Form 1 Attachment A - Form 4 - MIECHV Quarterly Performance Rep

The Maternal, Infant, and Early Childhood Home Visiting Program Quarterly Performance Report

Attachment A - Form 4 - MIECHV Quarterly Performance Report

Maternal, Infant, and Early Childhood Home Visiting Program Quarterly Performance Report

OMB: 0906-0016

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0906-0016 can be found here:

2021-10-12 - Revision of a currently approved collection

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OMB No: 0906-0016
Expiration date: 03/31/2019

THE MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING
PROGRAM

FORM 4

QUARTERLY PERFORMANCE REPORT

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a
currently valid OMB control number. The OMB control number for this project is 0906-0016. Public reporting burden for this collection of information is
estimated to average 24 hours per response for Section A and 40 200 hours per response for Section B, including the time for reviewing instructions, searching
existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-29, Rockville,
Maryland, 20857.

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

Maternal, Infant, and Early Childhood Home Visiting (MIECHV) and Tribal MIECHV grantees are required to submit the
information outlined below on a quarterly basis.
Quarterly reporting periods are defined as follows. Reports are due 60 1530 days after the end of each reporting period:





Q1 - October 1-December 31;
Q2 - January 1-March 31;
Q3 – April 1-June 30;
Q4 – July 1-September 30

Definitions for key terms are included in Appendix A. Please carefully consult key term definitions before completing this form.
Grant Number(s): ________________________________

Section A:
Commented [A1]: No proposed changes to this table.

Table A.1: Program Capacity
Column A
Number of New
Households Enrolled

Column B
Number of Continuing
Households

Column C
Column D
Current Caseload Maximum Service
(A+B)
Capacity
(Auto-Calculate)

Column E
Capacity Percentage (C÷D)
(Auto-Calculate)

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

Table A.2: Place-Based Services
Add a row for each additional communityLocal Implementing Agency (LIA) served providing services during the reporting period.
For each LIA, add the address of the LIA, the counties served by that LIA, the zip codes of families served within those counties by
that LIA, and the number of households served from each of those zip codes evidence based home visiting model(s) or promising
approaches implemented by the LIA.
Column A
CommunityLocal
Implementing Agency (LIA)
Organization Name

Column B
LIA Address

Column C**
Zip Codes within
Community
Countiesy*

Total

Column D**
Zip Codes

Column E**
Number of
Households
ServedEvidence
Based Home
Visiting Models or
Promising
Approaches

Sum of Column D
(all rows)

*Note that the same county can be served by multiple LIAs.
**Additional rows can be added if needed.

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

Commented [A2]: No proposed changes to this table.

Table A.3: Family Engagement
Column A1
Number of Households
Currently Receiving Services

Column B
Number of Households
who Completed Program

Column C
Number of Households who
Stopped Services Before
Completion

Column D
Other

Column E2
Total
(A+B+C+D)
(AutoCalculate)

Table A.4.1: Staff Recruitment and Retention
Column A
Number of
New FTE
MIECHV
Home
Visitors

1
2

Column B
Number of
Continuing
FTE
MIECHV
Home
Visitors

Column CA
Number of
FTE
MIECHV
Home
Visitors
(A+B)
(AutoCalculate)

Column D
Number of
New FTE
MIECHV
Supervisors

Column E
Number of
Continuing
FTE
MIECHV
Supervisors

Column FB
Number of
FTE
MIECHV
Supervisors
(D+E)
(AutoCalculate)

Column G
Number of
New FTE
MIECHV
Other Staff

Column H
Number of
Continuing
FTE
MIECHV
Other Staff

Column IC
Number of
FTE
MIECHV
Other Staff
(G+H)
(AutoCalculate)

Validation: Column A should equal Table A.1. columns A and B
Validation: Column E should equal Table A.2 sum of all rows in Column C

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

Table A.4.2: Staff Vacancies
Column A
Number of Vacant FTE
MIECHV Home Visitors

Column B
Number of Vacant FTE
MIECHV Supervisors

Column C
Number of Vacant FTE
MIECHV Other Staff

Column D
Number of FTE MIECHV Staff
Vacancies (A+B+C) (AutoCalculate)

Section B:
Section B is only applicable to awardees that are currently on a corrective action plan related to a formal assessment of improvement.

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

MEASURE 1
1.
BENCHMARK AREA: MATERNAL AND NEWBORN HEALTH
CONSTRUCT: PRETERM BIRTH
2.
TYPE OF MEASURE
Systems Outcome
3.
PERFORMANCE MEASURE
Percent of infants (among mothers who enrolled in home visiting prenatally before 37 weeks) who are born preterm
following program enrollment
4.
SPECIFICATION
NUMERATOR: Number of live births (index child or subsequent children among mothers who enrolled in home
visiting prenatally before 37 weeks) born before 37 completed weeks of gestation and after enr ollment
DENOMINATOR: Number of live births after enrollment who were born to mothers enrolled in home
visiting prenatally before 37 weeks
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from
measure calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. All cases
of missing data should be excluded from the
measure calculation.
7.
NOTES
* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

6
DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

MEASURE 2
1.
BENCHMARK AREA: MATERNAL AND NEWBORN HEALTH
CONSTRUCT: BREASTFEEDING
2.
TYPE OF MEASURE
Systems Outcome
3.
PERFORMANCE MEASURE
Percent of infants (among mothers who enrolled in home visiting prenatally) who were breastfed any amount
at 6 months of age
4.
SPECIFICATION
NUMERATOR: Number of infants aged 6-12 months (index child among mothers who enrolled in home
visiting prenatally) who were breastfed any amount at 6 months of age
DENOMINATOR: Number of infants aged 6-12 months (index child among mothers who enrolled in home visiting
prenatally) enrolled in home visiting for at least 6 months
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from
measure calculation:

* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

missing data, and if possible, plans to reduce the amount of missing data in future reporting.

MEASURE 3
1.
BENCHMARK AREA: MATERNAL AND NEWBORN HEALTH
CONSTRUCT: DEPRESSION SCREENING
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of primary caregivers enrolled in home visiting who are screened for depression using a validated
tool within 3 months of enrollment (for those not enrolled prenatally) or within 3 months of delivery (for
those enrolled prenatally)
4.
SPECIFICATION
NUMERATOR: For those not enrolled prenatally, number of primary caregivers enrolled in home visiting
who are screened for depression within the first 3 months since enrollment; for those enrolled prenatally, the number of
primary caregivers screened for depression within 3 months of delivery
DENOMINATOR: For those not enrolled prenatally, the number of primary caregivers enrolled in home visiting for at
least 3 months; for those enrolled prenatally, the number of primary caregivers enrolled in
home visiting for at least three months post delivery
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from measure
calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. When
there is no documentation of whether a screening
occurred using a validated tool, but all other data
elements are known, then the primary caregiver
should be included in the denominator (if eligible),

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

but not in the numerator. All cases of missing data
should be excluded from the measure calculation.
7.
NOTES

8. Measurement Tool Utilized
Indicate the validated measurement tool(s) utilized to address this measure
* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

9
DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

MEASURE 4
1.
BENCHMARK AREA: MATERNAL AND NEWBORN HEALTH
CONSTRUCT: WELL CHILD VISIT
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of children enrolled in home visiting who received the last recommended visit based on the
American Academy of Pediatrics (AAP) schedule
4.
SPECIFICATION
NUMERATOR: Number of children (index child) enrolled in home visiting who received the last
recommended well child visit based on the AAP schedule
DENOMINATOR: Number of children (index child) enrolled in home visiting
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from measure
calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown, including
if a home visit occurred but the home visitor did not
collect the data. All cases of missing data should be
excluded from the measure calculation.
7.
NOTES

* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the

10
DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

missing data, and if possible, plans to reduce the amount of missing data in future reporting
MEASURE 5
1.
BENCHMARK AREA: MATERNAL AND NEWBORN HEALTH
CONSTRUCT: POSTPARTUM CARE
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of mothers enrolled in home visiting prenatally or within 30 days after delivery who received a postpartum
visit with a healthcare provider within 8 weeks (56 days) of delivery
4.
SPECIFICATION
NUMERATOR: Number of mothers enrolled in home visiting prenatally or within 30 days after delivery
who received a postpartum visit with a healthcare provider within 8 weeks (56 days) of delivery
DENOMINATOR: Number of mothers who enrolled in home visiting prenatally or within 30 days after
delivery and remained enrolled for at least 8 weeks (56 days) after delivery
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from
measure calculation:

* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the

11
DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

missing data, and if possible, plans to reduce the amount of missing data in future reporting.
MEASURE 6
1.
BENCHMARK AREA: MATERNAL AND NEWBORN HEALTH
CONSTRUCT: TOBACCO CESSATION REFERRALS
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of primary caregivers enrolled in home visiting who reported using tobacco or cigarettes at
enrollment and were referred to tobacco cessation counseling or services within 3 months of enrollment.
4.
SPECIFICATION
NUMERATOR: Number of primary caregivers enrolled in home visiting who reported using tobacco or cigarettes at
enrollment and were referred to tobacco cessation counseling or services within 3 months of enrollment
DENOMINATOR: Number of primary caregivers enrolled in home visiting who reported using tobacco or
cigarettes at enrollment and were enrolled for at least 3 months
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from
measure calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown, including
if there is no documentation of whether the primary
caregiver used tobacco or cigarettes at enrollment
since inclusion in the denominator cannot be
determined if the screening result is unknown. When
there is no documentation of whether a referral was
provided, but all other data elements are known and
inclusion in the denominator can be determined,
then the primary caregiver should be included in the

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

denominator (if eligible), but not in the numerator.
All cases of missing data should be excluded from the
measure calculation.
7.
NOTES

13
DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

MEASURE 7
1.
BENCHMARK AREA: CHILD INJURIES, ABUSE, NEGLECT, AND MALTREATMENT AND EMERGENCY
DEPARTMENT VISITS
CONSTRUCT: SAFE SLEEP
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of infants enrolled in home visiting that are always placed to sleep on their backs, without
bed-sharing and without soft bedding
4.
SPECIFICATION
NUMERATOR: Number of infants (index child aged less than 1 year) enrolled in home visiting whose
primary caregiver reports that they are always placed to sleep on their backs, without bed-sharing and without soft
bedding
DENOMINATOR: Number of infants (index child) enrolled in home visiting who were aged less than 1 year during
the reporting period
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from
measure calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. All cases of
missing data should be excluded from the measure
calculation.
7.
NOTES
* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

14
DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

MEASURE 8
1.
BENCHMARK AREA: CHILD INJURIES, ABUSE, NEGLECT, AND MALTREATMENT AND EMERGENCY
DEPARTMENT VISITS
CONSTRUCT: CHILD INJURY
2.
TYPE OF MEASURE
Systems Outcome
3.
PERFORMANCE MEASURE
Rate of injury-related visits to the Emergency Department (ED) during the reporting period among children enrolled in
home visiting
4.
SPECIFICATION
NUMERATOR: Number of parent-reported nonfatal injury-related visits to the ED during the reporting period among
children (index child) enrolled in home visiting
DENOMINATOR: Number of children (index child) enrolled in home visiting
5.
VALUE FOR REPORTING PERIOD (rate)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from measure
calculation:

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

MEASURE 9
1.
BENCHMARK AREA: CHILD INJURIES, ABUSE, NEGLECT, AND MALTREATMENT AND EMERGENCY
DEPARTMENT VISITS
CONSTRUCT: CHILD MALTREATMENT
2.
TYPE OF MEASURE
Systems Outcome
3.
PERFORMANCE MEASURE
Percent of children enrolled in home visiting with at least 1 investigated case of maltreatment following enrollment
within the reporting period
4.
SPECIFICATION
NUMERATOR: Number of children (index child) enrolled in home visiting with at least 1 investigated case
of maltreatment following enrollment within the reporting period
DENOMINATOR: Number of children (index child) enrolled in home visiting
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from
measure calculation:

16
DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.
MEASURE 10
1.
BENCHMARK AREA: SCHOOL READINESS AND ACHIEVEMENT
CONSTRUCT: PARENT-CHILD INTERACTION
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of primary caregivers enrolled in home visiting who receive an observation of caregiver-child interaction by
the home visitor using a validated tool
4.
SPECIFICATION
NUMERATOR: Number of primary caregivers enrolled in home visiting who receive an observation of caregiver -child
interaction by the home visitor using a validated tool
DENOMINATOR: Number of primary caregivers enrolled in home visiting with children reaching the
target age range
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from
measure calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. When
there is no documentation of whether the index child
received an observation of caregiver-child
interaction by the home visitor using a validated tool,
but all other data elements are known, then the index
child should be included in the denominator (if
eligible), but not in the numerator. All cases of
missing data should be excluded from the measure
calculation.

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

7.
NOTES

8.
Measurement Tool Utilized
Indicate the validated measurement tool(s) utilized to address this measure
* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

18
DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

MEASURE 11
1.
BENCHMARK AREA: SCHOOL READINESS AND ACHIEVEMENT
CONSTRUCT: EARLY LANGUAGE AND LITERACY ACTIVITIES
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of children enrolled in home visiting with a family member who reported that during a typical week
s/he read, told stories, and/or sang songs with their child daily, every day
4.
SPECIFICATION
NUMERATOR: Number of children (index child) enrolled in home visiting with a family member who
reported that during a typical week s/he read, told stories, and/or sang songs with their child daily, every day
DENOMINATOR: Number of children (index child) enrolled in home visiting
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from
measure calculation:

19
DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

MEASURE 12
1.
BENCHMARK AREA: SCHOOL READINESS AND ACHIEVEMENT
CONSTRUCT: DEVELOPMENTAL SCREENING
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of children enrolled in home visiting with a timely screen for developmental delays using a validat ed parentcompleted tool
4.
SPECIFICATION
NUMERATOR: Number of children (index child) enrolled in home visiting with at least one screening
within the AAP-defined age groups during the reporting period
DENOMINATOR: Number of children (index child) enrolled in home visiting reaching the specified time
frame during the reporting period
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from
measure calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. When
there is no documentation of whether a screening
occurred using a validated tool, but all other data
elements are known, then the child should be
included in the denominator (if eligible), but not in
the numerator. All cases of missing data should be
excluded from the measure calculation.

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

7.
NOTES

8.
Measurement Tool Utilized
Indicate the validated measurement tool(s) utilized to address this measure
* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

21
DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

MEASURE 13
1.
BENCHMARK AREA: SCHOOL READINESS AND ACHIEVEMENT
CONSTRUCT: BEHAVIORAL CONCERNS
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of postnatal home visits where primary caregivers were asked if they have any concerns regarding their
child’s development, behavior, or learning
4.
SPECIFICATION
NUMERATOR: Number of postnatal home visits where primary caregivers enrolled in home visiting were asked if they
have any concerns regarding their child’s development, behavior, or learning
DENOMINATOR: Total number of postnatal home visits during the reporting period
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA

6.b. Value – Enter the number of cases missing from measure
calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. If a home
visit occurred, but there is no documentation of
whether the primary caregiver was asked about
behavioral concerns, then the home visit should be
included in the denominator (if eligible – i.e.,
postnatal visit), but not in the numerator. All cases of
missing data should be excluded from the measure
calculation.

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

7.
NOTES

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

MEASURE 14
1.
BENCHMARK AREA: CRIME OR DOMESTIC VIOLENCE
CONSTRUCT: INTIMATE PARTNER VIOLENCE SCREENING
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of primary caregivers enrolled in home visiting who are screened for intimate partner violence (IPV)
within 6 months of enrollment using a validated tool
4.
SPECIFICATION
NUMERATOR: Number of primary caregivers enrolled in home visiting who are screened for IPV using a validated tool
within 6 months of enrollment
DENOMINATOR: Number of primary caregivers enrolled in home visiting for at least 6 months
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from measure
calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. When
there is no documentation of whether a screening
occurred using a validated tool (including if a
screening did not occur because the caregiver was
male and they only have validated tools for use
among female caregivers), but all other data
elements are known, then the primary caregiver
should be included in the denominator (if eligible),
but not in the numerator. All cases of missing data
should be excluded from the measure calculation.

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

7.
NOTES

8.
Measurement Tool Utilized
Indicate the validated measurement tool(s) utilized to address this measure
* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

25
DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

MEASURE 15
1.
BENCHMARK AREA: FAMILY ECONOMIC SELF-SUFFICIENCY
CONSTRUCT: PRIMARY CAREGIVER EDUCATION
2.
TYPE OF MEASURE
Systems Outcome
3.
PERFORMANCE MEASURE
Percent of primary caregivers who enrolled in home visiting without a high school degree or equivalent who subsequently
enrolled in or maintained continuous enrollment in middle school or high school, or completed high school or equivalent
during their participation in home visiting
4.
SPECIFICATION
NUMERATOR: Number of primary caregivers who enrolled in or maintained continuous enrollment in middle school or
high school, or completed a high school degree or equivalent after enrollment in home visiting (and met the conditions
specified in the denominator)
DENOMINATOR: Number of primary caregivers without a high school degree or equivalent at enrollment
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from measure
calculation:

26
DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

MEASURE 16
1.
BENCHMARK AREA: FAMILY ECONOMIC SELF-SUFFICIENCY
CONSTRUCT: CONTINUITY OF INSURANCE COVERAGE
2.
TYPE OF MEASURE
Systems Outcome
3.
PERFORMANCE MEASURE
Percent of primary caregivers enrolled in home visiting who had continuous health insurance coverage for at least 6
consecutive months
4.
SPECIFICATION
NUMERATOR: Number of primary caregivers enrolled in home visiting who reported having health
insurance coverage for at least 6 consecutive months since enrollment in home visiting
DENOMINATOR: Number of primary caregivers enrolled in home visiting for at least 6 months
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from measure
calculation:

27
DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

MEASURE 17
1.
BENCHMARK AREA: COORDINATION AND REFERRALS FOR OTHER COMMUNITY RESOURCES AND
SUPPORTS
CONSTRUCT: COMPLETED DEPRESSION REFERRALS
2.
TYPE OF MEASURE
Systems Outcome
3.
PERFORMANCE MEASURE
Percent of primary caregivers referred to services for a positive screen for depression who receive one or
more service contacts
4.
SPECIFICATION
NUMERATOR: Number of primary caregivers enrolled in home visiting who received recommended
services for depression (and met the conditions specified in the denominator)
DENOMINATOR: Number of primary caregivers enrolled in home visiting who had a positive screen for depression
within 3 months of enrollment (for those not enrolled prenatally) or within 3 months of delivery (for those enrolled
prenatally) and were referred for services
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from measure
calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown, including
if there is no documentation of whether a screening
occurred using a validated tool, since inclusion in the
denominator cannot be determined if the screening
result is unknown. Data are also considered missing
if there is no documentation of whether a referral
was provided. All cases of missing data should be
excluded from the measure calculation.

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

7.
NOTES

8.
Measurement Tool Utilized
Indicate the validated measurement tool(s) utilized to address this measure
* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

MEASURE 18
1.
BENCHMARK AREA: COORDINATION AND REFERRALS FOR OTHER COMMUNITY RESOURCES AND
SUPPORTS
CONSTRUCT: COMPLETED DEVELOPMENTAL REFERRALS
2.
TYPE OF MEASURE
Systems Outcome
3.
PERFORMANCE MEASURE
Percent of children enrolled in home visiting with positive screens for developmental delays (measured using
a validated tool) who receive services in a timely manner
4.
SPECIFICATION
NUMERATOR: Number of children enrolled in home visiting who a) received individualized developmental support
from a home visitor; b) were referred to early intervention services and receive an evaluation within
45 days; OR c) were referred to other community services who received services within 30 days (and met the conditions
specified in the denominator)
DENOMINATOR: Number of children enrolled in home visiting with positive screens for developmental
delays (measured using a validated tool)
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from
measure calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown, including
if there is no documentation of whether a screening
occurred using a validated tool, since inclusion in the
denominator cannot be determined if the screening
result is unknown. When there is no documentation
of whether a referral was provided, but all other
data elements are available and inclusion in the
denominator can be determined, then the primary
caregiver should be included in the denominator (if
eligible), but not in the numerator. All cases of

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

missing data should be excluded from the measure
calculation.
7.
NOTES

8.
Measurement Tool Utilized
Indicate the validated measurement tool(s) utilized to address this measure
* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

31
DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

MEASURE 19
1.
BENCHMARK AREA: COORDINATION AND REFERRALS FOR OTHER COMMUNITY RESOURCES AND
SUPPORTS
CONSTRUCT: INTIMATE PARTNER VIOLENCE REFERRALS
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of primary caregivers enrolled in home visiting with positive screens for IPV (measured using a validated tool) who
receive referral information to IPV resources
4.
SPECIFICATION
NUMERATOR: Number of primary caregivers enrolled in home visiting who received referral information
to IPV resources (and met the conditions specified in the denominator)
DENOMINATOR: Number of primary caregivers enrolled in home visiting with positive screens for IPV (measured using a
validated tool) within 6 months of enrollment
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from measure
calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown, including
if there is no documentation of whether a screening
occurred using a validated tool, since inclusion in the
denominator cannot be determined if the screening
result is unknown. When there is no documentation
of whether a referral was provided, but all other
data elements are available and inclusion in the
denominator can be determined, then the primary
caregiver should be included in the denominator (if
eligible), but not in the numerator. All cases of
missing data should be excluded from the measure
calculation.

32
DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

7.
NOTES

8.
Measurement Tool Utilized
Indicate the validated measurement tool(s) utilized to address this measure
* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the missing
data, and if possible, plans to reduce the amount of missing data in future reporting.

33
DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019
Commented [A3]: Replaced to align with current MIECHV
performance measures

Section B:
Section B is only applicable to grantees that are currently on an Improvement Plan related to the
formal assessment of improvement conducted after Year 3 of their MIECHV grant. Grantees are
required to submit data for all constructs within the benchmark areas where they did not show
improvement at the end of Year 3. Grantees should only complete the benchmark areas
applicable to them.
Table B.1: Benchmark Area 1
Construct

Performance
Measure

Numerator

Denominator

Percent/Average/Count

Numerator

Denominator

Percent/Average/Count

Numerator

Denominator

Percent/Average/Count

1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
Table B.2: Benchmark Area 2
Construct

Performance
Measure

2.1
2.2
2.3
2.4
2.5
2.6
2.7

Table B.3: Benchmark Area 3
Construct

Performance
Measure

3.1
3.2
3.3
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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

3.4
3.5
3.6
3.7
3.8
3.9
Table B.4: Benchmark Area 4
Construct

Performance
Measure

Numerator

Denominator

Percent/Average/Count

Numerator

Denominator

Percent/Average/Count

Numerator

Denominator

Percent/Average/Count

4.1
4.2
4.3
4.4
4.5
Table B.5: Benchmark Area 5
Construct

Performance
Measure

5.1
5.2
5.3

Table B.6: Benchmark Area 6
Construct

Performance
Measure

6.1
6.2
6.3
6.4
6.5

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

DEFINITIONS OF KEY TERMS

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

Table
Number
A.1

Field
Program Capacity

Key Terms Requiring Definitions
New Household: A household, including a pregnant woman, female caregiver, and/or male caregiver who signs up
to participate in the home visiting program at any time during the reporting period and continues enrollment during
the reporting period. The household may include multiple caregivers depending on model-specific definitions.
Continuing Household: A household, including a pregnant woman, female caregiver, and/or male caregiver who
were signed up and actively enrolled in the home visiting program prior to the beginning of the reporting period and
continues enrollment during the reporting period. The household may include multiple caregivers depending on
model-specific definitions.
Current Caseload: The number of households actively enrolled at the end of the quarterly reporting period. All
members of one household represent a single caseload slot.
Maximum Service Capacity: The highest number of households that could potentially be enrolled at the end of the
quarterly reporting period if the program were operating with a full complement of hired and trained home visitors
Note: The maximum service capacity is equivalent to the caseload of family slots approved by HRSA
Caseload of Family Slots: The highest number of families (or households) that could potentially be enrolled
at any given time if the program were operating with a full complement of hired and trained home visitors.
Family slots are those enrollment slots identified as MIECHV in accordance with the identified enrollment
method of the awardee. For more information on the definition of a MIECHV family slot see the FY 2108
MIECHV Notice of Funding Opportunity Announcement. served by a trained home visitor implementing
services with fidelity to the model for whom at least 25% of his/her personnel costs (salary/wages including
benefits) are paid for with MIECHV funding. All members of one family or household represent a single
caseload slot. The count of slots should be distinguished from the cumulative number of enrolled families
during the grant period. It is known that the caseload of family slots may vary by federal fiscal year pending
variation in available funding in each fiscal year. Applicants should remember that inability to meet
proposed caseloads may results in deobligated funds, which may impact future funding.

A.3

Family Engagement

Capacity Percentage: Capacity percentage is a calculated indicator that results from dividing the current caseload
by the maximum service capacity and multiplying by 100.
Currently Receiving Services: The number of households currently receiving services refers to households that are
participating in services at the end of the reporting period.
Completed Program: The number of households who completed the program refers to households who have
completed the program or transitioned to another program according to home visiting model-specific definitions and
criteria during the reporting period.

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DRAFT REVISIONS – November 15, 2018

OMB No: 0906-0016
Expiration date: 03/31/2019

Stopped Services Before Completion: The number of households who stopped services before completion refers
to households who left the program for any reason prior to completion.

A.4.1

Staffing Recruitment and
Retention

Other: Other refers to those households who do not fall into the previous categories. and may include unreachable
participants (i.e. the family is not regularly participating but did not actively sever ties, etc.)
New Full Time Equivalent Home Visitor/Supervisor/Other Staff: A full time equivalent home
visitor(s)/supervisor(s)/other staff who begins employmentis employed with a contracted local implementing
agency during at the end of the quarterly reporting period. Grantees Awardees should only report the proportion of
the FTE that is supported by MIECHV grant funds.
Continuing Full Time Equivalent Home Visitor/Supervisor/Other Staff: A full time equivalent home
visitor(s)/supervisor(s)/other staff who was employed by a contracted local implementing agency during the
previous reporting period and continued employment. Grantees Awardees should only report the proportion of the
FTE that is supported by MIECHV grant funds.
For example, a 1.0 FTE staff member who is supported at 30% through MIECHV funds and 70% through other
funds would be reported as 0.3 FTE for the purposes of this table.

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DRAFT REVISIONS – November 15, 2018

File Type	application/pdf
File Modified	2018-11-16
File Created	2018-11-16