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MIECHV: Early Head Start


MIECHV Forms


Data Collection Manual

Chapter 1: Overview of MIECHV (pdf)

Chapter 2: Data Reporting Process (pdf) *revised 3/12/14 

Chapter 3: Data Collection and Reporting Schedule (pdf) *revised 1/1/14

Chapter 4: MIECHV Forms and Instructions (pdf)   *revised 10/1/14


Appendices: Home Visiting Tools

Appendix A: MIECHV Benchmarks

  1. Federal Requirements for Meeting Legislatively-Mandated Benchmarks (pdf)
  2. Oregon MIECHV Measures in Brief (pdf)
  3. Oregon MIECHV Benchmark Plan Narrative (pdf)
  4. Oregon MIECHV Measures (pdf)

Appendix B: PHQ-9

  1. PHQ-9 Tool - English (pdf)
  2. PHQ-9 Tool - Spanish (pdf)
  3. PHQ-9 Scoring (pdf)
  4. PHQ-9 Scores Proposed Actions (pdf)

Appendix C: Substance Use Risk Profile

  1. Substance Use Risk Profile Form -- Optional (pdf) *revised 4/17/14

Appendix D: Relationship Assessment Tool  *all revised 7/16/12

  1. Relationship Assessment Tool for Home Visitor - English (pdf)
  2. Relationship Assessment Tool for Nurse - English (pdf)
  3. Relationship Assessment Tool for Home Visitor - Spanish (pdf)
  4. Relationship Assessment Tool for Nurse - Spanish (pdf)
  5. Domestic Violence Organizations & Resources in Oregon

Appendix E: Safety Checklists

  1. Multnomah County Safety Checklist (pdf)
  2. OHSU Baby-Proof Home Safety Checklist - English (pdf)
  3. OHSU Child-Proof Home Safety Checklist - English (pdf)
  4. OHSU Baby/Child-Proof Home Safety Checklist - Spanish (pdf)
  5. Minnesota Dept of Health Home Safety Checklist - English (pdf)
  6. Minnesota Dept of Health Home Safety Checklist - Spanish (pdf)
  7. Minnesota Dept of Health Home Safety Checklist Reference Guide (pdf)
  8. Safe Kids Home Safety Tip Sheet - English (pdf)
  9. Safe Kids Home Safety Tip Sheet - Spanish (pdf)

Appendix F: PSI-4 Instructions (pdf)

Appendix G: ASQ-3 Resources