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 2 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. 3 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]. 4 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 5 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. 6 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 7 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). 8 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 9 Home Visitors Home Page Coordinators Home Page 10 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. 11 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. 12 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). 13 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 14 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 15 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). 16 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. 17 18 19 20 21 22 23 24 25 26 27 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. 28 29 30 31 32 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. 33 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. 34 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. 35 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