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APPENDIX A: 1999 CHECKLISTS

INDICATORS OF FULL IMPLEMENTATION FOR EHS PROGRAMS Program: _____________________________________ Date of Site Visit:_____________________

Dimension	Specific Indicators			Data Sources
	CHILD DEVELOPMENT CORNERSTONE
Frequency of child development services: services for children	Enrolled children receive child development services through the following modes of service delivery:			20, 26
	__	Center-based child care/child development services provided directly by the EHS program
		__	Average hours per week
		__	Proportion of enrolled children who receive this service
	__	Other developmentally appropriate child care
		__	Average hours per week
		__	Proportion of enrolled children who receive this service
	__	Home visits with a child development focus
		__	Average number of child development home visits completed per month
		__	Proportion of parents and children who receive this service
	__	Percentage of enrolled children who received any child development services within the past month
	SOURCES OF ESTIMATES: ______________________________
	DESCRIPTION OF MAIN CHILD DEVELOPMENT SERVICES:
Frequency of child development services: services for parents	__	Of those parents who have been enrolled in the program for at least one month, percentage who have received any parent education services within the past month		20,23
	SOURCE OF ESTIMATE: __________________________
	DESCRIPTION OF PARENT EDUCATION SERVICES:
Developmental assessments	__	Program provides age-appropriate developmental assessments		76-78
		Name of instrument(s): _________________________
		Schedule for conducting assessments: _________________________
	__	Percentage of children who have received age-appropriate developmental screenings in the past year
	__		Program staff use assessment results to plan child development services.
	__		ALL program staff who work with the child use assessment results to plan child development services.
	SOURCES OF ESTIMATES: ______________________________
	DESCRIPTION OF HOW SERVICES ARE PLANNED USING ASSESSMENT RESULTS:
Follow up on services for children with disabilities	__	Percentage of children with a suspected or diagnosed disability		82-90
	__	Percentage of children with a suspected or diagnosed disability who have been referred to PartC (IF LESS THAN 100 PERCENT, RECORD THE REASON.)
	__	Program makes vigorous efforts to recruit children with disabilities.
	Program coordinates with the Part C provider to:
	__	Develop joint individualized family service plans
	__	Coordinate services that families receive
	__	Ensure follow up on referrals is done quickly.
		Average length of time between Part C referral and assessment/service delivery: _________________________
	SOURCES OF ESTIMATES: ______________________________
	DESCRIPTION RECRUITMENT ACTIVITIES AND COORDINATION WITH PART C :
Health services	The program:			68-75
	__	Provides comprehensive health care directly; and/or
	__	Refers children to local health care providers and case managers monitor service delivery
	__	Collaborates with health care providers and parents to track well child care, immunizations, and treatment plans
	__	Ensures all children have access to dental care
	__	Ensures all children have access to mental health counseling
	__	Ensures that children receive needed follow up services without delay.
	Percentage of children who:
	__	Have a medical home
	__	Have up-to-date immunizations
	__	Have had a well-child exam in the past year
	__	Have a treatment plan for identified conditions
	SOURCES OF ESTIMATES: ______________________________
	DESCRIPTION OF HOW PROGRAM TRACKS HEALTH CARE SERVICES:
Child care: placement and referral	Number of program families who:			28-31, 33-34
				Parent guide-8
	__	Need child care
	__	Are receiving child care services
	__	Program provides child care directly. Number of children served:
	__	Program refers families to other child care providers. Number of children served:
	__	Program helps families find quality child care providers.
	__	Program helps families apply for child care subsidies.
	__	Program works with families to prevent interruptions in child care subsidies and services.
	SOURCES OF ESTIMATES: ______________________________
	DESCRIPTION OF CHILD CARE PLACEMENT AND REFERRAL ACTIVITIES:
Child care: monitoring and training	The program:			36-38,56,60, 66
				Parent guide-8
	__	Assesses the quality of child care settings to which it refers children to ensure that the setting meets HS performance standards. Name of assessment tool: _________________________
	__	Monitors the quality child care arrangements used by EHS children on a regular basis to ensure that the settings meet HS performance standards.
		Frequency of monitoring: _________________________
	__	Provides training and support to the child care providers used by EHS families to improve the quality of child care that EHS children receive
	DESCRIBE THE CHILD CARE ASSESSMENT, MONITORING, AND TRAINING/SUPPORT ACTIVITIES CARRIED OUT BY THE PROGRAM:
Parent involvement in child development services	The program:			115,145-146
	__	Involves parents in planning child development services
	__	Involves parents in planning parent education services
	__	Involves parents in planning child development home visits
	__	Proportion of families in which at least one parent participates in planning and/or delivery of child development services.
	__	Of those families with a father/father figure, proportion in which the father participate in planning and/or delivery of child development services.
	DESCRIPTION OF PARENT INVOLVEMENT IN CHILD DEVELOPMENT SERVICES:
Individualization of services	Percentage of enrolled families:			6, 93-95
	__	Whose primary language is not English
	__	Who receive child development services in their primary language
	SOURCES OF ESTIMATES: ______________________________
	The program:
	__	Provides child development services in a manner that respects families' cultural and ethnic traditions with regard to child rearing practices
	__	Provides child development services that are tailored to the circumstances and backgrounds of individual families and children
	__	for__ a few children with special needs,__ some children, most children, or__ almost all children
	DESCRIPTION OF INDIVIDUALIZATION ACTIVITIES:
Group socializations	__	The program provides group socialization activities at least two times a month for parents and children who receive child development services primarily through home visits.		96-102
	__	Proportion of families who regularly participate in group socialization activities
			SOURCES OF ESTIMATES:
			DESCRIPTION OF GROUP SOCIALIZATION ACTIVITIES:
	FAMILY DEVELOPMENT CORNERSTONE
Individualized family partnership agreements	Program engages families in a process of developing individualized family partnership agreements that:			132-139, staff guide-4
	__	Identify families' goals, strengths, and needed services
	__	Describe timetables and strategies for achieving goals
	__	Build upon plans developed by other programs
	__	Are developed jointly with other programs when appropriate
	__	Are reviewed and updated regularly
	__	Frequency of updates: _________________________
	__	Percentage of enrolled families for whom an individualized family partnership agreement has been developed
	SOURCE OF ESTIMATE: _________________________
	DESCRIPTION OF PLAN DEVELOPMENT PROCESS:
Availability of services: service provided directly and through referral	The program provides the following services directly or through referral to another agency. (INDICATE WHETHER EACH SERVICES IS PROVIDED DIRECTLY (D), PROVIDED THROUGH REFERRAL (R), OR NOT PROVIDED (N).			140-142
	__	Case Management
	__	Parent support through peer support groups and other approaches
	__	Health care for parents and other family members (including contraception/family planning)
	__	Comprehensive prenatal and postpartum care
	__	Prenatal education and information about breastfeeding
	__	Mental health services for parents and other family members
	__	Information about mental health issues such as substance abuse, child abuse and neglect, and domestic violence
	__	Services to improve health behavior, such as smoking cessation classes and substance abuse prevention and treatment
	__	Education and job training
	__	Employment services
	__	Emergency assistance
	__	Transportation to program services
	__	Program systematically follows up with families and service providers to ensure that families receive the services they need.
	DESCRIPTION OF SERVICE PROVISION AND FOLLOW UP:
Availability of services: monitoring quality	DESCRIBE THE PROGRAM'S PROCEDURES FOR MONITORING SERVICE QUALITY, INCLUDING FREQUENCY OF MONITORING, AND MAKING IMPROVEMENTS WHEN PROBLEMS ARE IDENTIFIED.			143
Receipt of services	__	Percentage of families who have had a meeting with their case manager in the past 30 days		20
	DESCRIPTION CASE MANAGEMENT ACTIVITIES:
Parent involvement	__	Number of staff members who are current or former EHS or HS parents		20, 145-153
	__	Percentage of families in which at least one parent has volunteered for program activities in the past year
	__	Of those families with a father/father figure, percentage of those with fathers who participate in planning or are otherwise involved in program activities
	SOURCE OF ESTIMATE: __________________________
	DESCRIPTION OF OPPORTUNITIES FOR PARENTS TO BECOME INVOLVED AS DECISION-MAKERS, LEADERS, VOLUNTEERS, AND STAFF MEMBERS:
	STAFF DEVELOPMENT CORNERSTONE
Supervision	DESCRIBE OF SUPERVISORY, MENTORING, AND OTHER STAFF SUPPORT ACTIVITIES DESIGNED TO SUSTAIN MOTIVATION AND PREVENT BURNOUT. DESCRIBE THE PERFORMANCE REVIEW PROCESS AND THE FREQUENCY OF REVIEWS.			198-204, staff guide-18,21
	__	Supervision and performance review activities include observation of staff delivering services.
Training	Staff development plan and curriculum:			190-197, staff guide 23-24
	__	Are based on an assessment of staff training needs
	__	Emphasize relationship building
	__	Employ techniques and opportunities for practice, feedback, and reflection
	__	Percentage of staff members who have received training in multiple areas in the past year.
	DESCRIPTION OF STAFF DEVELOPMENT ACTIVITIES:
Turnover	__	Percentage of staff who have left the program during the past 12 months due to reasons other than program downsizing.		189
	REASONS FOR STAFF TURNOVER:
Compensation	__	In the program director's opinion, staff salaries and benefits for EHS staff positions are at or above the average level for similar staff in other area programs.		205, Staff guide-25
		Staff can access the following benefits:
		__	Tuition reimbursement
		__	Child care
		__	Other "family friendly" benefits (DESCRIBE)
	DESCRIPTION OF HOW STAFF SALARIES AND BENEFITS COMPARE TO SIMILAR POSITIONS IN THE AREA:
Morale			DESCRIBE STAFF MORALE.	Staff guide-15-16
	COMMUNITY BUILDING CORNERSTONE
Collaborative relationships	__	Estimated number of other community providers with which the program communicates regularly		158-160
	__	Average frequency of communications with other community providers
	__	Program participates in a coordinating group of community service providers
	Program has in place:
	__	Written collaborate agreements
	__	Informal collaborate agreements
	SOURCE OF ESTIMATE: __________________________
	DESCRIPTION OF COLLABORATION ACTIVITIES:
Advisory committees	The program has established the following advisory committees:			171-178
	__	Health advisory committee
	__	Other advisory committee(s) that focuses on infant and toddler issues
	The health advisory committee:
	__	Meets regularly
	__	Frequency of meetings: _________________________
	__	Involves other community health services providers
	__	Discusses infant and toddler health issues
	DESCRIPTION OF ADVISORY COMMITTEE ACTIVITIES:
Transition plans	__	Of those children who are within 6 months of their third birthday, percentage who have a transition plan in place		174-178
	__	Parents are active participants in the transition planning process.
	DESCRIPTION OF TRANSITION PLANNING:
	MANAGEMENT SYSTEMS AND PROCEDURES
Policy council	__	A parent policy council has been established and meets regularly		206-208
		Frequency of meetings: _________________________
	__	The policy council is involved in making decisions about the EHS program.
	DESCRIPTION OF POLICY COUNCIL ACTIVITIES:
Communication systems	A system of regular communication exists:			209-212
	__	Among staff
	__	Between staff and parents
	__	Between the program and the grantee agency
	__	Between the program and the policy council and other governing bodies
	__	The communication system facilitates two-way communication among staff, parents, the grantee agency, the policy council, and others.
	DESCRIPTION OF COMMUNICATION SYSTEMS:
Goals, objectives, and plans	__	The program has developed a set of goals and objectives for the EHS program.		213-216
	__	The program has developed written plans for implementing services in each program area.
	__	Goals, objectives, and plans were developed through a collaborative planning process that included staff, parents, the policy council, advisory councils, and other community members.
	Date of most recent plan revision: _________________________
	DESCRIPTION OF THE PROGRAM'S PROCESS FOR DEVELOPING GOALS, OBJECTIVES, AND PLANS:
Self-assessment	__	The program has conducted an annual self-assessment within the past 12 months		217-220
		Dare of most recent self-assessment: _________________________
	__	Results of the self-assessment have been recorded in program records.
	__	The self-assessment process involved staff, parents, and community members.
	__	The results of the self-assessment have been used to make program improvements.
	DESCRIPTION OF SELF-ASSESSMENT PROCESS AND RECOMMENDATIONS FOR PROGRAM IMPROVEMENTS:
Community needs assessment	__	The program has conducted an in-depth assessment of community resources and needs within the past three years.		221-222
	__	Staff, parents, the policy council, advisory committees, and other community members were involved in the community assessment process.
	Date of most recent assessment: _________________________
	DESCRIPTION OF COMMUNITY ASSESSMENT PROCESS:
	Describe the community assessment process.

 

INDICATORS OF QUALITY FOR CHILD DEVELOPMENT HOME VISITS Program: _____________________________________ Date of Site Visit:_____________________

Dimension	Specific Indicators			Data Sources
Supervision	Home visitors receive supervision that includes:			123-124, 203
	___	Support
	___	Teaching
	___	Evaluation
	___	Individual supervision
		Frequency of individual supervision sessions: ___________
	___	Group supervision
		Frequency of group supervision sessions: ___________
	___	In-field supervision
		Frequency of in-field supervision: ___________
	___	Supervisor has a plan or schedule for regular in-field supervision.
	___	Home visitors report regular opportunities to discuss their experiences as home visitors with each other during staff meetings or other group supervision activities.
	DESCRIPTION OF HOME VISITOR SUPERVISION:
Training	___	Home visitors report that they have many opportunities to participate in training.		126-128
	___	The program's training curriculum, plan, and/or schedule provides for many opportunities for home visitor training.
	Training techniques include:
	___	Role playing
	___	Experiential learning
	___	Peer teaching
	___	In-service training follows a curriculum or plan that includes training on a variety of service areas.
	___	All home visitors have received training in child development.
	___	Home visitors report that they have received training in multiple areas.
		DESCRIPTION OF HOME VISITOR TRAINING:
Home visitor hiring and matching	When hiring home visitors, the program has considered the following:			119-122
	___	Specific program goals
	___	The complexity of families' needs
	___	Roles and responsibilities of home visitors
	___	Other (Describe.)
	The program requires home visitors:
	___	To have strong interpersonal and communication skills
	___	To be mature (based on previous relevant experience and age)
	___	To respect the values and beliefs of people from diverse background and cultures and to be able to respond in an appropriate and sensitive manner to people from a variety of backgrounds
	___	The program matches home visitors with families according to home visitors' skills, families' needs, and the individual characteristics of both home visitors and families.
	___	Of those families whose first language is not English, percentage who are matched with a home visitor who speaks their language or involves other staff who share the linguistic and cultural background of the families in the home visits
	SOURCE OF ESTIMATE: __________________________
	DESCRIPTION OF HOME VISITOR HIRING AND MATCHING WITH FAMILIES:
Planning home visits	Home visits are planned based on:			113-117, 126 Staff guide-13-15, Parent guide-13, 17
	___	Clear objectives and program goals
	___	Expected outcomes
	Home visitors develop plans for each visit using a curriculum or protocol that:
	___	Includes defined child development activities that take place during home visits
	___	Is responsive to the individual needs of families and children
	Name of curriculum: ________________________________
	The program's home visiting curriculum and training materials:
	___	Encourage home visitors to build on the strengths of parents and children
	___	Encourage home visitors to work in partnership with parents to provide child development services
	___	Emphasize the importance of building strong relationships with parents and children and the skills needed for relationship-building.
	___	Home visitors report that they are able to be flexible during home visits and modify planned activities when necessary to respond to families' needs.
	Parents report that:
	___	They are satisfied with their home visitor
	___	They regularly participate in planning home visits
	DESCRIPTION OF HOME VISIT PLANNING:
Frequency of home visits and caseload sizes	___	Average number of families per home visitor reported during site visit		20, 103, 107-110, Staff guide-15-16
	___	Average number of hours per home visitor per week spent on home visiting
	___	Average number of hours per home visitor per week spent on supervision/staff development activities
	___	Average number of hours per home visitor per week spent on record keeping
	SOURCE OF ESTIMATE: __________________________
	___	Home visitors report having adequate time for completing home visits and other duties.
	___	Average number of completed child development home visits per family per year reported during site visit
	___	Average number of completed child development home visits per family per month reported during site visit
	___	Percentage of families who receive at least one child development home visit per month
	SOURCE OF ESTIMATE: __________________________
	DESCRIPTION OF HOME VISITOR WORKLOAD AND BARRIERS THAT PREVENT COMPLETION OF HOME VISITS:
Emphasis on child development activities		Time devoted to child development and other activities in a typical child development home visit is appropriated as follows:		118
			Reported by program
	___	Percent of time spent directly with the child	______
	___	Percent of time spent with the parent and child together	______
	___	Percent of time spent directly with the parent for parenting education	______
	___	Percent of time spent on family social services	______
	___	Percent of time spent on other activities (describe other activities)	______
	SOURCES OF ESTIMATES: __________________________
	DESCRIPTION OF CHILD DEVELOPMENT ACTIVITIES CONDUCTED DURING HOME VISITS:
Addressing multiple needs	___	Home visitors provide comprehensive services that address multiple family needs.		104, 113
	___	Home visitors perform some case management functions, coordinating referrals to other program services or other service providers to needed services that are not provided during the home visit.
	DESCRIPTION OF HOW HOME VISITORS ADDRESS MULTIPLE NEEDS:

 

 

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