Help Me Grow Home Visiting Program
In this section Help Me Grow (HMG) staff can access materials related to the HMG Home Visiting Program, including narrative sections from the program manual, brochures, forms and FAQs.
Help Me Grow Home Visiting in SFY13
The Ohio Department of Health will enter into direct contractual relationships with Help Me Grow Home Visiting Providers. You will find various documents that will help you apply to the program and that will answer your questions.
HMG Home Visiting Provider Application
HMG Home Visiting: Contractor How to Guidance
Declaration of Non Assistance to Terrorist Organizations
Help Me Grow Home Visiting – Evidence Based Home Visiting Model Crosswalk
This document is for reference and comparison purposes only between HMG HV Program Standards and Evidence Based Home Visiting Model Fidelity. Refer to OAC 3701-8 Help Me Grow Program Rules for the comprehensive set of Help Me Grow Home Visiting Program requirements. Refer to the Evidence-Based Home Visiting Model’s website and the Home Visiting Evidence of Effectiveness website (http://homvee.acf.hhs.gov/Default.aspx) for more information about model fidelity requirements.
HMG Home Visiting Program Standards - Evidence Based Home Visiting Model Fidelity Crosswalk
Home Visiting Program Manual
Copies of the Home Visiting Program Manual were provided to county HMG programs on June 4, 2010. Electronic versions of each narrative section (including attachments) of the manual effective that date are available for download below in PDF format.
Overview section
Table of Contents
Overview tab materials (pages OV-1 to OV-6)
Help Me Grow Home Visiting Program Logic Model
Help Me Grow Home Visiting Program Timeline
A Science-Based Framework for Early Childhood Policy (article)
Home Visitation: Assessing Progress, Managing Expectations (article)
Personnel Section
Table of Contents
Personnel tab materials (pages PS-1 to PS-11)
Training Bulletin
Screening & Program Evaluation Tools
Table of Contents
Screening and Program Evaluation Tools tab materials (SA-1 to SA-18)
Adult-Adolescent Parenting Inventory (AAPI-2) Form A
(English version) (Spanish version) (Website Access)
Ages and Stages Questionnaire (ASQ-3) - this form is not available for download due to copyright
Ages and Stages Questionnaire Social-Emotional (ASQ-SE) - this form is not available for download due to copyright
Edinburgh Postnatal Depression Scale (EPDS)
(English version) (Spanish version)
Hearing Status Questionnaire (HSQ)
(Form) (Instructions)
Interpersonal Support Evaluation List, 12 item (ISEL)
(English version) (Spanish version) (Scoring Instructions)
Parent Stress Index - Short Form (PSI-SF) - this form is not available for download due to copyright
PEACH Survey Nutrition Screening
(Form) (Instructions)
Safety Checklist
(Form) (Tip Sheet)
Taking a Look Vision Screening
(Form) (Instructions)
Intake and Referral section
Table of Contents
Intake and Referral tab materials (CI-1 to CI-7)
Child Information and Referral Data Collection
(Form) (Instructions)
45-Day Data Collection Form
Referral Follow-up Form
County Central Intake and Referral Sites
Overall flow chart
Central Intake and Referral flow chart
Home Visiting flow chart
Home Visiting and Part C flow chart
Home Visits section
Table of Contents
Home Visits tab materials (HV-1 to HV-28)
Immunization Schedule (Chart)
Responsibilities of the Home Visitor flow chart
Consent for Services and Parents' Rights
(English version) (Spanish version)
Help Me Grow Case Notes Form
Help Me Grow Home Visiting Program Timeline
45-Day Data Collection Form
Initial Family Plan
(English version) (Spanish version)
Family Plan Review
(English version) (Spanish version)
Family Plan Review (optional form)
(English version) (Spanish version)
Ongoing Home Visit Data Collection
(Form) (Instructions)
Memo #10-03 HMG Home Visitation Program Curriculum Approval
Transition section
Table of Contents
Transition tab materials (TR-1 to TR-6)
Types of Child Care (chart)
Options for Transitioning out of Ohio's Help Me Grow Home Visiting Program (chart)
Program Oversight section
Table of Contents
Program Oversight tab materials (OS-1 to OS-4)
Help Me Grow Home Visiting Program Monitoring Indicators
Local Reporting Template for Monitoring the Help Me Grow Home Visiting Program
Guide for writing a Memorandum of Understanding (MOU)
Sample Memorandum of Understanding template
Forms section
Help Me Grow Case Notes Form
Consent for Services and Parents' Rights
(English version) (Spanish version)
Consent to Share or Release Information
(English version) (Spanish version)
Initial Family Plan
(English version) (Spanish version)
Family Plan Review
(English version) (Spanish version)
Family Plan Review (optional form)
(English version) (Spanish version)
Child Information and Referral Data Collection
(Form) (Instructions)
45 Day Data Collection
(Form) (Instructions)
Ongoing Home Visit Data Collection
(Form) (Instructions)
Referral Follow-up Form
Rules and Policies
Help Me Grow Rules (effective July 16, 2010)
Help Me Grow Policies
Resources
Table of Contents
Text4baby
Sample Physicians letter
Sample Public Service Announcements (PSAs)
Sample Outreach letter
Home Visiting works cited page
Ohio HMG Local Program Contact Information
Ordering Instructions for Home Visiting Materials
Home Visiting Tools
Adult-Adolescent Parenting Inventory (AAPI-2) Form A
(English version) (Spanish version) (Website Access)
Ages and Stages Questionnaire (ASQ-3) - this form is not available for download due to copyright
Ages and Stages Questionnaire Social-Emotional (ASQ-SE) - this form is not available for download due to copyright
Edinburgh Postnatal Depression Scale (EPDS)
(English version) (Spanish version)
Hearing Status Questionnaire (HSQ)
(Form) (Instructions)
Interpersonal Support Evaluation List, 12 item (ISEL)
(English version) (Spanish version) (Scoring Instructions)
Parent Stress Index - Short Form (PSI-SF) - this form is not available for download due to copyright
PEACH Survey Nutrition Screening
(Form) (Instructions)
Safety Checklist
(Form) (Tip Sheet)
Taking a Look Vision Screening
(Form) (Instructions)
Guidance Documents for Tools
Guidance documents for the following tools are available in PDF format by clicking on the link to the right of the tool name.
Adult-Adolescent Parenting Inventory (AAPI-2) Form A (Document)
Interpersonal Support Evaluation List, 12 item (ISEL) (Document)
Parent Stress Index - Short Form (PSI-SF) (Document)
Home Visiting Brochures
Local Program Contact Information
Contact list for HMG Project Directors, CI&R Sites and FCFC Coordinators
This page last updated on 5/7/12.