did not lead to excessive utilization but to more appropriate utilization.

Study Design: Time trend analysis

Setting: Western PA

Population of Focus: Children up to 19 years in families with incomes less than 235% FPL enrolled in the Children’s Health Insurance Program of Pennsylvania (BlueCHIP) and the Highmark Blue Cross Blue Shield Caring Program (Caring)

Data Source: Parent telephone survey

Sample Size: Study group (n=1,031) Comparison group (n=460)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): STATE, Medicaid Reform

Intervention Description: Pregnancy risk assessment monitoring system (PRAMS) data (2014–2015) and the Medicaid-SCHIP state dental association (MSDA) national profiles (2014–2015) were used in this study. The study sample included 16,612 Medicaid-enrolled women, for a weighted number of 965,046 women from 26 states and New York City. State Medicaid dental coverage was categorized into (1) no coverage for the dental cleaning, (2) coverage for dental cleaning and fillings, (3) extended dental coverage. The adjusted prevalence ratios (aPR) for dental visits for cleaning during pregnancy were examined by Medicaid dental coverage level.

Intervention Results: Medicaid-enrolled women in states with no dental coverage were less likely to visit dentists for cleaning during pregnancy (26.7%) compared with women in states with either limited dental coverage (36.6%) or extended dental coverage (44.9%). Medicaid-enrolled women in states with extended dental coverage were more likely to visit dentists for cleaning during pregnancy when adjusted for other sociodemographic variables and adequacy of prenatal care. A similar pattern of association was observed for a dental visit to address dental problems during pregnancy.

Conclusion: This study highlights the importance of Medicaid dental coverage for adult pregnant women related to dental service utilization during pregnancy.

Setting: Virginia

Population of Focus: State/Systems

Data Source: Community-based PRAMS data

Intervention Components (click on component to see a list of all articles that use that intervention): Increased Reimbursement, STATE, POPULATION-BASED SYSTEMS

Intervention Description: Objective was to determine whether perinatal referral patterns and clinical outcomes for very low birthweight infants changed in relation to changing Medicaid financial policies in coastal South Carolina.

Intervention Results: A decrease in the proportion of nonwhite very low birthweight infants was identified. There was an increase in very low birthweight infants with Medicaid funding born outside our level III center.

Conclusion: Changes in financial public policy have been successful in the movement of low risk pregnancies into the private sector. However, an increased proportion of deliveries of very low birthweight infants occurred outside the level III center.

Study Design: QE: pretest-posttest

Setting: All coastal South Carolina hospitals: Includes one level III hospital

Population of Focus: Infants born weighing <1500 gm

Data Source: Data source not provided.

Sample Size: Pretest (n= 255) Posttest (n= 265)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Collaboration with Local Agencies (State), Policy/Guideline (State)

Intervention Description: Project LAUNCH incorporates Enhanced Home Visiting as a core strategy. This program pairs families with trained professionals who visit them regularly throughout the child's early years. Home visitors provide a range of supports, including: Developmental screening: Identifying potential delays or concerns in a child's development. Parenting education: Equipping caregivers with skills to promote their child's social, emotional, and cognitive development. Connection to community resources: Linking families with essential services like healthcare, early childhood education, and mental health support. Social and emotional support: Offering guidance and encouragement to parents as they navigate the challenges of raising young children.

Intervention Results: Studies evaluating Project LAUNCH's Enhanced Home Visiting program have shown promising results. Participating families report increased knowledge and confidence in their parenting skills. Additionally, children enrolled in the program demonstrate improved developmental outcomes, particularly in areas like language and social-emotional development.

Conclusion: Project LAUNCH's Enhanced Home Visiting program offers a valuable intervention for families with young children. By providing comprehensive support, education, and resources within the familiar setting of the home, the program empowers parents and fosters healthy child development. Further research is needed to explore the program's long-term impact and cost-effectiveness, but the initial findings suggest that Enhanced Home Visiting can be a powerful tool for improving the well-being of young children and their families.

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): Access, Patient-Centered Medical Home, Policy/Guideline (State)

Intervention Description: In recent years, families with children have become one of the faster-growing subpopulation groups of homeless individuals, both in the United States and in Europe.1 In the United States, families made up almost one third of the 1.5 million people who were homeless in 2009, and more than half of this group were children (60%).1,2 Children who are homeless experience higher levels of stress and domestic violence compared with those who are not, and research suggests that the vast majority of homeless children have problems with their behavior, encounter difficulties in school, or have a mental health disorder.3

Intervention Results: Three models of care were developed to meet patients at their locations in homeless shelters, providing access to care.

Conclusion: Although children from homeless families are at risk for mental health disorders and developmental delays, flexible service delivery models have been developed to meet their needs. These models need to be rigorously evaluated. Culturally competent care is a crucial aspect of care delivery to “meet families where they are” and establish the kind of trust and mutual respect that is necessary for effective care provision. Timely care coordination is an important aspect of service delivery that may help break down access barriers to developmental and behavioral health care to mitigate the risks for the conditions that homeless children experience.

Setting: New York City

Population of Focus: healthcare providers, policymakers, social workers

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Active Management of Labor, Labor Support, HOSPITAL, STATE, Quality Improvement, Policy/Guideline (State), Collaboratives, Policy/Guideline (Hospital)

Intervention Description: California hospitals whose nulliparous, term, singleton, vertex cesarean delivery rates were above the Healthy People 2020 goal of 23.9% in 2015 were invited to participate in the Supporting Vaginal Birth collaborative led by the California Maternal Quality Care Collaborative (CMQCC). The participating hospitals were organized into small teams of six to eight hospitals each led by a physician and a nurse mentor who provided clinical expertise and quality-improvement coaching. The mentors were from other hospitals and had experience in prior CMQCC quality collaboratives. The collaborative focused on implementation of ACOG–SMFM guidelines for labor management and on increasing nursing labor support. A modified Institute for Healthcare Improvement Breakthrough Series collaborative model was used with monthly team check-in phone calls and sharing of implementation ideas and materials. Hospitals received training materials, Grand Rounds for physicians and nurses, educational webinars, and on-site assistance from their mentors.

Intervention Results: Among collaborative hospitals, the nulliparous, term, singleton, vertex cesarean delivery rate fell from 29.3% in 2015 to 25.0% in 2017 (2017 vs 2015 adjusted OR [aOR] 0.76, 95% CI 0.73-0.78). None of the six safety measures showed any difference comparing 2017 to 2015. As a sensitivity analysis, we examined the tercile of hospitals with the greatest decline (31.2%-20.6%, 2017 vs 2015 aOR 0.54, 95% CI 0.50-0.58) to evaluate whether they had greater risk of poor maternal and neonatal outcomes. Again, no measure was statistically worse, and the severe unexpected newborn complications composite actually declined (3.2%-2.2%, aOR 0.71, 95% CI 0.55-0.92).

Conclusion: Mothers and neonates participating in a large-scale Supporting Vaginal Birth collaborative had no evidence of worsened birth outcomes, even in hospitals with large cesarean delivery rate reductions, supporting the safety of efforts to reduce primary cesarean delivery using American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine guidelines and enhanced labor support.

Setting: 56 California hospitals

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): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: Seven pediatric primary care practices participated in New Mexico's Developmental Screening Initiative in a year-long quality improvement project with the goal of implementing standardized developmental screening tools.

Intervention Results: At baseline, there were dramatic differences among the practices, with some not engaged in screening at all.

Conclusion: Overall, the use of standardized developmental screening increased from 27% at baseline to 92% at the end of the project.

Study Design: QE: pretest-posttest

Setting: Seven primary care practices in a large urban area and small regional community in New Mexico

Population of Focus: Children ages 1 through 60 months

Data Source: Child medical record

Sample Size: Total medical records reviewed at baseline and follow-up (n=1139)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Collaboration with Local Agencies (State), Expert Support (Provider), Continuity of Care (Caseload), STATE, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This study aimed to examine the association between care-management and birth outcomes (low birthweight and preterm birth rates) among high-risk non-Hispanic White and Black pregnant people enrolled in the North Carolina Pregnancy Medical Home.

Intervention Results: From January 1, 2016 to December 31, 2017, a total of 3564 singleton pregnancies occurred among non-Hispanic Black and White pregnant Medicaid beneficiaries, who were a part of the Pregnancy Medical Home in North Carolina. White pregnant people comprised 57% and Black pregnant people comprised 43% of the sample. In the Method 1 analysis, intensive care management was significantly associated with reductions in preterm birth and low birthweight among Black and White pregnant people whereas in the Method 2 analysis, the implementation of a risk-stratification score only resulted in a significant reduction among Black pregnant people. In multivariable logistic modeling, race, number of prenatal visits, and intensive care management were all significantly associated with the outcomes of interest.

Conclusion: Care management is associated with reductions in preterm birth and low birthweight in the Medicaid-managed Pregnancy Medical Home in North Carolina. This study contributes to a growing body of literature on the role of state-based initiatives in reducing perinatal morbidity. These results are significant as it demonstrates the importance of care coordination and management, in identifying and providing resources for high-risk pregnant people. In the United States, where pregnancy-related outcomes are poor, programs that address the multitude of economic, social, and clinical complexities are becoming increasingly crucial and necessary.

Intervention Components (click on component to see a list of all articles that use that intervention): , , STATE, Engagement with Payers

Intervention Description: We sought to assess the knowledge, attitudes, and practices of caregivers of children who used a pediatric medical home (PMH) after embedding a Volunteer Income Tax Assistance (VITA) program site.

Intervention Results: We found that a PMH-VITA site was a convenient, trusted, useful, and potentially tax-filing behaviorchanging intervention. Importantly, most caregivers who did not use the PMH-VITA site had no knowledge of availability of free tax filing services but would consider using one the following year.

Conclusion: Improved marketing is needed to increase utilization in our target population.

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), STATE, Policy/Guideline (State), Funding Support

Intervention Description: This report summarizes the evaluation of a national demonstration program of such regionalization that was funded by the Robert Wood Johnson Foundation (RWJF) in 1975.

Intervention Results: In both funded regions and comparison areas, the neonatal mortality rates decreased sharply over the decade of the 1970s. This decline was linked to shifts in the hospital of delivery that indicated antepartum risk identification and transfer of management of high-risk pregnancies to tertiary centers for delivery, a change in service pattern consistent with some aspects of regionalization. The centralization of high-risk deliveries appeared so widespread that the special effect of the RWJF program could not be detected.

Conclusion: Surveys of surviving 1-year-old infants showed that the decrease in neonatal mortality was accompanied by a decrease in selected morbidity.

Study Design: QE: pretest-posttest nonequivalent control group

Setting: Eight regions and eight comparison regions

Population of Focus: Infants born weighing ≤1500

Data Source: Data from reproduced computer tapes of births and matched infant death and birth certificates obtained from state and local health offices in several states.

Sample Size: Intervention group: Pretest (n≈ 4080) Intervention (n≈ 3416) Posttest: (n≈ 4033) Comparison: Pretest: (n≈ 5221) Intervention: (n≈ 4297) Posttest: (n≈ 4596)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Collaboration with Local Agencies (State), Patient-Centered Medical Home, Enabling Services, STATE, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: This study assessed the Collaborative’s impact on access to coordinated care within patient-centered medical homes (PCMH).

Intervention Results: After algorithm implementation, there has been a significant decrease in the time required to establish care in PCMHs, increased provider acknowledgment of refugee status, and decreased emergency department (ED) visits. Multi-disciplinary, organized collaboration can facilitate enhanced access to care for refugee families at the population level.

Conclusion: After algorithm implementation, there has been a significant decrease in the time required to establish care in PCMHs, increased provider acknowledgment of refugee status, and decreased emergency department (ED) visits. Multi-disciplinary, organized collaboration can facilitate enhanced access to care for refugee families at the population level.

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Medicaid Reform

Intervention Description: The authors conducted a study of dental services used by women of childbearing age who were enrolled in Medicaid in Oregon during the early 2000s, a period of reform during which health care coverage was expanded.

Intervention Results: Before the intervention, the adjusted proportion of pregnant women with a dental service claim was 0.36. After the intervention, the proportion of pregnant women with a dental service claim declined to 0.22 (p<0.001).

Conclusion: Dental care is important for maternal and child health. However, utilization is unlikely to improve without changes in Medicaid and the dental care delivery system.

Intervention Components (click on component to see a list of all articles that use that intervention): Collaboration with Local Agencies (State), Peer Counselor, Other Education, PATIENT_CONSUMER, STATE

Intervention Description: Once recruited and engaged, parent partners are encouraged to hold meetings with other parents within the practice to share their experiences by discussing practice processes, workflows that are related to scheduling, referral coordination, telephone callbacks, patient portal communications, practice policies, and on-call protocols. Practices within the PAMHI practice network have used this feedback to inform practice quality improvement with demonstrable results, such as improved efficiency with phone trees, better immunization rates, better customer service, and more ideas for practice events. Parent partners also participate as part of the practice’s quality improvement team, teach medical students and residents as “family faculty,” and provide support to other parents in the practice. Some PAMHI practices and their parent partners have held “resource nights,” during which they invite a group of parents along with community partners into the practice to share ideas and resources.

Intervention Results: For other states, pediatrics practices, and hospital systems that are seeking to adopt similar programs, there are several key considerations, including the following: (1) recognizing the value of and evidence for parent partners in the adoption and implementation of the medical home model, (2) identifying strategic partners to assist in training and professional development for the parent partner role in practice, (3) establishing a formal role for parent partners as equal practice team members, and (4) ensuring that parent and/or caregiver feedback is garnered from parents across the practice and using the feedback of their experiences for meaningful quality and practice improvement to uphold the quadruple aim of health care.

Conclusion: The PAMHI parent advisor and/or parent partner role can be replicated and successful in other pediatric practice settings to foster the quadruple aim of health care. The PAMHI can be used to serve as a model of how pediatric practices can adopt medical home concepts, specifically patient- and family-centered care with parent partners, into their practices. The staff members of the PAMHI have found that parent partners are successful when they possess the following qualities: • are parents and/or caregivers of CSHCN experiencing multiple systems of care; • have not recently received a new diagnosis for their children; • can provide candid feedback regarding practice policies and procedures; can promote linkages between other parents; • possess good listening and communication skills and can interact professionally with practice administration and staff; • can help support a child’s care plan; • can speak to other parents beyond their own experiences with their children; • recognize that they have valuable expertise and experiences to share; • possess resiliency, empathy, and a genuine desire to help other parents; and • have the time to devote and agree to be a parent partner.

Intervention Components (click on component to see a list of all articles that use that intervention): STATE, Public Insurance (State), Enrollment Assistance

Intervention Description: There has been increasing interest among policy makers, navigators, and consumer organizations in developing novel outreach methods to address diverse barriers to enrollment. This study evaluates the impacts of personalized, live outbound telephone calls from service center representatives on enrollment in California's ACA Marketplace, Covered California, which accounts for 13.5% of national ACA Marketplace enrollment. The intervention targets consumers who had initiated the enrollment process by submitting an application but had yet to select a plan. Households in the study population were randomly assigned to one of two groups at the outset of the intervention period: a treatment group that was assigned to receive a phone call (hereafter referred to as an “outbound call”) from a service center representative and a control group that was assigned to not receive an outbound call. This intervention could address enrollment barriers such as lack of awareness of health insurance options, low health insurance literacy or computer literacy, preference for in-language assistance, and the time and cognitive costs of shifting through options. Those in the control group, similar to any other consumers, could contact the Covered California service center by calling the publicly available number that had been provided to them.

Intervention Results: Personalized telephone calls from service center representatives increased take-up of Covered California health insurance. Outbound calls were placed to 27,123 households in the treatment group (49%). Receiving an outbound call increased Marketplace health insurance take-up by 2.7 percentage points (p<0.001) for consumers who received a call because of random assignment—a 22.5 percent increase over the control-group rate. Enrollment impacts were statistically significant for lower-income households (below 200% of the FPL) but not for higher-income households as well as those who were referred from Medicaid, those ages 30-50 or older then age 50, those who were Hispanic, and those whose preferred spoken language was Spanish or English. The total intervention cost to Covered California was approximately $243,000, or approximately $224 per new member acquired. Our calculations suggested that the return on investment was 102%. Similiar to prior studies, we found that information interventions do not fully overcome barriers to enrollment for many consumers. Nonetheless, informational interventions may induce modest gains ine enrollment among certain segments of the population while yielding a positive return on investment.

Conclusion: The intervention provided a two-to-one return on investment. Yet absolute enrollment in the target population remained low; persistent enrollment barriers may have limited the intervention’s impact. These findings inform implementation of the American Rescue Plan Act of 2021, which expands eligibility for subsidized coverage.

Study Design: RCT

Setting: Service Center for Marketplace Insurance Enrollment in California

Population of Focus: Consumers who had applied but not selected a plan

Sample Size: 79,522 consumers (treatment group=55,519; control group=24,003)

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): STATE, Medicaid Reform

Intervention Description: Researchers used pooled cross-sectional data from six cycles of the Virginia Pregnancy Risk Assessment Monitoring System on women aged ≥21 years. Using logistic regression models and a difference-in-difference design, researchers compared the effects of policy implementation on dental insurance and utilization between pre-policy (2013–2014) and post-policy period (2016– 2019) among women enrolled in Medicaid (treatment, N = 1,105) vs. those with private insurance (control, N = 2,575).

Intervention Results: Among Medicaid-enrolled women, the report of dental insurance (71.6%) and utilization (37.7%) was higher in the post-period compared to their pre-period (44.4% and 30.3%, respectively) estimates. Adjusted analyses found that Medicaid- enrolled women had a significantly greater change in the probability of reporting dental insurance in all post-period years than women with private insurance. In 2019, there was a 16 percentage point increase (95% CI=0.05, 0.28) in the report of dental insurance and a 17 percentage point increase (95% CI=0.01–0.33) in utilization in treatment group compared to controls.

Conclusion: The 2015 pregnancy Medicaid dental benefit increased dental insurance and dental care utilization among Medicaid-enrolled women and reduced associated disparities between Medicaid and privately insured groups.

Setting: Community-based Virginia

Population of Focus: State/Systems

Data Source: Community-based PRAMS data

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Medicaid Reform

Intervention Description: To measure the impact of Medicaid reforms, in particular increases in Medicaid dental fees in Connecticut, Maryland, and Texas, on access to dental care among Medicaid-eligible children.

Intervention Results: Relative to Medicaid-ineligible children and all children from a group of control states, preventive dental care utilization increased among Medicaid-eligible children in Connecticut and Texas. Unmet dental need declined among Medicaid-eligible children in Texas.

Conclusion: Increasing Medicaid dental fees closer to private insurance fee levels has a significant impact on dental care utilization and unmet dental need among Medicaid-eligible children.

Study Design: QE: pretest-posttest nonequivalent control group

Setting: Intervention: CT, MD, TX Control: CA, FL, HI, IL, MA, ME, MO, MI, ND, OR, PA, UT, WA, WI

Population of Focus: Children aged 1-17 years eligible for Medicaid

Data Source: 2007 and 2011-2012 National Survey of Children’s Health

Sample Size: NR

Age Range: not specified

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

Intervention Description: To evaluate the effectiveness of an innovative reform in 2000 to the Dental Medicaid program in South Carolina.

Intervention Results: From 1998 to 1999, there was a downward trend in the number and percent of Medicaid enrollees ages 21 and younger receiving dental services and in the total number of services provided. This trend was dramatically reversed in 2000.

Conclusion: The January 2000 dental Medicaid reform in South Carolina had marked impact on Medicaid enrollees' access to dental services.

Study Design: QE: pretest-posttest

Setting: South Carolina

Population of Focus: Children aged 2-21 years enrolled in Medicaid

Data Source: Medicaid claims

Sample Size: 1998 (n=377,690) 1999 (n=447,069) 2000 (n=504,642)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): STATE, Policy/Guideline (State), Funding Support, POPULATION-BASED SYSTEMS, PATIENT/CONSUMER, Educational Material

Intervention Description: The goal of this study was to examine state measurements and improvements in risk-appropriate care for very low birth weight (VLBW) infants.

Intervention Results: Regulation of regionalization programs, data surveillance, review of adverse events, and consideration of geography and demographics were identified as mechanisms facilitating better measurement of risk-appropriate care. Antenatal or neonatal transfer arrangements, telemedicine networks, acquisition of funding, provision of financial incentives, and patient education comprised state actions for improving risk-appropriate care.

Conclusion: Guidelines should be collaboratively developed by healthcare providers and public health officials for consistent and suitable measures of perinatal risk-appropriate care.

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State),

Intervention Description: The intervention under study is the 2016 California policy to eliminate non-medical childhood vaccination exemptions

Intervention Results: The results of the study include findings related to the impact of the California policy on vaccination coverage, exemptions, and associated outcomes

Conclusion: Our study found that the 2016 California policy to eliminate nonmedical childhood vaccination exemptions was associated with an increase in vaccination coverage and a decrease in nonmedical exemptions.  The study findings support the hypothesis that government policies can be an effective tool to increase vaccination coverage, especially in the most “high- risk” (low vaccine coverage) settings.

Study Design: The study design involves a synthetic control analysis using state-level data and a difference-in-differences analysis using county-level data to estimate the relationship between the California vaccine policy and changes in vaccination coverage, exemptions, and other relevant factors

Setting: The setting of the study is California, specifically focusing on the 2016 California policy to eliminate non-medical childhood vaccination exemptions

Population of Focus: The target audience for the study includes researchers, policymakers, and public health professionals interested in vaccination policies and their impact on vaccination coverage and exemptions.

Sample Size: - The specific sample size is not provided in the excerpt.

Age Range: The age range of the study participants is not explicitly mentioned in the provided text.

Intervention Components (click on component to see a list of all articles that use that intervention): Collaboration with Local Agencies (State), Patient-Centered Medical Home, STATE, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This issue of the Rhode Island Medical Journal (RIMJ) chronicles the development and implementation of a statewide initiative, Patient-Centered Medical Homes for Kids (PCMH-Kids), which now impacts the health care of nearly 100,000, or half of the children living in Rhode Island.

Intervention Results: integration of behavioral health (BH) into pediatric primary care was a key focus of PCMH-Kids. BH needs in children present as pre-clinical or subclinical findings, and presents emerging social-emotional challenges for children and parents.

Conclusion: This issue of the Rhode Island Medical Journal (RIMJ) chronicles the development and implementation of a statewide initiative, Patient-Centered Medical Homes for Kids (PCMH-Kids), which now impacts the health care of nearly 100,000, or half of the children living in Rhode Island.

Intervention Components (click on component to see a list of all articles that use that intervention): Collaboration with Local Agencies (State), Patient-Centered Medical Home, HEALTH_CARE_PROVIDER_PRACTICE, STATE

Intervention Description: Each participating practice was paired with a transformation coach who assessed the practice and, with the office team, crafted a work plan to facilitate practice transformation. Plans included clarification of roles/job descriptions, team building, data capturing and reporting systems, behavioral health integration plans and care coordination needs and capabilities. All practices reported their quality metrics quarterly, uploading their data to a shared data repository. Additionally, all practices participated in collaborative learning, sharing best practices and lessons learned in quarterly meetings for care coordination, data reporting, integrated behavioral health and practice transformation.

Intervention Results: Through shared learning and practice coaching the cohort 1 practices implemented work flows and data and analysis metrics that address the contracted measures. Supported by strong transformation coaching and support, all practices achieved NCQA 3 recognition within the first contract year. In year two, 100% of the cohort 1 practices met both quality metrics for developmental screening and growth monitoring and counseling and posted improvement over time. [Figures 1 and 2] Patient and family satisfaction was high at baseline and 67% of the practices met the improvement benchmarks for customer service measure for access, communication and office staff. PCMH-Kids practices successfully decreased Emergency Department (ED) utilization and had a 2.5% reduction in ED usage compared to the peer group (rate for 1,000-member-months, excluding ERISA members).

Conclusion: PCMH-Kids practices successfully decreased Emergency Department (ED) utilization and had a 2.5% reduction in ED usage compared to the peer group (rate for 1,000-member-months, excluding ERISA members).

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Collaboration with Local Agencies (State), PROFESSIONAL_CAREGIVER, Outreach (caregiver), PATIENT_CONSUMER, Referrals, STATE, Mini Grants, Public Insurance (State)

Intervention Description: Small grants to community-based organizations have been shown to be effective in garnering the involvement of the local community in health promotion efforts. The Georgia Utilization Mini-grant Program leveraged modest funding and resources to promote community involvement to improve enrollment and utilization of Medicaid and CHIP services for children. It demonstrates how a state Medicaid agency can step outside its usual administrative role to play an important part in supporting local outreach and marketing efforts to promote Medicaid/CHIP enrollment and utilization.

Intervention Results: Funded community-based organizations improved utilization of children’s health services by developing innovative staffing patterns, creating new data systems for scheduling appointments and maintaining records, and forging new collaborative relationships to leverage financial support. Responses suggest that the program improved levels of enrollment, appointment-setting and referrals for social and other services. Common facilitators and barriers to success and ways to address them were also identified.

Conclusion: Elaboration on each of the facilitators of success led to the development of several recommendations as guidance for future outreach funding programs such as: staffing, data systems, collaboration and how to address incentives and barriers.

Study Design: Participatory approach

Setting: Community (Community-based organizations)

Population of Focus: Children enrolled in Medicaid and PeachCare

Data Source: Questionnaires, telephone interviews, one-on-one counseling, application assistance, home visits

Sample Size: 6 organizations

Age Range: Children; specific ages not stated

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

Intervention Description: Viewing the 1001-1500 gm regional cohort of fetuses as a potential "market" for center delivery, and measuring a center's penetration into this market, quantitates how well a center draws to itself these small, high-risk fetuses for delivery.

Intervention Results: An Illinois center's annual penetration rate into its regional market for the years 1973-1983 is presented and significant increases are found. The penetration rates of nine Illinois perinatal centers are calculated and wide discrepancies are found. Defining a high-risk regional cohort as a market stresses a perinatal center's obligation to its region.

Conclusion: The penetration rate into a defined market measures how well a center fulfills this obligation.

Study Design: Time trend analysis

Setting: Illinois North Central Perinatal Region: 31 hospitals including one tertiary center

Population of Focus: Infants born weighing 1001 to 1500 gm

Data Source: Data from 1973-1982 obtained from the Illinois Department of Public Health live birth files. Data from 1983 from an Illinois Department of Public Health administered monthly hospital reporting system.

Sample Size: 1973 (n= 100) 1974 (n= 104) 1975 (n= 102) 1976 (n= 88) 1977 (n= 102) 1978 (n= 97) 1979 (n= 101) 1980 (n= 85) 1981 (n= 100) 1982 (n= 83) 1983 (n= 81)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Collaboration with Local Agencies (State), Patient-Centered Medical Home, STATE, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This article summarizes the key, consensus-based financing elements to providing quality, effective, comprehensive care in the pediatric medical home: (1) first dollar coverage without deductibles, copays, or other cost-sharing for necessary preventive care services as recommended by Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents; (2) adoption of a uniform definition of medical necessity across payers that embraces services that promote optimal growth and development and prevent, diagnose, and treat the full range of pediatric physical, mental, behavioral, and developmental conditions, in accord with evidence-based science or evidence-informed expert opinion; (3) payment models that promote appropriate use of pediatric primary care and pediatric specialty services and discourage inappropriate, inefficient, or excessive use of medical services; and (4) payment models that strengthen the patient- and family-physician relationship and do not impose additional administrative burdens that will only erode the effectiveness of the medical home.

Intervention Results: Some programs are demonstrating positive results.43 On the other hand, pay-for-performance programs are still evolving. Many adult programs have features that are not pertinent to improving care provided to children or that cannot easily be translated into pediatric equivalents.

Conclusion: For a medical home for children to be both effective and fiscally viable, payers must adequately finance the full range of services required to optimize the physical, developmental, emotional, and behavioral well-being of children, which critically influence health throughout the life course. Some support is required to engage families initially with the medical home. Once engaged, appropriate support is needed for encounters, care coordination, continuous quality improvement, implementation of an effective electronic health record system, and innovative efforts to improve community health. This support should not impose additional administrative burdens that will erode the effectiveness of the medical home. Payers should consider how best to achieve better health care value without encouraging fragmented care outside the medical home.

Intervention Components (click on component to see a list of all articles that use that intervention): WIC Food Package Change, STATE-BASED, Policy/Guideline (National), NATIONALLY-BASED,

Intervention Description: To investigate the impact of the revised WIC program on maternal and child health in a large, multi-state data set.

Intervention Results: The main analysis included 331,946 mother-infant dyads. WIC recipients were more likely to be younger, Black or Hispanic/Latina, unmarried, and of greater parity. The revised WIC program was associated with reduced likelihood of more-than-recommended GWG (−1.29% points, 95% confidence interval [CI] −2.03, −0.56) and increased likelihood of ever breast fed (1.18% points, 95% CI 0.28, 2.08). We also identified heterogeneous effects on GWG, with more pronounced associations among women 35 and older. There were no associations with foetal growth.

Conclusion: The revised WIC program was associated with improvements in women's gestational weight gain and infant breast feeding.

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Collaboration with Local Agencies (State), Public Insurance (Health Care Provider/Practice), PROFESSIONAL_CAREGIVER, Outreach (caregiver), STATE, Data Collection System

Intervention Description: Florida Covering Kids & Families (FL-CKF) is dedicated to developing outreach methods for enrolling and retaining eligible children in the state’s CHIP. FL-CKP developed a strong data system that allows it to evaluate the effectiveness and success of statewide enrollment and retention efforts. Community and school outreach partners enter data each month on all completed CHIP applications via a secure interface, and data are then transmitted to the state. The data system is an outreach method for enrolling and retaining coverage; it can also monitor outcomes and provide feedback to community outreach partners. Organizations helping uninsured children apply for health insurance may benefit from creating data collection systems to monitor project efficacy and modify outreach and enrollment strategies for greater effectiveness.

Intervention Results: The highest number of application submissions were through outreach at a child’s school or childcare facility, through a community-based organization, or through targeted outreach events. However, even though those strategies resulted in the largest number of application, approval and denial rates show which of these strategies (through a CHIPRA grant partner site or government agency) yielded the highest enrollments. This information can be further stratified by individual project partner to show which strategies are working best in that region. The improved data collection system of Cycle II enables FL-CKF to better monitor the efforts of project partners by tracking monthly progress toward grant deliverable goals.

Conclusion: Organizations helping uninsured children apply for health insurance may benefit from creating data collection systems to monitor project efficacy and modify outreach and enrollment strategies for greater effectiveness.

Study Design: Evaluation assessment

Setting: Community (Community-based organizations and schools in Florida)

Population of Focus: Eligible children in Florida's CHIP

Data Source: Checkbox Survey Solutions data system

Sample Size: 502,866 children in Florida who are uninsured

Age Range: 0-17 years

Intervention Components (click on component to see a list of all articles that use that intervention): STATE/NATIONAL, WIC Food Package Change, POPULATION-BASED SYSTEMS, STATE

Intervention Description: This observational study investigated whether dietary intake and feeding practices of a sample of majority-Hispanic infants and toddlers participating in a WIC clinic in south central Texas improved after the revised food package changes.

Intervention Results: Significantly fewer infants received cereal in their bottles and fewer toddlers consumed vegetables and eggs after the package changes. The observed feeding practices of infants and toddlers among this sample did not reflect the WIC package changes.

Conclusion: Strategic and comprehensive breastfeeding and nutrition education are recommended. Package modifications such as adding eggs back to the toddler package and allowing more flexibility for purchasing fresh produce and baby foods may be warranted.

Study Design: QE: pretest-posttest

Setting: WIC clinic in south central TX

Population of Focus: Spanish and English-speaking caregivers of infants and toddlers

Data Source: Mother self-report

Sample Size: 2009 (n=84) 2011 (n=112)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State), Policy/Guideline (National),

Intervention Description: The intervention was the Medicaid expansion in 2014 under PPACA. The study compared changes in outcomes between states that expanded Medicaid (Iowa, Kentucky) and those that did not (Wisconsin, North Carolina).

Intervention Results: The results showed modest improvements in elective admissions, ambulatory surgery rates, length of stay, and discharge to home in Medicaid expansion states compared to non-expansion states. There were decreases in admission charges.

Conclusion: The conclusion was that PPACA-associated Medicaid expansion modestly improved children’s access to surgical care in the first year, with shifts towards more elective and ambulatory procedures.

Study Design: The study design was a retrospective analysis using administrative/claims data.

Setting: The setting was 4 U.S. states: Iowa, Kentucky, Wisconsin, and North Carolina.

Population of Focus: The target audience seems to be policymakers and researchers interested in the impact of PPACA and Medicaid expansion on children's health outcomes.

Sample Size: The sample size was 1,597,708 encounters across the 4 states.

Age Range: The age range was 0 to 30 years old.

Intervention Components (click on component to see a list of all articles that use that intervention): Environment Enhancements, Family Leave, Workplace Policies, State Laws, COMMUNITY

Intervention Description: To reduce the burden of chronic disease, the Centers for Disease Control and Prevention (CDC) funded the Orange County Partnerships to Improve Health (OC-PICH) project in Orange County, California

Intervention Results: The outdoor exercise equipment (OEE) was installed along a walking path in Edison Park (Anaheim) and grouped within a single area (a "fitness zone") in Garden Grove Park. In both parks, there were significantly greater odds of high-intensity physical activity overall after the installation-19% higher odds in Anaheim, and 23% higher odds in Garden Grove. However, the fitness zone area in Garden Grove had substantially higher odds of increased physical activity post-intervention (OR = 5.29, CI: 3.76-7.44, p < 0.001).

Conclusion: While the increases in physical activity levels are consistent with past studies that link OEE to higher levels of physical activity among park users, our findings also suggest that the location and placement of equipment within a park may be an important factor to consider when improving park amenities for physical activity.

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State)

Intervention Description: To determine whether the Healthy People 2000 objective to deliver very-low-birthweight (VLBW) infants at subspecialty perinatal care centres was met, and if improvements in the regional perinatal care system could reduce neonatal mortality further for 2010, we examined place of delivery for VLBW infants, associated maternal characteristics and the potential impact on neonatal mortality.

Intervention Results: Among 4770 VLBW infants, 77% were delivered at hospitals providing subspecialty perinatal care. The strongest predictor of birth hospital level was the mother's county of residence, defined using three levels: residence in a county with a subspecialty hospital, residence in a county adjacent to one with such a hospital or residence in a non-adjacent county. Eighty-nine per cent of infants born to women who resided in counties with subspecialty care hospitals delivered at such hospitals, compared with 53% of infants born to women who resided in a non-adjacent county. Women were also more likely to deliver outside subspecialty care if they had less than adequate prenatal care [adjusted odds ratio (AOR) 1.5, P-value = 0.0001]. The neonatal mortality rate varied by level of perinatal care at the birth hospital from 132.1/1000 to 283/1000 live births, with the highest death rate for infants born at hospitals offering the lowest level of care. Assuming that the differences in mortality were due to care level of the birth hospital, potentially 16-23% of neonatal deaths among VLBW infants could have been prevented if 90% of infants born outside subspecialty care were delivered at the recommended level.

Conclusion: These findings suggest that a state's support of strong, collaborative, regional perinatal care networks is required to ensure that high-risk women and infants receive optimal health care. Improved access to recommended care levels should further reduce neonatal mortality until interventions are identified to prevent VLBW births.

Study Design: N/A

Setting: Studies from Georgia

Data Source: linked birth and death records for the 1994–96 Georgia VLBW (i.e. 500–1499 g) birth cohorts.

Sample Size: 4770 infants

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State), Social Supports,

Intervention Description: We interviewed 20571 low-income caregivers of children <4 years old in urban pediatric clinics and/or emergency departments in 5 US cities. Categories of homelessness timing were prenatal, postnatal, both, or never; postnatal duration was >6 months or <6 months.

Intervention Results: After controlling for birth outcomes and other potential confounders, compared with never-homeless children, children who were homeless both pre- and postnatally were at the highest risk of the following: postneonatal hospitalizations (adjusted odds ratio [aOR] 1.41; confidence interval [CI] 1.18–1.69), fair or poor child health (aOR 1.97; CI 1.58–2.47), and developmental delays (aOR 1.48; CI 1.16–1.89). There was no significant association with risk of underweight (aOR 0.95; CI 0.76–1.18) or overweight status (aOR 1.07; CI 0.84–1.37). Children <1 year old with >6 months of homelessness versus those who were never homeless had high risks of fair or poor health (aOR 3.13; CI 2.05–4.79); children 1 to 4 years old who were homeless for >6 months were at risk for fair or poor health (aOR 1.89; CI 1.38–2.58).

Conclusion: After controlling for birth outcomes, the stress of prenatal and postnatal homelessness was found to be associated with an increased risk of adverse pediatric health outcomes relative to those who were never homeless. Interventions to stabilize young families as quickly as possible in adequate and affordable housing may result in improved pediatric health outcomes.

Study Design: cross-sectional study

Setting: 5 US cities

Population of Focus: healthcare professionals & policymakers

Sample Size: 20 571 low-income caregivers of children <4 years old

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): STATE, Policy/Guideline (State)

Intervention Description: This population-based cross-sectional study included infants who were born VPT to Illinois residents in Illinois perinatal-network hospitals between January 1, 2015, and December 31, 2016, and followed up for 28 days after birth. Data analysis was conducted from June 2017 to September 2018. Delivery of an infant who was VPT at a (1) level III hospital after maternal presentation at that hospital (reference group), (2) a level III hospital after antenatal (in utero) transfer from another hospital, or (3) a non–level III hospital.

Intervention Results: The study included 4817 infants who were VPT (gestational age, 22-31 completed weeks) and were born to Illinois residents in 2015 and 2016. Of those, 3302 infants (68.5%) were born at a level III hospital after maternal presentation at that hospital, 677 (14.1%) were born at a level III hospital after antenatal transfer, and 838 (17.4%) were born at a non–level III hospital. Neonatal mortality for all infants who were VPT included in this study was 573 of 4817 infants (11.9%). The neonatal mortality was 10.7% for the reference group (362 of 3302 infants), 9.8% for the antenatal transfer group (66 of 677 infants), and 17.3% for the non–level III birth group (145 of 838 infants). When adjusted for significant social and medical characteristics, infants born VPT at a level III hospital after antenatal transfer from another facility had a similar risk of neonatal mortality as infants born at a level III hospital (odds ratio, 0.79 [95% CI, 0.56-1.13]) after maternal presentation at the same hospital. Infants born at a non–level III hospital had an increased risk of neonatal mortality compared with infants born at a level III hospital after maternal presentation to the same hospital (odds ratio, 1.52 [95% CI, 1.14-2.02]).

Conclusion: The risk of neonatal mortality was similar for infants who were VPT, whether women initially presented at a level III hospital or were transferred to a level III hospital before delivery. This suggests that the increased risk of mortality associated with delivery at a non–level III hospital may be mitigated by optimizing opportunities for early maternal transfer to a level III hospital.

Setting: Hospitals in the Illinois perinatal network

Population of Focus: Very preterm infants delivered at one of the following: (1) level III hospital after maternal presentation at that hospital (reference group), (2) a level III hospital after antenatal (in utero) transfer from another hospital, or (3) a non–level III hospital

Intervention Components (click on component to see a list of all articles that use that intervention): Social Media, Policy/Guideline (State),

Intervention Description: The interventions include the suspension of mandatory vaccination in the Veneto Region, strengthened political commitment leading to the release of an updated National Immunization Prevention Plan, and the influence of social media influencers like Professor Roberto Burioni in promoting vaccination.

Intervention Results: The results highlight the impact of different interventions on vaccine coverage rates, changes in public attitudes towards immunization, and the success of social media influencers in promoting vaccination.

Conclusion: The study provides insights into the effectiveness of various vaccination strategies and offers a basis for discussion within the European public health community to evaluate similar policies implemented in different settings.

Study Design: The study employs a real-life case study approach to evaluate the impact of different vaccination strategies implemented in Italy. It critically appraises the strategies and quantitatively assesses their impact on coverage rates and other selected indicators.

Setting: The setting of the study is Italy, focusing on the implementation and impact of vaccination strategies within the country.

Population of Focus: The target audience includes the general population, public health practitioners, decision makers, and the broader European public health community.

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

Age Range: The age range of the study participants is not explicitly specified in the provided excerpts.

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State), Social Supports, Counseling (Parent/Family), Housing Supports

Intervention Description: Design: Participants were randomly assigned to: (1) housing + support services (n = 80), (2) housing-only (n = 80), or (3) services as usual (SAU) (n = 80) and were re-assessed at 3-, 6-, 9- and 12-months postbaseline. Settings: The study recruited a community-based sample from homeless service agencies and advertisements in a large Midwestern city. Participants: The study recruited two hundred forty (N = 240) women between the ages of 18 to 24 years, experiencing homelessness and with a substance use disorder (SUD) who also had a biological child under the age of 6 years in their care. Measurements: We measured frequency of alcohol and drug use using the Form 90 semi-structured interview, and self-efficacy using Pearlin and Schooler's (1978) 7-item Mastery Scale.

Intervention Results: mothers showed significant improvement in substance use and self-efficacy over time in each condition. However, as expected, patterns of change differentiated intervention groups with more mothers showing better substance use and self-efficacy outcomes in housing + supportive services than in SAU. Unexpectedly, more mothers in SAU showed better outcomes than those in housing-only.

Conclusion: Substance use decreased and self-efficacy increased over time, but patterns of change characterized the intervention groups. In particular, findings suggest that when providing housing to this population, supportive services should also be offered.

Setting: large Midwestern city

Sample Size: (1) housing + support services (n = 80), (2) housing-only (n = 80), or (3) services as usual (SAU) (n = 80) and were re-assessed at 3-, 6-, 9- and 12-months postbaseline.

Age Range: women between the ages of 18 to 24 years, experiencing homelessness and with a substance use disorder (SUD) who also had a biological child under the age of 6 years in their care.

Intervention Components (click on component to see a list of all articles that use that intervention): Public Insurance (State), Policy/Guideline (State), Medicaid Reform,

Intervention Description: The study aimed to examine whether this health reform was associated with reduced uninsurance and greater access to care for children at one and five years post-reform. The health reform implemented in Massachusetts, also known as Chapter 58, aimed to provide near-universal health insurance coverage to the state's residents. The reform was signed into law in 2006 and required all residents to have health insurance or face penalties. The reform also expanded Medicaid and created a state-run health insurance exchange, the Health Connector, to provide affordable health insurance options to individuals and small businesses. The reform also included subsidies to help low-income individuals and families afford health insurance.

Intervention Results: Compared to other New England states, Massachusetts's enactment of the individual mandate, Medicaid expansion, and essential benefits was associated with trends at 5 years post-reform toward lower uninsurance for children overall (DD = - 1.1, p-for-DD = 0.05), increased access to specialty care (DD = 7.7, p-for-DD = 0.06), but also with a decrease in access to preventive care (DD=-3.4, p-for-DD = 0.004). At 1 year post-reform, access to specialty care improved for children newly-Medicaid-eligible (DD = 18.3, p-for-DD = 0.03).

Conclusion: Adult-oriented health reforms may have reduced uninsurance and improved access to some types of care for children in Massachusetts. Repealing the ACA may produce modest detriments for children.

Study Design: Difference in difference analysis

Setting: State (Massachusetts)

Population of Focus: CSHCN in Massachusetts

Sample Size: 34,943 children (5,760 children in Massachusetts, 28,183 children in comparison New England states)

Age Range: 0-17 years

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State),

Intervention Description: Paid family leave implemented in the state of Rhode Island in 2014

Intervention Results: The policy was associated with a 2.18 percentage point increase (95% CI 0.98, 3.38, P=.004) in postpartum care. The increase in postpartum care associated with Rhode Island's paid family leave policy was 1.50 percentage points (95% CI 0.75, 2.25, P=.002) among White women. The policy was associated with a 3.38 percentage point increase (95% CI 1.12, 5.63, P=.009) among women from underrepresented racial groups, an effect size that was 1.92 percentage points (95% CI 0.58, 3.26, P=.005) greater than among White women

Conclusion: Increased paid leave in the United States may help reduce existing racial disparities in postpartum care use. It remains to be determined whether increased postpartum care leads to improved health outcomes.

Study Design: Retrospective observational study that used a difference-in-differences analysis

Setting: Rhode Island

Population of Focus: Postpartum women

Sample Size: 43,609 women (5,453 from Rhode Island and 38,156 from other northeastern states)

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State), Access,

Intervention Description: analyze the frequency and costs of pediatric ED visits for homelessness before and after this policy.

Intervention Results: There were 312 ED visits for homelessness; 95% (n = 297) of visits were after the policy. These visits increased 4.5 times after the policy (95% confidence interval: 1.33 to 15.23). Children seen after the policy were more likely to have no medical complaint (rate ratio: 3.27; 95% confidence interval: 1.18 to 9.01). Although the number of homeless children in Massachusetts increased 1.4 times over the study period, ED visits for homelessness increased 13-fold. Payments (average: $557 per visit) were >4 times what a night in a shelter would cost; 89% of payments were made through state-based insurance plans.

Conclusion: A policy change to Massachusetts’ shelter eligibility was associated with increased pediatric ED visits for homelessness along with substantial health care costs.

Study Design: retrospective study

Setting: Massachusetts

Age Range: families with children

Intervention Components (click on component to see a list of all articles that use that intervention): Continuity of Care (Caseload), Policy/Guideline (State), Care Coordination,

Intervention Description: N/A

Intervention Results: Persons with complex disabilities more frequently experienced continuity (83.7%) than persons without disabilities and those with basic disabilities (60.7% and 65.6%, respectively, p < 0.001). Seldom or never being sick was the most frequently reported reason for not having a usual provider; more persons without disabilities (64%) reported this reason than persons with disabilities (basic: 41.9%, p < 0.001; complex: 26.6%, p = 0.001). Persons with disabilities more frequently reported visiting different providers for different needs and not having a usual provider due to the costs of medical care than persons without disabilities.

Conclusion: Future research needs to examine the influence of continuity on healthcare disparities among persons with complex disabilities. Policies and practice must be attentive to how proposed changes to the healthcare system potentially reduce access to care among persons with disabilities.

Study Design: Pooled 2-year data from panels 14-16 (2009-2012) of the Medical Expenditure Panel Survey were examined. Working-age adults (18-64) were categorized as having no disability, basic disabilities, or complex disabilities. Persons were categorized having provider continuity (provider throughout the period) or discontinuity (gaining or losing providers during the period). χ2 and multinomial logistic regressions were used to examine outcomes by disability status.

Setting: Medical Expenditure Panel Survey

Population of Focus: Persons with disabilities

Sample Size: 26867

Age Range: 18-64

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), NATIONAL, Policy/Guideline (National), STATE, Prenatal Care Access

Intervention Description: Prenatal care is an important component of preventive health care with multigenerational consequences for women and their families. For low-income immigrant women, Emergency Medicaid, a federal safety net program for those poor enough to qualify for Medicaid but who cannot meet the citizenship requirements, covers the cost of a birth but not prenatal care or postpartum contraception. An “unborn child” option enacted in CHIP and CHIPRA gave states new options to provide prenatal care coverage with federal matching funds for extending coverage to immigrant children and pregnant women, regardless of their legal status or date of entry to the U.S. The study leveraged a natural experiment where unauthorized immigrant women eligible for Emergency Medicaid gained access to prenatal care coverage by the expansion of the Emergency Medicaid Plus program in Oregon.

Intervention Results: Expanding access to prenatal care coverage increased both utilization and quality of prenatal care, and women were more likely to receive adequate care and recommended preventive health services. After expansion of access to prenatal care, there was an increase in prenatal visits (7.2 more visits, 95% CI 6.46 to 7.98), receipt of adequate prenatal care (28% increased rate, CI 26 to 31), rates of diabetes screening (61% increased rate, CI 56 to 65) and fetal ultrasounds (74% increased rate, CI 72 to 77). Maternal access to prenatal care was also associated with an increased number of well-child visits (0.24 more visits, CI 0.07 to 0.41), increased rates of recommended screenings and vaccines, and reduced infant mortality (-1.04 per 1000, CI -1.45 to -0.62) and rates of extremely low birth weight (<1000g) (-1.5 per 1000, CI -2.58 to -0.53).

Conclusion: Our results provide evidence of increased utilization and improved health outcomes for unauthorized immigrants and their children who are United States citizens after introduction of prenatal care expansion in Oregon. This study contributes to the debate around reauthorization of the Children's Health Insurance Program in 2017.

Study Design: Quasi-experimental difference-in-difference

Setting: Policy (Oregon Health Authority)

Population of Focus: Pregnant low-income immigrant women and their infants

Data Source: Medical claims data from January 1, 2003 through October 1, 2015

Sample Size: 210,200 mothers and infants

Age Range: Pregnant women: 12-51 years; Infants: 0-1 years

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State),

Intervention Description: The intervention described in the document is the implementation of a mandatory immunization program in Italy in July 2017. This program mandated ten vaccinations for children up to 16 years old, including vaccinations for diphtheria, tetanus, pertussis, hepatitis B, polio, Haemophilus influenzae type b (Hib), measles, mumps, rubella, and varicella. The policy was adopted as part of the national response to a large outbreak of measles and aimed to address the decline in vaccine coverage (VC) that had occurred in previous years. The mandatory law required school-aged children to have completed the vaccination cycles in order to attend educational services, leading to an immediate impact on vaccine coverage. Additionally, catch-up activities were carried out to identify and offer mandatory vaccinations to unvaccinated or partly vaccinated children. These activities were monitored through the regional immunization information system (rIIS) and other indicators to assess their impact.

Intervention Results: The results reported in the document include the following key findings: 1. Impact on Vaccine Coverage: The mandatory law had an immediate impact on vaccine coverage, leading to an increase in measles vaccine coverage at 24 months of age to 91.81% in 2017 and 93.22% in 2018, with a total increase of 5.96% compared to the previous year. This increase was observed at both regional and national levels. 2. Catch-up Activities: Catch-up activities resulted in a substantial increase in measles vaccine coverage for the 2014 and 2015 birth cohorts, with a respective increase of +5.65% and +1.75% registered in Tuscany. As a result, one-dose measles vaccine coverage exceeded the World Health Organization target of 95% for these birth cohorts. 3. Identification of Unvaccinated/Partly Vaccinated Children: In Tuscany, systematic scrutiny of the rIIS led to the identification of 1528 unvaccinated/partly vaccinated children, representing 6.6% of the 2016 birth cohort in the region. Information on the reasons for incomplete vaccination status was available for 1503 of these children. 4. Reasons for Incomplete Vaccination: The document provides information on the reasons for incomplete vaccination status, including

Conclusion: In our opinion, mandates did not only affect hesitant parents, but forced local health services to allocate more resources to immunisation activities and to be more effective as a whole.

Study Design: The study design in the provided document appears to be an observational study that assesses the impact of the 2017 mandatory immunization program on various outcomes related to vaccination in the Tuscany region of Italy. The study utilizes data from the regional immunization information system (rIIS) and other sources to evaluate changes in vaccine coverage, organization of immunization services, catch-up activities, and reasons for delaying or refusing immunization. The study also discusses the impact of the mandatory law on vaccine hesitancy and public health services. The document does not explicitly state the study design, but based on the information provided, it aligns with an observational study.

Setting: The setting of the study is Tuscany, a region of central Italy with approximately 3.7 million inhabitants, corresponding to 6.2% of the national population. The study focuses on the impact of the 2017 mandatory immunization program on a broader spectrum of relevant outcomes, such as vaccine coverage, organization of immunization service and catch-up activities, regional immunization information system (rIIS) data quality, and reasons for delaying/refusing immunization in Tuscany. ,[object Object],

Population of Focus: The target audience of this PDF file is likely to be healthcare professionals, policymakers, and researchers interested in the impact of mandatory vaccination policies on vaccine coverage and vaccine hesitancy. It may also be of interest to the general public who are concerned about vaccination and public health policies.

Sample Size: The sample size mentioned in the document refers to the number of unvaccinated or partly vaccinated children identified through the regional immunization information system (rIIS) in Tuscany. Specifically, the document states that 1528 unvaccinated/partly vaccinated children were identified, representing 6.6% of 23,321 children in the 2016 birth cohort in the region. Additionally, information on the reasons for incomplete vaccination status was available for 1503 (98.4%) of these children. ,[object Object],

Age Range: The age range mentioned in the document is up to 16 years old, as this is the age range for which the Italian government mandated ten vaccinations in July 2017. The mandatory vaccinations were for children up to 16 years old, including vaccinations for diphtheria, tetanus, pertussis, hepatitis B, polio, Haemophilus influenzae type b (Hib), measles, mumps, rubella, and varicella. ,[object Object],

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State), Family-Based Interventions, Housing Supports

Intervention Description: A grounded theory approach was used to analyze semi-structured, qualitative interviews.

Intervention Results: Frontline providers exercised street-level bureaucratic discretion when interpreting child protection reporting mandates and they found ways to adapt the HF model to this population. In doing so, they worked to juggle both their mandates to child protection and to principles of HF to create a “child safety-modified” form of HF.

Conclusion: While our study shows that providers are modifying HF to address the needs of families involved in child welfare, it also raises questions as to the degree to which HF can be done with high fidelity when used with this population.

Study Design: grounded theory

Setting: 2 U.S. States

Sample Size: 13 participants working in programs that encouraged direct collaboration with Child Protective Services (CPS) in the program model and 13 participants from three non-CPS-aligned sites in a second state.

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State),

Intervention Description: Components of the T21 policy include 1) increase in minimum purchasing age to 21 2) restrictions on tobacco sales to individuals under 21 3) policy implementation and 4) ongoing surveillance

Intervention Results: The unweighted sample included 12 616 high school students (27.0% [95% CI, 26.9%-28.0%] in 10th grade; 50.9% [95% CI, 50.3%-51.6%] females) participating in 1 or more Youth Risk Behavior Surveys from 2013 to 2019, including 7064 students in Cleveland and 5552 students in the first-ring suburbs. Compared with the first-ring suburbs, Cleveland had a greater proportion of younger students (1623 [28.5%] ninth grade students vs 2179 [34.0%] ninth grade students) and Hispanic students (436 students [1.1%] vs 1433 students [12.6%]) and non-Hispanic Black students (2000 students [53.1%] vs 3971 students [75.1%]). Cigars were the most commonly used tobacco product in Cleveland, with use reported by 6201 students (19.8%) in 2013, 5877 students (21.3%) in 2015, and 5784 students (16.8%) in 2019. Compared with the first-ring suburbs, there was a greater decline in prevalence of use of cigars in Cleveland (β = 0.18 [SE, 0.05]; P < .001). The disparity across race, ethnicity, and sex decreased for all current tobacco product use. For example, the maximum difference between demographic subpopulations in current cigarette use was 11.6 (95% CI, 9.5-13.7) percentage points in 2013 between White females (16.1% [95% CI, 11.3%-20.8%]) and Black males (4.5% [95% CI, 3.5%-5.4%]). This maximum difference in current cigarette use decreased significantly to 5.1 (95% CI, 3.5-6.7) percentage points in 2019 between White females (6.9% [95% CI, 3.4%-10.3%]) and Black females (1.8% [95% CI, 0.7%-2.8%]).

Conclusion: This survey study found that there was a decline in youth-reported tobacco use across every tobacco product category from 2013 to 2019. This decline changed the trajectory of use among several demographic groups and brought the youth populations with the highest tobacco product use to similar rates of others.

Study Design: Survey analysis

Setting: Cuyahoga County, Ohio (and "first ring suburbs")

Population of Focus: Researchers, public health professionals, policymakers

Sample Size: 12616 high school students (7064 from Cleveland, 5552 students from the FRS)

Age Range: ages 14-18

Intervention Components (click on component to see a list of all articles that use that intervention): Nurse/Nurse Practitioner, Access, Collaboration with Local Agencies (State),

Intervention Description: There is increasing demand for primary care nationally, and advanced practice registered nurses are uniquely suited to meet this demand. Academic nursing programs are responding to this challenge by expanding graduate nurse practitioner (NP) programs, but they are limited by availability of student clinical placement sites and dedicated preceptors. We addressed these limitations by developing an academic-practice partnership between a College of Nursing pediatric nurse practitioner (PNP) program and a primary care clinic within an academic pediatric hospital. A novel PNP faculty role was developed with teaching, patient care, and clinical precepting responsibilities.

Intervention Results: This partnership increased access to pediatric primary care services within the local underserved community, increased the number of teaching faculty members and clinical preceptors, and expanded clinical education opportunities for PNP students.

Conclusion: This partnership increased access to pediatric primary care services within the local underserved community, increased the number of teaching faculty members and clinical preceptors, and expanded clinical education opportunities for PNP students.

Study Design: Program evaluation

Setting: A primary care pediatric clinic within an academic pediatric hospital in Colorado

Population of Focus: College of Nursing pediatric nurse practitioner (PNP) students, clinical preceptors, and teaching faculty members who participated in the academic-practice partnership with the primary care Child Health Clinic at Children's Hospital Colorado (CHCO)

Sample Size: 30 students

Age Range: Adult providers

Intervention Components (click on component to see a list of all articles that use that intervention): Collaboration with Local Agencies (State), Home Visit (caregiver), Continuity of Care (Caseload), STATE, PROFESSIONAL_CAREGIVER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This study examined state-level supports and barriers for coordination of home visiting with other entities within the early childhood system of care.

Intervention Results: Forty-two (75%) of the MIECHV administrators participated in the survey. States and territories varied widely within and across the 5 domains of support for coordination. MIECHV leadership was an area of relative strength, whereas data systems and finance showed the most room for improvement. State leadership and shared goals were associated with stronger perceptions of state-level coordination.

Conclusion: The findings indicate opportunities for shared learning among states to enhance coordination infrastructure. Such efforts should include multiple stakeholder perspectives and consideration of local and organizational contexts. This work could be facilitated using the service coordination toolkit developed as part of this project.

Intervention Components (click on component to see a list of all articles that use that intervention): STATE/NATIONAL, WIC Food Package Change, POPULATION-BASED SYSTEMS, STATE

Intervention Description: The purpose of this study was to measure changes in the following 3 outcomes: WIC food-package assignments, WIC infant formula amounts, and breastfeeding initiation.

Intervention Results: There were changes in WIC food-package assignments and infant formula amounts but no change in breastfeeding initiation.

Conclusion: After the change, fewer WIC mothers of new infants received the partial breastfeeding package. More WIC mothers received the full breastfeeding package, but more mothers also received the full formula package.

Study Design: QE: pretest-posttest

Setting: 17 local WIC agencies in 10 states (CA, FL, GA, ID, IL, MN, RI, TN, TX & UT)

Population of Focus: All mothers with infants 0-5 months before and after intervention implementation

Data Source: Mother self-report

Sample Size: Months 1-2 – preintervention (n=17,597) Months 5-12 – postintervention (n=62,427)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State),

Intervention Description: The policy examined in the study is Tobacco 21 (T21), which refers to the minimum legal sales age for tobacco products being raised from 18 to 21 years old.

Intervention Results: After adjusting for baseline tobacco use and other demographics, T21-exposed eighth and ninth-grade students had significantly lower odds of tobacco use than unexposed peers in five of eight models, i.e. any tobacco (aOR = 0.80, 95% CI: 0.74, 0.87), cigarettes (aOR = 0.81, 95% CI: 0.67, 0.99), e-cigarettes (aOR = 0.78, 95% CI: 0.71, 0.85), flavored tobacco (aOR = 0.79, CI: 0.70, 0.89), and dual/poly tobacco (aOR = 0.77, 95% CI: 0.65, 0.92). T21-exposed eleventh-grade students did not differ significantly in their odds of any tobacco use outcomes relative to their unexposed peers.

Conclusion: T21 exposure is associated with lower odds of multiple forms of tobacco use, particularly among younger adolescent populations, supporting the implementation of T21 policies to reduce tobacco use in this population.

Study Design: Cross-sectional survey analysis

Setting: Minnesota, USA

Population of Focus: Researchers, public health professionals, policymakers

Sample Size: 107981 youth from 2016; 102196 youth from 2019

Age Range: ages 13-18 (Grades 8, 9, 11)

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State),

Intervention Description: The intervention described in this study is the implementation of state-level dependent coverage expansion (DCE) policies, with or without additional health reforms such as an individual mandate, establishment of an exchange, Medicaid expansion, and prohibition of pre-existing condition exclusions.

Intervention Results: Implementation of DCE with other reforms was significantly associated with a 23 percent reduction in exit from dependent coverage among AYA compared to the reduction observed for DCE alone. Additionally, comprehensive reforms were associated with over two additional years of dependent coverage for the average AYA and a 33 percent increase in the odds of regaining dependent coverage after a prior loss.

Conclusion: Findings suggest that an individual mandate and other reforms may enhance the effect of DCE in preventing loss of coverage among AYA.

Study Design: Pre/post comparison

Setting: State (Massachusetts, Maine, New Hampshire)

Population of Focus: Adolescents and young adults enrolled as dependeings in commercial health plans in Massachusetts, Maine, and New Hampshire

Sample Size: 131,542 adolescents and young adults

Age Range: 16-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State),

Intervention Description: The introduction of new evidence-informed alcohol warning labels (AWLs) on alcohol containers sold in the government-run liquor store in Whitehorse, Yukon

Intervention Results: Total per capita retail alcohol sales in Whitehorse decreased by 6.31% (t test p < .001) during the intervention. Per capita sales of labeled products decreased by 6.59% (t test p < .001), whereas sales of unlabeled products increased by 6.91% (t test p < .05). There was a still larger reduction occurring after the intervention when pregnancy warning labels were reintroduced (-9.97% and -10.29%, t test p < .001).

Conclusion: Applying new AWLs was associated with reduced population alcohol consumption. The results are consistent with an accumulating impact of the addition of varying and highly visible labels with impactful messages.

Study Design: Interrrupted time series analysis

Setting: Whitehorse, Yukon, Canada, and the surrounding regions

Population of Focus: Individuals who consumer alcohol in the region

Sample Size: 300,000 alcohol warning labels to 98% of alcohol containers sold in Whitehorse during the intervention period

Age Range: ≥15

Intervention Components (click on component to see a list of all articles that use that intervention): STATE, Public Insurance (State), HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice)

Intervention Description: Researchers used data on individuals 12 years of age and older from the Canadian Health Survey to esitmate the marginal effects (ME) of having dental insurance including increased dental attendance.

Intervention Results: Having dental insurance increased the proportion of participants who visited the dentist in the past year (56.6 to 79.4%, ME: 22.8, 95% confidence interval (CI): 20.9–24.7) and who reported very good or excellent oral health (48.3 to 57.9%, ME: 9.6, 95%CI: 7.6–11.5).

Conclusion: Findings suggest that dental insurance is associated with improved dental visiting behaviours and oral health status outcomes. Policymakers could consider universal dental coverage as a means to support financially vulnerable populations and to reduce oral health disparities between the rich and the poor.

Setting: Community

Population of Focus: Children 12 years of age and older