FY19 MCH/HCP 4-Square Progress Report Master Template
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Instructions
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To Submit Quarterly Reports
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On a quarterly basis, please submit a copy of your MCH action plan(s), which include "clickable" fields for quarterly progress updates, and a copy of this MCH/HCP 4 Square Progress Report google workbook, which is designed to capture brief, narrative reflections on the status of local MCH and HCP initiatives.
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The completed 4 Square Progress Report documents should be reviewed by a point person on your internal team, such as the MCH Program Manager, to ensure completion prior to submission. It is suggested that an internal team meet regularly reflect on progress, challenges, and opportunities across work plans. After this internal review and once your report is finalized, please notify your MCH Generalist and HCP Consultant via email telling them that it is complete. This notification must be sent to us on or before the 15th of the month, as listed below:

By January 15: Submit report for Oct. – Dec.
By April 15: Submit report for Jan. – March
By July 15: Submit report for April – June
By October 31: Submit report for July – Sept.
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CYSHCN TAB: The HCP tab from previous years is now called CYSHCN. For ease of use, the HCP Care Coordination and Access to Pediatric Specialty Care Supplemental Funding quarterly reporting has been merged onto this one tab called CYSHCN. In addition, there is a separate tab for the supplemental funding report called CYSHCN Supplemental Funding Final Report and a FY20 CYSHCN Planning tab for Care Coordination. Beginning in FY19, the CYSCHN Section will merge all planning and reporting documents into this 4-Square Progress Report and, therefore, no other reporting documents will be required.
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Note: Individual priority areas (e.g., PRD, ECOP, Medical Home) may use supplemental tracking documents to assist with the collection of information for evaluation purposes; these efforts will be coordinated as part of technical assistance by the lead for that priority (the MIT).
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To Complete this Document
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Please complete a separate tab for each of your local action plans. Your customized template will contain the appropriate tabs (priorities) for your agency.
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Follow the guidance provided in the form for each section. Content should be brief and is not intended to be a documentation of all activity. The suggested completion time for each tab is approximately 15 minutes.
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Submitted quarterly progress reporting documents (i.e., action plans and MCH/HCP Four Square Progress Report workbook) will be reviewed by your MCH Generalist Consultant, HCP Consultant, and Priority Leads (MITs). They will be used as conversation tools during the quarterly check-in with your Generalist Consultant. At the progress check-in, the “Next Steps” section of the MCH/HCP 4 Square Progress Report may be updated to include emerging follow-up tasks. Both documents and the corresponding conversations are intended to provide a supportive foundation for shared learning, removal of barriers, and continuous quality improvement.
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