TVIS Application - View Version

Title V Block Grant Application
Forms (1-21)
State: TN
Application Year: 2007

OMB Approval No. 0348-0043

Previous Editions Not Usable

Standard Form 424 (REV. 4-88)
Prescribed by OMB A-102

[Secs. 504 (d) and 505(a)(3)(4)]

(Item 15a of the Application Face Sheet [SF 424])
Of the Federal Allocation (1 above), the amount earmarked for:

A.Preventive and primary care for children:

$ (%)

B.Children with special health care needs:

$ (%)
(If either A or B is less than 30%, a waiver request must accompany the application)[Sec. 505(a)(3)]

C.Title V admininstrative costs:

$ (%)
(The above figure cannot be more than 10% )[Sec. 504(d)]

(Item 15b of SF 424)

(Item 15c of the SF 424)

(Item 15d of SF 424)

(Item 15e of SF 424)

(Item 15f of SF 424)

(Lines 3 through 6)
(Below is your State's FY 1989 Maintainence of Effort Amount)
$

(Total lines 1 through 6. Same as line 15g of SF 424)

(Funds under the control of the person responsible for the administration of the Title V program)

	a. SPRANS:	$
	b. SSDI:	$
	c. CISS:	$
	d. Abstinence Education:	$
	e. Healthy Start:	$
	f. EMSC:	$
	g. WIC:	$
	h. AIDS:	$
	i. CDC:	$
	j. Education:	$
	k. Other:

		$
		$
		$

(SUBTOTAL of all Funds under item 9)

(Partnership subtotal + Other Federal MCH Funds subtotal)

Form Notes for Form 2
	None
Field Level Notes
	None

[Secs. 505(a) and 506((a)(I-3)]

1. Federal Allocation
(Line1, Form 2)

2. Unobligated Balance
(Line2, Form 2)

3. State Funds
(Line3, Form 2)

4. Local MCH Funds
(Line4, Form 2)

5. Other Funds
(Line5, Form 2)

6. Program Income
(Line6, Form 2)

7. Subtotal
(Line8, Form 2)

(THE FEDERAL-STATE TITLE BLOCK GRANT PARTNERSHIP)

8. Other Federal Funds
(Line10, Form 2)

9. Total
(Line11, Form 2)

(STATE MCH BUDGET TOTAL)

[Secs. 505(a) and 506((a)(I-3)]

1. Federal Allocation
(Line1, Form 2)

2. Unobligated Balance
(Line2, Form 2)

3. State Funds
(Line3, Form 2)

4. Local MCH Funds
(Line4, Form 2)

5. Other Funds
(Line5, Form 2)

6. Program Income
(Line6, Form 2)

7. Subtotal
(Line8, Form 2)

(THE FEDERAL-STATE TITLE BLOCK GRANT PARTNERSHIP)

8. Other Federal Funds
(Line10, Form 2)

9. Total
(Line11, Form 2)

(STATE MCH BUDGET TOTAL)

Form Notes for Form 3
	None
Field Level Notes
1.	Section Number: Main Field Name: FedAllocExpended Row Name: Federal Allocation Column Name: Expended Year: 2005 Field Note: Expended amount was estimated
2.	Section Number: Main Field Name: FedAllocExpended Row Name: Federal Allocation Column Name: Expended Year: 2004 Field Note: Budgeted amount was estimated.
3.	Section Number: Main Field Name: UnobligatedBalanceExpended Row Name: Unobligated Balance Column Name: Expended Year: 2005 Field Note: Budget was estimated
4.	Section Number: Main Field Name: UnobligatedBalanceExpended Row Name: Unobligated Balance Column Name: Expended Year: 2004 Field Note: Budgeted amount was estimated.
5.	Section Number: Main Field Name: StateMCHFundsExpended Row Name: State Funds Column Name: Expended Year: 2005 Field Note: Expended amount was estimated
6.	Section Number: Main Field Name: ProgramIncomeExpended Row Name: Program Income Column Name: Expended Year: 2005 Field Note: Expended amount was estimated
7.	Section Number: Main Field Name: ProgramIncomeExpended Row Name: Program Income Column Name: Expended Year: 2004 Field Note: Budgeted amount was over estimated.
8.	Section Number: Main Field Name: OtherFedFundsExpended Row Name: Other Federal Funds Column Name: Expended Year: 2005 Field Note: Expended amount was estimated
9.	Section Number: Main Field Name: OtherFedFundsExpended Row Name: Other Federal Funds Column Name: Expended Year: 2004 Field Note: Budgeted amounts were estimated.

[Secs 506(2)(2)(iv)]

II. Other Federal Funds (under the control of the person responsible for administration of the Title V program).
	FY 2005		FY 2006		FY 2007
I. Federal-State MCH Block Grant Partnership	Budgeted	Expended	Budgeted	Expended	Budgeted	Expended
a. Pregnant Women	$	$	$	$	$	$
b. Infants < 1 year old	$	$	$	$	$	$
c. Children 1 to 22 years old	$	$	$	$	$	$
d. Children with Special Healthcare Needs	$	$	$	$	$	$
e. Others	$	$	$	$	$	$
f. Administration	$	$	$	$	$	$

g. SUBTOTAL	$	$	$	$	$	$

a. SPRANS	$		$		$
b. SSDI	$		$		$
c. CISS	$		$		$
d. Abstinence Education	$		$		$
e. Healthy Start	$		$		$
f. EMSC	$		$		$
g. WIC	$		$		$
h. AIDS	$		$		$
i. CDC	$		$		$
j. Education	$		$		$
k.Other
CHAD	$		$		$
New Born Hearing	$		$		$
Title X F. P.	$		$		$
CISS-SECCS	$		$		$
Family Planning	$		$		$
Hearing Screening	$		$		$
Lead	$		$		$
III. SUBTOTAL	$		$		$

[Secs 506(2)(2)(iv)]

II. Other Federal Funds (under the control of the person responsible for administration of the Title V program).
	FY 2002		FY 2003		FY 2004
I. Federal-State MCH Block Grant Partnership	Budgeted	Expended	Budgeted	Expended	Budgeted	Expended
a. Pregnant Women	$	$	$	$	$	$
b. Infants < 1 year old	$	$	$	$	$	$
c. Children 1 to 22 years old	$	$	$	$	$	$
d. Children with Special Healthcare Needs	$	$	$	$	$	$
e. Others	$	$	$	$	$	$
f. Administration	$	$	$	$	$	$

g. SUBTOTAL	$	$	$	$	$	$

a. SPRANS	$		$		$
b. SSDI	$		$		$
c. CISS	$		$		$
d. Abstinence Education	$		$		$
e. Healthy Start	$		$		$
f. EMSC	$		$		$
g. WIC	$		$		$
h. AIDS	$		$		$
i. CDC	$		$		$
j. Education	$		$		$
k.Other
CHAD	$		$		$
Family Planning	$		$		$
Hearing Screening	$		$		$
Lead	$		$		$
CISS/GENETICS	$		$		$
HEARING SCREENING	$		$		$
LEAD	$		$		$
III. SUBTOTAL	$		$		$

Form Notes for Form 4
	Budgeted amount was estimated.
Field Level Notes
1.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: PregWomenBudgeted Row Name: Pregnant Women Column Name: Budgeted Year: 2007 Field Note: Budgeted amount was estimated.
2.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: PregWomenExpended Row Name: Pregnant Women Column Name: Expended Year: 2005 Field Note: Expended amount was estimated.
3.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: PregWomenExpended Row Name: Pregnant Women Column Name: Expended Year: 2004 Field Note: Budgeted amount was estimated.
4.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: Children_0_1Budgeted Row Name: Infants <1 year old Column Name: Budgeted Year: 2007 Field Note: Budgeted amount was estimated.
5.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: Children_0_1Expended Row Name: Infants <1 year old Column Name: Expended Year: 2005 Field Note: Expended amount was estimated.
6.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: Children_0_1Expended Row Name: Infants <1 year old Column Name: Expended Year: 2004 Field Note: Budgeted amount was over estimated.
7.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: Children_1_22Budgeted Row Name: Children 1 to 22 years old Column Name: Budgeted Year: 2007 Field Note: Budgeted amount was estimated.
8.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: Children_1_22Expended Row Name: Children 1 to 22 years old Column Name: Expended Year: 2005 Field Note: Expended amount was estimated.
9.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: Children_1_22Expended Row Name: Children 1 to 22 years old Column Name: Expended Year: 2004 Field Note: Budgeted amount was over estimated.
10.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: CSHCNBudgeted Row Name: CSHCN Column Name: Budgeted Year: 2007 Field Note: Budgeted amount was estimated.
11.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: CSHCNExpended Row Name: CSHCN Column Name: Expended Year: 2005 Field Note: Expended amount was estimated.
12.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: CSHCNExpended Row Name: CSHCN Column Name: Expended Year: 2004 Field Note: budgeted amount was over estimated.
13.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: AllOthersBudgeted Row Name: All Others Column Name: Budgeted Year: 2007 Field Note: Budgeted amount was estimated.
14.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: AllOthersExpended Row Name: All Others Column Name: Expended Year: 2005 Field Note: Expended amount was estimated.
15.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: AllOthersExpended Row Name: All Others Column Name: Expended Year: 2004 Field Note: Budgeted amount was over estimated.
16.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: AdminBudgeted Row Name: Administration Column Name: Budgeted Year: 2007 Field Note: Budgeted amount was estimated.
17.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: AdminExpended Row Name: Administration Column Name: Expended Year: 2005 Field Note: expended amount was estimated.
18.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: AdminExpended Row Name: Administration Column Name: Expended Year: 2004 Field Note: Budgeted amount was over estimated.

[Secs. 505(a)(2)(A-B) and 506(a)(1)(A-D)]

Type of Service	FY 2005		FY 2006		FY 2007
Type of Service	Budgeted	Expended	Budgeted	Expended	Budgeted	Expended
I. Direct Health Care Services (Basic Health Services and Health Services for CSHCN.)	$	$	$	$	$	$
II. Enabling Services (Transportation, Translation, Outreach, Respite Care, Health Education, Family Support Services, Purchase of Health Insurance, Case Management, and Coordination with Medicaid, WIC, and Education.)	$	$	$	$	$	$
III. Population-Based Services (Newborn Screening, Lead Screening, Immunization, Sudden Infant Death Syndrome Counseling, Oral Health, Injury Prevention, Nutrition, and Outreach/Public Education.)	$	$	$	$	$	$
IV. Infrastructure Building Services (Needs Assessment, Evaluation, Planning, Policy Development, Coordination, Quality Assurance, Standards Development, Monitoring, Training, Applied Research, Systems of Care, and Information Systems.)	$	$	$	$	$	$
V. Federal-State Title V Block Grant Partnership Total (Federal-State Partnership only. Item 15g of SF 42r. For the "Budget" columns this is the same figure that appears in Line 8, Form 2, and in the "Budgeted" columns of Line 7 Form 3. For the "Expended" columns this is the same figure that appears in the "Expended" columns of Line 7, Form 3.)	$	$	$	$	$	$

[Secs. 505(a)(2)(A-B) and 506(a)(1)(A-D)]

Type of Service	FY 2002		FY 2003		FY 2004
Type of Service	Budgeted	Expended	Budgeted	Expended	Budgeted	Expended
I. Direct Health Care Services (Basic Health Services and Health Services for CSHCN.)	$	$	$	$	$	$
II. Enabling Services (Transportation, Translation, Outreach, Respite Care, Health Education, Family Support Services, Purchase of Health Insurance, Case Management, and Coordination with Medicaid, WIC, and Education.)	$	$	$	$	$	$
III. Population-Based Services (Newborn Screening, Lead Screening, Immunization, Sudden Infant Death Syndrome Counseling, Oral Health, Injury Prevention, Nutrition, and Outreach/Public Education.)	$	$	$	$	$	$
IV. Infrastructure Building Services (Needs Assessment, Evaluation, Planning, Policy Development, Coordination, Quality Assurance, Standards Development, Monitoring, Training, Applied Research, Systems of Care, and Information Systems.)	$	$	$	$	$	$
V. Federal-State Title V Block Grant Partnership Total (Federal-State Partnership only. Item 15g of SF 42r. For the "Budget" columns this is the same figure that appears in Line 8, Form 2, and in the "Budgeted" columns of Line 7 Form 3. For the "Expended" columns this is the same figure that appears in the "Expended" columns of Line 7, Form 3.)	$	$	$	$	$	$

Form Notes for Form 5
	Budgeted and expended amount was estimated.
Field Level Notes
1.	Section Number: Main Field Name: DirectHCBudgeted Row Name: Direct Health Care Services Column Name: Budgeted Year: 2007 Field Note: Budgeted amount was estimated.
2.	Section Number: Main Field Name: DirectHCExpended Row Name: Direct Health Care Services Column Name: Expended Year: 2005 Field Note: Expended amount was estimated.
3.	Section Number: Main Field Name: DirectHCExpended Row Name: Direct Health Care Services Column Name: Expended Year: 2004 Field Note: Note pending
4.	Section Number: Main Field Name: EnablingBudgeted Row Name: Enabling Services Column Name: Budgeted Year: 2007 Field Note: Budgeted amount was estimated.
5.	Section Number: Main Field Name: EnablingExpended Row Name: Enabling Services Column Name: Expended Year: 2005 Field Note: Expended amount was estimated.
6.	Section Number: Main Field Name: EnablingExpended Row Name: Enabling Services Column Name: Expended Year: 2004 Field Note: Note pending
7.	Section Number: Main Field Name: PopBasedBudgeted Row Name: Population-Based Services Column Name: Budgeted Year: 2007 Field Note: Budgeted amount was estimated.
8.	Section Number: Main Field Name: PopBasedExpended Row Name: Population-Based Services Column Name: Expended Year: 2005 Field Note: Expended amount was estimated.
9.	Section Number: Main Field Name: PopBasedExpended Row Name: Population-Based Services Column Name: Expended Year: 2004 Field Note: Note pending
10.	Section Number: Main Field Name: InfrastrBuildBudgeted Row Name: Infrastructure Building Services Column Name: Budgeted Year: 2007 Field Note: Budgeted amount was estimated.
11.	Section Number: Main Field Name: InfrastrBuildExpended Row Name: Infrastructure Building Services Column Name: Expended Year: 2005 Field Note: Expended amount was estimated.
12.	Section Number: Main Field Name: InfrastrBuildExpended Row Name: Infrastructure Building Services Column Name: Expended Year: 2004 Field Note: Note pending

Sect. 506(a)(2)(B)(iii)

Total Births by Occurrence:

Reporting Year: 2004

Type of Screening Tests	(A) Receiving at least one Screen (1)		(B) No. of Presumptive Positive Screens	(C) No. Confirmed Cases (2)	(D) Needing Treatment that Received Treatment (3)
Type of Screening Tests	No.	%	(B) No. of Presumptive Positive Screens	(C) No. Confirmed Cases (2)	No.	%
Phenylketonuria
Congenital Hypothyroidism
Galactosemia
Sickle Cell Disease
Other Screening (Specify)
Biotinidase Deficiency
Hemoglobinopathies
Congenital Adrenal Hyperplasia (CAH)
Maple Syrup Urine Disease (MSUD)
Medium Chain AcylCo-A Dehydrogenase (MCAD)
Acylcarnitines
HCY (Met)
Amino Acids (Cit & Tyr)
Screening Programs for Older Children & Women (Specify Tests by name)
(1) Use occurrent births as denominator. (2) Report only those from resident births. (3) Use number of confirmed cases as denominator.

Form Notes for Form 6
	Data source is the State newborn screening database
Field Level Notes
1.	Section Number: Main Field Name: BirthOccurence Row Name: Total Births By Occurence Column Name: Total Births By Occurence Year: 2007 Field Note: Data Source is the Tennessee New Born Screening follow up data
2.	Section Number: Main Field Name: Phenylketonuria_OneScreenNo Row Name: Phenylketonuria Column Name: Receiving at least one screen Year: 2007 Field Note: Data source is the Tennessee New Born Screening follow up data.
3.	Section Number: Main Field Name: Congenital_OneScreenNo Row Name: Congenital Column Name: Receiving at least one screen Year: 2007 Field Note: Data Source is the Tennessee New Born Screening follow up data
4.	Section Number: Main Field Name: Galactosemia_OneScreenNo Row Name: Galactosemia Column Name: Receiving at least one screen Year: 2007 Field Note: Data Source is the Tennessee New Born Screening follow up data.
5.	Section Number: Main Field Name: SickleCellDisease_OneScreenNo Row Name: SickleCellDisease Column Name: Receiving at least one screen Year: 2007 Field Note: Screening data are included in hemoglobinopathies.
6.	Section Number: Other Screening Types Field Name: Other Row Name: All Rows Column Name: All Columns Year: 2007 Field Note: Screening data for hempglobinopathies include sickle cell disease. Of the 5 confirmed cases of biotinidase deficiency, 2 were deficient and 3 were partials.

[Sec. 506(a)(2)(A)(i-ii)]

Reporting Year: 2005

	TITLE V	PRIMARY SOURCES OF COVERAGE
Types of Individuals Served	(A) Total Served	(B) Title XIX %	(C) Title XXI %	(D) Private/Other %	(E) None %	(F) Unknown %
Pregnant Women
Infants < 1 year old
Children 1 to 22 years old
Children with Special Healthcare Needs
Others
TOTAL

Form Notes for Form 7
	Number of infants served is form the local health department data system and would include both residents, non resident and those who moved into the State who were less than one. Number of infants on form 6 are those tested in new born screening program.
Field Level Notes
1.	Section Number: Main Field Name: PregWomen_TS Row Name: Pregnant Women Column Name: Title V Total Served Year: 2007 Field Note: The low number of pregnant women was due to methodology in data collection. Data source is the State of Tennessee PTBMIS System(Patient Tracking Billing Management Information System). The decrease in the 2005 data for pregnant women data is likely to be the difference in the count in data collection from calendar year and fiscal year.
2.	Section Number: Main Field Name: Children_0_1_TS Row Name: Infants <1 year of age Column Name: Title V Total Served Year: 2007 Field Note: This data include children under 1 year old who were born in a fiscal year. Data source is the State of Tennessee PTBMIS system.
3.	Section Number: Main Field Name: Children_1_22_TS Row Name: Children 1 to 22 years of age Column Name: Title V Total Served Year: 2007 Field Note: State of Tennessee PTBMIS is the data source.
4.	Section Number: Main Field Name: CSHCN_TS Row Name: Children with Special Health Care Needs Column Name: Title V Total Served Year: 2007 Field Note: The fluctuation in the total number of children with special healthcare needs is due to change in methodology. The data was generated from the patient encounter. The source is the State of Tennessee PTBMIS system.

Reporting Year: 2005

	(A) Total All Races	(B) White	(C) Black or African American	(D) American Indian or Native Alaskan	(E) Asian	(F) Native Hawaiian or Other Pacific Islander	(G) More than one race reported	(H) Other and Unknown
Deliveries
Total Deliveries in State
Title V Served
Eligible for Title XIX
Infants
Total Infants in State
Title V Served
Eligible for Title XIX

	( A ) Total NOT Hispanic or Latino	( B ) Total Hispanic or Latino	( C ) Ethnicity Not Reported	( B.1 ) Mexican	( B.2 ) Cuban	( B.3 ) Puerto Rican	( B.4 ) Central and South American	( B.5 ) Other and Unknown
				HISPANIC OR LATINO (Sub-categories by country or area of origin)
Deliveries
Total Deliveries in State
Title V Served
Eligible for Title XIX
Infants
Total Infants in State
Title V Served
Eligible for Title XIX

Form Notes for Form 8
	Infants served data includes non-resident data and persons moving into the state. The unknown categories includes the hispanic population. Data source is the Tennessee Health Statistics
Field Level Notes
1.	Section Number: I. Unduplicated Count By Race Field Name: DeliveriesTotal_All Row Name: Total Deliveries in State Column Name: Total All Races Year: 2007 Field Note: Data includes both resident and non-resident data of children who moved to the state. Data in the unknown category includes the hispanic deliveries. Data source is Tennessee Health Statistics.
2.	Section Number: I. Unduplicated Count By Race Field Name: DeliveriesTitleV_All Row Name: Title V Served Column Name: Total All Races Year: 2007 Field Note: Data includes both resident and non-resident who moved to the state. Data source is tennessee Health Statistic.
3.	Section Number: I. Unduplicated Count By Race Field Name: DeliveriesTitleXIX_All Row Name: Eligible for Title XIX Column Name: Total All Races Year: 2007 Field Note: Data source is the Tennessee Health Statistics.
4.	Section Number: I. Unduplicated Count By Race Field Name: InfantsTotal_All Row Name: Total Infants in State Column Name: Total All Races Year: 2007 Field Note: Data source is the Tennessee Health Statistics.
5.	Section Number: I. Unduplicated Count By Race Field Name: InfantsTitleV_All Row Name: Title V Served Column Name: Total All Races Year: 2007 Field Note: Data includes resident and non-residents and infants who moved to the state.
6.	Section Number: I. Unduplicated Count By Race Field Name: InfantsTitleXIX_All Row Name: Eligible for Title XIX Column Name: Total All Races Year: 2007 Field Note: Data source is the Tennessee Health Statistics
7.	Section Number: II. Unduplicated Count by Ethnicity Field Name: DeliveriesTotal_TotalNotHispanic Row Name: Total Deliveries in State Column Name: Total Not Hispanic or Latino Year: 2007 Field Note: Data source is the State of Tennessee Health Statistics.
8.	Section Number: II. Unduplicated Count by Ethnicity Field Name: DeliveriesTotal_TotalHispanic Row Name: Total Deliveries in State Column Name: Total Hispanic or Latino Year: 2007 Field Note: Total hispanic is included in the unknown category.
9.	Section Number: II. Unduplicated Count by Ethnicity Field Name: DeliveriesTotal_EthnicityOther Row Name: Total Deliveries in State Column Name: Other and Unknown Year: 2007 Field Note: Data in B.5 includes the hispanic group
10.	Section Number: II. Unduplicated Count by Ethnicity Field Name: DeliveriesTitleV_TotalNotHispanic Row Name: Title V Served Column Name: Total Not Hispanic or Latino Year: 2007 Field Note: Data source is the Tennessee Health Statistics
11.	Section Number: II. Unduplicated Count by Ethnicity Field Name: DeliveriesTitleV_TotalHispanic Row Name: Title V Served Column Name: Total Hispanic or Latino Year: 2007 Field Note: Data for the Hispanic is included in the unknown category.
12.	Section Number: II. Unduplicated Count by Ethnicity Field Name: DeliveriesTitleXIX_TotalNotHispanic Row Name: Eligible for Title XIX Column Name: Total Not Hispanic or Latino Year: 2007 Field Note: Data source is the Tennessee Health Statistics
13.	Section Number: II. Unduplicated Count by Ethnicity Field Name: DeliveriesTitleXIX_TotalHispanic Row Name: Eligible for Title XIX Column Name: Total Hispanic or Latino Year: 2007 Field Note: Data for the hispanic deliveries in included in the unknown category.
14.	Section Number: II. Unduplicated Count by Ethnicity Field Name: InfantsTotal_TotalNotHispanic Row Name: Total Infants in State Column Name: Total Not Hispanic or Latino Year: 2007 Field Note: Data source is the Tennessee Health Statistics
15.	Section Number: II. Unduplicated Count by Ethnicity Field Name: InfantsTotal_TotalHispanic Row Name: Total Infants in State Column Name: Total Hispanic or Latino Year: 2007 Field Note: data for hispanic delivery is included in the unknown category.
16.	Section Number: II. Unduplicated Count by Ethnicity Field Name: InfantsTitleV_TotalNotHispanic Row Name: Title V Served Column Name: Total Not Hispanic or Latino Year: 2007 Field Note: Data source is the Tennessee Health Statistics
17.	Section Number: II. Unduplicated Count by Ethnicity Field Name: InfantsTitleV_TotalHispanic Row Name: Title V Served Column Name: Total Hispanic or Latino Year: 2007 Field Note: Data for the hispanic deliveries is inluded in the unknown category.
18.	Section Number: II. Unduplicated Count by Ethnicity Field Name: InfantsTitleXIX_TotalNotHispanic Row Name: Eligible for Title XIX Column Name: Total Not Hispanic or Latino Year: 2007 Field Note: Data source is the Tennessee Health Statistics
19.	Section Number: II. Unduplicated Count by Ethnicity Field Name: InfantsTitleXIX_TotalHispanic Row Name: Eligible for Title XIX Column Name: Total Hispanic or Latino Year: 2007 Field Note: Data for hispanic deliveries is included in the unknown category.

	FY 2007	FY 2006	FY 2005	FY 2004	FY 2003
1. State MCH Toll-Free "Hotline" Telephone Number
2. State MCH Toll-Free "Hotline" Name	Tn Baby Line	TN Baby Line	TN Baby Line	TN Baby Line	TN Baby Line
3. Name of Contact Person for State MCH "Hotline"
4. Contact Person's Telephone Number
5. Number of calls received on the State MCH "Hotline" this reporting period

	FY 2007	FY 2006	FY 2005	FY 2004	FY 2003
1. State MCH Toll-Free "Hotline" Telephone Number
2. State MCH Toll-Free "Hotline" Name
3. Name of Contact Person for State MCH "Hotline"
4. Contact Person's Telephone Number
5. Number of calls received on the State MCH "Hotline" this reporting period

Form Notes for Form 9
	Data source is the Tennessee Maternal and Child Health
Field Level Notes
1.	Section Number: Main Field Name: hnumber_2 Row Name: State MCH toll-free hotline telephone number Column Name: FY Year: 2007 Field Note: Data source is the Tennessee Maternal and Child Health.

State MCH toll-free telephone line data form

1. State MCH Administration:
(max 2500 characters)

Maternal and Child Health, within the Bureau of Health Services in the Tennessee Department of Health, consists of two sections; Child and Adolescent Health, Abstinence Only Education, SIDS, Early Childhood Comprehensive Systems Planning, School Health, Child Fatality Review, Child Care Resource and Referral Centers, EPSDT, and Childhood Lead Poisoning Prevention. Services for CSHCN (called Children Special Services) include; medical and other health needs; care coordination/case management; and a Parent Support Network (PEP). The Women’s Health/Genetics section includes comprehensive family planning services; prenatal care, adolescent pregnancy prevention, perinatal regionalization, women’s health, newborn screening follow-up, newborn hearing screening follow-up, and the network of the genetics and sickle cell centers.

Block Grant Funds

2. Federal Allocation (Line 1, Form 2)

3. Unobligated balance (Line 2, Form 2)

4. State Funds (Line 3, Form 2)

5. Local MCH Funds (Line 4, Form 2)

6. Other Funds (Line 5, Form 2)

7. Program Income (Line 6, Form 2)

8. Total Federal-State Partnership (Line 8, Form 2)

9. Most significant providers receiving MCH funds:

10. Individuals served by the Title V Program (Col. A, Form 7)

a. Pregnant Women

b. Infants < 1 year old

c. Children 1 to 22 years old

d. CSHCN

e. Others

11. Statewide Initiatives and Partnerships:

a. Direct Medical Care and Enabling Services:
(max 2500 characters)

Direct services, provided statewide through health department clinics and nonprofit agencies, include pregnancy testing, family planning, nutrition services, immunizations and well child visits, EPSDT screenings, follow-up and referral. The number of EPSDT screenings done in local health departments has greatly increased. All EPSDT screenings for children in state custody are done in health department clinics. Enabling services concentrate on access to care, care coordination, home visiting services, and newborn screening follow-up. In selected areas, prenatal care and primary care are available. The care coordination component of CSS and the PEP Program provide special support and enable families to better meet their child’s needs in a complex health care environment. Statewide home visiting services provide intensive services for pregnant women and families of infants and toddlers that emphasize education, parent support, infant stimulation, assessment and referral to assure that children are healthy, free from child abuse, and ready for school. The HUGS home visiting program has significantly expanded services, providing assistance with health care, social and educational needs. New EPSDT efforts include the statewide community outreach initiative and Call Center.

b. Population-Based Services:
(max 2500 characters)

Child Fatality Teams in 31 judicial districts review all deaths of children under age 18 and make reports of recommendations for prevention efforts. The state child fatality review team reviews reports from the local teams, analyzes statistics of the incidence and causes of child deaths. And makes recommendations to the Governor and General Assembly to promote the safety and well being of children. The State Team’s recommendation to expand the availability of autopsies for unexplained child deaths passed the General Assembly. The Childhood Lead Poisoning Prevention Program works to identify children with elevated blood lead levels and to educate citizens and health care providers, with the goal of preventing childhood lead poisoning. The Newborn Hearing Screening Program has a strong network of tertiary level providers for referral, case screening for 34 diseases which reflects 50 different genetic disorders.

c. Infrastructure Building Services:
(max 2500 characters)

Regional and County Health Councils operate in all 95 counties to assess needs and gaps, develop plans, seek resources, and implement strategies for action. Many of the targeted activities are for the MCH populations. The Tennessee Birth Defects Registry (TBDR) originated as a legislative requirement for the Tennessee Department of Health to maintain an ongoing statewide program for monitoring birth defects. The registry has continued to increase the number of years of data. The Department has established an Immunization Registry which combines data from both the public and private sectors in an electronic format. The system permits primary care providers (PCP) to access case specific information to assure that an infant or child’s immunization are up to date. Tennessee has a statewide network of Child Care Resources and Referral Centers each of which has a child care health consultatnt (CCHC). The centers provide technical assistance, training, consultation, and resources to child care provider to improve the health and safety of child care.

12. The primary Title V Program contact person:

13. The children with special health care needs (CSHCN) contact person:

Name
Title
Address
City
State
Zip
Phone
Fax
Email
Web

Name
Title
Address
City
State
Zip
Phone
Fax
Email
Web

Form Notes for Form 10
	None
Field Level Notes
	None

Form Level Notes for Form 11

Data source is the State of Tennessee Health Statistics. In 2007 the State may start the PRAMS survey.

The percent of screen positive newborns who received timely follow up to definitive diagnosis and clinical management for condition(s) mandated by their State-sponsored newborn screening programs.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Performance Measure #1 Field Name: PM01 Row Name: Column Name: Year: 2005 Field Note: Data source is the state of Tennessee New Born Screening data system. In 2007 the State may start the PRAMS survey.
2.	Section Number: Performance Measure #1 Field Name: PM01 Row Name: Column Name: Year: 2004 Field Note: All but 11 of those screened and determined presumptive positives have been confirmed for 2004.Data source is the state of Tennessee New Born Screening data system.
3.	Section Number: Performance Measure #1 Field Name: PM01 Row Name: Column Name: Year: 2003 Field Note: Data source is the state of Tennessee New Born Screening data system.

The percent of children with special health care needs age 0 to 18 years whose families partner in decision making at all levels and are satisfied with the services they receive. (CSHCN survey)

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Performance Measure #2 Field Name: PM02 Row Name: Column Name: Year: 2005 Field Note: The data reported in 2005 are pre-populated with the data from 2004 for this performance measure.
2.	Section Number: Performance Measure #2 Field Name: PM02 Row Name: Column Name: Year: 2004 Field Note: The data reported in 2004 are pre-populated with the data from 2003 for this performance measure.
3.	Section Number: Performance Measure #2 Field Name: PM02 Row Name: Column Name: Year: 2003 Field Note: The data reported in 2002 have pre-populated the data for 2003 for this performance measure.

The percent of children with special health care needs age 0 to 18 who receive coordinated, ongoing, comprehensive care within a medical home. (CSHCN Survey)

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Performance Measure #3 Field Name: PM03 Row Name: Column Name: Year: 2005 Field Note: The data reported in 2005 are pre-populated with the data from 2004 for this performance measure.
2.	Section Number: Performance Measure #3 Field Name: PM03 Row Name: Column Name: Year: 2004 Field Note: The data reported in 2004 are pre-populated with the data from 2003 for this performance measure.
3.	Section Number: Performance Measure #3 Field Name: PM03 Row Name: Column Name: Year: 2003 Field Note: The data reported in 2002 have pre-populated the data for 2003 for this performance measure.

The percent of children with special health care needs age 0 to 18 whose families have adequate private and/or public insurance to pay for the services they need. (CSHCN Survey)

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Performance Measure #4 Field Name: PM04 Row Name: Column Name: Year: 2005 Field Note: The data reported in 2005 are pre-populated with the data from 2004 for this performance measure.
2.	Section Number: Performance Measure #4 Field Name: PM04 Row Name: Column Name: Year: 2004 Field Note: The data reported in 2004 are pre-populated with the data from 2003 for this performance measure.
3.	Section Number: Performance Measure #4 Field Name: PM04 Row Name: Column Name: Year: 2003 Field Note: The data reported in 2002 have pre-populated the data for 2003 for this performance measure.

Percent of children with special health care needs age 0 to 18 whose families report the community-based service systems are organized so they can use them easily. (CSHCN Survey)

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Performance Measure #5 Field Name: PM05 Row Name: Column Name: Year: 2005 Field Note: The data reported in 2005 are pre-populated with the data from 2004 for this performance measure.
2.	Section Number: Performance Measure #5 Field Name: PM05 Row Name: Column Name: Year: 2004 Field Note: The data reported in 2004 are pre-populated with the data from 2003 for this performance measure.
3.	Section Number: Performance Measure #5 Field Name: PM05 Row Name: Column Name: Year: 2003 Field Note: The data reported in 2002 have pre-populated the data for 2003 for this performance measure.

The percentage of youth with special health care needs who received the services necessary to make transitions to all aspects of adult life, including adult health care, work, and independence.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Performance Measure #6 Field Name: PM06 Row Name: Column Name: Year: 2005 Field Note: The data reported in 2005 are pre-populated with the data from 2004 for this performance measure. The increase in the annual indicator was due to wrong methodology previously used in counnting the variables. The denominator entered previously were wrongly counted due to errors in count methodology. This has being corrected to show consistancy for future years. Changes were made to our annual indicators as well.
2.	Section Number: Performance Measure #6 Field Name: PM06 Row Name: Column Name: Year: 2004 Field Note: The data reported in 2004 are pre-populated with the data from 2003 for this performance measure. The increase in the annual indicator was due to wrong methodology previously used in counnting the variables. The denominator entered previously were wrongly counted due to errors in count methodology. This has being corrected to show consistancy for future years. Changes were made to our annual indicators as well.
3.	Section Number: Performance Measure #6 Field Name: PM06 Row Name: Column Name: Year: 2003 Field Note: The data reported in 2002 have pre-populated the data for 2003 for this performance measure. The increase in the annual indicator was due to wrong methodology previously used in counnting the variables. The denominator entered previously were wrongly counted due to errors in count methodology. This has being corrected to show consistancy for future years. Changes were made to our annual indicators as well.

Percent of 19 to 35 month olds who have received full schedule of age appropriate immunizations against Measles, Mumps, Rubella, Polio, Diphtheria, Tetanus, Pertussis, Haemophilus Influenza, and Hepatitis B.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Performance Measure #7 Field Name: PM07 Row Name: Column Name: Year: 2005 Field Note: Data is from NIS Data for Tennessee
2.	Section Number: Performance Measure #7 Field Name: PM07 Row Name: Column Name: Year: 2004 Field Note: Data is from NIS data for Tennessee
3.	Section Number: Performance Measure #7 Field Name: PM07 Row Name: Column Name: Year: 2003 Field Note: In years prior to 2003, the level of completion was measured as 4 Dtap/3 Polio/1 MMR. For comparison's sake, the level of "4:3:1" for 2003 was 83.7%. In 2003, the criterion for completion was changed to 4:3:1:3:3:1.

The rate of birth (per 1,000) for teenagers aged 15 through 17 years.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

Section Number: Performance Measure #8
Field Name: PM08
Row Name:
Column Name:
Year: 2005
Field Note:
Data source is the State of Tennessee Health Statistics System.
The increase of 1.2 appears to be a trend that might happen in the U.S. ( most states) and consistant with previous years.

Percent of third grade children who have received protective sealants on at least one permanent molar tooth.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Performance Measure #9 Field Name: PM09 Row Name: Column Name: Year: 2005 Field Note: This data is from the 1997 survey of Tennessee children as reported in the Tennessee Dental Association Journal.
2.	Section Number: Performance Measure #9 Field Name: PM09 Row Name: Column Name: Year: 2004 Field Note:
3.	Section Number: Performance Measure #9 Field Name: PM09 Row Name: Column Name: Year: 2003 Field Note: These numbers are low because the children surveyed were our target population not a random sampling. These numbers represent the most at risk and underserved population and not indicative of the state as a whole.

The rate of deaths to children aged 14 years and younger caused by motor vehicle crashes per 100,000 children.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Performance Measure #10 Field Name: PM10 Row Name: Column Name: Year: 2005 Field Note: Data source is the State of Tennessee Health Statistics System
2.	Section Number: Performance Measure #10 Field Name: PM10 Row Name: Column Name: Year: 2004 Field Note: Data source is the State of Tennessee Health Statistics System
3.	Section Number: Performance Measure #10 Field Name: PM10 Row Name: Column Name: Year: 2003 Field Note: Data source is the State of Tennessee Health Statistics System

The percent of mothers who breastfeed their infants at 6 months of age.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?					Final

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

Section Number: Performance Measure #11
Field Name: PM11
Row Name:
Column Name:
Year: 2005
Field Note:
Data is from National Immunization Survey. Tennessee 29.1 (+ - 4.2 ) Percent of 95 % confidence interval. Source: CDC.gov/breastfeeding/data
The numerators and Denominator are based on estimates of the CDC survey.

Percentage of mothers who breastfeed their infants at hospital discharge.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Old Performance Measure #11 Field Name: PM11R07 Row Name: Column Name: Year: 2005 Field Note: Data source is the State of Tennessee Health Statistics System
2.	Section Number: Old Performance Measure #11 Field Name: PM11R07 Row Name: Column Name: Year: 2004 Field Note: Data source is the State of Tennessee Health Statistics System

Percentage of newborns who have been screened for hearing before hospital discharge.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Performance Measure #12 Field Name: PM12 Row Name: Column Name: Year: 2005 Field Note: Data source is the State vital records and Newborn screening registry. No law requires hospitals in the state to report on screening.
2.	Section Number: Performance Measure #12 Field Name: PM12 Row Name: Column Name: Year: 2004 Field Note: Data source is State Vital record and Newborn screening registry

Percent of children without health insurance.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

Section Number: Performance Measure #13
Field Name: PM13
Row Name:
Column Name:
Year: 2005
Field Note:
Estimate was generated from the National survey of children health where 93.6 % of children had health insurance.
It is anticipated that the State of Tennessee might have Coverkids health coverage and this will cover both kids and pregnant women.

Percentage of children, ages 2 to 5 years, receiving WIC services with a Body Mass Index (BMI) at or above the 85th percentile.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?					Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Performance Measure #14 Field Name: PM14 Row Name: Column Name: Year: 2005 Field Note: Data source is state WIC database. Data categories may include children under the age of 2 years to 5 years.

Percentage of women who smoke in the last three months of pregnancy.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?					Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Performance Measure #15 Field Name: PM15 Row Name: Column Name: Year: 2005 Field Note: Data source is the State of Tennessee Health Statistics System

The rate (per 100,000) of suicide deaths among youths aged 15 through 19.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Performance Measure #16 Field Name: PM16 Row Name: Column Name: Year: 2005 Field Note: Data was from State Vital registry

Percent of very low birth weight infants delivered at facilities for high-risk deliveries and neonates.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Performance Measure #17 Field Name: PM17 Row Name: Column Name: Year: 2005 Field Note: Data source is the State of Tennessee Health Statistics System. In 2007 the State may start the PRAMS survey.
2.	Section Number: Performance Measure #17 Field Name: PM17 Row Name: Column Name: Year: 2004 Field Note: Data source is the State of Tennessee Health Statistics System In 2007 the State may start the PRAMS survey.

Percent of infants born to pregnant women receiving prenatal care beginning in the first trimester.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Performance Measure #18 Field Name: PM18 Row Name: Column Name: Year: 2005 Field Note: State Vital Records Data source is the State of Tennessee Health Statistics System
2.	Section Number: Performance Measure #18 Field Name: PM18 Row Name: Column Name: Year: 2004 Field Note: These data are estimates.

Reduce the percentage of high school students using tobacco (cigarettes and smokeless tobacco).

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: State Performance Measure #1 Field Name: SM1 Row Name: Column Name: Year: 2005 Field Note: The 2005 Youth Risk Behavior Survey (YRBSS) was the sources.
2.	Section Number: State Performance Measure #1 Field Name: SM1 Row Name: Column Name: Year: 2004 Field Note: 2003 Youth Behaviorial Risk Surveillance Survey (YRBSS) was used to estimate year 2004
3.	Section Number: State Performance Measure #1 Field Name: SM1 Row Name: Column Name: Year: 2003 Field Note: The 2003 Youth Risk Behavior Survey was the source.

Reduce the percentage of high school students using alcohol.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: State Performance Measure #2 Field Name: SM2 Row Name: Column Name: Year: 2005 Field Note: YRBSS was the data source.
2.	Section Number: State Performance Measure #2 Field Name: SM2 Row Name: Column Name: Year: 2004 Field Note: The Youth Behavioral Risk Surveillance Survey (YRBSS) is done every other year. The next set of data will come in 2005.
3.	Section Number: State Performance Measure #2 Field Name: SM2 Row Name: Column Name: Year: 2003 Field Note: The Youth Risk Behavior Survey was done in 2003

Reduce the incidence of maltreatment of children younger than age 18 including physical, sexual, emotional abuse and neglect to a rate no more than 8 per 1,000.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

Section Number: State Performance Measure #3
Field Name: SM3
Row Name:
Column Name:
Year: 2005
Field Note:
The DCS numbers are based on the date that the investigation is completed and classified. The numbers do not necessarily reflect the year that the abuse and/or neglect took place. Therefore, the dramatic increase in the 2004 numbers is due mainly to the department's concerted effort to eliminate investigation backlogs. The backlog has reduced substantially and is expected to be caught up by the end of 2005. DCS reports that counting by the classification date allows for a more consistent accounting. If they reported by the incident date, then the numbers for all the years would continue to change and would be fluid. This accounting system allows for consistency. Once the case backlogs are caught up, it is expected that the victim count will stabilize and provide a more accurate assessment of trends from year to year.

Section Number: State Performance Measure #3
Field Name: SM3
Row Name:
Column Name:
Year: 2004
Field Note:
The DCS numbers are based on the date that the investigation is completed and classified. The numbers do not necessarily reflect the year that the abuse and/or neglect took place. Therefore, the dramatic increase in the 2004 numbers is due mainly to the department's concerted effort to eliminate investigation backlogs. The backlog has reduced substantially and is expected to be caught up by the end of 2005. DCS reports that counting by the classification date allows for a more consistent accounting. If they reported by the incident date, then the numbers for all the years would continue to change and would be fluid. This accounting system allows for consistency. Once the case backlogs are caught up, it is expected that the victim count will stabilize and provide a more accurate assessment of trends from year to year.

Increase percentage of children with complete EPSDT annual examinations by 3 percent each year.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: State Performance Measure #4 Field Name: SM4 Row Name: Column Name: Year: 2005 Field Note: Data source is the State of Tennessee EPSDT data System
2.	Section Number: State Performance Measure #4 Field Name: SM4 Row Name: Column Name: Year: 2004 Field Note: Data source is the State of Tennessee EPSDT data System
3.	Section Number: State Performance Measure #4 Field Name: SM4 Row Name: Column Name: Year: 2003 Field Note: Data source is the State of Tennessee EPSDT data System

Reduce the proportion of teens and young adults ages 15 to 24 with chlamydia trachomatis infections attending family planning clinics

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: State Performance Measure #5 Field Name: SM5 Row Name: Column Name: Year: 2005 Field Note: Data source is the State of Tennessee Health Statistics System. The increase in the numerator is due testing. In mid 2003 there was a change in the methodology of testing and it appears the sensitivity of the test is great and able to capture all false negatives.
2.	Section Number: State Performance Measure #5 Field Name: SM5 Row Name: Column Name: Year: 2004 Field Note: Data source is the State of Tennessee Health Statistics System
3.	Section Number: State Performance Measure #5 Field Name: SM5 Row Name: Column Name: Year: 2003 Field Note: Data source is the State of Tennessee Health Statistics System

Reduce the number of babies born prematurely.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?					Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: State Performance Measure #6 Field Name: SM6 Row Name: Column Name: Year: 2005 Field Note: State of Tennessee data source. (Health Statistics)

Increase percentage of adolescents with complete Early Periodic Screening, Diagnosis and Treatment(EPSDT) annual examinations by 5% each year.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?					Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: State Performance Measure #7 Field Name: SM7 Row Name: Column Name: Year: 2005 Field Note: Data source is the State of Tennessee EPSDT data System

Reduce the number of pregnant women who smoke and or use illicit drugs.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?					Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: State Performance Measure #8 Field Name: SM8 Row Name: Column Name: Year: 2005 Field Note: Data source is Tennessee Health Statistics. Currently Tennessee does not have PRAMS data collection but efforts is under way to start the PRAMS by year 2007.

Reduce the number of overweight and obese children and adolescents.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?					Final

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: State Performance Measure #9 Field Name: SM9 Row Name: Column Name: Year: 2005 Field Note: 2005 Tennessee Risk Behavior Survey indicated that 31.9 % of school students were described as obese out of a total of 1,540 students surveyed.

Increase the percentage of youth with special health care needs, age 14 and older, who receive formal plans for transition to adulthood.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?					Final

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: State Performance Measure #10 Field Name: SM10 Row Name: Column Name: Year: 2005 Field Note: Data source is the State of Tennessee CSS data system

Form Level Notes for Form 12

Data is from state vital data

The infant mortality rate per 1,000 live births.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Outcome Measure 1 Field Name: OM01 Row Name: Column Name: Year: 2005 Field Note: Data source is the State vital records.
2.	Section Number: Outcome Measure 1 Field Name: OM01 Row Name: Column Name: Year: 2004 Field Note: Data source is the State vital records.
3.	Section Number: Outcome Measure 1 Field Name: OM01 Row Name: Column Name: Year: 2003 Field Note: Data source is the State vital records.

The ratio of the black infant mortality rate to the white infant mortality rate.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Outcome Measure 2 Field Name: OM02 Row Name: Column Name: Year: 2005 Field Note: Data source is the State vital records.
2.	Section Number: Outcome Measure 2 Field Name: OM02 Row Name: Column Name: Year: 2004 Field Note: Data source is the State vital records.

The neonatal mortality rate per 1,000 live births.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Outcome Measure 3 Field Name: OM03 Row Name: Column Name: Year: 2005 Field Note: Data source is the State vital records.
2.	Section Number: Outcome Measure 3 Field Name: OM03 Row Name: Column Name: Year: 2004 Field Note: Data source is the State vital records.

The postneonatal mortality rate per 1,000 live births.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Outcome Measure 4 Field Name: OM04 Row Name: Column Name: Year: 2005 Field Note: Data source is the State vital records.
2.	Section Number: Outcome Measure 4 Field Name: OM04 Row Name: Column Name: Year: 2004 Field Note: Data source is the State vital records.

The perinatal mortality rate per 1,000 live births plus fetal deaths.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Outcome Measure 5 Field Name: OM05 Row Name: Column Name: Year: 2005 Field Note: Data source is the State vital records. The increase in the numerator is due to the defination and methodolgy in counting the variables.
2.	Section Number: Outcome Measure 5 Field Name: OM05 Row Name: Column Name: Year: 2004 Field Note: Data source is the State vital records. The increase in the numerator is due to the defination and methodolgy in counting the variables.

The child death rate per 100,000 children aged 1 through 14.

	Annual Objective and Performance Data
	2001	2002	2003	2004	2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2006	2007	2008	2009	2010
Annual Performance Objective
Annual Indicator	Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1.	Section Number: Outcome Measure 6 Field Name: OM06 Row Name: Column Name: Year: 2005 Field Note: Data source is the State vital records.
2.	Section Number: Outcome Measure 6 Field Name: OM06 Row Name: Column Name: Year: 2004 Field Note: Data source is the State vital records.

1. Family members participate on advisory committee or task forces and are offering training, mentoring, and reimbursement, when appropriate.


2. Financial support (financial grants, technical assistance, travel, and child care) is offered for parent activities or parent groups.


3. Family members are involved in the Children with Special Health Care Needs elements of the MCH Block Grant Application process.


4. Family members are involved in service training of CSHCN staff and providers.


5. Family members hired as paid staff or consultants to the State CSHCN program (a family member is hired for his or her expertise as a family member).


6. Family members of diverse cultures are involved in all of the above activities.


Total Score:
Rating Key 0 = Not Met 1 = Partially Met 2 = Mostly Met 3 = Completely Met

Form Notes for Form 13
	None
Field Level Notes
	None

[Sec. 505(a)(5)]

Your State's 5-year Needs Assessment should identify the need for preventive and primary care services for pregnant women, mothers, and infants; preventive and primary care services for children and services for Children with Special Health Care Needs. With each year's Block Grant application, provide a list (whether or not the priority needs change) of the top maternal and child health needs in your state. Using simple sentence or phrase ,list below your State's needs. Examples of such statements are: "To reduce the barriers to the delivery of care for pregnant women, " and "The infant mortality rate for minorities should be reduced."

MCHB will capture annually every State's top 7 to 10 priority needs in an information system for comparison, tracking, and reporting purposes; you must list at least 7 and no more than 10. Note that the numbers listed below are for computer tracking only and are not meant to indicate priority order. If your State wishes to report more than 10 priority needs, list additional priority needs in a note at the form level.

1.	Reduce the number of premature births.
2.	Reduce child abuse and neglect.
3.	Reduce tobacco use by adolescents.
4.	Reduce alcohol use by adolescents.
5.	Improve Tennessee's EPSDT screening rates for children.
6.	Improve Tennessee's EPSDT screening rates for adolescents.
7.	Reduce the STD infection rates including chlamydia infection in adolescents.
8.	Reduce the number of overweight and obese children and teens.
9.	Reduce the number of pregnant women who smoke.
10.	Improve the number of youth with special health care needs who transition successfully to adulthood.

Form Notes for Form 14
	None
Field Level Notes
	None

STATE: TN

APPLICATION YEAR: 2007

No.	Category of Technical Assistance Requested	Description of Technical Assistance Requested (max 250 characters)	Reason(s) Why Assistance Is Needed (max 250 characters)	What State, Organization or Individual Would You suggest Provide the TA (if known) (max 250 characters)
1.	Other If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here:	No Technical Assistance is needed at this time.	No Technical Assistance is needed at this time.	No Technical Assistance is needed at this time.
2.	If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here:
3.	If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here:
4.	If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here:
5.	If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here:
6.	If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here:
7.	If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here:
8.	If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here:
9.	If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here:
10.	If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here:
11.	If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here:
12.	If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here:

Form Notes for Form 15
	Tennessee is not requesting Technical Assistance at this time.
Field Level Notes
	None

SP #
Performance Measure:	Reduce the percentage of high school students using tobacco (cigarettes and smokeless tobacco).
Status:	Active
Goal	To decrease the number of high school students using any form of tobacco.
Definition	The number of high school students using any form of tobacco.
	Numerator: Number of high school students using tobacco (cigarettes and smokeless tobacco) each year.
	Denominator: Total number of high school age students who took the Tennessee Youth Tobacco Survey.
	Units: 100 Text: Percent

Healthy People 2010 Objective
Data Sources and Data Issues	Tennessee Youth Tobacco Survey (YBRSS)
Significance	Tobacco is identified as a "gateway" drug often leading to experimentation and/or use of other substances known to be harmful to young people. With the recent court settlement with the tobacco companies, and known long term harmful affects of tobacco use on the health status and premature death of the users and persons experiencing second hand smoke. Tennessee will target a reduction in tobacco use by teens.

SP #
Performance Measure:	Reduce the percentage of high school students using alcohol.
Status:	Active
Goal	To reduce the percentage of high school students using alcohol.
Definition	The number of high school students using alcohol as a percentage of the number completing the survey.
	Numerator: The number of high school students who had at least one drink of alcohol on one or more of the past 30 days.
	Denominator: The number of high school students taking the YRBS survey.
	Units: 100 Text: Percent

Healthy People 2010 Objective
Data Sources and Data Issues	Youth Risk Behavior Survey
Significance	The State has established two sources of data regarding teen substance use and abuse. The Youth Behavior Risk Survey and a special survey conducted by the Bureau of Alcohol and Drugs in the Tennessee Department of Health. While prior studies indicate that use of these substances changes periodically, any use is prohibited by law and thought to be seriously harmful to young people. Our goal is to reduce substance use by adolescents in Tennessee.

SP #
Performance Measure:	Reduce the incidence of maltreatment of children younger than age 18 including physical, sexual, emotional abuse and neglect to a rate no more than 8 per 1,000.
Status:	Active
Goal	To reduce the incidence of maltreatment of children younger than age 18 including physical, sexual and emotional abuse and neglect to no more than the rate of 8 per 1000.
Definition
	Numerator: The number of children younger than age 18, who are victims of indicated abuse and neglect.
	Denominator: The total number of children under age 18 in a given year.
	Units: 1000 Text:

Healthy People 2010 Objective
Data Sources and Data Issues	Reports from the Department of Children's Services Child Protective Services Section.
Significance	Children must be free from abuse and neglect in order to be healthy both physically and emotionally. Maternal and Child Health programs such as home visiting have proven to be effective in reducing abuse and neglect.

SP #
Performance Measure:	Increase percentage of children with complete EPSDT annual examinations by 3 percent each year.
Status:	Active
Goal	To increase the percentage of children with complete EPSDT annual examinations each year.
Definition	The number of children enrolled in TennCare, ages 0 - 21 years, having had an annual examintion each year.
	Numerator: The number of children receiving EPSDT annual examinations
	Denominator: Number of children ages 0 - 21 years whom are eligible for EPSDT each year.
	Units: 100 Text: Percent

Healthy People 2010 Objective
Data Sources and Data Issues	Tenncare
Significance

SP #
Performance Measure:	Reduce the proportion of teens and young adults ages 15 to 24 with chlamydia trachomatis infections attending family planning clinics
Status:	Active
Goal	Reduce chlamydia trachomatis infections among teens and young adults ages 5 to 24 years (per 100) attending family planning clinics.
Definition
	Numerator: Number of teens and young adults identified with chlamydia trachomatis attending family planning clinics.
	Denominator: Total number of teens and young adults tested for chlamydia trachomatis in family planning clinics.
	Units: 100 Text: percent

Healthy People 2010 Objective
Data Sources and Data Issues	Region IV Chlamydia Screening project, STD Surveillance System
Significance	The Region IV chlamydia project tracks positivity rates for those clients tested in the project. In Tennessee, all teens and young adults attending family planning clinics are tested for chlamydia. This measure has been changed from SP#8 to reflect the data being collected and to state the method being used to track changes in the population. Past years data have been included for the new measure.

SP #
Performance Measure:	Reduce the number of babies born prematurely.
Status:	Active
Goal	To reduce the number of live births born prematurely.
Definition	Addressing certain known modifiable risk factors of preterm births can improve birth outcomes.
	Numerator: Number of live births with gestation less than 37 weeks in the calendar year.
	Denominator: Total number of live births in the calendar year.
	Units: 100 Text: Percent

Healthy People 2010 Objective	Objective 16-11. Reduce preterm births to 7.6%. (Baseline: 11.4 in 1997)
Data Sources and Data Issues	State's Vital Records
Significance	Prematurity is the leading cause of neonatal mortality in the U.S. Nearly 50% of preterm births have no known causes, but certain modifiable risk factors (medical, behavioral, and environmental) can be addressed.

SP #
Performance Measure:	Increase percentage of adolescents with complete Early Periodic Screening, Diagnosis and Treatment(EPSDT) annual examinations by 5% each year.
Status:	Active
Goal	To increase the percentage of adolescents with complete EPSDT annual examinations each year.
Definition	The number of teens enrolled in TennCare,ages birth to 20, having had an annual examination each year.
	Numerator: The number of teens aged birth to 20 receiving EPSDT annual examinations.
	Denominator: Number of teens ages birth to 20 whom are eligible for EPSDT examinations each year.
	Units: 100 Text: Percent

Healthy People 2010 Objective
Data Sources and Data Issues	TennCare
Significance

SP #
Performance Measure:	Reduce the number of pregnant women who smoke and or use illicit drugs.
Status:	Active
Goal	Decrease the number of pregnant women who smoke.
Definition	Addressing smoking cessation with pregnant women can improve birth outcomes.
	Numerator: Number of live births where birth certificate data indicates smoking during pregnancy in the calendar year.
	Denominator: Total number of live births in calendar year.
	Units: 100 Text: Percent

Healthy People 2010 Objective	16-17. Increase abstinence from alcohol, cigarettes, and illicit drugs among pregnant women.
Data Sources and Data Issues	State birth certificate system
Significance	A range of effects, including spontaneous abortion, LBW, and preterm delivery, have been associated with prenatal use of licit and illicit drugs, including alcohol, tobacco, cocaine and marijuana. Tobacco is associated with LBW and spontaneous abortion.

SP #
Performance Measure:	Reduce the number of overweight and obese children and adolescents.
Status:	Active
Goal	Reduce the number of overweight and obese children and adolescents.
Definition	Increasing healthy eating and physical activity among children and adolescents can reduce the number of children and adolescents who are overweight or obese.
	Numerator: 2003 Tennessee Youth Risk Behavior Survey data.
	Denominator: 2003 Tennessee Youth Risk Behavior data.
	Units: 100 Text: Percent

Healthy People 2010 Objective	19-3. Reduce the proportion of children and adolescents who are overweight or obese.
Data Sources and Data Issues	2005 Tennessee Risk Behavior Survey (YBRSS)
Significance	Maintenance of a healthy weight is a major goal in the effort to reduce the burden of illness and its consequent reduction in quality of life and life expectancy. Patterns of healthful eating behavior and physical activity begins in childhood.

SP #
Performance Measure:	Increase the percentage of youth with special health care needs, age 14 and older, who receive formal plans for transition to adulthood.
Status:	Active
Goal	To increase the percentage of youth with special health care needs, age 14-21 years, who receive formal plans necessary to transition to adult health care, post high school education, work and independence.
Definition
	Numerator: Number of youth in the Children's Special Services' program, age 14-21 years, who receive formal transition plans.
	Denominator: Number of youth in Children's Special Services, age 14 -21 years during the reporting period.
	Units: 100 Text: Percent

Healthy People 2010 Objective	Related to Objective 16.23:Increase the proportion of States and jurisdictions that have service systems for children with or at risk for chronic and disabling conditions as required by Public Law 101-239.
Data Sources and Data Issues	Tennessee Department of Health's client tracking and encounter system, PTBMIS, will be used to determine what services are provided to the client.
Significance	The transition from youth to adulthood has become a priority issue in Tennessee. This mirrors national priorities as evidenced by the President's "New Freedom Initiative: Delivering on the Promise" (March 2002). Most children with special health care needs now live to adulthood, but are less likely than their non-disabled peers to complete high school, attend college or to be employed.

Form Notes for Form 16
	None
Field Level Notes
	None

Form Level Notes for Form 17

Tennessee does not have a separate SCHIP program.

The rate of children hospitalized for asthma (ICD-9 Codes: 493.0 -493.9) per 10,000 children less than five years of age.

	Annual Indicator Data
	2001	2002	2003	2004	2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

Field Level Notes

1.	Section Number: Health Systems Capacity Indicator #01 Field Name: HSC01 Row Name: Column Name: Year: 2005 Field Note: Data source is State of Tennessee Health Statistics. (Hospital Discharge Data)
2.	Section Number: Health Systems Capacity Indicator #01 Field Name: HSC01 Row Name: Column Name: Year: 2004 Field Note: Data source is State of Tennessee Health Statistics. (Hospital Discharge Data)
3.	Section Number: Health Systems Capacity Indicator #01 Field Name: HSC01 Row Name: Column Name: Year: 2003 Field Note: Data source is State of Tennessee Health Statistics. (Hospital Discharge Data)

The percent Medicaid enrollees whose age is less than one year during the reporting year who received at least one initial periodic screen.

	Annual Indicator Data
	2001	2002	2003	2004	2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

Field Level Notes

1.	Section Number: Health Systems Capacity Indicator #02 Field Name: HSC02 Row Name: Column Name: Year: 2005 Field Note: Actual medicaid data was not obtainable. Data source is State's EPSDT database.
2.	Section Number: Health Systems Capacity Indicator #02 Field Name: HSC02 Row Name: Column Name: Year: 2004 Field Note: Actual medicaid data was not obtainable. Data source is State's EPSDT database.
3.	Section Number: Health Systems Capacity Indicator #02 Field Name: HSC02 Row Name: Column Name: Year: 2003 Field Note: The data for 2000 were not obtainable.

The percent State Childrens Health Insurance Program (SCHIP) enrollees whose age is less than one year during the reporting year who received at least one periodic screen.

	Annual Indicator Data
	2001	2002	2003	2004	2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Provisional	Provisional

Field Level Notes

1.	Section Number: Health Systems Capacity Indicator #03 Field Name: HSC03 Row Name: Column Name: Year: 2005 Field Note: Tennessee does not have a separate SCHIP program and N/A the data reported. All children are enrolled as medicaid eligible, uninsured or uninsurable under the TennCare program.
2.	Section Number: Health Systems Capacity Indicator #03 Field Name: HSC03 Row Name: Column Name: Year: 2004 Field Note: Tennessee does not have a separate SCHIP program. All children are enrolled as Medicaid-eligible, uninsured or uninsurable under the TennCare program
3.	Section Number: Health Systems Capacity Indicator #03 Field Name: HSC03 Row Name: Column Name: Year: 2003 Field Note: Tennessee does not have a separate SCHIP program. All children are enrolled as Medicaid-eligible, uninsured or uninsurable under the TennCare program

The percent of women (15 through 44) with a live birth during the reporting year whose observed to expected prenatal visits are greater than or equal to 80 percent on the Kotelchuck Index.

	Annual Indicator Data
	2001	2002	2003	2004	2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

Field Level Notes

1.	Section Number: Health Systems Capacity Indicator #04 Field Name: HSC04 Row Name: Column Name: Year: 2005 Field Note: State of Tennessee vital records.
2.	Section Number: Health Systems Capacity Indicator #04 Field Name: HSC04 Row Name: Column Name: Year: 2004 Field Note: State of Tennessee vital records.
3.	Section Number: Health Systems Capacity Indicator #04 Field Name: HSC04 Row Name: Column Name: Year: 2003 Field Note: State vital records

Percent of potentially Medicaid-eligible children who have received a service paid by the Medicaid Program.

	Annual Indicator Data
	2001	2002	2003	2004	2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

Field Level Notes

1.	Section Number: Health Systems Capacity Indicator #07A Field Name: HSC07A Row Name: Column Name: Year: 2005 Field Note: Data source is State medicaid data based on eligiblity.
2.	Section Number: Health Systems Capacity Indicator #07A Field Name: HSC07A Row Name: Column Name: Year: 2004 Field Note: Data source is State medicaid datebased on eligiblity.
3.	Section Number: Health Systems Capacity Indicator #07A Field Name: HSC07A Row Name: Column Name: Year: 2003 Field Note: Data source is State medicaid datebased on eligiblity.

The percent of EPSDT eligible children aged 6 through 9 years who have received any dental services during the year.

	Annual Indicator Data
	2001	2002	2003	2004	2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

Field Level Notes

1.	Section Number: Health Systems Capacity Indicator #07B Field Name: HSC07B Row Name: Column Name: Year: 2005 Field Note: State EPSDT database.
2.	Section Number: Health Systems Capacity Indicator #07B Field Name: HSC07B Row Name: Column Name: Year: 2004 Field Note: State EPSDT database.
3.	Section Number: Health Systems Capacity Indicator #07B Field Name: HSC07B Row Name: Column Name: Year: 2003 Field Note: State EPSDT database.

The percent of State SSI beneficiaries less than 16 years old receiving rehabilitative services from the State Children with Special Health Care Needs (CSHCN) Program.

	Annual Indicator Data
	2001	2002	2003	2004	2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

Field Level Notes

1.	Section Number: Health Systems Capacity Indicator #08 Field Name: HSC08 Row Name: Column Name: Year: 2005 Field Note: Data source is the State CSHCN, medicaid and SSI progam
2.	Section Number: Health Systems Capacity Indicator #08 Field Name: HSC08 Row Name: Column Name: Year: 2004 Field Note: Data source is the State CSHCN, medicaid and SSI progam
3.	Section Number: Health Systems Capacity Indicator #08 Field Name: HSC08 Row Name: Column Name: Year: 2003 Field Note: Data source is the State CSHCN, medicaid and SSI progam

INDICATOR #05 Comparison of health system capacity indicators for Medicaid, non-Medicaid, and all MCH populations in the State	YEAR	DATA SOURCE	POPULATION
	YEAR	DATA SOURCE	MEDICAID	NON-MEDICAID	ALL
a) Percent of low birth weight (< 2,500 grams)	2005	Matching data files
b) Infant deaths per 1,000 live births	2005	Matching data files
c) Percent of infants born to pregnant women receiving prenatal care beginning in the first trimester	2005	Matching data files
d) Percent of pregnant women with adequate prenatal care(observed to expected prenatal visits is greater than or equal to 80% [Kotelchuck Index])	2005	Matching data files

INDICATOR #06 The percent of poverty level for eligibility in the State's Medicaid programs for infants (0 to 1), children, Medicaid and pregnant women.	YEAR	PERCENT OF POVERTY LEVEL MEDICAID (Valid range: 100-300 percent)
a) Infants (0 to 1)	2005
b) Medicaid Children (Age range to ) (Age range to ) (Age range to )	2005
c) Pregnant Women	2005

INDICATOR #06 The percent of poverty level for eligibility in the State's SCHIP programs for infants (0 to 1), children, SCHIP and pregnant women.	YEAR	PERCENT OF POVERTY LEVEL SCHIP
a) Infants (0 to 1)	2005
b) Medicaid Children (Age range to ) (Age range to ) (Age range to )	2005
c) Pregnant Women	2005

Form Notes for Form 18
	Different data source. Data on non medicaid population is not available. State Vital Records: Linked Birth certificate and medicaid files. Data is based on estimates. Data on non-medicaid population are not available.
Field Level Notes
1.	Section Number: Indicator 06 - SCHIP Field Name: SCHIP_Infant Row Name: Infants Column Name: Year: 2007 Field Note: State Vital Records: Linked Birth certificate and medicaid files. Data is based on estimates. Data on non-medicaid population are not available.
2.	Section Number: Indicator 06 - SCHIP Field Name: SCHIP_Children Row Name: SCHIP Children Column Name: Year: 2007 Field Note: State Vital Records: Linked Birth certificate and medicaid files. Data is based on estimates. Data on non-medicaid population are not available.
3.	Section Number: Indicator 06 - SCHIP Field Name: SCHIP_Women Row Name: Pregnant Women Column Name: Year: 2007 Field Note: State Vital Records: Linked Birth certificate and medicaid files. Data is based on estimates. Data on non-medicaid population are not available.
4.	Section Number: Indicator 05 Field Name: LowBirthWeight Row Name: Percent of ow birth weight (<2,500 grams) Column Name: Year: 2007 Field Note: State Vital Records: Linked Birth certificate and medicaid files. Data is based on estimates. Data on non-medicaid population are not available.
5.	Section Number: Indicator 05 Field Name: InfantDeath Row Name: Infant deaths per 1,000 live births Column Name: Year: 2007 Field Note: State Vital Records: Linked Birth/Death certificate and medicaid files. Data is based on estimates. Data on the non-medicaid population are not available. Medicaid infant mortality rate is under work by staff.
6.	Section Number: Indicator 05 Field Name: CareFirstTrimester Row Name: Percent of infants born to pregnant women receiving prenatal care beginning in the first trimester Column Name: Year: 2007 Field Note: Different data source and Data on non medicaid population are not available.State Vital Records: Linked Birth certificate and medicaid files. Data may be based on estimates.
7.	Section Number: Indicator 05 Field Name: AdequateCare Row Name: Percent of pregnant women with adequate prenatal care Column Name: Year: 2007 Field Note: The Kotelchuck index is not calculated on the medicaid data. Data on the non medicaid population are not available. State Vital Records: Linked Birth certificate and medicaid files. Data is based on estimates.

HEALTH SYSTEMS CAPACITY INDICATOR #09A (General MCH Data Capacity)
(The Ability of the State to Assure MCH Program Access to Policy and Program Relevant Informatioin)

DATABASES OR SURVEYS	Does your MCH program have the ability to obtain data for program planning or policy purposes in a timely manner? (Select 1 - 3) *	Does your MCH program have Direct access to the electronic database for analysis? (Select Y/N)
ANNUAL DATA LINKAGES Annual linkage of infant birth and infant death certificates	3	No
Annual linkage of birth certificates and Medicaid Eligibility or Paid Claims Files	2	No
Annual linkage of birth certificates and WIC eligibility files	2	No
Annual linkage of birth certificates and newborn screening files	3	No
REGISTRIES AND SURVEYS Hospital discharge survey for at least 90% of in-State discharges	3	No
Annual birth defects surveillance system	3	No
Survey of recent mothers at least every two years (like PRAMS)	1	No
*Where: 1 = No, the MCH agency does not have this ability. 2 = Yes, the MCH agency sometimes has this ability, but not on a consistent basis. 3 = Yes, the MCH agency always has this ability.

DATA SOURCES	Does your state participate in the YRBS survey? (Select 1 - 3)*	Does your MCH program have direct access to the state YRBS database for analysis? (Select Y/N)
Youth Risk Behavior Survey (YRBS)	3	No
Other:	3	No
	3	No

*Where: 1 = No 2 = Yes, the State participates but the sample size is not large enough for valid statewide estimates for this age group. 3 = Yes, the State participates and the sample size is large enough for valid statewide estimates for this age group.
Notes:
1. HEALTH SYSTEMS CAPACITY INDICATOR #09B was formerly reported as Developmental Health Status Indicator #05.

Form Notes for Form 19
	None
Field Level Notes
1.	Section Number: Indicator 09A Field Name: RecentMother Row Name: Survey of recent mothers at least every two years (like PRAMS) Column Name: Year: 2007 Field Note: State may conduct the PRAMS survey in 2007

Form Level Notes for Form 11

These data which are from the hospital discharge dataset for 2005. These are estimates and provisional data.

The percent of live births weighing less than 2,500 grams.

	Annual Indicator Data
	2001	2002	2003	2004	2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

Field Level Notes

1.	Section Number: Health Status Indicator #01A Field Name: HSI01A Row Name: Column Name: Year: 2005 Field Note: Data source is State of Tennessee Vital Records
2.	Section Number: Health Status Indicator #01A Field Name: HSI01A Row Name: Column Name: Year: 2004 Field Note: Data source is State of Tennessee Vital Records.
3.	Section Number: Health Status Indicator #01A Field Name: HSI01A Row Name: Column Name: Year: 2003 Field Note: Data source is State Vital Records.

The percent of live singleton births weighing less than 2,500 grams.

	Annual Indicator Data
	2001	2002	2003	2004	2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

Field Level Notes

1.	Section Number: Health Status Indicator #01B Field Name: HSI01B Row Name: Column Name: Year: 2005 Field Note: Data source is State of Tennessee Vital Records.
2.	Section Number: Health Status Indicator #01B Field Name: HSI01B Row Name: Column Name: Year: 2004 Field Note: Data source is State of Tennessee Vital Records.
3.	Section Number: Health Status Indicator #01B Field Name: HSI01B Row Name: Column Name: Year: 2003 Field Note: Data source is State Vital Records.

The percent of live births weighing less than 1,500 grams.

	Annual Indicator Data
	2001	2002	2003	2004	2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

Field Level Notes

1.	Section Number: Health Status Indicator #02A Field Name: HSI02A Row Name: Column Name: Year: 2005 Field Note: Data source is State of Tennessee Vital Records.
2.	Section Number: Health Status Indicator #02A Field Name: HSI02A Row Name: Column Name: Year: 2004 Field Note: Data source is State of Tennessee Vital Records.
3.	Section Number: Health Status Indicator #02A Field Name: HSI02A Row Name: Column Name: Year: 2003 Field Note: Data source is State Vital Records.

The percent of live singleton births weighing less than 1,500 grams.

	Annual Indicator Data
	2001	2002	2003	2004	2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

Field Level Notes

1.	Section Number: Health Status Indicator #02B Field Name: HSI02B Row Name: Column Name: Year: 2005 Field Note: Data source is State of Tennessee Vital Records.
2.	Section Number: Health Status Indicator #02B Field Name: HSI02B Row Name: Column Name: Year: 2004 Field Note: Data source is State Vital Records.
3.	Section Number: Health Status Indicator #02B Field Name: HSI02B Row Name: Column Name: Year: 2003 Field Note: Data source is State Vital Records.

The death rate per 100,000 due to unintentional injuries among children aged 14 years and younger.

	Annual Indicator Data
	2001	2002	2003	2004	2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

Field Level Notes

1.	Section Number: Health Status Indicator #03A Field Name: HSI03A Row Name: Column Name: Year: 2005 Field Note: Data source is State Vital Records and Fatality Analysis Reporting System.
2.	Section Number: Health Status Indicator #03A Field Name: HSI03A Row Name: Column Name: Year: 2004 Field Note: Data source is State Vital Records and Fatality Analysis Reporting System.
3.	Section Number: Health Status Indicator #03A Field Name: HSI03A Row Name: Column Name: Year: 2003 Field Note: Data source is State Vital Records and Fatality Analysis Reporting System.

The death rate per 100,000 for unintentional injuries among children aged 14 years and younger due to motor vehicle crashes.

	Annual Indicator Data
	2001	2002	2003	2004	2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

Field Level Notes

1.	Section Number: Health Status Indicator #03B Field Name: HSI03B Row Name: Column Name: Year: 2005 Field Note: Data source is State Vital Records and Fatality Analysis Reporting System.
2.	Section Number: Health Status Indicator #03B Field Name: HSI03B Row Name: Column Name: Year: 2004 Field Note: Data source is State Vital Records and Fatality Analysis Reporting System.
3.	Section Number: Health Status Indicator #03B Field Name: HSI03B Row Name: Column Name: Year: 2003 Field Note: Data source is State Vital Records and Fatality Analysis Reporting System.

The death rate per 100,000 from unintentional injuries due to motor vehicle crashes among youth aged 15 through 24 years.

	Annual Indicator Data
	2001	2002	2003	2004	2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

Field Level Notes

1.	Section Number: Health Status Indicator #03C Field Name: HSI03C Row Name: Column Name: Year: 2005 Field Note: Data source is State Vital Records and Fatality Analysis Repoting System.
2.	Section Number: Health Status Indicator #03C Field Name: HSI03C Row Name: Column Name: Year: 2004 Field Note: Data source is State Vital Records and Fatality Analysis Reporting System.
3.	Section Number: Health Status Indicator #03C Field Name: HSI03C Row Name: Column Name: Year: 2003 Field Note: Data source is State Vital Records and Fatality Analysis Reporting System.

The rate per 100,000 of all nonfatal injuries among children aged 14 years and younger.

	Annual Indicator Data
	2001	2002	2003	2004	2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

Field Level Notes

1.	Section Number: Health Status Indicator #04A Field Name: HSI04A Row Name: Column Name: Year: 2005 Field Note: These data, which are from the hospital discharge dataset, are not yet available for 2005. These 2005 data are estimated.
2.	Section Number: Health Status Indicator #04A Field Name: HSI04A Row Name: Column Name: Year: 2004 Field Note: These data, which are from the hospital discharge dataset, are not yet available for 2004. These are estimates.
3.	Section Number: Health Status Indicator #04A Field Name: HSI04A Row Name: Column Name: Year: 2003 Field Note:

The rate per 100,000 of nonfatal injuries due to motor vehicle crashes among children aged 14 years and younger.

	Annual Indicator Data
	2001	2002	2003	2004	2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

Field Level Notes

1.	Section Number: Health Status Indicator #04B Field Name: HSI04B Row Name: Column Name: Year: 2005 Field Note: These data, which are from the hospital discharge dataset, are not yet available for 2005. These are estimates.
2.	Section Number: Health Status Indicator #04B Field Name: HSI04B Row Name: Column Name: Year: 2004 Field Note: Hospital discharge data for 2004 are not available; these are estimates.

The rate per 100,000 of nonfatal injuries due to motor vehicle crashes among youth aged 15 through 24 years.

	Annual Indicator Data
	2001	2002	2003	2004	2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

Field Level Notes

1.	Section Number: Health Status Indicator #04C Field Name: HSI04C Row Name: Column Name: Year: 2005 Field Note: These data, which are from the hospital discharge dataset, are not yet available for 2005.
2.	Section Number: Health Status Indicator #04C Field Name: HSI04C Row Name: Column Name: Year: 2004 Field Note: Data source is Hospital discharge data for 2004.

The rate per 1,000 women aged 15 through 19 years with a reported case of chlamydia.

	Annual Indicator Data
	2001	2002	2003	2004	2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

Field Level Notes

1.	Section Number: Health Status Indicator #05A Field Name: HSI05A Row Name: Column Name: Year: 2005 Field Note: Data source is the state STD program surveillance which is the Communicable Disease Surveillance system.
2.	Section Number: Health Status Indicator #05A Field Name: HSI05A Row Name: Column Name: Year: 2004 Field Note: Data source is the state STD program surveillance which is the Communicable Disease Surveillance system.
3.	Section Number: Health Status Indicator #05A Field Name: HSI05A Row Name: Column Name: Year: 2003 Field Note: Data source is the state STD program surveillance whish is the Communicable Disease Surveillance system.

The rate per 1,000 women aged 20 through 44 years with a reported case of chlamydia.

	Annual Indicator Data
	2001	2002	2003	2004	2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

Field Level Notes

1.	Section Number: Health Status Indicator #05B Field Name: HSI05B Row Name: Column Name: Year: 2005 Field Note: Data source is the state STD program surveillance which is the Communicable Disease Surveillance system.
2.	Section Number: Health Status Indicator #05B Field Name: HSI05B Row Name: Column Name: Year: 2004 Field Note: Data source is the state STD program surveillance which is the Communicable Disease Surveillance system.
3.	Section Number: Health Status Indicator #05B Field Name: HSI05B Row Name: Column Name: Year: 2003 Field Note: Data source is the state STD program surveillance which is the Communicable Disease Surveillance system.

HSI #06A - Demographics (Total Population) Infants and children aged 0 through 24 years enumerated by sub-populations of age group and race. (Demographics)

For both parts A and B: Reporting Year: 2005 Is this data from a State Projection? Yes Is this data final or provisional? Provisional

CATEGORY TOTAL POPULATION BY RACE	Total All Races	White	Black or African American	American Indian or Native Alaskan	Asian	Native Hawaiian or Other Pacific Islander	More than one race reported	Other and Unknown
Infants 0 to 1
Children 1 through 4
Children 5 through 9
Children 10 through 14
Children 15 through 19
Children 20 through 24
Children 0 through 24

HSI #06B - Demographics (Total Population) Infants and children aged 0 through 24 years enumerated by sub-populations of age group and ethnicity. (Demographics)

CATEGORY TOTAL POPULATION BY HISPANIC ETHNICITY	Total NOT Hispanic or Latino	Total Hispanic or Latino	Ethnicity Not Reported
Infants 0 to 1
Children 1 through 4
Children 5 through 9
Children 10 through 14
Children 15 through 19
Children 20 through 24
Children 0 through 24

HSI #07A - Demographics (Total live births) Live births to women (of all ages) enumerated by maternal age and race. (Demographics)

For both parts A and B: Reporting Year: 2005 Is this data from a State Projection? Yes Is this data final or provisional? Provisional

CATEGORY TOTAL LIVE BIRTHS BY RACE	Total All Races	White	Black or African American	American Indian or Native Alaskan	Asian	Native Hawaiian or Other Pacific Islander	More than one race reported	Other and Unknown
Women < 15
Women 15 through 17
Women 18 through 19
Women 20 through 34
Women 35 or older
Women of all ages

HSI #07B - Demographics (Total live births) Live births to women (of all ages) enumerated by maternal age and ethnicity. (Demographics)

CATEGORY TOTAL LIVE BIRTHS BY HISPANIC ETHNICITY	Total NOT Hispanic or Latino	Total Hispanic or Latino	Ethnicity Not Reported
Women < 15
Women 15 through 17
Women 18 through 19
Women 20 through 34
Women 35 or older
Women of all ages

HSI #08A - Demographics (Total deaths) Deaths of Infants and children aged 0 through 24 years enumerated by age subgroup and race. (Demographics)

For both parts A and B: Reporting Year: 2005 Is this data from a State Projection? Yes Is this data final or provisional? Provisional

CATEGORY TOTAL DEATHS BY RACE	Total All Races	White	Black or African American	American Indian or Native Alaskan	Asian	Native Hawaiian or Other Pacific Islander	More than one race reported	Other and Unknown
Infants 0 to 1
Children 1 through 4
Children 5 through 9
Children 10 through 14
Children 15 through 19
Children 20 through 24
Children 0 through 24

HSI #08B - Demographics (Total deaths) Deaths of Infants and children aged 0 through 24 years enumerated by age subgroup and ethnicity. (Demographics)

CATEGORY TOTAL DEATHS BY HISPANIC ETHNICITY	Total NOT Hispanic or Latino	Total Hispanic or Latino	Ethnicity Not Reported
Infants 0 to 1
Children 1 through 4
Children 5 through 9
Children 10 through 14
Children 15 through 19
Children 20 through 24
Children 0 through 24

HSI #09A - Demographics (Miscellaneous Data) Infants and children aged 0 through 19 years in miscellaneous situations or enrolled in various State programs enumerated by race. (Demographics)

Is this data final or provisional? Provisional

CATEGORY Miscellaneous Data BY RACE	Total All Races	White	Black or African American	American Indian or Native Alaskan	Asian	Native Hawaiian or Other Pacific Islander	More than one race reported	Other and Unknown	Specific Reporting Year
All children 0 through 19									2005
Percent in household headed by single parent									2005
Percent in TANF (Grant) families									2005
Number enrolled in Medicaid									2005
Number enrolled in SCHIP									2005
Number living in foster home care									2005
Number enrolled in food stamp program									2005
Number enrolled in WIC									2005
Rate (per 100,000) of juvenile crime arrests									2005
Percentage of high school drop-outs (grade 9 through 12)									2005

HSI #09B - Demographics (Miscellaneous Data) Infants and children aged 0 through 19 years in miscellaneous situations or enrolled in various State programs enumerated by ethnicity.(Demographics)

CATEGORY Miscellaneous Data BY HISPANIC ETHNICITY	Total NOT Hispanic or Latino	Total Hispanic or Latino	Ethnicity Not Reported	Specific Reporting Year
All children 0 through 19				2005
Percent in household headed by single parent				2005
Percent in TANF (Grant) families				2005
Number enrolled in Medicaid				2005
Number enrolled in SCHIP				2005
Number living in foster home care				2005
Number enrolled in food stamp program				2005
Number enrolled in WIC				2005
Rate (per 100,000) of juvenile crime arrests				2005
Percentage of high school drop-outs (grade 9 through 12)				2005

HSI #10 - Demographics (Geographic Living Area) Geographic living area for all resident children aged 0 through 19 years old. (Demographics)

Reporting Year: 2005 Is this data from a State Projection? Yes Is this data final or provisional? Provisional

GEOGRAPHIC LIVING AREAS	TOTAL
Living in metropolitan areas
Living in urban areas
Living in rural areas
Living in frontier areas
Total - all children 0 through 19
Note: The Total will be determined by adding reported numbers for urban, rural and frontier areas.

HSI #11 - Demographics (Poverty Levels) Percent of the State population at various levels of the federal poverty level. (Demographics)

Reporting Year: 2005 Is this data from a State Projection? Yes Is this data final or provisional? Provisional

POVERTY LEVELS	TOTAL
Total Population
Percent Below: 50% of poverty
100% of poverty
200% of poverty

HSI #12 - Demographics (Poverty Levels) Percent of the State population aged 0 through 19 at various levels of the federal poverty level. (Demographics)

Reporting Year: 2005 Is this data from a State Projection? Yes Is this data final or provisional? Provisional

POVERTY LEVELS	TOTAL
Children 0 through 19 years old
Percent Below: 50% of poverty
100% of poverty
200% of poverty

Form Notes for Form 21
	State Data source with projected estimates. U.S. Census Bureau data sources.
Field Level Notes
1.	Section Number: Indicator 06A Field Name: S06_Race_Infants Row Name: Infants 0 to 1 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
2.	Section Number: Indicator 06A Field Name: S06_Race_Children1to4 Row Name: children 1 through 4 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
3.	Section Number: Indicator 06A Field Name: S06_Race_Children5to9 Row Name: children 5 through 9 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
4.	Section Number: Indicator 06A Field Name: S06_Race_Children10to14 Row Name: children 10 through 14 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
5.	Section Number: Indicator 06A Field Name: S06_Race_Children15to19 Row Name: children 15 through 19 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
6.	Section Number: Indicator 06A Field Name: S06_Race_Children20to24 Row Name: children 20 through 24 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
7.	Section Number: Indicator 06B Field Name: S06_Ethnicity_Infants Row Name: Infants 0 to 1 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
8.	Section Number: Indicator 06B Field Name: S06_Ethnicity_Children1to4 Row Name: children 1 through 4 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
9.	Section Number: Indicator 06B Field Name: S06_Ethnicity_Children5to9 Row Name: children 5 through 9 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
10.	Section Number: Indicator 06B Field Name: S06_Ethnicity_Children10to14 Row Name: children 10 through 14 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
11.	Section Number: Indicator 06B Field Name: S06_Ethnicity_Children15to19 Row Name: children 15 through 19 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
12.	Section Number: Indicator 06B Field Name: S06_Ethnicity_Children20to24 Row Name: children 20 through 24 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
13.	Section Number: Indicator 07A Field Name: Race_Women15 Row Name: Women < 15 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
14.	Section Number: Indicator 07A Field Name: Race_Women15to17 Row Name: Women 15 through 17 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
15.	Section Number: Indicator 07A Field Name: Race_Women18to19 Row Name: Women 18 through 19 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
16.	Section Number: Indicator 07A Field Name: Race_Women20to34 Row Name: Women 20 through 34 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
17.	Section Number: Indicator 07A Field Name: Race_Women35 Row Name: Women 35 or older Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
18.	Section Number: Indicator 07B Field Name: Ethnicity_Women15 Row Name: Women < 15 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
19.	Section Number: Indicator 07B Field Name: Ethnicity_Women15to17 Row Name: Women 15 through 17 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
20.	Section Number: Indicator 07B Field Name: Ethnicity_Women18to19 Row Name: Women 18 through 19 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
21.	Section Number: Indicator 07B Field Name: Ethnicity_Women20to34 Row Name: Women 20 through 34 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
22.	Section Number: Indicator 07B Field Name: Ethnicity_Women35 Row Name: Women 35 or older Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
23.	Section Number: Indicator 08A Field Name: S08_Race_Infants Row Name: Infants 0 to 1 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
24.	Section Number: Indicator 08A Field Name: S08_Race_Children1to4 Row Name: children 1 through 4 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
25.	Section Number: Indicator 08A Field Name: S08_Race_Children5to9 Row Name: children 5 through 9 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
26.	Section Number: Indicator 08A Field Name: S08_Race_Children10to14 Row Name: children 10 through 14 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
27.	Section Number: Indicator 08A Field Name: S08_Race_Children15to19 Row Name: children 15 through 19 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
28.	Section Number: Indicator 08A Field Name: S08_Race_Children20to24 Row Name: children 20 through 24 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
29.	Section Number: Indicator 08B Field Name: S08_Ethnicity_Infants Row Name: Infants 0 to 1 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
30.	Section Number: Indicator 08B Field Name: S08_Ethnicity_Children1to4 Row Name: children 1 through 4 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
31.	Section Number: Indicator 08B Field Name: S08_Ethnicity_Children5to9 Row Name: children 5 through 9 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
32.	Section Number: Indicator 08B Field Name: S08_Ethnicity_Children10to14 Row Name: children 10 through 14 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
33.	Section Number: Indicator 08B Field Name: S08_Ethnicity_Children15to19 Row Name: children 15 through 19 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
34.	Section Number: Indicator 08B Field Name: S08_Ethnicity_Children20to24 Row Name: children 20 through 24 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
35.	Section Number: Indicator 09A Field Name: HSIRace_Children Row Name: All children 0 through 19 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
36.	Section Number: Indicator 09A Field Name: HSIRace_SingleParentPercent Row Name: Percent in household headed by single parent Column Name: Year: 2007 Field Note: These data are from the 2005 Kids Count data book and does not provide data by race or ethnicity.
37.	Section Number: Indicator 09A Field Name: HSIRace_MedicaidNo Row Name: Number enrolled in Medicaid Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics/Medicaid System
38.	Section Number: Indicator 09A Field Name: HSIRace_SCHIPNo Row Name: Number enrolled in SCHIP Column Name: Year: 2007 Field Note: Tennessee does not have a separate SCHIP program. Tennessee state data based on medicaid enrollees.
39.	Section Number: Indicator 09A Field Name: HSIRace_FoodStampNo Row Name: Number enrolled in food stamp program Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
40.	Section Number: Indicator 09A Field Name: HSIRace_WICNo Row Name: Number enrolled in WIC Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
41.	Section Number: Indicator 09A Field Name: HSIRace_JuvenileCrimeRate Row Name: Rate (per 100,000) of juvenile crime arrests Column Name: Year: 2007 Field Note: 214.4 per 100,000 juvenile crime arrests.These data are from Dept. of Justice and are for 2003. These are the latest which could be located.
42.	Section Number: Indicator 09A Field Name: HSIRace_DropOutPercent Row Name: Percentage of high school drop-outs (grade 9 through 12) Column Name: Year: 2007 Field Note: These data are from the Tennessee statewide report card.These data are from the 2005 Kids Count data book.
43.	Section Number: Indicator 09B Field Name: HSIEthnicity_Children Row Name: All children 0 through 19 Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
44.	Section Number: Indicator 09B Field Name: HSIEthnicity_SingleParentPercent Row Name: Percent in household headed by single parent Column Name: Year: 2007 Field Note: These data are from 2005 Kids count data. The source does not provide data by ethnicity.
45.	Section Number: Indicator 09B Field Name: HSIEthnicity_MedicaidNo Row Name: Number enrolled in Medicaid Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics/Medicaid System
46.	Section Number: Indicator 09B Field Name: HSIEthnicity_SCHIPNo Row Name: Number enrolled in SCHIP Column Name: Year: 2007 Field Note: Tennessee does not have SCHIP. These estimates are based on the medicaid data.
47.	Section Number: Indicator 09B Field Name: HSIEthnicity_FoodStampNo Row Name: Number enrolled in food stamp program Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics System
48.	Section Number: Indicator 09B Field Name: HSIEthnicity_JuvenileCrimeRate Row Name: Rate (per 100,000) of juvenile crime arrests Column Name: Year: 2007 Field Note: These data are from Dept. of Justice and are for 2003. These are the latest which could be located.
49.	Section Number: Indicator 09B Field Name: HSIEthnicity_DropOutPercent Row Name: Percentage of high school drop-outs (grade 9 through 12) Column Name: Year: 2007 Field Note: These data are from the 2005 Kids Count data book.
50.	Section Number: Indicator 10 Field Name: Metropolitan Row Name: Living in metropolitan areas Column Name: Year: 2007 Field Note: Tennessee classifies geographic area in two categories namely rural and urban areas.
51.	Section Number: Indicator 10 Field Name: Urban Row Name: Living in urban areas Column Name: Year: 2007 Field Note: These data are from State of Tennessee Health Statistics system.
52.	Section Number: Indicator 10 Field Name: Rural Row Name: Living in rural areas Column Name: Year: 2007 Field Note: These data are from State of Tennessee Health Statistics system.
53.	Section Number: Indicator 10 Field Name: Frontier Row Name: Living in frontier areas Column Name: Year: 2007 Field Note: Tennessee classifies geographic living areas by two categories namely urban and rural areas.
54.	Section Number: Indicator 11 Field Name: S11_total Row Name: Total Population Column Name: Year: 2007 Field Note: State Data source with projected estimates. U.S. Census Bureau data sources.
55.	Section Number: Indicator 11 Field Name: S11_50percent Row Name: Percent Below: 50% of poverty Column Name: Year: 2007 Field Note: State Data source with projected estimates. U.S. Census Bureau data sources.
56.	Section Number: Indicator 11 Field Name: S11_100percent Row Name: 100% of poverty Column Name: Year: 2007 Field Note: State Data source with projected estimates. U.S. Census Bureau data sources.
57.	Section Number: Indicator 11 Field Name: S11_200percent Row Name: 200% of poverty Column Name: Year: 2007 Field Note: State Data source with projected estimates. U.S. Census Bureau data sources.
58.	Section Number: Indicator 12 Field Name: S12_Children Row Name: Children 0 through 19 years old Column Name: Year: 2007 Field Note: State Data source with projected estimates. U.S. Census Bureau data sources.
59.	Section Number: Indicator 12 Field Name: S12_50percent Row Name: Percent Below: 50% of poverty Column Name: Year: 2007 Field Note: State Data source with projected estimates. U.S. Census Bureau data sources.
60.	Section Number: Indicator 12 Field Name: S12_100percent Row Name: 100% of poverty Column Name: Year: 2007 Field Note: State Data source with projected estimates. U.S. Census Bureau data sources.
61.	Section Number: Indicator 12 Field Name: S12_200percent Row Name: 200% of poverty Column Name: Year: 2007 Field Note: State Data source with projected estimates. U.S. Census Bureau data sources.
62.	Section Number: Indicator 09A Field Name: HSIRace_FosterCare Row Name: Number living in foster home care Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics/DCS System
63.	Section Number: Indicator 09B Field Name: HSIEthnicity_FosterCare Row Name: Number living in foster home care Column Name: Year: 2007 Field Note: Data source is State of Tennessee Health Statistics/DCS System

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