Health Resources and Services Administration

Attached for your review is our final report examining Department of Health and Human Services (HHS) agencies ' compliance with the medical malpractice reporting requirements of the National Practitioner Data Bank (NDB). The NPDB , which is managed by the Health Resources and Services Administration (HRSA), receives and maintains records of medical malpractice payments and of adverse actions taken by hospitals, other health care entities, licensure boards, and professional societies against licensed health care practitioners. The NPDB makes these reports available to hospitals other health care entities, and licensure boards to facilitate their background checks and credentialing.

The percent of programs promoting and facilitating state capacity for advancing the health of MCH populations.

II. RELATED OUTCOMES
A. Percentage of unlinked data sources with consistent and direct annual access ________(Column C Percentage) B. Percentage of data sources available more frequently than annually ________(Column D Percentage) C. Percentage of data sources with a lag length of ≤6 months ___________(Column E Percentage) D. Percentage of data sources linked to Vital Records Birth___________(Column F Percentage)

SIGNIFICANCE
Timely and comprehensive data are required for needs assessments and program design.

Goal: Prenatal Care Level: Grantee Domain: Women's/ Maternal Health
The percent of programs promoting and/or facilitating timely prenatal care.

GOAL
To ensure supportive programming for prenatal care.

MEASURE
The percent of MCHB funded projects addressing prenatal care. The percent of pregnant program participants who receive prenatal care beginning in the first trimester. The percent of programs promoting and/or facilitating timely prenatal care.

DEFINITION
prenatal care (entry after the first 12 weeks) are at risk for having undetected complications in pregnancy that can result in undesirable consequences for both mother and baby. The percent of programs promoting and/or facilitating timely postpartum care.

GOAL
To ensure supportive programming for postpartum care.

MEASURE
The percent of MCHB funded projects addressing perinatal and postpartum care. The percent of pregnant women with a postpartum visit within 4-6 weeks of delivery # receiving TA # receiving training # products developed # peer-reviewed publications published # receiving information and education through outreach # receiving screening/ assessment # referred/care coordinated # received direct service # participating in quality improvement initiatives Tier 4: What are the related outcomes in the reporting year? % of pregnant women with a postpartum visit within 4 to 6 weeks after delivery 1 Numerator: Women program participants who enrolled prenatally or within 30 days after delivery and received a postpartum visit within 4-6 weeks after delivery 2 Denominator: Women program participants who enrolled prenatally or within 30 days after delivery during the reporting period Definition: ACOG recommends that the postpartum visit occur between 4-6 weeks after delivery. ACOG suggests a 7-14 day postpartum visit for high-risk

GOAL
To ensure supportive programming for well woman visits/ preventive health care.

MEASURE
The percent of MCHB funded projects promoting and/ or facilitating well woman visits/ preventive health care and through what processes.

SIGNIFICANCE
A number of illnesses that affect women can be prevented when proper well-woman care is a priority and even illnesses that can't be prevented have a much better prognosis when detected early during a regular well-woman care exam. ACOG recommends annual assessments to counsel patients about preventive care and to provide or refer for recommended services. These assessments should include screening, evaluation and counseling, and immunizations based on age and risk factors. 6  The percent of programs promoting and/ or facilitating depression screening.

GOAL
To ensure supportive programming for depression screening.

MEASURE
The percent of MCHB funded projects promoting and/ or facilitating depression screening and through what processes. The percent of programs promoting and/ or facilitating depression screening. assist with systematically identifying patients with depression. 8 % of women who screened positive for depression who receive a referral for services Numerator: Number of women participants who screened positive for depression during the reporting period and received a subsequent referral for follow-up services. Denominator: Number of HS women participants who screened positive for depression during the reporting period.

DEFINITION
Definitions: A participant is considered to have been referred for follow-up services and included in the numerator if she is referred to a qualified practitioner for further assessment for depression. Referral can be to either an internal or external provider depending on availability and staffing model.

BENCHMARK DATA SOURCES
Related to Healthy People 2020 MICH #34 Objective: (Developmental) Decrease the proportion of women delivering a live birth who experience postpartum depressive symptoms. PRAMS (depression screening)

SIGNIFICANCE
Perinatal depression is one of the most common medical complications during pregnancy and may include major and minor depressive episodes. It is important to identify women with depression because when untreated, mood disorders can have adverse effects on women, infants, and families. Often, perinatal depression goes unrecognized because the changes are often attributed to normal pregnancy, such as changes in sleep and appetite. Therefore, it is important and recommended that clinicians screen patients at least once during the perinatal period for depression. Although screening is important for detecting perinatal depression, screening by itself is insufficient to improve clinical outcomes and must be paired with appropriate follow-up and treatment when indicated. The percent of Healthy Start participants who engage in safe sleep practices.

GOAL
To ensure supportive programming for safe sleep practices.

MEASURE
The percent of MCHB funded projects promoting and/ or facilitating safe sleep practices. # receiving TA # receiving training # products developed # peer-reviewed publications published # receiving information and education through outreach # receiving screening/ assessment # referred/care coordinated # received direct service # participating in quality improvement initiatives Tier 4: What are the related outcomes in the reporting year? % of infants placed to sleep following safe sleep practices 1 Numerator: Number of child program participants (aged <12 months) whose parent/ caregiver reports that they are placed to sleep following all three AAP recommended safe sleep practices. 2 Denominator: Total number of child program participants aged <12 months.

DEFINITION
A participant is considered to engage in safe sleep practices and included in the numerator if it is reported that the baby is 'always' or 'most often' 1) placed to sleep on their back, 2) always or often sleeps alone in his or her own crib or bed with no bed The percent of Healthy Start participants who engage in safe sleep practices.
sharing, and 3) sleeps on a firm sleep surface (crib, bassinet, pack and play, etc.) with no soft objects or loose bedding. 3 The requirement is that the baby is placed on their back to sleep. If they roll over onto their stomach after being placed to sleep, the standard is met. Although safe sleep behaviors are self-reported, programs are encouraged to observe safe sleep practices during home visits, as possible.

BENCHMARK DATA SOURCES
Related to MICH Objective #20: Increase the proportion of infants placed to sleep on their backs (Baseline: 69.0%, Target The percent of programs promoting and/ or facilitating breastfeeding.

GOAL
To ensure supportive programming for breastfeeding.

MEASURE
The percent of MCHB funded projects promoting and/ or facilitating breastfeeding. # receiving TA # receiving training # products developed # peer-reviewed publications published # receiving information and education through outreach # receiving screening/ assessment # referred/care coordinated # received direct service # participating in quality improvement initiatives Tier 4: What are the related outcomes in the reporting year? % of child program participants ever breastfed 6 Numerator: Total number of HS child participants aged <12 months whose parent was enrolled prenatally or at the time of delivery who were ever breastfed or fed pumped breast milk to their infant. Denominator: Total number of HS child participants aged <12 months whose parent was enrolled prenatally or at the time of delivery. Definition: A participant is considered to have ever breastfed and included in the numerator if the child received breast milk direct from the breast or expressed at any time in any amount. % of child program participants breastfed at 6 months 7 6 Consistent with Healthy Start Benchmark 7: Percent of Healthy Start child participants whose parent reports the child was ever breastfed or fed breastmilk, even for a short period of time. 7 Consistent with Healthy Start Benchmark 8: Percent of Healthy Start child participants whose parent reports the The percent of programs promoting and/ or facilitating breastfeeding.

DEFINITION
Numerator: Total number of HS child participants age 6 through 11 months whose parent was enrolled prenatally or at the time of delivery that were breastfed or were fed pumped breast milk in any amount at 6 months of age. Denominator: Total number of HS child participants age 6 through 11 months whose parent was enrolled prenatally or at the time of delivery. Definition: A participant is considered to have ever breastfed at 6 months and included in the numerator if the child received breast milk direct from the breast or expressed at any time in any amount during the sixth month.

GRANTEE DATA SOURCES
Grantee data systems.

SIGNIFICANCE
The American Academy of Pediatrics recommends breastfeeding for the first six months because scientific studies have shown that breastfeeding is good for both the baby's and mother's health. 8 Breastmilk contains vitamins and nutrients babies need for good health and to protect the baby from disease. Research shows that any amount of breastfeeding is beneficial for the baby and that skin-to-skin contact of breastfeeding has physical and emotional benefits. Some studies have found that breastfeeding may reduce risk for certain diseases while also increasing cognitive development. 9 child was breastfed or fed breastmilk at 6 months. 8 http://www.babycenter.com/0_how-breastfeeding-benefits-you-and-your-baby_8910.bc 9 http://www.nichd.nih.gov/health/topics/breastfeeding/conditioninfo/Pages/benefits.aspx

GOAL
To ensure supportive programming for newborn screenings.

MEASURE
The percent of MCHB funded projects promoting and/ or facilitating newborn screening and follow-up. % of eligible newborns screened with timely notification for out of range screens Numerator: # of eligible newborns screened with out of range results whose caregivers receive timely notification Denominator: # of eligible newborns screened with out of range results % of eligible newborns screened with timely notification for out of range screens who are followed up in a timely manner Numerator: # of eligible newborns screened with out of range results whose caregivers receive timely notification and receive timely follow up Denominator: # of eligible newborns screened with out of range results whose caregivers receive timely notification The percent of programs promoting and/ or facilitating well-child visits.

GOAL
To ensure supportive programming for well-child visits.

MEASURE
The percent of MCHB funded projects promoting and/ or facilitating well-child visits. The percent of programs promoting and/ or facilitating quality of well-child visits.

GOAL
To ensure supportive programming for quality of well child visits.

MEASURE
The percent of MCHB funded projects promoting or facilitating quality of well child visits.

SIGNIFICANCE
Children grow and develop very rapidly so it is important they see a pediatrician on a regular basis. Each visit should include a complete physical examination, record of height and weight, and information regarding hearing, vision, and annual screenings.

GOAL
To ensure supportive programming for developmental screenings.

MEASURE
The percent of MCHB funded projects promoting and/ or facilitating developmental screening and follow-up for children. Percent of programs promoting developmental screenings and follow-up for children.

SIGNIFICANCE
Early identification of developmental disorders is critical to the well-being of children and their families. It is an integral function of the primary care medical home and an appropriate responsibility of all pediatric health care professionals. The early identification of developmental problems should lead to further developmental and medical evaluation, diagnosis, and treatment, including early developmental intervention. Children diagnosed with developmental disorders should be identified as children with special health care needs, and chronic-condition management should be initiated. Identification of a developmental disorder and its underlying etiology may also drive a range of treatment planning, from medical treatment of the child to family planning for his or her parents. The percent of programs promoting and/ or facilitating injury prevention among children.

GOAL
To ensure supportive programming for injury prevention among children.

MEASURE
The percent of MCHB funded projects addressing injury prevention and through what processes. Rate of injury-related hospitalization to children ages 1-9. Numerator: Injury-related hospitalizations to children ages 1-9 Denominator: Children ages 1-9 in the target population Target Population: __________________________ Percent of children ages 6-11 missing 5 or more days of school because of illness or injury. Please use the form below to report what services you provided in which safety domains, and how many received those services. Please use the space provided for notes to specify the recipients of each type of service. The percent of programs promoting and/ or facilitating family engagement among children and youth with special health care needs.

GOAL
To ensure supportive programming for family engagement among children and youth with special health care needs.

MEASURE
The percent of MCHB funded projects promoting and/ or facilitating family engagement among children and youth with special health care needs. The percent of programs promoting and/ or facilitating family engagement among children and youth with special health care needs.

DEFINITION
Denominator: # of CSHCN in catchment area % of target population with family of CSHCN participating in information exchange forums Numerator: # participating in information exchange forums Denominator: # CSHCN in catchment area % of family and CSCHN leaders trained who report increased knowledge, skill, ability and self-efficacy to serve as leaders on systems-level teams Numerator: # of family and CSHCN leaders trained who report increased knowledge, skill, ability and selfefficacy to serve as leaders on systems-level teams Denominator: # of CSHCN in catchment area Definitions: Family Engagement is defined as "patients, families, their representatives, and health professionals working in active partnership at various levels across the health care system to improve health and health care." This definition is not intended to negate the various levels or degree to which the interaction between families and professionals can take place. Family and Youth Leaders are family members who have experience navigating through service systems and are knowledgeable and skilled in partnering with professionals to carry out necessary system changes. Family members are not limited to the immediate family within the household. Meaningful [Support] Roles for family members/leaders are above and beyond "feedback" surveys. Families are considered to have a meaningful role in decision making when the partnership involves all elements of shared decision-making which are: collaboration, respect, information sharing, encouragement and consideration of preferences and values, and shared responsibility for outcomes.

BENCHMARK DATA SOURCES
Related to Healthy People 2020 Family Planning Objectives

GRANTEE DATA SOURCES
Title V National Performance Measure #2

SIGNIFICANCE
In recent years, policy makers and program administrators have emphasized the central role of family engagement in policymaking activities. In accordance with this philosophy, MCHB is facilitating such partnerships at the local, state and national levels.
While there has been a significant increase in the level and types of family engagement, there is still a need to share strategies and mechanisms to recruit, train, monitor, and evaluate family engagement as a key component for CSHCN. The percent of programs promoting and/ or facilitating medical home access and use among children and youth with special health care needs.

GOAL
To ensure supportive programming medical home access and use among children and youth with special health care needs.

MEASURE
The percent of MCHB-funded projects promoting and/ or facilitating medical home access and use among children and youth with special health care needs. The percent of programs promoting and/or facilitating transition to adult health care for youth with special health care needs.

GOAL
To ensure supportive programming for transition to adult health care for youth with special health care needs.

MEASURE
The percent of MCHB funded projects promoting and/or facilitating transition to adult health care for youth with special health care needs. The terms "assessed for readiness" and "deemed ready" used here refer to language utilized by gottransition.org. Health care transition: is the process of changing from a pediatric to an adult model of health care. The goal of transition is to optimize health and assist youth in reaching their full potential. To achieve this goal requires an organized transition process to support youth in acquiring independent health care skills, preparing for an adult model of care, and transferring to new providers without disruption in care. Transition Readiness: Assessing youth's transition readiness and self-care skills is the third element in these health care transition quality recommendations. Use of a standardized transition assessment tool is helpful in engaging youth and families in setting health priorities; addressing self-care needs to prepare them for an adult approach to care at age 18, and navigating the adult health care system, including health insurance. Providers can use the results to jointly develop a plan of care with youth and families. Transition readiness assessment should begin at age 14 and continue through adolescence and young adulthood, as needed.

GRANTEE DATA SOURCES
Title V National Performance Measure #6 and #12, NS-CSHCN Survey Outcome #6

SIGNIFICANCE
Transitioning of children to adolescent services to adult services is important to ensure that growth and development is adequately and accurately screened throughout all stages. These stages of life represent a time of rapid development and it is important to make sure changes are documented and children and receiving appropriate treatment, preventive services, and screenings. The percent of programs promoting and/ or facilitating adolescent well visits.

GOAL
To ensure supportive programming for adolescent well visits.

MEASURE
The percent of MCHB funded projects promoting and/ or facilitating adolescent well visits. The percent of programs promoting and/ or facilitating adolescent well visits.

BENCHMARK DATA SOURCES
Related to Adolescent Health Objective 1: Increase the proportion of adolescent who have had a wellness checkup in the past 12 months Baseline: 68.7%, Target: 75.6%).

GRANTEE DATA SOURCES
Title V National Performance Measure 10, Adolescent Health (AH), National Vital Statistics System (NVSS) Birth File, Home Visiting

SIGNIFICANCE
Adolescence is an important period of development physically, psychologically, and socially. As adolescents move from childhood to adulthood, they are responsible for their health including annual preventive well visits which help to maintain a healthy lifestyle, avoid damaging behaviors, manage chronic conditions, and prevent disease. The percent of programs promoting and/ or facilitating adolescent injury prevention.

GOAL
To ensure supportive programming for adolescent injury prevention.

MEASURE
The percent of MCHB funded projects promoting and/ or facilitating injury prevention and through what processes.

Data Collection Form for Detail Sheet # AH 2
Please use the form below to report what services you provided in which safety domains, and how many received those services. Please use the space provided for notes to specify the recipients of each type of service. The percent of programs promoting and/ or facilitating screening for major depressive disorder.

GOAL
To ensure supportive programming for screening for major depressive disorder.

MEASURE
The percent of MCHB funded projects promoting and/ or facilitating screening for major depressive disorder for adolescents and through what processes. The percent of programs promoting and/ or facilitating adequate health insurance coverage.

GOAL
To ensure supportive programming for adequate health insurance coverage.

MEASURE
The percent of MCHB funded projects promoting and/ or facilitating adequate health insurance coverage. The percent of programs promoting and/ or facilitating tobacco and eCigarette cessation.

GOAL
To ensure supportive programming promoting and/ or facilitating tobacco and eCigarette cessation.

MEASURE
The percent of MCHB funded projects promoting and/ or facilitating tobacco and eCigarette cessation, and through what processes. The percent of programs promoting and/ or facilitating oral health.

GOAL
To ensure supportive programming for oral health.

MEASURE
The percent of MCHB funded projects promoting and/ or facilitating oral health, and through what activities. The percent of programs promoting and/ or facilitating oral health.

DEFINITION
low-income children and adolescents who receive any preventive dental service during the past year (Baseline: 30.2%, Target: 33.2%).

GRANTEE DATA SOURCES
Title V National Performance Measure #13

SIGNIFICANCE
Oral health is a vital component of overall health. Access to oral health care, good oral hygiene and adequate nutrition are essential components of oral health to help ensure individuals achieve and maintain oral health. Those with limited preventive oral health services access are at a greater risk for oral diseases.

Data Collection Form for #LC 3
Please use the form below to identify what services you provide to each population. For those that you provide the service to, please provide the number of services provided (i.e. number of children receiving referrals), for those that you do not, please leave blank.

MCH Training Program and Healthy Tomorrows Cultural Competence
Training 03

Healthy Tomorrows Title V Collaboration
Training 04

Title V Collaboration
Training 05

Policy
Training 06

Diversity of Long-Term Trainees
Training 07

MCH Pipeline Program -Work with MCH populations
Training 08

MCH Pipeline Program -Work with underserved or vulnerable populations
Training 09

MCH Pipeline -Graduate Program Enrollment
Training 10

Training 11
Work with MCH Populations

Training 12
Interdisciplinary Practice

Training 14
Medium-Term Trainees Skill and Knowledge (PPC-Specific)

Goal: Family/ Youth/ Community Engagement in MCH Training and Healthy Tomorrows Programs Level: Grantee Domain: MCH Workforce Development
The percent of MCHB training and Healthy Tomorrows programs that ensure family, youth, and community member participation in program and policy activities.

GOAL
To increase family, youth, and/or community member participation in MCH Training and Healthy Tomorrows programs.

MEASURE
The percent of MCHB training and Healthy Tomorrows programs that ensure family/ youth/ community member participation in program and policy activities.

DEFINITION
Attached is a

GRANTEE DATA SOURCES
Attached data collection form to be completed by grantee.

SIGNIFICANCE
Over the last decade, policy makers and program administrators have emphasized the central role of families and other community members as advisors and participants in program and policy-making activities. In accordance with this philosophy, MCH Training Programs and Healthy Tomorrows Programs are facilitating such partnerships at the local, State and national levels. MCH Training programs support interdisciplinary/interprofessional graduate education and training programs that emphasize leadership, and family-centered, community-based, and culturally competent systems of care. Training programs are required to incorporate family members/youth/community members as faculty, trainees, and partners. The Healthy Tomorrows program supports community initiated and community-based projects that apply principles of health promotion, disease prevention, and the benefits of coordinated health care to the provision of services that improve access to comprehensive, community-based, family-centered,

Goal: Family/ Youth/ Community Engagement in MCH Training and Healthy Tomorrows Programs Level: Grantee Domain: MCH Workforce Development
The percent of MCHB training and Healthy Tomorrows programs that ensure family, youth, and community member participation in program and policy activities.
culturally/linguistically competent, and coordinated care. Healthy Tomorrows projects are required to incorporate family members/youth/community members as project staff, advisors, volunteers, and partners.

DATA COLLECTION FORM FOR DETAIL SHEET: Training 01 -Family/ Youth/ Community Engagement in MCH Training and Healthy Tomorrows Programs
Please indicate if your MCH Training or Healthy Tomorrows program has included family members, youth, and/or community members in each of the program elements listed below. Use the space provided for notes to provide additional details about activities, as necessary. (NOTE: Programs are only required to have participation from family members or youth or community members for each element to answer "Yes")

Element
No Yes

Participatory Planning
Family members/youth/community members participate in and provide feedback on the planning, implementation and/or evaluation of the training or Healthy Tomorrows program's activities (e.g., strategic planning, program planning, materials development, program activities, and performance measure reporting).

Cultural Diversity
Culturally diverse family members/youth/community members facilitate the training or Healthy Tomorrows program's ability to meet the needs of the populations served.

Leadership Opportunities
Within your training or Healthy Tomorrows program, family members/youth/community members are offered training, mentoring, and/or opportunities for leadership roles on advisory committees or task forces.

Compensation
Family members/youth/community members who participate in the MCH Training or Healthy Tomorrows program are paid faculty, staff, consultants, or compensated for their time and expenses.

Train MCH/CSHCN staff
Family members/youth/community members work with their training or Healthy Tomorrows program to provide training (pre-service, in-service and professional development) to MCH/CSHCN faculty/staff, students/trainees, and/or providers. The percent of MCHB training and Healthy Tomorrows programs that have incorporated cultural and linguistic competence elements into their policies, guidelines, and training.

GOAL
To increase the percentage of MCH Training and Healthy Tomorrows programs that have integrated cultural and linguistic competence into their policies, guidelines, and training.

MEASURE
The percent of MCHB training and Healthy Tomorrows programs that have integrated cultural and linguistic competence into their policies, guidelines, and training. The percent of MCHB training and Healthy Tomorrows programs that have incorporated cultural and linguistic competence elements into their policies, guidelines, and training.

DEFINITIONS
linguistic competence knowledge and skills building efforts; research data on populations served according to racial, ethnic, and linguistic groupings; faculty and other instructors are racially and ethnically diverse; faculty and staff participate in professional development activities related to cultural and linguistic competence; and periodic assessment of trainees' progress in developing cultural and linguistic competence.

BENCHMARK DATA SOURCES
Related to the following HP2020 Objectives: PHI-3: Increase the proportion of Council on Education for Public Health (CEPH) accredited schools of public health, CEPH accredited academic programs, and schools of nursing (with a public health or community health component) that integrate Core Competencies for Public Health Professionals into curricula PHI-12: Increase the proportion of public health laboratory systems (including State, Tribal, and local) which perform at a high level of quality in support of the 10 Essential Public Health Services ECBP-11: Increase the proportion of local health departments that have established culturally appropriate and linguistically competent community health promotion and disease prevention programs

GRANTEE DATA SOURCES
Attached data collection form is to be completed by grantees.
There is no existing national data source to measure the extent to which MCHB supported programs have incorporated cultural competence elements into their policies, guidelines, and training.

SIGNIFICANCE
Over the last decade, researchers and policymakers have emphasized the central influence of cultural values and cultural/linguistic barriers: health seeking behavior, access to care, and racial and ethnic disparities. In accordance with these concerns, cultural competence objectives have been: (1)

DATA COLLECTION FORM FOR DETAIL SHEET: Training 02 -Cultural Competence in MCH Training and Healthy Tomorrows Programs
Please indicate if your MCH Training or Healthy Tomorrows program has incorporated the following cultural/linguistic competence elements into your policies, guidelines, and training. Please use the space provided for notes to provide additional details about the elements, as applicable.

Element
Yes 1 No 0

Written Guidelines
Strategies for advancing cultural and linguistic competency are integrated into your training or Healthy Tomorrows program's written plan(s) (e.g., grant application, recruiting plan, placement procedures, monitoring and evaluation plan, human resources, formal agreements, etc.).

Training
Cultural and linguistic competence knowledge and skills building are included in training aspects of your program.

Data
Research or program information gathering includes the collection and analysis of data on populations served according to racial, ethnic, and linguistic groupings, where appropriate.
4. Staff/faculty diversity MCH Training Program or Healthy Tomorrows staff and faculty reflect cultural and linguistic diversity of the significant populations served.

Professional development
MCH Training Program or Healthy Tomorrows staff and faculty participate in professional development activities to promote their cultural and linguistic competence.

Measure progress Measurement of Progress
A process is in place to assess the progress of MCH Training program or Healthy Tomorrows participants in developing cultural and linguistic competence.

GOAL
To assure that the Healthy Tomorrows program has collaborative interactions related to professional development, policy development and product development and dissemination with relevant national, state and local MCH programs, agencies and organizations.

MEASURE
The degree to which a Healthy Tomorrows program collaborates with State Title V agencies, other MCH or MCH-related programs and other professional organizations.

DEFINITION
Attached is a list of the 7 elements that describe activities carried out by Healthy Tomorrows programs for or in collaboration with State Title V and other agencies on a scale of 0 to 1 (0=no; 1=yes). If a value of '1' (yes) is selected, provide the number of activities for the element. The total score for this measure will be determined by the sum of those elements noted as '1.'  The degree to which the Healthy Tomorrows Partnership for Children program collaborates with State Title V agencies, other MCH or MCH-related programs.

SIGNIFICANCE
As a SPRANS grantee, a training program enhances the Title V State block grants that support the MCHB goal to promote comprehensive, coordinated, familycentered, and culturally-sensitive systems of health care that serve the diverse needs of all families within their own communities. Interactive collaboration between a training program and Federal, Tribal, State and local agencies dedicated to improving the health of MCH populations will increase active involvement of many disciplines across public and private sectors and increase the likelihood of success in meeting the goals of relevant stakeholders.
This measure will document a Healthy Tomorrows program's abilities to: 1) collaborate with State Title V and other agencies (at a systems level) to support achievement of the MCHB Strategic Goals and Healthy People 2020 action plan; 2) make the needs of MCH populations more visible to decision-makers and can help states achieve best practice standards for their systems of care; 3) internally use this data to assure a full scope of these program elements in all regions.

GOAL
To assure that a training program has collaborative interactions related to training, technical assistance, continuing education, and other capacity-building services with relevant national, state and local programs, agencies and organizations.

MEASURE
The degree to which a training program collaborates with State Title V agencies, other MCH or MCH-related programs and other professional organizations.

DEFINITION
Attached is a list of the 6 elements that describe activities carried out by training programs for or in collaboration with State Title V and other agencies on a scale of 0 to 1. If a value of '1' is selected, provide the number of activities for the element. The total score for this measure will be determined by the sum of those elements noted as '1.' the diverse needs of all families within their own communities. Interactive collaboration between a training program and Federal, Tribal, State and local agencies dedicated to improving the health of MCH populations will increase active involvement of many disciplines across public and private sectors and increase the likelihood of success in meeting the goals of relevant stakeholders.

BENCHMARK DATA SOURCES
This measure will document a training program's abilities to: 1) collaborate with State Title V and other agencies (at a systems level) to support achievement of MCHB Strategic Goals; 2) make the needs of MCH populations more visible to decision-makers and can help states achieve best practice standards for their systems of care; and 3) internally use this data to assure a full scope of these program elements in all regions. The degree to which MCH long-term training grantees engage in policy development, implementation, and evaluation.

GOAL
To increase the number of MCH long-term training programs that actively promote the transfer and utilization of MCH knowledge and research to the policy arena through the work of faculty, trainees, alumni, and collaboration with Title V.

MEASURE
The degree to which MCH long-term training grantees engage in policy development, implementation, and evaluation.

DEFINITION
Attached is a list of six elements that demonstrate policy engagement. Please check yes or no to indicate which the elements have been implemented. Please keep the completed checklist attached. Policy development, implementation and evaluation in the context of MCH training programs relates to the process of translating research to policy and training for leadership in the core public health function of policy development. Activelymutual commitment to policy-related projects or objectives within the past 12 months.

BENCHMARK DATA SOURCES
Related to PHI-3: Increase the proportion of Council on Education for Public Health (CEPH) accredited schools of public health, CEPH accredited academic programs, and schools of nursing (with a public health or community health component) that integrate Core Competencies for Public Health Professionals into curricula.

GRANTEE DATA SOURCES
• Attached data collection form to be completed by grantee.
• Data will be collected from competitive and continuation applications as part of the grant application process and annual reports. The elements of training program engagement in policy development, implementation, and evaluation need to be operationally defined with progress noted on the attached list with an example described more fully in the narrative application.

SIGNIFICANCE
Policy development is one of the three core functions of public health as defined by the Institute of Medicine in The Future of Public Health (National Academy Press, Washington DC). In this landmark report by the IOM, the committee recommends that "every public health agency exercise its responsibility to serve the public interest in the development of comprehensive public health policies by promoting use of the scientific knowledge base in decision-making about public health and by leading in developing public health policy." Academic institutions such as schools of public health and research universities have the dual responsibility to develop knowledge and to produce well-trained The percentage of participants in MCHB long-term training programs who are from underrepresented racial and ethnic groups.

GOAL
To increase the percentage of trainees participating in MCHB long-term training programs who are from underrepresented racial and ethnic groups.

MEASURE
The percentage of participants in MCHB long-term training programs who are from underrepresented racial and ethnic groups. The percentage of participants in MCHB long-term training programs who are from underrepresented racial and ethnic groups.

SIGNIFICANCE
HRSA's MCHB places special emphasis on improving service delivery to women, children and youth from communities with limited access to comprehensive care. Training a diverse group of professionals is necessary in order to provide a diverse public health workforce to meet the needs of the changing demographics of the U.S. and to ensure access to culturally competent and effective services. This performance measure provides the necessary data to report on HRSA's initiatives to reduce health disparities.

DATA COLLECTION FORM FOR DETAIL SHEET: Training 06 -Long Term Training Programs
Report on the percentage of long-term trainees (≥300 contact hours) who are from any underrepresented racial/ethnic group (i.e., Hispanic or Latino, American Indian or Alaskan Native, Asian, Black or African-American, Native Hawaiian or Pacific Islander, two or more race (OMB). Please use the space provided for notes to detail the data source and year of data used.
 Report on all long-term trainees (≥ 300 contact hours) including MCHB-funded and non MCHB-funded trainees  Report race and ethnicity separately  Trainees who select multiple ethnicities should be counted once  Grantee reported numerators and denominator will be used to calculate percentages The percent of MCHB Pipeline Program graduates who have been engaged in work focused on MCH populations.

GOAL
To increase the percent of graduates of MCH Pipeline Programs who have been/are engaged in work focused on MCH populations.

MEASURE
The percent of MCHB Pipeline Program graduates who have been engaged in work focused on MCH populations since graduating from the MCH Pipeline Training Program. MCH Pipeline Program graduates who report working with the maternal and child health population (i.e., women, infants, children, adolescents, young adults, and their families, including and children with special health care needs) 2 years and 5 years after graduating from their MCH Pipeline program.

DEFINITION
NOTE: If the individual works with more than one of these groups only count them once.

YEARS AFTER GRADUATING FROM MCH PIPELINE PROGRAM
A. The total number of graduates, 2 years following completion of program _________ B. The total number of graduates lost to follow-up _________ C. The total number of respondents (A-B) = denominator _________ D. Number of respondents who report working with an MCH population since graduating from the MCH Pipeline Training Program _________ E. Percent of respondents who report working with an MCH population Since graduating from the MCH Pipeline Training Program _________

YEARS AFTER GRADUATING FROM MCH PIPELINE PROGRAM
A. The total number of graduates, 5 years following completion of program _________ The percent of MCH Pipeline Program graduates who have been engaged in work with populations considered to be underserved or vulnerable.

GOAL
To increase the percent of graduates of MCH Pipeline Programs who have been engaged in work with populations considered to be underserved or vulnerable.

MEASURE
The percent of MCH Pipeline Program graduates who have been engaged in work with populations considered to be underserved or vulnerable since graduating from the MCH Pipeline Training Program. NOTE: If the individual works with more than one of these groups only count them once.

YEARS AFTER GRADUATING FROM MCH PIPELINE PROGRAM
A. The total number of graduates, 2 years following completion of program _________ The percent of pipeline graduates that enter graduate programs preparing them to work with the MCH population.

GOAL
To increase the number of pipeline graduates that enter graduate programs preparing them to work with the MCH population.

MEASURE
The percent of pipeline graduates that enter graduate programs preparing them to work with the MCH population. The percent of pipeline graduates that enter graduate programs preparing them to work with the MCH population.

SIGNIFICANCE
MCHB training programs assist in developing a public health workforce that addresses key MCH issues and fosters field leadership in the MCH arena. Denominator: The total number of long-term trainees, 2 years following completion of an MCHB-funded training program, included in this report.
Long-term trainees are defined as those who have completed a long-term (greater than or equal to 300 contact hours) MCH training program, including those who received MCH funds and those who did not.
A  Denominator: The total number of long-term trainees, 5 years following completion of an MCHB-funded training program, included in this report.
Long-term trainees are defined as those who have completed a long-term (greater than or equal to 300 contact hours) MCH training program, including those who received MCH funds and those who did not.  The percentage of long-term trainees who are engaged in work focused on MCH populations after completing their MCH Training Program.

GOAL
To increase the percent of long-term trainees engaged in work focused on MCH populations two and five years after completing their MCH Training Program.

MEASURE
The percentage of long-term trainees who are engaged in work focused on MCH populations after completing their MCH Training Program.

GRANTEE DATA SOURCES
A revised trainee follow-up survey that incorporates the new form for collecting data on the involvement of those completing an MCH training program in work related to MCH populations will be used to collect these data.

SIGNIFICANCE
HRSA's MCHB places special emphasis on improving service delivery to women, children and youth from communities with limited access to comprehensive care.

DATA COLLECTION FORM FOR DETAIL SHEET: Training 11 -Long-term trainees working with MCH populations
Individuals completing a long-term training program who report working with the maternal and child health population (i.e., women, infants, children, adolescents, young adults and their families, including children with special health care needs) at 2 years and at 5 years after completing their training program.
NOTE: If the individual works with more than one of these groups only count them once.

YEAR FOLLOW-UP
A. The total number of long-term trainees, 2 years following program completion ______ B. The total number of long-term trainees lost to follow-up ( The percent of long-term trainees who, at 2, 5 and 10 years post training, have worked in an interdisciplinary manner to serve the MCH population (e.g., individuals with disabilities and their families, adolescents and their families, etc.).

GOAL
To increase the percent of long-term trainees who, upon completing their training, work in an interdisciplinary manner to serve the MCH population.

MEASURE
The percent of long-term trainees who, at 2, 5 and 10 years post training have worked in an interdisciplinary manner to serve the MCH population.

DEFINITION Numerator:
The number of long-term trainees indicating that they have worked in an interdisciplinary manner serving the MCH population. Denominator: The total number of long-term trainees responding to the survey Units: 100 Text: Percent In addition, data on the total number of the long-term trainees and the number of non-respondents for each year will be collected.
Long-term trainees are defined as those who have completed a long-term (300+ hours) MCH Training program, including those who received MCH funds and those who did not.

BENCHMARK DATA SOURCES
Related to Healthy People 2020 Objectives:

GRANTEE DATA SOURCES
The trainee follow-up survey is used to collect these data.

Goal: Long-term Trainees Level: Grantee Domain: MCH Workforce Development
The percent of long-term trainees who, at 2, 5 and 10 years post training, have worked in an interdisciplinary manner to serve the MCH population (e.g., individuals with disabilities and their families, adolescents and their families, etc.).

SIGNIFICANCE
Leadership education is a complex interdisciplinary field that must meet the needs of MCH populations. This measure addresses one of a training program's core values and its unique role to prepare professionals for comprehensive systems of care/practice. By providing interdisciplinary coordinated care, training programs help to ensure that all MCH populations receive the most comprehensive care that takes into account the complete and unique needs of the individuals and their families. Denominator: The total number of long-term trainees, 10 years following completion of an MCHB-funded training program, responding to the survey.
The total number of long-term trainees, 10 years following program completion _________ The total number of program completers lost to follow-up _________ Percent of long-term trainees (10 years post program completion) who have worked in an interdisciplinary manner, demonstrating at least one of the following interdisciplinary skills: ________% Sought input or information from other professions or disciplines to address a need in your work ________% Provided input or information to other professions or disciplines. ________%

Developed a shared vision, roles and responsibilities within an interdisciplinary group. ________%
Utilized that information to develop a coordinated, prioritized plan across disciplines to address a need in your work ________% Established decision-making procedures in an interdisciplinary group. ________% The degree to which the LEAH program incorporates adolescents and parents from diverse ethnic and cultural backgrounds as advisors and participants in program activities.

GOAL
To increase appropriate involvement of adolescents and parents as consumers of LEAH program activities.

MEASURE
The degree to which adolescents and parents are incorporated as consumers of LEAH program activities.

DEFINITION
Attached is a checklist of 4 elements that document adolescent and parent participation. Respondents will note the presence or absence of this participation on a scale of 0-1 for a total possible score of 4.

BENCHMARK DATA SOURCES
Related to Objective HC/HIT-2: Increase the proportion of persons who report that their health care providers have satisfactory communication skills.

GRANTEE DATA SOURCES
Grantees report using a data collection form. These data may be collected with the LEAH self-assessment activities. Participation should be defined to permit assessment of youth and young adult involvement.

SIGNIFICANCE
Over the last decade, policy makers and program administrators have emphasized the central role of consumer of health services as advisors and participants in program activities. Satisfaction with health care is related to satisfaction with the quality of the communication with health providers. In accordance with this philosophy, LEAH facilitates such partnerships and believes that consumers (adolescents and parents) from diverse backgrounds have important roles in the training of future leaders in adolescent health care delivery systems.

DATA COLLECTION FORM FOR DETAIL SHEET: Training 13 -Adolescent Involvement
Indicate the degree to which your training program has the active involvement of adolescents and parents in your program and planning activities using the following values:

Goal: Medium-Term Trainees Skill and Knowledge Level: Grantee Domain: MCH Workforce Development
The percentage of Level I medium term trainees who report an increase in knowledge and the percentage of Level II medium term trainees who report an increase in knowledge or skills related to MCH core competencies .

GOAL
To increase the percentage of medium term trainees (MTT) who report increased knowledge or skills related to MCH core competencies.

MEASURE
The percentage of Level I medium term trainees who report an increase in knowledge and the percentage of Level II medium term trainees who report an increase in knowledge or skills related to MCH core competencies.

DEFINITION
Numerator: The number of Level I medium term trainees who report an increase in knowledge and Level II medium term trainees who report an increase in knowledge or skills related to MCH core competencies.

GRANTEE DATA SOURCES
End of training survey is used to collect these data.

SIGNIFICANCE
Medium Term trainees comprise a significant proportion of training efforts. These trainees impact the provision of care to CYSHCN nationally. The impact of this training must be measured and evaluated.

Level I Medium Term Trainees -Knowledge
A. The total number of Level I Medium-Term Trainees (

DIVISION OF CHILD ADOLESCENT, AND FAMILY HEALTH Emergency Medical Services for Children Program PERFORMANCE MEASURE DETAIL SHEET SUMMARY TABLE Performance Measure Topic EMSC 01
Using NEMSIS Data to Identify Pediatric Patient Care Needs.

EMSC 02
Pediatric Emergency Care Coordination

EMSC 03
Use of pediatric-specific equipment

EMSC 04
Pediatric medical emergencies

EMSC 06
Written inter-facility transfer guidelines that contain all the components as per the implementation manual.

EMSC 07
Written inter-facility transfer agreements that covers pediatric patients.

EMSC 08
Established permanence of EMSC

EMSC 09
Established permanence of EMSC by integrating EMSC priorities into statutes/regulations.

Goal: Submission of NEMSIS compliant version 3.x or higher data Level: Grantee Domain: Emergency Medical Services for Children
The degree to which EMS agencies submit NEMSIS compliant version 3.x or higher data to the State EMS Office.

NEMSIS: National EMS Information System. NEMSIS
is the national repository that is used to store EMS data from every state in the nation.

NEMSIS Version 3.X or higher compliant patient care data:
A national set of standardized data elements collected by EMS agencies.

NEMSIS Technical Assistance Center (TAC):
The NEMSIS TAC is the resource center for the NEMSIS project. The NEMSIS TAC provides assistance states, territories, and local EMS agencies, creates reference documents, maintains the NEMSIS database and XML schemas, and creates compliance policies.

Goal: Submission of NEMSIS compliant version 3.x or higher data Level: Grantee Domain: Emergency Medical Services for Children
The degree to which EMS agencies submit NEMSIS compliant version 3.x or higher data to the State EMS Office.

NHTSA -National Highway Traffic Safety Administration
HRSA STRATEGIC OBJECTIVE Improve Access to Quality Health Care and Services by strengthening health systems to support the delivery of quality health services.
Improve Health Equity by monitoring, identifying, and advancing evidence-based and promising practices to achieve health equity.

SIGNIFICANCE
Access to quality data and effective data management play an important role in improving the performance of an organization's health care systems. Collecting, analyzing, interpreting, and acting on data for specific performance measures allows health care professionals to identify where systems are falling short, to make corrective adjustments, and to track outcomes. However, uniform data collection is needed to consistently evaluate systems and develop Quality Improvement programs. The NEMSIS operated by the National Highway Traffic Safety Administration, provides a basic platform for states and territories to collect and report patient care data in a uniform manner.
NEMSIS enables both state and national EMS systems to evaluate their current prehospital delivery. As a first step toward Quality Improvement (QI) in pediatric emergency medical and trauma care, the EMSC Program seeks to first understand the proportion of EMS agencies reporting to the state EMS office NEMSIS version 3.X or higher compliant data, then use that information to identify pediatric patient care needs and promote its full use at the EMS agency level. In the next few years, NEMSIS will enable states and territories to evaluate patient outcomes and as a result, the next phase will employ full utilization of NEMSIS data on specific measures of pediatric data utilization. This will include implementing pediatric-specific EMS Compass measures in states, publishing results, publishing research using statewide EMS kids data, linking EMS data, providing performance information back to agencies, and building education programs around pediatric data, etc. This measure also aligns with the Healthy People 2020 objective PREP-19: Increase the number of states reporting 90% of emergency medical services (EMS) calls to National EMS Information System (NEMSIS) using the current accepted dataset standard.

Goal: Submission of NEMSIS compliant version 3.x or higher data Level: Grantee Domain: Emergency Medical Services for Children
The degree to which EMS agencies submit NEMSIS compliant version 3.x or higher data to the State EMS Office.
While most localities collect and most states report NEMSIS version 2.X compliant data currently, NEMSIS version 3.X or higher is available today and in use in several states. Version 3 includes an expanded data set, which significantly increases the information available on critically ill or injured children. NHTSA is encouraging states and localities to upgrade to version 3.X or higher compliant software and submit version 3.X data by January 1, 2017.

DATA COLLECTION FORM FOR DETAIL SHEET: EMSC 01
The percentage of EMS agencies in the state/territory that submit National Emergency Medical Services Information System (NEMSIS) version 3.X or higher compliant patient care data to the State Emergency Medical Services Office for all 911 initiated EMS activations.
State EMS Offices will be asked to select which of six (6) statements best describes their current status. The measure will be determined on a scale of 0-5. The following table shows the scoring rubric for responses. Achievement for grantees will be reached when 80% of EMS agencies are submitting NEMSIS version 3.X or higher compliant patient care data to the State EMS Office. This is represented by a score of "5".

Which statement best describes your current status? Current Progress
Our

Percent:
Proposed Survey Questions: As part of the HRSA's quest to improve the quality of healthcare, the EMSC Program is interested to hear about current efforts to collect NEMSIS version 3.X or higher compliant patient care data from EMS agencies in the state/territory. The EMSC Program aims to first understand the proportion of EMS agencies that are submitting NEMSIS version 3.X or higher compliant patient care data to the state EMS office.
The NEMSIS Technical Assistance Center will only collect version 3.X or higher compliant data beginning on January 1, 2017.

Goal: Pediatric Emergency Care Coordination Level: Grantee Domain: Emergency Medical Services for Children
The percentage of EMS agencies in the state/territory that have a designated individual who coordinates pediatric emergency care.

GOAL
By 2020, 30% of EMS agencies in the state/territory have a designated individual who coordinates pediatric emergency care.
By 2023, 60% of EMS agencies in the state/territory have a designated individual who coordinates pediatric emergency care.
By 2026, 90% of EMS agencies in the state/territory have a designated individual who coordinates pediatric emergency care.

MEASURE
The percentage of EMS agencies in the state/territory that have a designated individual who coordinates pediatric emergency care.

DEFINITION Numerator:
The number of EMS agencies in the state/territory that score a '3' on a 0-3 scale. Denominator: Total number of EMS agencies in the state/territory that provided data. Units: 100 Text: Percent Recommended Roles: Job related activities that a designated individual responsible for the coordination of pediatric emergency care might oversee for your EMS agency are:  Ensure that the pediatric perspective is included in the development of EMS protocols  Ensure that fellow EMS providers follow pediatric clinical practice guidelines  Promote pediatric continuing education opportunities  Oversee pediatric process improvement  Ensure the availability of pediatric medications, equipment, and supplies  Promote agency participation in pediatric prevention programs  Promote agency participation in pediatric research efforts  Liaises with the emergency department pediatric emergency care coordinator  Promote family-centered care at the agency EMS: Emergency Medical Services EMS Agency: An EMS agency is defined as an organization staffed with personnel who render medical care in response to a 911 or similar emergency call. Data will be gathered from both transporting and nontransporting agencies.

HRSA STRATEGIC OBJECTIVE
Strengthen the Health Workforce The percentage of EMS agencies in the state/territory that have a designated individual who coordinates pediatric emergency care.

SIGNIFICANCE
The Institute of Medicine (IOM) report "Emergency Care for Children: Growing Pains" (2007) recommends that EMS agencies and emergency departments (EDs) appoint a pediatric emergency care coordinator to provide pediatric leadership for the organization. This individual need not be dedicated solely to this role and could be personnel already in place with a special interest in children who assumes this role as part of their existing duties.
Gausche-Hill et al in a national study of EDs found that the presence of a physician or nurse pediatric emergency care coordinator was associated with an ED being more prepared to care for children. EDs with a coordinator were more likely to report having important policies in place and a quality improvement plan that addressed the needs of children than EDs that reported not having a coordinator.
The IOM report further states that pediatric coordinators are necessary to advocate for improved competencies and the availability of resources for pediatric patients. The presence of an individual who coordinates pediatric emergency care at EMS agencies may result in ensuring that the agency and its providers are more prepared to care for ill and injured children.
The individual designated as the Pediatric Emergency Care Coordinator (PECC) may be a member of the EMS agency or that individual could serve as the PECC for one of more individual EMS agencies within the county or region.

DATA COLLECTION FORM FOR DETAIL SHEET: EMSC 02
The percentage of EMS agencies in the state/territory that have a designated individual who coordinates pediatric emergency care.
Numerator: The number of EMS agencies in the state/territory that score a '3' on a 0-3 scale.
Denominator: Total number of EMS agencies in the state/territory that provided data.

Percent:
EMS agencies will be asked to select which of four statements best describes their agency. The measure will be determined on a scale of 0-3. The following table shows the scoring rubric for responses. Achievement for grantees will be reached when at least 90% of the EMS agencies in the state/territory report a '3' on the scale below.

Is this individual:
A member of your agency Located at the county level Located at a regional level

Other, please describe
To the best of your knowledge, does this individual serve as the pediatric coordinator for one or more than one EMS agency?
Just my agency The percentage of EMS agencies in the state/territory that have a process or plan that requires EMS providers to physically demonstrate the correct use of pediatricspecific equipment.

GOAL
By 2020, 30% of EMS agencies will have a process that requires EMS providers to physically demonstrate the correct use of pediatric-specific equipment, which is equal to a score of '6' or more on a 0-12 scale.
By 2023: 60% of EMS agencies will have a process that requires EMS providers to physically demonstrate the correct use of pediatric-specific equipment, which is equal to a score of '6' or more on a 0-12 scale.
By 2026: 90% of EMS agencies will have a process that requires EMS providers to physically demonstrate the correct use of pediatric-specific equipment, which is equal to a score of '6' or more on a 0-12 scale.

MEASURE
The percentage of EMS agencies in the state/territory that have a process that requires EMS providers to physically demonstrate the correct use of pediatric-specific equipment.

DEFINITION Numerator:
The number of EMS agencies in the state/territory that score a '6' or more on a 0-12 scale.
Denominator: Total number of EMS agencies in the state/territory that provided data.

EMS Agency:
An EMS agency is defined as an organization staffed with personnel who render medical care in response to a 911 or similar emergency call. Data will be gathered from both transporting and nontransporting agencies. The percentage of EMS agencies in the state/territory that have a process or plan that requires EMS providers to physically demonstrate the correct use of pediatricspecific equipment.

SIGNIFICANCE
The Institute of Medicine (IOM) report "Emergency Care for Children: Growing Pains" reports that because EMS providers rarely treat seriously ill or injured pediatric patients, providers may be unable to maintain the necessary skill level to care for these patients. For example, Lammers et al reported that paramedics manage an adult respiratory patient once every 20 days compared to once every 625 days for teens, 958 days for children and once every 1,087 days for infants. As a result, skills needed to care for pediatric patients may deteriorate. Another study by Su et al found that EMS provider knowledge rose sharply after a pediatric resuscitation course, but when providers were retested six months later; their knowledge was back to baseline.
Continuing education such as the Pediatric Advance Life Support (PALS) and Pediatric Education for Prehospital Professionals (PEPP) courses are vitally important for maintaining skills and are considered an effective remedy for skill atrophy. These courses are typically only required every two years. More frequent practice of skills using different methods of skill ascertainment are necessary for EMS providers to ensure their readiness to care for pediatric patients when faced with these infrequent encounters. These courses may be counted if an in-person skills check is required as part of the course.
Demonstrating skills using EMS equipment is best done in the field on actual patients but in the case of pediatric patients this can be difficult given how infrequently EMS providers see seriously ill or injured children. Other methods for assessing skills include simulation, case scenarios and skill stations. In the absence of pediatric patient encounters in the field. There is not definitive evidence that shows that one method is more effective than another for demonstrating clinical skills. But, Miller's Model of Clinical Competence posits via the skills complexity triangle that performance assessment can be demonstrated by a combination of task training, integrated skills training, and integrated team performance. In the EMS environment this can be translated to task training at skill stations, integrated skills training during case scenarios, and integrated team performance while treating patients in the field.

DATA COLLECTION FORM FOR DETAIL SHEET: EMSC 03
The percentage of EMS agencies in the state/territory that have a process that requires EMS providers to physically demonstrate the correct use of pediatric-specific equipment.
Numerator: The number of EMS agencies in the state/territory that score a '6' or more on a 0-12 scale.
Denominator: Total number of EMS agencies in the state/territory that provided data. Percent: EMS agencies will be asked to select the frequency of each of three methods used to evaluate EMS providers' use of pediatric-specific equipment. The measure will be determined on a scale of 0 -12.
The following table shows the scoring rubric for responses. Achievement for the grantees will be reached when at least 90% of the EMS agencies in a state/territory report a combined score of '6' or higher from a combination of the methods. In the next set of questions we are asking about the process or plan that your agency uses to evaluate your EMS providers' skills using pediatric-specific equipment.
While individual providers in your agency may take PEPP or PALS or other national training courses in pediatric emergency care, we are interested in learning more about the process or plans that your agency employs to evaluate skills on pediatric equipment.
We realize that there are multiple processes that might be used to assess correct use of pediatric equipment. Initial

Goal: Emergency Department Preparedness Level: Grantee Domain: Emergency Medical Services for Children
The percent of hospitals with an Emergency Department (ED) recognized through a statewide, territorial or regional standardized program that are able to stabilize and/or manage pediatric medical emergencies.

GOAL
By 2022: 25% of hospitals are recognized as part of a statewide, territorial, or regional standardized program that are able to stabilize and/or manage pediatric medical emergencies.

MEASURE
The percent of hospitals recognized through a statewide, territorial or regional program that are able to stabilize and/or manage pediatric medical emergencies.

DEFINITION
Numerator: Number of hospitals with an ED that are recognized through a statewide, territorial or regional standardized program that are able to stabilize and/or manage pediatric medical emergencies.
Denominator: Total number of hospitals with an ED in the State/Territory.

Units: 100
Text: Percent Standardized system: A system of care provides a framework for collaboration across agencies, health care organizations/services, families, and youths for the purposes of improving access and expanding coordinated culturally and linguistically competent care for children and youth. The system is coordinated, accountable and includes a facility recognition program for pediatric medical emergencies. Recognizing the pediatric emergency care capabilities of hospitals supports the development of a system of care that is responsive to the needs of children and extends access to specialty resources when needed.
Hospital: Facilities that provide definitive medical and/or surgical assessment, diagnoses, and life and/or limb saving interventions for the ill and injured AND have an Emergency Department. Excludes Military and Indian Health Service hospitals.

EMSC STRATEGIC OBJECTIVE
Ensure the operational capacity and infrastructure to provide pediatric emergency care.
Develop a statewide, territorial, or regional program that recognizes hospitals that are able to stabilize and/or manage pediatric medical emergencies.

GRANTEE DATA SOURCES
This performance measure will require grantees to determine how many hospitals participate in their facility recognition program (if the state has a facility recognition program) for medical emergencies.

Goal: Emergency Department Preparedness Level: Grantee Domain: Emergency Medical Services for Children
The percent of hospitals with an Emergency Department (ED) recognized through a statewide, territorial or regional standardized program that are able to stabilize and/or manage pediatric medical emergencies.

SIGNIFICANCE
The performance measure emphasizes the importance of the existence of a standardized statewide, territorial, or regional system of care for children that includes a recognition program for hospitals capable of stabilizing and/or managing pediatric medical emergencies. A standardized recognition and/or designation program, based on compliance with the current published pediatric emergency/trauma care guidelines, contributes to the development of an organized system of care that assists hospitals in determining their capacity and readiness to effectively deliver pediatric emergency/trauma and specialty care.
This measure helps to ensure essential resources and protocols are available in facilities where children receive care for medical and trauma emergencies. A recognition program can also facilitate EMS transfer of children to appropriate levels of resources. Additionally, a pediatric recognition program, that includes a verification process to identify facilities meeting specific criteria, has been shown to increase the degree to which EDs are compliant with published guidelines and improve hospital pediatric readiness statewide.
In addition, Performance Measure EMSC 04 does not require that the recognition program be mandated. Voluntary facility recognition is accepted.

DATA COLLECTION FORM FOR DETAIL SHEET: EMSC 04
The percent of hospitals with an Emergency Department (ED) that are recognized through a statewide, territorial or regional standardized program that are able to stabilize and/or manage pediatric medical emergencies.

Numerator: Denominator: Percent
Numerator: Number of hospitals with an ED that are recognized through a statewide, territorial or regional program that are able to stabilize and/or manage pediatric medical emergencies. Denominator: Total number of hospitals with an ED in the State/Territory.
Using a scale of 0-5, please rate the degree to which your State/Territory has made towards establishing a recognition system for pediatric medical emergencies. 1. Indicate the degree to which a facility recognition program for pediatric medical emergencies exists.
0= No progress has been made towards developing a statewide, territorial, or regional program that recognizes hospitals that are able to stabilize and/or manage pediatric medical emergencies 1= Research has been conducted on the effectiveness of a pediatric medical facility recognition program (i.e., improved pediatric outcomes) And/or Developing a pediatric medical facility recognition program has been discussed by the EMSC Advisory Committee and members are working on the issue.
2= Criteria that facilities must meet in order to receive recognition as being able to stabilize and/or manage pediatric medical emergencies have been developed.
3= An implementation process/plan for the pediatric medical facility recognition program has been developed.
4= The implementation process/plan for the pediatric medical facility recognition program has been piloted.
5= At least one facility has been formally recognized through the pediatric medical facility recognition program The percent of hospitals with an Emergency Department (ED) recognized through a statewide, territorial or regional standardized system that are able to stabilize and/or manage pediatric trauma.

GOAL
By 2022: 50% of hospitals are recognized as part of a statewide, territorial, or regional standardized system that recognizes hospitals that are able to stabilize and/or manage pediatric trauma.

MEASURE
The percent of hospitals recognized through a statewide, territorial or regional standardized system that are able to stabilize and/or manage pediatric traumatic emergencies.

DEFINITION
Numerator: Number of hospitals with an ED that are recognized through a statewide, territorial or regional standardized system that are able to stabilize and/or manage pediatric trauma.
Denominator: Total number of hospitals with an ED in the State/Territory.

Units: 100
Text: Percent Standardized system: A system of care provides a framework for collaboration across agencies, health care organizations/services, families, and youths for the purposes of improving access and expanding coordinated culturally and linguistically competent care for children and youth. The system is coordinated, accountable and includes a facility recognition program for pediatric traumatic injuries.
Recognizing the pediatric emergency care capabilities of hospitals supports the development of a system of care that is responsive to the needs of children and extends access to specialty resources when needed.
Hospital: Facilities that provide definitive medical and/or surgical assessment, diagnoses, and life and/or limb saving interventions for the ill and injured AND have an Emergency Department. Excludes Military and Indian Health Service hospitals.

EMSC STRATEGIC OBJECTIVE
Ensure the operational capacity and infrastructure to provide pediatric emergency care.
Develop a statewide, territorial, or regional standardized system that recognizes hospitals that are able to stabilize and/or manage pediatric medical emergencies and trauma.

GRANTEE DATA SOURCES
This performance measure will require grantees to determine how many hospitals participate in their facility recognition program (if the state has a facility recognition program) for pediatric trauma. The percent of hospitals with an Emergency Department (ED) recognized through a statewide, territorial or regional standardized system that are able to stabilize and/or manage pediatric trauma.

SIGNIFICANCE
The performance measure emphasizes the importance of the existence of a standardized statewide, territorial, or regional system of care for children that includes a recognition program for hospitals capable of stabilizing and/or managing pediatric trauma emergencies. A standardized recognition and/or designation program, based on compliance with the current published pediatric emergency/trauma care guidelines, contributes to the development of an organized system of care that assists hospitals in determining their capacity and readiness to effectively deliver pediatric emergency/trauma and specialty care.
This measure addresses the development of a pediatric trauma recognition program. Recognition programs are based upon State-defined criteria and/or adoption of national current published pediatric emergency and trauma care consensus guidelines that address administration and coordination of pediatric care; the qualifications of physicians, nurses and other ED staff; a formal pediatric quality improvement or monitoring program; patient safety; policies, procedures, and protocols; and the availability of pediatric equipment, supplies and medications.
Additionally, EMSC 05 does not require that the recognition program be mandated. Voluntary facility recognition is accepted. However, the preferred status is to have a program that is monitored by the State/Territory.

DATA COLLECTION FORM FOR DETAIL SHEET: EMSC 05
The percent of hospitals with an Emergency Department (ED) recognized through a statewide, territorial or regional standardized system that are able to stabilize and/or manage pediatric traumatic emergencies.

Numerator: Denominator: Percent
Numerator: Number of hospitals with an ED recognized through a statewide, territorial or regional standardized system that have been validated/designated as being capable of stabilizing and/or managing pediatric trauma patients.
Denominator: Total number of hospitals with an ED in the State/Territory.
Using a scale of 0-5, please rate the degree to which your State/Territory has made towards establishing a recognition system for pediatric traumatic emergencies. 1. Indicate the degree to which a standardized system for pediatric traumatic emergencies exists.
0= No progress has been made towards developing a statewide, territorial, or regional system that recognizes hospitals that are able to stabilize and/or manage pediatric trauma emergencies 1= Research has been conducted on the effectiveness of a pediatric trauma facility recognition program (i.e., improved pediatric outcomes) And/or Developing a pediatric trauma facility recognition program has been discussed by the EMSC Advisory Committee and members are working on the issue.
2= Criteria that facilities must meet in order to receive recognition as a pediatric trauma facility have been developed.
3= An implementation process/plan for the pediatric trauma facility recognition program has been developed.
4= The implementation process/plan for the pediatric trauma facility recognition program has been piloted.
5= At least one facility has been formally recognized through the pediatric trauma facility recognition program The percent of hospitals with an Emergency Department (ED) in the State/Territory that have written inter-facility transfer guidelines that cover pediatric patients and that contain all the components as per the implementation manual.

GOAL
By 2021: 90% of hospitals in the State/Territory have written inter-facility transfer guidelines that cover pediatric patients and that include specific components of transfer.

MEASURE
The percentage of hospitals in the State/Territory that have written inter-facility transfer guidelines that cover pediatric patients and that include the following components of transfer:  Defined process for initiation of transfer, including the roles and responsibilities of the referring facility and referral center (including responsibilities for requesting transfer and communication).  Process for selecting the appropriate care facility.  Process for selecting the appropriately staffed transport service to match the patient's acuity level (level of care required by patient, equipment needed in transport, etc.).  Process for patient transfer (including obtaining informed consent).  Plan for transfer of patient medical record  Plan for transfer of copy of signed transport consent  Plan for transfer of personal belongings of the patient  Plan for provision of directions and referral institution information to family DEFINITION Numerator: Number of hospitals with an ED that have written inter-facility transfer guidelines that cover pediatric patients and that include specific components of transfer according to the data collected.
Denominator: Total number of hospitals with an ED that provided data.

Units: 100 Text: Percent
Pediatric: Any person 0 to 18 years of age.
Inter-facility transfer guidelines: Hospital-to-hospital, including out of State/Territory, guidelines that outline procedural and administrative policies for transferring critically ill patients to facilities that provide specialized pediatric care, or pediatric services not available at the referring facility. Inter-facility guidelines do not have to specify transfers of pediatric patients only. A guideline that applies to all patients or patients of all The percent of hospitals with an Emergency Department (ED) in the State/Territory that have written inter-facility transfer guidelines that cover pediatric patients and that contain all the components as per the implementation manual. ages would suffice, as long as it is not written only for adults.
Grantees should consult the EMSC Program representative if they have questions regarding guideline inclusion of pediatric patients. In addition, hospitals may have one document that comprises both the inter-facility transfer guideline and agreement. This is acceptable as long as the document meets the definitions for pediatric inter-facility transfer guidelines and agreements (i.e., the document contains all components of transfer).
All hospitals in the State/Territory should have guidelines to transfer to a facility capable of providing pediatric services not available at the referring facility. If a facility cannot provide a particular type of care (e.g., burn care), then it also should have transfer guidelines in place. Consult the NRC to ensure that the facility (facilities) providing the highest level of care in the state/territory is capable of definitive care for all pediatric needs. Also, note that being in compliance with EMTALA does not constitute having inter-facility transfer guidelines.
Hospital: Facilities that provide definitive medical and/or surgical assessment, diagnoses, and life and/or limb saving interventions for the ill and injured AND have an Emergency Department (ED). Excludes Military and Indian Health Service hospitals.

EMSC STRATEGIC OBJECTIVE
Ensure the operational capacity and infrastructure to provide pediatric emergency care Develop written pediatric inter-facility transfer guidelines for hospitals.

GRANTEE DATA SOURCE(S)
 Surveys of hospitals with an emergency department.  Hospital licensure rules and regulations

SIGNIFICANCE
In order to assure that children receive optimal care, timely transfer to a specialty care center is essential. Such transfers are better coordinated through the presence of inter-facility transfer agreements and guidelines. Performance Measure EMSC 06: The percentage of hospitals in the State/Territory that have written interfacility transfer guidelines that cover pediatric patients and that include the following components of transfer:  Defined process for initiation of transfer, including the roles and responsibilities of the referring facility and referral center (including responsibilities for requesting transfer and communication).  Process for selecting the appropriate care facility.  Process for selecting the appropriately staffed transport service to match the patient's acuity level (level of care required by patient, equipment needed in transport, etc.).  Process for patient transfer (including obtaining informed consent).  Plan for transfer of patient medical record.  Plan for transfer of copy of signed transport consent.  Plan for transfer of personal belongings of the patient.  Plan for provision of directions and referral institution information to family.

Hospitals with Inter-facility Transfer Guidelines that Cover Pediatric Patients:
You will be asked to enter a numerator and a denominator, not a percentage. NOTE: This measure only applies to hospitals with an Emergency Department (ED).

NUMERATOR:
Number of hospitals with an ED that have written inter-facility transfer guidelines that cover pediatric patients and that include specific components of transfer according to the data collected.

DENOMINATOR:
Total number of hospitals with an ED that provided data. The percent of hospitals with an Emergency Department (ED) in the State/Territory that have written inter-facility transfer agreements that cover pediatric patients.

GOAL
By 2021: 90% of hospitals in the State/Territory have written inter-facility transfer agreements that cover pediatric patients.

MEASURE
The percentage of hospitals in the State/Territory that have written inter-facility transfer agreements that cover pediatric patients.

DEFINITION
Numerator: Number of hospitals with an ED that have written inter-facility transfer agreements that cover pediatric patients according to the data collected.

Denominator:
Total number of hospitals with an ED that provided data.

Units: 100 Text: Percent
Pediatric: Any person 0 to 18 years of age.
Inter-facility transfer agreements: Written contracts between a referring facility (e.g., community hospital) and a specialized pediatric center or facility with a higher level of care and the appropriate resources to provide needed care required by the child. The agreements must formalize arrangements for consultation and transport of a pediatric patient to the higher-level care facility. Inter-facility agreements do not have to specify transfers of pediatric patients only. An agreement that applies to all patients or patients of all ages would suffice, as long as it is not written ONLY for adults. Grantees should consult the NRC if they have questions regarding inclusion of pediatric patients in established agreements.

EMSC STRATEGIC OBJECTIVE
Ensure the operational capacity and infrastructure to provide pediatric emergency care.
Develop written pediatric inter-facility transfer agreements to facilitate timely movement of children to appropriate facilities.

DATA SOURCE(S) AND ISSUES
 Surveys of hospitals with an emergency department.  Hospital licensure rules and regulations The percent of hospitals with an Emergency Department (ED) in the State/Territory that have written inter-facility transfer agreements that cover pediatric patients.

SIGNIFICANCE
In order to assure that children receive optimal care, timely transfer to a specialty care center is essential. Such transfers are better coordinated through the presence of inter-facility transfer agreements and guidelines. Performance Measure EMSC 07: The percentage of hospitals in the State/Territory that have written interfacility transfer agreements that cover pediatric patients.

Hospitals with Inter-facility Transfer Agreements that Cover Pediatric Patients:
You will be asked to enter a numerator and a denominator, not a percentage. NOTE: This measure only applies to hospitals with an Emergency Department (ED).

NUMERATOR:
Number of hospitals with an ED that have written inter-facility transfer agreements that cover pediatric patients according to the data collected.

DENOMINATOR:
Total number of hospitals with an ED that provided data. The degree to which the State/Territory has established permanence of EMSC in the State/Territory EMS system.

GOAL
To increase the number of States/Territories that have established permanence of EMSC in the State/Territory EMS system.

MEASURE
The degree to which States/Territories have established permanence of EMSC in the State/Territory EMS system. The degree to which the State/Territory has established permanence of EMSC in the State/Territory EMS system.

GRANTEE DATA SOURCES
 Attached data collection form to be completed by grantee.

SIGNIFICANCE
Establishing permanence of EMSC in the State/Territory EMS system is important for building the infrastructure of the EMSC Program and is fundamental to its success. For the EMSC Program to be sustained in the long-term and reach permanence, it is important to establish an EMSC Advisory Committee to ensure that the priorities of the EMSC Program are addressed. It is also important to establish one full time equivalent EMSC Manager whose time is devoted solely (i.e., 100%) to the EMSC Program. Moreover, by ensuring pediatric representation on the State/Territory EMS Board, pediatric issues will more likely be addressed. The degree to which the State/Territory has established permanence of EMSC in the State/Territory EMS system by integrating EMSC priorities into statutes/regulations.

GOAL
By 2027, EMSC priorities will have been integrated into existing EMS or hospital/healthcare facility statutes/regulations.

MEASURE
The degree to which the State/Territory has established permanence of EMSC in the State/Territory EMS system by integrating EMSC priorities into statutes/regulations.

DEFINITION Priorities:
The priorities of the EMSC Program include the following: 1. EMS agencies are required to submit NEMSIS compliant data to the State EMS Office. 2. EMS agencies in the state/territory have a designated individual who coordinates pediatric emergency care. 3. EMS agencies in the state/territory have a process that requires EMS providers to physically demonstrate the correct use of pediatric-specific equipment. 4. The existence of a statewide, territorial, or regional standardized system that recognizes hospitals that are able to stabilize and/or manage  pediatric medical emergencies  trauma 5. Hospitals in the State/Territory have written interfacility transfer guidelines that cover pediatric patients and that include the following components of transfer:  Defined process for initiation of transfer, including the roles and responsibilities of the referring facility and referral center (including responsibilities for requesting transfer and communication).  Process for selecting the appropriate care facility.  Process for selecting the appropriately staffed transport service to match the patient's acuity level (level of care required by patient, equipment needed in transport, etc.).  Process for patient transfer (including obtaining informed consent).  Plan for transfer of patient medical record  Plan for transfer of copy of signed transport consent  Plan for transfer of personal belongings of the patient  Plan for provision of directions and referral institution information to family 6. Hospitals in the State/Territory have written inter-facility transfer agreements that cover pediatric patients. 7. BLS and ALS pre-hospital provider agencies in the State/Territory are required to have on-line and off-line pediatric medical direction available. have the essential pediatric equipment and supplies, as outlined in the nationally recognized and endorsed guidelines. 9. Requirements adopted by the State/Territory that requires pediatric continuing education prior to the renewal of BLS/ALS licensing/certification.

EMSC STRATEGIC OBJECTIVE
Establish permanence of EMSC in each State/Territory EMS system.

GRANTEE DATA SOURCES
Attached data collection form to be completed by grantee.

SIGNIFICANCE
For the EMSC Program to be sustained in the long-term and reach permanence, it is important for the Program's priorities to be integrated into existing State/Territory mandates. Integration of the EMSC priorities into mandates will help ensure pediatric emergency care issues and/or deficiencies are being addressed State/Territory-wide for the long-term. Please indicate the elements that your grant program has established to promote the permanence of EMSC in the State/Territory EMS system by integrating EMSC priorities into statutes/regulations.

Element
Yes No 1. There is a statute/regulation that requires the submission of NEMSIS compliant data to the state EMS office 2. There is a statute/regulation that assures an individual is designated to coordinate pediatric emergency care. 3. There is a statute/regulation that requires EMS providers to physically demonstrate the correct use of pediatric-specific equipment. 4. There is a statute/regulation for a hospital recognition program for identifying hospitals capable of dealing with pediatric medical emergencies. 5. There is a statute/regulation for a hospital recognition system for identifying hospitals capable of dealing with pediatric traumatic emergencies. 6. There is a statute/regulation for written inter-facility transfer guidelines that cover pediatric patients and include specific components of transfer. 7. There is a statute/regulation for written inter-facility transfer agreements that cover pediatric patients. 8. There is a statute/regulation for pediatric on-line medical direction for ALS and BLS pre-hospital provider agencies. 9. There is a statute/regulation for pediatric off-line medical direction for ALS and BLS pre-hospital provider agencies. 10. There is a statute/regulation for pediatric equipment for BLS and ALS patient care units. 11. There is a statute/regulation for the adoption of requirements for continuing pediatric education piror to recertification/relicensing of BLS and ALS providers.
Total number of elements your grant program has established (possible 0-11 score)

GOAL
To reduce the proportion of Healthy Start women participants who conceive within 18 months of a previous birth to 30%.

MEASURE
The percent of Healthy Start women participants who conceive within 18 months of a previous birth.

DEFINITION
Numerator: Number of Healthy Start (HS) women participants whose current pregnancy during the reporting period was conceived within 18 months of the previous birth. Denominator: Total number of HS women participants enrolled before the current pregnancy in the reporting period who had a prior pregnancy that ended in a live birth.
The interval between the most recent pregnancy and previous birth is derived from the delivery date of the birth and the date of conception for the most recent pregnancy.

BENCHMARK DATA SOURCES
CDC National Survey of Family Growth, Healthy People 2020 Family Planning Goal 5; Vital Statistics 7

SIGNIFICANCE
Family planning is important to ensure spacing pregnancies at least 18 months apart to reduce health risks for both mother and baby. Pregnancy within 18 months of giving birth is associated with increased risk for the baby including low birth weight, small size for gestational age, and preterm birth. Additionally, the mother needs time to fully recover from the previous birth.

GOAL
To increase proportion of Healthy Start women participants that demonstrate father and/or partner involvement (e.g., attend appointments, classes, etc.) to 90%.

MEASURE
The percent of Healthy Start women participants that demonstrate father and/or partner involvement during pregnancy.

GOAL
To increase proportion of HS women participants that demonstrate father and/or partner involvement (e.g., attend appointments, classes, infant/child care) with child <24 months to 80%.

MEASURE
The percent of Healthy Start women participants that demonstrate father and/or partner involvement with child <24 months.

DEFINITION
Numerator: Number of Healthy Start (HS) child participants whose mother reports supportive father and/or partner involvement (e.g., attend appointments, classes, child care, etc.) during the reporting period. Denominator: Total number of Healthy Start women participants with a child participant <24 months.
A participant is considered to have support and included in the numerator if she self-reports a partner who has a significant and positive role for the child.
Involvement includes, but is not limited to: 14  Engagement or direct interaction with the child, including taking care of, playing with, or teaching the child  Accessibility or availability, which includes monitoring behavior from the next room or nearby and allowing direct interaction if necessary  Responsibility for the care of the child, which includes making plans and arrangements for care  Economic support or breadwinning  Attending postpartum and well child visits  Other meaningful support The percent of Healthy Start child participants age 6 through 23 months who are read to by a family member 3 or more times per week, on average. 15

GOAL
To increase the proportion of Healthy Start child participants age 6 through 23 months who are read to 3 or more times per week to 50%.

MEASURE
The percent of Healthy Start child participants age 6 through 23 months who are read to by a family member 3 or more times per week, on average.

DEFINITION
Numerator: Number of Healthy Start children participants whose parent/ caregiver reports that they were read to by a family member on 3 or more days during the past week during the reporting period. Denominator: Total number of Healthy Start child participants 6 through 23 months of age during the reporting period.
Reading by a family member may include reading books, picture books, or telling stories.

GOAL
To increase the proportion of HS grantees with a fully implemented Community Action Network (CAN) to 100%.

MEASURE
The percent of Healthy Start grantees with a fully implemented Community Action Network (CAN). This is a scaled measure which reports progress towards full implementation of a CAN. A "yes" answer is scored 1 point; a "no" answer receives no point. To meet the standard of "fully implemented" for this measure, the HS grantee must answer "yes" to all three core elements listed below:

GOAL
To increase the proportion of Healthy Start grantees with at least 25% community members and Healthy Start program participants serving as members of their CAN to 100%.

MEASURE
The percent of Healthy Start grantees with at least 25% community members and Healthy Start program participants serving as members of their CAN. A Community Action Network, or CAN, is an existing, formally organized partnership of organizations and individuals. The CAN represents consumers and appropriate agencies which unite in an effort to collectively apply their resources to the implementation of one or more commons strategies to achieve a common goal within that project area.

GRANTEE DATA SOURCES
Grantee data systems

SIGNIFICANCE
Consumer involvement in setting the community agenda and informing efforts to effectively meet the community's needs is critical to the effectiveness of the CAN. The percent of families with Children with Special Health Care Needs (CSHCN) that have been provided information, education, and/or training by Family-to-Family Health Information Centers.

GOAL
To increase the number of families with CSHCN receiving needed health and related information, training, and/or education opportunities in order to partner in decision making and be satisfied with services that they receive.

Instructions:
Complete all required data cells. If an actual number is not available, use an estimate. Explain all estimates in a note.
The form is intended to provide funding data at a glance on the estimated budgeted amounts and actual expended amounts of an MCH project.
For each fiscal year, the data in the columns labeled Budgeted on this form are to contain the same figures that appear on the Application Face Sheet (for a non-competing continuation) or the Notice of Grant Award (for a performance report). The lines under the columns labeled Expended are to contain the actual amounts expended for each grant year that has been completed.

INSTRUCTIONS FOR COMPLETION OF FORM 3 BUDGET DETAILS BY TYPES OF INDIVIDUALS SERVED For Projects Providing Direct Services, Enabling, or Public Health Services and Systems
If the project provides direct services, complete all required data cells for all years of the grant. If an actual number is not available make an estimate. Please explain all estimates in a note.
All ages are to be read from x to y, not including y. For example, infants are those from birth to 1, and children and youth are from age 1 to 25.
Enter the budgeted amounts for the appropriate fiscal year, for each targeted population group. Note that the Total for each budgeted column is to be the same as that appearing in the corresponding budgeted column in Form 2, Line 5.
Enter the expended amounts for the appropriate fiscal year that has been completed for each target population group. Note that the Total for the expended column is to be the same as that appearing in the corresponding expended column in Form 2, Line 5.

INSTRUCTIONS FOR THE COMPLETION OF FORM 4 PROJECT BUDGET AND EXPENDITURES BY TYPES OF SERVICES
Complete all required data cells for all years of the grant. If an actual number is not available, make an estimate. Please explain all estimates in a note. Administrative dollars should be allocated to the appropriate level(s) of the pyramid on lines I, II, II or IV. If an estimate of administrative funds use is necessary, one method would be to allocate those dollars to Lines I, II, III and IV at the same percentage as program dollars are allocated to Lines I through IV.
Note: Lines I, II and II are for projects providing services. If grant funds are used to build the infrastructure for direct care delivery, enabling or population-based services, these amounts should be reported in Line IV (i.e., building data collection capacity for newborn hearing screening).
Line I Direct Health Care Services -enter the budgeted and expended amounts for the appropriate fiscal year completed and budget estimates only for all other years.
Direct Health Care Services are those services generally delivered one-on-one between a health professional and a patient in an office, clinic or emergency room which may include primary care physicians, registered dietitians, public health or visiting nurses, nurses certified for obstetric and pediatric primary care, medical social workers, nutritionists, dentists, sub-specialty physicians who serve children with special health care needs, audiologists, occupational therapists, physical therapists, speech and language therapists, specialty registered dietitians. Basic services include what most consider ordinary medical care, inpatient and outpatient medical services, allied health services, drugs, laboratory testing, x-ray services, dental care, and pharmaceutical products and services. State Title V programs support -by directly operating programs or by funding local providers -services such as prenatal care, child health including immunizations and treatment or referrals, school health and family planning. For CSHCN, these services include specialty and sub-specialty care for those with HIV/AIDS, hemophilia, birth defects, chronic illness, and other conditions requiring sophisticated technology, access to highly trained specialists, or an array of services not generally available in most communities.
Line II Enabling Services -enter the budgeted and expended amounts for the appropriate fiscal year completed and budget estimates only for all other years.
Enabling Services allow or provide for access to and the derivation of benefits from, the array of basic health care services and include such things as transportation, translation services, outreach, respite care, health education, family support services, purchase of health insurance, case management, coordination of with Medicaid, WIC and educations. These services are especially required for the low income, disadvantaged, geographically or culturally isolated, and those with special and complicated health needs. For many of these individuals, the enabling services are essential -for without them access is not possible. Enabling services most commonly provided by agencies for CSHCN include transportation, care coordination, translation services, home visiting, and family outreach. Family support activities include parent support groups, family training workshops, advocacy, nutrition and social work.
Line III Public Health Services and Systems -enter the budgeted and expended amounts for the appropriate fiscal year completed and budget estimates only for all other years.
Public Health Services and Systems include preventive interventions and personal health services, developed and available for the entire MCH population of the State rather than for individuals in a one-on-one situation. Disease prevention, health promotion, and statewide outreach are major components. Common among these services are newborn screening, lead screening, immunization, Sudden Infant Death Syndrome counseling, oral health, injury prevention, nutrition and outreach/public education. These services are generally available whether the mother or child receives care in the private or public system, in a rural clinic or an HMO, and whether insured or not. The other critical aspect of Public Health Services and Systems are activities directed at improving and maintaining the health status of all women and children by providing support for development and maintenance of comprehensive health services systems and resources such as health services standards/guidelines, training, data and planning systems. Examples

INSTRUCTIONS FOR THE COMPLETION OF FORM 7 PROJECT SUMMARY Section 1 -Project Service Focus
Select all that apply

Section 2 -Project Scope
Choose the one that best applies to your project.

Section 3 -Grantee Organization Type
Choose the one that best applies to your organization.

Section 4 -Project Infrastructure Focus
If applicable, choose all that apply.

Section 5 -Demographic Characteristics of Project Participants
Indicate the service level for the grant program. Multiple selections may be made. Please fill in each of the cells as appropriate.
Direct Health Care Services are those services generally delivered one-on-one between a health professional and a patient in an office, clinic or emergency room which may include primary care physicians, registered dietitians, public health or visiting nurses, nurses certified for obstetric and pediatric primary care, medical social workers, nutritionists, dentists, sub-specialty physicians who serve children with special health care needs, audiologists, occupational therapists, physical therapists, speech and language therapists, specialty registered dietitians. Basic services include what most consider ordinary medical care, inpatient and outpatient medical services, allied health services, drugs, laboratory testing, x-ray services, dental care, and pharmaceutical products and services. State Title V programs support -by directly operating programs or by funding local providers -services such as prenatal care, child health including immunizations and treatment or referrals, school health and family planning. For CSHCN, these services include specialty and sub-specialty care for those with HIV/AIDS, hemophilia, birth defects, chronic illness, and other conditions requiring sophisticated technology, access to highly trained specialists, or an array of services not generally available in most communities.
Enabling Services allow or provide for access to and the derivation of benefits from, the array of basic health care services and include such things as transportation, translation services, outreach, respite care, health education, family support services, purchase of health insurance, case management, coordination of with Medicaid, WIC and educations. These services are especially required for the low income, disadvantaged, geographically or culturally isolated, and those with special and complicated health needs. For many of these individuals, the enabling services are essential -for without them access is not possible. Enabling services most commonly provided by agencies for CSHCN include transportation, care coordination, translation services, home visiting, and family outreach. Family support activities include parent support groups, family training workshops, advocacy, nutrition and social work.
Public Health Services and Systems include preventive interventions and personal health services, developed and available for the entire MCH population of the State rather than for individuals in a one-on-one situation. Disease prevention, health promotion, and statewide outreach are major components. Common among these services are newborn screening, lead screening, immunization, Sudden Infant Death Syndrome counseling, oral health, injury prevention, nutrition and outreach/public education. These services are generally available whether the mother or child receives care in the private or public system, in a rural clinic or an HMO, and whether insured or not. The other critical aspect of Public Health Services and Systems are activities directed at improving and maintaining the health status of all women and children by providing support for development and maintenance of comprehensive health services systems and resources such as health services standards/guidelines, training, data and planning systems. Examples include needs assessment, evaluation, planning, policy development, coordination, quality assurance, standards development, monitoring, training, applied research, information systems and systems of care.
In the development of systems of care it should be assured that the systems are family centered, community based and culturally competent.

Section 6 -Clients Primary Language(s)
Indicate which languages your clients speak as their primary language, other than English, for the data provided in Section 6. List up to three languages.

INSTRUCTIONS FOR THE COMPLETION OF FORM 9 PERFORMANCE MEASURE TRACKING General Instructions:
Complete all required data cells. If an actual number is not available, make an estimate. Please explain all estimates in a footnote. If neither actual data nor an estimate can be provided, the State must provide a footnote that describes a time framed plan for providing the required data. In such cases, the Annual Performance Objective and Annual Performance Indicator lines are to be left blank.
This form serves two purposes: 1) to show performance measures with 5-year planned performance objective targets for the application, and 2) the performance Annual Performance Indicator,@ values actually achieved each year for the annual report for each performance measure.
For each program (i.e., Healthy Start, Research, LEND, etc.) there are appropriate, required Performance Measures. Under the applicable AFY@ heading, each project will complete the Annual Performance Objectives, the Annual Performance Indicators, and numerator and denominator data for each measure as described below under Specific Instructions. For project developed additional performance measures, enter these data on the form beginning with the first blank Performance Measure area under the national measure(s).

Specific Instructions:
In the first available space under "Performance Measure" on the appropriate form, enter the brief title of the project performance measure that has been selected. The titles are to be numbered consecutively with notations of "PP 1, PP 2, etc. Titles are to be written exactly as they appear on Form 10, "Project Performance/Outcome Measure Detail Sheet." For both national and project measures, in the lines labeled Annual Performance Objective enter a numerical value for the target the project plans to meet for the next 5 years. These values may be expressed as a number, a rate, a percentage, or yes -no For both national and project measures, in the lines labeled Annual Performance Indicator, enter the numerical value that expresses the progress the project has made toward the accomplishment of the performance objective for the appropriate reporting year. Note that the indicator data are to go in the years column from which they were actually derived even if the data are a year behind the "reporting" year. This value is to be expressed in the same units as the performance objective: a number, a rate, a percentage, or a yes -no.
If there are numerator and denominator data for the performance measures, enter those data on the appropriate lines for the appropriate fiscal year. If there are no numerator and denominator data leave these lines empty. NOTE: Do not enter numerator and denominator data for scale measures.
Repeat this process for each performance measure. A continuation page is included. If the continuation page is used, be sure to enter the number for each listed performance measure. If there are more than six performance measures, make as many copies of the continuation page as necessary. This form is to be used for both the nationally required Project Performance Measures and any Outcome Measure the project chooses to add. The project can choose to add either a single component Performance measure, using Option 1, or a tiered measure, using Option 2. Complete each section as appropriate for the measure being described.

Measure:
Enter the narrative description of the performance or outcome measure.

Level:
Select from National, State, or Grantee the most appropriate classification for the measure being described.

Category:
Select from Women's and Maternal Health, Perinatal Infant Health, Child Health, Children with Special Health Care Needs, Adolescent Health, Life Course/ Crosscutting, or Capacity Building the most appropriate classification for the measure being described.

Goal:
Enter a short statement indicating what the project hopes to accomplish by tracking this measure.

Measure:
Enter a brief statement of the measure with information sufficient to interpret the meaning of a value associated with it (e.g., The percent of children with special health care needs age 0 to 18 whose families have adequate private and/or public insurance to pay for needed services). The measure statement should not indicate a desired direction (e.g., an increase).

Definition:
Describe how the value of the measure is determined from the data. If the value of the measure is yes/no or some other narrative indicator such as a stage 1/stage 2/stage 3, a clear description of what those values mean and how they are determined should be provided. If using Option 2: Tier 1: Use dichotomous yes/no for respondents to state whether work is being done in the program Tier 2: Enter a list of related process activities related to the area of measurement that projects can select from to demonstrate what activities are being done Tier 3: Enter the same list as in Tier 2, but with space for reporting of numerical value for each process activity selected (e.g. if Technical Assistance is selected in Tier 2, then in Tier 3, space should be provided to report number of technical assistance encounters provided) Tier 4 or Option 1: Enter the following for outcome measures to be reported.

Numerator:
If the measure is a percentage, rate, or ratio, provide a clear description of the numerator. Denominator: If the measure is a percentage, rate, or ratio, provide a clear description of the denominator.

Units:
If the measure is a percentage, rate, ratio, or scale, indicate the units in which the measure is to be expressed (e.g., 1,000, 100) on the "Number" line and type of measure (e.g., percentage, rate, ratio or scale) on "Text" line. If the measure is a narrative, indicate yes/no or stage 1, stage 2", etc. on the "Text" line and make no entry on the "Number" line.

Healthy People 2020 Objective:
If the measure is related to a Healthy People 2020 objective describe the objective and corresponding number. If it relates to another benchmark data source, please describe that and include relevant information.

Grantee Data Sources:
Enter the source(s) of the data used in determining the value of the measure and any issues concerning the methods of data collection or limitations of the data used.

Significance:
Briefly describe why this measure is significant, especially as it relates to the Goal.

TECHNICAL ASSISTANCE/COLLABORATION FORM -REVISED JULY 2019
DEFINITION: Technical Assistance/Collaboration refers to mutual problem solving and collaboration on a range of issues, which may include program development, clinical services, collaboration, program evaluation, needs assessment, and policy & guidelines formulation. It may include administrative services, site visitation and review/advisory functions. Collaborative partners might include State or local health agencies, and education or social service agencies. Faculty may serve on advisory boards to develop &/or review policies at the local, State, regional, national or international levels. The technical assistance (TA) effort may be a one-time or on-going activity of brief or extended frequency. The intent of the measure is to illustrate the reach of the training program beyond trainees.
Provide the following summary information on ALL TA provided B. Provide information below on the 5-10 most significant technical assistance/ collaborative activities in the past year. In the notes, briefly state why these were the most significant TA events.

Title
Topic of Technical Assistance/Collaboration Select one from list A and all that apply from List B.

Recipient of TA/ Collaborator
Intensity of TA Primary Target

Part 1
Instructions: Please list the number of products, publications and submissions addressing maternal and child health that have been published or produced with grant support (either fully or partially) during the reporting period. Count the original completed product, not each time it is disseminated or presented.

Type Number
In Press peer-reviewed publications in scholarly journals  a. Sought input or information from other professions or disciplines to address a need in your work  b. Provided input or information to other professions or disciplines.  c. Developed a shared vision, roles and responsibilities within an interdisciplinary group.  d. Utilized that information to develop a coordinated, prioritized plan across disciplines to address a need in your work  e. Established decision-making procedures in an interdisciplinary group.  f. Collaborated with various disciplines across agencies/entities  g. Advanced policies & programs that promote collaboration with other disciplines or professions  h. None

Confidentiality Statement
Thank you for agreeing to provide information that will enable your training program to track your training experience and follow up with you after the completion of your training. Your input is critical to our own improvement efforts and our compliance with Federal reporting requirements. Please know that your participation in providing information is entirely voluntary. The information you provide will only be used for monitoring and improvement of the training program. Please also be assured that we take the confidentiality of your personal information very seriously. We very much appreciate your time and assistance in helping to document outcomes of the Training Program. We look forward to learning about your academic and professional development.