ATTCHMNT C HV SFY19 FTF DATA RPTNG REQ.PDF
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ATTACHMENT C - HOME VISITATION SFY19 FTF DATA REPORTING REQUIREMENTS FTF-RC035-19-0609-00 Page 151 of 232 FIRST THINGS FIRST Home Visitation SFY19 FTF Data Reporting Requirements This document details the SFY2019 data reporting requirement for this strategy. Review closely and complete as instructed. The completed FTF Data Reporting Requirements document is to be included as an attachment with your application. To assist with the completion of this document, please refer to the supplemental document in the Guidance Materials Section of this RFGA entitled FTF Data Reporting Requirements Definitions for more information on the definitions of each of the data fields listed below. I. Program implementation and Programmatic Outcome Data: 0 N/A El Yes, Required for SFY 2019 0 Yes, Capacity Building in SFY 2019 Purpose: To inform grant partner performance on strategy implementation, program monitoring/Quality Assurance, quarterly data reporting to Regional Councils, and FTF annual reporting. Additionally, programmatic outcome data will be used to inform fidelity of implementation and to fully assess and document the impact of FTF strategies and outcomes for young children, their families, and the professionals that serve them. Data Submission Guidelines: In SFY 2019, grant partners shall enter data into their program model data systems to meet data reporting requirements for FTF. The following are the SFY 2019 Program Model Data System Submission Requirements for the various evidence-based home visitation models: • Parents As Teachers: PAT Penelope Data System or FileMaker* • Healthy Families Arizona: ETO Data System/DHS MIECHV Data System • Nurse Family Partnership: NFP Penelope Data System • Early Head Start: Head Start Enterprise System (HSES) • Family Spirit: FileMaker, Flat file or File Transfer Protocol (FTP)* *Note: Grant Partners implementing home visitation services on tribal lands, who are not utilizing a national model data system, may have the option to submit data requirements using File Maker, Visit Tracker, a flat file or FTP in coordination with FTF and upon tribal approvals. FTF will work with tribes on approaches for data collection that are in alignment with individual tribal council agreements with FTF. Instructions: 1. Review the FTF program implementation and programmatic outcome data reporting requirements in the table below. Complete this section by indicating whether your program is currently collecting each of the data indicators listed by choosing Yes or No. First Things First I Data Reporting Requirements SFYI 9 Rome Visitation Page 1 of :13 a. Enrollment Information Data Field Data Format/Field Currently Collecting? Source of Referral to Text YES 01 NO 0 Home Visitation Program Date Family is Waitlisted Date (mm/dd/yyyy) YES IN NO 0 Date Family is Enrolled Date (mm /dd/yyyy) YES El NO 0 b. Family and Child Assessment: As part of program implementation, for each family served, grant partners are required to collect and submit data using at least one recommended assessment/screening tool (see Column 2 in chart below) for every assessment/screening type (see Column I. in chart below) per program model guidelines. For each family that completes an assessment/screening tool, grant partners are required to collect and report on families' responses to every question on the tool. Note: If the applicant includes an additional assessment/screening tool, FTF reserves the right to determine whether or not the tool meets the requirements of FTF. Assessment/Screening Recommended Assessment/Screening Tools Currently Type Collecting? Life Skills Progression (LSP) YES 0 NO 0 Healthy Families Parent Survey/Inventory (HFPI) YES 0 NO 0 Family Functioning Assessment Strength and Risk Framework (STAR) YES IN NO Li Other (please specify the assessment/screening tool YES CI NO 0 that will be utilized): Parent/Caregiver and Parenting Interactions with Children: Checklist of YES CI NO 0 Child Interaction Observations Linked to Outcomes (PICCOLO) Assessment YES DI NO D Dyadic Assessment of Naturalistic Caregiver-Child First Things First I Data Reporting Requirements SFY19 I Home Visitation Page 2 of 13 Assessment/Screening Recommended Assessment/Screening Tools Currently Type Collecting? Experiences (DANCE) Keys to Interactive Parenting Scale (KIPS) YES E NO 0 Home Observation Measurement of the Environment YES D NO 0 (HOME) Cues, Holding, Expression, Empathy, YES 0 NO 0 Rhythmicity/Reciprocity, and Smiles (CHEERS) Check-in Other (please specify the assessment/ screening tool YES 7 NO 7 that will be utilized): Edinburgh Postnatal Depression Scale (EPSD) YES 0 NO 0 Patient Health Questionnaire (PHQ) YES Ell NO El Parent/Caregiver Mental Health Assessment Other (please specify the assessment/ screening tool YES El NO 0 that will be utilized): Generalized Anxiety Disorder-7 Home Safety Checklist Please specify the assessment tool that will be utilized: YES El NO El c. Developmental and Sensory Screening and Preventative Health Services: For each child (birth-5 years old) in families participating in home visitation services, grant partners are required to collect and submit results of the developmental screening(s). Sensory screening is an optional strategy component that may be required per the scope of work. Please refer to the scope of work for sensory screening (vision and hearing screening) requirements. Data field Data Field/Format Currently Collecting? Date of Screening (mm/dd/yyyy) YES El NO 0 Developmental Screening Screening Tool Used (e.g., Ages and Stages YES El NO 0 Questionnaire [ASO]) ASQ:3, ASQ:SE First Things First I Data Reporting Requirements SFY.1.9 I Horne Visitation Page 3 of 13 Data field Data Field/Format Currently Collecting? Item-Level Responses to Screening Questions YES E NO n1 Summary Scores and Results of Screening YES 0 NO El Date Child was Referred to Services (mmicld/yyyy) YES 0 NO El Type of Services Referred To YES 0 NO DI Date of the Referral Follow-up (mmiddiyyyy) YES 0 NO IN Date Child Received Services (mmiddiyyyy) YES 0 NO El Type of Services Received by the Child YES 0 NO nl Date of Screening (mmiddhyyy) YES El NO El Screening Tools Used (i.e., Plusoptix, Spot machine, YES El NO El Retinomax) Results of Screening YES LI NO El Date Child was Referred to Services (as needed) YES 71 NO El Vision Screening (mm/cldhyyy) Type of Services Referred To YES E NO DI Date of the Referral Follow-up (mm/dcl/yyyy) YES El NO El Date Child Received Services (mmicld/yyyy) YES 0 NO El Type of Services Received by the Child YES El NO 12 Date of Screening (mmicld/yyyy) YES El NO El Screening Tools Used (i.e., OAE, Pure tone audiometric YES El NO El Hearing Screenings equipment, Tympanometry equipment) Results of Screening YES El NO El Date Child was Referred to Services (mmidd/yyyy) YES El NO El First Things First Date Reporting Requirements SFY19 Home Visitation Page 4o13 Data field Data Field/Format Currently Collecting? Type of Services Referred To YES El NO III Date of the Referral Follow-up (mm/dd/yyyy) YES 0 NO El Date Child Received Services (mm/c1d/yyyy) YES 0 NO El Type of Services Received by the Child YES L NO El Child Development, Developmental, Behavioral, or Learning Concerns YES El NO 0 Behavior, or Learning Discussed at Home Visits Well-Child Visits Children Attending Well-Child Visits YES NO Ei Infants Placed to Sleep Safely YES El NO LI Child Injuries, Child Abuse, Neglect, or ER Visits for Children YES El NO 0 Maltreatment, and Emergency Room Visits Child Maltreatment YES IN NO 0 Maternal and Newborn Breastfeeding YES El NO El Flea Ith Postpartum Care YES El NO El d. Home Visitation Services: Grant partners are required to collect and submit the following data fields for each family participating in home visitation services. Data field Data Field/Format Currently Collecting? Date of Home Visit (mm/dd/yyyy) YES El NO 0 Home Visit Details Location of Home Visit YES El NO 0 Length/Duration of Home visit YES El NO El First Things First Data Reporting Requirements SEM- I Home Visitation Rage 5 or 13 Data field Data Field/Format Currently Collecting? Topics Covered (e.g., positive parenting practices, child YES IIM1 NO 0 health, child development) Individuals Who Actively Participated in the Home Visit YES 12 NO E (e.g., mother, father, other adult caregiver, target child(ren), non-enrolled child(ren), other). Reason for Cancellation of Home visit (as applicable) YES Di NO E Referrals for Services Date Parent/Caregiver or Child was Referred to Services YES El NO 0 Given to (mm/dd/yyyy) Parent/Caregiver and Child(ren) Type of Services Referred To YES Ill NO 0 (Note: excluding those Date of the Referral Follow-up (mm/dd/yyyy) YES 0 NO 114 referrals given to families based on results Date Parent/Caregiver or Child Received Services YES 0 NO of Developmental (rnm/dd/yyyy) and/or Sensory Type of Services Received by the Parent/Caregiver or YES 0 NO ni Screenings) Child Date Developed and/or Revised (mm/dd/yyyy) YES 0 NO 10 Description of Goals Set YES 0 NO Ila Home Visitation Service and Goal Plan Goal status: YES 0 NO 12 Goals met/completed Goals ongoing/in progress Goals discontinued/abandoned During the past week, how many days did you or other YES 10 NO 0 family members read to your child(ren)? Early Literacy Activities in the Home During the past week, how many days did you or other YES DI NO 0 family members tell stories or sing songs to your child(ren)? Date Parents/Caregivers Attended Family Social YES 0 NO El Family Social Connection Connection Activities (mm/dd/yyyy) Activities Location of Activity YES 0 NO 10 First Things First I Data Report ig Requirr -rw..W:s SFYI1.9 I Horne VisIta .ion Page 6 of 13 Data field Data Field/Format Currently Collecting? Type of Activity YES 0 NO El Family Satisfaction YES 1:i NO DI Survey: Intended to gather families' self-reported satisfaction ratings of Item-Level Results of the Survey the program (e.g., staff, scheduling, program curriculum, program quality, etc.) Family Disenrollment Date of Disenrollment or Program Completion YES El NO D from Home Visitation (mmicld/yyyy) Services Reason for Disenrollment YES El NO CI e. Home Visitor Staff Information Data field Data Field/Format Currently Collecting? Family Identifier (i.e., Numeric YES El NO 0 unique ID) Home Visitor Identifier Numeric YES El NO E (i.e., unique ID) Supervisor Identifier Numeric YES 114 NO D (i.e., unique ID) Staff Information: Home Arizona Early Childhood Workforce Registry Profile YES 0 NO El Visitors and Supervisors information Home Visitor Caseload # of Families Assigned to Home Visitor Identifier YES El NO D Supervisor Caseload # of FTE Home Visitors Using Home Visitor Identifier YES DI NO D and Supervisor Identifier Home Visitor Turnover Home Visitor Employment Start and End Date YES El NO CI First Things First I Data Raparting Requirements SFY19 I Home Visitation Page 7 of 13 2. If your response is a NO, for any types of data marked required in the table above, describe how you will modify your data collection to comply with the FTF data requirements upon award. Provide sufficient details to clarify your plan. The Arizona Nurse Consultant for NFP NSO has been in conversation with the FTF Data Analyst about the new NFP data collection system Penelope, and opportunities to add additional data fields from FTF to the current NSO data requirements. In the interim period, MCDPH will add required questions to forms to be completed on home visits, and create a supplemental ACCESS database to collect the required additional data points. The supervisor will run reports from the ACCESS database quarterly for FTF reporting. b. Family & Child Assessment Home Safety Checklist- Use of the Safekids Home Safety Checklist will be documented and submitted by the nurse home visitor for data entry into the supplemental database. c. Developmental & Sensory Screening: ASQ: 3, ASQSE 2, vision and hearing screening data will be submitted by the nurse home visitor for data entry into the supplemental database. Entries will include date of screening, screening tool used, item responses, summary scores and results. When a screening indicates the need for referral to services, the nurse home visitor will initiate a Referral Tracking form indicating date child referred to services, type of services referred to, date of referral follow-up, date child received services and type of services received. After services have been received the Referral Tracking form will be submitted for data entry into the supplemental database. The Nurse Supervisor will run a Screening report each month listing all children who received developmental screenings and follow-up received. The supervisor will follow-up with Nurse Home Visitors during weekly supervision. d. Home Visitation Services Referrals for Services- Date parent or child was referred for services and type of services are currently being collected. When a screening indicates the need for referral to services the nurse home visitor will initiate a Referral Tracking form indicating date parent or child referred to services, type of services referred to, date of referral follow-up, date parent or child received services and type of services received. After services have been received the Referral Tracking form will be submitted for entry to the supplemental database. The Nurse supervisor will run a Referrals report each month listing all referrals and follow-up received. The supervisor will follow-up with the Nurse Home Visitor during weekly supervision. Home Visitation Service Goal Plan- The current Service Goal Plan information will be submitted by the nurse home visitor for data entry every 90 days and will include the date developed and/or revised, goals set, goal status, goals met/completed, goals ongoing/in progress, goals discontinued/abandoned. The Nurse supervisor will run a Service Plan report every 90 days listing all clients with their current goal data. The supervisor will follow-up with the Nurse Home Visitor during weekly supervision. First iThings First I Data Reporting Requirements SFY19 I Home Visitation Family Social Connection Activities- Questions will be added to the Home Visit Encounter form completed at each home visit to collect social connection activities including the date the parent attended a family social connection activity, location of the activity and type of activity. This information will be submitted for entry to the supplemental database. Family Satisfaction Survey- Until such time as NFP NSO develops the satisfaction survey in Penelope, MCDPH will set up the current 12 item satisfaction survey in a mobile survey device. The surveys are to be completed at 36 weeks of pregnancy & at the child's lst birthday. Email invites to complete the survey will be sent to clients at those time points and item level responses will be submitted for entry to the supplemental database. e. Home Visitor Staff Information All FTF funded staff will register profile information in the Arizona Early Childhood Workforce Registry before program implementation and complete required trainings. Participant Level Demographic information: 0 N/A IN Yes, Required for SFY 2019 0 Yes, Capacity Building in SFY 2019 Purpose: To better understand the reach of FTF programs within and across strategies and regions and to ensure that services are provided to the intended audiences in alignment with the scope of work. Data Submission Guidelines: FTF requires that grant partners will submit participant level demographic information on an annual basis via their program model data systems or when applicable FTP and/or flat file to meet data reporting requirements for FTF. Instructions: 1. Review the FTF participant level demographic data requirements in the table below. Complete this section by indicating whether your program is currently collecting each of the data indicators listed by choosing Yes or No. Data Field Response Options Currently Collecting? Family Identifier (i.e., unique ID) YES El NO El Caregiver Information: The following data fields and response options will be collected for all caregivers in the family household (as appropriate or available) Caregiver Identifier (i.e., unique ID) YES Vil NO D Caregiver First and Last Name YES El NO E Caregiver Address/City/Zip YES IN NO El Caregiver Phone Number YES El NO E Caregiver Date of Birth Date (mm/dd/yyyy) YES El NO E FIrst Things First. I Data Reporting Requirements SFY19 I Home VIsitation Caregiver Sex Category: YES ID NO 0 Male Female Caregiver Race Category: YES El NO El Alaska Native American Indian Asian Black or African American Native Hawaiian or Pacific Islander White nthor Caregiver Marital Status Category: YES El NO 0 Single Married Divorced Separated Caregiver Ethnicity Hispanic or Latino: YES El NO L Yes No Caregiver Highest Education Level Category: YES El NO Li Less than high school High school graduate or GED Some College Technical or vocational degree Bachelor's degree or higher Caregiver Employed Category: YES ni NO El Yes No Caregiver Education Status Category: YES El NO 0 Full-time Student Part-time Student Data Field Response Options Currently Collecting? Caregiver Primary Language Category: YES El NO El English Spanish Other (please specify) Caregiver Primary Language Spoken at Category: YES 0 NO El Home English Spanish Other (please specify) First Things First Dale Reporting Requirements SFY19 Horne Visitation Caregiver Medical Insurance Type Category: YES 10 NO 0 Employer Private AHCCCS Indian Health Services Military None Other (please specify) Caregiver Has Primary Health Care Category: YES El NO Ill Provider Yes No Due Date for Expectant Mothers Date (mm/dd/yyyy) YES 12 NO El Date Medical Home Established (Usual Date (mmicid/yyyy) YES 12 NO Source of Medical Care): Prenatal Women Caregiver Has Dental Insurance Category: YES E NO IN Yes No Date Dental Home Established (Usual Date (mmiddiyyyy) YES 0 NO 12 Source of Dental Care): Prenatal Women Caregiver Relationship to Child(ren) in Category: (Select All That Apply) YES 0 NO 12 Household Parent Grandparent Foster Parent Other Relative (please specify) Other Non-Relative (please specify) Caregiver Legal Guardian to One or Category: YES 0 NO la More Child(ren) in Household Yes No Data Field Response Options Currently Collecting? Child Information: The following data fields and response options will be collected for all children living in the Family Household (as appropriate or available) Child Identifier (i.e., unique ID) YES 111 NO 0 Child First and Last Name YES 114 NO 0 Child Date of Birth YES IN NO 0 First Things First I Data Reporting Requiremod -rts SFY19 I Home Visit -al ion Child Sex Category: YES NO El Male Female Child Race Category: YES I1 NO IL Alaska Native American Indian Asian Black or African American Native Hawaiian or Pacific Islander White Other Child Ethnicity Hispanic/Latino: YES 1 NO 0 Yes No Child Primary Language Category: YES E NO El English Spanish Other (please specify) Child with Special Needs Category: Yes/No YES CI NO El Child Medical Insurance Type Category: YES 0 NO El Employer Private AHCCCS Indian Health Services Military None Other (please specify) Child Has Primary Health Care Category: YES El NO D Provider Yes No Data Field Response Options Currently Collecting? Date Medical Home Established Date (mm/dd/yyyy) YES CI NO El (Usual Source of Medical Care): Child(ren) Child Has Dental Insurance Category; YES LI NO El Yes No Date Dental Home Established (Usual Date (mm/dd/yyyy) YES 0 NO El Source of Dental Care): Child(ren) Household information: The following data fields and response options will be collected for each Family Household (as appropriate or available) First Things First: I Data Raporting RrL, quirernents SFY11.9 I FIorne lnsitation Household Income Category: YES El NO El less than $15,000 $15,000-$30,000 $31,000-$45,000 $46,000-$60,000 $61,000-$75,000 $76,000-$90,000 $91,000-$105,000 over $105,000 Housing Status Families that did not have a place YES El NO El to live in the past 12 months: Yes rsh, Number of times family moved in YES C NO El the past 12 months: Parents/Caregivers reporting they are Category: YES 17 NO El food insecure Yes No Adult(s) in Household Who are Active Category: YES El NO in the Military or a Military Veteran Yes No Household Public Assistance Category: YES El NO 0 WIC Food Stamps/EBT/SNAP Cash Assistance/TANF DES Child Care Subsidy Quality First Scholarship Other (please specify) Number of Children in the Household 6-17 years old YES 0 NO 12 Data Field Response Options Currently Collecting? Child Care Type Category: YES NO El My partner or I take care of my child(ren) at home Head Start Child care center/preschool program Family child care home Relative/neighbor or babysitter First Things First I Data Reporting Requirements SFYIL9 I Horne VNtation 2. If your response is a NO, for any types of data marked required in the table above, describe how you will modify your data collection to comply with the FTF data requirements upon award. Provide sufficient details to clarify your plan. Caregiver Information: Caregiver Primary language Spoken at Home- Question will be added to the current Demographic form collected on home visits at intake, 12 months and 24 months and entered to the supplemental database. Caregiver Has a Primary Health Care Provider- Question will be added to the current Demographic form collected on home visits at intake, 12 months and 24 months and entered to the supplemental database. Date Medical Home Established: Prenatal- Question will be added to the Maternal Health Assessment at Intake which currently asks for weeks of pregnancy when care began. Data will be entered to the supplemental database. Caregiver has Dental Insurance- Question will be added to the current Demographic form collected on home visits at intake, 12 months and 24 months and entered to the supplemental database. Date Dental Home Established- Question will be added to the Maternal Health Assessment at Intake and entered to the supplemental database. Caregiver Relationship to Children in the Household- Question will be added to the current Demographic form collected on home visits at intake and entered to the supplemental database. Caregiver Legal Guardian to One or More Child(ren) in Household - Question will be added to the current Demographic form collected on home visits at intake and entered to the supplemental database. Child Information: Child's Primary Language- Question will be added to the Infant Health Care form completed every 6 months and entered to the supplemental database. Child with Special Needs —Question will be added to the Infant Birth form and the Infant Health Care form completed every 6 months and entered to the supplemental ACCESS database. Child Has Dental Insurance Question will be added to Infant Health Care form completed every 6 month and entered to the supplemental ACCESS database. Date Dental Home Established (Usual Source of Dental Care): Child(ren) — Question will be added to Infant Health Care form completed every 6 month and entered to the supplemental ACCESS database. Date Dental Home Established- Question will be added to Infant Health Care form completed every 6 month and entered to the supplemental ACCESS database. Household Information: Housing Status- Question will be added to the current Demographic form collected on home visits at intake, 12 months and 24 months and entered to the supplemental database. Number of times family moved in the past 12 months- Question will be added to the current Demographic form collected on home visits at intake, 12 months and 24 months and entered to the supplemental database. First Things First I Data Reporting Requitements SFY1.9 I Horne Visitation Parents/Caregivers reporting they are food insecure - Question will be added to the current Demographic form collected on home visits at intake, birth, 12 months and 24 months and entered to the supplemental database. Number of Children in Household 6-17 years old- Question will be added to the current Demographic form collected on home visits at intake, birth, 12 months and 24 months and entered to the supplemental database. Child Care Type - Question will be added to the Infant Birth form and the Infant Health Care form completed every 6 months and entered to the supplemental database. III.Data Collection Process 1. For the required types of data (i.e. program implementation and programmatic outcome data, and participant level demographic information), describe the proposed data collection process; who will be responsible for data collection and data submission; what procedures will be in place to ensure timely, accurate, and secure collection and submission; and how data will be used to inform and improve programming. If the data processes are different for each type of data, clarify the approach for each separately. If applicable, also include the anticipated approval process to collect, submit, and report data from tribal government programs. [The Arizona Nurse Consultant for NFP NSO has been in conversation with the FTF Data Analyst 'regarding Penelope, the new NFP data collection system and opportunities to add additional data fields required by FTF to the required NSO data requirements. MCPDH will work closely with FTF and the NFP NSO to ensure program compliance and quality assurance. Because NFP is an evidence-based program, data collection is essential to program management. MCDPH will maintain an ACCESS database that collects and tracks data indicators not currently collected by the Penelope system for FTF reporting. Questions that capture all required FTF data will be added to forms to facilitate data collection on home visits. The nurse home visitor has a vital role in gathering information for Nurse-Family Partnership. The nurse home visitor collects data on secure laptops on demographics, client and child assessments, preventive health services, and home visitation services during home visits. All visit forms are completed within 24 hours of a visit, submitted to the data entry staff for entry to Penelope and the supplemental database within one week of the visit. The Nurse Supervisor is responsible to monitor the data collection through chart reviews and running the Data Forms Due report. The Nurse Supervisor will have overall responsibility to First Things First for data collection, and data submission. Dates of home visits as well as dates of data submission and entry to Penelope and the supplemental database will be tracked by the supervisor to ensure timely data entry. Accuracy of data is monitored by multiple data quality reports and chart reviews. The Nurse Supervisor will work closely with the Public Health Information Management Analyst in the Office of Family Health to ensure all required data will be captured in and reportable from NSO Penelope system and the supplemental ACCESS database. First Things First I Data epo ting Require,,roPilt FY19 I Home 1/1sitton Continuous quality measures ensure fidelity to the NFP model at every phase of the program by focusing on client interactions, program implementation and outcome achievement. The data collection system is also utilized by nurse home visitors and nurse supervisors to guide their practice, assess and guide program implementation, inform clinical supervision, enhance program quality, and demonstrate program fidelity. Finally, the data collection system is utilized by the NFP NSO and their partners to monitor implementing agencies' program fidelity and the quality of the data collection and provide feedback as appropriate. All quality reports are used to inform practice, for example the outcomes report is utilized by the Nurse Supervisor and in team meeting to identify potential indicators for quality improvement projects, the current caseload report identifies NHV caseloads as well as when the last visit was completed for discussion in supervision as needed. Note: If demographic and programmatic outcome • ata is gathered in a tribal community region e.g. ata gathering in tribal lands), appropriate tribal approvals must be in place prior to commencing data collection. In instances when tribal data approvals are necessary, FTF's Research and Evaluation and Tribal Affairs divisions will work with grant partners to secure approvals from the tribe(s). (Refer to the Tribal Data Policy and the Ownership of Intellectual Property sections under the Grant Terms and Conditions in this RFGA). Additionally, grant partners will be required to ensure they have culturally appropriate methodology (e.g., in- person interviews) and a culturally responsive approach for gathering participant level demographic information and/or programmatic outcome data from program participants. First Things First I Data Reperting Requirements SFY19 Home Visitation