Home
Visiting Activities
|
Did
you implement any home visiting activities?
Activity
name (example list)
Screening
children/adults (with type)
Consultation
for home visitors
Training
for home visitors
Home
visits with parents/children
Brief
description of activity
Type
of activity
Professional
training
Screening
Classroom
intervention
Parent/family
education
Who
does the activity directly interact with
How
many individuals did the activity directly interact with
Who
is the intended beneficiary
Age
of children, if children were intended beneficiaries
Where
activity was implemented
|
From
Direct Services survey (no specific HV survey)
Description
of program
Does
program include services for parents/families
What
types of services are provided in this program?
Does
program include separate services for children
How
would you describe program/service
Who
is the target population
Location
of services
|
Mental
health consultation in school and ECE settings
|
Did
you implement any MH consultation in school and ECE setting
activities?
Activity
name (example list)
Programmatic
consultation
Individual
child/parent consultation
Implementation
of EBP with teachers (with type)
Formal
training for ECE or school staff
Brief
description of activity
Activity
type
Professional
training
Screening
Classroom
intervention
Parent/family
education
Who
does the activity directly interact with
How
many individuals did the activity directly interact with
Who
is the intended beneficiary
Age
of children, if children were intended beneficiaries
Where
activity was implemented
|
Did
LAUNCH support developmental screening and assessments of
children conducted by the MH consultant?
What
are the preferred qualifications of MH consultants who are
working in these settings?
What
are the professional affiliations of these MH consultants?
How
many providers were involved with MH consultation in school and
ECE settings?
Who
are the staff in these settings?
Number
of children screened and/or assessed for MH services
Number
of children referred for MH services
Number
of family members screened and/or assessed for MH services
Number
of family members referred for MH services
Number
of staff who received training in MH-related
practices/activities
Is
there training for school staff on LAUNCH-supported MH
activities
Who
conducted screenings and/or assessments of children?
How
many screening/assessment instruments were used for family
members
Does
the MH consultation model/approach have a data system in place
to track client information
Amount
of change in providers/staff knowledge about:
Amount
of staff change in use of MH consultation
Amount
of staff change in use of screening/assessment
What
are some of the changes?
Percentage
of providers/staff represented in above responses
|
Integrating
behavioral health into primary health care
|
Did
you implement any activities related to integrating BH into PHC?
Activity
name (examples)
Screening
children/adults (with type)
Training
for PC staff
Mental
health consultation
MH
assessment, brief intervention, referral to treatment
Brief
description of activity
Activity
type
Professional
training
Screening
Classroom
intervention
Parent/family
education
Who
does the activity directly interact with
How
many individuals did the activity directly interact with
Who
is the intended beneficiary
Age
of children, if children were intended beneficiaries
Where
activity was implemented
|
Types
of MH related activities
Brief
description of model/approach
Types
of primary care settings involved
Did
LAUNCH support screening
Did
LAUNCH support training of staff
Did
LAUNCH support consultation:
between
MH staff and PHC providers
between
MH staff and families
by
MH staff about practices in PHC setting
Number
of settings for integrating MH into PHC
Number
of PHC providers
Number
of children
Preferred/required
qualifications of MH staff
Professional
affiliations of MH staff
Did
LAUNCH support supervision of MH staff
Did
LAUNCH support training for MH staff
|
Family
strengthening activities
|
Did
you implement any family-strengthening activities?
Activity
name (examples)
Brief
description of activity
Activity
type
Professional
training
Screening
Classroom
intervention
Parent/family
education
Who
does the activity directly interact with
How
many individuals did the activity directly interact with
Who
is the intended beneficiary
Age
of children, if children were intended beneficiaries
Where
activity was implemented
|
From
Direct Services survey (no specific family strengthening survey)
Description
of program
Does
program include services for parents/families
What
types of services are provided in this program?
Does
program include separate services for children
How
would you describe program/service
Who
is the target population
Location
of services
|
Other
Direct Service Activities
|
Did
you implement any other direct service activities?
Activity
name
Brief
description of activity
Activity
type
Professional
training
Screening
Classroom
intervention
Parent/family
education
Who
does the activity directly interact with
How
many individuals did the activity directly interact with
Who
is the intended beneficiary
Age
of children, if children were intended beneficiaries
Where
activity was implemented
|
Questions
below are from “MH services in other settings” survey
Brief
description of integration model/approach
Which
types of settings were involved
Qualifications
of MH staff
Professional
affiliations of MH staff
Number
of settings in which model was implemented
Did
LAUNCH support training for MH consultants and other staff
What
types of training
Number
trained
Did
MH consultation involve consultation about individual
children/families
Types
of consultation services
Did
MH consultation involve consultation about staff practices
Other
MH activities supported as part of model
Number
of children/families seen
Did
LAUNCH support training for MH staff who are working with these
settings on the MH model
Did
LAUNCH support supervision for MH staff who are working with
these settings on the MH model
Is
there a systematic process for monitoring fidelity of
model/approach
What
types of measures are used
What
methods are used to monitor fidelity
How
often is fidelity of implementation assessed
Was
the fidelity of the model assessed in the past 12 months
Rate
the overall fidelity of the model
Did
the MH consultation model have a data system in place to track
contacts
What
types of data are included in the system
Electronic,
paper, or combo data system
Are
there data sharing agreements in place
What
types of data sharing occur
How
many other MH consultants share data with this model
Who
are the other programs part of the data sharing
Amount
of change in providers/staff knowledge about:
Amount
of staff change in use of MH consultation
Amount
of staff change in use of screening/assessment
What
are some of the changes?
Number
and percent of providers/staff represented in above responses
|
Staff
Allocation
|
Name
Job
description
Number
of hours on LAUNCH
Allocate
hours spent per week for each activity entered (direct service
and systems activities)
Total
number of activities per staff person
|
|
Facilities,
Equipment, Transportation
|
Each
activity listed in direct services and systems surveys is
pre-populated here
Did
you rent out space for this activity?
Amount
spent on renting space
Purchase
equipment for this activity?
Amount
spent on purchasing equipment
Transportation
costs associated with activity?
Amount
spent on transportation
|
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|
Activities
and subcontracting
|
Each
activity listed in direct services and systems surveys is
pre-populated here
Was
activity initiated under LAUNCH?
Do
you pay others to do this work for you – subcontract?
Dollar
value of subcontract
Does
subcontract pay for more than one activity?
Percentage
of contract spent on this activity?
|
For
all activity types (MH in PHC, MH in schools/ECEs, etc): was the
model initiated under LAUNCH
Was
the model started “from scratch” by LAUNCH in the
target community
Proportion
of funding for model came from LAUNCH
Other
sources of funding that supported the model
|
Screening/
assessment of children and families
|
Integrated
above into direct services sections
|
From
all surveys, including overall direct services and MH
consultation in other settings
Did
LAUNCH support developmental screening/assessment of children
How
many different measures were used
Name
and domains of each measure
Who
conducted the screenings/assessments
Did
LAUNCH support physical health screening
What
aspects of physical health were screened
As
part of the LAUNCH MH consultation model, did LAUNCH support
screening/assessment of family members
How
many different measures were used
Name
and domains of each measure
Who
conducted the screenings/assessments
-
|
Demographics
|
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|
From
Direct Services Survey
Total
number new children in past 6 months
Newly
enrolled families
Age
of target child
Gender
of target child
Is
target child Hispanic
Race
of target child
Parents
or primary caregivers of target child in household
Highest
education level of parent/primary caregiver
Average
number of children in household
Primary
language in household
Number
of households with member on active duty in Armed Force or
reserve
Number
of households in which 1 or more children has been homeless in
past 12 months
Number
of families that:
Teen
mother
Single
parent family
PC
without GED or HS education
PC
not employed and not in school
Household
participates in at least one assistance program
Three
or more characteristics above
Number
of families:
Member
of household has mental illness
Member
of household has substance abuse problem
Any
child victim of violence or trauma
More
than one characteristic above
|
Programs/
Services Expanded or Enhanced
|
--
|
From
Direct Services survey
Were
LAUNCH funds used to expand the existing program/service by
increasing number of children/families
Were
more families served through additional funding
Do
additional families represent previously unserved or underserved
population
Were
LAUNCH funds used to expand the existing program/service by
adding a new program component
Were
LAUNCH funds used to make program culturally competent
Were
LAUNCH funds used to expand the existing program/service by
providing training to staff
Were
LAUNCH funds used to expand the existing program/service by
funding program administration/management
Were
LAUNCH funds used to expand the existing program/service in any
other way
|
Service
Counts
|
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|
From
“Direct Services” survey, programs initiated under
LAUNCH
Program
size
Number
of additional families able to serve
Number
of children/families served
Number
of families who left before the planned end of the
program/service
In
what ways were services provided?
part
of home visiting program
home
visits in a different program
parent
training/education or support groups
parent/child
sessions or groups other than for mental health treatment
computerized
lessons for parents
any
other types of direct contact
|