Efforts To Outcomes (ETO) User's Guide - Hippy USA

Efforts To Outcomes (ETO)
User’s Guide
Created by
May 2011
HIPPY USA 1221 Bishop Street Little Rock, Arkansas 72202 Phone 501.537.7726 Fax 501.537.7716 www.hippyusa.org

Table of Contents
ETO Training Information .......................................................................................................................... 3
Introduction .................................................................................................................................................. 5
ETO Software® ......................................................................................................................................... 5
ETO and HIPPY Evaluation ....................................................................................................................... 6
Data Entry Instructions ................................................................................................................................................ 8
Login ....................................................................................................................................................................... 8
Parents, Children, Home Visitors, and Coordinators Programs .............................................................................. 8
Home Pages ........................................................................................................................................................... 9
Entering Demographics ........................................................................................................................................ 11
Updating Participant Information ........................................................................................................................... 14
Entering Assessments .......................................................................................................................................... 14
Entering Single Participant Points of Service ........................................................................................................ 15
Entering Multiple Participant Points of Service ..................................................................................................... 15
Entering a Referral ................................................................................................................................................ 16
Adding an Entity .................................................................................................................................................... 17
Viewing/Editing an Entity ...................................................................................................................................... 17
Sample Forms ............................................................................................................................... 18
HIPPY Application ................................................................................................................................................. 18
Parent Questionnaire – Baseline .......................................................................................................................... 19
Parent Questionnaire – Follow-up ........................................................................................................................ 20
Family Exit Form ................................................................................................................................................... 21
Home Visit Scheduling .......................................................................................................................................... 22
Home Visit Progress ............................................................................................................................................. 23
Group Meeting Summary Form ............................................................................................................................ 24
Home Visitor Background ..................................................................................................................................... 25
Coordinator Background ....................................................................................................................................... 26
Funding Information Form ..................................................................................................................................... 27
ETO Reports .................................................................................................................................. 28
ETO Demographics Reports ................................................................................................................................. 29
ETO Assessment Report ...................................................................................................................................... 30
ETO Glossary of Terms ................................................................................................................ 33
ETO Support .................................................................................................................................. 36
Appendix 1 .................................................................................................................................... 37
HIPPY Logic Model
ETO Pilot Site Contacts ................................................................................................................ 38
Coordinator and Home Visitor ETO Responsibilities ................................................................ 39
2

ETO Training Information
Each HIPPY program site will receive ETO training as an introduction to the software. HIPPY USA utilizes
web-based training in addition to hands-on training. The web based lab environment will be hosted through
ReadyTech. Hands-on training will be scheduled with the HIPPY USA ETO administrator, Angela Jones
(501.537.7739 or ajones@hippyusa.org).
ReadyTech log in and access instructions
Step 1: Go to https://hippyusa.hostedtraining.com
Step 2: Click Configure Automatically
Step 3: Click Continue to ActiveX Download
Step 4: If all goes well, you will receive the message below.
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This ReadyTech connection will provide the visual part of the training. The software, which is referred to as
the virtual classroom, is a remote desktop. This will allow HIPPY USA to observe each user’s navigation
through tasks, similar to the way an instructor would walk through a computer lab and observe students’
progress. For this reason, you must work on a unique computer.
Be sure to perform the connection check (described in detail on the previous page) at least one day prior to
your scheduled training time. It typically takes less than a minute. Be sure to perform this on the computer
which will be used during the training.
On the day of training, please begin the log in process for the web conference 30 minutes prior to the
scheduled start time.
If problems arise, please contact ReadyTech Support:
Ready Tech Support
get-support@readytech.com
(510) 289.8992
Audio Access
The HIPPY USA toll-free teleconference line will be used for the audio portion of ETO training.
Dial 866.228.9900 and enter the pass code 124467.
During the call, *6 will mute and un-mute your phone.
Questions? Call Angela Jones at 501.537.7739
or email ajones@hippyusa.org.
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Introduction
ETO Software®
ETO Software® is a web-based performance management solution for human services organizations. It
gives organizations a clear picture of which efforts are having the greatest impact on the social issues they
strive to address. With this knowledge, government, private, and nonprofit firms can reinforce what's
working, adjust what isn't, and more easily report successes to key stakeholders.
Having a positive impact on society requires more than hard work and good intentions – it calls for a
strategic approach that connects an organization’s mission to the daily work of its staff members and the
expectations of its funders and supporters. ETO Software® transforms data into knowledge that you can
access via a multitude of easily generated reports to monitor, measure, and optimize your impact.
Information Access
The core value of ETO Software® lies within its reporting capabilities. These capabilities provide you with
fast, secure access to information that will empower you to:
Identify which of your efforts, services, staff and programs are most effective at achieving desired
outcomes
Identify and track key trends
Monitor participant attendance
Manage and analyze participant demographic data
Analyze assessment results
Manage referrals
Maintain a comprehensive history of participant information
Address multi-funder reporting obligations – in minutes
As with any software solution, the information you get out of it is only as good as the information you
put into it. Understanding this, we have gone to great lengths to include functionality that will encourage
HIPPY staff to use ETO Software®. These features include:
To Do Lists (screenshot – opens new window)
Task Reminders
Alerts
Searches/Queries
To supplement and enhance your use of ETO Software®, you also have access to a set of best practices
contained within our ETO City Repository. Here you will find:
Samples of outcomes
Use cases
Analysis methods
Report samples
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Data Capture
Data can be submitted into ETO through form submission (assessments, demographic forms, applications,
etc). The types of data typically captured with ETO Software® include:
Demographics
Assessment Data
Referral Data
Attendance Data
Case Notes
Client History
How ETO Ties in with HIPPY Evaluation
The ETO program has been designed keeping in mind the activities, outputs and outcomes and indicators
developed in the HIPPY Logic Model. (See Appendix 1 – page 39.) Data is collected in ETO using:
• Application and information forms – collect demographics data such as contact information,
cultural, language, schooling and educational background
• Assessments – collect data related to progression toward parent outcomes; to measure progression
it will be necessary to collect baseline data at the beginning or the program year and follow up data
at the end of the program year.
• Points of Service (POS) – collect data related to home visits, group meetings and special events
participation
• Referrals – records referrals made to other community organizations, education and employment
The ETO has been developed using 4 programs to best represent the efforts and outcomes:
1. Parents
2. Children
3. Home Visitors
4. Coordinators
The national office is assembling a committee comprised of researchers, representatives from the field, and
HIPPY staff to evaluate and determine various assessment tools that can be utilized on a national level. We
anticipate this process to take some time, but will incorporate the tools into the ETO software once they are
determined.
Until that time, HIPPY USA has included the assessments outlined in this manual and featured in the ETO
software as EXAMPLES ONLY. Site-specific assessments can be incorporated as needed. Contact
Angela Jones at ajones@hippyusa.org or 501.537.7739 for more information about incorporating site
specific assessments.
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The table below lists each of the forms used by program and describes what it is used for, when and why.
Parents Program
Form Title Why, When and Frequency of Use
To collect basic demographics data of the parent, child, and family
HIPPY Application
Used once when the parent enters the HIPPY program
Updated as demographics data changes
To collect baseline data on parent outcomes/indicators
Parent Questionnaire – To measure where the parent is when she/he begins the HIPPY program, progress is
Baseline
measured by comparing this baseline data with data collected at the end of each program year
Used after family has started the HIPPY program (one month to three months)
To collect progress data on parent outcomes/indicators
Parent Questionnaire – This data is compared with the baseline data taken at the beginning of the HIPPY year and
Follow Up
shows the changes (progress) during the HIPPY year
Used at the end of the HIPPY year
To collect information on why the family left HIPPY early, at what point (week) in the program
Family Exit Form
and what steps were taken to support the family in staying in HIPPY
Complete once when the family leaves the HIPPY program prematurely
Home Visit Scheduling
Data entered after HIPPY child has received weekly packet
Form
This data is used to track the number of home visits made
To collect data about each home visit after the HIPPY Home Visitor and primary adult have
reviewed the last week’s packet
Home Visit Progress Form
Data is entered for each parent individually
Taken after each home visit – 30 entries for families who complete the HIPPY year
To collect data about the group meeting
Group Meeting Summary
Data is entered for all parents (attendees) at the same time
Form
Taken after each group meeting
Other “site specific” forms may be created and used to enter the following types of data:
Special Event Form
Referral Form
Add /Edit Entity Form
To collect data about the group meeting/special event
Data is entered for all parents (attendees) at the same time
Taken after each group meeting/special event
To collect data on the type of referral made to the parent/family, as well as progress made for
each referral
Entered as referrals to outside service providers are made
Updated as parents follow up on the referral
To collect names and contact information of outside service providers to which families have
been referred
Data is entered once when the referral is made and is updated as contact information changes
Children Program
Form Title Why, When and Frequency of Use
To collect basic demographics data of the parent and child
HIPPY Application
Used once when the parent enters the HIPPY program
Updated as demographics data changes
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Home Visitors Program
Form Title Why, When and Frequency of Use
Home Visitor Background
Form
To collect basic demographics data of home visitors
Used once when home visitor is hired
Updated as demographics data changes
Performance Assessment –
Baseline (currently disabled)
To collect data related to the home visitor’s initial job performance
Assessments are completed by the coordinator
Used once after 12 months of employment
Performance Assessment –
Follow Up (currently disabled)
To collect data related to the home visitor’s changes in job performance
Assessments are completed by the coordinator
Used every 12 months of employment, starting after one year of employment
Coordinators Program
Form Title Why, When and Frequency of Use
To collect basic demographics data of coordinators
Coordinator Background Used at the beginning of every program year or each time a new coordinator is hired
Updated as demographics data changes
To collect funding data at the beginning of every program year
Funding Information Form
Updated as funding information data changes
Data Entry Instructions
1) Login
Internet Explorer (version 6.0 or higher) is the only web browser that can support ETO software. Log in at:
website: http://hippyusa.etosoftware.com
Use the user name and password provided. Only your site will appear. State offices will have access to
their statewide programs.
2) Parents, Children, Home Visitors, and Coordinators Programs
Make sure you are in the correct program: (Note: Coordinators have access to all four programs listed
below. Home visitors have access to only the Parents and Childrens programs).
Parents – data entry for family demographics, parent assessments, home visits, group meeting and special
event and family referrals.
Children – data entry for child demographics and child assessments
Home Visitors – data entry for home visitor demographics, all training, assessments and referrals
pertaining to home visitors
Coordinators – data entry for coordinator demographics, all training, educational and employment
advancements.
To switch between the four programs: Click (Change Program) and select the program from the pull
down menu (green text).
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3) Home Pages
The home pages for all programs contain links to all data entry windows. Click on the appropriate
icon on the right hand side of each item.
NOTE: The data entry process for all programs is very similar, and includes entering demographics
information, points of service, assessments and referrals. This manual describes the basic data entry
instructions for the four programs, but more detailed information is shared during the ETO training.
Parents Home Page
Children Home Page
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Home Visitors Home Page
Coordinators Home Page
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4) Entering Demographics
Coordinators
Click the next to “Add New Participant” on the home page.
Complete the participant information. The ALERT field is for any special reminders or indicators. All fields in
yellow are required fields.
NOTE: Each agency/site will determine if personal or office information will be used when entering the
Coordinator Background Information.
Enter the coordinator’s actual date of hire in the PROGRAM START DATE field.
Click when all information has been entered.
NOTE: Do not click the browser’s BACK arrow. ALL DATA WILL BE LOST. Always use the options on the
ETO toolbar to navigate through the system.
Funding Information Form
By submitting the Coordinator Background Information, the system automatically routes the user to the
Funding Information Form screen. (To enter information for additional coordinators, select the Home Page
option on the ETO toolbar and repeat the previous steps.)
Funding information should be completed only ONCE per site. To skip this step, select the Home Page
option on the ETO toolbar to continue.
NOTE: Do not use commas when entering financial information into the Funding Information Form.
Click when all information has been entered. You will then have the option to review and/or edit the
information. Click continue if all information is correct.
Home Visitors (Coordinators will enter this information)
Select “Home Visitors” from the change program option. Click next to “Add New Participant”.
Complete the participant information. The ALERT field is for any special reminders or indicators. All fields in
yellow are required fields.
Enter the home visitor’s actual date of hire in the PROGRAM START DATE field.
Click when all information has been entered.
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Parents (Home visitors will enter this information)
Select “Parents” from the change program option. Click the next to “Add Household” on the home page.
In the next window, click on the blue
arrow to activate the drop down menu
and select “Adult”.
Complete the participant information. By default all members are added into the Parents program on
today’s date. Change the date to the actual enrollment date by either typing the date or clicking on the
calendar icon.
If entering only one adult for the household, enter their program start date and save. If there are other
adults in the home, select “Adult” (using the drop down box) to add additional adults for this family.
A new demographics form will be appear at the bottom of the previous form. Continue with the same steps
until all adult members of this household have been entered. Next, enroll all members of this household into
the Parents program at the bottom of the demographics page.
NOTE: The Parents program will be used to track home visits, assessments, and group meeting and
special event attendance.
Children (Home visitors will enter this information)
Select “Children” from the change program option. Click next to “Add New Participant” on the home page.
Complete the participant information. (Remember to change the date to the actual enrollment date by either typing the date or
clicking on the calendar icon.) Click when all information has been entered. Repeat steps for additional children.
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Assign Participants (Families/Households) to Home Visitors
After the home visitors have entered demographic information for all participants, coordinators can then assign
families to each home visitor. Once assigned, each home visitor will have access to only their families. If
families are not assigned to home visitors, they will be unable to retrieve household data. After the
coordinator assigns the parents and children to the home visitor, the home visitor can now link the families.
To Set Up Dashboards
Step 1: From Parents program, click .
Step 2: All parents entered will appear. Select the
name. A green pop up window will
appear with a list of tasks.
Step 3: Click on the participant’s
dashboard.
Step 4: Click “Edit Dashboard.”
Step 5: Click .
Step 6: The ETO Parts Catalog window will pop up
on the left-hand side of the screen.
Step 7: Select Caseworkers and Staff Caseload.
Step 8: Click and .
Step 9: Click “Edit” under Caseworkers section to
assign Home Visitors. Under Staff Caseload, the
coordinator may select the home visitor from the
drop down box and assign all parents to that home
visitor at once. Repeat steps to assign children.
If Participant Dashboard Already Exists
Step 2
Step 1: From Parents program home page click .
All parents entered will appear. Select the name.
A green pop up window will appear with a list of tasks.
Step 2: Click on the participant’s dashboard.
Step 3: Click Edit under the Caseworkers section
Step 4: Select the assigned Home Visitor
Step 5: Repeat until all parents are assigned.
Step 6: Repeat steps to assign children.
Linking Adults and Children (Creating Households)
From the Parents Home Page, Home Visitors will click the option next to Link Family Members.
Click for a list of all
participants. (This will allow you to
view the full list to determine if
participants have been linked
correctly.) Select the first name in
which you’d like to link.
Select and click the blue text “Search for Others”. Click for a complete listing of all
participants. Check the box next to each participant that will be added to this family (household) and click
“Add Check Participants / Contact to Family”. Repeat steps for all families (households).
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5) Updating Participant Information
Complete this only if the demographics information for the family has changed (for example, they have
moved) or to correct mistakes and/or add missing information. Click the appropriate on the home
page.
In the next window, click next to the
family information to be updated.
6) Entering Assessments
To obtain a list of all families in
the system, select .
To search for a specific family,
type the first letter of the LAST
name. This will give you list of all
families with the last name
beginning with this letter.
A green pop up window will appear with a list of tasks.
Click View / Edit and the demographics screen will appear.
Click when all changes and updates
are complete.
Repeat this step to complete other tasks
listed in the green pop up window.
Select the appropriate icon on the home page. The first two screens displayed are identical to
updating demographics information screens:
for the family
Click next to the family in which you are collecting data
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Select “Take New Assessment”
Select the drop down menu (blue arrow), and
select the assessment in which you are
taking.
Click . The next screen contains
the assessment. Click when complete.
7) Recording Efforts for a Single Participant
(Entering Single Participant Point of Service: Home Visits and Attendance Reporting)
Select the appropriate icon on the home page. The first two screens displayed are identical to
updating demographics information screens:
for the family
Click next to the family in which you are collecting data
Select the drop down menu (blue arrow), and
select the point of service in which you are
entering.
Click . The next screen contains the
assessment. Click when complete.
The next screen will be the Participant Efforts screen. Complete all the fields and select:
1) “Save Effort and Close” if entering only one home visit, group meeting or special event; or
2) “Save Effort and Record Similar Effort” if you are entering an additional home visit, group meeting or special
event for this family; or
3) “Save Effort and View/Edit Participant” if you’d like to review the data entered.
8) Recording Efforts for Multiple Participants
(Entering Multiple Participant Point of Service)
Click the appropriate icon on the home page. Click “Participant” in the next window. Click . Check the
boxes beside all the individuals attending or participating in a specific point of service. Click .
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The next screen will be the Multiple Participant Efforts screen. Complete all the fields and select:
“Record Effort” if entering only one effort; or
“Save Effort and Record Similar Effort” if you are entering an additional effort.
9) Entering a Referral
This function is used to record referrals to outside agencies and services.
Select the drop down menu (blue arrow), and
select the point of service in which you are
entering.
Click . The next screen contains the
assessment. Click when complete.
Select the appropriate icon on the home page. The first two screens displayed are identical to
updating demographics information screens:
for the family
Click next to the family in which you are collecting data
Click on the appropriate entity and click .
The next screen displayed is the Referral screen.
Complete all fields and click .
Each time a new entity (outside service provider)
is entered, it will be added to the available list of
providers and will appear in the drop down menu
the next time a referral is entered for a household
(family).
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10) Adding An Entity
This function is used to record information on all
outside service providers.
Click the appropriate icon on the home page.
In the next screen enter the entity name and all
contact information.
Once completed, click .
11) Viewing/Editing Entity
This function is used to review or change outside service provider information.
Click the appropriate icon on the home page.
Click to obtain a list of all service
providers, or
Type the first letter of the service provider name
to obtain a list of all service providers listed
whose name begins with the specified letter.
Click the service provider to view/change. Make all changes in the next window and click when complete.
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ETO Reports
The ETO program has hundreds of standard reports that can be easily obtained with a click of the mouse.
Standard reports have been created by Social Solutions Group and are available to all program users.
These reports are listed by category and are created using Crystal Reports. Crystal Reports Viewer must
be installed to access these reports. An automatic prompt will appear when the reports are first accessed.
Reports may also be created by running queries, ranging from extremely simple to very complex.
NOTE: The following reports are samples using data from a training session. More details about reports
and running queries will be discussed during training, but more information can be found in the ETO Help
Manual:
http://sites.google.com/site/etosoftwarehelpmanual/
HIPPY USA offers additional training on reports and queries after initial training is completed.
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ETO Glossary of Terms
Assessment – One of the major data collection tools most all ETO sites include. Assessments can capture
data about participants, families, entities, general, and staff. Assessments in ETO will probably include
fields found on paper forms used by your organization prior to ETO, or they may be performance
management tools taken from the Library of ETO City. To capture a score on an assessment, elements
should be numeric or include weights.
Assessments are most typically used in one of two ways:
As a continuation of demographic data, like in an extensive intake form
Questionnaires that track knowledge, belief, attitude, and/or behavior that are completed more than
one time (at the beginning and end of service, for example) and allow for comparative analysis to
determine the impact of services
Attribute – Characteristics of Entities that are not expected to change as a result of service. ETO comes
with Standard Attributes, additional Attributes are created with the Attribute Wizard. Attributes are to
Entities what Demographics are to Participants. Attributes appear on the Add New Entity and View/Edit
Entity screens.
Boolean: Refers to any Yes/No field in ETO Software, including: Demographics, Assessment Elements,
Points of Service, and Attributes. The term Boolean is seen on several screens throughout the software,
but especially in the Query Wizard.
Demographic – Characteristics of Participants that are not expected to change as a result of service. ETO
comes with Standard Demographics, which can be disabled if they don’t meet an organization’s needs.
Additional Demographics are created with the Demographics Wizard. Demographics appear on the Add
New Participant, Add New Household, and View/Edit Participant screens, among others.
Entering Demographics is considered the most basic function for a staff using ETO. Additional data cannot
be entered about a Participant unless the Standard Demographic fields for first and last name have been
entered.
Custom Report – Typically a query that is saved and shared on the Manage Queries screen. A small
percentage of customers purchase Custom Reports from Social Solutions to meet their specific reporting
requirements.
Effort – Entry of Point of Service data, which is also known as recording efforts. There are several record
efforts features in ETO: Efforts can be recorded for Participants, Entities, or General. Efforts can be
recorded for one Participant (Entity) at a time, or Multiple Participants (Participants).
Most Point of Service elements are built with a field to capture time spent on contact. Time spent on
contact and number of contacts both track effort on behalf of staff entering their work. ETO has the
capacity for many efforts to be recorded for a given participant on the same day; effort data is typically
entered with more frequency than any other type.
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Effort Qualifiers – Fields that are created and attached to Point of Service elements to capture additional
information about efforts or contacts. Also known as EQs, Effort Qualifiers are best used for counting, or to
prompt staff to provide specific details about the contact. EQs are unique because they are built and edited
with one feature – Manage Effort Qualifiers, and can be attached to efforts with the Point of Service Wizard
or Manage Point of Service feature.
Enroll – To bring a participant that exists in ETO into the selected program, and enter a program start date.
Entities – Typically a third party that somehow impacts Participants, such as Employers, Education
Institutions, or other community based organizations where Participants are referred. Some organizations
whose mission is to improve the safety of communities work primarily with Entities. Like Participants,
Entities can be tracked with assessments, efforts, and processes.
ETO Report – Reports populated by recording efforts. Most ETO Reports come in two formats – Crystal
(the best option for reports containing large data sets, also easy to export into other formats) and non-
Crystal (which appear within the frames of ETO). The most impactful ETO Report is the non-Crystal
version for Point of Service elements set to measure and increase or decrease.
Family – Participants that are in some way related or share a home; families are recognized as a unit of
linked participants. Family functionality allows for the number of families served to be captured in addition
to the number of individuals. The term family is synonymous with the term household in ETO.
Feeder Table – Drop boxes found throughout features in ETO. The names of feeder tables are hardcoded,
but options are populated by the ETO Administrator. Some of the more popular feeder tables include
Contact Location Method (found on the Record Efforts screen), Reason for Dismissal (found on several
screens, including Dismiss Participant), Family Relationships (found on the Add New Household and
Add/Edit Families screens), and Reason for Referral (found on the Add Referral, Multiple Participant
Participant Referrals, and View/Edit Referrals screens).
Group - A subset of Participants who receive services simultaneously
Home Page - The link in the upper right corner of the ETO interface takes users to the page that’s seen by
default when users first log in. Important information, including links to functionality can be incorporated
onto the home page.
Household - Participants that are in some way related or share a home; households are recognized as a
unit of linked participants. Household functionality allows for the number of families served to be captured
in addition to the number of individuals. The term family is synonymous with the term household in ETO.
Library of ETO City – A website where Social Solutions provides summaries on a variety of program
areas, complete with references. There are also Point of Service and Assessments in the Library that are
built into customer sites during implementation. Customers may return to the Library at any time and
borrow information. The website is demo2.etosoftware.com. The username is librarian and the password
is librarian2.
Log Off – The link in the upper right corner of the software that all users should click before closing their
browser to ensure the data remains as secure as possible.
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Manage – The features in the software used by Administrators to make additions and modifications to
ETO. The majority of these features are found below the Site Administration component, and several are
directly related to the wizard features.
Navigation Bar – The green bar that’s accessible on the right side of the ETO interface. ETO
Administrators have the option to add or remove features, and dictate whether the bar is expanded or
collapsed by default, all from the Manage Site Navigation page.
Outcome – The “O” in ETO, outcomes can be tracked in Point of Service elements that are built to
measure and increase or decrease in attitude, performance, knowledge, etc. Also, assessments that
include weighted elements that are completed more than once allow for comparative analysis, and outcome
tracking.
Output – Point of Service elements that are tracking either an increase or decrease, and are used for
counting.
Participant – Member of the target population, recipient of service.
Point of Service – This is where time and energy spent is tracked within ETO. Whenever possible, it’s
best to set up a Point of Service so that time spent can be related to progress (such as going from
unemployed to under employed to gainfully employed). Points of Service are entered by Recording Efforts,
and are reported with ETO Reports (as well as several Standard Reports). The Manage for Point of
Service is below Program Administration on the Navigation Bar rather than Site Administration.
Process – A checklist that allows for tracking things such as documents in participant files. This feature is
not utilized as often as other features such as Demographics, Assessments, and Points of Service.
Program Group – A group of programs that fit into the same category. Demographics and Assessments
can be secured to a Program Group, and there are several Program Group reports for several types of
data.
Quality Indicator – Point of Service elements that are tracking an increase or decrease or neither, and are
used for counting efforts that are mission related.
Query – A request of information for ETO that can only be completed by a user who has been assigned a
Department Head or above. Queries appear in a grid that can easily be copied and pasted into Excel.
Queries can be built and saved, and shared to be accessible to lower user roles.
Referral – To “push” a participant to another program within ETO (versus Enroll, which is a pull), or to an
Entity Employer, Education Institution, or Service Provider.
Review Participant Efforts – The most popular report in ETO! It contains detailed data about a selected
participant within a date range, including efforts, employment, referrals, assessments, etc. The original
view shows summary statistics, there is the option to drill down to see more details, such as case notes.
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Standard Report – A “canned” report that came with ETO. While there is a feature on the Navigation Bar
named Standard Reports, the Demographic Reports, ETO Reports, Assessment Reports, etc., are also
considered Standard.
Survey – Like an assessment, but anonymous. Managed from the Manage Survey/Assessment screen,
but created with the Survey Wizard. ETO does have the capability for Participants or Entities to log into
ETO to enter Survey data directly into the system to eliminate staff data entry.
User Account – A unique log on that is provided with access to specific features and programs in ETO.
It’s recommended that users who enter data each have a user account so that staff are accountable for
their data and program managers can supervise them through ETO.
Wizard – A building tool in ETO that is used to create a new field or set of fields (in the case of an
assessment, for example) from scratch.
ETO Software Support
The first point of contact for all ETO software issues is the HIPPY USA ETO Administrator, Angela
Jones. She can be reached at 501.537.7739 or ajones@hippyusa.org.
ETO software support is also available by clicking in the lower right-hand corner of your screen
and selecting the appropriate help tool on the next screen to access a variety of training videos,
demonstrations, and overviews of all ETO software features.
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ETO Pilot Site Contacts
Name Site City, State Email Phone Number
Deborah Baker Jeffco HIPPY Lakewood, CO dbbaker@jeffco.k12.co.us 303.982.0014
Eric Biel
Brenda Brinson
Keshia Bruno
FL HIPPY State
Office
Hillsborough County
Center for Excellence
TX HIPPY State
Office
Tampa, FL ebiel@fmhi.usf.edu 813.974.2177
West Palm Beach, FL brinson@fmhi.usf.edu 813.224.0558
Dallas, TX keshia.bruno@unt.edu 214.442.1660
Susanna Cruz Jeffco HIPPY Lakewood, CO sucruz@jeffco.k12.co.us 303.982.0014
Pamela Gaines
Alta Jones
Kelly Keur
Racquel Lopez
Cathy McCrary
Glenda Nelson
Vicki Porter
Jacqueline
Richardson
Joanne Shum
David Tisdale
Nancy Tobias
Carla Weir
Community Students
Learning Center –
PIRC
AR HIPPY State
Office
InterCare Community
Health Network
Imperial Valley
Regional
Occupational
Program Project
Nenes
St. Michael’s
Preschool HIPPY
West Memphis
School District
Children’s Outing
Association COA
Youth and Family
Centers
AR HIPPY State
Office
AL HIPPY State
Office
CO HIPPY State
Office
Baltimore County
Public
TX HIPPY State
Office
Lexington, MS pamelajgaines@bellsouth.net 662.834.0905
Little Rock, AR jonesam@archildrens.org 501.364.3671
Benton Harbor, MI kkeur@intercare.org 269.605.1277
El Centro, CA rlopez@ivrop.org 760.562.5924
Hot Springs, AR cathymccrary@yahoo.com 501.623.2073
West Memphis, AR gjnnelson@yahoo.com 870.732.8572
Milwaukee, WI v_porter@coa-yfc.org 414.263.8383
Little Rock, AR richardsonjm@archildrens.org 501.364.3671
Montgomery, AL joanneshum@hippyalabama.com 334.265.2364
Denver, CO david@cpcfonline.org 303.860.6000
Baltimore, MD ntobias@bcps.org 410.887.3037
Dallas, TX carla.weir@unt.edu 214.442.1660
Julan Wood Heber Springs HIPPY Heber Springs, AR jwood@hssd.k12.ar.us 501.362.7580
Please feel free to contact Angela Jones (ajones@hippyusa.org or 501.537.7739) at any time to ask questions,
share concerns, and offer suggestions.
38

Coordinator and Home Visitor ETO Responsibilities
Coordinator
1) Enters his/her background information
2) Enters home visitor background information
3) Instructs home visitors to enter family information
This page outlines the “step-by-step” process involved in the
coordinator and home visitor ETO data entry. Following these
steps ensures smooth navigation throughout the ETO software
as information is entered into the system.
Home Visitor
1) Enters each family individually
2) Enters parent
3) Change program to “Children” to enter child
4) Switch back to the “Parent” program to work on next family file
5) Continue until all families are entered
6) Notify coordinator that all families are entered
Coordinator
1) Enters the “Parent” program
a. Select “Search”
b. Select a parent
c. Enter into the parent dashboard
2) Edit dashboard
a. Add ETO Parts Catalog
b. Select Caseworkers and Staff Caseload
c. Select Add and Close
d. Select Done Editing (located on upper right hand side)
3) Select Staff Caseload
a. Select Add (dropdown box, select the home visitor that will be assigned to parents)
b. Select all parents assigned to this home visitor
c. Save
d. Repeat to assign the children to the appropriate home visitor
e. Notify staff when all parents and children are assigned
Home Visitor
1) Now links child to parent
2) Enters points of services for their families
Coordinator
1) Continuously monitors ETO data input
39

Notes
40

Notes
41

Notes
42

Notes
43

HIPPY USA 1221 Bishop Street Little Rock, Arkansas 72202 Phone 501.537.7726 Fax 501.537.7716 www.hippyusa.org
44

HIPPY Excellence Model Guidance Accreditation
Revised December 2011
ETO Document Location Guide
Essential Feature: Curriculum
Accreditation Standard 1: ETO Enrollment Reports
This report can be retrieved from any program in ETO.
1. Select Reports → View Reports from the green menu bar on the right.
2. Select HUSA Enrollment Numbers by HIPPY Year.
3. Select your date range, Click Refresh Values for site name to appear, double click your site name, and
Run Query.
Please note if another site appears under Enter values for Site Name, feel free to double click that site to remove it.
Select your date range, Site name, and program.
For each prompt (date, site, program) enter the
value below.
Enter prompts here

Essential Feature: Home Visits
Accreditation Standard 1: Review ETO Efforts Report
This report can be retrieved only from the Parent program
1. Select Reports → Standard Reports → Review Efforts for Participant (crystal)
2. Select Search or enter the participant last name.
3. Select the participant.
4. Enter your date range.
5. Locate and select in the report Home Visit Contact. The report will now show the location of the home
visit, amount of time spent, if the packet was delivered, and the contact date.
Accreditation Standard 3:
This report can be retrieved only from the Parents program.
Using the same report:
1. Return to Main Report. Select Track Delivery of Curriculum to Parents (3/4) or (5) to determine the
weeks or packets.
2. Continue to select each outcome to locate desired data.
Revised December 2011

Home Visit Contact (example)
Track Delivery (example)
Essential Feature: Coordinators
Accreditation Standard 3:
1. Select Reports → View Reports →HUSA POS Totals
2. Enter your date range
Refresh Values to select your site
Please note: If another site name appears under Enter values for Site name, double click the unwanted site to remove it from
the list
3. Run Query.
Revised December 2011
Enter value for
Program name:
defaulted to Home
Visitors

Essential Feature: Home Visitors
Accreditation Standard 1: Home Visitor’s Background Forms
This report can be retrieved only from the Home Visitors program.
1. Select Update Participant Information.
2. Enter the home visitor last name or Search.
3. Select participant.
4. Return to the home page and select Update Participant Information and continue to review other
home visitor information.
Essential Feature: Administration
Accreditation Standard 2: ETO Referral Report
1. From the Home Page of the Home
Visitors or Parents program, select
Update Referral.
2. Select Show all Participants
across Site, Search.
3. Select Show All Details to view a list
of all referrals made.
4. For additional referral details, select
Show All Details.
Revised December 2011

Essential Feature: Administration
Accreditation Standard 3, 5: ETO HUSA Home Visitor Caseload Report
This report can be retrieved from any program in ETO.
1. Select Reports → View Reports → HUSA Home Visitor Caseload Count
2. Refresh Values.
3. Only the site in which the coordinator is logged into will appear.
4. Double click the site name (it will move over to Enter Values for Site Name) and Run Query.
Please note: If another site name appears under Enter values for Site name, double click the unwanted site to remove it from
the list
Only your site name will
appear.
Essential Feature: Administration
Accreditation Standard 11: Advisory Council Roster
This report can be retrieved from any program in ETO.
1. Select Reports → Entity Reports → Custom Entity Attributes: In my Site (Crystal)
Revised December 2011

Essential Feature: Administration (continued)
2. Once the reports generates, select Community Advisory Group and the roster will appear.
Names marked True are advisory members
Please note: If the site has not entered their advisory members in ETO during the 2011-12 program year, you may review hard
copies.
Revised December 2011

Coordinator and Home Visitor ETO Responsibilities
Coordinator
1) Enters his/her background information
2) Enters home visitor background information
3) Instructs home visitors to enter family information
Revised December 2011
This page outlines the “step-by-step” process involved in the
coordinator and home visitor ETO data entry. Following these
steps ensures smooth navigation throughout the ETO software
as information is entered into the system.
Home Visitor
1) Enters each family individually
2) Enters parent
3) Change program to “Children” to enter child
4) Switch back to the “Parent” program to work on next family file
5) Continue until all families are entered
6) Notify coordinator that all families are entered
Coordinator
1) Enters the “Parent” program
a. Select “Search”
b. Select a parent
c. Enter into the parent dashboard
2) Edit dashboard
a. Add ETO Parts Catalog
b. Select Caseworkers and Staff Caseload
c. Select Add and Close
d. Select Done Editing (located on upper right hand side)
3) Select Staff Caseload
a. Select Add (dropdown box, select the home visitor that will be assigned to parents)
b. Select all parents assigned to this home visitor
c. Save
d. Repeat to assign the children to the appropriate home visitor
e. Notify staff when all parents and children are assigned
Home Visitor
1) Now links child to parent
2) Enters points of services for their families
Coordinator
1) Continuously monitors ETO data input

Notes
Revised December 2011

ETO Software Frequently Asked Questions
Use the green navigation bar on the right to:
• Enroll participants in a different program (Participants)
• Merge duplicated participants (Participants)
• Edit efforts (My Work)
• Review/Edit efforts entered by staff (Program Administration)
Use your Home Page to:
• Enter Advisory Members
• Refer Home Visitors and Parents to:
o Outside Service Providers
o Educational Institutions
o ETO Programs (Coordinators, Parents or Home Visitors)
o Employers
How Do I……
March 2012
Enroll Participants in another Program
• Select the Program in which you wish to enroll the participant in
• Participants, Enroll Participants, enter their name, select the individual, and enter their
program start date
• Go back to the Home Page, select Update Participant Information, select the newly
enrolled participant. The Parent program calls for more information than the Home
Visitor program. You will need to add any missing demographic information for that
participant
o If the person you enrolled was originally in the Home Visitors or Coordinators
program, and you enroll them in the Parent program, in order for them to appear
as a Family when you select Link Family Members, you must select Add New
Family.
o Enter the primary parent first and last name followed by Family (Angela Fake
Family)
o Select Add New Family
o Select the blue link to Search for Others
o Select all participants that belong in that family (this includes all adults and
children)
1

Notes:
How Do I……
March 2012
2

How Do I……
March 2012
Merge Duplicated Participants
If you have enrolled a participant in a program more than once, you have the ability to merge
those duplicated entries.
• Participants, Duplicated Participants—all duplicated entries will appear
• You may only merge two records at a time (same name)
• Check the two duplicated entries you would like to merge (the name could show several
times, depending on the number of times they were entered in ETO) and select Merge
Selected Records
• Select the most recent entry to become the Master record to merge
• Continue
• The next screen will show a Warning Page. Select Yes. Continue until all duplicates
merge
Notes:
3

How Do I……
March 2012
Edit my Efforts
You have the ability to edit any efforts (home visits, group meetings, special events, trainings,
etc.) that you enter or your staff enters.
To edit efforts you entered when using your assigned ETO login you will
• Select My Work, Edit my Efforts
• Select Search by Participants (enter the last name or leave blank), Submit
**Depending on the program (parents or home visitors), the list of participants will
appear or the individual with the last name you entered will appear.
• Select your participant
• If any efforts were entered by you for the selected participant, those efforts will appear
• You will see red and blue links for you to edit or delete efforts
Group meeting efforts:
When reviewing group meeting efforts you will see the date of the group meeting, the
location, attendance (value will show yes or no), time spent and any notes.
If you need to make changes to the group meeting that took place on a particular date (i.e.,
February 8), you would select Edit Group Effort. On the next screen, you are able to modify
as needed and update the effort at the bottom of the screen.
4

Home visit efforts:
How Do I……
March 2012
When reviewing home visit efforts, you will see all the effort qualifier questions you
answered and any notes you may have entered. If you entered the incorrect week (for
delivery) or the wrong date in which the home visit took place, select Edit Composite Effort.
Make all necessary changes and update effort at the bottom of the screen.
5

How Do I……
March 2012
If you selected the wrong composite (if the family is age 3 Spanish and you selected age 4),
you will need to Delete Composite Effort. This would require you to enter the appropriate
composite for the family.
Coordinator or designated ETO staff personnel: if you are reviewing or needing to edit
efforts entered by your staff (home visitors), you would use Program Administration, Edit
Staff Efforts. You would follow the steps above. The screens all look the same.
Notes:
6

How Do I……
March 2012
Enter Advisory Members (Home Page)
From the Coordinator program, select Add Entity
• Entity Name-Member first and last name
• Entity type-Administrative
• Check the box for Individual
• Enter member contact information
• Check the box at the very bottom-Community Advisory Member (if you do not check
the box, the member will not appear on your Advisory Roster—please refer to your
ETO Document Location Guide, page 5, on how to retrieve the Advisory Roster)
• Add Entity to the System
Notes:
7

How Do I……
March 2012
Refer Staff and Families (Home Page)
Parents and Home Visitors can be referred out. If you are referring a family, you must refer
from the Parent program. If you are referring your staff, it must be done in the Home Visitors
program.
Refer a Family:
• Add Referral
• Select the family to be referred
• Select the referral type and Submit
• Enter as much information as possible and select Submit at the bottom of the screen
Refer a Home Visitor:
• Add Referral
• Select the family to be referred
• Select the referral type and Submit
• Enter as much information as possible and select Submit at the bottom of the screen
**To review your referrals please refer to your ETO Document Location Guide, page 4, on how
to retrieve the ETO Referral Report
Notes:
8

Coordinator Background
Revised January 2011
Coordinator Background
*Last Name *First Name
*Address 1
Address 2
City State *Zip
Home Phone
Alternate Phone
(cell, emergency)
*DOB
*Email *Gender Female Male
*Site ID Number *Site Name Year Initiated
*Position Coordinator Assistant Coordinator
Coordinator
Educational
Level
Child
Development
Associate Credential
Associates Degree
(Assistant Coordinator
only)
Full Time (w/HIPPY
ONLY)
Bachelors
Degree
Part Time
Masters Degree Doctorate
Other degree/certification (please specify) ___________________________________________________________
Currently pursuing a degree? Yes No (If yes, please specify) ____________________________________________________
Professional specialization (check all that apply)
Child Development Secondary Education Higher and Adult Education Psychology
Early Childhood Education Special Education English as a Second Language Sociology
Elementary Education Family & Community Education Social Work Other(specify)________
Is Coordinator fluent in more than one language? Yes No If yes, please list _______________________________________
Month
Number of coordinator
supervised home visits
Month
January July
February August
March September
April October
May November
June December
Number of coordinator
supervised home visits
Please duplicate this information and complete for each additional site coordinator.

Family Exit Form
Adult First Name Adult Last Name
Child First Name Child Last Name
Current address information
Address
City, State, Zip
Previous address information
Address
City, State, Zip
Enrollment Date HIPPY 3 (H3) HIPPY 4 (H4) HIPPY 5 (H5)
Dismissal Date (month/year in which family quit program)
Week of dismissal (week in which family quit program)
1 2 3 4 5 6
7 8 9 10 11 12
13 14 15 16 17 18
19 20 21 22 23 24
25 26 27 28 29 30
Was family behind when dismissed? Yes No
If so, how many weeks?
1 2 3 4 5 6
7 8 9 10 11 12
13 14 15 16 17 18
19 20 21 22 23 24
25 26 27 28 29 30
Reason for dismissal
A family member said “no” Crisis in family Moved out of HIPPY area
No parental interest Unable to schedule time Never started program
Work School Other ___________________________
Retention strategies (strategies used to keep family)
Switched home visitor Rearranged HIPPY schedule Reduced program core elements
Increased visit frequency Provided peer reference Temporary leave
Other (please specify) _______________________________________________________________________________________
1
HIPPY Family Exit Form
Revised January 2011

Home Visitor Comments
Coordinator Comments
2
HIPPY Family Exit Form
Revised January 2011

Funding Information Form
Site ID Number Site Name State
Project funding source(s) for current program year.
Please check the appropriate boxes and fill in the exact amount received by each source.
Section B. Federal Sources
US Department of
Education
Title I
$________________
Migrant Workers
$________________
Even Start
$________________
Bilingual Education
$________________
PIRC
$________________
Other (please specify)
$ ________________
Column Total
$ ________________
Section C. State Sources
Dept of Education
$________________
Section D. Private Source(s)
Foundations
$________________
Faith-based/Churches
$________________
US Department of
Housing and Urban
Development
HOPE VI
$________________
Other (please specify)
$_________________
Other (please specify)
$_________________
Other (please specify)
$_________________
Other (please specify)
$_________________
Other (please specify)
$_________________
Column Total
$ ________________
Legislative Action
$__________________
United Way
$________________
Other (please specify)
$________________
Funding Totals
Direct Funding (Totals of section B, C, & D)
$_____________________
Funding Information Report – Revised January 2012
In-kind
US Department of
Health and Human
Services
Head Start
$________________
Early Head Start
$________________
Early Learning
Opportunities Act (ELOA)
$________________
Other (please specify)
$ ________________
Other (please specify)
$_________________
Other (please specify)
$_________________
Column Total
$ ________________
State University
$________________
Volunteers
$________________
Other (please specify)
$________________
$___________________________
Other Federal
Sources
AmeriCorps
$________________
Other (please specify)
$ ________________
Other (please specify)
$_________________
Other (please specify)
$_________________
Other (please specify)
$_________________
Other (please specify)
$_________________
Column Total
$ ________________
Other (please specify)
$ ________________
Corporate (please specify)
$________________
Other (please specify)
$________________
Total budget
Do you have staff
capacity to write
grants?
Yes No
If yes, please list name
and title below.
Name:
Title:
Federal Sources Total
$ ________________
State Sources Total
$ ________________
Individual donors
$________________
Private Sources Total
$ ________________
$___________________________

Group Meeting Summary Form
HIPPY USA Site ID Coordinator(s)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Date of
Meeting
Topic
Total number of
children
Total number of
adults
Total number of
HIPPY families
represented
Total number of
families currently
enrolled in
program
Total number of
AmeriCorps
families
represented
Total number of
AmeriCorps
families currently
enrolled in
program

HIPPY Application, Page 1
Revised January 2011
HIPPY Application
PRIMARY HIPPY ADULT OR CAREGIVER
*Last Name *First Name
*Address 1
Address 2
City State *Zip
Home Phone
Alternate Phone
(cell, emergency)
*DOB
(mm/dd/yyyy)
Email
*Gender Female
Male
*Marital
Status
*Relationship to HIPPY Child Mother Father Grandmother
Other (specify)
Stepmother Stepfather Grandfather
__________________________ Foster Mother Foster Father Aunt/Uncle
*Number of children enrolled in HIPPY this
program year _____________________
*Enrollment
Status
Married Single Divorced Separated Widowed
Applied Enrolled Declined Not Eligible
*Curriculum age parent is working with the child HIPPY 3 (H3) HIPPY 4 (H4) HIPPY 5 (H5)
How did you hear about HIPPY? ______________________________________________________________________
Country of origin USA Other (please specify) _____________________ Number of years in USA _______
LANGUAGE INFORMATION
Primary Language English Spanish Other (specify) _______________________________
Secondary Language English Spanish Other (specify) _______________________________
Oral English
comprehension
Advanced
Low
*HIPPY
Curriculum
Language
English Spanish Both Other (specify) _________________
EMPLOYMENT INFORMATION
Employed Yes No Employer ____________________________________________________
Occupation Student Work, part-time Work, full-time Self-employed Homemaker Unemployed

HIPPY Application, Page 2
Revised January 2011
EDUCATION INFORMATION
High School Graduate Yes No College Graduate Yes No
If not high school graduate, enter last grade completed ______________ GED Yes No
Currently enrolled in high school
Yes No
Currently enrolled in college
Yes No
RACE AND ETHNICITY
Highest level of education completed
_________________________________________
If enrolled in college, specify course of study
__________________________________________
*Hispanic origin No, not Spanish/Hispanic/Latino Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican Yes, Cuban Yes, other Spanish/Hispanic/Latino (specify) __________________________
*Race Chinese Native Hawaiian
White Filipino Guamanian or Chamorro
Black or African American Japanese Samoan
American Indian and Alaska Natives Korean Other Pacific Islander (please specify)
(specify principal tribe) Vietnamese ________________________________
______________________________ Other Asian (please specify) Other _________________________
Asian Indian ________________________ Unknown
*Migrant Family?
Yes No
*Immigrant Family?
Yes No
HOUSEHOLD DEMOGRAPHICS
Total Number
of Adults
__________
Total Number
of Children
___________
Parent lives with Extended family Alone with child(ren)
Area
Type
Total Number
in household
_____________
Father/mother of HIPPY child Another partner Other (please specify)__________________________
Metropolitan
(a) cities with 50,000 or more people
(b) counties with 50,000 or more, related to central city
with 100,000 or more
Household Income
$ _______________
Sources of Income (check all that apply)
Urban
(a) 2,500 or more people
(b) densely populated area surrounding
central city of 50,000 or more
Rural
Less than 2,500 people
Wages/ Salary Unemployment Child Support/Alimony Parent not comfortable
TANF Social Security
Other (specify)
__________________
answering this question
Housing Own Rent Subsidized housing
Monday
Tuesday
Wednesday
Thursday
Friday
Parent not comfortable
answering this question
GROUP MEETING PREFERENCE
Saturday
Morning
Afternoon
Child care
needed
Number of children
needing childcare ____
Other (please specify)
____________________
Age(s):

ADULT SERVICES RECORD FOR PRIMARY ADULT
Please indicate all services received by placing a check in box.
Adult Basic Education Medicaid Individual Counseling
GED Preparation Regular Health Care Family Counseling
English as Second Language Special care/ Disability Substance Abuse Treatment
Technical/Vocational Education Financial Assistance Employment Training
Other Literacy Program
(specify)_________________________
Healthy Families America (HFA)
Nurse Family Partnership (NFP)
FAMILY STATUS UPDATE
Did the family transfer IN from another HIPPY site? Yes No
Did the family transfer OUT to another HIPPY site? Yes No
Year
HIPPY 3 (H3) HIPPY 4 (H4) HIPPY 5 (H5) Social Security Number
HIPPY Application, Page 3
Revised January 2011
Other (specify)
________________________________
Family Dropped HIPPY? Yes No Drop-Out Date ____________________________________
If family dropped, check the reason why they left.
Moved Dissatisfied with HIPPY Dissatisfied with Home Visitor Life Situation
Other (specify)__________________________________________________________________________________
Notes:
CHILD SERVICES RECORD
*TANF Eligible: Yes No N/A *This child participates in a longitudinal study: Yes No
State Office Approved TANF: Yes No State Office Administrator:
Primary HIPPY Adult *Last Name *First Name
HIPPY Child *Last Name *First Name
*Address 1
Address 2
City State *Zip
Home Phone
*HIPPY
*DOB
(mm/dd/yyyy)
*Gender Female
Male

HIPPY Application, Page 4
Revised January 2011
CHILD SERVICES RECORD (continued)
*Hispanic origin No, not Spanish/Hispanic/Latino Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican Yes, Cuban Yes, other Spanish/Hispanic/Latino (specify) __________________________
*Race Chinese Native Hawaiian
White Filipino Guamanian or Chamorro
Black or African American Japanese Samoan
American Indian and Alaska Natives Korean Other Pacific Islander (please specify)
(specify principal tribe) Vietnamese ________________________________
______________________________ Other Asian (please specify) Other _________________________
Asian Indian ________________________ Unknown
*Primary Language English Spanish Other (specify) _____________________________
Secondary Language English Spanish Other (specify) _____________________________
Please indicate all services received by placing a check in box to the left.
Center-based care WIC Vision Therapy
In-home child care Food Stamps Occupational Therapy
Head Start Free/reduced lunch Assistance for child’s emotional or behavior problems
Prekindergarten Homeless shelter Regular health care
Even Start Speech Therapy Medicaid
Parents as
Teachers
Hearing Therapy
EPSDT
Kindergarten Physical Therapy Immunizations
School Name/School ID/Teacher Name
Please indicate if the HIPPY child has a diagnosed disability or a suspected undiagnosed disability.
Does your child have a diagnosed disability? Yes No Unknown
If yes, specify: _____________________________________________________________________________________
Does your child have a suspected disability? Yes No Unknown
If yes, specify: _____________________________________________________________________________________
Please indicate if the child participated in pre- or post-testing.
Was pre-test/assessment administered? Test Name
Yes No Test Score
Was post-test/assessment administered? Test Name
Yes No Test Score
CHILD STATUS UPDATE
Is child temporarily inactive? Yes No Inactive start date _______________ Inactive stop date _______________
Child dropped HIPPY? Yes No Drop out date __________________________________________________
If child dropped, check the reason why they left:
Moved Dissatisfied with HIPPY Dissatisfied with Home Visitor Life Situation
Other (specify) _____________________________________________________________________________________

Home Visit Progress
Family ID Child Last Name Child First Name
Revised November 2010
Primary HIPPY Adult Last Name First Name
AmeriCorps Family? Yes No
Home Visitor Code
_______________
Home Visitor Last Name HV Initial
HIPPY 3 (H3) HIPPY 4 (H4) HIPPY 5 (H5)
Packet
number
delivered
Date
Number of
days worked
Average
number of
minutes/day
Comments
1

Home Visit Scheduling
Family ID Child Last Name Child First Name
Revised November 2010
Primary HIPPY Adult Last Name First Name
AmeriCorps Family? Yes No
Home Visitor Code
_______________
Home Visitor Last Name HV Initial
HIPPY 3 (H3) HIPPY 4 (H4) HIPPY 5 (H5)
Directions: Indicate the number of times each reason was a factor in not completing a Home Visit. If a home visit was made, write
in the date and the number of the Activity Packet which was delivered during that home visit.
Packet
Number
Adult not
home
Adult
canceled
Home
Visitor
canceled
Total
attempts
Packet received
during Home Visit?
Packet received at
Group Meeting?
Date
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
1

Home Visit Scheduling
Did you have any problems scheduling a home visit? If yes, please describe.
Revised November 2010
2

Home Visitor Background – Revised February 2011
Home Visitor Background
*Last Name *First Name
*Address 1
Address 2
City State *Zip
Home Phone
Alternate Phone
(cell, emergency)
*DOB
*Email *Gender Female Male
*Site ID Number *Site Name
HIPPY employment
information
Is the Home Visitor a current
HIPPY Parent? Yes No
Training
(Please check all that apply.)
Enter number of years of
prior experience
Salary $__________________
(FL programs only)
Social Security Number
(FL, MD, & WI programs only)
Full Time (w/HIPPY ONLY) Part Time AmeriCorps Non AmeriCorps
Is the Home Visitor a former
HIPPY Parent? Yes No
CDA
credentialed
Classroom
Teacher/Aide
__________
Completed other
ECE/CD training
Community
Organization
__________
Primary language? English Spanish Other? ___________________
Secondary language? English Spanish Other? ________________
Currently enrolled in
CDA training
Parent
Training
________
Currently enrolled in
other ECE/CD training
Other
(please specify)
______________________
If the Home Visitor is employed in work other than HIPPY, please share the number of non-HIPPY hours worked per week _______ .
Education Level (Check all that apply) Child Development Associate credential Doctorate
Less than a high school diploma or GED Associates Degree Other Degree _____________________
High school graduate Bachelors Degree Currently pursuing degree/certification
GED Masters Degree (please specify) ______________________
Professional specialization (Check all that apply)
Child Development Secondary Education Higher and Adult Education Psychology
Early Childhood Education Special Education English as a Second Language Sociology
Elementary Education Family & Community Education Social Work Other(specify)________
Total number of Home Visit Observations conducted by Coordinator this program year _______________.
If the Home Visitor left the program, please check reason(s).
Moved Other job Poor performance Low pay Other (specify) _______________________________________
Employment dates
(Program enrollment)
*Start date
(mm/dd/yyyy)
End date
(mm/dd/yyyy)

Parent Questionnaire – Baseline
1) What are some of your favorite ways to spend time with your child? (Check all that apply.)
talking reading drawing pictures sitting quietly watching educational videos
playing playing games playing educational games watching TV Telling stories about family or culture
taking walks going to the library shopping sports other ___________________________
2) Of those activities, on which three do you spend the most time with your child?
talking reading drawing pictures sitting quietly watching educational videos
playing playing games playing educational games watching TV Telling stories about family or culture
taking walks going to the library shopping sports other ___________________________
3) How much time do you have available to spend “one-on-one” time with your child each week?
1 to 2 hours 3 to 5 hours 5 to 8 hours 8 to 10 hours 10 hours or more
4) Is there a special “homework” place for your child to complete activities? Yes No
5) Do you have resources (strategies, activities, ideas, materials) to work with your child? Yes No
6) Please describe them (strategies, activities, ideas, materials) and how you developed or received them?
7) Have you visited your child’s pre-school/daycare this year? Yes No N/A
8) If yes, please check the reason for your visit:
parent/teacher conference child drop off/pick up help in the classroom help with field trips library volunteer
special events other ____________________________________________________________________________
9) Approximately how many times in the last year did you attend a parent/teacher conference?
1 time 2 to 3 times 3 or more times N/A
10) Approximately how many times last year did you help in the classroom?
1 time 2 to 3 times 3 or more times N/A
11) Approximately how many times last year did you help with field trips?
1 time 2 to 3 times 3 or more times N/A
12) Approximately how many times last year did you volunteer at the library?
1 time 2 to 3 times 3 or more times N/A
13) Approximately how many times last year did you attend a special event?
1 time 2 to 3 times 3 or more times N/A
1
HIPPY Parent Questionnaire – Baseline
Revised November 2010

14) Approximately how many times last year did you attend other events?
1 time 2 to 3 times 3 or more times N/A
Describe “other” events:
15) Did the pre-school/daycare
make you feel comfortable?
Can you explain why you felt this way? Did something special happen?
16) Do you help out/volunteer in your community? Yes No
No Somewhat uncomfortable Not sure Somewhat comfortable Very comfortable
17) If so, where and in what type of activity do you participate?
religious institution cultural practices school library community center HIPPY other
Specify where/what activities you are thinking of helping out/volunteering?
18) Do you participate in other community activities/groups? Yes No
Please list them and tell us how you found out about them:
Community Activity/Group How you found out about them
19) During the past year, have you participated in any course or workshop in any of the following areas? (This includes
college/university programs.)
Food safety Language Computer
CPR Professional skills Child development
Parenting Employment Other
If so, please specify where:
Course/Workshop Location
2
HIPPY Parent Questionnaire – Baseline
Revised November 2010

Parent Questionnaire – Follow Up
1) What are some of your favorite ways to spend time with your child? (Check all that apply.)
talking reading drawing pictures sitting quietly watching educational videos
playing playing games playing educational games watching TV Telling stories about family or culture
taking walks going to the library shopping sports other ___________________________
2) Of those activities, on which three do you spend the most time with your child?
talking reading drawing pictures sitting quietly watching educational videos
playing playing games playing educational games watching TV Telling stories about family or culture
taking walks going to the library shopping sports other ___________________________
3) How much time do you have available to spend “one-on-one” time with your child each week?
1 to 2 hours 3 to 5 hours 5 to 8 hours 8 to 10 hours 10 hours or more
4) Is there a special “homework” place for your child to complete activities? Yes No
5) Do you have resources (strategies, activities, ideas, materials) to work with your child? Yes No
6) Please describe them (strategies, activities, ideas, materials) and how you developed or received them?
7) Have you visited your child’s pre-school/daycare this year? Yes No N/A
8) If yes, please check the reason for your visit:
parent/teacher conference child drop off/pick up help in the classroom help with field trips library volunteer
special events other ____________________________________________________________________________
9) Approximately how many times in the last year did you attend a parent/teacher conference?
1 time 2 to 3 times 3 or more times N/A
10) Approximately how many times last year did you help in the classroom?
1 time 2 to 3 times 3 or more times N/A
11) Approximately how many times last year did you help with field trips?
1 time 2 to 3 times 3 or more times N/A
12) Approximately how many times last year did you volunteer at the library?
1 time 2 to 3 times 3 or more times N/A
13) Approximately how many times last year did you attend a special event?
1 time 2 to 3 times 3 or more times N/A
1
HIPPY Parent Questionnaire – Follow Up
Revised November 2010

14) Approximately how many times last year did you attend other events?
1 time 2 to 3 times 3 or more times N/A
Describe “other” events:
15) Did the pre-school/daycare
make you feel comfortable?
Can you explain why you felt this way? Did something special happen?
16) Do you help out/volunteer in your community? Yes No
No Somewhat uncomfortable Not sure Somewhat comfortable Very comfortable
17) If so, where and in what type of activity do you participate?
religious institution cultural practices school library community center HIPPY other
Specify where/what activities you are thinking of helping out/volunteering?
18) Do you participate in other community activities/groups? Yes No
Please list them and tell us how you found out about them:
Community Activity/Group How you found out about them
19) During the past year, have you participated in any course or workshop in any of the following areas? (This includes
college/university programs.)
Food safety Language Computer
CPR Professional skills Child development
Parenting Employment Other
If so, please specify where:
Course/Workshop Location
2
HIPPY Parent Questionnaire – Follow Up
Revised November 2010

Formación del coordinador
Revisado en enero de 2011
Formación del coordinador
*Apellido *Nombre
*Dirección 1
Dirección 2
Ciudad Estado Código postal
Número de teléfono
Teléfono alternativo
(celular, urgencias)
Fecha de nacimiento
*Correo electrónico *Sexo Femenino Masculino
*Número de ID del sitio *Nombre del sitio Año de inicio
*Puesto Coordinador Subcoordinador
Nivel
educativo del
coordinador
Credencial
colegiada en
Desarrollo infantil
Licenciado adjunto
(Subcoordinador únicamente)
Tiempo completo (con HIPPY
SOLAMENTE)
Tiempo parcial
Licenciatura Maestría Doctorado
Otro grado/certificación (Especificar) ___________________________________________________________________________
¿Estudia para graduarse? Sí No (Respuesta afirmativa: especificar) _____________________________________________________________
Especialización profesional (Marcar todo lo que corresponda)
Desarrollo infantil Educación secundaria Educación superior y de adultos Sicología
Educación infantil temprana Educación especial Inglés como segundo idioma Sociología
Educación elemental
Educación de la familia y la
comunidad
Asistencia social
Otra (Especificar)
_______________
¿Habla más de un idioma con fluidez? Sí No (Respuesta afirmativa, dar lista:) ____________________________________________________
Mes
Número de visitas de hogar
supervisadas del coordinador
Mes
Enero Julio
Febrero Agosto
Marzo Septiembre
Abril Octubre
Mayo Noviembre
Junio Diciembre
Número de visitas de hogar
supervisadas del coordinador
Duplique esta información y complétela por cada coordinador adicional de un sitio.

Formulario de salida de la familia
Nombre del adulto Apellido del adulto
Nombre del niño(a) Apellido del niño(a)
Dirección actual
Dirección
Ciudad, Estado, Código postal
Dirección anterior
Dirección
Ciudad, Estado, Código postal
Fecha de inscripción HIPPY 3 (H3) HIPPY 4 (H4) HIPPY 5 (H5)
Fecha del despido (mes/año en que la familia dejó el programa)
Fecha del despido (semana en que la familia dejó el programa)
1 2 3 4 5 6
7 8 9 10 11 12
13 14 15 16 17 18
19 20 21 22 23 24
25 26 27 28 29 30
¿Estaba la familia atrasada cuando se la despidió? Sí No
De ser así, ¿en cuántas semanas?
1 2 3 4 5 6
7 8 9 10 11 12
13 14 15 16 17 18
19 20 21 22 23 24
25 26 27 28 29 30
Razón del despido
Un miembro de la familia dijo que “no” Crisis en la familia Se trasladó fuera del área de HIPPY
No hubo interés de los padres No pudo programar el tiempo Nunca empezó el programa
Trabajo Escuela Otra ________________________________
Estrategias de retención (estrategias para retener la familia)
Cambió de visitante de hogar Reorganizó el programa de HIPPY Redujo los elementos básicos del programa
Aumentó la frecuencia de las visitas Proporcionó referencia paritaria Permiso temporal
Otra (Especificar) ______________________________________________________________________________________________________
1
HIPPY Formulario de salida de la familia
Revisado en enero de 2011

Comentarios del visitante de hogar
Comentarios del coordinador
2
HIPPY Formulario de salida de la familia
Revisado en enero de 2011

Formulario de información financiera
Número de ID del sitio Nombre del sitio Estado
Sección B. Fuentes federales
Departamento de
Educación de los EE.
UU.
Título I
$________________
Trabajadores
migratorios
$________________
Even Start
$________________
Educación bilingüe
$________________
PIRC
$________________
Otra (Especificar) $
________________
Total de la columna
$ ________________
Sección C. Fuentes estatales
Depto. de Educación
$________________
Sección D. Fuentes privadas
Fundaciones
$________________
Basado en la fe/Iglesias
$________________
Fuentes de financiación del proyecto para el programa del año en curso.
Marque las casillas correspondientes e indique la cantidad exacta recibida por cada fuente.
Departamento de Vivienda
y Desarrollo Urbano de los
EE. UU.
HOPE VI
$________________
Otra (Especificar)
$_________________
Otra (Especificar)
$_________________
Otra (Especificar)
$_________________
Otra (Especificar)
$_________________
Otra (Especificar)
$_________________
Total de la columna
$ ________________
Acción legislativa
$__________________
United Way
$________________
Otra (Especificar)
$________________
Totales de financiación
Financiación directa (Totales de las secciones B,
C y D)
$_____________________
Información financiera – Revisada en enero de 2011
En especie
Departamento de Salud y
Servicios Humanos de los
EE. UU.
Head Start
$________________
Early Head Start
$________________
Ley de Oportunidades de
aprendizaje temprano
(ELOA)
$________________
Otra (Especificar)
$ ________________
Otra (Especificar)
$_________________
Otra (Especificar)
$_________________
Total de la columna
$ ________________
Universidad estatal
$________________
Voluntarios
$________________
Otra (Especificar)
$________________
$___________________________
Otras fuentes federales
AmeriCorps
$________________
Otra (Especificar)
$ ________________
Otra (Especificar)
$_________________
Otra (Especificar)
$_________________
Otra (Especificar)
$_________________
Otra (Especificar)
$_________________
Total de la columna
$ ________________
Otra (Especificar)
$ ________________
Corporativa (Especificar)
$________________
Otra (Especificar)
$________________
Presupuesto total
Total de fuentes
federales
$ ________________
Total de fuentes
estatales
$ ________________
Donantes individuales
$________________
Total de fuentes privadas
$ ________________
$___________________________

Formulario de resumen del encuentro del grupo
HIPPY USA ID del sitio Coordinador(es)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Fecha del
encuentro
Tema Total de niños Total de adultos
Total de familias de
HIPPY
representadas
Total de familias
inscritas
actualmente en el
programa
Total de familias de
AmeriCorps
representadas
Total de familias de
AmeriCorps
inscritas
actualmente en el
programa

Solicitud de HIPPY, Página 1
Revisada en enero de 2011
Solicitud de HIPPY
ADULTO PRIMARIO O CUIDADOR DE HIPPY
*Apellido *Nombre
*Dirección 1
Dirección 2
Ciudad Estado *Código postal
Teléfono
Teléfono alternatvo
(celular, urgencias)
Sexo Femenino
Masculino
*Fecha de nacimiento
(dd/mm/aaaa)
Correo electrónico
*Estado
civil Casado Soltero Divorciado Separado Viudo
*Relación con el niño de HIPPY Madre Padre Abuela
Otra (Especificar)
Madrastra Padrastro Abuelo
__________________________ Madre de crianza Padre de crianza Tía/Tío
*Número de niños inscritos en HIPPY este año del
programa ________________________________
*Estado de la
inscripción
*Edad del currículo para el que los padres se preparan con el
niño
Solicitó Inscrito Rehusado No elegible
HIPPY 3 (H3) HIPPY 4 (H4) HIPPY 5 (H5)
¿Cómo se enteró de HIPPY? ___________________________________________________________________________________
País de origen EE. UU. Otro (Especificar) _______________________________ Años en los EE. UU. ____________
INFORMACIÓN SOBRE IDIOMAS
Primer idioma Inglés Español Otro (Especificar) ___________________________________
Segundo idioma Inglés Español Otro (Especificar) ___________________________________
Comprensión del
inglés hablado
Avanzada
Baja
*Idioma del
currículo de
HIPPY
Inglés Español Ambos Otro (Especificar) __________________
INFORMACIÓN SOBRE EMPLEO
Empleado Sí No Empleador _________________________________________________________
Ocupación Estudiante
Trabaja tiempo
parcial
Trabaja tiempo
completo
Trabaja por
cuenta propia
Hogar Desempleado

Solicitud de HIPPY, Página 2
Revisada en enero de 2011
INFORMACIÓN SOBRE EDUCACIÓN
Grado de secundaria Sí No Grado universitario Sí No
Si no tiene grado de secundaria, indique el último año completado
______________
Inscrito actualmente en secundaria
Sí No
Inscrito actualmente en la
universidad
Sí No
RAZA Y ETNICIDAD
Nivel más alto de educación alcanzado
_________________________________________
GED Sí No
Si está inscrito en la universidad, especifique el curso
_______________________________________________
*Origen hispano No, no es español/hispano/latino Sí, mexicano, mexicoamericano, chicano
Sí, puertorriqueño Sí, cubano Sí, otro español/hispano/latino (Especificar) _________________________________
*Raza Chino Nativo de Hawai
Blanco Filipino Guamaní o chamorro
Negro o afroamericano Japonés Samoano
Indio americano y nativos de Alaska Coreano Otro isleño del Pacífico (Especificar)
(Especificar la tribu principal) Vietnamita ___________________________________
_________________________________________ Otra región asiática (Especificar) Otra _____________________________
Indio asiático ____________________________ Desconocida
*¿Familia migratoria?
Sí No
*¿Familia inmigrante?
Sí No
DEMOGRAFÍA DE LA FAMILIA
Número de adultos
__________
El padre / La madre vive con Familia extendida Solo(a) con el niño(s)
Número de niños
___________
Total en la vivienda
_____________
Padre/madre del niño de HIPPY Otro(a) compañero(a) Otro (Especificar) ___________________________________
Área
Metropolitana
(a) ciudades de 50.000 personas o más
(b) condados de 50.000 o más, en relación con la ciudad
central de 100.000 o más
Ingreso del hogar
$ _______________
Fuentes de ingreso (Marcar todas las que correspondan)
Paga/ Salario Desempleo
TANF Seguro Social
Vivienda Propia Alquilada Subvencionada
Lunes
Martes
Miércoles
Jueves
Urbana
(a) 2.500 personas o más
(b) área densamente poblada que rodea a
una ciudad central de 50.000 o más
Manutención del
menor/Pensión alimenticia
Otra (Especificar)
__________________
Le incomoda responder
esta pregunta
PREFERENCIA DE ENCUENTROS DEL GRUPO
Viernes
Sábado
Mañana
Tarde
Se necesita
cuidado de
niños
Número de niños que
necesitan cuidado ______
Rural
Menos de 2.500 personas
Le incomoda responder
esta pregunta
Otra (Especificar)
____________________
Edad (es):

Solicitud de HIPPY, Página 3
Revisada en enero de 2011
HISTORIAL DE ATENCIÓN DEL ADULTO PRIMARIO
Marque las casillas correspondientes para indicar toda la atención recibida.
Educación básica del adulto Medicaid Orientación individual
Preparación para el GED Atención regular de la salud Orientación familiar
Inglés como segundo idioma Atención especial/ Discapacidad Tratamiento para el abuso de sustancias
Educación técnica/vocacional Ayuda financiera Capacitación para empleo
Otro programa de alfabetización
(Especificar) _________________________
Healthy Families America (HFA)
Nurse Family Partnership (NFP)
¿Famiia transferida AQUÍ desde otro sitio de HIPPY? Sí No
¿Familia transferida A otro sitio de HIPPY? Sí No
ACTUALIZACIÓN DEL ESTADO DE LA FAMILIA
Otra (Especificar) ___________________
¿Familia que se salió de HIPPY? Sí No Fecha de salida _________________________________________
Si la familia se salió, marque el motivo que tuvo para salirse.
Traslado Insatisfecha con HIPPY Insatisfecha con el visitante de hogar Hechos de la vida
Otro (Especificar)__________________________________________________________________________________
Notas:
*TANF Elegibles: Sí No N/A
HISTORIAL DEL CUIDADO DEL NIÑO
*Esta niña participa en un estudio longitudinal: Sí No
Oficina Estatal Aprobado TANF: Sí No Administrador Estatal de Office:
Adulto primario de
HIPPY
*Apellido *Nombre
HIPPY Child *Apellido *Nombre
*Dirección 1
Dirección 2
Ciudad Estado *Código postal
Teléfono
*Fecha de nacimiento
(dd/mm/aaaa)
*Sexo Femenino
Masculino

*Año de
HIPPY
Solicitud de HIPPY, Página 4
Revisada en enero de 2011
HIPPY 3 (H3) HIPPY 4 (H4) HIPPY 5 (H5) Número de Seguro Social
HISTORIAL DEL CUIDADO DEL NIÑO (Continuación)
*Origen hispano No, no es español/hispano/latino Sí, mexicano, mexicanoamericano, chicano
Sí, puertorriqueño Sí, cubano Sí, otro español/hispano/latino (Especificar) __________________________________
*Raza Chino Nativo de Hawai
Blanco Filipino Guamaní o chamorro
Negro o afroamericano Japonés Samoano
Indio Americano y natives de Alaska Coreano Otro isleño del Pacífico (Especificar)
(Especificar la tribu principal) Vietnamita ___________________________________
_________________________________________ Otra region asiática (Especificar) Otra _____________________________
Indio asiático ____________________________ Desconocida
*Primer idioma Inglés Español Otro (Especificar) _________________________________
Segundo idioma Inglés Español Otro (Especify) ___________________________________
Marque las casillas correspondientes a la izquierda para indicar toda la atención recibida.
Centro de cuidado WIC Terapia visual
Cuidado del niño en
casa
Estampillas de alimentos Terapia ocupacional
Head Start Almuerzo gratis/reducido Ayuda para problemas emocionales o de conducta del niño
Prekindergarten Albergue para indigentes Atención regular de la salud
Even Start Logopedia Medicaid
Parents as Teachers Terapia del oído EPSDT
Kindergarten Fisioterapia Inmunizaciones
Nombre de la escuela/ ID de la escuela/Nombre de la maestra
Indique si al niño de HIPPY se le ha diagnosticado discapacidad o se sospecha de alguna no diagnosticada.
¿Tiene su niño una discapacidad diagnosticada? Sí No Desconocido
Respuesta afirmativa, especificar: ________________________________________________________________________________
¿Se sospecha que su niño tenga una discapacidad? Sí No Desconocido
Respuesta afirmativa, especificar: _______________________________________________________________________________
Indique si el niño participó en pruebas anteriores o posteriores.
¿Se hizo prueba o evaluación previa? Nombre de la prueba
Sí No Puntaje de la prueba
¿Se hizo prueba o evaluación previa? Nombre de la prueba
Sí No Puntaje de la prueba
ACTUALIZACIÓN DEL ESTADO DEL NIÑO
¿Temporalmente inactivo? Sí No Fecha de inicio de la Inactividad _______________ Fecha de terminación de la inactividad
_______________
¿Se fue de HIPPY? Sí No Fecha de ida __________________________________________________
Si el niño se fue, señale el motivo:
Traslado Insatisfecho con HIPPY Insatisfecho con el visitante de hogar Hechos de la vida
Otra (Especificar) _____________________________________________________________________________________________

Progreso de la visita de hogar
ID de la familia Apellido del niño(a) Nombre del niño(a)
Apellido del adulto primario de HIPPY Nombre
¿Familia AmeriCorps? Sí No
Código del visitante de
hogar_______________
Revisado en noviembre de 2010
Apellido del visitante de hogar Inicial del VH
HIPPY 3 (H3) HIPPY 4 (H4) HIPPY 5 (H5)
Número
del
paquete
entregado
Fecha
Número de días
trabajados
Promedio del
número de
minutos/día
Comentarios

Programa de visitas de hogar
ID de la familia Apellido del niño(a) Nombre del niño(a)
Apellido del adulto primario de HIPPY Nombre
¿Familia AmeriCorps? Sí No
Código del visitante de
hogar _______________
Revisado en noviembre de 2010
Apellido del visitante de hogar Inicial del VH
HIPPY 3 (H3) HIPPY 4 (H4) HIPPY 5 (H5)
Instrucciones: Indique el número de veces en las que cada motivo fue un factor para no completar una visita de hogar. Si se hizo una visita de
hogar, anote la fecha y el número del Paquete de actividad entregado durante esa visita.
Número
del
paquete
Adulto no
estaba en
casa
Adulto
canceló
Visitante de
hogar
canceló
Total de
intentos
¿Paquete recibido
durante la visita de
hogar?
¿Paquete recibido en
reunión de grupo?
Fecha
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
Sí No Sí No
1

Programa de visitas de hogar
¿Tuvo algún problema al programar una visita de hogar? Respuesta afirmativa: describir.
Revisado en noviembre de 2010
2

Formación del visitante de hogar
*Apellido *Nombre
*Dirección 1
Dirección 2
Ciudad Estado *Código postal
Número de teléfono
Teléfono alternativo
(celular, urgencias)
Formación del visitante de hogar – Revisado en enero de 2011
*Fecha de nacimiento
*Correo electrónico *Sexo Femenino Masculino
*Número de ID del sitio *Nombre del sitio
Información de empleo de
HIPPY
¿Es el visitante de hogar padre de
HIPPY? Sí No
Capacitación
(Marcar todo lo que corresponda)
Años de experiencia
Sueldo $_________________
(Programas de FL únicamente)
Tiempo completo (con HIPPY
SOLAMENTE)
¿Fue el visitante de hogar padre
de HIPPY? Sí No
Acreditado como
CDA
Maestro(a)
/Asistente
__________
Completó otra
capacitación ECE/CD
Organización
comunitaria
__________
Número de Seguro Social
(Programas de FL, MD y WI únicamente)
Tiempo parcial AmeriCorps No de AmeriCorps
¿Tiene el visitante de hogar fluidez en más de un idioma?
Sí NO (Respuesta afirmativa: dar lista) _______________________
Inscrito actualmente en
capacitación CDA
Capacitación de padres
________
Inscrito actualmente en otra
capacitación ECE/CD
Otra
(Especificar)
________________________
Si el visitante de hogar está empleado en trabajo que no es de HIPPY,
Número de horas que no trabaja para HIPPY:
indique el número de horas semanales que no trabaja para HIPPY.
_____________________________________
Nivel educativo (Marcar todo lo que
corresponda)
Credencial colegiada en Desarrollo infantil Doctorado
Menos que diploma de bachillerato o GED Licenciado adjunto Otro grado __________________________
Grado de bachillerato Licenciatura Actualmente prosigue grado/certificación
GED Maestría (Especificar) ___________________________
Especialización profesional (Marcar todo lo que corresponda)
Desarrollo infantil Educación secundaria Educación superior y de adultos Sicología
Educación infantil temprana Educación especial Inglés como segundo idioma Sociología
Educación elemental Educación de familia y comunidad Asistencia social Otra (Especificar) ________
Total de observaciones de la visita de hogar hecha por el coordinador en este año del programa ____________________.
Si el visitante de hogar dejó el programa, indique el motivo o los motivos.
Traslaso Otro trabajo Mal rendimiento Pago bajo Otro (Especificar) ___________________________________________
Fechas de empleo
(Inscripción en el programa)
*Fecha de inicio
(dd/mm/aaaa)
Fecha de terminación
(dd/mm/aaaa)

Cuestionario de los padres – Referencia
1) ¿Cuáles son algunas de sus formas favoritas de pasar el tiempo con su niño? (Marcar todo lo que corresponda)
Conversar Leer Dibujar Sentarnos en silencio Ver videos educativos
Jugar Juegos Juegos educativos Ver televisión Contar historias de familia o cultura
Caminar Ir a la biblioteca Irnos de compras Deportes Otra _______________________________
2) De estas actividades, indique tres en las que pasa más tiempo con su niño:
Conversar Leer Dibujar Sentarnos en silencio Ver videos educativos
Jugar Juegos Juegos educativos Ver televisión Contar historias de familia o cultura
Caminar Ir a la biblioteca Irnos de compras Deportes Otra _______________________________
3) ¿Cuánto tiempo tiene disponible para pasar “cara a cara” con su niño cada semana?
1 a 2 horas 3 a 5 horas 5 a 8 horas 8 a 10 horas 10 horas o más
4) ¿Hay un lugar especial “de tareas” para que su niño complete las actividades? Sí No
5) ¿Tiene recursos (estrategias, actividades, ideas, materiales) para trabajar con su niño? Sí No
6) Descríbalas (estrategias, actividades, ideas, materiales) y diga cómo las desarrolló o las recibió:
7) ¿Ha visitado el preescolar/la guardería de su niño este año? Sí No N/A
8) Respuesta afirmativa, indique el motivo de su visita:
Conferencia de padres y
Llevar o recoger al niño Ayuda en el salón de Ayuda en excursiones Voluntario en la biblioteca
profesores
clases
Eventos especiales Otro ________________________________________________________________________________________________
9) El año pasado, ¿aproximadamente cuántas veces asistió a conferencias de padres y profesores?
1 vez 2 a 3 veces 3 o más veces N/A
10) El año pasado, ¿aproximadamente cuántas veces ayudó en el salón de clases?
1 vez 2 a 3 veces 3 o más veces N/A
11) El año pasado, ¿aproximadamente cuántas veces ayudó en excursiones?
1 vez 2 a 3 veces 3 o más veces N/A
12) El año pasado, ¿aproximadamente cuántas veces fue voluntario en la biblioteca?
1 vez 2 a 3 veces 3 o más veces N/A
13) El año pasado, ¿aproximadamente cuántas veces asistió a un evento especial?
1 vez 2 a 3 veces 3 o más veces N/A
14) El año pasado, ¿aproximadamente cuántas veces asistió a otros eventos?
1 vez 2 a 3 veces 3 o más veces N/A
1
Cuestionario de los padres de HIPPY – Referencia
Revisado en noviembre de 2010

Describa “otros” eventos:
15) ¿Se sintió cómodo(a) en el
preescolar/la guardería?
No Algo incómodo(a)
¿Puede explicar por qué se sintió así? ¿Ocurrió algo especial?
16) ¿Ayuda o sirve de voluntario en su comunidad? Sí No
No estoy
seguro(a)
Algo cómodo(a) Muy cómodo(a)
17) Si es así, ¿dónde y en qué tipo de actividad participa?
Institución religiosa Prácticas culturales Escuela Biblioteca Centro comunitario HIPPY Otro
Especifique dónde y en cuáles actividades piensa ayudar o ser voluntario:
18) ¿Participa en otras actividades/grupos comunitarios? Sí No
Haga una lista y díganos cómo se enteró de ellas:
Actividad/Grupo comunitario ¿Cómo se enteró de ellas?
19) Durante el año pasado, ¿participó en algún curso o taller en alguno de los campos siguientes? (Esto incluye programas preuniversitarios/
universitarios).
Seguridad alimentaria Lenguaje Computadoras
CPR (Resucitación
cardiopulmonar)
Formación profesional Desarrollo infantil
Crianza de niños Empleo Otro
Si es así, especifique dónde:
Curso/Taller Lugar
2
Cuestionario de los padres de HIPPY – Referencia
Revisado en noviembre de 2010

Cuestionario de los padres – Seguimiento
1) ¿Cuáles son algunas de sus formas favoritas de pasar el tiempo con su niño? (Marcar todo lo que corresponda)
Conversar Leer Dibujar Sentarnos en silencio Ver videos educativos
Jugar Juegos Juegos educativos Ver televisión Contar historias de familia o cultura
Caminar Ir a la biblioteca Irnos de compras Deportes Otra ________________________________
2) De estas actividades, indique tres en las que pasa más tiempo con su niño:
Conversar Leer Dibujar Sentarnos en silencio Ver videos educativos
Jugar Juegos Juegos educativos Ver television Contar historias de familia o cultura
Caminar Ir a la biblioteca Irnos de compras Deportes Otra ________________________________
3) ¿Cuánto tiempo tiene disponible para pasar “cara a cara” con su niño cada semana?
1 a 2 horas 3 a 5 horas 5 a 8 horas 8 a 10 horas 10 horas o más
4) ¿Hay un lugar especial “de tareas” para que su niño complete las actividades? Sí No
5) ¿Tiene recursos (estrategias, actividades, ideas, materiales) para trabajar con su niño? Sí No
6) Descríbalas (estrategias, actividades, ideas, materiales) y diga cómo las desarrolló o las recibió:
7) ¿Ha visitado el preescolar/la guardería de su niño este año? Sí No N/A
8) Respuesta afirmativa, indique el motivo de su visita:
Conferencia de padres y
Llevar o recoger al niño Ayuda en el salón de Ayuda en excursiones Voluntario en la biblioteca
profesores
clases
Eventos especiales Otro ________________________________________________________________________________________________
9) El año pasado, ¿aproximadamente cuántas veces asistió a conferencias de padres y profesores?
1 vez 2 a 3 veces 3 o más veces N/A
10) El año pasado, ¿aproximadamente cuántas veces ayudó en el salón de clases?
1 vez 2 a 3 veces 3 o más veces N/A
11) El año pasado, ¿aproximadamente cuántas veces ayudó en excursiones?
1 vez 2 a 3 veces 3 o más veces N/A
12) El año pasado, ¿aproximadamente cuántas veces fue voluntario en la biblioteca?
1 vez 2 a 3 veces 3 o más veces N/A
13) El año pasado, ¿aproximadamente cuántas veces asistió a un evento especial?
1 vez 2 a 3 veces 3 o más veces N/A
14) El año pasado, ¿aproximadamente cuántas veces asistió a otros eventos?
1 vez 2 a 3 veces 3 o más veces N/A
Cuestionario de los padres de HIPPY – Seguimiento
Revisado en noviembre de 2010
1

Describa “otros” eventos:
15) ¿Se sintió cómodo(a) en el
preescolar/la guardería?
No Algo incómodo(a)
¿Puede explicar por qué se sintió así? ¿Ocurrió algo especial?
16) ¿Ayuda o sirve de voluntario en su comunidad? Sí No
No estoy
seguro(a)
Algo cómodo(a) Muy cómodo(a)
17) Si es así, ¿dónde y en qué tipo de actividad participa?
Institución religiosa Prácticas culturales Escuela Biblioteca Centro comunitario HIPPY Otro
Especifique dónde y en cuáles actividades piensa ayudar o ser voluntario:
18) ¿Participa en otras actividades/grupos comunitarios? Sí No
Haga una lista y díganos cómo se enteró de ellas:
Actividad/Grupo comunitario ¿Cómo se enteró de ellas?
19) Durante el año pasado, ¿participó en algún curso o taller en alguno de los campos siguientes? (Esto incluye programas preuniversitarios/
universitarios).
Seguridad alimentaria Lenguaje Computadoras
CPR (Resucitación
cardiopulmonar)
Formación profesional Desarrollo infantil
Crianza de niños Empleo Otro
Si es así, especifique dónde:
Curso/Taller Lugar
Cuestionario de los padres de HIPPY – Seguimiento
Revisado en noviembre de 2010
2