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Criteria for Selecting Promising Models

The below criteria are adapted from the 2017 National Academies report Communities in Action: Pathways to Health Equity (NASEM, 2017) that this report is building from per the committee Statement of Task. The criteria were used to identify promising models from the prenatal through early childhood phases to highlight in this report. The committee did not evaluate the overall effectiveness of these efforts; rather, it used these promising models as examples throughout the report to highlight bright spots that have been able to use what is known from the science to advance health equity in the preconception through early childhood periods. Furthermore, “promising” does not imply that the model is new but rather that it is a program or intervention that met the committee’s core criteria, and each promising model has a unique approach and is at a different phase of development: some have been around for more than 30 years and have changed based on evaluations or input from users, while others have emerged in the past few years. These examples are not blueprints, and exact replicas might not work with all populations or locations, but the lessons learned and approaches used are valuable to those working to create positive change toward health equity during the preconception through early childhood periods. See Chapter 1 for more details.

This report applied three sets of criteria:

1. Core criteria: These function like inclusion criteria (i.e., to be included for consideration, the examples need to meet each of the six core criteria).

2. Aspirational criteria: The examples need to meet at least one, and preferably more, of the aspirational criteria.
3. Contextual criteria: These criteria are applied to the examples that meet the six core criteria and a number of the aspirational criteria to ensure that the examples are diverse in terms of communities/populations, approaches to solutions, and other characteristics.

Set 1: Core Criteria

1. It focuses on preconception/prenatal and/or early childhood (whether intervention is focused on children or caregivers in their lives).
2. It is informed by findings from the neurobiological, closed-behavioral, and/or biological sciences.
3. It addresses at least one, preferably more, of the nine social determinants of health identified in the 2017 National Academies report (health systems and services, education, employment, the physical environment, the social environment, housing, income and wealth, public safety, and transportation) (NASEM, 2017).
4. It is designed to have or has evidence of having an impact on a group or population that experiences health inequities.
5. It is multisectoral (i.e., at least two sectors engaged).
6. It includes an assessment of evidence, including data or best available information, to
   1. identify a problem and
   2. develop a solution that has a measurable outcome that there are plans to measure.

Set 2: Aspirational Criteria

1. It includes nontraditional partners and/or nonhealth domains.

   Note: This is meant to be inclusive of nontraditional partners for communities to engage that may not necessarily be sectors (i.e., community organizers, parent–teacher association groups).

2. It is interdisciplinary.
   1. The solution draws on multiple sources, including practice-based experience and research from multiple disciplines.
3. It is multilevel—the intervention has multiple levels of influence, such as individual, family, organizational/institutional, or governmental.

   Note: This does not mean that a solution must target each of these levels.

4. It has a strong evaluation plan in place, including relevant measures to track the impact of the intervention.
5. It documents what it is trying to achieve, why that is important, how it plans to achieve the desired outcome (i.e., a theory of change), and/or the mechanisms being targeted based on scientific evidence.
6. It includes a plan for sustainability, including consideration of
   1. Long-term strategy and structure;
   2. Funding, operating costs, resources, etc.;
   3. Efficient use of resources;
   4. Potential cost savings realized or return on investment;
   5. Increased community capacity to shape outcomes;
   6. Building the next generation of leaders; and
   7. Clear policy solutions/changes at the local, state, or federal levels to support or scale a promising intervention or strategy.
7. It has transferable key elements¹ that could practically be applied or adapted to similar contexts in order to scale impact.
8. It incorporates the evidence required of proposed intervention(s):
   1. It addresses a significant health disparity (or disparities) based on data of a documented need or problem and data showing impact on at least one proximal or distal measure of a health disparity.
   2. The actual or projected health benefits are substantial/meaningful to the population(s) and community as a whole (not just statistically significant).
   3. There is ongoing data collection of processes and outcomes (flexibility in terms of what type of data is generated and applied).
   4. There is one or more high- or moderate-quality impact study of the approach.
      Note: This includes health outcomes in a broad sense, related to social determinants (e.g., 3rd-grade reading level rates) that are strongly linked to health outcomes.
9. The implementation process is well documented, including
   1. The key elements and subtleties of how the solution is contributing to success (not referring to legal documents/individual health data);
   2. Performance measurement;

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¹ Key elements are the functions or principles and activities of the solution that are necessary to achieve similar outcomes.

9. 3. Particular practice (training, supervisory);
   4. Funding;
   5. Regulatory context; and
   6. Political context.
10. It is community-driven or informed: engagement with the community is evident preintervention and incorporated in the solution or the solution is initiated by the community/a community group/local government.
11. The solution is freely available to the community and not a proprietary resource.

Set 3: Contextual Criteria

As a whole, the set of examples selected will

1. Address a range of the nine determinants of health identified in the 2017 National Academies report (health systems and services, education, employment, the physical environment, the social environment, housing, income and wealth, public safety, and transportation).
2. Reflect rural, suburban, and urban contexts.
3. Reflect diversity in several of the following population characteristics:
   1. Race,
   2. Ethnicity,
   3. Age,
   4. Gender identity,
   5. Sexual orientation status,
   6. Socioeconomic status,
   7. Disability status, or
   8. Other statuses (e.g., documentation status).
4. Include solutions that require changes in the systems or policies within which the solution was implemented and those that did not require changes in systems or policies to be effective.
5. Reflect various levels of political engagement.

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