EBHV grantee systems web-based data entry

EBHV GRANTEE SYSTEMS WEB-BASED DATA ENTRY

SYSTEMS DOMAIN DATA FIELDS AND RESPONSE CATEGORIES

REPORTING ENTITY: GRANTEE (N=17)

FREQUENCY OF REPORTING: EVERY 6 MONTHS

This document is intended to provide information about reporting expectations for the system domain. This is not intended to be a data collection instrument. All data will be collection via a web-based data collection instrument. The instrument consists of the following sections:

SECTION I: INFRASTRUCTURE DEVELOPMENT GOALS

SECTION II: EXTERNAL ENVIRONMENT – CHANGES AND KEY EVENTS

SECTION III: EBHV PROGRAM SUCCESSES AND CHALLENGES

SECTION IV: INFRASTRUCTURE CAPACITY

SECTION V: IMPLEMENTING AGENCIES AND LOCATIONS

SECTION VI: FAMILIES ENROLLED IN EBHV SERVICES

SECTION I: INFRASTRUCTURE GOALS

SHORT-TERM INFRASTRUCTURE GOALS:

Question	Response Type	Response Categories
According to our records, the following are short-term infrastructure development goals for your EBHV grant program.	Pre-populated	[Pre-populated with goals identified by grantees]
Please list any new short-term infrastructure development goals you have added between xx/xxxx and xx/xxxx.	Open field
For each short-term infrastructure development goal, please list the indicators you are using to measure your progress.	Open field
For each goal, short-term infrastructure development please indicate its current status – attained, in progress, or no longer a goal.	Drop down	Attained In Progress No Longer a Goal
If “in progress,” please indicate how close you are to attaining each goal on a scale from 0 to 99 percent.	Open number field	Valid response 0 to 99 percent
If “in progress,” please briefly describe the concrete actions you have taken toward attainment of each short-term infrastructure development goal.	Open field
If “no longer a goal,” please indicate why it is no longer a goal.	Open field

LONG-TERM INFRASTRUCTURE DEVELOPMENT GOALS:

Question	Response Type	Response Categories
According to our records, the following are long-term infrastructure development goals for your EBHV grant program.	Pre-populated	[Pre-populated with goals identified by grantees]
Please list any new long-term infrastructure development goals you have added between xx/xxxx and xx/xxxx.	Open field
For each long-term infrastructure development goal, please indicate its current status – attained, in progress, or no longer a goal.	Drop down	Attained In Progress No Longer a Goal
If “in progress,” please indicate how close you are to attaining each goal on a scale from 0 to 99 percent.	Open number field	Valid response 0 to 99 percent
If “in progress,” please briefly describe the concrete actions you have taken toward attainment of each long-term infrastructure development goal.	Open field
If “no longer a goal,” please indicate why it is no longer a goal.	Open field

SECTION II: EXTERNAL ENVIRONMENT – CHANGES AND KEY EVENTS

Question	Response Type	Response Categories
Did changes or events occur external to your organization that affected (helped or hindered) your grant activities between xx/xxxx and xx/xxxx.	Check Box	Yes No
If yes, please list each change or event.	Open field
For each change or event, please explain how it has affected your grant activities.	Open field
For each change or key event, how did your EBHV program adapt?	Open field
For each change or key event, please indicate which infrastructure capacities were affected by the change or key event.	Check all that apply	Strategic planning or other program development activities Program outreach, intake, home visiting, or referral services Fiscal planning or fundraising activities Communicating program information to program partners, stakeholders, or the public Developing formal and informal program partnerships or collaborations Building community awareness or political support for the program Providing training, coaching, supervision, or other technical assistance Program monitoring, evaluation, or quality improvement activities

SECTION III: EBHV PROGRAM SUCCESSES AND CHALLENGES

SUCCESSES

Question	Response Type	Response Categories
What are the three most important successes that your organization has achieved related to developing the infrastructure capacity of the EBHV grant program in the past six months?	Open field	1. [text field] 2. [text field] 3. [text field]
For each, briefly describe the main factors that contributed to the success.	Open field	1. [text field] 2. [text field] 3. [text field]
For each success, briefly describe why it was important.	Open field	1. [text field] 2. [text field] 3. [text field]

CHALLENGES

Question	Response Type	Response Categories
What are the three most important challenges that your organization has faced related to developing the infrastructure capacity of the EBHV grant program in the past six months?	Open field	1. [text field] 2. [text field] 3. [text field]
For each, briefly describe the main factors that contributed to the challenge.	Open field	1. [text field] 2. [text field] 3. [text field]
For each challenge, briefly describe why it was important.	Open field	1. [text field] 2. [text field] 3. [text field]

SECTION IV: INFRASTRUCTURE CAPACITIES

Question	Response Type	Response Categories
On a scale from 1 to 5, where 1 is undeveloped, 3 is partially developed, and 5 is fully developed, how would you rate the following infrastructure capacities of your organization’s EBHV grant program at this point in time? Planning: Strategic planning or other program development activities Operations: Program outreach, intake, home visiting, or referral services Funding: Fiscal planning or fundraising activities Communication: Communicating program information to program partners, stakeholders, or the public Collaboration: Developing formal and informal program partnerships or collaborations Community and Political Support: Building community awareness or political support for the program Workforce Development: Providing training, coaching, supervision, or other technical assistance Evaluation: Program monitoring, evaluation, or quality improvement activities	Check box	1 to 5

FINAL 4 9/15/09