Michigan Department of Community Health



Michigan Department of Community Health

Child and Adolescent Health Center Services

Health Education Presentation Reporting Form

|1. Agency Name: |3. Report Period End Date: |

| | |

| | |

|2: Center Name: |_____/_____/_____ |

| |(mm/dd/yy) |

|Presentation Information (see note below) |

# Sessions

Presented # Participants Categories (definitions on page 2)

| | | |a) Chronic Disease Management |

| | | |b) Family Planning/Reproductive Health |

| | | |c) Health Promotion and Risk Reduction |

| | | |d) Immunizations |

| | | |e) Mental Health |

| | | |f) Prenatal and Postpartum Care |

| | | |g) STI, HIV |

| | | |h) Substance Abuse |

| | | |i) General Medical |

| | | |j) Medicaid Outreach Information (Outreach Area 1) |

| | | |TOTAL |

Definitions:

Session: Check only one primary topic (i.e. topics covered in a-i) per session provided. If Medicaid Outreach is addressed in the presentation, please provide information on # sessions and # participants in addition to the primary topic area.

# Participants: This will not be an unduplicated count. Participants reported here must be adolescents, not parents of teens/other professionals unless covering Medicaid Outreach Information.

Definitions of Educational Presentation Categories

The following definitions should be utilized to describe all large group/class educational sessions provided. Check only one primary topic for each presentation (i.e. topics covered in a-i). This will not be an unduplicated count. If Medicaid Outreach is addressed in the presentation, please provide information on # sessions and # participants in addition to the primary topic area.

Individual and small groups meeting the criteria should be reported under non-clinical teen health center services and referrals.

a. Chronic Disease Education includes information regarding prevention, symptom recognition and management of chronic conditions such as hypertension, diabetes, sickle cell anemia, scoliosis, asthma, cystic fibrosis, irreversible heart murmur, allergies, and irreversible skin anomalies.

b. Family Planning/Reproductive Health Education includes information regarding sexuality development and family planning, which enables individuals to exercise choice in fulfilling personal childbearing objectives.

c. Health Promotion and Risk Reduction Education includes information on reducing risks of health problems and developing healthy behaviors, which limit the incidence of disease and injuries. It may also include information on health resources and utilization of health systems.

d. Immunization Education includes information on the importance of receiving primary immunization and maintaining a positive immunization status.

e. Mental Health Education includes topics designed to facilitate the best possible psychological and emotional well being of adolescents. Examples include general information on development of positive self-esteem, stress/anger management, suicide prevention, family, and peer interactions.

f. Prenatal and Postpartum Care Education includes information provided to pregnant and postpartum adolescents.

g. STI and HIV Prevention Education includes information regarding the prevention and management of sexually transmitted diseases, including HIV and AIDS.

h. Substance Abuse prevention Education includes information about drug abuse prevention, treatment, and counseling.

i. General Medical Education includes information regarding a variety of diseases and injuries that do not logically fall into other listed categories.

j. Medicaid Outreach Information (Outreach Area 1): includes informing eligible or potentially eligible individuals about Medicaid and how to access Medicaid programs, describing services covered under Medicaid, and information on how to obtain Medicaid preventative services.

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