B Attachment B - Form 2 Benchmark Performance Measures CLE

OMB No: 0906-0017
Expiration Date: 03/31/2019

THE MATERNAL, INFANT, AND EARLY CHILDHOOD
HOME VISITING PROGRAM

FORM 2

PERFORMANCE AND SYSTEMS OUTCOME
MEASURES

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 0906-0017. Public reporting burden for this collection of information is estimated to average 200
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.
July 19, 2018

OMB No: 0906-0017
Expiration Date: 03/31/2019

MEASURE 1
1.
BENCHMARK AREA: MATERNAL AND NEWBORN HEALTH
CONSTRUCT: PRETERM BIRTH
2.
TYPE OF MEASURE
Systems Outcome
3.
PERFORMANCE MEASURE
Percent of infants (among mothers who enrolled in home visiting prenatally before 37 weeks) who are born preterm
following program enrollment
4.
SPECIFICATION
NUMERATOR: Number of live births (index child or subsequent children among mothers who enrolled in home
visiting prenatally before 37 weeks) born before 37 completed weeks of gestation and after enrollment
DENOMINATOR: Number of live births after enrollment who were born to mothers enrolled in home
visiting prenatally before 37 weeks
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from
measure calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. All cases
of missing data should be excluded from the
measure calculation.
7.
NOTES
* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

July 19, 2018

OMB No: 0906-0017
Expiration Date: 03/31/2019

MEASURE 2
1.
BENCHMARK AREA: MATERNAL AND NEWBORN HEALTH
CONSTRUCT: BREASTFEEDING
2.
TYPE OF MEASURE
Systems Outcome
3.
PERFORMANCE MEASURE
Percent of infants (among mothers who enrolled in home visiting prenatally) who were breastfed any amount
at 6 months of age
4.
SPECIFICATION
NUMERATOR: Number of infants aged 6-12 months (index child among mothers who enrolled in home
visiting prenatally) who were breastfed any amount at 6 months of age
DENOMINATOR: Number of infants aged 6-12 months (index child among mothers who enrolled in home visiting
prenatally) enrolled in home visiting for at least 6 months
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from
measure calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. All cases of
missing data should be excluded from the measure
calculation.
7.
NOTES

* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

July 19, 2018

OMB No: 0906-0017
Expiration Date: 03/31/2019

MEASURE 3
1.
BENCHMARK AREA: MATERNAL AND NEWBORN HEALTH
CONSTRUCT: DEPRESSION SCREENING
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of primary caregivers enrolled in home visiting who are screened for depression using a validated
tool within 3 months of enrollment (for those not enrolled prenatally) or within 3 months of delivery (for
those enrolled prenatally)
4.
SPECIFICATION
NUMERATOR: For those not enrolled prenatally, number of primary caregivers enrolled in home visiting
who are screened for depression within the first 3 months since enrollment; for those enrolled prenatally, the number of
primary caregivers screened for depression within 3 months of delivery
DENOMINATOR: For those not enrolled prenatally, the number of primary caregivers enrolled in home visiting for at
least 3 months; for those enrolled prenatally, the number of primary caregivers enrolled in
home visiting for at least three months post delivery
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*
6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. When
there is no documentation of whether a screening
occurred using a validated tool, but all other data
elements are known, then the primary caregiver
should be included in the denominator (if eligible),
but not in the numerator. All cases of missing data
should be excluded from the measure calculation.

July 19, 2018

6.b. Value – Enter the number of cases missing from measure
calculation:

OMB No: 0906-0017
Expiration Date: 03/31/2019

7.
NOTES

8. Measurement Tool Utilized
Indicate the validated measurement tool(s) utilized to address this measure
* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

July 19, 2018

OMB No: 0906-0017
Expiration Date: 03/31/2019

MEASURE 4
1.
BENCHMARK AREA: MATERNAL AND NEWBORN HEALTH
CONSTRUCT: WELL CHILD VISIT
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of children enrolled in home visiting who received the last recommended visit based on the
American Academy of Pediatrics (AAP) schedule
4.
SPECIFICATION
NUMERATOR: Number of children (index child) enrolled in home visiting who received the last
recommended well child visit based on the AAP schedule
DENOMINATOR: Number of children (index child) enrolled in home visiting
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from measure
calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown, including
if a home visit occurred but the home visitor did not
collect the data. All cases of missing data should be
excluded from the measure calculation.
7.
NOTES

* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

July 19, 2018

OMB No: 0906-0017
Expiration Date: 03/31/2019

MEASURE 5
1.
BENCHMARK AREA: MATERNAL AND NEWBORN HEALTH
CONSTRUCT: POSTPARTUM CARE
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of mothers enrolled in home visiting prenatally or within 30 days after delivery who received a postpartum
visit with a healthcare provider within 8 weeks (56 days) of delivery
4.
SPECIFICATION
NUMERATOR: Number of mothers enrolled in home visiting prenatally or within 30 days after delivery
who received a postpartum visit with a healthcare provider within 8 weeks (56 days) of delivery
DENOMINATOR: Number of mothers who enrolled in home visiting prenatally or within 30 days after
delivery and remained enrolled for at least 8 weeks (56 days) after delivery
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from
measure calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. All cases of
missing data should be excluded from the measure
calculation.
7.
NOTES

* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

July 19, 2018

OMB No: 0906-0017
Expiration Date: 03/31/2019

MEASURE 6
1.
BENCHMARK AREA: MATERNAL AND NEWBORN HEALTH
CONSTRUCT: TOBACCO CESSATION REFERRALS
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of primary caregivers enrolled in home visiting who reported using tobacco or cigarettes at
enrollment and were referred to tobacco cessation counseling or services within 3 months of enrollment.
4.
SPECIFICATION
NUMERATOR: Number of primary caregivers enrolled in home visiting who reported using tobacco or cigarettes at
enrollment and were referred to tobacco cessation counseling or services within 3 months of enrollment
DENOMINATOR: Number of primary caregivers enrolled in home visiting who reported using tobacco or
cigarettes at enrollment and were enrolled for at least 3 months
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*
6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown, including
if there is no documentation of whether the primary
caregiver used tobacco or cigarettes at enrollment
since inclusion in the denominator cannot be
determined if the screening result is unknown. When
there is no documentation of whether a referral was
provided, but all other data elements are known and
inclusion in the denominator can be determined,
then the primary caregiver should be included in the
denominator (if eligible), but not in the numerator.

July 19, 2018

6.b. Value – Enter the number of cases missing from
measure calculation:

OMB No: 0906-0017
Expiration Date: 03/31/2019

All cases of missing data should be excluded from the
measure calculation.
7.
NOTES

* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

July 19, 2018

OMB No: 0906-0017
Expiration Date: 03/31/2019

MEASURE 7
1.
BENCHMARK AREA: CHILD INJURIES, ABUSE, NEGLECT, AND MALTREATMENT AND EMERGENCY
DEPARTMENT VISITS
CONSTRUCT: SAFE SLEEP
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of infants enrolled in home visiting that are always placed to sleep on their backs, without
bed-sharing and without soft bedding
4.
SPECIFICATION
NUMERATOR: Number of infants (index child aged less than 1 year) enrolled in home visiting whose
primary caregiver reports that they are always placed to sleep on their backs, without bed-sharing and without soft
bedding
DENOMINATOR: Number of infants (index child) enrolled in home visiting who were aged less than 1 year during
the reporting period
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from
measure calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. All cases of
missing data should be excluded from the measure
calculation.
7.
NOTES

* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.
July 19, 2018

OMB No: 0906-0017
Expiration Date: 03/31/2019

MEASURE 8
1.
BENCHMARK AREA: CHILD INJURIES, ABUSE, NEGLECT, AND MALTREATMENT AND EMERGENCY
DEPARTMENT VISITS
CONSTRUCT: CHILD INJURY
2.
TYPE OF MEASURE
Systems Outcome
3.
PERFORMANCE MEASURE
Rate of injury-related visits to the Emergency Department (ED) during the reporting period among children enrolled in
home visiting
4.
SPECIFICATION
NUMERATOR: Number of parent-reported nonfatal injury-related visits to the ED during the reporting period among
children (index child) enrolled in home visiting
DENOMINATOR: Number of children (index child) enrolled in home visiting
5.
VALUE FOR REPORTING PERIOD (rate)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from measure
calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. All cases of
missing data should be excluded from the measure
calculation.
7.
NOTES

* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

July 19, 2018

OMB No: 0906-0017
Expiration Date: 03/31/2019

MEASURE 9
1.
BENCHMARK AREA: CHILD INJURIES, ABUSE, NEGLECT, AND MALTREATMENT AND EMERGENCY
DEPARTMENT VISITS
CONSTRUCT: CHILD MALTREATMENT
2.
TYPE OF MEASURE
Systems Outcome
3.
PERFORMANCE MEASURE
Percent of children enrolled in home visiting with at least 1 investigated case of maltreatment following enrollment
within the reporting period
4.
SPECIFICATION
NUMERATOR: Number of children (index child) enrolled in home visiting with at least 1 investigated case
of maltreatment following enrollment within the reporting period
DENOMINATOR: Number of children (index child) enrolled in home visiting
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from
measure calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. All cases of
missing data should be excluded from the measure
calculation.
7.
NOTES

* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

July 19, 2018

OMB No: 0906-0017
Expiration Date: 03/31/2019

MEASURE 10
1.
BENCHMARK AREA: SCHOOL READINESS AND ACHIEVEMENT
CONSTRUCT: PARENT-CHILD INTERACTION
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of primary caregivers enrolled in home visiting who receive an observation of caregiver-child interaction by
the home visitor using a validated tool
4.
SPECIFICATION
NUMERATOR: Number of primary caregivers enrolled in home visiting who receive an observation of caregiver-child
interaction by the home visitor using a validated tool
DENOMINATOR: Number of primary caregivers enrolled in home visiting with children reaching the
target age range
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*
6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. When
there is no documentation of whether the index child
received an observation of caregiver-child
interaction by the home visitor using a validated tool,
but all other data elements are known, then the index
child should be included in the denominator (if
eligible), but not in the numerator. All cases of
missing data should be excluded from the measure
calculation.

July 19, 2018

6.b. Value – Enter the number of cases missing from
measure calculation:

OMB No: 0906-0017
Expiration Date: 03/31/2019

7.
NOTES

8.
Measurement Tool Utilized
Indicate the validated measurement tool(s) utilized to address this measure
* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

July 19, 2018

OMB No: 0906-0017
Expiration Date: 03/31/2019

MEASURE 11
1.
BENCHMARK AREA: SCHOOL READINESS AND ACHIEVEMENT
CONSTRUCT: EARLY LANGUAGE AND LITERACY ACTIVITIES
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of children enrolled in home visiting with a family member who reported that during a typical week
s/he read, told stories, and/or sang songs with their child daily, every day
4.
SPECIFICATION
NUMERATOR: Number of children (index child) enrolled in home visiting with a family member who
reported that during a typical week s/he read, told stories, and/or sang songs with their child daily, every day
DENOMINATOR: Number of children (index child) enrolled in home visiting
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from
measure calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. All cases of
missing data should be excluded from the measure
calculation.
7.
NOTES

* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

July 19, 2018

OMB No: 0906-0017
Expiration Date: 03/31/2019

MEASURE 12
1.
BENCHMARK AREA: SCHOOL READINESS AND ACHIEVEMENT
CONSTRUCT: DEVELOPMENTAL SCREENING
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of children enrolled in home visiting with a timely screen for developmental delays using a validated parentcompleted tool
4.
SPECIFICATION
NUMERATOR: Number of children (index child) enrolled in home visiting with at least one screening
within the AAP-defined age groups during the reporting period
DENOMINATOR: Number of children (index child) enrolled in home visiting reaching the specified time
frame during the reporting period
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*
6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. When
there is no documentation of whether a screening
occurred using a validated tool, but all other data
elements are known, then the child should be
included in the denominator (if eligible), but not in
the numerator. All cases of missing data should be
excluded from the measure calculation.
7.
NOTES

July 19, 2018

6.b. Value – Enter the number of cases missing from
measure calculation:

OMB No: 0906-0017
Expiration Date: 03/31/2019

8.
Measurement Tool Utilized
Indicate the validated measurement tool(s) utilized to address this measure
* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

July 19, 2018

OMB No: 0906-0017
Expiration Date: 03/31/2019

MEASURE 13
1.
BENCHMARK AREA: SCHOOL READINESS AND ACHIEVEMENT
CONSTRUCT: BEHAVIORAL CONCERNS
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of postnatal home visits where primary caregivers were asked if they have any concerns regarding their
child’s development, behavior, or learning
4.
SPECIFICATION
NUMERATOR: Number of postnatal home visits where primary caregivers enrolled in home visiting were asked if they
have any concerns regarding their child’s development, behavior, or learning
DENOMINATOR: Total number of postnatal home visits during the reporting period
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA
6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. If a home
visit occurred, but there is no documentation of
whether the primary caregiver was asked about
behavioral concerns, then the home visit should be
included in the denominator (if eligible – i.e.,
postnatal visit), but not in the numerator. All cases of
missing data should be excluded from the measure
calculation.
7.
NOTES

July 19, 2018

6.b. Value – Enter the number of cases missing from measure
calculation:

OMB No: 0906-0017
Expiration Date: 03/31/2019

* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

July 19, 2018

OMB No: 0906-0017
Expiration Date: 03/31/2019

MEASURE 14
1.
BENCHMARK AREA: CRIME OR DOMESTIC VIOLENCE
CONSTRUCT: INTIMATE PARTNER VIOLENCE SCREENING
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of primary caregivers enrolled in home visiting who are screened for intimate partner violence (IPV)
within 6 months of enrollment using a validated tool
4.
SPECIFICATION
NUMERATOR: Number of primary caregivers enrolled in home visiting who are screened for IPV using a validated tool
within 6 months of enrollment
DENOMINATOR: Number of primary caregivers enrolled in home visiting for at least 6 months
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*
6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. When
there is no documentation of whether a screening
occurred using a validated tool (including if a
screening did not occur because the caregiver was
male and they only have validated tools for use
among female caregivers), but all other data
elements are known, then the primary caregiver
should be included in the denominator (if eligible),
but not in the numerator. All cases of missing data
should be excluded from the measure calculation.

July 19, 2018

6.b. Value – Enter the number of cases missing from measure
calculation:

OMB No: 0906-0017
Expiration Date: 03/31/2019

7.
NOTES

8.
Measurement Tool Utilized
Indicate the validated measurement tool(s) utilized to address this measure
* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

July 19, 2018

OMB No: 0906-0017
Expiration Date: 03/31/2019

MEASURE 15
1.
BENCHMARK AREA: FAMILY ECONOMIC SELF-SUFFICIENCY
CONSTRUCT: PRIMARY CAREGIVER EDUCATION
2.
TYPE OF MEASURE
Systems Outcome
3.
PERFORMANCE MEASURE
Percent of primary caregivers who enrolled in home visiting without a high school degree or equivalent who subsequently
enrolled in or maintained continuous enrollment in middle school or high school, or completed high school or equivalent
during their participation in home visiting
4.
SPECIFICATION
NUMERATOR: Number of primary caregivers who enrolled in or maintained continuous enrollment in middle school or
high school, or completed a high school degree or equivalent after enrollment in home visiting (and met the conditions
specified in the denominator)
DENOMINATOR: Number of primary caregivers without a high school degree or equivalent at enrollment
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from measure
calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. All cases of
missing data should be excluded from the measure
calculation.
7.
NOTES

* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the missing
data, and if possible, plans to reduce the amount of missing data in future reporting.

July 19, 2018

OMB No: 0906-0017
Expiration Date: 03/31/2019

MEASURE 16
1.
BENCHMARK AREA: FAMILY ECONOMIC SELF-SUFFICIENCY
CONSTRUCT: CONTINUITY OF INSURANCE COVERAGE
2.
TYPE OF MEASURE
Systems Outcome
3.
PERFORMANCE MEASURE
Percent of primary caregivers enrolled in home visiting who had continuous health insurance coverage for at least 6
consecutive months
4.
SPECIFICATION
NUMERATOR: Number of primary caregivers enrolled in home visiting who reported having health
insurance coverage for at least 6 consecutive months since enrollment in home visiting
DENOMINATOR: Number of primary caregivers enrolled in home visiting for at least 6 months
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*

6.b. Value – Enter the number of cases missing from measure
calculation:

6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown. All cases of
missing data should be excluded from the measure
calculation.
7.
NOTES

* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

July 19, 2018

OMB No: 0906-0017
Expiration Date: 03/31/2019

MEASURE 17
1.
BENCHMARK AREA: COORDINATION AND REFERRALS FOR OTHER COMMUNITY RESOURCES AND
SUPPORTS
CONSTRUCT: COMPLETED DEPRESSION REFERRALS
2.
TYPE OF MEASURE
Systems Outcome
3.
PERFORMANCE MEASURE
Percent of primary caregivers referred to services for a positive screen for depression who receive one or
more service contacts
4.
SPECIFICATION
NUMERATOR: Number of primary caregivers enrolled in home visiting who received recommended
services for depression (and met the conditions specified in the denominator)
DENOMINATOR: Number of primary caregivers enrolled in home visiting who had a positive screen for depression
within 3 months of enrollment (for those not enrolled prenatally) or within 3 months of delivery (for those enrolled
prenatally) and were referred for services
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*
6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown, including
if there is no documentation of whether a screening
occurred using a validated tool, since inclusion in the
denominator cannot be determined if the screening
result is unknown. Data are also considered missing
if there is no documentation of whether a referral
was provided. All cases of missing data should be
excluded from the measure calculation.

July 19, 2018

6.b. Value – Enter the number of cases missing from measure
calculation:

OMB No: 0906-0017
Expiration Date: 03/31/2019

7.
NOTES

8.
Measurement Tool Utilized
Indicate the validated measurement tool(s) utilized to address this measure
* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

July 19, 2018

OMB No: 0906-0017
Expiration Date: 03/31/2019

MEASURE 18
1.
BENCHMARK AREA: COORDINATION AND REFERRALS FOR OTHER COMMUNITY RESOURCES AND
SUPPORTS
CONSTRUCT: COMPLETED DEVELOPMENTAL REFERRALS
2.
TYPE OF MEASURE
Systems Outcome
3.
PERFORMANCE MEASURE
Percent of children enrolled in home visiting with positive screens for developmental delays (measured using
a validated tool) who receive services in a timely manner
4.
SPECIFICATION
NUMERATOR: Number of children enrolled in home visiting who a) received individualized developmental support
from a home visitor; b) were referred to early intervention services and receive an evaluation within
45 days; OR c) were referred to other community services who received services within 30 days (and met the conditions
specified in the denominator)
DENOMINATOR: Number of children enrolled in home visiting with positive screens for developmental
delays (measured using a validated tool)
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*
6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown, including
if there is no documentation of whether a screening
occurred using a validated tool, since inclusion in the
denominator cannot be determined if the screening
result is unknown. When there is no documentation
of whether a referral was provided, but all other
data elements are available and inclusion in the
denominator can be determined, then the primary
caregiver should be included in the denominator (if

July 19, 2018

6.b. Value – Enter the number of cases missing from
measure calculation:

OMB No: 0906-0017
Expiration Date: 03/31/2019

eligible), but not in the numerator. All cases of
missing data should be excluded from the measure
calculation.
7.
NOTES

8.
Measurement Tool Utilized
Indicate the validated measurement tool(s) utilized to address this measure
* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the
missing data, and if possible, plans to reduce the amount of missing data in future reporting.

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OMB No: 0906-0017
Expiration Date: 03/31/2019

MEASURE 19
1.
BENCHMARK AREA: COORDINATION AND REFERRALS FOR OTHER COMMUNITY RESOURCES AND
SUPPORTS
CONSTRUCT: INTIMATE PARTNER VIOLENCE REFERRALS
2.
TYPE OF MEASURE
Performance Indicator
3.
PERFORMANCE MEASURE
Percent of primary caregivers enrolled in home visiting with positive screens for IPV (measured using a validated tool) who
receive referral information to IPV resources
4.
SPECIFICATION
NUMERATOR: Number of primary caregivers enrolled in home visiting who received referral information
to IPV resources (and met the conditions specified in the denominator)
DENOMINATOR: Number of primary caregivers enrolled in home visiting with positive screens for IPV (measured using a
validated tool) within 6 months of enrollment
5.
VALUE FOR REPORTING PERIOD (percentage)

Numerator:

Value:
Denominator:
6.
MISSING DATA*
6.a. Definition
Data are considered missing if one or more data
elements needed to determine inclusion in the
numerator or denominator are unknown, including
if there is no documentation of whether a screening
occurred using a validated tool, since inclusion in the
denominator cannot be determined if the screening
result is unknown. When there is no documentation
of whether a referral was provided, but all other
data elements are available and inclusion in the
denominator can be determined, then the primary
caregiver should be included in the denominator (if
eligible), but not in the numerator. All cases of

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6.b. Value – Enter the number of cases missing from measure
calculation:

OMB No: 0906-0017
Expiration Date: 03/31/2019

missing data should be excluded from the measure
calculation.
7.
NOTES

8.
Measurement Tool Utilized
Indicate the validated measurement tool(s) utilized to address this measure
* Note: When the percent of missing data is ≥10%, a table note should be provided that addresses the reason for the missing
data, and if possible, plans to reduce the amount of missing data in future reporting.

July 19, 2018

OMB No: 0906-0017
Expiration Date: 03/31/2019

DEFINITIONS OF KEY TERMS

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Construct
Number
1.

Construct
Preterm Birth

2.

Breastfeeding

3.
4.

Depression
Screening
Well-Child Visit

5.

Postpartum Care

6.

Tobacco Cessation
Referrals
Safe Sleep
Child Injury

7.
8.

9.

Child
Maltreatment

10.

Parent-Child
Interaction
Early Language
and Literacy
Activities
Developmental
Screening

11.

12.

1

Key Term Definitions
Preterm Birth: a birth before 37 completed weeks of gestation (defined as up to 36 weeks and
6 days).1
Breastfeeding: in addition to breast milk fed directly from the mother to the infant,
breastfeeding also includes feeding the infant pumped or expressed breast milk.
Depression: aligned with each grantee’s validated depression screening tool’s definition of
depression.
AAP schedule for Well-Child Visits: Updated AAP 2017 Recommendations for Pediatric
Preventive Health Care https://www.aap.org/en-us/Documents/periodicity_schedule.pdf
Postpartum Care Visit: A postpartum visit is a visit between the woman and her health care
provider to assess the mother’s current physical health, including the status of pregnancy-related
conditions like gestational diabetes, screen for postpartum depression, provide counseling on
infant care and family planning as well as screening and referrals for the management of
chronic conditions. Additionally, a provider may use this opportunity to conduct a breast exam
and discuss breastfeeding. The American College of Obstetricians and Gynecologists
recommends that mothers receive a postpartum care visit within 6 weeks after delivery. 2
Tobacco Use: combustibles (cigarettes, cigars, pipes, hookahs, bidis), non-combustibles (chew,
dip, snuff, snus, and dissolvables), and ENDS.
No definitions required
Injury-related Emergency Department Visit: Injuries refer to the following causes of
mechanisms of injury: motor vehicle, suffocation, drowning, poisoning, fire/burns, falls, sports
and recreation, and intentional injuries, such as child maltreatment. 3
Investigated Case: all children with an allegation of maltreatment that were screened-in for
investigation or assessment and further received an investigation. 4 A screened-in report is one
that is accepted for investigation or assessment based on the state’s screen-in criteria. 5
No definitions required
No definitions required

Developmental Delay: delays in any or all areas including cognitive, social, language, sensory,

Behrman R, Stith Butler A. eds. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press, 2007.
Optimizing postpartum care. Committee Opinion No. 666. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;127:e187–92. Retrieved from https://www.acog.org//media/Committee-Opinions/Committee-on-Obstetric-Practice/co666.pdf?dmc=1&ts=20180221T1421452301
3
Centers for Disease Control and Prevention. National Action Plan for Child Injury Prevention. 2012. Retrieved from http://www.cdc.gov/safechild/NAP/background.html#unint
4
Child Welfare Information Gateway. Child Maltreatment 2015: Summary of Key Findings. Retrieved from https://www.childwelfare.gov/pubs/factsheets/canstats/
5
Child Welfare Information Gateway. Screening and Intake. Retrieved from https://www.childwelfare.gov/topics/responding/iia/screening/
2

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and emotional development.6
13.
14.

15.
16.

17.

18.

19.

6

Behavioral
Concerns
IPV Screening

Primary Caregiver
Education
Continuity of
Insurance
Coverage
Completed
Depression
Referrals
Completed
Developmental
Referrals
IPV Referrals

No definitions required
Intimate Partner Violence: physical violence, sexual violence, stalking and psychological
aggression (including coercive acts) by a current or former intimate partner. An intimate partner
is a person with whom one has a close personal relationship that can be characterized by the
following: emotional connectedness, regular contact, ongoing physical contact and sexual
behavior, identity as a couple, familiarity and knowledge about each other’s lives. 7
No definitions required
Continuous Health Insurance Coverage: having health insurance coverage without any
lapses.
Recommended services: specific techniques and intervention models delivered in the context
of client characteristics, culture, and preferences that have shown to have positive effects on
outcomes through rigorous evaluations and have demonstrated to achieve positive outcomes for
the client.8
Developmental Delay: delays in any or all areas including cognitive, social, language, sensory,
and emotional development.6
Intimate Partner Violence: physical violence, sexual violence, stalking and psychological
aggression (including coercive acts) by a current or former intimate partner. An intimate partner
is a person with whom one has a close personal relationship that can be characterized by the
following: emotional connectedness, regular contact, ongoing physical contact and sexual
behavior, identity as a couple, familiarity and knowledge about each other’s lives. 7

U.S. National Library of Medicine, National Institutes of Health. Psychological Index Terms via Unified Medical Language System, 2015. Retrieved from
http://ghr.nlm.nih.gov/glossary=developmentaldelay
7
Centers for Disease Control and Prevention. Injury Prevention and Control: Division of Violence Prevention, 2015. Retrieved from
http://www.cdc.gov/violenceprevention/intimatepartnerviolence/definitions.html
8
Home Visiting Collaborative Improvement and Innovation Network.

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