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Strengthen 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 (85 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

Rocky Mountain Network of Oral Health. 2022. RoMoNOH [Rocky Mountain Network of Oral Health] parent/caregiver oral health risk assessment. Denver, CO: Denver Health and Hospital Authority, 2 pp.

Annotation: This form for parents to complete at well-child visits for infants and children ages 6 months to 6 years includes space to provide the infant’s or child’s name and date of birth and the current date. It also provides a list of questions about the infant’s or child’s oral health and oral hygiene, their eating and drinking behaviors, whether they have seen an oral health professional in the past 6 months, whether they have a special health care need that makes it difficult to brush their teeth, and whether the parent thinks there is something they could do better to keep their infant’s or child’s teeth healthy. [Funded by the Maternal and Child Health Bureau]

Contact: Denver Health and Hospital Authority, 301 West 6th Avenue, Denver, CO 80204, Web Site: https://www.denverhealth.org/ Available from the website.

Keywords: Children, Forms, Infant health, Infants, Nutrition, Oral health, Oral hygiene, Special health care needs

Young D, Brown ZM, Somers S, Perkins J. 2021. Children's health under Medicaid: A national review of early and periodic screening, diagnostic, and treatment services 2015-2019 (4th ed.). Chapel Hill, NC: National Health Law Program, 163 pp.

Annotation: This chartbook presents Centers for Medicare & Medicaid Services Form CMS-416 annual data submitted by states for federal fiscal years 2015 to 2019. This form measures states’ efforts to ensure that children who are eligible for services, including oral health services provided through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program, receive these services. The chartbook includes background and provides an overview of EPSDT, describes the scope of EPSDT, and presents EPSDT reporting requirements.

Contact: National Health Law Program, North Carolina Office, 1512 E. Franklin St., Suite 110, Chapel Hill, NC 27514, Telephone: (919) 968-6308 Fax: (919) 968-8855 E-mail: nhelpnc@healthlaw.org Web Site: http://www.healthlaw.org Available from the website.

Keywords: Access to health care, EPSDT, Forms, Medicare, Oral health, State programs, Statistical data

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, to be completed by parents and oral health professionals, 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 is designed as a tool 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

Technical Assistance and Analytic Support for the Medicaid and CHIP Quality Measurement and Improvement Program. 2019. FFY 2019 Form CMS-416: Data quality checklist for states. Baltimore, MD: U.S. Centers for Medicare & Medicaid Services, 3 pp. (Medicaid & CHIP health care quality measures Technical assistance resource)

Annotation: This checklist was developed as a tool to assist states in completing Form CMS-416 (the annual Early and Periodic Screening, Diagnostic, and Treatment [EPSDT] program report) and help them improve the accuracy, completeness, consistency, and documentation of data reported for federal fiscal year (FFY) 2019. The checklist includes common issues noted in the data reported for FFY 2018 and earlier years.

Contact: U.S. Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244, Telephone: (877) 267-2323 Secondary Telephone: (410) 786-3000 Fax: Web Site: https://www.cms.gov Available from the website.

Keywords: EPSDT, Forms, Medicaid, Oral health, State materials, Statistical data

New Mexico Perinatal Oral Health Quality Improvement Project. [2018]. Setting oral health self-management goals. Albuquerque, NM: University of New Mexico Center for Development and Disability, 14 pp.

Annotation: This document includes forms that health professionals can use to help children and adults, including pregnant women, set oral health self-management goals, as well as in introduction to the forms. The forms are two-sided, with one side for the health professional and the other side to show the patient. Instructions for how to use the form are provided, and additional oral health resources in English and in Spanish are included.

Contact: University of New Mexico Center for Development and Disability, 2300 Menaul Boulevard, NE, Albuquerque, NM 87107, Telephone: (505) 272-3000 Fax: (505) 272-5280 Web Site: http://cdd.unm.edu Available from the website.

Keywords: Adult health, Forms, Health education, Oral health, Pregnant women, Prevention, Spanish language materials

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 (SBSPs) under the Ohio Department of Health (ODH). Contents include local program operations, regulatory compliance, compliance with ODH policies, SBSP 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 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.

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, Referrals, 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: These practice guidelines provide information on the oral health care of pregnant women in South Carolina. They contain data on infant mortality and preterm birth, oral health care and counseling utilization, and key findings from the South Carolina Pregnancy Risk Assessment Monitoring Systems (PRAMS) for 2012–2013. The guidelines also include 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

National Center on Early Childhood Health and Wellness. 2017. 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

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: CareQuest Institute for Oral Health, 465 Medford Street, Boston, MA 02129-1454, Telephone: (617) 886-1700 Web Site: https://www.carequest.org

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

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

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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.