Health Promotion Workforce Development & Leadership Health Screening Other: Intentional/Unintentional Injury Access to Health Care Mental Health Autism/ Dev. Disabilities Nutrition/Physical Activity Defects Prevention Oral Health Birth Outcomes (incl. infant Prenatal Care mortality, prematurity) Primary/Preventative Health Care Chronic Disease Quality Assurance What additional issues Data Assessment/Evaluation Reproductive Health does your practice Emergency Preparedness Service Coordination/Integration address? Family/Consumer Involvement Specialized Care Check one Financing & Insurance Substance/Tobacco Use Health Inequity/Disparity Workforce Development & Leadership Health Promotion Other: Health Screening N/A Intentional/Unintentional Injury Maternal Mortality/Morbidity Adolescent Health Life Course What is the primary Child Health Perinatal/Infant Health population domain/focus of Children and Youth with Special Health Women’s/Maternal Health your practice? Care Needs Families/Consumers one Child Health Health Care Providers Well-woman Visit Bullying Low-risk Cesarean Delivery Adolescent Well Visit Which MCH Block Grant Perinatal Regionalization Medical Home performance measure does Breastfeeding Transition your practice address? Safe Sleep Oral Health Developmental Screening Smoking Check all that apply Injury Adequate Insurance Coverage Physical Activity N/A ADD/ADHD Diagnoses Low or Very Low Birth Weight Adolescent Motor Vehicle Mortality Deliveries Adolescent Suicide Non-medically Indicated Elected Adolescent Vaccination (HPV, Tdap, Delivery MCV4) Neonatal Abstinence Syndrome Autism Spectrum Disorder Diagnoses Perinatal, Neonatal, or Infant Mortality Which MCH Block Grant Mental/Behavioral Health School Readiness outcome measures Treatment Sleep-related SUID does your practice Child Mortality Tooth Decay and Children’s Oral address? Child Well-being Health Check all that apply Childhood Vaccination (routine, flu) Well-functioning System of Care for Children’s Health Insurance Coverage Alcohol Exposure N/A First Trimester Prenatal Care
Health Promotion Health Screening Intentional/Unintentional Injury Workforce Development & Leadership Other: What additional issues does your practice address? Check one Access to Health Care Autism/ Dev. Disabilities Defects Prevention Birth Outcomes (incl. infant mortality, prematurity) Chronic Disease Data Assessment/Evaluation Emergency Preparedness Family/Consumer Involvement Financing & Insurance Health Inequity/Disparity Health Promotion Health Screening Intentional/Unintentional Injury Maternal Mortality/Morbidity Mental Health Nutrition/Physical Activity Oral Health Prenatal Care Primary/Preventative Health Care Quality Assurance Reproductive Health Service Coordination/Integration Specialized Care Substance/Tobacco Use Workforce Development & Leadership Other: N/A What is the primary population domain/focus of your practice? one Adolescent Health Child Health Children and Youth with Special Health Care Needs Child Health Life Course Perinatal/Infant Health Women’s/Maternal Health Families/Consumers Health Care Providers Which MCH Block Grant performance measure does your practice address? Check all that apply Well-woman Visit Low-risk Cesarean Delivery Perinatal Regionalization Breastfeeding Safe Sleep Developmental Screening Injury Physical Activity Bullying Adolescent Well Visit Medical Home Transition Oral Health Smoking Adequate Insurance Coverage N/A Which MCH Block Grant outcome measures does your practice address? Check all that apply ADD/ADHD Diagnoses Adolescent Motor Vehicle Mortality Adolescent Suicide Adolescent Vaccination (HPV, Tdap, MCV4) Autism Spectrum Disorder Diagnoses Mental/Behavioral Health Treatment Child Mortality Child Well-being Childhood Vaccination (routine, flu) Children’s Health Insurance Coverage Alcohol Exposure First Trimester Prenatal Care Low or Very Low Birth Weight Deliveries Non-medically Indicated Elected Delivery Neonatal Abstinence Syndrome Perinatal, Neonatal, or Infant Mortality School Readiness Sleep-related SUID Tooth Decay and Children’s Oral Health Well-functioning System of Care for N/A
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