Children’s Healthy Weight CoIIN Connecting Evidence, Strategies, and Measurement with a focus on Breastfeeding and Physical Activity NCEMCH Georgetown University This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. �
Objectives and Introductions • Understand the purpose and methods of Results Based Accountability (RBA) • Apply RBA methods to link selected National Performance Measures (NPMs) and Evidence based State Measures (ESMs) • Analyze, Develop and Improve ESMs using RBA methods • Identify opportunities to integrate RBA methods into block grant program management
Agenda • Population Health and RBA • Population Accountability • RBA and ESMs • RBA and NPMs 4 and 8 • Performance Accountability • Next Steps
Population Health and Results Based Accountability • What is RBA? • Why use RBA? Results-Based Accountability A framework to help you move from reporting “what did we do?” to “how well did we do it?” and eventually to “is anyone better off from our efforts?”
RBA Applied to ESMs
ESM Examples (NPM 13: Oral Health)
RBA Applied to ESMs Measure Count Total # of ESMs 760 Minimum (by State) 5 Maximum (by State) 40 Mean 13 Median 10
RBA Applied to ESMs • NPM 4 - Breastfeeding • NPM 8 – Physical Activity National Statistics: • Breastfeeding - 80 total ESMs (2018) • Physical Activity - 51 total ESMs (2018) • All category 1 and 2
RBA Applied to ESMs
RBA Reports • National Summary Report • State Specific Reports Reports are based on experiential learning: • Active analysis • Reflective involvement • Building analytic skills • Knowledge for problem solving Copies of National Report are on our homepage: www.mchevidence.org
RBA Reports: Tips Strategies should be: • Meaningful • Measurable • Achievable Tips for Strengthening ESMs were compiled using: • Block grant guidance • Presentations that MCHB has given to the states • Block grant reviews
RBA Reports: NPM 4 – Breastfeeding Peer-Reviewed Evidenc Peer-Reviewed Evidence e The following trends emerged from analysis of peer- reviewed evidence. While findings might not completely align with your ESM, they can serve as ideas to expand your ESM in the future. • Lactation consultant interventions and home visits provided by professionals (other than lactation consultants or peer counselors) appear to be effective for increasing both breastfeeding initiation and exclusivity at 6 months. • Peer counselor interventions appear to be effective and are more likely to influence initiation than exclusivity at 6 months. • There is less clear evidence to support the WIC food package change, group education, or hospital policies. • Access the published evidence: https://www.mchlibrary.org/evidence/ established-results.php? q=&NPM=4%3A+Breastfeeding
RBA Reports: NPM 4 – Breastfeeding Current ESM Examp mples Possible Strategies Po ssible Strategies Category 1 • Number of pregnant women provided with breastfeeding education and counseling. • Number of delivering hospitals in Colorado that are certified as Baby-Friendly • Number of women referred for breastfeeding peer counseling support. Category 2 • Percent of Arkansas birthing hospitals aware of the ADH's breastfeeding toolkit • Percent of families enrolled in an evidence based home visitation program who received safe sleep education from a trained home visitation provider • Percent of counties that have at least one public health nurse trained as a Certified Lactation Consultant (CLC)
RBA Reports: NPM 8 – Physical Activity Peer-Reviewed Evidenc Peer-Reviewed Evidence. e. Evidence report is under development. However, certain trends have emerged: • Some evidence that targeting physical activity alone, rather than in combination with diet or as part of a weight gain prevention program, may be a more effective strategy • After-school programs can improve physical activity levels and other health-related aspects • Printed educational materials and changes to the school curriculum that promote physical activity during school hours result in positive effects • Other recommended interventions: point-of- decision prompts, community-wide campaigns, school-based PE, individually-adapted health behavior change programs, creation of or enhanced access to places for physical activity combined with informational outreach activities
RBA Reports: NPM 8 – Physical Activity Current ESM Examp mples Possible Strategies Po ssible Strategies Category 1 • Number of school districts who have participated in focus groups to explore challenges and opportunities to implement physical activity before, during and after school • Number of physical activity hours among school- aged kids through the Go Noodle physical activity program Category 2 • Percent of schools facilitating evidence based physical activity curricula and/or programs recommended by OSSE • Percent of licensed child care facilities (centers and preschools) assessed for a Level 3-5 that attained the Colorado Shines activity point • Percent of children participating in the WV Coordinated Approach to Child Health (CATCH) Program
RBA Applied to ESMs Advancing Your ESMs: • Strengthening Category 1. You may want to address “how well did we deliver the service” by measuring reach. • Strengthening Category 2. You may want to address the quality of the services provided. • Strengthening Category 3. Consider moving toward the reach of the effect. • Strengthening Category 4. You can begin to assess the results and health outcomes of your target population through a specific program.
Check-In Let’s Pause to Ask: • How are we connecting for you? • Questions? • A-ha moments?
Performance Accountability Seven Performance Accountability Questions: 1. Who are your customers? 2. How can we measure if our customers are better off? 3. How can we measure if we are serving our customers well? 4. How are we doing on the most important of these? 5. Who are the partners that have a role to play in doing better? 6. What works to do better? 7. What do we propose to do?
Performance Accountability 1. Who are your customers? Remember: • You have customers that are intermediaries • Your customers will vary based on your agency’s roles and approaches
Performance Accountability 2. How can we measure if our customers are better off? 3. How can we measure if we are serving our customers well?
Performance Accountability 4. How are we doing on the most important of these? Remember: • Think back to the needs assessment. How are we addressing the needs identified? • When is it okay to be in quadrants 1 and 2? • When should you push to be in quadrants 3 and 4?
Performance Accountability 5. Who are the partners that have a role to play in doing better? Remember: • Who is feeling the impact? • Don’t forget about family engagement • RBA as a way to engage stakeholders, including families, in the discussion of what matters and how to measure it
Performance Accountability 6. What works to do better? Strengthen the Evidence for MCH Programs: Resources (www.mchevidence.org) • Technical Assistance • Evidence Tools • Team of Experts • Learning Resources • MCH Digital Library (www.mchlibrary.org) • Evidence Resources (Established, Emerging, and ESMs) • Seminal and Historic Resources
Performance Accountability 7. What do we propose to do? Remember: • RBA process can be connected to block grant application • You can start by looking at a single NPM • This can lead to strengthened ESMs • How does this connect to your decision making? • Who else needs to be involved? Who do you need to tell about your evolving thoughts on ESMs? • What do you need to change ESMs?
Exercise: Improve Measurement – NPM 4 Current ESM Examp mples Category 1 • Number of pregnant women provided with breastfeeding education and counseling. • Number of delivering hospitals in Colorado that are certified as Baby-Friendly • Number of women referred for breastfeeding peer counseling support. Category 2 • Percent of Arkansas birthing hospitals aware of the ADH's breastfeeding toolkit • Percent of families enrolled in an evidence based home visitation program who received safe sleep education from a trained home visitation provider • Percent of counties that have at least one public health nurse trained as a Certified Lactation Consultant (CLC)
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