Direct assessments of caregivers - MIHOPE-K

OMB No.: 0970-0402

E xpiration Date:

Mother and Infant Home Visiting Program Evaluation

MIHOPE-K

DIRECT ASSESSMENTS OF CAREGIVERS: VISIT PROTOCOL

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0970-0402. The time required to complete this information collection is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

April 2018

Client MPR ID: | | | | | | | | |

Date of interview: | | | / | | | / | | | | |

Month Day Year

FIELD INTERVIEWER ID: | | | | | | | | |

Note: At this point respondents will have already heard the OMB introduction language. See SSA Attachment 2 – MIHOPE – K Direct assessments of children for this language.

SAY TO THE CAREGIVER: We’re almost done, but I have a quick memory activity for you to do. Do you have any questions? (ANSWER ANY QUESTIONS.)

SAY TO CHILD: Thank you for playing these games with me. I’m going to play a quick game with your (mom/caregiver). I have (a sticker sheet/some crayons) for you to play with while I do this game with her. Do you want to play with them now? You can also keep them after I leave.

MIHOPE DIGIT SPAN ASSESSMENT

ADMINISTER DIGIT SPAN

Items in this section are from the Digit Span assessment.