Electronic Data Reporting: Services Measures

Project LAUNCH Cross-Site Evaluation

Project LAUNCH - Instrument #3 - Electronic Data Reporting - Services Measures

Electronic Data Reporting: Services Measures

OMB: 0970-0373

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Direct Services to Children, Families (home visiting and family strengthening programs)

Descriptive information


Associated Count over Reporting Period


Name of evidence-based model/program being implemented



Settings where services are being delivered


Number of settings in which services were provided over last reporting period

Any training for staff who are providing service on evidence-based model/program


Number of staff trained on evidence-based model/program over last reporting period

--If staff training is provided, is there follow-up monitoring/support






Whether LAUNCH-supported developmental screening and/or assessment of children is conducted as part of service



--If so, name(s) of screening/assessment measures, domains assessed with each measure, who conducts the screening/assessment


Number of children screened and/or assessed as part of service over last reporting period



Number of children referred for follow-up assessment/services based on screening/assessment over last reporting period



Number of children who successfully received follow-up care (estimated)

Whether LAUNCH-supported health screening for children (vision, hearing, weight, etc) is conducted as part of service


Number of children who received health screenings over last reporting period

Whether LAUNCH-supported screening and/or assessment of families is conducted as part of service



--If so, name(s) of measures, domains assessed, who conducts the screening/assessment


Number of families screened and/or assessed over last reporting period

Whether program is universal or targeted



--If targeted to subgroups of children, describe eligible children


Number of eligible children in community

--If targeted to subgroups of families, describe eligible families


Number of eligible families in community






Number of children served over last reporting period [if program is direct service to children]



Number of families served over last reporting period [if program provides direct services to families]



Number of units of service delivered over last reporting period (e.g., home visits, parent groups)




Any monitoring of program implementation/fidelity


If so, rating of fidelity of implementation of model at end of reporting period



If so, rating of proportion of providers implementing the model with fidelity at end of reporting period



Rating of progress towards full implementation of all critical components of model at the end of the reporting period




Questions for providers who receive training as part of this service



--Changes in knowledge of children’s socio-emotional and behavioral health and development as a result of Project LAUNCH


Prop providers who report no change

Prop providers who report a small change

Prop providers who report some change

Prop providers who report substantial change

--Changes in knowledge of the available options for follow-up services for children with mental or behavioral health issues as a result of Project LAUNCH


Prop providers who report no change

Prop providers who report a small change

Prop providers who report some change

Prop providers who report substantial change

--Changes in use of mental health professionals to consult with about children with mental or behavioral health issues as a result of Project LAUNCH


Prop providers who report no change

Prop providers who report a small change

Prop providers who report some change

Prop providers who report substantial change

--Changes in provider work settings in the use of Project LAUNCH-related screening and/or assessment of children


Prop providers who report no change

Prop providers who report a small change

Prop providers who report some change

Prop providers who report substantial change

--List of ways providers report that their work practices have changed as a result of Project LAUNCH


Open-ended responses

--List of ways providers report that the practices in their work settings have changed as a result of Project LAUNCH


Open-ended responses

Mental Health Consultation (MHC) Services

Descriptive information


Associated Count over Reporting Period


Description of model/service/practice being used to implement MHC consultation



Qualifications of mental health staff providing consultation services



Any monitoring of program implementation/fidelity


Rating of fidelity of implementation of model (if calculated by grantee)



Rating of proportion of providers implementing the model with fidelity (if calculated by grantee)



Rating of progress towards full implementation of all critical components of model




Any training for mental health staff providing consultation services


Number of mental health staff trained on MHC model over last reporting period

--If training is provided, is there follow-up monitoring/support after training



Any training for providers for whom mental health consultation is being provided



--If training is provided, is there follow-up monitoring/support after training






Types of settings where MHC services are being delivered (primary care settings, early childhood education and care settings, social service settings, schools)



For each type of setting where MHC is being provided, enter data on the series of 6 questions below:


Number of settings of this type in community that are eligible to be involved in MHC (estimated)

--Types of providers involved in MHC


Total number of providers who practice in all of these eligible settings of this type in the community (estimated)

--Ways in which MHC consultation occurs (meetings, phone calls, etc)


Number of children receiving care from the providers in all of the eligible settings of this type in community (estimated)






Number of settings of this type involved in MHC over last reporting period



Number of providers participating in MHC over last reporting period



Number of providers trained on MHC model over last reporting period



Number of children served by providers participating in MHC over last reporting period

--Whether LAUNCH-supported developmental screening and/or assessment of children is conducted in this setting as part of MHC



----If so, name(s) of screening/assessment measures, domains assessed with each measure, who conducts the screening/assessment


Number of children screened and/or assessed as part of MHC over last reporting period



Number of children referred for follow-up assessment/services based on screening/assessments



Number of referred children who successfully received follow-up care (estimated)

--Whether LAUNCH-supported health screening for children (vision, hearing, weight, etc) is conducted in this setting as part of MHC


Number of children who received health screenings as part of MHC over last reporting period


--Whether LAUNCH-supported screening and/or assessment of families is conducted in this setting as part of MHC



----If so, name(s) of measures, domains assessed, who conducts the screening/assessment


Number of families screened and/or assessed as part of MHC over last reporting period




Questions for providers who receive training as part of this service



--Changes in knowledge of children’s socio-emotional and behavioral health and development as a result of Project LAUNCH


Prop providers who report no change

Prop providers who report a small change

Prop providers who report some change

Prop providers who report substantial change

--Changes in knowledge of the available options for follow-up services for children with mental or behavioral health issues as a result of Project LAUNCH


Prop providers who report no change

Prop providers who report a small change

Prop providers who report some change

Prop providers who report substantial change

--Changes in use of mental health professionals to consult with about children with mental or behavioral health issues as a result of Project LAUNCH


Prop providers who report no change

Prop providers who report a small change

Prop providers who report some change

Prop providers who report substantial change

--Changes in provider work settings in the use of Project LAUNCH-related screening and/or assessment of children


Prop providers who report no change

Prop providers who report a small change

Prop providers who report some change

Prop providers who report substantial change

--List of ways providers report that their work practices have changed as a result of Project LAUNCH


Open-ended responses

--List of ways providers report that the practices in their work settings have changed as a result of Project LAUNCH


Open-ended responses

Integration of Mental Health into Primary Care (IMH Services)

Descriptive information


Associated Count over Reporting Period


Description of model/service/practice being used to implement IMH services



Qualifications of mental health staff involved in IMH services



Any monitoring of program implementation/fidelity


Rating of fidelity of implementation of model (if calculated by grantee)



Rating of proportion of providers implementing the model with fidelity (if calculated by grantee)



Rating of progress towards full implementation of all critical components of model

Any training for mental health staff involved in IMH services


Number of mental health staff trained on IMH practice model over last reporting period

--If training is provided, is there follow-up monitoring/support



Any training for providers involved in IMH services



--If training is provided, is there follow-up monitoring/support






Types of settings where IMH services are being delivered (primary care settings, early childhood education and care settings, social service settings, schools)



For each type of setting where IMH services are being provided, enter data on the series of questions below:


Number of settings of this type in community that are eligible to be involved in IMH (estimated)

--Types of providers involved in IMH


Total number of providers who practice in all of these eligible settings of this type in the community (estimated)

--Ways in which IMH integration occurs (co-located staff, meetings, phone calls, etc)


Number of children receiving care from the providers in all of the eligible settings of this type in community (estimated)






Number of settings of this type involved in IMH services over last reporting period



Number of providers participating in IMH services over last reporting period



Number of providers trained on IMH practice model over last reporting period



Number of children served by providers participating in IMH services over last reporting period

--Whether LAUNCH-supported developmental screening and/or assessment of children is conducted in this setting as part of IMH services



----If so, name(s) of screening/assessment measures, domains assessed with each measure, who conducts the screening/assessment


Number of children screened and/or assessed as part of IMH over last reporting period



Number of children referred for follow-up assessment/services based on screening/assessments as part of IMH services over last reporting period



Number of children who successfully received follow-up care (estimated)

--Whether LAUNCH-supported health screening for children (vision, hearing, weight, etc) is conducted in this setting as part of IMH


Number of children who received health screenings as part of IMH services over last reporting period

--Whether LAUNCH-supported screening and/or assessment of families is conducted in this setting as part of IMH services



----If so, name(s) of measures, domains assessed, who conducts the screening/assessment


Number of families screened and/or assessed as part of IMH services over last reporting period




Questions for providers who receive training as part of this service



--Changes in knowledge of children’s socio-emotional and behavioral health and development as a result of Project LAUNCH


Prop providers who report no change

Prop providers who report a small change

Prop providers who report some change

Prop providers who report substantial change

--Changes in knowledge of the available options for follow-up services for children with mental or behavioral health issues as a result of Project LAUNCH


Prop providers who report no change

Prop providers who report a small change

Prop providers who report some change

Prop providers who report substantial change

--Changes in use of mental health professionals to consult with about children with mental or behavioral health issues as a result of Project LAUNCH


Prop providers who report no change

Prop providers who report a small change

Prop providers who report some change

Prop providers who report substantial change

--Changes in provider work settings in the use of Project LAUNCH-related screening and/or assessment of children


Prop providers who report no change

Prop providers who report a small change

Prop providers who report some change

Prop providers who report substantial change

--List of ways providers report that their work practices have changed as a result of Project LAUNCH


Open-ended responses

--List of ways providers report that the practices in their work settings have changed as a result of Project LAUNCH


Open-ended responses

Other Developmental Screening and Assessment that is NOT Part of Any Other LAUNCH Service

(i.e., this section is for LAUNCH-supported developmental screening/assessment that is not already reported under one of the program strands)

Descriptive information


Associated Count over Reporting Period


Settings where LAUNCH-supported developmental screening and/or assessment is being conducted


Number of settings of this type in community that are eligible to be involved in screening/assessing children



Number of providers practicing across all of these eligible settings (estimated)

Name(s) of screening/assessment measures, domains assessed with each measure, who conducts the screening/assessment


Number of children receiving care across all of these eligible settings (estimated)



Number of settings of this type in community where children received screening/assessing over last reporting period



Number of children screened and/or assessed over last reporting period



Number of children referred for follow-up assessment/services based on screening/assessments



Number of children who successfully received follow-up care (estimated)

Any LAUNCH-supported health screening for children (vision, hearing, weight, etc)


Number of children who received health screenings

Any LAUNCH-supported screening and/or assessment of families



--If so, names of measures, domains assessed, staff who are doing assessments


Number of families who were screened/assessed over last reporting period




Any training for staff on administration of measures


Number of staff trained on screener/assessment over last reporting period

--If training is provided, is there follow-up monitoring/support after training






Other LAUNCH-Related Training that is NOT Part of Other LAUNCH Service


Name/topic of training/purpose of training



Settings where screening/assessment is being conducted


Total number of eligible settings in community that could be involved in training

Types of providers, other community members who are being trained


Total number of providers across all of these eligible settings in community (estimated)



Number of children receiving care across from all of these eligible providers (estimated)






Total number of settings involved in training over last reporting period



Total number of providers trained over last reporting period



Number of children receiving care from the providers who were trained over last reporting period




Questions for providers who receive training as part of this service



--Changes in knowledge of children’s socio-emotional and behavioral health and development as a result of Project LAUNCH


Prop providers who report no change

Prop providers who report a small change

Prop providers who report some change

Prop providers who report substantial change

--Changes in knowledge of the available options for follow-up services for children with mental or behavioral health issues as a result of Project LAUNCH


Prop providers who report no change

Prop providers who report a small change

Prop providers who report some change

Prop providers who report substantial change

--Changes in use of mental health professionals to consult with about children with mental or behavioral health issues as a result of Project LAUNCH


Prop providers who report no change

Prop providers who report a small change

Prop providers who report some change

Prop providers who report substantial change

--Changes in provider work settings in the use of Project LAUNCH-related screening and/or assessment of children


Prop providers who report no change

Prop providers who report a small change

Prop providers who report some change

Prop providers who report substantial change

--List of ways providers report that their work practices have changed as a result of Project LAUNCH


Open-ended responses

--List of ways providers report that the practices in their work settings have changed as a result of Project LAUNCH


Open-ended responses

Demographic Characteristics of Families/Children Involved in Direct Service

(Section is for aggregate demographic information on subset of families who have received direct services (home visiting or family strengthening) for the first time in last reporting period)

Demographic variable


Associated Count over Reporting Period




Target child for survey: age, gender






Family composition


Average # family members



Prop families with < 3, 4-6, > 7 members



Average # children under 18 years



Prop families with 1, 2-3, 4-5, > 6 children




Primary caregiver of target child


Prop target children in each category

--Biological mother



--Biological father



--Adopted/foster parent



--Grandparent



--Other relative



--Other






Marital status of primary caregiver


Prop families in each category

--Single parent



--Married parents



--Two parents, unmarried






Race, ethnicity, language


Prop families in each category

--Mother of Hispanic/Latino origin



--Mother’s race



--Father of Hispanic/Latino origin



--Father’s race



--Target child of Hispanic/Latino origin



--Target child’s race






Primary language spoken in home


Prop families speaking non-English languages




Parent education/employment



Mother level of education


Prop mothers at each level of education

Mother employed full-time, part-time, not employed


Prop mothers in each category

Mother in school full-time, part-time, not in school


Prop mothers in each category

Father level of education


Prop fathers at each level of education

Father employed full-time, part-time, not employed


Prop fathers in each category

Father in school full-time, part-time, not in school


Prop fathers in each category




Sources of family income


Prop families with each type of income

--From employment wages



--Cash assistance or TANF



--Food Stamps



--WIC



--Free or reduced-price lunches






Family housing


Prop families in each type of housing

--Home owned by family



--Rental



--Homeless shelter



--Other



--Living as single family or sharing space with other family(ies)


Prop families in shared housing




Age of mother of target child at birth of first child


Prop mothers in each age category: < 16 yrs, 17-18 yrs, 19-20 yrs, > 21 yrs




Two new risk composites have been added (from Early Head Start); answering them will require grantee to combine risks factors across individual families




Risk composite #1



Prop. of families with > 3 of the characteristics: <10%, 11-25%, 26-50% , 51-75%, 76% or more

1. Teen mother at birth of first child [Demographics Q. O]



2. Single parent family (primary caregiver of child not married or living with a partner) [Demographics Q. L-4a]




3.. Primary caregiver does not have a high school diploma or GED [Demographics Q. M-1a/1b]




4. Anyone in family receives welfare payments (cash assistance or

TANF) [Demographics Q. M-5b]



5. Primary caregiver is not employed or in school [Demographics Q. M-2e & 3c or M4e & 5c]







Rick composite #2


Prop. of families with > 1 of the characteristics: <10%, 11-25%, 26-50% , 51-75%, 76% or more

1. Mental health problems



2. Substance abuse problems



3. Reside in an unsafe neighborhood



4. Experience family violence




2


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File TitleAbt Memorandum Template
AuthorBursteinN
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File Modified2011-04-20
File Created2011-04-20

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