Healthy Start Data Collection Forms (formerly called Screening Tools) Updated 12/16/2020

On March 3, 2020, the Division of Healthy Start & Perinatal Services (DHSPS) released the new, OMB-approved Healthy Start Data Collection Forms. On July 1, 2020 and December 16, 2020 minor revisions were made to the forms and these updated versions of the forms were posted below.

Goals of New Data Collection Forms

The new data collection forms were created with extensive input from grantees via the public comment periods with the following goals:

• Reduce the burden of client-level data collection by simplifying, streamlining, and consolidating the former six tools into just three forms—Background Information, Prenatal, and Parent/Child
• Provide a more clear focus on program performance and other mission-critical goals
• Facilitate and increase accuracy in reporting

HRSA has given the Healthy Start TA Center permission to post the OMB approved versions of these forms here for easy access. NOTE: minor revisions have been made and the forms were re-posted here on 12/16/20. Please be sure you are using the versions below with “Dec 2020” in the filename. 

Any changes to the wording or layout of the form nullifies federal approval of the use of the form.

• Background Information Form (doc) (Dec 2020)
  • Background Information Form Fillable PDF
  • Background Information Form – Spanish
  • Background Information Form – Spanish Fillable PDF
• Prenatal Form (doc) (Dec 2020)
  • Prenatal Form Fillable PDF
  • Prenatal Form – Spanish
  • Prenatal Form – Spanish Fillable PDF
• Parent/Child Form (doc) (Dec 2020)
  • Parent/Child Form Fillable PDF
  • Parent/Child Form – Spanish
  • Parent/Child Form – Spanish Fillable PDF

The crosswalk document found here takes each item in the new HS Data Collection Forms and identifies the corresponding item in the old forms (previously called HS Screening Tools).

The FAQ document found here answers questions that were posed by grantees before and during the Data Collection Forms trainings.

Many thanks to all who have contributed to the creation and implementation of the new data collection forms, including Healthy Start grantees, MCHB staff and leadership, Healthy Start CoIIN members, and NICHQ/HS TA Center Staff.

With support from the Healthy Start TA & Support Center, DHSPS provided a three-part training series on the new data collection forms.

All three sessions are required to receive the full training on the new data collection forms. You must receive the full training before administering the forms to Healthy Start participants. 

The session recordings and slides are below:

Session 1: Forms Overview & Background Form Training

View slides from DCF training session one.

Session 2: Prenatal Form Training

View the slides from DCF training session two.

Session 3: Parent/Child Form Training

View slides from DCF training session three.

 

During each training, the TA & Support Center shared a demonstration video of each Data Collection Form. We would like to thank the Boston Healthy Start team for their support and participation in the videos! You can access the demonstration videos below:

Background Information Form Demo Video

Prenatal Form Demo Video

Parent/Child Form Demo Video

Please direct any questions about the new forms/ data collection to HealthyStartData@hrsa.gov.  Please indicate what the question pertains to in the subject line (e.g.,  Careware, HSMED2, or Data Collection Forms).