**U.S. Department of Health and Human Services**

**Health Resources and Services Administration**

**Maternal and Child Health Bureau**

**Maternal and Child Health Training Program**

***5-T17-05-001-Pediatric Dentistry (PD)***

***5-T19-05-001-Social Work (SW)***

***5-T71-05-001-Adolescent Health (LEAH)***

***5-T73-05-001-Leadership Education in Neurodevelopmental Disorders
(LEND)***

***5-T77-05-001-Developmental-Behavioral Pediatrics (DBP)***

***5-T79-05-001-Nutrition (NUT)***

***5-T80-05-001-Nursing (NUR)***

***5-T83-05-001-Communication Disorders (CD)***

**Catalog of Federal Domestic Assistance (CFDA) No. 93.110**

**CONTINUATION APPLICATION PROGRAM GUIDANCE**

**Non-Competitive Renewal**

Fiscal Year 2005

**Application Due Date: April 22, 2005**

**Release Date: *February 21, 2005***

> Contact Names: PD, DBP, NUR, CD---Nanette Pepper, BSRN, MEd, (301)
> 443-6445
>
> SW---Diana L. Rule, MPH, (301) 443-0233
>
> LEAH---Madhavi Reddy, MSPH, (301) 443-0754
>
> LEND, NUT---Denise Sofka, RD, MPH, (301) 443-0344
>
> Titles, Offices: Program Officers; Division of Research Training and
> Education
>
> Fax: (301) 443-4842
>
> Legislative Authority: Title V of the Social Security Act, as amended

**TABLE OF CONTENTS**

**I. PURPOSE 4**

**II. AWARD INFORMATION 4**

> Summary of Funding 4

**III. ELECTRONIC SUBMISSION INSTRUCTIONS 4**

> A. Background and Rationale for Electronic Submission 4
>
> B. Getting Started 5
>
> 1\. Registration 5
>
> 2\. Overview of the Electronic Process 6
>
> 3\. Length Limitation 6
>
> 4\. Assistance with Electronic Submission 6
>
> C. Basic Information 7
>
> 1\. Applicant Organization Information 7
>
> 2\. Applicant Project Information and Project Abstract 7
>
> D. Budget Information 7
>
> 1\. Detailed Budget 8
>
> 2\. Consolidated Budget 8
>
> 3\. Budget Narrative - Budget Justification 8
>
> E. Project Details 9
>
> 1\. Table of Contents 9
>
> 2\. Continuation Application Narrative 9
>
> 3\. Format Requirements 10
>
> F. Assurances and Certifications 11
>
> G. Appendices 11
>
> 1\. Biographical Sketches 11
>
> 2\. Letters of Support 11
>
> 3\. Funding Priority Requests 11
>
> 4\. Appendices 11
>
> H. Program Specific Information 11
>
> I. Paper Submission Format 14

**IV. Submission Dates and Times 15**

**V. Intergovernmental Review 15**

**VI Funding Restrictions 15**

**VII. Continuation Application Review Information 16**

> A. Review Process 16

**VIII. Agency Contacts 16**

> A. Business, Administration and Fiscal Inquiries 16
>
> B. Programmatic Assistance 16
>
> C. Electronic Application, HRSA Electronic Handbooks Assistance 17

**IX. Guidance Appendices 18**

> Appendix A: Sample Completed Status Page 18
>
> Appendix B: Key Word List 19
>
> Appendix C: Program Specific Forms 24
>
> Appendix D: Training Web Site 58

#### I. PURPOSE 

A continuation application is required for continuation of grant funding
for each budget year within a project period. This application serves as
the primary source of information regarding activities, accomplishments,
outcomes, and obstacles related to achieving project outcomes during the
current budget period. It provides documentation necessary to justify
continuation of the project.

#### II. Award Information

**Summary of Funding**

The budget period is July 1, 2005 through June 30, 2006. Your
continuation budget request should not exceed your budget from last
year. If you have any questions regarding your budget request, contact
your project officer. All budget items and amounts must be fully
justified based on the proposed activities. Funding is dependent on the
availability of appropriated funds in subsequent years and satisfactory
grantee performance.

#### III. ELECTRONIC SUBMISSION INSTRUCTIONS

**A. Background and Rationale for Electronic Submission**

A new online application and reporting system has been implemented
during FY 2005 and all Health Resources and Services Administration
(HRSA) grantees are now required to submit non-competing continuation
applications electronically using the HRSA Electronic Handbooks (EHB).
Ultimately, this system will provide grantees with information from
previous years, including budget and services data. There are several
features of the online system that are designed to ease the reporting
burden on grantees:

-   Data are submitted via forms to a central database and reports and
    other documents are attached on line.

-   Since electronic submissions are saved to a central database, you
    will not need to resubmit the same information year after year.  In
    subsequent years, data previously submitted will be accessed and
    displayed. 

-   When the same item is requested on multiple forms, you will only be
    required to enter it once.  The system will insert the data to the
    appropriate fields on subsequent forms.  This reduces the need for
    redundant data entry. 

-   The system has built-in checks to help improve the quality of
    reported data, including features that guard against data entry or
    calculation errors.  For example, the system checks to ensure that
    budget totals match across financial forms, and alerts the applicant
    when errors are detected. 

>  
>
> For grant reviewers, the system will provide quick access to submitted
> data, as data will be automatically transmitted to the HRSA database,
> and those data can be accessed immediately thereafter by program
> management staff.  Compared to the paper submission process, lag time
> will be greatly reduced.

**B. Getting Started**

This section describes the HRSA EHB's registration process and provides
an overview of how the electronic system works.

**1. Registration**

To access the HRSA EHB, go to
<https://grants.hrsa.gov/webexternal/home.asp>.

> Your organization and each person within your organization who will
> contribute to the continuation application must register within the
> EHB. The purpose of the registration process is to collect consistent
> information from all users, avoid collection of redundant information,
> and uniquely identify each system user.
>
> Registration within the HRSA EHB is a two-step process:

-   In the first step, individual users from an organization who will
    work on a grant application or continuation application must create
    individual system accounts.

-   In the second step, the users must search for and select their
    organization. Because this is a non-competing continuation
    application, your grantee organization record exists within EHB,
    there is no need to create a new organizational record. Each user
    should register only once.

> Multiple individuals within your organization can work on an
> application, but the application can only be submitted by your
> organization's designated Authorizing Official (AO). Ensure that your
> AO registers so that applications can be submitted. The AO is the
> individual within your organization who will assume the obligations
> required by Federal laws, regulations and conditions associated with
> the application process.
>
> To complete the registration quickly and efficiently we recommend that
> you have the following information handy:

-   Your role in the grants management process: HRSA EHB offers three
    functional roles for external organization users, the AO, Business
    Official (BO) and Other Employee (for project directors, assistant
    staff, AO designees and others). For more information on functional
    responsibilities refer to the online help.

-   If you are legally responsible for the contents of this application,
    as well as regulatory compliance with conditions of grant awards on
    behalf of your organization, select AO. Remember that as AO you must
    review and submit the final application to HRSA.

-   If you are the individual responsible for financial transactions
    related to this grant, select BO.

-   If you are not covered by the two categories described above (e.g.,
    you are the project director, project staff, etc.) choose "Other."

-   The 10-digit grant number from a Notice of Grant Award (NGA) which
    uniquely identifies your grant. Use the grant number to find your
    organization during registration. To start your non-competing
    continuation application, click on \"Noncompeting Continuations\"
    after logging in. Use your grant number to search for the funding
    opportunity and follow the instructions.

> For step-by-step instructions about the online application and how to
> get started, go to MCHB Critical Highlights at:
>
> <https://performance.hrsa.gov/mchb/mchreports/criticalhighlights.asp>.
>
>   

**2. Overview of the Electronic Process**

Once you have completed the EHB registration process, you will see an
Application Forms Status Menu (See Appendix A). You can track your
progress in completing the application through this menu. As you
complete items, the status menu will note that those portions of the
application are complete.

> The sections of the application are:

+---------------------+------------------------------------------------+
| > Basic Information | Grantee organization information, DUNS and CCR |
|                     | numbers, project information, and a project    |
|                     | abstract                                       |
+---------------------+------------------------------------------------+
| > Budget            | 6025 Training Budget Form, Consolidated Budget |
| > Information       | Form, and Budget Narrative                     |
+---------------------+------------------------------------------------+
| > Project Details   | Continuation Application Narrative             |
+---------------------+------------------------------------------------+
| > Assurances and    | Checklist of policies                          |
| > Certifications    |                                                |
+---------------------+------------------------------------------------+
| > Appendices        | Biographical sketches for new faculty          |
+---------------------+------------------------------------------------+
| > Program Specific  | Data about your project and performance        |
| > Information       | measures                                       |
+---------------------+------------------------------------------------+

> **3. Length Limitation**
>
> If applying online, the total size of all uploaded files may not
> exceed either 30 pages when printed or a total combined file size of 5
> MB.  This 30-page limit includes the abstract, project and budget
> narratives, the HRSA 6025, attachments, and any appendices such as
> letters of commitment and support.  However, it does not include
> program specific forms required by funding programs (found in the
> Programs Specific Information Section, i.e., financial, program and
> performance measures forms) -- Guidance Appendix C.
>
>  
>
> If applying on paper, the entire application may not exceed 30 pages
> in length, with the exclusion of the Program Specific Information as
> discussed above.  Pages must be numbered consecutively.  
>
> ** **
>
> **Applications that exceed the specified limits (30 pages or
> approximately 5 MB, excluding programs specific required forms) will
> be deemed non-compliant.  All non-compliant applications will be
> returned to the applicant, which may lead to a delay in funding.**

**4. Assistance with Electronic Submission**

> For assistance in using HRSA EHB, call 877-Go4-HRSA (877-464-4772)
> between 9:00 am to 5:30 pm ET or e-mail: <callcenter@hrsa.gov>.

**C. Basic Information**

General information about the organization and the project are requested
in this section:

**1. Applicant Organization Information:**

Enter your type of organization, and contact information for your
project director, business official, single point of contact and
authorizing official, and update your mailing address if needed. Provide
your Data Universal Numbering System (DUNS) number and Central
Contractor Registry (CCR) number.

> **DUNS and CCR Numbers**
>
> All applicant organizations are required to have a Data Universal
> Numbering System (DUNS) number in order to apply for a grant from the
> Federal Government. The DUNS number is a unique nine-character
> identification number provided by the commercial company, Dun and
> Bradstreet. There is no charge to obtain a DUNS number. Information
> about obtaining a DUNS number can be found at
> [http://www.hrsa.gov/grants/preview/dunsccr.htm](http://www.hrsa.gov/grants/duns.htm)
> or call 1-866-705-5711. Please include the DUNS number beneath the
> Grant Number on the progress report cover page. Progress reports
> ***will not*** be reviewed without a DUNS number.
>
> Additionally, the applicant organization will be required to register
> with the Federal Government's Central Contractor Registry (CCR) in
> order to do business with the Federal Government, including
> electronic. Information about registering with the CCR can be found at
> <http://www.hrsa.gov/grants/preview/dunsccr.htm>.

**2. Applicant Project Information:**

Provide project information, such as the title of your grant program if
it differs from the announcement and revisions to your period of
performance if necessary, and note other congressional districts that
benefit from your application. Attach your Project Abstract. A Project
Summary is not required for this grant program.

**Project Abstract:**

> MCHB grants are not required to attach a project abstract in the
> Applicant Information Section, as the requirements for providing a
> project abstract are fulfilled by completing Form 6 in the Program
> Specific Information Section. The text sections in Form 6 have length
> limitations so be concise when composing your abstract.

**D. Budget Information**

> Complete a budget form and budget justification for the coming project
> year (July 1, 2005 through June 30, 2006). Include all direct and
> indirect expenses supported by the grant on the budget form, HRSA 6025
> budget form. All line items must be well justified in a narrative
> budget justification. By completing the Budget Information Section in
> the HRSA EHB, you are completing the HRSA 6025 budget form. You will
> also complete financial forms in the Program Specific Information, see
> Appendix C.
>
> The Budget Information Section is comprised of three subsections:
> Detailed Budget, Consolidated Budget and the Budget Narrative.

**1. Detailed Budget**

> The detailed budget form tracks those expenses that are planned for
> the application year in the following categories: non-trainee expenses
> -- personnel, other non-trainee expenses, and trainee expenses.
> Trainee stipend levels for Health Resources and Services
> Administration training grantees were last updated on February 4,
> 2005, and posted at
> <http://grants.nih.gov/grants/guide/notice-files/NOT-OD-05-032.html>.
> The stipend levels may, for the Maternal and Child Health Training
> Program, be treated as ceilings rather than mandatory amounts, i.e.,
> stipends may be less than but may not exceed the amounts indicated.
> However, where lesser amounts are awarded, the institution must have
> an established written policy which identifies the basis for such
> variation and which ensures equitable treatment of all eligible
> trainees/fellows.
>
> Also note that under the trainee expenses, a separate justification
> for trainee travel is not required, simply justify the expense in the
> budget narrative (budget justification).

**2. Consolidated Budget**

> **Consolidated Budget (Direct/Indirect Costs)**
>
> In the HRSA EHB, budget amounts that you enter in the Detailed Budget
> are brought forward to the Consolidated Budget for the current
> application year. To adjust any of these amounts for the application
> year, return to the Detailed Budget to change these values.
>
> To enter budgets for future years, select the button "Add New Budget
> Period" to provide budget information.
>
> **Consolidated Budget (Total) -- Funding Sources**
>
> Enter the Federal amount request for the application year and future
> years under this grant. Because this training grant is not
> cost-sharing, there is no requirement to complete the other funding
> categories (Other Federal Funding, Applicant/Institution, State,
> Local/Other and Project Income) on this form. Entering these amounts
> is required in the Program Specific Information Section for Form 1,
> where this budget information is collected.

**3. Budget Narrative**

> Provide a narrative that explains the amounts requested for each line
> in the budget (i.e., personnel, consultant costs, equipment,
> contracts, supplies, staff travel, other expenses for non-trainee
> expenses and stipends, tuition and fees and trainee travel for
> trainees as well as indirect costs). In particular, provide detailed
> justifications for all consultant, contract, and travel costs,
> providing name of consultants and hourly rates, clear descriptions of
> contractual costs, and detailed break-outs of all travel costs (number
> of trips, destination, cost per trip, etc.). The budget justification
> must clearly describe each cost element and explain how each cost
> contributes to meeting the project's objectives/goals. Please show how
> each item in the "other" category is justified.
>
> The budget justification should be completed on your desktop and
> attached to the online application.

**E. Project Details**

Attach your continuation application narrative. Report achievements to
date for the past budget period and projected plans for the coming
budget period, July 1, 2005 through June 30, 2006.

**1. Table of Contents**

> The Table of Contents should be the first page of your Continuation
> Application Narrative, and should display the Sections in the
> following order: Abstract, Budget Justification, Continuation
> Application Narrative, and Appendices. The Table of Contents should
> provide the title of each section of the narrative and appendices with
> corresponding page numbers.
>
> **2. Continuation Application Narrative**---Section headings for the
> continuation application narrative should be:
>
> **A. Administration/Organization**---Indicate any changes affecting
> the structure or placement of the program, significant changes in
> administration, faculty/staff, resources, funding, facilities, etc. If
> personnel changes are to be made, indicate the plan for staffing the
> training program during the transition, and plans for any new hires.
> In the appendix, include a Biographical Sketch (two page maximum) for
> new grant-supported faculty appointed during the past year, i.e.,
> since the last continuation application was submitted.
>
> **B. Project Plan Amendments**---Describe and justify proposed
> amendments/revisions to your originally approved project plan and /or
> previously approved continuation application.
>
> **C. Training---** Provide a narrative description of the training
> program supported by your grant in the past year, including the goals,
> objectives, activities, and outcomes that you planned to achieve in
> your original grant submission, and any changes that are noteworthy.
> Indicate any needs assessments conducted, methods used, outcomes, and
> any lessons learned. Significant challenges to program implementation
> should also be identified, as well as your plans to address them.
>
> **D. Collaboration/Coordination**--- Describe the purpose and outcomes
> from collaborative, consultative and technical assistance activities
> provided through your training program in the past year. In
> particular, the activities related to, or resulting from, established
> relationships of the program and faculty with State and local Title V
> agencies/programs and with other maternal and child health programs in
> the community, state, and region should be described.
>
> Describe any collaborative activities with other MCH training
> programs, outlining areas of cross-fertilization, trainee
> participation in activities, outcomes and lessons learned. Describe
> any collaborative activities with other academic programs (MCH or
> non-MCH) at your university, including recruitment efforts.
>
> **E. Leadership**---Briefly describe (1-2 paragraphs) any best
> practices or innovations that your program has implemented to promote
> leadership development in your trainees and faculty.
>
> Provide profiles (one paragraph or one-third page each) of one or two
> faculty and one or two former trainees who exemplify leadership. These
> should be written as narratives that highlight their leadership
> activities, e.g., participation on advisory boards, significant
> positions/roles in professional organizations, research, teaching,
> publications, or other efforts in which they may be influential in
> changing policy, services, or systems to improve the health of the MCH
> population and/or further the development of their field/profession.
>
> **F. Marketing/Dissemination**---Describe how you market your training
> program(s) and disseminate any products. Do not send copies of
> publications and other materials with the Continuation Application.
>
> **G. Evaluation/Impact**---Describe the outcomes to date of the
> evaluation plan presented in your initial proposal. Are you meeting
> project goals and objectives? If so, how are you measuring this?
>
> How does this training grant make a difference in your training
> program? Summarize the benefits of this grant to the
> program/department/ institution, e.g., outcomes that are linked to
> this MCHB support. In addition, briefly explain the training grant's
> impact at the local, state, regional and national levels.

**3. Format Requirements**

a.  **Font:** Please use an easily readable serif typeface, such as
    Times Roman, Courier, or CG Times. The text and table portions of
    the progress report must be submitted in not less than 12 point and
    1.0 line spacing. Narrative reports and attachments not adhering to
    12 point font requirements may be returned.

> []{.mark}

b.  **Paper Size and Margins:** Please format the continuation
    application narrative for 8 ½" x 11" paper. Margins must be at least
    one (1) inch at the top, bottom, left and right of the paper. Please
    left-align text.

c.  **Numbering:** Please number the pages of the attachments
    sequentially from page 1 to the end of the application, including
    all appendices, such as charts, figures, and tables. Follow the
    order as outlined in the Table of Contents above for numbering these
    pages.

d.  **Names:** Please include the name of the applicant on each page.

e.  **Section Headings:** Please put all section headings flush left in
    bold type.

**F. Assurances and Certifications**

Review the assurances and certifications and certify each listed. If one
or more of the following are not met, check \"NO\" for the assurance or
certification and attach an explanation.

**G. Appendices**

Attachments may be provided in the following categories:

> 1\. Biographical Sketches: Please include only biographical sketches
> of key personnel that are NEW faculty. Biographical sketches should
> not to exceed two pages in length. The biographical sketch must
> include: Name (Last, first, middle initial), Title on Training Grant,
> Education, and, Professional Experience, beginning with the current
> position, then in reverse chronological order, a list of relevant
> previous employment and experience. Also, a list, in reverse
> chronological order, of all relevant publications, or the most
> representative, must be provided.
>
> 2\. Letters of Support: Please include letters of support that you
> have that are from NEW collaborations.
>
> 3\. Funding Priority Requests: No attachment is needed in this
> section.
>
> 4\. Appendices: Provide additional attachments of appendices needed to
> support your continuation application.

**H. Program Specific Information -- MCHB Performance Measures and Data
Collection**

The Health Resources and Services Administration (HRSA) has modified its
reporting requirements for SPRANS projects, CISS projects, and other
grant programs administered by the MCHB to include national performance
measures being developed in accordance with the requirements of the
Government Performance and Results Act (GPRA) of 1993 (Public Law
103-62). This Act requires the establishment of measurable goals for
Federal programs that can be reported as part of the budgetary process,
thus linking funding decisions with performance. Performance measures
for States have also been established under the Block Grant provisions
of Title V of the Social Security Act, the MCHB's authorizing
legislation. Performance measures for other MCHB-funded grant programs
have been approved by the Office of Management and Budget and are
primarily based on existing or administrative data that projects should
easily be able to access or collect.

Performance measures and other data collection information are collected
in the Program Specific Information Section. MCH Long Term Training
Programs report on four (4) national performance measures each year. Two
(07 and 11) are self-reported measures of family participation in your
program and cultural competence in your curricula/training. Two (08 and
09) are measures about your trainees. Other performance measures are
assigned to some of these long-term training programs.

When you click on the Program Specific Information link, a menu of the
forms assigned to your specific training program is displayed. These
include performance measures, financial, program, and additional data
element forms. Refer to Appendix C for these forms and performance
measures.

**All long-term training programs complete the following Program
Specific Forms:**

Form 1: MCHB Project Budget Detail

Form 2: Project Funding Profile

Form 4: Project Budget and Expenditures by Types of Services

Form 6: Maternal and Child Health Discretionary Grant Project Abstract

Form 7: Discretionary Grant Project Summary Data

Form 9: Tracking Project Performance Measures (See Individual PM\'s
below)

Form 10: Project Performance/Outcome Measure Detail Sheet (See
Individual PM\'s below)

-   Performance Measure 07: The degree to which MCHB supported programs
    ensure family participation in program and policy activities.

-   Performance Measure 08: The percent of graduates of MCHB long‑term
    training programs that demonstrate field leadership after
    graduation.

-   Performance Measure 09: The percent of participants in MCHB
    long-term training programs who are from underrepresented groups.

-   Performance Measure 11: The degree to which MCHB long‑term training
    grantees include cultural competency in their curricula/training.

-   Program Performance Measure 62: Products and Publications

    MCH Training and Education Program Data Form

    Additional forms and performance measures are required of certain
    long-term training programs. These are listed under the name of the
    program.

**T17-Pediatric Dentistry (PD)**

None

**T19-Social Work (SW)**

None

**T71-Adolescent Health (LEAH)**

Form 5: Number of Individuals Served (Unduplicated) by Type of
Individual and Source of Primary Insurance Coverage

Program Performance Measure (PPM) 59: Collaboration with State Title V
Agencies

PPM 60: Long Term Trainees Working in Interdisciplinary Manner

PPM 64: Degree to Which LEAH Programs Incorporate Diverse Adolescents
and Parents into the Training Program

**T73-Leadership Education in Neurodevelopmental Disorders (LEND)**

Form 5: Number of Individuals Served (Unduplicated) by Type of
Individual and Source of Primary Insurance Coverage

Program Performance Measure (PPM) 59: Collaboration with State Title V
Agencies

PPM 60: Long Term Trainees Working in Interdisciplinary Manner

PPM 61: Trainees Value Interdisciplinary Training (Developmental Measure
to be reported in 2006)

PPM 63: Degree to Which LEND Programs Incorporate Medical Home Concepts

**T77-Developmental-Behavioral Pediatrics (DBP)**

None

**T79-Nutrition (NUT)**

PPM 65: Nutrition Trainees Practicing in the MCH Field

**T80-Nursing (NUR)**

None

**T83-Communication Disorders (CD)**

None

**Completing the Program Specific Information for this Continuation
Application**

Certain information is required to be entered in the Program Specific
forms for the non-competing continuation application:

Form 1: Complete the budget details for next year's budget period (July
1, 2005-June 30, 2006).

Form 2: Complete the budget for future budget years by source of
funding.

Form 4: Complete the budget for next year's budget and future budget
years by types of service. Training programs should put all funding into
the infrastructure category.

Form 5 (for LEND AND LEAH only): Report provisionally the populations
served from July 1, 2004 through June 30, 2005. You will be able to
finalize these data when the current budget period has ended.

Form 6: Enter your abstract.

Form 7: Enter discretionary grant information, including the number of
products and publications.

For All Performance Measures: Enter objectives for future years. Unless
your data are final, report provisionally the indicators or scores for
the performance measures for the period July 1, 2004 through June 30,
2005.

MCH Training and Education Program Data Form: Unless your data are
final, report provisionally for the period July 1, 2004 through June 30,
2005 for all sections.

**Completing the MCH Training and Education Program Data Form**

The MCH Training and Education Program Data Form is comprised of the
following seven sections: 1. Catalog of Federal Domestic Assistance
(CFDA) Number, 2. Faculty and Staff Information, 3. Trainee Information
(Long-term Trainee), 4. Former Trainee Information (Long-term Trainee),
5. Short and Medium Term Trainee Information, 6. Technical
Assistance/Collaboration, and 7. Continuing Education. Specific
instructions for completing sections of this form are provided below:

**Section 2, Faculty and Staff Information:** Complete for faculty and
staff members supported by the grant.

**Section 3, Long Term Trainee Information.** Current trainees are
defined as long term trainees (those with greater than or equal to 300
contact hours with the training program) benefiting from the training
grant (both supported and non-supported trainees). Please provide the
following information for your trainees: total number, name,
race/ethnicity, gender, discipline, degree(s), and position upon entry
to your program, degree program in which they are enrolled, whether and
how much MCH support they receive (indicate stipend, tuition, graduate
research assistantship, etc.), type of student (pre or post doctoral
student and part time or full time), and any products that they have
produced in the past year.

**Section 4, Former Trainee Information**. Complete the Former Trainee
section. Former trainees are defined as grant supported trainees who
completed the training five years ago (completed training in 2000).
Please provide the following information for former trainees: total
number, name, year completed the training, degree earned, whether the
university was able to contact the trainee, the trainee's current
position title and work setting, city and state of residence, and
whether they have remained in the MCH field.

**Section 5, Short and Medium Term Trainee Information**. Complete the
Short and Medium Term Trainee section for all trainees reached by your
program in the past year. Short term trainees are those who have had
less than 40 contact hours with your training program in the last 12
month grant period. Medium term trainees are those with 40 or more but
less than 300 contact hours in the past 12 month grant period. Indicate
the number and disciplines of short and medium term trainees.

**Section 6, Technical Assistance/Collaboration**. Complete the
technical assistance/collaboration section, listing the 8-10 most
significant technical assistance/collaborative activities in the past
year, starting with the most significant one. At the bottom of the form,
provide summary data for ALL the technical assistance/collaborative
activities for the year.

**Section 7, Continuing Education**. Complete the Continuing Education
section for all CE activities in the past year. Presentations/seminars,
workshops/conferences, web-based courses, and audio and video
conferences should be reported, indicating topics, methods, number of
students, duration, and whether CE units were provided for the top 5
most significant CE events provided last year, and a total number of CE
events and trainees reached for ALL events in the past year.

**I. Paper Submission**

Electronic submission of this non-competing continuation and progress
report is the standard, so hard-copy submission is considered the
exception to the rule. If you are unable to submit electronically, you
must contact the project officer informing them of a hard-copy
submission and requesting a forms package and instructions.

#### IV. Submission Dates and Times

**The Continuation Application due date is April 22, 2005 at 5:00 p.m.
E.T.**

Applications completed online are considered formally submitted when the
AO electronically submits the application to HRSA.  However, to complete
the submission requirements, a hard-copy of the HRSA 6025 Face Sheet
must be printed, signed, and submitted to the HRSA Grants Application
Center.  The Face Sheet can be printed from the online application.

 

**For an online application, the signed Face Sheet must be postmarked on
or before the deadline date and mailed to the following address:**

 

HRSA Grants Application Center

MCHB Continuation Application, CFDA# 93.110

Announcement \# **5-TXX-05-001**

ATTN: **XX**                

901 Russell Avenue, Suite 450

Gaithersburg, MD 20879

Telephone: 1-877-477-2123

** **

Applications will be considered as having met the deadline if:

-   all parts of the online application are noted as COMPLETE on the
    Application Forms Status menu,

-   the application has been submitted electronically by your
    organization's Authorizing Official to HRSA on or before the
    deadline date and time, and

-   the signed HRSA 6025 Face Sheet is postmarked on or before the
    deadline date and received in time for orderly processing and
    review.

**REMINDER:**  Only applicants who apply online are permitted to forego
hard-copy submission of all application forms EXCEPT the signed HRSA
6025 Face Sheet.   If you are submitting a hard-copy application, the
application must be received by the deadline noted above.

#### V. Intergovernmental Review

EO 12372 does not apply to this program.

#### VI. Funding Restrictions

Awards to support projects beyond the first budget year will be
contingent upon Congressional appropriation, satisfactory progress in
meeting the project's objectives, and a determination that continued
funding would be in the best interest of the government.

Indirect costs are limited to 8%.

#### VII. Continuation Application Review Information

**Review Process**

All Continuation Applications are reviewed by grants management
officials (business and financial review) and program staff (technical
review and analysis of performance measures).

#### VIII. Agency Contacts

Grantees are encouraged to request assistance in the development of
their continuation applications.

**A. Business, Administrative and Fiscal Inquiries**

Grantees may obtain additional information regarding business,
administrative, or fiscal issues by contacting:

> Ms. Jacquelyn Whitaker
>
> Lead Grants Management Specialist
>
> Research and Training Branch, HRSA
>
> Div. of Grants Management Operations
>
> 5600 Fishers Lane, Room 11A-16
>
> Rockville, MD 20857
>
> Telephone:  (301) 443-3893
>
> Email: <jwhitaker@hrsa.gov>

**B. Programmatic Assistance**

Additional information related to the overall program issues or
technical assistance may be obtained by contacting your project officer.
The mailing address and fax for all project officers is:

> Maternal and Child Health Bureau
>
> 5600 Fishers Lane, Room 18A55
>
> Rockville, MD 20857
>
> Fax: (301) 443-4842

Telephone numbers and email addresses for individual project officers
are as follows:

**PD, DBP, NUR, CD** Nanette Pepper, BSRN, MEd

\(301\) 443-6445

<npepper@hrsa.gov>

**SW** Diana L. Rule, MPH

\(301\) 443-0233

<drule@hrsa.gov>

**LEAH** Madhavi Reddy, MPH

\(301\) 443-0754

<mreddy@hrsa.gov>

**LEND, NUT** Denise Sofka, RD, MPH

\(301\) 443-0344

<dsofka@hrsa.gov>

**C. Electronic Application, HRSA EHB Assistance**

Grantees may need assistance when working online to submit their
continuation application forms. For assistance, contact:

> HRSA Call Center\
> 12530 Parklawn Drive, Suite 350\
> Rockville, MD 20852\
> Phone: (877) GO4-HRSA or (877) 464-4772\
> Fax: (301) 998-7377\
> E-mail: <CallCenter@HRSA.GOV>

####  IX. GUIDANCE APPENDICES

**Guidance Appendix A: Sample Completed Status Page---MCHB Training
Noncompeting Continuation**

**HRSA's Electronic Handbooks (EHBs) Application Forms Status Page**

![](media/image1.png){width="6.678472222222222in"
height="6.247916666666667in"}

**Guidance Appendix B: Key Words for Project Abstract**

**Menu of Suggested Key Words for Project Abstracts**

A list of keywords used to describe MCHB-funded projects follows. Please
choose from this list when selecting terms to classify your project.

If no term on this list adequately describes a concept that you would
like to convey, please select a term which you think is appropriate and
include it in your list of keywords.

Access to Health Care

Adolescent Health Programs

Adolescent Nutrition

Adolescent Parents

Adolescent Pregnancy

Adolescent Pregnancy Prevention

Adolescent Risk Behavior Prevention

Adolescents

Adolescents with Disabilities

Advocacy

African Americans

Agricultural Safety

AIDS

AIDS Prevention

Alaska Natives

Alcohol

American Academy of Pediatrics

American College of Obstetricians and Gynecologists

American Public Health Association

Amniocentesis

Anemia

Anticipatory Guidance

Appalachians

Arthritis

Asian Language Materials

Asians

Asthma

Attachment

Attachment Behavior

Attention Deficit Disorder

Audiology

Audiometry

Audiovisual Materials

Baby Bottle Tooth Decay

Battered Women

Behavior Disorders

Behavioral Pediatrics

Bereavement

Bicycle Helmets

Bicycle Safety

Bilingual Services

Biochemical Genetics

Blindness

Blood Pressure Determination

Body Composition

Bonding

Brain Injuries

Breast Pumps

Breastfeeding

Bronchopulmonary Dysplasia

Burns

Cambodians

Caregivers

Case Management

Cerebral Palsy

Chelation Therapy

Child Abuse

Child Abuse Prevention

Child Care

Child Care Centers

Child Care Workers

Child Mortality

Child Neglect

Child Nutrition

Child Sexual Abuse

Childhood Cancer

Children with Special Health Needs

Child Death Review

Chronic Illnesses and Disabilities

Cleft Lip

Cleft Palate

Clinical Genetics

Clinics

Cocaine

Collaborative Office Rounds

Communicable Diseases

Communication Disorders

Communication Systems

Community Based Health Education

Community Based Health Services

Community Based Preventive Health

Community Development

Community Health Centers

Community Integrated Service System

Community Participation

Compliance

Comprehensive Primary Care

Computer Linkage

Computer Systems

Conferences

Congenital Abnormalities

Consortia

Continuing Education

Continuity of Care

Cost Effectiveness

Counseling

County Health Agencies

Craniofacial Abnormalities

Cultural Diversity

Cultural Sensitivity

Curricula

Cystic Fibrosis

Cytogenetics

Data Analysis

Data Collection

Data Systems

Databases

Deafness

Decision Making Skills

Delayed Development

Dental Sealants

Dental Treatment of Children with Disabilities

Depression

Developmental Disabilities

Developmental Evaluation

Developmental Screening

Diagnosis

Diarrhea

Dietitians

Dispute Resolution

Dissemination

Distance Education

Divorce

DNA Analysis

Down Syndrome

Drowning

Early Childhood Development

Early Intervention

Electronic Bulletin Boards

Electronic Mail

Eligibility Determination

Emergency Medical Services for Children

Emergency Medical Technicians

Emergency Room Personnel

Emotional Disorders

Emotional Health

Employers

Enabling Services

Enteral Nutrition

EPSDT

Erythrocyte Protoporphyrin

Ethics

Evoked Otoacoustic Emissions

Failure to Thrive

Families

Family Centered Health Care

Family Centered Health Education

Family Characteristics

Family Environment

Family Medicine

Family Planning

Family Professional Collaboration

Family Relations

Family Support Programs

Family Support Services

Family Violence Prevention

Farm Workers

Fathers

Feeding Disorders

Fetal and Infant Mortality Review

Fetal Alcohol Effects

Fetal Alcohol Syndrome

Financing

Food Preparation in Child Care

Formula

Foster Care

Foster Children

Foster Homes

Foster Parents

Fragile X Syndrome

Genetic Counseling

Genetic Disorders

Genetic Screening

Genetic Services

Genetics Education

Gestational Weight Gain

Glucose Intolerance

Governors

Grief

Gynecologists

Hawaiians

Head Start

Health Care Financing

Health Care Reform

Health care utilization

Health Education

Health Insurance

Health Maintenance Organizations

Health Professionals

Health Promotion

Health Supervision

Healthy Mothers Healthy Babies Coalition

Healthy Start Initiative

Healthy Tomorrows Partnership for Children

Hearing Disorders

Hearing Loss

Hearing Screening

Hearing Tests

Hemoglobinopathies

Hemophilia

Hepatitis B

Hispanics

HIV

Hmong

Home Health Services

Home Visiting for At Risk Families

Home Visiting Programs

Home Visiting Services

Homeless Persons

Hospitals

Hygiene

Hyperactivity

Hypertension

Illnesses in Child Care

Immigrants

Immunization

Incarcerated Women

Incarcerated Youth

Indian Health Service

Indigence

Individualized Family Service Plans

Infant Health Care

Infant Morbidity

Infant Mortality

Infant Mortality Review Programs

Infant Nutrition

Infant Screening

Infant Temperament

Infants

Information Networks

Information Services

Information Sources

Information Systems

Injuries

Injury Prevention

Intensive Care

Interagency Cooperation

Interdisciplinary Teams

Internship and Residency

Intubation

Iron Deficiency Anemia

Iron Supplements

Jews

Juvenile Rheumatoid Arthritis

Laboratories

Lactose Intolerance

Language Barriers

Language Disorders

Laotians

Lead Poisoning

Lead Poisoning Prevention

Lead Poisoning Screening

Leadership Training

Learning Disabilities

Legal Issues

Life Support Care

Literacy

Local Health Agencies

Local MCH Programs

Low Birthweight

Low Income Population

Lower Birthweight

Males

Managed Care

Managed Competition

Marijuana

Marital Conflict

Maternal and Child Health Bureau

Maternal Nutrition

MCH Research

Media Campaigns

Medicaid

Medicaid Managed Care

Medical Genetics

Medical History

Medical Home

Mental Health

Mental Health Services

Mental Retardation

Metabolic Disorders

Mexicans

Micronesians

Migrant Health Centers

Migrants

Minority Groups

Minority Health Professionals

Mobile Health Units

Molecular Genetics

Morbidity

Mortality

Motor Vehicle Crashes

Multiple Births

Myelodysplasia

National Information Resource Centers

National Programs

Native Americans

Needs Assessment

Neonatal Intensive Care

Neonatal Intensive Care Units

Neonatal Mortality

Neonates

Networking

Neurological Disorders

Newborn Screening

Nurse Midwives

Nurses

Nutrition

Obstetricians

Occupational Therapy

One Stop Shopping

Online Databases

Online Systems

Oral Health

Organic Acidemia

Otitis Media

Outreach

P. L. 99-457

Pacific Islanders

Pain

Paraprofessional Education

Parent Education

Parent Education Programs

Parent Networks

Parent Professional Communication

Parent Support Groups

Parent Support Services

Parental Visits

Parenteral Nutrition

Parenting Skills

Parents

Patient Education

Patient Education Materials

Pediatric Advanced Life Support Programs

Pediatric Dentistry

Pediatric Intensive Care Units

Pediatric Nurse Practitioners

Pediatricians

Peer Counseling

Peer Support Programs

Perinatal Health

Phenylketonuria

Physical Disabilities

Physical Therapy

Pneumococcal Infections

Poisons

Preconception Care

Pregnant Adolescents

Pregnant Women

Prematurity

Prenatal Care

Prenatal Diagnosis

Prenatal Screening

Preschool Children

Preterm Birth

Preventive Health Care

Preventive Health Care Education

Primary Care

Professional Education in Adolescent Health

Professional Education in Behavioral Pediatrics

Professional Education in Breastfeeding

Professional Education in Chronic Illnesses and Disabilities

Professional Education in Communication Disorders

Professional Education in CSHN

Professional Education in Cultural Sensitivity

Professional Education in Dentistry

Professional Education in Developmental Disabilities

Professional Education in EMSC

Professional Education in Family Medicine

Professional Education in Genetics

Professional Education in Lead Poisoning

Professional Education in MCH

Professional Education in Metabolic Disorders

Professional Education in Nurse Midwifery

Professional Education in Nursing

Professional Education in Nutrition

Professional Education in Occupational Therapy

Professional Education in Physical Therapy

Professional Education in Primary Care

Professional Education in Psychological Evaluation

Professional Education in Pulmonary Disease

Professional Education in Social Work

Professional Education in Violence Prevention

Provider Participation

Psychological Evaluation

Psychological Problems

Psychosocial Services

Public Health Academic Programs

Public Health Education

Public Health Nurses

Public Policy

Public Private Partnership

Puerto Ricans

Pulmonary Disease

Quality Assurance

Recombinant DNA Technology

Referrals

Regional Programs

Regionalized Care

Regulatory Disorders

Rehabilitation

Reimbursement

Repeat pregnancy prevention

Research

Residential Care

Respiratory Illnesses

Retinitis Pigmentosa

Rheumatic Diseases

RNA Analysis

Robert Wood Johnson Foundation

Runaways

Rural Population

Russian Jews

Safety in Child Care

Safety Seats

Sanitation in Child Care

School Age Children

School Dropouts

School Health Programs

School Health Services

School Nurses

Schools

Screening

Seat Belts

Self Esteem

Sensory Impairments

Service Coordination

Sex Roles

Sexual Behavior

Sexuality Education

Sexually Transmitted Diseases

Shaken Infant Syndrome

Siblings

Sickle Cell Disease

Sleep Disorders

Smoking During Pregnancy

Social Work

Southeast Asians

Spanish Language Materials

Special Education Programs

Specialized Care

Specialized Child Care Services

Speech Disorders

Speech Pathology

Spina Bifida

Spouse Abuse

Standards of Care

State Health Agencies

State Health Officials

State Legislation

State Programs

State Staff Development

State Systems Development Initiative

Stress

Substance Abuse

Substance Abuse Prevention

Substance Abuse Treatment

Substance Abusing Mothers

Substance Abusing Pregnant Women

Substance Exposed Children

Substance Exposed Infants

Sudden Infant Death Syndrome

Suicide

Supplemental Security Income Program

Support Groups

Surveys

Tay Sachs Disease

Technology Dependence

Teleconferences

Television

Teratogens

Terminally Ill Children

Tertiary Care Centers

Thalassemias

Third Party Payers

Title V Programs

Toddlers

Training

Transportation

Trauma

Tuberculosis

Twins

Uninsured

Unintentional Injuries

University Affiliated Programs

Urban Population

Urinary Tract Infections

Usher Syndrome

Vietnamese

Violence

Violence Prevention

Vision Screening

Vocational Training

Waiver 1115

Well Baby Care

Well Child Care

WIC

Youth in Transition

**Guidance Appendix C: Program Specific Forms**

**MCH Training Performance Measures**

**OMB #0915-0272**

**Expiration Date:  January 31, 2006**

+-----------------------------------+-----------------------------------+
| #### 07 PERFORMANCE MEASURE       | The degree to which MCHB          |
|                                   | supported programs ensure family  |
| **Goal 1: Provide National        | participation in program and      |
| Leadership for MCHB**             | policy activities.                |
|                                   |                                   |
| **(Promote family participation   |                                   |
| in care)**                        |                                   |
|                                   |                                   |
| **Level: Grantee**                |                                   |
|                                   |                                   |
| **Category: Family                |                                   |
| Participation**                   |                                   |
+-----------------------------------+-----------------------------------+
| **GOAL**                          | To increase family participation  |
|                                   | in MCHB programs.                 |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **MEASURE**                       | The degree to which MCHB          |
|                                   | supported programs ensure family  |
|                                   | participation in program and      |
|                                   | policy activities.                |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **DEFINITION**                    | Attached is a checklist of 6      |
|                                   | elements that demonstrate family  |
|                                   | participation. Please check the   |
|                                   | degree to which the elements have |
|                                   | been implemented.                 |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **HEALTHY PEOPLE 2010 OBJECTIVE** | Related to Objective 16.23.       |
|                                   | Increase the proportion of        |
|                                   | Territories and States that have  |
|                                   | service systems for Children with |
|                                   | Special Health Care Needs to 100  |
|                                   | percent.                          |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **DATA SOURCE(S) AND ISSUES**     | Attached data collection form to  |
|                                   | be completed by grantees.         |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **SIGNIFICANCE**                  | Over the last decade, policy      |
|                                   | makers and program administrators |
|                                   | have emphasized the central role  |
|                                   | of families as advisors and       |
|                                   | participants in policy-making     |
|                                   | activities. In accordance with    |
|                                   | this philosophy, MCHB is          |
|                                   | facilitating such partnerships at |
|                                   | the local, state and national     |
|                                   | levels. Family/professional       |
|                                   | partnerships have been:           |
|                                   | incorporated into the MCHB Block  |
|                                   | Grant Application, the MCHB       |
|                                   | strategic plan and is a           |
|                                   | requirement in the Omnibus Budget |
|                                   | Reconciliation Act of 1989 (OBRA  |
|                                   | '89), the legislative mandate     |
|                                   | that health programs supported by |
|                                   | Maternal and Child Health Bureau  |
|                                   | (MCHB) Children with Special      |
|                                   | Health Care Needs (CSHCN) provide |
|                                   | and promote family centered,      |
|                                   | community‑based, coordinated      |
|                                   | care.                             |
+-----------------------------------+-----------------------------------+

DATA COLLECTION FORM FOR PERFORMANCE MEASURE #07

**OMB #0915-0272**

**Expiration Date:  January 31, 2006**

Using a scale of 0-3, please rate the degree to which our grant program
has included families into their program and planning activities.

+------+------+------+------+------------------------------------------+
| *    | *    | *    | *    | **Element**                              |
| *0** | *1** | *2** | *3** |                                          |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 1.  Family members participate on        |
|      |      |      |      |     advisory committees or task forces   |
|      |      |      |      |     and are offered training, mentoring  |
|      |      |      |      |     and reimbursement.                   |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 2.  Financial support (financial grants, |
|      |      |      |      |     technical assistance, travel, and    |
|      |      |      |      |     child care) is offered for parent    |
|      |      |      |      |     activities or parent groups.         |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 3.  Family members participate in the    |
|      |      |      |      |     planning, implementation and         |
|      |      |      |      |     evaluation of the program's          |
|      |      |      |      |     activities.                          |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 4.  Families members work with their     |
|      |      |      |      |     professional partners to provide     |
|      |      |      |      |     training ( pre‑service, in-service   |
|      |      |      |      |     and professional development) to     |
|      |      |      |      |     MCH/CSHCN staff and providers.       |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 5.  Family members are hired as paid     |
|      |      |      |      |     staff or consultants to the program  |
|      |      |      |      |     (a family member is hired for his or |
|      |      |      |      |     her expertise as a family member).   |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 6.  Family members of diverse cultures   |
|      |      |      |      |     are involved in all of the above     |
|      |      |      |      |     activities.                          |
+------+------+------+------+------------------------------------------+

0=Not Met

1=Partially Met

2=Mostly Met

3=Completely Met

Total the numbers in the boxes (possible 0‑18 score) \_\_\_\_\_\_\_\_\_

**MCH Training Performance Measures**

**OMB #0915-0272**

**Expiration Date:  January 31, 2006**

+-----------------------------------+-----------------------------------+
| **08 PERFORMANCE MEASURE**        | The percent of graduates of MCHB  |
|                                   | long‑term training programs that  |
| **Goal 1: Provide National        | demonstrate field leadership      |
| Leadership for Maternal and Child | after graduation.                 |
| Health**                          |                                   |
|                                   |                                   |
| **(Provide both graduate level    |                                   |
| and continuing education training |                                   |
| to assure interdisciplinary MCH   |                                   |
| public health leadership          |                                   |
| nationwide)**                     |                                   |
|                                   |                                   |
| **Level: Grantee**                |                                   |
|                                   |                                   |
| **Category: Training**            |                                   |
+-----------------------------------+-----------------------------------+
| **GOAL**                          | > To increase the percent of      |
|                                   | > graduates of long‑term training |
|                                   | > programs that demonstrate field |
|                                   | > leadership five years after     |
|                                   | > graduation.[^1]                 |
+-----------------------------------+-----------------------------------+
| **MEASURE**                       | The percent of graduates of MCHB  |
|                                   | long‑term training programs that  |
|                                   | demonstrate field leadership      |
|                                   | after graduation.                 |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **DEFINITION**                    | Attached is a checklist of 4      |
|                                   | elements that demonstrate field   |
|                                   | leadership. For each element,     |
|                                   | identify the number of graduates  |
|                                   | of MCHB long‑term training        |
|                                   | programs that demonstrate field   |
|                                   | leadership 5 years after          |
|                                   | graduation. Please keep the       |
|                                   | completed checklist attached.     |
+-----------------------------------+-----------------------------------+
|                                   | "Field leadership" refers to but  |
|                                   | is not limited to providing MCH   |
|                                   | leadership within the clinical,   |
|                                   | advocacy, academic, research,     |
|                                   | public health, public policy or   |
|                                   | governmental realms. Refer to     |
|                                   | attachment for complete           |
|                                   | definition.                       |
|                                   |                                   |
|                                   | Cohort is defined as those who    |
|                                   | graduate in a certain project     |
|                                   | period. Data form for each cohort |
|                                   | year will be collected for five   |
|                                   | years.                            |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **HEALTHY PEOPLE 2010 OBJECTIVE** | Related to Objective 1.7:         |
|                                   | (Developmental) Increase the      |
|                                   | proportion of schools of          |
|                                   | medicine, schools of nursing, and |
|                                   | other health professional         |
|                                   | training schools whose basic      |
|                                   | curriculum for health care        |
|                                   | providers includes the core       |
|                                   | competencies in health promotion  |
|                                   | and disease prevention.           |
|                                   |                                   |
|                                   | Related to Objective 23.8:        |
|                                   | (Developmental) Increase the      |
|                                   | proportion of Federal, Tribal,    |
|                                   | State, and local agencies that    |
|                                   | incorporate specific competencies |
|                                   | in the essential public health    |
|                                   | services into personnel systems.  |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **DATA SOURCE(S) AND ISSUES**     | Attached data collection form to  |
|                                   | be completed by grantees.         |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **SIGNIFICANCE**                  | An MCHB trained workforce is a    |
|                                   | vital participant in clinical,    |
|                                   | administrative, policy, public    |
|                                   | health and various other arenas.  |
|                                   | MCHB long‑term training programs  |
|                                   | assist in developing a public     |
|                                   | health workforce that addresses   |
|                                   | MCH concerns and fosters field    |
|                                   | leadership in the MCH arena.      |
+-----------------------------------+-----------------------------------+

######  DATA COLLECTION FORM FOR PERFORMANCE MEASURE #08

**OMB #0915-0272**

**Expiration Date:  January 31, 2006**

The total number of graduates, 5 years post graduation, included in this
report \_\_\_\_\_\_\_\_\_

The total number of graduates lost to follow-up \_\_\_\_\_\_\_\_\_

Percent of graduates (5 years post graduation) demonstrate MCH
leadership

in **at least one** of the following areas: \_\_\_\_\_\_\_\_%

-   Academics‑‑i.e. faculty member teaching‑mentoring in MCH related
    field; \_\_\_\_\_\_\_\_%

and/or conducting MCH related research; and /or providing consultation

or technical assistance in MCH; and/or publishing and presenting in key

MCH areas; and/or success in procuring grant and other funding in MCH

-   Clinical‑‑i.e. development of guidelines for specific MCH
    conditions; \_\_\_\_\_\_\_\_%

and/or participation as officer or chairperson of committees on State,

National, or local clinical organizations, task forces, community
boards,

etc.; and/or clinical preceptor for MCH trainees; and/or research,
publication,

and key presentations on MCH clinical issues; and/or serves in a
clinical

leadership position as director, team leader, chairperson, etc.

-   Public Health/Public Policy‑‑i.e. leadership position in local,
    State or \_\_\_\_\_\_\_\_%

National public organizations, government entity; and/or conducts

strategic planning; participates in program evaluation and public policy

development; and/or success in procuring grant and other funding;

and/or influencing MCH legislation; and/or publication, presentations

in key MCH issues.

-   Advocacy‑‑i.e. through efforts at the community, State, Regional and
    \_\_\_\_\_\_\_\_%

National levels influencing positive change in MCH through creative

promotion, support and activities‑‑both private and public. For example,

> developing a city‑wide SIDS awareness and prevention program through\
> community churches.

**MCH Training Performance Measures**

**OMB #0915-0272**

**Expiration Date:  January 31, 2006**

+-----------------------------------+-----------------+-----------------+
| **09 PERFORMANCE MEASURE**        | The percent of  |                 |
|                                   | participants in |                 |
| **Goal 2: Eliminate Health        | MCHB long-term  |                 |
| Barriers and Disparities**        | training        |                 |
|                                   | programs who    |                 |
| **(Train an MCH Workforce that is | are from        |                 |
| culturally competent and reflects | u               |                 |
| an increasingly diverse           | nderrepresented |                 |
| population)**                     | groups.         |                 |
|                                   |                 |                 |
| **Level: Grantee**                |                 |                 |
|                                   |                 |                 |
| **Category: Training**            |                 |                 |
+-----------------------------------+-----------------+-----------------+
| **GOAL**                          | To increase the |                 |
|                                   | percent of      |                 |
|                                   | trainees        |                 |
|                                   | participating   |                 |
|                                   | in MCHB         |                 |
|                                   | long‑term       |                 |
|                                   | training        |                 |
|                                   | programs who    |                 |
|                                   | are from        |                 |
|                                   | u               |                 |
|                                   | nderrepresented |                 |
|                                   | groups.         |                 |
+-----------------------------------+-----------------+-----------------+
|                                   |                 |                 |
+-----------------------------------+-----------------+-----------------+
| **MEASURE**                       | The percent of  |                 |
|                                   | participants in |                 |
|                                   | MCHB long-term  |                 |
|                                   | training        |                 |
|                                   | programs who    |                 |
|                                   | are from        |                 |
|                                   | u               |                 |
|                                   | nderrepresented |                 |
|                                   | groups.         |                 |
+-----------------------------------+-----------------+-----------------+
|                                   |                 |                 |
+-----------------------------------+-----------------+-----------------+
| **DEFINITION**                    | Numerator:      |                 |
+-----------------------------------+-----------------+-----------------+
|                                   | Number of       |                 |
|                                   | trainees        |                 |
|                                   | reported by     |                 |
|                                   | MCHB long‑term  |                 |
|                                   | training        |                 |
|                                   | programs to be  |                 |
|                                   | from            |                 |
|                                   | u               |                 |
|                                   | nderrepresented |                 |
|                                   | groups.         |                 |
+-----------------------------------+-----------------+-----------------+
|                                   | Denominator:    |                 |
+-----------------------------------+-----------------+-----------------+
|                                   | Total number of |                 |
|                                   | trainees        |                 |
|                                   | participating   |                 |
|                                   | in MCHB         |                 |
|                                   | long‑term       |                 |
|                                   | training        |                 |
|                                   | programs.       |                 |
+-----------------------------------+-----------------+-----------------+
|                                   | **Units:** 100  | **Text:**       |
|                                   |                 | Percent         |
+-----------------------------------+-----------------+-----------------+
|                                   | "U              |                 |
|                                   | nderrepresented |                 |
|                                   | groups" refer   |                 |
|                                   | to, but are not |                 |
|                                   | limited to,     |                 |
|                                   | groups based on |                 |
|                                   | race,           |                 |
|                                   | ethnicity,      |                 |
|                                   | geographic      |                 |
|                                   | location and    |                 |
|                                   | gender who are  |                 |
|                                   | u               |                 |
|                                   | nderrepresented |                 |
|                                   | in a field of   |                 |
|                                   | study.          |                 |
+-----------------------------------+-----------------+-----------------+
|                                   |                 |                 |
+-----------------------------------+-----------------+-----------------+
| **HEALTHY PEOPLE 2010 OBJECTIVE** | Related to      |                 |
|                                   | Objective 1.8:  |                 |
|                                   | In the health   |                 |
|                                   | professions,    |                 |
|                                   | allied and      |                 |
|                                   | associated      |                 |
|                                   | health          |                 |
|                                   | professions,    |                 |
|                                   | and the nursing |                 |
|                                   | field, increase |                 |
|                                   | the proportion  |                 |
|                                   | of all degrees  |                 |
|                                   | awarded to      |                 |
|                                   | members of      |                 |
|                                   | u               |                 |
|                                   | nderrepresented |                 |
|                                   | racial and      |                 |
|                                   | ethnic groups.  |                 |
+-----------------------------------+-----------------+-----------------+
|                                   |                 |                 |
+-----------------------------------+-----------------+-----------------+
| **DATA SOURCE(S) AND ISSUES**     | -   Data will   |                 |
|                                   |     be          |                 |
|                                   |     collected   |                 |
|                                   |     annually    |                 |
|                                   |     from        |                 |
|                                   |     grantees    |                 |
|                                   |     about       |                 |
|                                   |     enrolled    |                 |
|                                   |     students    |                 |
|                                   |     from the    |                 |
|                                   |     Minimum     |                 |
|                                   |     Data Set or |                 |
|                                   |     a data      |                 |
|                                   |     collection  |                 |
|                                   |     form will   |                 |
|                                   |     be          |                 |
|                                   |     developed   |                 |
|                                   |     if          |                 |
|                                   |     necessary.  |                 |
|                                   |                 |                 |
|                                   | -   MCHB does   |                 |
|                                   |     not         |                 |
|                                   |     maintain a  |                 |
|                                   |     master list |                 |
|                                   |     of all      |                 |
|                                   |     trainees    |                 |
|                                   |     who are     |                 |
|                                   |     supported   |                 |
|                                   |     by MCHB     |                 |
|                                   |     long‑term   |                 |
|                                   |     training    |                 |
|                                   |     programs.   |                 |
+-----------------------------------+-----------------+-----------------+
| **SIGNIFICANCE**                  | HRSA's MCHB     |                 |
|                                   | places special  |                 |
|                                   | emphasis on     |                 |
|                                   | improving       |                 |
|                                   | service         |                 |
|                                   | delivery to     |                 |
|                                   | women, children |                 |
|                                   | and youth from  |                 |
|                                   | communities     |                 |
|                                   | with limited    |                 |
|                                   | access to       |                 |
|                                   | comprehensive   |                 |
|                                   | care. Training  |                 |
|                                   | a diverse group |                 |
|                                   | of              |                 |
|                                   | professionals   |                 |
|                                   | is necessary in |                 |
|                                   | order to        |                 |
|                                   | provide a       |                 |
|                                   | diverse public  |                 |
|                                   | health          |                 |
|                                   | workforce to    |                 |
|                                   | meet the needs  |                 |
|                                   | of the changing |                 |
|                                   | demographics of |                 |
|                                   | the U.S. and to |                 |
|                                   | ensure access   |                 |
|                                   | to culturally   |                 |
|                                   | competent and   |                 |
|                                   | effective       |                 |
|                                   | services. This  |                 |
|                                   | performance     |                 |
|                                   | measure         |                 |
|                                   | provides the    |                 |
|                                   | necessary data  |                 |
|                                   | to report on    |                 |
|                                   | HRSA's          |                 |
|                                   | initiatives to  |                 |
|                                   | reduce          |                 |
|                                   | disparities.    |                 |
+-----------------------------------+-----------------+-----------------+

###### DATA COLLECTION FORM FOR PERFORMANCE MEASURE #09

**OMB #0915-0272**

**Expiration Date:  January 31, 2006**

The percent of participants in MCHB long-term training programs who are
from underrepresented groups.

Numerator: \_\_\_\_\_\_\_\_

Number of trainees reported by MCHB long‑term training programs to be
from underrepresented groups. "Underrepresented groups" refer to, but
are not limited to, groups based on race, ethnicity, geographic location
and gender who are underrepresented in a field of study.

Denominator: \_\_\_\_\_\_\_\_

Total number of trainees participating in MCHB long‑term training
programs.

Measure: \_\_\_\_\_\_\_\_\_\_\_\_\_\_

**MCH Training Performance Measures**

**OMB #0915-0272**

**Expiration Date:  January 31, 2006**

+-----------------------------------+-----------------------------------+
| #### 11 PERFORMANCE MEASURE       | The degree to which MCHB          |
|                                   | long‑term training grantees       |
| **Goal 2: Eliminate Health        | include cultural competency in    |
| Barriers & Disparities**          | their curricula/training.         |
|                                   |                                   |
| **(Train and MCH Workforce that   |                                   |
| is culturally competent and       |                                   |
| reflect an increasingly diverse   |                                   |
| population)**                     |                                   |
|                                   |                                   |
| **Level: Grantee**                |                                   |
|                                   |                                   |
| **Category: Cultural Competence** |                                   |
+-----------------------------------+-----------------------------------+
| **GOAL**                          | To increase the number of MCHB    |
|                                   | long‑term training programs that  |
|                                   | include each element of cultural  |
|                                   | competency in their               |
|                                   | curricula/training.               |
+-----------------------------------+-----------------------------------+
| **MEASURE**                       | The degree to which MCHB          |
|                                   | long‑term training grantees       |
|                                   | include cultural competency in    |
|                                   | their curricula/training.         |
+-----------------------------------+-----------------------------------+
| **DEFINITION**                    | Attached is a checklist of nine   |
|                                   | elements that demonstrate         |
|                                   | cultural competency. Please check |
|                                   | the degree to which the elements  |
|                                   | have been implemented. The answer |
|                                   | scale is 0-27. Please keep the    |
|                                   | completed checklist attached.     |
+-----------------------------------+-----------------------------------+
|                                   | Cultural competency training is   |
|                                   | defined as including the          |
|                                   | following elements: written       |
|                                   | cultural competence plan;         |
|                                   | cultural and linguistic           |
|                                   | competency policies; cultural and |
|                                   | linguistic competence knowledge   |
|                                   | and skills; research data on      |
|                                   | populations served according to   |
|                                   | racial, ethnic, and linguistic    |
|                                   | groupings; participation of       |
|                                   | community and family members of   |
|                                   | diverse cultures; faculty/staff   |
|                                   | with expertise in cultural and    |
|                                   | linguistic competence;            |
|                                   | faculty/staff trained in cultural |
|                                   | and linguistic competence issues; |
|                                   | and periodic assessment and       |
|                                   | planning.                         |
+-----------------------------------+-----------------------------------+
| **HEALTHY PEOPLE 2010 OBJECTIVE** | Related to Objective 23.9:        |
|                                   | (Developmental) Increase the      |
|                                   | proportion of schools for public  |
|                                   | health workers that integrate     |
|                                   | into their curricula specific     |
|                                   | content to develop competency in  |
|                                   | the essential public health       |
|                                   | services.                         |
+-----------------------------------+-----------------------------------+
| **DATA SOURCE(S) AND ISSUES**     | -   Attached data collection form |
|                                   |     to be completed by grantee.   |
|                                   |                                   |
|                                   | -   Data will be collected from   |
|                                   |     competitive and continuation  |
|                                   |     applications as part of the   |
|                                   |     grant application process and |
|                                   |     annual reports. The elements  |
|                                   |     of a quality cultural         |
|                                   |     competency program are        |
|                                   |     operationally defined.        |
+-----------------------------------+-----------------------------------+
| **SIGNIFICANCE**                  | Certain racial and ethnic groups  |
|                                   | and low-income communities lag    |
|                                   | behind the overall U.S.           |
|                                   | population on virtually all       |
|                                   | health status indicators. Access  |
|                                   | to health care that is culturally |
|                                   | appropriate is part of this a     |
|                                   | problem. A lack of understanding  |
|                                   | by providers creates barriers to  |
|                                   | care for racial/ethnic groups. To |
|                                   | effective reduce cultural         |
|                                   | barriers, providers need cultural |
|                                   | competency training. This will    |
|                                   | help to provide an effective      |
|                                   | public health workforce that      |
|                                   | meets the needs of the changing   |
|                                   | demographics of the US.           |
+-----------------------------------+-----------------------------------+

DATA COLLECTION FORM FOR PERFORMANCE MEASURE #11

**OMB #0915-0272**

**Expiration Date:  January 31, 2006**

Using a scale of 0-3, please rate the degree to which your training
program has addressed the following cultural competence elements.

  ------- ------- ------- ------- -------------------------------------------
  **0**   **1**   **2**   **3**   **Element**

                                  1\. A written cultural competence plan for
                                  your training program emphasizes your
                                  commitment to delivering a culturally
                                  competent training experience to your
                                  trainees.

                                  2\. Cultural and linguistic competency
                                  policies are incorporated into the overall
                                  administration of your training program
                                  (recruitment plan and other policies and
                                  procedures).

                                  3\. Cultural and linguistic competence
                                  knowledge and skills building are included
                                  in the didactic portion of your training
                                  experience.

                                  4\. Cultural and linguistic competence
                                  knowledge and skills building are included
                                  in the practicum/field/clinical experience
                                  portion of your training experience.

                                  5\. Research conducted by trainees and
                                  faculty includes the collection and
                                  analysis of data on populations served
                                  according to racial, ethnic, and linguistic
                                  groupings, where appropriate.

                                  6\. Community and family members of diverse
                                  cultures are involved in partnerships and
                                  collaborations for the planning, delivery,
                                  and evaluation of your training program.

                                  7\. Faculty/staff are culturally diverse
                                  and linguistically and culturally
                                  competent.

                                  8\. Faculty and staff are regularly trained
                                  on cultural and linguistic competency
                                  issues.

                                  9\. A process is in place for periodic
                                  assessment and planning related to the
                                  cultural and linguistic competence of your
                                  trainees.
  ------- ------- ------- ------- -------------------------------------------

0=Not Met

1=Partially Met

2=Mostly Met

3=Completely Met

Total the numbers in the boxes (possible 0‑27 score)
\_\_\_\_\_\_\_\_\_\_\_

+---------------------------------+------------------------------------+
| PROGRAM PERFORMANCE MEASURE 59  | The degree to which a training     |
|                                 | program collaborates with State    |
|                                 | Title V agencies, other MCH or     |
|                                 | MCH-related programs.              |
+---------------------------------+------------------------------------+
| **GOAL**                        | To assure that a training program  |
|                                 | has collaborative interactions     |
|                                 | related to training, technical     |
|                                 | assistance, continuing education,  |
|                                 | and other capacity-building        |
|                                 | services with relevant national,   |
|                                 | state and local programs, agencies |
|                                 | and organizations.                 |
+---------------------------------+------------------------------------+
| **MEASURE**                     | The degree to which a training     |
|                                 | program collaborates with State    |
|                                 | Title V agencies, other MCH or     |
|                                 | MCH-related programs and other     |
|                                 | professional organizations.        |
+---------------------------------+------------------------------------+
| **DEFINITION**                  | Attached is a list of the 6        |
|                                 | elements that describe activities  |
|                                 | carried out by training programs   |
|                                 | for or in collaboration with State |
|                                 | Title V and other agencies on a    |
|                                 | scale of 0 to 1. If a value of '1' |
|                                 | is selected, provide the number of |
|                                 | activities for the element. The    |
|                                 | total score for this measure will  |
|                                 | be determined by the sum of those  |
|                                 | elements noted as '1.'             |
+---------------------------------+------------------------------------+
| **HEALTHY PEOPLE 2010           | 1-7. Increase the proportion of    |
| OBJECTIVE**                     | schools of medicine, schools of    |
|                                 | nursing, and other health          |
|                                 | professional training schools      |
|                                 | whose basic curriculum for health  |
|                                 | care providers includes the core   |
|                                 | competencies in health promotion   |
|                                 | and disease prevention.            |
|                                 |                                    |
|                                 | 7-2. Increase the proportion of    |
|                                 | middle, junior high, and senior    |
|                                 | high schools that provide school   |
|                                 | health education to prevent health |
|                                 | problems...                        |
|                                 |                                    |
|                                 | 7-11. Increase the proportion of   |
|                                 | local health departments that have |
|                                 | established culturally appropriate |
|                                 | and linguistically competent       |
|                                 | community health promotion and     |
|                                 | disease prevention programs.       |
|                                 |                                    |
|                                 | 23-8, 23-10. Increase the          |
|                                 | proportion of Federal, Tribal,     |
|                                 | State, and local agencies that     |
|                                 | incorporate specific competencies  |
|                                 | and provide continuing education   |
|                                 | to develop competency in the       |
|                                 | essential public health            |
|                                 | services...                        |
+---------------------------------+------------------------------------+
| **DATA SOURCES AND ISSUES**     | The training program completes the |
|                                 | attached table which describes the |
|                                 | categories of collaborative        |
|                                 | activity.                          |
+---------------------------------+------------------------------------+
| # SIGNIFICANCE                  | As a SPRANS, a training program    |
|                                 | enhances the Title V State block   |
|                                 | grants that support the MCHB goal  |
|                                 | to promote comprehensive,          |
|                                 | coordinated, family-centered, and  |
|                                 | culturally-sensitive systems of    |
|                                 | health care that serve the diverse |
|                                 | needs of all families within their |
|                                 | own communities. Interactive       |
|                                 | collaboration between a training   |
|                                 | program and Federal, Tribal, State |
|                                 | and local agencies dedicated to    |
|                                 | improving the health of MCH        |
|                                 | populations will increase active   |
|                                 | involvement of many disciplines    |
|                                 | across public and private sectors  |
|                                 | and increase the likelihood of     |
|                                 | success in meeting the goals of    |
|                                 | relevant stakeholders.             |
|                                 |                                    |
|                                 | This measure will document a       |
|                                 | training program's abilities to:   |
|                                 |                                    |
|                                 | 1)  collaborate with State Title V |
|                                 |     and other agencies (at a       |
|                                 |     systems level) to support      |
|                                 |     achievement of the MCHB        |
|                                 |     Strategic Goals and CSHCN      |
|                                 |     Healthy People 2010 action     |
|                                 |     plan;                          |
|                                 |                                    |
|                                 | 2)  make the needs of MCH          |
|                                 |     populations more visible to    |
|                                 |     decision-makers and can help   |
|                                 |     states achieve best practice   |
|                                 |     standards for their systems of |
|                                 |     care;                          |
|                                 |                                    |
|                                 | 3)  reinforce the importance of    |
|                                 |     the value added to LEND        |
|                                 |     program dollars in supporting  |
|                                 |     faculty leaders to work at all |
|                                 |     levels of systems change; and  |
|                                 |                                    |
|                                 | 4)  internally use this data to    |
|                                 |     assure a full scope of these   |
|                                 |     program elements in all        |
|                                 |     regions.                       |
+---------------------------------+------------------------------------+

###### DATA COLLECTION FORM FOR DETAIL SHEET PM #59

Indicate the degree to which your training program collaborates with
State Title V (MCH) agencies and other MCH or MCH-related programs using
the following values:

0= The training program [does not]{.underline} collaborate on this
element.

> 1=The training program [does]{.underline} collaborate on this element.

If your program does collaborate, provide the total number of activities
for the element.

+-----------------------------------+---------+---------+-------------+
| **Element**                       | **0**   | **1**   | **Total     |
|                                   |         |         | Number**    |
|                                   |         |         |             |
|                                   |         |         | **of        |
|                                   |         |         | A           |
|                                   |         |         | ctivities** |
+-----------------------------------+---------+---------+-------------+
| 1.  **[Service]{.underline}**     |         |         |             |
|                                   |         |         |             |
| Examples might include: Clinics   |         |         |             |
| run by the training program and/  |         |         |             |
| or in collaboration with other    |         |         |             |
| agencies                          |         |         |             |
+-----------------------------------+---------+---------+-------------+
| 2.  **[Training]{.underline}**    |         |         |             |
|                                   |         |         |             |
| Examples might include: Training  |         |         |             |
| in *Bright Futures...*; Workshops |         |         |             |
| related to adolescent health      |         |         |             |
| practice; and Community-based     |         |         |             |
| practices. It would not include   |         |         |             |
| clinical supervision of long-term |         |         |             |
| trainees.                         |         |         |             |
+-----------------------------------+---------+---------+-------------+
| 3.  **[Continuing                 |         |         |             |
|     Education]{.underline}**      |         |         |             |
|                                   |         |         |             |
| Examples might include:           |         |         |             |
| Conferences; Distance learning;   |         |         |             |
| and Computer-based educational    |         |         |             |
| experiences. It would not include |         |         |             |
| formal classes or seminars for    |         |         |             |
| long-term trainees.               |         |         |             |
+-----------------------------------+---------+---------+-------------+
| 4.  **[Technical                  |         |         |             |
|     Assistance]{.underline}**     |         |         |             |
|                                   |         |         |             |
| Examples might include:           |         |         |             |
| Conducting needs assessments with |         |         |             |
| State programs; policy            |         |         |             |
| development; grant writing        |         |         |             |
| assistance; identifying           |         |         |             |
| best-practices; and leading       |         |         |             |
| collaborative groups. It would    |         |         |             |
| not include conducting needs      |         |         |             |
| assessments of consumers of the   |         |         |             |
| training program services.        |         |         |             |
+-----------------------------------+---------+---------+-------------+
| 5.  **[Product                    |         |         |             |
|     Development]{.underline}**    |         |         |             |
|                                   |         |         |             |
| Examples might include:           |         |         |             |
| Collaborataive development of     |         |         |             |
| journal articles and training or  |         |         |             |
| informational videos.             |         |         |             |
+-----------------------------------+---------+---------+-------------+
| 6.  **[Research]{.underline}**    |         |         |             |
|                                   |         |         |             |
| Examples might include:           |         |         |             |
| Collaborative submission of       |         |         |             |
| research grants, research teams   |         |         |             |
| that include Title V or other     |         |         |             |
| MCH-program staff and the         |         |         |             |
| training program's faculty.       |         |         |             |
+-----------------------------------+---------+---------+-------------+

**Total Score (possible 0‑6 score) \_\_\_\_\_\_\_\_**

**Total Number of Collaborative Activities \_\_\_\_\_\_\_\_\_**

+--------------------------------+-------+---+--------+------+--------+
| PROGRAM PERFORMANCE MEASURE 60 | The   |   |        |      |        |
|                                | pe    |   |        |      |        |
|                                | rcent |   |        |      |        |
|                                | of    |   |        |      |        |
|                                | long  |   |        |      |        |
|                                | -term |   |        |      |        |
|                                | tra   |   |        |      |        |
|                                | inees |   |        |      |        |
|                                | who,  |   |        |      |        |
|                                | at 1, |   |        |      |        |
|                                | 5 and |   |        |      |        |
|                                | 10    |   |        |      |        |
|                                | years |   |        |      |        |
|                                | post  |   |        |      |        |
|                                | trai  |   |        |      |        |
|                                | ning, |   |        |      |        |
|                                | work  |   |        |      |        |
|                                | in an |   |        |      |        |
|                                | in    |   |        |      |        |
|                                | terdi |   |        |      |        |
|                                | scipl |   |        |      |        |
|                                | inary |   |        |      |        |
|                                | m     |   |        |      |        |
|                                | anner |   |        |      |        |
|                                | to    |   |        |      |        |
|                                | serve |   |        |      |        |
|                                | the   |   |        |      |        |
|                                | MCH   |   |        |      |        |
|                                | popul |   |        |      |        |
|                                | ation |   |        |      |        |
|                                | (     |   |        |      |        |
|                                | e.g., |   |        |      |        |
|                                | i     |   |        |      |        |
|                                | ndivi |   |        |      |        |
|                                | duals |   |        |      |        |
|                                | with  |   |        |      |        |
|                                | di    |   |        |      |        |
|                                | sabil |   |        |      |        |
|                                | ities |   |        |      |        |
|                                | and   |   |        |      |        |
|                                | their |   |        |      |        |
|                                | fami  |   |        |      |        |
|                                | lies, |   |        |      |        |
|                                | a     |   |        |      |        |
|                                | doles |   |        |      |        |
|                                | cents |   |        |      |        |
|                                | and   |   |        |      |        |
|                                | their |   |        |      |        |
|                                | fami  |   |        |      |        |
|                                | lies, |   |        |      |        |
|                                | e     |   |        |      |        |
|                                | tc.). |   |        |      |        |
+--------------------------------+-------+---+--------+------+--------+
| **GOAL**                       | To    |   |        |      |        |
|                                | inc   |   |        |      |        |
|                                | rease |   |        |      |        |
|                                | the   |   |        |      |        |
|                                | pe    |   |        |      |        |
|                                | rcent |   |        |      |        |
|                                | of    |   |        |      |        |
|                                | long  |   |        |      |        |
|                                | -term |   |        |      |        |
|                                | tra   |   |        |      |        |
|                                | inees |   |        |      |        |
|                                | who,  |   |        |      |        |
|                                | upon  |   |        |      |        |
|                                | compl |   |        |      |        |
|                                | eting |   |        |      |        |
|                                | their |   |        |      |        |
|                                | trai  |   |        |      |        |
|                                | ning, |   |        |      |        |
|                                | work  |   |        |      |        |
|                                | in an |   |        |      |        |
|                                | in    |   |        |      |        |
|                                | terdi |   |        |      |        |
|                                | scipl |   |        |      |        |
|                                | inary |   |        |      |        |
|                                | m     |   |        |      |        |
|                                | anner |   |        |      |        |
|                                | to    |   |        |      |        |
|                                | serve |   |        |      |        |
|                                | the   |   |        |      |        |
|                                | MCH   |   |        |      |        |
|                                | p     |   |        |      |        |
|                                | opula |   |        |      |        |
|                                | tion. |   |        |      |        |
+--------------------------------+-------+---+--------+------+--------+
| **MEASURE**                    | The   |   |        |      |        |
|                                | pe    |   |        |      |        |
|                                | rcent |   |        |      |        |
|                                | of    |   |        |      |        |
|                                | long  |   |        |      |        |
|                                | -term |   |        |      |        |
|                                | tra   |   |        |      |        |
|                                | inees |   |        |      |        |
|                                | who,  |   |        |      |        |
|                                | at 1, |   |        |      |        |
|                                | 5 and |   |        |      |        |
|                                | 10    |   |        |      |        |
|                                | years |   |        |      |        |
|                                | post  |   |        |      |        |
|                                | tra   |   |        |      |        |
|                                | ining |   |        |      |        |
|                                | work  |   |        |      |        |
|                                | in an |   |        |      |        |
|                                | in    |   |        |      |        |
|                                | terdi |   |        |      |        |
|                                | scipl |   |        |      |        |
|                                | inary |   |        |      |        |
|                                | m     |   |        |      |        |
|                                | anner |   |        |      |        |
|                                | to    |   |        |      |        |
|                                | serve |   |        |      |        |
|                                | the   |   |        |      |        |
|                                | MCH   |   |        |      |        |
|                                | p     |   |        |      |        |
|                                | opula |   |        |      |        |
|                                | tion. |   |        |      |        |
+--------------------------------+-------+---+--------+------+--------+
| **DEFINITION**                 | **Nu  |   | The    |      |        |
|                                | merat |   | number |      |        |
|                                | or:** |   | of     |      |        |
|                                |       |   | tr     |      |        |
|                                |       |   | ainees |      |        |
|                                |       |   | indi   |      |        |
|                                |       |   | cating |      |        |
|                                |       |   | that   |      |        |
|                                |       |   | they   |      |        |
|                                |       |   | co     |      |        |
|                                |       |   | ntinue |      |        |
|                                |       |   | to     |      |        |
|                                |       |   | work   |      |        |
|                                |       |   | in an  |      |        |
|                                |       |   | inter  |      |        |
|                                |       |   | discip |      |        |
|                                |       |   | linary |      |        |
|                                |       |   | s      |      |        |
|                                |       |   | etting |      |        |
|                                |       |   | s      |      |        |
|                                |       |   | erving |      |        |
|                                |       |   | the    |      |        |
|                                |       |   | MCH    |      |        |
|                                |       |   | popul  |      |        |
|                                |       |   | ation. |      |        |
+--------------------------------+-------+---+--------+------+--------+
|                                | *     |   | The    |      |        |
|                                | *Deno |   | total  |      |        |
|                                | minat |   | number |      |        |
|                                | or:** |   | of     |      |        |
|                                |       |   | tr     |      |        |
|                                |       |   | ainees |      |        |
|                                |       |   | resp   |      |        |
|                                |       |   | onding |      |        |
|                                |       |   | to the |      |        |
|                                |       |   | survey |      |        |
+--------------------------------+-------+---+--------+------+--------+
|                                | **Uni | 1 |        | *    | P      |
|                                | ts:** | 0 |        | *Tex | ercent |
|                                |       | 0 |        | t:** |        |
+--------------------------------+-------+---+--------+------+--------+
|                                | In    |   |        |      |        |
|                                | addi  |   |        |      |        |
|                                | tion, |   |        |      |        |
|                                | data  |   |        |      |        |
|                                | on    |   |        |      |        |
|                                | the   |   |        |      |        |
|                                | total |   |        |      |        |
|                                | n     |   |        |      |        |
|                                | umber |   |        |      |        |
|                                | of    |   |        |      |        |
|                                | the   |   |        |      |        |
|                                | tra   |   |        |      |        |
|                                | inees |   |        |      |        |
|                                | and   |   |        |      |        |
|                                | the   |   |        |      |        |
|                                | n     |   |        |      |        |
|                                | umber |   |        |      |        |
|                                | of    |   |        |      |        |
|                                | non-r |   |        |      |        |
|                                | espon |   |        |      |        |
|                                | dents |   |        |      |        |
|                                | for   |   |        |      |        |
|                                | each  |   |        |      |        |
|                                | year  |   |        |      |        |
|                                | will  |   |        |      |        |
|                                | be    |   |        |      |        |
|                                | colle |   |        |      |        |
|                                | cted. |   |        |      |        |
|                                |       |   |        |      |        |
|                                | Long  |   |        |      |        |
|                                | -term |   |        |      |        |
|                                | tra   |   |        |      |        |
|                                | inees |   |        |      |        |
|                                | are   |   |        |      |        |
|                                | de    |   |        |      |        |
|                                | fined |   |        |      |        |
|                                | as    |   |        |      |        |
|                                | those |   |        |      |        |
|                                | who   |   |        |      |        |
|                                | have  |   |        |      |        |
|                                | comp  |   |        |      |        |
|                                | leted |   |        |      |        |
|                                | a     |   |        |      |        |
|                                | long  |   |        |      |        |
|                                | -term |   |        |      |        |
|                                | (300+ |   |        |      |        |
|                                | h     |   |        |      |        |
|                                | ours) |   |        |      |        |
|                                | leade |   |        |      |        |
|                                | rship |   |        |      |        |
|                                | tra   |   |        |      |        |
|                                | ining |   |        |      |        |
|                                | pro   |   |        |      |        |
|                                | gram, |   |        |      |        |
|                                | incl  |   |        |      |        |
|                                | uding |   |        |      |        |
|                                | those |   |        |      |        |
|                                | who   |   |        |      |        |
|                                | rec   |   |        |      |        |
|                                | eived |   |        |      |        |
|                                | MCH   |   |        |      |        |
|                                | funds |   |        |      |        |
|                                | and   |   |        |      |        |
|                                | those |   |        |      |        |
|                                | who   |   |        |      |        |
|                                | did   |   |        |      |        |
|                                | not.  |   |        |      |        |
+--------------------------------+-------+---+--------+------+--------+
| **HEALTHY PEOPLE 2010          | 1-7:  |   |        |      |        |
| OBJECTIVE**                    | Inc   |   |        |      |        |
|                                | rease |   |        |      |        |
|                                | propo |   |        |      |        |
|                                | rtion |   |        |      |        |
|                                | of    |   |        |      |        |
|                                | sc    |   |        |      |        |
|                                | hools |   |        |      |        |
|                                | of    |   |        |      |        |
|                                | medi  |   |        |      |        |
|                                | cine, |   |        |      |        |
|                                | sc    |   |        |      |        |
|                                | hools |   |        |      |        |
|                                | of    |   |        |      |        |
|                                | nur   |   |        |      |        |
|                                | sing, |   |        |      |        |
|                                | and   |   |        |      |        |
|                                | other |   |        |      |        |
|                                | h     |   |        |      |        |
|                                | ealth |   |        |      |        |
|                                | pr    |   |        |      |        |
|                                | ofess |   |        |      |        |
|                                | ional |   |        |      |        |
|                                | tra   |   |        |      |        |
|                                | ining |   |        |      |        |
|                                | sc    |   |        |      |        |
|                                | hools |   |        |      |        |
|                                | whose |   |        |      |        |
|                                | basic |   |        |      |        |
|                                | curri |   |        |      |        |
|                                | culum |   |        |      |        |
|                                | for   |   |        |      |        |
|                                | h     |   |        |      |        |
|                                | ealth |   |        |      |        |
|                                | care  |   |        |      |        |
|                                | prov  |   |        |      |        |
|                                | iders |   |        |      |        |
|                                | inc   |   |        |      |        |
|                                | ludes |   |        |      |        |
|                                | the   |   |        |      |        |
|                                | core  |   |        |      |        |
|                                | co    |   |        |      |        |
|                                | mpete |   |        |      |        |
|                                | ncies |   |        |      |        |
|                                | in    |   |        |      |        |
|                                | h     |   |        |      |        |
|                                | ealth |   |        |      |        |
|                                | prom  |   |        |      |        |
|                                | otion |   |        |      |        |
|                                | and   |   |        |      |        |
|                                | di    |   |        |      |        |
|                                | sease |   |        |      |        |
|                                | p     |   |        |      |        |
|                                | reven |   |        |      |        |
|                                | tion. |   |        |      |        |
|                                |       |   |        |      |        |
|                                | 1     |   |        |      |        |
|                                | 6-23: |   |        |      |        |
|                                | Inc   |   |        |      |        |
|                                | rease |   |        |      |        |
|                                | the   |   |        |      |        |
|                                | propo |   |        |      |        |
|                                | rtion |   |        |      |        |
|                                | of    |   |        |      |        |
|                                | T     |   |        |      |        |
|                                | errit |   |        |      |        |
|                                | ories |   |        |      |        |
|                                | and   |   |        |      |        |
|                                | S     |   |        |      |        |
|                                | tates |   |        |      |        |
|                                | that  |   |        |      |        |
|                                | have  |   |        |      |        |
|                                | se    |   |        |      |        |
|                                | rvice |   |        |      |        |
|                                | sy    |   |        |      |        |
|                                | stems |   |        |      |        |
|                                | for   |   |        |      |        |
|                                | chi   |   |        |      |        |
|                                | ldren |   |        |      |        |
|                                | with  |   |        |      |        |
|                                | sp    |   |        |      |        |
|                                | ecial |   |        |      |        |
|                                | h     |   |        |      |        |
|                                | ealth |   |        |      |        |
|                                | care  |   |        |      |        |
|                                | n     |   |        |      |        |
|                                | eeds. |   |        |      |        |
|                                |       |   |        |      |        |
|                                | 23-9: |   |        |      |        |
|                                | Inc   |   |        |      |        |
|                                | rease |   |        |      |        |
|                                | the   |   |        |      |        |
|                                | propo |   |        |      |        |
|                                | rtion |   |        |      |        |
|                                | of    |   |        |      |        |
|                                | sc    |   |        |      |        |
|                                | hools |   |        |      |        |
|                                | for   |   |        |      |        |
|                                | p     |   |        |      |        |
|                                | ublic |   |        |      |        |
|                                | h     |   |        |      |        |
|                                | ealth |   |        |      |        |
|                                | wo    |   |        |      |        |
|                                | rkers |   |        |      |        |
|                                | that  |   |        |      |        |
|                                | inte  |   |        |      |        |
|                                | grate |   |        |      |        |
|                                | into  |   |        |      |        |
|                                | their |   |        |      |        |
|                                | curr  |   |        |      |        |
|                                | icula |   |        |      |        |
|                                | spe   |   |        |      |        |
|                                | cific |   |        |      |        |
|                                | co    |   |        |      |        |
|                                | ntent |   |        |      |        |
|                                | to    |   |        |      |        |
|                                | de    |   |        |      |        |
|                                | velop |   |        |      |        |
|                                | compe |   |        |      |        |
|                                | tency |   |        |      |        |
|                                | in    |   |        |      |        |
|                                | the   |   |        |      |        |
|                                | esse  |   |        |      |        |
|                                | ntial |   |        |      |        |
|                                | p     |   |        |      |        |
|                                | ublic |   |        |      |        |
|                                | h     |   |        |      |        |
|                                | ealth |   |        |      |        |
|                                | serv  |   |        |      |        |
|                                | ices. |   |        |      |        |
+--------------------------------+-------+---+--------+------+--------+
| **DATA SOURCE(S) AND ISSUES**  | The   |   |        |      |        |
|                                | tr    |   |        |      |        |
|                                | ainee |   |        |      |        |
|                                | foll  |   |        |      |        |
|                                | ow-up |   |        |      |        |
|                                | s     |   |        |      |        |
|                                | urvey |   |        |      |        |
|                                | is    |   |        |      |        |
|                                | used  |   |        |      |        |
|                                | to    |   |        |      |        |
|                                | co    |   |        |      |        |
|                                | llect |   |        |      |        |
|                                | these |   |        |      |        |
|                                | data. |   |        |      |        |
+--------------------------------+-------+---+--------+------+--------+
| **SIGNIFICANCE**               | Leade |   |        |      |        |
|                                | rship |   |        |      |        |
|                                | educ  |   |        |      |        |
|                                | ation |   |        |      |        |
|                                | is a  |   |        |      |        |
|                                | co    |   |        |      |        |
|                                | mplex |   |        |      |        |
|                                | in    |   |        |      |        |
|                                | terdi |   |        |      |        |
|                                | scipl |   |        |      |        |
|                                | inary |   |        |      |        |
|                                | field |   |        |      |        |
|                                | that  |   |        |      |        |
|                                | must  |   |        |      |        |
|                                | meet  |   |        |      |        |
|                                | the   |   |        |      |        |
|                                | needs |   |        |      |        |
|                                | of    |   |        |      |        |
|                                | MCH   |   |        |      |        |
|                                | po    |   |        |      |        |
|                                | pulat |   |        |      |        |
|                                | ions. |   |        |      |        |
|                                | This  |   |        |      |        |
|                                | me    |   |        |      |        |
|                                | asure |   |        |      |        |
|                                | addr  |   |        |      |        |
|                                | esses |   |        |      |        |
|                                | one   |   |        |      |        |
|                                | of a  |   |        |      |        |
|                                | tra   |   |        |      |        |
|                                | ining |   |        |      |        |
|                                | prog  |   |        |      |        |
|                                | ram's |   |        |      |        |
|                                | core  |   |        |      |        |
|                                | v     |   |        |      |        |
|                                | alues |   |        |      |        |
|                                | and   |   |        |      |        |
|                                | its   |   |        |      |        |
|                                | u     |   |        |      |        |
|                                | nique |   |        |      |        |
|                                | role  |   |        |      |        |
|                                | to    |   |        |      |        |
|                                | pr    |   |        |      |        |
|                                | epare |   |        |      |        |
|                                | pro   |   |        |      |        |
|                                | fessi |   |        |      |        |
|                                | onals |   |        |      |        |
|                                | for   |   |        |      |        |
|                                | com   |   |        |      |        |
|                                | prehe |   |        |      |        |
|                                | nsive |   |        |      |        |
|                                | sy    |   |        |      |        |
|                                | stems |   |        |      |        |
|                                | of    |   |        |      |        |
|                                | care. |   |        |      |        |
|                                | By    |   |        |      |        |
|                                | prov  |   |        |      |        |
|                                | iding |   |        |      |        |
|                                | in    |   |        |      |        |
|                                | terdi |   |        |      |        |
|                                | scipl |   |        |      |        |
|                                | inary |   |        |      |        |
|                                | c     |   |        |      |        |
|                                | oordi |   |        |      |        |
|                                | nated |   |        |      |        |
|                                | care, |   |        |      |        |
|                                | tra   |   |        |      |        |
|                                | ining |   |        |      |        |
|                                | pro   |   |        |      |        |
|                                | grams |   |        |      |        |
|                                | help  |   |        |      |        |
|                                | to    |   |        |      |        |
|                                | e     |   |        |      |        |
|                                | nsure |   |        |      |        |
|                                | that  |   |        |      |        |
|                                | all   |   |        |      |        |
|                                | MCH   |   |        |      |        |
|                                | p     |   |        |      |        |
|                                | opula |   |        |      |        |
|                                | tions |   |        |      |        |
|                                | re    |   |        |      |        |
|                                | ceive |   |        |      |        |
|                                | the   |   |        |      |        |
|                                | most  |   |        |      |        |
|                                | com   |   |        |      |        |
|                                | prehe |   |        |      |        |
|                                | nsive |   |        |      |        |
|                                | care  |   |        |      |        |
|                                | that  |   |        |      |        |
|                                | takes |   |        |      |        |
|                                | into  |   |        |      |        |
|                                | ac    |   |        |      |        |
|                                | count |   |        |      |        |
|                                | the   |   |        |      |        |
|                                | com   |   |        |      |        |
|                                | plete |   |        |      |        |
|                                | and   |   |        |      |        |
|                                | u     |   |        |      |        |
|                                | nique |   |        |      |        |
|                                | needs |   |        |      |        |
|                                | of    |   |        |      |        |
|                                | the   |   |        |      |        |
|                                | i     |   |        |      |        |
|                                | ndivi |   |        |      |        |
|                                | duals |   |        |      |        |
|                                | and   |   |        |      |        |
|                                | their |   |        |      |        |
|                                | fami  |   |        |      |        |
|                                | lies. |   |        |      |        |
+--------------------------------+-------+---+--------+------+--------+

**Developmental Measure**

+---------------------------------+------+---+-----+------------------+
| PROGRAM PERFORMANCE MEASURE 61  | The  |   |     |                  |
|                                 | pe   |   |     |                  |
|                                 | rcen |   |     |                  |
|                                 | tage |   |     |                  |
|                                 | of   |   |     |                  |
|                                 | long |   |     |                  |
|                                 | term |   |     |                  |
|                                 | i    |   |     |                  |
|                                 | nter |   |     |                  |
|                                 | disc |   |     |                  |
|                                 | ipli |   |     |                  |
|                                 | nary |   |     |                  |
|                                 | trai |   |     |                  |
|                                 | nees |   |     |                  |
|                                 | who  |   |     |                  |
|                                 | re   |   |     |                  |
|                                 | port |   |     |                  |
|                                 | val  |   |     |                  |
|                                 | uing |   |     |                  |
|                                 | t    |   |     |                  |
|                                 | heir |   |     |                  |
|                                 | i    |   |     |                  |
|                                 | nter |   |     |                  |
|                                 | disc |   |     |                  |
|                                 | ipli |   |     |                  |
|                                 | nary |   |     |                  |
|                                 | trai |   |     |                  |
|                                 | ning |   |     |                  |
|                                 | at 1 |   |     |                  |
|                                 | and  |   |     |                  |
|                                 | 5    |   |     |                  |
|                                 | y    |   |     |                  |
|                                 | ears |   |     |                  |
+---------------------------------+------+---+-----+------------------+
| **GOAL**                        | To   |   |     |                  |
|                                 | incr |   |     |                  |
|                                 | ease |   |     |                  |
|                                 | the  |   |     |                  |
|                                 | pe   |   |     |                  |
|                                 | rcen |   |     |                  |
|                                 | tage |   |     |                  |
|                                 | of   |   |     |                  |
|                                 | fo   |   |     |                  |
|                                 | rmer |   |     |                  |
|                                 | LEND |   |     |                  |
|                                 | trai |   |     |                  |
|                                 | nees |   |     |                  |
|                                 | w    |   |     |                  |
|                                 | hose |   |     |                  |
|                                 | ca   |   |     |                  |
|                                 | reer |   |     |                  |
|                                 | ch   |   |     |                  |
|                                 | oice |   |     |                  |
|                                 | and  |   |     |                  |
|                                 | per  |   |     |                  |
|                                 | form |   |     |                  |
|                                 | ance |   |     |                  |
|                                 | is   |   |     |                  |
|                                 | po   |   |     |                  |
|                                 | siti |   |     |                  |
|                                 | vely |   |     |                  |
|                                 | impa |   |     |                  |
|                                 | cted |   |     |                  |
|                                 | by   |   |     |                  |
|                                 | t    |   |     |                  |
|                                 | heir |   |     |                  |
|                                 | LEND |   |     |                  |
|                                 | trai |   |     |                  |
|                                 | ning |   |     |                  |
|                                 | wi   |   |     |                  |
|                                 | thin |   |     |                  |
|                                 | five |   |     |                  |
|                                 | y    |   |     |                  |
|                                 | ears |   |     |                  |
|                                 | of   |   |     |                  |
|                                 | trai |   |     |                  |
|                                 | ning |   |     |                  |
|                                 | com  |   |     |                  |
|                                 | plet |   |     |                  |
|                                 | ion. |   |     |                  |
+---------------------------------+------+---+-----+------------------+
| **MEASURE**                     | The  |   |     |                  |
|                                 | de   |   |     |                  |
|                                 | gree |   |     |                  |
|                                 | to   |   |     |                  |
|                                 | w    |   |     |                  |
|                                 | hich |   |     |                  |
|                                 | MCH  |   |     |                  |
|                                 | long |   |     |                  |
|                                 | term |   |     |                  |
|                                 | i    |   |     |                  |
|                                 | nter |   |     |                  |
|                                 | disc |   |     |                  |
|                                 | ipli |   |     |                  |
|                                 | nary |   |     |                  |
|                                 | trai |   |     |                  |
|                                 | nees |   |     |                  |
|                                 | re   |   |     |                  |
|                                 | port |   |     |                  |
|                                 | val  |   |     |                  |
|                                 | uing |   |     |                  |
|                                 | t    |   |     |                  |
|                                 | heir |   |     |                  |
|                                 | i    |   |     |                  |
|                                 | nter |   |     |                  |
|                                 | disc |   |     |                  |
|                                 | ipli |   |     |                  |
|                                 | nary |   |     |                  |
|                                 | trai |   |     |                  |
|                                 | ning |   |     |                  |
|                                 | at   |   |     |                  |
|                                 | 1,   |   |     |                  |
|                                 | and  |   |     |                  |
|                                 | 5    |   |     |                  |
|                                 | ye   |   |     |                  |
|                                 | ars. |   |     |                  |
+---------------------------------+------+---+-----+------------------+
| **DEFINITION**                  | **   |   | Num |                  |
|                                 | Nume |   | ber |                  |
|                                 | rato |   | of  |                  |
|                                 | r:** |   | tr  |                  |
|                                 |      |   | ain |                  |
|                                 |      |   | ees |                  |
|                                 |      |   | r   |                  |
|                                 |      |   | esp |                  |
|                                 |      |   | ond |                  |
|                                 |      |   | ing |                  |
|                                 |      |   | w   |                  |
|                                 |      |   | ith |                  |
|                                 |      |   | a 3 |                  |
|                                 |      |   | or  |                  |
|                                 |      |   | 2.  |                  |
+---------------------------------+------+---+-----+------------------+
|                                 | **De |   | To  |                  |
|                                 | nomi |   | tal |                  |
|                                 | nato |   | num |                  |
|                                 | r:** |   | ber |                  |
|                                 |      |   | of  |                  |
|                                 |      |   | tr  |                  |
|                                 |      |   | ain |                  |
|                                 |      |   | ees |                  |
|                                 |      |   | re  |                  |
|                                 |      |   | spo |                  |
|                                 |      |   | ndi |                  |
|                                 |      |   | ng. |                  |
+---------------------------------+------+---+-----+------------------+
|                                 | **   | \ | **T | Aggregate % from |
|                                 | Unit | % | ext | network data     |
|                                 | s:** |   | :** |                  |
+---------------------------------+------+---+-----+------------------+
| **HEALTHY PEOPLE 2010           | Rel  |   |     |                  |
| OBJECTIVE**                     | ated |   |     |                  |
|                                 | to   |   |     |                  |
|                                 | 16   |   |     |                  |
|                                 | -23: |   |     |                  |
|                                 | Incr |   |     |                  |
|                                 | ease |   |     |                  |
|                                 | the  |   |     |                  |
|                                 | pr   |   |     |                  |
|                                 | opor |   |     |                  |
|                                 | tion |   |     |                  |
|                                 | of   |   |     |                  |
|                                 | Ter  |   |     |                  |
|                                 | rito |   |     |                  |
|                                 | ries |   |     |                  |
|                                 | and  |   |     |                  |
|                                 | St   |   |     |                  |
|                                 | ates |   |     |                  |
|                                 | that |   |     |                  |
|                                 | have |   |     |                  |
|                                 | ser  |   |     |                  |
|                                 | vice |   |     |                  |
|                                 | sys  |   |     |                  |
|                                 | tems |   |     |                  |
|                                 | for  |   |     |                  |
|                                 | chil |   |     |                  |
|                                 | dren |   |     |                  |
|                                 | with |   |     |                  |
|                                 | spe  |   |     |                  |
|                                 | cial |   |     |                  |
|                                 | he   |   |     |                  |
|                                 | alth |   |     |                  |
|                                 | care |   |     |                  |
|                                 | ne   |   |     |                  |
|                                 | eds. |   |     |                  |
+---------------------------------+------+---+-----+------------------+
| **DATA SOURCE(S) AND ISSUES**   | This |   |     |                  |
|                                 | requ |   |     |                  |
|                                 | ires |   |     |                  |
|                                 | pri  |   |     |                  |
|                                 | mary |   |     |                  |
|                                 | data |   |     |                  |
|                                 | col  |   |     |                  |
|                                 | lect |   |     |                  |
|                                 | ion. |   |     |                  |
|                                 | The  |   |     |                  |
|                                 | co   |   |     |                  |
|                                 | llec |   |     |                  |
|                                 | tion |   |     |                  |
|                                 | t    |   |     |                  |
|                                 | ool, |   |     |                  |
|                                 | w    |   |     |                  |
|                                 | hich |   |     |                  |
|                                 | will |   |     |                  |
|                                 | be   |   |     |                  |
|                                 | the  |   |     |                  |
|                                 | tra  |   |     |                  |
|                                 | inee |   |     |                  |
|                                 | f    |   |     |                  |
|                                 | ollo |   |     |                  |
|                                 | w-up |   |     |                  |
|                                 | sur  |   |     |                  |
|                                 | vey, |   |     |                  |
|                                 | will |   |     |                  |
|                                 | ask  |   |     |                  |
|                                 | trai |   |     |                  |
|                                 | nees |   |     |                  |
|                                 | to   |   |     |                  |
|                                 | rate |   |     |                  |
|                                 | how  |   |     |                  |
|                                 | they |   |     |                  |
|                                 | have |   |     |                  |
|                                 | va   |   |     |                  |
|                                 | lued |   |     |                  |
|                                 | t    |   |     |                  |
|                                 | heir |   |     |                  |
|                                 | i    |   |     |                  |
|                                 | nter |   |     |                  |
|                                 | disc |   |     |                  |
|                                 | ipli |   |     |                  |
|                                 | nary |   |     |                  |
|                                 | trai |   |     |                  |
|                                 | ning |   |     |                  |
|                                 | on a |   |     |                  |
|                                 | s    |   |     |                  |
|                                 | cale |   |     |                  |
|                                 | of 0 |   |     |                  |
|                                 | to   |   |     |                  |
|                                 | 3.   |   |     |                  |
|                                 | Each |   |     |                  |
|                                 | pro  |   |     |                  |
|                                 | gram |   |     |                  |
|                                 | will |   |     |                  |
|                                 | then |   |     |                  |
|                                 | a    |   |     |                  |
|                                 | ggre |   |     |                  |
|                                 | gate |   |     |                  |
|                                 | repo |   |     |                  |
|                                 | rted |   |     |                  |
|                                 | data |   |     |                  |
|                                 | and  |   |     |                  |
|                                 | re   |   |     |                  |
|                                 | port |   |     |                  |
|                                 | the  |   |     |                  |
|                                 | dist |   |     |                  |
|                                 | ribu |   |     |                  |
|                                 | tion |   |     |                  |
|                                 | of   |   |     |                  |
|                                 | how  |   |     |                  |
|                                 | many |   |     |                  |
|                                 | res  |   |     |                  |
|                                 | pond |   |     |                  |
|                                 | ents |   |     |                  |
|                                 | r    |   |     |                  |
|                                 | ated |   |     |                  |
|                                 | t    |   |     |                  |
|                                 | heir |   |     |                  |
|                                 | trai |   |     |                  |
|                                 | ning |   |     |                  |
|                                 | a 1, |   |     |                  |
|                                 | how  |   |     |                  |
|                                 | many |   |     |                  |
|                                 | 2,   |   |     |                  |
|                                 | etc. |   |     |                  |
|                                 | thr  |   |     |                  |
|                                 | ough |   |     |                  |
|                                 | 3.   |   |     |                  |
|                                 | *For |   |     |                  |
|                                 | the  |   |     |                  |
|                                 | f    |   |     |                  |
|                                 | ollo |   |     |                  |
|                                 | wing |   |     |                  |
|                                 | qu   |   |     |                  |
|                                 | esti |   |     |                  |
|                                 | ons, |   |     |                  |
|                                 | rank |   |     |                  |
|                                 | each |   |     |                  |
|                                 | an   |   |     |                  |
|                                 | swer |   |     |                  |
|                                 | 3=g  |   |     |                  |
|                                 | reat |   |     |                  |
|                                 | posi |   |     |                  |
|                                 | tive |   |     |                  |
|                                 | in   |   |     |                  |
|                                 | flue |   |     |                  |
|                                 | nce; |   |     |                  |
|                                 | 2=   |   |     |                  |
|                                 | some |   |     |                  |
|                                 | posi |   |     |                  |
|                                 | tive |   |     |                  |
|                                 | in   |   |     |                  |
|                                 | flue |   |     |                  |
|                                 | nce; |   |     |                  |
|                                 | 1=li |   |     |                  |
|                                 | ttle |   |     |                  |
|                                 | in   |   |     |                  |
|                                 | flue |   |     |                  |
|                                 | nce; |   |     |                  |
|                                 | 0=   |   |     |                  |
|                                 | nega |   |     |                  |
|                                 | tive |   |     |                  |
|                                 | in   |   |     |                  |
|                                 | flue |   |     |                  |
|                                 | nce* |   |     |                  |
|                                 |      |   |     |                  |
|                                 | **My |   |     |                  |
|                                 | LEND |   |     |                  |
|                                 | trai |   |     |                  |
|                                 | ning |   |     |                  |
|                                 | has  |   |     |                  |
|                                 | po   |   |     |                  |
|                                 | siti |   |     |                  |
|                                 | vely |   |     |                  |
|                                 | in   |   |     |                  |
|                                 | flue |   |     |                  |
|                                 | nced |   |     |                  |
|                                 | my   |   |     |                  |
|                                 | cur  |   |     |                  |
|                                 | rent |   |     |                  |
|                                 | ca   |   |     |                  |
|                                 | reer |   |     |                  |
|                                 | ch   |   |     |                  |
|                                 | oice |   |     |                  |
|                                 | and  |   |     |                  |
|                                 | pe   |   |     |                  |
|                                 | rfor |   |     |                  |
|                                 | manc |   |     |                  |
|                                 | e:** |   |     |                  |
|                                 |      |   |     |                  |
|                                 | \_   |   |     |                  |
|                                 | \_\_ |   |     |                  |
|                                 | 3    |   |     |                  |
|                                 | \_   |   |     |                  |
|                                 | \_\_ |   |     |                  |
|                                 | 2    |   |     |                  |
|                                 | \_   |   |     |                  |
|                                 | \_\_ |   |     |                  |
|                                 | 1    |   |     |                  |
|                                 | \_   |   |     |                  |
|                                 | \_\_ |   |     |                  |
|                                 | 0    |   |     |                  |
+---------------------------------+------+---+-----+------------------+
| **SIGNIFICANCE**                | As   |   |     |                  |
|                                 | king |   |     |                  |
|                                 | the  |   |     |                  |
|                                 | re   |   |     |                  |
|                                 | cipi |   |     |                  |
|                                 | ents |   |     |                  |
|                                 | of   |   |     |                  |
|                                 | any  |   |     |                  |
|                                 | ser  |   |     |                  |
|                                 | vice |   |     |                  |
|                                 | a    |   |     |                  |
|                                 | bout |   |     |                  |
|                                 | the  |   |     |                  |
|                                 | v    |   |     |                  |
|                                 | alue |   |     |                  |
|                                 | of   |   |     |                  |
|                                 | the  |   |     |                  |
|                                 | ser  |   |     |                  |
|                                 | vice |   |     |                  |
|                                 | prov |   |     |                  |
|                                 | ided |   |     |                  |
|                                 | to   |   |     |                  |
|                                 | them |   |     |                  |
|                                 | is   |   |     |                  |
|                                 | an   |   |     |                  |
|                                 | i    |   |     |                  |
|                                 | mpor |   |     |                  |
|                                 | tant |   |     |                  |
|                                 | p    |   |     |                  |
|                                 | rinc |   |     |                  |
|                                 | iple |   |     |                  |
|                                 | of   |   |     |                  |
|                                 | cust |   |     |                  |
|                                 | omer |   |     |                  |
|                                 | ser  |   |     |                  |
|                                 | vice |   |     |                  |
|                                 | and  |   |     |                  |
|                                 | eva  |   |     |                  |
|                                 | luat |   |     |                  |
|                                 | ion. |   |     |                  |
|                                 | U    |   |     |                  |
|                                 | nder |   |     |                  |
|                                 | stan |   |     |                  |
|                                 | ding |   |     |                  |
|                                 | the  |   |     |                  |
|                                 | de   |   |     |                  |
|                                 | gree |   |     |                  |
|                                 | to   |   |     |                  |
|                                 | w    |   |     |                  |
|                                 | hich |   |     |                  |
|                                 | MCH  |   |     |                  |
|                                 | long |   |     |                  |
|                                 | term |   |     |                  |
|                                 | i    |   |     |                  |
|                                 | nter |   |     |                  |
|                                 | disc |   |     |                  |
|                                 | ipli |   |     |                  |
|                                 | nary |   |     |                  |
|                                 | trai |   |     |                  |
|                                 | nees |   |     |                  |
|                                 | v    |   |     |                  |
|                                 | alue |   |     |                  |
|                                 | trai |   |     |                  |
|                                 | ning |   |     |                  |
|                                 | will |   |     |                  |
|                                 | have |   |     |                  |
|                                 | mult |   |     |                  |
|                                 | iple |   |     |                  |
|                                 | aff  |   |     |                  |
|                                 | ects |   |     |                  |
|                                 | on   |   |     |                  |
|                                 | the  |   |     |                  |
|                                 | l    |   |     |                  |
|                                 | ong- |   |     |                  |
|                                 | term |   |     |                  |
|                                 | ob   |   |     |                  |
|                                 | ject |   |     |                  |
|                                 | ives |   |     |                  |
|                                 | of   |   |     |                  |
|                                 | the  |   |     |                  |
|                                 | prog |   |     |                  |
|                                 | ram. |   |     |                  |
|                                 | Feed |   |     |                  |
|                                 | back |   |     |                  |
|                                 | from |   |     |                  |
|                                 | trai |   |     |                  |
|                                 | nees |   |     |                  |
|                                 | is   |   |     |                  |
|                                 | crit |   |     |                  |
|                                 | ical |   |     |                  |
|                                 | to   |   |     |                  |
|                                 | insu |   |     |                  |
|                                 | ring |   |     |                  |
|                                 | that |   |     |                  |
|                                 | trai |   |     |                  |
|                                 | ning |   |     |                  |
|                                 | a    |   |     |                  |
|                                 | ddre |   |     |                  |
|                                 | sses |   |     |                  |
|                                 | the  |   |     |                  |
|                                 | n    |   |     |                  |
|                                 | eeds |   |     |                  |
|                                 | of   |   |     |                  |
|                                 | fu   |   |     |                  |
|                                 | ture |   |     |                  |
|                                 | lea  |   |     |                  |
|                                 | ders |   |     |                  |
|                                 | in   |   |     |                  |
|                                 | the  |   |     |                  |
|                                 | fi   |   |     |                  |
|                                 | eld. |   |     |                  |
|                                 | The  |   |     |                  |
|                                 | inf  |   |     |                  |
|                                 | orma |   |     |                  |
|                                 | tion |   |     |                  |
|                                 | c    |   |     |                  |
|                                 | ould |   |     |                  |
|                                 | lead |   |     |                  |
|                                 | to   |   |     |                  |
|                                 | s    |   |     |                  |
|                                 | trat |   |     |                  |
|                                 | egic |   |     |                  |
|                                 | pro  |   |     |                  |
|                                 | gram |   |     |                  |
|                                 | impr |   |     |                  |
|                                 | ovem |   |     |                  |
|                                 | ents |   |     |                  |
|                                 | as   |   |     |                  |
|                                 | well |   |     |                  |
|                                 | as   |   |     |                  |
|                                 | incr |   |     |                  |
|                                 | ease |   |     |                  |
|                                 | the  |   |     |                  |
|                                 | re   |   |     |                  |
|                                 | spon |   |     |                  |
|                                 | sive |   |     |                  |
|                                 | ness |   |     |                  |
|                                 | of   |   |     |                  |
|                                 | i    |   |     |                  |
|                                 | nter |   |     |                  |
|                                 | disc |   |     |                  |
|                                 | ipli |   |     |                  |
|                                 | nary |   |     |                  |
|                                 | trai |   |     |                  |
|                                 | ning |   |     |                  |
|                                 | p    |   |     |                  |
|                                 | rogr |   |     |                  |
|                                 | ams. |   |     |                  |
|                                 | Ult  |   |     |                  |
|                                 | imat |   |     |                  |
|                                 | ely, |   |     |                  |
|                                 | the  |   |     |                  |
|                                 | li   |   |     |                  |
|                                 | keli |   |     |                  |
|                                 | hood |   |     |                  |
|                                 | that |   |     |                  |
|                                 | trai |   |     |                  |
|                                 | nees |   |     |                  |
|                                 | are  |   |     |                  |
|                                 | pr   |   |     |                  |
|                                 | acti |   |     |                  |
|                                 | cing |   |     |                  |
|                                 | in   |   |     |                  |
|                                 | an   |   |     |                  |
|                                 | i    |   |     |                  |
|                                 | nter |   |     |                  |
|                                 | disc |   |     |                  |
|                                 | ipli |   |     |                  |
|                                 | nary |   |     |                  |
|                                 | sy   |   |     |                  |
|                                 | stem |   |     |                  |
|                                 | co   |   |     |                  |
|                                 | nsis |   |     |                  |
|                                 | tent |   |     |                  |
|                                 | with |   |     |                  |
|                                 | the  |   |     |                  |
|                                 | pr   |   |     |                  |
|                                 | inci |   |     |                  |
|                                 | ples |   |     |                  |
|                                 | of   |   |     |                  |
|                                 | the  |   |     |                  |
|                                 | C    |   |     |                  |
|                                 | SHCN |   |     |                  |
|                                 | sy   |   |     |                  |
|                                 | stem |   |     |                  |
|                                 | sh   |   |     |                  |
|                                 | ould |   |     |                  |
|                                 | incr |   |     |                  |
|                                 | ease |   |     |                  |
|                                 | if   |   |     |                  |
|                                 | trai |   |     |                  |
|                                 | ning |   |     |                  |
|                                 | be   |   |     |                  |
|                                 | tter |   |     |                  |
|                                 | m    |   |     |                  |
|                                 | eets |   |     |                  |
|                                 | t    |   |     |                  |
|                                 | heir |   |     |                  |
|                                 | ne   |   |     |                  |
|                                 | eds. |   |     |                  |
|                                 |      |   |     |                  |
|                                 | Ch   |   |     |                  |
|                                 | alle |   |     |                  |
|                                 | nges |   |     |                  |
|                                 | inc  |   |     |                  |
|                                 | lude |   |     |                  |
|                                 | is   |   |     |                  |
|                                 | sues |   |     |                  |
|                                 | in   |   |     |                  |
|                                 | trac |   |     |                  |
|                                 | king |   |     |                  |
|                                 | g    |   |     |                  |
|                                 | radu |   |     |                  |
|                                 | ates |   |     |                  |
|                                 | in   |   |     |                  |
|                                 | the  |   |     |                  |
|                                 | fut  |   |     |                  |
|                                 | ure, |   |     |                  |
|                                 | o    |   |     |                  |
|                                 | btai |   |     |                  |
|                                 | ning |   |     |                  |
|                                 | a    |   |     |                  |
|                                 | high |   |     |                  |
|                                 | resp |   |     |                  |
|                                 | onse |   |     |                  |
|                                 | r    |   |     |                  |
|                                 | ate, |   |     |                  |
|                                 | and  |   |     |                  |
|                                 | i    |   |     |                  |
|                                 | ncor |   |     |                  |
|                                 | pora |   |     |                  |
|                                 | ting |   |     |                  |
|                                 | the  |   |     |                  |
|                                 | ev   |   |     |                  |
|                                 | alua |   |     |                  |
|                                 | tion |   |     |                  |
|                                 | in   |   |     |                  |
|                                 | me   |   |     |                  |
|                                 | anin |   |     |                  |
|                                 | gful |   |     |                  |
|                                 | pro  |   |     |                  |
|                                 | gram |   |     |                  |
|                                 | deci |   |     |                  |
|                                 | sion |   |     |                  |
|                                 | -mak |   |     |                  |
|                                 | ing. |   |     |                  |
+---------------------------------+------+---+-----+------------------+

+---------------------------------+--------+---------------------------+
| PROGRAM PERFORMANCE MEASURE 62  | The    |                           |
|                                 | number |                           |
|                                 | of     |                           |
|                                 | pr     |                           |
|                                 | oducts |                           |
|                                 | and    |                           |
|                                 | public |                           |
|                                 | ations |                           |
|                                 | that   |                           |
|                                 | were   |                           |
|                                 | pr     |                           |
|                                 | oduced |                           |
|                                 | by a   |                           |
|                                 | tr     |                           |
|                                 | aining |                           |
|                                 | pro    |                           |
|                                 | gram's |                           |
|                                 | f      |                           |
|                                 | aculty |                           |
|                                 | and    |                           |
|                                 | tr     |                           |
|                                 | ainees |                           |
|                                 | each   |                           |
|                                 | year.  |                           |
+---------------------------------+--------+---------------------------+
| **GOAL**                        | To     |                           |
|                                 | i      |                           |
|                                 | mprove |                           |
|                                 | the    |                           |
|                                 | d      |                           |
|                                 | issemi |                           |
|                                 | nation |                           |
|                                 | of new |                           |
|                                 | kno    |                           |
|                                 | wledge |                           |
|                                 | to the |                           |
|                                 | MCH    |                           |
|                                 | field  |                           |
|                                 | by     |                           |
|                                 | incr   |                           |
|                                 | easing |                           |
|                                 | the    |                           |
|                                 | number |                           |
|                                 | of     |                           |
|                                 | p      |                           |
|                                 | ublica |                           |
|                                 | tions, |                           |
|                                 | inc    |                           |
|                                 | luding |                           |
|                                 | art    |                           |
|                                 | icles, |                           |
|                                 | cha    |                           |
|                                 | pters, |                           |
|                                 | books  |                           |
|                                 | and    |                           |
|                                 | other  |                           |
|                                 | mat    |                           |
|                                 | erials |                           |
|                                 | pr     |                           |
|                                 | oduced |                           |
|                                 | by     |                           |
|                                 | tr     |                           |
|                                 | aining |                           |
|                                 | staff  |                           |
|                                 | (with  |                           |
|                                 | em     |                           |
|                                 | phasis |                           |
|                                 | on     |                           |
|                                 | those  |                           |
|                                 | that   |                           |
|                                 | add    |                           |
|                                 | ressed |                           |
|                                 | the    |                           |
|                                 | tr     |                           |
|                                 | aining |                           |
|                                 | pro    |                           |
|                                 | gram's |                           |
|                                 | str    |                           |
|                                 | ategic |                           |
|                                 | plan   |                           |
|                                 | goals) |                           |
|                                 | and    |                           |
|                                 | tra    |                           |
|                                 | inees. |                           |
|                                 | This   |                           |
|                                 | does   |                           |
|                                 | not    |                           |
|                                 | i      |                           |
|                                 | nclude |                           |
|                                 | pamp   |                           |
|                                 | hlets, |                           |
|                                 | han    |                           |
|                                 | douts, |                           |
|                                 | indi   |                           |
|                                 | vidual |                           |
|                                 | web    |                           |
|                                 | pages, |                           |
|                                 | or     |                           |
|                                 | confer |                           |
|                                 | ences. |                           |
+---------------------------------+--------+---------------------------+
| **MEASURE**                     | The    |                           |
|                                 | number |                           |
|                                 | of     |                           |
|                                 | pr     |                           |
|                                 | oducts |                           |
|                                 | and    |                           |
|                                 | public |                           |
|                                 | ations |                           |
|                                 | that   |                           |
|                                 | were   |                           |
|                                 | pr     |                           |
|                                 | oduced |                           |
|                                 | by a   |                           |
|                                 | tr     |                           |
|                                 | aining |                           |
|                                 | pro    |                           |
|                                 | gram's |                           |
|                                 | f      |                           |
|                                 | aculty |                           |
|                                 | and    |                           |
|                                 | tr     |                           |
|                                 | ainees |                           |
|                                 | each   |                           |
|                                 | year.  |                           |
+---------------------------------+--------+---------------------------+
| **DEFINITION**                  | Public |                           |
|                                 | ations |                           |
|                                 | are    |                           |
|                                 | art    |                           |
|                                 | icles, |                           |
|                                 | books  |                           |
|                                 | or     |                           |
|                                 | ch     |                           |
|                                 | apters |                           |
|                                 | pub    |                           |
|                                 | lished |                           |
|                                 | during |                           |
|                                 | the    |                           |
|                                 | year   |                           |
|                                 | being  |                           |
|                                 | rep    |                           |
|                                 | orted, |                           |
|                                 | espe   |                           |
|                                 | cially |                           |
|                                 | public |                           |
|                                 | ations |                           |
|                                 | that   |                           |
|                                 | are    |                           |
|                                 | peer   |                           |
|                                 | rev    |                           |
|                                 | iewed. |                           |
|                                 | Pr     |                           |
|                                 | oducts |                           |
|                                 | i      |                           |
|                                 | nclude |                           |
|                                 | video  |                           |
|                                 | tr     |                           |
|                                 | aining |                           |
|                                 | tapes, |                           |
|                                 | CD     |                           |
|                                 | roms,  |                           |
|                                 | curr   |                           |
|                                 | iculum |                           |
|                                 | m      |                           |
|                                 | odules |                           |
|                                 | for    |                           |
|                                 | tr     |                           |
|                                 | aining |                           |
|                                 | pur    |                           |
|                                 | poses, |                           |
|                                 | mat    |                           |
|                                 | erials |                           |
|                                 | c      |                           |
|                                 | reated |                           |
|                                 | for    |                           |
|                                 | con    |                           |
|                                 | sumers |                           |
|                                 | (pa    |                           |
|                                 | rents/ |                           |
|                                 | childr |                           |
|                                 | en/com |                           |
|                                 | munity |                           |
|                                 | agen   |                           |
|                                 | cies), |                           |
|                                 | dev    |                           |
|                                 | eloped |                           |
|                                 | by the |                           |
|                                 | tr     |                           |
|                                 | aining |                           |
|                                 | pro    |                           |
|                                 | gram's |                           |
|                                 | fa     |                           |
|                                 | culty. |                           |
|                                 |        |                           |
|                                 | D      |                           |
|                                 | etails |                           |
|                                 | on     |                           |
|                                 | these  |                           |
|                                 | public |                           |
|                                 | ations |                           |
|                                 | and    |                           |
|                                 | pr     |                           |
|                                 | oducts |                           |
|                                 | are    |                           |
|                                 | re     |                           |
|                                 | ported |                           |
|                                 | on a   |                           |
|                                 | data   |                           |
|                                 | coll   |                           |
|                                 | ection |                           |
|                                 | form.  |                           |
|                                 | These  |                           |
|                                 | pr     |                           |
|                                 | oducts |                           |
|                                 | are    |                           |
|                                 | summed |                           |
|                                 | by     |                           |
|                                 | ca     |                           |
|                                 | tegory |                           |
|                                 | and    |                           |
|                                 | the    |                           |
|                                 | total  |                           |
|                                 | number |                           |
|                                 | of all |                           |
|                                 | public |                           |
|                                 | ations |                           |
|                                 | and    |                           |
|                                 | pr     |                           |
|                                 | oducts |                           |
|                                 | are    |                           |
|                                 | re     |                           |
|                                 | ported |                           |
|                                 | on a   |                           |
|                                 | perfo  |                           |
|                                 | rmance |                           |
|                                 | m      |                           |
|                                 | easure |                           |
|                                 | tr     |                           |
|                                 | acking |                           |
|                                 | form   |                           |
|                                 | for a  |                           |
|                                 | rep    |                           |
|                                 | orting |                           |
|                                 | year.  |                           |
|                                 |        |                           |
|                                 | The    |                           |
|                                 | tr     |                           |
|                                 | aining |                           |
|                                 | pro    |                           |
|                                 | gram's |                           |
|                                 | f      |                           |
|                                 | aculty |                           |
|                                 | is     |                           |
|                                 | d      |                           |
|                                 | efined |                           |
|                                 | as any |                           |
|                                 | indiv  |                           |
|                                 | iduals |                           |
|                                 | who    |                           |
|                                 | r      |                           |
|                                 | eceive |                           |
|                                 | MCHB   |                           |
|                                 | tr     |                           |
|                                 | aining |                           |
|                                 | grant  |                           |
|                                 | f      |                           |
|                                 | unding |                           |
|                                 | or are |                           |
|                                 | listed |                           |
|                                 | as a   |                           |
|                                 | f      |                           |
|                                 | aculty |                           |
|                                 | m      |                           |
|                                 | embers |                           |
|                                 | in a   |                           |
|                                 | MCHB   |                           |
|                                 | tr     |                           |
|                                 | aining |                           |
|                                 | grant  |                           |
|                                 | (not   |                           |
|                                 | only   |                           |
|                                 | those  |                           |
|                                 | di     |                           |
|                                 | rectly |                           |
|                                 | sup    |                           |
|                                 | ported |                           |
|                                 | by     |                           |
|                                 | grant  |                           |
|                                 | dol    |                           |
|                                 | lars). |                           |
+---------------------------------+--------+---------------------------+
|                                 | **     | **Text:** This will be a  |
|                                 | Units: | numerical count of        |
|                                 | \# 1** | publications and products |
+---------------------------------+--------+---------------------------+
| **HEALTHY PEOPLE 2010           | R      |                           |
| OBJECTIVE**                     | elated |                           |
|                                 | to     |                           |
|                                 | Goal   |                           |
|                                 | 1:     |                           |
|                                 | I      |                           |
|                                 | mprove |                           |
|                                 | access |                           |
|                                 | to     |                           |
|                                 | co     |                           |
|                                 | mprehe |                           |
|                                 | nsive, |                           |
|                                 | high-q |                           |
|                                 | uality |                           |
|                                 | health |                           |
|                                 | care   |                           |
|                                 | se     |                           |
|                                 | rvices |                           |
|                                 | (Obje  |                           |
|                                 | ctives |                           |
|                                 | 1.1-   |                           |
|                                 | 1.16). |                           |
|                                 |        |                           |
|                                 | R      |                           |
|                                 | elated |                           |
|                                 | to     |                           |
|                                 | Goal 7 |                           |
|                                 | --     |                           |
|                                 | Educa  |                           |
|                                 | tional |                           |
|                                 | and    |                           |
|                                 | com    |                           |
|                                 | munity |                           |
|                                 | -based |                           |
|                                 | pro    |                           |
|                                 | grams: |                           |
|                                 | In     |                           |
|                                 | crease |                           |
|                                 | the    |                           |
|                                 | qu     |                           |
|                                 | ality, |                           |
|                                 | availa |                           |
|                                 | bility |                           |
|                                 | and    |                           |
|                                 | e      |                           |
|                                 | ffecti |                           |
|                                 | veness |                           |
|                                 | of     |                           |
|                                 | educa  |                           |
|                                 | tional |                           |
|                                 | and    |                           |
|                                 | com    |                           |
|                                 | munity |                           |
|                                 | -based |                           |
|                                 | pr     |                           |
|                                 | ograms |                           |
|                                 | de     |                           |
|                                 | signed |                           |
|                                 | to     |                           |
|                                 | p      |                           |
|                                 | revent |                           |
|                                 | d      |                           |
|                                 | isease |                           |
|                                 | and    |                           |
|                                 | i      |                           |
|                                 | mprove |                           |
|                                 | health |                           |
|                                 | and    |                           |
|                                 | q      |                           |
|                                 | uality |                           |
|                                 | of     |                           |
|                                 | life.  |                           |
|                                 | Sp     |                           |
|                                 | ecific |                           |
|                                 | objec  |                           |
|                                 | tives: |                           |
|                                 | 7-7    |                           |
|                                 | t      |                           |
|                                 | hrough |                           |
|                                 | 7-11.  |                           |
|                                 |        |                           |
|                                 | R      |                           |
|                                 | elated |                           |
|                                 | to     |                           |
|                                 | Goal   |                           |
|                                 | 23 --  |                           |
|                                 | Public |                           |
|                                 | Health |                           |
|                                 | Inf    |                           |
|                                 | rastru |                           |
|                                 | cture: |                           |
|                                 | Ensure |                           |
|                                 | that   |                           |
|                                 | Fe     |                           |
|                                 | deral, |                           |
|                                 | T      |                           |
|                                 | ribal, |                           |
|                                 | State, |                           |
|                                 | and    |                           |
|                                 | local  |                           |
|                                 | health |                           |
|                                 | ag     |                           |
|                                 | encies |                           |
|                                 | have   |                           |
|                                 | the    |                           |
|                                 | in     |                           |
|                                 | frastr |                           |
|                                 | ucture |                           |
|                                 | to     |                           |
|                                 | p      |                           |
|                                 | rovide |                           |
|                                 | ess    |                           |
|                                 | ential |                           |
|                                 | public |                           |
|                                 | health |                           |
|                                 | se     |                           |
|                                 | rvices |                           |
|                                 | effect |                           |
|                                 | ively. |                           |
|                                 | Sp     |                           |
|                                 | ecific |                           |
|                                 | objec  |                           |
|                                 | tives: |                           |
|                                 | 23-8   |                           |
|                                 | t      |                           |
|                                 | hrough |                           |
|                                 | 23-10  |                           |
+---------------------------------+--------+---------------------------+
| **DATA SOURCE(S) AND ISSUES**   | Data   |                           |
|                                 | will   |                           |
|                                 | be     |                           |
|                                 | col    |                           |
|                                 | lected |                           |
|                                 | by the |                           |
|                                 | tr     |                           |
|                                 | aining |                           |
|                                 | pr     |                           |
|                                 | ograms |                           |
|                                 | thro   |                           |
|                                 | ughout |                           |
|                                 | the    |                           |
|                                 | year   |                           |
|                                 | and    |                           |
|                                 | re     |                           |
|                                 | ported |                           |
|                                 | in     |                           |
|                                 | their  |                           |
|                                 | annual |                           |
|                                 | r      |                           |
|                                 | eports |                           |
|                                 | and    |                           |
|                                 | via    |                           |
|                                 | this   |                           |
|                                 | mea    |                           |
|                                 | sure's |                           |
|                                 | data   |                           |
|                                 | coll   |                           |
|                                 | ection |                           |
|                                 | form.  |                           |
+---------------------------------+--------+---------------------------+
| **SIGNIFICANCE**                | Adv    |                           |
|                                 | ancing |                           |
|                                 | the    |                           |
|                                 | field  |                           |
|                                 | of     |                           |
|                                 | ma     |                           |
|                                 | ternal |                           |
|                                 | and    |                           |
|                                 | child  |                           |
|                                 | health |                           |
|                                 | based  |                           |
|                                 | on     |                           |
|                                 | scie   |                           |
|                                 | ntific |                           |
|                                 | advan  |                           |
|                                 | cement |                           |
|                                 | and    |                           |
|                                 | d      |                           |
|                                 | issemi |                           |
|                                 | nation |                           |
|                                 | of     |                           |
|                                 | these  |                           |
|                                 | advanc |                           |
|                                 | ements |                           |
|                                 | is an  |                           |
|                                 | imp    |                           |
|                                 | ortant |                           |
|                                 | role   |                           |
|                                 | for    |                           |
|                                 | lead   |                           |
|                                 | ership |                           |
|                                 | tr     |                           |
|                                 | aining |                           |
|                                 | pro    |                           |
|                                 | grams. |                           |
|                                 | Coll   |                           |
|                                 | ection |                           |
|                                 | of the |                           |
|                                 | types  |                           |
|                                 | of and |                           |
|                                 | d      |                           |
|                                 | issemi |                           |
|                                 | nation |                           |
|                                 | of MCH |                           |
|                                 | pr     |                           |
|                                 | oducts |                           |
|                                 | and    |                           |
|                                 | public |                           |
|                                 | ations |                           |
|                                 | is     |                           |
|                                 | c      |                           |
|                                 | rucial |                           |
|                                 | for    |                           |
|                                 | adv    |                           |
|                                 | ancing |                           |
|                                 | the    |                           |
|                                 | field. |                           |
|                                 | This   |                           |
|                                 | perfo  |                           |
|                                 | rmance |                           |
|                                 | m      |                           |
|                                 | easure |                           |
|                                 | add    |                           |
|                                 | resses |                           |
|                                 | the    |                           |
|                                 | obj    |                           |
|                                 | ective |                           |
|                                 | of     |                           |
|                                 | MCHB   |                           |
|                                 | to     |                           |
|                                 | disse  |                           |
|                                 | minate |                           |
|                                 | new    |                           |
|                                 | kno    |                           |
|                                 | wledge |                           |
|                                 | of     |                           |
|                                 | signif |                           |
|                                 | icance |                           |
|                                 | to the |                           |
|                                 | field  |                           |
|                                 | and    |                           |
|                                 | gauges |                           |
|                                 | the    |                           |
|                                 | s      |                           |
|                                 | uccess |                           |
|                                 | of     |                           |
|                                 | d      |                           |
|                                 | issemi |                           |
|                                 | nation |                           |
|                                 | to     |                           |
|                                 | target |                           |
|                                 | audi   |                           |
|                                 | ences. |                           |
+---------------------------------+--------+---------------------------+

**DATA COLLECTION FORM FOR DETAIL SHEET PM #62**

Please list the number of publications and products addressing maternal
and child health that have been published or produced by your training
program's faculty and trainees in the past year:

  --------------------------------------------------------- -------------
  Element                                                   Number

  Peer-reviewed publications in scholarly journals          

  Non peer-reviewed publications                            

  Books                                                     

  Book chapters                                             

  Reports/monographs                                        

  Electronic educational products (CD-ROM, audio or         
  videotapes, or Web-based) (not individual web pages)      

  Course development                                        

  Distance learning modules or materials                    

  Doctoral dissertations                                    

  **Total**                                                 
  --------------------------------------------------------- -------------

###### DATA COLLECTION FORM FOR DETAIL SHEET FOR PM #62

**Publications and Products Authored by MCHB Training Award Faculty or
Trainees**

**Data collection form for [Peer-reviewed publications in scholarly
journals]{.underline}**

TITLE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

AUTHOR:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

PUBLICATION:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Volume: \_\_\_\_\_ Number:\_\_\_\_\_\_\_\_\_ Supplement:\_\_\_\_\_\_\_
Year:\_\_\_\_\_\_\_ Page(s):\_\_\_\_\_\_\_

Target Audience: Consumers \_\_\_\_\_ Professionals \_\_\_\_\_\_\_

Circulation: \_\_\_\_\_\_\_\_\_\_

**Data collection form for [Non peer-reviewed
publications]{.underline}**

TITLE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

AUTHOR:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

PUBLICATION:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Volume: \_\_\_\_\_\_\_ Number: \_\_\_\_\_\_\_\_\_
Supplement:\_\_\_\_\_\_\_ Year:\_\_\_\_\_\_\_ Page(s):\_\_\_\_\_\_\_

Target Audience: Consumers \_\_\_\_\_ Professionals \_\_\_\_\_\_\_

Circulation: \_\_\_\_\_\_

To obtain copies (if not commercially available):

Contact Name: \_\_\_\_\_\_\_\_\_\_\_\_\_\_ Address1 :
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address2: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ City: \_\_\_\_\_\_\_\_\_\_\_
State: \_\_\_\_\_\_\_\_\_\_\_\_ Zip:\_\_\_\_\_\_\_\_\_\_

Telephone number: \_\_\_\_\_\_\_\_\_ URL: \_\_\_\_\_\_\_\_\_\_\_\_

**Data collection form for [Books]{.underline}**

TITLE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

AUTHOR:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Publisher \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Location \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Year
\_\_\_\_\_\_\_

Target Audience: Consumers \_\_\_\_\_ Professionals \_\_\_\_\_\_\_

Number Printed: \_\_\_\_\_\_

Number Sold: \_\_\_\_\_\_\_\_\_

**Data collection form for [Book Chapters]{.underline}**

TITLE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

AUTHOR:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

CHAPTER:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Publisher \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Location \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Year
\_\_\_\_\_\_\_

Target Audience: Consumers \_\_\_\_\_ Professionals \_\_\_\_\_\_\_

Number Printed: \_\_\_\_\_\_

Number Sold: \_\_\_\_\_\_\_\_\_

**Data collection form for [Reports/monographs]{.underline}**

TITLE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

AUTHOR:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Year: \_\_\_\_\_\_\_\_\_

Target Audience: Consumers \_\_\_\_\_ Professionals \_\_\_\_\_\_\_

Number of copies: \_\_\_\_\_\_\_

To obtain copies: Contact Name: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Address1
: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address2: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ City: \_\_\_\_\_\_\_\_\_\_
State: \_\_\_\_\_\_\_\_\_\_\_\_ Zip:\_\_\_\_\_\_\_\_\_\_

Telephone number: \_\_\_\_\_\_\_\_\_\_ URL: \_\_\_\_\_\_\_\_\_\_\_\_

**Data collection form for [Electronic education products]{.underline}**

TITLE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

AUTHOR:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Year: \_\_\_\_\_\_\_\_\_\_

Target Audience: Consumers \_\_\_\_\_ Professionals \_\_\_\_\_\_\_

Number of copies made: \_\_\_\_\_\_\_

To obtain copies: Contact Name: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Address1
: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address2: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ City: \_\_\_\_\_\_\_\_\_\_
State: \_\_\_\_\_\_\_\_\_\_\_\_ Zip:\_\_\_\_\_\_\_\_\_\_

Telephone number: \_\_\_\_\_\_\_\_\_\_ URL: \_\_\_\_\_\_\_\_\_\_\_\_

**Data collection form for [Course Development]{.underline}**

TITLE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

AUTHOR:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Year: \_\_\_\_\_\_\_\_\_\_

Target Audience: Consumers \_\_\_\_\_ Professionals \_\_\_\_\_\_\_

Number of students: \_\_\_\_\_\_\_\_\_

To obtain copies: Contact Name: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Address1
: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address2: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ City: \_\_\_\_\_\_\_\_\_\_
State: \_\_\_\_\_\_\_\_\_\_\_\_ Zip:\_\_\_\_\_\_\_\_\_\_

Telephone number: \_\_\_\_\_\_\_\_\_\_ URL: \_\_\_\_\_\_\_\_\_\_\_\_

# Data collection form for Distance learning modules or materials

TITLE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

AUTHOR:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Year: \_\_\_\_\_\_\_\_\_\_

Target Audience: Consumers \_\_\_\_\_ Professionals \_\_\_\_\_\_\_

Number of students: \_\_\_\_\_\_\_\_\_

To obtain copies: Contact Name: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Address1
: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address2: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ City: \_\_\_\_\_\_\_\_\_\_
State: \_\_\_\_\_\_\_\_\_\_\_\_ Zip:\_\_\_\_\_\_\_\_\_\_

Telephone number: \_\_\_\_\_\_\_\_\_\_ URL: \_\_\_\_\_\_\_\_\_\_\_\_

**Data collection form for [Doctoral dissertation]{.underline}**

TITLE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

AUTHOR:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Year: \_\_\_\_\_\_\_\_\_\_

Number of copies made: \_\_\_\_\_\_\_

To obtain copies: Contact Name: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Address1
: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address2: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ City: \_\_\_\_\_\_\_\_\_\_
State: \_\_\_\_\_\_\_\_\_\_\_\_ Zip:\_\_\_\_\_\_\_\_\_\_

Telephone number: \_\_\_\_\_\_\_\_\_\_ URL: \_\_\_\_\_\_\_\_\_\_\_\_

+---------------------------------+------------------------------------+
| PROGRAM PERFORMANCE MEASURE 63  | The degree to which LEND programs  |
|                                 | incorporate medical home concepts  |
|                                 | into their curricula/training.     |
+---------------------------------+------------------------------------+
| **GOAL**                        | To increase the number of LEND     |
|                                 | programs that incorporate medical  |
|                                 | home concepts into their           |
|                                 | interdisciplinary training         |
|                                 | programs.                          |
+---------------------------------+------------------------------------+
| **MEASURE**                     | The degree to which LEND programs  |
|                                 | incorporate medical home concepts  |
|                                 | into their curricula/training.     |
+---------------------------------+------------------------------------+
| **DEFINITION**                  | A medical home is defined by the   |
|                                 | AAP as an approach to care that is |
|                                 | "accessible, family-centered,      |
|                                 | continuous, comprehensive,         |
|                                 | coordinated, compassionate and     |
|                                 | culturally competent. This is the  |
|                                 | definition that the MCHB uses.     |
|                                 |                                    |
|                                 | Attached is a checklist of 6       |
|                                 | elements that are part of the      |
|                                 | medical home concept. Please check |
|                                 | the degree to which the elements   |
|                                 | have been incorporated by on a     |
|                                 | scale of 0-4. Please keep the      |
|                                 | completed checklist attached.      |
|                                 |                                    |
|                                 | \[Note: A baseline will be         |
|                                 | established and incremental goals  |
|                                 | set for the future.\]              |
+---------------------------------+------------------------------------+
| **HEALTHY PEOPLE 2010           | Related to 16.22 (developmental):  |
| OBJECTIVE**                     | Increase the proportion of CSHCN   |
|                                 | who have access to a medical home. |
+---------------------------------+------------------------------------+
| **DATA SOURCE(S) AND ISSUES**   | Data is collected via the data     |
|                                 | collection form that measures what |
|                                 | elements of a medical home have    |
|                                 | been incorporated into its         |
|                                 | training program curricula.        |
+---------------------------------+------------------------------------+
| **SIGNIFICANCE**                | Providing primary care to children |
|                                 | in a "medical home" is the         |
|                                 | standard of practice. Research     |
|                                 | indicates that children with a     |
|                                 | stable and continuous source of    |
|                                 | health care are more likely to     |
|                                 | receive appropriate preventative   |
|                                 | care and immunizations, are less   |
|                                 | likely to be hospitalized for      |
|                                 | preventable conditions, and are    |
|                                 | more likely to be diagnosed early  |
|                                 | for chronic or disabling           |
|                                 | conditions. The inclusion of       |
|                                 | medical home concepts in           |
|                                 | interdisciplinary training will    |
|                                 | ensure that professionals serving  |
|                                 | children with special health care  |
|                                 | needs and their families provide   |
|                                 | the best type of care possible and |
|                                 | involve the individual and/or his  |
|                                 | or her family in decision-making   |
|                                 | and care.                          |
+---------------------------------+------------------------------------+

DATA COLLECTION FORM FOR DETAIL SHEET PM #63

Using the following scale of 0-4, please rate your training program's
attention to medical home concepts in the six elements noted.

> 0=Not Taught
>
> 1=Taught at an awareness level---concept is presented
>
> 2=Taught at a knowledge level---reading, discussion and assignments on
> the concept
>
> 3=Taught at the skill level---students observe aspects of and get a
> chance to practice elements of a medical home
>
> 4=Concept woven throughout training program: information, knowledge
> and practice

+-------------------------------------+-----+-----+------+------+-----+
| **Element**                         | **  | **  | *    | *    | **  |
|                                     | 0** | 1** | *2** | *3** | 4** |
+-------------------------------------+-----+-----+------+------+-----+
| 1.  The importance of providing     |     |     |      |      |     |
|     accessible care is incorporated |     |     |      |      |     |
|     into your curricula and         |     |     |      |      |     |
|     clinical training experiences.  |     |     |      |      |     |
+-------------------------------------+-----+-----+------+------+-----+
| 2.  Family-centered care is         |     |     |      |      |     |
|     included in your curricula and  |     |     |      |      |     |
|     clinical training experiences   |     |     |      |      |     |
|     and trainees are taught to      |     |     |      |      |     |
|     include families in health care |     |     |      |      |     |
|     decisions.                      |     |     |      |      |     |
+-------------------------------------+-----+-----+------+------+-----+
| 3.  The importance of providing     |     |     |      |      |     |
|     continuous, comprehensive care  |     |     |      |      |     |
|     and the skills to do so are     |     |     |      |      |     |
|     incorporated in your curricula  |     |     |      |      |     |
|     and clinical training           |     |     |      |      |     |
|     experiences.                    |     |     |      |      |     |
+-------------------------------------+-----+-----+------+------+-----+
| 4.  Trainees are taught and         |     |     |      |      |     |
|     encouraged to provide           |     |     |      |      |     |
|     coordinated care across a range |     |     |      |      |     |
|     of disciplines.                 |     |     |      |      |     |
+-------------------------------------+-----+-----+------+------+-----+
| 5.  Cultural and linguistic         |     |     |      |      |     |
|     competence is a regular part of |     |     |      |      |     |
|     the training experience.        |     |     |      |      |     |
+-------------------------------------+-----+-----+------+------+-----+
| 6.  Faculty/staff who have          |     |     |      |      |     |
|     expertise in providing a        |     |     |      |      |     |
|     medical home are readily        |     |     |      |      |     |
|     accessible to your program      |     |     |      |      |     |
+-------------------------------------+-----+-----+------+------+-----+

Total Score (possible 0‑24) \_\_\_\_\_\_\_

+---------------------------------+------------------------------------+
| PROGRAM PERFORMANCE MEASURE 64  | The degree to which the LEAH       |
|                                 | program incorporates adolescents   |
|                                 | and parents from diverse ethnic    |
|                                 | and cultural backgrounds as        |
|                                 | advisors and participants in       |
|                                 | program activities.                |
+---------------------------------+------------------------------------+
| **GOAL**                        | To increase appropriate            |
|                                 | involvement of adolescents and     |
|                                 | parents as consumers of LEAH       |
|                                 | program activities.                |
+---------------------------------+------------------------------------+
| **MEASURE**                     | The degree to which adolescents    |
|                                 | and parents are incorporated as    |
|                                 | consumers of LEAH program          |
|                                 | activities.                        |
+---------------------------------+------------------------------------+
| **DEFINITION**                  | Attached is a checklist of 4       |
|                                 | elements that document adolescent  |
|                                 | and parent participation.          |
|                                 | Respondents will note the presence |
|                                 | or absence of this participation   |
|                                 | on a scale of 0-1 for a total      |
|                                 | possible score of 4.               |
+---------------------------------+------------------------------------+
| **HEALTHY PEOPLE 2010           | 11-3. (Developmental) Increase the |
| OBJECTIVE**                     | proportion of health communication |
|                                 | activities that include research   |
|                                 | and evaluation                     |
|                                 |                                    |
|                                 | 11.6 (Developmental) Increase the  |
|                                 | proportion of persons who report   |
|                                 | that their health care providers   |
|                                 | have satisfactory communication    |
|                                 | skills.                            |
+---------------------------------+------------------------------------+
| **DATA SOURCE(S) AND ISSUES**   | Grantees report using a data       |
|                                 | collection form. These data may be |
|                                 | collected with the LEAH            |
|                                 | self-assessment activities.        |
|                                 | Participation should be defined to |
|                                 | permit assessment of youth and     |
|                                 | young adult involvement.           |
+---------------------------------+------------------------------------+
| **SIGNIFICANCE**                | Over the last decade, policy       |
|                                 | makers and program administrators  |
|                                 | have emphasized the central role   |
|                                 | of consumer of health services as  |
|                                 | advisors and participants in       |
|                                 | program activities. Satisfaction   |
|                                 | with health care is related to     |
|                                 | satisfaction with the quality of   |
|                                 | the communication with health      |
|                                 | providers. In accordance with this |
|                                 | philosophy, LEAH facilitates such  |
|                                 | partnerships and believes that     |
|                                 | consumers (adolescents and         |
|                                 | parents) from diverse backgrounds  |
|                                 | have important roles in the        |
|                                 | training of future leaders in      |
|                                 | adolescent health care delivery    |
|                                 | systems.                           |
+---------------------------------+------------------------------------+

**DATA COLLECTION FORM FOR DETAIL SHEET PM #64**

Indicate the degree to which your training program has the active
involvement of adolescents and parents in your program and planning
activities using the following values:

> 0 = The training program [does not]{.underline} have active
> involvement of adolescents and parents in your program and planning
> activities.
>
> 1 = The training program [does]{.underline} have active involvement of
> adolescents and parents in your program and planning activities.

If your program does collaborate, provide the total number of activities
for the element.

+--------------------------------------------------------+------+-----+
| **Element**                                            | *    | **  |
|                                                        | *0** | 1** |
+--------------------------------------------------------+------+-----+
| 1.  Adolescents from diverse ethnic backgrounds and    |      |     |
|     cultures participate in an advisory capacity.      |      |     |
+--------------------------------------------------------+------+-----+
| 2.  Parents of adolescents from diverse ethnic         |      |     |
|     backgrounds and cultures participate in an         |      |     |
|     advisory capacity.                                 |      |     |
+--------------------------------------------------------+------+-----+
| 3.  Adolescents from diverse ethnic backgrounds and    |      |     |
|     cultures participate in the planning,              |      |     |
|     implementation and evaluation of program           |      |     |
|     activities related to adolescents as consumers     |      |     |
+--------------------------------------------------------+------+-----+
| 4.  Parents of adolescents from diverse ethnic         |      |     |
|     backgrounds and cultures participate in the        |      |     |
|     planning, implementation and evaluation of program |      |     |
|     activities related to parents as consumers         |      |     |
+--------------------------------------------------------+------+-----+

**Total Score (possible 0‑4 score**) \_\_\_\_\_\_\_\_

+---------------------------------+--------+---+----+------+------------+
| PROGRAM PERFORMANCE MEASURE 65  | The    |   |    |      |            |
|                                 | p      |   |    |      |            |
|                                 | ercent |   |    |      |            |
|                                 | of     |   |    |      |            |
|                                 | indiv  |   |    |      |            |
|                                 | iduals |   |    |      |            |
|                                 | who    |   |    |      |            |
|                                 | partic |   |    |      |            |
|                                 | ipated |   |    |      |            |
|                                 | in     |   |    |      |            |
|                                 | lon    |   |    |      |            |
|                                 | g-term |   |    |      |            |
|                                 | nut    |   |    |      |            |
|                                 | rition |   |    |      |            |
|                                 | tr     |   |    |      |            |
|                                 | aining |   |    |      |            |
|                                 | that   |   |    |      |            |
|                                 | are    |   |    |      |            |
|                                 | prac   |   |    |      |            |
|                                 | ticing |   |    |      |            |
|                                 | in a   |   |    |      |            |
|                                 | Ma     |   |    |      |            |
|                                 | ternal |   |    |      |            |
|                                 | and    |   |    |      |            |
|                                 | Child  |   |    |      |            |
|                                 | Health |   |    |      |            |
|                                 | (MCH)  |   |    |      |            |
|                                 | r      |   |    |      |            |
|                                 | elated |   |    |      |            |
|                                 | field  |   |    |      |            |
|                                 | within |   |    |      |            |
|                                 | 5      |   |    |      |            |
|                                 | years  |   |    |      |            |
|                                 | after  |   |    |      |            |
|                                 | rec    |   |    |      |            |
|                                 | eiving |   |    |      |            |
|                                 | tra    |   |    |      |            |
|                                 | ining. |   |    |      |            |
+---------------------------------+--------+---+----+------+------------+
| ## GOAL                         | To     |   |    |      |            |
|                                 | in     |   |    |      |            |
|                                 | crease |   |    |      |            |
|                                 | the    |   |    |      |            |
|                                 | number |   |    |      |            |
|                                 | of     |   |    |      |            |
|                                 | indiv  |   |    |      |            |
|                                 | iduals |   |    |      |            |
|                                 | who    |   |    |      |            |
|                                 | partic |   |    |      |            |
|                                 | ipated |   |    |      |            |
|                                 | in     |   |    |      |            |
|                                 | lon    |   |    |      |            |
|                                 | g-term |   |    |      |            |
|                                 | nut    |   |    |      |            |
|                                 | rition |   |    |      |            |
|                                 | tr     |   |    |      |            |
|                                 | aining |   |    |      |            |
|                                 | that   |   |    |      |            |
|                                 | pr     |   |    |      |            |
|                                 | actice |   |    |      |            |
|                                 | in the |   |    |      |            |
|                                 | MCH    |   |    |      |            |
|                                 | field. |   |    |      |            |
+---------------------------------+--------+---+----+------+------------+
| **MEASURE**                     | The    |   |    |      |            |
|                                 | p      |   |    |      |            |
|                                 | ercent |   |    |      |            |
|                                 | of     |   |    |      |            |
|                                 | indiv  |   |    |      |            |
|                                 | iduals |   |    |      |            |
|                                 | who    |   |    |      |            |
|                                 | partic |   |    |      |            |
|                                 | ipated |   |    |      |            |
|                                 | in     |   |    |      |            |
|                                 | lon    |   |    |      |            |
|                                 | g-term |   |    |      |            |
|                                 | nut    |   |    |      |            |
|                                 | rition |   |    |      |            |
|                                 | tr     |   |    |      |            |
|                                 | aining |   |    |      |            |
|                                 | that   |   |    |      |            |
|                                 | are    |   |    |      |            |
|                                 | prac   |   |    |      |            |
|                                 | ticing |   |    |      |            |
|                                 | in a   |   |    |      |            |
|                                 | Ma     |   |    |      |            |
|                                 | ternal |   |    |      |            |
|                                 | and    |   |    |      |            |
|                                 | Child  |   |    |      |            |
|                                 | Health |   |    |      |            |
|                                 | (MCH)  |   |    |      |            |
|                                 | r      |   |    |      |            |
|                                 | elated |   |    |      |            |
|                                 | field  |   |    |      |            |
|                                 | within |   |    |      |            |
|                                 | 5      |   |    |      |            |
|                                 | years  |   |    |      |            |
|                                 | after  |   |    |      |            |
|                                 | rec    |   |    |      |            |
|                                 | eiving |   |    |      |            |
|                                 | tra    |   |    |      |            |
|                                 | ining. |   |    |      |            |
+---------------------------------+--------+---+----+------+------------+
| **DEFINITION**                  | **     |   | T  |      |            |
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+---------------------------------+--------+---+----+------+------------+
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|                                 |        |   | al |      |            |
|                                 |        |   | nu |      |            |
|                                 |        |   | mb |      |            |
|                                 |        |   | er |      |            |
|                                 |        |   | of |      |            |
|                                 |        |   | i  |      |            |
|                                 |        |   | nd |      |            |
|                                 |        |   | iv |      |            |
|                                 |        |   | id |      |            |
|                                 |        |   | ua |      |            |
|                                 |        |   | ls |      |            |
|                                 |        |   | w  |      |            |
|                                 |        |   | ho |      |            |
|                                 |        |   | pa |      |            |
|                                 |        |   | rt |      |            |
|                                 |        |   | ic |      |            |
|                                 |        |   | ip |      |            |
|                                 |        |   | at |      |            |
|                                 |        |   | ed |      |            |
|                                 |        |   | in |      |            |
|                                 |        |   | lo |      |            |
|                                 |        |   | ng |      |            |
|                                 |        |   | te |      |            |
|                                 |        |   | rm |      |            |
|                                 |        |   | n  |      |            |
|                                 |        |   | ut |      |            |
|                                 |        |   | ri |      |            |
|                                 |        |   | ti |      |            |
|                                 |        |   | on |      |            |
|                                 |        |   | tr |      |            |
|                                 |        |   | ai |      |            |
|                                 |        |   | ni |      |            |
|                                 |        |   | ng |      |            |
|                                 |        |   | th |      |            |
|                                 |        |   | at |      |            |
|                                 |        |   | c  |      |            |
|                                 |        |   | om |      |            |
|                                 |        |   | pl |      |            |
|                                 |        |   | et |      |            |
|                                 |        |   | ed |      |            |
|                                 |        |   | t  |      |            |
|                                 |        |   | ra |      |            |
|                                 |        |   | in |      |            |
|                                 |        |   | in |      |            |
|                                 |        |   | g. |      |            |
|                                 |        |   | Tr |      |            |
|                                 |        |   | ai |      |            |
|                                 |        |   | ne |      |            |
|                                 |        |   | es |      |            |
|                                 |        |   | a  |      |            |
|                                 |        |   | re |      |            |
|                                 |        |   | he |      |            |
|                                 |        |   | al |      |            |
|                                 |        |   | th |      |            |
|                                 |        |   | ca |      |            |
|                                 |        |   | re |      |            |
|                                 |        |   | p  |      |            |
|                                 |        |   | ro |      |            |
|                                 |        |   | fe |      |            |
|                                 |        |   | ss |      |            |
|                                 |        |   | io |      |            |
|                                 |        |   | na |      |            |
|                                 |        |   | ls |      |            |
|                                 |        |   | r  |      |            |
|                                 |        |   | ec |      |            |
|                                 |        |   | ei |      |            |
|                                 |        |   | vi |      |            |
|                                 |        |   | ng |      |            |
|                                 |        |   | n  |      |            |
|                                 |        |   | ut |      |            |
|                                 |        |   | ri |      |            |
|                                 |        |   | ti |      |            |
|                                 |        |   | on |      |            |
|                                 |        |   | al |      |            |
|                                 |        |   | tr |      |            |
|                                 |        |   | ai |      |            |
|                                 |        |   | ni |      |            |
|                                 |        |   | ng |      |            |
|                                 |        |   | s  |      |            |
|                                 |        |   | up |      |            |
|                                 |        |   | po |      |            |
|                                 |        |   | rt |      |            |
|                                 |        |   | ed |      |            |
|                                 |        |   | by |      |            |
|                                 |        |   | MC |      |            |
|                                 |        |   | HB |      |            |
|                                 |        |   | n  |      |            |
|                                 |        |   | ut |      |            |
|                                 |        |   | ri |      |            |
|                                 |        |   | ti |      |            |
|                                 |        |   | on |      |            |
|                                 |        |   | tr |      |            |
|                                 |        |   | ai |      |            |
|                                 |        |   | ni |      |            |
|                                 |        |   | ng |      |            |
|                                 |        |   | gr |      |            |
|                                 |        |   | an |      |            |
|                                 |        |   | ts |      |            |
|                                 |        |   | i  |      |            |
|                                 |        |   | nc |      |            |
|                                 |        |   | lu |      |            |
|                                 |        |   | di |      |            |
|                                 |        |   | ng |      |            |
|                                 |        |   | t  |      |            |
|                                 |        |   | ho |      |            |
|                                 |        |   | se |      |            |
|                                 |        |   | r  |      |            |
|                                 |        |   | ec |      |            |
|                                 |        |   | ei |      |            |
|                                 |        |   | vi |      |            |
|                                 |        |   | ng |      |            |
|                                 |        |   | M  |      |            |
|                                 |        |   | CH |      |            |
|                                 |        |   | st |      |            |
|                                 |        |   | ip |      |            |
|                                 |        |   | en |      |            |
|                                 |        |   | ds |      |            |
|                                 |        |   | a  |      |            |
|                                 |        |   | nd |      |            |
|                                 |        |   | t  |      |            |
|                                 |        |   | ho |      |            |
|                                 |        |   | se |      |            |
|                                 |        |   | n  |      |            |
|                                 |        |   | ot |      |            |
|                                 |        |   | r  |      |            |
|                                 |        |   | ec |      |            |
|                                 |        |   | ei |      |            |
|                                 |        |   | vi |      |            |
|                                 |        |   | ng |      |            |
|                                 |        |   | M  |      |            |
|                                 |        |   | CH |      |            |
|                                 |        |   | s  |      |            |
|                                 |        |   | ti |      |            |
|                                 |        |   | pe |      |            |
|                                 |        |   | nd |      |            |
|                                 |        |   | s. |      |            |
+---------------------------------+--------+---+----+------+------------+
|                                 | **Un   | 1 |    | *    | Percent    |
|                                 | its:** | 0 |    | *Tex |            |
|                                 |        | 0 |    | t:** |            |
+---------------------------------+--------+---+----+------+------------+
| **HEALTHY PEOPLE 2010           | Obj    |   |    |      |            |
| OBJECTIVE**                     | ective |   |    |      |            |
|                                 | 7.7    |   |    |      |            |
|                                 | (De    |   |    |      |            |
|                                 | velopm |   |    |      |            |
|                                 | ental) |   |    |      |            |
|                                 | In     |   |    |      |            |
|                                 | crease |   |    |      |            |
|                                 | the    |   |    |      |            |
|                                 | prop   |   |    |      |            |
|                                 | ortion |   |    |      |            |
|                                 | of     |   |    |      |            |
|                                 | health |   |    |      |            |
|                                 | care   |   |    |      |            |
|                                 | o      |   |    |      |            |
|                                 | rganiz |   |    |      |            |
|                                 | ations |   |    |      |            |
|                                 | that   |   |    |      |            |
|                                 | p      |   |    |      |            |
|                                 | rovide |   |    |      |            |
|                                 | p      |   |    |      |            |
|                                 | atient |   |    |      |            |
|                                 | and    |   |    |      |            |
|                                 | family |   |    |      |            |
|                                 | edu    |   |    |      |            |
|                                 | cation |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 | Obj    |   |    |      |            |
|                                 | ective |   |    |      |            |
|                                 | 23.10  |   |    |      |            |
|                                 | (De    |   |    |      |            |
|                                 | velopm |   |    |      |            |
|                                 | ental) |   |    |      |            |
|                                 | In     |   |    |      |            |
|                                 | crease |   |    |      |            |
|                                 | the    |   |    |      |            |
|                                 | prop   |   |    |      |            |
|                                 | ortion |   |    |      |            |
|                                 | of     |   |    |      |            |
|                                 | Fe     |   |    |      |            |
|                                 | deral, |   |    |      |            |
|                                 | T      |   |    |      |            |
|                                 | ribal, |   |    |      |            |
|                                 | State, |   |    |      |            |
|                                 | and    |   |    |      |            |
|                                 | local  |   |    |      |            |
|                                 | public |   |    |      |            |
|                                 | health |   |    |      |            |
|                                 | ag     |   |    |      |            |
|                                 | encies |   |    |      |            |
|                                 | that   |   |    |      |            |
|                                 | p      |   |    |      |            |
|                                 | rovide |   |    |      |            |
|                                 | cont   |   |    |      |            |
|                                 | inuing |   |    |      |            |
|                                 | edu    |   |    |      |            |
|                                 | cation |   |    |      |            |
|                                 | to     |   |    |      |            |
|                                 | d      |   |    |      |            |
|                                 | evelop |   |    |      |            |
|                                 | comp   |   |    |      |            |
|                                 | etency |   |    |      |            |
|                                 | in     |   |    |      |            |
|                                 | ess    |   |    |      |            |
|                                 | ential |   |    |      |            |
|                                 | public |   |    |      |            |
|                                 | health |   |    |      |            |
|                                 | se     |   |    |      |            |
|                                 | rvices |   |    |      |            |
|                                 | for    |   |    |      |            |
|                                 | their  |   |    |      |            |
|                                 | empl   |   |    |      |            |
|                                 | oyees. |   |    |      |            |
+---------------------------------+--------+---+----+------+------------+
| **DATA SOURCE(S) AND ISSUES**   | These  |   |    |      |            |
|                                 | data   |   |    |      |            |
|                                 | are    |   |    |      |            |
|                                 | col    |   |    |      |            |
|                                 | lected |   |    |      |            |
|                                 | from   |   |    |      |            |
|                                 | an     |   |    |      |            |
|                                 | annual |   |    |      |            |
|                                 | survey |   |    |      |            |
|                                 | of     |   |    |      |            |
|                                 | tr     |   |    |      |            |
|                                 | ainees |   |    |      |            |
|                                 | who    |   |    |      |            |
|                                 | com    |   |    |      |            |
|                                 | pleted |   |    |      |            |
|                                 | a      |   |    |      |            |
|                                 | nut    |   |    |      |            |
|                                 | rition |   |    |      |            |
|                                 | tr     |   |    |      |            |
|                                 | aining |   |    |      |            |
|                                 | pr     |   |    |      |            |
|                                 | ogram. |   |    |      |            |
|                                 | This   |   |    |      |            |
|                                 | survey |   |    |      |            |
|                                 | could  |   |    |      |            |
|                                 | be     |   |    |      |            |
|                                 | mailed |   |    |      |            |
|                                 | by     |   |    |      |            |
|                                 | each   |   |    |      |            |
|                                 | grant  |   |    |      |            |
|                                 | p      |   |    |      |            |
|                                 | rogram |   |    |      |            |
|                                 | or     |   |    |      |            |
|                                 | done   |   |    |      |            |
|                                 | ele    |   |    |      |            |
|                                 | ctroni |   |    |      |            |
|                                 | cally. |   |    |      |            |
+---------------------------------+--------+---+----+------+------------+
| **SIGNIFICANCE**                | -      |   |    |      |            |
|                                 |   Good |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    nut |   |    |      |            |
|                                 | rition |   |    |      |            |
|                                 |     is |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    ess |   |    |      |            |
|                                 | ential |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    for |   |    |      |            |
|                                 |     g  |   |    |      |            |
|                                 | rowth, |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 | develo |   |    |      |            |
|                                 | pment, |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    and |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |   well |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 | being. |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |   Four |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    out |   |    |      |            |
|                                 |     of |   |    |      |            |
|                                 |     10 |   |    |      |            |
|                                 |     l  |   |    |      |            |
|                                 | eading |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 | causes |   |    |      |            |
|                                 |     of |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |  death |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    are |   |    |      |            |
|                                 |     r  |   |    |      |            |
|                                 | elated |   |    |      |            |
|                                 |     to |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |   poor |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |  nutri |   |    |      |            |
|                                 | tional |   |    |      |            |
|                                 |     h  |   |    |      |            |
|                                 | abits. |   |    |      |            |
|                                 |     In |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |  order |   |    |      |            |
|                                 |     to |   |    |      |            |
|                                 |     i  |   |    |      |            |
|                                 | mprove |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 | health |   |    |      |            |
|                                 |     ou |   |    |      |            |
|                                 | tcomes |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |  among |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |  women |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    and |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    chi |   |    |      |            |
|                                 | ldren, |   |    |      |            |
|                                 |     it |   |    |      |            |
|                                 |     is |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |  vital |   |    |      |            |
|                                 |     to |   |    |      |            |
|                                 |     i  |   |    |      |            |
|                                 | mprove |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |  nutri |   |    |      |            |
|                                 | tional |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 | habits |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 | within |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    the |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    MCH |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |  popul |   |    |      |            |
|                                 | ation. |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 | -   It |   |    |      |            |
|                                 |     is |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    ess |   |    |      |            |
|                                 | ential |   |    |      |            |
|                                 |     to |   |    |      |            |
|                                 |     ma |   |    |      |            |
|                                 | intain |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    and |   |    |      |            |
|                                 |     e  |   |    |      |            |
|                                 | nhance |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    the |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    nut |   |    |      |            |
|                                 | rition |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    wor |   |    |      |            |
|                                 | kforce |   |    |      |            |
|                                 |     in |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |  order |   |    |      |            |
|                                 |     to |   |    |      |            |
|                                 |     i  |   |    |      |            |
|                                 | mprove |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    the |   |    |      |            |
|                                 |     q  |   |    |      |            |
|                                 | uality |   |    |      |            |
|                                 |     of |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |   care |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    and |   |    |      |            |
|                                 |     p  |   |    |      |            |
|                                 | rovide |   |    |      |            |
|                                 |     ad |   |    |      |            |
|                                 | equate |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    nut |   |    |      |            |
|                                 | rition |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |   coun |   |    |      |            |
|                                 | seling |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    ser |   |    |      |            |
|                                 | vices. |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |  These |   |    |      |            |
|                                 |     w  |   |    |      |            |
|                                 | orkers |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    are |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |  vital |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 | partic |   |    |      |            |
|                                 | ipants |   |    |      |            |
|                                 |     in |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    the |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 | system |   |    |      |            |
|                                 |     of |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |   care |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    and |   |    |      |            |
|                                 |     e  |   |    |      |            |
|                                 | nhance |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    the |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |   prev |   |    |      |            |
|                                 | entive |   |    |      |            |
|                                 |     se |   |    |      |            |
|                                 | rvices |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    inf |   |    |      |            |
|                                 | rastru |   |    |      |            |
|                                 | cture. |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 | -      |   |    |      |            |
|                                 | Having |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |   data |   |    |      |            |
|                                 |     on |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    the |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 | number |   |    |      |            |
|                                 |     of |   |    |      |            |
|                                 |     tr |   |    |      |            |
|                                 | ainees |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |   cont |   |    |      |            |
|                                 | inuing |   |    |      |            |
|                                 |     to |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |   work |   |    |      |            |
|                                 |     in |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    the |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    MCH |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |  field |   |    |      |            |
|                                 |     e  |   |    |      |            |
|                                 | nables |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |   MCHB |   |    |      |            |
|                                 |     to |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 | assess |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    the |   |    |      |            |
|                                 |     ad |   |    |      |            |
|                                 | equacy |   |    |      |            |
|                                 |     of |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    the |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |    nut |   |    |      |            |
|                                 | rition |   |    |      |            |
|                                 |     se |   |    |      |            |
|                                 | rvices |   |    |      |            |
|                                 |        |   |    |      |            |
|                                 |   infr |   |    |      |            |
|                                 | astruc |   |    |      |            |
|                                 | tures. |   |    |      |            |
+---------------------------------+--------+---+----+------+------------+

# DATA COLLECTION FORM

The total number of graduates of long term nutrition training
programs\*‑‑5 years post graduation‑‑being reported in this report
#\_\_\_\_\_\_\_\_\_

The total number of graduates of long term nutrition training programs
\* lost to follow-up?

\# \_\_\_\_\_\_\_

What percent of graduates of long term nutrition training programs \*
‑‑5 years post graduation‑‑ demonstrate MCH leadership in **at least
one** of the following areas: \_\_\_\_\_\_\_\_%

-   Academics‑‑i.e., faculty member teaching‑mentoring in MCH related
    field; and/or conducting MCH related research; and /or providing
    consultation‑technical assistance in MCH; and/or publishing and
    presenting in key MCH areas; and/or success in procuring grant and
    other funding in MCH

> \[#\_\_\_\_\_\_ meeting this criteria\]

-   Clinical‑‑i.e., development of guidelines for specific MCH
    conditions; and/or participation as officer or chairperson of
    committees on State, National, or local clinical organizations, task
    forces, community boards, etc.; and/or clinical preceptor for MCH
    trainees; and/or research, publication, and key presentations on MCH
    clinical issues; and/or serves in a clinical leadership position as
    director, team leader, chairperson, etc.

> \[#\_\_\_\_\_\_\_meeting this criteria\]

-   Public Health/Public Policy‑‑i.e., leadership position in local,
    State or National public organizations, government entity; and/or
    conducts strategic planning; participates in program evaluation and
    public policy development; and/or success in procuring grant and
    other funding; and/or influencing MCH legislation; and/or
    publication, presentations in key MCH issues.

> \[#\_\_\_\_\_\_\_meeting this criteria\]

-   Advocacy‑‑i.e., through efforts at the community, State, Regional
    and National levels influencing positive change in MCH through
    creative promotion, support and activities‑‑both private and public.
    For example, developing a city‑wide pediatric obesity and prevention
    program through community churches.

\[#\_\_\_\_\_\_\_meeting this criteria\]

-   Decreasing Disparities---i.e., participating in community, state,
    regional or national activities specifically targeting reducing
    disparities; and/or participating in or providing cultural
    competency training.

\[#\_\_\_\_\_\_\_meeting this criteria\]

\* Graduates of long term nutrition training programs include both those
that receive MCH stipends and those not receiving MCH stipends.

**MCH Training and Education Program Data Form**

**OMB #0915-0272**

**Expiration Date:  January 31, 2006**

Section 1

CFDA Number is 93.110

Section 2, Faculty and Staff Information

List all personnel (faculty, staff, and others) contributing to your
training project, include those not supported by the grant.

  -----------------------------------------------------------------------
  Personnel (Do not list trainees)

  -----------------------------------------------------------------------

+----------------+-----------+-------+------+--------+-------+-------+
| Name           | Race      | Ethn  | Ge   | Disc   | De    | F     |
|                | (indicate | icity | nder | ipline | grees | ormer |
|                | all that  |       |      |        |       |       |
|                | apply     |       |      |        |       | MCHB  |
|                | e.g.,     |       |      |        |       |       |
|                | American  |       |      |        |       | Trai  |
|                | Indian or |       |      |        |       | nee ? |
|                | Alaska    |       |      |        |       |       |
|                | Native,   |       |      |        |       | Y/N   |
|                | Asian,    |       |      |        |       |       |
|                | Black or  |       |      |        |       |       |
|                | African   |       |      |        |       |       |
|                | American, |       |      |        |       |       |
|                | Native    |       |      |        |       |       |
|                | Hawaiian  |       |      |        |       |       |
|                | or Other  |       |      |        |       |       |
|                | Pacific   |       |      |        |       |       |
|                | Islander, |       |      |        |       |       |
|                | White)    |       |      |        |       |       |
+----------------+-----------+-------+------+--------+-------+-------+
| Faculty        |           |       |      |        |       |       |
+----------------+-----------+-------+------+--------+-------+-------+
|                |           |       |      |        |       |       |
+----------------+-----------+-------+------+--------+-------+-------+
|                |           |       |      |        |       |       |
+----------------+-----------+-------+------+--------+-------+-------+
|                |           |       |      |        |       |       |
+----------------+-----------+-------+------+--------+-------+-------+
| Staff          |           |       |      |        |       |       |
+----------------+-----------+-------+------+--------+-------+-------+
|                |           |       |      |        |       |       |
+----------------+-----------+-------+------+--------+-------+-------+
|                |           |       |      |        |       |       |
+----------------+-----------+-------+------+--------+-------+-------+
| Other          |           |       |      |        |       |       |
+----------------+-----------+-------+------+--------+-------+-------+
|                |           |       |      |        |       |       |
+----------------+-----------+-------+------+--------+-------+-------+

**MCH Training and Education Program Data Form, Section 3**

**Current Long Term Trainee Form**

**OMB #0915-0272**

**Expiration Date:  January 31, 2006**

**Trainee Information (Long --term Trainees Only)**

> Definition: Long-term trainees (those with greater than or equal to
> 300 contact hours within the training program) benefiting from the
> training grant (both supported and non-supported trainees).

Total Number of long term trainees participating in the training program
\_\_\_\_\_\_\_\_\_\_\*

\*All trainees participating in the program, whether receiving MCH
stipend support or not.

REPORTING PERIOD FROM [(date)]{.underline} TO [(date)]{.underline}

<table>
<colgroup>
<col style="width: 9%" />
<col style="width: 7%" />
<col style="width: 6%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 10%" />
<col style="width: 6%" />
<col style="width: 10%" />
</colgroup>
<tbody>
<tr class="odd">
<td>Name</td>
<td>Race/<br />
Ethnicity</td>
<td>Gender</td>
<td>Discipline at Entry</td>
<td>Degrees at Entry</td>
<td>Position at Entry</td>
<td><p>Degree Program</p>
<p>Enrolled</p></td>
<td>MCH Support?</td>
<td>Amount</td>
<td><p>Student Type</p>
<p>Pre/Post Doc</p></td>
<td><p>Part/</p>
<p>Full time</p></td>
<td>Products</td>
</tr>
<tr class="even">
<td>SAMPLE:<br />
Jose Padilla</td>
<td>5</td>
<td>M</td>
<td>Medicine</td>
<td>M.D.</td>
<td>MCH Director</td>
<td>Post Doc DBP Residency</td>
<td>Yes, stipend and tuition</td>
<td>$40,000</td>
<td><p>Post Doc</p>
<p>Full time</p></td>
<td></td>
<td>2 Journal articles</td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><p>Total</p>
<p># and % by Column</p></td>
<td><p>White</p>
<p># ___</p>
<p>% ___</p>
<p>Black</p>
<p># ___</p>
<p>% ___</p>
<p>Hispanic</p>
<p>Etc.</p></td>
<td><p>Female</p>
<p># __</p>
<p>% __</p>
<p>Male</p>
<p># __</p>
<p>% __</p></td>
<td></td>
<td>No totals needed here</td>
<td></td>
<td></td>
<td><p># Supported __</p>
<p>% supported ______</p></td>
<td><p>Total</p>
<p># Stipends</p>
<p>______</p>
<p>$ Stipends<br />
_______</p></td>
<td><p>Pre Doc</p>
<p>10 (33%)</p>
<p>Post Doc</p>
<p>20 (66%)</p></td>
<td><p>PT</p>
<p>15 (50%)</p>
<p>FT</p>
<p>15 (50%)</p></td>
<td>Total Products = XX</td>
</tr>
</tbody>
</table>

1.  American Indian or Alaskan Native 5 Hispanic

2.  Native Hawaiian or Other Pacific Islander 6 White, not of Hispanic
    origin

3.  Asian 7 More than one race reported

4.  Black, not of Hispanic origin

**MCH Training and Education Program Data Form, Section 4**

> **Former Trainee Information (For Long-term Trainees ONLY) Form**

**OMB #0915-0272**

**Expiration Date:  January 31, 2006**

**(**Definition of Former Trainee = Grant supported trainees 5 years
post graduation)

FORMER LONG TERM TRAINEES, Total Number \_\_\_\_

+-----+---------+--------+--------+-------+-------+--------+--------+
| N   | Year    | Deg    | Was    | Cu    | Cu    | City   | Re     |
| ame | Co      | ree(s) | the    | rrent | rrent | and    | mained |
|     | mpleted | earned | Univ   | Pos   | Pos   | State  | in MCH |
|     |         | with   | ersity | ition | ition | of     | Field? |
|     | T       | MCH    | Able   | Title | Se    | Res    | Y/N    |
|     | raining | S      | to     |       | tting | idence |        |
|     | Program | upport | C      |       |       |        |        |
|     |         |        | ontact |       |       |        |        |
|     |         |        | the    |       |       |        |        |
|     |         |        | Tr     |       |       |        |        |
|     |         |        | ainee? |       |       |        |        |
|     |         |        | Y/N    |       |       |        |        |
+-----+---------+--------+--------+-------+-------+--------+--------+
|     |         |        |        |       |       |        |        |
+-----+---------+--------+--------+-------+-------+--------+--------+
|     |         |        |        |       |       |        |        |
+-----+---------+--------+--------+-------+-------+--------+--------+
|     |         |        |        |       |       |        |        |
+-----+---------+--------+--------+-------+-------+--------+--------+
|     |         |        |        |       |       |        |        |
+-----+---------+--------+--------+-------+-------+--------+--------+
|     |         |        |        |       |       |        |        |
+-----+---------+--------+--------+-------+-------+--------+--------+

Current Position Setting = private practice, public sector health
agency, other sector agency, academic, professional organization,
private/non-profit, hospital/HMO/clinic

**MCH Training and Education Program Data Form, Section 5**

> **Short and Medium Term Trainee Information Form**

**OMB #0915-0272**

**Expiration Date:  January 31, 2006**

> **Short-term (Less than 40 contact hours) and Medium-term (40 or more
> and less than 300 contact hours) Training Information**
>
> Number of Short term Trainees during the past 12-month grant
> period\_\_\_\_\_\_\_
>
> List types/disciplines (i.e., pediatricians, nutritionists, etc.)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Number of Medium term Trainees during the past 12-month grant period
> \_\_\_\_\_\_\_
>
> List types/disciplines (i.e., residents, interns, etc.)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**MCH Training and Education Program Data Form, Section 6**

> **Technical Assistance/Collaboration Form**

**OMB #0915-0272**

**Expiration Date:  January 31, 2006**

Definition: The provision of technical advice in a range of issues
including program development, clinical services, program evaluation,
and policy and guidelines formulation. For example, your project may
have provided technical advice to state or local health, education, or
social service agencies. Or, faculty may serve on advisory boards to
formulate new guidelines at the state or national level.

+------------------+------------------+-----------+-------------------+
| **Topic of       | **Recipient of   | *         | **Geographic      |
| Technical        | TA/              | *Indicate | Description\*\*** |
| Assistance       | Collaborator\*** | Level of  |                   |
| /Collaboration** |                  | Coll      |                   |
|                  |                  | aboration |                   |
|                  |                  | (low,     |                   |
|                  |                  | medium,   |                   |
|                  |                  | high)**   |                   |
+------------------+------------------+-----------+-------------------+
|                  |                  |           |                   |
+------------------+------------------+-----------+-------------------+
|                  |                  |           |                   |
+------------------+------------------+-----------+-------------------+
|                  |                  |           |                   |
+------------------+------------------+-----------+-------------------+
| Total Number     | Total \# and %   | No Totals | Local #\_\_\_     |
| \_\_\_\_\_       | of Recipients    | Here      | ;%\_\_\_          |
|                  |                  |           |                   |
|                  |                  |           | State #\_\_\_     |
|                  |                  |           | ;%\_\_\_          |
|                  |                  |           |                   |
|                  |                  |           | Another State     |
|                  |                  |           | #\_\_\_ ;%\_\_\_  |
|                  |                  |           |                   |
|                  |                  |           | Regional #\_\_\_  |
|                  |                  |           | ;%\_\_\_          |
|                  |                  |           |                   |
|                  |                  |           | National #\_\_\_  |
|                  |                  |           | ;%\_\_\_          |
|                  |                  |           |                   |
|                  |                  |           | International     |
|                  |                  |           | #\_\_\_ ;%\_\_\_  |
+------------------+------------------+-----------+-------------------+

List the 8-10 most significant technical assistance/collaborative
activities in the past year, start with the most significant one.

\*Recipient = Other departments in your university, Title V (MCH
Programs), Medicaid Agency, Health Insurance/Managed Care Organization,
Provider Organization, State Department of Education or Local School
District, Social Service Agency, Developmental Disability Agency, Mental
Health agency, Legal entity, Independent research or policy
organization, foundation, family and/or consumer group, Other (please
specify)

\*\*local, within state, another state, regional, national,
international

**MCH Training and Education Program Data Form, Section 7**

**Continuing Education and Continuing Education/Distance Learning Form**

**OMB #0915-0272**

**Expiration Date:  January 31, 2006**

  -------------------- -------------- ------------- ------------ --------------
  **Topic**            **Method\***   **Number of   **Duration   **Continuing
                                      CE Students** in Hours**   Education
                                                                 Credits
                                                                 Provided?
                                                                 Y/N**

                                                                 

                                                                 

  Total                               \##                        
  -------------------- -------------- ------------- ------------ --------------

\*Method: Presentation/Seminar; Workshop/Conference; Web-based Course;
Audioconference; Videoconference, etc.

List the Topics, methods, number of students, duration and whether CE
units were provided for all CE activities in the past project year.
Provide the total number of CE students reached through your training
program last year.

**Guidance Appendix D**

**MCH Training Web Site**

**For a map and contact information of all currently funded MCH Training
Programs, visit the MCH Training Web Site at
[www.mchb.hrsa.gov/training](http://www.mchb.hrsa.gov/training)**

[^1]: After baseline data is established, a more specific target goal
    will be determined.