Collaborative Improvement & Innovation Networks (CoIINs)

Collaborative Improvement and Innovation Networks (CoIINs) are multidisciplinary teams of federal, state, and local leaders working together to tackle a common problem. Using technology to remove geographic barriers, participants with a collective vision share ideas, best practices, and lessons learned, and track their progress toward similar benchmarks and shared goals. CoIIN provides a way for participants to self-organize, forge partnerships, and take coordinated action to address complex issues through structured collaborative learning, quality improvement, and innovative activities. 

Each successful CoIIN does the following:

  • Works together to identify common aims and specific, measurable, action-oriented, realistic, and time-specific objectives to clearly describe what they are setting out to achieve;
  • Identifies and utilizes evidence-based strategies to show how these objective will be accomplished; and
  • Uses clear-cut metrics and shares real-time data to show what’s working and determine if the aim was achieved.

HRSA-supported CoIINs address a range of topics across the lifespan that align with state Title V MCH Program priorities and other MCH issues that community-based organizations are working on.  These topics include: maternal health, prenatal and infant/child oral health, newborn screening, infant mortality, home visiting, pediatric emergency care, child safety, school-based health, children’s healthy weight, adolescent and young adult health, and environmental health.

Maternal and Women’s Health

Maternal Health CoIIN

The Maternal Health CoIIN, also known as the Maternal Health Initiative (MHI), is a partnership of U.S. government agencies and private organizations working together to reverse alarming and costly trends in maternal sickness/death (also known as maternal morbidity and mortality).

This initiative focuses on the following:

  • Improving women’s health before, during and beyond pregnancy.
  • Reducing low-risk cesareans.
  • Ensuring every single birthing hospital in America has access to maternal safety bundles.
    • Safety bundles are guidelines, toolkits, checklists and resources to improve patient safety.
    • Six bundles have been developed for some of the leading causes of maternal mortality. Four more will be coming, including one for cardiovascular disease.

Partners include HHS’s Office on Women’s Health, Centers for Medicare and Medicaid Services, Centers for Disease Control and Prevention, The American Congress of Obstetricians and Gynecologistsexit disclaimer icon, and The Association of Maternal and Child Health Programsexit disclaimer icon.

Home Visiting CoIIN

Launched in September 2013, through a three-year cooperative agreement with Education Development Center, Inc. (EDC)exit disclaimer icon, the Home Visiting CoIIN works to achieve breakthrough improvements in select process and outcome measures, including benchmark areas legislatively mandated for the Federal Home Visiting program, while reducing or maintaining program costs.

By creating a CoIIN, the intention is to develop seamless channels to spread information on learning and improvements more widely within participating organizations and to other Federal Home Visiting grantees and local implementing agencies.

Ultimately, the goal is to identify evidence- and experience-based practices that result in significant change.

Of families enrolled in home visiting:

84% are retained at three months; 71% at six months.

Perinatal and Infant Health

Infant Mortality CoIIN

Infant mortality refers to the death of a baby before his or her first birthday.

“The U.S infant mortality rate has declined 15 percent, from 6.86 infant deaths per 1,000 in 2005, to 5.82 in 2014.” 1

The first HRSA-supported CoIIN, which now includes teams in every state and region across the country, works to prevent and reduce infant mortality and the eliminate disparities in birth outcomes in the U.S. The work focuses on six key strategy areas:

  • Improve safe sleep practices
  • Reduce smoking before, during and/or after pregnancy
  • Promote excellent health for women before, after and in between pregnancies
  • Use evidence-based policies and programs to improve, and achieve equity in, birth outcomes
  • Prevent pre-term and early-term births
  • Increase the delivery of higher risk infants and mothers at hospitals that are best able to care for them

Ultimately, achieving success in each of these key areas will work to ensure every child reaches his or her first birthday and beyond.

Healthy Start CoIIN

The Healthy Start (HS) CoIIN is a partnership of Healthy Start grantees dedicated to strengthening HS services and systems, in order to advance program goals to reduce infant mortality and improve birth outcomes. The HS CoIIN functions as an Expert Panel to the Division of Healthy Start and Perinatal Services (DHSPS) and the Healthy Start EPIC Center, the training and technical assistance provider for the program.

The HS CoIIN seeks to promote the implementation of standardized evidence-based and field-tested approaches to essential HS components such as risk assessment, case management, and participant engagement. The goal of the HS CoIIN is to strengthen HS services and systems by promoting the implementation of standardized evidence-based approaches to core elements of the HS program.

The specific objectives of the HS CoIIN are to:

  • Promote communication among grantees, DHSPS and HS EPIC Center to ensure all grantees have a voice in setting the direction for HS;
  • Brainstorm and test opportunities to strengthen the program especially related to standardizing components of the HS model;
  • Disseminate lessons learned to the HS community; and
  • Promote HS as an effective and vital community-based resource in all communities to ensure the long-term success of HS.

The HS CoIIN has successfully developed standardized screening tools that will be implemented in 2017 by the 100 Healthy Start programs nationwide.

Child Health

Child Safety CoIIN

Injuries are the leading cause of death for children and adolescents.

The Child Safety CoIIN – made up of federal partners, national organizations and states – aims to prevent child deaths, hospitalization and ER visits due to preventable injuries. The consequences of these injuries impact the life of the child and members of their family, including:

  • lost time in school,
  • decreased academic achievement,
  • economic impacts due to missed work and medical expenses,
  • children who have long-term special health needs, and
  • emotional stress.

Each year:

  • 13,000 children die from preventable injuries
  • almost 300,000 are hospitalized, and
  • 8.9 million visit the emergency room for medical treatment.

But—this is a preventable issue. Over the past three decades, researchers and practitioners have successfully led efforts to generate an evidence base of effective interventions. To put them into practice on a national scale, takes a coordinated, collaborative effort, such as the CoIIN.

Early Childhood Comprehensive Systems Impact (ECCS Impact) CoIIN

The Early Childhood Comprehensive Systems Impact (ECCS Impact) grant program uses a Collaborative Innovation and Improvement Network (CoIIN) approach to enhance early childhood (EC) systems building and demonstrate improved outcomes in population-based children’s developmental health and family well-being indicators.

Additionally, these grants develop collective impact expertise, and implement and sustain efforts at the state, county and community levels. 

How It Works

Grant recipients identify up to five place-based communities within their state or territory to participate in the Early Childhood Comprehensive Systems Collaborative Innovation and Improvement Network (ECCS CoIIN). At least one of the identified communities in each state receives state and/or tribal Maternal, Infant and Early Childhood Home Visiting (MIECHV) services. 

ECCS CoIIN Coordination Center 

The Early Childhood Comprehensive Systems Collaborative Innovation and Improvement Network Coordination Center (ECCS CoIIN CC) manages, coordinates, and executes the CoIIN process with the ECCS Impact recipients and communities and guides and facilitates three successive 18-month CoIIN cohorts of one to five place-based communities per participating ECCS Impact grantee. 

To improve results for families, the ECCS CoIIN CC CoIIN uses the following approaches:

  • collaborative learning, 
  • identification of core indicators/benchmarks, 
  • implementation of coordinated strategies, 
  • rapid tests of change, and 
  • real-time date and collective impact principles.

The ECCS CoIIN CC will provide intensive, targeted assistance to the ECCS Impact recipients in providing support to their identified place-based communities.

School-based Health CoIIN

National level school-based health data would improve our understanding of the needs and gaps at the local and state level and allow us to collectively solve those potential issues.

“Currently, school-based health care is not tied to standardized performance measures at the national level. ”

Through a cooperative agreement led by the School-Based Health Allianceexit disclaimer icon, CoIIN participants, including individual School-Based Health Centers (SBHC), sponsoring organizations, and community- and state-level organizations, aim to:

  1. Build the capacity to document and report SBHC performance measures, and
  2. Identify best practices to increase sustainable business practices of SBHC programs.

Participants receive ongoing expert-led trainings, personalized coaching, and technical assistance to support and guide program improvement.

Adolescent and Young Adult Health

Adolescent and Young Adult Health (AYAH) CoIIN

Adolescence and young adulthood are crucial developmental periods – where behaviors can impact both immediate and ongoing health outcomes.

“ Nearly ¾ of adolescents (age 12-17) had a well-visit check-up in the past year. ”

The aims of the Adolescent and Young Adult Health (AYAH) CoIIN are to identify and implement evidence-based strategies to increase access to, and the quality of, preventive health care visits for adolescents and young adults. The collaborative network currently includes five states: New Mexico, Texas, Iowa, Mississippi, and Vermont.

Cross-Cutting/Life Course

Children’s Healthy Weight CoIIN

With a focus on early childhood, the Children’s Healthy Weight CoIIN works to provide core nutrition services for the prevention and treatment of childhood obesity.

In 2015, MCHB supported a one-year pilot program, the MCHB Pediatric Obesity Mini CoIIN to focus on policies and practices in early care and education (ECE) facilities to improve nutrition and physical activity at the state level.

Children who are obese are more likely to become obese adults.3,4

  • Adult obesity is associated with a number of serious health conditions including heart disease, diabetes, metabolic syndrome, and cancer.5, 6

Strategies used in the Mini CoIIN were based on  The Expert Committee Recommendations Regarding the Prevention, Assessment and Treatment of Child and Adolescent Overweight and Obesity . Four state teams (Arkansas, Louisiana, Ohio, and Wisconsin) participated in the MCHB Pediatric Obesity Mini CoIIN.

State teams integrated the work of the Mini CoIIN with other initiatives addressing nutrition, physical activity, and obesity prevention in early care and education settings in their state.

In 2016, MCHB will launch the Children’s Healthy Weight CoIIN which is broader in scope than the MCHB Pediatric Obesity Mini CoIIN. It will focus more broadly in settings beyond early care and education and including a larger population (ages birth to 21 years), will include a larger number of state teams, and will focus on helping state Title V programs implement strategies related to physical activity and breastfeeding.


1 Kochanek KD, Murphy SL, Xu JQ, Tejada-Vera B. Deaths: Final data for 2014. National vital statistics reports; vol 65 no 4. Hyattsville, MD: National Center for Health Statistics. 2016.

2 Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. JAMA.2014;311(8):806-814. doi:10.1001/jama.2014.732.

3 Freedman DS, Khan LK, Serdula MK, Dietz WH, Srinivasan SR, Berenson GS. The relation of childhood BMI to adult adiposity: the Bogalusa Heart Study. Pediatrics. 2005;115:22-7.

4 Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. Risk factors and adult body mass index among overweight children: the Bogalusa Heart Study. Pediatrics. 2009;123:750-57.

5 Biro FM, Wien M. Childhood obesity and adult morbidities. Am J Clin Nutr. May 2010;91(5):1499S-1505S.

6 Lobstein T, Jackson-Leach R. Estimated burden of paediatric obesity and co-morbidities in Europe. Part 2. Numbers of children with indicators of obesity-related disease. International Journal of Pediatric Obesity. 2006;1:33-41.


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