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 |
|
|
File Type | application/msword |
File Title | Abt Memorandum Template |
Author | BursteinN |
Last Modified By | Department of Health and Human Services |
File Modified | 2011-04-20 |
File Created | 2011-04-20 |