2 HV form 2

Finalized by Data Work Group 6/19/2012

Public Burden Statement:  An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  The OMB control number for this project is 0915-XXXX.  Public reporting burden for this collection of information is estimated to average ______ hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-29, Rockville, Maryland, 20857.

MIECHV

DRAFT HOME VISITING FORM 2

GRANTEE PERFORMANCE MEASURES

1. BENCHMARK AREA: CONSTRUCT:
2. PERFORMANCE MEASURE Name or brief description: Type (process or outcome):
3. OPERATIONAL DEFINITION Definition: Key terms: Participant population involved: Type of scoring:	If type of scoring is percentage or rate: Numerator: Denominator:
4. MEASUREMENT TOOL UTILIZED: Yes/no If yes: scale or instrument utilized	If no: question(s) posed
5. RATIONALE FOR THE MEASURE	6. VALUE FOR REPORTING PERIOD Value: Numerator: Denominator:
7. DEFINITION OF IMPROVEMENT Direction: Type of Comparison: Description of baseline and comparison periods: Baseline value: Numerator: Denominator: Comparison value: Numerator: Denominator:	Target: yes/no If target selected, specification: Rationale/Source:
8. IMPROVEMENT Three-year improvement: yes/no Considerations:

INSTRUCTIONS FOR THE COMPLETION OF HOME VISITING FORM 2

GRANTEE PERFORMANCE MEASURES

Please complete each numbered section as appropriate for the measure being described.

1. Benchmark Area: Select the name of the benchmark area.

Construct: Select the construct captured by the performance measure.

2. Performance Measure: Identify only one measure for the construct (it can be a process or outcome measure).

Name: Enter a brief description of the performance measure.

Type: Indicate the type of performance measure selected: process or outcome.

3. Operational Definition: Provide a detailed, specific definition of the performance measure. Describe how the value of the measure can be unambiguously constructed from the data by specifying:

Key terms: Clarify the meaning of the terms utilized in the definition (e.g., what counts as “care received”?); describe the criteria to be used (e.g., the time window during which the measurement ought to occur such as, in the case of breastfeeding for instance: at 3 months postpartum).

Participant population involved: For each measure define the categories of participants included and excluded from the calculation (e.g., is “child” the index child, all children in the household, or all siblings 0-5 years old?)

Type of scoring: Indicate if the measure is a count, a percentage, a rate or other type of scoring. If the measure is a percentage or a rate provide a clear and separate description of numerator and denominator

4. Measurement Tool Utilized or Question(s) Posed: Include any scale utilized to capture the data; if no measurement tool or scale is needed, articulate the type of observation or question(s) posed to capture the needed information.

5. Rationale for the Performance Measure Selected: Include reasons for the selection of this indicator among various other possible performance measures (e.g.,What is the purpose of this indicator? What are the factors or stakeholder views that have determined the selection?)

6. Value for Reporting Period

Value: Enter the value of the performance measure for the reporting period, e.g., count, average scale score, or rate based on the type of scoring specified above. Specify numerator and denominator if score reported is a rate or percent.

7. Definition of Improvement

Direction: Specify if the direction of the desired change is an increase, decrease, or maintenance of a level considered acceptable.

Type of comparison: Individual, cohort, or cross-sectional. Individual comparison assesses change at two points in time for the same group of individuals. Cohort comparison assesses improvement of participants who are grouped by timing of enrollment. Cross-sectional comparison occurs between two groups of participants on the basis of data available for defined time periods (e.g., funding year 1 and funding year 2).

Description of Baseline and Comparison Periods: Identify the periods utilized for comparison, i.e., specify the time of data collection for the baseline group and the comparison group. For example:

Individual-level change: Baseline (Time1) = assessment data collected at intake compared to (Time 2) assessment data collected at 6 months post-enrollment for the same client population.

Cohort comparison: Baseline (Time 1) = data for participants enrolled in year 1 (defined for instance as the first grant reporting period) compared to (Time 2) data for participants enrolled in year 2 (second grant reporting period).

Cross-sectional comparison: Baseline (Time 1) = data collected through funding year 1 (first reporting period) compared to data collected during funding year 3 (3^rd reporting period).

For cohort and cross-sectional comparisons: Indicate the period that was used to collect baseline data for this measure. Specify beginning and ending date for baseline data collection. Grantees have discretion in defining the length of the baseline period to collect an adequate amount of data (i.e., the baseline period for purposes of comparison to show improvement need not coincide with the first reporting period after grant award).

Baseline Value: Enter the actual baseline score (i.e., the value of the measure for the baseline period considered). Specify numerator and denominator if value reported is a rate or percent.

Comparison Value: Enter the actual score or value obtained for the indicator during the comparison period. This is the value utilized to demonstrate improvement for a given construct by the end of the third reporting year. Specify numerator and denominator if score reported is a rate or percent.

Target: Specify the target if one adopted; articulate rationale and whether external or internally developed.

8. Improvement

Three-year improvement: Indicate whether improvement for the initial three-year period of program implementation was achieved or not based on the definition provided by the grantee and the values obtained for the baseline and comparison periods.

Considerations: Explain any factors that affected grantee’s ability to show improvement for the performance measure (e.g., a major employer in the community closed a facility affecting the ability of program participants to obtain employment and improve family economic self-sufficiency).