Attachment B - Measures and Detail Sheets_Clean

Maternal and Child Health Bureau Performance Measures for Discretionary Grant Information System (DGIS)

Attachment B - Measures and Detail Sheets_Clean

OMB: 0915-0298

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0915-0298 can be found here:

2024-04-17 - No material or nonsubstantive change to a currently approved collection

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OMB Number: 0915-0298

Expiration Date: [Insert Date]

Health Resources and Services Administration

Maternal and Child Health Bureau

Discretionary Grant Performance Measures

OMB No. 0915-0298

Expires: ________

Attachment B:

Core Measures, Population Domain Measures,

Program-Specific Measures (Detail Sheets)

OMB Clearance Package

Table of Contents

Attachment B:
Core Measures, Population Domain Measures, Program-Specific Measures (Detail Sheets)

Core Measures 4

Capacity Building Measures 6

Activity Data Collection Form for Selected Measures 14

Population Domain Measures

Women’s/ Maternal Health 15

Perinatal Infant Health 23

Child Health 29

Children and Youth with Special Health Care Needs 39

Adolescent Health 46

Life Course/ Cross Cutting 53

Program-Specific Measures

Division of MCH Workforce Development 62

Div. of Child Adolescent, & Family Health – Emergency Medical Services for Children Program 112

Division of Healthy Start and Perinatal Services 142

Div. of Children with Special Health Needs – Family to Family Health Information Ctr Program 155

DGIS Performance Measures, Numbering by Domain
Performance Measure	Topic
Core 3	Health Equity
CB 1	State Capacity for Advancing the Health of MCH Populations
CB 3	Impact Measurement
CB 4	Sustainability
CB 5	Scientific Publications
CB 6	Products
CB 8	Quality Improvement
WMH 1	Prenatal Care
WMH 2	Perinatal/ Postpartum Care
WMH 3	Well Woman Visit/ Preventive Health Care
WMH 4	Depression Screening
PIH 1	Safe Sleep
PIH 2	Breastfeeding
PIH 3	Newborn Screening
CH 1	Well Child Visit
CH 2	Quality of Well Child Visit
CH 3	Developmental Screening
CH 4	Injury Prevention
CSHCN 1	Family Engagement
CSHCN 2	Access to and Use of Medical Home
CSHCN 3	Transition
AH 1	Adolescent Well Visit
AH 2	Injury Prevention
AH 3	Screening for Major Depressive Disorder
LC 1	Adequate Health Insurance Coverage
LC 2	Tobacco and eCigarette Use
LC 3	Oral Health


Core 3 PERFORMANCE MEASURE Goal: Health Equity Level: Grantee Domain: Capacity Building		The percent of programs promoting and/ or facilitating improving health equity.
GOAL		To ensure MCHB grantees have established specific aims related to improving health equity.

MEASURE		The percent of MCHB funded projects with specific measurable aims related to promoting health equity.

DEFINITION		Tier 1: Are you promoting and/ or facilitating health equity in your program? Yes No Tier 2: Through which activity domains are you promoting and/or facilitating health equity with your program (check all that apply): Creating and Supporting Collaborations and Partnerships with other health and non-health sectors that influence the well-being of individuals. Collaboration is necessary to address social determinants of health and can include family/community representatives as advisors or leaders. Creating and Supporting a Culture of Equity by increasing organizational diversity and inclusion. Creating and Supporting the Infrastructure and Capacity for Equity by improving data capacity, workforce knowledge and cultural competence, and promoting policies and procedures that advance equity. Collecting and Using Data on race, ethnicity, etc. to measure and address equity. Providing Services to individuals and communities in a manner that promotes equity. What type(s) of equity topics do your activities target? Race/ ethnicity Sex/ gender/ sexual orientation/ gender identity Income/ socioeconomic status Health status/ disability Age Language Geography – rural/urban Other: ________________ Tier 3: Implementation Has your program set stated goal/ objectives for health equity? Y/N If yes, what are those aims? _____________ Tier 4: What are the related outcomes? Has your program made progress on your stated goals/ objectives around health equity? Y/N If yes, what progress has been made? ____ * Health equity exists when challenges and barriers have been removed for those groups who experience greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.

BENCHMARK DATA SOURCES		N/A

GRANTEE DATA SOURCES		Grantee self-reported.

SIGNIFICANCE		Health equity is achieved when every individual has the opportunity to attain his or her full health potential and no one is “disadvantaged from achieving this potential because of social position or socially determined consequences.” Achieving health equity is a top priority in the United States.

CB 1 PERFORMANCE MEASURE Goal: State capacity for advancing the health of MCH populations (for National programs) Level: Grantee Domain: Capacity Building	The percent of programs promoting and facilitating state capacity for advancing the health of MCH populations.
GOAL	To ensure adequate and increasing state capacity for advancing the health of MCH populations.

MEASURE	The percent of MCHB-funded projects of a national scale promoting and facilitating state capacity for advancing the health of MCH populations, and through what processes.

DEFINITION	Tier 1: Are you promoting and facilitating state capacity for advancing the health of MCH populations for _________’s* priority topic? Yes No *prepopulated with program focus
	Tier 2: Through what activities are you promoting and facilitating state capacity for advancing the health of MCH populations? Delivery of training on program priority topic Support state strategic planning activities Serve as expert and champion on the priority topic Facilitate state level partnerships to advance priority topics Maintain consistent state-level staffing support for priority topic (State-level programs only) Collect data to track changes in prevalence of program priority issues Utilize available data to track changes in prevalence of program priority issue on national/ regional level Issue model standards of practice for use in the clinical setting Tier 3: Implementation # of professionals trained on program priority topic How frequently are data collected and analyzed to monitor status and refine strategies?: Less frequently than annually Bi-annual Quarterly Monthly # of MOUs between State agencies addressing priority area
	# of State agencies/departments participating on priority area. This includes the following key state agencies (check all that apply): Commissions/ Task Forces MCH/CSHCN Genetics Newborn Screening Early Hearing and Detection EMSC Oral Health Developmental Disabilities Medicaid Mental & Behavioral Health Housing Early Intervention/Head Start Education Child Care Juvenile Justice/Judicial System Foster Care/Adoption Agency Transportation Higher Education Law Enforcement Children’s Cabinet Other (Specify______) Have model standards of practice been established to increase integration of MCH priority issue into clinical setting? Y/N Development or identification of reimbursable services codes to cover delivery of clinical services on MCH priority topic? Y/N Inclusion of specific language in Medicaid managed care contracts to assure coverage of payment for clinical services on MCH priority topic? Y/N
	Tier 4: What are the related outcomes in the reporting year? (National Programs Only) % of state/ jurisdictions have a strategic plan on program priority topic % of states/ jurisdictions receiving training on this program topic % of states/ jurisdictions which have state FTEs designated for this MCH topic % of MCH programs have an identified state lead designated on this topic % of states/ jurisdictions utilizing reimbursable services codes to cover delivery of clinical services on MCH priority topic? % of states/jurisdictions which report progress on strategic plan goals and objectives?

BENCHMARK DATA SOURCES	N/A

GRANTEE DATA SOURCES	Grantee Self-Reported.

CB 3 PERFORMANCE MEASURE Goal: Impact Measurement Level: Grantee Domain: Capacity Building	The percent of grantees that collect and analyze data on the impact of their grants on the field.
GOAL	To ensure supportive programming for impact measurement.

MEASURE	The percent of grantees that collect and analyze data on the impact of their grants on the field, and the methods used to collect data.

DEFINITION	Tier 1: Are you collecting and analyzing data related to impact measurement in your program? Yes No Tier 2: How are you measuring impact? Conduct participant surveys Collect client level data Qualitative assessments Case reports Other:______________ Tier 3: Implementation List of tools used Specify Tools: _______________ Outcomes of qualitative assessment # of participant surveys # of clients whose level data collected # of case reports Tier 4: What are the related outcomes in the reporting year? % of grantees that collect data on the impact of their grants on the field (and methods used to collect data) Numerator: # of grantees that collect data on the impact of their grants on the field Denominator: # of grantees How is data collected:________________________ % of grantees that collect and analyze data on the impact of their grants on the field (and methods used to analyze data) Numerator: # of grantees that analyze data on the impact of their grants on the field Denominator: # of grantees How is data analyzed:________________________

GRANTEE DATA SOURCES	Grantee self-reported.

SIGNIFICANCE	Impact as referenced here is a change in condition or status of life. This can include a change in health, social, economic or environmental condition. Examples may include improved health for a community/population or a reduction in disparities for a specific disease or increased adoption of a practice.

CB 4 PERFORMANCE MEASURE Goal: Sustainability Level: Grantee Domain: Capacity Building	The percent of MCHB funded initiatives working to promote sustainability of their programs or initiatives beyond the life of MCHB funding.
GOAL	To ensure sustainability of programs or initiatives over time, beyond the duration of MCHB funding.

MEASURE	The percent of MCHB funded initiatives working to promote sustainability of their programs or initiatives beyond the life of MCHB funding, and through what methods.

DEFINITION	Tier 1: Are you addressing sustainability in your program? Yes No Tier 2: Through what processes/ mechanisms are you addressing sustainability? A written sustainability plan is in place within two years of the MCHB award with goals, objectives, action steps, and timelines to monitor plan progress Staff and leaders in the organization engage and build partnerships with consumers, and other key stakeholders in the community, in the early project planning, and I sustainability planning and implementation processes There is support for the MCHB-funded program or initiative within the parent agency or organization, including from individuals with planning and decision making authority There is an advisory group or a formal board that includes family, community and state partners, and other stakeholders who can leverage resources or otherwise help to sustain the successful aspects of the program or initiative The program’s successes and identification of needs are communicated within and outside the organization among partners and the public, using various internal communication, outreach, and marketing strategies The grantee identified, actively sought out, and obtained other funding sources and in-kind resources to sustain the entire MCHB-funded program or initiative Policies and procedures developed for the successful aspects of the program or initiative are incorporated into the parent or another organization’s system of programs and services The responsibilities for carrying out key successful aspects of the program or initiative have begun to be transferred to permanent staff positions in other ongoing programs or organizations The grantee has secured financial or in-kind support from within the parent organization or external organizations to sustain the successful aspects of the MCHB-funded program or initiative Tier 3: Implementation N/A Tier 4: What are the related outcomes? % of grants that have sustainability plans

BENCHMARK DATA SOURCES	N/A

GRANTEE DATA SOURCES	Grantee self-reported.

SIGNIFICANCE	In recognition of the increasing call for recipients of public funds to sustain their programs after initial funding ends, MCHB encourages grantees to work toward sustainability throughout their grant periods. A number of different terms and explanations have been used as operational components of sustainability. These components fall into four major categories, each emphasizing a distinct focal point as being at the heart of the sustainability process: (1) adherence to program principles and objectives, (2) organizational integration, (3) maintenance of health benefits, and (4) State or community capacity building. Specific recommended actions that can help grantees build toward each of these four sustainability components are included as the Tier 2 data elements for this measure.

CB 5 PERFORMANCE MEASURE Goal: Scientific Publications Level: Grantee Domain: Capacity Building	The percent of programs supporting the production of scientific publications and through what means, and related outcomes.
GOAL	To ensure supportive programming for the production of scientific publications.

MEASURE	The percent of MCHB funded projects programs supporting the production of scientific publications.

DEFINITION	Tier 1: Are you supporting the production of scientific publications in your program? Yes No Tier 2: Indicate the categories of scientific publication that have been produced with grant support (either fully or partially) during the reporting period. Submitted In press Published Tier 3: How many are reached through those activities? # of scientific/ peer-reviewed publications Tier 4: How, if at all, have these publications been disseminated (check all that apply)? Note: research only; include this as Part B of publications form TV/ Radio interview(s) Newspaper interview(s) Online publication interview(s) Press release Social Networking sites Listservs Presentation at conference (poster, abstract, presentation) Websites

GRANTEE DATA SOURCES	Grantee self-reported.

SIGNIFICANCE	Advancing the field of MCH based on evidence-based, field-tested quality products. Collection of the types of and dissemination of MCH products and publications is crucial for advancing the field. This measure addresses the production and quality of new informational resources created by grantees for families, professionals, other providers, and the public.

CB 6 PERFORMANCE MEASURE Goal: Products Level: Grantee Domain: Capacity Building	The percent of programs supporting the development of informational products and through what means, and related outcomes.
GOAL	To ensure supportive programming for the development of informational products.

MEASURE	The percent of MCHB funded projects supporting the development of informational products, and through what processes.

DEFINITION	Tier 1: Are you creating products as part of your MCHB-supported program? Yes No Tier 2: Indicate the categories of products that have been produced with grant support (either fully or partially) during the reporting period. Count the original completed product, not each time it is disseminated or presented. Books Book chapters Reports and monographs (including policy briefs, best practice reports, white papers) Conference presentations and posters presented Web-based products (website, blogs, webinars, newsletters, distance learning modules, wikis, RSS feeds, social networking sites) Excluding video/ audio products that are posted online post-production Audio/ Video products (podcasts, produced videos, video clips.CD-ROMs, CDs, or audio) Press communications (TV/ Radio interviews, newspaper interviews, public service announcements, and editorial articles) Newsletters (electronic or print) Pamphlets, brochures, or fact sheets Academic course development Distance learning modules Doctoral dissertations/ Master’s theses Other: ________________ Tier 3: Implementation of products # products created in each category

GRANTEE DATA SOURCES	Grantee self-reported.

SIGNIFICANCE	Advancing the field of MCH based on evidence-based, field-tested quality products. Collection of the types of and dissemination of MCH products and publications is crucial for advancing the field. This PM addresses the production and quality of new informational resources created by grantees for families, professionals, other providers, and the public.

CB 8 PERFORMANCE MEASURE Goal: Quality Improvement Level: Grantee Domain: Capacity Building	The percent of programs engaging in quality improvement and through what means, and related outcomes.
GOAL	To measure quality improvement initiatives.

MEASURE	The percent of MCHB funded projects implementing quality improvement initiatives.

DEFINITION	Tier 1: Are you implementing quality improvement (QI) initiatives in your program? Yes No Tier 2: QI initiative: What type of QI structure do you have? (Check all that apply) Team established within a division, office, department, etc. of an organization to improve a process, policy, program, etc. Team within and across an organization focused on organizational improvement Cross sectorial collaborative across multiple organizations What types of aims are included in your QI initiative? (Check all that apply) Population health Improve service delivery (process or program) Improve client satisfaction/ outcomes Improve work flow Policy improvement Reducing variation or errors Tier 3: Implementation Are QI goals directly aligned with organization’s strategic goals? Y/ N Has the QI team received training in QI? Y/N Do you have metrics to track improvement? Y/N Which methodology are you utilizing for quality improvement? (Check all that apply) Plan, Do, Study, Act Cycles Lean Six Sigma Other: _________________ Tier 4: What are the related outcomes? Is there data to support improvement in population health as a result of the QI activities? Y/N Is there data to support organizational improvement as a result of QI activities? Y/N Is there data to support improvement in cross sectorial collaboration as a result of QI activities? Y/N

BENCHMARK DATA SOURCES	N/A

GRANTEE DATA SOURCES	Grantee self-reported.

Table 1: Activity Data Collection Form for Selected Measures

Please use the form below to identify what services you provide to each segment. For those you provide the service to, please provide the number reached by the services provided (e.g., # of women receiving referrals or # of partners receiving TA). Report the number reached by each activity for each participant type. Only report a participant under one participant type (select the best category for the participant). For those services you do not provide, or segments you do not reach, please leave the cell blank.

	Participants/ Public	Providers/ Health Care Professionals	Community/ Local Partners	State or National Partners
Technical Assistance
Training
Product Development
Research/ Peer-reviewed publications
Outreach/ Information Dissemination/ Education
Screening/ Assessment
Referral/ care coordination
Direct Service
Quality improvement initiatives

WMH 1 PERFORMANCE MEASURE Goal: Prenatal Care Level: Grantee Domain: Women’s/ Maternal Health	The percent of programs promoting and/or facilitating timely prenatal care.
GOAL	To ensure supportive programming for prenatal care.

MEASURE	The percent of MCHB funded projects addressing prenatal care. The percent of pregnant program participants who receive prenatal care beginning in the first trimester.

DEFINITION	Tier 1: Are you addressing prenatal care in your program? Yes No Tier 2: Through what processes/ mechanisms are you addressing prenatal care? Technical Assistance Training Product Development Research/ Peer-reviewed publications Outreach/ Information Dissemination/ Education Tracking/ Surveillance Screening/ Assessment Referral/ care coordination Direct Service Quality improvement initiatives Tier 3: How many are reached through those activities? (Report in Table 1: Activity Data Collection Form) # receiving TA # receiving training # products developed # peer-reviewed publications published # receiving information and education through outreach # receiving screening/ assessment # referred/care coordinated # received direct service # participating in quality improvement initiatives Tier 4: What are the related outcomes? % of pregnant women who receive prenatal care beginning in the first trimester Numerator: Number of pregnant program participants who began prenatal care in the first trimester of pregnancy. Denominator: Number of pregnant program participants who were enrolled prenatally, prior to their second trimester of pregnancy, during the reporting period.

BENCHMARK DATA SOURCES	Related to Healthy People 2030 MICH Objective #08: Increase the proportion of pregnant women who receive early and adequate prenatal care. (Baseline: 76.4% in 2018, Target: 80.5%).

GRANTEE DATA SOURCES	Title V National Outcome Measure #1.

SIGNIFICANCE	Early and continuous prenatal care is essential for identification of maternal disease and risks for complications of pregnancy or birth. This can help ensure that women with complex problems, chronic illness, or other risks are seen by specialists. Prenatal care can also provide important education and counseling on modifiable risks in pregnancy, including smoking, drinking, and inadequate or excessive weight gain.

WMH 2 PERFORMANCE MEASURE Goal: Perinatal/ Postpartum Care Level: Grantee Domain: Women’s/ Maternal Health	The percent of programs promoting and/or facilitating timely postpartum care.
GOAL	To ensure supportive programming for postpartum care.

MEASURE	The percent of MCHB funded projects addressing postpartum care. The percent of pregnant women with a postpartum visit within 4-6 weeks of delivery

DEFINITION	Tier 1: Are you promoting and/ or facilitating timely postpartum care in your program? Yes No Tier 2: Through what processes/ mechanisms are you promoting and/ or facilitating postpartum care? Technical Assistance Training Product Development Research/ Peer-reviewed publications Outreach/ Information Dissemination/ Education Tracking/ Surveillance Screening/ Assessment Referral/ care coordination Direct Service Quality improvement initiatives Tier 3: How many are reached through those activities? (Report in Table 1: Activity Data Collection Form) # receiving TA # receiving training # products developed # peer-reviewed publications published # receiving information and education through outreach # receiving screening/ assessment # referred/care coordinated # received direct service # participating in quality improvement initiatives Tier 4: What are the related outcomes in the reporting year? % of pregnant women with a postpartum visit within 4 to 6 weeks after delivery⁰ Numerator: Number of women program participants who enrolled prenatally or within 30 days after delivery and received a postpartum visit within 4-6 weeks after delivery⁰ Denominator: Number of women program participants who enrolled prenatally or within 30 days after delivery during the reporting period Definition: ACOG recommends that the postpartum visit occur between 4-6 weeks after delivery. ACOG suggests a 7-14 day postpartum visit for high-risk women.⁰ A participant who has a visit prior to 4-6 weeks must still have a visit between 4-6 weeks to meet the standard and be included in the numerator.

BENCHMARK DATA SOURCES	Related to Healthy People 2030 MICH- D01: Increase the proportion of women giving birth who attend a postpartum care visit with a health worker. Pregnancy Risk Assessment Monitoring System (PRAMS) (91% in 14 states with no timing restriction, 2011); Healthcare Effectiveness Data and Information Set (HEDIS) – (61.8% Medicaid HMO, 2014)

GRANTEE DATA SOURCES	Grantee Data System; Pregnancy Risk Assessment Monitoring System

SIGNIFICANCE	Since the period immediately following birth is a time of many physical and emotional adjustments, the postpartum visit is important for educating new mothers on what to expect during this period and address any concerns which may arise. Additional issues include any health complications the mother may have and the health benefits of breastfeeding for the mother and baby. ⁰ACOG Committee on Obstetric Practice. Guidelines for Perinatal Care (7th Edition, p. 207) state that 4 to 6 weeks after delivery, women should have a postpartum visit with her doctor.

WMH 3 PERFORMANCE MEASURE Goal: Well Woman Visit/ Preventive Health Care Level: Grantee Domain: Women’s/ Maternal Health	The percent of programs promoting and/ or facilitating well woman visits/ preventive health care.
GOAL	To ensure supportive programming for well woman visits/ preventive health care.

MEASURE	The percent of MCHB funded projects promoting and/ or facilitating well woman visits/ preventive health care and through what processes.

DEFINITION	Tier 1: Are you promoting and/ or facilitating well woman visits/ preventive health care in your program? Yes No Tier 2: Through what activities are you promoting and/ or facilitating well woman visits/ preventive health care? Technical Assistance Training Product Development Research/ Peer-reviewed publications Outreach/ Information Dissemination/ Education Tracking/ Surveillance Screening/ Assessment Referral/ care coordination Direct Service Quality improvement initiatives Tier 3: How many are reached through those activities? (Report in Table 1: Activity Data Collection Form) # receiving TA # receiving training # products developed # peer-reviewed publications published # receiving information and education through outreach # receiving screening/ assessment # referred/care coordinated # received direct service # participating in quality improvement initiatives Tier 4: What are the related outcomes in the reporting year? % of women with a well woman/ preventative visit in the past year.⁰ Numerator: Number of women program participants who received a well-woman or preventive visit (including prenatal or postpartum visit) in the past 12 months prior to last assessment within the reporting period. Denominator: Number of women program participants during the reporting period Definition: A participant is considered to have a well-woman or preventive visit and included in the numerator if she has a documented health assessment visit where she obtained recommended preventive services that are age and developmentally appropriate within twelve months of her last contact with the Program in the reporting year. For purposes of reporting, a prenatal visit or postpartum visit during the twelve month period would meet the standard.

BENCHMARK DATA SOURCES	BRFSS (Women 18-44 with a past-year preventive visit: 65.2%, 2013); Vital Statistics (any prenatal care: 98.4%, 2014); PRAMS (postpartum visit: 91%, 2011)

GRANTEE DATA SOURCES	Grantee Data Systems

SIGNIFICANCE	An annual well-woman visit provides a critical opportunity to receive recommended clinical preventive services, including screening, counseling, and immunizations, which can lead to appropriate identification, treatment, and prevention of disease to optimize the health of women before, between, and beyond potential pregnancies. The American College of Obstetrics and Gynecologists (ACOG) recommends an annual well-woman visit beginning in adolescence and continuing across the lifespan with any health care provider offering preventive well-woman care.

WMH 4 PERFORMANCE MEASURE Goal: Depression Screening Level: Grantee Domain: Women’s/ Maternal Health	The percent of programs promoting and/ or facilitating depression screening.
GOAL	To ensure supportive programming for depression screening.

MEASURE	The percent of MCHB funded projects promoting and/ or facilitating depression screening and through what processes.

DEFINITION	Tier 1: Are you promoting and/ or facilitating depression screening in your program? Yes No Tier 2: Through what activities are you promoting and/ or facilitating depression screening? Technical Assistance Training Product Development Research/ Peer-reviewed publications Outreach/ Information Dissemination/ Education Tracking/ Surveillance Screening/ Assessment Referral/ care coordination Direct Service Quality improvement initiatives Tier 3: How many are reached through those activities? (Report in Table 1: Activity Data Collection Form) # receiving TA # receiving training # products developed # peer-reviewed publications published # receiving information and education through outreach # receiving screening/ assessment # referred/care coordinated # received direct service # participating in quality improvement initiatives Tier 4: What are the related outcomes in the reporting year? % of women screened for depression using a validated tool⁰ Numerator: Number of women program participants who were screened for depression with a validated tool during the reporting period. Denominator: Number of women program participants in the reporting period. Definition: A participant is considered to have been screened and included in the numerator if a standardized screening tool which is appropriately validated for her circumstances is used. Several screening instruments have been validated for use to assist with systematically identifying patients with depression.⁰ % of women who screened positive for depression who receive a referral for services Numerator: Number of women participants who screened positive for depression during the reporting period and received a subsequent referral for follow-up services. Denominator: Number of HS women participants who screened positive for depression during the reporting period. Definitions: A participant is considered to have been referred for follow-up services and included in the numerator if she is referred to a qualified practitioner for further assessment for depression. Referral can be to either an internal or external provider depending on availability and staffing model.

BENCHMARK DATA SOURCES	Related to Healthy People 2030 MICH-D01Objective: (Developmental) Increase the proportion of women who are screened for postpartum depression at their postpartum checkup PRAMS (depression screening).

GRANTEE DATA SOURCES	Grantee Data Systems

SIGNIFICANCE	Postpartum depression (PPD) is common, affecting as many as 1 in 7 mothers.⁸Symptoms may include depressed mood, loss of interest or pleasure in activities, sleep disturbance, appetite disturbance, loss of energy, feelings of worthlessness or guilt, diminished concentration, irritability, anxiety, and thoughts of suicide.⁰ PPD is associated with negative maternal physical and psychological health, relationship problems, and risky behaviors. ⁰ PPD is also associated with poor maternal and infant bonding and may negatively influence child development. Infant consequences of PPD include less infant weight gain and stunting, problems with sleep, poor social, emotional, behavioral, cognitive, and language development.¹⁰ Universal screening and treatment for pregnant and postpartum women is recommended by the American College of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP), and the U.S. Preventive Services Task Force.⁸

PIH 1 PERFORMANCE MEASURE Goal: Safe Sleep Level: Grantee Domain: Perinatal Infant Health	The percent of MCHB funded projects promoting and/ or facilitating safe sleep practices.
GOAL	To ensure supportive programming for safe sleep practices.

MEASURE	The percent of MCHB funded projects promoting and/ or facilitating safe sleep practices.

DEFINITION	Tier 1: Are you promoting and/ or facilitating safe sleep in your program? Yes No Tier 2: Through what activities are you promoting and/ or facilitating safe sleep? Technical Assistance Training Product Development Research/ Peer-reviewed publications Outreach/ Information Dissemination/ Education Tracking/ Surveillance Screening/ Assessment Referral/ care coordination Direct Service Quality improvement initiatives Tier 3: How many are reached through those activities? (Report in Table 1: Activity Data Collection Form) # receiving TA # receiving training # products developed # peer-reviewed publications published # receiving information and education through outreach # receiving screening/ assessment # referred/care coordinated # received direct service # participating in quality improvement initiatives Tier 4: What are the related outcomes in the reporting year? % of infants placed to sleep following safe sleep practices⁰ Numerator: Number of child program participants aged <12 months whose parent/ caregiver reports that they are placed to sleep following all three AAP recommended safe sleep practices.⁰ Denominator: Total number of child program participants aged <12 months. A participant is considered to engage in safe sleep practices and included in the numerator if it is reported that the baby is ‘always’ or ‘most often’ 1) placed to sleep on their back, 2) always or often sleeps alone in his or her own crib or bed with no bed sharing, and 3) sleeps on a firm sleep surface (crib, bassinet, pack and play, etc.) with no soft objects or loose bedding.⁰ The requirement is that the baby is placed on their back to sleep. If they roll over onto their stomach after being placed to sleep, the standard is met. Although safe sleep behaviors are self-reported, programs are encouraged to observe safe sleep practices during home visits, as possible.

BENCHMARK DATA SOURCES	Related to Healthy People 2030 MICH-04: Increase the proportion of infants placed to sleep on their backs (Baseline: 78.7% in 2016; Target: 88.9%); Healthy People 2030 MICH-D3: Increase the proportion of infants who are put to sleep in a safe sleep environment. (Developmental) Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 7, Question 48 (Sleep Position) and F1 (Bed Sharing).⁰

GRANTEE DATA SOURCES	Grantee Data Systems

SIGNIFICANCE	Sleep-related infant deaths, also called Sudden Unexpected Infant Deaths (SUID), are the leading cause of infant death after the first month of life and the third leading cause of infant death overall. Sleep-related SUIDs include Sudden Infant Death Syndrome (SIDS), unknown cause, and accidental suffocation and strangulation in bed. Due to heightened risk of SIDS when infants are placed to sleep in side (lateral) or stomach (prone) sleep positions, the American Academy of Pediatrics (AAP) has long recommended the back (supine) sleep position. In 2011, AAP expanded its recommendations to help reduce the risk of all sleep-related deaths through a safe sleep environment that includes use of the back-sleep position, on a separate firm sleep surface (room-sharing without bed sharing), and without loose bedding. ⁰

PIH 2 PERFORMANCE MEASURE Goal: Breastfeeding Level: Grantee Domain: Perinatal Infant Health	The percent of programs promoting and/ or facilitating breastfeeding.
GOAL	To ensure supportive programming for breastfeeding.

MEASURE	The percent of MCHB funded projects promoting and/ or facilitating breastfeeding.

DEFINITION	Tier 1: Are you promoting and/ or facilitating breastfeeding in your program? Yes No Tier 2: Through what activities are you promoting and/ or facilitating breastfeeding? Technical Assistance Training Product Development Research/ Peer-reviewed publications Outreach/ Information Dissemination/ Education Tracking/ Surveillance Screening/ Assessment Referral/ care coordination Direct Service Quality improvement initiatives Tier 3: How many are reached through those activities? (Report in Table 1: Activity Data Collection Form) # receiving TA # receiving training # products developed # peer-reviewed publications published # receiving information and education through outreach # receiving screening/ assessment # referred/care coordinated # received direct service # participating in quality improvement initiatives Tier 4: What are the related outcomes in the reporting year? % of child program participants ever breastfed⁰ Numerator: Total number of child program participants aged <12 months who were ever breastfed or fed pumped breast milk, and whose parent was enrolled prenatally. Denominator: Total number of child program participants aged <12 months whose parent was enrolled prenatally. Definition: A participant is considered to have ever breastfed and included in the numerator if the child received breast milk direct from the breast or expressed at any time in any amount. % of child program participants breastfed at 6 months⁰ Numerator: Total number of child program participants age 6 through 11 months that were breastfed or were fed pumped breast milk in any amount at 6 months of age, and whose parent was enrolled prenatally. Denominator: Total number of child program participants age 6 through 11 months whose parent was enrolled prenatally. Definition: A participant is considered to have ever breastfed at 6 months and included in the numerator if the child received breast milk direct from the breast or expressed at any time in any amount during the sixth month.

BENCHMARK DATA SOURCES	Related to Healthy People 2030 MICH-15: Increase the proportion of infants who are breastfed exclusively through 6 months (Baseline: 24.9% in 2015, Target: 42.4%); Related to Healthy People 2030 MICH-16: Increase the proportion of infants who are breastfed at 1 year (Baseline: 35.9% in 2015, Target: 54.1%).

GRANTEE DATA SOURCES	Grantee data systems.

SIGNIFICANCE	The American Academy of Pediatrics (AAP) recommends all infants (including premature and sick newborns) exclusively breastfeed for about six months, followed by continued breastfeeding as complementary foods are introduced for 1 year or longer. Exclusive breastfeeding for six months supports optimal growth and development by providing all required nutrients during that time. Breastfeeding strengthens the immune system, reduces respiratory infections, gastrointestinal illness, and SIDS, and promotes neurodevelopment. Breastfed children may also be less likely to develop diabetes, childhood obesity, and asthma. Maternal benefits include reduced postpartum blood loss due to oxytocin release and possible protective effects against breast and ovarian cancer, diabetes, hypertension, and heart disease.

PIH 3 PERFORMANCE MEASURE Goal: Newborn Screening Level: Grantee Domain: Perinatal Infant Health	Percent of programs promoting newborn screenings and follow-up.
GOAL	To ensure supportive programming for newborn screenings.

MEASURE	The percent of MCHB funded projects promoting and/ or facilitating newborn screening and follow-up.

DEFINITION	Tier 1: Are you promoting and/or facilitating newborn screening and follow-up in your program? Yes No Tier 2: Through what processes/ mechanisms are you promoting or facilitating newborn screening and follow-up? Technical Assistance Training Product Development Research/ Peer-reviewed publications Outreach/ Information Dissemination/ Education Tracking/ Surveillance Screening/ Assessment Referral/ care coordination Direct Service Quality improvement initiatives Tier 3: How many are reached through those activities? (Report in Table 1: Activity Data Collection Form) # receiving TA # receiving training # products developed # peer-reviewed publications published # receiving information and education through outreach # receiving screening/ assessment # referred/care coordinated # received direct service # participating in quality improvement initiatives Tier 4: What are the related outcomes in the reporting year? % of eligible newborns screened with timely notification for out of range screens Numerator: # of eligible newborns screened with out of range results whose caregivers receive timely notification Denominator: # of eligible newborns screened with out of range results % of eligible newborns screened with timely notification for out of range screens who are followed up in a timely manner Numerator: # of eligible newborns screened with out of range results whose caregivers receive timely notification and receive timely follow up Denominator: # of eligible newborns screened with out of range results whose caregivers receive timely notification

BENCHMARK DATA SOURCES

GRANTEE DATA SOURCES	Title V National Outcome Measure #12 (Developmental)

SIGNIFICANCE	Newborn screening detects thousands of babies each year with potentially devastating, but treatable disorders. The benefits of newborn screening depend upon timely collection of the newborn blood-spots or administration of a point-of-care test (pulse oximeter for critical congenital heart disease), receipt of the newborn blood spot at the laboratory, testing of the newborn blood spot, and reporting out of all results. Timely detection and follow-up with appropriate treatment prevents death or disability and enables children to reach their full potential.⁰

CH 1 PERFORMANCE MEASURE Goal: Well Child Visit Level: Grantee Domain: Child Health	The percent of programs promoting and/ or facilitating well-child visits.
GOAL	To ensure supportive programming for well-child visits.

MEASURE	The percent of MCHB funded projects promoting and/ or facilitating well-child visits.

DEFINITION	Tier 1: Are you promoting and/ or facilitating well-child visits in your program? Yes No Tier 2: Through what activities are you promoting and/ or facilitating well-child visits? Technical Assistance Training Product Development Research/ Peer-reviewed publications Outreach/ Information Dissemination/ Education Tracking/ Surveillance Screening/ Assessment Referral/ care coordination Direct Service Quality improvement initiatives Tier 3: How many are reached through those activities? (Report in Table 1: Activity Data Collection Form) # receiving TA # receiving training # products developed # peer-reviewed publications published # receiving information and education through outreach # receiving screening/ assessment # referred/care coordinated # received direct service # participating in quality improvement initiatives Tier 4: What are the related outcomes in the reporting year? % of child program participants who received recommended well child visits.⁰ Numerator: Number of child program participants whose parent/ caregiver reports that they received the last recommended well child visit based on the AAP schedule well child visit as of the last assessment within the reporting period. Denominator: Total number of child program participants in the reporting period. Definition: A participant is considered to have received the last recommended a well child visit based on the AAP schedule when they have been seen by a healthcare provider for preventive care, generally to include age-appropriate developmental screenings and milestones, and immunizations, in the month recommended by AAP. The AAP recommends children be seen by a healthcare provider for preventive care at each of the following ages: by 1 month, 2 months, 4 months, 6 months, 9 months, 1 year, 15 months, 18 months, 24 months/ 2 years, 30 months, 3 years, and then annually thereafter.⁰ % of children enrolled in Medicaid/ CHIP with at least one well care visit in the past year Numerator: Medicaid/ CHIP-enrolled child program participants who received a well-child visit in the reporting year. Denominator: Total number of Medicaid/ CHIP-enrolled child program participants in the reporting year

BENCHMARK DATA SOURCES	National Survey of Children’s Health K4Q20

GRANTEE DATA SOURCES	Title V National Performance Measure #10,

SIGNIFICANCE	Routine pediatrician visits are important to (1) prevent illness and injury through immunizations and anticipatory guidance, (2) track growth and development and refer for interventions as needed, (3) address parent concerns (e.g., behavior, sleep, eating, milestones), and (4) build trusting parent-provider relationships to support optimal physical, mental, and social health of a child.⁰

CH 2 PERFORMANCE MEASURE Goal: Quality of Well Child Visit Level: Grantee Domain: Child Health	The percent of programs promoting and/ or facilitating quality of well-child visits.
GOAL	To ensure supportive programming for quality of well child visits.

MEASURE	The percent of MCHB funded projects promoting or facilitating quality of well child visits.

DEFINITION	Tier 1: Are you addressing the quality of well child visits in your program? Yes No Tier 2: Through what activities are you addressing quality of well child visits? Technical Assistance Training Product Development Research/ Peer-reviewed publications Outreach/ Information Dissemination/ Education Quality improvement initiatives Tier 3: How many are reached through those activities? # receiving TA # receiving training # product disseminated # reached while guideline setting # peer-reviewed publications published # receiving information and education through outreach # participating in quality improvement initiatives See data collection form. Tier 4: What are the related outcomes in the reporting year? % providers trained in conducting a quality well-child visit Numerator: # of providers trained Denominator:# of providers targeted through the program

BENCHMARK DATA SOURCES	N/A

GRANTEE DATA SOURCES	Grantee self-reported.

SIGNIFICANCE	Comprehensive well-child visits include (1) complete history about birth; prior screenings; diet; sleep; dental care; and medical, surgical, family, and social histories, (2) head-to-toe examination and review of growth, (3) immunization review and delivery, (4) screening for postpartum depression in mothers of infants up to six months of age, (5) age-appropriate health and development screenings (e.g., developmental, vision, hearing, autism), (6) age-appropriate guidance to address parent questions/concerns and encouragement of positive parenting practices (e.g., screen time, nutrition, physical activity, sleep), and (7) developmentally appropriate injury prevention guidance (e.g., car seat safety, bicycle helmet, substance use).⁰ .

	Providers/ Health Care Professionals	Community/ Local Partners	State or National Partners
Technical Assistance
Training
Product Development
Research/ Peer-reviewed publications
Guideline Setting
Outreach/ Information Dissemination/ Education
Quality improvement initiatives

CH 3 PERFORMANCE MEASURE Goal: Developmental Screening Level: Grantee Domain: Child Health	Percent of programs promoting developmental screenings and follow-up for children.
GOAL	To ensure supportive programming for developmental screenings.

MEASURE	The percent of MCHB funded projects promoting and/ or facilitating developmental screening and follow-up for children.

DEFINITION	Tier 1: Are you promoting and/or facilitating developmental screening and follow-up in your program? Yes No Tier 2: Through what processes/ mechanisms are you promoting or facilitating developmental screening and follow-up? Technical Assistance Training Product Development Research/ Peer-reviewed publications Outreach/ Information Dissemination/ Education Tracking/ Surveillance Screening/ Assessment Referral/ care coordination Direct Service Quality improvement initiatives Tier 3: How many are reached through those activities? (Report in Table 1: Activity Data Collection Form) # receiving TA # receiving training # products developed # peer-reviewed publications published # receiving information and education through outreach # receiving screening/ assessment # referred/care coordinated # received direct service # participating in quality improvement initiatives Tier 4: What are the related outcomes in the reporting year? % of children 9 through 35 months receiving a developmental screening using a parental-completed tool? Numerator: Children of program participants aged 9 to 35 months who have received a developmental screening using a parent/ caretaker-completed tool Denominator: Children, aged 9 to 35 months, of program participants

BENCHMARK DATA SOURCES	Related to Healthy People 2030 MICH-17: Increase the proportion of children who receive a developmental screening. (Baseline: 31.1% in 2016-17, Target: 35.8%).

GRANTEE DATA SOURCES	Title V National Performance Measure #6, Title V National Outcome Measure #12.

SIGNIFICANCE	Early identification of developmental disorders is critical to the well-being of children and their families. It is an integral function of the primary care medical home. The percent of children with a developmental disorder has been increasing, yet overall screening rates have remained low. The American Academy of Pediatrics (AAP) recommends screening tests at the 9, 18, and 24 or 30 month visit. The developmental screening measure is endorsed by the National Quality Forum and is part of the Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP.⁰

CH 4 PERFORMANCE MEASURE Goal: Injury Prevention Level: Grantee Domain: Child Health	The percent of programs promoting and/ or facilitating injury prevention among children.
GOAL	To ensure supportive programming for injury prevention among children.
MEASURE	The percent of MCHB funded projects addressing injury prevention and through what processes.
DEFINITION	Tier 1: Are you promoting and/ or facilitating injury prevention among children in your program? Yes No Tier 2: Through what processes/ mechanisms are you addressing injury-prevention? See data collection form. Technical Assistance Training Research/ dissemination Peer-reviewed publications Outreach/ Information Dissemination/ Education Referral/ care coordination Quality improvement initiatives Use of fatality review data Please check which child safety domains which program activities were designed to impact: Motor Vehicle Traffic Suicide/ Self-Harm Falls Bullying Child Maltreatment Unintentional Poisoning Prescription drug overdose Traumatic Brain Injury Drowning Other Tier 3: How many are reached through those activities? # receiving TA # receiving professional/organizational development training # of peer-reviewed publications published # receiving information and education through outreach # referred/ managed % using fatality review data See data collection form. Tier 4: What are the related outcomes in the reporting year? Rate of injury-related hospitalization to children ages 1-9. Numerator: Injury-related hospitalizations to children ages 1-9 Denominator: Children ages 1-9 in the target population Target Population: __________________________ Percent of children ages 6-11 missing 5 or more days of school because of illness or injury. Numerator: # of children ages 6-11 missing 5 or more days of school Denominator: Total number of children ages 6-11 represented in National Survey of Children’s Health results Dataset reporting from: ___________________

BENCHMARK DATA SOURCES	Related to HP2030 IVP-02: Reduce emergency department (ED) visits for nonfatal injuries. (Baseline: 9,349.5 ED visits per 100,000 population in 2017 (age adjusted to the year 2000 standard population), Target: 7,738.2 ED visits per 100,000 population).

GRANTEE DATA SOURCES	Title V National Performance Measure #7 Child Injury, AHRQ Healthcare Cost and Utilization Project: National Inpatient Sample or State Inpatient Database; National Survey of Children’s Health, Question G1 in the 6-11 year old survey

SIGNIFICANCE	Unintential injury is the leading cause of child and adolescent mortality, from age 1 through 19.⁰ Homicide and suicide, violent or intentional injury, are the second and third leading causes of death for adolescents ages 15 through 19.⁴ The total death rate for persons aged 10-19 years decreased 33% between 1999 and 2013, then increased 12% between 2013 and 2016 due to an increase in injury deaths.⁰For those who suffer non-fatal severe injuries, many will become children with special health care needs. Effective interventions to reduce injury exist but are not fully implemented in systems of care that serve children and their families. Reducing the burden of nonfatal injury can greatly improve the life course trajectory of infants, children, and adolescents resulting in improved quality of life and cost savings.

Data Collection Form for Detail Sheet # CH 4

Please use the form below to report what services you provided in which safety domains, and how many recipients received those services. Please use the space provided for notes to specify the recipients of each type of service.

	Motor Vehicle Traffic	Suicide/ Self-Harm	Falls	Bullying	Child Maltreatment	Unintentional Poisoning	Prescription drug overdose	Traumatic Brain Injury	Drowning	Other (Specify)
Technical Assistance
Training
Research/ dissemination
Peer-reviewed publications
Outreach/ Information Dissemination/ Education
Referral/ care coordination
Quality improvement initiatives
Use of fatality review data
Notes:

CSHCN 1 PERFORMANCE MEASURE Goal: Family Engagement Level: Grantee Domain: CSHCN	The percent of programs promoting and/ or facilitating family engagement among children and youth with special health care needs.
GOAL	To ensure supportive programming for family engagement among children and youth with special health care needs.

MEASURE	The percent of MCHB funded projects promoting and/ or facilitating family engagement among children and youth with special health care needs.

DEFINITION	Tier 1: Are you promoting and/ or facilitating family engagement among children and youth with special health care needs in your program? Yes No Tier 2: Through what processes/ mechanisms are you promoting and/ or facilitating family engagement? Technical Assistance Training Product Development Research/ Peer-reviewed publications Outreach/ Information Dissemination/ Education Tracking/ Surveillance Screening/ Assessment Referral/ care coordination Direct Service Quality improvement initiatives Tier 3: How many are reached through those activities? (Report in Table 1: Activity Data Collection Form) # receiving TA # receiving training # products developed # peer-reviewed publications published # receiving information and education through outreach # receiving screening/ assessment # referred/care coordinated # received direct service # participating in quality improvement initiatives Tier 4: What are the related outcomes? % of target population with family and CSHCN leaders with meaningful roles on community/ state/ regional/ national level teams focused on CSHCN systems Numerator: # of Family and CSHCN leaders with meaningful roles on community/state/regional/national level teams focused on CSHCN systems Denominator: # of CSHCN in catchment area % of racial and ethnic family and CSCHN leaders who are trained and serving on community/ state/ regional/ national level teams focused on CSHCN systems Numerator: #of racial and ethnic family and CSHCN leaders trained and serving on community/state/ regional/ national level teams focused on CSHCN systems Denominator: # of CSHCN in catchment area % of target population with family of CSHCN participating in information exchange forums Numerator: # participating in information exchange forums Denominator: # CSHCN in catchment area % of family and CSCHN leaders trained who report increased knowledge, skill, ability and self-efficacy to serve as leaders on systems-level teams Numerator: # of family and CSHCN leaders trained who report increased knowledge, skill, ability and self-efficacy to serve as leaders on systems-level teams Denominator: # of CSHCN in catchment area Definitions: Family Engagement is defined as “patients, families, their representatives, and health professionals working in active partnership at various levels across the health care system to improve health and health care.” This definition is not intended to negate the various levels or degree to which the interaction between families and professionals can take place. Family and Youth Leaders are family members who have experience navigating through service systems and are knowledgeable and skilled in partnering with professionals to carry out necessary system changes. Family members are not limited to the immediate family within the household. Meaningful [Support] Roles for family members/leaders are above and beyond “feedback” surveys. Families are considered to have a meaningful role in decision making when the partnership involves all elements of shared decision-making which are: collaboration, respect, information sharing, encouragement and consideration of preferences and values, and shared responsibility for outcomes.

BENCHMARK DATA SOURCES	N/A

GRANTEE DATA SOURCES	Title V National Outcome Measure #17.2

SIGNIFICANCE	Children and youth live within the context of families, who are the ultimate decision-makers and health enablers for their children.

CSHCN 2 PERFORMANCE MEASURE Goal: Access to and Use of Medical Home Level: Grantee Domain: CSHCN	The percent of programs promoting and/ or facilitating medical home access and use among children and youth with special health care needs.
GOAL	To ensure supportive programming medical home access and use among children and youth with special health care needs.

MEASURE	The percent of MCHB-funded projects promoting and/ or facilitating medical home access and use among children and youth with special health care needs.

DEFINITION	Tier 1: Are you promoting and/ or facilitating medical home access and use among children and youth with special health care needs? Yes No Tier 2: Through what processes/ mechanisms are you addressing medical home access and use? Technical Assistance Training Product Development Research/ Peer-reviewed publications Outreach/ Information Dissemination/ Education Tracking/ Surveillance Screening/ Assessment Referral/ care coordination Direct Service Quality improvement initiatives Tier 3: How many are reached through those activities? (Report in Table 1: Activity Data Collection Form) # receiving TA # receiving training # products developed # peer-reviewed publications published # receiving information and education through outreach # receiving screening/ assessment # referred/care coordinated # received direct service # participating in quality improvement initiatives Tier 4: What are the related outcomes? % of target population that demonstrate a direct linkage to a coordinated medical home community as a direct result of activities conducted by project Numerator: Target population with a demonstrated direct linkage to a coordinated medical home. Denominator: Target population (as identified in grantee application) Definitions: Medical Home: The pediatric medical home can be defined by the AAP as having the following characteristics: the medical care of infants, children, and adolescents ideally should be accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective. It should be delivered or directed by well-trained physicians who provide primary care and help to manage and facilitate essentially all aspects of pediatric care.

BENCHMARK DATA SOURCES	Related to HP2030 MICH-19: Increase the proportion of children and adolescents who receive care in a medical home. (Baseline: 48.6% in 2016-17, Target: 53.6%)

GRANTEE DATA SOURCES	Title V National Performance Measure #11

SIGNIFICANCE	The American Academy of Pediatrics (AAP) specifies seven qualities essential to medical home care, which include accessible, family-centered, continuous, comprehensive, coordinated, compassionate and culturally effective. Providing comprehensive and coordinated care to children in a medical home is the standard of pediatric practice. Research indicates that children with a stable and continuous source of health care are more likely to receive appropriate preventive care, are less likely to be hospitalized for preventable conditions, and are more likely to be diagnosed early for chronic or disabling conditions.

CSHCN 3 PERFORMANCE MEASURE Goal: Transition Level: Grantee Domain: CSHCN	The percent of programs promoting and/or facilitating transition to adult health care for youth with special health care needs.
GOAL	To ensure supportive programming for transition to adult health care for youth with special health care needs.

MEASURE	The percent of MCHB funded projects promoting and/or facilitating transition to adult health care for youth with special health care needs.

DEFINITION	Tier 1: Are you addressing the transitional needs to adult health care for youth with special health care needs in your program? Yes No Tier 2: Through what activities are you promoting or facilitating the transition to adult health care for youth with special health care needs? Technical Assistance Training Product Development Research/ Peer-reviewed publications Outreach/ Information Dissemination/ Education Tracking/ Surveillance Screening/ Assessment Referral/ care coordination Direct Service Quality improvement initiatives Tier 3: How many are reached through those activities? (Report in Table 1: Activity Data Collection Form) # receiving TA # receiving training # products developed # peer-reviewed publications published # receiving information and education through outreach # receiving screening/ readiness assessment # referred/ care coordinated # received direct service # participating in quality improvement initiatives Tier 4: What are the related outcomes? % of grantees promoting an evidence-informed framework and clinical recommendations for transition from pediatric to adult health care. Numerator: Number of Grantees promoting an evidence informed framework Denominator: Total Number of grantees reporting transition performance measure % of grantees involving both pediatric and adult providers/systems in transition efforts Numerator: Number of pediatric and adult providers involved in grantee transition efforts Denominator: Total number of transition practices sponsored by grantee % of grantees initiating or encouraging transition planning early in adolescence Numerator: Number of Grantees promoting transition planning early in adolescence Denominator: Total number of grantees reporting transition performance measure % of grantees linking transition efforts with medical home initiatives Numerator: Number of Grantees promoting transition as part of routine medical home care Denominator: Total number of grantees reporting transition performance measure % of grantees linking transition efforts with adolescent preventive care efforts Numerator: Number of grantees promoting transition as part of routine adolescent preventive care Denominator: Total number of grantees reporting transition performance measure Definitions: The terms “assessed for readiness” and “deemed ready” used here refer to language utilized by gottransition.org. Health care transition: is the process of changing from a pediatric to an adult model of health care. The goal of transition is to optimize health and assist youth in reaching their full potential. To achieve this goal requires an organized transition process to support youth in acquiring independent health care skills, preparing for an adult model of care, and transferring to new providers without disruption in care. Transition Readiness: Assessing youth’s transition readiness and self-care skills is the third element in these health care transition quality recommendations. Use of a standardized transition assessment tool is helpful in engaging youth and families in setting health priorities; addressing self-care needs to prepare them for an adult approach to care at age 18, and navigating the adult health care system, including health insurance. Providers can use the results to jointly develop a plan of care with youth and families. Transition readiness assessment should begin at age 14 and continue through adolescence and young adulthood, as needed.

BENCHMARK DATA SOURCES	Related to HP2030 AH-02: Increase the proportion of adolescents who speak privately with a physician or other health care provider during a preventive medical visit. (Baseline: 38.4% in 2016-17, Target: 43.3%). Related to HP2030 AH-R01: Increase the proportion of adolescents (aged 12 to 17 years) with and without special health care needs who receive services to support their transition to adult health care. (Research)

GRANTEE DATA SOURCES	Title V National Performance Measure #12.

SIGNIFICANCE	Over 90 percent of children with special health care needs now live to adulthood, but are less likely than their non-disabled peers to complete high school, attend college, or be employed. Health and health care are cited as two of the major barriers to making successful transitions. The transition of youth to adulthood, including moving from a child to adult healthcare, is a national priority as evidenced by the 2011 clinical report and algorithm developed jointly by the AAP, American Academy of Family Physicians and American College of Physicians to improve healthcare transitions for all youth and families.⁰

AH 1 PERFORMANCE MEASURE Goal: Adolescent Well Visit Level: Grantee Domain: Adolescent Health	The percent of programs promoting and/ or facilitating adolescent well visits.
GOAL	To ensure supportive programming for adolescent well visits.

MEASURE	The percent of MCHB funded projects promoting and/ or facilitating adolescent well visits.

DEFINITION	Tier 1: Are you promoting and/ or facilitating adolescent well visits in your program? Yes No Tier 2: Through what processes/ mechanisms are you promoting and/ or facilitating adolescent well visits? Technical Assistance Training Product Development Research/ Peer-reviewed publications Outreach/ Information Dissemination/ Education Tracking/ Surveillance Screening/ Assessment Referral/ care coordination Direct Service Quality improvement initiatives Tier 3: How many are reached through those activities? (Report in Table 1: Activity Data Collection Form) # receiving TA # receiving training # products developed # peer-reviewed publications published # receiving information and education through outreach # receiving screening/ assessment training # referred/care coordinated # received direct service # participating in quality improvement initiatives Tier 4: What are the related outcomes in the reporting year? % of adolescents with an adolescent well visit in the past year Numerator: Adolescents reached by the program in reporting year who had an adolescent well visit during the reporting period. Denominator: Adolescents reached by the program in reporting year % of adolescents enrolled in Medicaid/ CHIP with at least one adolescent well visit in the past year Numerator: Adolescents enrolled in Medicaid/ CHIP reached by the program in reporting year with at least one adolescent well visit in the reporting year Denominator: Adolescents enrolled in Medicaid/ CHIP reached by the program in reporting year. Age range of adolescents served: ________________________

BENCHMARK DATA SOURCES	HP2030 AH-01: Increase the proportion of adolescents who received a preventive health care visit in the past year. (Baseline: 78.7% in 2016-17, Target: 82%)

GRANTEE DATA SOURCES	Title V National Performance Measure #10, National Vital Statistics System (NVSS) Birth File.

SIGNIFICANCE	As adolescents move from childhood to adulthood, they assume individual responsibility for health habits, and those who have chronic health problems take on a greater role in managing those conditions. Initiation of risky behaviors, such as unsafe sexual activity, unsafe driving, and substance use, is a critical health issue during adolescence, as adolescents try on adult roles and behaviors. An annual preventive well visit may help adolescents adopt or maintain healthy habits and behaviors, avoid health‐damaging behaviors, manage chronic conditions, and prevent disease.

AH 2 PERFORMANCE MEASURE Goal: Injury Prevention Level: Grantee Domain: Adolescent Health	The percent of programs promoting and/ or facilitating adolescent injury prevention.
GOAL	To ensure supportive programming for adolescent injury prevention.

MEASURE	The percent of MCHB funded projects promoting and/ or facilitating injury prevention and through what processes.

DEFINITION	Tier 1: Are you promoting and/ or facilitating injury prevention in your program? Yes No Tier 2: Through what processes/ mechanisms are you promoting and/ or facilitating injury-prevention? See data collection form. Technical Assistance Training Research/ dissemination Peer-reviewed publications Outreach/ Information Dissemination/ Education Referral/ care coordination Quality improvement initiatives Use of fatality review data Please check which child safety domains which program activities were designed to impact: Motor Vehicle Traffic Suicide/ Self-Harm Falls Bullying Youth Violence (other than bullying) Child Maltreatment Unintentional Poisoning Prescription drug overdose Traumatic Brain Injury Drowning Other Tier 3: How many are reached through those activities? # receiving TA # receiving professional/organizational development training # of peer-reviewed publications published # receiving information and education through outreach # referred/ managed % using fatality review data See data collection form. Tier 4: What are the related outcomes in the reporting year? Rate of injury-related hospitalization to children ages 10-19. Numerator: # of injury-related hospitalizations to children ages 10-19 Denominator: # of children ages 10-19 in the target population Target Population:___________________________ Percent of children ages 12-17 missing 11 or more days of school because of illness or injury. Numerator: # of children ages 12-17 missing 11 or more days of school Denominator: Total number of children ages 12-17 represented in National Survey of Children’s Health result Dataset used: _______________________________

BENCHMARK DATA SOURCES	Related to Healthy People 2030 Injury and Violence Prevention (IVP) objectives 1-7, 9-24 and Injury and Violence Developmental (IV-D) objectives 1-5.

GRANTEE DATA SOURCES	AHRQ Healthcare Cost and Utilization Project: National Inpatient Sample or State Inpatient Database. National Survey of Children’s Health, 6-11 year old and 12-17 year old survey, Question G1.

SIGNIFICANCE	Unintentional injury is the leading cause of child and adolescent mortality, from age 1 through 19. Homicide and suicide, violent or intentional injury are the second and third leading causes of death for adolescents ages 15 through 19.⁴ The total death rate for persons aged 10-19 years decreased 33% between 1999 and 2013, then increased 12% between 2013 and 2016 due to an increase in injury deaths. For those who suffer non-fatal severe injuries, many will become children with special health care needs. Effective interventions to reduce injury exist but are not fully implemented in systems of care that serve children and their families. Reducing the burden of nonfatal injury can greatly improve the life course trajectory of infants, children, and adolescents resulting in improved quality of life and cost savings.

Data Collection Form for Detail Sheet # AH 2

	Motor Vehicle Traffic	Suicide / Self-Harm	Falls	Bullying	Youth Violence (other than bullying)	Child Maltreatment	Unintentional Poisoning	Prescription drug overdose	Traumatic Brain Injury	Drowning	Other (Specify)
Technical Assistance
Training
Research/ dissemination
Peer-reviewed publications
Outreach/ Information Dissemination/ Education
Referral/ care coordination
Quality improvement initiatives
Use of fatality review data
Notes:

AH 3 PERFORMANCE MEASURE Goal: Screening for Major Depressive Disorder Level: Grantee Domain: Adolescent Health	The percent of programs promoting and/ or facilitating screening for major depressive disorder.
GOAL	To ensure supportive programming for screening for major depressive disorder.

MEASURE	The percent of MCHB funded projects promoting and/ or facilitating screening for major depressive disorder for adolescents and through what processes.
DEFINITION	Tier 1: Are you promoting and/ or facilitating screening major depressive disorder for adolescents in your program? Yes No Tier 2: Through what processes/ mechanisms are you addressing screening for major depressive disorder for adolescents? Technical Assistance Training Product Development Research/ Peer-reviewed publications Outreach/ Information Dissemination/ Education Tracking/ Surveillance Screening/ Assessment Referral/ care coordination Direct Service Quality improvement initiatives Tier 3: How many are reached through those activities? (Report in Table 1: Activity Data Collection Form) # receiving TA # receiving training # products developed # peer-reviewed publications published # receiving information and education through outreach # receiving screening/ assessment training # referred/ care coordinated # received direct service # participating in quality improvement initiatives Tier 4: What are the related outcomes in the reporting year? % of 12-17 year olds screened for major depressive disorder (MDD) in the past year in community level or school health settings Numerator: Adolescents involved with your program in the reporting year who were screened for MDD in a community-level or school health setting. Denominator: Adolescents involved with your program in the reporting year. % of adolescent well care visits that include screening for MDD Numerator: Adolescents involved with your program in the reporting year that had a well-child that included a screening for MDD, in the reporting year. Denominator: Adolescents involved with your program in the reporting year that had a well-child visit in the reporting year. % of adolescents identified with a MDD that receive treatment Numerator: Adolescents involved with your program identified as having an MDD that received treatment during the reporting year Denominator: Adolescents involved with your program during the reporting year identified as having an MDD % of adolescents with a MDD Numerator: Adolescents involved with your program during the reporting year identified as having an MDD Denominator: Adolescents involved with your program in the reporting year. Age range of adolescents served: ________________________

BENCHMARK DATA SOURCES	Healthy People 2030 MHMD-08: Increase the proportion of primary care office visits where adolescents and adults are screened for depression (Baseline 8.5% of primary care office visits included screening for depression in persons aged 12 years and over in 2016, Target: 13.5%). Healthy People 2030 MHMD-06: Increase the proportion of adolescents with major depressive episodes (MDEs) who receive treatment (Baseline: 41.4% of adolescents aged 12 to 17 years with MDEs received treatment in the past 12 months, in 2018; Target: 46.4%).

GRANTEE DATA SOURCES	Grantee Data Systems

SIGNIFICANCE	Depression is under recognized and undertreated in adolescents, with an estimated 75% of depressed adolescents not receiving treatment. Untreated depression in adolescence is associated with debilitating immediate and long-term psychological and physical outcomes, as well as increased risk of suicide. Validated screening instruments and effective treatment are available. Routine depression screening for all adolescents helps reduce the challenges of case-finding due to stigma, parental/patient denial and common assumptions about “typical teenage” behavior.⁰

LC 1 PERFORMANCE MEASURE Goal: Adequate Health Insurance Coverage Level: Grantee Domain: Life Course/ Cross Cutting	The percent of programs promoting and/ or facilitating adequate health insurance coverage.
GOAL	To ensure supportive programming for adequate health insurance coverage.

MEASURE	The percent of MCHB funded projects promoting and/ or facilitating adequate health insurance coverage.

DEFINITION	Tier 1: Are you promoting and/ or facilitating adequate health insurance coverage in your program? Yes No Tier 2: Through what activities are you promoting and/ or facilitating adequate health insurance coverage? Technical Assistance Training Product Development Research/ Peer-reviewed publications Outreach/ Information Dissemination/ Education Tracking/ Surveillance Screening/ Assessment Referral to insurance enrollment Quality improvement initiatives Tier 3: How many are reached through those activities? See data LC 1 Data Collection Form. Tier 4: What are the related outcomes? % with health insurance⁰ Numerator: Number of program participants with health insurance as of the last assessment during the reporting period Denominator: Number of program participants during the reporting period Participants are identified as not insured if they report not having any of the following: private health insurance, Medicare, Medicaid, Children's Health Insurance Program (CHIP), State-sponsored or other government-sponsored health plan, or military plan at the time of the interview. A participant is also defined as uninsured if he or she reported having only Indian Health Service coverage, or only a private plan that paid for one type of service such as family planning, accidents, or dental care. For more information regarding health insurance questions please refer to Section VII (page 35) of the 2014 National Health Interview Survey (NHIS) Survey Description % with adequate health insurance in the reporting year Numerator: Program participants who reported having adequate insurance coverage during the reporting period Denominator: Program participants during the reporting period

BENCHMARK DATA SOURCES	Related to HP2030 AHS-01: Increase the proportion of people with health insurance (Baseline: 89.0% of persons under 65 years had medical insurance in 2018; Target: 92.1%)

GRANTEE DATA SOURCES	Grantee data systems

SIGNIFICANCE	Inadequately insured children are more likely to have delayed or forgone care, lack a medical home, be less likely to receive needed referrals and care coordination, and receive family-centered care.⁰ Approximately 27% of American children were not adequately insured in 2018-2019.⁰

Data Collection form for #LC 1

Please check all population domains that you engage in each activity listed in Tier 2 related to adequate health insurance coverage. For those activities or population domains that do not pertain to you, please leave them blank.

	Pregnant/ Perinatal Women (Col 1)	Infants (Col 2)	Children (Col3)	CSHCN (Col 4)	Adolescents (Col 5)	Non-pregnant Adults (Col 5)	Providers/ Health Care Professionals (Col 6)	Community/ Local Partners (Col 7)	State or National Partners (Col 8)	Other Specify____ (Col 9)
Technical Assistance
Training
Product Development
Research/ Peer-reviewed publications
Outreach/ Information Dissemination/ Education
Tracking/ Surveillance
Screening/ Assessment
Referral
Direct Service
Quality improvement initiatives

LC 2 PERFORMANCE MEASURE Goal: Tobacco and eCigarette Use Level: Grantee Domain: Life Course/ Cross Cutting	The percent of programs promoting and/ or facilitating tobacco and eCigarette cessation.
GOAL	To ensure supportive programming promoting and/ or facilitating tobacco and eCigarette cessation.

MEASURE	The percent of MCHB funded projects promoting and/ or facilitating tobacco and eCigarette cessation, and through what processes.

DEFINITION	Tier 1: Are you addressing tobacco and eCigarette cessation in your program? Yes No Tier 2: Through what activities are you promoting and/ or facilitating tobacco and eCigarette cessation? Technical Assistance Training Product Development Research/ Peer-reviewed publications Outreach/ Information Dissemination/ Education Tracking/ Surveillance Screening/ Assessment Referral/ care coordination Direct Service Quality improvement initiatives Tier 3: How many are reached through those activities? See data LC 2 Data Collection Form. Tier 4: What are the related outcomes in the reporting year? % of prenatal program participants who abstain from smoking Numerator: Number of prenatal program participants who do not smoke cigarettes as of their last contact in the reporting year. Denominator: Number of prenatal program participants during the reporting year. % of prenatal program participants that abstain from smoking cigarettes in their third trimester. Numerator: Number of prenatal program participants who abstained from using any tobacco products during the last 3 months (third trimester) of pregnancy. Denominator: Total number of prenatal program participants who were enrolled at least 90 days before delivery. Smoking includes all tobacco products and e-cigarettes.

BENCHMARK DATA SOURCES	Related to HP2030 MICH-10: Increase abstinence from cigarette smoking among pregnant women. (Baseline: 93.5% in 2018, Target: 95.7%). Related to HP2030 TU-15: Increase smoking cessation success during pregnancy among females. (Baseline: 20.2% in 2018, Target 24.4%)

GRANTEE DATA SOURCES	Grantee data systems

SIGNIFICANCE	Women who smoke during pregnancy are more likely to experience a fetal death or deliver a low birth weight baby. Adverse effects of parental smoking on children have been a clinical and public health concern for decades.⁰ Children have an increased frequency of ear infections; acute respiratory illnesses and related hospital admissions during infancy; severe asthma and asthma-related problems; lower respiratory tract infections; and SIDS.

Data Collection form for #LC 2

Please check all population domains that you engage in each activity listed in Tier 2 related to tobacco cessation. For those activities or population domains that do not pertain to you, please leave them blank.

	Pregnant/ Perinatal Women (Col 1)	Infants (Col 2)	Children (Col3)	CSHCN (Col 4)	Adolescents (Col 5)	Non-pregnant Adults (Col 5)	Providers/ Health Care Professionals (Col 6)	Community/ Local Partners (Col 7)	State or National Partners (Col 8)	Other Specify____ (Col 9)
Technical Assistance
Training
Product Development
Research/ Peer-reviewed publications
Outreach/ Information Dissemination/ Education
Tracking/ Surveillance
Screening/ Assessment
Referral
Direct Service
Quality improvement initiatives

LC 3 PERFORMANCE MEASURE Goal: Oral Health Level: Grantee Domain: Life Course/ Cross Cutting	The percent of programs promoting and/ or facilitating oral health.
GOAL	To ensure supportive programming for oral health.

MEASURE	The percent of MCHB funded projects promoting and/ or facilitating oral health, and through what activities.

DEFINITION	Tier 1: Are you promoting and/ or facilitating oral health in your program? Yes No Tier 2: Through what activities are you promoting and/ or facilitating oral health? Technical Assistance Training Product Development Research/ Peer-reviewed publications Outreach/ Information Dissemination/ Education Tracking/ Surveillance Screening/ Assessment Referral Direct Service Quality improvement initiatives Tier 3: How many from each population are reached through each of the activities? See data LC 3 Data Collection Form. Tier 4: What are the related outcomes in the reporting year? % of program participants receiving an oral health risk assessment Numerator: Number of program participants who received an oral health risk assessment in the reporting year Denominator: All program participants % of women in program population who had a dental visit during pregnancy Numerator: Program participants who were pregnant during the reporting year who had a dental visit Denominator: Program participants who were pregnant during the reporting year % of those aged 1 through 17 who had preventative oral health visit during the last year Numerator: Infants and children involved with the program who received a preventative oral health visit in the reporting year Denominator: Infants and children involved with the program during the reporting year.

BENCHMARK DATA SOURCES	Related to HP2030 OH-8: Increase the proportion of children, adolescents, and adults who use the oral health care system (Baseline: 43.3% in 2016; Target: 45.0%). Related to HP2030 OH-9: Increase the proportion of low income youth who have a preventive dental visit (Baseline: 78.8% of children aged 1 through 17 years who reside in households with income less than 200 percent of the federal poverty level received a preventive dental service in 2016-17; Target: 82.7%).

GRANTEE DATA SOURCES	Title V National Performance Measure #13

SIGNIFICANCE	Oral health is a vital component of overall health and oral health care remains the greatest unmet health need for children. Insufficient access to oral health care and effective preventive services affects children’s health, education, and ability to prosper. To prevent tooth decay and oral infection, the American Academy of Pediatric Dentistry (AAPD) recommends preventive dental care for all children after the eruption of the first tooth or by 12 months of age, usually at intervals of every 6 months.⁰ Preventive dental care in pregnancy is also recommended by the American College of Obstetricians and Gynecologists (ACOG) to improve lifelong oral hygiene habits and dietary behavior for women and their families.⁰

Data Collection Form for #LC 3

Please use the form below to identify what services you provide to each population. For those that you provide the service to, please provide the number reached by the services provided (i.e. number of children receiving referrals), for those that you do not, please leave blank.

	Pregnant/ Perinatal Women (Col 1)	Infants (Col 2)	Children (Col3)	CSHCN (Col 4)	Adolescents (Col 5)	Non-pregnant Adults (Col 5)	Providers/ Health Care Professionals (Col 6)	Community/ Local Partners (Col 7)	State or National Partners (Col 8)	Other Specify____ (Col 9)
Technical Assistance
Training
Product Development
Research/ Peer-reviewed publications
Outreach/ Information Dissemination/ Education
Tracking/ Surveillance
Screening/ Assessment
Referral
Direct Service
Quality improvement initiatives

DIVISION OF MCH WORKFORCE DEVELOPMENT:

PERFORMANCE MEASURE DETAIL SHEET SUMMARY TABLE

Performance Measure	Topic
Training 01	MCH Training Program and Healthy Tomorrows Family Member/Youth/Community Member participation
Training 02	MCH Training Program and Healthy Tomorrows Cultural Responsiveness
Training 03	Healthy Tomorrows Title V Collaboration
Training 04	Title V Collaboration
Training 05	Policy
Training 06	Racial and Ethnic Diversity of Long-Term Trainees
Training 07	MCH LEAP Program – Work with MCH populations
Training 08	MCH LEAP Program – Work with populations that are underserved or have been marginalized
Training 09	MCH LEAP - Graduate Program Enrollment
Training 10	Leadership
Training 11	Work with MCH Populations
Training 12	Interdisciplinary Practice
Training 14	Medium-Term Trainees Skill and Knowledge (PPC-Specific)
Training 15	Teleconsultation and Training for Mental and Behavioral Health

Training 01 PERFORMANCE MEASURE Goal: Family/ Youth/ Community Engagement in MCH Training and Healthy Tomorrows Programs Level: Grantee Domain: MCH Workforce Development	The percent of MCHB training and Healthy Tomorrows programs that ensure family, youth, and community member participation in program and policy activities.
GOAL	To increase family, youth, and/or community member participation in MCH Training and Healthy Tomorrows programs.

MEASURE	The percent of MCHB training and Healthy Tomorrows programs that ensure family/ youth/ community member participation in program and policy activities.

DEFINITION	Attached is a table of five elements that demonstrate family member/youth/community member participation, including an emphasis on partnerships and building leadership opportunities for family members/youth/community members in MCH Training or Healthy Tomorrows programs. Please check yes or no to indicate if your MCH Training Program or Healthy Tomorrows program has met each element.

BENCHMARK DATA SOURCES	PHI-3: Increase the proportion of Council on Education for Public Health (CEPH) accredited schools of public health, CEPH accredited academic programs, and schools of nursing (with a public health or community health component) that integrate Core Competencies for Public Health Professionals into curricula

GRANTEE DATA SOURCES	Attached data collection form to be completed by grantee.

SIGNIFICANCE	Over the last decade, policy makers and program administrators have emphasized the central role of families and other community members as advisors and participants in program and policy-making activities. In accordance with this philosophy, MCH Training Programs and Healthy Tomorrows Programs are facilitating such partnerships at the local, State and national levels. MCH Training programs support interdisciplinary/interprofessional graduate education and training programs that emphasize leadership, and family-centered, community-based, and culturally responsive systems of care. Training programs are required to incorporate family members/youth/community members as faculty, trainees, and partners. The Healthy Tomorrows program supports community initiated and community-based projects that apply principles of health promotion, disease prevention, and the benefits of coordinated health care to the provision of services that improve access to comprehensive, community-based, family-centered, culturally/linguistically responsive, and coordinated care. Healthy Tomorrows projects are required to incorporate family members/youth/community members as project staff, advisors, volunteers, and partners. This performance measure directly relates to MCHB Strategic Plan Objective 1.3: Ensure family and consumer leadership and partnership in efforts to improve health and strengthen MCH systems of care.

DATA COLLECTION FORM FOR DETAIL SHEET: Training 01 - Family/ Youth/ Community Engagement in MCH Training and Healthy Tomorrows Programs

Please indicate if your MCH Training or Healthy Tomorrows program has included family members, youth, and/or community members in each of the program elements listed below. Use the space provided for notes to provide additional details about activities, as necessary. (NOTE: Programs are only required to have participation from family members or youth or community members for each element to answer “Yes”)

Element	Yes 1	No 0
Participatory Planning Family members/youth/community members participate in and provide feedback on the planning, implementation and/or evaluation of the training or Healthy Tomorrows program’s activities (e.g., strategic planning, program planning, materials development, program activities, and performance measure reporting).
Cultural Diversity Culturally diverse family members/youth/community members facilitate the training or Healthy Tomorrows program’s ability to meet the needs of the populations served.
Leadership Opportunities Within your training or Healthy Tomorrows program, family members/youth/community members are offered training, mentoring, and/or opportunities for leadership roles on advisory committees or task forces.
Compensation Family members/youth/community members who participate in the MCH Training or Healthy Tomorrows program are paid faculty, staff, consultants, or compensated for their time and expenses.
Train MCH/CSHCN staff Family members/youth/community members work with their training or Healthy Tomorrows program to provide training (pre‑service, in-service and professional development) to MCH/CSHCN faculty/staff, students/trainees, and/or providers.

NOTES/COMMENTS:

Training 02 PERFORMANCE MEASURE Goal: Cultural Responsiveness in MCH Training and Healthy Tomorrows Programs Level: Grantee Domain: MCH Workforce Development	The percent of MCHB training and Healthy Tomorrows programs that have incorporated cultural and linguistic responsiveness elements into their policies, guidelines, and training.
GOAL	To increase the percentage of MCH Training and Healthy Tomorrows programs that have integrated cultural and linguistic responsiveness into their policies, guidelines, and training.

MEASURE	The percent of MCHB training and Healthy Tomorrows programs that have integrated cultural and linguistic responsiveness into their policies, guidelines, and training.

DEFINITIONS	Attached is a checklist of 6 elements that demonstrate cultural and linguistic responsiveness. Please check yes or no to indicate if your MCH Training or Healthy Tomorrows program has met each element. Please keep the completed checklist attached. Cultural and linguistic responsiveness is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. ‘Culture’ refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. ‘Responsiveness’ implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities. (Adapted from Cross, 1989; cited from National Center for Cultural Competence (http://nccc.georgeto wn.edu/foundations/frameworks.html) Linguistic responsiveness is the capacity of an organization and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse audiences including persons of limited English proficiency, those who have low literacy skills or are not literate, and individuals with disabilities. Linguistic responsiveness requires organizational and provider capacity to respond effectively to the health literacy needs of populations served. The organization must have policy, structures, practices, procedures, and dedicated resources to support this capacity. (Goode, T. and W. Jones, 2004. National Center for Cultural Competence; http://www.nccccurricula.info/linguisticcompetence.html) Cultural and linguistic responsiveness is a process that occurs along a developmental continuum. A culturally and linguistically responsive program is characterized by elements including the following: written strategies for advancing cultural responsiveness; cultural and linguistic responsiveness policies and practices; cultural and linguistic responsiveness knowledge and skills building efforts; research data on populations served according to racial, ethnic, and linguistic groupings; faculty and other instructors are racially and ethnically diverse; faculty and staff participate in professional development activities related to cultural and linguistic responsiveness; and periodic assessment of trainees’ progress in developing cultural and linguistic responsiveness.

BENCHMARK DATA SOURCES	Related to the following HP2030 Objectives: PHI-RO3: Increase the use of core and discipline-specific competencies to drive workforce development PHI-06: Increase the proportion of state public health agencies that use core competencies in continuing education. PHI-07: Increase the proportion of local public health agencies that use core competencies in continuing education

GRANTEE DATA SOURCES	Attached data collection form is to be completed by grantees. There is no existing national data source to measure the extent to which MCHB supported programs have incorporated cultural responsiveness elements into their policies, guidelines, and training.

SIGNIFICANCE	Over the last decade, researchers and policymakers have emphasized the central influence of cultural values and cultural/linguistic barriers: health seeking behavior, access to care, and racial and ethnic disparities. In accordance with these concerns, cultural responsiveness objectives have been: (1) incorporated into the Division of MCH Workforce Development priorities; and (2) in guidance materials related to the MCH Training and Healthy Tomorrows Programs. The Division of MCH Workforce Development provides support to programs that address cultural and linguistic responsiveness through development of curricula, research, learning and practice environments. This performance measure directly relates to MCHB Strategic Plan Objective 3.2: Support training and educational opportunities to create a diverse an culturally responsive MCH workforce, including professionals, community-based workers, and families.

DATA COLLECTION FORM FOR DETAIL SHEET: Training 02 – Cultural Responsiveness in MCH Training and Healthy Tomorrows Programs

Please indicate if your MCH Training or Healthy Tomorrows program has incorporated the following cultural/linguistic responsiveness elements into your policies, guidelines, and training.

Please use the space provided for notes to provide additional details about the elements, as applicable.

Element	Yes 1	No 0
Written Guidelines Strategies for advancing cultural and linguistic responsiveness are integrated into your training or Healthy Tomorrows program’s written plan(s) (e.g., grant application, recruiting plan, placement procedures, monitoring and evaluation plan, human resources, formal agreements, etc.).
Training Cultural and linguistic responsiveness knowledge and skills building are included in training aspects of your program.
Data Research or program information gathering includes the collection and analysis of data on populations served according to racial, ethnic, and linguistic groupings, where appropriate.
Staff/faculty cultural and linguistic diversity MCH Training Program or Healthy Tomorrows staff and faculty reflect cultural and linguistic diversity of the significant populations served.
Professional development MCH Training Program or Healthy Tomorrows staff and faculty participate in professional development activities to promote their cultural and linguistic competence.
Measure progress Measurement of Progress A process is in place to assess the progress of MCH Training program or Healthy Tomorrows participants in developing cultural and linguistic responsiveness.

NOTES/COMMENTS:

Training 03 PERFORMANCE MEASURE Goal: Healthy Tomorrow’s Partnership Level: Grantee Domain: MCH Workforce Development	The degree to which the Healthy Tomorrows Partnership for Children program collaborates with State Title V agencies, other MCH or MCH-related programs.
GOAL	To assure that the Healthy Tomorrows program has collaborative interactions related to professional development, policy development and product development and dissemination with relevant national, state and local MCH programs, agencies and organizations.

MEASURE	The degree to which a Healthy Tomorrows program collaborates with State Title V agencies, and other MCH or MCH-related programs.

DEFINITION	Attached is a list of the 7 elements that describe activities carried out by Healthy Tomorrows programs for or in collaboration with State Title V and other agencies on a scale of 0 to 1 (0=no; 1=yes). If a value of ‘1’ (yes) is selected, provide the number of activities for the element. The total score for this measure will be determined by the sum of those elements noted as ‘1.’

BENCHMARK DATA SOURCES	ECBP-DO9: Increase core clinical prevention and population health education in medical schools. ECBP-D10: Increase core clinical prevention and population health education in nursing schools. ECBP-D11: Increase core clinical prevention and population health education in physician assistant training programs. ECBP-D12: Increase core clinical prevention and population health education in pharmacy schools. ECBP-D13: Increase core clinical prevention and population health education in dental schools. PHI-06: Increase the proportion of state public health agencies that use core competencies in continuing education. PHI-07: Increase the proportion of local public health agencies that use core competencies in continuing education. PHI-DO1: Increase the proportion of tribal public health agencies that use core competencies in continuing education.

GRANTEE DATA SOURCES	The Healthy Tomorrows program completes the attached table which describes the categories of collaborative activity.

SIGNIFICANCE	As a SPRANS grantee, a Healthy Tomorrows program enhances the Title V State block grants that support MCHB Strategic Plan Goal 1: to assure access to high-quality and equitable health services to optimize health and well-being for all MCH populations. Interactive collaboration between a Healthy Tomorrows program and Federal, Tribal, State and local agencies dedicated to improving the health of MCH populations will increase active involvement of many disciplines across public and private sectors and increase the likelihood of success in meeting the goals of relevant stakeholders. This measure will document a Healthy Tomorrows program’s abilities to: collaborate with State Title V and other agencies (at a systems level) to support achievement of the MCHB Strategic Goals and Healthy People 2030 objectives; make the needs of MCH populations more visible to decision-makers and help states achieve best practice standards for their systems of care; internally use these data to assure a full scope of these program elements in all regions.

DATA COLLECTION FORM FOR DETAIL SHEET: Training 03 – Healthy Tomorrows Partnership

Indicate the degree to which the Healthy Tomorrows program collaborates with State Title V (MCH Block Grant) agencies and other MCH or MCH-related programs^1,2 by entering the following values:

0= Does not collaborate on this element 1= Does collaborate on this element.

If your program does collaborate, provide the total number of activities for the element.

	State Title V Agencies¹			Other MCH-related programs²
Element	0	1	Total number of activities	0	1	Total number of activities
Advisory Committee Examples might include: having representation from State Title V or other MCH program on your advisory committee
Professional Development & Training Examples might include: collaborating with state Title V agency to develop state training activity
Policy Development Examples might include: working with State Title V agency to develop and pass legislation
Research, Evaluation, and Quality Improvement Examples might include: working with MCH partners on quality improvement efforts
Product Development Examples might include: participating on collaborative with MCH partners to develop community materials
Dissemination Examples might include: disseminating information on program implementation to local MCH partners
Sustainability Examples might include: working with state and local MCH representatives to develop sustainability plans
Total

¹State Title V programs include State Block Grant funded or supported activities.

²Other maternal and child health-related programs (both MCHB-funded and funded from other sources) include, but are not limited to:

State Health Department
State Adolescent Health
Social Service Agency
Medicaid Agency
Education
Juvenile Justice
Early Intervention
Home Visiting
Professional Organizations/Associations
Family and/or Consumer Group
Self-Advocacy Groups
Foundations
Clinical Program/Hospitals
Local and state division of mental health
Developmental disability agencies
Tribal governments and organizations
School-based programs, including heath centers
City and County Health Departments
Health care organizations
Behavioral health disorder support and advocacy organizations
College/University programs
Faith-based programs
Other programs working with maternal and child health populations

Training 04 PERFORMANCE MEASURE Goal: Collaborative Interactions Level: Grantee Domain: MCH Workforce Development	The degree to which a training program collaborates with State Title V agencies, other MCH or MCH-related programs.
GOAL	To assure that a training program has collaborative interactions related to training, technical assistance, continuing education, and other capacity-building services with relevant national, state and local programs, agencies and organizations.

MEASURE	The degree to which a training program collaborates with State Title V agencies, other MCH or MCH-related programs and other professional organizations.

DEFINITION	Attached is a list of the 6 elements that describe activities carried out by training programs for or in collaboration with State Title V and other agencies on a scale of 0 to 1. If a value of ‘1’ is selected, provide the number of activities for the element. The total score for this measure will be determined by the sum of those elements noted as ‘1.’

BENCHMARK DATA SOURCES	ECBP-DO9: Increase core clinical prevention and population health education in medical schools. ECBP-D10: Increase core clinical prevention and population health education in nursing schools. ECBP-D11: Increase core clinical prevention and population health education in physician assistant training programs. ECBP-D12: Increase core clinical prevention and population health education in pharmacy schools. ECBP-D13: Increase core clinical prevention and population health education in dental schools. PHI-06: Increase the proportion of state public health agencies that use core competencies in continuing education. PHI-07: Increase the proportion of local public health agencies that use core competencies in continuing education. PHI-DO1: Increase the proportion of tribal public health agencies that use core competencies in continuing education.

GRANTEE DATA SOURCES	The training program completes the attached table which describes the categories of collaborative activity.

SIGNIFICANCE	As a SPRANS grantee, a training program enhances the Title V State block grants that support the MCHB Strategic Plan Goal 1: to assure access to high-quality and equitable health services to optimize health and well-being for all MCH populations. Interactive collaboration between a training program and Federal, Tribal, State and local agencies dedicated to improving the health of MCH populations will increase active involvement of many disciplines across public and private sectors and increase the likelihood of success in meeting the goals of relevant stakeholders. This measure will document a training program’s abilities to: collaborate with State Title V and other agencies (at a systems level) to support achievement of MCHB Strategic Goals and Healthy People 2030 objectives; make the needs of MCH populations more visible to decision-makers and can help states achieve best practice standards for their systems of care; and internally use these data to assure a full scope of these program elements in all regions.

DATA COLLECTION FORM FOR DETAIL SHEET PM #Training 04 – Collaborative Interactions

Indicate the degree to which your training program collaborates with State Title V (MCH Block Grant) agencies and other MCH-related programs* by entering the following values:

0= Does not collaborate on this element 1= Does collaborate on this element.

If your program does collaborate, provide the total number of activities for the element.

Element	State Title V programs¹			Other MCH-related programs²
Element	0	1	Total number of activities	0	1	Total number of activities
Service* Examples might include: Clinics run by the training program and/ or in collaboration with other agencies
Training Examples might include: Training in Bright Futures; Workshops related to adolescent health practice; and Community-based practices. It would not include clinical supervision of long-term trainees.
Continuing Education Examples might include: Conferences; Distance learning; and Computer-based educational experiences. It would not include formal classes or seminars for long-term trainees.
Technical Assistance Examples might include: Conducting needs assessments with State programs; policy development; grant writing assistance; identifying best-practices; and leading collaborative groups. It would not include conducting needs assessments of consumers of the training program services.
Product Development Examples might include: Collaborative development of journal articles and training or informational videos.
Research Examples might include: Collaborative submission of research grants, research teams that include Title V or other MCH-program staff and the training program’s faculty.
Total

¹State Title V programs include State Block Grant funded or supported activities.

²Other maternal and child health-related programs (both MCHB-funded and funded from other sources) include, but are not limited to:

State Health Department
State Adolescent Health
Social Service Agency
Medicaid Agency
Education
Juvenile Justice
Early Intervention
Home Visiting
Professional Organizations/Associations
Family and/or Consumer Group
Self-Advocacy Groups
Foundations
Clinical Program/Hospitals
Local and state division of mental health
Developmental disability agencies
Tribal governments and organizations
School-based programs, including heath centers
City and County Health Departments
Health care organizations
Behavioral health disorder support and advocacy organizations
College/University programs
Faith-based programs
Other programs working with maternal and child health populations

*Ongoing collaborations with clinical locations should be counted as one activity (For example: multiple trainees rotate through the same community-based clinical site over the course of the year. This should be counted as one activity.)

Training 05 PERFORMANCE MEASURE Goal: Policy Development Level: Grantee Domain: MCH Workforce Development	The degree to which MCH long-term training grantees engage in policy development, implementation, and evaluation.
GOAL	To increase the number of MCH long-term training programs that actively promote the transfer and utilization of MCH knowledge and research to the policy arena through the work of faculty, trainees, alumni, and collaboration with Title V.

MEASURE	The degree to which MCH long-term training grantees engage in policy development, implementation, and evaluation.

DEFINITION	Attached is a list of six elements that demonstrate policy engagement. Please check yes or no to indicate which the elements have been implemented. Please keep the completed checklist attached. Policy development, implementation and evaluation in the context of MCH training programs relates to the process of translating research to policy and training for leadership in the core public health function of policy development.

BENCHMARK DATA SOURCES	PHI-R02: Expand public health pipeline programs that include service or experiential learning. PHI-R03: Increase use of core and discipline-specific competencies to drive workforce development.

GRANTEE DATA SOURCES	Attached data collection form to be completed by grantee. Data will be collected from competitive and continuation applications as part of the grant application process and annual reports. The elements of training program engagement in policy development, implementation, and evaluation need to be operationally defined with progress noted on the attached list with an example described more fully in the narrative application.

SIGNIFICANCE	Policy development is one of the three core functions of public health as defined by the Institute of Medicine in The Future of Public Health (National Academy Press, Washington DC, 2015). In this landmark report by the IOM, the committee recommends that “every public health agency exercise its responsibility to serve the public interest in the development of comprehensive public health policies by promoting use of the scientific knowledge base in decision-making about public health and by leading in developing public health policy.” Academic institutions such as schools of public health and research universities have the dual responsibility to develop knowledge and to produce well-trained professional practitioners. This national performance measure relates directly to MCHB Strategic Plan Goal 3: Strengthen public health capacity and workforce in MCH.

DATA COLLECTION FORM FOR DETAIL SHEET: Training 05 - Policy Development

Using a response of Yes (1) or No (0), indicate whether your training program has addressed the following policy training and policy participation elements.

CATEGORY #1: Training on Policy and Advocacy

Element	Yes 1	No 0
Your MCHB-funded Training Program provides didactic opportunities for training on policy development and advocacy to increase understanding of how the policy process works at the federal, state and/or local levels.
Your MCHB-funded Training Program provides an opportunity for application of policy and advocacy knowledge through one or more of the following educational experiences If Yes, check all that apply: Write a policy brief about an emerging local MCH public health issue Attend a meeting of a local MCH stakeholder group, provide a written summary of their approach Attend a professional association meeting and actively participate on a committee Educate Policymakers Provide written and/or oral testimony to the state legislature Write an article on an MCH topic for a lay audience Observe a legislative hearing on CSPAN, or if possible, attend a legislative hearing on an MCH topic Track a bill over the Internet over the course of a legislative session Interview an agency or organization-based MCH policy maker, administrator, or advocate and prepare written and/or oral mock testimony from the perspective of the agency/association interviewed Other, please describe ________________________
A pre/post assessment is in place to measure increased policy knowledge and skills of long-term trainees (NOTE: Long-term trainees are defined as those who have completed a long-term [greater than or equal to 300 contact hours] MCH Training Program, including those who received funds and those who did not). If Yes, report: % of current trainees reporting increased policy knowledge _____________ % of current trainees reporting increased policy skills ________________

CATEGORY #2: Participation in Policy Change and Translation of Research into Policy

Element	Yes 1	No 0
Trainees, faculty and/or staff contribute to the development of guidelines, regulation, legislation or other public policy at the local, state, and/or national level. If yes, indicate all policy arenas to which they have contributed: Local State National
Trainees, faculty and/or staff participate in local, state and/or national MCH advocacy networks and initiatives If yes, indicate all policy arenas to which they have contributed : Local State National
Trainees, faculty and/or staff participate in disseminating and communicating research findings (both original and non-original) directly to public health agency leaders and/or policy officials. If yes, indicate all policy arenas to which they have contributed: Local State National

Training 06 PERFORMANCE MEASURE Goal: Long Term Training Programs Level: Grantee Domain: MCH Workforce Development	The percentage of participants in MCHB long-term training programs who are from underrepresented racial and ethnic groups.
GOAL	To increase the percentage of trainees participating in MCHB long‑term training programs who are from racial and ethnic groups who are underrepresented in the MCH workforce.

MEASURE	The percentage of participants in MCHB long-term training programs who are from racial and ethnic groups who are underrepresented in the MCH workforce.

DEFINITION	Ethnicity Numerator: Total number of long‑term trainees (≥ 300 contact hours) participating in MCHB training programs reported to be from ethnic groups that are underrepresented in the MCH workforce. (Include MCHB-supported and non-supported trainees.) Denominator: Total number of long‑term trainees (≥ 300 contact hours) participating in MCHB training programs. (Include MCHB-supported and non-supported trainees.) Units: 100 Text: Percentage Hispanic or Latino is defined as a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. People who identify as Hispanic, Latino, or Spanish may be any race. Race Numerator: Total number of long term trainees (≥ 300 contact hours) participating in MCHB training programs reported to be from racial groups that are underrepresented in the MCH workforce. (Include MCHB-supported and non-supported trainees.) Denominator: Total number of long term trainees (≥ 300 contact hours) participating in MCHB training programs. (Include MCHB-supported and non-supported trainees.) Units: 100 Text: Percentage .

BENCHMARK DATA SOURCES	Related to Healthy People 2030 Objectives: AHS-R01: Increase the ability of primary care and behavioral health professionals to provide more high-quality care to patients who need it. AHS-R02: Increase the use to telehealth to improve access to health services.

GRANTEE DATA SOURCES	Data will be collected annually from grantees about their trainees. MCHB does not maintain a master list of all trainees who are supported by MCHB long‑term training programs. References supporting Workforce Diversity:  In the Nation’s Compelling Interest: Ensuring Diversity in the Healthcare Workforce (2004). Institute of Medicine.  Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (2002). Institute of Medicine.

SIGNIFICANCE	HRSA’s MCHB places special emphasis on improving service delivery to women, children and youth from communities with limited access to comprehensive care. Training an ethnically and racially diverse group of professionals is necessary in order to provide a diverse public health workforce to meet the needs of the changing demographics of the U.S. and to ensure access to culturally responsive and effective services. This performance measure provides the necessary data to report on HRSA’s initiatives to reduce health disparities. This national performance measure relates directly to MCHB Strategic Plan Objective 3.2: Support training and educational opportunities to create a diverse and culturally responsive MCH workforce, including professionals, community-based workers, and families.

DATA COLLECTION FORM FOR DETAIL SHEET: Training 06 – Long Term Training Programs

Report on the percentage of long-term trainees (≥300 contact hours) who are from a racial/ethnic group (i.e., Hispanic or Latino, American Indian or Alaskan Native, Asian, Black or African-American, Native Hawaiian or Pacific Islander, more than one race (OMB) that is underrepresented in the MCH workforce. Please use the space provided for notes to detail the data source and year of data used.

Report on all long-term trainees (≥ 300 contact hours) including MCHB-funded and non MCHB-funded trainees
Report race and ethnicity separately
Trainees who select multiple ethnicities should be counted once
Grantee reported numerators and denominator will be used to calculate percentages

Total number of long term trainees (≥ 300 contact hours) participating in the training program. (Include MCHB-supported and non-supported trainees.)

________

Ethnic Categories

Number of long-term trainees who are Hispanic or Latino (Ethnicity) ________

Racial Categories

Number of long-term trainees who are American Indian or Alaskan Native ________

Number of long-term trainees who are Asian descent ________

Number of long-term trainees who are Black or African-American ________

Number of long-term trainees who are Native Hawaiian or Pacific Islanders ________

Number of long-term trainees who are more than one race ________

Notes/Comments:

Training 07 PERFORMANCE MEASURE Goal: MCH Pipeline Programs Level: Grantee Domain: MCH Workforce Development	The percent of MCHB LEAP Program graduates who have been engaged in work focused on MCH populations.
GOAL	To increase the percent of graduates of MCH Leadership, Education and Advancement in Undergraduate Pathways (LEAP) Programs who have been/are engaged in work focused on MCH populations.

MEASURE	The percent of MCHB LEAP Program graduates who have been engaged in work focused on MCH populations since graduating from the MCH LEAP Training Program.

DEFINITION	Numerator: Number of LEAP graduates reporting they have been engaged in work focused on MCH populations since graduating from the MCH LEAP Training Program. Denominator: The total number of trainees responding to the survey Units: 100 Text: Percent MCH LEAP trainees are defined as undergraduate students from underserved or underrepresented backgrounds, including trainees from racially and ethnically underrepresented groups who receive education, mentoring, and guidance to increase their interest and entry into MCH public health and related health professions. MCH Populations: Includes women, infants and children, adolescents, young adults, and their families including fathers, and children and youth with special health care needs

BENCHMARK DATA SOURCES	Related to Healthy People 2030: AHS-R01: Increase the ability of primary care and behavioral health professionals to provide more high-quality care to patients who need it. AHS-R02: Increase the use to telehealth to improve access to health services. PHI-R02: Expand public health pipeline programs that include service or experiential learning. PHI-R03: Increase use of core and discipline-specific competencies to drive workforce development

GRANTEE DATA SOURCES	A LEAP program follow-up survey will be used to collect these data. Data Sources Related to Training and Work Settings/Populations: Rittenhouse Diane R, George E. Fryer, Robert L. Pillips et al. Impact of Title Vii Training Programs on Community Health Center Staffing and National Health Service Corps Participation. Ann Fam Med 2008;6:397-405. DOI: 10.1370/afm.885. Karen E. Hauer, Steven J. Durning, Walter N. Kernan, et al. Factors Associated With Medical Students' Career Choices Regarding Internal Medicine JAMA. 2008;300(10):1154-1164 (doi:10.1001/jama.300.10.1154)

SIGNIFICANCE	HRSA’s MCHB places special emphasis on improving service delivery to women, children and youth from communities with limited access to comprehensive care. This national performance measure relates directly to MCHB Strategic Plan Goal 3: Strengthen public health capacity and workforce for MCH.

DATA COLLECTION FORM FOR DETAIL SHEET: Training 07 - MCH LEAP Program

MCH Leadership, Education and Advancement in Undergraduate Pathways (LEAP) Program graduates who report working with the maternal and child health population (i.e., women, infants, children, adolescents, young adults, and their families, including and children with special health care needs) 2 years and 5 years after graduating from their MCH LEAP program.

NOTE: Each LEAP trainee should be counted once.

2 YEARS AFTER GRADUATING FROM MCH LEAP PROGRAM

A. The total number of graduates, 2 years following completion of program _________

B. The total number of graduates lost to follow-up

_________

C. The total number of respondents (A-B) = denominator

_________

D. Number of respondents who report working with an MCH population

since graduating from the MCH LEAP Training Program _________

E. Percent of respondents who report working with an MCH population

Since graduating from the MCH LEAP Training Program _________

5 YEARS AFTER GRADUATING FROM MCH LEAP PROGRAM

A. The total number of graduates, 5 years following completion of program _________

B. The total number of graduates lost to follow-up _________

C. The total number of respondents (A-B) = denominator _________

D. Number of respondents who report working with an MCH population

since graduating from the MCH LEAP Training Program _________

E. Percent of respondents who report working with an MCH population

since graduating from the MCH LEAP Training Program _________

Training 08 PERFORMANCE MEASURE Goal: MCH LEAP Program Level: Grantee Domain: MCH Workforce Development	The percent of MCH LEAP Program graduates who have been engaged in work with populations that are underserved or have been marginalized.
GOAL	To increase the percent of graduates of MCH Leadership, Education and Advancement in Undergraduate Pathways (LEAP) Programs who have been engaged in work with populations that are underserved or have been marginalized.

MEASURE	The percent of MCH LEAP Program graduates who have been engaged in work with populations that are underserved or have been marginalized since graduating from the MCH LEAP Training Program.

DEFINITION	Numerator: Number of LEAP graduates reporting they have been engaged in work with populations that are underserved or have been marginalized since graduating from the MCH LEAP Training Program. Denominator: The total number of trainees responding to the survey Units: 100 Text: Percent MCH LEAP trainees are defined as undergraduate students from underserved or underrepresented backgrounds, including trainees from racially and ethnically underrepresented groups who receive education, mentoring, and guidance to increase their interest and entry into MCH public health and related fields. Populations that are underserved or have been marginalized refers to groups of individuals at higher risk for health disparities by virtue of their race or ethnicity, socioeconomic status, geography, gender,age, disability status, or other risk factors including those associated with sex and gender.

BENCHMARK DATA SOURCES	Related to Healthy People 2030: AHS-R01: Increase the ability of primary care and behavioral health professionals to provide more high-quality care to patients who need it. AHS-R02: Increase the use of telehealth to improve access to health services. PHI-R02: Expand public health pipeline programs that include service or experiential learning. PHI-R03: Increase use of core and discipline-specific competencies to drive workforce development.

GRANTEE DATA SOURCES	A LEAP program follow-up survey will be used to collect these data. Data Sources Related to Training and Work Settings/Populations: Rittenhouse Diane R, George E. Fryer, Robert L. Pillips et al. Impact of Title Vii Training Programs on Community Health Center Staffing and National Health Service Corps Participation. Ann Fam Med 2008;6:397-405. DOI: 10.1370/afm.885. Karen E. Hauer, Steven J. Durning, Walter N. Kernan, et al. Factors Associated With Medical Students' Career Choices Regarding Internal Medicine JAMA. 2008;300(10):1154-1164 (doi:10.1001/jama.300.10.1154)

SIGNIFICANCE	HRSA’s MCHB places special emphasis on improving service delivery to women, children and youth from communities with limited access to comprehensive care. This national performance measure relates directly to MCHB Strategic Plan Goal 3: Strengthen public health capacity and workforce for MCH.

DATA COLLECTION FORM FOR DETAIL SHEET: Training 08 - MCH LEAP Program

MCH Leadership, Education and Advancement in Undergraduate Pathways (LEAP) Program graduates who have worked with populations that are underserved or have been marginalized 2 years and 5 years after graduating from their MCH LEAP program.

NOTE: Each LEAP trainee should be counted once.

2 YEARS AFTER GRADUATING FROM MCH LEAP PROGRAM

A. The total number of graduates, 2 years following completion of program

_________

B. The total number of graduates lost to follow-up

_________

C. The total number of respondents (A-B) = denominator

_________

D. Number of respondents who have worked with populations that are underserved or have been marginalized since graduating from the MCH LEAP Training Program

_________

E. Percent of respondents who have worked with populations that are underserved or have been marginalized since graduating from the MCH LEAP Training Program

_________

5 YEARS AFTER GRADUATING FROM MCH LEAP PROGRAM

A. The total number of graduates, 5 years following completion of program

_________

B. The total number of graduates lost to follow-up

_________

C. The total number of respondents (A-B) = denominator

_________

D. Number of respondents who have worked with populations that are underserved or have been marginalized since graduating from the MCH LEAP Training Program

_________

E. Percent of respondents who have worked with populations that are underserved or have been marginalized since graduating from the MCH LEAP Training Program

_________

Training 09 PERFORMANCE MEASURE Goal: Graduate Program Enrollment Level: Grantee Domain: MCH Workforce Development	The percent of LEAP graduates that enter graduate programs preparing them to work with the MCH population.
GOAL	To increase the number of Leadership, Education and Advancement in Undergraduate Pathways (LEAP) graduates that enter graduate programs preparing them to work with the MCH population.

MEASURE	The percent of LEAP graduates that enter graduate programs preparing them to work with the MCH population.

DEFINITION	Numerator: Total number of MCH LEAP trainees enrolled in or who have completed a graduate school program preparing them to work with the MCH population, 2 or 5 years after graduating from the MCH LEAP program. Denominator: Total number of MCH LEAP Trainees who graduated from the MCH LEAP program 2 or 5 years previously.

BENCHMARK DATA SOURCES	Related to Healthy People 2030 Objectives: ECBP-DO9: Increase core clinical prevention and population health education in medical schools. ECBP-D10: Increase core clinical prevention and population health education in nursing schools. ECBP-D11: Increase core clinical prevention and population health education in physician assistant training programs. ECBP-D12: Increase core clinical prevention and population health education in pharmacy schools. ECBP-D13: Increase core clinical prevention and population health education in dental schools. PHI-R03: Increase use of core and discipline-specific competencies to drive workforce development. PHI-06: Increase the proportion of state public health agencies that use core competencies in continuing education. PHI-07: Increase the proportion of local public health agencies that use core competencies in continuing education. PHI-DO1: Increase the proportion of tribal public health agencies that use core competencies in continuing education

GRANTEE DATA SOURCES	Attached data collection form to be completed by grantees.
SIGNIFICANCE	MCHB training programs assist in developing a public health workforce that addresses key MCH issues and fosters field leadership in the MCH arena. This national performance measure relates directly to MCHB Strategic Plan Goal 3: Strengthen public health capacity and workforce for MCH.

DATA COLLECTION FORM FOR DETAIL SHEET: Training 09 – Graduate Program Enrollment

2 YEARS AFTER GRADUATING FROM MCH LEAP PROGRAM

A. The total number of LEAP Trainees, 2 years following graduation from the program _________

B. The total number of graduates lost to follow-up ________

C. The total number of respondents (A-B) = denominator ________

D. Total number of respondents that are enrolled in or have completed graduate

Programs preparing them work with the MCH population ________

Specify the number of respondents that are enrolled in or have completed the following graduate programs:

Medicine (e.g. Pediatric, Ob/Gyn, Primary Care): _____

Public health: _____

Nutrition: _____

Social work: _____

Nursing: _____

Pediatric dentistry: _____

Psychology: _____

Pediatric occupational/physical therapy: _____

Speech language pathology: _____

Other MCH-related health profession (specify):_____

E. Percent of respondents that are enrolled in or have completed graduate

Programs preparing them work with the MCH population ________

F. Number of LEAP trainees who indicate MCH LEAP Training Program helped in

admission to and/or being successful in a graduate program __________

G. Percent of LEAP trainees who indicate MCH LEAP Training Program helped in

admission to and/or being successful in a graduate program ___________

5 YEARS AFTER GRADUATING FROM MCH LEAP PROGRAM

A. The total number of LEAP Trainees, 5 years following graduation from the program _________

B. The total number of graduates lost to follow-up ________

C. The total number of respondents (A-B) = denominator ________

D. Number of respondents that are enrolled in or have completed graduate

Programs preparing them work with the MCH population** ________

E. Percent of respondents that are enrolled in or have completed graduate

Programs preparing them work with the MCH population ________

Training 10 PERFORMANCE MEASURE Goal: Field Leadership Level: Grantee Domain: MCH Workforce Development	The percent of long-term trainees that have demonstrated field leadership after completing an MCH training program.
GOAL	To increase the percentage of long-term trainees that have demonstrated field leadership two and five years after completing their MCH Training Program.

MEASURE	The percentage of long-term trainees that have demonstrated field leadership after completing an MCH Training Program.

DEFINITION	Attached is a checklist of four elements that demonstrate field leadership. For each element, identify the number of long-term trainees that have demonstrated field leadership two and five years after program completion. Please keep the completed checklist attached. Long-term trainees are defined as those who have completed a long-term (greater than or equal to 300 contact hours) MCH training program, including those who received MCH funds and those who did not. “Field leadership” refers to but is not limited to providing MCH leadership within the clinical, advocacy, academic, research, public health, public policy or governmental realms. Refer to attachment for complete definition.

BENCHMARK DATA SOURCES	Related to Healthy People 2030 Objectives: ECBP-DO9: Increase core clinical prevention and population health education in medical schools. ECBP-D10: Increase core clinical prevention and population health education in nursing schools. ECBP-D11: Increase core clinical prevention and population health education in physician assistant training programs. ECBP-D12: Increase core clinical prevention and population health education in pharmacy schools. ECBP-D13: Increase core clinical prevention and population health education in dental schools. PHI-R03: Increase use of core and discipline-specific competencies to drive workforce development. PHI-06: Increase the proportion of state public health agencies that use core competencies in continuing education. PHI-07: Increase the proportion of local public health agencies that use core competencies in continuing education. PHI-DO1: Increase the proportion of tribal public health agencies that use core competencies in continuing education.

GRANTEE DATA SOURCES	Attached data collection form to be completed by grantees.

SIGNIFICANCE	An MCHB trained workforce is a vital participant in clinical, administrative, policy, public health and various other arenas. MCHB long term training programs assist in developing a public health workforce that addresses MCH concerns and fosters field leadership in the MCH arena. This national performance measure relates directly to MCHB Strategic Plan Goal 3: Strengthen public health capacity and workforce for MCH.

DATA COLLECTION FORM FOR DETAIL SHEET: Training 10 – Field Leadership

SECTION A: 2 YEAR FOLLOW-UP

Numerator: The number of long-term trainees who have demonstrated field leadership 2 years after completing their MCH Training Program.

Denominator: The total number of long-term trainees, 2 years following completion of an MCHB-funded training program, included in this report.

Long-term trainees are defined as those who have completed a long-term (greater than or equal to 300 contact hours) MCH training program, including those who received MCHB funds and those who did not.

The total number of long-term trainees, 2 years post program completion, included in this report	_________
The total number of long-term trainees, 2 years post program completion, to follow-up	_________
Number of respondents (A-B) Number of respondents who have demonstrated field leadership in at least one of the following areas below Percent of long-term trainees, 2 years post program completion, who have demonstrated field leadership in at least one of the following areas: (Individual respondents may have leadership activities in multiple areas below)	_________ _________ _________
Number of trainees that have participated in academic leadership activities since completing their MCH Training Program Disseminated information on MCH Issues (e.g., Peer-reviewed publications, key presentations, training manuals, issue briefs, best practices documents, standards of care) Conducted research or quality improvement on MCH issues Provided consultation or technical assistance in MCH areas Taught/mentored in their discipline or other MCH related field Served as a reviewer (e.g., for a journal, conference abstracts, grant, quality assurance process) Procured grant and other funding in MCH areas Conducted strategic planning or program evaluation	_________
Number of trainees that have participated in clinical leadership activities since completing their MCH Training Program Participated as a group leader, initiator, key contributor or in a position of influence/authority on any of the following: committees of State, national, or local organizations; task forces; community boards; advocacy groups; research societies; professional societies; etc. Served in a clinical position of influence (e.g. director, senior therapist, team leader, etc Taught/mentored in their discipline or other MCH related field Conducted research or quality improvement on MCH issues Disseminated information on MCH Issues (e.g., Peer-reviewed publications, key presentations, training manuals, issue briefs, best practices documents, standards of care) Served as a reviewer (e.g., for a journal, conference abstracts, grant, quality assurance process)	_________
3. Number of trainees that have participated in public health practice leadership activities since completing their MCH Training Program Provided consultation, technical assistance, or training in MCH areas Procured grant or other funding in MCH areas Conducted strategic planning or program evaluation Conducted research or quality improvement on MCH issues Served as a reviewer (e.g., for a journal, conference abstracts, grant, quality assurance process) Participated in public policy development activities (e.g., Participated in community engagement or coalition building efforts, written policy or guidelines, provided testimony, educated policymakers, etc.)	_________
4. Number of trainees that have participated in public policy & advocacy leadership activities since completing their MCH Training Program Participated in public policy development activities (e.g., participated in community engagement or coalition building efforts, written policy or guidelines, influenced MCH related legislation, provided testimony, educated legislators) Participated on any of the following as a group leader, initiator, key contributor, or in a position of influence/authority: committees of State, national, or local organizations; task forces; community boards; advocacy groups; research societies; professional societies; etc. Disseminated information on MCH public policy issues (e.g., Peer-reviewed publications, key presentations, training manuals, issue briefs, best practices documents, standards of care, commentaries, and chapters)	_________

SECTION B: 5 YEAR FOLLOW-UP

Numerator: The number of long-term trainees who have demonstrated field leadership 5 years after completing their MCH Training Program.

Denominator: The total number of long-term trainees, 5 years following completion of an MCHB-funded training program, included in this report.

Long-term trainees are defined as those who have completed a long-term (greater than or equal to 300 contact hours) MCH training program, including those who received MCH funds and those who did not.

The total number of long-term trainees, 5 years post program completion, included in this report	_________
The total number of long-term trainees, 5 years post program completion, lost to follow-up	_________
Number of respondents (A-B) Number of respondents who have demonstrated field leadership in at least one of the following areas below Percent of long-term trainees, 5 years post program completion, who have demonstrated field leadership in at least one of the following areas: (Individual respondents may have leadership activities in multiple areas below)	_________ _________ _________
1. Number of trainees that have participated in academic leadership activities since completing their MCH Training Program Disseminated information on MCH Issues (e.g., Peer-reviewed publications, key presentations, training manuals, issue briefs, best practices documents, standards of care) Conducted research or quality improvement on MCH issues Provided consultation or technical assistance in MCH areas Taught/mentored in their discipline or other MCH related field Served as a reviewer (e.g., for a journal, conference abstracts, grant, quality assurance process) Procured grant and other funding in MCH areas Conducted strategic planning or program evaluation	________
2. Number of trainees that have participated in clinical leadership activities since completing their MCH Training Program Participated as a group leader, initiator, key contributor or in a position of influence/authority on any of the following: committees of State, national, or local organizations; task forces; community boards; advocacy groups; research societies; professional societies; etc. Served in a clinical position of influence (e.g. director, senior therapist, team leader, etc Taught/mentored in their discipline or other MCH related field Conducted research or quality improvement on MCH issues Disseminated information on MCH Issues (e.g., Peer-reviewed publications, key presentations, training manuals, issue briefs, best practices documents, standards of care) Served as a reviewer (e.g., for a journal, conference abstracts, grant, quality assurance process)	_________
3. Number of trainees that have participated in public health practice leadership activities since completing their MCH Training Program Provided consultation, technical assistance, or training in MCH areas Procured grant or other funding in MCH areas Conducted strategic planning or program evaluation Conducted research or quality improvement on MCH issues Served as a reviewer (e.g., for a journal, conference abstracts, grant, quality assurance process) Participated in public policy development activities (e.g., Participated in community engagement or coalition building efforts, written policy or guidelines, provided testimony, educated policymakers , etc.)	_________
4. Number of trainees that have participated in public policy & advocacy leadership activities since completing their MCH Training Program Participated in public policy development activities (e.g., participated in community engagement or coalition building efforts, written policy or guidelines, influenced MCH related legislation, provided testimony, educated legislators) Participated on any of the following as a group leader, initiator, key contributor, or in a position of influence/authority: committees of State, national, or local organizations; task forces; community boards; advocacy groups; research societies; professional societies; etc. Disseminated information on MCH public policy issues (e.g., Peer-reviewed publications, key presentations, training manuals, issue briefs, best practices documents, standards of care, commentaries, and chapters)	_________

NOTES/COMMENTS:

Training 11 PERFORMANCE MEASURE Goal: Long-term trainees working with MCH populations Level: Grantee Domain: MCH Workforce Development	The percentage of long-term trainees who are engaged in work focused on MCH populations after completing their MCH Training Program.
GOAL	To increase the percent of long-term trainees engaged in work focused on MCH populations two and five years after completing their MCH Training Program.

MEASURE	The percentage of long-term trainees who are engaged in work focused on MCH populations after completing their MCH Training Program.

DEFINITION	Numerator: Number of long-term trainees reporting they are engaged in work focused on MCH populations after completing their MCH Training Program. Denominator: The total number of trainees responding to the survey Units: 100 Text: Percent Long-term trainees are defined as those who have completed a long-term (greater than or equal to 300 contact hours) MCH Training Program, including those who received MCH funds and those who did not. MCH Populations: Includes all of the Nation’s women, infants, children, adolescents, young adults and their families, including and children with special health care needs.

BENCHMARK DATA SOURCES	Related to Healthy People 2030 objectives: PHI-R03: Increase use of core and discipline-specific competencies to drive workforce development. PHI-06: Increase the proportion of state public health agencies that use core competencies in continuing education. PHI-07: Increase the proportion of local public health agencies that use core competencies in continuing education. PHI-DO1: Increase the proportion of tribal public health agencies that use core competencies in continuing education

GRANTEE DATA SOURCES	A trainee follow-up survey that incorporates the new form for collecting data on the involvement of those completing an MCH training program in work related to MCH populations will be used to collect these data. Data Sources Related to Training and Work Settings/Populations: Rittenhouse Diane R, George E. Fryer, Robert L. Pillips et al. Impact of Title Vii Training Programs on Community Health Center Staffing and National Health Service Corps Participation. Ann Fam Med2008;6:397-405. DOI: 10.1370/afm.885. Karen E. Hauer, Steven J. Durning, Walter N. Kernan, et al. Factors Associated With Medical Students' Career Choices Regarding Internal Medicine JAMA.2008;300(10):1154-1164 (doi:10.1001/jama.300.10.1154).

SIGNIFICANCE	HRSA’s MCHB places special emphasis on improving service delivery to women, children and youth from communities with limited access to comprehensive care. This national performance measure relates directly to MCHB Strategic Plan Goal 3: Strengthen public health capacity and workforce for MCH.

DATA COLLECTION FORM FOR DETAIL SHEET: Training 11 - Long-term trainees working with MCH populations

Individuals completing a long-term training program who report working with the maternal and child health population (i.e., women, infants, children, adolescents, young adults and their families, including children with special health care needs) at 2 years and at 5 years after completing their training program.

NOTE: If the individual works with more than one of these groups only count them once.

2 YEAR FOLLOW-UP
A. The total number of long-term trainees, 2 years following program completion	______
B. The total number of long-term trainees lost to follow-up (2 years following program completion)	______
C. The total number of respondents (A-B) = denominator	______
D. Number of respondents 2 years following completion of program who report working with an MCH population	______
E. Percent of respondents 2 years following completion of program who report working with an MCH population

__________________________________________________

5 YEAR FOLLOW-UP
F. The total number of long-term trainees, 5 years following program completion	______
G. The total number of long-term trainees lost to follow-up (5 years following program completion),	______
H. The total number of respondents (F-G) = denominator	______
I. Number of respondents 5 years following completion of program who report working with an MCH population	______
J. Percent of respondents 5 years following completion of program who report working with an MCH population

Training 12 PERFORMANCE MEASURE Goal: Long-term Trainees Level: Grantee Domain: MCH Workforce Development	The percent of long-term trainees who, at 2, 5 and 10 years post training, have worked in an interdisciplinary manner to serve the MCH population (e.g., individuals with disabilities and their families, adolescents and their families, etc.).
GOAL	To increase the percent of long-term trainees who, upon completing their training, work in an interdisciplinary manner to serve the MCH population.

MEASURE	The percent of long-term trainees who, at 2, 5 and 10 years post training have worked in an interdisciplinary manner to serve the MCH population.

DEFINITION	Numerator: The number of long-term trainees indicating that they have worked in an interdisciplinary manner serving the MCH population. Denominator: The total number of long-term trainees responding to the survey Units: 100 Text: Percent In addition, data on the total number of the long-term trainees and the number of non-respondents for each year will be collected. Long-term trainees are defined as those who have completed a long-term (300+ hours) MCH Training program, including those who received MCH funds and those who did not. Individuals working in an interdisciplinary manner value the skills and expertise of team members from different disciplines, including a variety of professionals, MCH populations, and community partners, are acknowledged and seen as essential and synergistic. Input from each team member is elicited and valued in making collaborative, outcome-driven decisions to address individual, community-level, or systems-level problems.

BENCHMARK DATA SOURCES	Related to Healthy People 2030 Objectives: ECBP-DO9: Increase core clinical prevention and population health education in medical schools. ECBP-D10: Increase core clinical prevention and population health educationin nursing schools. ECBP-D11: Increase core clinical prevention and population health education in physician assistant training programs. ECBP-D12: Increase core clinical prevention and population health education in pharmacy schools. ECBP-D13: Increase core clinical prevention and population health education in dental schools. PHI-06: Increase the proportion of state public health agencies that use core competencies in continuing education. PHI-07: Increase the proportion of local public health agencies that use core competencies in continuing education. PHI-DO1: Increase the proportion of tribal public health agencies that use core competencies in continuing education. MICH-20: Increase the proportion of children and adolescents with special health care needs who have a system of care.

GRANTEE DATA SOURCES	The trainee follow-up survey is used to collect these data.

SIGNIFICANCE	Leadership education is a complex interdisciplinary field that must meet the needs of MCH populations. This measure addresses one of a training program’s core values and its unique role to prepare professionals for comprehensive systems of care/practice. By providing interdisciplinary coordinated care, training programs help to ensure that all MCH populations receive the most comprehensive care that takes into account the complete and unique needs of the individuals and their families. This national performance measure relates directly to MCHB Strategic Plan Goal 3: Strengthen public health capacity and workforce for MCH.

DATA COLLECTION FORM FOR DETAIL SHEET: Training 12 – Long-term Trainees

2 YEAR FOLLOW-UP

Numerator: The number of long-term trainees who have worked in an interdisciplinary manner 2 years following completion of an MCHB-funded training program, demonstrating at least one of the interdisciplinary skills listed below.

Denominator: The total number of long-term trainees, 2 years following completion of an MCHB-funded training program, responding to the survey

The total number of long-term trainees, 2 years following program completion	_________
The total number of program completers lost to follow-up	_________
Number of respondents (Denominator)	_________
The number of long-term trainees who have worked in an interdisciplinary manner 2 years following completion of an MCHB-funded training program, demonstrating at least one of the interdisciplinary skills listed	_________
The total number of program completers lost to follow-up	_________
Percent of long-term trainees (2 years post program completion) who have worked in an interdisciplinary manner, demonstrating at least one of the following interdisciplinary skills:	________%
Sought input or information from other professions or disciplines to address a need in your work	________%
Provided input or information to other professions or disciplines.	________%
Developed a shared vision, roles and responsibilities within an interdisciplinary group.	________%
Utilized information to develop a coordinated, prioritized plan across disciplines to address a need in your work	________%
Established decision-making procedures in an interdisciplinary group.	________%
Collaborated with various disciplines across agencies/entities?	________%
Advanced policies & programs that promote collaboration with other disciplines or professions	________%

B. 5 YEAR FOLLOW-UP

Numerator: The number of long-term trainees who have worked in an interdisciplinary manner 5 years following completion of an MCHB-funded training program, demonstrating at least one of the interdisciplinary skills listed.

Denominator: The total number of long-term trainees, 5 years following completion of an MCHB-funded training program, responding to the survey.

The total number of long-term trainees, 5 years following program completion	_________
The total number of program completers lost to follow-up	_________
The number of long-term trainees who have worked in an interdisciplinary manner 5 years following completion of an MCHB-funded training program, demonstrating at least one of the interdisciplinary skills listed	_________
Percent of long-term trainees (5 years post program completion) who have worked in an interdisciplinary manner, demonstrating at least one of the following interdisciplinary skills:	________%
Sought input or information from other professions or disciplines to address a need in your work	________%
Provided input or information to other professions or disciplines.	________%
Developed a shared vision, roles and responsibilities within an interdisciplinary group.	________%
Utilized information to develop a coordinated, prioritized plan across disciplines to address a need in your work	________%
Established decision-making procedures in an interdisciplinary group.	________%
Collaborated with various disciplines across agencies/entities?	________%
Advanced policies & programs that promote collaboration with other disciplines or professions	________%

C. 10 YEAR FOLLOW-UP

Numerator: The number of long-term trainees who have worked in an interdisciplinary manner 10 years following completion of an MCHB-funded training program, demonstrating at least one of the interdisciplinary skills listed.

Denominator: The total number of long-term trainees, 10 years following completion of an MCHB-funded training program, responding to the survey.

The total number of long-term trainees, 10 years following program completion	_________
The total number of program completers lost to follow-up	_________
Percent of long-term trainees (10 years post program completion) who have worked in an interdisciplinary manner, demonstrating at least one of the following interdisciplinary skills:	________%
Sought input or information from other professions or disciplines to address a need in your work	________%
Provided input or information to other professions or disciplines.	________%
Developed a shared vision, roles and responsibilities within an interdisciplinary group.	________%
Utilized information to develop a coordinated, prioritized plan across disciplines to address a need in your work	________%
Established decision-making procedures in an interdisciplinary group.	________%
Collaborated with various disciplines across agencies/entities?	________%
Advanced policies & programs that promote collaboration with other disciplines or professions	________%

Training 14 PERFORMANCE MEASURE Goal: Medium-Term Trainees Skill and Knowledge Level: Grantee Domain: MCH Workforce Development	The percentage of Level I medium-term trainees who report an increase in knowledge and the percentage of Level II medium-term trainees who report an increase in knowledge or skills related to MCH core competencies .
GOAL	To increase the percentage of medium-term trainees (MTT) who report increased knowledge or skills related to MCH core competencies.

MEASURE	The percentage of Level I medium-term trainees who report an increase in knowledge and the percentage of Level II medium-term trainees who report an increase in knowledge or skills related to MCH core competencies.

DEFINITION	Numerator: The number of Level I medium-term trainees who report an increase in knowledge and Level II medium-term trainees who report an increase in knowledge or skills related to MCH core competencies. Denominator: The total number of medium-term trainees responding to the survey. Medium Term trainees: Level I MTT complete 40-149 hours of training. Level II MTT complete 150–299 hours of training.

BENCHMARK DATA SOURCES	ECBP-DO9: Increase core clinical prevention and population health education in medical schools. ECBP-D10: Increase core clinical prevention and population health education in nursing schools. ECBP-D11: Increase core clinical prevention and population health education in physician assistant training programs. ECBP-D12: Increase core clinical prevention and population health education in pharmacy schools. ECBP-D13: Increase core clinical prevention and population health education in dental schools. PHI-06: Increase the proportion of state public health agencies that use core competencies in continuing education. PHI-07: Increase the proportion of local public health agencies that use core competencies in continuing education. PHI-DO1: Increase the proportion of tribal public health agencies that use core competencies in continuing education. MICH-20: Increase the proportion of children and adolescents with special health care needs who have a system of care.

GRANTEE DATA SOURCES	End of training survey is used to collect these data.

SIGNIFICANCE	Medium-Term trainees comprise a significant proportion of training efforts. These trainees impact the provision of care to MCH populations nationally. The impact of this training must be measured and evaluated. This national performance measure relates directly to MCHB Strategic Plan Goal 3: Strengthen public health capacity and workforce for MCH.

TA COLLECTION FORM FOR DETAIL SHEET: Training 14 – Medium-Term Trainees Skill and Knowledge

Level I Medium-Term Trainees - Knowledge

The total number of Level I Medium-Term Trainees (40-149 hours) _______
The total number of Level I MTT lost to follow-up _______
The total number of respondents (A-B) _______
Number of respondents reporting increased knowledge _______
Percentage of respondents reporting increased knowledge _______

Level II Medium-Term Trainees – Knowledge:

The total number of Level II Medium-Term Trainees (150-299 hours) _______
The total number of Level II MTT lost to follow-up _______
The total number of respondents (A-B) _______
Number of respondents reporting increased knowledge _______
Percentage of respondents reporting increased knowledge _______

Level II Medium-Term Trainees - Skills :

The total number of Level II Medium-Term Trainees (150-299 hours) ________
The total number of Level II MTT lost to follow-up ________
The total number of respondents (A-B) ________
Number of respondents reporting increased skills ________
Percentage of respondents reporting increased skills ________

Training 15 PERFORMANCE MEASURE Goal: Consultation and Training for Mental and Behavioral Health Level: Grantee Domain: MCH Workforce Development
GOAL	Increase the availability and accessibility of consultation services to providers caring for individuals with behavioral or mental health conditions.

MEASURE	Number of providers participating in consultation and care coordination support services.

DEFINITION	Total number of providers participating in consultation (teleconsultation and in-person) and care coordination support services provided by the Pediatric Mental Health Care Access (PMHCA) program and the Screening for Maternal Depression and Related Behavioral Disorders (MDRBD) program.

BENCHMARK DATA SOURCES

GRANTEE DATA SOURCES	PMHCA and MDRBD awardees report using the data collection form.

SIGNIFICANCE	Mental and behavioral health issues are prevalent among children and adolescents, and pregnant and postpartum women in the United States. However, due to shortages in the number of psychiatrists, developmental-behavioral providers, and other behavioral health clinicians, access to mental and behavioral health services is lacking. Research indicates that telehealth can improve access to care, reduce health care costs, improve health outcomes, and address workforce shortages in underserved areas. Telehealth strategies that connect primary care providers with specialty mental and behavioral health care providers can be an effective means of increasing access to mental and behavioral health services for children and pregnant and postpartum women, especially those living in rural and other underserved areas.

Training 15 Data Collection Form

Provider Consultation and Training

Consultation:

Provider Type		Number enrolled (if applicable)^⁰	Number participating^⁰	Number enrolled AND participating (if applicable)^⁰
Primary Care Providers (non-specialty)	Pediatrician
	Family Medicine
	OB/GYN
	Internal Medicine
	Advanced Practice Nurse/Nurse Practitioner
	Certified Nurse Midwife
	Physician Assistant
Others	Psychiatrist
	Developmental-Behavioral Pediatrician
	Nurse
	Behavioral Health Clinician (e.g. psychologist, therapist, counselor)
	Care Coordinator/ Patient Navigator
	Other Specialist Physician, APN/NP, PA (specify type):
	Other (specify type):
Unknown Provider type
Total (will auto-populate)
Total Primary Care (will auto-populate)

Number and types of providers enrolled for and participating in program consultation (teleconsultation or in-person) and care coordination support services^⁰.

Use of program consultation and care coordination support services.
1. Number of provider contacts with the program for consultation (teleconsultation or in-person), care coordination support, or both.

Type of contact	Number of provider contacts with the program for services
Consultation Only
Care Coordination Support Only
Both

Number of consultations and referrals^⁰ given to providers.

Consultation or referral	Number of consultations or referrals given
Consultations via telehealth
Consultations in-person
Referrals

Please indicate the condition(s) about which providers contacted the program for consultation (teleconsultation or in-person) or care coordination support services. Select all conditions that apply. Specify the number of contacts for each condition. Each contact can involve more than one condition^⁰.

Anxiety disorders
- Number of contacts for this reason _________
Depressive disorders
- Number of contacts for this reason _________
Bipolar and related disorders
- Number of contacts for this reason _________
Attention-Deficit/ Hyperactivity Disorder (ADHD)
- Number of contacts for this reason _________
Autism Spectrum Disorder
- Number of contacts for this reason _________
Disruptive, impulse-control, and conduct disorders
- Number of contacts for this reason _________
Feeding and eating disorders
- Number of contacts for this reason _________
Obsessive-compulsive and related disorders
- Number of contacts for this reason _________
Trauma and stressor-related disorders
- Number of contacts for this reason _________
Schizophrenia spectrum and other psychotic disorders
- Number of contacts for this reason _________
Substance-related disorders
- Number of contacts for alcohol _________
- Number of contacts for marijuana _________
- Number of contacts for nicotine _________
- Number of contacts for opioids _________
- Number of contacts for other substance-related disorders _______
Suicidality or self-harm
- Number of contacts for this reason _________
Other (please specify)___________
- Number of contacts for this reason _________

Number of consultations (teleconsultations and in-person) and referrals provided by each member of the mental health team. [Measures applies only to PMHCA awardees]

Member of mental health team	Number of consultations provided	Number of referrals provided
Psychiatrist
Psychologist
Social Worker
Counselor
Care Coordinator
Other behavioral clinicians
Other (specify type):
Total (will auto-populate)

Training:
1. Number and types of providers trained.

Provider Type		Number Trained
Primary Care Providers (non-specialty)	Pediatrician
	Family Medicine
	OB/GYN
	Internal Medicine
	Advanced Practice Nurse/Nurse Practitioner
	Certified Nurse Midwife
	Physician Assistant
Others	Psychiatrist
	Developmental-Behavioral Pediatrician
	Nurse
	Behavioral Health Clinician (e.g. psychologist, therapist, counselor)
	Care Coordinator/ Patient Navigator
	Other Specialist Physician, APN/NP, PA (specify type):
	Other (specify type):
Unknown Provider type
Total Primary Care (will auto-populate)
Total (will auto-populate)

Total number of trainings held ____
1. Topics covered by trainings and number of trainings per topic. Select all that apply:

 Mental or behavioral health conditions-related trainings (e.g., anxiety, depression, substance use disorder, ADHD, OCD, eating disorders, tics, Autism, developmental delay, behavioral dysregulation, etc.) Please include comprehensive trainings that cover medications, screenings, treatments, etc. for specific conditions in this category.