Inventory of Evidence-Based Practices (EBPs) for Healthy Start Programs

Evidence-based practices include actions, activities, strategies, or approaches that improve the health of women, before, during, and after pregnancy in order to improve birth outcomes and give infants up to age two years a healthy start. Also included in the collection are informational materials and tools that make it easier to implement evidence-based practices. To search by title, use the main search box located at the top of this page.


Updated Immunization Schedule for Children and Adolescents Aged 18 Years or Younger

In February 2019, ACIP updated its immunization guidelines for children and adolescents. The revised guidelines are available in two newly redesigned charts, one for providers and one for parents. They include new or revised recommendations for hepatitis A vaccine (HepA), hepatitis B vaccine (Hep B), influenza vaccine, and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap), as well as clarification of the recommendations for inactivated poliovirus vaccines (IPV).

Topics:

Immunization

Approaches:

Promote Quality

Benchmarks:

Well Child Visits

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

Screening for Syphilis Infection in Pregnancy

The incidence of syphilis in American women doubled between 2012 and 2016, and the incidence of congenital syphilis rose concomitantly. Congenital syphilis can lead to stillbirth, neonatal death, and lasting effects such as bone deformities and neurologic impairment in the newborn. Because of this, the USPSTF has reiterated its guidance that all pregnant women be tested for syphilis at their first prenatal visit. They also point out that many organizations recommend repeat testing of high-risk women in the third trimester and at delivery.

Topics:

Prenatal Care and Education STDs including HIV

Approaches:

Improve Women's Health Promote Quality

Benchmarks:

Evidence Rating: II. Promising practices—Innovative practices employed in the field, based on state-of-science knowledge about what works to improve outcomes, and gathering evidence of effectiveness.

ACOG Committee Opinion on Prenatal HIV Testing

This recently revised document discusses the rationale and recommendations for “opt-out” HIV testing in pregnancy. It explains how test results can be used to guide treatment for HIV in pregnancy in order to optimize outcomes for both mother and baby.

Topics:

Prenatal Care and Education STDs including HIV

Approaches:

Improve Women's Health Promote Quality

Benchmarks:

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

ACOG Committee Opinion on Optimizing Postpartum Care

Because one half of all pregnancy-related maternal deaths occur postpartum, the weeks following childbirth are a critical period for a woman and her infant. In addition, health issues that arise in pregnancy can persist and presage long-term medical problems. In this Committee Opinion, ACOG lays out a new vision for postpartum care, redefining it as an ongoing process beginning within the first 3 weeks postpartum and tailored to a woman’s needs. The document includes practical advice on postpartum care as well as useful charts including a Timeline for Postpartum Care, a listing of The Components of Postpartum Care, and a table identifying Members of the Postpartum Care Team.

Topics:

Breastfeeding Chronic Disease Depression Reproductive Life Planning/Family Planning

Approaches:

Improve Women's Health Promote Quality Strengthen Family Resilience

Benchmarks:

Birth Spacing Initiating Breastfeeding Perinatal Depression Follow Up Perinatal Depression Screening Postpartum Visit Reproductive Life Plan Sustaining Breastfeeding Well Woman Visits

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

Alcohol Screening and Brief Intervention: A guide for public health practitioners

Screening and brief intervention (SBI) is a structured set of questions designed to identify individuals at risk for alcohol use problems, followed by a brief discussion between an individual and a service provider, with referral to specialized treatment as needed. This manual is designed to provide public health professionals, such as health educators and community health workers, with the information, skills, and tools needed to conduct SBI so that they can help at-risk drinkers reduce their alcohol use to a safe amount or stop drinking. The manual offers background information and practical steps for conducting SBI in a variety of public health settings, including trauma centers, emergency departments, other clinical settings, home visits, and public events.

Topics:

Alcohol/Drug Services Case Management/Care Coordination Risk Assessment

Approaches:

Improve Women's Health

Benchmarks:

Well Woman Visits

Evidence Rating: II. Promising practices—Innovative practices employed in the field, based on state-of-science knowledge about what works to improve outcomes, and gathering evidence of effectiveness.

Black Mamas Matter: Advancing the Human Right to Safe and Respectful Maternal Health Care

This toolkit provides a foundation, framework and resources for advancing maternal health in the U.S. as a human rights issue. It provides a research overview of maternal morbidity and mortality, focusing on trends, health disparities and inequities. Based on the deliberations of a cross-sectoral convening of stakeholders it offers a state policy framework for upholding the right to safe and respectful maternal health care, which offers recommendations in six key areas: improving access to reproductive health care, improving quality of maternal health care, ensuring acceptability of maternal health care for women most at risk, ensuring widespread availability of maternal health services, ensuring non-discrimination in access to care and social determinants of health, and fostering accountability to human rights standards for maternal health care.

Topics:

Case Management/Care Coordination Home Visiting Insurance Coverage Life Course Model Patient-centered Medical Home Prenatal Care and Education Reproductive Life Planning/Family Planning

Approaches:

Improve Women's Health

Benchmarks:

Health Insurance Postpartum Visit Well Woman Visits

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders

This guide is intended to support the efforts of states, tribes, and local communities in addressing the needs of pregnant women with opioid use disorders and their infants and families, through a coordinated, multi-sytem approach. The guide is designed to assist healthcare providers, SUD treatment providers, child welfare programs and judicial systems to improve their collaborative practice, and to offer information about additional resources that will strengthen their capacity to provide coordinated, best-practice care and services Collaborative planning and implementation of services that reflect best practices for treating opioid use disorders during pregnancy are yielding promising results in communities across the country. .

Topics:

Alcohol/Drug Services Case Management/Care Coordination Patient-centered Medical Home Prenatal Care and Education

Approaches:

Improve Women's Health

Benchmarks:

Evidence Rating: II. Promising practices—Innovative practices employed in the field, based on state-of-science knowledge about what works to improve outcomes, and gathering evidence of effectiveness.

Recruiting and Retaining Men in Responsible Fatherhood Programs: A Research-to-Practice Brief

This research-to-practice brief summarizes several promising practices from the Strengthening Families Evidence Review (SFER) on recruitment and retention. It provides guidance on on how to plan for recruitment, engage fathers in services, and maintain high rates of participation. The strategies can be tailored to meet the needs of specific programs and fathers. Regardless of the strategies used, all programs should be prepared for an intensive effort to recruit and enroll fathers.

Topics:

Participant Recruitment and Retention Partner Involvement

Approaches:

Strengthen Family Resilience

Benchmarks:

Father/Partner Parenting Involvement Father/Partner Prenatal Involvement

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

2018 Prevention Resource Guide

This prevention resource guide offers information, strategies, and resources to support community service providers as they work with parents, caregivers, and children to prevent child maltreatment and promote social and emotional well-being. The guide focuses on protective factors that build on family strengths and promote optimal child and youth development. Information about protective factors is augmented with tools and strategies that help providers, advocates and policymakers integrate the factors into community programs and systems. The guide includes tip sheets for parents in English and Spanish on a range of parenting and child development topics.

Topics:

Intimate Partner Violence Life Course Model Parenting Education Partner Involvement Socio-emotional Development for Children

Approaches:

Strengthen Family Resilience

Benchmarks:

Father/Partner Parenting Involvement Father/Partner Prenatal Involvement Intimate Partner Violence

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

American Academy of Pediatrics/Safe Sleep

This webpage offers resources for providers and families on safe sleep practices. Resources for providers include the AAP Policy Statement: SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Resources for families include a videos, posters and infographics on safe sleep practices.

Topics:

Parenting Education Safe Sleep

Approaches:

Promote Quality

Benchmarks:

Safe Sleep

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

Promundo: Program P: A Manual for Engaging Men in Fatherhood, Caregiving, and Maternal and Child Health

Program P is a resource developed as part of the global MenCare campaign coordinated by Promundo and the Sonke Gender Justice Network. The manual outlines concrete strategies for engaging men in active caregiving from their partner’s pregnancy through their child’s early years, and preventing violence against women and children. It includes tools to aid in creating open spaces for men in the clinic setting, detailed guidance on providing gender-transformative group education for men, and advice on encouraging community mobilization around fatherhood, child protection, maternal and child health and gender equality. It is available in 5 languages.

Topics:

Intimate Partner Violence Parenting Education Partner Involvement Prenatal Care and Education

Approaches:

Strengthen Family Resilience

Benchmarks:

Father/Partner Parenting Involvement Father/Partner Prenatal Involvement

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

WHO Guidelines for Identification and Management of Substance Use and Substance Use Disorders in Pregnancy

This 244-page publication contains detailed guidelines and recommendations on the identification and management of women who are pregnant or postpartum and use alcohol or drugs or have a substance use disorder. It includes extensive information on screening and brief interventions, psychosocial interventions, detoxification and quitting programs, pharmacological treatment, breastfeeding and maternal substance use, and management of infants exposed to alcohol and other psychoactive substances. The document also features a comprehensive review of the evidence behind the recommendations.

Topics:

Alcohol/Drug Services Breastfeeding Prenatal Care and Education Risk Assessment

Approaches:

Benchmarks:

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

Bringing Fathers In Fact Sheets

This set of 9 fact sheets for programs that serve families makes the case and provides implementation tips for fully and effectively engaging fathers. The fact sheets describe the importance of involved fathers for improving maternal and child health outcomes, supporting children’s early learning and reducing family and community violence. They also provide best practice do’s and don’ts, tips for attracting fathers to programs, and father-inclusive evaluation strategies.

Topics:

Participant Recruitment and Retention Partner Involvement

Approaches:

Strengthen Family Resilience

Benchmarks:

Father/Partner Parenting Involvement Father/Partner Prenatal Involvement

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

Smoking Cessation During Pregnancy

Smoking is the one of the most important modifiable causes of poor pregnancy outcomes in the United States, and is associated with maternal, fetal, and infant morbidity and mortality. This ACOG Committee Opinion provides evidence-based guidance on helping pregnant women quit smoking. It contains examples of effective smoking cessation interventions and instructions for use of the 5A’s, a counseling intervention specifically targeted to pregnant women. The potential effects on pregnancy and lactation of alternative forms of nicotine, such as e-cigarettes and vaping, as well as medications used to help with smoking cessation, are also discussed.

Topics:

Prenatal Care and Education Tobacco Cessation

Approaches:

Promote Quality

Benchmarks:

Smoking Abstinence

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

Marijuana Use During Pregnancy and Lactation

Marijuana is the most common mood-altering drug used during pregnancy, and with legalization occurring in several states, there is concern that its use may increase. This ACOG Committee Opinion provides a comprehensive summary of current evidence regarding risks of recreational or medicinal marijuana use during pregnancy and lactation to both the mother and the fetus.

Topics:

Alcohol/Drug Services

Approaches:

Benchmarks:

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

American College of Nurse-Midwives Position Statement on Screening and Brief Intervention to Prevent Alcohol-Exposed Pregnancy

ACNM encourages CNMs, CMs, and other professionals who provide care for reproductive-aged women to routinely use evidence-based strategies to prevent alcohol exposed pregnancy, including:
–Conduct universal alcohol screening and appropriate follow-up at least annually for all adults. For pregnant women, screen at the initial prenatal visit and during each trimester thereafter.
–Be aware of state reporting laws and potential practice implications regarding the use of ICD-10 codes to indicate alcohol use during pregnancy if recording alcohol exposure in the prenatal problem list.
–Provide education about the potentially harmful effects of alcohol on a developing fetus
–Advise use of effective contraception to prevent pregnancy; if the woman is not using contraception consistently, advise her to consider abstaining from alcohol use.
–Encourage women who are attempting to become pregnant to abstain from alcohol.
–Provide a brief behavioral intervention and appropriate follow-up plan for those who screen positive for symptoms or dependency, including a referral to specialty services as needed.
In addition,CNMs and CMs should seek information and training to enhance their knowledge and build theclinical skills needed to address alcohol use with women, especially those of reproductive age.

Topics:

Alcohol/Drug Services Prenatal Care and Education

Approaches:

Improve Women's Health

Benchmarks:

Well Woman Visits

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

ACOG Committee Opinion on Opioid Use and Opioid Use Disorder in Pregnancy

This Committee Opinion states ACOG’s recommendations for screening and treatment of opioid use during pregnancy. Pregnancy provides an important opportunity to identify and treat women with substance use disorders, Universal screening for substance use should be a part of comprehensive obstetric care and should be done at the first prenatal visit in partnership with the pregnant woman. Multidisciplinary long-term follow-up should include medical, developmental, and social support. Infants born to women who used opioids during pregnancy should be monitored for neonatal abstinence syndrome by a pediatric care provider. Early universal screening, brief intervention (such as engaging a patient in a short conversation, providing feedback and advice), and referral for treatment of pregnant women with opioid use and opioid use disorder improve maternal and infant outcomes.

Topics:

Alcohol/Drug Services Prenatal Care and Education

Approaches:

Improve Women's Health

Benchmarks:

Well Woman Visits

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

AAP Fetal Alcohol Spectrum Disorders Toolkit

The American Academy of Pediatrics FASD Toolkit was developed in coordination with the CDC to raise awareness, promote surveillance and screening, and ensure that all children who possibly have FASDs receive appropriate and timely interventions. Focused primarily on providers, it features basic information on FASD, diagnostic tools for use in children suspected of being affected, evidence-based interventions, and guidelines for case management/care coordination. The site also contains FAQ and a list of resources for families and school professionals who care for children with FASD.

Topics:

Alcohol/Drug Services Case Management/Care Coordination Parenting Education

Approaches:

Benchmarks:

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

ACOG Fetal Alcohol Spectrum Disorders (FASD) Prevention Program

The Fetal Alcohol Spectrum Disorders (FASD) Prevention Program is a collaboration between ACOG and the CDC designed to empower healthcare providers to speak with their patients about abstaining from alcohol use during pregnancy. The program includes evidence-based ACOG Committee Opinions regarding ethics, alcohol use in pregnancy, and motivational interviewing techniques, as well as videos and free downloadable materials for both providers and patients.

Topics:

Alcohol/Drug Services

Approaches:

Benchmarks:

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

A Public Health Response to Opioid Use in Pregnancy

This policy statement from the AAP advocates a public health response to the opioid epidemic and substance use during pregnancy, and recommends: a focus on preventing unintended pregnancies and improving access to contraception; universal screening for alcohol and other drug use in women of childbearing age; knowledge and informed consent of maternal drug testing and reporting practices;improved access to prenatal care, including opioid replacement therapy; gender-specific substance use treatment programs;and improved funding for social services and child welfare systems.

Topics:

Alcohol/Drug Services Prenatal Care and Education

Approaches:

Improve Women's Health

Benchmarks:

Reproductive Life Plan Well Woman Visits

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

Guidelines for Identification and Management of Lead Exposure in Pregnant and Lactating Women

This is a comprehensive source of information on the risks of exposure to lead during pregnancy and lactation. It contains detailed information on sources of lead exposure in adults, and known risks of lead on the mother, developing fetus, and infant. Sample screening tools for assessing possible exposure, and information on management of women found to have elevated lead levels are also included.

Topics:

Breastfeeding Prenatal Care and Education Risk Assessment

Approaches:

Benchmarks:

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

Childhood Lead Poisoning

This CDC website provides concise information on risks for lead poisoning in children and evidence-based recommendations for decreasing those risks. It features both tips for parents and guidelines for providers to prevent childhood lead poisoning, along with info graphics and educational recommendations for children affected by lead.

Topics:

Parenting Education Risk Assessment

Approaches:

Benchmarks:

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

The Surgeon General’s Call to Action to Support Breastfeeding

For nearly all infants, breastfeeding is the best source of nutrition and immunologic protection, and it provides remarkable health benefits to mothers as well. Many mothers in the United States want to breastfeed, and most try. Yet within only three months after giving birth, more than two thirds of breastfeeding mothers have already begun using formula. By six months postpartum, more than half of mothers have given up on breastfeeding. This Call to Action describes specific steps people can take to participate in a society-wide approach to support mothers and babies who are breastfeeding. It provides recommendations for women and families, communities, health care providers, employers, public health agencies, and researchers.

Topics:

Breastfeeding Prenatal Care and Education

Approaches:

Promote Quality

Benchmarks:

Initiating Breastfeeding Sustaining Breastfeeding

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

The Injury Prevention Program (TIPP): A Guide to Safety Counseling in Office Practice

Counseling parents and children about the prevention of common childhood injuries is an important contribution toward preventing the major cause of childhood morbidity and mortality. TIPP is designed to provide a systematic method for pediatricians to counsel parents and children about adopting behaviors to prevent injuries—behaviors that are effective and capable of being accomplished by most families.This Guide includes a table showing the major safety issues and injury hazards for each age group for children 0-10 years old, and provides counseling guidelines for educating parents about injury prevention tailored to the age of their child.

 

Topics:

Parenting Education

Approaches:

Benchmarks:

Well Child Visits

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

Components of the Well-Woman Visit

Annual well-woman visits provide an excellent opportunity for health maintenance and preventive care, including preconception and interconception counseling. Under the Affordable Care Act of 2010, Medicaid and most private insurance plans cover these visits without copay. The American College of Obstetricians and Gynecologists released these guidelines on recommended components of the annual visit based on previous evidence-based guidelines, current expert opinion, and the recommendations of a multidisciplinary task force. Recommendations on screening, laboratory tests, evaluation and counseling, and immunizations are organized into the age ranges 13-18, 19-45, 46-64, and >64.

Topics:

Alcohol/Drug Services Chronic Disease Depression Healthy Weight Immunization Intimate Partner Violence Nutrition Reproductive Life Planning/Family Planning Risk Assessment STDs including HIV Tobacco Cessation

Approaches:

Improve Women's Health

Benchmarks:

Well Woman Visits

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

Final Recommendation Statement: Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: Screening

The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians screen for intimate partner violence (IPV) in women of reproductive age and provide or refer women who screen positive to ongoing support services. This recommendation statement provides information on several screening instruments that accurately detect IPV in the past year among adult women: Humiliation, Afraid, Rape, Kick (HARK); Hurt, Insult, Threaten, Scream (HITS); Extended–Hurt, Insult, Threaten, Scream (E-HITS); Partner Violence Screen (PVS); and Woman Abuse Screening Tool (WAST).

Topics:

Intimate Partner Violence

Approaches:

Strengthen Family Resilience

Benchmarks:

Intimate Partner Violence

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

Recommendations for Preventive Pediatric Health Care

This chart shows recommended pediatric preventive health care services to be delivered at well-child visits for children ages 0-21, including history, measurements, screenings, assessments, procedures, physical exam, oral health,  and anticipatory guidance. These guidelines represent a consensus by the American Academy of Pediatrics (AAP) and Bright Futures. The recommendations in this statement do not indicate an exclusive course of treatment or standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

Topics:

Other

Approaches:

Promote Quality

Benchmarks:

Well Child Visits

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

Oral Health Care During Pregnancy: A National Consensus Statement

This national consensus statement was developed to help health professionals, program administrators, policymakers, advocates, and other stakeholders respond to the need for improvements in the provision of oral health services to women during pregnancy. This statement is the product of the Oral Health Care During Pregnancy Consensus Development Expert Workgroup Meeting convened by HRSA’s MCHB in collaboration with ACOG and the American Dental Association.

Topics:

Oral Health

Approaches:

Improve Women's Health

Benchmarks:

Well Woman Visits

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

ACOG Recommendation for Postpartum Management of Gestational Diabetes

ACOG (The American College of Obstetricians and Gynecologists) Practice Bulletin #137 on Gestational Diabetes Mellitus (GDM) contains a flow chart for postpartum management of women with gestational diabetes. The purpose of the document is to provide a brief overview of the understanding of GDM, provide evidence-based management guidelines, and identify needs for further research.

Topics:

Chronic Disease

Approaches:

Improve Women's Health

Benchmarks:

Postpartum Visit

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.

Neonatal Abstinence Syndrome: How States Can Help Advance the Knowledge Base for Primary Prevention and Best Practices of Care

Published by the Association of State and Territorial Health Officials (ASTHO), this document contains the most recent (2014) guidelines for the screening, referral, and treatment of Neonatal Abstinence Syndrome.

Topics:

Alcohol/Drug Services Other Risk Assessment

Approaches:

Improve Women's Health

Benchmarks:

Well Woman Visits

Evidence Rating: III. Expert guidelines—Protocols, standards of practice, or recommendations based on expert consensus.