Efforts To Outcomes (ETO) User's Guide - HIPPY USA Basic.pdf · Efforts To Outcomes (ETO) User’s Guide Created by May 2011 HIPPY USA 1221 Bishop Street Little Rock, Arkansas 72202

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

2

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

3

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.

mailto:[email protected]

https://hippyusa.hostedtraining.com/

4

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].


5

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

6

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.


7

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 Why, When and Frequency of Use

HIPPY Application

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

Parent Questionnaire – Baseline

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)

Parent Questionnaire – Follow Up

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

Family Exit Form 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

Home Visit Scheduling Form

Data entered after HIPPY child has received weekly packet

This data is used to track the number of home visits made

Home Visit Progress Form

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

Group Meeting Summary Form

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

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

Referral Form

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

Add /Edit Entity Form 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 Why, When and Frequency of Use

HIPPY Application

To collect basic demographics data of the parent and child

Used once when the parent enters the HIPPY program


8

Home Visitors Program Form Title Why, When and Frequency of Use

Home Visitor Background Form

To collect basic demographics data of home visitors

Used once when home visitor is hired


Performance Assessment – Baseline (currently disabled)

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

Performance Assessment – Follow Up (currently disabled)

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 Why, When and Frequency of Use

Coordinator Background

To collect basic demographics data of coordinators

Used at the beginning of every program year or each time a new coordinator is hired


Funding Information Form 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).

9

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

10

Home Visitors Home Page

Coordinators Home Page

11

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.

12

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.

13

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.

If Participant Dashboard Already Exists

Linking Adults and Children (Creating Households) From the Parents Home Page, Home Visitors will click the option next to Link Family Members.

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).

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.

To Set Up Dashboards 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

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.

14

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.

In the next window, click next to the family information to be updated.

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

Use HUSA Screen shot

To obtain a list of all families in the system, select .

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.

15

Select “Take New Assessment”

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 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 . Check the boxes beside all the individuals attending or participating in a specific point of service. Click .

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.

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.

16

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

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.

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).

17

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 .

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.

10) Adding An Entity

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 the service provider to view/change. Make all changes in the next window and click when complete.

18

19

20

21

22

23

24

25

26

27

28

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.

29

30

31

32

33

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.

34

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 non-Crystal (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.

35

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.

36

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.


37

37

38

ETO Pilot Site Contacts

Name Site City, State Email Phone Number

Deborah Baker Jeffco HIPPY Lakewood, CO [email protected] 303.982.0014

Eric Biel FL HIPPY State Office

Tampa, FL [email protected] 813.974.2177

Brenda Brinson Hillsborough County Center for Excellence

West Palm Beach, FL [email protected] 813.224.0558

Keshia Bruno TX HIPPY State Office

Dallas, TX [email protected] 214.442.1660

Susanna Cruz Jeffco HIPPY Lakewood, CO [email protected] 303.982.0014

Pamela Gaines Community Students Learning Center – PIRC

Lexington, MS [email protected] 662.834.0905

Alta Jones AR HIPPY State Office

Little Rock, AR [email protected] 501.364.3671

Kelly Keur InterCare Community Health Network

Benton Harbor, MI [email protected] 269.605.1277

Racquel Lopez

Imperial Valley Regional Occupational Program Project Nenes

El Centro, CA [email protected] 760.562.5924

Cathy McCrary St. Michael’s Preschool HIPPY

Hot Springs, AR [email protected] 501.623.2073

Glenda Nelson West Memphis School District

West Memphis, AR [email protected] 870.732.8572

Vicki Porter

Children’s Outing Association COA Youth and Family Centers

Milwaukee, WI [email protected] 414.263.8383

Jacqueline Richardson

AR HIPPY State Office

Little Rock, AR [email protected] 501.364.3671

Joanne Shum AL HIPPY State Office

Montgomery, AL [email protected] 334.265.2364

David Tisdale CO HIPPY State Office

Denver, CO [email protected] 303.860.6000

Nancy Tobias Baltimore County Public

Baltimore, MD [email protected] 410.887.3037

Carla Weir TX HIPPY State Office

Dallas, TX [email protected] 214.442.1660

Julan Wood Heber Springs HIPPY 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.




















39

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) Enters each family individually 2) Enters parent 3) Change program to “Children” to enter child 4) Switch back to the “Parent” program to work on next family file 5) Continue until all families are entered 6) 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

40

Notes

41

Notes

42

Notes

43

Notes

44

HIPPY USA 1221 Bishop Street Little Rock, Arkansas 72202 Phone 501.537.7726 Fax 501.537.7716 www.hippyusa.org

Revised December 2011

Enter prompts here

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.


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.


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


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.


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

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)

Only your site name will

appear.


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.


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) Enters each family individually 2) Enters parent 3) Change program to “Children” to enter child 4) Switch back to the “Parent” program to work on next family file 5) Continue until all families are entered 6) 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


Notes

How Do I…… March 2012

1

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 Enter the primary parent first and last name followed by Family (Angela Fake Family)

o Select Add New Family o Select the blue link to Search for Others o Select all participants that belong in that family (this includes all adults and

children)


2

Notes:


3

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:


4

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.


5

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.


6

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:


7

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:


8

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:

Coordinator Background Revised January 2011

Coordinator Background *Last Name *First Name

*Address 1

Address 2

City State *Zip

Home Phone Alternate Phone (cell, emergency)

*DOB

*Email *Gender Female Male

*Site ID Number *Site Name Year Initiated

*Position Coordinator Assistant Coordinator Full Time (w/HIPPY

ONLY) Part Time

Coordinator Educational Level

Child

Development Associate Credential

Associates Degree

(Assistant Coordinator only)

Bachelors

Degree 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 No If yes, please list _______________________________________

Month Number of coordinator supervised home visits

Month

Number of coordinator supervised home visits

January July

February August

March September

April October

May November

June December

Please duplicate this information and complete for each additional site coordinator.

1

HIPPY Family Exit Form Revised January 2011

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)

Dismissal Date (month/year in which family quit program)

Week of dismissal (week in which family quit program)

1 2 3 4 5 6

7 8 9 10 11 12

13 14 15 16 17 18

19 20 21 22 23 24 25 26 27 28 29 30

Was family behind when dismissed? Yes No

If so, how many weeks? 1 2 3 4 5 6

7 8 9 10 11 12

13 14 15 16 17 18

19 20 21 22 23 24 25 26 27 28 29 30

Reason for dismissal

A family member said “no” Crisis in family Moved out of HIPPY area

No parental interest Unable to schedule time Never started program

Work School 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) _______________________________________________________________________________________

2

HIPPY Family Exit Form Revised January 2011

Home Visitor Comments

Coordinator Comments

Funding Information Report – Revised January 2012

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

US Department of Education

US Department of Housing and Urban Development

US Department of Health and Human Services

Other Federal Sources

Do you have staff capacity to write grants?

Title I $________________

HOPE VI $________________

Head Start $________________

AmeriCorps $________________ � Yes � No

Migrant Workers $________________

Other (please specify) $_________________

Early Head Start $________________

Other (please specify) $ ________________

If yes, please list name and title below. Name:

Even Start $________________


Early Learning Opportunities Act (ELOA) $________________


Bilingual Education $________________




PIRC $________________




Title:





Column Total $ ________________

Column Total $ ________________

Column Total $ ________________

Column Total $ ________________

Federal Sources Total $ ________________

Section C. State Sources Dept of Education $________________

Legislative Action $__________________

State University $________________


State Sources Total $ ________________

Section D. Private Source(s) Foundations $________________

United Way $________________

Volunteers $________________

Corporate (please specify) $________________

Individual donors $________________

Faith-based/Churches $________________

Other (please specify) $________________



Private Sources Total $ ________________

Funding Totals Direct Funding (Totals of section B, C, & D) $_____________________

In-kind $___________________________

Total budget $___________________________

Group Meeting Summary Form HIPPY USA Site ID Coordinator(s)

Date of Meeting 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

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

HIPPY Application, Page 1 Revised January 2011

HIPPY Application

PRIMARY HIPPY ADULT OR CAREGIVER

*Last Name *First Name

*Address 1

Address 2

City State *Zip


*DOB (mm/dd/yyyy)

Email *Gender Female

Male

*Marital Status

Married Single Divorced Separated Widowed

*Relationship to HIPPY Child Mother Father Grandmother

Other (specify) __________________________

Stepmother Stepfather Grandfather

Foster Mother Foster Father Aunt/Uncle

*Number of children enrolled in HIPPY this program year _____________________

*Enrollment Status

Applied Enrolled Declined Not Eligible

*Curriculum age parent is working with the child HIPPY 3 (H3) HIPPY 4 (H4) 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

Advanced

Low

*HIPPY Curriculum Language

English Spanish Both Other (specify) _________________

EMPLOYMENT INFORMATION

Employed Yes No Employer ____________________________________________________

Occupation Student Work, part-time Work, full-time Self-employed Homemaker Unemployed


EDUCATION INFORMATION

High School Graduate Yes No College Graduate Yes No Highest level of education completed _________________________________________

If not high school graduate, enter last grade completed ______________ GED Yes No

Currently enrolled in high school

Yes No

Currently enrolled in college

Yes No

If enrolled in college, specify course of study __________________________________________

RACE AND ETHNICITY

*Hispanic origin No, not Spanish/Hispanic/Latino Yes, Mexican, Mexican American, Chicano

Yes, Puerto Rican Yes, Cuban Yes, other Spanish/Hispanic/Latino (specify) __________________________

*Race Chinese Native Hawaiian

White Filipino Guamanian or Chamorro

Black or African American Japanese Samoan

American Indian and Alaska Natives Korean Other Pacific Islander (please specify)

(specify principal tribe) Vietnamese ________________________________

______________________________ Other Asian (please specify) Other _________________________

Asian Indian ________________________ Unknown

HOUSEHOLD DEMOGRAPHICS

*Migrant Family?

Yes No

*Immigrant Family?

Yes No

Total Number of Adults

__________

Total Number of Children

___________

Total Number in household

_____________

Parent lives with Extended family Alone with child(ren)

Father/mother of HIPPY child Another partner Other (please specify)__________________________

Area Type

Metropolitan (a) cities with 50,000 or more people (b) counties with 50,000 or more, related to central city with 100,000 or more

Urban (a) 2,500 or more people (b) densely populated area surrounding central city of 50,000 or more

Rural Less than 2,500 people

Household Income $ _______________

Sources of Income (check all that apply)

Wages/ Salary Unemployment Child Support/Alimony Parent not comfortable

answering this question

TANF Social Security Other (specify)

__________________

Housing Own Rent Subsidized housing Parent not comfortable

answering this question

Other (please specify) ____________________

GROUP MEETING PREFERENCE

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Morning

Afternoon

Child care

needed Number of children needing childcare ____

Age(s):


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

Other Literacy Program

(specify)_________________________

Healthy Families America (HFA)

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 No Drop-Out Date ____________________________________

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 N/A *This child participates in a longitudinal study: Yes No

State Office Approved TANF: Yes No State Office Administrator:

Primary HIPPY Adult *Last Name *First Name

HIPPY Child *Last Name *First Name

*Address 1

Address 2

City State *Zip

Home Phone *DOB (mm/dd/yyyy)

*Gender Female

Male

*HIPPY Year

HIPPY 3 (H3) HIPPY 4 (H4) HIPPY 5 (H5) Social Security Number


CHILD SERVICES RECORD (continued)

*Hispanic origin No, not Spanish/Hispanic/Latino Yes, Mexican, Mexican American, Chicano

Yes, Puerto Rican Yes, Cuban Yes, other Spanish/Hispanic/Latino (specify) __________________________

*Race Chinese Native Hawaiian

White Filipino Guamanian or Chamorro

Black or African American Japanese Samoan

American Indian and Alaska Natives Korean Other Pacific Islander (please specify)

(specify principal tribe) Vietnamese ________________________________

______________________________ Other Asian (please specify) Other _________________________

Asian Indian ________________________ 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

Teachers

Hearing Therapy EPSDT

Kindergarten Physical Therapy Immunizations

School Name/School ID/Teacher Name

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

Yes No Test Score

Was post-test/assessment administered? Test Name

Yes No Test Score

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) _____________________________________________________________________________________

Revised November 2010

1

Home Visit Progress Family ID Child Last Name Child First Name Primary HIPPY Adult Last Name First Name

AmeriCorps Family? � Yes � No Home Visitor Code _______________

Home Visitor Last Name HV Initial

� HIPPY 3 (H3) � HIPPY 4 (H4) � HIPPY 5 (H5) Packet number

delivered Date Number of

days worked Average

number of minutes/day

Comments


1

Home Visit Scheduling Family ID Child Last Name Child First Name Primary HIPPY Adult Last Name First Name

AmeriCorps Family? � Yes � No Home Visitor Code _______________

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.

Packet Number

Adult not home

Adult canceled

Home Visitor

canceled Total

attempts Packet received

during Home Visit? Packet received at Group Meeting? Date

� � � � 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


2

Home Visit Scheduling

Did you have any problems scheduling a home visit? If yes, please describe.

Home Visitor Background – Revised February 2011

Home Visitor Background

*Last Name *First Name

*Address 1

Address 2

City State *Zip


*DOB

*Email *Gender Female Male

*Site ID Number *Site Name

HIPPY employment information

Salary $__________________ (FL programs only)

Social Security Number (FL, MD, & WI programs only)

Full Time (w/HIPPY ONLY) Part Time AmeriCorps Non AmeriCorps

Is the Home Visitor a current

HIPPY Parent? Yes No

Is the Home Visitor a former

HIPPY Parent? Yes No

Primary language? English Spanish Other? ___________________

Secondary language? English Spanish Other? ________________

Training (Please check all that apply.)

CDA

credentialed Completed other

ECE/CD training

Currently enrolled in

CDA training Currently enrolled in

other ECE/CD training

Enter number of years of prior experience

Classroom

Teacher/Aide __________

Community

Organization __________

Parent

Training ________

Other (please specify)

______________________

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

GED Masters Degree (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)________

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 (mm/dd/yyyy)

End date (mm/dd/yyyy)

1

HIPPY Parent Questionnaire – Baseline Revised November 2010

Parent Questionnaire – Baseline 1) What are some of your favorite ways to spend time with your child? (Check all that apply.) � talking � reading �drawing pictures � sitting quietly � watching educational videos � playing � playing games � playing educational games � watching TV � Telling stories about family or culture � taking walks � going to the library � shopping � sports � other ___________________________ 2) Of those activities, on which three do you spend the most time with your child? � talking � reading �drawing pictures � sitting quietly � watching educational videos � playing � playing games � playing educational games � watching TV � Telling stories about family or culture � taking walks � going to the library � shopping � sports � 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 � No � N/A 8) If yes, please check the reason for your visit: � parent/teacher conference � child drop off/pick up � help in the classroom � 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

2

HIPPY Parent Questionnaire – Baseline Revised November 2010

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 � Language � Computer � CPR � Professional skills � Child development � Parenting � Employment � Other If so, please specify where:

Course/Workshop Location

1

HIPPY Parent Questionnaire – Follow Up Revised November 2010

Parent Questionnaire – Follow Up 1) What are some of your favorite ways to spend time with your child? (Check all that apply.) � talking � reading �drawing pictures � sitting quietly � watching educational videos � playing � playing games � playing educational games � watching TV � Telling stories about family or culture � taking walks � going to the library � shopping � sports � other ___________________________ 2) Of those activities, on which three do you spend the most time with your child? � talking � reading �drawing pictures � sitting quietly � watching educational videos � playing � playing games � playing educational games � watching TV � Telling stories about family or culture � taking walks � going to the library � shopping � sports � 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 � No � N/A 8) If yes, please check the reason for your visit: � parent/teacher conference � child drop off/pick up � help in the classroom � 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

2

HIPPY Parent Questionnaire – Follow Up Revised November 2010

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 � Language � Computer � CPR � Professional skills � Child development � Parenting � Employment � Other If so, please specify where:

Course/Workshop Location

Formación del coordinador Revisado en enero de 2011

Formación del coordinador *Apellido *Nombre

*Dirección 1

Dirección 2

Ciudad Estado Código postal

Número de teléfono Teléfono alternativo (celular, urgencias) Fecha de nacimiento

*Correo electrónico *Sexo � Femenino � Masculino

*Número de ID del sitio *Nombre del sitio Año de inicio

*Puesto � Coordinador � Subcoordinador � Tiempo completo (con HIPPY SOLAMENTE) � Tiempo parcial

Nivel educativo del coordinador

� Credencial colegiada en Desarrollo infantil

� Licenciado adjunto (Subcoordinador únicamente) � Licenciatura � 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 superior y de adultos � Sicología � Educación infantil temprana � Educación especial � Inglés como segundo idioma � Sociología

� Educación elemental � Educación de la familia y la comunidad � Asistencia social � Otra (Especificar)

_______________ ¿Habla más de un idioma con fluidez? � Sí � No (Respuesta afirmativa, dar lista:) ____________________________________________________

Mes Número de visitas de hogar supervisadas del coordinador

Mes Número de visitas de hogar supervisadas del coordinador

Enero Julio Febrero Agosto Marzo Septiembre Abril Octubre Mayo Noviembre Junio Diciembre

Duplique esta información y complétela por cada coordinador adicional de un sitio.

1

HIPPY Formulario de salida de la familia Revisado en enero de 2011

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)

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 4 5 6

7 8 9 10 11 12

13 14 15 16 17 18

19 20 21 22 23 24 25 26 27 28 29 30

¿Estaba la familia atrasada cuando se la despidió? Sí No

De ser así, ¿en cuántas semanas?

1 2 3 4 5 6

7 8 9 10 11 12

13 14 15 16 17 18

19 20 21 22 23 24 25 26 27 28 29 30

Razón del despido

Un miembro de la familia dijo que “no” Crisis en la familia Se trasladó fuera del área de HIPPY

No hubo interés de los padres No pudo programar el tiempo Nunca empezó el programa

Trabajo Escuela 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) ______________________________________________________________________________________________________

2

HIPPY Formulario de salida de la familia Revisado en enero de 2011

Comentarios del visitante de hogar

Comentarios del coordinador

Información financiera – Revisada 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.

Departamento de Vivienda y Desarrollo Urbano de los EE. UU.

Departamento de Salud y Servicios Humanos de los EE. UU.

Otras fuentes federales

Total de fuentes federales $ ________________

Título I $________________

HOPE VI $________________

Head Start $________________

AmeriCorps $________________

Trabajadores migratorios $________________

Otra (Especificar) $_________________

Early Head Start $________________

Otra (Especificar) $ ________________

Even Start $________________


Ley de Oportunidades de aprendizaje temprano (ELOA) $________________


Educación bilingüe $________________




PIRC $________________








Total de la columna $ ________________




Sección C. Fuentes estatales

Depto. de Educación $________________

Acción legislativa $__________________

Universidad estatal $________________


Total de fuentes estatales $ ________________

Sección D. Fuentes privadas

Fundaciones $________________

United Way $________________

Voluntarios $________________

Corporativa (Especificar) $________________

Donantes individuales $________________

Basado en la fe/Iglesias $________________

Otra (Especificar) $________________



Total de fuentes privadas $ ________________

Totales de financiación Financiación directa (Totales de las secciones B,

C y D)

$_____________________

En especie $___________________________

Presupuesto total $___________________________

Formulario de resumen del encuentro del grupo HIPPY USA ID del sitio Coordinador(es)

Fecha del encuentro

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

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

Solicitud de HIPPY, Página 1 Revisada en enero de 2011

Solicitud de HIPPY

ADULTO PRIMARIO O CUIDADOR DE HIPPY *Apellido *Nombre

*Dirección 1

Dirección 2

Ciudad Estado *Código postal

Teléfono Teléfono alternatvo (celular, urgencias)

*Fecha de nacimiento (dd/mm/aaaa)

Correo electrónico Sexo � Femenino � Masculino

*Estado civil

� � � � � Casado Soltero Divorciado Separado Viudo

*Relación con el niño de HIPPY � Madre � Padre � Abuela � Otra (Especificar) __________________________

� Madrastra � Padrastro � Abuelo � Madre de crianza � Padre de crianza � Tía/Tío

*Número de niños inscritos en HIPPY este año del programa ________________________________

*Estado de la inscripción � Solicitó � Inscrito � Rehusado � No elegible

*Edad del currículo para el que los padres se preparan con el niño � HIPPY 3 (H3) � HIPPY 4 (H4) � 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 � No Empleador _________________________________________________________

Ocupación � Estudiante � Trabaja tiempo parcial

� Trabaja tiempo completo

� Trabaja por cuenta propia � Hogar � Desempleado


INFORMACIÓN SOBRE EDUCACIÓN

Grado de secundaria Sí � No � Grado universitario Sí � No � Nivel más alto de educación alcanzado _________________________________________

Si no tiene grado de secundaria, indique el último año completado ______________ GED Sí � No �

Inscrito actualmente en secundaria Sí � No �

Inscrito actualmente en la universidad Sí � No �

Si está inscrito en la universidad, especifique el curso _______________________________________________

RAZA Y ETNICIDAD *Origen hispano � No, no es español/hispano/latino � Sí, mexicano, mexicoamericano, chicano � Sí, puertorriqueño � Sí, cubano � Sí, otro español/hispano/latino (Especificar) _________________________________ *Raza � Chino � Nativo de Hawai � Blanco � Filipino � Guamaní o chamorro � Negro o afroamericano � Japonés � Samoano � Indio americano y nativos de Alaska � 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

Número de adultos __________

Número de niños ___________

Total en la vivienda _____________

El padre / La madre vive con � Familia extendida � Solo(a) con el niño(s)

� Padre/madre del niño de HIPPY � Otro(a) compañero(a) � Otro (Especificar) ___________________________________

Área � Metropolitana (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

� Rural Menos de 2.500 personas

Ingreso del hogar $ _______________

Fuentes de ingreso (Marcar todas las que correspondan)

� Paga/ Salario � Desempleo � Manutención del menor/Pensión alimenticia

� Le incomoda responder esta pregunta � TANF � Seguro Social � Otra (Especificar)

__________________

Vivienda � Propia � Alquilada � Subvencionada � Le incomoda responder esta pregunta

� Otra (Especificar) ____________________

PREFERENCIA DE ENCUENTROS DEL GRUPO � Lunes � Martes

� Miércoles � Jueves

� Viernes � Sábado

� Mañana � Tarde

� Se necesita cuidado de niños

Número de niños que necesitan cuidado ______

Edad (es):


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 (Especificar) _________________________

� Healthy Families America (HFA) � Nurse Family Partnership (NFP) � Otra (Especificar) ___________________

ACTUALIZACIÓN DEL ESTADO DE LA FAMILIA

¿Famiia transferida AQUÍ desde otro sitio de HIPPY? � Sí � No

¿Familia transferida A otro sitio de HIPPY? � Sí � No

¿Familia que se salió de HIPPY? � Sí � No Fecha de salida _________________________________________

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 � N/A *Esta niña participa en un estudio longitudinal: � Sí � No

Oficina Estatal Aprobado TANF: � Sí � No Administrador Estatal de Office: Adulto primario de HIPPY *Apellido *Nombre

HIPPY Child *Apellido *Nombre

*Dirección 1

Dirección 2


Teléfono *Fecha de nacimiento (dd/mm/aaaa)

*Sexo � Femenino � Masculino


*Año de HIPPY � HIPPY 3 (H3) � HIPPY 4 (H4) � HIPPY 5 (H5) Número de Seguro Social

HISTORIAL DEL CUIDADO DEL NIÑO (Continuación) *Origen hispano � No, no es español/hispano/latino � Sí, mexicano, mexicanoamericano, chicano

� Sí, puertorriqueño � Sí, cubano � Sí, otro español/hispano/latino (Especificar) __________________________________

*Raza � Chino � Nativo de Hawai � Blanco � Filipino � Guamaní o chamorro � Negro o afroamericano � Japonés � Samoano � Indio Americano y natives de Alaska � 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 � WIC � Terapia visual � Cuidado del niño en casa � Estampillas de alimentos � Terapia ocupacional

� Head Start � Almuerzo gratis/reducido � Ayuda para problemas emocionales o de conducta del niño � Prekindergarten � Albergue para indigentes � Atención regular de la salud � Even Start � Logopedia � Medicaid � Parents as Teachers � Terapia del oído � EPSDT � Kindergarten � Fisioterapia � 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? Nombre de la prueba � Sí � No Puntaje de la prueba ¿Se hizo prueba o evaluación previa? Nombre de la prueba � Sí � No Puntaje de la prueba

ACTUALIZACIÓN DEL ESTADO DEL NIÑO ¿Temporalmente inactivo? � Sí � No Fecha de inicio de la Inactividad _______________ Fecha de terminación de la inactividad _______________ ¿Se fue de HIPPY? � Sí � 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) _____________________________________________________________________________________________

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 Nombre

¿Familia AmeriCorps? Sí No Código del visitante de

hogar_______________

Apellido del visitante de hogar Inicial del VH

HIPPY 3 (H3) HIPPY 4 (H4) HIPPY 5 (H5)

Número del

paquete entregado

Fecha Número de días

trabajados

Promedio del número de minutos/día

Comentarios


1

Programa de visitas de hogar

ID de la familia Apellido del niño(a) Nombre del niño(a)

Apellido del adulto primario de HIPPY Nombre

¿Familia AmeriCorps? Sí No Código del visitante de

hogar _______________

Apellido del visitante de hogar Inicial del VH

HIPPY 3 (H3) HIPPY 4 (H4) 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 del

paquete

Adulto no estaba en

casa

Adulto canceló

Visitante de hogar

canceló

Total de intentos

¿Paquete recibido durante la visita de

hogar?

¿Paquete recibido en reunión de grupo?

Fecha

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


2

Programa de visitas de hogar

¿Tuvo algún problema al programar una visita de hogar? Respuesta afirmativa: describir.

Formación del visitante de hogar – Revisado en enero de 2011

Formación del visitante de hogar

*Apellido *Nombre

*Dirección 1

Dirección 2


Número de teléfono Teléfono alternativo (celular, urgencias) *Fecha de nacimiento

*Correo electrónico *Sexo � Femenino � Masculino

*Número de ID del sitio *Nombre del sitio

Información de empleo de HIPPY

Sueldo $_________________ (Programas de FL únicamente)

Número de Seguro Social (Programas de FL, MD y WI únicamente)

� Tiempo completo (con HIPPY SOLAMENTE) � Tiempo parcial � AmeriCorps � No de AmeriCorps

¿Es el visitante de hogar padre de HIPPY? � Sí � No

¿Fue el visitante de hogar padre de HIPPY? � Sí � No

¿Tiene el visitante de hogar fluidez en más de un idioma? � Sí � NO (Respuesta afirmativa: dar lista) _______________________

Capacitación (Marcar todo lo que corresponda)

� Acreditado como CDA

� Completó otra capacitación ECE/CD

� Inscrito actualmente en capacitación CDA

� Inscrito actualmente en otra capacitación ECE/CD

Años de experiencia � Maestro(a) /Asistente __________

� Organización comunitaria __________

� Capacitación de padres ________

� Otra (Especificar) ________________________

Si el visitante de hogar está empleado en trabajo que no es de HIPPY, indique el número de horas semanales que no trabaja para HIPPY.

Número de horas que no trabaja para HIPPY: _____________________________________

Nivel educativo (Marcar todo lo que corresponda) � Credencial colegiada en Desarrollo infantil � Doctorado � Menos que diploma de bachillerato o GED � Licenciado adjunto � Otro grado __________________________ � Grado de bachillerato � Licenciatura � Actualmente prosigue grado/certificación � GED � Maestría (Especificar) ___________________________ Especialización profesional (Marcar todo lo que corresponda) � Desarrollo infantil � Educación secundaria � Educación superior y de adultos � Sicología � Educación infantil temprana � Educación especial � Inglés como segundo idioma � Sociología � Educación elemental � Educación de familia y comunidad � Asistencia social � 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)

Fecha de terminación (dd/mm/aaaa)

1

Cuestionario de los padres de HIPPY – Referencia Revisado en noviembre de 2010

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 Leer Dibujar Sentarnos en silencio Ver videos educativos

Jugar Juegos Juegos educativos Ver televisión Contar historias de familia o cultura

Caminar Ir a la biblioteca Irnos de compras Deportes Otra _______________________________

2) De estas actividades, indique tres en las que pasa más tiempo con su niño: Conversar Leer Dibujar Sentarnos en silencio Ver videos educativos


Caminar Ir a la biblioteca Irnos de compras Deportes Otra _______________________________

3) ¿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 No

5) ¿Tiene recursos (estrategias, actividades, ideas, materiales) para trabajar con su niño? Sí No

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 No N/A

8) Respuesta afirmativa, indique el motivo de su visita:

Conferencia de padres y profesores

Llevar o recoger al niño Ayuda en el salón de clases

Ayuda en excursiones Voluntario en la biblioteca

Eventos especiales Otro ________________________________________________________________________________________________

9) 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?


11) El año pasado, ¿aproximadamente cuántas veces ayudó en excursiones?


12) El año pasado, ¿aproximadamente cuántas veces fue voluntario en la biblioteca?


13) El año pasado, ¿aproximadamente cuántas veces asistió a un evento especial?


14) El año pasado, ¿aproximadamente cuántas veces asistió a otros eventos? 1 vez 2 a 3 veces 3 o más veces N/A

2

Cuestionario de los padres de HIPPY – Referencia Revisado en noviembre de 2010

Describa “otros” eventos:

15) ¿Se sintió cómodo(a) en el

preescolar/la guardería? No Algo incómodo(a)

No estoy seguro(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 Lenguaje Computadoras

CPR (Resucitación cardiopulmonar)

Formación profesional Desarrollo infantil

Crianza de niños Empleo Otro

Si es así, especifique dónde:

Curso/Taller Lugar

1

Cuestionario de los padres de HIPPY – Seguimiento Revisado en noviembre de 2010

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 Leer Dibujar Sentarnos en silencio Ver videos educativos


Caminar Ir a la biblioteca Irnos de compras Deportes Otra ________________________________

2) De estas actividades, indique tres en las que pasa más tiempo con su niño:

Conversar Leer Dibujar Sentarnos en silencio Ver videos educativos

Jugar Juegos Juegos educativos Ver television Contar historias de familia o cultura

Caminar Ir a la biblioteca Irnos de compras Deportes Otra ________________________________

3) ¿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 No

5) ¿Tiene recursos (estrategias, actividades, ideas, materiales) para trabajar con su niño? Sí No

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 No N/A

8) Respuesta afirmativa, indique el motivo de su visita:

Conferencia de padres y profesores

Llevar o recoger al niño Ayuda en el salón de clases

Ayuda en excursiones Voluntario en la biblioteca

Eventos especiales Otro ________________________________________________________________________________________________

9) El año pasado, ¿aproximadamente cuántas veces asistió a conferencias de padres y profesores?


10) El año pasado, ¿aproximadamente cuántas veces ayudó en el salón de clases?


11) El año pasado, ¿aproximadamente cuántas veces ayudó en excursiones?


12) El año pasado, ¿aproximadamente cuántas veces fue voluntario en la biblioteca?


13) El año pasado, ¿aproximadamente cuántas veces asistió a un evento especial?


14) El año pasado, ¿aproximadamente cuántas veces asistió a otros eventos? 1 vez 2 a 3 veces 3 o más veces N/A

2

Cuestionario de los padres de HIPPY – Seguimiento Revisado en noviembre de 2010

Describa “otros” eventos:

15) ¿Se sintió cómodo(a) en el

preescolar/la guardería? No Algo incómodo(a)

No estoy seguro(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 Lenguaje Computadoras

CPR (Resucitación cardiopulmonar)

Formación profesional Desarrollo infantil

Crianza de niños Empleo Otro

Si es así, especifique dónde:

Curso/Taller Lugar

Documents

Efforts To Outcomes (ETO) User's Guide - HIPPY USA Basic.pdf · Efforts To Outcomes (ETO) User’s Guide Created by May 2011 HIPPY USA 1221 Bishop Street Little Rock, Arkansas 72202