EXHIBIT 1
HEAD START ORAL HEALTH INITIATIVE
Winter 2006-2007
Site: [Site ID]
Dates of interview: [xx/xx/xx]
Interviewer: [Name]
1. RESPONDENT INFORMATION
(Questions 1-3: Job title, current responsibilities, time employed by grantee, time in current position, other positions held at agency)
2. GRANTEE CHARACTERISTICS
2.1 OHI CONTACT INFORMATION
(Intro and Question 4: Agency address and phone number; OHI contact, job title, and email address)
2.2 AGENCY BACKGROUND
(Question 5-6, 10: Main programs agency operates (other than HS), agency size, number of families served annually, number of staff, years of operation in the community)
2.3 HEAD START PROGRAM
(Question 7-11: Whether agency operates Head Start, Early Head Start, Migrant/Seasonal Head Start and number of families agency is funded to serve annually under each program; service options, number of centers, years of operation of HS, EHS, and/or MSHS program; operating schedule for HS, EHS, MSHS programs)
3. COMMUNITY AND FAMILY CHARACTERISTICS
3.1 SERVICE AREA
(Questions 12 and 14: Geographic service area for HS, EHS, MSHS programs; service area for OHI and reason if different from HS service area; variation in implementation across sites; availability of other services in community)
3.2 FAMILY CHARACTERISTICS
(Questions 13, 15-16: Family characteristics, including languages spoken and cultural/ethnic backgrounds; barriers to accessing oral health care, including availability of providers, access to insurance coverage, and cultural competency of providers; families’ cultural norms and oral health care practices; prevalence of practices that threaten oral health)
4. OHI GOALS, OBJECTIVES, AND KEY COMPONENTS
4.1 GOALS AND OBJECTIVES
(Questions 17- 18: Rationale for applying for OHI grant; OHI goals and objectives, whether they have changed since beginning implementation, and if so, why)
4.2 KEY COMPONENTS
(Questions 19-21: Key components of OHI; number of children and pregnant women to be served, and how program decided which children and families to target for OHI; whether program will serve other family members; annual budget for OHI and proportion of funds spent on staff, dental services, supplies, and other expenses)
5. DESIGN PROCESS
(Questions: 22-27: How program identified goals and objectives; who was involved in the OHI design process; resources used for designing the initiative; whether program did a community needs assessment or used an existing one; if needs assessment used, how it was used; whether built on existing activities or designed a new approach, and how this was done; community and family characteristics most important in design decisions)
6. STAFFING STRUCTURE AND TRAINING
STAFFING STRUCTURE
(Questions 28-32: Informant’s time on OHI; number of staff assigned to OHI, including their job titles, main duties, and qualifications; whether all planned OHI positions are filled and how long this took; how staffing was decided; whether used new and/or existing staff and why; how well staffing structure is working out so far)
6.2 STAFF TRAINING
(Question 33-36: Content of OHI preservice training and staff who received it; training received since implementation began; plans for future training; plans for training new hires due to turnover in OHI staff; T/TA received from OHS, oral health consultants, other sources and helpfulness of T/TA)
7. COMMUNITY PARTNERS
7.1 NUMBER AND TYPES OF COMMUNITY PARTNERS
(Question 37: Number and types of OHI partners, rationale for recruiting them, other partners needed and their potential roles on OHI)
7.2 DEVELOPING PARTNERSHIPS
(Question 38-39 42: How partners identified and recruited, whether formal partnership agreements in place, content of agreements, training provided to partners, and helpfulness of training)
7.3 PARTNERS’ ROLES ON OHI
(Questions 40-41: Partners roles and services provided to HS children and families, whether partners receive referrals, whether partners report outcomes of referrals back to HS agency)
7.4 PARTNERSHIPS SUCCESSES AND CHALLENGES
(Question 43: How well partnerships are working out, successes and challenges)
8. SERVICE DELIVERY
8.1 RISK ASSESSMENT
(Questions 44-46: Whether program conducts routine oral health assessments, how assessments are conducted, who conducts assessments, whether a formal assessment tool is used and why selected, how assessment results are used)
8.2 CLINICAL SERVICES
(Questions 47-49: Types of clinical preventive and treatment services provided to children and pregnant women, whether provided directly or through partners/community providers, where services are provided, how costs of the services are covered, types of clinical services provided to other family members )
8.3 SUPPORT SERVICES
(Questions 41, 50-52: Whether program has referral system in place and how it works; how program tracks treatment outcomes and follow up needs; whether program provides help making appointments, transportation, translation/interpretation, or supports; who provides support services)
8.4 DENTAL HOME
(Question 53: Program’s definition of a dental home, whether program helps families establish dental homes, how programs help families establish dental homes)
8.5 ORAL HEALTH EDUCATION
(Questions 54-57, 59-60: Oral health education for parents, pregnant women, and children; who provides oral health education, where oral health education provided; curricula used to provide oral health education; helpfulness of the curriculum and whether changes have been made; steps taken to tailor oral health education to needs and cultural norms of families)
8.6 ORAL HYGIENE SUPPLIES
(Question 58: Types of oral hygiene supplies provided, who receives supplies, how often provided, whether training on how to use the supplies is provided)
8.7 COMMUNITY OUTREACH
(Question 60: Steps taken to expand OHI to the broader community, such as participation in community health fairs or other events)
9. EARLY IMPLEMENTATION EXPERIENCES
9.1 FUNDING
(Questions 61-62: Sufficiency of OHI funding to implement as planned, additional funding sources, whether program has applied for additional funding sources, how new funds will be used if received)
9.2 DESIGN CHANGES, SUCCESSES, AND CHALLENGES
(Questions 63-67: Progress towards goals, design changes and rationale for changes, successes, challenges, strategies to address challenges, how well strategies are working)
9.3 CONSULTATION AND T/TA
(Questions 68-69: consultation with other OHI grantees, additional T/TA that would be helpful from OHS or T/TA network)
10. OTHER ISSUES
(Question 70: other issues mentioned by informant)
| File Type | application/msword |
| File Title | MEMORANDUM |
| Author | Diane Paulsell |
| Last Modified By | Diane Paulsell |
| File Modified | 2007-01-06 |
| File Created | 2007-01-06 |