OCSHCN PARENT-LED COMMUNITY ACTION TEAM
PARENT COMMUNITY DEVELOPMENT LEADERS

This online report is due monthly and fulfills your team’s requirement as stated by the Scope of Work in your Organizational Support Contract.

After describing your current activities, please select one or more of the Maternal Child Health Bureau’s six performance measures that relates to the activity that you are reporting.

Please call Linda Hamman at (602-364-1403) or email with any questions or help in filling out this report.

 
Team Name
Contractor Name
Reporter Name

Initiatives
Please list the new projects or initiatives that your team is currently working on.
    

Please note which Key System Outcomes were achieved by your Collaborations

1. All children with special health care needs will receive coordinated ongoing comprehensive care within a medical home.
2. All families of children with special health care needs will have adequate private and/or public insurance to pay for the services they need.
3. All children will be screened early and continuously for special health needs.
4. Services for children with special health care needs and their families will get organized in ways that families can use them easily.
5. Families of children with special health care needs will partner in decision-making at all levels and will be satisfied with the services they receive.
6. All youth with special health care needs will receive the services necessary to make appropriate transitions to adult health care, work, and independence.
 
 
Collaborative Activity
Please list any new opportunities for partnering.
    

Please note which Key System Outcomes were achieved by your Collaborations

1. All children with special health care needs will receive coordinated ongoing comprehensive care within a medical home.
2. All families of children with special health care needs will have adequate private and/or public insurance to pay for the services they need.
3. All children will be screened early and continuously for special health needs.
4. Services for children with special health care needs and their families will get organized in ways that families can use them easily.
5. Families of children with special health care needs will partner in decision-making at all levels and will be satisfied with the services they receive.
6. All youth with special health care needs will receive the services necessary to make appropriate transitions to adult health care, work, and independence.
 
Grant Activity
Please list any new grants that your team has applied for or received.
    

Please note which Key System Outcomes were achieved by your Grant Activities

1. All children with special health care needs will receive coordinated ongoing comprehensive care within a medical home.
2. All families of children with special health care needs will have adequate private and/or public insurance to pay for the services they need.
3. All children will be screened early and continuously for special health needs.
4. Services for children with special health care needs and their families will get organized in ways that families can use them easily.
5. Families of children with special health care needs will partner in decision-making at all levels and will be satisfied with the services they receive.
6. All youth with special health care needs will receive the services necessary to make appropriate transitions to adult health care, work, and independence.
 
Marketing Activity
Please list the promotional activity and the # of people reached.
    

Please note which Key System Outcomes were achieved by your Marketing Activities

1. All children with special health care needs will receive coordinated ongoing comprehensive care within a medical home.
2. All families of children with special health care needs will have adequate private and/or public insurance to pay for the services they need.
3. All children will be screened early and continuously for special health needs.
4. Services for children with special health care needs and their families will get organized in ways that families can use them easily.
5. Families of children with special health care needs will partner in decision-making at all levels and will be satisfied with the services they receive.
6. All youth with special health care needs will receive the services necessary to make appropriate transitions to adult health care, work, and independence.

 
Newsletter Activity
List date and # of newsletters distributed
    

Please note which Key System Outcomes were achieved by your Newsletter Activites

1. All children with special health care needs will receive coordinated ongoing comprehensive care within a medical home.
2. All families of children with special health care needs will have adequate private and/or public insurance to pay for the services they need.
3. All children will be screened early and continuously for special health needs.
4. Services for children with special health care needs and their families will get organized in ways that families can use them easily.
5. Families of children with special health care needs will partner in decision-making at all levels and will be satisfied with the services they receive.
6. All youth with special health care needs will receive the services necessary to make appropriate transitions to adult health care, work, and independence.

 
Presentation Activity
 
    

Please note which Key System Outcomes were achieved by your Presentation Activities

1. All children with special health care needs will receive coordinated ongoing comprehensive care within a medical home.
2. All families of children with special health care needs will have adequate private and/or public insurance to pay for the services they need.
3. All children will be screened early and continuously for special health needs.
4. Services for children with special health care needs and their families will get organized in ways that families can use them easily.
5. Families of children with special health care needs will partner in decision-making at all levels and will be satisfied with the services they receive.
6. All youth with special health care needs will receive the services necessary to make appropriate transitions to adult health care, work, and independence.

 
Trainings Given
Please list date, topic and # in attendance
    

Please note which Key System Outcomes were achieved by the trainings you held

1. All children with special health care needs will receive coordinated ongoing comprehensive care within a medical home.
2. All families of children with special health care needs will have adequate private and/or public insurance to pay for the services they need.
3. All children will be screened early and continuously for special health needs.
4. Services for children with special health care needs and their families will get organized in ways that families can use them easily.
5. Families of children with special health care needs will partner in decision-making at all levels and will be satisfied with the services they receive.
6. All youth with special health care needs will receive the services necessary to make appropriate transitions to adult health care, work, and independence.

 
Trainings Attended
Please list date, topic and presenter
    

Please note which Key System Outcomes were achieved by the trainings you attended.

1. All children with special health care needs will receive coordinated ongoing comprehensive care within a medical home.
2. All families of children with special health care needs will have adequate private and/or public insurance to pay for the services they need.
3. All children will be screened early and continuously for special health needs.
4. Services for children with special health care needs and their families will get organized in ways that families can use them easily.
5. Families of children with special health care needs will partner in decision-making at all levels and will be satisfied with the services they receive.
6. All youth with special health care needs will receive the services necessary to make appropriate transitions to adult health care, work, and independence.

 
Team Meetings
Please list date and # of family partners and # of community partners and any presenters, main agenda items.
 
    

Please note which Key System Outcomes were achieved by your Team Meetings

1. All children with special health care needs will receive coordinated ongoing comprehensive care within a medical home.
2. All families of children with special health care needs will have adequate private and/or public insurance to pay for the services they need.
3. All children will be screened early and continuously for special health needs.
4. Services for children with special health care needs and their families will get organized in ways that families can use them easily.
5. Families of children with special health care needs will partner in decision-making at all levels and will be satisfied with the services they receive.
6. All youth with special health care needs will receive the services necessary to make appropriate transitions to adult health care, work, and independence.

 
Resources
Please list amount and kind of donations received from the community for example: Printing, food, meeting space etc.
    

Please note which Key System Outcomes were achieved by your reources

1. All children with special health care needs will receive coordinated ongoing comprehensive care within a medical home.
2. All families of children with special health care needs will have adequate private and/or public insurance to pay for the services they need.
3. All children will be screened early and continuously for special health needs.
4. Services for children with special health care needs and their families will get organized in ways that families can use them easily.
5. Families of children with special health care needs will partner in decision-making at all levels and will be satisfied with the services they receive.
6. All youth with special health care needs will receive the services necessary to make appropriate transitions to adult health care, work, and independence.

 
State Initiatives
Please list participation by family partners in projects, activities.
    

Please note which Key System Outcomes were achieved by your State Initiatives activities

1. All children with special health care needs will receive coordinated ongoing comprehensive care within a medical home.
2. All families of children with special health care needs will have adequate private and/or public insurance to pay for the services they need.
3. All children will be screened early and continuously for special health needs.
4. Services for children with special health care needs and their families will get organized in ways that families can use them easily.
5. Families of children with special health care needs will partner in decision-making at all levels and will be satisfied with the services they receive.
6. All youth with special health care needs will receive the services necessary to make appropriate transitions to adult health care, work, and independence.

 
Federal Initiatives
Please list participation by family partners in projects, activities.
    

Please note which Key System Outcomes were achieved by your Federal Initiative activites

1. All children with special health care needs will receive coordinated ongoing comprehensive care within a medical home.
2. All families of children with special health care needs will have adequate private and/or public insurance to pay for the services they need.
3. All children will be screened early and continuously for special health needs.
4. Services for children with special health care needs and their families will get organized in ways that families can use them easily.
5. Families of children with special health care needs will partner in decision-making at all levels and will be satisfied with the services they receive.
6. All youth with special health care needs will receive the services necessary to make appropriate transitions to adult health care, work, and independence.

 
Accomplishments
Please list any new activities to celebrate.
    

Please note which Key System Outcomes were achieved by your recent accomplishments

1. All children with special health care needs will receive coordinated ongoing comprehensive care within a medical home.
2. All families of children with special health care needs will have adequate private and/or public insurance to pay for the services they need.
3. All children will be screened early and continuously for special health needs.
4. Services for children with special health care needs and their families will get organized in ways that families can use them easily.
5. Families of children with special health care needs will partner in decision-making at all levels and will be satisfied with the services they receive.
6. All youth with special health care needs will receive the services necessary to make appropriate transitions to adult health care, work, and independence.

 
Signs of Impact
Please relate any unintended outcomes of your work.
    

Please note which Key System Outcomes were achieved by your Signs of Impact

1. All children with special health care needs will receive coordinated ongoing comprehensive care within a medical home.
2. All families of children with special health care needs will have adequate private and/or public insurance to pay for the services they need.
3. All children will be screened early and continuously for special health needs.
4. Services for children with special health care needs and their families will get organized in ways that families can use them easily.
5. Families of children with special health care needs will partner in decision-making at all levels and will be satisfied with the services they receive.
6. All youth with special health care needs will receive the services necessary to make appropriate transitions to adult health care, work, and independence.

 
Barriers and/or Challenges
Please describe any ongoing barriers or challenges that you have experienced as well as any that you have been able to break down.
    

Please note which Key System Outcomes were achieved by making changes to your Barriers and Challenges

1. All children with special health care needs will receive coordinated ongoing comprehensive care within a medical home.
2. All families of children with special health care needs will have adequate private and/or public insurance to pay for the services they need.
3. All children will be screened early and continuously for special health needs.
4. Services for children with special health care needs and their families will get organized in ways that families can use them easily.
5. Families of children with special health care needs will partner in decision-making at all levels and will be satisfied with the services they receive.
6. All youth with special health care needs will receive the services necessary to make appropriate transitions to adult health care, work, and independence.

 

Sustainability
Please list any activities related to your team’s sustainability.
    

Please choose which elements your sustainability activity falls under.
   Membership  Leadership  Structure  Funding  Working Relationships