BABIES FIRST! PROGRAM REVIEW TOOL
AGENCY:
REVIEWER:
ADMINISTRATOR:
PARTICIPANTS:
DATE(S) OF REVIEW (mm/dd/yyyy):
-
Criteria for Compliance
DATE OF REPORT (mm/dd/yyyy):
Compliance
Yes
No
Comments/Documentation/Explanation/Timeline
I. USE OF FUNDS
A. A staff member has been designated as the Babies First!/Nurse-Family
Partnership coordinator. PE42 (7)(b)(i)
B. Babies First!/Nurse-Family Partnership services are delivered or
directed by public health nurses (PHNs).
1. Number of PHNs and FTEs in program PE42 (7)(a)
C. Babies First!/Nurse-Family Partnership services are provided during
home visits. PE42 (7)(a)
D. PHNs conduct assessment, screening, case management and health
education to improve outcomes for high-risk children. PE42 (7)(a)
E. PHNs must complete assessments and screenings at 0–6 wks. and 4, 8,
12, 18, 24, 36, 48 and 60 months, or by LPHA agreement with NFP
National Service Office. Screenings and assessment include, but are
not limited to: PE42 (7)(b)(ii)(A)(I)-(VII)
1. Assessment of child’s growth
2. Age appropriate developmental screenings
3. Hearing, vision and dental screening
4. Assessment of parent/child interactions
5. Assessment of environmental learning opportunities and safety
Hover over link for date it was verified
Page 1 of 5
LE 9804 Revised and Approved: 4/1/15
Shaded cells indicate items reviewed for Quality assurance only.
Criteria for Compliance
Compliance
Yes
No
Comments/Documentation/Explanation/Timeline
6. Assessment of the child’s immunization status
7. Referral for medical and other care when assessments indicate that
care is needed.
F. PHNs follow up on referrals made by OHA for Early Hearing
Detection and Intervention. OAR 333-020-0149 (1)(a)-(c);
PE42 (7)(b)(ii)(C)
G. PHNs use nursing process that includes assessing, making nursing
diagnoses, planning, intervening and evaluating.
OAR 851-045-0030 (2)(1)
H. PHNs apply nursing knowledge, critical thinking, and clinical
judgment for nursing practice implementation of Babies1st!/NurseFamily Partnership programs. Activities include:
OAR 851-045-0060 (2)(a)-(e)
1. Initial and ongoing assessments
2. Establishment and documentation of nursing diagnostic statements
and/or reasoned conclusions which serve as the basis for the plan of
care
3. Development of a plan of nursing care
4. Implementation of plan of care
5. Evaluation of client responses to nursing interventions and progress
toward desired outcomes
I. Initial and ongoing PHN nursing assessments reflect the collection of
subjective and objective data. OAR 851-045-0060 (2)(a)(A)
J. PHN plan of care identifies priorities and sets realistic and measurable
goals. OAR 851-045-0060 (2)(c)(A)(B)
K. PHNs implement the plan of care and document nursing interventions
and responses to care in an accurate, timely, thorough and clear
Hover over link for date it was verified
Page 2 of 5
LE 9804 Revised and Approved: 4/1/15
Shaded cells indicate items reviewed for Quality assurance only.
Criteria for Compliance
Compliance
Yes
No
Comments/Documentation/Explanation/Timeline
manner. OAR 851-045-0060 (2)(d)(A)(B)
L. PHNs maintain adequate and accurate client records documenting
nursing process. OAR 851-045-0070 (3)
M. Frequency and types of interventions are based on client need and
acuity.
N. A referral-in system is in place.
O. A visit tracking system is used.
II. TARGETED CASE MANAGEMENT
A. All Targeted Case Management (TCM) case managers are employees
of the local county health department, or other public or private
agency contracted by the local county health department.
OAR 410-138-0060 (11)(a)
B. All TCM case managers are licensed registered nurses with one year
of experience in community health, public health or child health
nursing. All community health workers, family advocates or
promotoras will work under the direction of the RN, as defined above.
OAR 410-138-0060 (11)(b)
C. All TCM case managers work under the policies, procedures and
protocols of the State Title V Maternal and Child Health Program and
Medicaid. OAR 410-138-0060 (11)(c)
D. All TCM case managers use the most current version of the TCM
Assessment and Plan Form and TCM Visit Form documents provided
by the Center for Prevention and Health Promotion.
OAR 410-138-0060 (11)(c)
E. Provider bills only for allowable activities in the Babies First!/NurseFamily Partnership programs. TCM services billed to Medicaid
include one or more of the following components:
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Page 3 of 5
LE 9804 Revised and Approved: 4/1/15
Shaded cells indicate items reviewed for Quality assurance only.
Criteria for Compliance
Compliance
Yes
No
Comments/Documentation/Explanation/Timeline
OAR 410-138-0080 (5); OAR 410-138-0007 (2)(a)-(d)
1. Assessment to determine need for medical, educational, social or
other services
2. Development of a care plan based on assessment
3. Referral, linking, and coordination of services and related activities
4. Monitoring of the above components
F. LPHA, as a provider of Medicaid services, complies with the TCM
billing policy and codes in OAR 410-138-0000 through 410-1380390; PE42 (7)(b)(iii).
III. Data Collection
A. Data is collected and reported to the department in an acceptable form
including: PE42 (7)(c)(ii)
1. Number of clients served
2. Demographic profile of clients
3. Number of visits or encounters
4. Types of services provided
5. Source of payment for services
B. At a minimum, by September 30 of each year, all client visit data for
the previous fiscal year (July1–June 30) has been entered into the
Oregon Child Health Information Data System (ORCHIDS), or in an
electronic file structure defined by OHA. PE42 (7)(c)(i)(a)
C. All PHN staff working in the program have participated in an
orientation by the Center for Prevention and Health Promotion.
OAR 410-138-0060 (11)(c)
D. There are current written policies and procedures that support Babies
First! Program implementation.
Hover over link for date it was verified
Page 4 of 5
LE 9804 Revised and Approved: 4/1/15
Shaded cells indicate items reviewed for Quality assurance only.
Criteria for Compliance
Compliance
Yes
No
Comments/Documentation/Explanation/Timeline
E. PHNs working in the program have on-going and continuing
education and training that enables them to assess infant growth and
development, health, maternal/infant interaction and community
resources.
1. Specific trainings
a. NCAST/Parent-child interaction
b. Physical assessment
c. Breast feeding consultation
d. MCH conferences
e. Other
Hover over link for date it was verified
Page 5 of 5
LE 9804 Revised and Approved: 4/1/15
Shaded cells indicate items reviewed for Quality assurance only.