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): STATE Policy/Guideline (State)

Intervention Description: The intervention is the implementation of Tobacco-21 (T-21) laws, which raise the minimum legal purchase age for tobacco products to 21 years. The policies were implemented at different times in various locations across the United States, starting with Needham, Massachusetts in 2005. The study focuses on the impact of these policies on maternal smoking behavior among mothers aged 18-20. Specific implementation dates include 2013 for New York City and 2016 for California.

Intervention Results: - The implementation of Tobacco-21 laws led to small but statistically significant reductions in maternal smoking before and during pregnancy. - The primary mechanism by which T-21 reduces maternal smoking is by decreasing the initiation of smoking before pregnancy, rather than increasing quit rates during pregnancy. - The study observed a reduction in maternal smoking in California by up to 14% from baseline.

Conclusion: The study found small but statistically significant reductions in smoking among mothers aged 18-20 due to T-21 laws, with a 7.75% decrease from baseline in pre-pregnancy smoking. The primary mechanism of T-21's impact is by reducing the initiation of smoking before pregnancy rather than increasing quit rates during pregnancy. The study suggests that the demand for cigarettes among young mothers may be less elastic compared to the general youth population, which could explain the smaller reductions found compared to other studies. The findings have implications for public health policy, suggesting that T-21 laws can contribute to reducing smoking initiation.

Study Design: Observational study, quasi-experimental design, difference-in-differences model, extended two-way fixed effects (ETWFE) specifications, retrospective analysis

Setting: - Time period: 2012 to 2019 - Population: Young mothers aged 18-20 years old - Location: United States, with a focus on counties and states that implemented T-21 policies, particularly New York City and California - Data source: United States Vital Statistics data

Population of Focus: Young mothers aged 18 to 20

Sample Size: - Overall: 1,781,644 (Table 9, page 1) - New York City: 42,641 (Table 9, page 1) - California: 234,001 (Table 9, page 1)

Age Range: 18-20 years old

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): HOSPITAL Quality Improvement Elective Induction Policy STATE Policy/Guideline (State)

Intervention Description: Labor induction was the primary intervention studied. The frequency of labor induction increased from 14.7% to 22.8% over the study period from 2016 to 2022. The study does not specify the exact methods, duration, or dose of labor induction.

Intervention Results: - Labor induction was associated with an increased risk of cesarean delivery, with an adjusted odds ratio of 1.67. - The rate of labor induction increased from 14.9% in 2016 to 23.1% in 2022, but this increase was linked to higher cesarean delivery rates. - The study found no statistically significant improvements in maternal or neonatal outcomes with labor induction.

Conclusion: - Labor induction was associated with an increased risk of cesarean delivery both before and after the ARRIVE trial. - Despite statewide efforts to reduce cesarean delivery rates, the study observed a decrease in cesarean delivery rates in both induced and non-induced populations, indicating that improved labor management may be more effective than increasing induction rates. - The significant increase in labor induction rates from 2016 to 2022 did not lead to a corresponding decrease in cesarean delivery rates, suggesting that other factors such as labor management are crucial. - The study did not find significant improvements in maternal or neonatal outcomes with labor induction, challenging its benefits in these areas.

Study Design: Retrospective cohort study, observational study, multi-site study

Setting: - Location: Three Sacramento Valley community hospitals (Sutter Medical Center, Sutter Roseville, Sutter Davis Hospital) - Time period: 2016 to 2022 - Population: Low-risk, nulliparous, term, singleton, vertex (NTSV) individuals - Environmental factors: Statewide efforts to reduce cesarean rates"

Population of Focus: Mothers (low-risk, nulliparous, term, singleton, vertex) and their newborns

Sample Size: 10821

Age Range: The age range for the study population is primarily between 20 and 35 years of age, with individuals over 45 years excluded from the sample.

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): HEALTH_CARE_PROVIDER_PRACTICE Data Collection Training for Staff HOSPITAL Quality Improvement STATE Perinatal Committees/Councils

Intervention Description: Hospitals implemented AAP-compliant safe sleep policies, provided staff and family education, and conducted monthly safe sleep audits. Virtual huddles and learning sessions supported implementation.

Intervention Results: Safe sleep compliance increased by 22%. Most common failure reasons: crib items (49%), unsafe bedding (27%), head-of-bed elevation (24%).

Conclusion: Statewide QI can identify and address barriers, share resources, and improve compliance with safe sleep recommendations.

Study Design: Statewide QI collaborative with monthly audits, huddles, semiannual learning sessions.

Setting: Thirteen birthing hospitals and NICUs across Tennessee (urban and rural).

Population of Focus: Infants 0–12 months hospitalized in newborn nurseries and NICUs; healthcare staff; parents.

Sample Size: 13 hospitals serving >40% of live births in Tennessee. 671 infants audited for compliance.

Age Range: Infants 0–12 months (eligibility criteria).

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: - Intervention: CVS discontinuing tobacco sales - Intervention: Family Dollar and Dollar General starting to sell tobacco products - Note: These interventions are described in terms of their impact on tobacco retailer density rather than specific frequencies, durations, or doses.

Intervention Results: - Across the six-state region, smoking during pregnancy (SDP) decreased by 15.6% from 2011 to 2016. - The change in tobacco retailer density (TRD) due to corporate policy changes significantly affected SDP rates, with counties experiencing high TRD changes showing less reduction in SDP. - High TRD may inhibit progress in reducing smoking during pregnancy, regardless of rurality and socioeconomic vulnerability.

Conclusion: The study found an association between smoking during pregnancy and increased tobacco retailer density due to corporate sales decisions. High TRD inhibits progress in smoking reduction, regardless of rurality and socioeconomic vulnerability. Localities should consider licensing and zoning strategies to reduce TRD, and states should fund smoking cessation programs and health communications.

Study Design: Observational study

Setting: - Location: Six southeastern states in the United States (Florida, Georgia, Mississippi, North Carolina, South Carolina, and Tennessee) - Time period: January 1, 2011, to December 31, 2016 - Population: Low-income populations in the six states - Environmental factors: Socioeconomic vulnerability, rurality, presence of smoke-free laws

Population of Focus: Low-income populations in the six southeastern states (Florida, Georgia, Mississippi, North Carolina, South Carolina, and Tennessee) affected by changes in tobacco retailer density and smoking during pregnancy rates.

Sample Size: Not mentioned (the paper does not explicitly state the sample size)

Age Range: Not mentioned (the paper does not specify an age range for the study participants)

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): STATE Policy/Guideline (State)

Intervention Description: - Cigarette taxes: Increase by $1.00, associated with a 3.45 percentage point decrease in prenatal smoking among white mothers and a 1.20 percentage point decrease among black mothers. - Smoke-free legislation: Implemented in some states, but effects are limited.

Intervention Results: - Cigarette taxes significantly reduced prenatal smoking among white and black mothers with less than a high school degree. - The reduction in prenatal smoking due to increased taxes led to improved birth outcomes, specifically an increase in birth weight for babies born to these mothers. - Smoke-free legislation had limited effects on smoking, quitting, or birth outcomes.

Conclusion: - Cigarette taxes significantly reduce prenatal smoking and improve birth outcomes among vulnerable mothers and infants. - White and black mothers with less than a high school degree are most responsive to cigarette taxes. - Every $1.00 increase in taxes decreases prenatal smoking by 3.45% among white mothers and 1.20% among black mothers. - Birth weight increases by 4.19g for white mothers and 0.89g for black mothers with each $1.00 tax increase. - Limited effects of smoke-free legislation on smoking, quitting, or birth outcomes were found.

Study Design: Observational study using retrospective data analysis with conditional mixed-process models and difference-in-differences models.

Setting: - Time period: 2005-2015 - Location: 47 states and the District of Columbia - Population: Singletons born at 30 to 44 weeks of gestation to women aged 16 to 49 years - Experimental context: Observational study using birth certificate data linked to state-level tobacco control policies

Population of Focus: Mothers and their infants

Sample Size: 26436541

Age Range: 16 to 49 years

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): STATE Policy/Guideline (State)

Intervention Description: The intervention is exposure to higher state-level in-utero cigarette taxes during the mother's conception year, specifically between 1965 and 2001. The intervention is a policy environment rather than a direct program or practice. The frequency and duration are implicit in the study's focus on taxes over this period and their impact on later-life smoking behaviors.

Intervention Results: - Higher in-utero cigarette taxes reduce the likelihood of smoking during pregnancy and before pregnancy for first-time mothers. - A 1% increase in in-utero cigarette taxes leads to a 0.14% reduction in prenatal smoking and a 0.12% reduction in pre-pregnancy smoking. - Higher in-utero cigarette taxes have intergenerational health benefits, including reduced low birth weight in newborns, and their influence on prenatal smoking has increased over time, especially after 2006.

Conclusion: This study examines the long-term impact of in-utero cigarette taxes on adult prenatal smoking, finding that higher taxes reduce smoking in adulthood. It also shows long-lasting effects on adult health and intergenerational consequences for infant health. The study highlights that in-utero taxes have become more influential in recent years, while contemporary and teenage taxes have become less effective. The findings suggest that public policies have cohort-specific effects and that in-utero influences directly impact health and health behaviors. These results have implications for policy, particularly regarding the effectiveness of cigarette taxes over time.

Study Design: Observational study, retrospective analysis

Setting: The setting of the study is the United States, focusing on the impact of in-utero cigarette taxes from 1965 to 2001 on adult prenatal smoking behaviors observed in first-time mothers aged 18 to 49, using birth certificate records from 2009 to 2020. The data is sourced from the CDC and NCHS Natality Detail Files.

Population of Focus: Mothers aged 18 to 49 who had first deliveries between 2009 and 2020

Sample Size: Not mentioned (the paper does not provide a specific numerical value for the sample size)

Age Range: 18 to 49

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): PARENT_FAMILY Training (Parent/Family) COMMUNITY Community Events STATE Collaboration with Local Agencies (State)

Intervention Description: Evaluation of NAPPSS-IIN: community-level strategies promoting safe sleep and breastfeeding; interviews with providers and linkage with PRAMS/OPAS outcome data.

Intervention Results: Identified gaps between promotion and outcomes, with persistent racial/ethnic disparities. Conversational approaches and community collaboration may improve outcomes.

Conclusion: Community-level organizations should tailor strategies with conversational approaches and partnerships to address disparities in safe sleep and breastfeeding outcomes.

Study Design: Mixed methods study with hermeneutical phenomenology and descriptive quantitative analysis.

Setting: Community-level providers across six U.S. states (New Jersey, Kansas, Ohio, Florida, Maryland, Mississippi).

Population of Focus: Community-level perinatal service providers (e.g., clinicians, lactation consultants, directors).

Sample Size: Qualitative: 7 key informants; Quantitative: PRAMS and OPAS datasets.

Age Range: Providers; infants/mothers represented in PRAMS and OPAS data (not directly recruited).

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): HOSPITAL Quality Improvement Crib Card STATE Data Collection System

Intervention Description: Standardized safe sleep criteria implemented via universal and site-specific strategies: phased staff education, weekly crib audits with real-time feedback, crib cards, EHR updates, nursing documentation changes, therapeutic positioning plans, and 'Face Up Fridays' integration into daily rounds.

Intervention Results: Safe sleep compliance improved from 34% at baseline to a sustained 90% across sites; failures related to head-of-bed elevation, positioners, and extra crib items decreased substantially.

Conclusion: A systematic, regional QI approach improved and sustained NICU safe sleep compliance, fostering cultural change. Future work should focus on family education, post-discharge environments, and replication in other pediatric settings.

Study Design: Regional quality improvement initiative using PDSA cycles, run charts, Pareto analysis; multidisciplinary, multi-site, sustained over three years.

Setting: Four Level III/IV NICUs across different healthcare systems in Ohio, USA.

Population of Focus: Neonates hospitalized in Level III/IV NICUs and their healthcare providers.

Sample Size: 1,976 infants assessed; average of 73.2 infants audited weekly (range: 37–167).

Age Range: ≥32 weeks postmenstrual age (eligibility criteria).

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.