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Strengthening the evidence for maternal and child health programs

Search Results: MCHLine

Items in this list may be obtained from the sources cited. Contact information reflects the most current data about the source that has been provided to the MCH Digital Library.


Displaying records 1 through 20 (82 total).

Clark D. n.d.. Dietary score: Assessment tools and instructions. Des Moines, IA: Iowa Department of Public Health , 20 pp.

Annotation: This manual is a dietary assessment tool used by licensed dietitians for WIC applicants and participants. The tool is divided into four sections, which are: 1) dietary questions, 2) food frequency, 3) nutrition risk assessment, and 4) space for a nutrition care plan. Each section has blank forms and instructions and suggestions.

Contact: Iowa Department of Public Health, 321 East 12th Street, Des Moines, IA 50319-0075, Telephone: (515) 281-7689 Secondary Telephone: (866) 227-9878 Contact Phone: (515) 281-5787 E-mail: https://www.idph.iowa.gov/Contact-Us Web Site: http://www.idph.iowa.gov Price unknown.

Keywords: Dietary assessment, Dietitians, Food habits, Forms, Nutrition assessment, Nutrition education, Nutrition monitoring, Nutrition research, WIC Program

National Network for Oral Health Access. n.d.. Dental forms library. Denver, CO: National Network for Oral Health Access, multiple items. (See also Unique no. 37885 (consent form for silver diamine flouoride))

Annotation: This resource presents a collection of forms in use by safety-net oral health programs across the country. The forms are organized into the following categories: consent forms, dental practice policies and procedures, guidelines and instructions, human resources forms, and quality. Some of the forms are available in English and Spanish.

Contact: National Network for Oral Health Access, 181 East 56th Avenue, Suite 501, Denver, CO 80216, Telephone: (866) 316-4995 Fax: (866) 316-4995 E-mail: info@nnoha.org Web Site: http://www.nnoha.org Available from the website.

Keywords: Forms, Oral health, Spanish language materials

National Center on Early Childhood Health and Wellness. n.d.. Head Start oral health forms. [Elk Grove Village, IL]: National Center on Early Childhood Health and Wellness, 4 items.

Annotation: These forms are designed for oral health professionals to record key information from dental visits with children and pregnant women enrolled in Head Start. The forms include space to record dental home status, oral health status, and what oral health care services were delivered during the dental visit (e.g., diagnostic and preventive services, counseling, restorative and emergency care, referral to a specialist for care). The forms also serve as records of what oral health care services are needed and of information to share with others. There are separate forms for children, pregnant women, and both, plus a sample provider letter.

Contact: Early Childhood Learning and Knowledge Center, Telephone: (866) 763-6481 E-mail: health@ecetta.info Web Site: https://eclkc.ohs.acf.hhs.gov Available from the website.

Keywords: Children, Forms, Head Start, Oral health, Patient care management, Pregnant women, Screening

Aronson SS, Shope TR, eds. 2019. Managing infectious diseases in child care and schools: A quick reference guide (5th ed.). Elk Grove Village, IL: American Academy of Pediatrics, 253 pp.

Annotation: This guide is a tool to encourage common understanding among educators, families, and health professionals about infectious diseases in group settings for children. The guide identifies the role of educators, families, public health officials, and health professionals in preventing and controlling the spread of communicable infections; symptoms of infections commonly found in group settings for children; how infections are spread (route of transmission); when to seek medical attention; inclusion and exclusion criteria; strategies and sample forms for communications involving directors/caregivers, parents/guardians, and health professionals; and resources for professional development for directors/teachers/caregivers related to infectious diseases.

Contact: American Academy of Pediatrics, 345 Park Boulevard, Itasca, IL 60143, Telephone: (630) 626-6000 Secondary Telephone: (847) 434-4000 Fax: (847) 434-8000 Web Site: https://www.aap.org . Document Number: ISBN 978-1-61002-050-3.

Keywords: Child care, Child health, Communicable disease control, Communicable diseases, Forms, Infection control, Infections, Prevention, Resources for professionals, Schools

DC Health. 2019. Oral health assessment form. Washington, DC: District of Columbia Department of Health, 1 p.

Annotation: This form, for parents and oral health professionals to fill out, provides space to write information about children over age 3 to give the child’s child care facility or school. Part I, for parents to fill out, is for the child’s name, age, birthdate, grade, and child care facility or school name. Part II, for an oral health professional to fill out, is for the child’s oral health status and insurance status. Space for the oral health professional’s name, signature, and stamp, as well as the date of the oral examination, is included.

Contact: District of Columbia Department of Health, 899 North Capitol Street, N.E., Washington, DC 20002, Telephone: (202) 442-5955 Fax: (202) 442-4795 E-mail: doh@dc.gov Web Site: http://doh.dc.gov/ Available from the website.

Keywords: Adolescent health, Child health, Forms, Oral health, School age children, Young children

National Center on Early Childhood Health and Wellness. 2019. Getting to know me: Information for your dental office while you are pregnant. Itasca, IL: National Center on Early Childhood Health and Wellness, 1 p.

Annotation: This form for pregnant women to provide information to help dental office staff understand and meet their needs. The form includes information about prenatal care received, what the woman does to take care of her mouth and teeth, and what questions she has about taking care of her mouth and teeth. It also includes information about problems experienced during pregnancy and whether the woman smokes, vapes, or drinks alcohol. [Funded in part by the Maternal and Child Health Bureau]

Contact: National Center on Early Childhood Health and Wellness, American Academy of Pediatrics, 345 Park Boulevard, Itasca, IL 60143, Telephone: (888) 227-5125 E-mail: health@ecetta.info Web Site: https://eclkc.ohs.acf.hhs.gov/ncechw Available from the website.

Keywords: , Forms, Health care utilization, Oral health, Pregnant women, Prevention, Treatment

Ohio Department of Health, Bureau of Maternal, Child, and Family Health. 2018. School-based dental sealant program manual. [Columbus, OH]: Ohio Department of Health, Bureau of Maternal, Child, and Family Health, 47 pp.

Annotation: This manual provides professional recommendations and states’ expectations for school-based dental sealant programs under the Ohio Department of Health (ODH). Contents include local program operations, regulatory compliance, compliance with ODH policies, sealant program eligibility, sample program forms, clinical materials and methods, retention checks, Medicaid billing and collection, reimbursement guidelines, health professional enrollment, filing claims, performance benchmarks and performance standards, reporting, ODH program reviews, and compliance with other ODH requirements. The appendices contain sample forms, records, letters, and other practice-related materials.

Contact: Ohio Department of Health, 246 North High Street, Columbus, OH 43215, Telephone: (614) 466-3543 Web Site: http://www.odh.ohio.gov Available from the website.

Keywords: Children, Dental sealants, Forms, Guideline adherence, Manuals, Ohio, Oral health, Parents, Resources for professionals, School based clinics, State programs

Children's Health Alliance of Wisconsin. 2018. Wisconsin Seal-A-Smile Administration Manual. Milwaukee, WI: Children's Health Alliance of Wisconsin, 35 pp.

Annotation: This manual provides policies and procedures for all Wisconsin Seal-A-Smile (SAS) grantees, with the goal of helping them administer programs and ensure consistency across programs. The purpose of SAS is to improve the oral health of Wisconsin children through school-based dental sealant programs. Topics include administrative and regulatory guidelines; program requirements; forms, reporting, and recording; and budget and funding information. Information about infection control and safe delivery of oral health care outside the dental office is included in appendices.

Contact: Children's Health Alliance of Wisconsin, 620 South 76th Street, Suite 120, Milwaukee, WI 53214, Telephone: (414) 292-4000 Secondary Telephone: (414) 337-4561 Fax: (414) 231-4972 Web Site: https://www.chawisconsin.org/ Available from the website.

Keywords: Administration, Data collection, Dental sealants, Disease prevention, Forms, Grants management, Oral health, Prevention programs, Reimbursement, School age children, School health programs, School health services, Screening, State programs, Wisconsin

Maryland Department of Health. 2018. Dental referral form for pregnant women. Baltimore, MD: Maryland Department of Health, 1 p.

Annotation: This form for pregnant women includes two sections, the first for a prenatal care professional to complete and send to an oral health professional and the second for an oral health professional to complete and return to the prenatal care professional. The first section has space for information about the woman, the referring health professional, allergies and precautions, and procedures and medications considered safe during pregnancy. The second section has space for the diagnosis, the treatment plan, and information about the oral health professional. [Funded by the Maternal and Child Health Bureau]

Contact: Maryland Department of Health, 201 West Preston Street, Baltimore, MD 21201, Telephone: (410) 767-6500 Secondary Telephone: (877) 463-3464 Web Site: http://www.dhmh.maryland.gov Available from the website.

Keywords: , Diagnosis, Forms, Oral health, Pregnant women, Referral, Treatment

South Carolina Oral Health Coalition. 2017. Oral health care for pregnant women. [Columbia, SC]: South Carolina Department of Health and Environmental Control, 30 pp.

Annotation: This document presents clinical practice guidelines for the oral health care of pregnant women in South Carolina. The document contains data on infant mortality and preterm birth, oral health care and counseling utilization. It includes recommendations for health professionals and for oral health professionals, referral forms for oral health care, and dentists' reports for prenatal care professionals. [Funded by the Maternal and Child Health Bureau]

Contact: South Carolina Department of Health and Environmental Control, 2600 Bull Street, Columbia, SC 29201, Telephone: (803) 898-3432 Fax: (803) 898-3323 E-mail: info@dhec.sc.gov Web Site: http://www.scdhec.gov Available from the website.

Keywords: Dental care, Disease management, Forms, Guidelines, Oral health, Pregnant women, Prevention services, Referrals, Resources for professionals, Service coordination, South Carolina, State programs

Byrne J. 2017. Perinatal and infant oral health community of practice: Quality improvement toolkit. Sacramento, CA: California Department of Public Health, Oral Health Program, multiple items. (Version 3: April 10, 2017)

Annotation: This toolkit provides guidance on assessing the effectiveness of a project to improve the delivery of oral health care services provided to pregnant women, infants, and young children by integrating oral health care into primary care. Contents include worksheets and guides for identifying, planning, implementing, and interpreting the effectiveness of a quality-improvement project. Topics include plan, do, study, act cycles and process mapping. [Funded by the Maternal and Child Health Bureau]

Contact: California Department of Public Health, Oral Health Program, MS Code 8305, P.O. Box 997377, MS 0500, Sacramento, CA 95899-7377, Telephone: (916) 558-1784 E-mail: mchinet@cdph.ca.gov Web Site: https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CDCB/Pages/OralHealthProgram/OralHealthProgram.aspx

Keywords: Organizational change, Data collection, Forms, Infant health, Infants, Oral health, Perinatal health, Pregnancy, Pregnant women, Program improvement, Qualitative evaluation, Quality assurance, Quantitative evaluation, Records management

National Center for Chronic Disease Prevention and Health Promotion, Division of Oral Health. 2017. Screening and evaluating safer dental devices. Atlanta, GA: Centers for Disease Control and Prevention, 2 items.

Annotation: This form is designed to assist oral health professionals in screening and evaluating devices for clinical acceptability and to increase safety for both oral health professionals and their clients. Contents include information about developing programs to prevent injuries, identifying safer dental devices, developing evaluation criteria, screening devices, and evaluating devices. Instructions for using the sample screening and device evaluation forms are included.

Contact: Centers for Disease Control and Prevention, Division of Oral Health, 1600 Clifton Road, Atlanta, GA 30329-4027, Telephone: (800) 232-4636 Secondary Telephone: (888) 232-6348 E-mail: cdcinfo@cdc.gov Web Site: http://www.cdc.gov/OralHealth Available from the website.

Keywords: Dental care, Forms, Infection control, Injury prevention, Oral health, Prevention programs, Safety

DentaQuest Institute. 2017. MORE care: The interprofessional oral health referral. Westborough, MA: DentaQuest Institute, 8 pp.

Annotation: This document describes the Medical-Oral Expanded Care (MORE Care) process designed to address challenges to the interprofessional referral process. The document enumerates challenges to the process; describes the development of MORE Care; and provides referral tools, forms, and a dental referral treatment report. Referral recommendations for different scenarios are provided. Risk-based population health and referral type are also discussed.

Contact: DentaQuest Partnership for Oral Health Advancement, 465 Medford Street, Boston, MA 02129-1454, Telephone: (617) 886-1700 Web Site: http://www.dentaquestpartnership.org

Keywords: Collaboration, Forms, Interdisciplinary approach, Oral health, Referrals

Future Smiles. 2016–. Future Smiles: Program forms. Las Vegas, NV: Future Smiles, 3 items.

Annotation: These forms are intended for use in implementing a school-based oral hygiene program to provide preventive oral health services (screenings, cleanings, fluoride varnish applications, dental sealant application, and education) for children from families with low incomes in Nevada. Contents include referral and consent forms and a privacy notice in English and Spanish.

Contact: Future Smiles, 3074 Arville Street, Las Vegas, NV 89102, Telephone: (702) 889-3763 E-mail: info@futuresmiles.net Web Site: http://futuresmilies.net Available from the website.

Keywords: Access to health care, Adolescents, Children, Consumer education materials, Dental sealants, Disease prevention, Fluorides, Forms, Infants, Low income groups, Nevada, Oral health, Oral hygiene, Preventive health services, Referrals, Schools, Spanish language materials

Future Smiles. 2016-. Future Smiles: Participation forms. Las Vegas, NV: Future Smiles, 4 items.

Annotation: These forms are intended for use in implementing a school-based oral hygiene program to provide preventive oral health services (screenings, cleanings, fluoride varnish applications, dental sealant application, and education) for children from families with low incomes in Nevada. Contents include a consent form, a data-collection form, a parent letter, and a privacy notice.

Contact: Future Smiles, 3074 Arville Street, Las Vegas, NV 89102, Telephone: (702) 889-3763 E-mail: info@futuresmiles.net Web Site: http://futuresmilies.net Available from the website.

Keywords: Dental sealants, Fluoride varnish, Forms, Low income groups, Nevada, Oral health, Oral hygiene, Prevention, School health programs, State programs

Wyoming Department of Health, Oral Health Program. 2016. State of Wyoming Marginal Dental Health Program. Cheyenne, WY: Wyoming Department of Health, Oral Health Program, 4 pp.

Annotation: This form is designed to help families with low incomes understand and apply for dental benefits for their infant, child, or adolescent from birth to age 19 in Wyoming who is not covered by Medicaid or the Children's Health Insurance Program. Contents include a description of program eligibility and benefits, including information about co-payments and coverage for dental sealants.

Contact: Wyoming Department of Health, Oral Health Program, 6101 Yellowstone Road, Suite 420, Cheyenne, WY 82002, Telephone: (307) 777-6921 Web Site: https://health.wyo.gov/healthcarefin/medicaid/ihs-638-tribal-health/dental-services Available on request from OHRC.

Keywords: Adolescents, Applications, Children, Dental care, Dental insurance, Dental sealants, Eligibility, Forms, Low income groups, Oral health, Program descriptions, State programs, Third party payers, Wyoming

U.S. Maternal and Child Health Bureau. 2016. Discretionary grant performance measures. Rockville, MD: U.S. Maternal and Child Health Bureau, 25 pp.

Annotation: This document for recipients of the federal Maternal and Child Health Bureau's Discretionary Grant Program contains instructions and forms for submitting performance measure data. Contents include information about the goals, definitions, benchmark and grantee data sources, and significance for each measure by domain; instructions and forms for collecting budget and expenditure data and project abstract and summary data; and forms for tracking project performance and outcome measures.

Contact: U.S. Maternal and Child Health Bureau, Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD 20857, Telephone: (301) 443-2170 Web Site: https://mchb.hrsa.gov Available from the website.

Keywords: Data collection, Federal grants, Forms, MCH programs, MCH research, MCH training, Measures, Outcome and process assessment, Program evaluation, Program improvement, Program planning, Progress reports

Rhode Island Department of Health. 2016. State of Rhode Island school dental screening form. Providence, RI: Rhode Island Department of Health, 1 p.

Annotation: This form for school oral health programs includes information to share with parents about their child’s oral health screening. In addition to space to insert the child’s school, name, grade, and classroom, the form allows school oral health programs to indicate whether the child has no obvious oral health problems, has problems that should be evaluated by a dentist, or needs immediate care by a dentist. Space for notes and additional comments as well as the screener’s name and screening date is included.

Contact: Rhode Island Department of Health, Three Capitol Hill, Providence, RI 02908, Telephone: (401) 222-5960 Web Site: http://www.health.state.ri.us

Keywords: Dental care, Forms, Oral health, Rhode Island, School age children, School health services, State programs

Iowa Department of Public Health, Oral Health Bureau. 2015–. Public health supervision of dental assistants. Des Moines, IA: Iowa Department of Public Health, Oral Health Bureau,

Annotation: This template can be used to document a collaborative agreement between a dentist and a dental assistant to allow the assistant to provide services to individuals in public health settings before being examined by a dentist.

Contact: Iowa Department of Public Health, Bureau of Oral and Health Delivery Systems, Lucas State Office Building, 321 East 12th Street, Des Moines, IA 50319-0075, Telephone: (515) 242-6383 Secondary Telephone: (866) 528-4020 Fax: (515) 242-6384 Web Site: http://www.idph.iowa.gov/ohds Available from the website.

Keywords: Collaboration, Dental assistants, Forms, Iowa, Oral health, Public health services, State programs, Supervision

Connecticut State Department of Education, Health Promotion Services/School Nurse Program. 2015. Early childhood health assessment record (for children ages birth–5) (rev.). Hartford, CT: Connecticut State Department of Education, 2 pp.

Annotation: This form is designed to help school nurses collect health data and communicate health standards and health status for children before they start school. The record includes two parts, one to be completed by parents and one to be completed by a health professional. The form provides a consistent format for primary care health professionals and program administrators who must complete the form and gather data on children's health and a consistent set of expectations for early child care professionals.

Contact: Connecticut State Department of Education, Bureau of Health/Nutrition, Family Services and Adult Education, 25 Industrial Park Road, Middletown, CT 06457, Telephone: (860) 807-2108 Fax: (860) 807-2127 Web Site: https://portal.ct.gov/SDE/Student-Supports/Student-Supports-Home-Page/Bureau-of-Health-Nutrition-Family-Services-and-Adult-Education Available from the website.

Keywords: Assessment, Data collection, Forms, Health status, Health supervision, School readiness, Young children

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This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.