Tribal Home Visiting Continuous Quality Improvement Collaboratives

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CQIC Family of Measures Quarterly Reporting Template
Tribal Home Visiting Resource Institute for Excellence
[Please note this form will be entered into Qualtrics for data entry.]
Introduction
Each of the measures below are related to the overarching goal and/or primary drivers for this CQIC. Your data will be combined with other grant recipients’ data to provide a holistic picture of progress in family engagement across participating programs. Thank you for your time! Please reach out to your THRIVE Data TA Specialist if you have any questions about the measures. Also, please refer to the FAQ document for definitions and questions that have been addressed.
One person from each grant recipient team should submit the data for their program (i.e., only one entry per program).
This data collection is for quarter [insert quarter] of the CQIC, which reflects [date to date].
Administrative Information
Cohort: _________
Grant recipient program name: _____________________
Data Entry
Measure 1: Service Uptake
Numerator: Number of families who receive an “initial contact” by program staff and who complete their first home visit during the reporting quarter

Denominator: Number of families who receive an “initial contact” by program staff during the reporting quarter

Service Uptake Value
%
Service Uptake Notes (optional)



Measure 2: Program Capacity
Number of new households enrolled during the reporting quarter + the number of continuing households 

Maximum service capacity during the reporting quarter

Program Capacity Value
%
Program Capacity Notes (optional)



Measure 3: Referral Pathways
Number of families referred to the program during the reporting quarter who received initial contact from the program

Number of families referred to the program during the reporting quarter

Referral Pathway Value
%
Referral Pathway Notes (optional)



Measure 4: Program Attrition  
Number of households who exited before completing the program during the reporting quarter

Number of households enrolled in the program at any point during the reporting quarter

Program Attrition Value
%
Program Attrition Notes (optional)



PAPERWORK REDUCTION ACT OF 1995 (Public Law 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to support the implementation of the 2026 Tribal Home Visiting Continuous Quality Improvement Collaborative (CQIC) and to inform the Administration for Children and Families (ACF) provision of training and technical assistance to participating Tribal MIECHV grant recipients. The information collected will provide structured, timely data on grant recipient progress toward collaborative aims, implementation activities, and key measures to support continuous quality improvement and shared learning. Public reporting burden for this collection of information is estimated to average 1 hour per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0531 and the expiration date is 9/30/2028. If you have any comments on this collection of information, please contact [email protected].