| Question # | Priority Area Addressed | Topic | Purpose of Item | Target Information | Benchmark (EPIC Center Data Dictionary) | Goal | Related DGIS measure | Related PM | Source of 2016 item | Exact Wording of Standardized Survey Item, 2016 | Wording Used in 2016 Version | Source of May 2019 Item | Exact Wording of Standardized Survey Item, May 2019 | Wording Used in May 2019 Version | Source of Sept 2019 Version | Exact Wording of Standardized Survey Item, Sept 2019 | Wording Used in Sept 2019 Version | Rationale for Change |
| 1 | Strengthen Family Resilience | Father Involvement | Supports understanding/ documentation of who the program is serving, with long-term goal of reducing health inequities by engaging fathers; specifically, the participation of males who are linked to participating women and children as husbands/ partners / fathers can be counted in this way. In addition, questions asking about the relationship of the partner to both the participant woman and any participating children are asked on the cover sheets of all 3 revised questionnaires. | sex of person being interviewed | not asked | https://aspe.hhs.gov/basic-report/hhs-implementation-guidance-data-collection-standards-race-ethnicity-sex-primary-language-and-disability-status | "SEX DATA STANDARD What is your sex? a. _____ Male b. _____Female" |
Female Male Don’t know Declined to answer |
same as May 2019 | same as May 2019 | What is your sex? Select one. Female Male Declined to answer |
Program goal of increasing father/partner involvement necessitates counting and collecting data on them, hence a question about participant sex has been added. | ||||||
| 2 | Health Equity – MCH Outcomes | Who Does HS Serve? | Supports understanding/ documentation of who the program is serving with long-term goal of reducing health inequities; teen parents and women over age 35 have been identified as high-risk groups with regard to pregnancy outcomes that may be particularly in need of HS services. Collecting information regarding age of participant allows us to know how many we serve fall into these particularly vulnerable categories. |
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PRAMS Phase 6 Core#6 | What is your date of birth? [BOX]/[BOX]/20[BOX] MonthDayYear |
what is your date of birth? ____/____/________ (month/day/year) | 2015-2017 NSFG Female AA-1 | How old are you? ENTER age at last birthday in years __________ |
How old are you? Age in years _________ Don’t know Declined to answer |
PRAMS Phase 8 Core 3 | What is your date of birth? Month/Day/Year | What is your date of birth? [month/day/year] _____________ Don’t know Declined to answer |
Date of birth is needed in order for grantees to make calculations related to specific HS reporting requirements. | ||||
| 3 | Quality Improvement | Supports Accurate Reporting and Quality Control | This question aligns directly with HS reporting requirements and as such supports accuracy in documenting/reporting who the program is serving, with the proximal goal of improving program services for high-risk groups, which in turn supports the long-term goal of promoting interconception health and healthy pregnancy outcomes among reproductive age women. | Age classifications that align with HS reporting requirements | Age not directly asked | N/A | Age classifications not included | HS reporting requirements | N/A | Staff: Indicate which age group below the participant falls into: 10-14 years 15-19 years 20-24 years 25-34 years 35-44 years 45+ years |
Based on Aug 2019 grantee piloting and feedback, this added question captures the information as mandated in the HS reporting requirements. It is in red font, indicating that the staff person enters this information without framing it as a question for the participant. Together with the date of birth in item #3, this will help to streamline data collection and improve accuracy with regard to specific reporting requirements that use these age ranges to capture data regarding participants served. | |||||||
| 4 | Health Equity – MCH Outcomes | Who Does HS Serve? | Supports understanding/ documentation of who the program is serving with long-term goal of reducing health inequities; lower levels of education are often associated with lower health literacy, as well as fewer finacial resources, both of which can increase a participant's need for the types of services HS offers. Asking this will aid us in documenting that HS is reaching high-need participants. | education | 2011 NSCH/SLAITS #K11Q20 | What is the highest grade or year of school [you have / [S.C.]’s [MOTHER TYPE] has completed? NOTE TO INTERVIEWER: AT THIS QUESTION, COLLECT INFORMATION ABOUT THE MOTHER (BIOLOGICAL, STEP, FOSTER, ADOPTIVE) LIVING IN THIS HOUSE. (1) 8th GRADE OR LESS (2) 9th-12th GRADE NO DIPLOMA (3) HIGH SCHOOL GRADUATE OR GED COMPLETED (4) COMPLETED A VOCATIONAL, TRADE, OR BUSINESS SCHOOL PROGRAM (5) SOME COLLEGE CREDIT BUT NO DEGREE (6) ASSOCIATE DEGREE (AA, AS) (7) BACHELOR’S DEGREE (BA, BS, AB) (8) MASTER’S DEGREE (MA, MS, MSW, MBA) (9) DOCTORATE (PhD, EdD) or PROFESSIONAL DEGREE (MD, DDS, DVM, JD) (77) DON’T KNOW (99) REFUSED |
What is the highest grade or year of school you have completed? Less than high school; high school or ged; some college or vocational; college graduate; more than college; don't know; decline to answer | NSCH 2018; https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/questionnaires/2018/NSCH-T1.pdf | What is the highest grade or level of school you have completed? Mark (X) ONE box. 8th grade or less 9th-12th grade; No diploma High School Graduate or GED Completed Completed a vocational, trade, or business school program Some College Credit, but no Degree Associate Degree (AA, AS) Bachelor’s Degree (BA, BS, AB) Master’s Degree (MA, MS, MSW, MBA) Doctorate (PhD, EdD) or Professional Degree (MD, DDS, DVM, JD) 26018036 18 |
What is the highest grade or level of school you have completed? Select one only. Did not complete high school diploma/GED or equivalent in home-country Completed high school diploma/GED or equivalent in home-country Some college or trade/vocational training College graduate or more Don't Know Declined to answer |
The Fragile Families and Child Wellbeing Study (SURVEY OF NEW PARENTS), Mothers’ Baseline Survey, Public Use Version, April 2013, Question I1 | Now I’d like to ask some questions about your education and work experience. What is the highest grade or year of regular school that you have completed? (HAND CARD 6) No formal schooling .....................................1 8th grade or less ..........................................2 Some high school (Grades 9,10,11, & 12).......3 High school diploma (Completed 12th grade) ..4 G.E.D...........................................................5 Some college or 2 year degree ....................6 Technical or trade school .............................7 Bachelor’s degree ........................................8 Graduate or professional school...................9 |
Now I’d like to ask some questions about your education. What is the highest grade or level of school that you have completed? No formal schooling 8th grade or less Some high school (Grades 9, 10, 11, & 12) High school diploma (Completed 12th grade) G.E.D. Some college or 2 year degree Technical or trade school Bachelor’s degree Graduate or professional school |
Fragile Families Survey item used, since they target a population similar to that of Healthy Start, and so the response options for education are more suitable for HS participants than those that target the general population. | ||||
| 5 | Health Equity – MCH Outcomes | Who Does HS Serve? | Supports understanding/ documentation of who the program is serving with long-term goal of reducing health inequities; specifically, past research has found that inequities exist in pregnancy outcomes based on race and ethnicity, so capturing this information about our participants will enable us to track outcomes among vulnerable populations. | Hispanic ethnicity | http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf | Is Person of Hispanic, Latino, or Spanish origin? No, not of Hispanic, Latino, or Spanish origin Yes, Mexican, Mexican Am., Chicano Yes, Puerto Rican Yes, Cuban Yes, another Hispanic, Latino, or Spanish origin Print origin, for example, Argentinean, Columbian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on |
Are you of Hispanic, Latino, or Spanish origin? Select all that apply. No, not of Hispanic, Latino, or Spanish origin Yes, Mexican, Mexican Am., Chicano Yes, Puerto Rican Yes, Cuban Yes, another Hispanic, Latino, or Spanish origin — Print origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on. |
https://aspe.hhs.gov/basic-report/hhs-implementation-guidance-data-collection-standards-race-ethnicity-sex-primary-language-and-disability-status | "The OMB minimum categories for ethnicity are: Hispanic or Latino and Not Hispanic or Latino" | Are you of Hispanic or Latino/a origin? Select one only. No Yes Don't Know Declined to answer |
same as May 2019 | same as May 2019 | Are you of Hispanic or Latino/a origin? Select one. Yes, Hispanic or Latino No, Not Hispanic or Latino Don’t know Declined to answer |
The Sept 2019 wording exactly follows OMB 'minimal set' of guidelines for ethnicity by wording response options as 'yes, Hispanic or Latino/a' and 'No, Not Hispanic or Latino/a.' | ||||
| 6 | Health Equity – MCH Outcomes | Who Does HS Serve? | Supports understanding/ documentation of who the program is serving with long-term goal of reducing health inequities; specifically, past research has found that inequities exist in pregnancy outcomes based on race and ethnicity, so capturing this information about our participants will enable us to track outcomes among vulnerable populations. | race | https://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf | What is Person 1’s race? Mark one or more boxes. White Black, African Am., or Negro American Indian or Alaska Native — Print name of enrolled or principal tribe. Asian Indian Chinese Filipino Other Asian — Print race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on. Japanese Korean Vietnamese Native Hawaiian Guamanian or Chamorro Samoan Other Pacific Islander — Print race, for example, Fijian, Tongan, and so on. Some other race — Print race. |
What is your race? Select all that apply. White Black or African American American Indian or Alaska Native Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Asian Native Hawaiian Guamanian or Chamorro Samoan Other Pacific Islander Don't Know Declined to answer White Black or African American American Indian or Alaska Native Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Asian Native Hawaiian Guamanian or Chamorro Samoan Other Pacific Islander Don't Know Declined to answer |
https://aspe.hhs.gov/basic-report/hhs-implementation-guidance-data-collection-standards-race-ethnicity-sex-primary-language-and-disability-status | "The OMB minimum categories for race are: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White." |
Select one or more. American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Don’t know Declined to answer |
same as May 2019 | same as May 2019 | What is your race? Select all that apply. American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Don’t know Declined to answer |
As with ethnicity, OMB minimum categories are used for race since this is not a national survey. The order of the ethnicity/race questions (ethnicity first) reflects the OMB recommended order of these 2 questions. | ||||
| 7 | Improve Women's/ Maternal Health | Access to Care | benchmark / performance measure associated with access to quality health care | usual source of medical care |
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Improve Women’s Health | The percent of Healthy Start women and child participants that have a usual source of medical care. (HS2) | PM 12: 80% of Healthy Start women and child participants that have a usual source of care. | NSCH 2011, K4Q01 | Is there a place that [S.C.] USUALLY goes when [he/she] is sick or you need advice about [his/her] health? (1) YES (2) NO [SKIP TO K4Q04] (3) THERE IS MORE THAN ONE PLACE (77) DON’T KNOW [SKIP TO K4Q04] (99) REFUSED [SKIP TO K4Q04] |
Is there a place that you USUALLY go for care when you are sick or need advice about your health? Select one only Yes No (Go to question 16) There is more than one place Don't know Declined to answer |
NSCH 2018 C10; https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/questionnaires/2018/NSCH-T1.pdf | Is there a place you or another caregiver USUALLY take this child when he or she is sick or you need advice about his or her health? 26018143 7 §;"rL¤ Yes No ➔ SKIP to question |
Select one only. Yes No [skip next question] Don't know Declined to answer |
same as May 2019 | same as May 2019 | Is there a place that you USUALLY go for care when you are sick or need advice about your health? Yes No Don't know Declined to answer |
2019 item updated to new NSCH. |
| 8 | Improve Women's/ Maternal Health | Access to Care | benchmark/performance measure associated with access to quality health care | what kind of place do you go to for health care |
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Improve Women’s Health | The percent of Healthy Start women and child participants that have a usual source of medical care. (HS2) | PM 12: 80% of Healthy Start women and child participants that have a usual source of care. | NSCH 2011, K4Q02 | IF K4Q01 = 1, SAY “What kind of place is it?” IF K4Q01 = 3, SAY “What kind of place does [S.C.] go to most often?” Is it a doctor’s office, emergency room, hospital outpatient department, clinic, or some other place? (1) DOCTOR’S OFFICE (2) HOSPITAL EMERGENCY ROOM (3) HOSPITAL OUTPATIENT DEPARTMENT (4) CLINIC OR HEALTH CENTER (5) RETAIL STORE CLINIC OR “MINUTE CLINIC” (6) SCHOOL (NURSE, ATHLETIC TRAINER, ETC) (7) FRIEND/RELATIVE (8) MEXICO/OTHER LOCATIONS OUT OF US (9) SOME OTHER PLACE [RECORD VERBATIM RESPONSE] (10) DOES NOT GO TO ONE PLACE MOST OFTEN (77) DON’T KNOW (99) REFUSED |
What kind of place do you go to most often when you are sick or you need advice about your health? Is it a doctor's office, emergency room, hospital outpatient department, clinic or some other place? | NSCH 2018 C11; https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/questionnaires/2018/NSCH-T1.pdf | If yes, where does this child USUALLY go first? Mark (X) ONE box.Doctor’s Office Hospital Emergency Room Hospital Outpatient Department Clinic or Health Center Retail Store Clinic or “Minute Clinic” School (Nurse’s Office, Athletic Trainer’s Office) Some other place |
Select one only. Doctor’s Office Hospital Emergency Room Hospital Outpatient Department Clinic or Health Center Retail Store Clinic or “Minute Clinic” School (Nurse’s Office, Athletic Trainer’s Office) Some other place _________________ Don't Know Declined to answer |
same as May 2019 | same as May 2019 | Where do you USUALLY go first? Select one only. Doctor’s Office Hospital Emergency Room Hospital Outpatient Department Clinic or Health Center Retail Store Clinic or “Minute Clinic” School (Nurse’s Office, Athletic Trainer’s Office) Some other place _________________ Don't Know Declined to answer Declined to answer |
2019 Item updated to new NSCH. |
| 9 | Life Course/ Cross-cutting | Access to Care | benchmark/performance measure associated with access to quality health care | any health insurance past year | Increase the proportion of Healthy Start women and child participants with health insurance to 90% (reduce uninsured to less than 10%) | Improve Women’s Health | The percent of Healthy Start women and child participants with health insurance. (LC1) | PM 4: 90% of MCHB funded projects promoting and/ or facilitating adequate health insurance coverage. | not asked | NSCH 2018 E3 | Is this child CURRENTLY covered by ANY kind of health insurance or health coverage plan? D11 No ➔ SKIP to question |
DURING THE PAST 12 MONTHS, were you EVER covered by ANY kind of health insurance or health coverage plan? Yes, I was covered all 12 months Yes, but I had a gap in coverage No ➔ SKIP next question Don’t know Declined to answer |
same as May 2019 | same as May 2019 | DURING THE PAST 12 MONTHS, were you EVER covered by ANY kind of health insurance or health coverage plan? Yes, I was covered all 12 months Yes, but I had a gap in coverage No Don’t know Declined to answer |
Item updated to new NSCH. | ||
| 10 | Life Course/ Cross-cutting | Access to Care | benchmark / performance measure associated with access to quality health care |
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Increase the proportion of Healthy Start women and child participants with health insurance to 90% (reduce uninsured to less than 10%) | Improve Women’s Health | The percent of Healthy Start women and child participants with health insurance. (LC1) | PM 4: 90% of MCHB funded projects promoting and/ or facilitating adequate health insurance coverage. | PRAMS Phase 6 H2 | What kind of health insurance plan is your new baby covered by? Check all that apply Health insurance from your job or the job of your husband, partner, or parents Health insurance that you or someone else pays for (not from a job) Medicaid or (state Medicaid name) TRICARE or other military health care State option (IHS, etc.) State option (SCHIP or CHIP program) Other source(s) => Please tell us [BOX] I do not have health insurance for my new baby |
Please tell me what kind of health insurance you have: Select all that apply. Private insurance through my job, or the job of my husband, partner or parents. Insurance purchased directly from an insurance company Medicaid, Medical Assistance, or any kind of government assistance plan for those with low incomes or a disability TRICARE or other military health care Indian Health Service Other, specify: ___________________ No insurance Don’t know Declined to answer |
NSCH 2018 E4; https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/questionnaires/2018/NSCH-T1.pdf | Is this child CURRENTLY covered by any of the following types of health insurance or health coverage plans? Mark (X) Yes or No for EACH item. Insurance through a current or former employer or union b. Insurance purchased directly from an insurance company Yes No c. Medicaid, Medical Assistance, or any kind of government assistance plan for those with low incomes or a disability d. TRICARE or other military health care e. Indian Health Service f. Other, specify |
Insurance through a current or former employer or union Insurance purchased directly from an insurance company Medicaid, Medical Assistance, or any kind of government assistance plan for those with low incomes or a disability TRICARE or other military health care Indian Health Service Other, specify: __________________ Don’t know Declined to answer |
PRAMS Phase 8 Core 11 | What kind of health insurance do you have now? Check ALL that apply Private health insurance from my job or the job of my husband or partner Private health insurance from my parents Private health insurance from the <State> Health Insurance Marketplace or <statewebsite>, or Healthcare.gov Medicaid (required: state Medicaid name) State-specific option (Other government plan or program such as SCHIP/CHIP) State-specific option (Other government plan or program not listed above such as MCH program, indigent program or family planning program) State-specific option (TRICARE or other military health care) 30 State-specific option (IHS or tribal) Other health insurance: Please tell us: I do not have health insurance now |
What kind of health insurance do you have now? Please select all that apply. Insurance Type Check if Currently have Private health insurance from my job or the job of my husband or partner Private health insurance from my parents Private health insurance from the <State> Health Insurance Marketplace or <state website> or HealthCare.gov Medicaid (Title XIX) (required: state Medicaid name_______________) CHIP (Title XXI) Subsidized ACA plan (also called ‘subsidized premium or subsidized coverage through the Affordable Care Act’) TRICARE or other military health care Indian Health Service or tribal Other health insurance, Please tell us:______________________ I do not have health insurance now Don’t know Declined to answer Insurance Type Check if Currently have Private health insurance from my job or the job of my husband or partner Private health insurance from my parents Private health insurance from the <State> Health Insurance Marketplace or <state website> or HealthCare.gov Medicaid (Title XIX) (required: state Medicaid name_______________) CHIP (Title XXI) Subsidized ACA plan (also called ‘subsidized premium or subsidized coverage through the Affordable Care Act’) TRICARE or other military health care Indian Health Service or tribal [Staff note: this item will be counted as ‘no health insurance coverage’; however, HRSA will track it as a separate item before combining it into ‘no health insurance coverage’.] Other health insurance, Please tell us:______________________ I do not have any health insurance for myself Don’t know Declined to answer |
PRAMS Phase 8 Core 11 used for Sept 2019 as it was in 2016. |
| 11 | Improve Women's/ Maternal Health | Access to Care | benchmark / performance measure associated with access to quality health care | well-visit care | Increase proportion of Healthy Start women participants that receive a well-woman visit to 80%. | Improve Women’s Health | The percent of Healthy Start women participants who have a well-woman visit. (WMH3) | Overlap with PM 7 | NSCH 2011/SLAITS #S4Q01 | [During the past 12 months/Since [his/her] birth], did [S.C.] see a doctor, nurse, or other health care professional for any kind of medical care, including sick-child care, well-child check-ups, physical exams, and hospitalizations? (1) YES (2) NO [SKIP TO K4Q30] (77) DON'T KNOW [SKIP TO K4Q30] (99) REFUSED [SKIP TO K4Q30] |
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NSCH 2018 C2 | If yes, DURING THE PAST 12 MONTHS, how many times did this child visit a doctor, nurse, or other health care professional to receive a PREVENTIVE check-up? A preventive check-up is when this child was not sick or injured, such as an annual or sports physical, or well-child visit. 0 visits, 1 visit, 2 or more visits. |
During the past 12 months, did you see a doctor, nurse, or other health care professional for PREVENTIVE medical care, such as a physical or well-visit checkup? A preventive check-up is when you are not sick or injured, such as an annual or sports physical, or well- visit. Select one only. Yes No Don't know Declined to Answer |
same as May 2019 | same as May 2019 | During the past 12 months, did you see a doctor, nurse, or other health care professional for PREVENTIVE medical care, such as a physical or well-visit checkup? A preventive check-up is when you are not sick or injured, such as an annual or sports physical, or well-visit. Select one only. Yes No Don't know Declined to Answer |
Updated to NSCH 2018. |
| 12 | Health Equity – MCH Outcomes | Who Does HS Serve? | Supports understanding/ documentation of who the program is serving with long-term goal of reducing health inequities; specifically, financial resources have an impact on the types and quality of health and health-related services a family can typically access. Assessing a family's distance from the federal poverty threshold is one way to assess their level of need, in order to document that HS services are reaching high-need populations. Income and the number of people depending on an income are used to calculate distance from poverty threshold. | household income | PRAMS Phase 6 Core 54 | During the 12 months before your new baby was born, what was your yearly total household income before taxes? Include your income, your husband’s or partner’s income, and any other income you may have received. (All information will be kept private and will not affect any services you are now getting.) □ Less than $10,000 □ $10,000 to $14,999 □ $15,000 to $19,999 □ $20,000 to $24,999 □ $25,000 to $34,999 □ $35,000 to $49,999 □ $50,000 or more |
What is your yearly total household income before taxes? Include your income, your husband’s or partner’s income, and any other income you may have received. All information will be kept private and will not affect any services you are now getting. Select one only. Less than $10,000 $10,000 to less than $15,000 $15,000 to less than $20,000 $20,000 to less than $25,000 $25,000 to less than $35,000 $35,000 to less than $50,000 $50,000 or more Don’t know |
PRAMS Phase 8 Core 50 | During the 12 months before your new baby was born, what was your yearly total household income before taxes? Include your income, your husband’s or partner’s income, and any other income you may have received. All information will be kept private and will not affect any services you are now getting. $0 to $16,000 $16,001 to $20,000 $20,001 to $24,000 $24,001 to $28,000 $28,001 to $32,000 $32,001 to $40,000 $40,001 to $48,000 $48,001 to $57,000 $57,001 to $60,000 $60,001 to $73,000 $73,001 to $85,000 $85,001 or more |
Less than $10,000 $10,000 to less than $15,000 $15,000 to less than $20,000 $20,000 to less than $25,000 $25,000 to less than $35,000 $35,000 to less than $50,000 $50,000 or more Don’t know Declined to answer |
same as May 2019 | same as May 2019 | First, can you tell me, during the past 12 months, what was your yearly total household income before taxes? Please include all sources of income, including your income, your husband’s or partner’s income, and any other income you may have received. All information will be kept private and will not affect any services you are now getting. Select one only. First, can you tell me, during the past 12 months, what was your yearly total household income before taxes? Please include all sources of income, including your income, your husband’s or partner’s income, and any other income you may have received. All information will be kept private and will not affect any services you are now getting. Select one only. $0 to $16,000 $16,001 to $20,000 $20,001 to $24,000 $24,001 to $28,000 $28,001 to $32,000 $32,001 to $40,000 $40,001 to $48,000 $48,001 to $57,000 $57,001 to $60,000 $60,001 to $73,000 $73,001 to $85,000 $85,001 or more Don’t know Declined to answer |
The 2019 versions updated to PRAMS Phase 8. | ||||
| 13 | Health Equity – MCH Outcomes | Who Does HS Serve? | Supports understanding/ documentation of who the program is serving with long-term goal of reducing health inequities; specifically, financial resources have an impact on the types and quality of health and health-related services a family can typically access. Assessing a family's distance from the federal poverty threshold is one way to assess their level of need, in order to document that HS services are reaching high-need populations. Income and the number of people depending on an income are used to calculate distance from poverty threshold. | number people supported on household income | PRAMS Phase 6 Standard 55 | During the 12 months before your new baby was born, how many people, including yourself, depended on this income? [BOX] People |
How many people are supported by this income? STAFF: Enter number of people. _____ Adults age 18 or older _____ Children age 17 or younger Don’t know Declined to answer |
PRAMS Phase 8 Core 51 | During the 12 months before your new baby was born, how many people, including yourself, depended on this income? _____People |
STAFF: Enter number of people. Adults age 18 or older:_____________ [Note: A pregnant woman counts as one person] Children age 17 or younger:________ Don’t know Declined to answer |
same as May 2019 | same as May 2019 | During the 12 months before your baby was born, how many people, including yourself, depended on this income? STAFF: Enter number of people. _____People |
2019 versions updated to PRAMS Phase 8. | ||||
| 14 | Quality Improvement | Supports Accurate Reporting and Quality Control | Supports understanding/ documentation of who the program is serving with the goal of improving the quality of services provided, with the ultimate goal of improving the health of reproductive age women and so also the health of her pregnancies and infants; specifically, documenting where the participant is in the reproductive phase allows the grantee to determine the types of services the participant is likely to need at that time point. Women who have children under 18 months of age may enroll their child in HS services, and will also need attention to parenting and interconception-related needs. Knowing this information will aid in the allocation of different types of resources in order to facilitate services. | children under 18 months old enrolled in HS | not directly asked | Staff record: generated by program for programmatic purpose | N/A | Are any of your children who currently live with you less than 18 months old? Select one only. Yes [Complete the mandatory Parent/Child Questions] No Declined to answer |
Staff record generated by program for programmatic purpose | N/A | [If participant currently has children, ask:] Do you have any children less than 18 months old who are enrolled or you would like to enroll in Healthy Start? Select one only. Yes [Participant will need to complete the mandatory Parent/Child Form if the child is or will be enrolled in HS] How many? _____________ No Don’t know Declined to answer |
This question allows the grantee to determine whether participant has a child who might be eligible for HS services, and reminds them to complete the Parent/Child form. Based on Aug 2019 grantee piloting, this item was moved to follow the question on number of people in household, and the wording is changed to be more of a direct question regarding child enrollment in the program, rather than simply asking if a participant has a child under 18 months old. | ||||||
| 15 | Improve Women's/ Maternal Health | Mental Health | benchmark / performance measure; this 2-item screener of depressive symptomatology can provide a grantee with a way of determining whether a referral for further evaluation is needed. Maternal depression has been found to have a significant impact on child development. | depression screener | Increase the proportion of Healthy Start women participants who receive depression screening and referral to 100%. | Strengthen Family Resilience | The percent of Healthy Start women participants who receive depression screening and referral. (WMH4) | PM 8: 100% of MCHB funded projects promoting and/ or facilitating depression screening, and through what processes. | PHQ-2, https://www.aafp.org/afp/2012/0115/p139.html#sec-2 | Over the past two weeks, how often have you been bothered by any of the following problems? Not at all Several days More than onehalf the days Nearly every day Little interest or pleasure in doing things 0 1 2 3 Feeling down, depressed, or hopeless 0 1 2 3 NOTE: If the patient has a positive response to either question, consider administering the Patient Health Questionnaire-9 or asking the patient more questions about possible depression. For older adults, consider the Patient Health Questionnaire-9 or the 15-item Geriatric Depression Scale. A negative response to both questions is considered a negative result for depression. |
Over the past two weeks, how often have you experienced any of the following, would you say never, several days, more than half the days, or nearly every day? Little interest or pleasure in doing things Feeling down, depressed, or hopeless |
same as 2016 | same as 2016 | Over the past two weeks, how often have you experienced any of the following, would you say never, several days, more than half the days, or nearly every day? Little interest or pleasure in doing things Feeling down, depressed, or hopeless |
same as 2016 | same as 2016 | Over the past two weeks, how often have you experienced any of the following-- would you say not at all, several days, more than half the days, or nearly every day? STAFF: Read each item to participant, and check one response for each item. A Total Score of 2 or more indicates additional screening and possible referral is needed. Mood Not at all Several Days More than half the days Nearly every day Score a. Little interest or pleasure in doing things 0 1 2 3 b. Feeling down, depressed, or hopeless 0 1 2 3 TOTAL SCORE |
The PHQ-2 is a commonly used 2-question screener for depression developed for use in primary care/clinical settings. The 2016 version uses a modified question stem; this modified wording was retained in the 2019 versions. The response options themselves retain the standardized wording across all 3 versions. The Sept 2019 version includes an instruction to staff that further referral/further screening is needed if the participant scores a 2 or above. Using 2 as a threshold has been found to have high sensitivity https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906530/. |
| 16 | Improve Women's/ Maternal Health | Mental Health | benchmark / performance measure; this staff notation documents that the participant has completed the depression screener, for the purpose of evaluating progress towards this as a performance measure; this notation can be cross-checked with the items from the actual screening tool to verify the staff notation. However, creating a separate variable for this makes it possible for HS staff who do not have specialized training in statistics to pull the needed information up from a database. |
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Increase the proportion of Healthy Start women participants who receive depression screening and referral to 100%. | Strengthen Family Resilience | The percent of Healthy Start women participants who receive depression screening and referral. (WMH4) | PM 8: 100% of MCHB funded projects promoting and/ or facilitating depression screening, and through what processes. | not directly asked | Staff record generated by program for programmatic purpose | N/A | Staff: has this participant responded to both items of the depression screening in the previous question? Yes No |
Staff record generated by program for programmatic purpose | N/A | Staff: has this participant responded to the items of the depression screening in the previous question? Yes, both items Yes, but only one item No, was not able to administer this |
This direct question makes information directly responsive to the depression screening performance measure easier for a lay person to pull up. The Aug 2019 version provides more detailed response options, based on grantee feedback. | ||
| 17 | Improve Women's/ Maternal Health | Mental Health | benchmark / performance measure; staff notation that the participant was provided with a referral for further evaluation of depressive symptomatology provides information with regard to that part of the performance measure. Maternal depression has been found to have a significant impact on child development. | referred for depression? | Increase the proportion of Healthy Start women participants who receive depression screening and referral to 100%. | Strengthen Family Resilience | The percent of Healthy Start women participants who receive depression screening and referral. (WMH4) | PM 8: 100% of MCHB funded projects promoting and/ or facilitating depression screening, and through what processes. | not directly asked | Staff record generated by program for programmatic purpose | N/A | Staff: Was this participant referred for follow-up services related to possible depression? Yes No |
Staff record generated by program for programmatic purpose | N/A | 17. Staff: Please indicate whether this participant was referred for additional screening and/or follow-up services related to possible depression? Yes (A Total Score of 2 or more indicates additional screening and possible referral is needed) |
Public comment suggested a direct question addressing the 'referral' part of the depression screening performance measure. Wording modified based on Aug 2019 grantee pilot feedback. | ||
| 18 | Life Course/ Cross-cutting | Substance Use | Priorities of the current administration include attention to different kinds of substance use, particularly opioids; this NIDA screener will allow the case worker to assess a participant's need for additional intervention with regard to her substance use, and also allow program to collect data on this priority topic; this is particularly important given the impact of substance use on the developing fetus, and will allow examination of this as a contributing factor to suboptimal birth outcomes. | substance use | NIDA Quick Screen, using instructions found at https://www.drugabuse.gov/publications/resource-guide-screening-drug-use-in-general-medical-settings/nida-quick-screen | In the past year, how often have you used the following? Alcohol (For men, 5 or more drinks a day. For women, 4 or more drinks a day) Never Once or Twice Monthly Weekly Daily or Almost Daily Tobacco Products Never Once or Twice Monthly Weekly Daily or Almost Daily Prescription Drugs for Non-Medical Reasons Never Once or Twice Monthly Weekly Daily or Almost Daily Illegal Drugs Never Once or Twice Monthly Weekly Daily or Almost Daily |
In the past 12 months, how often have you used the following? STAFF: Read substances and answers to participant and enter one response for each substance. Substance Never Once or Twice Monthly Weekly Daily or Almost Daily Declined to answer Alcohol (4 or more drinks per day) Tobacco Products (including cigarettes, chewing tobacco, snuff, iqmik, or other tobacco products like snus Camel Snus, orbs, e-cigarettes, lozenges, cigars, or hookah) Mood-altering Drugs (including marijuana) Prescription Drugs for Non-Medical Reasons (including opioids, diet pills) Illegal Drugs (cocaine, crack, heroin, uppers/crank/meth, PCP, LSD) |
The Tobacco, Alcohol, Prescription medications, and other Substance (TAPS) Tool Part 1; https://cde.drugabuse.gov/sites/nida_cde/files/TAPS%20Tool%20Parts%20I%20and%20II%20V2.pdf |
In the PAST 12 MONTHS, how often have you used any tobacco product (for example, cigarettes, e-cigarettes, cigars, pipes, or smokeless tobacco)? Daily or Almost Daily Weekly Monthly Less Than Monthly Never 2.In the PAST 12 MONTHS, how often have you had 5 or more drinks containing alcohol in one day?One standard drink is about 1 small glass of wine (5 oz), 1 beer (12 oz), or 1 single shot of liquor.(Note: This question should only be answered by males). Daily or Almost Daily Weekly Monthly Less Than Monthly Never 3.In the PAST 12 MONTHS, how often have you had 4 or more drinks containing alcohol in one day?One standard drink is about 1 small glass of wine (5 oz), 1 beer (12 oz), or 1 single shot of liquor.(Note: This question should only be answered by females). Daily or Almost Daily Weekly Monthly Less Than Monthly NeverIn the PAST 12 MONTHS, how often have you used any drugs including marijuana, cocaine or crack,heroin, methamphetamine (crystal meth), hallucinogens, ecstasy/MDMA? Daily or Almost Daily Weekly Monthly Less Than Monthly Never 5.In the PAST 12 MONTHS, how often have you used any prescription medications just for the feeling,more than prescribed or that were not prescribed for you? Prescription medications that may be usedthis way include: Opiate pain relievers (for example, OxyContin, Vicodin, Percocet, Methadone)Medications for anxiety or sleeping (for example, Xanax, Ativan, Klonopin) Medications for ADHD (forexample, Adderall or Ritalin) Daily or Almost Daily Weekly Monthly Less ThanMonthly Never |
Substance Type Daily or Almost Daily Weekly Monthly Less than Monthly Never Declined to answer Used any tobacco product (for example, cigarettes, ecigarettes, cigars, pipes, or smokeless tobacco)? For women: Had 4 or more drinks containing alcohol in one day? For men: Had 5 or more drinks containing alcohol in one day? One standard drink is about 1 small glass of wine (5 oz), 1 beer (12 oz), or 1 single shot of liquor. Used any (illegal) drugs including marijuana, cocaine or crack, heroin, methamphetamine (crystal meth), hallucinogens, ecstasy/MDMA? Used any prescription medications just for the feeling, more than prescribed, or that were not prescribed for you? Prescription medications that may be used this way include: Opiate pain relievers (for example, OxyContin, Vicodin, Percocet, Methadone) Medications for anxiety or sleeping (for example, Xanax, Ativan, Klonopin) Medications for ADHD (for example, Adderall or Ritalin) |
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same as May 2019 | In the past 12 months, how often have you…? STAFF: Read substances and answers to the participant and enter one response for each type of substance. Substance Type Daily or Almost Daily Weekly Monthly Less than Monthly Never Declined to answer Used any tobacco product (for example, cigarettes, ecigarettes, cigars, pipes, or smokeless tobacco)? For women: Had 4 or more drinks containing alcohol in one day? For men: Had 5 or more drinks containing alcohol in one day? One standard drink is about 1 small glass of wine (5 oz), 1 beer (12 oz), or 1 single shot of liquor. Used marijuana? Used any illicit drugs including cocaine or crack, heroin, methamphetamine (crystal meth), hallucinogens, ecstasy/MDMA? Used any prescription medications just for the feeling, more than prescribed, or that were not prescribed for you? Prescription medications that may be used this way include: Opioid pain relievers (for example, OxyContin, Vicodin, Percocet, Methadone) Medications for anxiety or sleeping (for example, Xanax, Ativan, Klonopin) Medications for ADHD (for example, Adderall or Ritalin) |
In 2016, a modified version of the NIDA quick-screen was used, based on guidelines found on a drugabuse.gov website referenced in the 2016 source column; the 2016 instructions generally follow the referenced guidelines, whereas the response options include extensive modifications to the quick-screen online tool (specifically, much greater detail). The 2019 versions use the NIDA TAPS rather than the NIDA quick-screen, because the TAPS provides detail/guidance regarding which specific substances to include under which category, particularly with regard to the misuse of prescribed drugs, such as opioids. All HS versions included reformatting what were repeated questions using the same question stem into a chart to facilitate administration. In addition, based on grantee feedback and changing societal laws, the Sept 2019 version moves marijuana out of the 'illegal' drug category and adds it as a separate line; and, to facilitate understanding based on current societal concerns, changes the word 'opiate' to 'opioid'. | ||||
| 19 | Improve Women's/ Maternal Health | Mental Health | benchmark / performance measure; specifically, this screener will help the grantee determine if a woman is at risk for IPV or violence from others besides her partner or ex-partner, so that intervention can be provided if needed. | IPV screener | Increase proportion of Healthy Start women participants who receive intimate partner violence (IPV) screening to 100%. | Strengthen Family Resilience | The percent of HS women participants who receive intimate partner violence screening. (HS5) | PM 14: 100% of Healthy Start women participants who receive intimate partner violence screening. | PRAMS Standard Phase 6, Z1, Z5 | This question is about things that may have happened during your most recent pregnancy. For each thing, circle Y (Yes) if it happened to you or circle N (No) if it did not. During your most recent pregnancy— No Yes a. Your husband or partner threatened you or made you feel unsafe in some way N ...................................................................................................................Y b. You were frightened for the safety of yourself or your family because of the anger or threats of your husband or partner ...............................................N Y c. Your husband or partner tried to control your daily activities, for example, controlling who you could talk to or where you could go .............................N Y d. Your husband or partner forced you to take part in touching or any sexual activity when you did not want to .....................................................................................N Y Z5. During the 12 months before you got pregnant with your new baby, did an ex-husband or ex-partner push, hit, slap, kick, choke, or physically hurt you in any other way? □ No □ Yes |
We are concerned about the safety of all participants. Please answer the following questions about experiences that you may have had during the past 12 months so that we can help you if needed. STAFF: Please read each question to participant and enter one response for each question. Q# During the past 12 months… Yes No Declined to answer 44.1 Did your husband or partner threaten or make you feel unsafe in some way? 44.2 Were you frightened for your safety or your family’s safety because of the anger or threats of your husband or partner? 44.3 Did your husband or partner try to control your daily activities, for example, control who you could talk to or where you could go? 44.4 Did your husband or partner push, hit, slap, kick, choke, or physically hurt you in any other way? 44.5 Did your husband or partner force you to take part in touching or any sexual activity when you did not want to? 44.6 Did anyone else physically hurt you in any way? |
PRAMS Phase 8 Core 28, Standard Z1 | In the 12 months before you got pregnant with your new baby, did any of the following people push, hit, slap, kick, choke, or physically hurt you in any other way? For each person, check No if they did not hurt you during this time, or Yes if they did. a. My husband or partner b. My ex-husband or ex-partner c. State option (Another family member) d. State option (Someone else) During your most recent pregnancy, did any of the following things happen to you? For each thing, check No if it did not happen to you or Yes if it did. No Yes a. My husband or partner threatened me or made me feel unsafe in some way b. I was frightened for my safety or my family’s safety because of the anger or threats of my husband or partner c. My husband or partner tried to control my daily activities, for example, controlling who I could talk to or where I could go d. My husband or partner forced me to take part in touching or any sexual activity when I did not want to |
During the past 12 months… During the past 12 months….. Spouse or Partner Ex-Spouse or Ex-Partner Other Family Member Someone Else No-one Declined to answer a. Did any of these people threaten or make you feel unsafe in some way? b. Were you frightened for your safety or your family’s safety because of the anger or threats of any of these people? c. Did any of these people try to control your daily activities, for example, control who you could talk to or where you could go? d. Did any of these people push, hit, slap, kick, choke, or physically hurt you in any other way? e. Did any of these people force you to take part in touching or any sexual activity when you did not want to? Did one of these people push, hit, slap, kick, choke, or physically hurt you in any other way? Did one of these people force you to take part in touching or any sexual activity when you did not want to? |
same as May 2019 | same as May 2019 | We are concerned about the safety of all participants. Please answer the following questions so that we can help you if needed. During the past 12 months, has anyone… During the past 12 months has anyone… Current or Former Intimate Partner Other Family Member Someone Else No-one Declined to answer a. Threatened you or made you feel unsafe in some way? b. Made you feel frightened for your safety or your family’s safety because of their anger or threats? c. Tried to control your daily activities, for example, control who you could talk to or where you could go? d. Pushed, hit, slapped, kicked, choked, or physically hurt you in any other way? e. Forced you to take part in touching or any sexual activity when you did not want to? |
The 2019 item was updated to PRAMS Phase 8. |
| 20 | Improve Women's/ Maternal Health | Mental Health | benchmark / performance measure; this staff notation documents that the participant has completed the IPV screener, for the purpose of evaluating progress towards this as a performance measure; this notation can be cross-checked with the items from the actual screening tool to verify the staff notation. However, creating a separate variable for this makes it possible for HS staff who do not have specialized training in statistics to pull the needed information up from a database. |
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Increase proportion of Healthy Start women participants who receive intimate partner violence (IPV) screening to 100%. | Strengthen Family Resilience | The percent of HS women participants who receive intimate partner violence screening. (HS5) | PM 14: 100% of Healthy Start women participants who receive intimate partner violence screening. | not directly asked | Staff record generated by program for programmatic purpose | N/A | Staff: has this participant responded to the IPV screening questions above? Yes No |
Staff record generated by program for programmatic purpose | N/A | Staff, Indicate IPV screening status below: Screening completed (all questions answered) Screening not completed due to o Presence of partner o Presence of family member/friend o Participant declined to answer one or more questions o Other reason, please specify____________ |
This direct question makes information directly responsive to the IPV screening performance measure easier for a lay person to pull up. | ||
| 21 | Improve Women's/ Maternal Health | Reproductive Life Plan | benchmark / performance measure; a reproductive life plan is designed to help a woman think about her childbearing plans and the steps she needs to take to achieve those, with the long-term goal of improving the health of both the reproductive-age woman and any infants she has. | RPL-more children desired? | Increase the proportion of Healthy Start women participants who have a documented reproductive life plan to 90%. | Improve Women’s Health | The percent of Healthy Start women participants that have a documented reproductive life plan. (HS1) | PM 11: 90% of Healthy Start women participants that have a documented reproductive life plan. | Questions based on examples and information found in a Reproductive Life Plan brochure entitled, 'Steps to a Healthier Baby and Me,' available by following links at: https://www.cdc.gov/preconception/showyourlove/documents/Healthier_Baby_Me_Plan-508.pdf | I want to have ___child or children. | Do you plan to have any children? Select one only. Yes (Go to question 42.1) No (Go to question 43) Unable to get pregnant [Survey is Complete] Don’t know (Go to question 43) Declined to answer(Go to question 43) 42.2 Would you like to become pregnant in the next year? Select one only. Yes (Go to question 43) No (Go to question 42.3) I am okay either way (Go to question 43) Don’t know (Go to question 42.3) Declined to answer (Go to question 42.3) 42.3 How long would you like to wait until you become pregnant? Select one only. 1 year -17 months 18 months to 2 years More than 2 years Don’t know Declined to answer |
Every Woman California, Preconception Health Council of California, Your Future and Children, http://www.everywomancalifornia.org/content_display.cfm?categoriesID=68&contentID=461 | Do you want any more children? |
No [Complete question 25, then skip to question 29] Yes [Go to question 26] Unable to get pregnant [Skip to question 29] Don’t know [Go to question 25] Declined to answer [Go to question 25] |
same as May 2019 | same as May 2019 | Do you want any (more) children? Yes [Go to next question] No [Skip to question 24] Unable to get pregnant [Skip to question 25] Don’t know [Skip to question 24] Declined to answer [Skip to question 24] |
To assess whether a woman has established a reproductive life plan (and to help her establish one if she has not), the 2016 version adopted a series of (unstandardized) questions based on statements from a brochure linked through an HHS/CDC website (updated URL listed here as 2016 source). (One purpose of including RLP questions in this form is to provide an RLP template that is standard across grantees.) In searching this year for reproductive life plans, although I was not able to find a 'standardized' set of questions, I was able to locate a very thoughtful RLP template put together by Every Woman California, Preconception Health Council of California, "Your Future and Children." The 2019 versions are based on this set of questions. The modifications made primarily reflect formatting, ordering, and elaboration of the set of questions provided in the referenced Every Woman California source; in addition, an 'unable to get pregnant' option used in the 2016 version was retained to allow interviewers to be as sensitive as possible to participant situations when asking these questions. The wording for this set of questions is unchanged between the May and Sept 2019 versions. |
| 22 | Improve Women's/ Maternal Health | Reproductive Life Plan | benchmark / performance measure; a reproductive life plan is designed to help a woman think about her childbearing plans and the steps she needs to take to achieve those, with the long-term goal of improving the health of both the reproductive-age woman and any infants she has. | RPL-total # children desired | Increase the proportion of Healthy Start women participants who have a documented reproductive life plan to 90%. | Improve Women’s Health | The percent of Healthy Start women participants that have a documented reproductive life plan. (HS1) | PM 11: 90% of Healthy Start women participants that have a documented reproductive life plan. | Questions based on examples and information found in a Reproductive Life Plan brochure entitled, 'Steps to a Healthier Baby and Me,' available by following links at: https://www.cdc.gov/preconception/showyourlove/documents/Healthier_Baby_Me_Plan-508.pdf | I want to have ___child or children. | How many children would you like to have? Please enter number of children: _____________Children (Go to question 42.2) Don’t know Declined to answer |
Every Woman California, Preconception Health Council of California, Your Future and Children, http://www.everywomancalifornia.org/content_display.cfm?categoriesID=68&contentID=461 | If you want more children... How Many More Children Do You Want? |
→If you WANT (more) children... How many (more) children do you want? ______________ | same as May 2019 | same as May 2019 | →If you WANT (more) children... How many (more) children do you want? ______________ | To assess whether a woman has established a reproductive life plan (and to help her establish one if she has not), the 2016 version adopted a series of (unstandardized) questions based on statements from a brochure linked through an HHS/CDC website (updated URL listed here as 2016 source). (One purpose of including RLP questions in this form is to provide an RLP template that is standard across grantees.) In searching this year for reproductive life plans, although I was not able to find a 'standardized' set of questions, I was able to locate a very thoughtful RLP template put together by Every Woman California, Preconception Health Council of California, "Your Future and Children." The 2019 versions are based on this set of questions. The modifications made primarily reflect formatting, ordering, and elaboration of the set of questions provided in the referenced Every Woman California source; in addition, an 'unable to get pregnant' option used in the 2016 version was retained to allow interviewers to be as sensitive as possible to participant situations when asking these questions. The wording for this set of questions is unchanged between the May and Sept 2019 versions. |
| 23 | Improve Women's/ Maternal Health | Reproductive Life Plan | benchmark / performance measure; a reproductive life plan is designed to help a woman think about her childbearing plans and the steps she needs to take to achieve those, with the long-term goal of improving the health of both the reproductive-age woman and any infants she has. | RPL-when would participant like to become pregnant? | Increase the proportion of Healthy Start women participants who have a documented reproductive life plan to 90%. | Improve Women’s Health | The percent of Healthy Start women participants that have a documented reproductive life plan. (HS1) | PM 11: 90% of Healthy Start women participants that have a documented reproductive life plan. | Questions based on examples and information found in a Reproductive Life Plan brochure entitled, 'Steps to a Healthier Baby and Me,' available by following links at: https://www.cdc.gov/preconception/showyourlove/documents/Healthier_Baby_Me_Plan-508.pdf | I want to have children ____ years apart | How long would you like to wait until you become pregnant? Select one only. 1 year -17 months 18 months to 2 years More than 2 years Don’t know Declined to answer |
Every Woman California, Preconception Health Council of California, Your Future and Children, http://www.everywomancalifornia.org/content_display.cfm?categoriesID=68&contentID=461 | How long do you plan to wait until you become pregnant again? |
→If you WANT (more) children... How long do you plan to wait until you become pregnant (again)? ___________________ |
same as May 2019 | same as May 2019 | →If you WANT (more) children... How long do you plan to wait until you become pregnant (again)? ___________________ |
To assess whether a woman has established a reproductive life plan (and to help her establish one if she has not), the 2016 version adopted a series of (unstandardized) questions based on statements from a brochure linked through an HHS/CDC website (updated URL listed here as 2016 source). (One purpose of including RLP questions in this form is to provide an RLP template that is standard across grantees.) In searching this year for reproductive life plans, although I was not able to find a 'standardized' set of questions, I was able to locate a very thoughtful RLP template put together by Every Woman California, Preconception Health Council of California, "Your Future and Children." The 2019 versions are based on this set of questions. The modifications made primarily reflect formatting, ordering, and elaboration of the set of questions provided in the referenced Every Woman California source; in addition, an 'unable to get pregnant' option used in the 2016 version was retained to allow interviewers to be as sensitive as possible to participant situations when asking these questions. The wording for this set of questions is unchanged between the May and Sept 2019 versions. |
| 24 | Improve Women's/ Maternal Health | Reproductive Life Plan | benchmark / performance measure; a reproductive life plan is designed to help a woman think about her childbearing plans and the steps she needs to take to achieve those, with the long-term goal of improving the health of both the reproductive-age woman and any infants she has. | RPL-birth control until ready to become pregnant? | Increase the proportion of Healthy Start women participants who have a documented reproductive life plan to 90%. | Improve Women’s Health | The percent of Healthy Start women participants that have a documented reproductive life plan. (HS1) | PM 11: 90% of Healthy Start women participants that have a documented reproductive life plan. | Questions based on examples and information found in a Reproductive Life Plan brochure entitled, 'Steps to a Healthier Baby and Me,' available by following links at: https://www.cdc.gov/preconception/showyourlove/documents/Healthier_Baby_Me_Plan-508.pdf | Make sure I have my chosen method of contraception. IUD or implant. Depo-Provera (contraceptive shot). Birth control pills, patch, or ring. Condoms. Spermicidal gel, cream, foam, suppository, or sponge. there are no holes, and I use it every time |
43. Are you currently using any form of contraception or birth control to either prevent pregnancy or prevent sexually transmitted infections? Select one only. Yes (Go to question 43.1) No [Screening Tool is Complete] Don’t know [Screening Tool is Complete] Declined to answer [Screening Tool is Complete] |
Every Woman California, Preconception Health Council of California, Your Future and Children, http://www.everywomancalifornia.org/content_display.cfm?categoriesID=68&contentID=461 | Are you using a method of birth control to make sure you do not get pregnant before you are ready? |
→If you WANT (more) children... Are you using a method of birth control to make sure you do not get pregnant before you are ready?Select one only. Yes No Don’t know Declined to answer All women… Are you currently using a condom to prevent sexually transmitted infections? Select one only. Yes No Don’t know Declined to answer |
PRAMS Phase 8 Core 45 | What kind of birth control are you or your husband or partner using now to keep from getting pregnant? Check ALL that apply Tubes tied or blocked (female sterilization or Essure®) Vasectomy (male sterilization) Birth control pills Condoms Shots or injections (Depo-Provera®) Contraceptive patch (OrthoEvra®) or vaginal ring (NuvaRing®) IUD (including Mirena®, ParaGard®, Liletta®,or Skyla®) Contraceptive implant in the arm (Nexplanon® or Implanon® ) Natural family planning (including rhythm method) Withdrawal (pulling out) Not having sex (abstinence) Other: Please tell us: |
All participants... What kind of birth control are you using now to keep from getting pregnant before you are ready? Or, if you are currently pregnant, what method do you plan to use following your pregnancy to prevent becoming pregnant again before you are ready? Select all that apply. Tubes tied or blocked (female sterilization or Essure®) Vasectomy (male sterilization) Birth control pills Condoms Shots or injections (Depo-Provera®) Contraceptive patch (OrthoEvra®) or vaginal ring (NuvaRing®) IUD (including Mirena®, ParaGard®, Liletta®,or Skyla®) Contraceptive implant in the arm (Nexplanon® or Implanon® ) Natural family planning (including rhythm method) Withdrawal (pulling out) Not having sex (abstinence) Other, Please specify ________ None Don’t know Declined to answer |
Based on Aug 2019 grantee piloting feedback, a PRAMS item offering response options for different kinds of birth control methods was used in the Set 2019 version. The Sept 2019 version adds women who are currently pregnant in the question stem, reflecting the broader set of women, compared to the PRAMS, that this question is targeted to. In addition, the 2016 RLP question regarding birth control use combined preventing pregnancy and preventing STDs into a single question. The 2019 version separates these 2 out to reflect the fact that a currently pregnant (or infertile) woman may not need birth control to prevent pregnancy, but they nonetheless need to consider protection against STDs. |
| 25 | Improve Women's/ Maternal Health | Reproductive Life Plan | benchmark / performance measure; a reproductive life plan is designed to help a woman think about her childbearing plans and the steps she needs to take to achieve those, with the long-term goal of improving the health of both the reproductive-age woman and any infants she has. The use of a condom to prevent STDs is an important consideration for all women and is typically included in a reproductive life plan (RPL). | RPL-condom to prevent STDs? | Increase the proportion of Healthy Start women participants who have a documented reproductive life plan to 90%. | Improve Women’s Health | The percent of Healthy Start women participants that have a documented reproductive life plan. (HS1) | PM 11: 90% of Healthy Start women participants that have a documented reproductive life plan. | Not asked separately | generated by program for programmatic purposes | no standardized survey question asking about condom use in relation to STIs was identified | All women… Are you currently using a condom to prevent sexually transmitted infections? Select one only. Yes No Don’t know Declined to answer |
same as May 2019 | same as May 2019 | All participants… Are you currently using a condom to prevent sexually transmitted infections? Select one only. Yes No N/A—not sexually active Don’t know Declined to answer |
The 2016 RLP question regarding birth control combined prevent pregnancy and prevent STIs into a single question. The 2019 version separates these 2 out to reflect the fact that a currently pregnant (or infertile) woman may not need birth control to prevent pregnancy, but they nonetheless need to consider protection against STIs. | ||
| 26 | Improve Women's/ Maternal Health | Reproductive Life Plan | benchmark / performance measure; a reproductive life plan is designed to help a woman think about her childbearing plans and the steps she needs to take to achieve those, with the long-term goal of improving the health of both the reproductive-age woman and any infants she has. This staff notation documents that the participant has completed an RPL, for the purpose of evaluating progress towards this as a performance measure; this notation can be cross-checked with the items from the actual screening tool to verify the staff notation. However, creating a separate variable for this makes it possible for HS staff who do not have specialized training in statistics to pull the needed information up from a database. | Does this participant have a current reproductive life plan (RPL)? | Increase the proportion of Healthy Start women participants who have a documented reproductive life plan to 90%. | Improve Women’s Health | The percent of Healthy Start women participants that have a documented reproductive life plan. (HS1) | PM 11: 90% of Healthy Start women participants that have a documented reproductive life plan. | not directly asked | Staff record generated by program for programmatic purpose | N/A | Staff: has this participant responded to the questions in this section, as appropriate, to create her Reproductive Life Plan? Yes No |
same as May 2019 | same as May 2019 | Staff: has this participant responded to the questions in this section, as relevant, to create a satisfactory Reproductive Life Plan (RPL)? [that is, if she does not want (more) children, she has identified a method of birth control to use to prevent pregnancy (q 24); or if she does want (more) children, she has thought about how many (q 22), and their spacing (q 23) and how to prevent pregnancy until she is ready (q 24).] Yes, participant has completed all relevant items to create a satisfactory RPL Participant responded to at least some of the questions but the RPL leaves her/him vulnerable to unplanned pregnancies No, was not able to administer this |
This direct question makes information directly responsive to the RLP performance measure easier for a lay person to pull up. Wording modified based on Aug 2019 grantee pilot feedback. | ||
| 27 | Quality Improvement | Supports Accurate Reporting and Quality Control | Supports understanding/ documentation of who the program is serving, with the goal of improving the quality of services provided, with the ultimate goal of improving the health of reproductive age women and so also the health of her pregnancies and infants; specifically, documenting where the participant is in the reproductive cycle allows the grantee to determine the types of services the participant is likely to need at that time point. Women who are pregnant will need attention to pregnancy-related needs. Knowing this information will aid in the allocation of different types of resources in order to assure women's/maternal health. | pregnancy status | 2013-2015 NSFG Female Questionnaire, #BA-2 | Are you pregnant now? Yes ........1 No .........5 |
Are you pregnant now? Select one only. Yes (Go to question 1.1 AND Complete the Prenatal Screening Tool) No (Go to question 2) Don’t know (Go to question 2) Declined to answer (Go to question 2) |
2015-2017 NSFG Female Questionnaire, #BA-2 | Are you pregnant now? Yes ........1 No .........5 |
Are you pregnant now? Select one only. Yes [Complete the Prenatal Mandatory Questions] No Don’t know Declined to answer |
same as May 2019 | same as May 2019 | Are you pregnant now? Select one only. Yes [Participant will need to complete the mandatory Prenatal Form] No Don’t know Declined to answer |
The wording for this item has remained unchanged across the 3 versions, and compared to the standardized wording in the NSFG. This question allows the grantee to determine whether a participant is in the prenatal phase and will thus need corresponding services. The 2019 versions contain a staff instruction with regard to following up with the Prenatal Form if the woman is currently pregnant. | ||||
| 28 | Health Equity – MCH Outcomes | Prior Pregnancy / Infant Outcomes | Supports understanding/ documentation of who the program is serving with the long term goal of reducing health inequities; specifically, if a woman has had prior pregnancies that ended in miscarriage or fetal death, then this suggests that this woman may be at elevated risk with regard to her current or future pregnancy outcomes. Documenting this kind of pre-existing risk: (a) demonstrates need for HS services, and (b) can provide a baseline for evaluating pregnancy outcomes while receiving HS services. | pregnancy history | NSFG 2013-2015 Female Questionnaire BC0-BC4a - summary of previous pregnancies vs. one by one | { PREGNANCY LOOP BEGINS HERE. { THESE QUESTIONS ARE ASKED FOR EACH COMPLETED PREGNANCY.BC-0. Now I'd like to ask some questions specifically about your (PREGFILL) pregnancy. (Remember, we’ll be talking about each of your pregnancies in the order they occurred.)BC-1. In which of the ways shown on Card 12 did the pregnancy end? If pregnancy had more than one type of outcome, such as miscarriage and live birth, enter all that apply. If pregnancy resulted in multiples (such as twins or triplets) born vaginally and by cesarean section, enter both [5] and [6]. PROBE if R says DK or RF. Do not probe AO. This is a critical item. Miscarriage ..........................1 Stillbirth ...........................2 Abortion .............................3 Ectopic or tubal pregnancy ...........4 Live birth by Cesarean section .......5 Live birth by vaginal delivery ....... BC-1b. I understand that you may not want to answer this question in detail. If you are willing to say, did this pregnancy result in a baby or babies born alive, or did it end in some other way? Live birth ...............1 Some other way ...........5 { IF PREGNANCY ENDED IN ANY LIVE BIRTH NBRNALIV BC-2. (With your (nth) pregnancy,) How many babies did you have that were born alive? Please include babies that may have died shortly after birth and babies that you placed for adoption. Number { IF MORE THAN 1 LIVEBORN BABY REPORTED FROM THIS PREGNANCY MULTBRTH BC-3. Did you have (twins/triplets/all of these babies with this [nth] pregnancy)? Yes ...........1 No ............5 { IF ANY LIVEBORN BABY FROM THIS PREGNANCY, GO TO BC-5 GESTASUN. { IF THIS PREGNANCY DID NOT RESULT IN LIVEBIRTH DATPRGEN_M, DATPRGEN_Y BC-4a. In what month and year did this pregnancy end? After R has given the year, say: Please record the pregnancy in the “Birth or Pregnancy Ending Dates” section below the calendar. Then, if the pregnancy ended in January [YEAR OF INTERVIEW - 3] or later, please record “S" for a stillbirth, “M" for miscarriage or ectopic, or “A" for abortion in the appropriate box on the “Births & Other Pregnancies" row of the calendar. { ASKED FOR EACH COMPLETED PREGNANCY, REGARDLESS OF OUTCOME GESTASUN_M, GESTASUN_W |
Please tell me how your previous pregnancies ended. STAFF: PLEASE READ OUT LOUD the following responses: Live birth, miscarriage, ectopic or tubal pregnancy, abortion, or fetal death or stillbirth, and enter type for each of participant’s five most recent pregnancies. For any live birth and fetal death / stillbirth, please indicate how many babies for each type of pregnancy, and the date of birth. Please indicate the date of miscarriage, ectopic or tubal pregnancy, or abortion for each pregnancy. Pregnancy 1 refers to the most recent pregnancy. Please include information for any child for whom the participant is a caretaker. Live Birth Miscarriage Ectopic or Tubal pregnancy Abortion Fetal Death/Stillbirth Pregnancy 1 # ____ Date: __ / __ / ____ Date: __ / __ / ____ Date: __ / __ / ____ Date: __ / __ / ____ # ____ Date: __ / __ / ____ Pregnancy 2 # ____ Date: __ / __ / ____ Date: __ / __ / ____ Date: __ / __ / ____ Date: __ / __ / ____ # ____ Date: __ / __ / ____ Pregnancy 3 # ____ Date: __ / __ / ____ Date: __ / __ / ____ Date: __ / __ / ____ Date: __ / __ / ____ # ____ Date: __ / __ / ____ Pregnancy 4 # ____ Date: __ / __ / ____ Date: __ / __ / ____ Date: __ / __ / ____ Date: __ / __ / ____ # ____ Date: __ / __ / ____ Pregnancy 5 # ____ Date: __ / __ / ____ Date: __ / __ / ____ Date: __ / __ / ____ Date: __ / __ / ____ # ____ Date: __ / __ / ____ DO NOT READ OUT LOUD: Declined to answer |
NSFG 2015-2017 Female Questionnaire BC1-BC1b - summary of previous pregnancies vs. one by one | BC-1. In which of the ways shown on Card 12 did the pregnancy end? ENTER all that apply. If this pregnancy included had more than one type of outcome, such as miscarriage of one fetus and live birth for the other fetus, enter all that apply. If pregnancy resulted in multiples (such as twins or triplets) born vaginally and by cesarean section, enter both [5] and [6]. If all the babies from this pregnancy were born the same way, enter that code [5] or [6] only once. NOTE: This is a critical item. PROBE if R says DK or RF. Miscarriage ..........................1 Stillbirth ...........................2 Abortion .............................3 Ectopic or tubal pregnancy ...........4 2015-2017 NSFG FEMALE CAPI-Lite OMB No. 0920-0314 18 Live birth by Cesarean section .......5 Live birth by vaginal delivery .......6 {ASKED IF R RESPONDED DK OR REF TO PREGEND HOWENDDK BC-1b. I understand that you may not want to answer this question in detail. If you are willing to say, did this pregnancy result in a baby or babies born alive, or did it end in some other way? Live birth ...............1 Some other way ...........5 |
Select all that apply. Live birth, Specify how many_______ Ectopic or tubal pregnancy Miscarriage (baby died before 20 weeks of pregnancy) Fetal death (baby died before being born) or stillbirth None of the above Don’t know Declined to answer |
same as May 2019 | same as May 2019 | Have you ever had any of the following? Select all that apply. Live birth, Number________ Pregnancy that did not result in a live birth o Ectopic or tubal pregnancy, Number ______ o Miscarriage (pregnancy ended spontaneously before 20 weeks), Number _______ o Stillbirth or fetal death (pregnancy ended at 20 weeks or more), Number _____ o Termination of pregnancy, Number _____ None of the above (no prior pregnancies) Don’t know Declined to answer |
The modifications used across all 3 versions reflect an attempt to condense content that appears in the original source across multiple questions, and then repeated for each prior pregnancy, into a single question, in order to reduce time burden. The 2016 version did this by creating a chart. The 2019 versions do this by creating a checklist that includes number of times each type of event has occurred in the past. The chart was replaced with the checklist in order to simplify reporting and eliminate information that is not needed (eg, precise dates for each past pregnancy event are not needed--interconception intervals are addressed in the parent/child form using a different question/format). Pregnancy termination as a response option and definitions (eg, miscarriage v fetal death) were added to the 2019 versions based on Aug 2019 grantee pilot feedback and public comment. | ||||
| 29 | Health Equity – MCH Outcomes | Pregnancy / Infant Outcomes | Supports understanding/ documentation of who the program is serving with the long term goal of reducing health inequities; specifically, if a woman has had prior pregnancies that ended in preterm birth, then this suggests that this woman may be at elevated risk with regard to her current or future pregnancy outcomes. Documenting this kind of pre-existing risk: (a) demonstrates need for HS services, and (b) can provide a baseline for evaluating pregnancy outcomes while receiving HS services. | previous preterm birth | 2011 NSCH K2Q05 | Was [S.C.] born prematurely, that is, more than 3 weeks before [his/her] due date? (1) YES (2) NO (77) DON'T KNOW (99) REFUSED READ IF NECESSARY: Most pregnancies last about 40 weeks. A premature birth is when a baby is born more than three weeks before the due date. |
Were any of your babies born more than 3 weeks before his or her due date? Select one only. Yes, please specify how many: ________________ No Don’t know Declined to answer |
|
Was this child born more than 3 weeks before his or her due date? Yes No |
Were any of your babies born more than 3 weeks before their due date? Select one only. Yes No Don’t know Declined to answer |
|
A preterm delivery is one that occurs at 36 weeks or earlier in pregnancy. As far as you know, did you have a preterm delivery? Yes ...............1 No ................5 |
A preterm delivery is one that occurs at 36 weeks or earlier in pregnancy. As far as you know, have you had a preterm delivery in the past? Select one only. Yes, How many prior pregnancies delivered more than 3 weeks before due date: _____ No, How many prior pregnancies delivered full term: _____ Don’t know |
Based on grantee feedback and the fact that a history of preterm births is a risk factor for future preterm births, the Sept 2019 version clarifies that we are talking about number of pregnancies delivered preterm, and includes a prompt to specify the number of previous preterm deliveries as well as the number of previous full-term deliveries. Gathering this information will provide a full picture of risk based on previous preterm births for HS participants. | ||||
| 30 | Health Equity – MCH Outcomes | Pregnancy / Infant Outcomes | Supports understanding/ documentation of who the program is serving with the long term goal of reducing health inequities; specifically, if a woman has had prior pregnancies that ended in low birthweight, then this suggests that this woman may be at elevated risk with regard to her current or future pregnancy outcomes. Documenting this kind of pre-existing risk: (a) demonstrates need for HS services, and (b) can provide a baseline for evaluating pregnancy outcomes while receiving HS services. | previous LBW | 2013-2015 NSFG Female Questionnaire #BD-4 - modified to summary question | Did (she/he) weigh 5 1/2 pounds or more, or less than 5 1/2 pounds? 5 1/2 pounds or more ................. 1 Less than 5 1/2 pounds ............... 2 |
Did any of your babies weigh less than 5 pounds, 8 ounces at birth? Select one only. Yes, please specify how many: ________________ No Don’t know Declined to answer |
2015-2017 NSFG Female Questionnaire #BD-4 - modified to summary question | Did (she/he) weigh 5 1/2 pounds or more, or less than 5 1/2 pounds? 5 1/2 pounds or more ................. 1 Less than 5 1/2 pounds ............... 2 |
Did any of your babies weigh less than 5 pounds, 8 ounces at birth? Select one only. Yes No Don’t know |
same as May 2019 | same as May 2019 | Did any of your babies weigh LESS than 5 pounds, 8 ounces [2500 grams] at birth? Select one. Yes, How many babies: _____ No How many babies born normal weight (5 lb, 8 oz -- 9 lb, 4 oz): _____ How many babies born weighing MORE THAN 9 lb 4 oz [4500 grams]: ____ Don’t know Declined to answer |
This item allows further examination of risk history among HS women with regard to past births. In the Sept 2019 version, grams were added as a specification for staff use in case needed, and prompts for number of previous LBW, normal weight, and high-weight births were added, in order to provide a full picture of risk with regard to previous birthweight among HS participants. | ||||
| 31 | Pregnancy / Infant Outcomes | Supports understanding/ documentation of who the program is serving with the long term goal of reducing health inequities; specifically, if a woman has had prior pregnancies that ended in very low birthweight, then this suggests that this woman may be at elevated risk with regard to her current or future pregnancy outcomes. Documenting this kind of pre-existing risk: (a) demonstrates need for HS services, and (b) can provide a baseline for evaluating pregnancy outcomes while receiving HS services. | previous Very Low Birthweight | not asked | not asked | Generated by program for programmatic purposes | N/A | [Staff: skip this question if mother has not had previous babies born less than 5 lb, 8 oz] Thinking about your babies who were born weighing less than 5 pounds, 8 ounces, how many of them weighed LESS THAN 3 pounds, 5 ounces [1500 grams] at birth? Select one. Yes, How many babies: _____ No Don’t know Declined to answer |
Item added based on grantee feedback and internal discussion to document pre-existing risk: (a) demonstrates need for HS services, and (b) can provide a baseline for evaluating pregnancy outcomes while receiving HS services. | |||||||||
| 32 | Health Equity – MCH Outcomes | Pregnancy / Infant Outcomes | Supports understanding/ documentation of who the program is serving with the long term goal of reducing health inequities; specifically, if a woman has had prior pregnancies that ended with an extended hospital stay for the infant, then this suggests that this woman may be at elevated risk with regard to her current or future pregnancy outcomes. Documenting this kind of pre-existing risk: (a) demonstrates need for HS services, and (b) can provide a baseline for evaluating pregnancy outcomes while receiving HS services. | infant hospital stay | CoIIN-Care Coordination - |
N/A | Did any of your babies stay in the hospital after you came home? Select one only. Yes, Please specify reason:________________________ No Declined to answer |
CoIIN-Care Coordination - |
N/A | Did any of your babies stay in the hospital after you came home? Select one only. Yes, Please specify reason:________________________ No Declined to answer |
CoIIN-Care Coordination - |
N/A | Did any of your babies stay in the hospital after you came home? Select one only. Yes, How many_______, Please specify reason _____________________________ No Declined to answer |
An extended hospital stay is an indicator of prior pregnancy complications/poor birth outcomes: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb163.pdf . Wording is unchanged across the three versions. | ||||
| 33 | Health Equity – MCH Outcomes | Pregnancy / Infant Outcomes | Supports understanding/ documentation of who the program is serving with the long term goal of reducing health inequities; specifically, if a woman has experienced previous infant mortality, then this suggests that this woman may be at elevated risk with regard to her current or future infants' outcomes. Documenting this kind of pre-existing risk: (a) demonstrates need for HS services, and (b) can provide a baseline for evaluating outcomes while receiving HS services. | previous infant death? | not directly asked | PRAMS Phase 8 Core 32 | Is your baby alive now? No Yes |
Yes No, Can you tell me how many babies you lost? __________ [Complete next question] Don’t know Declined to answer |
2015-2017 NSFG, BI-4a | With this pregnancy, how many babies did you have that were born alive? Please include babies that may have died shortly after birth and babies that you placed for adoption. ENTER number of babies |
Are all of your babies or children who were born alive still alive? Yes [this form is complete] No [GO TO NEXT QUESTION] Don’t know [this form is complete] Declined to answer [this form is complete] |
Public comment suggested that previous infant mortality be ascertained directly, given its importance as an outcome. In the Sept 2019 version, this is ascertained through a series of two questions plus a staff record. In this first question, the participant is asked essentially whether all her previous babies or children are still alive. | ||||||
| 34 | Health Equity – MCH Outcomes | Pregnancy / Infant Outcomes | Supports understanding/ documentation of who the program is serving with the long term goal of reducing health inequities; specifically, if a woman has experienced previous infant mortality, then this suggests that this woman may be at elevated risk with regard to her current or future infants' outcomes. Documenting this kind of pre-existing risk: (a) demonstrates need for HS services, and (b) can provide a baseline for evaluating outcomes while receiving HS services. | number of previous infant mortalities | not directly asked | not asked separately | generated by program for programmatic purposes | N/A | [If mother indicates prior loss of child in previous question:] Can you tell me how many babies or children you have lost? __________ |
Public comment and Aug 2019 grantee pilot feedback were used to create questions that would directly address the issue of infant mortality. | ||||||||
| 35 | Health Equity – MCH Outcomes | Pregnancy / Infant Outcomes | Supports understanding/ documentation of who the program is serving with the long term goal of reducing health inequities; specifically, if a woman has experienced previous infant mortality, then this suggests that she may be at elevated risk with regard to her current or future infant's outcomes. Documenting this kind of pre-existing risk: (a) demonstrates need for HS services, and (b) can provide a baseline for evaluating outcomes while receiving HS services. Staff are asked to complete this item after sensitively probing the participant for the age of her child's death. This staff notation documents whether the child died in first 27 days of life (neonatal death), under 1 year of life (infant mortality), or later. | staff record re: infant mortality | not directly asked | generated by program for programmatic purpose | N/A | Staff: If participant has experienced the loss of a child, sensitively probe for the child’s or children’s age(s) at death and select one or more of the following: Indicate number of children who died within first 27 days of life:_______ Indicate number of children who died before one year of age:______ Indicate number of children who died at 12 months or older: _____ |
Generated by program for programmatic purposes | N/A | [Staff, sensitively probe for the child’s or children’s age(s) at death and record below:] Number of children who died within 0 to 27 days of life:_______ Number of children who died 28 to 364 days after birth:______ Number of children who died at 12 months or older: _____ |
Age of child at death needed to determine infant mortality. Given emotional nature of the topic, case workers are advised to probe sensitively for this information. | ||||||
| cover page | Quality Improvement | Supports Accurate Reporting and Quality Control | Supports understanding/ documentation of who the program is serving with the goal of improving the quality of services provided, with the ultimate goal of improving the health of reproductive age women and so also the health of her pregnancies and infants; specifically, documenting where the participant is in the reproductive phase (preconception, pregnancy, postpartum, interconception/parenting) allows the grantee to determine the types of services the participant is likely to need at that time point. Knowing this information will aid in the allocation of different types of resources in order to assure women's/maternal health. | phase of HS participation | not asked | Staff record--generated by program for programmatic purpoes | N/A | Staff: Determine phase(s) of the reproductive cycle that woman will be receiving services in. Select all that apply. Preconception (no living children) Prenatal (currently pregnant) Postpartum (has a living baby at home under 6 months old) Parenting/Interconception (has a living child at home 6-18 months old, or older children) |
Staff record--generated by program for programmatic purpoes | N/A | What Phase of the Reproductive Cycle is the Enrolled Woman Currently in? Preconception (no prior pregnancies) Prenatal (currently pregnant) Postpartum (has a live infant less than 6 months old) Parenting/Interconception (has child[ren] 6 months or older, or a recent pregnancy terminated without a live birth) |
The current tools do not have a way of determining which phase of HS participation a particular woman is in, apart from making note of which screening tool she completed. Asking this information explicitly and recording it as a variable in the dataset will allow for greater flexibility in pulling up different sets of information. In addition, it serves as a check on the number of women served in each reproductive phase, and provides a stable denominator across grantees for these numbers. | ||||||
| cover page | Quality Improvement | Supports Accurate Reporting and Quality Control | Supports analysis and reporting of benchmarks; when the woman entered HS is critical for understanding whether any pregnancy or pregnancy-related health outcomes occurred while she was in HS or not. | date of enrollment in the HS program | not asked | Staff record--generated by program for programmatic purpoes | N/A | On cover page: Date of Participant Enrollment in Healthy Start Program: _____ | Staff record--generated by program for programmatic purpoes | N/A | Date of Enrollment in Healthy Start: Primary Participant_________________ Accompanying Adult _____________ Enrolled Child if applicable ______________ |
A significant issue with the 2017 data has been that there is no way to determine the length of time a mother has been with the HS program. That information is recorded here in order to correct this issue. In addition, date of enrollment is important for calculating several of the performance measures. Question was simplified for May 2019 revision based on public comment, and then further refined to differentiate among enrolled woman, enrolled child, and accompanying adult (eg, fathers) based on Aug 2019 grantee pilot feedback. | ||||||
| cover page | Quality Improvement | Supports Accurate Reporting and Quality Control | Supports understanding/ documentation of who the program is serving, with long-term goal of reducing health inequities; specifically, capturing a respondent's relationship to the participant as well as relationship to any participating child, will clarify situations in which the person completing the background questionnaire is not actually the biological mother. This may be important information if, eg, there are a large number of 'don't know' responses in a questionnaire. | participant type | not asked | Staff record--generated by program for programmatic purpoes | N/A | On cover page: Relationship of Respondent to Participant: ______ • Relationship of Respondent to any Unborn Child (Prenatal Phase):________________ • Relationship of Respondent to Participating Child 0-18 months (Parent/Child Phase): ___________________ |
Staff record--generated by program for programmatic purpoes | N/A | Participant Type: Primary Participant Enrolled woman (woman is primary parent receiving support) Enrolled father (father is primary parent receiving support) Accompanying Adult [Select all that apply] Primary Participant’s spouse or partner Enrolled child’s co-parent Other caregiver with primary responsibility for the care of the enrolled child, or support person attending with Primary Participant on a regular basis There is at least one child participant linked to this Primary Participant (information form for the child is located in the Parent/Child form) Yes [child unique ID must be listed in the gray box above] No |
The intent here is to provide a way to track participating adult males, such as an enrolled woman's spouse or the father of the enrolled child if there is no enrolled woman. This has been revised based on Aug 2019 grantee pilot feedback. | ||||||
| cover page | Health Equity – MCH Outcomes | Who Does HS Serve? | Supports understanding/ documentation of who the program is serving, with the long term goal of reducing health inequities. Specifically, different geographical settings are associated with differential access to health care, thus increasing need among participants for HS services. | grantee urban v. rural setting | not included in client-level dataset | HS Reporting Requirements | N/A |
Urban Rural Tribal Border Border |
HS reporting requirements | N/A | WHAT TYPE OF AREA DOES THIS GRANTEE SITE SERVE: Urban Rural Tribal Border |
Geographic setting is a significant factor of the grant that could contribute to outcomes across the grantees. Including this information in the client-level database will facilitate examining grantee data by urban/rural differences. | ||||||
| cover page | Health Equity – MCH Outcomes | Who Does HS Serve? | Supports understanding/ documentation of who the program is serving, with the long term goal of reducing health inequities. Specifically, different regions of the country are associated with differential rates of high-risk pregnancies, and birth outcomes such as preterm birth, LBW, and neonatal death. Taking into account which region of the country a woman lives in (as well as other risk factors), can provide a better comparison point for these birth outcomes than national rates alone, and thus provide context for outcomes among women who participate in HS during pregnancy. | grantee region | not included in client-level dataset | not included in client-level data | HS reporting requirements | N/A | WHAT REGION IS THIS GRANTEE SITE LOCATED IN: I II III V VII IX IV VI VIII X |
HRSA Regional categories that grantees are distributed within may provide context for differences in birth outcomes that may arise across HS participants. Including this information in the client-level database will facilitate examining grantee data by region. | ||||||||
| cover page | Quality Improvement | Supports Accurate Reporting and Quality Control | Supports analysis and reporting of benchmarks; date that form is completed is used to complete age-and time-related variables and ensures accuracy in reporting. | date of form completion | CoIIN-Care Coordination - |
N/A | Date of Completion: __________________ | CoIIN-Care Coordination - |
N/A | Date of Form Completion: ___________________ | CoIIN-Care Coordination - |
N/A | Date of Background Information Form Completion: ___________________ | Allows calculation of age- or time-related measures, with goal of ensuring accuracy in reporting. | ||||
| Question # | Priority Area Addressed | Topic | Purpose of Item | Target Information | Benchmark (EPIC Center Data Dictionary) | Goal | Related DGIS measure | Related PM | Source of 2016 item | Exact Wording of Standardized Survey Item, 2016 | Wording Used in 2016 Version | Source of May 2019 Item | Exact Wording of Standardized Survey Item, May 2019 | Wording Used in May 2019 Version | Source of Sept 2019 Version | Exact Wording of Standardized Survey Item, Sept 2019 | Wording Used in Sept 2019 Version | Rationale for Change |
| 1 | Quality Improvement | Supports Accurate Reporting and Quality Control | Supports calculation of information the grantee needs for reporting requirements, with long-term goal of reducing gap in aggregate versus client-level reporting, and ensuring accuracy in reporting. In addition, date of birth can be used in conjunction with date of administration to calculate child's age at visit. | child's date of birth | CoIIN/per discussion with OER 5/5/16--included in postpartum tool | When was your baby / were your babies born? STAFF: Enter birth date for each baby. Date: (month/day/year) Baby 1 __/__/____ Baby 2 __/__/____ Baby 3 __/__/____ Baby 4 __/__/____ |
Generated by program for programmatic purposes | N/A | When was your baby born? Date of birth: [mo./day/year] __________________ |
same as May 2019 | same as May 2019 | When was your baby born? Date of birth: [mo/day/year] __________________ |
Changed in 2019 versions to focus on just one child at a time, with each child requiring a separate Parent/Child form, in order to support accuracy in reporting. | |||||
| 2 | Quality Improvement | Supports Accurate Reporting and Quality Control | Supports analysis and reporting of benchmarks; when the woman entered HS is critical for understanding whether any pregnancy or pregnancy-related health outcomes occurred while she was in HS or not. The time units provided here matches an important reporting question, and having this question here with the preceding question allows for verification and promotes accuracy in reporting. | child enrollment relative to pregnancy | not asked | HS Reporting Requirements | N/A | Did you enroll in Healthy Start: Prior to your pregnancy with this child While pregnant or within/through 30 days after delivery of this child More than 30 days after this baby’s birth |
HS Reporting Requirements | N/A | Was this child: Select one of the options below. Receiving HS services before birth (i.e., ‘born into the program’) Part of a family enrolled for services within 30 days following child’s birth Part of a family enrolled for services more than 30 days following child’s birth o If enrolled more than 30 days following birth, please indicate child’s age at enrollment _______ |
Suggested by public comment to support calculations needed for aggregate reporting requirements; in addition, it provides clarification/verification for questions 1 and 2, and should help with long-term goal of closing the gap between aggregate level and client-level reporting. | ||||||
| 3 | Health Equity - MCH Outcomes | Who Does HS Serve? | Supports understanding/ documentation of who the program is serving with long-term goal of reducing health inequities; specifically, past research has found that inequities exist in child health outcomes based on race and ethnicity, so capturing this information about our participants will enable us to track outcomes among vulnerable populations. | child ethnicity | not asked | https://aspe.hhs.gov/basic-report/hhs-implementation-guidance-data-collection-standards-race-ethnicity-sex-primary-language-and-disability-status | "The OMB minimum categories for ethnicity are: Hispanic or Latino and Not Hispanic or Latino" | Is this child of Hispanic or Latino/a origin? Select one only. No Yes Don't Know Declined to answer |
same as May 2019 | same as May 2019 | Is this child of Hispanic or Latino/a origin? Select one only. Yes, of Hispanic or Latino/a origin No, Not of Hispanic or Latino/a origin Don't Know Declined to answer |
Information on child ethnicity was suggested by public comment to support reporting requirements. May 2019 version used yes/no format as response options to 'are you of Hispanic or Latino/a origin.' The Sept 2019 wording exactly follows OMB 'minimal set' of guidelines for ethnicity by wording response options as 'yes, of Hispanic or Latino/a origin' and 'No, Not of Hispanic or Latino/a origin.' | ||||||
| 4 | Health Equity - MCH Outcomes | Who Does HS Serve? | Supports understanding/ documentation of who the program is serving with long-term goal of reducing health inequities; specifically, past research has found that inequities exist in child health outcomes based on race and ethnicity, so capturing this information about our participants will enable us to track outcomes among vulnerable populations. | child race | not asked | https://aspe.hhs.gov/basic-report/hhs-implementation-guidance-data-collection-standards-race-ethnicity-sex-primary-language-and-disability-status | "The OMB minimum categories for race are: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White." | What is this child’s racial background(s)? Select one or more. American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White or Caucasian Declined to answer Don’t know |
same as May 2019 | same as May 2019 | What is this child’s race? Select all that apply. American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Other, specify ______________ Don’t know Declined to answer |
Information on child race was added to 2019 versions based on public comment in order to support reporting requirements. | ||||||
| 5 | Health Equity - MCH Outcomes | Pregnancy/ Infant Outcomes | Supports understanding/ documentation of who the program is serving with the long term goal of reducing health inequities; specifically, if a woman enters HS with an infant under 18 months old, and that infant represents a preterm birth, then this suggests that this woman may be at elevated risk with regard to current or future pregnancy outcomes. Documenting this kind of pre-existing risk: (a) demonstrates need for HS services, and (b) can provide a baseline for evaluating pregnancy and child outcomes while receiving HS services. | weeks gestation | 2013-2015 NSFG Female Question-naire #BC-5 | How many months or weeks had you been pregnant when (the baby was born/the [MULT] were born/that pregnancy ended)? | How many weeks pregnant were you when your baby was/babies were born? STAFF: Please enter number of weeks. _____________weeks Don’t know Declined to answer |
2015-2017 NSFG Female Questionnaire #BC-5 | How many months or weeks had you been pregnant when (the baby was born/the [MULT] were born/that pregnancy ended)? | How many weeks pregnant were you when he/she was born? STAFF: Please enter number of weeks. ________weeks Don’t know Declined to answer |
same as May 2019 | same as May 2019 | How many weeks pregnant were you when he/she was born? STAFF: Please enter number of weeks. If mother does not know number of weeks, help her calculate backwards from the baby’s original due date to determine weeks gestation at birth. ________weeks Don’t know Declined to answer |
In the new tools, parents are instructed to complete a separate form for each participating child, so plural (your babies etc) changed to his/her. In addition, due to complications in the 2017 data related to accepting info in both weeks and months, weeks are specified in the 2019 versions in order to increase accuracy in reporting. For the Sept 2019 version, additional instructions have been added for staff if mother does not know how many weeks pregnant she was when baby was born. | ||||
| 6 | Health Equity - MCH Outcomes | Pregnancy/ Infant Outcomes | Supports understanding/ documentation of who the program is serving with the long term goal of reducing health inequities; specifically, if a woman enters HS with an infant under 18 months old, and that infant represents a preterm birth, then this suggests that this woman may be at elevated risk with regard to current or future pregnancy outcome. Documenting this kind of pre-existing risk: (a) demonstrates need for HS services, and (b) can provide a baseline for evaluating pregnancy and child outcomes while receiving HS services. | birth weight | 2013-2015 NSFG Female Questionnaire #BD-3 | How much did (BABYFILL /this (NTH) baby) weigh at birth? Pounds and ounces _______ |
How much did your baby/babies weigh at birth? STAFF: Enter weight in pounds and ounces for each baby. Weight in pounds and ounces Don’t know Declined to answer Baby 1 ____pounds ____ounces Baby 2 ____pounds ____ounces Baby 3 ____pounds ____ounces Baby 4 ____pounds ____ounces |
2015-2017 NSFG Female Questionnaire #BD-3 | How much did (BABY NAME) weigh at birth? Pounds and ounces _______ |
______pounds, ______ounces OR grams __________ Don’t know Declined to answer |
same as May 2019 | same as May 2019 | How much did he/she weigh at birth? ______pounds, ______ounces OR grams __________ Don’t know Declined to answer |
Plural pronouns used in 2016 changed to singular 'his/her' to reflect the fact that a separate form will be completed for each child. Including weight in grams as an option was introduced in May 2019 version based on public comment. The original standardized wording uses only pounds/ounces. | ||||
| 7 | Health Equity - MCH Outcomes | Pregnancy/ Infant Outcomes | Supports understanding/ documentation of who the program is serving with the long term goal of reducing health inequities; specifically, if a woman enters HS with an infant under 18 months old, and that infant was low birthweight, then this suggests that this woman may be at elevated risk with regard to current or future pregnancy outcome. Documenting this kind of pre-existing risk: (a) demonstrates need for HS services, and (b) can provide a baseline for evaluating pregnancy and child outcomes while receiving HS services. | LBW indicator | not asked | Staff record: generated by program for programmatic purposes | N/A | Staff: Please check appropriate box below for baby’s birthweight: Very low birthweight (Less than 3 pounds 5 ounces or 1500 grams) Low birthweight (Less than 5 pounds 8 ounces or 2500 grams) High birthweight (More than 9 pounds 4 ounces or 4200 grams) Normal weight range (5 pounds 8 ounces to 9 pounds 4 ounces) Don’t know Declined to answer |
Staff record: generated by program for programmatic purposes | N/A | Staff: Please check appropriate box below for baby’s birthweight: Very low birthweight (Less than 3 pounds 5 ounces or 1500 grams) Low birthweight (Less than 5 pounds 8 ounces or 2500 grams) Normal weight range (5 pounds 8 ounces to 9 pounds 4 ounces) High birthweight (More than 9 pounds 4 ounces or 4500 grams) Don’t know Declined to answer |
This question, which asks staff to flag if birthweight is Low, Very Low, or High, has been added to the standard question asking just for pounds and ounces. This is recommended to aid with analyses and reporting requirements. | ||||||
| 8 | Quality Improvement | Supports Accurate Reporting and Quality Control | Provides information the grantee needs to meet reporting requirements, with long-term goal of ensuring accuracy in reporting. | Was/Is this child a singleton or one of multiples? | not asked | not asked | Generated by program for programmatic purposes | N/A | Was this child the only baby you were [the mother was] pregnant with, or was it a multiple birth, such as twins, triplets, or more? Singleton (from a pregnancy involving just one baby) Twins Triplets or more Don’t know Declined to answer |
Question added based on Aug 2019 grantee pilot feedback to align with reporting requirements. | ||||||||
| 9 | Improve Child Health | Access to Care | benchmark / performance measure associated with access to quality health care | child usual source of medical care | Increase proportion Healthy Start women and child participants who have a usual source of medical care to 80%. | Improve Women’s Health | The percent of Healthy Start women and child participants that have a usual source of medical care. (HS2) | PM 12: 80% of Healthy Start women and child participants that have a usual source of care. | NSCH 2011 K4Q01, https://www.cdc.gov/nchs/data/slaits/2011NSCHQuestionnaire.pdf | Is there a place that [S.C.] USUALLY goes when [he/she] is sick or you need advice about [his/her] health? (1) YES (2) NO [SKIP TO K4Q04] (3) THERE IS MORE THAN ONE PLACE (77) DON’T KNOW [SKIP TO K4Q04] (99) REFUSED [SKIP TO K4Q04] |
Is there a place that your baby/babies USUALLY goes/go for care when he or she is sick or when you or another caregiver need advice about your baby’s health? Select one response only for each baby. Yes No There is more than one place Don’t Know Declined to Answer Baby 1 Baby 2 Baby 3 Baby 4 |
NSCH 2018 C10, https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/questionnaires/2018/NSCH-T1.pdf | Is there a place you or another caregiver USUALLY take this child when he or she is sick or you need advice about his or her health? (NSCH 26018143 7 §;"rL¤ Yes No ➔ SKIP to question on page 8 |
Yes No [skip next question] Don't know Declined to answer |
same as May 2019 | same as May 2019 | Is there a place you or another caregiver USUALLY take this child when he or she is sick or you need advice about his or her health? Yes No Don't Know Decline to Answer |
Sept 2019 version updated to new NSCH. |
| 10 | Improve Child Health | Access to Care | benchmark / performance measure associated with access to quality health care | child place of care | Increase proportion Healthy Start women and child participants who have a usual source of medical care to 80%. | Improve Women’s Health | The percent of Healthy Start women and child participants that have a usual source of medical care. (HS2) | PM 12: 80% of Healthy Start women and child participants that have a usual source of care. | NSCH 2011 K4Q02, https://www.cdc.gov/nchs/data/slaits/2011NSCHQuestionnaire.pdf | IF K4Q01 = 1, SAY “What kind of place is it?” IF K4Q01 = 3, SAY “What kind of place does [S.C.] go to most often?” Is it a doctor’s office, emergency room, hospital outpatient department, clinic, or some other place? (1) DOCTOR’S OFFICE (2) HOSPITAL EMERGENCY ROOM (3) HOSPITAL OUTPATIENT DEPARTMENT (4) CLINIC OR HEALTH CENTER (5) RETAIL STORE CLINIC OR “MINUTE CLINIC” (6) SCHOOL (NURSE, ATHLETIC TRAINER, ETC) (7) FRIEND/RELATIVE (8) MEXICO/OTHER LOCATIONS OUT OF US (9) SOME OTHER PLACE [RECORD VERBATIM RESPONSE] (10) DOES NOT GO TO ONE PLACE MOST OFTEN (77) DON’T KNOW (99) REFUSED |
What kind of place does your baby/ do your babies go to most often when he/she is sick or you need advice about his/her health? Is it a doctor’s office, emergency room, hospital outpatient department, clinic or some other place? Select one only for each baby. Baby 1 Baby 2 Baby 3 Baby 4 Doctor’s Office Hospital Emergency Room Hospital Outpatient Department Clinic or Health Center Retail Store Clinic or “Minute Clinic School (Nurse’s Office, Athletic Trainer’s Office) Some other place Don’t know Declined to answer |
NSCH 2018 C11, https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/questionnaires/2018/NSCH-T1.pdf | If yes, where does this child USUALLY go first? Mark (X) ONE box. Doctor’s Office Hospital Emergency Room Hospital Outpatient Department Clinic or Health Center Retail Store Clinic or “Minute Clinic” School (Nurse’s Office, Athletic Trainer’s Office) Some other place |
Where does this child usually go FIRST? Select one only. Doctor’s Office Hospital Emergency Room Hospital Outpatient Department Clinic or Health Center Retail Store Clinic or “Minute Clinic” School (Nurse’s Office, Athletic Trainer’s Office) Some other place _________________ Don't Know Declined to answer |
same as May 2019 | same as May 2019 | Where does this child USUALLY go first? Select one only. Doctor’s Office Hospital Emergency Room Hospital Outpatient Department Clinic or Health Center Retail Store Clinic or “Minute Clinic” School (Nurse’s Office, Athletic Trainer’s Office) Some other place _________________ Don't Know Declined to answer |
Updated to 2018 NSCH |
| 11 | Life Course/ Cross-cutting | Access to Care | benchmark / performance measure associated with access to quality health care | child health insurance coverage past year? | Increase the proportion of Healthy Start women and child participants with health insurance to 90% (reduce uninsured to less than 10%) | Improve Women’s Health | The percent of Healthy Start women and child participants with health insurance. (LC1) | PM 4: 90% of MCHB funded projects promoting and/ or facilitating adequate health insurance coverage. | not asked | NSCH 2018, E1 https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/questionnaires/2018/NSCH-T1.pdf | DURING THE PAST 12 MONTHS, was this child EVER covered by ANY kind of health insurance or health coverage plan? Yes, this child was covered all 12 months ➔ SKIP to question E4 Yes, but this child had a gap in coverage No |
DURING THE PAST 12 MONTHS, was this child EVER covered by ANY kind of health insurance or health coverage plan? Yes, he/she was covered all 12 months Yes, but he/she had a gap in coverage No➔ SKIP next question Don’t know Declined to answer |
same as May 2019 | same as May 2019 | DURING THE PAST 12 MONTHS, was this child EVER covered by ANY kind of health insurance or health coverage plan? Yes, this child was covered all 12 months Yes, but this child had a gap in coverage No Don’t know Declined to answer |
NSCH 2018 | ||
| 12 | Life Course/ Cross-cutting | Access to Care | benchmark / performance measure associated with access to quality health care | type of child health insurance | Increase the proportion of Healthy Start women and child participants with health insurance to 90% (reduce uninsured to less than 10%) | Improve Women’s Health | The percent of Healthy Start women and child participants with health insurance. (LC1) | PM 4: 90% of MCHB funded projects promoting and/ or facilitating adequate health insurance coverage. | PRAMS Phase 6 H2 | What kind of health insurance plan is your new baby covered by? Check all that apply Health insurance from your job or the job of your husband, partner, or parents Health insurance that you or someone else pays for (not from a job) Medicaid or (state Medicaid name) TRICARE or other military health care State option (IHS, etc.) State option (SCHIP or CHIP program) Other source(s) => Please tell us [BOX] I do not have health insurance for my new baby |
Please tell me what kind of health insurance your baby has/babies have: Select all that apply for each baby. Baby 1 Baby 2 Baby 3 Baby 4 Private health insurance through my job, or the job of my husband, partner or parents Insurance purchased directly from an insurance company Medicaid, Medical Assistance, or any kind of government assistance plan for those with low incomes or a disability TRICARE or other military health care Indian Health Service Other, specify No insurance Don’t know Declined to answer |
NSCH 2018 E4 https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/questionnaires/2018/NSCH-T1.pdf | Is this child CURRENTLY covered by any of the following types of health insurance or health coverage plans? Mark (X) Yes or No for EACH item. Insurance through a current or former employer or union b. Insurance purchased directly from an insurance company Yes No c. Medicaid, Medical Assistance, or any kind of government assistance plan for those with low incomes or a disability d. TRICARE or other military health care e. Indian Health Service f. Other, specify |
Select Yes or No for EACH item, or indicate don’t know or declined to answer as appropriate. Insurance Type Yes No Don’t Know Decline to Answer Insurance through a current or former employer or union Insurance purchased directly from an insurance company Medicaid, Medical Assistance, or any kind of government assistance plan for those with low incomes or a disability TRICARE or other military health care Indian Health Service Other, specify: _______ |
PRAMS Phase 8 H2 | What kind of health insurance is your new baby covered by now? Check ALL that apply Private health insurance from my job or the job of my husband or partner Private health insurance from my parents Private health insurance from the <State> Health Insurance Marketplace or <state website> or HealthCare.gov Medicaid (required: state Medicaid name) State-specific option (Other government plan or program such as SCHIP/CHIP) State-specific option (Other government plan or program not listed above such as MCH program, indigent program or family planning program) State-specific option (TRICARE or other military health care) State-specific option (IHS or tribal) Other health insurance Please tell us: I do not have any health insurance for my new baby |
What kind of health insurance is your child covered by now? Please select all that apply. Insurance Type Check if Currently have Private health insurance from my job or the job of my husband or partner Private health insurance from my parents Private health insurance from the <State> Health Insurance Marketplace or <state website> or HealthCare.gov Medicaid (Title XIX) (required: state Medicaid name_______________) CHIP (Title XXI) Subsidized ACA plan (also called ‘subsidized premium or subsidized coverage through the Affordable Care Act’) TRICARE or other military health care Indian Health Service or tribal [Staff note: this item will be counted as ‘no health insurance coverage’; however, HRSA will track it as a separate item before combining it into ‘no health insurance coverage’.] Other health insurance, Please tell us:______________________ I do not have any health insurance for this child Don’t know Declined to answer |
PRAMS Phase 8 Core 11 was used for Sept 2019 version. |
| 13 | Improve Child Health | Access to Care | benchmark / performance measure associated with access to quality health care | child well-visits | Increase proportion of Healthy Start child participants who receive the last age-appropriate recommended well child visit based on AAP schedule to 90%. | Promote Quality | The percent of Healthy Start child participants who receive well child visits. (CH2) | CoIIN- Care Coordination/Case Management |
N/A | When was your child's last visit to a doctor, nurse, or other health provider for a well-child check-up? Select one response only for each child. Date of child’s last visit Don’t know Declined to answer Child 1 __ / __ / ____ Child 2 __ / __ / ____ Child 3 __ / __ / ____ Child 4 __ / __ / ____ |
PRAMS Phase 8 Standard question X9 | Has your new baby had a well-baby checkup? A well-baby checkup is a regular health visit for your baby usually at 1, 2, 4, and 6 months of age. |
27. Has your child had a well-baby checkup? A well-baby checkup is when a child sees the doctor for a general check-up but is not sick or injured, such as an annual or physical, or well- visit. No Yes Don’t know Declined to answer 28. How old was your baby at his/her most recent well-child visit? Select one only. The first week visit (first 7 days of life) At least 8 days old but under 2 months old 2-3 months old 4-5 months old 6-8 months old 9-11 months old 12-14 months old 15-17 months old 18 months old No visit yet Don’t know Declined to answer |
CoIIN- Care Coordination/Case Management | N/A | [Staff: below is the AAP-recommended schedule of well visits for the first 18 months of life.] Next is a list of recommended well-baby visits to the doctor for young children. Which of these well-baby check-ups has your baby had so far? Select all that apply. First week of life 1 month old 2 months old 4 months old 6 months old 9 months old 12 months old 15 months old 18 months old No visit yet Don’t know Declined to answer |
The original version of the well-child visit proved challenging to combine with other child information to address the well-child visit PM. In the May 2019 version, a series of questions is asked to obtain the information needed to address the PM. Based on extensive feedback from the Aug 2019 grantee pilot, this has been simplified to 1 question followed by a staff record. | |
| 14 | Improve Child Health | Access to Care | benchmark / performance measure associated with access to quality health care | Child most recent age-appropriate recommended well-visit? | Increase proportion of Healthy Start child participants who receive the last age-appropriate recommended well child visit based on AAP schedule to 90%. | Promote Quality | The percent of Healthy Start child participants who receive well child visits. (CH2) | not asked | Staff record: Generated by program for programmatic purposes | N/A | Staff: Compare child’s current age with age at most recent well-visit, and determine: was this child’s last well-child visit within the time frame recommended for this child’s age (e.g., a 10 month old baby has had her 9 month visit)? Yes [skip next question] No [go to next question] Unable to determine [go to next question] |
Staff record: Generated by program for programmatic purposes | N/A | Staff: Compare child’s current age with age at most recent well-visit, and determine: was this child’s last well-child visit within the time frame recommended for this child’s age (e.g., a 10 month old baby has had her 9 month visit)? Yes No Unable to determine |
The original version of the well-child visit proved challenging to combine with other child information to address the well-child visit PM. In the May 2019 version, a series of questions is asked to obtain the information needed to address the PM. Based on extensive feedback from the Aug 2019 grantee pilot, this has been simplified to 1 question followed by a staff record. | |||
| 15 | Improve Perinatal Infant Health | Breastfeeding | benchmark / performance measure associated with child health outcomes | Breastfed ever | Increase proportion of Healthy Start child participants whose parent/ caregiver reports they were ever breastfed or pumped breast milk to feed their baby to 82%. | Promote Quality | The percent of Healthy Start child participants whose parent reports they were ever breastfed or fed breast milk, even for a short period of time. (PIH2) | PM 10: 82% of MCHB funded projects promoting and/ or facilitating breastfeeding | PRAMS Phase 6 45 | Did you ever breastfeed or pump breast milk to feed your new baby after delivery? □ No = Go to Question 48b □ Yes |
Did you ever breast feed or pump breast milk to feed your baby/babies after delivery, even for a short period of time? Select one response only for each baby. Yes No Declined to answer Baby 1 Baby 2 Baby 3 |
Prams Phase 8 Core 35 | Did you ever breastfeed or pump breast milk to feed your new baby, even for a short period of time? No Go to Question [Core 38] Yes |
Did you ever breast feed or pump breast milk to feed this child after delivery, even for a short period of time? Select one response only. Yes No Don't know Declined to answer |
same as May 2019 | same as May 2019 | Did you [or the biological mother] EVER breast feed or pump breast milk to feed this child after delivery, even for a short period of time? Select one response only. Yes No Don’t know Declined to answer |
Sept 2019 question stem changed to allow for possibiity that a child's father or other accompanying adult could be completing this. |
| 16 | Improve Perinatal Infant Health | Breastfeeding | benchmark / performance measure associated with child health outcomes | Breastfeed currently? | Increase proportion of Healthy Start child participants whose parent/ caregiver reports they were breastfed or fed breast milk at 6 months to 61%. | Promote Quality | The percent of Healthy Start child participants whose parent reports they were breastfeed or fed breast milk at 6 months. (PIH2) | PM 10: 82% of MCHB funded projects promoting and/ or facilitating breastfeeding | not asked separately (embedded as response option in another item) | Prams Phase 8 Core 36 | Are you currently breastfeeding or feeding pumped milk to your new baby? No Yes |
Are you currently breastfeeding or feeding pumped milk to this child? Yes No Don’t know Declined to answer 33. How many weeks or months did you breastfeed |
same as May 2019 | same as May 2019 | Is this baby currently being breastfed or fed pumped milk? Yes No Don’t know Declined to answer |
Sept 2019 question stem converted to passive voice in order to allow for possibiity that a child's father or other accompanying adult could be completing this. | ||
| 17 | Improve Perinatal Infant Health | Breastfeeding | benchmark / performance measure associated with child health outcomes | how long breastfed? | Increase proportion of Healthy Start child participants whose parent/ caregiver reports they were breastfed or fed breast milk at 6 months to 61%. | Promote Quality | The percent of Healthy Start child participants whose parent reports they were breastfeed or fed breast milk at 6 months. (PIH2) | PM 10: 82% of MCHB funded projects promoting and/ or facilitating breastfeeding | PRAMS Phase 6 Core 47 |
How many weeks or months did you breastfeed or pump milk to feed your baby? [BOX] Weeks OR [BOX] Months Less than 1 week |
How many days, weeks or months did you breastfeed or pump breast milk for your baby/babies? STAFF: Please write in the number provided by the participant and enter number of days, weeks OR months for each baby. Number of days, weeks or months (record number and circle appropriate time period) Still/Currently breastfeeding Don’t know Declined to answer Baby 1 Days Weeks ________ Months Baby 2 Days Weeks ________ Months Baby 3 Days Weeks ________ Months Baby 4 Days Weeks ________ Months |
Prams Phase 8 Core 37 | How many weeks or months did you breastfeed or pump milk to feed your baby? [BOX] Weeks OR [BOX] Months Less than 1 week |
How many weeks or months did you breastfeed or feed pumped milk to this child? Less than 1 week _____Weeks OR _____Months [Enter weeks OR months, not both] Don’t know Declined to answer |
same as May 2019 | same as May 2019 | How many months [up till current date] was this child breastfed or fed pumped milk? Not at all Less than 1 month ____ Months Don’t know Declined to answer |
Based on issues that emerged with the 2017 data, as well as with Aug 2019 grantee pilot feedback, this question has been simplified to reduce potential confusion and to directly capture the information that is necessary to respond to the targeted PM. |
| 18 | Improve Perinatal Infant Health | Breastfeeding | benchmark / performance measure associated with child health outcomes | breastfed at 6 months | Increase proportion of Healthy Start child participants whose parent/ caregiver reports they were breastfed or fed breast milk at 6 months to 61%. | Promote Quality | The percent of Healthy Start child participants whose parent reports they were breastfeed or fed breast milk at 6 months. (PIH2) | PM 10: 82% of MCHB funded projects promoting and/ or facilitating breastfeeding | not asked separately | Staff record: generated by program for programmatic purposes | N/A | Staff: Was this child breastfed or fed pumped milk for first 6 months of life? Select one response only. Yes Child is currently less than 6 months old No, child is older than 6 months but was not breastfed for first 6 months of life Don’t know Unable to determine |
same as May 2019 | same as May 2019 | Staff: Was this child breastfed or fed pumped milk for first 6 months of life? Select one response only. Yes Not yet. Child is currently less than 6 months old. No, child is older than 6 months and was not breastfed for the first 6 months of life Don’t know Unable to determine |
Length of time breastfeeding was very challenging to determine in 2017 data. In the 2019 versions, a staff record is added to directly address the '6-month' performance measure based on participant's responses to the previous breastfeeding questions. Aug 2019 piloting led to slight changes in response option wording to continue to clarify the information sought. | ||
| 19 | Improve Perinatal Infant Health | Safe Sleep | benchmark / performance measure associated with infant safety | infant sleep position | Increase proportion of Healthy Start women participants who engage in safe sleep practices to 80%. | Promote Quality | The percent of Healthy Start child participants who are placed to sleep following safe sleep behaviors. (PIH1) | PM 9: 80% of MCHB funded projects promoting and/ or facilitating safe sleep practices. | PRAMS Phase 6 Core 49 | In which one position do you most often lay your baby down to sleep now? Check one answer On his or her side On his or her back On his or her stomach |
In which one position do you most often lie your baby/babies down to sleep now? STAFF: Please read responses to participant. Select one response only for each baby. On his or her side On his or her back On his or her stomach Declined to answer Baby 1 Baby 2 Baby 3 Baby 4 |
PRAMS Phase 8 Core 38 | In which one position do you most often lay your baby down to sleep now? Check ONE answer On his or her side On his or her back On his or her stomach |
Select ONE answer. On his or her side On his or her back On his or her stomach Not applicable [child 12 months or older] |
same as May 2019 | same as May 2019 | In which one position do you most often lay your baby down to sleep now? Select ONE answer. On his or her side On his or her back On his or her stomach Not applicable [child 12 months or older] |
The 2019 versions include Instructions for staff regarding babies who are less than versus older than 12 months old. Item unchanged otherwise. |
| 20 | Improve Perinatal Infant Health | Safe Sleep | benchmark / performance measure associated with infant safety | where sleep | Increase proportion of Healthy Start women participants who engage in safe sleep practices to 80%. | Promote Quality | The percent of Healthy Start child participants who are placed to sleep following safe sleep behaviors. (PIH1) | PM 9: 80% of MCHB funded projects promoting and/ or facilitating safe sleep practices. | PRAMS Phase 6 Standard F1 | How often does your new baby sleep in the same bed with you or anyone else? Always Often Sometimes Rarely Never |
In the past 2 weeks, how often has your new baby/have your new babies slept alone in his or her/their own crib or bed? Would you say always, often, sometimes, rarely, or never? Select one response only for each baby. Responses Always Often Sometimes Rarely Never Don’t know Declined to answer Baby 1 Baby 2 Baby 3 Baby 4 |
PRAMS Phase 8 Core question 39 | In the past 2 weeks, how often has your new baby slept alone in his or her own crib or bed? Always Often Sometimes Rarely Never Go to Question |
[For babies less than 12 months ask:] In the past 2 weeks, how often has your baby slept alone in his or her own crib or bed? Always Often Sometimes Rarely Never Not applicable [child 12 months or older] |
same as May 2019 | same as May 2019 | In the past 2 weeks, how often has your baby slept alone in his or her own crib or bed? [Note: That is, the baby is the only person in the crib or bed; the baby’s crib or bed may be in the parent(s) room] Always Often Sometimes Rarely Never Not applicable [child 12 months or older] |
In the 2019 versions, instructions were added for staff regarding babies less than versus older than 12 months old. |
| 21 | Strengthen Family Resilience | Reading to Child | benchmark / performance measure; parents spending time reading to their child is an activity associated with enhanced cognitive outcomes | reading to child | Increase the proportion of Healthy Start child participants aged <24 months who are read to by a parent or family member 3 or more times per week to 50% | Strengthen Family Resilience | The percent of Healthy Start child participants age 6 through 23 months who are read to 3 or more times per week, on average. (HS8) | PM 17: 50% 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. | NCHS 2010-2011 http://childhealthdata.org/learn/NSCH/topics_questions/2011-12-nsch#S6 | During the past week, how many days did you or other family members read to [CHILD'S NAME] ? | Please tell me the number of days you or a family member read to your child during the past week. Reading includes books with words or pictures but not books read by an audio tape, record, CD, or computer. STAFF: Record the total number of days, from 0 days (no days) to 7 days (everyday). Days per week (Record the number) Don’t know Declined to answer Child 1 Child 2 Child 3 Child 4 |
PRAMS Phase 8 State Specific question NYC86, modified | During the past week, how many days did you or other family members read, sing, or tell stories to your new baby? No days 1 or 2 days 3 or 4 days 5 or 6 days Everyday |
No days 1 or 2 days 3 or 4 days 5 or 6 days Every day Don’t know Declined to answer |
PRAMS Phase 8 State Specific question RI71 | During the past week, how many days did you or other family members read or look at books with your baby? Did not read to the baby this week 1-3 days this week 4-7 days this week |
During the past week, how many days did you or other family members read or look at books with your new baby? Reading includes books with words or pictures but NOT books read by an audio tape, record, CD, or computer. Did not read to the baby this week 1-2 days this week 3 days this week 4-7 days this week Don’t know Declined to answer |
PM specifies percentage of children read to 3 or more times per week. |
| 22 | Improve Women's/ Maternal Health | Access to Care | benchmark / performance measure; a postpartum visit promotes the health of the new mother and her baby. | postpartum visits first 12 weeks | Increase the proportion of Healthy Start women participants who receive a postpartum visit to 80%. | Improve Women’s Health | The percent of Healthy Start women participants who receive a postpartum visit. (WMH2) | PM 6: 80% of programs promoting and/ or facilitating timely postpartum care. | PRAMS Standard Phase 6, #L8 | Since your new baby was born, have you had a postpartum checkup for yourself? (A postpartum checkup is the regular checkup a woman has about 6 weeks after she gives birth.) □ No □ Yes |
Since your child was /children were born, have you had a postpartum visit for yourself? A postpartum visit is the regular checkup a woman has 4-6 weeks after she gives birth. When did you have your postpartum visit? STAFF: Please enter day of postpartum visit. __ / __ / ____ (month/day/year) (Go to question 33) 33.2 Do you have one scheduled? Select one only. Yes: Please indicate date of scheduled appointment: ___ / __ / ____ (month/day/year) No Declined to answer |
PRAMS Phase 8 Core 46 | Since your new baby was born, have you had a postpartum checkup for yourself? A postpartum checkup is the regular checkup a woman has about 4-6 weeks after she gives birth. No Yes |
Yes No Don't know Declined to answer |
New ACOG guidelines regarding postpartum care+reporting requirements; https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care | none available yet | Postpartum care, now called ‘the fourth trimester,’ includes ongoing contact with an obstetric care provider (e.g., OB/GYN, nurse midwife) during the 12 weeks following labor and delivery to ensure your ongoing health. Did you receive postpartum care from a doctor: Select all that apply. Yes, within the first 3 weeks following delivery Yes, between 4 weeks and 6 weeks following delivery Yes, between 7 weeks and 8 weeks following delivery Yes, between 9 and 12 weeks following delivery [Note: if participant responds, “Yes, after 12 weeks,” explain that it is not considered a postpartum checkup after 12 weeks] No, but scheduled No, none scheduled Don’t know Declined to answer |
Question has been revised to reflect ACOG's 2018 statement on postpartum care, as well as different reporting requirements. https://www.acog.org/About-ACOG/News-Room/News-Releases/2018/ACOG-Redesigns-Postpartum-Care?IsMobileSet=false |
| 23 | Strengthen Family Resilience | Father Involvement | benchmark / performance measure; supports greater HS program emphasis on increasing engagement of spouses/ partners/ fathers in HS program activities | father involvement with child | Increase proportion of Healthy Start women participants that demonstrate father and/or partner involvement (e.g., attend appointments, classes, infant/child care) with their child participant to 80%. | Strengthen Family Resilience | The percent of Healthy Start women participants that demonstrate father and/or partner involvement with infant <24 months. (HS7) | PM 16: 80% of Healthy Start women participants that demonstrate father and/or partner involvement with child <24 months. | Michigan Maternal Risk Identifier Worksheet | N/A | Would you describe your partner or the father of your baby/babies as: STAFF: Please read responses to participant, and select only one response. Involved and supportive of me and my baby/babies (Go to question 50.1) Involved but not supportive of me or my baby/babies (Go to question 50.1) Not involved [Screening tool is complete] Staff: DO NOT READ OUT LOUD: Declined to answer [Screening tool is complete] |
Michigan Maternal Risk Identifier Worksheet | N/A | Finally, this is our last question. Would you describe your partner or the father of your child as: STAFF: Please read responses to participant, and select only one response. Involved and supportive of me and my child Involved with child but not supportive of me Not regularly involved in child’s life Staff: DO NOT READ OUT LOUD: Don’t know Declined to answer Declined to answer |
Michigan Maternal Risk Identifier Worksheet | N/A | Next, we have a question about home relationships. Would you describe your partner or the father of your child as: Involved and supportive of me and my child Involved with child but not supportive of me Not regularly involved in child’s life Don’t know Declined to answer |
Only one minor change from version developed by CoIIN: word 'baby' changed to 'child' given age range of children. |
| 24 | Life Course/ Cross-cutting | Substance Use | benchmark / performance measure; specifically, supports long-term goal of reducing health inequities by reducing/eliminating tobacco use during pregnancy among HS participants; since women vary on when in their pregnancies they begin receiving HS services, asking this question enables this benchmark to be fully addressed once the pregnancy is over. | use of cigarettes and other tobacco products in last 3 months of pregnancy | Increase the proportion of pregnant Healthy Start participants that abstain from cigarette smoking to 90%. | Promote Quality | The percent of Healthy Start prenatal participants that abstain from smoking cigarettes in their third trimester. (LC2) | PM 5: 90% of MCHB funded projects promoting and/ or facilitating tobacco and e-cigarette cessation, and through what processes | PRAMS Phase 6 Core 25, 27 | Have you smoked any cigarettes in the past 2 years? □ No = Go to Question 29 □ YesIn the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day? (A pack has 20 cigarettes.) □ 41 cigarettes or more □ 21 to 40 cigarettes □ 11 to 20 cigarettes □ 6 to 10 cigarettes □ 1 to 5 cigarettes □ Less than 1 cigarette □ I didn’t smoke then |
Did you smoke any cigarettes or use any tobacco products during the last 3 months of your pregnancy? Select one only. Yes (Go to question 42.1) No (Go to question 43) Don’t know (Go to question 43) Declined to answer (Go to question 43) 42.1. During the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day? Select one only. 41 cigarettes or more 21 to 40 cigarettes 11 to 20 cigarettes 6 to 10 cigarettes 1 to 5 cigarettes Less than 1 cigarette Declined to answer |
PRAMS Phase 8 Core 21 | In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day? A pack has 20 cigarettes. 41 cigarettes or more 21 to 40 cigarettes 11 to 20 cigarettes 6 to 10 cigarettes 1 to 5 cigarettes Less than 1 cigarette I didn’t smoke thenHave you used any of the following products in the past 2 years? For each item, check No if you did not use it, or Yes if you did. No Yes a. E-cigarettes or other electronic nicotine products b. Hookah c. State added option (Chewing tobacco, snuff, snus, or dip) d. State added option (Cigars, cigarillos, or little filtered cigars) |
In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day? A pack has 20 cigarettes. 41 cigarettes or more 21 to 40 cigarettes 11 to 20 cigarettes 6 to 10 cigarettes 1 to 5 cigarettes Less than 1 cigarette I didn’t smoke then Don’t know Declined to answer 10. During the last 3 months of your pregnancy, on average, how often did you use e-cigarettes or other electronic nicotine products? More than once a day Once a day 2-6 days a week 1 day a week or less I did not use e-cigarettes or other nicotine-containing e-vaping products then Don’t Know Declined to Answer E-cigarettes or other electronic nicotine products Hookah Chewing tobacco, snuff, snus, or dip Cigars, cigarillos, or little filtered cigars |
same as May 2019 | same as May 2019 | During the last 3 months of your pregnancy, on average, how often did you smoke cigarettes or use other tobacco or nicotine products? More than once a day Once a day 2-6 days a week 1 day a week or less Not at all Don’t Know Declined to Answer Cigarettes E-cigarettes or other electronic nicotine products Hookah Chewing tobacco, snuff, snus, or dip Cigars, cigarillos, or little filtered cigars |
The relevant PM asks about smoking cigarettes during pregnancy; other program reporting requirements request information on smoking cigarettes and use of other tobacco products in the last 3 months of pregnancy. |
| 25 | Life Course/ Cross-cutting | Substance Use | benchmark / performance measure; specifically, supports long-term goal of reducing health inequities by reducing/eliminating tobacco use during pregnancy among HS participants; since women vary on when in their pregnancies they begin receiving HS services, asking this question enables this benchmark to be fully addressed once the pregnancy is over. | use of cigarettes and other tobacco products in last 3 months of pregnancy | Increase the proportion of pregnant Healthy Start participants that abstain from cigarette smoking to 90%. | Promote Quality | The percent of Healthy Start prenatal participants that abstain from smoking cigarettes in their third trimester. (LC2) | PM 5: 90% of MCHB funded projects promoting and/ or facilitating tobacco and e-cigarette cessation, and through what processes | PRAMS Phase 6 Core 25, 27 | Have you smoked any cigarettes in the past 2 years? □ No = Go to Question 29 □ YesIn the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day? (A pack has 20 cigarettes.) □ 41 cigarettes or more □ 21 to 40 cigarettes □ 11 to 20 cigarettes □ 6 to 10 cigarettes □ 1 to 5 cigarettes □ Less than 1 cigarette □ I didn’t smoke then |
Did you smoke any cigarettes or use any tobacco products during the last 3 months of your pregnancy? Select one only. Yes (Go to question 42.1) No (Go to question 43) Don’t know (Go to question 43) Declined to answer (Go to question 43) 42.1. During the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day? Select one only. 41 cigarettes or more 21 to 40 cigarettes 11 to 20 cigarettes 6 to 10 cigarettes 1 to 5 cigarettes Less than 1 cigarette Declined to answer |
PRAMS Phase 8 Core 23 with State Options | Have you used any of the following products in the past 2 years? For each item, check No if you did not use it, or Yes if you did. No Yes a. E-cigarettes or other electronic nicotine products b. Hookah c. State added option (Chewing tobacco, snuff, snus, or dip) d. State added option (Cigars, cigarillos, or little filtered cigars) |
In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day? A pack has 20 cigarettes. 41 cigarettes or more 21 to 40 cigarettes 11 to 20 cigarettes 6 to 10 cigarettes 1 to 5 cigarettes Less than 1 cigarette I didn’t smoke then Don’t know Declined to answer 10. During the last 3 months of your pregnancy, on average, how often did you use e-cigarettes or other electronic nicotine products? More than once a day Once a day 2-6 days a week 1 day a week or less I did not use e-cigarettes or other nicotine-containing e-vaping products then Don’t Know Declined to Answer E-cigarettes or other electronic nicotine products Hookah Chewing tobacco, snuff, snus, or dip Cigars, cigarillos, or little filtered cigars |
same as May 2019 | same as May 2019 | During the last 3 months of your pregnancy, on average, how often did you use other tobacco or nicotine products? More than once a day Once a day 2-6 days a week 1 day a week or less Not at all Don’t Know Declined to Answer E-cigarettes or other electronic nicotine products Hookah Chewing tobacco, snuff, snus, or dip Cigars, cigarillos, or little filtered cigars |
The relevant PM asks about smoking cigarettes during pregnancy; other program reporting requirements request information on smoking cigarettes and use of other tobacco products in the last 3 months of pregnancy. |
| cover page | Quality Improvement | Supports Accurate Reporting and Quality Control | Supports understanding/ documentation of who the program is serving, with long-term goal of reducing health inequities; specifically, capturing a respondent's relationship to the participant as well as relationship to any participating child, will clarify situations in which the person completing the background questionnaire is not actually the biological mother. This may be important information if, eg, there are a large number of 'don't know' responses in a questionnaire. | participant type | not asked | Staff record: generated by program for programmatic purposes | N/A | • Relationship of Respondent to Participant: _______________ • Relationship of Respondent to Participating Child 0-18 months (Parent/Child Phase): ___________________ • Relationship of Respondent to Participant: _______________ • Relationship of Respondent to Participating Child 0-18 months (Parent/Child Phase): ___________________ • Relationship of Respondent to Participant: _______________ • Relationship of Respondent to Participating Child 0-18 months (Parent/Child Phase): ___________________ |
Staff record: generated by program for programmatic purposes | N/A | Participant Type: Primary Participant o Enrolled woman (woman is primary parent receiving support) o Enrolled father (father is primary parent receiving support) This Primary Participant is LINKED TO CHILD, ____________ [Name of child for grantee’s record. Child unique ID must be listed in gray box above.] Accompanying Adult [Select all that apply] o Primary Participant’s spouse or partner o Enrolled child’s co-parent o Other caregiver with primary responsibility for the care of the enrolled child, or support person attending with Primary Participant on a regular basis |
This allows identification of Spouses/Partners/ Fathers, which has increased in priority, serving as either the primary participant or as the accompanying adult of a participant. In addition, it clarifies if child is under the primary care of someone besides the mother or father. | ||||||
| cover page | Quality Improvement | Supports Accurate Reporting and Quality Control | Supports analysis and reporting of benchmarks; when the parents/child entered HS is critical for understanding whether relevant health outcomes occurred while they were in HS or not. This question also supports immediate calculation of information the grantee needs for aggregate reporting requirements, with the long-term goal of reducing gap in aggregate versus client-level reporting, and ensuring accuracy in reporting. | enrollment dates | not asked | Staff record: generated by program for programmatic purposes | N/A | • Date of Enrollment in Healthy Start: _______________________ |
Date of Enrollment in Healthy Start: Primary Participant_________________ Enrolled Child ______________ Accompanying Adult _____________ |
Suggested by public comment to support calculations needed for reporting requirements. Broken down by participant type following Aug 2019 grantee pilot feedback. | ||||||||
| cover page | Quality Improvement | Pregnancy/ Infant Outcomes | Compared to female infants, male infants have been found to have a higher rate of morbidity and mortality in the neonatal period. Including child gender as a variable contributes to our understanding of risk in early infancy among HS participants. | child gender | not asked | not asked | Staff record: generated by program for programmatic purposes | N/A | Child is o Female o Male |
Including this variable allows us to examine birth outcomes by child's gender, and so provides a fuller understanding of different neonatal outcomes among HS participants. | ||||||||
| cover page | Quality Improvement | Supports Accurate Reporting and Quality Control | Supports analysis and reporting of benchmarks; date that form is completed is used to complete age-and time-related variables and ensures accuracy in reporting. | date of form completion | CoIIN-Care Coordination - |
N/A | Date of Completion: __________________ | CoIIN-Care Coordination | N/A | Date of Form Completion: ___________________ | same as May 2019 | same as May 2019 | Date of Mandatory Parent/Child Form Completion: ___________________ | Allows calculation of age- or time-related measures, with goal of ensuring accuracy in reporting. Name of form specified in Sept 2019 revision, based on grantee pilot feedback. |
| Name of Commenter | Comment(s) | Action Taken | Response 1 | Response 2 | Response 3 |
| Mary-Powell Thomas | Our chief recommendation is to support the recommendations of Lisa Bain, director of Healthy Start San Diego (attached), especially to: •Focus on children born into the program and/or younger than 18 months (not 24 months), since that is the target population for the grant; •Have participant complete a separate form for each child younger than 18 months of age; •Adjust questions as appropriate to ensure that using these forms will provide all data needed for reporting on the Healthy Start performance measures. In addition, throughout the tools, the word “couple” should be followed by “of”—“We’ll start with a couple of questions,” etc. Here are our additional suggestions: Healthy Start Background Mandatory Questions Question 6: Our Arabic clients do not feel represented by any of the current racial or ethnic categories. Therefore, we recommend changing this question to “What is your ethnicity?” Answers should include: • Hispanic, Latino, or Spanish • Middle Eastern/North African • Other • None of the above • Don’t know • Declined to answer Question 7: We recommend adding “Other” as an answer option for race. Question 25 should specify whether a pregnant woman counts as one person or two for the purposes of this question. Questions 27 and 30: What additional information is being sought by asking whether the participant has answered the questions that the staff person asked? Question 29: If this form is to be used with male participants as well as female, these sub-questions should be revised to “husband, wife, or partner.” Healthy Start Prenatal Mandatory Questions Questions 3: Add “including e-cigarettes and vaping,” as on the Background form. In addition, consider deleting mention of the impact of tobacco and alcohol on the developing baby, which may make the participant less likely to answer truthfully. Healthy Start Mandatory Questions: Children We recommend sequential numbering of all questions from the beginning to the end of the form, as on the Background tool. Birth Intervals, Question 1: Change “Current Pregnancy?” to “Currently pregnant?” Health at Birth: If only one form is filled out, it should focus on the youngest child—i.e., the one most likely to have been affected by Healthy Start services. Health at Birth, Question 1: Change the third answer option to “Grandmother/grandfather.” Health at Birth, Question 2: Delete “if adopted,” to account for non-mothers who are filling out the form. Health at Birth, Question 4: Add an answer option of “Not yet, but I have an appointment.” Health at Birth, Questions 4-6 should read “you or the biological mother,” “yourself/herself,” and “you/she.” Infant Feeding, Questions 7-8 should read “you or the biological mother.” Child Health Care, Question 13: Delete the word “So” at the beginning of this question, to make its tone match that of the others. Family Life, Question 16: The question about reading should be asked for all children, not just those 6 months or older. Family Life, Question 17: The introduction does not seem to match the question. We recommend either deleting the sentence about looking to others for support or restoring Question 58 from the Interconception/Parenting tool, about the types of support available to the participant. Many thanks for the work that has gone into revising these questionnaires, and for considering our suggestions for improving them further. |
All suggested items were incorporated or addressed in the revision to the extent possible. More detailed responses to 3 specific items are given in columns D through F in this row. | "Our Arabic clients do not feel represented by any of the current racial or ethnic categories". RESPONSE: As part of the executive branch of the federal government, we are required to follow the response option guidelines for race and ethnicity that have been set forth by the Office of Management and Budget. According to the U.S. Census Bureau: "the Census Bureau’s 2018 End-to-End Test will a) employ the successful question format design which uses a combined question with detailed checkboxes design and b) include a dedicated “Middle Eastern or North African” response category. The Census Bureau is recommending a separate response category for MENA respondents, where any MENA responses would be aggregated to the White category following the current OMB Standards. However, it will ultimately be up to OMB to determine if the MENA category will be a minimum reporting category that is distinct from the White category. OMB is currently conducting a review of these standards, and it will be OMB’s decision as to whether or not MENA will become a new minimum reporting category outside of the White category". For a more detailed discussion, go to: https://www.census.gov/about/our-research/race-ethnicity.html | "What additional information is being sought by asking whether the participant has answered the questions that the staff person asked?" Our purpose in including questions that direct the staff person to make a specific notation is to create a single item that will be easier for a person who does not have special expertise in statistics to pull up from a data base. Eg, the depression screening contains answers to 2 questions. The staff notation creates a yes/no response that directly addresses the question: 'What percentage of women have been screened for depression', and specific data on this can then be pulled up easily from the database by staff. Please let us know if it would be helpful to provide a specific explanation about this at the beginning of each of the 3 questionnaires. | "you or the biological mother" We do want to find a way to acknowledge and track different relationships among biological mother, participant, and respondent. We experimented with applying 'you or the biological mother' consistently, but it became quite unwieldy across the many questions. To address this, we have added questions on the cover page of each form that identify who the respondent is, and his/her relationship to the participant and the target child. In addition, on the Parent/Child form we have added an instruction that "IF THE PARTICIPANT IS NOT THE BIOLOGICAL MOTHER OF THE TARGET CHILD, then please have her, to the best of her ability, answer each question with information regarding the biological mother’s experience." |
| Healthy Start San Diego, PCI/ Lisa Bain | With a few modifications these tools can be used to meet almost the full reporting obligations of Healthy Start grantees. In our opinion, every effort should be made to do so, including a careful mapping of each item in the EHB to these forms. This will reduce the need for supplemental data tools and systems, which frequently generate incongruous results. Background Mandatory Questions: 1. Question 3 (Have you been with the Healthy Start program less than a month or more than a month) is not clear and we anticipate confusion among staff and participants. You might consider asking for the Date of Enrollment in the program and/or if the woman has participated in Healthy Start for prior pregnancies/children as an alternative. 2. We recommend adding a follow up to the PHQ-2 depression screening and Q27 (has this participant completed the depression screening in the previous question?) Ask if the participant screened was referred for follow up services for her depression score. This will address WMH4-B: Number of women participants who screened positive for depression during the reporting period and received a subsequent referral for follow-up services. 3. Q16 asks about information for children under 24 months of age. The new Healthy Start guidelines indicate we should work with families up to 18 month of age. You may want to change the max age to 18 months so you ensure that the data you collect is only for children enrolled and Healthy Start services. Prenatal Mandatory Questions: 1. We recommend to add the woman’s EDD and Date Enrolled in HS services for this pregnancy. EDD is essential for understanding the issues and concerns a woman may be having during her pregnancy. In addition, a. This will address the denominator for WMH1: Pregnant program participants who were enrolled prenatally, prior to their second trimester of pregnancy. Q. 2 addresses the numerator, but not the denominator for first trimester prenatal care. b. This will address the denominator for LC2-B (smoking in 3rd trimester): Total number of Healthy Start prenatal women participants who were enrolled at least 90 days before delivery. 2. Recommend increasing the response choices for Q7 “Record outcome of this pregnancy” to include the scenario where a Mother gives birth to twins (or more), with different birth outcomes including neonatal death for one of the twins. PostPartum/Interconceptional Form 1. We recommend to require a unique PostPartum/Internconceptional Form PER child enrolled in Healthy Start services (not multiple children on the same form). This allows us to document different outcomes per child (different medical homes, insurance status, birthweights) and clearly outlines true denominators of parents vs. children. 2. We also recommend you add a question that asks if the child was receiving HS services before birth (i.e. “Born into the program”) or part of a family enrolled for services after the child’s birth (e.g. enrolled at 9m of age, etc). This will allow you to determine which children should be included in PIH 1 (Safe Sleep), PIH 2-A and B (BF ever & @6m). 3. Recommend to document race, ethnicity, and if there is a special health care need the child. Again this helps clearly define denominators and would also allow the screening tools to be the basis for answering the monthly aggregate report and Forms 5 and 7 in the electronic handbook. 4. All Q’s should focus on YOUNGEST child to ensure we are collecting data for HS children (older children are least likely to be recipients of the full range of HS services). If the forms are changed to require 1 form per child enrolled as a Healthy Start beneficiary (as suggested above), the instruction for oldest/youngest will not be necessary. 5. Qs 3 and 4 about 18-month interval: Presumably these questions are here to answer HS03. The wording is confusing and we foresee the data coming back unclearly. Since this is an outcome for the woman, we would suggest connecting it to something else. One option would be her Healthy Start birth outcome on the prenatal form; after Q7 “Record outcome of this pregnancy” you could add Q8 “Was this birth 18 months or more after her most recent prior (live) birth?”. 6. Q4 “Did you or have you had a postpartum visit for yourself after this baby was born?” – should reflect response options that allow us to document if a postpartum visit happened, even if it was not in the 4-6 week time period. Frequently we see that a high number of women DO get their postpartum check, but fewer get it between 4-6 weeks. This is still an important finding and helps us address bigger issues (like wait time for clinic appointments, etc). The language on the past ICC screening tool was fairly straightforward. Option A (former screening tool questions) Option B (new question edited) Did you have a postpartum checkup after your youngest child was born? Select one only. Yes / No / Declined to Answer Approximately how many weeks postpartum did you have your postpartum checkup? _______________Number of Weeks Did you or have you had a postpartum visit for yourself after this baby was born? A postpartum visit is the regular checkup a woman has 4-6 weeks after she gives birth. Select one only. • Yes I got a visit between 4-6 weeks • I got a visit but it was not between 4-6 weeks after I gave birth • Not yet--baby is still less than 6 weeks old • No, I did not have a postpartum visit at all • Don't know • N/A—child is legally adopted • Declined to answer 7. This form asks about information for children under 24 months of age. The new Healthy Start guidelines indicate we should work with families up to 18 month of age. You may want to change the max age so you ensure that the data you collect is only for children enrolled and Healthy Start services. Other: • There is no question on any of the new form that address LC 2-B, “abstained from smoking in their third trimester”. Prior Screening Tool question was “Did you smoke any cigarettes or use any tobacco products during the last 3 months of your pregnancy?” This question could be added to the prenatal form after Q7 “Record outcome of this pregnancy” since it is connected to the pregnancy (and mother denominators) but cannot be determined until after the child is born. • There is no question to assess infant mortality. For a national program that is intended to reduce the disparities in infant death, this seems incredibly important. One option for capturing this might an “infant loss” form, to be filled out (internally by staff) in the case a child dies before their first birthday. We have an example that we are happy to share if you like. • B3 Warm regards, Lisa K. |
All suggested items were incorporated or addressed in the revision to the extent possible. More detailed responses to 3 specific items are given in columns D through F in this row. | With a few modifications these tools can be used to meet almost the full reporting obligations of Healthy Start grantees. In our opinion, every effort should be made to do so, including a careful mapping of each item in the EHB to these forms. This will reduce the need for supplemental data tools and systems, which frequently generate incongruous results. Thanks so much for the detail provided here to enable us to do this. We welcome similar comments for the 30-day comment period. Mapping each item in the EHB to these forms will need to be a separate step. |
Qs 3 and 4 about 18-month interval: Presumably these questions are here to answer HS03. The wording is confusing and we foresee the data coming back unclearly. Since this is an outcome for the woman, we would suggest connecting it to something else. One option would be her Healthy Start birth outcome on the prenatal form; after Q7 “Record outcome of this pregnancy” you could add Q8 “Was this birth 18 months or more after her most recent prior (live) birth?”. We have addressed this by adding a series of 3 questions followed by a staff notation in the Parent/Child form. | Any question that is used to address the Pediatric Performance Measures should be on a form filled out per child. Any question used to address the Women’s/Caregivers Performance Measures should be on a different form. This allows for the cleanest determination of numerators and denominators. We have separated out the questions related to the participant/biological mother from the questions related to the child, with questions related to the woman's health during the perinatal period of that particular pregnancy in the first part, and questions related to the target child in the second part. In the instructions we have clarified that, because the parent part of this form focuses on pregnancy-related health with the target child, participants will need to complete both the parent and child sections of this form separately for each child under 18 months old. |
| Michele Spainhower | Is the intent of the Mandatory Questionnaires to collect snippets of data (just a survey) or the full data needed for HRSA Performance Measure reporting? If the intent is to collect the full data needed for HRSA Performance Measure reporting, the following are points to be addressed. Background Mandatory Questions: 1. Q. 3: Have you been with the Healthy Start program less than a month or more than a month….Including periods of time that happened in the past • Does this time frame include if a participant was previously in the program two years ago and is back with a subsequent pregnancy? • As an alternative and providing less room for interpretation, please consider asking for the Date of Enrollment in the program. 2. Will the Background Mandatory Questionnaire be completed annually, to meet the definition of those performance that require the information based on the reporting period? The tool does not make this distinction, in its current state. 3. WMH4-B ~ Numerator: Number of women participants who screened positive for depression during the reporting period and received a subsequent referral for follow-up services. • The Background Questionnaire provides the PHQ-2 for screening. However, if the participant screens positive, it does not ask if the participant was referred for services. Prenatal Mandatory Questions: 1. WMH1 ~ Denominator: Pregnant program participants who were enrolled prenatally, prior to their second trimester of pregnancy. • Q. 2 asks how many weeks or months pregnant the participant was when they had their first visit for prenatal care, however, there is no where that asks when the participant was enrolled nor asks for their EDD to determine if they were enrolled in the Healthy Start program prior to their second trimester. 2. LC2 ~ Numerator: Number of Healthy Start prenatal women participants who abstained from using any tobacco products during the last 3 months of pregnancy. Denominator: Total number of Healthy Start prenatal women participants who were enrolled at least 90 days before delivery. • Q. 3 asks if the participant if they currently smoke. Again, with the enrollment date, a question for EDD, and adding a question in the Pregnancy Follow-Up section asking if the participant smoked in the last 3 months of pregnancy, WMH1 could be measured. Children Mandatory Questions: 1. HS03 ~ Numerator: Number of healthy start (HS) women participants whose pregnancy during the reporting period was conceived within 18 months of the previous live birth. Denominator: Total number of women HS participants enrolled before the current pregnancy in the reporting period who had a prior pregnancy that ended in live birth. • Q. 3 asks if there is at least an 18-month interval between the birth dates of Child 1 and Child 2 and Q. 4 asks if there is at least an 18-month interval between the estimated due date for any current pregnancy and the most recent live birth for this participant. However, these questions do not delineate if the participant was enrolled prior to the most current pregnancy. 2. WMH2~ Numerator: Women program participants who enrolled prenatally or within 30 days after delivery and received a postpartum visit between 4·6 weeks after delivery. Denominator: Women program participants who enrolled prenatally or within 30 days after delivery during the reporting period. • Q. 4 asks if the participant had a postpartum visit four to six weeks after this baby was born. The questionnaire does not delineate if this person was a participant and this child was born in the program and/or if the participant enrolled within 30 days of the birth of this child. 3. Pediatric Performance Measures: The Children Questionnaire gathers information for two children. It then states: If you have more than one child who meets those criteria, we ask you to focus only on the OLDEST of these children. All remaining questions ask about that child only. This child will be the Target Child of these questions. • This tool will not collect the information, needed for performance measure reporting, for all pediatric participants enrolled in the healthy start program. • Q. 3 asks about baby’s birthweight and does not delineate if the baby was born into the program. This question also does not differentiate between low and very low birth weight. • Q. 6 asks about substance use during the pregnancy. Is this to collect background information that may affect the baby’s growth/development or is this to be used for reporting? If for reporting, this does not delineate if mom’s pregnancy occurred while enrolled in the Healthy Start program. • PIH2-A ~ 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 o Q. 7 asks if the baby was fed breastmilk after the deliver……however, does not delineate if the participant was enrolled prenatally or at the time of delivery. • PIH2-B ~ 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. o Q. 8 looks at duration of breastfeeding…….however, does not delineate if the participant was enrolled prenatally or at the time of delivery. 4. It would be useful if the Children Tool could be split. The woman questions would be listed on a Postpartum/ICC tool and the Children tool would then be used to collect the information for each Pediatric participant and pediatric participants would subsequently be uploaded to HSMED. 5. There is no measurement of infant death, once baby is born, on the Children Questionnaire. |
All suggested items were incorporated or addressed in the revision to the extent possible. | |||
| Lindsay Zeman | 1. How will this data be used? What questions will be answered using this data? 2. Do you have an evaluation plan for grantees to review? 3. Were the screening tools designed so mothers, guardians, and fathers can enroll? a. Questions were inconsistently worded with some questions for biological mothers only, and others more general so a guardian or father can respond. b. We strongly suggest a review and testing of the new screening tools with the various types (Mother, father, guardian, etc.) of Healthy Start participants. 4. Health Start is a program focusing on B5reducing infant mortality, we suggest incorporating question/form to assess infant mortality. 5. Suggest keeping all benchmark/performance measure questions (questions that allow grantees to calculate numerators and denominators) the same and included in the new screening tools so benchmark measures can be compared. a. For example, we suggest the woman’s EDD and date enrolled in HS services for this pregnancy be added to the prenatal form. EDD is essential for understanding the issues and concerns a woman may be having during her pregnancy. In addition, this will address the denominator for WMH1: Pregnant program participants who were enrolled prenatally, prior to their second trimester of pregnancy. b. Additionally, there is no question on any of the new form that address LC 2-B, “abstained from smoking in their third trimester”. Prior Screening Tool question was “Did you smoke any cigarettes or use any tobacco products during the last 3 months of your pregnancy?” This question could be added to the prenatal form after Q7 “Record outcome of this pregnancy” since it is connected to the pregnancy (and mother denominators) but cannot be determined until after the child is born. 6. Questions throughout the proposed screening tools asked for information on children under 24 months, but new guidelines restricted this to children under 18 months. 7. Healthy Start Mandatory Questions: Children screening tool suggestions/feedback: a. Overall, questions were confusing, and the purpose of them was unclear. b. We strongly suggest reorganizing questions for easier completion. For example, into age categories and/or biological and non-biological categories. i. By organizing by section, you can eliminate the numerous response options indicating not applicable (N/A – child legally adopted, Not Applicable (baby is 12 months or older) ii. Separating by category such as biological and non-biological specific questions will allow for a more streamlined data collection process. Having excess rules and conditions within the questions that are not read out loud will make data collection choppier. c. Overall labeling for this screening tool was inconsistent. We were not able to clearly identify the child we were to consider when responding to the questions. d. We also recommend filling out one “Children” form per child receiving Healthy Start Services e. Finally, if we continue with only one form, we recommend using the youngest, most recent child under 18 months as the target child. Again, it causes more confusion, for example, when you transition into the infant feeding questions and are now talking about a different child, and “Child 1” isn’t necessarily referring to the same child throughout the form. It also seems like the most recent pregnancy would be the best predictor of the current pregnancy. |
All suggested items were incorporated or addressed in the revision to the extent possible. More detailed responses to 3 specific items are given in columns D through F in this row. | 1. How will this data be used? What questions will be answered using this data? 2. Do you have an evaluation plan for grantees to review? This evaluation focuses on the HS performance measures and information needed to complete reporting requirements. Participants are told before beginning the forms that, "The purpose of the evaluation is to examine how well the Healthy Start program is meeting its goals of helping women to improve their health and the health of their babies." |
Separating by category such as biological and non-biological specific questions will allow for a more streamlined data collection process. Having excess rules and conditions within the questions that are not read out loud will make data collection choppier. We have attempted to clarify many of the instructions, particularly regarding the participant's relationship to the child, and the respondent's relationship to both the participant and the child. We hope that these clarifications will address many of the concerns expressed here. | c. Overall labeling for this screening tool was inconsistent. We were not able to clearly identify the child we were to consider when responding to the questions. d. We also recommend filling out one “Children” form per child receiving Healthy Start Services We have attempted to clarify who the questions refer to, and also that a separate form will be completed per child |
| Christine Vang | • With the new Healthy Start grant of now serving male partners or father of baby – Is there a tool to screen for father of baby or male partner involvement? • Which tool(s) is most appropriate for screening male partner or father of baby involvement - Background Mandatory Tool? |
These two related questions have been addressed in the revision to the extent possible. More detail is provided in Column D of this row. | Instructions are now included in the Background Form that the father/male partner will receive a unique Partner ID and the specific questions he will answer in the Background form are marked. | ||
| Maxine Vance | I reviewed the forms you shared and for the most part, it contains items that are necessary for the benchmark reporting. I noticed that Lisa Bain also echoed several of my thoughts around the wording and options choices for some of the questions. The one additional comment I had was the capture of birth weight information for child born Very Low Birth Weight or Low Birth Weight. As it stands now, on the PostPartum/Internconceptional Form, question 5 (pg.4) only captures if the baby was less than 5lbs or greater than 9lbs but there is no way to distinguish if the baby was born with VLBW or LBW as I didn't see any place where weight was captured. It might be good to include a question that captures the weight of the baby/babies at birth(s). | This suggestion has been incorporated. More detail is provided in Column D of this row. | VLBW is now included as a response option to the question in the Parent/Child form regarding preterm birth. | ||
| Lee Ann Grogen | The following are general concerns from Healthy Start of Southern Oregon: • The tools do not address all aspects of the current benchmarks. How will this be addressed--will the benchmarks change or will additional questions be added? • The revised versions no longer address: dental health, sexually transmitted infections, or reproductive life planning (in that One K+B8ey Question is not included in the screen) and this has been helpful and important information to address with our clients. The following are positive aspects noted from our program: • I like the description of about Hispanic origin; It gives more room for people to decided how to answer it. It could be very confusing for this cultural group at times. I appreciate that. • The NICU question and the one about having a child who passed away are very important topics to touch too. • Well-check question for the child is more clear on the time it took place. It opens opportunities to educate parents on the importance of following vaccination schedule. Background Questionnaire: • Will this form be completed once only, like the current Demographic form, or will it need to be completed annually? • Reproductive Life Plan: Women who have no previous pregnancies and no adopted clients are instructed to skip to Personal Well Being section which means they would not answer this question. Also, if this form gets completed once only, how do we update 'current' RLP in future years? • Depression: If this form gets completed only once, does this mean women are only screened for depression once, not annually? Also, there is not a place to record a referral for depression, which is currently a benchmark for the program. • Well-Woman Exam: Question 11 tracks preventative care--where would this be recorded in subsequent years? • Substance Use: the question is to determine use in the past 12-month period. Often, clients may have been using, but quit once they know they are pregnant and may remain sober after delivery, but would still screen positive for substance use. Our workers would like to see an option that allows for addressing the healthy changes that our clients make. • IPV: The screening questions only identify the partner, but some of our clients live in homes where others who live in the same house may+B8 be abusive towards them and it would be difficult to address their safety with this limitation. Prenatal Form: • Children: are noted as under 24 months of age instead of 18 months. Will this be changed? • Pregnancy Health: Does not have space for estimated delivery date, which is helpful to track. PP/ICC Form: • If woman enrolls pregnant and with a child under 24 months, this form will be completed on the existing child. Will a new form be created when the new child is born? • Again, child is followed up to 24 months instead of 18--will this be corrected? • Target Child: if there is more than one child under 24 months that are enrolled with the mother, data will only be on older child. Younger child will be part of the denominator, but not part of the numerator. Is the expectation to fill out a separate form for each child or record data on both children here? • Health at Birth: No place to record low birthweight or pre-term birth for younger child, if more than 1 under 24 months. • Safe Sleep: if client has 2 children say 20 months old and 6 months old, the 20 month will be the Target. However, the Target child is too old for the Safe Sleep questions. As above the younger child will be part of the denominator and not included in the numerator. |
All suggested items were incorporated or addressed in the revision to the extent possible. More detailed responses to 3 specific items are given in columns D through F of this row. | • The tools do not address all aspects of the current benchmarks. How will this be addressed--will the benchmarks change or will additional questions be added? • The revised versions no longer address: dental health, sexually transmitted infections, or reproductive life planning (in that One Key Question is not included in the screen) and this has been helpful and important information to address with our clients. We have made revisions with an eye towards creating forms that address all aspects of the current benchmarks. In terms of the range of topics, there are many questions and issues we wish we could include. To reduce burden on grantees, caseworkers, and participants, this evaluation focuses on program progress regarding the performance measures--in particular, questions that directly address or facilitate reporting, or that allow us to identify areas to target for program improvement. Albeit important, the items you mention, like many other items, are ultimately important clinical issues that grantees need to work on with each woman as appropriate, but they fall outside the scope of this more focused evaluation. |
Will this form be completed once only, like the current Demographic form, or will it need to be completed annually? To clarify this, we have added extensive instructions to each of the forms regarding when they are to be completed. | Substance Use: the question is to determine use in the past 12-month period. Often, clients may have been using, but quit once they know they are pregnant and may remain sober after delivery, but would still screen positive for substance use. Our workers would like to see an option that allows for addressing the healthy changes that our clients make. One alternative we tried during the process of revising was to ask separate questions for 'before pregnancy' versus 'during pregnancy', and 'during pregnancy' versus 'now'. However, that ended up proliferating the number of questions devoted to substance use relative to other topics. We are reluctant to add response options that distinguish between people who have never used a substance and those that used before pregnancy but then stopped during pregnancy, because of the impact this has on our ability to do direct comparisons between HS results and national standards. We agree that women who make healthy changes during their pregnancy should be commended by program staff and their case worker. |
| Aisha Bowen | Our comments and suggestions are below---thank you! Overall the shorten version is better, however a few question questions we would like to see ADDED OR RETURNED to the form and one suggested omission: NewPkBackgroundForm- p.1, q2.-add question about clients actual age p.3, q5.-add option on in answer list “trade/vocational training p.6, q16.- change cut off range to “18 months” per new NOFO criteria p.6- add back “reproductive life questions” back to this section p.6- add back question about “complications during delivery” p.8-add back the chart of “assistance programs” p.10-add back questions about medications-“do you currently have any pain”; “what medications are you currently taking, including over the counter” NewPkPrenatalForm- p.4-add back height and weight before pregnancy and current We would like to see th+B9ese items omitted: NewPkBackgroundForm- p.1, q4.-ommit this question, our program is urban so our clients would always ‘live in’ an urban area |
We have incorporated the first 4 suggestions into the revisions. The remaining suggestions are addressed in columns D through F in this row. | p.6- add back question about “complications during delivery” p.8-add back the chart of “assistance programs” p.10-add back questions about medications-“do you currently have any pain”; “what medications are you currently taking, including over the counter” p.4-add back height and weight before pregnancy and current As described elsewhere, there are many questions and issues we wish we could include. To reduce burden on grantees, caseworkers, and participants, this evaluation focuses on program progress regarding the performance measures--in particular, questions that directly address or facilitate reporting, or that allow us to identify areas to target for program improvement. Albeit important, the items you mention, like many other items, are ultimately important clinical issues that grantees need to work on with each woman as appropriate, but they fall outside the scope of this more focused evaluation. |
We would like to see these items omitted: NewPkBackgroundForm- p.1, q4.-ommit this question, our program is urban so our clients would always ‘live in’ an urban area We have moved this item to the cover page, with instructions to indicate what type of area the program as a whole serves (urban, rural, tribal, border). |
| Source | Comment | RH Response/ Action Taken | ||
| OER Excel Sheet | Ghandour, Reem (HRSA):You will want to standardize the use of "participant" v. "respondent". | Robin Harwood: Incorporated by clarifying/defining the term 'respondent' where it appears on the cover pages of each document and in the first (General Information) section of the Background questionnaire, which spouses/partners/ fathers will complete; I have also double checked for consistent usage throughout the documents. | ||
| OER Excel Sheet | Ghandour, Reem (HRSA):To map to the NSCH, you would need to also ask question E1 to capture whether the client had gaps in coverae, presumably an important piece of information. See: https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/questionnaires/2018/NSCH-T1.pdf |
Robin Harwood: question added as advised | ||
| OER Excel Sheet | Ghandour, Reem (HRSA): I have concerns about adding a second item that basically reports on whether something happened. You're introducing the potential for error here -- what will you if the data collector does in fact screen but then erroneously notes that no screen was done? Or if two people end up completing the data form? It is more appropriate to, post hoc, create a separate variable that is based directly on the data entered from the screen above.Windows User:If this question is included solely for analytic ease, then to Reem's point, this may cause more issues if there is discordance between this and the question above. However, if we believe that a lack of response to the screener items above should not assume a participant was not screened, then I can see the utility of this question for purposes of understanding how many women were screened (and not just what the value of the screening was). |
Robin Harwood: Each screening tool creates a series of variables. An additional variable needs to be created from that series in order to respond directly to the PM. It depends ultimately on who will be working with the data. if that will include people who are not from OER or who are not external contractors with statistical expertise, then creating a separate, ready-made variable here may lead to less cause for confusion and so less error. Ultimately, this notation can be cross-checked with the items from the actual screening tools to verify the staff notation. However, creating a separate variable for this makes it possible for HS staff who do not have specialized training in statistics to pull the needed information up from a database. |
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| OER Excel Sheet | Ghandour, Reem (HRSA):See comment above re: creation of second depression screening var | Robin Harwood: As above, each screening tool creates a series of variables. An additional variable needs to be created from that series in order to respond directly to the PM. It depends ultimately on who will be working with the data. if that will include people who are not from OER or who are not external contractors with statistical expertise, then creating a separate, ready-made variable here may lead to less cause for confusion and so less error. Ultimately, this notation can be cross-checked with the items from the actual screening tools to verify the staff notation. However, creating a separate variable for this makes it possible for HS staff who do not have specialized training in statistics to pull the needed information up from a database. |
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| OER Excel Sheet | Windows User: Since this is on the prenatal form, is this for the prior pregnancy? Or does the staff person go back and complete this once the current pregnancy has ended? |
Robin Harwood:yes staff person needs to go back and complete once current pregnancy has ended. Since not all women continue into the postpartum phase, this would allow a record to be kept of outcomes for all women who are with HS during the prenatal period. Recommend some piloting with grantees to see how this will work in practice. | ||
| OER Excel Sheet | Ghandour, Reem (HRSA): A couple of considerations for the modifications made: 1) use of the word "worker" v. "professional" as we use in the NSCH. Are you comfortable with clients reporting any kind of contact with someone that they percieve to be a health care "worker" -- this could be a community health worker or....? 2) We include prompting language "A preventive check-up is when this child was not sick or injured, such as an annual or sports physical, or well-child visit." Do you want to include a similar type of prompt/clarification? |
Robin Harwood: have added the additional prompt/clarification to the question stem, and changed 'worker' to 'professional' |
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| OER Excel Sheet | What is the highest grade or level of school you have completed? Mark (X) ONE box... Technically, a GED is not a "year" of school, hence we use "level". This has been congnitvely tested. |
Robin Harwood: Question stem changed per OER's request. | ||
| OER Excel Sheet | Ghandour, Reem (HRSA): Why use old NSCH? Current item from 2018 NSCH (https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/questionnaires/2018/NSCH-T1.pdf) : What is the highest grade or level of school you have completed? Mark (X) ONE box... |
Item updated to new NSCH. | ||
| OER Excel Sheet | Ghandour, Reem (HRSA): Why use old survey? |
Robin Harwood: items updated to new NSCH | ||
| OER Excel Sheet | Windows User: FYI - This link did not work for me. I found the information here: https://www.cdc.gov/breastfeeding/pdf/ifps/ifps_ii/prenatal/prenantalfnlquest.pdf |
Robin Harwood: Link updated in the revised excel file |
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| OER Excel Sheet | Ghandour, Reem (HRSA):It looks like you have question numbers that need to be corrected/stnadardized before resubmission, e.g., #2 follows #3. | Robin Harwood: item numbers removed from column L to avoid confusion under different excel sorting circumstances | ||
| OER Excel Sheet | Ghandour, Reem (HRSA): You will not be able to make statements about the participant's geographic location based on this information as you are capturing data for the site, not the participant. Isn't site location available from some other data source already? If so, this may not be the best use of real estate. |
Robin Harwood: he Rural/Urban/Border/Tribal categories are used by sites when they submit their grant applications; different geographical settings are associated with differential access to health care, thus indicating generally higher need among participants for HS services. The purpose of asking grantees to report the information here is to integrate information used in both grantee aggregate and client-level reporting into one document in order to reduce burden and to increase accuracy in reporting. | ||
| OER Excel Sheet | Ghandour, Reem (HRSA):You might consider reordering: White Black or African American American Indian or Alaska Native Asian Native Hawaiian or Other Pacific Islander |
Robin Harwood: Linked Document Section II states that "Data standards are for person-level data collected in population-based health surveys, where subjects either self-report information or a knowledgeable proxy provides information about the subject or responds for all persons in a household." A population-based survey uses specific sampling methods to yield a group of participants that is representative of the target population (in this case, HS women). Since survey sampling methods were not used to select HS participants, and since we have no way of knowing who did not complete the survey, we don't in fact know what the HS population 'is' in order to create a representative sample of it. Because of this, this evaluation cannot be considered a population-based health survey, and so the data standards do not apply. However, I am using the OMB minimum categories in the order that they introduce them. From Section III: "The OMB minimum categories for race are: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White." The OMB minimum categories for ethnicity are: Hispanic or Latino and Not Hispanic or Latino. Source: https://aspe.hhs.gov/basic-report/hhs-implementation-guidance-data-collection-standards-race-ethnicity-sex-primary-language-and-disability-status |
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| OER Excel Sheet | Ghandour, Reem (HRSA): Per the most recent NSCH survey, we do not allow respondents to report "more than one place". See: https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/questionnaires/2018/NSCH-T1.pdf, Question C10. The "more than one" wording only appears in the Question about personal doctor or nurse (D1) There is also a skip so that folks who respond "no" to this question are not asked the subsequent item on type of place. Also, you will want to standardize "Mark One", "Select One", "...ONE" |
Robin Harwood: option 'more than one place' removed and 'skip' instruction inserted per OER request. Instruction for case worker kept as 'select one only' because this is the language CoIIN chose to use with this population throughout the tools. Have doublechecked the usage for consistency. | ||
| OER Excel Sheet | Ghandour, Reem (HRSA): This isn't the wording from the most recent NSCH. See: https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/questionnaires/2018/NSCH-T1.pdf, Question C11. Is School an appropriate response option for your client population? This could a place where you might want/need to amend the source item. |
Robin Harwood: Wording updated. In terms of 'school' as a response option, many of the clients served by HS are teenage girls, and some are even preteens. It would seem appropriate given this to include school as an option, in case it applies for a particular girl. | ||
| OER Excel Sheet | Ghandour, Reem (HRSA): This does not actually map to quesiont E4 as it is worded such that only one kind of coverage is allowed. See: https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/questionnaires/2018/NSCH-T1.pdf [Are you ] CURRENTLY covered by any of the following types of health insurance or health coverage plans? Mark (X) Yes or No for EACH item... It seems like you needed to amend the first response option -- did this come from somewhere in particular? I *think* it will still work, but I was wondering if this wording had been cognitively tested for another data collection effort. Also, it appears that you have two response options for uninsured |
Robin Harwood: Updated NSCH item, with yes/no grid to indicate response to each item. | ||
| OER Excel Sheet | Ghandour, Reem (HRSA): I like how you combined the CTS with the psychological measures -- this seems to be a much more comprehensive item. My only concern is the last item feels like it doesn't quite fit. Do you definitely want this? I know that the the PRAMS Core item includes a "someone else" category, but the item is more limited overall. You're covering a lot of ground with this item and wonder if including a catch-all physical violence item is helpful in the end. |
Robin Harwood: I was thinking about this as well, and after thinking about it, created a new chart that includes possibility that participant may have experienced these from someone besides husband/partner/ex | ||
| OER Excel Sheet | Ghandour, Reem (HRSA): Admitadly, this is not my wheelhouse, but it looks like PRAMS includes miscarriage, fetal death and still birth in the same question. We don't seem to mention fetal death here -- should that be included? I see that NSFG just notes Miscarriage and stillbirth (and abortion) -- is there any programmatic reason to include abortion? Windows User: I think "fetal death" is covered by "stillbirth" here since the time period range is the same and these terms are often used synonymously ("stillbirth" may be better for a lay audience). I do think the inclusion of abortion or induced termination would be more comprehensive, unless there's a programmatic reason not to (as Reem notes). Although. this may not be related to "pregnancy risk" the way the other responses are (which is the intent of this, I believe).Robin Harwood: yes, 'stillbirth' was used because it is more easily understandable to a lay audience; i am not aware of any programmatic stance per se regarding including abortion, but i am concerned about putting an instrument out there that contains that term in this administration; it's leadership's call though--certainly it can be included as an option if leadership is comfortable with this. In addition, the purpose of the item is not to account for every pregnancy the woman has had but to gain an impression of her prior risk for poor pregnancy outcomes, and abortion is a different kind of event than eg miscarriage or fetal death. However, I defer to leadership on this. I did change response option language to include 'fetal death' and 'or tubal' Robin Harwood: |
Robin Harwood: yes, 'stillbirth' was used because it is more easily understandable to a lay audience; i am not aware of any programmatic stance per se regarding including abortion, although I have wondered about putting an instrument out there that contains that term; it's leadership's call though--certainly it can be included as an option if people would prefer that. In addition, the purpose of the item is not to account for every pregnancy the woman has had but to gain an impression of her prior risk for poor pregnancy outcomes, and abortion is a different kind of event than eg miscarriage or fetal death. However, I defer to leadership on this. I did change response option language to include 'fetal death' and 'or tubal as suggested here.' Robin Harwood: |
Err:509 | |
| OER Excel Sheet | Ghandour, Reem (HRSA): Same issue as above with depression and IPV screening add-on items.Windows User: This may be my lack of knowledge on this, but are those questions above the only way having a RLP is measured? If so, then fine to just keep those questions above (although, do they all have to be answered to say that the participant has a RLP? What happens if only some of the questions are answered, but not all? Should it say "completed ALL of the RLP questions"?) |
Robin Harwood:RLP now includes 5 questions, and all questions are separated out in the revised excel file. The wording of the question to staff has been changed so that it indicates all questions were responded to as appropriate. | ||
| OER Excel Sheet | Source should be latest NSCH: https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/questionnaires/2018/NSCH-T1.pdf | Robin Harwood: Link in excel sheet updated. |
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| OER Excel Sheet | Windows User: So, I assume we are clear that this may go beyond infant mortality and include child mortality, right? We would only be able to make that determination if they provided the child's age at death (which is noted will be sensitively probed). |
Robin Harwood: True, follow-up probe regarding child's age made an additional question instead of embedded as it was formerly, so it will be more certain to be answered | ||
| OER Excel Sheet | Ghandour, Reem (HRSA): Why ask this? Many women won't know -- why not just calculate based on due date? Especially given uncertainty with reporting, you could end up with highly inaccurate data here.Windows User: I also worry here as this is defined according to months, but it gets tricky when we start thinking in weeks and the conversion from months to weeks for this. I agree women may not know exactly which trimester they are in (as many women think in terms of weeks). |
Robin Harwood: This has been changed to be an item that staff completes. This information is for reporting purposes and grantees must calculate it based on due date. Putting the due date and calculated trimester here together facilitates accurate reporting, and helps to close the existing gap between aggregate and client-level data. In addition, trimester by weeks definitions have been added to response options. |
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| OER Excel Sheet | Ghandour, Reem (HRSA): Same as above.Windows User:This could just be determined from the prior question. |
This has been changed to be an item that staff completes. This information is for reporting purposes and grantees must calculate it based on due date. Putting the due date and calculated trimester for beginning prenatal care here together facilitates accurate reporting, and helps to close the existing gap between aggregate and client-level data. In addition, trimester by weeks definitions have been added to response options. | ||
| OER Excel Sheet | Ghandour, Reem (HRSA): Separate out questions. |
Robin Harwood: Each of the interconception questions has now been given its own separate line item in the excel file. | ||
| OER Excel Sheet | Ghandour, Reem (HRSA): Is it possible to add in a question about pumping and whether she's received counseling or guidance on obtaining a pump and/or pumping breastmilk? |
Robin Harwood: There are many, many questions and issues we wish we could include. To reduce burden on grantees, caseworkers, and participants, this evaluation focuses on program progress regarding the performance measures--in particular, questions that directly address or facilitate reporting, or that allow us to identify areas to target program improvement. Albeit important, pumping, like many other items, are ultimately clinical issues that grantees need to work on with each woman as appropriate. However, it should be noted that the question and response options make room for feeding pumped milk. | ||
| OER Excel Sheet | Ghandour, Reem (HRSA): This is different than above.Windows User: This is the same as row 49 above, but it's a different tool. Also, for interconception interval, are we also capturing live births occurring during the 2 years before getting pregnant with your new baby? Sorry if I missed this. |
Robin Harwood: yes i added live birth--thanks for picking up on this. Source cleaned up in revised excel. |
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| OER Excel Sheet | Windows User:Overall comment - while not our fault (as we are including questions informed by other sources), there is inconsistency in the inclusion of fetal death vs. still birth and the accompanying definitions across a few questions on these tools. It's fine to leave as is, but just something to note. | Robin Harwood: Have tried to improve consistency in use of fetal death/stillbirth. Additionally, language changed as recommended per Catherine's comments directly in documents. | ||
| OER Excel Sheet | Ghandour, Reem (HRSA): Please separate these out into different line items -- they are very different questions |
Robin Harwood: This question was actually deleted from the follow-up, and asked only in the parent-child questionnaire. However, each question has now been given its own separate line item in the excel file. | ||
| OER Excel Sheet | Windows User: Should be stated as less than 2500 grams for LBW. Also, LBW is defined as <2500 g and encompasses VLBW, so it's not necessariyl accurate to label this in between range as "low birth weight" by itself, I don't think. Suggest only labeling VLBW and HBW |
Robin Harwood: modification made to response options as suggested. | ||
| OER Excel Sheet | Ghandour, Reem (HRSA): This is different than above.Windows User:Exactly! It appears to be PRAMS vs. NSFG. I think we should be consistent in our response options for these to avoid confusion. |
Robin Harwood: NSFG now in excel file as used for both. | ||
| OER Excel Sheet | Ghandour, Reem (HRSA): Why not just calculate based on birth date?Windows User: Agree, although from the comment it appears DOB was problematic. I'm also not sure the response options capture all ages (to me, the term "between" does not include the lower and upper bounds, persay, but I may be too technical in my thinking. Why not 31 days through 5 months; 6 months through... etc. |
Robin Harwood: yes, calculating based on DOB was challenging. Age-related boundaries have been clarified as requested. | ||
| OER Excel Sheet | Ghandour, Reem (HRSA): It really isn't appropriate to ask this as a single item. Special Health Care Need Status can only be assessed using the the validated 5-item screener. See: https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/questionnaires/2018/NSCH-S1.pdf |
Robin Harwood:this is not intended to be a screener for special health care needs. it is intended to be a program flag for children who are known to have special health care needs for program reporting purposes. i guess a question is how grantees determine this in the first place for reporting purpose. Following phone conversation with Reem on May 1 where this was discussed, I have changed the language here so it is clearer we are not making a reference to CSHCN per se, but only to infants/toddlers that have been identified to program as having complex chronic health conditions. | ||
| OER Excel Sheet | Windows User: Why does it say "not applicable" in the last response option? |
Robin Harwood:instructions are to put in N/A for safe-sleep items if child is older than 12 months. Per conversation with Reem on May 1, instructions have been modified so this is highlighted in each of these two questions | ||
| OER Excel Sheet | Ghandour, Reem (HRSA): Please use the most recent version of the NSCH as these items have changed since the survey was redesigned. https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/questionnaires/2018/NSCH-T1.pdf This item is C10 and the following item should map to C11. |
Robin Harwood:the links to sources for the health care questions have been changed/updated. | ||
| OER Excel Sheet | Windows User: Side note - I'm curious how this is tracked and whether the responses to women and children's usual source of care (which are asked separately) are reported separately for this PM ? |
Robin Harwood: I think the intent is that they will be tracked separately; I know they are being analyzed separately by Abt. |
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| OER Excel Sheet | I recall seeing a question (that I cannot currently find) regarding the use of 'depend on this income' v. 'supported by this income.' I had responded to this question, and am pasting my original response here, plus elaborating on that response some. | Robin Harwood: 'supported by' was selected by CoIIN and used in the 2016 instruments, and among Hispanics at least many people send money regularly to relatives in their country of origin, essentially supporting them. So in this context 'supported by' makes sense. |
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| OER Excel Sheet | Windows User: Where does it ask whether the appointment is scheduled? |
Robin Harwood:Separate questions asking whether appointment has been scheduled has been added for all relevant items. | ||
| OER Excel Sheet | I recall seeing a suggestion (that I cannot currently find among the stickies) that the 'how often do you sing songs, tell stories, etc.' item be added, along with the 'reading' item. | If the questions were going to be used to predict child development outcomes, then I agree that including both questions would be important. However, the HS evaluation is not designed to predict longer-term developmental outcomes. Instead, the PM specifically targets reading, and reading to the child is a specific behavior that the HS program wants to encourage among their participants. So it is appropriate that the question would ask specifically about reading. Positive parent-infant social interactions that include singing and telling stories are a desirable goal that caseworkers should discuss with the participants if it is a concern, but as a question here, it falls outside of the more focused scope of this evaluation. | ||
| Comments from CV in Background Q | I assume the page footers will also be updated (the date says 2016) | Yes updated | ||
| Comments from CV in Background Q | Would it be more clear if you had two separate variables; one for ORG ID and one for Participant Unique ID? I’m a little concerned that there could be confusion around using the term “participant unique ID” both for the combined number (org ID + PID) and the participant unique ID they already use. I know why we want ORG ID attached to it, based on our previous exploration of the data, but thought we didn’t even have ORG ID in the screening tools before so wondered why it couldn’t just live as a separate variable. |
I did make some changes to the wording here, but this may bear some further discussion with grantees through the 30-day public comment period. The 2016 database has org and unique ID as separate variables, and this created a lot of issues at this end, particularly with regard to duplicated unique IDs across sites that Abt could only solve by going back to the grantees, a very time-consuming process. I think the ideal ID would include the Org Code at the beginning, so that duplicate IDs across sites are essentially not possible because every ID will include the unique Org Code as well. I think if Org Code is consistently the first three letters of an ID, then it should be possible to still identify the unique ID they formerly had—perhaps they could be hyphenated? Just want to avoid the issues we had first time around with Org ID and Participant Unique ID treated as two separate variables. | ||
| Comments from CV in Background Q | Why not use all of the possible response options and then they could be grouped for analysis purposes during the analysis stage? 8th grade or less 9-12th grade; no diploma Etc… |
CoIIN chose a simpler, more consolidated list; in addition, many of the original response options were for levels of education beyond college, and very few of the HS participants are at this level. It could make sense to add more differentiation at the lower end. However, one issue when using a migrant population is that the educational levels they have in their countries of origin may not correspond well to our levels here, so less detail is easier for them to fit into their own experience than more detail—eg, an equivalent to ‘high school diploma’ in a different country could be called 10th grade or 13th grade or any number of things, but it has the same functional purpose, and it then becomes difficult for the migrant and the case worker to determine where to ‘put’ their 10th grade or 13th grade, when there is more differentiation; but just, ‘high school diploma or equivalent’ works. With that in mind, I made a couple changes to the first two options. | ||
| Comments from CV in Background Q | Did you consider reordering these? The ASPE link has White first. | Section II of the linked document states that "Data standards are for person-level data collected in population-based health surveys..." A population-based survey uses specific sampling methods to yield a group of participants that is representative of the target population (in this case, HS women). Since survey sampling methods were not used to select HS participants, and since we have no way of knowing who did not complete the survey, we don't in fact know what the HS population 'is' in order to create a representative sample of it. Because of this, this evaluation cannot be considered a population-based health survey, and so the data standards do not apply. However, I am using the OMB minimum categories in the order that they introduce them. From Section III: "The OMB minimum categories for race are: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White." The OMB minimum categories for ethnicity are: Hispanic or Latino and Not Hispanic or Latino. Source: https://aspe.hhs.gov/basic-report/hhs-implementation-guidance-data-collection-standards-race-ethnicity-sex-primary-language-and-disability-status |
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| Comments from CV in Background Q | Are there school-aged parents? This response option may not be relevant here (unless there are very young parents?) | Yes there are both teen participants as well as even some preteen. | ||
| Comments from CV in Background Q | Per previous comment, it was suggested that this be changed to “depended on” | The term 'supported by' was selected by CoIIN and used in the 2016 instruments, and among Hispanics at least many people send money regularly to relatives in their country of origin, essentially supporting them. So in this context 'supported by' makes sense. |
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| Comments from CV in Background Q | And this would only be relevant for those who screened “positive” for depression; so I assume any calculations for % who received a referral would be estimated using the correct denominator in the analysis stage. That way the staff wouldn’t have to determine WHO should be referred based on this questionnaire alone. | Yes, the denominator should be women who scored in the ‘needs further screening’ range (2 or more for this screener). | ||
| Comments from CV in Background Q | The font size is smaller than elsewhere. | Yes, using a slightly smaller font allows the individual cells to take up less space and so fit on the page better; in addition, it visually sets off definitions from the actual question, hopefully making it easier for caseworkers to track as they read this to participants. | ||
| Comments from CV in Background Q | See comments on the other two forms about this definition. Here it aligns with the data source used for this question, but it’s inconsistent elsewhere. | The definitions used across forms have been updated to match their source. | ||
| Comments from CV in Background Q | I don’t think this is necessary here. Again, are you getting at whether they filled in the checkboxes above? or that the person was actually asked these questions? Same question applies to depression questions. |
All questions are read to participants and case worker records their answers. Wording changed to clarify. The instructions for the caseworkers were added in response to public comment. | ||
| Comments from CV in Background Q | Is this a new question? | This question was not directly asked in 2016. | ||
| Comments from CV in Background Q | Reem suggested not including this. | This is a comment that I did not see/ could not find among the excel file stickies. ‘Unable to get pregnant’ was a response option used by CoIIN in a similar question in the 2016 tools. It is a way to skip asking mothers who cannot get pregnant questions that are upsetting to them and/or that they may have trouble answering because they feel it doesn’t apply to them, since they are unable to get pregnant. | ||
| Comments from CV in Background Q | Although rare, it’s possible they lost more than one child. How would that be tracked here? | Good suggestion. I have added indicators for number as well as age. | ||
| Comments from CV in Prenatal Q | I assume the page footers will also be updated. | Yes done. | ||
| Comments from CV in Prenatal Q | Changed for consistency with ACOG (without adding the specificity of days – e.g., 13 6/7): https://www.acog.org/Patients/FAQs/How-Your-Fetus-Grows-During-Pregnancy?IsMobileSet=false | Thank you! | ||
| Comments from CV in Prenatal Q | Changed for consistency with ACOG (without adding the specificity of days – e.g., 13 6/7): https://www.acog.org/Patients/FAQs/How-Your-Fetus-Grows-During-Pregnancy?IsMobileSet=false Again – why is this needed when #6 can be used to calculate this? |
This has been changed to be an item that staff completes. This information is for reporting purposes and grantees must calculate it based on due date. Putting the due date and calculated trimester for beginning prenatal care here together facilitates accurate reporting, and helps to close the existing gap between aggregate and client-level data. In addition, trimester by weeks definitions have been added to response options. | ||
| Comments from CV in Prenatal Q | This is stated a bit awkwardly to me. Is this being used to estimate IPI? Why not just say: During the 2 years before you got pregnant, did you have a another pregnancy? |
Not a problem—changed from ‘any other’ to ‘another’ | ||
| Comments from CV in Prenatal Q | By “current pregnancy” do you mean “before getting pregnant”? I think we want to make sure it’s clear we want to know time from end of prior pregnancy to conception (to the extent we are capturing this latter part) of the next pregnancy. I know PRAMS frames it according to “getting pregnant with my new baby”, but of course, not all of our women have delivered yet since this is the prenatal questionnaire. What if we added “began” to the end of each response option? | Thanks—good to clarify! | ||
| Comments from CV in Prenatal Q | Reem had wondered if pumping could be included here? | There are many, many questions and issues we wish we could include. To reduce burden on grantees, caseworkers, and participants, this evaluation focuses on program progress regarding the performance measures--in particular, questions that directly address or facilitate reporting, or that allow us to identify areas to target program improvement. Albeit important, pumping, like many other items, are ultimately clinical issues that grantees need to work on with each woman as appropriate. However, it should be noted that the question and response options make room for feeding pumped milk. | ||
| Comments from CV in Prenatal Q | Can you clarify where this came from? (PRAMS uses slightly different language, so I am just curious). I see now this is from the TAPS (right?); then why on the parent/child form is this defined the way PRAMS does? Theses should be consistent. A drink is 1 glass of wine, wine cooler, can or bottle of beer, shot of liquor, or mixed drink. |
This item comes from the PRAMS, so definition changed to PRAMS as well. The definition was not included in the actual question I used so I did not put it together that PRAMS had its own definition of this, but I felt it was important to include a definition, so for consistency I included the one I was aware of (from NIDA TAPS). Updated, though, to PRAM’s definition. | ||
| Comments from CV in Prenatal Q | We should be consistent with language across the forms (on the background form it says “baby dies…”) | Same wording now used for these two response options across this questionnaire and the Background form. | ||
| Comments from CV in Prenatal Q | I’m still wondering about the consistency of how this is reported. In the pregnancy history section of the background it’s framed differently. Where is this list from? I see in PRAMS standard form it’s “fetal death (baby died before being born) or stillbirth” |
Same wording now used for these two response options across this questionnaire and the Background form. | ||
| Comments from CV in Prenatal Q | Neonatal deaths and live births should be mutually exclusive for reporting. I suggest neonatal deaths be separated into a different question/reporting about follow-up of live births, if needed. I want to make sure that the # of live births above includes those who ultimately died either during the neonatal period or later. | Neonatal death is now its own question. | ||
| Comments from CV in Parent/ Child Q | Would it be more clear if you had two separate variables; one for ORG ID and one for Participant Unique ID? I’m a little concerned that there could be confusion around using the term “participant unique ID” both for the combined number (org ID + PID) and the participant unique ID they already use. I know why we want ORG ID attached to it, based on our previous exploration of the data, but thought we didn’t even have ORG ID in the screening tools before so wondered why it couldn’t just live as a separate variable. |
I did make some changes to the wording here, but this may bear some further discussion with grantees through the 30-day public comment period. The 2016 database has org and unique ID as separate variables, and this created a lot of issues at this end, particularly with regard to duplicated unique IDs across sites that Abt could only solve by going back to the grantees, a very time-consuming process. I think the ideal ID would include the Org Code at the beginning, so that duplicate IDs across sites are essentially not possible because every ID will include the unique Org Code as well. I think the ideal ID would include the Org Code at the beginning. I think if Org Code is consistently the first three letters of an ID, then it should be possible to still identify the unique ID they formerly had—perhaps they could be hyphenated? Just want to avoid the issues we had first time around with Org ID and Participant Unique ID treated as two separate variables. | ||
| Comments from CV in Parent/ Child Q | See comment on prenatal care form. | ‘any other’ changed to ‘another’ per recommendation | ||
| Comments from CV in Parent/ Child Q | This should be consistent with prenatal form wording. | It has been made consistent. | ||
| Comments from CV in Parent/ Child Q | Since this can be calculated using two dates, is this here in case the DOB is missing? | Yes that is definitely one purpose it can serve. Generally, including both the DOB and the child’s current age here together facilitates accurate reporting, especially in those cases where participants may be unwilling to provide an accurate birthdate. | ||
| Comments from CV in Parent/ Child Q | See comment on background form about ordering. | Linked Document: Section II states that "Data standards are for person-level data collected in population-based health surveys, where subjects either self-report information or a knowledgeable proxy provides information about the subject or responds for all persons in a household." A population-based survey uses specific sampling methods to yield a group of participants that is representative of the target population (in this case, HS women). Since survey sampling methods were not used to select HS participants, and since we have no way of knowing who did not complete the survey, we don't in fact know what the HS population 'is' in order to create a representative sample of it. Because of this, this evaluation cannot be considered a population-based health survey, and so the data standards do not apply. However, I am using the OMB minimum categories in the order that they introduce them. From Section III: "The OMB minimum categories for race are: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White." The OMB minimum categories for ethnicity are: Hispanic or Latino and Not Hispanic or Latino. Source: https://aspe.hhs.gov/basic-report/hhs-implementation-guidance-data-collection-standards-race-ethnicity-sex-primary-language-and-disability-status |
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| Comments from CV in Parent/ Child Q | On the background form “White” is the option, not “White or Caucasian”; these should be consistent. | Must have been an oversight since I thought I had removed it—thanks for the pick-up. | ||
| Comments from CV in Parent/ Child Q | I see this has changed since the previous version. Reem had wondered about using the CSHCN screener questions from the NSCH. | Yes, following phone conversation with Reem on May 1 where this was discussed, I have changed the language here so it is clearer we are not making a reference to CSHCN per se, but only to infants/toddlers that have been identified to program as having complex chronic health conditions. This question is not intended to be a screener for special health care needs. It is intended to be a program flag for children who are known to have special health care needs for program reporting purposes. i guess a question is how grantees determine this in the first place for their reporting purpose. | ||
| Comments from CV in Parent/ Child Q | Is this even necessary? We can calculate this from the information in #20. I’m still a bit concerned about the response options. It’s strange to have normal weight out of order, but I see why you did that since it’s a range and the others are < or > | As with a few other items, it depends ultimately on who will be working with the data. if that will include people who are not from OER or who are not external contractors with statistical expertise, then creating a separate, ready-made variable here may lead to less cause for confusion and so less error. Ultimately, this notation can be cross-checked using the two dates. However, creating a separate variable for this makes it possible for HS staff who do not have specialized training in statistics to pull the needed information up from a database. In terms of the order, ‘normal weight’ was originally in the ‘right’ order, but there was an objection to including it at all, so I moved it to a less obtrusive place in the order. Basically, if a baby is not LBW, VLBW, or HBW, then marking the baby as ‘normal’ birthweight range establishes that the question was not skipped inadvertently, and the correct data regarding BW has been gotten from all participants who have a participating child. This makes it possible to make statements such as, 'X% of pregnant HS participants delivered babies in the normal weight range.' Without that check mark, there is no confirming data one way or the other without resorting to analyses that require date subtraction in a software program—not the easiest thing to do, esp if the DOB is entered incorrectly or inconsistently, and then we can't be certain that the lack of data means a baby was normal birthweight. | ||
| Comments from CV in Parent/ Child Q | Just thinking…I know this is consistent with the NSCH, but in this instance, we are talking about infants so this category may not be relevant for this pop. | True. I can remove it as an option here, although it was included as an option in the 2016 tools, and concern has also been expressed regarding comparability of instruments across time. So I guess one question is whether in the 2016 data, there are any responses that the child usually gets their care in a school setting. It seems unlikely but I guess it is an empirical question. Eg, would it ever be possible that a teen mother attends a school that offers certain kinds of support for their teen parents, including health advice? | ||
| Comments from CV in Parent/ Child Q | These aren’t lined up accurately. | It looks like a space from the answer line was accidentally deleted somewhere along the line. I have put the space back in and this is fixed now. | ||
| Comments from CV in Parent/ Child Q | I’m curious why these changed to ranges? | The 2016 item asked for the date of the visit. I am not sure that in all cases mothers will remember the exact date of the visit, and we may not be able to assume that every mother has a datebook/calendar on her that she can check. However, beyond that, It depends ultimately on who will be working with the data. At some point, the date of the visit needs to be calculated against child’s date of birth to produce a variable that answers the question, ‘how old was the child at the last visit?’ and then this age needs to be checked against the recommended well-visit schedule for the first 18 months in order to address the PM. However, if people working with the data will include people who are not from OER or who are not external contractors with statistical expertise, then a series of questions here that produce an outcome that directly aligns with the recommended well-visit schedule may lead to less cause for confusion and so less error. This particular question provides range responses that do align with the recommended schedule of visits. Ultimately, the staff notation can be cross-checked with the necessary dates to verify the staff notation. However, creating a separate variable for this makes it possible for HS staff who do not have specialized training in statistics to pull the needed information up from a database. | ||
| Comments from CV in Parent/ Child Q | Recommended to include two items from the NSCH as previously noted. | I am familiar with the 2 types of questions that are used in the NSCH, as these are often used in child development research as a way to predict outcomes that parent-child reading alone cannot capture. If these 2 questions were going to be used to predict child development outcomes, then I agree that including both questions would be important. However, the HS evaluation is not designed to predict longer-term developmental outcomes for the child (e.g., cognitive development, kindergarten readiness)—it is focused instead on women’s health and health in the first 18 months of life. The PM itself specifically targets reading, and reading to the child is a specific behavior that the HS program wants to encourage among their participants. So it is appropriate that the relevant question would ask specifically about reading. Positive, verbally-rich parent-infant social interactions that include singing and telling stories are a desirable goal that caseworkers should discuss with the participants if it is a concern, but as a question here, it falls outside of the more focused scope of this evaluation. | ||
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| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |