| 3Ps Question # |
3Ps Question |
Change Status |
Reformatted 3Ps Tool Question |
Revised Question/ Description of revision |
Justification |
| A1 |
What is your date of birth? |
Kept from 3Ps in Screening Tools |
Demographic #1, |
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| A2 |
Are you American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or other Pacific Islander, or White? |
Kept from 3Ps in Screening Tools |
Demographic #5 |
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| A3 |
Are you Hispanic or Latina? |
Kept from 3Ps in Screening Tools |
Demographic #4 |
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| A4 |
What is the zip code of where you live? |
Kept from 3Ps in Screening Tools |
Demographic #2 |
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| A5 |
Were you born in the US? |
Kept from 3Ps in Screening Tools |
Demographic #6 |
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| A6 |
If not born in the US, what country were you born in? |
Kept from 3Ps in Screening Tools |
Demographic #6.2 |
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| A8 |
What is the highest grade or year of school completed |
Kept from 3Ps in Screening Tools |
Demographic #3 |
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| A9 |
Are you married, living with a partner, separated, widowed, divorced, never married, and not living with a partner? |
Kept from 3Ps in Screening Tools |
Preconception #1, Prenatal #10, Postpartum #16, Parenting/ IC #17 |
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| A10 |
What health insurance do you have |
Kept from 3Ps in Screening Tools |
Preconception #17, Prenatal #9, Postpartum #32, Parenting/ IC #34 |
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| A13 |
Total household income |
Kept from 3Ps in Screening Tools |
Preconception #3, Prenatal #12, Postpartum #18, Parenting/ IC #19 |
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| A15 |
Housing arrangement: own, rent, public housing, stay with a family member, homeless |
Kept from 3Ps in Screening Tools |
Preconception #7, Prenatal #16, Postpartum #22, Parenting/ IC #23 |
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| B1 |
are you pregnant now? |
Kept from 3Ps in Screening Tools |
Pregnancy History #1 |
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| B1a |
How many weeks or mo pregnant? |
Kept from 3Ps in Screening Tools |
Pregnancy History #1.1, Prenatal #1 |
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| C1 |
How would you rate your overall health? |
Kept from 3Ps in Screening Tools |
Preconception #19, Prenatal #24, Postpartum #34, Parenting/ IC #35 |
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| C2 |
How would you rate your mental health? |
Kept from 3Ps in Screening Tools |
Preconception #20, Prenatal #25, Postpartum #35, Parenting/ IC #36 |
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| C3 |
How tall are you? |
Kept from 3Ps in Screening Tools |
Preconception #22.1, Prenatal #26.1, Postpartum #36.1, Parenting/ IC #37.1 |
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| C4 |
How much did you weigh before pregnancy? |
Kept from 3Ps in Screening Tools |
Prenatal #26.2, Postpartum #36.2, Parenting/ IC #37.2 |
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| C7 |
How many times a week are you taking vitamins or folic acid per week |
Kept from 3Ps in Screening Tools |
Preconception #25, Prenatal #30, Postpartum #38, Parenting/ IC #42 |
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| C8 |
Currently smoke |
Kept from 3Ps in Screening Tools |
Prenatal #40 |
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| C9 |
Describe rules about smoking inside your home |
Kept from 3Ps in Screening Tools |
Preconception #34, Prenatal #41, Postpartum #42, Parenting/ IC #50 |
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| C10 |
Hrs per day spent in room or car with someone who smokes (secondhand smoke) |
Kept from 3Ps in Screening Tools |
Preconception #35, Prenatal #42, Postpartum #43, Parenting/ IC #51 |
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| C12 |
seatbelt use |
Kept from 3Ps in Screening Tools |
Prenatal #37 |
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| C13 |
flu vaccination |
Kept from 3Ps in Screening Tools |
Preconception #26, Prenatal #31, Postpartum #38, Parenting/ IC #43 |
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| C14 |
teeth cleaned |
Kept from 3Ps in Screening Tools |
Preconception #31, Prenatal #36, Postpartum #39, Parenting/ IC #47 |
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| D3 |
weight gain during pregnancy |
Kept from 3Ps in Screening Tools |
Pregnancy History #11 |
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| E1 |
# vaginal deliveries |
Kept from 3Ps in Screening Tools |
Pregnancy History #4 |
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| E2 |
# cesarean deliveries |
Kept from 3Ps in Screening Tools |
Pregnancy History #5 |
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| E10 |
Diagnosed medical conditions at birth per child |
Kept from 3Ps in Screening Tools |
Pregnancy History #9, #9.1 |
Were any of your babies diagnosed with any medical conditions at birth? If so, what were they diagnosed with? |
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| F4 |
Did you breast feed or pump breast milk to feed your baby after delivery, even for a short period of time? |
Kept from 3Ps in Screening Tools |
Postpartum #2, Parenting/ IC #2 |
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| F4a |
How many days, weeks or months did you breastfeed or pump breastmilk for your child? |
Kept from 3Ps in Screening Tools |
Postpartum #2.1, Parenting/ IC #2.1 |
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| F6 |
How many hours a day is your baby in the same room or car with someone who is smoking? |
Kept from 3Ps in Screening Tools |
Postpartum #44, Parenting/ IC #52 |
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| F7 |
When riding in a car, how often does your child ride in an infant car seat? |
Kept from 3Ps in Screening Tools |
Postpartum #8, Parenting/ IC #8 |
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| F8 |
In which position to you most often place your child down to sleep? |
Kept from 3Ps in Screening Tools |
Postpartum #5, Parenting/ IC #5 |
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| F9 |
In the past 2 weeks, how often has your new baby slept alone in his or her own crib or bed? |
Kept from 3Ps in Screening Tools |
Postpartum #6, Parenting/ IC #6 |
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| F15 |
concerns about speech |
Kept from 3Ps in Screening Tools |
Parenting/ IC #4.1 |
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| F16 |
concern about use of arms and legs |
Kept from 3Ps in Screening Tools |
Parenting/ IC #4.2 |
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| F17 |
concern hands and fingers |
Kept from 3Ps in Screening Tools |
Parenting/ IC #4.3 |
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| F18 |
concern about learning |
Kept from 3Ps in Screening Tools |
Parenting/ IC #4.4 |
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| F19 |
concern about behavior |
Kept from 3Ps in Screening Tools |
Parenting/ IC #4.5 |
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| H3 |
Do you have a personal doctor/ nurse (familiar with health history, etc.)? |
Kept from 3Ps in Screening Tools |
Preconception #15, #15.1, Prenatal #7, #7.1, Postpartum #30, #30.1, Parenting/ IC #31, #31.1 |
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| H4 |
In the past 12 months, did you see doctor/ nurse/ health care worker for preventive care? |
Kept from 3Ps in Screening Tools |
Preconception #18, |
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| H7 |
Does your child have a personal doctor/ nurse (familiar with health history, etc.)? |
Kept from 3Ps in Screening Tools |
Postpartum #9, #9.1, Parenting/ IC #10, #10.1 |
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| I1a |
People in my neighborhood/ community help each other out |
Kept from 3Ps in Screening Tools |
Preconception #11.1, Prenatal #20.1, Postpartum #26.1, Parenting/ IC #27.1 |
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| I1b |
We watch out for each other's children in this neighborhood or community |
Kept from 3Ps in Screening Tools |
Preconception #11.2, Prenatal #20.2, Postpartum #26.2, Parenting/ IC #27.2 |
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| I1c |
There are people I can count on in this neighborhood and community |
Kept from 3Ps in Screening Tools |
Preconception #11.3, Prenatal #20.3, Postpartum #26.3, Parenting/ IC #27.3 |
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| I2 |
How often do you feel safe in your community or neighborhood? |
Kept from 3Ps in Screening Tools |
Preconception #12, Prenatal #21, Postpartum #27, Parenting/ IC #28 |
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| I3 |
How often do you get together to talk with family, friends, neighbors? |
Kept from 3Ps in Screening Tools |
Preconception #14, Prenatal #22, Postpartum #28, Parenting/ IC #30 |
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| I4 |
How often do you participate in school, community, or neighborhood activities? |
Kept from 3Ps in Screening Tools |
Preconception #13, Prenatal #23, Postpartum #29, Parenting/ IC #29 |
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New question in Screening Tools, Not originally in 3Ps |
Demographic 6.3 |
When did you come to live in the United States? |
More comprehensive information is necessary to ensure that participants are receiving culturally appropriate services and being connected with service providers that can meet their needs. |
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New question in Screening Tools, Not originally in 3Ps |
Postpartum #12, , Parenting/ IC #12 |
What kind of insurance does your child have? |
Insurance needs to be captured for both mother and child for benchmark reporting and adequate care coordination. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #10, #10.1, Prenatal #19, #19.1, Postpartum #25, #25.1, Parenting/ IC #26, #26.1 |
Have you ever had a case with child protective services? If yes, do you currently have one? |
Important for assessment and care coordination. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #4, Prenatal #13, Postpartum #19, Parenting/ IC #20 |
How often has it been very hard to get by on your family's income, by this I mean pay for food or housing? |
Assess need for services as well as risk. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #5, Prenatal #14, Postpartum #20, Parenting/ IC #21 |
How often do you need transportation to medical appointments? |
Assesses need for transportation services, and identifies barriers to accessing care. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #6, Prenatal #15, Postpartum #21, Parenting/ IC #22 |
Question about whether you were able to afford the food you need. Which statement best describes your food situation? |
Assess food security and identify need for services. |
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New question in Screening Tools, Not originally in 3Ps |
Pregnancy History #12 |
Are all of your children living with you? |
Important for assessment and care coordination. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #7.1, Prenatal #16.1, Postpartum #22.1, Parenting/ IC #23.1 |
Is this place where you live now a regular place to stay? By 'a regular place to stay'� I am referring to a house, apartment, room, or other housing where you could stay 30 days in a row or more in the same place. |
The focus of housing questions was changed from quantifying to quality. Quality and stability of housing is important for the health and safety of pregnant and parenting women. These questions allow for thorough screening related to this, and therefore timely referral to services can be given as appropriate. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #7.2, Prenatal #16.2, Postpartum #22.2, Parenting/ IC #23.2 |
Do you share housing with someone, live in an emergency or transition shelter, or have some other living arrangement? |
The focus of housing questions was changed from quantifying to quality. Quality and stability of housing is important for the health and safety of pregnant and parenting women. These questions allow for thorough screening related to this, and therefore timely referral to services can be given as appropriate. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #8, Prenatal #17, Postpartum #23, Parenting/ IC #24 |
How do you feel about your current housing situation--do you feel very stable and secure, fairly stable and |
The focus of housing questions was changed from quantifying to quality. Quality and stability of housing is important for the health and safety of pregnant and parenting women. These questions allow for thorough screening related to this, and therefore timely referral to services can be given as appropriate. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #8.1, Prenatal #17.1, Postpartum #23.1, Parenting/ IC #24.1 |
If concerned, what issues concern you about your housing situation? |
The focus of housing questions was changed from quantifying to quality. Quality and stability of housing is important for the health and safety of pregnant and parenting women. These questions allow for thorough screening related to this, and therefore timely referral to services can be given as appropriate. |
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New question in Screening Tools, Not originally in 3Ps |
Prenatal #2 |
What is your baby's due date? |
Important for assessment and care coordination. |
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New question in Screening Tools, Not originally in 3Ps |
Prenatal #3 |
How many months or weeks pregnant were you when you had your first visit for prenatal care? |
Access and receipt of prenatal care is critical to healthy mothers and infants. Therefore understanding access and use of prenatal care is very important for Healthy Start programs. |
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New question in Screening Tools, Not originally in 3Ps |
Prenatal #4 |
Are you currently receiving prenatal care? |
Access and receipt of prenatal care is critical to healthy mothers and infants. Therefore understanding access and use of prenatal care is very important for Healthy Start programs. |
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New question in Screening Tools, Not originally in 3Ps |
Prenatal #5 |
If yes, when was your last prenatal visit? |
Access and receipt of prenatal care is critical to healthy mothers and infants. Therefore understanding access and use of prenatal care is very important for Healthy Start programs. |
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New question in Screening Tools, Not originally in 3Ps |
Prenatal #6 |
Have you had any difficulty getting the prenatal care that you need? |
Access and receipt of prenatal care is critical to healthy mothers and infants. Therefore understanding access and use of prenatal care is very important for Healthy Start programs. |
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New question in Screening Tools, Not originally in 3Ps |
Prenatal #6.1 |
If yes, what are the reasons for the difficulty in getting prenatal care? |
Access and receipt of prenatal care is critical to healthy mothers and infants. Therefore understanding access and use of prenatal care is very important for Healthy Start programs. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #21.2, Prenatal #29.3, Postpartum #36.3 |
How much do you weigh now? |
Important for assessment and care coordination. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #22.1, #22.2, Prenatal #27.1, #27.2, Parenting/ IC #39.1 |
If yes to #22, then have you been seen in the emergency room or hospitalized for any of these conditions within the last 6 months? If so, which ones? |
Important for assessment and care coordination. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #23, Prenatal #28, Parenting/ IC #40 |
Currently having any pain? |
Important for assessment and care coordination. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #24, Prenatal #29, Parenting/ IC #41 |
Taking any prescription medications? |
Assess medications that pose a risk to fetal development. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #24.1, Prenatal #29.1, Parenting/ IC #41.1 |
If yes to prior, please specify which medications |
Assess medications that pose a risk to fetal development. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #24.2, Prenatal #29.2, Parenting/ IC #41.2 |
If yes, are you taking these medications as prescribed? |
Assess medications and drug use that pose a risk to fetal development. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #24.3, Prenatal #29.3, Parenting/ IC #41.3 |
If no, which medications are you taking not as prescribed? |
Assess medications and drug use that pose a risk to fetal development. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #33, Prenatal #39, Postpartum #41, Parenting/ IC #49 |
In the past year how often have you used the following (table; row headers: Alcohol, tobacco, mood altering drugs, prescription drugs for non-medical reasons, illegal drugs; column headers: Never, once or twice a month, weekly, daily or almost daily, declined to answer) |
Assess medications and drug use that pose a risk to fetal development. |
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New question in Screening Tools, Not originally in 3Ps |
Postpartum #41.1 |
Did you smoke any cigarettes or use any tobacco products in the last 3 months of your pregnancy? |
Needed for benchmark reporting. |
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New question in Screening Tools, Not originally in 3Ps |
Prenatal #43 |
Which describes your alcohol consumption now (for participants that are currently pregnant)? |
Important for assessment and care coordination. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #27 (27.1-27.5), Parenting/ IC #44 (44.1-44.5) |
Ever received other vaccines? |
Assesses current immunization status, based on ACOG recommendation. |
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New question in Screening Tools, Not originally in 3Ps |
Prenatal #32 |
Have you receives a Tdap and/ or Hep B shot/ vaccine since you became proegnant? |
Important for assessment and care coordination. |
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New question in Screening Tools, Not originally in 3Ps |
Prenatal #33 |
Have you been tested for Hep C since you became pregnant? |
Important for assessment and care coordination. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #28, Prenatal #34, Parenting/ IC #45 |
Have you ever been diagnosed with any of the following? (list of STDs-- HIV, Chlamydia, Hepatitis B or C, Syphillis, etc.) |
Important for assessment and care coordination. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #30 |
In the past 12 months would you say you used a condom with your partner or partners every time, most of the time, about half the time, some of the time, or none of the time? |
Assess for sexual/ reproductive health purposes. |
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New question in Screening Tools, Not originally in 3Ps |
Postpartum #1 |
Please tell me the outcome of your pregnancy (live birth-- single or multiple, abortion, fetal death/ still birth, miscarriage) |
Reframing existing questions to capture in a more meaningful way. |
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New question in Screening Tools, Not originally in 3Ps |
Postpartum #1.3 |
Was your labor induced? |
Important for care coordination and appropriate referral to services. |
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New question in Screening Tools, Not originally in 3Ps |
Postpartum #1.4 |
Was your baby born vaginally or by c-section? |
Important for care coordination and appropriate referral to services. |
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New question in Screening Tools, Not originally in 3Ps |
Postpartum #1.4.1 |
If by c-section, what were the reasons? |
Important for care coordination and appropriate referral to services. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #36, Prenatal #44, Postpartum #45, Parenting/ IC #53 |
Personal Safety: Partner threatened or made feel unsafe, frightened for your/ your family's safety because of partner's anger/ threats, partner controlling activities, partner physically hurt you. partner forced sexual activity, anyone else physically hurt you in any of these ways? |
Intimate Partner Violence screening. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #37, Prenatal #50, Postpartum #46, Parenting/ IC #54 |
Did any of the following potentially stressful events occur in the last 12 months (sick family member, separation/ divorce, moved, homeless, partner job loss, personal job loss, personal or partner cut in hours, military deployment, arguments, problems paying bills, partner or personal jail, drug use of someone close to you, death of someone close to you)? |
Assess stress/ chronic stress/ resiliance as a risk factor. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #38, Prenatal #51, Postpartum #47, Parenting/ IC #55 |
How have other people treated you in day to day life": Table; row headers: less courtesy or respect than others, receive poorer service, as not smart, afraid of you, threatened or harassed; column headers: almost every day, at least once a week, a few times a month, a few times a year, less than once a year, never, declined to answer |
Assess stress/ chronic stress/ resiliance as a risk factor. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #39, Prenatal #52, Postpartum #48, Parenting/ IC #56 |
If more than a few times a month for prior question, what do you think is the main reason for these experiences? (national origin, gender, race, religion, weight, sexual orientation, skin color, education/ income) |
Assess stress/ chronic stress/ resiliance as a risk factor. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #40, Prenatal #53, Postpartum #49, Parenting/ IC #57 |
Which is true most of the time for how you handle life events (I tend to bounce back quickly, I have a hard time making it through, it does not take me long to recover from a stressful event, it is hard for me to snap back when something bad happens) |
Assess stress/ chronic stress/ resiliance as a risk factor. |
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New question in Screening Tools, Not originally in 3Ps |
Postpartum #3 |
What are you currently feeding your baby? |
Important for assessment and care coordination. |
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New question in Screening Tools, Not originally in 3Ps |
Postpartum #4 |
Do you have any concern's about your baby's feeding? |
Important for assessment and care coordination. |
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New question in Screening Tools, Not originally in 3Ps |
Postpartum #4.1 |
If yes, what is your concern? |
Important for assessment and care coordination. |
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New question in Screening Tools, Not originally in 3Ps |
Postpartum #7, Parenting/ IC #7 |
Please tell us about your child's sleeping location in the past 2 weeks |
AAP recommends 3 specific aspects of safe sleep, the first two are addressed in the prior screening tool questions, this question assesses whether the child sleeps on a firm surface free of loose/ soft toys and blankets |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #41, Prenatal #54, Postpartum #50, Parenting/ IC #58 |
Social Support: How often is someone available to: table; row headers: Provide temporary financial support, do nothing enjoyable with you, help with daily chores, turn o for suggestions about how to deal with a problem, watch your baby for you; column headers: all the time, most of the time, some of the time, a little of the time, none of the time |
Priority area for Healthy Start program and important for care coordination. |
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New question in Screening Tools, Not originally in 3Ps |
Prenatal #55.1, Postpartum #51.1, Parenting/ IC #59.1 |
Would you describe the father of your baby as involved and supportive, involved but not supporting, not involved, declined to answer |
Priority area for Healthy Start program, needed for benchmark reporting. |
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New question in Screening Tools, Not originally in 3Ps |
Prenatal #56, Postpartum #52, Parenting/ IC #60 |
Is there someone you can count on to help you with your baby? |
Priority area for Healthy Start program and important for care coordination. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #42, Prenatal #57, Postpartum #53, Parenting/ IC #61 |
If yes to prior, who can you count on? |
Priority area for Healthy Start program and important for care coordination. |
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New question in Screening Tools, Not originally in 3Ps |
Preconception #16.2, Prenatal #8.2, Postpartum #10.2 |
If 'some other place' in prior question, friend/ relative, Mexico/ other location outside of the US, other____ |
Combined into more meaningful question that get's at usual source of care and can be used to report benchmark. |
| A14b |
work 35 or more hours per week |
Removed 3Ps question; not included in Screening Tools |
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Question deemed not necessary, as the information it is getting at (working, financial security, etc.) is captured elsewhere. |
| A16 |
Number of household members |
Removed 3Ps question; not included in Screening Tools |
|
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Determined to be less critical than other information for the purposes of assessment and care coordination.
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| A17 |
Which adults live in the same house, apt or trailer? |
Removed 3Ps question; not included in Screening Tools |
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Determined to be less critical than other information for the purposes of assessment and care coordination.
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| A18 |
How many babies, children and teenagers live in the house |
Removed 3Ps question; not included in Screening Tools |
|
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Determined to be less critical than other information for the purposes of assessment and care coordination.
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| A18a |
How many babies, children and teenagers live in the house with you are male |
Removed 3Ps question; not included in Screening Tools |
|
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Determined to be less critical than other information for the purposes of assessment and care coordination.
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| A18b |
ages of household members |
Removed 3Ps question; not included in Screening Tools |
|
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Determined to be less critical than other information for the purposes of assessment and care coordination.
|
| A19a |
How many household members are less than 12 months |
Removed 3Ps question; not included in Screening Tools |
|
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Determined to be less critical than other information for the purposes of assessment and care coordination.
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| A19b |
How many household members are 1-5 years |
Removed 3Ps question; not included in Screening Tools |
|
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Determined to be less critical than other information for the purposes of assessment and care coordination.
|
| A19c |
How many household members are 6-17 years |
Removed 3Ps question; not included in Screening Tools |
|
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Determined to be less critical than other information for the purposes of assessment and care coordination.
|
| Ca8b |
Advised to quit smoking |
Removed 3Ps question; not included in Screening Tools |
|
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Captured in other questions. |
| C11a |
how many drinks per week |
Removed 3Ps question; not included in Screening Tools |
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| D1 |
Pregnancy in past 12 mo |
Removed 3Ps question; not included in Screening Tools |
|
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Relevant information was captured elsewhere |
| D2 |
prior pregnancy - first prenatal visit |
Removed 3Ps question; not included in Screening Tools |
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Determined to be less important for the purposes of these tools than other information collected. Program unable to impact and this information is gathered about current pregnancy and/ or women's experience. |
| D6 |
multivitamin or folic acid (during last pregnancy) |
Removed 3Ps question; not included in Screening Tools |
|
|
Determined to be less critical for the purposes of these tools than other information collected. Program unable to impact and this information is gathered about current pregnancy and/ or women's experience. |
| D7 |
smoked cigarettes (during last pregnancy) |
Removed 3Ps question; not included in Screening Tools |
|
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Determined to be less critical for the purposes of these tools than other information collected. Program unable to impact and this information is gathered about current pregnancy and/ or women's experience. |
| D7a |
number of cigarettes (during last pregnancy) |
Removed 3Ps question; not included in Screening Tools |
|
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Determined to be less critical for the purposes of these tools than other information collected. Program unable to impact and this information is gathered about current pregnancy and/ or women's experience. |
| D7b |
advise to quit (during last pregnancy) |
Removed 3Ps question; not included in Screening Tools |
|
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Determined to be less critical for the purposes of these tools than other information collected. Program unable to impact and this information is gathered about current pregnancy and/ or women's experience. |
| D8 |
smoking in the house (during last pregnancy) |
Removed 3Ps question; not included in Screening Tools |
|
|
Determined to be less critical for the purposes of these tools than other information collected. Program unable to impact and this information is gathered about current pregnancy and/ or women's experience. |
| D9 |
smoking in car (during last pregnancy) |
Removed 3Ps question; not included in Screening Tools |
|
|
Determined to be less critical for the purposes of these tools than other information collected. Program unable to impact and this information is gathered about current pregnancy and/ or women's experience. |
| D10 |
alcoholic drinks (during last pregnancy) |
Removed 3Ps question; not included in Screening Tools |
|
|
Determined to be less critical for the purposes of these tools than other information collected. Program unable to impact and this information is gathered about current pregnancy and/ or women's experience. |
| D11 |
seatbelt use (during last pregnancy) |
Removed 3Ps question; not included in Screening Tools |
|
|
Determined to be less critical for the purposes of these tools than other information collected. Program unable to impact and this information is gathered about current pregnancy and/ or women's experience. |
| D12 |
flu vaccination (during last pregnancy) |
Removed 3Ps question; not included in Screening Tools |
|
|
Determined to be less critical for the purposes of these tools than other information collected. Program unable to impact and this information is gathered about current pregnancy and/ or women's experience. |
| D13 |
dentist (during last pregnancy) |
Removed 3Ps question; not included in Screening Tools |
|
|
Determined to be less critical for the purposes of these tools than other information collected. Program unable to impact and this information is gathered about current pregnancy and/ or women's experience. |
| D14 |
HIV test (during last pregnancy) |
Removed 3Ps question; not included in Screening Tools |
|
|
Determined to be less critical for the purposes of these tools than other information collected. Program unable to impact and this information is gathered about current pregnancy and/ or women's experience. |
| D15 |
Chlamydia test (during last pregnancy) |
Removed 3Ps question; not included in Screening Tools |
|
|
Determined to be less critical for the purposes of these tools than other information collected. Program unable to impact and this information is gathered about current pregnancy and/ or women's experience. |
| D16 |
STD test (during last pregnancy) |
Removed 3Ps question; not included in Screening Tools |
|
|
Determined to be less critical for the purposes of these tools than other information collected. Program unable to impact and this information is gathered about current pregnancy and/ or women's experience. |
| E2A |
C-Section before 39 weeks? |
Removed 3Ps question; not included in Screening Tools |
|
|
Reframing existing questions to capture in a more meaningful way. |
| E2B |
What were the reasons for having C-Section before 39 weeks? |
Removed 3Ps question; not included in Screening Tools |
|
|
Reframing existing questions to capture in a more meaningful way. |
| E3B |
# months when lost baby |
Removed 3Ps question; not included in Screening Tools |
|
|
Determined to be less important for the purposes of these tools than other information collected. |
| E4B |
# of months before abortion |
Removed 3Ps question; not included in Screening Tools |
|
|
Determined to be less important for the purposes of these tools than other information collected. |
| E12 |
types of people in the room at delivery of last child |
Removed 3Ps question; not included in Screening Tools |
|
|
Determined to be less important for the purposes of these tools than other information collected. |
| E13 |
1 week check up for child |
Removed 3Ps question; not included in Screening Tools |
|
|
Determined better to capture in another way. |
| F1 |
child's race |
Removed 3Ps question; not included in Screening Tools |
|
|
|
| F2 |
Child's ethnicity |
Removed 3Ps question; not included in Screening Tools |
|
|
|
| F5 |
child's overall health |
Removed 3Ps question; not included in Screening Tools |
|
|
Addressed through other questions. |
| F11 |
family attend class |
Removed 3Ps question; not included in Screening Tools |
|
|
Information is captured in a number of different questions, on a broader level. |
| F12b |
you/ your partner tell stories/ sing songs |
Removed 3Ps question; not included in Screening Tools |
|
|
Information is captured in a number of different questions, on a broader level. |
| F12c |
you/ your partner take on outings |
Removed 3Ps question; not included in Screening Tools |
|
|
Information is captured in a number of different questions, on a broader level. |
| F13b |
family members tell stories |
Removed 3Ps question; not included in Screening Tools |
|
|
Information is captured in a number of different questions, on a broader level. |
| F13c |
family members take on outings |
Removed 3Ps question; not included in Screening Tools |
|
|
Information is captured in a number of different questions, on a broader level. |
| F14 |
Child's last check up develop screen |
Removed 3Ps question; not included in Screening Tools |
|
|
Information is captured in a number of different questions, on a broader level. |
| H4a |
# times to see doctor |
Removed 3Ps question; not included in Screening Tools |
|
|
Relevant information is captured in other questions. |
| I1d |
If my child were outside playing and got hurt or scared, there are adults nearby who I trust to help my child |
Removed 3Ps question; not included in Screening Tools |
|
|
|
| I5 |
member of CAN |
Removed 3Ps question; not included in Screening Tools |
|
|
Programs capture this information elsewhere
|
| A7 |
What is the language you speak at home |
Revised 3Ps question is included in Screening Tools |
Demographic #7, #8, #8.1 |
How well do you speak English?; Do you speak a language other than English at home? ; If yes, What is this language? |
More comprehensive information is necessary to ensure that participants are receiving culturally appropriate services and being connected with service providers that can meet their needs. |
| A11 |
Are you on WIC? |
Revised 3Ps question is included in Screening Tools |
Preconception #9, Prenatal #18, Postpartum #24, Parenting/ IC #25 |
Staff to read to participant: I am going to read a list of services. Please tell me if you are receiving the service, if you have applied for the service and are waiting to find out if you will receive services, if you need services, or if you don't need services. I want to remind you that I ask these questions so we can provide the best services for your family. |
Questions about public assistance are combined into single table, for ease of use. |
| A12 |
Are you receiving TANF? |
Revised 3Ps question is included in Screening Tools |
Preconception #9, Prenatal #18, Postpartum #24, Parenting/ IC #25 |
Staff to read to participant: I am going to read a list of services. Please tell me if you are receiving the service, if you have applied for the service and are waiting to find out if you will receive services, if you need services, or if you don't need services. I want to remind you that I ask these questions so we can provide the best services for your family. |
Questions about public assistance are combined into single table, for ease of use. |
| A14a |
Are you working at a paying job? |
Revised 3Ps question is included in Screening Tools |
Preconception #2, Prenatal #11, Postpartum #17, Parenting/ IC #18 |
Are you currently employed for wages, self-employed, out of work 1 year or more, out of work for less than 1 year, homemaker, student, retired, unable to work. |
Answer options changed to be more comprehensive. |
| B2 |
How many times have you been pregnant? |
Revised 3Ps question is included in Screening Tools |
Pregnancy History #2, #3 |
|
#2 if currently pregnant, #3 if not currently pregnant |
| C5 |
Ever been told by a doctor that you have hypertension? |
Revised 3Ps question is included in Screening Tools |
Preconception #22, Prenatal #27, Parenting/ IC #39 |
Questions on Screening Tools ask about a number of medical conditions (asthma, Autoimmune diseases, cancer, cardiovascular disease, depression/ mental health conditions, diabetes, eating disorders, gestational diabetes, high blood pressure/ hypertension, PKU, renal disease, seizure disorders, sickle cell, thrombophilia, thyroid) |
Important for assessment and care coordination. |
| C6 |
Ever been told by a doctor that you have Diabetes? |
Revised 3Ps question is included in Screening Tools |
Preconception #22, Prenatal #27, Parenting/ IC #39 |
Questions on Screening Tools ask about a number of medical conditions (asthma, Autoimmune diseases, cancer, cardiovascular disease, depression/ mental health conditions, diabetes, eating disorders, gestational diabetes, high blood pressure/ hypertension, PKU, renal disease, seizure disorders, sickle cell, thrombophilia, thyroid) |
Important for assessment and care coordination. |
| C8a |
# cigarettes per day |
Revised 3Ps question is included in Screening Tools |
Postpartum #41.2 |
Only asked of postpartum women about the last 3 months of pregnancy. |
Information is only needed from a subset of information. |
| C11 |
Do you drink alcoholic drinks? |
Revised 3Ps question is included in Screening Tools |
Preconception #33, Prenatal #39, Postpartum #41 |
In the past year how often have you used the following (table; row headers: Alcohol, tobacco, mood altering drugs, prescription drugs for non-medical reasons, illegal drugs; column headers: Never, once or twice a month, weekly, daily or almost daily, declined to answer) |
Important for assessment and care coordination. |
| C15 |
HIV test |
Revised 3Ps question is included in Screening Tools |
Preconception #29, Prenatal #35, Parenting/ IC #44 |
When was the last time you were tested for STDs or STIs? Includes table of STDs/ STIs with timeframes. |
Combined into comprehensive STD/ STI testing question. |
| C16 |
Chlamydia test |
Revised 3Ps question is included in Screening Tools |
Preconception #29, Prenatal #35, Parenting/ IC #44 |
When was the last time you were tested for STDs or STIs? Includes table of STDs/ STIs with timeframes. |
Combined into comprehensive STD/ STI testing question. |
| C17 |
STD test including gonorrhea, etc. |
Revised 3Ps question is included in Screening Tools |
Preconception #29, Prenatal #35, Parenting/ IC #44 |
When was the last time you were tested for STDs or STIs? Includes table of STDs/ STIs with timeframes. |
Combined into comprehensive STD/ STI testing question. |
| D4 |
preeclampsia |
Revised 3Ps question is included in Screening Tools |
Pregnancy History #6, #6.1 |
Did you have any problems or complications with any of your past pregnancies?; If so, what problems or complications did you experience? |
Important for assessment and care coordination. |
| D5 |
gestational diabetes |
Revised 3Ps question is included in Screening Tools |
Pregnancy History #6, #6.1 |
Did you have any problems or complications with any of your past pregnancies?; If so, what problems or complications did you experience? |
Important for assessment and care coordination. |
| E3A |
unintentional loss of pregnancy |
Revised 3Ps question is included in Screening Tools |
Pregnancy History #3 |
Please tell me how your previous pregnancies ended... live birth, miscarriage, Ectopic or tubal pregnancy, abortion, fetal death/ stillbirth |
In screening tools, outcomes of prior births are captured in one table now, recording # of pregnacies by each outcome |
| E4A |
abortion |
Revised 3Ps question is included in Screening Tools |
Pregnancy History #3 |
Please tell me how your previous pregnancies ended... live birth, miscarriage, Ectopic or tubal pregnancy, abortion, fetal death/ stillbirth |
In screening tools, outcomes of prior births are captured in one table now, recording # of pregnacies by each outcome |
| E5 |
DOB of children |
Revised 3Ps question is included in Screening Tools |
Pregnancy History #3, Postpartum #1.1, Parenting/ IC #1 |
DOB of last live or still birth |
Information about the last live or still birth is important for assessing interconception spacing. |
| E6 |
location of delivery per child |
Revised 3Ps question is included in Screening Tools |
Postpartum #1.2 |
Just collected for most recent child in screening tools. |
Only captured in detail for most recent delivery |
| E7 |
weeks pregnant at delivery per child |
Revised 3Ps question is included in Screening Tools |
Pregnancy History #7, Postpartum #1.7 |
|
Only captured in detail for the most recent delivery |
| E8 |
Child weight at birth per child |
Revised 3Ps question is included in Screening Tools |
Pregnancy History #8, Postpartum #1.8 |
Did any of your babies weigh less than 5 pounds 8 oz at birth?, How much did your child weigh at birth? |
Important for assessment and care coordination. |
| E9 |
what type of nursery did your child spend time in after birth per child |
Revised 3Ps question is included in Screening Tools |
Pregnancy History #10 |
Did any of your babies stay in the hospital after you came home? |
Important for assessment and care coordination. |
| E11 |
Child days in the hospital after birth per child |
Revised 3Ps question is included in Screening Tools |
Postpartum #1.6 |
Did your baby stay in the hospital after you came home? |
Important for assessment and care coordination. |
| E14 |
postpartum visit |
Revised 3Ps question is included in Screening Tools |
Postpartum #33, #33.1, #33.2, Parenting/ IC #38, #38.1 |
Since your baby was born, have you had a postpartum visit? If yes, when? If no, do you have one scheduled? |
Needed for benchmark reporting. |
| E15 |
How often do you feel down/ depressed/ sad? |
Revised 3Ps question is included in Screening Tools |
Preconception #32.2, Prenatal #38.2, Postpartum #40.2, Parenting/ IC #48.2 |
How often do you feel down, depressed, hopeless? |
Combined two very similar questions into one. |
| E16 |
How often do you feel hopeless? |
Revised 3Ps question is included in Screening Tools |
Preconception #32.2, Prenatal #38.2, Postpartum #40.2, Parenting/ IC #48.2 |
How often do you feel down, depressed, hopeless? |
Combined two very similar questions into one. |
| E17 |
How often do you feel slowed down? |
Revised 3Ps question is included in Screening Tools |
Preconception #32.1, Prenatal #38.1, Postpartum #40.2, Parenting/ IC #48.1 |
How do you often do you feel little interest or pleasure in doing things? |
Important for assessment and care coordination. |
| F3 |
breastfeeding info/ education |
Revised 3Ps question is included in Screening Tools |
Postpartum #2, #2.1 |
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. |
Important for assessment and care coordination. |
| F10 |
Father/ partner attend class/ appointments |
Revised 3Ps question is included in Screening Tools |
Prenatal #55, Postpartum #51, Parenting/ IC #59 |
What is the baby's father's role in your life? |
Priority area for Healthy Start program, needed for benchmark reporting. |
| F12a |
you/ your partner read |
Revised 3Ps question is included in Screening Tools |
Parenting/ IC #3 |
Please indicate the number of days you or a family member read to your child during the past week. |
Combined you, partner, and family |
| F13a |
family members read |
Revised 3Ps question is included in Screening Tools |
Parenting/ IC #3 |
Please indicate the number of days you or a family member read to your child during the past week. |
|
| G1 |
received info/edu about folic acid/ multivitamin from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G2 |
received info/edu about eating healthy food from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G3 |
received info/edu about weight gain during pregnancy from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G4 |
received info/edu about health risks during pregnancy from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G5 |
received info/edu about seatbelts from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G6 |
received info/edu about smoking from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G7 |
received info/edu about alcohol/ drugs from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G8 |
received info/edu about depressed/ baby blues from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G9 |
received info/edu about parenting from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G10 |
received info/edu about installing/ using car seat from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G11 |
received info/edu about safe sleep positions from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G12 |
received info/edu about family planning/ birth control from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G13 |
received info/edu about what to do in instances of IPV from HS or other source? |
Revised 3Ps question is included in Screening Tools |
Preconception #36- Follow Up |
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G14 |
received info/edu about get support if feeling depressed from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G15 |
received info/edu about managing stress from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G16 |
received info/edu vaccines from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G17 |
received info/edu about maintaining healthy weight from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G18 |
received info/edu about keeping teeth healthy from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G19 |
received info/edu about STIs from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G20 |
received info/edu about medicaid eligibility from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| G21 |
received info/edu about eligible for WIC from HS or other source? |
Revised 3Ps question is included in Screening Tools |
|
Internally, the program documents whether they provided information and education, as deemed appropriate by assessment questions. No additional questions are asked of participants related to this. |
|
| H1 |
usual source of sick care |
Revised 3Ps question is included in Screening Tools |
Preconception #16, Prenatal #8, Postpartum #31, Parenting/ IC #32 |
Is there a place that you usually go for care when you are sick or need advice about your health? |
Combined into more meaningful question that get's at usual source of care and can be used to report benchmark. |
| H1a |
where do you go for sick care |
Revised 3Ps question is included in Screening Tools |
Preconception #16.1, Prenatal #8.1, Postpartum #31.1, Parenting/ IC #32.1 |
If yes, What kind of place do you usually go when you are sick or need advice about your health? (doctor's office, ED, outpatient clinic, retail clinic, school, some other place) |
Combined into more meaningful question that get's at usual source of care and can be used to report benchmark. |
| H2 |
Usual source of routine care/ check up |
Revised 3Ps question is included in Screening Tools |
Preconception #16, Prenatal #8, Postpartum #31, Parenting/ IC #32 |
Is there a place that you usually go for care when you are sick or need advice about your health? |
Combined into more meaningful question that get's at usual source of care and can be used to report benchmark. |
| H2a |
where do you go for checkup |
Revised 3Ps question is included in Screening Tools |
Preconception #16.1, Prenatal #8.1, Postpartum #31.1, Parenting/ IC #32.1 |
If yes, What kind of place do you usually go when you are sick or need advice about your health? (doctor's office, ED, outpatient clinic, retail clinic, school, some other place) |
Combined into more meaningful question that get's at usual source of care and can be used to report benchmark. |
| H5 |
child's usual source of sick care |
Revised 3Ps question is included in Screening Tools |
Postpartum #10, Parenting/ IC #11 |
Is there a place that your child usually goes for care when he/ she is sick or when advice is needed about your baby's health? |
Combined questions to be consistent with questions about mother and with benchmark reporting. |
| H5a |
where is child's source of sick care |
Revised 3Ps question is included in Screening Tools |
Postpartum #10, Parenting/ IC #11 |
Is there a place that your child usually goes for care when he/ she is sick or when advice is needed about your baby's health? |
Combined questions to be consistent with questions about mother and with benchmark reporting. |
| H6 |
Is there a place for routine care for child? |
Revised 3Ps question is included in Screening Tools |
Postpartum #10.1, Parenting/ IC #11.1 |
What kind of place does your baby most often go when sick or you are in need of advice about his/ her health? |
Combined questions to be consistent with questions about mother and with benchmark reporting. |
| H6a |
If yes, what is child's usual source of routine care |
Revised 3Ps question is included in Screening Tools |
Postpartum #10.1, Parenting/ IC #11 |
What kind of place does your baby most often go when sick or you are in need of advice about his/ her health? |
Combined questions to be consistent with questions about mother and with benchmark reporting. |
| H8 |
child get routine medical care |
Revised 3Ps question is included in Screening Tools |
Postpartum #10, Parenting/ IC #11 |
Is there a place that your child usually goes for care when he/ she is sick or when advice is needed about your baby's health? |
Combined questions to be consistent with questions about mother and with benchmark reporting. |
| H8a |
child preventive visits in prior 12 months |
Revised 3Ps question is included in Screening Tools |
Postpartum #11, Parenting/ IC #13 |
When was your child's last visit to a doctor, nurse or other healthcare provider for a well-child checkup? |
Revised question to capture more meaningful information and to align with required benchmark reporting. |
| H9 |
vaccines for child |
Revised 3Ps question is included in Screening Tools |
Postpartum #11.1, Parenting/ IC #13.1 |
Did your baby receive vaccines at this visit (referring to date provided in Postpartum #11) |
Vaccines are asked about in conjunction with last well child visit, so the date of the well child visit is used. |
| H9a |
last vaccine date |
Revised 3Ps question is included in Screening Tools |
Postpartum #11.1, Parenting/ IC #13.1 |
Did your baby receive vaccines at this visit (referring to date provided in Postpartum #11) |
Vaccines are asked about in conjunction with last well child visit, so the date of the well child visit is used. |
| H10 |
Contraception use "What are you using to keep from getting pregnant?" |
Revised 3Ps question is included in Screening Tools |
Preconception #43-45.1, Prenatal #58-59.1, Postpartum #13-15.1, Parenting/ IC #14-16.1 |
Reproductive Life Plan: Do you plan to have any children at any time in your future?; How many children would you like to have?; Would you like to be pregnant in the next year?; How long would you like to wait until you become pregnant?; Are you currently using any form of contraception to prevent pregnancy or STIs?; What kind of birth control are you you using now?; Are you satisfied with your birth control method?; If not using contraception, what family planning method do you plan to use to avoid pregnancy?; How confident are you that you will be able to use this method without any problems? |
Reproductive life planning is a primary function of Healthy Start Program and is necessary to both meet and report on Healthy Start Benchmarks |