Performance Measures

Family Support Performance Measures

  • The six benchmark areas captured through these performance measures are:
    • Improved maternal and newborn health;
    • Prevention of child injuries, child abuse, neglect, or maltreatment, and reduction of emergency department visits;
    • Improvement in school readiness and achievement;
    • Reduction in crime or domestic violence;
    • Improvements in family economic self-sufficiency; and
    • Improvements in the coordination and referrals for other community resources and supports.

1. Preterm Birth – Percent of infants (among mothers who enrolled in home visiting prenatally before 37 weeks) who are born preterm following program enrollment

Caregiver Measure
Collected via the demographics
1. For each child enrolled in your program at any point during the reporting period, was s/he born during the reporting period?
- Yes – Continue to next question.
- No – This child is not included in the numerator or denominator and is not counted as missing.
- Information missing – Include in missing cases for this measure.

2. Did the primary caregiver enroll prenatally prior to 37 completed weeks of gestation?
- Yes – Continue to next question.
- No – This child is not included in the numerator or denominator and is not counted as missing.
- Information missing – Include in missing cases for this measure.

3. What was the gestational age at the time of birth?
- Gestational age at birth determined – Continue to next question.
- Gestational age at birth not determined – Include in missing cases for this measure.

4. Was the child born less than 37 completed weeks of gestation?
- Yes – Include in numerator and denominator for this measure.
- No – Include in denominator for this measure, but do not include in numerator.
- Information missing – Include in missing cases for this measure.
To be included in the reporting period, participants need to have enrolled prior to 37 completed weeks of gestation and delivered the baby during the reporting period. If the participant enrolls prior to 37 weeks in the current reporting period but delivers in the subsequent reporting period, the participant will be included in the subsequent reporting submission. If she enrolls prior to 37 weeks in the previous reporting period but delivers in the current reporting period, she will be included in the current report submission.

Preterm birth is defined as a birth before the 37 completed weeks of gestation (defined as up to 36 weeks and 6 days). The “37 completed weeks” means 36 weeks and 7 days.

2. Breastfeeding – Percent of infants (among mothers who enrolled in home visiting prenatally) who were breastfed any amount at 3 and 6 months of age

Caregiver Measure
Only if Caregiver Enrolled Prenatally
3 Months Post Enrollment of Child using the DOB - Starting July 1st, 2019
6 Months Post Enrollment of Child using the DOB - Current and Continuing July 1st, 2019
1. Did the index child’s mother enroll in home visiting prenatally?

Yes – Continue to next question.
No – This index child is not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure. 2. Was the index child between 6 to 12 months of age during the reporting period? Yes – Continue to next question. No – This index child is not included in the numerator or denominator and is not counted as missing. Information missing – Include in missing cases for this measure. ? ? Form 2 Performance Indicators and Systems Outcomes Toolkit 10 November 2017 3. Did the date of the breastfeeding assessment occur between the index child’s age of 6 and 12 months? Yes – Continue to next question. No – This index child is not included in the numerator or denominator and is not counted as missing. Information missing – Include in missing cases for this measure. 4. Did the breastfeeding assessment indicate the index child received breastmilk in any amount when s/he was 6 months of age? Yes – Include in numerator and denominator for this measure. No – Include in denominator for this measure, but do not include in numerator. Information missing – Include in missing cases for this measure.
The measure captures if the index child received breastmilk in any amount at 6 months of age, not if the child was continuously or exclusively breastfed for 6 months.

This measure may be assessed retrospectively.
Infected with human immunodeficiency virus (HIV), Taking antiretroviral medications, have untreated, active tuberculosis, infected with human T-cell lymphotropic virus type I or type II, Using or is dependent upon an illicit drug, taking prescribed cancer chemotherapy agents, such as antimetabolites that interfere with DNA replication and cell division, Undergoing radiation therapies
Yes, the definition of breastfeeding does include both breastfeeding and the feeding of breast milk. These are both acceptable methods for inclusion in this measure.

3. Depression Screening – Percent of primary caregivers enrolled in home visiting who are screened for depression using a validated tool within 3 months of enrollment (for those not enrolled prenatally) or within 3 months of delivery (for those enrolled prenatally)

Caregiver Measure
If Enrolled Prenatally
3 Months Post Birth

If Not Enrolled Prenatally
3 Months Post Enrollment
Family Support Programs and Home Visiting Programs must use a validated tool for this measure. Depression should be defined in accordance to the validated depression screening tool’s definition of depression.

Current, As of July 1, 2019
☐ Edinburgh Postnatal Depression Scale (EPDS)
☐ Patient Health Questionnaire-9 (PHQ-9)
☐ Center for Epidemiologic Studies Depression Scale (CES-D)
☐ Center for Epidemiologic Studies Depression Scale Revised (CESD-R)
☐ Patient Health Questionnaire-2 (PHQ-2)
☐ Brief Symptom Inventory (BSI)
☐ Brief Depression Inventory-II (BDI-II)
1. For each primary caregiver enrolled in your program, did she enroll prenatally or postnatally?

Primary caregiver enrolled prenatally – Continue to next question.
Primary caregiver enrolled postnatally – Continue to question 4.
Information missing – Include in missing cases for this measure.

2. For each primary caregiver who enrolled prenatally, did she reach 3 months postpartum during the reporting period?

Yes – Continue to next question.
No – The primary caregiver is not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure.

3. For each primary caregiver who enrolled prenatally, was she screened for depression with a validated tool within 3 months postpartum?

Yes – Include in the numerator and denominator for this measure.
No – Include in the denominator for this measure, but do not include in the numerator.
Screening information missing – Include in the denominator for this measure, but not in the numerator.

4. For each primary caregiver who enrolled postnatally, was she enrolled for at least 3 months during the reporting period?

Yes – Continue to next question.
No – This primary caregiver is not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure.

5. For each primary caregiver who enrolled postnatally, was she screened for depression using a validated tool within 3 months of enrollment?

Yes – Include in numerator and denominator for this measure.
No – Include in the denominator for this measure, but do not include in the numerator.
Screening information missing – Include in the denominator for this measure, but not the numerator.
Yes; you must screen all primary caregivers for depression regardless of whether they are receiving mental health services when they enroll in home visiting.

4. Well Child Visit – Percent of children enrolled in home visiting who received the last recommended visit based on the American Academy of Pediatrics (AAP) schedule

Child Measure
Start: 3 Months Post Birth
6, 9, 12, 15, 18, 21, 24*, 27, 30, 33 Months Post Birth
On the 3rd, 4th and 5th birthdays Post Birth
*NFP ends at 24 months post birth
1. For each index child enrolled in your program, was s/he actively enrolled in home visiting for any part of the reporting period?

Yes – Continue to next question.
No – This index child is not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure.

2. When was the last home visit with the family?

Date provided – Continue to next question.
Date not provided – Include in missing cases for this measure.

3. What was the index child’s age at the time of the last home visit with the family?

Index child’s age is known/can be calculated – Continue to next question.
Unable to determine index child’s age – Include in missing cases for this measure.

4. Prior to the last home visit with the family, what was the last expected well-child visit based on AAP recommendations?

Index child’s age range during last expected well-child visit is known/can be calculated – Continue to next question.
Index child’s age range during last expected well-child visit cannot be determined – Include in missing cases for this measure.

5. What was the index child’s age at her/his last reported well-child visit?

Index child’s age at last well-child visit is known/can be calculated – Continue to next question.
Index child’s age at last well-child visit cannot be determined – Include in missing cases for this measure.

6. Did the last reported well-child visit for the index child fall within the age range of the last expected well-child visit?

Yes – Include in numerator and denominator for this measure.
No – Include in denominator for this measure, but do not include in numerator.
All index children who received services for any length of time during the reporting period should be counted in that reporting period.

This measure does not assess if the index child is up to date on visits, but assesses if the last expected well-child visit was completed based on the child’s current age and the date it was collected.

Awardees should use the following intervals, which are based on the https://www.aap.org/en-us/Documents/periodicity_schedule.pdf and depend on the child’s age. These intervals allow for a window for the visits to occur. For instance, the 9-month visit could occur for the index child anytime between 9 to 10 months of age.
Only the visits that have taken place in the last 3 months need to be entered since the list in the data system will prepopulate with already tracked completed visits.
No. Since we are capturing the data every 3 months, no is an appropriate answer.
Well-child tele-health visits completed according to the AAP schedule can be included as meeting the numerator criteria for Performance Measure 4. The AAP has issued guidance on providing well-child care vis telehealth during COVID-19. We recognize that not all providers may offer well-child visits, in person or via telehealth, during this time. AAP Guidance

5. Postpartum Care – Percent of mothers enrolled in home visiting prenatally or within 30 days after delivery who received a postpartum visit with a healthcare provider within 8 weeks (56 days) of delivery

Caregiver Measure
If Enrolled Prenatally
8 Weeks Post Birth

If Enrolled within 30 days of Giving Birth
8 Weeks Post Birth
1. For each mother enrolled in your program at any point during the reporting period, was she enrolled prenatally or within 30 days after delivery?

Yes – Continue to next question.
No – This mother is not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure.

2. Was the mother enrolled in your program for at least 8 weeks (56 days) after delivery within the reporting period?

Yes – Continue to next question.
No – This mother is not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure.

3. Did the mother complete a postpartum visit on or before 8 weeks (56 days) after delivery?

Yes – Include in numerator and denominator for this measure.
No – Include in the denominator for this measure, but do not include in the numerator.
Information missing – Include in missing cases for this measure.
A postpartum visit is defined as a visit between the mother and her health care provider to assess her current physical health, including the status of pregnancy-related conditions like gestational diabetes, screen for postpartum depression, provide counseling on infant care and family planning as well as screening and referrals for the management of chronic conditions. Additionally, a provider may use this opportunity to conduct a breast exam and discuss breastfeeding.

The American College of Obstetricians and Gynecologists recommends that mothers receive a postpartum care visit 4 to 6 weeks after delivery. (Reference: Health Resources and Services Administration. Child Health USA 2013: Postpartum Visit and Well-Baby Care.)
Postpartum tele-health visits that meet the timeline criteria defined in the Performance Measure can be included as a completed visit. The American College of Obstetricians and Gynecologists recommends that women connect with their health care provider to discuss how their postpartum care visits may change during this time, including a shift to telemedicine or telehealth. ACOG Guidance

6. Tobacco Cessation Referrals – Percent of primary caregivers enrolled in home visiting who reported using tobacco or cigarettes at enrollment and were referred to tobacco cessation counseling or services within 3 months of enrollment

Caregiver Measure
Entry
3 Months Post Enrollment (Non NFP)
36 Weeks Gestation*
12 Months Post Birth*
*NFP Only
Combustibles (Cigars, Pipes, Hookahs, Bidis), Non-Combustibles (Chew, Dip, Snuff, Snus, Dissolvable), Electronic Nicotine Delivery Systems (ENDS)
1. For each primary caregiver enrolled in your program, did s/he report tobacco or cigarette use at the time of enrollment?

Yes – Continue to next question.
No – This primary caregiver is not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure.

2. For each primary caregiver who indicated “yes” to tobacco use, was s/he already receiving tobacco cessation services?

Yes – Exclude from the numerator and denominator, do not include in missing.
No – Continue to next question.

3. Was the primary caregiver enrolled for at least 3 months during the reporting period?

Yes – Continue to next question.
No – This primary caregiver is not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure.

4. Was the primary caregiver referred to tobacco cessation counseling or services within 3 months of enrollment?

Yes – Include in numerator and denominator for this measure.
No – Include in the denominator for this measure, but do not include in the numerator.
Classes, support groups, hospitals, health insurance, talk to PCP.

7. Safe Sleep – Percent of infants enrolled in home visiting that are always placed to sleep on their backs, without bed-sharing or soft bedding

Child Measure
Non-NFP
3 Months Post Birth
6 Months Post Birth
9 Months Post Birth
12 Months Post Birth

NFP
0 Months Post Birth
6 Months Post Birth
12 Months Post Birth
1. For each index child enrolled in your program, was s/he exactly 1 year old or younger at any point in the reporting period?

Yes – Continue to next question.
No – This index child is not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure.

2. Did the primary caregiver report that s/he always placed her/his index child to sleep on her/his back and without bed-sharing or soft bedding?

Yes – Include in numerator and denominator for this measure.
No – Include in the denominator for this measure, but do not include in the numerator.
Information missing/safe sleep assessment not completed – Include in missing cases for this measure.
To assess the measure accurately, the primary caregiver should be asked specifically (1) if s/he always places the index child to sleep on her/his back and (2) if s/he always places the index child to sleep without bed-sharing or soft bedding. To be assessed as having safe sleep habits, the primary caregiver needs to answer “yes” to both parts of the measure.

Safe sleep practices may be assessed at multiple data collection points. If measured at multiple points in time during enrollment (such as by asking the primary caregiver during each visit), then the assessment completed in the home visit closest to the end of the reporting period should be used in the calculation.
Blankets, pillows, stuffed animals, or bumper pads.

8. Child Injury – Rate of injury-related visits to the Emergency Department (ED) since enrollment among children enrolled in home visiting

Child Measure
ALL EBHV
Start: 3 Months Post Enrollment
6, 9, 12, 15, 18, 21, 24, 27, 30, 33, 36 Months

Every 6 Months After 36 Months (3 Years)
42, 48, 54, 60, 66, 72, 78, 84 Months
Injury-related emergency department visits are defined as injuries resulting from the following causes or mechanisms of injury: motor vehicle, suffocation, drowning, poisoning, fire/burns, falls, sports and recreation, and intentional injuries, such as child maltreatment. (Reference: Centers for Disease Control and Prevention. National Action Plan for Child Injury Prevention. 2012.)
1. For each index child enrolled in your program, was s/he actively enrolled for any part of the reporting period?

Yes – Continue to next question.
No – This index child is not included in the denominator, no visits are included in the numerator, and the case is not counted as missing.
Information missing – Include in missing cases for this measure.

2. How many nonfatal injury-related ED visits did the primary caregiver report the index child had during the reporting period?

Number of ED visits assessed – Include the total number of reported ED visits in the numerator.
Information missing/ED assessment not completed – Include in missing cases for this measure.
No except if the ingestion resulted in poisoning.

9. Child Maltreatment – Percent of children enrolled in home visiting with at least 1 investigated case of maltreatment following enrollment within the reporting period

Child Measure
Collected via administrative data from Office of Children, Youth and Families (OCYF)
1. For each index child enrolled in your program, was s/he actively enrolled for any part of the reporting period?

Yes – Continue to next question.
No – This index child is not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure.

2. As reported by the child welfare agency, has the index child had at least one investigated case of maltreatment since enrollment?

Yes – Include in numerator and denominator for this measure.
No – Include in the denominator for this measure, but do not include in the numerator.
Information missing – Include in missing cases for this measure.
Regardless of the disposition or outcome of the investigation, this measure captures children with at least one investigated case of maltreatment. For this measure, investigated cases have an allegation of maltreatment that was screened-in for investigation or assessment and received further investigation. (Reference: U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2017). Child Maltreatment 2015.)

Child maltreatment data should only be recorded if they occur during enrollment. Incidences that occurred during the reporting period but prior to enrollment should be excluded.

10. Parent-Child Interaction – Percent of primary caregivers enrolled in home visiting who receive an observation of caregiver-child interaction by the home visitor using a validated tool

Child Measure
Non-NFP
Collected on the child's 1st, 2nd, 3rd, 4th, 5th, and 6th Birthdays Post Birth

NFP
3, 10, 17, and 23 Months Post Birth
Current, As of July 1, 2019
☐ Dyadic Assessment of Naturalistic Caregiver-Child Experiences (DANCE)
☐ Home Observation for Measurement of the Environment (HOME) – Infant/Toddler Inventory, 3rd Ed.
☐ Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO)
☐ Keys to Interactive Parenting Scale (KIPS)
☐ CHEEERS-Based Validated Tool
☐ Dads' Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO-D)
☐ Nursing Child Assessment Teaching Scale (NCAST)
☐ Child Well-Being Scales
1. For each primary caregiver enrolled in your program, did any have an index child who reached the valid age range required by the parent-child interaction tool during the reporting period?

Yes – Continue to next question.
No – This primary caregiver is not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure if the index child’s age cannot be determined or is missing.

2. For each primary caregiver enrolled in your program, did s/he receive a caregiver-child interaction by the home visitor using a validated tool during the reporting period?

Yes – Include in numerator and denominator for this measure.
No – Include in the denominator for this measure, but do not include in the numerator.
Information missing – Include in denominator for this measure, but do not include in numerator.
If the child is outside of the age range of the chosen tool the following should be selected: Not Screened, Reason: Child too young or too old for screening tool

11. Early Language and Literacy Activities – Percent of children enrolled in home visiting with a family member who reported that during a typical week s/he read, told stories, and/or sang songs with their child daily, every day

Child Measure
Non-NFP
Start: 3 Months Post Enrollment
6, 9, 12, 15, 18, 21, 24, 27, 30, 33, 36 Months Post Enrollment

Every 6 Months After 36 Months (3 Years)
42, 48, 54, 60, 66, 72, 78, 84 Months

NFP
0, 6, 12, 18, and 24 Months Post Enrollment
1. For each index child enrolled in your program, was s/he actively enrolled for any part of the reporting period?

Yes – Continue to next question.
No – This index child is not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure.

2. Did the caregiver or family member report that during a typical week s/he read, told stories, and/or sang songs with her/his index child daily, every day?

Yes – Include in numerator and denominator for this measure.
No – Include in the denominator for this measure, but do not include in the numerator.
Information missing – Include in missing cases for this measure.
To accurately assess this measure, caregivers or family members should be asked if they (1) read, (2) told stories, and/or (3) sang songs to their children every day during a typical week.

The measure asks primary caregivers or other family members to reflect on a typical week and report if at least one of the activities occurred each day during the week. Any combination of these activities over the week meets the criteria.

Support of early language and literacy activities may be provided by a primary caregiver or other family members and does not need to be the same person each day.
Shared: The Caregiver should answer the question to the best of their ability based on what they understand to be occurring.

Lost Custody: Respond with 0 unless the answer is known by the Caregiver enrolled in the EBHV model.

12. Developmental Screening – Percent of children enrolled in home visiting with a timely screen for developmental delays using a validated parent-completed tool

Child Measure
Non-NFP
9, 18, and 30 Months Post Birth

NFP
9 and 18 Months Post Birth
1. For each index child enrolled in your program, was s/he between 9 and 30 months of age?

Yes – Continue to next question.
No – The index child is not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure.

2. Was the index child screened for developmental delays with a validated tool during the reporting period?

Yes – Include in the numerator and denominator for this measure.
No – Continue to the next question.
Screening information missing – Include in the denominator for this measure but not the numerator.

3. If the index child was not screened for developmental delays during the reporting period, did s/he have a previous positive screen in a prior reporting period or before being enrolled?

Yes – Exclude from the measure.
No – Include in the denominator for this measure, but not the numerator.
Information missing – Include in the denominator for this measure but not the numerator.
Developmental delays include delays in any or all areas including cognitive, social, language, sensory, and emotional development. (Reference: U.S. National Library of Medicine, National Institutes of Health. Psychological Index Terms via Unified Medical Language System, 2015.)

Family Support and Home Visiting Programs should screen index children for developmental delays at each AAP-recommended age interval. AAP recommends that, at a minimum, standardized developmental screening tools should be administered when the child is 9-months, 18-months, and 24- or 30-months of age.

A child may be excluded from the denominator if s/he has a previously identified developmental delay (prior to enrollment or prior to reaching an age-recommended screening).
Programs may choose to screen at additional ages but are expected to report on screenings at the AAP-recommended ages. If grantees choose to screen at additional ages beyond the AAP recommendations, only data about screenings based on the AAP recommendations should be reported.
This is not a required screening at this time. However, it may be required by your model.
It does not take this into account. According to the ASQ developers: Adjust a child’s age only if he or she is 3 or more weeks premature. This means a child born at or before 36 weeks should have his or her age-adjusted. Age should only be adjusted for children under age 2. Once a child is 2 or older, prematurity no longer needs to be considered and the actual age should be used. The ASQ developers provide an online calculator to determine which assessment to use: https://agesandstages.com/free-resources/asq-calculator/. Using the calculator if a Baby was Born on November 9th, 2019 on August 9th, 2019 they would be 9 months of age (but they were born 4 weeks premature) so it says to use the 8 month ASQ for the 9-month screening. Measure 12 is following the American Academy of Pediatrics (AAP) recommended screening protocols: The AAP recommends conducting developmental surveillance at every health supervision visit and conducting general developmental screening using evidence-based tools at 9, 18, and 30 months, or whenever a concern is expressed The federal guidance for this exact question under MIECHV is: Awardees should follow the implementation instructions for the ASQ. The ASQ provides guidance on adjusting for premature birth.
A child may be excluded from the screening if s/he has a previously identified developmental delay (prior to enrollment or prior to reaching an age-recommended screening).

13. Behavioral Concerns and Home Visits – Percent of home visits where primary caregivers were asked if they have any concerns regarding their child’s development, behavior, or learning

Caregiver Measure
Every home visit is documented (prenatal and postpartum)

Prenatal Home Visits
Not required to ask M13 Question

Postpartum Home Visits
Required to ask M13 Question
1. Was the primary caregiver postnatal for any length of time during the reporting period?

Yes – Continue to next question.
No – This primary caregiver’s home visits are not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure.

2. How many home visits occurred during the reporting period in which the primary caregiver was postnatal?

Include the total number of home visits that met this criterion in the denominator.

3. How many home visits occurred in the reporting period in which the primary caregiver was asked if she had any concerns regarding her index child’s development, behavior, or learning?

Include the total number of home visits that met this criterion in the numerator.
This measure requires home visitors to document if they did or did not ask the primary caregiver about developmental, behavioral, or learning concerns during each home visit that occurs postnatally.

This measure captures the proportion of home visits where behavior concerns were discussed during all home visits in the reporting period.
There are no age restrictions for collecting data on behavioral concerns. This question should be asked at all postnatal home visits regardless of the index child’s age.
Telehealth Visits
Only enter if this is considered a completed visiting under the EBHV model.

In-person visit is completed with another caregiver, not the primary caregiver
Only enter if this is considered a completed visiting under the EBHV model.

Texting
No, this is not considered a visit and should not be entered.

Care Coordination
No, this is not considered a visit and should not be entered (suchs as calls to coordinate appointments, consulting calls with OCYF, etc.
Yes, if the telehealth or virtual visit is approved by the EBHV model and counts as an approved model visit

14. Intimate Partner Violence Screening Indicator – Percent of primary caregivers enrolled in home visiting who are screened for intimate partner violence (IPV) within 6 months of enrollment using a validated tool

Caregiver Measure
6 Months Post Enrollment
Current, As of July 1, 2019
☐ Harassment in Abusive Relationships: A Self-Report Scale (HARASS)
☐ Hurt, Insulted, Threatened with Harm and Screamed (HITS)
☐ Profile of Psychological Abuse (PPA)
☐ Women's Experience with Battering (WEB)
☐ Severity of Violence Against Women Scale (SVAWS)
☐ Abuse Behavior Inventory (ABI)
☐ Abuse Assessment Screen (AAS)
☐ Humiliation, Afraid, Rape, Kick, Child (HARK-C)
☐ Ongoing Abuse Screening (OAS)
☐ Universal Violence Prevention Screening Protocol-Adapted
☐ Partner Violence Screen (PVS)
☐ The Relationship Chart
1. For each primary caregiver enrolled in your program, did s/he reach 6 months post enrollment during the reporting period?

Yes – Continue to next question.
No – This primary caregiver is not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure

2. Did the primary caregiver receive an IPV screening using a validated tool within 6 months of enrollment?

Yes – Include in numerator and denominator for this measure.
No – Include in the denominator for this measure, but do not include in the numerator.
Screening information missing – Include in the denominator for this measure, but do not include in the numerator.
Yes, all primary caregivers should be screened for IPV regardless of relationship status while enrolled in Evidence-Based Home Visiting or Family Support Programs.

IPV refers to physical violence, sexual violence, stalking, and psychological aggression (including coercive acts) by a current or former intimate partner. An intimate partner is a person with whom one has a close personal relationship that can be characterized by the following: emotional connectedness, regular contact, ongoing physical contact and sexual behavior, identity as a couple, and familiarity and knowledge about each other’s lives. (Reference: Centers for Disease Control and Prevention. Injury Prevention and Control: Division of Violence Prevention, 2015.)
The tool NFP uses includes all of the same questions as the HITS screening tool. NFP providers should select the HITS. For NFP Susan Jack’s work is for the nurse to also use to support our intervention.

15. Primary Caregiver Education – Percent of primary caregivers who enrolled in home visiting without a high school degree or equivalent who subsequently enrolled in, maintained continuous enrollment in, or completed high school or equivalent during their participation in home visiting

Caregiver Measure
Collected via demographics, at entry, update, or at exit. Only collected if caregiver does not already have a high school diploma, equivalent such as a GED, or a higher degree.
1. For each primary caregiver enrolled in your program, did s/he report not having a high school diploma or equivalent at the time of enrollment?

Yes – Continue to next question.
No – The primary caregiver is not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure.

2. Did the primary caregiver report being enrolled in or completing a high school diploma or equivalent at or near the end of the reporting period?

Yes – Include in numerator and denominator for this measure.
No – Include in the denominator for this measure, but do not include in the numerator.
Information missing – Include in missing cases for this measure.
This behavior is as expected. Update will generate a new measure 15 while edit will display the previously entered measure 15. If it is showing what they entered on edit, then the information saved correctly.

16. Continuity of Insurance Coverage – Percent of primary caregivers enrolled in home visiting who had continuous health insurance coverage for at least 6 consecutive months

Caregiver Measure
All EBHV
Start: 3 Months Post Enrollment
6, 9, 15, 18, 21, 24, 27, 30, 33, 36* Months Post Enrollment

After 3 Years Post Enrollment
Every 6 Months
42, 48, 54, 60, 66, 72, 78, 84 Months Post Enrollment

NFP
*Ends at 36 Months Post Enrollment (3 Years)
1. For each primary caregiver enrolled in your program, was s/he enrolled in the program for at least 6 months during the reporting period?

Yes – Continue to next question.
No – This primary caregiver is not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure.

2. During the reporting period, did the primary caregiver report having health insurance coverage for 6 consecutive months?

Yes – Include in numerator and denominator for this measure.
No – Include in the denominator for this measure, but do not include in the numerator. Information missing – Do not include in the numerator or denominator.
Continuous health insurance coverage refers to having coverage without any lapses.

This could be collected by (1) directly asking primary caregivers how many months they have had continuous health insurance coverage each reporting year or by (2) tracking health insurance status for each month to compute whether insurance was maintained for at least 6 consecutive months.

17. Completed Depression Referrals – Percent of primary caregivers referred to services for a positive screen for depression who receive one or more service contacts

Caregiver Measure
Only Collected If Caregiver Screens Positive

If Enrolled Prenatally
6 Months Post Birth

If Not Enrolled Prenatally
6 Months Post Enrollment

If Caregiver Does Not Receive a Service They Need To Be Rescreened Until They:
1. No Longer Screen Positive
2. Receive a Service
1. For each primary caregiver enrolled in your program, did she screen positive for depressive symptoms within 3 months of enrollment (for those not enrolled prenatally) or within 3 months of delivery (for those enrolled prenatally)?

Yes – Continue to next question.
No – This primary caregiver is not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure.

2. Did the primary caregiver receive a referral for the positive screening?

Yes – Continue to next question.
No, but reason unknown – The primary caregiver is included in the denominator but not the numerator.
No, because the primary caregiver is already receiving services for depressive symptoms – The primary caregiver is not included in the numerator or denominator and is not counted as missing.
Information missing – The primary caregiver is included in the denominator but not the numerator.

3. Did the primary caregivers receive recommended services for depressive symptoms?

Yes – Include in numerator and denominator for this measure.
No – Included in the denominator for this measure, but do not include in the numerator. Information missing – Include in the denominator for this measure, but not the numerator.
Recommended referral services refer to specific techniques and intervention models delivered in the context of client characteristics, culture, and preferences that have shown to have positive effects on outcomes through rigorous evaluations and have demonstrated to achieve positive outcomes for the client. (Reference: Home Visiting Collaborative Improvement and Innovation Network.)
For those participants who screen positive for depressive symptoms but are already receiving services for depression, you do not need to provide a referral.
Appointment with a therapist, appointment with a psychiatrist, meeting with a mental health consultant, follow up with primary care physician, follow up with OBGYN, inpatient psychiatric hospitalization, support groups.

18. Completed Developmental Referrals – Percent of children enrolled in home visiting with positive screens for developmental delays (measured using a validated tool) who receive services in a timely manner

Child Measure
Only collected if Child Scores Below The Cutoff

12 Months Post Birth
21 Months Post Birth*
33 Months Post Birth

*NFP
Ends at 21 Months Post Birth
1. For each index child enrolled in your program who was screened for developmental delays, did s/he screen positive?

Yes – Continue to next question.
No – This index child is not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure.

2. For each index child enrolled in your program who screened positive for developmental delays, were one of the following criteria met: a) received individualized developmental support from a home visitor, b) referred to early intervention services and received an evaluation within 45 days, OR c) referred to other community services who received services within 30 days?

Yes – Include in numerator and denominator for this measure.
No, because the index child was already receiving services or had a previously identified developmental delay (prior to enrollment or prior to the due date for an age recommended screening) – This child is not included in the numerator or denominator and is not counted as missing.
No, for other reason – Include in denominator for this measure, but do not include in numerator.
Information missing – Include in denominator for this measure, but do not include in numerator.
Developmental delays may include delays in any or all areas including cognitive, social, language, sensory, and emotional development. (Reference: U.S. National Library of Medicine, National Institutes of Health. Psychological Index Terms via Unified Medical Language System, 2015.)

A child may be excluded from the denominator if s/he has a previously identified developmental delay (prior to enrollment or prior to reaching an age-recommended screening).

Each of the three individual conditions described below can satisfy the numerator. The home visitor may be required to have a developmental screening follow up process that involves tracking the services the primary caregiver and/or index child received and the dates associated with the follow up. To be counted in the numerator, the index child must meet one of three conditions.

(1) Received individualized developmental support from a home visitor. This is a home visitor-delivered, specific developmental promotion to address the area of concern. This can include more frequent screenings, activities by model curriculum, ASQ activities, and CDC materials to target the developmental skill or domain for which there was a concern or positive screen.

(2) Received a referral to early intervention services and received an evaluation or individualized service plan within 45 days of that referral. This refers to index children with developmental and behavioral concerns that meet the criteria for referral to Part B or Part C early intervention services. The criteria for referral to Part B and Part C early intervention services vary by state and locale. Each program needs to be aware of what local criteria are for referring children.

(3) Received a referral to another community service and received services from that provider within 30 days. This includes any services available that provide developmentally-enhancing support to children and families that do not fall under the funding/ reimbursement system for Part B or Part C early intervention services. Examples include drop-in centers, parent-child groups, early literacy supports, and parent training. This may also include early childhood mental health treatment.

19. Intimate Partner Violence Referrals – Percent of primary caregivers enrolled in home visiting with positive screens for IPV (measured using a validated tool) who receive referral information for IPV

Caregiver Measure
Only if Caregiver Screens Positive for IPV

9 Months Post Enrollment
1. For each primary caregiver enrolled in your program, did s/he screen positive for IPV using a validated tool within the first 6 months of enrollment?

Yes – Continue to next question.
No – The primary caregiver is not included in the numerator or denominator and is not counted as missing.
Information missing – Include in missing cases for this measure.

2. Did the primary caregiver receive a referral for IPV resources during the reporting period?

Yes – Include in numerator and denominator for this measure.
No – Include in the denominator for this measure, but do not include in the numerator.
Referral status missing – Include in the denominator for this measure, but do not include in the numerator.
IPV refers to physical violence, sexual violence, stalking and psychological aggression (including coercive acts) by a current or former intimate partner. An intimate partner is a person with whom one has a close personal relationship characterized by the following: emotional connectedness, regular contact, ongoing physical contact and sexual behavior, identity as a couple, and familiarity and knowledge about each other’s lives. (Reference: Centers for Disease Control and Prevention. Injury Prevention and Control: Division of Violence Prevention, 2015.)

Although IPV screenings must occur within 6 months of enrollment, there is no specific time frame for when the referral should occur. The referral can occur in a different reporting period than the screening. The screening and referral can occur when safe for the caregiver and Family Support Program staff member.

All primary caregivers should be screened for IPV regardless of relationship status.
No, you are expected to provide referral information regardless of whether or not the primary caregiver previously received a referral for services prior to enrolling in the home visiting program.