• Appendix A
• Appendix B
• Appendix C
• Appendix D
• Appendix E
• Data Dictionary
• Administer the following required, standardized screening/assessment tools at the following minimum schedule.
  • Administer the American College of Obstetricians and Gynecologists (ACOG) Violence Against Women Screening Tool at admission of the pregnant client and infant and repeat as indicated.
  • Administer the 5 P’s Substance Abuse Screening Tool at admission of the pregnant client and repeat as indicated.
  • Administer the Edinburgh Postnatal Depression Scale (EPDS) at admission of the pregnant client and repeat postpartum (through the end of the month of the 60th day after pregnancy ends) and/or at admission of the infant.
  • Administer the Ages and Stages Developmental Questionnaire(ASQ) by 8 months of age to the infant.
  • Administer the Ages and Stages Questionnaire: Social Emotional (ASQ: SE) by 10 months of age to the infant.

Reports, Deliverables and Due Dates

• High Risk Pregnant Woman (HRPW) data and High Risk Infant (HRI) data should be submitted electronically via mt.gov ePass Montana to jgedrose@mt.gov or msquires2@mt.gov annually by the 15th of August for the prior State Fiscal Year.

Public Health Home Visiting data collected at intake and outcome should be standardized and focused on data measuring intended outcomes. To meet the data requirements, each participating site purchases software from CHC Software, Inc. User’s Manual

For technical support e-mail helpdesk@hdis.org or telephone (440) 963-7175.

A set of required Data Elements are to be reported. One subset focuses on the high-risk pregnant woman and the other subset is to be used for the infant of a high-risk client or an infant with special health care needs.