# Brief: Early childhood and pediatric care Prepared from Grant Precedent, 2026-10-23; data as of precedent 2026-10-21, measures 2026-10-22. ## Measures funders require ### Maternal and Child Health Bureau (Health Resources and Services Administration, U.S. Department of Health and Human Services), Transforming Pediatrics for Early Childhood (TPEC) Program #### Number of pediatric primary care staff trained statewide - Code: No. 1 - Requirement: required - Instrument: HRSA-26-104 NOFO, Performance measurement, evaluation, and continuous quality improvement - Reporting frequency: annual (through the Discretionary Grant Information System, DGIS) - Target rule: No target rule stated - Source: HRSA performance measures, PDF p. 10 (printed 'Page 9 of 33'), https://files.simpler.grants.gov/opportunities/16919e15-9eca-4eb7-9da5-c8eb7c849e6f/attachments/f81cf7f1-9a74-4e7b-a3c2-c5f250341280/HRSA-26-104_final.pdf #### Number of partner pediatric practices - Code: No. 2 - Requirement: required - Instrument: HRSA-26-104 NOFO, Performance measurement, evaluation, and continuous quality improvement - Reporting frequency: annual (through the Discretionary Grant Information System, DGIS) - Target rule: No target rule stated - Source: HRSA performance measures, PDF p. 10 (printed 'Page 9 of 33'), https://files.simpler.grants.gov/opportunities/16919e15-9eca-4eb7-9da5-c8eb7c849e6f/attachments/f81cf7f1-9a74-4e7b-a3c2-c5f250341280/HRSA-26-104_final.pdf #### Number of ECD experts placed in partner pediatric practices - Code: No. 3 - Requirement: required - Instrument: HRSA-26-104 NOFO, Performance measurement, evaluation, and continuous quality improvement - Reporting frequency: annual (through the Discretionary Grant Information System, DGIS) - Target rule: No target rule stated - Source: HRSA performance measures, PDF p. 10 (printed 'Page 9 of 33'), https://files.simpler.grants.gov/opportunities/16919e15-9eca-4eb7-9da5-c8eb7c849e6f/attachments/f81cf7f1-9a74-4e7b-a3c2-c5f250341280/HRSA-26-104_final.pdf #### Percentage of children (aged 5 and under) served in partner pediatric practices that received a timely well-child visit - Code: No. 4 - Requirement: required - Instrument: HRSA-26-104 NOFO, Performance measurement, evaluation, and continuous quality improvement - Reporting frequency: annual (through the Discretionary Grant Information System, DGIS) - Target rule: Funder sets the target - Source: HRSA performance measures, PDF p. 10 (printed 'Page 9 of 33'); goal PDF p. 7 (printed 'Funding Opportunity Goals', 'should work towards'), https://files.simpler.grants.gov/opportunities/16919e15-9eca-4eb7-9da5-c8eb7c849e6f/attachments/f81cf7f1-9a74-4e7b-a3c2-c5f250341280/HRSA-26-104_final.pdf #### Percentage of children (aged 9-30 months) served in partner pediatric practices that received a timely developmental screening using a validated parent-completed tool - Code: No. 5 - Requirement: required - Instrument: HRSA-26-104 NOFO, Performance measurement, evaluation, and continuous quality improvement - Reporting frequency: annual (through the Discretionary Grant Information System, DGIS) - Target rule: Funder sets the target - Source: HRSA performance measures, PDF p. 11 (printed 'Page 10 of 33'); goal PDF p. 7 (printed 'Funding Opportunity Goals', 'should work towards'), https://files.simpler.grants.gov/opportunities/16919e15-9eca-4eb7-9da5-c8eb7c849e6f/attachments/f81cf7f1-9a74-4e7b-a3c2-c5f250341280/HRSA-26-104_final.pdf #### Percentage of children (aged 5 and under) and their families served in partner pediatric practices comprehensively screened (e.g., caregiver depression, food assistance, housing, etc.) - Code: No. 6 - Requirement: required - Instrument: HRSA-26-104 NOFO, Performance measurement, evaluation, and continuous quality improvement - Reporting frequency: annual (through the Discretionary Grant Information System, DGIS) - Target rule: Funder sets the target - Source: HRSA performance measures, PDF p. 11 (printed 'Page 10 of 33'); goal PDF p. 7 (printed 'Funding Opportunity Goals', 'should work towards'), https://files.simpler.grants.gov/opportunities/16919e15-9eca-4eb7-9da5-c8eb7c849e6f/attachments/f81cf7f1-9a74-4e7b-a3c2-c5f250341280/HRSA-26-104_final.pdf #### Percentage of children (aged 5 and under) and their families served in partner pediatric practices that received appropriate follow-up services - Code: No. 7 - Requirement: required - Instrument: HRSA-26-104 NOFO, Performance measurement, evaluation, and continuous quality improvement - Reporting frequency: annual (through the Discretionary Grant Information System, DGIS) - Target rule: No target rule stated - Source: HRSA performance measures, PDF p. 11 (printed 'Page 10 of 33'), https://files.simpler.grants.gov/opportunities/16919e15-9eca-4eb7-9da5-c8eb7c849e6f/attachments/f81cf7f1-9a74-4e7b-a3c2-c5f250341280/HRSA-26-104_final.pdf #### Percentage of children (aged 6 months-5 years) served in partner pediatric practices that meet flourishing criteria, as aligned with the National Survey of Children’s Health - Code: No. 8 - Requirement: required - Instrument: HRSA-26-104 NOFO, Performance measurement, evaluation, and continuous quality improvement - Reporting frequency: annual (through the Discretionary Grant Information System, DGIS) - Target rule: No target rule stated - Source: HRSA performance measures, PDF p. 11 (printed 'Page 10 of 33'), https://files.simpler.grants.gov/opportunities/16919e15-9eca-4eb7-9da5-c8eb7c849e6f/attachments/f81cf7f1-9a74-4e7b-a3c2-c5f250341280/HRSA-26-104_final.pdf ## What you can collect, and how Tier 1 is collected today from your own records. Tier 2 needs one free instrument. Tier 3 needs a partner under a data agreement. A measure that matches no rule has no tier. ### Tier 1: Collect today from your own records #### Number of pediatric primary care staff trained statewide - Collect today from your own records. A count of services or people, held in the organization’s own records. #### Number of partner pediatric practices - Collect today from your own records. A count of services or people, held in the organization’s own records. #### Number of ECD experts placed in partner pediatric practices - Collect today from your own records. A count of services or people, held in the organization’s own records. #### Percentage of children (aged 9-30 months) served in partner pediatric practices that received a timely developmental screening using a validated parent-completed tool - Collect today from your own records. An output the funder classes as a count of activity. #### Percentage of children (aged 5 and under) and their families served in partner pediatric practices comprehensively screened (e.g., caregiver depression, food assistance, housing, etc.) - Collect today from your own records. An output the funder classes as a count of activity. #### Percentage of children (aged 5 and under) and their families served in partner pediatric practices that received appropriate follow-up services - Collect today from your own records. An output the funder classes as a count of activity. ### Tier 1 + 3: Collect today from your own records; and Needs a partner under an agreement #### Percentage of children (aged 5 and under) served in partner pediatric practices that received a timely well-child visit - Collect today from your own records. An output the funder classes as a count of activity. - You count your own participants; the health agency or provider record confirms the outcome. - Partner route: CA: Medicaid utilization, diagnoses, services and continuity of coverage, held by Department of Health Care Services, Medi-Cal. Lag: 6-18 months for service-data completeness; approval time is additional. Request: https://www.dhcs.ca.gov/data-statistics/data-resources/accessing-dhcs-protected-data-for-research-and-public-health/ - Partner route: WA: Medicaid service utilization and program-evaluation outcomes, held by Washington Health Care Authority. Lag: Event and completeness lag NR. HCA offers an initial discussion within one month; that is not an approval or delivery deadline. Request: https://www.hca.wa.gov/about-hca/data-and-reports/data-hca - Partner route: NY: hospital and ED utilization, diagnoses and readmissions, held by NY Department of Health, SPARCS. Lag: 8-10 months after the period ends for data to be considered complete. Request: https://sparcssupport.zendesk.com/hc/en-us/articles/21276354948763-How-do-I-apply-for-SPARCS-data - 2 more health utilization and vital records routes are listed on the data-routes page. - Caveat: A HIPAA limited data set cannot be used to match participants. ### Tier not determined #### Percentage of children (aged 6 months-5 years) served in partner pediatric practices that meet flourishing criteria, as aligned with the National Survey of Children’s Health ## What grantees achieved 2 grantees of Maternal & Child Health – Maternal Depression (MOMS) reported 23 results against targets over 4 periods; the median result was 113% of target (middle half 105% to 117%), and 91% met or exceeded the target. Source: Children's Services Council of Broward County, annual performance reports, https://www.cscbroward.org/wp-content/uploads/2025/01/APR-FY-23-24-Book-002.pdf. - Memorial Healthcare System (FY2022-23): Families who successfully completed program.; promised 75%, actual 79% (105% of target); unit: %. Source: https://www.cscbroward.org/wp-content/uploads/2024/01/APR-FY-22-23-Book71.pdf - Healthy Mothers Healthy Babies Coalition of Broward County (HMHB) (FY2022-23): Infants and children that scored within range for developmental milestones.; promised 85%, actual 87% (102% of target); unit: %. Source: https://www.cscbroward.org/wp-content/uploads/2024/01/APR-FY-22-23-Book71.pdf 2 grantees of Early Childhood Consultation (ECC) reported 19 results against targets over 2 periods; the median result was 108% of target (middle half 103% to 110%), and 89% met or exceeded the target. Source: Juvenile Welfare Board of Pinellas County, program monitoring reports, https://www.jwbpinellas.org/wp-content/uploads/2020/07/VII-C-Program-and-Financial-Monitoring-Information.pdf. - Directions for Living (DFL) (FY2020): Percent of children will not experience an out-of-home placement during services as measured by independent verification FSFN.; promised 90%, actual 98% (109% of target); unit: %. Source: https://www.jwbpinellas.org/wp-content/uploads/2021/01/VII-B-Program-and-Financial-Monitoring.pdf - Directions for Living (FY2019): Percent of adults will score within average (5, 6, 7) to above average (8, 9, 10) ranges at post-test on Construct E: Oppressing Children's Power and Independence as measured by the AAPI-2.; promised 85%, actual 92% (108% of target); unit: %. Source: https://www.jwbpinellas.org/wp-content/uploads/2020/07/VII-D-Program-and-Financial-Monitoring-Information.pdf 2 grantees of Infant Family Center reported 14 results against targets over 2 periods; the median result was 108% of target (middle half 86% to 126%), and 64% met or exceeded the target. Source: Juvenile Welfare Board of Pinellas County, program monitoring reports, https://www.jwbpinellas.org/wp-content/uploads/2020/07/VII-C-Program-and-Financial-Monitoring-Information.pdf. - University of South Florida Board of Trustees (FY2020): Percent of children who have completed the program will not experience an out-of- home placement for a period of twelve months following case closure as measured by independent verification FSFN.; promised 85%, actual 96% (113% of target); unit: %. Source: https://www.jwbpinellas.org/wp-content/uploads/2021/01/VII-C-Program-and-Financial-Monitoring-1.pdf - The University of South Florida Board of Trustees (FY2024): Participants served (target vs actual); promised 250, actual 190 (76% of target); unit: count. Source: https://www.jwbpinellas.org/wp-content/uploads/2024/08/VII.D.-Program-and-Financial-Monitoring-Information.pdf 2 grantees of Early Childhood Court reported 8 results against targets over 5 periods; the median result was 133% of target (middle half 110% to 144%), and 100% met or exceeded the target. Source: Juvenile Welfare Board of Pinellas County, program monitoring reports, https://www.jwbpinellas.org/wp-content/uploads/2020/07/VII-C-Program-and-Financial-Monitoring-Information.pdf. - Sixth Judicial Circuit of Florida (FY2022): Participants served (target vs actual); promised 40, actual 42 (105% of target); unit: count. Source: https://www.jwbpinellas.org/wp-content/uploads/2023/11/VIII.B.-Program-and-Financial-Monitoring-Information.pdf - Sixth Judicial Circuit Court (SJCC) (FY2020): Percent of all ECC cases will have no additional verified abuse reports for children after reunification for up to one year after program completion. Seay, K. D., & McRell, A. S. (2021). Child Welfare Services Response to COVID-19: Addressing Face-to-Face Contacts. Journal of Child and Family Studies, 1-13.; promised 70%, actual 100% (143% of target); unit: %. Source: https://www.jwbpinellas.org/wp-content/uploads/2021/01/VIII-D-Program-and-Financial-Monitoring.pdf 1 grantee of Maternal & Child Health - Healthy Families reported 7 results against targets over 1 period; the median result was 102% of target (middle half 98% to 109%), and 57% met or exceeded the target. Source: Children's Services Council of Broward County, annual performance reports, https://www.cscbroward.org/wp-content/uploads/2025/01/APR-FY-23-24-Book-002.pdf. - Broward Healthy Start Coalition, Inc. (FY2024-25): Percentage of families completing the program with no findings of verified child maltreatment within 12 months; promised 95%, actual 97% (102% of target); unit: %. Source: https://www.cscbroward.org/wp-content/uploads/2026/01/APR-Book-FY-24-25.pdf 1 grantee of Maternal & Child Health - Nurse Family Partnership Program reported 6 results against targets over 1 period; the median result was 110% of target (middle half 105% to 112%), and 100% met or exceeded the target. Source: Children's Services Council of Broward County, annual performance reports, https://www.cscbroward.org/wp-content/uploads/2025/01/APR-FY-23-24-Book-002.pdf. - Broward Health (FY2024-25): Percentage of infants always placed to sleep on their backs, without bed sharing or soft bedding; promised 80%, actual 100% (125% of target); unit: %. Source: https://www.cscbroward.org/wp-content/uploads/2026/01/APR-Book-FY-24-25.pdf 1 grantee of Maternal & Child Health - Maternal Depression (MOMS) reported 4 results against targets over 1 period; the median result was 118% of target (middle half 115% to 121%), and 100% met or exceeded the target. Source: Children's Services Council of Broward County, annual performance reports, https://www.cscbroward.org/wp-content/uploads/2025/01/APR-FY-23-24-Book-002.pdf. - Memorial Healthcare System (FY2024-25): Percentage of mothers reporting fewer symptoms of depression and/or anxiety; promised 80%, actual 96% (120% of target); unit: %. Source: https://www.cscbroward.org/wp-content/uploads/2026/01/APR-Book-FY-24-25.pdf 3 grantees of Early Childhood Consultation Services reported 3 results against targets over 3 periods; the median result was 54% of target (middle half 47% to 55%), and 0% met or exceeded the target. Source: Juvenile Welfare Board of Pinellas County, program monitoring reports, https://www.jwbpinellas.org/wp-content/uploads/2020/07/VII-C-Program-and-Financial-Monitoring-Information.pdf. - Directions For Living (FY2025): Participants served (target vs actual); promised 210, actual 114 (54% of target); unit: count. Source: https://www.jwbpinellas.org/wp-content/uploads/2026/06/VII.B.-Program-and-Financial-Monitoring-Information-1.pdf - Directions for Mental Health, Inc. d/b/a Directions for Living (FY2022): Participants served (target vs actual); promised 262, actual 147 (56% of target); unit: count. Source: https://www.jwbpinellas.org/wp-content/uploads/2023/11/VIII.B.-Program-and-Financial-Monitoring-Information.pdf - Directions for Mental Health Inc., d/b/a Directions for Living (FY2024): Participants served (target vs actual); promised 210, actual 82 (39% of target); unit: count. Source: https://www.jwbpinellas.org/wp-content/uploads/2024/08/VII.D.-Program-and-Financial-Monitoring-Information.pdf 8 of 24 matched precedent programs shown, largest first. ## Target-setting language with precedent Each item comes from one funder, one program or one department; none is a government-wide rule. Showing clauses from HHS, Education and USDA. - CDC DP-23-0002 applicant FAQ (2023): Quote: “you may enter a '0' and then TBD for targets in the work plan” — https://archive.cdc.gov/www_cdc_gov/healthyschools/nofo/nofo.htm - EDGAR, 34 CFR 75.110(c) (2024): Paraphrase: An applicant that lacks a baseline explains how and when it will establish one. — https://www.govinfo.gov/content/pkg/FR-2024-08-29/html/2024-17239.htm - USDA FAS Food for Progress FY2025, applicant Q&A, questions 72-73 (2025): Paraphrase: Yearly targets may be written as percentage-point change when the baseline value is not known. — https://apply07.grants.gov/grantsws/rest/opportunity/att/download/348844 - SAMHSA CMHS Infrastructure, Prevention and Promotion Overview Guide, v2.0, p. 9 (2022): Quote: “grantees can revise annual goals in consultation with their GPO during the first quarter of each fiscal year” — https://spars.samhsa.gov/sites/default/files/2023-01/OE%20SPARS%20CMHS%20IPP%20Overview%20Guide.pdf - Promise Neighborhoods guidance document, third edition (2025): Quote: “target setting will be an iterative process throughout implementation as more performance data is available” — https://promiseneighborhoods.ed.gov/pdf/Promise_Neighborhoods_Guidance_Document_508c.pdf - HRSA-26-057 ECCS SEED applicant FAQs, p. 6 (2026): Paraphrase: Baseline estimates are confirmed or updated within six months of award. — https://files.simpler.grants.gov/opportunities/45e009d7-46ed-482f-8aa7-02812f207f71/attachments/54ad1b19-2651-43c7-8ade-76203c7770d7/HRSA-26-057_ECCS_SEED_Applicant_FAQs.pdf - NIH PAR-25-383, Section VI (2025): Paraphrase: Future-year milestones may be renegotiated based on prior-year data. — https://grants.nih.gov/grants/guide/pa-files/PAR-25-383.html - Arizona Rural Health Transformation, approved program narrative, pp. 20-22 (2026): Paraphrase: A baseline assessment is done after award, and targets are set from it. — https://www.azahcccs.gov/AHCCCS/Downloads/Initiatives/RHTP/Arizona%27sApprovedProgramNarrative.pdf - HRSA Health Center Program (H80) patient targets, Primary Health Care Digest (2022): Quote: “confirm or request adjustment to their patient target by the deadline in their email” — https://content.govdelivery.com/accounts/USHHSHRSA/bulletins/3120df3 ## What reviewers penalize These ten weaknesses recur in 17 published reviewer critiques, mostly U.S. Department of Education and NIH. The count is the number of critiques that name it, not a rate, and a reviewer comment is a judgment. - [ ] Attrition or missing-data handling left unresolved (named in 7 of 17 critiques). Reviewers wrote: “the applicant did not address how missing data will be handled” U.S. Department of Education, Education Innovation and Research (EIR) Mid-Phase, WestEd, S411B220027, 2022, Technical Review Form, pp. 25, 29. https://www.ed.gov/sites/ed/files/2022/12/S411B220027_WestEd_TRF.pdf#page=29 - [ ] Comparisons vulnerable to selection, contamination, baseline differences or incompatible data (named in 7 of 17 critiques). Reviewers wrote: “may require additional interpretation” National Institutes of Health, NIAID, K01 AI131895 (Rebeiro, Vanderbilt), applicant-authorized summary statement; a research application, pp. 5-6. https://beta.nih.gov/sites/default/files/migrated_media/2026-09/k01-rebeiro-summary-statement.pdf#page=6 - [ ] Feasibility assumptions or fallback arrangements unsupported (named in 6 of 17 critiques). Reviewers wrote: “no alternative analysis plan is provided” National Institutes of Health, NIDCD, R01 DC017174 (Heinemann and Cherney), applicant-authorized summary statement; a research application, pp. 3, 5-6. https://www.nidcd.nih.gov/sites/default/files/2022-03/sanitized-heinemann-cherney-summary-statement-redacted.pdf#page=5 - [ ] Implementation fidelity, thresholds or mediators inadequately specified (named in 5 of 17 critiques). Reviewers wrote: “Mediators are not described.” U.S. Department of Education, EIR Early-Phase, Education Development Center, U411C190275, 2019, Technical Review Form, p. 4. https://www.ed.gov/sites/ed/files/2019/11/U411C190275-Education-Development-Center-Inc.-TRF-Tier-2.pdf#page=4 - [ ] Measurement tools insufficiently identified, supported or protected against reporting bias (named in 4 of 17 critiques). Reviewers wrote: “no detail is provided” U.S. Department of Education, EIR Mid-Phase, Niswonger Foundation, U411B170038, 2017, Technical Review Form, pp. 4-5. https://www.ed.gov/sites/ed/files/2016/12/U411B170038_TRF.pdf#page=4 - [ ] Targets or success criteria missing, inconsistent or disconnected from the project (named in 4 of 17 critiques). Reviewers wrote: “lacks a specific number” U.S. Department of Education, EIR Mid-Phase, ASSISTments Foundation, S411B220024, 2022, Technical Review Form, p. 14. https://www.ed.gov/sites/ed/files/2022/12/S411B220024_ASSISTments-Foundation-Inc_TRF.pdf#page=14 - [ ] Analysis procedures insufficiently specified for the stated questions or model (named in 4 of 17 critiques). Reviewers wrote: “methods of data analysis are not adequately described” National Institutes of Health, NIAID, R01 AI098472 renewal (Gandhi, UCSF), applicant-authorized summary statement; a research application, pp. 4-5. https://beta.nih.gov/sites/default/files/migrated_media/2026-09/2-R01-AI098472-06_Ganhdi_Summary.pdf#page=4 - [ ] Data protection, management or cross-site coordination incomplete (named in 3 of 17 critiques). Reviewers wrote: “The data management plan stops midsentence on page 125” National Institutes of Health, NIDCD, R01 DC017683 (Gifford and Camarata, Vanderbilt), applicant-authorized summary statement; a research application, pp. 9-10. https://www.nidcd.nih.gov/sites/default/files/2022-05/sanitized-giffordcamarataapplicationsummary-dc017683-01a1.pdf#page=10 - [ ] Feedback collection lacks a specified route into program decisions (named in 2 of 17 critiques). Reviewers wrote: “The applicant does not discuss how often the team will review data or implement changes.” U.S. Department of Education, EIR Early-Phase, Orange County Superintendent of Schools, S411C200130, 2020, Technical Review Form, pp. 16, 19. https://www.ed.gov/sites/ed/files/2020/12/S411C200130-Orange-County-Superintendent-of-Schools-TRF.pdf#page=19 - [ ] Evaluator independence insufficiently explained (named in 1 of 17 critiques). Reviewers wrote: “The level of independence is not made clear” U.S. Department of Education, EIR Early-Phase, Research Triangle Institute, S411C220065, 2022, Technical Review Form, pp. 24-25. https://www.ed.gov/sites/ed/files/2022/12/S411C220065_Research-Triangle-Institute-_TRF.pdf#page=24 ## Protocol skeleton ### Draft text, edit before use Measures: Number of pediatric primary care staff trained statewide; Number of partner pediatric practices; Number of ECD experts placed in partner pediatric practices; Percentage of children (aged 5 and under) served in partner pediatric practices that received a timely well-child visit; Percentage of children (aged 9-30 months) served in partner pediatric practices that received a timely developmental screening using a validated parent-completed tool; Percentage of children (aged 5 and under) and their families served in partner pediatric practices comprehensively screened (e.g., caregiver depression, food assistance, housing, etc.); Percentage of children (aged 5 and under) and their families served in partner pediatric practices that received appropriate follow-up services; Percentage of children (aged 6 months-5 years) served in partner pediatric practices that meet flourishing criteria, as aligned with the National Survey of Children’s Health. Baseline: \_\_\_\_ months from award, using HRSA-26-104 NOFO, Performance measurement, evaluation, and continuous quality improvement. Targets: set from the observed baseline at month \_\_\_\_, or committed now as a change of \_\_\_\_ percentage points from baseline (see the USDA FAS precedent above). Missing-data plan (how dropout and missing observations will be handled): \_\_\_\_ Comparison group or baseline (what you compare against and how the groups started): \_\_\_\_ Fallback if recruitment, data access or the first analysis falls short: \_\_\_\_ Fidelity threshold (what counts as full implementation, and how it is measured): \_\_\_\_ Instrument named, with its validity evidence and its rights (license) status: \_\_\_\_ Numeric target for each measure (a number, not a direction): \_\_\_\_ Analysis for each outcome (method, comparison, adjustment): \_\_\_\_ Data protection and data management (who holds identifiable data, where, for how long): \_\_\_\_ Feedback schedule (who reviews the data, how often, and what changes as a result): \_\_\_\_ Evaluator role and independence (who evaluates and how they are separate from delivery): \_\_\_\_ The text is copied or summarized from public documents. It is not legal advice.