User Guide Key Terms and Definitions

Key Terms and Definitions

Direct Services are preventive, primary, or specialty clinical services for which MCHB program funds are used to reimburse or fund providers for these services through a formal process similar to paying a medical billing claim or managed care contracts. Reporting on direct services should NOT include the costs of clinical services which are delivered with program dollars but reimbursed by Medicaid, CHIP, or other public or private payers. Examples include, but are not limited to the following, paid for with program funds: preventive, primary, or specialty care visits, emergency department visits, inpatient services, outpatient and inpatient mental and behavioral health services, prescription drugs, occupational and physical therapy, speech therapy, durable medical equipment and medical supplies, medical foods, dental care, and vision care.

Enabling Services are non-clinical services (i.e., not included as direct or public health services) that enable individuals to access healthcare and improve health outcomes where MCHB program funds are used to finance these services. Enabling services include, but are not limited to case management, care coordination, referrals, translation/interpretation, transportation, eligibility assistance, health education for individuals or families, environmental health risk reduction, health literacy, and beneficiary outreach. Reporting on enabling services should NOT include the costs for enabling services that are reimbursed by Medicaid, CHIP, or other public and private payers. Enabling services may include salary and operational support to a clinic that enables individuals to access healthcare or improve health outcomes. Examples include the salary of a public health nurse who provides prenatal care in a local clinic or compensation provided to a specialist pediatrician who provides services for children with special health care needs. In both cases, the direct services might still be billed to Medicaid or other insurance, but providing for the availability of the provider enables individuals to access the services, and therefore counts as enabling services.

Public Health Services and Systems are activities and infrastructure to carry out the core public health functions of assessment, assurance, and policy development, and the 10 essential public health services. Examples include the development of standards and guidelines, needs assessment, program planning, implementation, and evaluation, policy development, quality assurance and improvement, workforce development, population-based outreach and education, and research. 

Direct Services are preventive, primary, or specialty clinical services, where MCHB program funds are used to reimburse or fund individually delivered services through a formal process similar to paying a medical billing claim or managed care contracts. Reporting on direct services should NOT include the costs of clinical services which are delivered with program dollars but reimbursed by Medicaid, CHIP, or other public or private payers. (Definition Source: Adapted from TVIS Glossary https://mchb.tvisdata.hrsa.gov/Glossary/Glossary)

• Services may be provided by clinical or non-clinical professionals and paraprofessionals.
• Examples include, but are not limited to (where MCHB program funds are used to reimburse or fund individually delivered services through a formal process similar to paying a medical billing claim or managed care contracts), preventive, primary, or specialty care visits, emergency department visits, inpatient services, outpatient and inpatient mental and behavioral health services, prescription drugs, occupational and physical therapy, speech therapy, durable medical equipment and medical supplies (purchased directly for a person to use themselves at home), medical foods, oral health care, and vision care.
• The recipients of these services are individuals or members of families.

Enabling Services are non-clinical services that aid individuals to access health care and supportive care and improve health and well-being outcomes. (Definition Source: Adapted from TVIS Glossary https://mchb.tvisdata.hrsa.gov/Glossary/Glossary)

• Enabling services include, but are not limited to: case management, care coordination, referrals, services to support transition from pediatric to adult health care, consultation, translation/interpretation, transportation, eligibility assistance, health education for individuals or families, environmental health risk reduction, health literacy, beneficiary outreach, and purchase of equipment and medical supplies (to support the care of people in a care setting).
• The recipients of these services are individuals or members of families.

Families include individuals in traditional or non-traditional family structures and may include biological, foster, or adoptive parents and/or siblings, spouses or partners, or members of an extended family.

Telehealth is the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, health administration, and public health

Degree, Certification, or Formal Course refers to training provided through a standard curriculum that may result in a degree or certification. Post-graduates and early research investigators are also included, even though they will not receive a degree or certificate. Also included are individuals that receive a portion of the curriculum but do not complete all of the curriculum or receive a degree or certificate. This may include:
- Short-term, medium-term, and long-term Division of Maternal and Child Health Workforce Development training program trainees
- Research network mentees
- Individuals receiving EMS certification
- Individuals receiving doula certification

Continuing Education refers to trainings that maintain or strengthen knowledge and skills of the MCH workforce (including community outreach workers, families, and other members who directly serve the community), and are not part of a degree, certification, or formal course. This includes trainings that may be used to maintain the credentials and licensure of health care providers, public health practitioners, other members of the practicing MCH workforce.

Partnerships and Collaboration refers to activities that build and strengthen connections between organizations and individuals with similar interests, missions, and activities to allow for information sharing, learning, and capacity building across organizations/individuals. These activities include creation or strengthening of relevant organizational relationships that serve to expand the capacity and reach of a program in meeting the needs of its MCH population. Partnerships and collaborations are intended to be mutually beneficial relationships for all parties involved. Programs that build partnerships and collaboration between organizations, but themselves are not active in or beneficiaries of the partnerships (for example, a TA center that sets up a peer-to-peer network but does NOT participate as a recipient or beneficiary), should not complete this form.

Persons with Lived Experience: Individuals with knowledge and experience on health or social issues relevant to a particular program that is gained through direct, first-hand involvement in everyday events rather than through representations constructed by other people. Community-based organizations, for example, would not be included under this definition. For the purposes of this form, engagement of persons with lived experience is measured through two categories: "Family Engagement" and "Other Persons with Lived Experience." Family members often navigate systems and services on behalf of individuals, so their lived experience is collected separately. Therefore, for data collection purposes, the term "Other Persons with Lived Experience" is used to delineate from family engagement and avoid duplicated counts.

Family Engagement: Family members include individuals in traditional or non-traditional family structures and may include biological, foster, or adoptive parents and/or siblings, spouses or partners, or members of an extended family. These family members have lived experience through their first-hand knowledge of navigating systems and services either on behalf of a family member or for the family as a whole (for example, parents of infants and toddlers, family members of children and youth with special health care needs, etc.). Family engagement refers to family members serving as representatives or leaders who build and strengthen programs and systems rather than being the direct recipient of services.

Other Persons with Lived Experience: This subcategory excludes family members, as defined above. Engaging other individual persons with lived experience entails actively and intentionally seeking and implementing input from individuals with personal knowledge pertaining to the issue the program is trying to address. For the purpose of this form, individuals with lived experiences represent their own personal history and experience navigating systems and services for themselves, rather than on behalf of a family member. Examples of persons with lived experience include self-advocates or individuals with direct experience on a health issue (for example, youth self-advocates with special health care needs, pregnant or postpartum women, individual community members affected by a public health emergency, etc.).

Technical Assistance (TA) includes a range of targeted support activities that build skills or capacities and increase knowledge, with the intention to address organizational needs or accelerate programmatic outcomes. TA is the process of providing guidance, assistance, and training by an expert with specific technical/content knowledge to address an identified need. TA relationships are program- or initiative-focused, and may use an interactive, on-site/hands-on approach, as well as telephone or email assistance

Outreach and Education refers to activities to inform, generate interest, and provide more in-depth messaging on topics of interest. Outreach can be seen as a way to introduce the topic during brief interactions. Education can be seen as those activities that allow messaging and discussion to be tailored to individuals and small groups, as staff respond to questions and address concerns about a topic.

Research refers to activities that support the systematic investigation of topics related to the health of maternal and child health (MCH) populations. This includes programs that provide direct funding for research studies.

Infrastructure Support refers to providing resources, logistical support, or the coordination of services for researchers to conduct research and foster innovation (for example, research networks, etc.). A grantee can have both research and infrastructure support activities.

Intervention is defined as a manipulation of the subject or subject's environment to modify one or more health-related biomedical or behavioral processes and/or endpoints or outcomes for MCH populations.

Guidelines refer to activities that develop, modify, or implement guidelines within or between organizations and/or institutions, or at the local, state, or national level. Guidelines are guidance that is recommended but not mandatory (for example, Bright Futures, Women's Preventive Services Initiative, etc.).

Policies refer to activities that develop, modify, or implement policies within or between organizations and/or institutions, or at the local, state, or national level. Policies outline the requirements or rules that must be met. Policies frequently refer to standards or guidelines as the basis for their existence (for example, state policy that Medicaid cover recommended preventive services, etc.). 

Data and Information System activities include activities that improve the ability of other organizations to collect, access, and link data across multiple systems and programs. The purpose of these activities is to improve the overall public health infrastructure and not individual program process improvement or quality improvement around data. 

Quality Improvement includes activities that use deliberate processes to improve the efficacy and impact of activities, programs, or systems (for example, PDSA cycles, etc.).

Evaluation includes activities that systematically collect information to assess a project, program, or system's performance or outcomes.

Knowledge Change refers to immediate or initial changes in awareness, familiarity, or understanding, which are the result of learning and can be observed and measured immediately after an activity/intervention.

Behavior Change refers to intermediate changes in behavior/practice that result from an action/intervention, taking some time to be observed after an action/intervention.

Linguistic responsiveness is the capacity of an organization and its personnel to communicate effectively and convey information in a manner that is easily understood by diverse audiences including persons of limited English proficiency, those who have low literacy skills or are not literate, and individuals with disabilities. Linguistic responsiveness requires organizational and provider capacity to respond effectively to the health literacy needs of populations served. The organization must have policy, structures, practices, procedures, and dedicated resources to support this capacity. (T. Goode and W. Jones, 2004. National Center for Cultural Competence)

Cultural and linguistic responsiveness is a process that occurs along a developmental continuum. A culturally and linguistically responsive program is characterized by elements including the following: written strategies for advancing cultural responsiveness; cultural and linguistic responsiveness policies and practices; cultural and linguistic responsiveness knowledge and skills building efforts; research data on populations served according to racial, ethnic, and linguistic groupings; faculty and other instructors are racially and ethnically diverse; faculty and staff participate in professional development activities related to cultural and linguistic responsiveness; and periodic assessment of trainees' progress in developing cultural and linguistic responsiveness.

MCH LEAP trainees are defined as undergraduate students from underserved or underrepresented backgrounds, including trainees from racially and ethnically underrepresented groups who receive education, mentoring, and guidance to increase their interest and entry into MCH public health and related health professions.

MCH Populations: Includes women, infants and children, adolescents, young adults, and their families including fathers, and children and youth with special health care needs. 

Enrolled Provider: A provider who has formally registered with the program to facilitate use of consultation (teleconsultation or in-person) or care coordination support services, at the time of reporting. An enrolled provider is currently enrolled with the program even if initial enrollment occurred prior to current reporting period. An enrolled provider may or may not be a participating provider.

Participating Provider: A provider who has contacted the program for consultation (teleconsultation or in-person) or care coordination support services, and who may or may not be an enrolled provider.

Enrolled AND Participating Provider: Refers to the number of enrolled providers (registered) who are participating in the program (contacting the program for consultation or care coordination support services).

Care Coordination Support: In context of MMHSUD/PMHCA, care coordination support means, at minimum, that the program provides resources and referrals to a provider when they contact the program, or to the patient/family when the program works with patients/families directly. In these programs, "care coordination support" is synonymous with "providing resources and referrals".

Telehealth is the use of electronic information and telecommunication technologies to support and promote long-distance clinical consultation, patient and professional health-related education, public health and health administration. Permitted telehealth modalities between providers include (but are not limited to): real-time video, telephonic communications, electronic mail (email) with encryption, store-and-forward imaging, and mobile health (mHealth) applications.

Referrals are given to providers (or directly to the patients/families) by the program to introduce specific health providers or services. Recommending "family therapy" without providing a specific provider name or practice would not be considered a referral, but a recommendation for treatment. Referrals are typically provided using resources included in the referral database. Referrals fall under the category of care coordination support in the context of MMHSUD/PMHCA.

Training refers to education programs or sessions that serve to enhance the knowledge and/or maintain the credentials and licensure of professional providers. Training may also serve to enhance the knowledge base of community outreach workers, families, and other members who directly serve the community. Examples of trainings include mental or behavioral health conditions, medication, screening and assessment, treatment modalities, trauma, etc. Conference presentations would be considered training if training was the intent of the presentation. A conference presentation that describes an intervention or program would not be considered training.

• In-person training is any form of training that occurs "in person" and in real time between trainers and participants.
• Project ECHO (Extension for Community Healthcare Outcomes) distance learning cohort refers to a group of individuals who advance through an educational program together as part of their participation in Project ECHO. Project ECHO is a collaborative model of medical education and care management that uses tele-mentoring to share knowledge between specialists and outlying Primary Care Providers (PCPs) with the goals of supporting PCPs in their administration of high-quality, leading-edge care to their patients and improving health outcomes for underserved patients.
• ECHO-like distance learning cohort is a technology-enabled educational model, in which a mentor with specialized knowledge provides interactive and case-based guidance to a group of mentees for the purpose of strengthening their skills and knowledge to provide high-quality healthcare. These programs are similar in structure and goals to Project ECHO but not officially Project ECHO.
• Web-based training refers to computer-based training that takes place online via the internet. This can include synchronous web-based training that is trainer-led and involves real-time interactions between trainers and trainees; asynchronous web-based training that takes place without real-time instruction, where content is available online, pre-recorded, and trainees can access it at their convenience; or blended web-based training, which involves both real-time interactions between a trainer and trainees and pre-recorded content that can be self-paced according to one's schedule.
• Hybrid (combination of virtual and in-person) training refers to a training model that involves both in-person and online instruction and activities.

Treatment is the provision, coordination, or management of health care and related services among health care providers. Providers contacting the programs for consultation may or may not be the ones providing the treatment that is recommended by the consulting provider.

Rural/Underserved: HRSA defines rural areas as all counties that are not designated as parts of metropolitan areas (MAs) by the Office of Management and Budget. In addition, HRSA uses Rural Urban Commuting Area Codes to designate rural areas within MAs. This rural definition can be accessed at: https://www.hrsa.gov/rural-health/about-us/what-is-rural. If the county is not entirely rural or urban, follow the link for "Rural Health Grants Eligibility Analyzer" to determine if a specific site qualifies as rural based on its specific census tract within an otherwise urban county. Underserved areas are defined by the following terms: Any Medically Underserved Area/Population (MUA/P); or a Partially MUA/P. MUA/Ps are accessible through https://data.hrsa.gov/tools/shortage-area/mua-find. 

Ethnicity Definitions

• Hispanic or Latino is defined as a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. People who identify as Hispanic, Latino, or Spanish may be any race.

Race Definitions

• American Indian or Alaska Native: The category "American Indian or Alaska Native" includes all individuals who identify with any of the original peoples of North and South America (including Central America) and who maintain tribal affiliation or community attachment. It includes people who identify as "American Indian" or "Alaska Native" and includes groups such as Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, and Nome Eskimo Community.
• Asian: The category "Asian" includes all individuals who identify with one or more nationalities or ethnic groups originating in the Far East, Southeast Asia, or the Indian subcontinent. Examples of these groups include, but are not limited to, Chinese, Filipino, Asian Indian, Vietnamese, Korean, and Japanese. The category also includes groups such as Pakistani, Cambodian, Hmong, Thai, Bengali, Mien, etc.
• Black or African American: The category "Black or African American" includes all individuals who identify with one or more nationalities or ethnic groups originating in any of the black racial groups of Africa. Examples of these groups include, but are not limited to, African American, Jamaican, Haitian, Nigerian, Ethiopian, and Somali. The category also includes groups such as Ghanaian, South African, Barbadian, Kenyan, Liberian, and Bahamian.
• Native Hawaiian and Pacific Islander: The category "Native Hawaiian or Other Pacific Islander" includes all individuals who identify with one or more nationalities or ethnic groups originating in Hawaii, Guam, Samoa, or other Pacific Islands. Examples of these groups include, but are not limited to, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, and Marshallese. The category also includes groups such as Palauan, Tahitian, Chuukese, Pohnpeian, Saipanese, Yapese, etc.
• White: The category "White" includes all individuals who identify with one or more nationalities or ethnic groups originating in Europe, the Middle East, or North Africa. Examples of these groups include, but are not limited to, German, Irish, English, Italian, Lebanese, Egyptian, Polish, French, Iranian, Slavic, Cajun, and Chaldean.
• More than One Race: This category includes individuals who identify with more than one race.

First-generation college students are students who are enrolled in postsecondary education and whose parents do not have any postsecondary education experience.

Trainees who are not enrolled in a formal degree program may include non-degree seeking students and post-graduate trainees who are completing a fellowship.

Work full time includes LEAP trainees who have worked full-time (>35 hours/week) at any point during the reporting period.

Interdisciplinary/Interprofessional are the skills and expertise of team members from different disciplines, including a variety of professionals, MCH populations, and community partners, are acknowledged and seen as essential and synergistic. Input from each team member is elicited and valued in making collaborative, outcome-driven decisions to address individual, community-level, or systems-level problems.

Leadership activities Definitions

• Academic leadership activities
• Disseminated information on MCH Issues (e.g., Peer-reviewed publications, key presentations, training manuals, issue briefs, best practices documents, standards of care)
• Conducted research or quality improvement on MCH issues
• Provided consultation or technical assistance in MCH areas
• Taught/mentored in their discipline or other MCH related field
• Served as a reviewer (e.g., for a journal, conference abstracts, grant, quality assurance process)
• Procured grant and other funding in MCH areas
• Conducted strategic planning or program evaluation
• Clinical leadership activities
• Participated as a group leader, initiator, key contributor or in a position of influence/authority on any of the following: committees of State, national, or local organizations; task forces; community boards; advocacy groups; research societies; professional societies; etc.
• Served in a clinical leadership position (e.g. director, senior therapist, team leader, etc)
• Taught/mentored in their discipline or other MCH related field
• Conducted research or quality improvement on MCH issues
• Disseminated information on MCH Issues (e.g., Peer-reviewed publications, key presentations, training manuals, issue briefs, best practices documents, standards of care)
• Served as a reviewer (e.g., for a journal, conference abstracts, grant, quality assurance process)
• Public health leadership activities
• Provided consultation, technical assistance, or training in MCH areas
• Procured grant or other funding in MCH areas
• Conducted strategic planning or program evaluation
• Conducted research or quality improvement on MCH issues
• Served as a reviewer (e.g., for a journal, conference abstracts, grant, quality assurance process)
• Collaborated with community partners
• Public policy leadership activities
• Participated in public policy development activities at local, state, or national levels (e.g., participated in community engagement or coalition building efforts, written policy or guidelines, influenced MCH related legislation, provided testimony, educated legislators)
• Participated on any of the following as a group leader, initiator, or key contributor: committees of State, national, or local organizations; task forces; community boards; research societies; professional societies; etc.
• Presented or disseminated information on MCH public policy issues to a legislative body, key decision makers, foundations, or the general public (e.g., Peer-reviewed publications, key presentations, training manuals, issue briefs, best practices documents, standards of care, commentaries, and chapters)

Short-term trainees are trainees with less than 40 contact hours in the reporting period. Continuing Education participants are not counted in this category.

Hospital: Facilities that provide definitive medical and/or surgical assessment, diagnoses, and life and/or limb saving interventions for the ill and injured AND have an Emergency Department. For the purposes of this measure, data reported should exclude Military and Indian Health Service hospitals.

Standardized program: A program or system of care, also referred to as a pediatric readiness recognition program, that provides a framework for collaboration across agencies, health care organizations/services, families, and youths for the purposes of improving access and expanding coordinated, culturally, and linguistically competent care for children and youth. The program/system is coordinated, accountable and recognizes the pediatric emergency care capabilities of hospitals in a state, territory or region. The program supports the development of a standardized system of care that is responsive to the emergency needs of children and extends access to specialty resources when needed

Prehospital EMS Agency: A prehospital EMS agency is defined as an organization staffed with personnel who render medical care in response to a 911 or similar emergency call. Data will be gathered from both transporting and non-transporting agencies.

One-to-one services include all services that an F2F can collect recipient demographic/identifier information to be able to collect an unduplicated number. Examples include but are not limited to family navigation, consultation, counseling, education, referrals, case management, mentoring and individualized assistance.