Efforts To Outcomes (ETO) User`s Guide

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Efforts To Outcomes (ETO)
User’s Guide
Created by
May 2011
HIPPY USA 1221 Bishop Street Little Rock, Arkansas 72202 Phone 501.537.7726 Fax 501.537.7716 www.hippyusa.org
Table of Contents
ETO Training Information .......................................................................................................................... 3
Introduction.................................................................................................................................................. 5
ETO Software® ......................................................................................................................................... 5
ETO and HIPPY Evaluation ....................................................................................................................... 6
Data Entry Instructions................................................................................................................................................ 8
Login ....................................................................................................................................................................... 8
Parents, Children, Home Visitors, and Coordinators Programs .............................................................................. 8
Home Pages ........................................................................................................................................................... 9
Entering Demographics ........................................................................................................................................ 11
Updating Participant Information ........................................................................................................................... 14
Entering Assessments .......................................................................................................................................... 14
Entering Single Participant Points of Service ........................................................................................................ 15
Entering Multiple Participant Points of Service ..................................................................................................... 15
Entering a Referral ................................................................................................................................................ 16
Adding an Entity .................................................................................................................................................... 17
Viewing/Editing an Entity ...................................................................................................................................... 17
Sample Forms ...............................................................................................................................18
HIPPY Application................................................................................................................................................. 18
Parent Questionnaire – Baseline .......................................................................................................................... 19
Parent Questionnaire – Follow-up ........................................................................................................................ 20
Family Exit Form ................................................................................................................................................... 21
Home Visit Scheduling .......................................................................................................................................... 22
Home Visit Progress ............................................................................................................................................. 23
Group Meeting Summary Form ............................................................................................................................ 24
Home Visitor Background ..................................................................................................................................... 25
Coordinator Background ....................................................................................................................................... 26
Funding Information Form..................................................................................................................................... 27
ETO Reports ..................................................................................................................................28
ETO Demographics Reports ................................................................................................................................. 29
ETO Assessment Report ...................................................................................................................................... 30
ETO Glossary of Terms ................................................................................................................33
ETO Support..................................................................................................................................36
Appendix 1 ....................................................................................................................................37
HIPPY Logic Model
ETO Pilot Site Contacts ................................................................................................................38
Coordinator and Home Visitor ETO Responsibilities ................................................................39
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ETO Training Information
Each HIPPY program site will receive ETO training as an introduction to the software. HIPPY USA utilizes
web-based training in addition to hands-on training. The web based lab environment will be hosted through
ReadyTech. Hands-on training will be scheduled with the HIPPY USA ETO administrator, Angela Jones
(501.537.7739 or [email protected]).
ReadyTech log in and access instructions
Step 1: Go to https://hippyusa.hostedtraining.com
Step 2: Click Configure Automatically
Step 3: Click Continue to ActiveX Download
Step 4: If all goes well, you will receive the message below.
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This ReadyTech connection will provide the visual part of the training. The software, which is referred to as
the virtual classroom, is a remote desktop. This will allow HIPPY USA to observe each user’s navigation
through tasks, similar to the way an instructor would walk through a computer lab and observe students’
progress. For this reason, you must work on a unique computer.
Be sure to perform the connection check (described in detail on the previous page) at least one day prior to
your scheduled training time. It typically takes less than a minute. Be sure to perform this on the computer
which will be used during the training.
On the day of training, please begin the log in process for the web conference 30 minutes prior to the
scheduled start time.
If problems arise, please contact ReadyTech Support:
Ready Tech Support
[email protected]
(510) 289.8992
Audio Access
The HIPPY USA toll-free teleconference line will be used for the audio portion of ETO training.
Dial 866.228.9900 and enter the pass code 124467.
During the call, *6 will mute and un-mute your phone.
Questions? Call Angela Jones at 501.537.7739
or email [email protected]a.org.
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Introduction
ETO Software®
ETO Software® is a web-based performance management solution for human services organizations. It
gives organizations a clear picture of which efforts are having the greatest impact on the social issues they
strive to address. With this knowledge, government, private, and nonprofit firms can reinforce what's
working, adjust what isn't, and more easily report successes to key stakeholders.
Having a positive impact on society requires more than hard work and good intentions – it calls for a
strategic approach that connects an organization’s mission to the daily work of its staff members and the
expectations of its funders and supporters. ETO Software® transforms data into knowledge that you can
access via a multitude of easily generated reports to monitor, measure, and optimize your impact.
Information Access
The core value of ETO Software® lies within its reporting capabilities. These capabilities provide you with
fast, secure access to information that will empower you to:
Identify which of your efforts, services, staff and programs are most effective at achieving desired
outcomes
Identify and track key trends
Monitor participant attendance
Manage and analyze participant demographic data
Analyze assessment results
Manage referrals
Maintain a comprehensive history of participant information
Address multi-funder reporting obligations – in minutes
As with any software solution, the information you get out of it is only as good as the information you
put into it. Understanding this, we have gone to great lengths to include functionality that will encourage
HIPPY staff to use ETO Software®. These features include:
To Do Lists (screenshot – opens new window)
Task Reminders
Alerts
Searches/Queries
To supplement and enhance your use of ETO Software®, you also have access to a set of best practices
contained within our ETO City Repository. Here you will find:
Samples of outcomes
Use cases
Analysis methods
Report samples
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Data Capture
Data can be submitted into ETO through form submission (assessments, demographic forms, applications,
etc). The types of data typically captured with ETO Software® include:
Demographics
Assessment Data
Referral Data
Attendance Data
Case Notes
Client History
How ETO Ties in with HIPPY Evaluation
The ETO program has been designed keeping in mind the activities, outputs and outcomes and indicators
developed in the HIPPY Logic Model. (See Appendix 1 – page 39.) Data is collected in ETO using:
• Application and information forms – collect demographics data such as contact information,
cultural, language, schooling and educational background
• Assessments – collect data related to progression toward parent outcomes; to measure progression
it will be necessary to collect baseline data at the beginning or the program year and follow up data
at the end of the program year.
• Points of Service (POS) – collect data related to home visits, group meetings and special events
participation
• Referrals – records referrals made to other community organizations, education and employment
The ETO has been developed using 4 programs to best represent the efforts and outcomes:
1. Parents
2. Children
3. Home Visitors
4. Coordinators
The national office is assembling a committee comprised of researchers, representatives from the field, and
HIPPY staff to evaluate and determine various assessment tools that can be utilized on a national level. We
anticipate this process to take some time, but will incorporate the tools into the ETO software once they are
determined.
Until that time, HIPPY USA has included the assessments outlined in this manual and featured in the ETO
software as EXAMPLES ONLY. Site-specific assessments can be incorporated as needed. Contact
Angela Jones at [email protected] or 501.537.7739 for more information about incorporating site
specific assessments.
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The table below lists each of the forms used by program and describes what it is used for, when and why.
Parents Program
Form Title
HIPPY Application
Parent Questionnaire –
Baseline
Parent Questionnaire –
Follow Up
Family Exit Form
Home Visit Scheduling
Form
Home Visit Progress Form
Group Meeting Summary
Form
Why, When and Frequency of Use
To collect basic demographics data of the parent, child, and family
Used once when the parent enters the HIPPY program
Updated as demographics data changes
To collect baseline data on parent outcomes/indicators
To measure where the parent is when she/he begins the HIPPY program, progress is
measured by comparing this baseline data with data collected at the end of each program year
Used after family has started the HIPPY program (one month to three months)
To collect progress data on parent outcomes/indicators
This data is compared with the baseline data taken at the beginning of the HIPPY year and
shows the changes (progress) during the HIPPY year
Used at the end of the HIPPY year
To collect information on why the family left HIPPY early, at what point (week) in the program
and what steps were taken to support the family in staying in HIPPY
Complete once when the family leaves the HIPPY program prematurely
Data entered after HIPPY child has received weekly packet
This data is used to track the number of home visits made
To collect data about each home visit after the HIPPY Home Visitor and primary adult have
reviewed the last week’s packet
Data is entered for each parent individually
Taken after each home visit – 30 entries for families who complete the HIPPY year
To collect data about the group meeting
Data is entered for all parents (attendees) at the same time
Taken after each group meeting
Other “site specific” forms may be created and used to enter the following types of data:
Special Event Form
Referral Form
Add /Edit Entity Form
To collect data about the group meeting/special event
Data is entered for all parents (attendees) at the same time
Taken after each group meeting/special event
To collect data on the type of referral made to the parent/family, as well as progress made for
each referral
Entered as referrals to outside service providers are made
Updated as parents follow up on the referral
To collect names and contact information of outside service providers to which families have
been referred
Data is entered once when the referral is made and is updated as contact information changes
Children Program
Form Title
HIPPY Application
Why, When and Frequency of Use
To collect basic demographics data of the parent and child
Used once when the parent enters the HIPPY program
Updated as demographics data changes
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Home Visitors Program
Form Title
Home Visitor Background
Form
Performance Assessment –
Baseline (currently disabled)
Performance Assessment –
Follow Up (currently disabled)
Why, When and Frequency of Use
To collect basic demographics data of home visitors
Used once when home visitor is hired
Updated as demographics data changes
To collect data related to the home visitor’s initial job performance
Assessments are completed by the coordinator
Used once after 12 months of employment
To collect data related to the home visitor’s changes in job performance
Assessments are completed by the coordinator
Used every 12 months of employment, starting after one year of employment
Coordinators Program
Form Title
Coordinator Background
Funding Information Form
Why, When and Frequency of Use
To collect basic demographics data of coordinators
Used at the beginning of every program year or each time a new coordinator is hired
Updated as demographics data changes
To collect funding data at the beginning of every program year
Updated as funding information data changes
Data Entry Instructions
1) Login
Internet Explorer (version 6.0 or higher) is the only web browser that can support ETO software. Log in at:
website: http://hippyusa.etosoftware.com
Use the user name and password provided. Only your site will appear. State offices will have access to
their statewide programs.
2) Parents, Children, Home Visitors, and Coordinators Programs
Make sure you are in the correct program: (Note: Coordinators have access to all four programs listed
below. Home visitors have access to only the Parents and Childrens programs).
Parents – data entry for family demographics, parent assessments, home visits, group meeting and special
event and family referrals.
Children – data entry for child demographics and child assessments
Home Visitors – data entry for home visitor demographics, all training, assessments and referrals
pertaining to home visitors
Coordinators – data entry for coordinator demographics, all training, educational and employment
advancements.
To switch between the four programs: Click (Change Program) and select the program from the pull
down menu (green text).
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3) Home Pages
The home pages for all programs contain links to all data entry windows. Click on the appropriate
icon on the right hand side of each item.
NOTE: The data entry process for all programs is very similar, and includes entering demographics
information, points of service, assessments and referrals. This manual describes the basic data entry
instructions for the four programs, but more detailed information is shared during the ETO training.
Parents Home Page
Children Home Page
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Home Visitors Home Page
Coordinators Home Page
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4) Entering Demographics
Coordinators
Click the
next to “Add New Participant” on the home page.
Complete the participant information. The ALERT field is for any special reminders or indicators. All fields in
yellow are required fields.
NOTE: Each agency/site will determine if personal or office information will be used when entering the
Coordinator Background Information.
Enter the coordinator’s actual date of hire in the PROGRAM START DATE field.
Click
when all information has been entered.
NOTE: Do not click the browser’s BACK arrow. ALL DATA WILL BE LOST. Always use the options on the
ETO toolbar to navigate through the system.
Funding Information Form
By submitting the Coordinator Background Information, the system automatically routes the user to the
Funding Information Form screen. (To enter information for additional coordinators, select the Home Page
option on the ETO toolbar and repeat the previous steps.)
Funding information should be completed only ONCE per site. To skip this step, select the Home Page
option on the ETO toolbar to continue.
NOTE: Do not use commas when entering financial information into the Funding Information Form.
Click
when all information has been entered. You will then have the option to review and/or edit the
information. Click continue if all information is correct.
Home Visitors (Coordinators will enter this information)
Select “Home Visitors” from the change program option. Click
next to “Add New Participant”.
Complete the participant information. The ALERT field is for any special reminders or indicators. All fields in
yellow are required fields.
Enter the home visitor’s actual date of hire in the PROGRAM START DATE field.
Click
when all information has been entered.
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Parents (Home visitors will enter this information)
Select “Parents” from the change program option. Click the
next to “Add Household” on the home page.
In the next window, click on the blue
arrow to activate the drop down menu
and select “Adult”.
Complete the participant information. By default all members are added into the Parents program on
today’s date. Change the date to the actual enrollment date by either typing the date or clicking on the
calendar icon.
If entering only one adult for the household, enter their program start date and save. If there are other
adults in the home, select “Adult” (using the drop down box) to add additional adults for this family.
A new demographics form will be appear at the bottom of the previous form. Continue with the same steps
until all adult members of this household have been entered. Next, enroll all members of this household into
the Parents program at the bottom of the demographics page.
NOTE: The Parents program will be used to track home visits, assessments, and group meeting and
special event attendance.
Children (Home visitors will enter this information)
Select “Children” from the change program option. Click
next to “Add New Participant” on the home page.
Complete the participant information. (Remember to change the date to the actual enrollment date by either typing the date or
clicking on the calendar icon.) Click
when all information has been entered. Repeat steps for additional children.
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Assign Participants (Families/Households) to Home Visitors
After the home visitors have entered demographic information for all participants, coordinators can then assign
families to each home visitor. Once assigned, each home visitor will have access to only their families. If
families are not assigned to home visitors, they will be unable to retrieve household data. After the
coordinator assigns the parents and children to the home visitor, the home visitor can now link the families.
To Set Up Dashboards
If Participant Dashboard Already Exists
Step 1: From Parents program, click
.
Step 2: All parents entered will appear. Select the
name. A green pop up window will
appear with a list of tasks.
Step 3: Click on the participant’s
dashboard.
Step 4: Click “Edit Dashboard.”
Step 5: Click
.
Step 6: The ETO Parts Catalog window will pop up
on the left-hand side of the screen.
Step 7: Select Caseworkers and Staff Caseload.
Step 8: Click
and
.
Step 9: Click “Edit” under Caseworkers section to
assign Home Visitors. Under Staff Caseload, the
coordinator may select the home visitor from the
drop down box and assign all parents to that home
visitor at once. Repeat steps to assign children.
Step 2
Step 1: From Parents program home page click
.
All parents entered will appear. Select the name.
A green pop up window will appear with a list of tasks.
Step 2: Click on the participant’s dashboard.
Step 3: Click Edit under the Caseworkers section
Step 4: Select the assigned Home Visitor
Step 5: Repeat until all parents are assigned.
Step 6: Repeat steps to assign children.
Linking Adults and Children (Creating Households)
From the Parents Home Page, Home Visitors will click the
option next to Link Family Members.
Click
for a list of all
participants. (This will allow you to
view the full list to determine if
participants have been linked
correctly.) Select the first name in
which you’d like to link.
Select
and click the blue text “Search for Others”. Click
for a complete listing of all
participants. Check the box next to each participant that will be added to this family (household) and click
“Add Check Participants / Contact to Family”. Repeat steps for all families (households).
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5) Updating Participant Information
Complete this only if the demographics information for the family has changed (for example, they have
moved) or to correct mistakes and/or add missing information. Click the appropriate
on the home
page.
To obtain a list of all families in
the system, select
.
In the next window, click next to the
family information to be updated.
To search for a specific family,
type the first letter of the LAST
name. This will give you list of all
families with the last name
beginning with this letter.
A green pop up window will appear with a list of tasks.
Click View / Edit and the demographics screen will appear.
Click
when all changes and updates
are complete.
Repeat this step to complete other tasks
listed in the green pop up window.
6) Entering Assessments
Select the appropriate
icon on the home page. The first two screens displayed are identical to
updating demographics information screens:
for the family
Click next to the family in which you are collecting data
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Select “Take New Assessment”
Select the drop down menu (blue arrow), and
select the assessment in which you are
taking.
Click
. The next screen contains
the assessment. Click
when complete.
7) Recording Efforts for a Single Participant
(Entering Single Participant Point of Service: Home Visits and Attendance Reporting)
Select the appropriate
icon on the home page. The first two screens displayed are identical to
updating demographics information screens:
for the family
Click next to the family in which you are collecting data
Select the drop down menu (blue arrow), and
select the point of service in which you are
entering.
Click
. The next screen contains the
assessment. Click
when complete.
The next screen will be the Participant Efforts screen. Complete all the fields and select:
1) “Save Effort and Close” if entering only one home visit, group meeting or special event; or
2) “Save Effort and Record Similar Effort” if you are entering an additional home visit, group meeting or special
event for this family; or
3) “Save Effort and View/Edit Participant” if you’d like to review the data entered.
8) Recording Efforts for Multiple Participants
(Entering Multiple Participant Point of Service)
Click the appropriate
icon on the home page. Click “Participant” in the next window. Click
boxes beside all the individuals attending or participating in a specific point of service. Click
.
. Check the
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Select the drop down menu (blue arrow), and
select the point of service in which you are
entering.
Click
. The next screen contains the
assessment. Click
when complete.
The next screen will be the Multiple Participant Efforts screen. Complete all the fields and select:
“Record Effort” if entering only one effort; or
“Save Effort and Record Similar Effort” if you are entering an additional effort.
9) Entering a Referral
This function is used to record referrals to outside agencies and services.
Select the appropriate
icon on the home page. The first two screens displayed are identical to
updating demographics information screens:
for the family
Click next to the family in which you are collecting data
Click on the appropriate entity and click
.
The next screen displayed is the Referral screen.
Complete all fields and click
.
Each time a new entity (outside service provider)
is entered, it will be added to the available list of
providers and will appear in the drop down menu
the next time a referral is entered for a household
(family).
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10) Adding An Entity
This function is used to record information on all
outside service providers.
Click the appropriate
icon on the home page.
In the next screen enter the entity name and all
contact information.
Once completed, click
.
11) Viewing/Editing Entity
This function is used to review or change outside service provider information.
Click the appropriate
icon on the home page.
Click
to obtain a list of all service
providers, or
Type the first letter of the service provider name
to obtain a list of all service providers listed
whose name begins with the specified letter.
Click the service provider to view/change. Make all changes in the next window and click
when complete.
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ETO Reports
The ETO program has hundreds of standard reports that can be easily obtained with a click of the mouse.
Standard reports have been created by Social Solutions Group and are available to all program users.
These reports are listed by category and are created using Crystal Reports. Crystal Reports Viewer must
be installed to access these reports. An automatic prompt will appear when the reports are first accessed.
Reports may also be created by running queries, ranging from extremely simple to very complex.
NOTE: The following reports are samples using data from a training session. More details about reports
and running queries will be discussed during training, but more information can be found in the ETO Help
Manual:
http://sites.google.com/site/etosoftwarehelpmanual/
HIPPY USA offers additional training on reports and queries after initial training is completed.
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ETO Glossary of Terms
Assessment – One of the major data collection tools most all ETO sites include. Assessments can capture
data about participants, families, entities, general, and staff. Assessments in ETO will probably include
fields found on paper forms used by your organization prior to ETO, or they may be performance
management tools taken from the Library of ETO City. To capture a score on an assessment, elements
should be numeric or include weights.
Assessments are most typically used in one of two ways:
As a continuation of demographic data, like in an extensive intake form
Questionnaires that track knowledge, belief, attitude, and/or behavior that are completed more than
one time (at the beginning and end of service, for example) and allow for comparative analysis to
determine the impact of services
Attribute – Characteristics of Entities that are not expected to change as a result of service. ETO comes
with Standard Attributes, additional Attributes are created with the Attribute Wizard. Attributes are to
Entities what Demographics are to Participants. Attributes appear on the Add New Entity and View/Edit
Entity screens.
Boolean: Refers to any Yes/No field in ETO Software, including: Demographics, Assessment Elements,
Points of Service, and Attributes. The term Boolean is seen on several screens throughout the software,
but especially in the Query Wizard.
Demographic – Characteristics of Participants that are not expected to change as a result of service. ETO
comes with Standard Demographics, which can be disabled if they don’t meet an organization’s needs.
Additional Demographics are created with the Demographics Wizard. Demographics appear on the Add
New Participant, Add New Household, and View/Edit Participant screens, among others.
Entering Demographics is considered the most basic function for a staff using ETO. Additional data cannot
be entered about a Participant unless the Standard Demographic fields for first and last name have been
entered.
Custom Report – Typically a query that is saved and shared on the Manage Queries screen. A small
percentage of customers purchase Custom Reports from Social Solutions to meet their specific reporting
requirements.
Effort – Entry of Point of Service data, which is also known as recording efforts. There are several record
efforts features in ETO: Efforts can be recorded for Participants, Entities, or General. Efforts can be
recorded for one Participant (Entity) at a time, or Multiple Participants (Participants).
Most Point of Service elements are built with a field to capture time spent on contact. Time spent on
contact and number of contacts both track effort on behalf of staff entering their work. ETO has the
capacity for many efforts to be recorded for a given participant on the same day; effort data is typically
entered with more frequency than any other type.
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Effort Qualifiers – Fields that are created and attached to Point of Service elements to capture additional
information about efforts or contacts. Also known as EQs, Effort Qualifiers are best used for counting, or to
prompt staff to provide specific details about the contact. EQs are unique because they are built and edited
with one feature – Manage Effort Qualifiers, and can be attached to efforts with the Point of Service Wizard
or Manage Point of Service feature.
Enroll – To bring a participant that exists in ETO into the selected program, and enter a program start date.
Entities – Typically a third party that somehow impacts Participants, such as Employers, Education
Institutions, or other community based organizations where Participants are referred. Some organizations
whose mission is to improve the safety of communities work primarily with Entities. Like Participants,
Entities can be tracked with assessments, efforts, and processes.
ETO Report – Reports populated by recording efforts. Most ETO Reports come in two formats – Crystal
(the best option for reports containing large data sets, also easy to export into other formats) and nonCrystal (which appear within the frames of ETO). The most impactful ETO Report is the non-Crystal
version for Point of Service elements set to measure and increase or decrease.
Family – Participants that are in some way related or share a home; families are recognized as a unit of
linked participants. Family functionality allows for the number of families served to be captured in addition
to the number of individuals. The term family is synonymous with the term household in ETO.
Feeder Table – Drop boxes found throughout features in ETO. The names of feeder tables are hardcoded,
but options are populated by the ETO Administrator. Some of the more popular feeder tables include
Contact Location Method (found on the Record Efforts screen), Reason for Dismissal (found on several
screens, including Dismiss Participant), Family Relationships (found on the Add New Household and
Add/Edit Families screens), and Reason for Referral (found on the Add Referral, Multiple Participant
Participant Referrals, and View/Edit Referrals screens).
Group - A subset of Participants who receive services simultaneously
Home Page - The link in the upper right corner of the ETO interface takes users to the page that’s seen by
default when users first log in. Important information, including links to functionality can be incorporated
onto the home page.
Household - Participants that are in some way related or share a home; households are recognized as a
unit of linked participants. Household functionality allows for the number of families served to be captured
in addition to the number of individuals. The term family is synonymous with the term household in ETO.
Library of ETO City – A website where Social Solutions provides summaries on a variety of program
areas, complete with references. There are also Point of Service and Assessments in the Library that are
built into customer sites during implementation. Customers may return to the Library at any time and
borrow information. The website is demo2.etosoftware.com. The username is librarian and the password
is librarian2.
Log Off – The link in the upper right corner of the software that all users should click before closing their
browser to ensure the data remains as secure as possible.
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Manage – The features in the software used by Administrators to make additions and modifications to
ETO. The majority of these features are found below the Site Administration component, and several are
directly related to the wizard features.
Navigation Bar – The green bar that’s accessible on the right side of the ETO interface. ETO
Administrators have the option to add or remove features, and dictate whether the bar is expanded or
collapsed by default, all from the Manage Site Navigation page.
Outcome – The “O” in ETO, outcomes can be tracked in Point of Service elements that are built to
measure and increase or decrease in attitude, performance, knowledge, etc. Also, assessments that
include weighted elements that are completed more than once allow for comparative analysis, and outcome
tracking.
Output – Point of Service elements that are tracking either an increase or decrease, and are used for
counting.
Participant – Member of the target population, recipient of service.
Point of Service – This is where time and energy spent is tracked within ETO. Whenever possible, it’s
best to set up a Point of Service so that time spent can be related to progress (such as going from
unemployed to under employed to gainfully employed). Points of Service are entered by Recording Efforts,
and are reported with ETO Reports (as well as several Standard Reports). The Manage for Point of
Service is below Program Administration on the Navigation Bar rather than Site Administration.
Process – A checklist that allows for tracking things such as documents in participant files. This feature is
not utilized as often as other features such as Demographics, Assessments, and Points of Service.
Program Group – A group of programs that fit into the same category. Demographics and Assessments
can be secured to a Program Group, and there are several Program Group reports for several types of
data.
Quality Indicator – Point of Service elements that are tracking an increase or decrease or neither, and are
used for counting efforts that are mission related.
Query – A request of information for ETO that can only be completed by a user who has been assigned a
Department Head or above. Queries appear in a grid that can easily be copied and pasted into Excel.
Queries can be built and saved, and shared to be accessible to lower user roles.
Referral – To “push” a participant to another program within ETO (versus Enroll, which is a pull), or to an
Entity Employer, Education Institution, or Service Provider.
Review Participant Efforts – The most popular report in ETO! It contains detailed data about a selected
participant within a date range, including efforts, employment, referrals, assessments, etc. The original
view shows summary statistics, there is the option to drill down to see more details, such as case notes.
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Standard Report – A “canned” report that came with ETO. While there is a feature on the Navigation Bar
named Standard Reports, the Demographic Reports, ETO Reports, Assessment Reports, etc., are also
considered Standard.
Survey – Like an assessment, but anonymous. Managed from the Manage Survey/Assessment screen,
but created with the Survey Wizard. ETO does have the capability for Participants or Entities to log into
ETO to enter Survey data directly into the system to eliminate staff data entry.
User Account – A unique log on that is provided with access to specific features and programs in ETO.
It’s recommended that users who enter data each have a user account so that staff are accountable for
their data and program managers can supervise them through ETO.
Wizard – A building tool in ETO that is used to create a new field or set of fields (in the case of an
assessment, for example) from scratch.
ETO Software Support
The first point of contact for all ETO software issues is the HIPPY USA ETO Administrator, Angela
Jones. She can be reached at 501.537.7739 or [email protected]
ETO software support is also available by clicking
in the lower right-hand corner of your screen
and selecting the appropriate help tool on the next screen to access a variety of training videos,
demonstrations, and overviews of all ETO software features.
36
37 37
ETO Pilot Site Contacts
Name
Deborah Baker
Eric Biel
Brenda Brinson
Keshia Bruno
Susanna Cruz
Pamela Gaines
Alta Jones
Kelly Keur
Racquel Lopez
Cathy McCrary
Glenda Nelson
Vicki Porter
Jacqueline
Richardson
Joanne Shum
David Tisdale
Nancy Tobias
Carla Weir
Julan Wood
Site
Jeffco HIPPY
FL HIPPY State
Office
Hillsborough County
Center for Excellence
TX HIPPY State
Office
Jeffco HIPPY
Community Students
Learning Center –
PIRC
AR HIPPY State
Office
InterCare Community
Health Network
Imperial Valley
Regional
Occupational
Program Project
Nenes
St. Michael’s
Preschool HIPPY
West Memphis
School District
Children’s Outing
Association COA
Youth and Family
Centers
AR HIPPY State
Office
AL HIPPY State
Office
CO HIPPY State
Office
Baltimore County
Public
TX HIPPY State
Office
Heber Springs HIPPY
City, State
Email
Phone Number
Lakewood, CO
[email protected]
303.982.0014
Tampa, FL
[email protected]
813.974.2177
West Palm Beach, FL
[email protected]
813.224.0558
Dallas, TX
[email protected]
214.442.1660
Lakewood, CO
[email protected]
303.982.0014
Lexington, MS
[email protected]
662.834.0905
Little Rock, AR
[email protected]
501.364.3671
Benton Harbor, MI
[email protected]
269.605.1277
El Centro, CA
[email protected]
760.562.5924
Hot Springs, AR
[email protected]
501.623.2073
West Memphis, AR
[email protected]
870.732.8572
Milwaukee, WI
[email protected]
414.263.8383
Little Rock, AR
[email protected]
501.364.3671
Montgomery, AL
[email protected]
334.265.2364
Denver, CO
[email protected]
303.860.6000
Baltimore, MD
[email protected]
410.887.3037
Dallas, TX
[email protected]
214.442.1660
Heber Springs, AR
[email protected]
501.362.7580
Please feel free to contact Angela Jones ([email protected] or 501.537.7739) at any time to ask questions,
share concerns, and offer suggestions.
38
Coordinator and Home Visitor ETO Responsibilities
This page outlines the “step-by-step” process involved in the
coordinator and home visitor ETO data entry. Following these
steps ensures smooth navigation throughout the ETO software
as information is entered into the system.
Coordinator
1) Enters his/her background information
2) Enters home visitor background information
3) Instructs home visitors to enter family information
Home Visitor
1)
2)
3)
4)
5)
6)
Enters each family individually
Enters parent
Change program to “Children” to enter child
Switch back to the “Parent” program to work on next family file
Continue until all families are entered
Notify coordinator that all families are entered
Coordinator
1) Enters the “Parent” program
a. Select “Search”
b. Select a parent
c. Enter into the parent dashboard
2) Edit dashboard
a. Add ETO Parts Catalog
b. Select Caseworkers and Staff Caseload
c. Select Add and Close
d. Select Done Editing (located on upper right hand side)
3) Select Staff Caseload
a. Select Add (dropdown box, select the home visitor that will be assigned to parents)
b. Select all parents assigned to this home visitor
c. Save
d. Repeat to assign the children to the appropriate home visitor
e. Notify staff when all parents and children are assigned
Home Visitor
1) Now links child to parent
2) Enters points of services for their families
Coordinator
1) Continuously monitors ETO data input
39
Notes
40
Notes
41
Notes
42
Notes
43
44
HIPPY USA
1221 Bishop Street Little Rock, Arkansas 72202
Phone 501.537.7726
Fax 501.537.7716 www.hippyusa.org
HIPPY Excellence Model Guidance Accreditation
ETO Document Location Guide
Essential Feature: Curriculum
Accreditation Standard 1: ETO Enrollment Reports
This report can be retrieved from any program in ETO.
1. Select Reports → View Reports from the green menu bar on the right.
2. Select HUSA Enrollment Numbers by HIPPY Year.
3. Select your date range, Click Refresh Values for site name to appear, double click your site name, and
Run Query.
Please note if another site appears under Enter values for Site Name, feel free to double click that site to remove it.
Select your date range, Site name, and program.
For each prompt (date, site, program) enter the
value below.
Enter prompts here
Revised December 2011
Essential Feature: Home Visits
Accreditation Standard 1: Review ETO Efforts Report
This report can be retrieved only from the Parent program
1. Select Reports → Standard Reports → Review Efforts for Participant (crystal)
2. Select Search or enter the participant last name.
3. Select the participant.
4. Enter your date range.
5. Locate and select in the report Home Visit Contact. The report will now show the location of the home
visit, amount of time spent, if the packet was delivered, and the contact date.
Accreditation Standard 3:
This report can be retrieved only from the Parents program.
Using the same report:
1. Return to Main Report. Select Track Delivery of Curriculum to Parents (3/4) or (5) to determine the
weeks or packets.
2. Continue to select each outcome to locate desired data.
Revised December 2011
Home Visit Contact (example)
Track Delivery (example)
Essential Feature: Coordinators
Accreditation Standard 3:
1. Select Reports → View Reports →HUSA POS Totals
2. Enter your date range
Refresh Values to select your site
Please note: If another site name appears under Enter values for Site name, double click the unwanted site to remove it from
the list
3. Run Query.
Enter value for
Program name:
defaulted to Home
Visitors
Revised December 2011
Essential Feature: Home Visitors
Accreditation Standard 1: Home Visitor’s Background Forms
This report can be retrieved only from the Home Visitors program.
1. Select Update Participant Information.
2. Enter the home visitor last name or Search.
3. Select participant.
4. Return to the home page and select Update Participant Information and continue to review other
home visitor information.
Essential Feature: Administration
Accreditation Standard 2: ETO Referral Report
1. From the Home Page of the Home
Visitors or Parents program, select
Update Referral.
2. Select Show all Participants
across Site, Search.
3. Select Show All Details to view a list
of all referrals made.
4. For additional referral details, select
Show All Details.
Revised December 2011
Essential Feature: Administration
Accreditation Standard 3, 5: ETO HUSA Home Visitor Caseload Report
This report can be retrieved from any program in ETO.
1. Select Reports → View Reports → HUSA Home Visitor Caseload Count
2. Refresh Values.
3. Only the site in which the coordinator is logged into will appear.
4. Double click the site name (it will move over to Enter Values for Site Name) and Run Query.
Please note: If another site name appears under Enter values for Site name, double click the unwanted site to remove it from
the list
Only your site name will
appear.
Essential Feature: Administration
Accreditation Standard 11: Advisory Council Roster
This report can be retrieved from any program in ETO.
1. Select Reports → Entity Reports → Custom Entity Attributes: In my Site (Crystal)
Revised December 2011
Essential Feature: Administration (continued)
2. Once the reports generates, select Community Advisory Group and the roster will appear.
Names marked True are advisory members
Please note: If the site has not entered their advisory members in ETO during the 2011-12 program year, you may review hard
copies.
Revised December 2011
Coordinator and Home Visitor ETO Responsibilities
This page outlines the “step-by-step” process involved in the
coordinator and home visitor ETO data entry. Following these
steps ensures smooth navigation throughout the ETO software
as information is entered into the system.
Coordinator
1) Enters his/her background information
2) Enters home visitor background information
3) Instructs home visitors to enter family information
Home Visitor
1)
2)
3)
4)
5)
6)
Enters each family individually
Enters parent
Change program to “Children” to enter child
Switch back to the “Parent” program to work on next family file
Continue until all families are entered
Notify coordinator that all families are entered
Coordinator
1) Enters the “Parent” program
a. Select “Search”
b. Select a parent
c. Enter into the parent dashboard
2) Edit dashboard
a. Add ETO Parts Catalog
b. Select Caseworkers and Staff Caseload
c. Select Add and Close
d. Select Done Editing (located on upper right hand side)
3) Select Staff Caseload
a. Select Add (dropdown box, select the home visitor that will be assigned to parents)
b. Select all parents assigned to this home visitor
c. Save
d. Repeat to assign the children to the appropriate home visitor
e. Notify staff when all parents and children are assigned
Home Visitor
1) Now links child to parent
2) Enters points of services for their families
Coordinator
1) Continuously monitors ETO data input
Revised December 2011
Notes
Revised December 2011
How Do I……
March 2012
ETO Software Frequently Asked Questions
Use the green navigation bar on the right to:
• Enroll participants in a different program (Participants)
• Merge duplicated participants (Participants)
• Edit efforts (My Work)
• Review/Edit efforts entered by staff (Program Administration)
Use your Home Page to:
• Enter Advisory Members
• Refer Home Visitors and Parents to:
o Outside Service Providers
o Educational Institutions
o ETO Programs (Coordinators, Parents or Home Visitors)
o Employers
Enroll Participants in another Program
• Select the Program in which you wish to enroll the participant in
• Participants, Enroll Participants, enter their name, select the individual, and enter their
program start date
• Go back to the Home Page, select Update Participant Information, select the newly
enrolled participant. The Parent program calls for more information than the Home
Visitor program. You will need to add any missing demographic information for that
participant
o If the person you enrolled was originally in the Home Visitors or Coordinators
program, and you enroll them in the Parent program, in order for them to appear
as a Family when you select Link Family Members, you must select Add New
Family.
o
o
o
o
Enter the primary parent first and last name followed by Family (Angela Fake
Family)
Select Add New Family
Select the blue link to Search for Others
Select all participants that belong in that family (this includes all adults and
children)
1
How Do I……
March 2012
Notes:
2
How Do I……
March 2012
Merge Duplicated Participants
If you have enrolled a participant in a program more than once, you have the ability to merge
those duplicated entries.
• Participants, Duplicated Participants—all duplicated entries will appear
• You may only merge two records at a time (same name)
• Check the two duplicated entries you would like to merge (the name could show several
times, depending on the number of times they were entered in ETO) and select Merge
Selected Records
•
•
Select the most recent entry to become the Master record to merge
Continue
•
The next screen will show a Warning Page. Select Yes. Continue until all duplicates
merge
Notes:
3
How Do I……
March 2012
Edit my Efforts
You have the ability to edit any efforts (home visits, group meetings, special events, trainings,
etc.) that you enter or your staff enters.
To edit efforts you entered when using your assigned ETO login you will
• Select My Work, Edit my Efforts
• Select Search by Participants (enter the last name or leave blank), Submit
•
•
•
**Depending on the program (parents or home visitors), the list of participants will
appear or the individual with the last name you entered will appear.
Select your participant
If any efforts were entered by you for the selected participant, those efforts will appear
You will see red and blue links for you to edit or delete efforts
Group meeting efforts:
When reviewing group meeting efforts you will see the date of the group meeting, the
location, attendance (value will show yes or no), time spent and any notes.
If you need to make changes to the group meeting that took place on a particular date (i.e.,
February 8), you would select Edit Group Effort. On the next screen, you are able to modify
as needed and update the effort at the bottom of the screen.
4
How Do I……
March 2012
Home visit efforts:
When reviewing home visit efforts, you will see all the effort qualifier questions you
answered and any notes you may have entered. If you entered the incorrect week (for
delivery) or the wrong date in which the home visit took place, select Edit Composite Effort.
Make all necessary changes and update effort at the bottom of the screen.
5
How Do I……
March 2012
If you selected the wrong composite (if the family is age 3 Spanish and you selected age 4),
you will need to Delete Composite Effort. This would require you to enter the appropriate
composite for the family.
Coordinator or designated ETO staff personnel: if you are reviewing or needing to edit
efforts entered by your staff (home visitors), you would use Program Administration, Edit
Staff Efforts. You would follow the steps above. The screens all look the same.
Notes:
6
How Do I……
March 2012
Enter Advisory Members (Home Page)
From the Coordinator program, select Add Entity
• Entity Name-Member first and last name
• Entity type-Administrative
• Check the box for Individual
• Enter member contact information
• Check the box at the very bottom-Community Advisory Member (if you do not check
the box, the member will not appear on your Advisory Roster—please refer to your
ETO Document Location Guide, page 5, on how to retrieve the Advisory Roster)
• Add Entity to the System
Notes:
7
How Do I……
March 2012
Refer Staff and Families (Home Page)
Parents and Home Visitors can be referred out. If you are referring a family, you must refer
from the Parent program. If you are referring your staff, it must be done in the Home Visitors
program.
Refer a Family:
• Add Referral
• Select the family to be referred
• Select the referral type and Submit
• Enter as much information as possible and select Submit at the bottom of the screen
Refer a Home Visitor:
• Add Referral
• Select the family to be referred
• Select the referral type and Submit
• Enter as much information as possible and select Submit at the bottom of the screen
**To review your referrals please refer to your ETO Document Location Guide, page 4, on how
to retrieve the ETO Referral Report
Notes:
8
Coordinator Background
*Last Name
*First Name
*Address 1
Address 2
City
State
*Zip
Alternate Phone
Home Phone
*DOB
(cell, emergency)
*Email
*Gender
*Site ID Number
*Position
Coordinator
Educational
Level
Female
*Site Name
Coordinator
Year Initiated
Full Time (w/HIPPY
ONLY)
Assistant Coordinator
Child
Development
Associate Credential
Male
Associates Degree
(Assistant Coordinator
only)
Bachelors
Degree
Part Time
Masters Degree
Doctorate
Other degree/certification (please specify) ___________________________________________________________
Currently pursuing a degree? Yes No (If yes, please specify) ____________________________________________________
Professional specialization (check all that apply)
Child Development
Secondary Education
Higher and Adult Education
Psychology
Early Childhood Education
Special Education
English as a Second Language
Sociology
Elementary Education
Family & Community Education
Social Work
Other(specify)________
Is Coordinator fluent in more than one language?
Yes
Number of coordinator
supervised home visits
Month
No
If yes, please list _______________________________________
Month
January
July
February
August
March
Number of coordinator
supervised home visits
September
April
October
May
November
June
December
Please duplicate this information and complete for each additional site coordinator.
Coordinator Background
Revised January 2011
1
Family Exit Form
Adult First Name
Adult Last Name
Child First Name
Child Last Name
Current address information
Address
City, State, Zip
Previous address information
Address
City, State, Zip
Enrollment Date
HIPPY 3 (H3)
HIPPY 4 (H4)
HIPPY 5 (H5)
4
10
16
22
28
5
11
17
23
29
6
12
18
24
30
4
10
16
22
28
5
11
17
23
29
6
12
18
24
30
Dismissal Date (month/year in which family quit program)
Week of dismissal (week in which family quit program)
1
7
13
19
25
2
8
14
20
26
Was family behind when dismissed?
If so, how many weeks?
1
7
13
19
25
2
8
14
20
26
Reason for dismissal
A family member said “no”
No parental interest
Work
3
9
15
21
27
Yes
No
3
9
15
21
27
Crisis in family
Unable to schedule time
School
Moved out of HIPPY area
Never started program
Other ___________________________
Retention strategies (strategies used to keep family)
Switched home visitor
Rearranged HIPPY schedule
Reduced program core elements
Increased visit frequency
Provided peer reference
Temporary leave
Other (please specify) _______________________________________________________________________________________
HIPPY Family Exit Form
Revised January 2011
2
Home Visitor Comments
Coordinator Comments
HIPPY Family Exit Form
Revised January 2011
Funding Information Form
Site ID Number
Site Name
State
Project funding source(s) for current program year.
Please check the appropriate boxes and fill in the exact amount received by each source.
Section B. Federal Sources
Title I
$________________
US Department of
Housing and Urban
Development
HOPE VI
$________________
US Department of
Health and Human
Services
Head Start
$________________
Migrant Workers
$________________
Other (please specify)
$_________________
Even Start
$________________
Other (please specify)
$_________________
Bilingual Education
$________________
Other (please specify)
$_________________
Early Head Start
$________________
Early Learning
Opportunities Act (ELOA)
$________________
Other (please specify)
$ ________________
Other (please specify)
$_________________
PIRC
$________________
Other (please specify)
$_________________
Other (please specify)
$_________________
Other (please specify)
$_________________
Other (please specify)
$ ________________
Other (please specify)
$_________________
Other (please specify)
$_________________
Other (please specify)
$_________________
Column Total
$ ________________
Column Total
$ ________________
Column Total
$ ________________
Column Total
$ ________________
Federal Sources Total
$ ________________
State University
$________________
Other (please specify)
$ ________________
State Sources Total
$ ________________
United Way
$________________
Volunteers
$________________
Corporate (please specify)
$________________
Individual donors
$________________
Faith-based/Churches Other (please specify)
$________________ $________________
Other (please specify)
$________________
Other (please specify)
$________________
Private Sources Total
$ ________________
US Department of
Education
Other Federal
Sources
AmeriCorps
$________________
Other (please specify)
$ ________________
Other (please specify)
$_________________
Do you have staff
capacity to write
grants?
Yes
No
If yes, please list name
and title below.
Name:
Title:
Section C. State Sources
Dept of Education
$________________
Legislative Action
$__________________
Section D. Private Source(s)
Foundations
$________________
Funding Totals
Direct Funding (Totals of section B, C, & D)
In-kind
Total budget
$_____________________
$___________________________
$___________________________
Funding Information Report – Revised January 2012
HIPPY USA Site ID
Date of
Meeting
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Group Meeting Summary Form
Coordinator(s)
Topic
Total number of
children
Total number of
adults
Total number of
HIPPY families
represented
Total number of
families currently
enrolled in
program
Total number of
AmeriCorps
families
represented
Total number of
AmeriCorps
families currently
enrolled in
program
HIPPY Application
PRIMARY HIPPY ADULT OR CAREGIVER
*Last Name
*First Name
*Address 1
Address 2
City
State
*Zip
Alternate Phone
(cell, emergency)
*Gender Female
Male
Mother
Stepmother
Foster Mother
Home Phone
Email
*Relationship to HIPPY Child
Other (specify)
__________________________
*Number of children enrolled in HIPPY this
program year _____________________
*DOB
(mm/dd/yyyy)
*Marital
Status
Married
Father
Stepfather
Foster Father
*Enrollment
Status
*Curriculum age parent is working with the child
Applied
Single
Divorced
Separated
Widowed
Grandmother
Grandfather
Aunt/Uncle
Enrolled
HIPPY 3 (H3)
Declined
HIPPY 4 (H4)
Not Eligible
HIPPY 5 (H5)
How did you hear about HIPPY? ______________________________________________________________________
Country of origin
USA
Other (please specify) _____________________
Number of years in USA _______
LANGUAGE INFORMATION
Primary Language
English
Spanish
Other (specify) _______________________________
Secondary Language
English
Spanish
Other (specify) _______________________________
Oral English
comprehension
*HIPPY
Advanced
Curriculum
Low
Language
English
Spanish
Both
Other (specify) _________________
EMPLOYMENT INFORMATION
Employed
Yes
Occupation
Student
HIPPY Application, Page 1
Revised January 2011
No
Employer ____________________________________________________
Work, part-time
Work, full-time
Self-employed
Homemaker
Unemployed
EDUCATION INFORMATION
High School Graduate Yes
No
College Graduate Yes
Highest level of education completed
_________________________________________
No
If not high school graduate, enter last grade completed ______________ GED Yes
Currently enrolled in high school
Yes No
Currently enrolled in college
Yes No
No
If enrolled in college, specify course of study
__________________________________________
RACE AND ETHNICITY
*Hispanic origin
No, not Spanish/Hispanic/Latino
Yes, Puerto Rican
Yes, Cuban
*Race
White
Black or African American
American Indian and Alaska Natives
(specify principal tribe)
______________________________
Asian Indian
Yes, Mexican, Mexican American, Chicano
Yes, other Spanish/Hispanic/Latino (specify) __________________________
Chinese
Native Hawaiian
Filipino
Guamanian or Chamorro
Japanese
Samoan
Korean
Other Pacific Islander (please specify)
________________________________
Vietnamese
Other Asian (please specify)
Other _________________________
________________________
Unknown
HOUSEHOLD DEMOGRAPHICS
*Migrant Family?
Yes
No
*Immigrant Family?
Yes
No
Parent lives with
Father/mother of HIPPY child
Area
Type
Total Number
of Adults
__________
Total Number
of Children
___________
Total Number
in household
_____________
Extended family
Alone with child(ren)
Another partner
Other (please specify)__________________________
Metropolitan
Urban
Rural
(a) cities with 50,000 or more people
(a) 2,500 or more people
(b) counties with 50,000 or more, related to central city
with 100,000 or more
(b) densely populated area surrounding
central city of 50,000 or more
Sources of Income (check all that apply)
Household Income
$ _______________
Housing
Less than 2,500 people
Wages/ Salary
Unemployment
TANF
Social Security
Own
Rent
Subsidized housing
Child Support/Alimony
Other (specify)
__________________
Parent not comfortable
answering this question
Parent not comfortable
answering this question
Other (please specify)
____________________
GROUP MEETING PREFERENCE
Monday
Wednesday
Friday
Tuesday
Thursday
Saturday
HIPPY Application, Page 2
Revised January 2011
Age(s):
Child care Number of children
needing childcare ____
Afternoon needed
Morning
ADULT SERVICES RECORD FOR PRIMARY ADULT
Please indicate all services received by placing a check in box.
Adult Basic Education
Medicaid
Individual Counseling
GED Preparation
Regular Health Care
Family Counseling
English as Second Language
Special care/ Disability
Substance Abuse Treatment
Technical/Vocational Education
Financial Assistance
Employment Training
Healthy Families America (HFA)
Other Literacy Program
(specify)_________________________
Nurse Family Partnership (NFP)
Other (specify)
________________________________
FAMILY STATUS UPDATE
Did the family transfer IN from another HIPPY site?
Yes
No
Did the family transfer OUT to another HIPPY site?
Yes
No
Family Dropped HIPPY?
Yes
Drop-Out Date ____________________________________
No
If family dropped, check the reason why they left.
Moved
Dissatisfied with HIPPY
Dissatisfied with Home Visitor
Life Situation
Other (specify)__________________________________________________________________________________
Notes:
CHILD SERVICES RECORD
*TANF Eligible:
Yes
No
State Office Approved TANF:
N/A
Yes
*This child participates in a longitudinal study:
No
State Office Administrator:
Primary HIPPY Adult *Last Name
*First Name
HIPPY Child
*First Name
*Last Name
*Address 1
Address 2
City
Home Phone
*HIPPY
Year
State
*Zip
*DOB
*Gender
(mm/dd/yyyy)
HIPPY 3 (H3)
HIPPY Application, Page 3
Revised January 2011
HIPPY 4 (H4)
Female
Male
HIPPY 5 (H5) Social Security Number
Yes
No
CHILD SERVICES RECORD (continued)
*Hispanic origin
Yes, Puerto Rican
No, not Spanish/Hispanic/Latino
Yes, Cuban
Yes, Mexican, Mexican American, Chicano
Yes, other Spanish/Hispanic/Latino (specify) __________________________
*Race
White
Black or African American
American Indian and Alaska Natives
(specify principal tribe)
______________________________
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian (please specify)
________________________
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander (please specify)
________________________________
Other _________________________
Unknown
*Primary Language
English
Spanish
Other (specify) _____________________________
Secondary Language
English
Spanish
Other (specify) _____________________________
Please indicate all services received by placing a check in box to the left.
Center-based care
WIC
Vision Therapy
In-home child care
Food Stamps
Occupational Therapy
Head Start
Free/reduced lunch
Assistance for child’s emotional or behavior problems
Prekindergarten
Homeless shelter
Regular health care
Even Start
Speech Therapy
Medicaid
Parents as
Hearing Therapy
Teachers
Kindergarten
Physical Therapy
School Name/School ID/Teacher Name
EPSDT
Immunizations
Please indicate if the HIPPY child has a diagnosed disability or a suspected undiagnosed disability.
Does your child have a diagnosed disability?
Yes
No
Unknown
If yes, specify: _____________________________________________________________________________________
Does your child have a suspected disability?
Yes
No
Unknown
If yes, specify: _____________________________________________________________________________________
Please indicate if the child participated in pre- or post-testing.
Was pre-test/assessment administered?
Test Name
Test Score
Yes
No
Was post-test/assessment administered?
Test Name
Test Score
Yes
No
CHILD STATUS UPDATE
Is child temporarily inactive?
Yes
No Inactive start date _______________ Inactive stop date _______________
Child dropped HIPPY?
Yes
No Drop out date __________________________________________________
If child dropped, check the reason why they left:
Moved
Dissatisfied with HIPPY
Dissatisfied with Home Visitor
Life Situation
Other (specify) _____________________________________________________________________________________
HIPPY Application, Page 4
Revised January 2011
Revised November 2010
Home Visit Progress
Family ID
Child Last Name
Primary HIPPY Adult Last Name
AmeriCorps Family?
HIPPY 3 (H3)
Packet
number
delivered
Yes
Date
No
Home Visitor Code
_______________
HIPPY 4 (H4)
Average
Number of
number of
days worked
minutes/day
Child First Name
First Name
Home Visitor Last Name
HV Initial
HIPPY 5 (H5)
Comments
1
Revised November 2010
Home Visit Scheduling
Family ID
Child Last Name
Child First Name
Primary HIPPY Adult Last Name
AmeriCorps Family?
Yes
No
Home Visitor Code
_______________
First Name
Home Visitor Last Name
HV Initial
HIPPY 3 (H3)
HIPPY 4 (H4)
HIPPY 5 (H5)
Directions: Indicate the number of times each reason was a factor in not completing a Home Visit. If a home visit was made, write
in the date and the number of the Activity Packet which was delivered during that home visit.
Home
Packet
Adult not
Adult
Total
Packet received
Packet received at
Visitor
Date
Number
home
canceled
attempts during Home Visit?
Group Meeting?
canceled
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
1
Revised November 2010
Home Visit Scheduling
Did you have any problems scheduling a home visit? If yes, please describe.
2
Home Visitor Background
*Last Name
*First Name
*Address 1
Address 2
City
State
*Zip
Alternate Phone
Home Phone
*DOB
(cell, emergency)
*Email
*Gender
*Site ID Number
*Site Name
HIPPY employment
information
Salary $__________________
(FL programs only)
Full Time (w/HIPPY ONLY)
Is the Home Visitor a current
HIPPY Parent? Yes
No
Training
(Please check all that apply.)
Enter number of years of
prior experience
Is the Home Visitor a former
HIPPY Parent? Yes
No
Female
Male
Social Security Number
(FL, MD, & WI programs only)
Part Time
AmeriCorps
Non AmeriCorps
Primary language? English Spanish Other? ___________________
Secondary language? English Spanish Other? ________________
CDA
credentialed
Completed other
ECE/CD training
Currently enrolled in
CDA training
Currently enrolled in
other ECE/CD training
Classroom
Teacher/Aide
__________
Community
Organization
__________
Parent
Training
________
(please specify)
Other
______________________
If the Home Visitor is employed in work other than HIPPY, please share the number of non-HIPPY hours worked per week _______ .
Education Level (Check all that apply)
Child Development Associate credential
Doctorate
Less than a high school diploma or GED
Associates Degree
Other Degree _____________________
High school graduate
Bachelors Degree
Currently pursuing degree/certification
(please specify) ______________________
GED
Masters Degree
Professional specialization (Check all that apply)
Child Development
Secondary Education
Higher and Adult Education
Psychology
Early Childhood Education
Special Education
English as a Second Language
Sociology
Elementary Education
Family & Community Education
Social Work
Other(specify)________
Total number of Home Visit Observations conducted by Coordinator this program year _______________.
If the Home Visitor left the program, please check reason(s).
Moved
Other job
Poor performance
Low pay
Other (specify) _______________________________________
Employment dates
(Program enrollment)
*Start date
End date
(mm/dd/yyyy)
(mm/dd/yyyy)
Home Visitor Background – Revised February 2011
1
Parent Questionnaire – Baseline
1) What are some of your favorite ways to spend time with your child? (Check all that apply.)
talking
playing
taking walks
reading
playing games
going to the library
drawing pictures
playing educational games
shopping
sitting quietly
watching TV
sports
2) Of those activities, on which three do you spend the most time with your child?
talking
playing
taking walks
reading
playing games
going to the library
drawing pictures
playing educational games
shopping
sitting quietly
watching TV
sports
watching educational videos
Telling stories about family or culture
other ___________________________
watching educational videos
Telling stories about family or culture
other ___________________________
3) How much time do you have available to spend “one-on-one” time with your child each week?
1 to 2 hours
3 to 5 hours
5 to 8 hours
8 to 10 hours
10 hours or more
4) Is there a special “homework” place for your child to complete activities? Yes
No
5) Do you have resources (strategies, activities, ideas, materials) to work with your child? Yes
No
6) Please describe them (strategies, activities, ideas, materials) and how you developed or received them?
7) Have you visited your child’s pre-school/daycare this year? Yes
8) If yes, please check the reason for your visit:
No
help in the classroom
N/A
parent/teacher conference
child drop off/pick up
help with field trips
library volunteer
special events
other ____________________________________________________________________________
9) Approximately how many times in the last year did you attend a parent/teacher conference?
1 time
2 to 3 times
3 or more times
N/A
10) Approximately how many times last year did you help in the classroom?
1 time
2 to 3 times
3 or more times
N/A
11) Approximately how many times last year did you help with field trips?
1 time
2 to 3 times
3 or more times
N/A
12) Approximately how many times last year did you volunteer at the library?
1 time
2 to 3 times
3 or more times
N/A
13) Approximately how many times last year did you attend a special event?
1 time
2 to 3 times
3 or more times
N/A
HIPPY Parent Questionnaire – Baseline
Revised November 2010
2
14) Approximately how many times last year did you attend other events?
1 time
2 to 3 times
3 or more times
N/A
Describe “other” events:
15) Did the pre-school/daycare
make you feel comfortable?
No
Somewhat uncomfortable
Not sure
Somewhat comfortable
Very comfortable
Can you explain why you felt this way? Did something special happen?
16) Do you help out/volunteer in your community? Yes
No
17) If so, where and in what type of activity do you participate?
religious institution
cultural practices
school
library
community center
HIPPY
other
Specify where/what activities you are thinking of helping out/volunteering?
18) Do you participate in other community activities/groups? Yes
No
Please list them and tell us how you found out about them:
Community Activity/Group
How you found out about them
19) During the past year, have you participated in any course or workshop in any of the following areas? (This includes
college/university programs.)
Food safety
CPR
Parenting
Language
Professional skills
Employment
If so, please specify where:
Course/Workshop
Computer
Child development
Other
Location
HIPPY Parent Questionnaire – Baseline
Revised November 2010
1
Parent Questionnaire – Follow Up
1) What are some of your favorite ways to spend time with your child? (Check all that apply.)
talking
playing
taking walks
reading
playing games
going to the library
drawing pictures
playing educational games
shopping
sitting quietly
watching TV
sports
2) Of those activities, on which three do you spend the most time with your child?
talking
playing
taking walks
reading
playing games
going to the library
drawing pictures
playing educational games
shopping
sitting quietly
watching TV
sports
watching educational videos
Telling stories about family or culture
other ___________________________
watching educational videos
Telling stories about family or culture
other ___________________________
3) How much time do you have available to spend “one-on-one” time with your child each week?
1 to 2 hours
3 to 5 hours
5 to 8 hours
8 to 10 hours
10 hours or more
4) Is there a special “homework” place for your child to complete activities? Yes
No
5) Do you have resources (strategies, activities, ideas, materials) to work with your child? Yes
No
6) Please describe them (strategies, activities, ideas, materials) and how you developed or received them?
7) Have you visited your child’s pre-school/daycare this year? Yes
8) If yes, please check the reason for your visit:
No
help in the classroom
N/A
parent/teacher conference
child drop off/pick up
help with field trips
library volunteer
special events
other ____________________________________________________________________________
9) Approximately how many times in the last year did you attend a parent/teacher conference?
1 time
2 to 3 times
3 or more times
N/A
10) Approximately how many times last year did you help in the classroom?
1 time
2 to 3 times
3 or more times
N/A
11) Approximately how many times last year did you help with field trips?
1 time
2 to 3 times
3 or more times
N/A
12) Approximately how many times last year did you volunteer at the library?
1 time
2 to 3 times
3 or more times
N/A
13) Approximately how many times last year did you attend a special event?
1 time
2 to 3 times
3 or more times
N/A
HIPPY Parent Questionnaire – Follow Up
Revised November 2010
2
14) Approximately how many times last year did you attend other events?
1 time
2 to 3 times
3 or more times
N/A
Describe “other” events:
15) Did the pre-school/daycare
make you feel comfortable?
No
Somewhat uncomfortable
Not sure
Somewhat comfortable
Very comfortable
Can you explain why you felt this way? Did something special happen?
16) Do you help out/volunteer in your community? Yes
No
17) If so, where and in what type of activity do you participate?
religious institution
cultural practices
school
library
community center
HIPPY
other
Specify where/what activities you are thinking of helping out/volunteering?
18) Do you participate in other community activities/groups? Yes
No
Please list them and tell us how you found out about them:
Community Activity/Group
How you found out about them
19) During the past year, have you participated in any course or workshop in any of the following areas? (This includes
college/university programs.)
Food safety
CPR
Parenting
Language
Professional skills
Employment
If so, please specify where:
Course/Workshop
Computer
Child development
Other
Location
HIPPY Parent Questionnaire – Follow Up
Revised November 2010
Formación del coordinador
*Apellido
*Nombre
*Dirección 1
Dirección 2
Ciudad
Estado
Teléfono alternativo
Número de teléfono
*Sexo
*Número de ID del sitio
Femenino
Masculino
*Nombre del sitio
Coordinador
Nivel
educativo del
coordinador
Fecha de nacimiento
(celular, urgencias)
*Correo electrónico
*Puesto
Código postal
Subcoordinador
Credencial
colegiada en
Desarrollo infantil
Año de inicio
Tiempo completo (con HIPPY
SOLAMENTE)
Licenciado adjunto
(Subcoordinador únicamente)
Licenciatura
Tiempo parcial
Maestría
Doctorado
Otro grado/certificación (Especificar) ___________________________________________________________________________
¿Estudia para graduarse?
Sí
No (Respuesta afirmativa: especificar) _____________________________________________________________
Especialización profesional (Marcar todo lo que corresponda)
Desarrollo infantil
Educación secundaria
Educación infantil temprana
Educación especial
Educación de la familia y la
Educación elemental
comunidad
¿Habla más de un idioma con fluidez?
Sí
Enero
Asistencia social
Sicología
Sociología
Otra (Especificar)
_______________
No (Respuesta afirmativa, dar lista:) ____________________________________________________
Número de visitas de hogar
supervisadas del coordinador
Mes
Educación superior y de adultos
Inglés como segundo idioma
Mes
Número de visitas de hogar
supervisadas del coordinador
Julio
Febrero
Agosto
Marzo
Septiembre
Abril
Octubre
Mayo
Noviembre
Junio
Diciembre
Duplique esta información y complétela por cada coordinador adicional de un sitio.
Formación del coordinador
Revisado en enero de 2011
1
Formulario de salida de la familia
Nombre del adulto
Apellido del adulto
Nombre del niño(a)
Apellido del niño(a)
Dirección actual
Dirección
Ciudad, Estado, Código postal
Dirección anterior
Dirección
Ciudad, Estado, Código postal
Fecha de inscripción
HIPPY 3 (H3)
HIPPY 4 (H4)
HIPPY 5 (H5)
4
10
16
22
28
5
11
17
23
29
6
12
18
24
30
4
10
16
22
28
5
11
17
23
29
6
12
18
24
30
Fecha del despido (mes/año en que la familia dejó el programa)
Fecha del despido (semana en que la familia dejó el programa)
1
2
3
7
8
9
13
14
15
19
20
21
25
26
27
¿Estaba la familia atrasada cuando se la despidió?
Sí
No
De ser así, ¿en cuántas semanas?
1
2
7
8
13
14
19
20
25
26
3
9
15
21
27
Razón del despido
Un miembro de la familia dijo que “no”
No hubo interés de los padres
Trabajo
Crisis en la familia
No pudo programar el tiempo
Escuela
Se trasladó fuera del área de HIPPY
Nunca empezó el programa
Otra ________________________________
Estrategias de retención (estrategias para retener la familia)
Cambió de visitante de hogar
Reorganizó el programa de HIPPY
Redujo los elementos básicos del programa
Aumentó la frecuencia de las visitas
Proporcionó referencia paritaria
Permiso temporal
Otra (Especificar) ______________________________________________________________________________________________________
HIPPY Formulario de salida de la familia
Revisado en enero de 2011
2
Comentarios del visitante de hogar
Comentarios del coordinador
HIPPY Formulario de salida de la familia
Revisado en enero de 2011
Formulario de información financiera
Número de ID del sitio
Nombre del sitio
Estado
Fuentes de financiación del proyecto para el programa del año en curso.
Marque las casillas correspondientes e indique la cantidad exacta recibida por cada fuente.
Sección B. Fuentes federales
Departamento de
Educación de los EE.
UU.
Título I
$________________
Trabajadores
migratorios
$________________
Departamento de Vivienda
y Desarrollo Urbano de los
EE. UU.
HOPE VI
$________________
Departamento de Salud y
Servicios Humanos de los
EE. UU.
Head Start
$________________
Otra (Especificar)
$_________________
Early Head Start
$________________
Even Start
$________________
Otra (Especificar)
$_________________
Educación bilingüe
$________________
Otra (Especificar)
$_________________
Ley de Oportunidades de
aprendizaje temprano
(ELOA)
$________________
Otra (Especificar)
$ ________________
PIRC
$________________
Otra (Especificar)
$_________________
Otra (Especificar)
$_________________
Otra (Especificar)
$_________________
Otra (Especificar) $
________________
Otra (Especificar)
$_________________
Otra (Especificar)
$_________________
Otra (Especificar)
$_________________
Total de la columna
$ ________________
Total de la columna
$ ________________
Total de la columna
$ ________________
Total de la columna
$ ________________
Otras fuentes federales
AmeriCorps
$________________
Otra (Especificar)
$ ________________
Otra (Especificar)
$_________________
Total de fuentes
federales
Otra (Especificar)
$_________________
$ ________________
Sección C. Fuentes estatales
Depto. de Educación
$________________
Acción legislativa
$__________________
Universidad estatal
$________________
Otra (Especificar)
$ ________________
Total de fuentes
estatales
$ ________________
Sección D. Fuentes privadas
Fundaciones
$________________
United Way
$________________
Voluntarios
$________________
Corporativa (Especificar)
$________________
Donantes individuales
$________________
Basado en la fe/Iglesias
$________________
Otra (Especificar)
$________________
Otra (Especificar)
$________________
Otra (Especificar)
$________________
Total de fuentes privadas
$ ________________
Totales de financiación
Financiación directa (Totales de las secciones B,
C y D)
$_____________________
Información financiera – Revisada en enero de 2011
En especie
Presupuesto total
$___________________________
$___________________________
Formulario de resumen del encuentro del grupo
HIPPY USA ID del sitio
Fecha del
encuentro
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Coordinador(es)
Tema
Total de niños
Total de adultos
Total de familias de
HIPPY
representadas
Total de familias
inscritas
actualmente en el
programa
Total de familias de
AmeriCorps
representadas
Total de familias de
AmeriCorps
inscritas
actualmente en el
programa
Solicitud de HIPPY
ADULTO PRIMARIO O CUIDADOR DE HIPPY
*Apellido
*Nombre
*Dirección 1
Dirección 2
Ciudad
Teléfono
Estado
*Código postal
Teléfono alternatvo
*Fecha de nacimiento
(celular, urgencias)
Sexo
Correo electrónico
*Relación con el niño de HIPPY
Otra (Especificar)
__________________________
Femenino
Masculino
Madre
Madrastra
Madre de crianza
*Número de niños inscritos en HIPPY este año del
programa ________________________________
(dd/mm/aaaa)
*Estado
civil
Casado
Padre
Padrastro
Padre de crianza
*Estado de la
inscripción
*Edad del currículo para el que los padres se preparan con el
niño
Solicitó
Soltero
Separado
Viudo
Abuela
Abuelo
Tía/Tío
Inscrito
HIPPY 3 (H3)
Divorciado
Rehusado
HIPPY 4 (H4)
No elegible
HIPPY 5 (H5)
¿Cómo se enteró de HIPPY? ___________________________________________________________________________________
País de origen
EE. UU.
Otro (Especificar) _______________________________ Años en los EE. UU. ____________
INFORMACIÓN SOBRE IDIOMAS
Primer idioma
Inglés
Español
Otro (Especificar) ___________________________________
Segundo idioma
Inglés
Español
Otro (Especificar) ___________________________________
Comprensión del
inglés hablado
Avanzada
Baja
*Idioma del
currículo de
HIPPY
Inglés
Español
Ambos
Otro (Especificar) __________________
INFORMACIÓN SOBRE EMPLEO
Empleado
Sí
Ocupación
Estudiante
Solicitud de HIPPY, Página 1
Revisada en enero de 2011
No
Empleador _________________________________________________________
Trabaja tiempo
parcial
Trabaja tiempo
completo
Trabaja por
cuenta propia
Hogar
Desempleado
INFORMACIÓN SOBRE EDUCACIÓN
Grado de secundaria Sí
Grado universitario Sí
No
Nivel más alto de educación alcanzado
_________________________________________
No
Si no tiene grado de secundaria, indique el último año completado
______________
Inscrito actualmente en la
universidad
Sí No
Inscrito actualmente en secundaria
Sí No
GED Sí
No
Si está inscrito en la universidad, especifique el curso
_______________________________________________
RAZA Y ETNICIDAD
*Origen hispano
No, no es español/hispano/latino
Sí, puertorriqueño
Sí, cubano
*Raza
Blanco
Negro o afroamericano
Indio americano y nativos de Alaska
Sí, mexicano, mexicoamericano, chicano
Sí, otro español/hispano/latino (Especificar) _________________________________
Chino
Nativo de Hawai
Filipino
Guamaní o chamorro
Japonés
Samoano
Coreano
Otro isleño del Pacífico (Especificar)
(Especificar la tribu principal)
___________________________________
Vietnamita
_________________________________________ Otra región asiática (Especificar)
Otra _____________________________
____________________________
Indio asiático
Desconocida
DEMOGRAFÍA DE LA FAMILIA
*¿Familia migratoria?
Sí
No
*¿Familia inmigrante?
Sí
No
El padre / La madre vive con
Padre/madre del niño de HIPPY
Número de adultos
__________
Total en la vivienda
_____________
Familia extendida
Solo(a) con el niño(s)
Otro(a) compañero(a)
Otro (Especificar) ___________________________________
Metropolitana
Área
Número de niños
___________
(a) ciudades de 50.000 personas o más
(b) condados de 50.000 o más, en relación con la ciudad
central de 100.000 o más
Urbana
(a) 2.500 personas o más
(b) área densamente poblada que rodea a
una ciudad central de 50.000 o más
Fuentes de ingreso (Marcar todas las que correspondan)
Manutención del
Paga/ Salario
Desempleo
menor/Pensión alimenticia
$ _______________
Otra (Especificar)
TANF
Seguro Social
__________________
Le incomoda responder
Vivienda
Propia
Alquilada
Subvencionada
esta pregunta
Ingreso del hogar
Rural
Menos de 2.500 personas
Le incomoda responder
esta pregunta
Otra (Especificar)
____________________
PREFERENCIA DE ENCUENTROS DEL GRUPO
Lunes
Martes
Miércoles
Jueves
Solicitud de HIPPY, Página 2
Revisada en enero de 2011
Viernes
Sábado
Mañana
Tarde
Edad (es):
Se necesita
Número de niños que
cuidado de
necesitan cuidado ______
niños
HISTORIAL DE ATENCIÓN DEL ADULTO PRIMARIO
Marque las casillas correspondientes para indicar toda la atención recibida.
Educación básica del adulto
Medicaid
Orientación individual
Preparación para el GED
Atención regular de la salud
Orientación familiar
Inglés como segundo idioma
Atención especial/ Discapacidad
Tratamiento para el abuso de sustancias
Educación técnica/vocacional
Ayuda financiera
Capacitación para empleo
Otro programa de alfabetización
Healthy Families America (HFA)
Nurse Family Partnership (NFP)
Otra (Especificar) ___________________
(Especificar) _________________________
ACTUALIZACIÓN DEL ESTADO DE LA FAMILIA
¿Famiia transferida AQUÍ desde otro sitio de HIPPY?
¿Familia transferida A otro sitio de HIPPY?
¿Familia que se salió de HIPPY?
Sí
Sí
Sí
No
No
Fecha de salida _________________________________________
No
Si la familia se salió, marque el motivo que tuvo para salirse.
Traslado
Insatisfecha con HIPPY
Insatisfecha con el visitante de hogar
Hechos de la vida
Otro (Especificar)__________________________________________________________________________________
Notas:
HISTORIAL DEL CUIDADO DEL NIÑO
*TANF Elegibles:
Sí
No
Oficina Estatal Aprobado TANF: Sí
Adulto primario de
*Apellido
HIPPY
HIPPY Child
*Esta niña participa en un estudio longitudinal:
N/A
No
Sí
Administrador Estatal de Office:
*Nombre
*Apellido
*Nombre
*Dirección 1
Dirección 2
Ciudad
Teléfono
Solicitud de HIPPY, Página 3
Revisada en enero de 2011
Estado
*Código postal
*Fecha de nacimiento
*Sexo
(dd/mm/aaaa)
Femenino
Masculino
No
*Año de
HIPPY
HIPPY 3 (H3)
*Origen hispano
Sí, puertorriqueño
HIPPY 4 (H4)
HIPPY 5 (H5)
Número de Seguro Social
HISTORIAL DEL CUIDADO DEL NIÑO (Continuación)
No, no es español/hispano/latino
Sí, cubano
Sí, mexicano, mexicanoamericano, chicano
Sí, otro español/hispano/latino (Especificar) __________________________________
*Raza
Blanco
Negro o afroamericano
Indio Americano y natives de Alaska
Chino
Nativo de Hawai
Filipino
Guamaní o chamorro
Japonés
Samoano
Coreano
Otro isleño del Pacífico (Especificar)
(Especificar la tribu principal)
___________________________________
Vietnamita
_________________________________________
Otra region asiática (Especificar)
Otra _____________________________
____________________________
Indio asiático
Desconocida
*Primer idioma
Inglés
Español
Otro (Especificar) _________________________________
Segundo idioma
Inglés
Español
Otro (Especify) ___________________________________
Marque las casillas correspondientes a la izquierda para indicar toda la atención recibida.
Centro de cuidado
Cuidado del niño en
casa
Head Start
Prekindergarten
Even Start
Parents as Teachers
Kindergarten
WIC
Terapia visual
Estampillas de alimentos
Terapia ocupacional
Almuerzo gratis/reducido
Albergue para indigentes
Logopedia
Terapia del oído
Fisioterapia
Ayuda para problemas emocionales o de conducta del niño
Atención regular de la salud
Medicaid
EPSDT
Inmunizaciones
Nombre de la escuela/ ID de la escuela/Nombre de la maestra
Indique si al niño de HIPPY se le ha diagnosticado discapacidad o se sospecha de alguna no diagnosticada.
¿Tiene su niño una discapacidad diagnosticada?
Sí No Desconocido
Respuesta afirmativa, especificar: ________________________________________________________________________________
¿Se sospecha que su niño tenga una discapacidad?
Sí No Desconocido
Respuesta afirmativa, especificar: _______________________________________________________________________________
Indique si el niño participó en pruebas anteriores o posteriores.
¿Se hizo prueba o evaluación previa?
Sí No
¿Se hizo prueba o evaluación previa?
Sí No
¿Temporalmente inactivo?
_______________
¿Se fue de HIPPY?
Sí
Sí
Nombre de la prueba
Puntaje de la prueba
Nombre de la prueba
Puntaje de la prueba
ACTUALIZACIÓN DEL ESTADO DEL NIÑO
No Fecha de inicio de la Inactividad _______________ Fecha de terminación de la inactividad
No
Fecha de ida __________________________________________________
Si el niño se fue, señale el motivo:
Traslado
Insatisfecho con HIPPY
Insatisfecho con el visitante de hogar
Hechos de la vida
Otra (Especificar) _____________________________________________________________________________________________
Solicitud de HIPPY, Página 4
Revisada en enero de 2011
Revisado en noviembre de 2010
Progreso de la visita de hogar
ID de la familia
Apellido del niño(a)
Nombre del niño(a)
Apellido del adulto primario de HIPPY
¿Familia AmeriCorps?
Sí
HIPPY 3 (H3)
Número
del
paquete
entregado
No
Nombre
Código del visitante de
hogar_______________
HIPPY 4 (H4)
Fecha
Número de días
trabajados
Promedio del
número de
minutos/día
Apellido del visitante de hogar
HIPPY 5 (H5)
Comentarios
Inicial del VH
Revisado en noviembre de 2010
Programa de visitas de hogar
ID de la familia
Apellido del niño(a)
Apellido del adulto primario de HIPPY
¿Familia AmeriCorps?
HIPPY 3 (H3)
Sí
No
Nombre del niño(a)
Nombre
Código del visitante de
hogar _______________
HIPPY 4 (H4)
Apellido del visitante de hogar
Inicial del VH
HIPPY 5 (H5)
Instrucciones: Indique el número de veces en las que cada motivo fue un factor para no completar una visita de hogar. Si se hizo una visita de
hogar, anote la fecha y el número del Paquete de actividad entregado durante esa visita.
Número
Adulto no
Visitante de
¿Paquete recibido
Adulto
Total de
¿Paquete recibido en
del
estaba en
hogar
durante la visita de
Fecha
canceló
intentos
reunión de grupo?
paquete
casa
canceló
hogar?
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
Sí
No
1
Revisado en noviembre de 2010
Programa de visitas de hogar
¿Tuvo algún problema al programar una visita de hogar? Respuesta afirmativa: describir.
2
Formación del visitante de hogar
*Apellido
*Nombre
*Dirección 1
Dirección 2
Ciudad
Número de teléfono
Estado
*Código postal
Teléfono alternativo
*Fecha de nacimiento
(celular, urgencias)
*Correo electrónico
*Sexo
*Número de ID del sitio
*Nombre del sitio
Información de empleo de
HIPPY
Sueldo $_________________
(Programas de FL únicamente)
Tiempo completo (con HIPPY
SOLAMENTE)
¿Es el visitante de hogar padre de
HIPPY? Sí
No
Capacitación
(Marcar todo lo que corresponda)
Años de experiencia
¿Fue el visitante de hogar padre
de HIPPY? Sí
No
Femenino
Masculino
Número de Seguro Social
(Programas de FL, MD y WI únicamente)
Tiempo parcial
AmeriCorps
No de AmeriCorps
¿Tiene el visitante de hogar fluidez en más de un idioma?
Sí
NO (Respuesta afirmativa: dar lista) _______________________
Acreditado como
CDA
Completó otra
capacitación ECE/CD
Inscrito actualmente en
capacitación CDA
Inscrito actualmente en otra
capacitación ECE/CD
Maestro(a)
/Asistente
__________
Organización
comunitaria
__________
Capacitación de padres
________
(Especificar)
Otra
________________________
Si el visitante de hogar está empleado en trabajo que no es de HIPPY,
Número de horas que no trabaja para HIPPY:
indique el número de horas semanales que no trabaja para HIPPY.
_____________________________________
Nivel educativo (Marcar todo lo que
Credencial colegiada en Desarrollo infantil
Doctorado
corresponda)
Menos que diploma de bachillerato o GED
Licenciado adjunto
Grado de bachillerato
Licenciatura
GED
Maestría
Especialización profesional (Marcar todo lo que corresponda)
Desarrollo infantil
Educación secundaria
Educación infantil temprana
Educación especial
Educación elemental
Educación de familia y comunidad
Otro grado __________________________
Actualmente prosigue grado/certificación
(Especificar) ___________________________
Educación superior y de adultos
Inglés como segundo idioma
Asistencia social
Sicología
Sociología
Otra (Especificar) ________
Total de observaciones de la visita de hogar hecha por el coordinador en este año del programa ____________________.
Si el visitante de hogar dejó el programa, indique el motivo o los motivos.
Traslaso
Otro trabajo
Mal rendimiento
Pago bajo
Otro (Especificar) ___________________________________________
Fechas de empleo
(Inscripción en el programa)
*Fecha de inicio
(dd/mm/aaaa)
Formación del visitante de hogar – Revisado en enero de 2011
Fecha de terminación
(dd/mm/aaaa)
1
Cuestionario de los padres – Referencia
1)
¿Cuáles son algunas de sus formas favoritas de pasar el tiempo con su niño? (Marcar todo lo que corresponda)
Conversar
Jugar
Caminar
2)
Dibujar
Juegos educativos
Irnos de compras
Sentarnos en silencio
Ver televisión
Deportes
Ver videos educativos
Contar historias de familia o cultura
Otra _______________________________
Sentarnos en silencio
Ver televisión
Deportes
Ver videos educativos
Contar historias de familia o cultura
Otra _______________________________
De estas actividades, indique tres en las que pasa más tiempo con su niño:
Conversar
Jugar
Caminar
3)
Leer
Juegos
Ir a la biblioteca
Leer
Juegos
Ir a la biblioteca
Dibujar
Juegos educativos
Irnos de compras
¿Cuánto tiempo tiene disponible para pasar “cara a cara” con su niño cada semana?
1 a 2 horas
3 a 5 horas
5 a 8 horas
8 a 10 horas
10 horas o más
4)
¿Hay un lugar especial “de tareas” para que su niño complete las actividades? Sí
5)
¿Tiene recursos (estrategias, actividades, ideas, materiales) para trabajar con su niño? Sí
6)
Descríbalas (estrategias, actividades, ideas, materiales) y diga cómo las desarrolló o las recibió:
7)
¿Ha visitado el preescolar/la guardería de su niño este año? Sí
8)
Respuesta afirmativa, indique el motivo de su visita:
Conferencia de padres y
profesores
Eventos especiales
9)
No
No
No
N/A
Llevar o recoger al niño
Ayuda en el salón de
Ayuda en excursiones
Voluntario en la biblioteca
clases
Otro ________________________________________________________________________________________________
El año pasado, ¿aproximadamente cuántas veces asistió a conferencias de padres y profesores?
1 vez
2 a 3 veces
3 o más veces
N/A
10) El año pasado, ¿aproximadamente cuántas veces ayudó en el salón de clases?
1 vez
2 a 3 veces
3 o más veces
N/A
11) El año pasado, ¿aproximadamente cuántas veces ayudó en excursiones?
1 vez
2 a 3 veces
3 o más veces
N/A
12) El año pasado, ¿aproximadamente cuántas veces fue voluntario en la biblioteca?
1 vez
2 a 3 veces
3 o más veces
N/A
13) El año pasado, ¿aproximadamente cuántas veces asistió a un evento especial?
1 vez
2 a 3 veces
3 o más veces
N/A
1 vez
2 a 3 veces
3 o más veces
N/A
14) El año pasado, ¿aproximadamente cuántas veces asistió a otros eventos?
Cuestionario de los padres de HIPPY – Referencia
Revisado en noviembre de 2010
2
Describa “otros” eventos:
15)
¿Se sintió cómodo(a) en el
preescolar/la guardería?
No
No estoy
seguro(a)
Algo incómodo(a)
Algo cómodo(a)
Muy cómodo(a)
¿Puede explicar por qué se sintió así? ¿Ocurrió algo especial?
16) ¿Ayuda o sirve de voluntario en su comunidad? Sí
No
17) Si es así, ¿dónde y en qué tipo de actividad participa?
Institución religiosa
Prácticas culturales
Escuela
Biblioteca
Centro comunitario
HIPPY
Otro
Especifique dónde y en cuáles actividades piensa ayudar o ser voluntario:
18) ¿Participa en otras actividades/grupos comunitarios? Sí
No
Haga una lista y díganos cómo se enteró de ellas:
Actividad/Grupo comunitario
¿Cómo se enteró de ellas?
19) Durante el año pasado, ¿participó en algún curso o taller en alguno de los campos siguientes? (Esto incluye programas preuniversitarios/
universitarios).
Seguridad alimentaria
CPR (Resucitación
cardiopulmonar)
Crianza de niños
Lenguaje
Formación profesional
Computadoras
Desarrollo infantil
Empleo
Otro
Si es así, especifique dónde:
Curso/Taller
Lugar
Cuestionario de los padres de HIPPY – Referencia
Revisado en noviembre de 2010
1
Cuestionario de los padres – Seguimiento
1)
¿Cuáles son algunas de sus formas favoritas de pasar el tiempo con su niño? (Marcar todo lo que corresponda)
Conversar
Jugar
Caminar
2)
Dibujar
Juegos educativos
Irnos de compras
Sentarnos en silencio
Ver televisión
Deportes
Ver videos educativos
Contar historias de familia o cultura
Otra ________________________________
Sentarnos en silencio
Ver television
Deportes
Ver videos educativos
Contar historias de familia o cultura
Otra ________________________________
De estas actividades, indique tres en las que pasa más tiempo con su niño:
Conversar
Jugar
Caminar
3)
Leer
Juegos
Ir a la biblioteca
Leer
Juegos
Ir a la biblioteca
Dibujar
Juegos educativos
Irnos de compras
¿Cuánto tiempo tiene disponible para pasar “cara a cara” con su niño cada semana?
1 a 2 horas
3 a 5 horas
5 a 8 horas
8 a 10 horas
10 horas o más
4)
¿Hay un lugar especial “de tareas” para que su niño complete las actividades?
5)
¿Tiene recursos (estrategias, actividades, ideas, materiales) para trabajar con su niño?
6)
Descríbalas (estrategias, actividades, ideas, materiales) y diga cómo las desarrolló o las recibió:
7)
¿Ha visitado el preescolar/la guardería de su niño este año? Sí
8)
Respuesta afirmativa, indique el motivo de su visita:
Conferencia de padres y
profesores
Eventos especiales
9)
No
Sí
No
Sí
No
N/A
Llevar o recoger al niño
Ayuda en el salón de
Ayuda en excursiones
Voluntario en la biblioteca
clases
Otro ________________________________________________________________________________________________
El año pasado, ¿aproximadamente cuántas veces asistió a conferencias de padres y profesores?
1 vez
2 a 3 veces
3 o más veces
N/A
10) El año pasado, ¿aproximadamente cuántas veces ayudó en el salón de clases?
1 vez
2 a 3 veces
3 o más veces
N/A
11) El año pasado, ¿aproximadamente cuántas veces ayudó en excursiones?
1 vez
2 a 3 veces
3 o más veces
N/A
12) El año pasado, ¿aproximadamente cuántas veces fue voluntario en la biblioteca?
1 vez
2 a 3 veces
3 o más veces
N/A
13) El año pasado, ¿aproximadamente cuántas veces asistió a un evento especial?
1 vez
2 a 3 veces
3 o más veces
N/A
1 vez
2 a 3 veces
3 o más veces
N/A
14) El año pasado, ¿aproximadamente cuántas veces asistió a otros eventos?
Cuestionario de los padres de HIPPY – Seguimiento
Revisado en noviembre de 2010
2
Describa “otros” eventos:
15)
¿Se sintió cómodo(a) en el
preescolar/la guardería?
No
No estoy
seguro(a)
Algo incómodo(a)
Algo cómodo(a)
Muy cómodo(a)
¿Puede explicar por qué se sintió así? ¿Ocurrió algo especial?
16) ¿Ayuda o sirve de voluntario en su comunidad? Sí
No
17) Si es así, ¿dónde y en qué tipo de actividad participa?
Institución religiosa
Prácticas culturales
Escuela
Biblioteca
Centro comunitario
HIPPY
Otro
Especifique dónde y en cuáles actividades piensa ayudar o ser voluntario:
18) ¿Participa en otras actividades/grupos comunitarios? Sí
No
Haga una lista y díganos cómo se enteró de ellas:
Actividad/Grupo comunitario
¿Cómo se enteró de ellas?
19) Durante el año pasado, ¿participó en algún curso o taller en alguno de los campos siguientes? (Esto incluye programas preuniversitarios/
universitarios).
Seguridad alimentaria
CPR (Resucitación
cardiopulmonar)
Crianza de niños
Lenguaje
Formación profesional
Computadoras
Desarrollo infantil
Empleo
Otro
Si es así, especifique dónde:
Curso/Taller
Lugar
Cuestionario de los padres de HIPPY – Seguimiento
Revisado en noviembre de 2010
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