Crosswalk

MCH Jurisdictional Survey Crosswalk.docx

Maternal and Child Health Jurisdictional Survey Instrument for the Title V MCH Block Grant Program

Crosswalk

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MCH Jurisdictional Survey

Crosswalk of Survey Questions to National Outcome and Performance Measures*


*Other survey questions will be used as covariates or have been requested specifically by the jurisdictions


#

National Outcome Measure

Survey Questions

1

Percent of pregnant women who receive prenatal care beginning in the first trimester

AS1, AS2, NM1, VI11

4

Percent of low birth weight deliveries (<2,500 grams)

C2

6

Percent of early term births (37,38 weeks gestation)

C1

9.5

Sleep-related Sudden Unexpected Infant Death (SUID) rate per 100,000

GM13, GM14

13

Percent of children meeting the criteria developed for school readiness (DEVELOPMENTAL)

H3, I2, I3

14

Percent of children, ages 1 through 17, who have decayed teeth or cavities in the past year

B3

17.1

Percent of children with special health care needs (CSHCN), ages 0 through 17

A10, A11, A12, A13, A14, A21, A22, A23, A24, A25, A32, A33, A34, A35, A36, A43, A44, A45, A46, A47

17.2

Percent of children with special health care needs (CSHCN), ages 0 through 17, who receive care in a well-functioning system

D7, D8, D9, E3, E5, E6, AS4, MI18, MI19, PR3, PR4, PR5, PR6, PR7, PR8, PR9, PR10, VI4, VI5, VI6, VI7

17.3

Percent of children, ages 3 through 17, diagnosed with an autism spectrum disorder

B5, PR1, VI8

17.4

Percent of children, ages 3 through 17, diagnosed with Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD)

B5

18

Percent of children, ages 3 through 17, with a mental/behavioral condition who receive treatment or counseling

A14, A25, A36, A47, D9

19

Percent of children, ages 0 through 17, in excellent or very good health

B1, B5, B6, B7, B9, B10, B11

20

Percent of children, ages 2 through 4, and adolescents, ages 10 through 17, who are obese (BMI at or above the 95th percentile)

D3, D4

21

Percent of children, ages 0 through 17, without health insurance

F1, F2, F3

24

Percent of women who experience postpartum depressive symptoms following a recent live birth

NM7, NM8, GM3,

25

Percent of children, ages 0 through 17, who were not able to obtain needed health care in the last year

D10, D11

*Other survey questions will be used as covariates or have been requested specifically by the jurisdictions



#

National Performance Measure

Survey Questions

1

Percent of women, ages 18 through 44, with a preventive medical visit in the past year

L1, NM11, NM12, MI2, MI3, MI4,

4

A)Percent of infants who are ever breastfed and B) Percent of infants breastfed exclusively through 6 months

C5, C6, MC3

5

A) Percent of infants placed to sleep on their backs, B) Percent of infants placed to sleep on a separate approved sleep surface, C) Percent of infants placed to sleep without soft objects or loose bedding

C4, GM13, GM14

6

Percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year

D5, D6, MC1, MI20, PA1, PR15

7

Rate of hospitalization for non-fatal injury per 100,000 children, ages 0 through 9; and rate of hospitalization for non-fatal injury per 100,000 children, ages 10 through 19

D12

8

8.1 Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day; and percent of adolescents, ages 12 through 17, who are physically active at least 60 minutes per day

H8

9

Percent of adolescents, ages 12 through 17, who are bullied or who bully others

AS5, AS6, NM13, NM14, PA2, PA3, PR13, PR14

10

Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year

D1, VI1

11

Percent of children with and without special health care needs, ages 0 through 17, who have a medical home

E1, E2, E3, E4, E5, E6

12

Percent of adolescents with and without special health care needs, ages 12 through 17, who received services necessary to make transitions to adult health care

E7, E8, E9, E10

13.1

Percent of women who had a dental visit during pregnancy;

L4

13.2

Percent of children, ages 1 through 17, who had a preventive dental visit in the past year

B2, D9, D10

14.1

Percent of women who smoke during pregnancy; and

L7, L9, L10

14.2

Percent of children, ages 0 through 17, who live in households where someone smokes

J1, J2, L7, L9, L10

15

Percent of children, ages 0 through 17, who are continuously and adequately insured

F1, F2, F3, F4, F5, F6, G1, G2, G3, G4


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