16. MUSE Administrative Data Elements 7.26.18 CLEAN

January 2019

OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for data submission: 24 hours

MULTI-SITE IMPLEMENTATION EVALUATION OF TRIBAL HOME VISITING (MUSE)
ADMINISTRATIVE DATA ELEMENTS

Public reporting burden for this collection of information is estimated to average 24 hours per response,
including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the
collection of information. 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 number and
expiration date for this collection are OMB #: 0970-0521, Exp: 12/31/2021. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden to Kate Lyon, James Bell Associates; 3033 Wilson Blvd. Suite 650, Arlington, VA 22201;
MUSE.info@jbassoc.com.

Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: MUSE
Administrative Data Elements
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January 2019

OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for data submission: 24 hours

MUSE Administrative Data Elements
Thank you for taking part in the Multi-Site Implementation Evaluation of Tribal Home Visiting (MUSE).
The purpose of this study is to learn about tribal home visiting programs and the experiences of families
receiving home visiting services.
Tribal Home Visiting grantees collect data for various purposes including:
•
•
•
•
•

Reporting participant demographics and service utilization to the Administration for Children
and Families (ACF)
Reporting performance measurement data to ACF
Reporting data to home visiting models for quality assurance and accreditation purposes
Conducting internal program monitoring and continuous quality improvement
Reporting to other funders

Grantees are being asked to submit data collected by the program for the purposes outlined above to
the MUSE study. While grantees submit aggregate data to ACF, in order to include these data in analyses
for MUSE, grantees will submit person-level data to the MUSE study team. Administrative data elements
requested include data about participating caregivers and children and the services they received.
Grantees will upload de-identified administrative data to a secure cloud-based document storage
system. The data grantees provide will be kept private. Only the MUSE study team and the grantee will
have access to this information. We will not report information collected in this study in a way that
could identify grantees, grantee staff, or any of the participants grantees are reporting data for.
The amount of time it takes to compile and submit the existing administrative data elements varies
depending on the number of caregivers who consent to participate in MUSE (including sharing
administrative data) at each grantee and the number of home visits provided to participants. It also
varies depending on the grantee’s data system and it’s reporting capabilities. For grantees using PAT and
NFP data systems, the MUSE Team will be able to obtain data files directly from the model which will
require only minimal involvement from the grantee. It will take grantees that are using PAT and NFP
data systems substantially less time to complete this instrument. On average, it will take grantees 24
hours to develop and run reports, and compile, clean and submit these data for a single submission.
Grantees will submit data semi-annually for a total of 4 times.
There is no required format or template for submitting administrative data, rather the MUSE study team
will accept a range of acceptable formats. Tribal Home Visiting grantees will work with MUSE and their
evaluation TA provider to determine the format for reporting that will be the least burdensome for each
site.

Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: MUSE
Administrative Data Elements
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January 2019

DATA ELEMENT

OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for data submission: 24 hours

RESPONSE CATEGORIES/DATA TYPE

Administrative Data Elements Collected for Reporting Participant Demographics and Service
Utilization to ACF
Sex

Male, Female

Age

<17, 18-19, 20-21, 22-24, 25-29, 30-34, 35-44, 45-54, 55-64, >65

Pregnancy status at enrollment

Y/N

Educational status

Student/Trainee, Not a Student/Trainee, Unknown/Did not report

Employment status

Employed full time, Employed part-time, Not employed,
Unknown/Did not report

Household income

Form dependent - dollar amount or income ranges

Child age at enrollment

Under 12 months, 12-24 months, 25-35 months, 37-60 months,
60-72 months, Unknown/did not report

Housing status

Not homeless, Homeless and sharing housing, Homeless and
living in an emergency or transitional shelter, Homeless with
some other arrangement, Unknown/Did not report

Type of health insurance

Not insured but has access to IHS, CHS, or UIHP facility; Not
insured and does not have access to IHS, CHS, or UIHP facility,
Medicaid or CHIP, TriCare, Private Insurance, Unknown/Did not
report

Race

AIAN, Asian, Black or African American, Native Hawaiian or other
Pacific Islander, White, More than one race including AIAN, More
than one race not including AIAN, Unknown/did not report

Child race

AIAN, Asian, Black or African American, Native Hawaiian or other
Pacific Islander, White, More than one race including AIAN, More
than one race not including AIAN, Unknown/did not report

Ethnicity

Hispanic or Latino, Not Hispanic or Latino, Unknown/did not
report

Marital status

Single, Legally married, Not married but living together with
partner, Separated/divorced/widowed, Unknown/did not report

Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: MUSE
Administrative Data Elements
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January 2019

OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for data submission: 24 hours

Educational attainment

Less than HS diploma, HS diploma/GED, Some college/training,
Technical training or certification, Associates degree, Bachelor's
degree or higher, Other, Unknown/did not report

Primary language spoken in
home

English, Spanish, Any Native language, Other, Unknown/did not
report

Secondary language spoken in
home

English, Spanish, Any Native language, Other, Unknown/did not
report

Administrative Data Elements Collected for Calculating and Reporting Performance Measurement
Data to ACF
Dates of screening for substance
abuse

DATE

Substance abuse screening itemlevel responses **These data are
optional. Grantees can opt out of
providing these data to MUSE.**

Item scores

Dates of screening for parental
depression

DATE

Depression screening total scores Total score
**These data are optional.
Grantees can opt out of providing
these data to MUSE.**
Dates of screening for unmet
basic needs (Family Resource
Check-in)

DATE

Screening for unmet basic needs
(Family Resource Check-in) item
level responses

Item scores

Dates of screening for
developmental delays

DATE

Results of screening for
developmental delay

Above cutoff/below cutoff

Dates of screening for intimate
partner violence

DATE

Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: MUSE
Administrative Data Elements
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January 2019

OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for data submission: 24 hours

Date of observation of caregiverchild interaction by the home
visitor

DATE

Expected visit frequency

Form dependent

Dates of changes to expected
visit frequency

DATE

Administrative Data Elements Collected for Home Visiting Model Reporting and/or Internal
Performance Monitoring and Continuous Quality Improvement
Caregiver age at enrollment

NUMBER

Caregiver relationship to index
child

Form dependent

Index child's birth month and
year

MONTH YEAR

Caregiver referral source to THV

Form dependent

Date of caregiver referral to THV

DATE

Date of caregiver enrollment in
THV

DATE

Dates of each missed visit

DATE

Reason for missed visit

Caregiver cancelled/Home visitor cancelled/Unable to confirm
visit/No-show

Dates of each home visit
completed

DATE

Home visitor completing each
home visit

NAME

Length of home visit

MINUTES

Date of caregiver exit from
program

DATE

Reason for caregiver exit from
program

Form dependent

Date of group events attended by
caregiver

DATE

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Administrative Data Elements
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