TVIS Application - View Version

Title V Block Grant Application
Forms (2-21)
State: VT
Application Year: 2008

[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: StateMCHFundsExpended Row Name: State Funds Column Name: Expended Year: 2006 Field Note: The original budget for FY 06 assumed that expenditures for purchased medical care would be lower.
2.	Section Number: Main Field Name: StateMCHFundsExpended Row Name: State Funds Column Name: Expended Year: 2005 Field Note: The FY05 Expended amount exceeds the FY05 Budgeted amount by $7,000 more than the 10% margin. The variation is due to unanticipated effects of the Agency of Human Services reorganization, which took effect in FY05. Specifically, the transfer of the Family, Infant and Toddler program out of the Health Dept involved a larger-than-anticipated reduction in federal Medicaid receipts available to the Health Dept.
3.	Section Number: Main Field Name: OtherFedFundsExpended Row Name: Other Federal Funds Column Name: Expended Year: 2006 Field Note: Beginning with FY 06 the State of Vermont entered into a new waiver agreement for medicaid. This wavier program is called "Global Commitment for Health." As a result, medicaid expenditures for FY 06 are not comparable to previous years. Medicaid Administration expenditures were included in the FY 06 budgeted number, but because the actual expenditures under "Global Commitment" are not comparable they are omitted from the "expended" column.

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

II. Other Federal Funds (under the control of the person responsible for administration of the Title V program).
	FY 2003		FY 2004		FY 2005
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
Family Planning	$		$		$
Medicaid	$		$		$
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 2006		FY 2007		FY 2008
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
Family Planning	$		$		$
Medicaid Administrat	$		$		$
Medicaid	$		$		$
III. SUBTOTAL	$		$		$

Form Notes for Form 4
	None
Field Level Notes
1.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: PregWomenExpended Row Name: Pregnant Women Column Name: Expended Year: 2006 Field Note: On assumption the expenditures would be the sum of federal grant and required state match plus Maintenance of Effort in reality expenditures have never been that low. Actual FY 06 were higher than the projection used for FY 06 budgeted
2.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: PregWomenExpended Row Name: Pregnant Women Column Name: Expended Year: 2005 Field Note: The Expended amount for pregnant women is over the Budgeted amount by about $50,000, a large variance considering the small amount budgeted. This represents an increase in time coded to MCH by staff in District Offices around the state. Anecdotal information suggests that the increase in time is due to coding to MCH instead of coding to Medicaid Administration, for two reasons: (1) the transfer of the Healthy Babies program out of the Health Department resulted in confusion about whether it was legitimate to code time to Medicaid and (2) the OIG audit of staff charges to Medicaid Admin had a chilling effect on staff who otherwise might have coded to Medicaid.
3.	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: The amount for Infants decreased from the budgeted amount due to contract payments being processed late.
4.	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: 2006 Field Note: On assumption the expenditures would be sum of federal grant and required state match plus Maintenance of Effort in reality expenditures have never been that low. Actual FY06 were higher than the projection used for FY 06 budgeted
5.	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: Significant increase in costs over the budgeted amount are due to: (1) increase in dental services charged to MCH block grant; (2) overestimate of the amount of costs that could be diverted to Medicaid in the budgeted amount.
6.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: CSHCNExpended Row Name: CSHCN Column Name: Expended Year: 2006 Field Note: On assumption the expenditures would be the sum of federal grant and required state match plus Maintenance of Effort, in reality expenditures have never been that low. Actual FY 06 were higher than the projection used for FY 06 budgeted.
7.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: AdminExpended Row Name: Administration Column Name: Expended Year: 2006 Field Note: On assumption the expenditures would be sum of federal grand and required state match plus Maintenance of Effort, in reality expenditures have never been that low. Actual FY 06 were higher than the projection used for FY 06 budgeted.
8.	Section Number: I. Federal-State MCH Block Grant Partnership Field Name: AdminExpended Row Name: Administration Column Name: Expended Year: 2005 Field Note: The amount for Administration is less than budgeted, probably due to the implementation of an entirely new Cost Allocation Plan in FY05.

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

Type of Service	FY 2003		FY 2004		FY 2005
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 2006		FY 2007		FY 2008
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
	None
Field Level Notes
1.	Section Number: Main Field Name: DirectHCExpended Row Name: Direct Health Care Services Column Name: Expended Year: 2006 Field Note: On assumption the expenditures would be sum of Federal Grant and required state match plus the maintenance of effort, in reality expenditures have never been that low. Actual FY 06 wer higher than the projection used for FY 06 budgeted
2.	Section Number: Main Field Name: DirectHCExpended Row Name: Direct Health Care Services Column Name: Expended Year: 2005 Field Note: Expended amount differs from Budget amount largely due to overestimatng amount of costs that could be diverted to Medicaid in FY05 Budgeted.
3.	Section Number: Main Field Name: EnablingExpended Row Name: Enabling Services Column Name: Expended Year: 2006 Field Note: Assumed the expenditures would be the sum of federal grant and required state match plus Maintenance of Effort, in reality expenditures have never been that low. Actual FY 06 were higher than the projection used for FY 06 budgeted
4.	Section Number: Main Field Name: PopBasedExpended Row Name: Population-Based Services Column Name: Expended Year: 2005 Field Note: Budget costs for Population Based services were over-estimated for FY05 Budgeted and FY06 Budgeted due to unusually high expenditures in a small amount of data that was used as the base period.
5.	Section Number: Main Field Name: InfrastrBuildExpended Row Name: Infrastructure Building Services Column Name: Expended Year: 2006 Field Note: On assumption the expenditures would be the sum of federal grant and required state match plus the Maintenance of Effort, in reality expenditures have never been that low. Actual FY06 were higher than the projection used for FY 06 budgeted.
6.	Section Number: Main Field Name: InfrastrBuildExpended Row Name: Infrastructure Building Services Column Name: Expended Year: 2005 Field Note: FY05 Expended costs exceed FY05 Budgeted amounts because staff time coded to MCH Block Grant by staff performing these functions increased.

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

Total Births by Occurrence:

Reporting Year: 2005

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)
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
	The difference between the number of infants screened and the number of occurrent births was due to (a) infants born in VT but screened out-of-state. (b) infants who died in the neonatal period before screening, and (c) infants whose parents refused screening. 100% of occurrent births have been tracked and accounted for.
Field Level Notes
1.	Section Number: Main Field Name: Galactosemia_Confirmed Row Name: Galactosemia Column Name: Confirmed Cases Year: 2008 Field Note: There were no presumptive positive screens reported, thus the number of confirmed cases also equals zero.
2.	Section Number: Main Field Name: SickleCellDisease_Confirmed Row Name: SickleCellDisease Column Name: Confirmed Cases Year: 2008 Field Note: There were no presumptive positive screens reported, thus the number of confirmed cases also equals zero.

[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
	The total of 115,012 reflects women and children served under Title V, but this is not unduplicated. Another figure for determining unduplicated individuals would be to total the number of pregant women, infants, and children or 110,515.
Field Level Notes
1.	Section Number: Main Field Name: PregWomen_TS Row Name: Pregnant Women Column Name: Title V Total Served Year: 2008 Field Note: Reflects the number of pregnant women receiving Medicaid - who are also eligible for many Title V supported services such as outreach and referral, WIC, home visits, etc.
2.	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: 2008 Field Note: Reflects the number of children enrolled in Medicaid during CY 2005
3.	Section Number: Main Field Name: CSHCN_XIX Row Name: Children with Special Health Care Needs Column Name: Title XIX % Year: 2008 Field Note: Reflects the percentage of children who use Medicaid as their primary source of insurance.
4.	Section Number: Main Field Name: CSHCN_Private Row Name: Children with Special Health Care Needs Column Name: Private/Other % Year: 2008 Field Note: Reflects the percentage of children who have private/other as their primary source of insurance.
5.	Section Number: Main Field Name: AllOthers_TS Row Name: Others Column Name: Title V Total Served Year: 2008 Field Note: Title V individuals are included in the other categories in Form 7, there are no Title V individuals appropriate to count in this section of "other"

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
	Population estimates presented for VT-occurrent deliveries are derived from Vital Records for live births and fetal deaths. Counts of race of live born infants are based on single-race bridge files for mother and father provided by NCHS, combined into single race for child using algorithm provided by VT Vital Records. Ethnicity of infant is based on ethnicity of mother since no algorithm is available to combine ethnicity of father and mother. Population estimates for total number of infants in State are based on State estimates. The disparity between the number of occurrent deliveries and the total infants in state is due to a number of factors including, births of out-of-state residents in VT (included in occurrent live births but excluded from population estimates), and VT-resident infants born out-of-state (excluded from occurrent live births but included in population estimates).
Field Level Notes
1.	Section Number: I. Unduplicated Count By Race Field Name: InfantsTotal_All Row Name: Total Infants in State Column Name: Total All Races Year: 2008 Field Note: Vermont population estimates do not separate out Asian and Pacific Islanders. The total is reported here under Asian.

	FY 2008	FY 2007	FY 2006	FY 2005	FY 2004
1. State MCH Toll-Free "Hotline" Telephone Number
2. State MCH Toll-Free "Hotline" Name	Help Your Baby, Help Yourself Hotline	Help Your Baby, Help Yourself Hotline	Help Your Baby; Help Yourself Hotline	Help Your Baby; Help Yourself Hotline	Help Your Baby; Help Yourself Hotline
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 2008	FY 2007	FY 2006	FY 2005	FY 2004
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
	None
Field Level Notes
	None

State MCH toll-free telephone line data form

1. State MCH Administration:
(max 2500 characters)

Title V is administered by the Vermont Department of Health, within the Agency of Human Services. Title V related services include: Direct services: multi disciplinary clinic-based services to CSHN of all ages, immunization services for children with marginal access to preventative health care, collaboration with Healthy Babies, Kids, and Families for care coordination and services for pregnant women and young children. Enabling services: outreach, information, and referral and administrative case management for children enrolled in Medicaid, nursing, social work, care coordination, and respite care for CSHN, Medicaid prior authorization of certain medical and dental services (in collaboration with Medicaid and managed care,) primary care medical home support. Population Services: Newborn metabolic and hearing screening, breastfeeding support programs, lead screening. Infrastructure: Statewide interagency and community based health care system and public health planning for the MCH population, including CSHCN.

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)

Vermont’s CSHCN Program provides direct services at site accessible around the state. The services are multidisciplinary specialty medical clinics and include the support of wraparound teams, typically nurse and medical social workers. The CSHN programs also have a substantial component of care coordination and outreach, even for families who do not receive services through one of the clinics. Title V provides funding for respite care for CSHN. In partnership with a consortium of Vermont hospitals, the Hearing Outreach Program makes available outpatient hearing screening, performed by a pediatric audiologist, for infants and young children or hard-to-test older children and coordinates universal hearing screening for all newborns. The statewide Healthy Babies Kids and Families program (now out of DCF) provides both direct public health nursing care and enabling services (case management and services system coordination) for pregnant women, infants, and children up to age five who use Medicaid. The intensity of service is determined by a periodic assessment of medical and psychosocial need. EPSDT sponsored services in school settings have been expanded and target medical and dental health needs. WIC provides nutrition and education services and coordinates closely with other state and local programs.

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

The state newborn screening program continues to reach a high percent of Vermont newborns. A statewide Fluoride Mouthwash Program continues to be provided in many Vermont schools in regions without fluoridated water systems. In addition, a variety of funds (state and Medicaid) is supporting the development of dental health screening and promotion programs in schools and provider [practices. The CSAP-funded State Incentive Cooperative Agreement Grant is providing support to communities for provision of comprehensive, research based programs for tobacco, alcohol and other drug prevention. Statewide population-based services (related to Title V) include reproductive health services, immunization program, genetic services, SIDS/SUDI prevention program, WIC, EPSDT, tobacco cessation, and lead poisoning prevention.

c. Infrastructure Building Services:
(max 2500 characters)

Title V, in partnership with Part C IDEA funding, continues to expand capacity to provide nutrition services for CSHCN. Collaborations with Parent to Parent and AAP are continuing to expand medical home system for all children, including CSHCN. Healthy Babies Kids and Families, out of DCF, has established a strong collaborative infrastructure in each health district. MCH Coalitions in each region are bringing together primary care, OB/GYN, home health, Parent Child Centers, and other community providers. Vermont has expanded Medicaid coverage to children in families with incomes of up to 300% of poverty and continues with extensive outreach to increase enrollment. Several collaborative efforts are underway to develop infrastructure of coordinated systems for the preventative health, dental, mental health care an other services for children and families: examples of public health issue planning are: birth outcomes, childhood obesity, physical activity, lead poisoning, autism spectrum disorders, breastfeeding, women’s health, injury prevention. Collaboration with the ECCS grant funded activities (Building Bright Futures) is designed to establish a statewide system of coordinated early childhood programs.

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

None

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
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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 #1
Field Name: PM01
Row Name:
Column Name:
Year: 2005
Field Note:
The data to calculate this measure for 2005 are currently not consistently available, but will be available at the end of the 2006 calendar year.

Section Number: Performance Measure #1
Field Name: PM01
Row Name:
Column Name:
Year: 2004
Field Note:
The denominator is the number of newborns screened and confirmed with conditions mandated by state NB screening program. The numerator is the number of newborns screened and confirmed with conditions mandated by state NB screening program who received appropriate follow up as defined by the state.

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
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final	Final

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: The data reported in 2006 are pre-populated with the data from 2005 for this performance measure.
2.	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.
3.	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.

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
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: The data reported in 2006 are pre-populated with the data from 2005 for this performance measure.
2.	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.
3.	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. In addition, in our focus groups for this year's Needs Assessment , only 15% identified their PCP as central to their CSHCN's overall care; 44% said the PCP provided little or no care coordination; 59% said their PCP provided little or no information. However, significantly, 98% said they, as parents, wanted TOTAL CONTROL and FULL RESPONSIBILITY themselves, not the PCP.

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
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final	Final

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: The data reported in 2006 are pre-populated with the data from 2005 for this performance measure.
2.	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.
3.	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. However, please also see the data on Form 7 which indicates a higher percentage of insurance coverage for children with whom we work through our CSHN programs.

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
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: The data reported in 2006 are pre-populated with the data from 2005 for this performance measure.
2.	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.
3.	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. Among the parents who participated in our Needs Assessment focus groups, 81% said that they have access to all needed services for their CSHCN.

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
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final	Final

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: The data reported in 2006 are pre-populated with the data from 2005 for this performance measure.
2.	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.
3.	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. We hope to be able to review the percentage of adolescents with Medicaid who have had an annual care plan paid by medicaid, compared to younger children and compared over time. Only CSHCN are able to have care plans paid for.

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
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final	Final

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: Reflects the 4:3:1:3 schedule for Q3/2005 - Q2/2006. Percentages for this same time period are 4:3:1:3:3 is 83.3 % and for 4:3:1:3:3:1 is 68%.
2.	Section Number: Performance Measure #7 Field Name: PM07 Row Name: Column Name: Year: 2005 Field Note: Data is from NIS for July, 2003-June, 2004. Reflects the 4:3:1:3: schedule. The percentage is entered - the acutal numerator and denominator are not available. The data for 2005 is not yet available at the time of the preparation of this report.
3.	Section Number: Performance Measure #7 Field Name: PM07 Row Name: Column Name: Year: 2004 Field Note: Data is from NIS for July, 2003-June, 2004. Reflects the 4:3:1:3: schedule. The percentage is entered - the acutal numerator and denominator are not available.

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

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Provisional

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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 #8 Field Name: PM08 Row Name: Column Name: Year: 2006 Field Note: VT population estimates currently are unavailable for 2006.
2.	Section Number: Performance Measure #8 Field Name: PM08 Row Name: Column Name: Year: 2005 Field Note: The data to calculate this measure for 2005 are currently not consistently available, but will be available at the end of the 2006 calendar year.
3.	Section Number: Performance Measure #8 Field Name: PM08 Row Name: Column Name: Year: 2004 Field Note: The data to calculate this measure for 2004 are currently not consistently available, but will be available at the end of the 2005 calendar year.

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

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final	Final

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: Data is from a one-time non invasive screening of 1,238 children in grades 1-3 in the year 2002-2003. There has not been another screening conducted since that time. Medicaid data indicates that there were 1,452 children receiving sealants during FFY06.
2.	Section Number: Performance Measure #9 Field Name: PM09 Row Name: Column Name: Year: 2005 Field Note: Data is from a one-time non invasive screening of 1,238 children in grades 1-3 in the year 2002-2003. There has not been another screening since that time. However, Medicaid data shows that there were 1,472 children receiving sealants during FFY05 (or 30% of those children ages 6-9 using Medicaid during FFY05.)
3.	Section Number: Performance Measure #9 Field Name: PM09 Row Name: Column Name: Year: 2004 Field Note: Data for 2004 are the same as for the two previous years. Data are from a one-time, non-invasive, screening of 1,283 children in grades 1-3. No new data are available which would be considered more accurate or complete than these survey data.

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
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: VT population estimates currently are unavailable for 2006.
2.	Section Number: Performance Measure #10 Field Name: PM10 Row Name: Column Name: Year: 2004 Field Note: In 2004, 2 children aged 14 or younger died due to motor vehicle crashes in Vermont, a number below the threshold for which rates are to be calculated.

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

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final	Final

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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 #11 Field Name: PM11 Row Name: Column Name: Year: 2006 Field Note: The 2006 rate is an estimate based on the 2005 rate from the National Immunization Survey. The numerator and denominator were not reported.
2.	Section Number: Performance Measure #11 Field Name: PM11 Row Name: Column Name: Year: 2005 Field Note: 2004 data from the National Immunization Survey, where only % are provided, without numerator or denominator.

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

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Provisional	Provisional

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: Consistent data is presently unavailable.
2.	Section Number: Performance Measure #12 Field Name: PM12 Row Name: Column Name: Year: 2005 Field Note: Since this performance measure relates to infants screened before discharge from hospital, only births that occurred in VT hospitals are included in the denominator.
3.	Section Number: Performance Measure #12 Field Name: PM12 Row Name: Column Name: Year: 2004 Field Note: Since the PM requests data for babies screened "before discharge", we are reporting only on babies born in Vermont hospitals. There were also 168 VT home births, some of whom had hearing screens as well but are not included in this data. There were 104 babies reported by hospitals as discharged without a screen. However, 86 (83%) of these were screened as outpatients. In 2004 there were 107 hospital-born infants for whom no information was reported (neither a result nor a reported miss). We know, from examining a similar group in the 2005 births, that a significant portion of these were, in fact, screened, some before and some after discharge.

Percent of children without health insurance.

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006
Field Note:
Insurance data and VT population estimates currently are unavailable for 2006.

Section Number: Performance Measure #13
Field Name: PM13
Row Name:
Column Name:
Year: 2005
Field Note:
1) These data are reported from Kaiser Family Foundation State Health Facts. For consistency, the total population estimate reported by Kaiser is used for the denominator even though this number is at variance with the VT population estimate used elsewhere.

2) It should be noted that the age range reported here is 0-18 yrs, not <18 yrs as originally defined for the numerator and denominator.

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
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: Data for the past years: 2001: 28.4%, 2002: 27.7%, 2003: 29.3%, 2004: 27.8%. Data for 2006 is not available at this writing and so the value for 2005 is used as placeholder. 2006 will be updated for next year's application.
2.	Section Number: Performance Measure #14 Field Name: PM14 Row Name: Column Name: Year: 2005 Field Note: These values for 2004 are from the 2004 Pediatric Nutrition Survey and are for children 2-4 years of age.

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

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: Consistent data for 2006 are currently unavailable. As was the case in previous entries, the 2006 entry has been pre-populated with an estimate based on the previous year's data.
2.	Section Number: Performance Measure #15 Field Name: PM15 Row Name: Column Name: Year: 2005 Field Note: This is 2004 data from the Vermont birth certificate system. Data from 2005 will not be available until the end of the 2006 calendar year.

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

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Provisional

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: VT population data for 2006 were not available at the time the report was submitted.
2.	Section Number: Performance Measure #16 Field Name: PM16 Row Name: Column Name: Year: 2005 Field Note: Only two deaths were reported in 2005, which is below the minimum numerator size for reporting.

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

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Provisional

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: Consistent data for 2006 are not yet available.
2.	Section Number: Performance Measure #17 Field Name: PM17 Row Name: Column Name: Year: 2005 Field Note: Sub specialty facilities are Fletcher Allen Health Care (VT), Boston Children's Hospital (MA), Bay State Medical Center (MA), Dartmouth Hitchcock Medical Center (NH), Albany Medical Center (NY), Brigham and Women's Hospital (MA), Maine Medical Center (ME).

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

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Provisional

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: Data for 2006 was not available at the time the report was submitted.
2.	Section Number: Performance Measure #18 Field Name: PM18 Row Name: Column Name: Year: 2005 Field Note: The data to calculate this measure for 2005 are currently not consistently available, but will be available at the end of the 2006 calendar year.

The percent of Vermont women who indicate that their pregnancies are intended.

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Provisional	Provisional

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: Estimated data for 2006 are pre-populated with data from 2004. Actual data for 2006 were not available at the time of reporting.
2.	Section Number: State Performance Measure #1 Field Name: SM1 Row Name: Column Name: Year: 2005 Field Note: Estimated data for 2005 are pre-populated with data from 2004. Actual data for 2005 were not available at the time of reporting.

The percent of licensed child care centers serving children age birth to five who have on-site consultation.

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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 #2
Field Name: SM2
Row Name:
Column Name:
Year: 2006
Field Note:
The measure for child care health consultant visits is considered developmental. The numerator is from record reviews and surveys and the denominator is from state program data. The percentage has decreased markedly from 2005 because of a more accurate determination of licensed child cares appropriate to include in the denominator. Also, there is still not a reliable data base to collect information on the number of visits by a child care health consultant. Planning for a web-based data base to be developed over the next year.

Section Number: State Performance Measure #2
Field Name: SM2
Row Name:
Column Name:
Year: 2005
Field Note:
The measure for child health consultation for child care centers is considered developmental. The numerator is from record review s and surveys. The denominator is from state program data. State planning is underway for feasibility of developing an electronic data system for data tracking for this measure and other related data. Data from previous years is not available.

The percent of youth who do not binge drink on alcoholic beverages.

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Final

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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 #3 Field Name: SM3 Row Name: Column Name: Year: 2006 Field Note: Data are the unweighted figures from the 2005 YRBS.
2.	Section Number: State Performance Measure #3 Field Name: SM3 Row Name: Column Name: Year: 2005 Field Note: Data are the unweighted figures from the 2005 YRBS.

The percent of women of childbearing age who consume at least two servings of fruit and three servings of vegetables daily.

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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 #4
Field Name: SM4
Row Name:
Column Name:
Year: 2006
Field Note:
Data for this item are derived from a BRFSS question that is asked every other year. Estimated data for 2006 are therefore pre-populated with actual data from 2005.

Section Number: State Performance Measure #4
Field Name: SM4
Row Name:
Column Name:
Year: 2005
Field Note:
Data is the weighted counts from the 2005 BRFS for 5 servings of fruit and vegetables. In addition, 39% of women (ages 18-44) reported eating 2 or more servings of fruits. 34% of women (ages 18-44) reported eating 3 or more servings of vegetables daily. This is a new performance measure and data for previous years is not available.

The percent of youth who feel like they matter to people.

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Final

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: Weighted data is from the 2005 YRBS which is conducted every other year.
2.	Section Number: State Performance Measure #5 Field Name: SM5 Row Name: Column Name: Year: 2005 Field Note: Weighted Data is from the 2005 YRBS. The unweighted data is 4029/9150.
3.	Section Number: State Performance Measure #5 Field Name: SM5 Row Name: Column Name: Year: 2004 Field Note: Data from 2003 YRBS

The percent of Vermont towns (population of 2,000 or more) who have at least one organized physical activity program in place that is open to all and promoted as a family activity

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Final

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: The programs to achieve this measure are continuing, however, no new towns have begun programs to the extent that they are able to be included in the numerator.
2.	Section Number: State Performance Measure #6 Field Name: SM6 Row Name: Column Name: Year: 2005 Field Note: 2005 is the first year for this measure which is newly created for Title V. Data from previous years is not available.

The percent of children with SSI who receive an annual care plan.

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Final

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: Last year's provisional results were recalculated with more complete data and indicated that there were 175 care plans written in 2005, compared with 203 for 2006.
2.	Section Number: State Performance Measure #7 Field Name: SM7 Row Name: Column Name: Year: 2005 Field Note: Data from previous years is not readily available.

The percent of low income children (with Medicaid) who utilize dental services in a year.

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Final

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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 #8
Field Name: SM8
Row Name:
Column Name:
Year: 2004
Field Note:
The measure of low income children's utilization of dental services will be continued as a state performance measure for the next Title V five year block grant cycle. Related to Priority Goal of "All children will receive continuous and comprehensive oral health care within a dental home."

The percent of children with emotional, developmental, or behavioral problems that require treatment or counseling who received needed mental health services in the past year.

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Provisional

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: These data are derived from a NSCH survey that was last carried out in 2005. The estimate for 2006 is therefore carried over from the previous year.
2.	Section Number: State Performance Measure #9 Field Name: SM9 Row Name: Column Name: Year: 2005 Field Note: 2005 data is from NSCH. US rate is 58.7%. This is a new measure created for the FY07 TItle V application.

The percent of one year old children who are screened for blood lead poisoning.

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final?				Final	Final

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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

None

Form Level Notes for Form 12

None

The infant mortality rate per 1,000 live births.

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: Consistent data for 2006 were not available at the time of submission. Population Estimates for 2006 will be available at the end of CT2007.

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

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Provisional

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: Consistent data for 2006 were not available at the time of submission. Population Estimates for 2006 will be available at the end of CT2007.
2.	Section Number: Outcome Measure 2 Field Name: OM02 Row Name: Column Name: Year: 2005 Field Note: In 2005, there were two black infant deaths. This number is below the threshold for which rates are calculated.
3.	Section Number: Outcome Measure 2 Field Name: OM02 Row Name: Column Name: Year: 2004 Field Note: In 2004, there were no black infant deaths. This number is below the threshold for which rates are calculated.

The neonatal mortality rate per 1,000 live births.

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Provisional

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: Consistent data for 2006 were not available at the time of submission. Population Estimates for 2006 will be available at the end of CT2007.
2.	Section Number: Outcome Measure 3 Field Name: OM03 Row Name: Column Name: Year: 2004 Field Note: Following the procedures outlined in Technical Note IX, Guidelines for Calculating Performance Measures using small samples, the data presented here are three year averages, using in this case the summed data for 2002, 2003, and 2004 in both the numerator and denominator.

The postneonatal mortality rate per 1,000 live births.

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Provisional

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: Consistent data for 2006 were not available at the time of submission. Population Estimates for 2006 will be available at the end of CT2007.
2.	Section Number: Outcome Measure 4 Field Name: OM04 Row Name: Column Name: Year: 2005 Field Note: Following the procedures outlined in Technical Note IX, Guidelines for Calculating Performance Measures using small samples, the data presented here are three year averages, using in this case the summed data for 2005, 2004 and 2003 in both numerator and denominator.
3.	Section Number: Outcome Measure 4 Field Name: OM04 Row Name: Column Name: Year: 2004 Field Note: Following the procedures outlined in Technical Note IX, Guidelines for Calculating Performance Measures using small samples, the data presented here are three year averages, using in this case the summed data for 2004, 2003 and 2002 in both numerator and denominator.

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

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Provisional

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: Consistent data for 2006 were not available at the time of submission. Population Estimates for 2006 will be available at the end of CT2007.
2.	Section Number: Outcome Measure 5 Field Name: OM05 Row Name: Column Name: Year: 2004 Field Note: The data to calculate this measure for 2004 are not currently available, but will be at the end of the 2005 calendar year. The 2004 data provided here is the 2003 data, to be seen as a rough estimate of the situation in 2004.

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

	Annual Objective and Performance Data
	2002	2003	2004	2005	2006
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Provisional

	Annual Objective and Performance Data
	2007	2008	2009	2010	2011
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: 2006 Field Note: Consistent data for 2006 were not available at the time of submission. Population Estimates for 2006 will be available at the end of CT2007.
2.	Section Number: Outcome Measure 6 Field Name: OM06 Row Name: Column Name: Year: 2004 Field Note: Following the procedures outlined in Technical Note IX, Guidelines for Calculating Performance Measures using small samples, the data presented here are three year averages, using in this case the summed data for 2004, 2003, and 2002 in both numerator and denominator.

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
1.	Section Number: Main Field Name: Question1 Row Name: #1. Family members participate on advisory committee or task forces... Column Name: Year: 2008 Field Note: One region of our statewide Child Development Clinic program has developed a strong parent advisory committee to the clinic team serving their region (two counties); the committee input has affected the model of care and the evaluation process.
2.	Section Number: Main Field Name: Question3 Row Name: #3. Family members are involved in the Children with Special Health Care Needs... Column Name: Year: 2008 Field Note: The leadership of Parent to Parent of Vermont has reviewed this year's application.
3.	Section Number: Main Field Name: Question5 Row Name: #5. Family members hired as paid staff or consultants to the State CSHCN program... Column Name: Year: 2008 Field Note: We continue to provide significant infrastructure support to Parent to Parent of Vermont and Vermont Parent Information Center, which employ parents and provide both service and consultation.

[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.	Pregnant women and young children thrive.
2.	Children live in stable, supported families.
3.	Youth choose healthy behaviors and will thrive.
4.	Women lead healthy and productive lives.
5.	Youth successfully transition to adulthood.
6.	Communities provide safety and support for families.
7.	All children, including CSHN, receive continuous and comprehensive health care within a medical home.
8.	All children receive continuous and comprehensive oral health care within a dental home.
9.	Children and families are emotionally healthy.
10.	Children and families live in healthy environments.

Form Notes for Form 14
	None
Field Level Notes
	None

STATE: VT

APPLICATION YEAR: 2008

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.	General Systems Capacity Issues 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:	Funding for hotel and travel to Boston for one day session on Lifecourse model	Learning about Lifecourse will assist with broader concepts of MCH and birth outcomes. Assist with VDH realignment. MCH strategic planning and Title V needs assessment.	Dr. NeaL Halfon and Dr. Deb Allen and the Boston University School of Public Health
2.	General Systems Capacity Issues 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:	Funding for professional facilitation to guide VDH MCH strategic planning	VDH realignment and the upcoming Title V Strengths and Needs Assessment will be complemented by a VDH MCH strategic plan.	To contract with experienced PH facilitator, yet to be determined
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
	None
Field Level Notes
	None

SP #
Performance Measure:	The percent of Vermont women who indicate that their pregnancies are intended.
Status:	Active
Goal	To increase the percent of women whose pregnancies are intended.
Definition	The percent of Vermont PRAMS respondents (Vermont resident births occurring in either Vermont or New Hampshire) who respond to the PRAMS question of “Thinking back to just before you got pregnant, how did you feel about becoming pregnant?” and answering Yes to “I wanted to be pregnant then” or “I wanted to be pregnant sooner.”
	Numerator: Those women responding to the PRAMS question of “Thinking back to just before you got pregnant, how did you feel about becoming pregnant?” and answering Yes to “I wanted to be pregnant then” or “I wanted to be pregnant sooner.”
	Denominator: Those women responding to the PRAMS question of “Thinking back to just before you got pregnant, how did you feel about becoming pregnant?”
	Units: 100 Text: Percent

Healthy People 2010 Objective	Related Objective 9-3: Increase the proportion of females at risk of unwanted pregnancy (and their p Target: 100%. Baseline: 93% of females aged 15-44 at risk of unwanted pregnancy used contraception in 1995. Related Objective 9-4:Reduce the proportion of females experiencing pregnancy despite use of a rever Target: 7%. Baseline: 13% of females experienced pregnancy despite use of a reversible contraceptive method.
Data Sources and Data Issues	PRAMS Question: "Thinking back to just before you got pregnant, how did you feel about becoming pregnant?" And responded "I wanted to be pregnant then" or "I wanted to be pregnant sooner."
Significance	According to data from the National Survey of Family Growth (NSFG), in the United States, approximately half of all pregnancies across the age spectrum are “unintended” and may be associated with social, economic, and medical costs. Although a pregnancy may be reported as unintended, most children at birth are welcomed and nurtured. However, the social costs of unintended births can include reduced educational attainment and employment opportunity, greater dependence on welfare, and increased potential for child abuse and neglect, with a greater impact noted for adolescent mothers. In general, women who lack preparedness for pregnancy are less likely to receive timely prenatal care, and their infants are more likely to lack sufficient resources for healthy development (Healthy People 1010 Progress Review, Family Planning, December, 2004.)

SP #
Performance Measure:	The percent of licensed child care centers serving children age birth to five who have on-site consultation.
Status:	Active
Goal	To support children to thrive within families by enhancing early education system which is defined broadly to indicate collaboration with MCH and public health.
Definition	The number of center-based child care providers licensed by the Department of Children and Families who serve children aged birth through six years that receive and least one visit annually from a child health care consultant.
	Numerator: Number of licensed center-based facilities that serve children under six years of age who have received a visit from a child care health consultant in the past year.
	Denominator: Licensed center-based facilities that serve any child under six years of age.
	Units: 100 Text: Percent

Healthy People 2010 Objective	N/A
Data Sources and Data Issues	Data, including the denominator, is available from the Vermont Department for Children and Families, Child Development Division. Although there are a variety of systems that can be accessed for basic data for this measure’s numerator, there is not yet a fully automated statewide system for entry and retrieval of data related to activity of Child Health Care Consultants. Over the next few years, a more comprehensive system will be developed. The data for the denominator is available from the Child Development Division’s Building Bright Futures data system (public portal available at www.brightfuturesinfo.org.)
Significance	To be able to measure the link between comprehensive early childhood systems and the strengthening of assets in young children and families.. A strong system of early childhood services promotes the health and welfare of children and their families. Region 1 has committed to create a measure that captures this concept within the mission of Title V programs. The measure incorporates the philosophy of assets and also an ecological model of factors that influence child health and development. Nationally, the number of children ages birth to age six in out-of-home care has increased from 30% to over 76% since the 1970’s. Thus, it has become increasingly important to be able to evaluate child care programs, to assess quality and accessibility, and to know the impact of care on children’s health. Child care health consultants play a critical role in promoting healthy and safe child care environments and supporting education for children, their families, and child care providers. This support specifically includes children with special health care needs. Child care health consultants also improve access to preventive health services such as medical and dental homes, early intervention and family support. This measure is consistent with recommendations from the AAP, APHA, and MCHB/HRSA.

SP #
Performance Measure:	The percent of youth who do not binge drink on alcoholic beverages.
Status:	Active
Goal	To increase the percent of youth who do not binge drink using alcoholic beverages as a strategy to support healthy behaviors in youth.
Definition	The percent of youth who did not binge drink on alcohol in the last thirty days.
	Numerator: The number of youth in 8th-12th grade reporting that they did not binge drink on alcohol in the last thirty days.
	Denominator: Number of youth in 8th-12th grade participating in the (comparable)Youth Risk Behavior Survey.
	Units: 100 Text: Percent

Healthy People 2010 Objective	HP 2010 26-11 HP 2010 Objective 26-11: Reduce the proportion of persons engaging in binge drinking of alcoholic beverages. Baseline for HS Seniors: 32% (1998) Target: 11%. Baseline for College Students: 39% (1998) Target: 20%.
Data Sources and Data Issues	Youth Risk Behavior Survey. Binge drinking is defined as having five or more drinks of alcohol within a couple of hours.
Significance	Binge drinking is a national problem, especially among males and young adults. In Vermont, 21% of students reported binge drinking during the past 20 days in 2005 (vs. 23% in 2003.) Twelfth graders were over four times as likely as 8th graders to binge drink (33% vs. 7%). The perceived acceptance of drug-using behavior among family, peers, and society influences an adolescent’s decision to use or avoid alcohol, tobacco, and drugs. The perception that alcohol use is socially acceptable correlates with the fact that more than 80% of youth nationally consume alcohol before their 21st birthday, whereas the lack of social acceptance of other drugs correlates with comparatively lower rates of use. Similarly, widespread societal expectations that youth will engage in binge drinking may encourage this highly dangerous form of alcohol consumption (HP2010, CDC.) For this measure, Vermont is testing the approach of using assets-based wording to measure the absence of binge drinking in youth, so as to emphasize the social and cultural changes that must take place for youth to understand that binge drinking can become the antithesis to the social norm.

SP #
Performance Measure:	The percent of women of childbearing age who consume at least two servings of fruit and three servings of vegetables daily.
Status:	Active
Goal	To increase the number of women of childbearing age who eat a healthy diet as measured by fruit and vegetable intake in order to improve overall birth outcomes.
Definition	The number of women of childbearing age who comsume at least five servings of fruit and vegetables daily, as measured by two servings daily of fruit and three servings daily of vegetables.
	Numerator: The number of women ages 18-44 who report eating at least five or more servings of fruit and vegetables per day. There are two submeasures - the number of woemn 18-44 who consume at least 2 daily servings of fruit; the number of women 18-44 who consume at least 3 servings of vegetables.
	Denominator: The number of women ages 18-44 participating in the (comparable) BRFS
	Units: 100 Text: Percent

Healthy People 2010 Objective	Related Objective 19-5 Increase the proportion of persons aged 2 years and older who consume at least two daily servings of fruit. Target: 75%. Baseline: 28% of persons aged 2 years and older consumed at least two daily servings of fruit (1994-1996) Related Objective 19-6 Increase the proportion of persons aged 2 years and older who consume at least three daily servings of vegetables, with at least one-third being dark green or orange vegetables. Target: 50%. Baseline: 3% of persons aged 2 years and older consumed at least three daily servings of vegetables (1994-1996)
Data Sources and Data Issues	Adult BRFS (BRFS is a population health risk assessment survey using a representative sample of Vermonters over 18 years of age performed every two years.)
Significance	The importance of improving preconceptual health in women of childbearing age has become a priority for health and public health professionals in their efforts to improve birth outcomes. Health and social systems should support women and their partners to adopt health lifestyles during the time they may be intending to have a family. Women need to be supported in certain actions, such as in eating a healthy diet, maintaining a proper weight, getting adequate exercise, avoiding smoking and substance abuse, and obtaining regular health care. One measure of these healthy habits is consumption of adequate amounts of fruits and vegetables. (MMWR - Recommendations to Improve Preconception Heath and Health Care – Unites States, April 21, 2006)

SP #
Performance Measure:	The percent of youth who feel like they matter to people.
Status:	Active
Goal	To increase the percent of youth who feel valued by their community as a strategy to support successful transition to adulthood.
Definition	The percent of youth who feel valued by their communities.
	Numerator: The number of youth in grades 8-12 reporting that they agree or strongly agree with the statement: In my community, I feel like I matter to people.
	Denominator: Number of youth in grades 8-12 participating in the (comparable) YRBS.
	Units: 100 Text: Percent

Healthy People 2010 Objective	No related objectives
Data Sources and Data Issues	YRBS
Significance	Assets research for adolescents is demonstrating an association between healthy youth behaviors and certain defined assets. In response to this research, Vermont added five asset questions to the YRBS in 2001 in order to gather information on youth assets in relation to youth risk taking behavior. The state of Maine also uses this indicator, however worded slightly differently - “Do you feel that in your community, you feel like you matter to people.” Also, in response to assets research, MCHB Region One began to incorporate a philosophy that would address a population’s assets in addition to a population’s needs in for the 2005 Title V MCH Needs Assessment. Choosing an asset indicator for Priority Goal #5 is viewed as a strategy to operationalize the assessment of youth assets in addition to analyzing youth risk-taking behavior. A collaboration between Vermont and Maine allows these two states to measure the same youth asset. A New England-wide collaboration has begun to support other New England states to also include similar measures into their TV planning process.

SP #
Performance Measure:	The percent of Vermont towns (population of 2,000 or more) who have at least one organized physical activity program in place that is open to all and promoted as a family activity
Status:	Active
Goal	To promote regular exercise and physical activity as a family activity by offering comunity-based opportunities to engage in physical activity.
Definition	The number of Vermont cities and towns with a population of 2,000 or more with at least one organized physical activity program in place that is open to all and promoted as a family activity.
	Numerator: Number of cities and towns with a population of 2,000 or more with at least one organized physical activity program in place that is open to all and promoted as a family activity.
	Denominator: Number of cities and towns in Vermont with a population of 2,000 or more (86)
	Units: 100 Text: Percent

Healthy People 2010 Objective	Related HP 2010 Goal: Increase the % of adults who engage in regular physical activity to 50%. Presently, Vermont's rate for adult regular moderate physical activity is 55% and the goal is to increase by 15 percent by 2010 (ABRFS, 2003.) Of Vermont's youth, 27% report they exercised moderately five or more days per week (YRBS, 2005) Note: Adequate physical activity levels for adults and youth are defined as 30 minutes moderate exercise five or more times a week.)
Data Sources and Data Issues	VDH community grant reports from the Community Walking Program, supported by Vermont state funds via the Blueprint for Health. This goal is also found in Vermont’s Obesity State Plan and in the Blueprint for Health.
Significance	The VDH is working on several initiatives to encourage communitites to enhance residents' health by creating opportunities to be physically active. Communities are developing such attributes as sidewalks, footpaths, hiking/walking trails, schools open to the public after school hours, and local farmers' markets. Moderate daily physical activity is essential to a healthy lifestyle, yet many Americans, for numerous reasons, lead sedentary lifestyles. Reasons include automated workplaces resulting in many jobs requiring workers to spend hours sitting at desks, use of automobiles for even short trips, diminishing recess and physical education programs, and excessive television and computer use. Another factor is that many communities, designed around the automobile, lack walkways and bikeways to safely accommodate non-motorists. Also in Vermont, the rural nature of the state often means children have long commutes to schools requiring busing or, if they choose to walk, there few sidewalks along rural roads. Organized community-based physical activity programs for families are but one strategy to create an environment that encourages and fosters regular physical activity.

SP #
Performance Measure:	The percent of children with SSI who receive an annual care plan.
Status:	Active
Goal	To increase the percent of CSHN who receive an annual care plan within a medical home.
Definition	The percentage of children under age 16 with SSI whose primary care provider has billed Medicaid for a comprehensive, annual care plan.
	Numerator: The number of children under age 16 with SSI whose primary care provider has billed Medicaid for a comprehensive, annual care plan.
	Denominator: The number of children with SSI under the age of 16.
	Units: 100 Text: Percent

Healthy People 2010 Objective	Related HP Objective 16-22 (Developmental) Increase the proportion of children with special health care needs who have access to a medical home Related HP Objective 16-23 Increase the proportion of Territories and States that have service systems for children with special health care needs. Target: 100%. Baseline: 15.7% of Territories and States met the Title V guidelines for service systems for CSHN in FY 1997.
Data Sources and Data Issues	Medicaid claims data. All Vermont children with SSI have Medicaid. Only primary care providers may bill for annual care plans. See also HSCI #8: The percent of state SSI beneficiaries less than 16 years old receiving rehabilitative services from the CSHCN program.
Significance	This measure represents an effort to measure the prevalence and utilization of one element of a Medical Home for CSHCN - the writing of a substantial, comprehensive, annual care plan. VT Medicaid has implemented a system of payment to the PCP for an annual care plan written for a CSHCN. VDH has access to Medicaid claims data and all VT children who have SSI are enrolled in Medicaid. Children who have SSI have met clinical criteria for having a serious, chronic disability, and thus, are children who would benefit particularly from a comprehensive plan of care through a medical home. This SPM, therefore, is a measure of the access of children with SSI to a practicing Medical Home. The same data and similar process is used for HSCI#8 (children with SSI up to age 16.) This measure is a reasonable window into measurement of and supporting access for all CSHCN to a Medical Home.

SP #
Performance Measure:	The percent of low income children (with Medicaid) who utilize dental services in a year.
Status:	Active
Goal	To prevent dental caries in children by increasing appropriate use of dental services.
Definition	The number of low income children who use dental services within a one-year period.
	Numerator: Number of Vermont children with Medicaid insurance who visit a dental office during a one-year period.
	Denominator: Number of Vermont children with Medicaid insurance during a one-year period.
	Units: 100 Text: Percent

Healthy People 2010 Objective	HP 2010 Related Objective 21-10 HP Related Objective 21-10: Increase the proportion of children and adults who use the oral health system each year. Target: 56%. Baseline: 44% of persons aged 2 years and older in 1996 visited a dentist the previous year.
Data Sources and Data Issues	Medicaid data and data from Electronic Data Systems (EDS).
Significance	Although appropriate home oral health care and population based prevention are essential, professional care is also necessary to maintain optimal oral and craniofacial health. Regular dental visits provide an opportunity for the early prevention, diagnosis, and treatment of oral and craniofacial diseases and conditions. Experts recommmend that children as young as age 1 year be examined for evidence of developing dental caries. Dental caries is the single most common chronic disease in children. Despite the reduction in cases of caries in recent years, more than half of all children have caries by the second grade and, by the time children finish high school, about 80% have caries (Healthy People, 2010, CDC.) The dental services utilization rate of children using Medicaid insurance in Vermont has been steady for the last 5 years at approximately 45 percent. If many of the remaining 55 percent can access dental services, the number of dental caries can be reduced through preventive measures.

SP #
Performance Measure:	The percent of children with emotional, developmental, or behavioral problems that require treatment or counseling who received needed mental health services in the past year.
Status:	Active
Goal	To strengthen the mental health service delivery system so as to enable all children with emotional, developmental, or behavioral problems to receive counseling or treatment.
Definition	The percent of children with emotional, developmental, or behavioral problems that required treatment or counseling and received the needed treatment and counseling over the past year. Value for Vermont is 70% in 2005.
	Numerator: The unduplicated count of children who both needed and received treatment whereas the denominator is all children who needed treatment. Thus, the numerator is those answering yes on S2Q16 (Does your chiuld have any kind of emotional, developmental,or behavioral problem for which he/she needs treatment or counseling?) and S4Q23 (During the past 12 months, did your child receive any mental health care or counseling?)
	Denominator: All children, ages 1-17, with a current emotional, developmental, or behavioral health condition requiring treatment or counseling (S2Q16).
	Units: 100 Text: Percent

Healthy People 2010 Objective	Obj. 18-7 Increase the proportion of children with mental health problems who receive treatment Developmental objective. No data or specific 2010 numerical value available.
Data Sources and Data Issues	National Survey of Children's Health, 2005
Significance	Mental health services, including counseling, medications, or specialized therapies, are beneficial for children with behavioral or emotional problems. However, these services are often not readily available or affordable to the children and their families who would benefit from them. Nationally, 58.7% of children with ongoing emotional, developmental, or behavioral problems needing treatment or counseling received mental health care as reported in the 2005 NSCH. Children with health insurance, public or private, are more likely to receive the mental health services they need. Of these children needing services who are without health insurance, only 33.8% received any mental health care or counseling. (The Health and Well-Being of Children, National Survey of Children’s Health, 2005)

SP #
Performance Measure:	The percent of one year old children who are screened for blood lead poisoning.
Status:	Active
Goal	To increase the number of one year old children who are screened for blood lead levels.
Definition	The number of children aged one year old who are screened for blood lead levels.
	Numerator: The number of Vermont one year old children who are screened for blood lead levels.
	Denominator: The number of Vermont children who are one year of age.
	Units: 100 Text: Percent

Healthy People 2010 Objective	Objective 8-11: Eliminate elevated blood lead levels in children. Target: Zero percent. Baseline: 4.4% of children aged 1-6 years had blood lead levels exceeding 10 ug/ml during 1991-1994.
Data Sources and Data Issues	Vermont Department of Health maintins a data base of all screening and testing done for lead levels by labs via community clinics and primary cae offices.
Significance	Lead is a highly toxic metal that has been and still is used in household and industrial products. Lead exposure can increase the risk of miscarriage, premature birth, stillbirth, or low birth weight. Lead enters the body by inhaling or ingesting the lead directly, most often as lead dust. In a pregnant women, lead can cross to the placenta. Children are most vulnerable to lead poisoning when they are under six years old, and especially at ages one and two when they normally exhibit hand-to-mouth behavior. Lead poisoning can cause permanent damage to a child’ brain and kidneys. Even small amounts of lead can cause serious learning and behavior problems. The CDC has recommended that all children be screened for lead poisoning at ages one and two years. Vermont has the second oldest housing stock in the nation with about 60% built before 1978, the year lead paint was banned. Most Vermont children who become lead poisoned have ingested lead dust or lead from soil that has been tracked into their home

Form Notes for Form 16
	None
Field Level Notes
	None

Form Level Notes for Form 17

None

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
	2002	2003	2004	2005	2006
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final

Field Level Notes

1.	Section Number: Health Systems Capacity Indicator #01 Field Name: HSC01 Row Name: Column Name: Year: 2006 Field Note: Hospital Discharge data for 2006 were not available at the time of submission.

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
	2002	2003	2004	2005	2006
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Provisional	Provisional

Field Level Notes

1.	Section Number: Health Systems Capacity Indicator #02 Field Name: HSC02 Row Name: Column Name: Year: 2006 Field Note: In contrast to previous years, data for enrollment in Medicaid during 2004, 2005 and 2006 are split out from SCHIP - which is reported separtely, below. As a consequence, results from 2003 and earlier should not be compared directly to 2004 onwards.
2.	Section Number: Health Systems Capacity Indicator #02 Field Name: HSC02 Row Name: Column Name: Year: 2005 Field Note: In contrast to previous years, data for enrollment in Medicaid during 2004, 2005 and 2006 are split out from SCHIP - which is reported separtely, below. As a consequence, results from 2003 and earlier should not be compared directly to 2004 onwards.
3.	Section Number: Health Systems Capacity Indicator #02 Field Name: HSC02 Row Name: Column Name: Year: 2004 Field Note: In contrast to previous years, data for enrollment in Medicaid during 2004, 2005 and 2006 are split out from SCHIP - which is reported separtely, below. As a consequence, results from 2003 and earlier should not be compared directly to 2004 onwards.

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
	2002	2003	2004	2005	2006
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
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: 2006 Field Note: In contrast to previous years, data for enrollment in SCHIP during 2004, 2005 and 2006 are split out from Medicaid - which is reported separtely, above. As a consequence, results from 2003 and earlier should not be compared directly to 2004 onwards.
2.	Section Number: Health Systems Capacity Indicator #03 Field Name: HSC03 Row Name: Column Name: Year: 2005 Field Note: In contrast to previous years, data for enrollment in SCHIP during 2004, 2005 and 2006 are split out from Medicaid - which is reported separtely, above. As a consequence, results from 2003 and earlier should not be compared directly to 2004 onwards.
3.	Section Number: Health Systems Capacity Indicator #03 Field Name: HSC03 Row Name: Column Name: Year: 2004 Field Note: In contrast to previous years, data for enrollment in SCHIP during 2004, 2005 and 2006 are split out from Medicaid - which is reported separtely, above. As a consequence, results from 2003 and earlier should not be compared directly to 2004 onwards.

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
	2002	2003	2004	2005	2006
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Provisional

Field Level Notes

1.	Section Number: Health Systems Capacity Indicator #04 Field Name: HSC04 Row Name: Column Name: Year: 2006 Field Note: Consistent data for 2006 were not available at the time of submission.

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

	Annual Indicator Data
	2002	2003	2004	2005	2006
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final	Final

Field Level Notes

1.	Section Number: Health Systems Capacity Indicator #07A Field Name: HSC07A Row Name: Column Name: Year: 2006 Field Note: The estimate for the number of children aged 1-21 years who are potentially eligible for Medicaid services is based on the sum of the number of children enrolled in Medicaid at the end of FFY 2006 plus the number of children aged 1-21 with household income <300% of Federal Poverty Level who lacked Health insurance in 2005 (data source VT Banking, Insurance, Securities and Health Care Administration, 2005 Vermont Household Health Insurance Survey). Estimates of uninsured children for 2003 -2004 were based on a previous survey carried out in 2000.
2.	Section Number: Health Systems Capacity Indicator #07A Field Name: HSC07A Row Name: Column Name: Year: 2005 Field Note: The estimate for the number of children aged 1-21 years who are potentially eligible for Medicaid services is based on the sum of the number of children enrolled in Medicaid at the end of FFY 2005 plus the number of children aged 1-21 with household income <300% of Federal Poverty Level who lacked Health insurance in 2005 (data source VT Banking, Insurance, Securities and Health Care Administration, 2005 Vermont Household Health Insurance Survey). Estimates of uninsured children for 2003 -2004 were based on a previous survey carried out in 2000.
3.	Section Number: Health Systems Capacity Indicator #07A Field Name: HSC07A Row Name: Column Name: Year: 2004 Field Note: The estimate for the number of children aged 1-21 years who are potentially eligible for Medicaid services is based on the sum of the number of children enrolled in Medicaid at the end of FFY 2004 plus the number of children aged 1-21 with household income <300% of Federal Poverty Level who lacked Health insurance in 2000 (data source VT Banking, Insurance, Securities and Health Care Administration, 2000 Vermont Family Health Insurance Survey).

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

	Annual Indicator Data
	2002	2003	2004	2005	2006
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final	Final

Field Level Notes

1.	Section Number: Health Systems Capacity Indicator #07B Field Name: HSC07B Row Name: Column Name: Year: 2005 Field Note: For FY05
2.	Section Number: Health Systems Capacity Indicator #07B Field Name: HSC07B Row Name: Column Name: Year: 2004 Field Note: Data is for FFY04

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
	2002	2003	2004	2005	2006
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final	Final

Field Level Notes

1.	Section Number: Health Systems Capacity Indicator #08 Field Name: HSC08 Row Name: Column Name: Year: 2006 Field Note: The indicator begins with a claims-data review of SSI-eligible children under age 16 who received a Medicaid service in 2006. This is, of necessity, an under-count of the children who had SSI in that year, some of whom received no services, and some of whom have private insurance that paid for the services they did receive. They are matched to CSHN-enrolled children. In addition, CSHN annotates SSI status as the information becomes available. In 2006, 1,625 SSI children received a service. There were 654 children whose CSHN records show that they have SSI. 621 of the 654 were also on the SSI list (perhaps the 33 were among those who did not have a service paid in the reporting year.) In addition, 212 CSHN children, when crossmatched, were found to have SSI although the CSHN file did not indicate SSI. Therefore a total of 866 of the 1,625 SSI children, or 53.3% are dually enrolled. The annual SSA statistical report of each state’s children who have SSI, reported 1415 Vermont children had SSI in December, 2006.
2.	Section Number: Health Systems Capacity Indicator #08 Field Name: HSC08 Row Name: Column Name: Year: 2005 Field Note: VT Medicaid reports that there were 1,536 children under the age of 16 who were SSI eligible and who received a medical service paid for by Medicaid in CY 2005. This figure compares to 1,384, the number of children under 126 who were SSI eligible as of December 2005, as reported by the SSA website ("Table 7. Number and percentage distribution of children in Vt receiving federally administered SSI payments, by selected characteristics, Dec 2005.") 691 of the 1,536 identified children (45%) also receive services through Vt CSHN, services which include, at least, care coordination. This is the figure reported (691 is 49% of 1,384, the SSA figure.)
3.	Section Number: Health Systems Capacity Indicator #08 Field Name: HSC08 Row Name: Column Name: Year: 2004 Field Note: We continue to crossmatch by hand, the names/DOB of under 16 yo enrolled in CSHN, with the names of those receiving at least one medicaid-funded service whose medicaid eligibility includes SSI. The crossmatch for this year shows that there are 435 children under 16 enrolled in CSHN who are also receiving SSI, representing 29.3% of SSI children.

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)	2006
b) Medicaid Children (Age range to ) (Age range to ) (Age range to )	2006
c) Pregnant Women	2006

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)	2006
b) Medicaid Children (Age range to ) (Age range to ) (Age range to )	2006
c) Pregnant Women	2006

Form Notes for Form 18
	None
Field Level Notes
1.	Section Number: Indicator 05 Field Name: LowBirthWeight Row Name: Percent of ow birth weight (<2,500 grams) Column Name: Year: 2008 Field Note: 1) The source of these data is matched files from WIC and birth certificate used for the Pregnancy Nutrition Surveillance System. State eligibility criteria for WIC is the same as for Medicaid, and prenatal enrollment in WIC is used as a surrogate for the Medicaid population.
2.	Section Number: Indicator 05 Field Name: InfantDeath Row Name: Infant deaths per 1,000 live births Column Name: Year: 2008 Field Note: 1) The source of these data is matched files from WIC and birth certificate used for the Pregnancy Nutrition Surveillance System. State eligibility criteria for WIC is the same as for Medicaid, and prenatal enrollment in WIC is used as a surrogate for the Medicaid population. 2) The denominator is based on a 2005 estimate derived from combined birth certificate data collected from 01/01/05 through 06/30/05 under the 2000 U.S. Standard with data collected from 07/01/05 through 12/31/05 under the 2003 U.S. Standard. This data set has yet to be finalized, resulting in discrepancies in the estimates of total number of Vermont resident births used in OM#01 compared to HSCI#05b.
3.	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: 2008 Field Note: 1) The source of these data is matched files from WIC and birth certificate used for the Pregnancy Nutrition Surveillance System. State eligibility criteria for WIC is the same as for Medicaid, and prenatal enrollment in WIC is used as a surrogate for the Medicaid population. 2) The denominator is based on a 2005 estimate derived from combined birth certificate data collected from 01/01/05 through 06/30/05 under the 2000 U.S. Standard with data collected from 07/01/05 through 12/31/05 under the 2003 U.S. Standard. This data set has yet to be finalized, resulting in discrepancies in the estimates of total number of Vermont resident births used in PM#18 compared to HSCI#05c.
4.	Section Number: Indicator 05 Field Name: AdequateCare Row Name: Percent of pregnant women with adequate prenatal care Column Name: Year: 2008 Field Note: 1) The source of these data is matched files from WIC and birth certificate used for the Pregnancy Nutrition Surveillance System. State eligibility criteria for WIC is the same as for Medicaid, and prenatal enrollment in WIC is used as a surrogate for the Medicaid population. 2) The denominator is based on a 2005 estimate derived from combined birth certificate data collected from 01/01/05 through 06/30/05 under the 2000 U.S. Standard with data collected from 07/01/05 through 12/31/05 under the 2003 U.S. Standard. This data set has yet to be finalized, resulting in discrepancies in the estimates of total number of Vermont resident births used in HSCI#04 compared to HSCI#05d.

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	Yes
Annual linkage of birth certificates and Medicaid Eligibility or Paid Claims Files	3	Yes
Annual linkage of birth certificates and WIC eligibility files	3	Yes
Annual linkage of birth certificates and newborn screening files	3	Yes
REGISTRIES AND SURVEYS Hospital discharge survey for at least 90% of in-State discharges	3	Yes
Annual birth defects surveillance system	2	No
Survey of recent mothers at least every two years (like PRAMS)	3	Yes
*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	Yes
Other:	3	Yes
	3	Yes

*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
	None

Form Level Notes for Form 11

None

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

	Annual Indicator Data
	2002	2003	2004	2005	2006
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Provisional

Field Level Notes

1.	Section Number: Health Status Indicator #01A Field Name: HSI01A Row Name: Column Name: Year: 2006 Field Note: Population estimates for 2006 were not available at the time of submission.

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

	Annual Indicator Data
	2002	2003	2004	2005	2006
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Provisional

Field Level Notes

1.	Section Number: Health Status Indicator #01B Field Name: HSI01B Row Name: Column Name: Year: 2006 Field Note: Population estimates for 2006 were not available at the time of submission.

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

	Annual Indicator Data
	2002	2003	2004	2005	2006
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Provisional

Field Level Notes

1.	Section Number: Health Status Indicator #02A Field Name: HSI02A Row Name: Column Name: Year: 2006 Field Note: Population estimates for 2006 were not available at the time of submission.

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

	Annual Indicator Data
	2002	2003	2004	2005	2006
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Provisional

Field Level Notes

1.	Section Number: Health Status Indicator #02B Field Name: HSI02B Row Name: Column Name: Year: 2006 Field Note: Population estimates for 2006 were not available at the time of submission.

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

	Annual Indicator Data
	2002	2003	2004	2005	2006
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final

Field Level Notes

1.	Section Number: Health Status Indicator #03A Field Name: HSI03A Row Name: Column Name: Year: 2006 Field Note: Population estimates for 2006 were not available at the time of submission.
2.	Section Number: Health Status Indicator #03A Field Name: HSI03A Row Name: Column Name: Year: 2005 Field Note: In 2004 there were 16 deaths. Following the procedures outlined in Technical Note IX, Guidelines for Calculating Performance Measures using small samples, a rate is calculated from a numerator and denominator averaged over three years (2003, 2004 and 2005).
3.	Section Number: Health Status Indicator #03A Field Name: HSI03A Row Name: Column Name: Year: 2004 Field Note: In 2004 there were only 3 deaths.Following the procedures outlined in Technical Note IX, Guidelines for Calculating Performance Measures using small samples, a rate is calculated from a numerator and denominator averaged over three years (2002, 2003 and 2004).

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

	Annual Indicator Data
	2002	2003	2004	2005	2006
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final

Field Level Notes

1.	Section Number: Health Status Indicator #03B Field Name: HSI03B Row Name: Column Name: Year: 2006 Field Note: Population estimates for 2006 were not available at the time of submission.
2.	Section Number: Health Status Indicator #03B Field Name: HSI03B Row Name: Column Name: Year: 2005 Field Note: In 2005 there were 5 deaths. Following the procedures outlined in Technical Note IX, Guidelines for Calculating Performance Measures using small samples, a rate is calculated from a numerator and denominator averaged over three years (2003, 2004 and 2005).
3.	Section Number: Health Status Indicator #03B Field Name: HSI03B Row Name: Column Name: Year: 2004 Field Note: Following the procedures outlined in Technical Note IX, Guidelines for Calculating Performance Measures using Small Samples, null values are entered here in lieu of a rate. In 2004, 2 children aged 14 or younger died due to motor vehicle crashes in Vermont, a number below the threshold for which rates are to be calculated.

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

	Annual Indicator Data
	2002	2003	2004	2005	2006
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final

Field Level Notes

1.	Section Number: Health Status Indicator #03C Field Name: HSI03C Row Name: Column Name: Year: 2006 Field Note: Population estimates for 2006 were not available at the time of submission.

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

	Annual Indicator Data
	2002	2003	2004	2005	2006
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Provisional	Provisional

Field Level Notes

1.	Section Number: Health Status Indicator #04A Field Name: HSI04A Row Name: Column Name: Year: 2006 Field Note: Population estimates for 2005 were not available at the time of submission but should be available at the end of 2007.
2.	Section Number: Health Status Indicator #04A Field Name: HSI04A Row Name: Column Name: Year: 2005 Field Note: Consistent with previous years, data are derived from Hospital Discharge dataset (source: VT Banking, Insurance, Securities and Haelth Care Administration) discharges from inpatient hospital setting. Since only a minority of injuries result in inpatient admissions, it is estimated that the numerator represents less than 2% of total injuries reported.
3.	Section Number: Health Status Indicator #04A Field Name: HSI04A Row Name: Column Name: Year: 2004 Field Note: Consistent with previous years, data are derived from Hospital Discharge dataset (source: VT Banking, Insurance, Securities and Haelth Care Administration) discharges from inpatient hospital setting. Since only a minority of injuries result in inpatient admissions, it is estimated that the numerator represents less than 2% of total injuries reported.

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

	Annual Indicator Data
	2002	2003	2004	2005	2006
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final

Field Level Notes

1.	Section Number: Health Status Indicator #04B Field Name: HSI04B Row Name: Column Name: Year: 2006 Field Note: Population estimates for 2006 were not available at the time of submission.
2.	Section Number: Health Status Indicator #04B Field Name: HSI04B Row Name: Column Name: Year: 2005 Field Note: Consistent with previous years, data are derived from Hospital Discharge dataset (source: VT Banking, Insurance, Securities and Haelth Care Administration) discharges from inpatient hospital setting. Since only a minority of injuries result in inpatient admissions, it is estimated that the numerator represents less than 2% of total injuries reported. See IV E for discussion.
3.	Section Number: Health Status Indicator #04B Field Name: HSI04B Row Name: Column Name: Year: 2004 Field Note: Consistent with previous years, data are derived from Hospital Discharge dataset (source: VT Banking, Insurance, Securities and Haelth Care Administration) discharges from inpatient hospital setting. Since only a minority of injuries result in inpatient admissions, it is estimated that the numerator represents less than 2% of total injuries reported.

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

	Annual Indicator Data
	2002	2003	2004	2005	2006
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final

Field Level Notes

1.	Section Number: Health Status Indicator #04C Field Name: HSI04C Row Name: Column Name: Year: 2006 Field Note: Population data for 2006 were not available at the time of submission.
2.	Section Number: Health Status Indicator #04C Field Name: HSI04C Row Name: Column Name: Year: 2005 Field Note: Consistent with previous years, data are derived from Hospital Discharge dataset (source: VT Banking, Insurance, Securities and Haelth Care Administration) discharges from inpatient hospital setting. Since only a minority of injuries result in inpatient admissions, it is estimated that the numerator represents less than 2% of total injuries reported.
3.	Section Number: Health Status Indicator #04C Field Name: HSI04C Row Name: Column Name: Year: 2004 Field Note: Consistent with previous years, data are derived from Hospital Discharge dataset (source: VT Banking, Insurance, Securities and Haelth Care Administration) discharges from inpatient hospital setting. Since only a minority of injuries result in inpatient admissions, it is estimated that the numerator represents less than 2% of total injuries reported.

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

	Annual Indicator Data
	2002	2003	2004	2005	2006
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final

Field Level Notes

1.	Section Number: Health Status Indicator #05A Field Name: HSI05A Row Name: Column Name: Year: 2006 Field Note: Data to complete this item are currently unavailable. Population estimates for 2006 will be available at the end of CY2007.
2.	Section Number: Health Status Indicator #05A Field Name: HSI05A Row Name: Column Name: Year: 2005 Field Note: The data to calculate this measure for 2005 are currently not consistently available, but will be available at the end of the 2006 calendar year.
3.	Section Number: Health Status Indicator #05A Field Name: HSI05A Row Name: Column Name: Year: 2004 Field Note: The data to calculate this measure for 2004 are currently not consistently available, but will be available at the end of the 2005 calendar year. 2004 data provided here is the 2003 data, to be seen as a crude estimate of the situation in 2004.

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

	Annual Indicator Data
	2002	2003	2004	2005	2006
Annual Indicator
Numerator
Denominator
Check this box if you cannot report the numerator because 1. There are fewer than 5 events over the last year, and 2.The average number of events over the last 3 years is fewer than 5 and therefore a 3-year moving average cannot be applied. (Explain data in a year note. See Guidance, Appendix IX.)
Is the Data Provisional or Final?				Final

Field Level Notes

1.	Section Number: Health Status Indicator #05B Field Name: HSI05B Row Name: Column Name: Year: 2006 Field Note: Data to complete this item are currently unavailable. Population estimates for 2006 will be available at the end of CY2007.
2.	Section Number: Health Status Indicator #05B Field Name: HSI05B Row Name: Column Name: Year: 2005 Field Note: The data to calculate this measure for 2005 are currently not consistently available, but will be available at the end of the 2006 calendar year.
3.	Section Number: Health Status Indicator #05B Field Name: HSI05B Row Name: Column Name: Year: 2004 Field Note: The data to calculate this measure for 2004 are currently not consistently available, but will be available at the end of the 2005 calendar year. 2004 data provided here is the 2003 data, to be seen as a crude estimate of the situation in 2004.

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? Final

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? No 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? No Is this data final or provisional? Final

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									2004
Percent in TANF (Grant) families									2004
Number enrolled in Medicaid									2006
Number enrolled in SCHIP									2006
Number living in foster home care									2004
Number enrolled in food stamp program									2004
Number enrolled in WIC									2006
Rate (per 100,000) of juvenile crime arrests									2004
Percentage of high school drop-outs (grade 9 through 12)									2006

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				2004
Percent in TANF (Grant) families				2004
Number enrolled in Medicaid				2006
Number enrolled in SCHIP				2006
Number living in foster home care				2004
Number enrolled in food stamp program				2004
Number enrolled in WIC				2006
Rate (per 100,000) of juvenile crime arrests				2004
Percentage of high school drop-outs (grade 9 through 12)				2004

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? No 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: 2006 Is this data from a State Projection? No Is this data final or provisional? Final

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: 2006 Is this data from a State Projection? No 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
	None
Field Level Notes
1.	Section Number: Indicator 06A Field Name: S06_Race_Infants Row Name: Infants 0 to 1 Column Name: Year: 2008 Field Note: Data from state population estimate contains a pooled number for Asian plus Native Hawaiian or Other Pacific Islander, reported here under Asian. The number of Vermont residents claiming Native Hawaiian or Other Pacific Islander race is however likely to be very small.
2.	Section Number: Indicator 06A Field Name: S06_Race_Children1to4 Row Name: children 1 through 4 Column Name: Year: 2008 Field Note: Data from state population estimate contains a pooled number for Asian plus Native Hawaiian or Other Pacific Islander, reported here under Asian. The number of Vermont residents claiming Native Hawaiian or Other Pacific Islander race is however likely to be very small.
3.	Section Number: Indicator 06A Field Name: S06_Race_Children5to9 Row Name: children 5 through 9 Column Name: Year: 2008 Field Note: Data from state population estimate contains a pooled number for Asian plus Native Hawaiian or Other Pacific Islander, reported here under Asian. The number of Vermont residents claiming Native Hawaiian or Other Pacific Islander race is however likely to be very small.
4.	Section Number: Indicator 06A Field Name: S06_Race_Children10to14 Row Name: children 10 through 14 Column Name: Year: 2008 Field Note: Data from state population estimate contains a pooled number for Asian plus Native Hawaiian or Other Pacific Islander, reported here under Asian. The number of Vermont residents claiming Native Hawaiian or Other Pacific Islander race is however likely to be very small.
5.	Section Number: Indicator 06A Field Name: S06_Race_Children15to19 Row Name: children 15 through 19 Column Name: Year: 2008 Field Note: Data from state population estimate contains a pooled number for Asian plus Native Hawaiian or Other Pacific Islander, reported here under Asian. The number of Vermont residents claiming Native Hawaiian or Other Pacific Islander race is however likely to be very small.
6.	Section Number: Indicator 06A Field Name: S06_Race_Children20to24 Row Name: children 20 through 24 Column Name: Year: 2008 Field Note: Data from state population estimate contains a pooled number for Asian plus Native Hawaiian or Other Pacific Islander, reported here under Asian. The number of Vermont residents claiming Native Hawaiian or Other Pacific Islander race is however likely to be very small.
7.	Section Number: Indicator 07A Field Name: Race_Women15 Row Name: Women < 15 Column Name: Year: 2008 Field Note: The 2005 population estimate combines birth certificate data collected from 01/01/05 through 06/30/05 under the 2000 U.S. Standard with data collected from 07/01/05 through 12/31/05 under the 2003 U.S. Standard. The 2005 data set has yet to be finalized, resulting in discrepancies in the available estimates of total number of Vermont resident births.
8.	Section Number: Indicator 07A Field Name: Race_Women15to17 Row Name: Women 15 through 17 Column Name: Year: 2008 Field Note: The 2005 population estimate combines birth certificate data collected from 01/01/05 through 06/30/05 under the 2000 U.S. Standard with data collected from 07/01/05 through 12/31/05 under the 2003 U.S. Standard. The 2005 data set has yet to be finalized, resulting in discrepancies in the available estimates of total number of Vermont resident births.
9.	Section Number: Indicator 07A Field Name: Race_Women18to19 Row Name: Women 18 through 19 Column Name: Year: 2008 Field Note: The 2005 population estimate combines birth certificate data collected from 01/01/05 through 06/30/05 under the 2000 U.S. Standard with data collected from 07/01/05 through 12/31/05 under the 2003 U.S. Standard. The 2005 data set has yet to be finalized, resulting in discrepancies in the available estimates of total number of Vermont resident births.
10.	Section Number: Indicator 07A Field Name: Race_Women20to34 Row Name: Women 20 through 34 Column Name: Year: 2008 Field Note: The 2005 population estimate combines birth certificate data collected from 01/01/05 through 06/30/05 under the 2000 U.S. Standard with data collected from 07/01/05 through 12/31/05 under the 2003 U.S. Standard. The 2005 data set has yet to be finalized, resulting in discrepancies in the available estimates of total number of Vermont resident births.
11.	Section Number: Indicator 07A Field Name: Race_Women35 Row Name: Women 35 or older Column Name: Year: 2008 Field Note: The 2005 population estimate combines birth certificate data collected from 01/01/05 through 06/30/05 under the 2000 U.S. Standard with data collected from 07/01/05 through 12/31/05 under the 2003 U.S. Standard. The 2005 data set has yet to be finalized, resulting in discrepancies in the available estimates of total number of Vermont resident births.
12.	Section Number: Indicator 07B Field Name: Ethnicity_Women15 Row Name: Women < 15 Column Name: Year: 2008 Field Note: The 2005 population estimate combines birth certificate data collected from 01/01/05 through 06/30/05 under the 2000 U.S. Standard with data collected from 07/01/05 through 12/31/05 under the 2003 U.S. Standard. The 2005 data set has yet to be finalized, resulting in discrepancies in the available estimates of total number of Vermont resident births.
13.	Section Number: Indicator 07B Field Name: Ethnicity_Women15to17 Row Name: Women 15 through 17 Column Name: Year: 2008 Field Note: The 2005 population estimate combines birth certificate data collected from 01/01/05 through 06/30/05 under the 2000 U.S. Standard with data collected from 07/01/05 through 12/31/05 under the 2003 U.S. Standard. The 2005 data set has yet to be finalized, resulting in discrepancies in the available estimates of total number of Vermont resident births.
14.	Section Number: Indicator 07B Field Name: Ethnicity_Women18to19 Row Name: Women 18 through 19 Column Name: Year: 2008 Field Note: The 2005 population estimate combines birth certificate data collected from 01/01/05 through 06/30/05 under the 2000 U.S. Standard with data collected from 07/01/05 through 12/31/05 under the 2003 U.S. Standard. The 2005 data set has yet to be finalized, resulting in discrepancies in the available estimates of total number of Vermont resident births.
15.	Section Number: Indicator 07B Field Name: Ethnicity_Women20to34 Row Name: Women 20 through 34 Column Name: Year: 2008 Field Note: The 2005 population estimate combines birth certificate data collected from 01/01/05 through 06/30/05 under the 2000 U.S. Standard with data collected from 07/01/05 through 12/31/05 under the 2003 U.S. Standard. The 2005 data set has yet to be finalized, resulting in discrepancies in the available estimates of total number of Vermont resident births.
16.	Section Number: Indicator 07B Field Name: Ethnicity_Women35 Row Name: Women 35 or older Column Name: Year: 2008 Field Note: The 2005 population estimate combines birth certificate data collected from 01/01/05 through 06/30/05 under the 2000 U.S. Standard with data collected from 07/01/05 through 12/31/05 under the 2003 U.S. Standard. The 2005 data set has yet to be finalized, resulting in discrepancies in the available estimates of total number of Vermont resident births.
17.	Section Number: Indicator 09A Field Name: HSIRace_Children Row Name: All children 0 through 19 Column Name: Year: 2008 Field Note: Data from VT State Population Estimate for 2005. Note that this dataset does not distinguish Native Hawaiian and Other Pacific Islander from Asian, and the former category is included under the latter. However, the number of individuals in Vermont who might report their race as Native Hawaiian and Other Pacific Islander is expected to be very small.
18.	Section Number: Indicator 09A Field Name: HSIRace_SingleParentPercent Row Name: Percent in household headed by single parent Column Name: Year: 2008 Field Note: Data not available for race/ethnicity.
19.	Section Number: Indicator 09A Field Name: HSIRace_TANFPercent Row Name: Percent in TANF (Grant) families Column Name: Year: 2008 Field Note: Data is from 2004, indicates the percent Vermont children ages 5-17 in families receiving TANF. Data not available by race or ethnicity.
20.	Section Number: Indicator 09A Field Name: HSIRace_MedicaidNo Row Name: Number enrolled in Medicaid Column Name: Year: 2008 Field Note: Data from Medicaid Claims database. Note that this dataset does not distinguish Native Hawaiian and Other Pacific Islander from Asian, and the former category is included under the latter. However, the number of individuals in Vermont who might report their race as Native Hawaiian and Other Pacific Islander is expected to be very small.
21.	Section Number: Indicator 09A Field Name: HSIRace_SCHIPNo Row Name: Number enrolled in SCHIP Column Name: Year: 2008 Field Note: Data from Medicaid Claims database. Note that this dataset does not distinguish Native Hawaiian and Other Pacific Islander from Asian, and the former category is included under the latter. However, the number of individuals in Vermont who might report their race as Native Hawaiian and Other Pacific Islander is expected to be very small.
22.	Section Number: Indicator 09A Field Name: HSIRace_FoodStampNo Row Name: Number enrolled in food stamp program Column Name: Year: 2008 Field Note: App. 12.1% of Vermont children live in families who receive food stamps. Data not available by race/ethnicity
23.	Section Number: Indicator 09A Field Name: HSIRace_JuvenileCrimeRate Row Name: Rate (per 100,000) of juvenile crime arrests Column Name: Year: 2008 Field Note: Data indicates the number of "delinquent" children in custody - these youths are conisdered delinquent if they commit offenses that would be crimes if they were adults. 52% of Vermont's delinquent youth are in custody. Data not available by race/ethnicity.
24.	Section Number: Indicator 09A Field Name: HSIRace_DropOutPercent Row Name: Percentage of high school drop-outs (grade 9 through 12) Column Name: Year: 2008 Field Note: The number reflects the percent of the total high school population (grades 9-12) who withdrew from school during the previous summer and during the school year. Calculated according to the National Center for Education Statistics formula. Data is for the 2005-2006 school year. Data not available by race/ethnicity.
25.	Section Number: Indicator 09B Field Name: HSIEthnicity_SingleParentPercent Row Name: Percent in household headed by single parent Column Name: Year: 2008 Field Note: Data not reported by Hispanic/not Hispanic
26.	Section Number: Indicator 09B Field Name: HSIEthnicity_MedicaidNo Row Name: Number enrolled in Medicaid Column Name: Year: 2008 Field Note: Data from Medicaid Claims database. Note that this dataset does not collect data on non-Hispanic ethnicity per se. The number of non-Hispanic individuals is estimated by subtraction of the "Hispanic" category from the total.
27.	Section Number: Indicator 09B Field Name: HSIEthnicity_SCHIPNo Row Name: Number enrolled in SCHIP Column Name: Year: 2008 Field Note: Data from Medicaid Claims database. Note that this dataset does not collect data on non-Hispanic ethnicity per se. The number of non-Hispanic individuals is estimated by subtraction of the "Hispanic" category from the total.
28.	Section Number: Indicator 10 Field Name: Metropolitan Row Name: Living in metropolitan areas Column Name: Year: 2008 Field Note: 2005 State population estimate is based on the U.S. Census Bureau. Census 2000 Summary File 1, Matrix P12. Note that the available data are for children aged 0-17 years (not 0-19 years as defined). The total for children living in urban areas is the sum of children living in metropolitan plus non-metropolitan urban areas, as defined by the U.S. Census Bureau.
29.	Section Number: Indicator 10 Field Name: Urban Row Name: Living in urban areas Column Name: Year: 2008 Field Note: 2005 State population estimate is based on the U.S. Census Bureau. Census 2000 Summary File 1, Matrix P12. Note that the available data are for children aged 0-17 years (not 0-19 years as defined). The total for children living in urban areas is the sum of children living in metropolitan plus non-metropolitan urban areas, as defined by the U.S. Census Bureau.
30.	Section Number: Indicator 10 Field Name: Rural Row Name: Living in rural areas Column Name: Year: 2008 Field Note: 2005 State population estimate is based on the U.S. Census Bureau. Census 2000 Summary File 1, Matrix P12. Note that the available data are for children aged 0-17 years (not 0-19 years as defined). The total for children living in urban areas is the sum of children living in metropolitan plus non-metropolitan urban areas, as defined by the U.S. Census Bureau.
31.	Section Number: Indicator 10 Field Name: Frontier Row Name: Living in frontier areas Column Name: Year: 2008 Field Note: 2005 State population estimate is based on the U.S. Census Bureau. Census 2000 Summary File 1, Matrix P12. Note that the available data are for children aged 0-17 years (not 0-19 years as defined). The total for children living in urban areas is the sum of children living in metropolitan plus non-metropolitan urban areas, as defined by the U.S. Census Bureau.
32.	Section Number: Indicator 11 Field Name: S11_total Row Name: Total Population Column Name: Year: 2008 Field Note: Data source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2006.
33.	Section Number: Indicator 11 Field Name: S11_50percent Row Name: Percent Below: 50% of poverty Column Name: Year: 2008 Field Note: Data source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2006.
34.	Section Number: Indicator 11 Field Name: S11_100percent Row Name: 100% of poverty Column Name: Year: 2008 Field Note: Data source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2006.
35.	Section Number: Indicator 11 Field Name: S11_200percent Row Name: 200% of poverty Column Name: Year: 2008 Field Note: Data source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2006.
36.	Section Number: Indicator 12 Field Name: S12_Children Row Name: Children 0 through 19 years old Column Name: Year: 2008 Field Note: Data source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2006.
37.	Section Number: Indicator 12 Field Name: S12_50percent Row Name: Percent Below: 50% of poverty Column Name: Year: 2008 Field Note: Data source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2006.
38.	Section Number: Indicator 12 Field Name: S12_100percent Row Name: 100% of poverty Column Name: Year: 2008 Field Note: Data source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2006.
39.	Section Number: Indicator 12 Field Name: S12_200percent Row Name: 200% of poverty Column Name: Year: 2008 Field Note: Data source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2006.
40.	Section Number: Indicator 09A Field Name: HSIRace_FosterCare Row Name: Number living in foster home care Column Name: Year: 2008 Field Note: Data not available by race/ethnicity.

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