Maternal and Child Health Services

Detailed Client Encounter Data Collection

Submit detailed client encounter data in a timely manner, in either paper or electronic format in accordance with the guidance provided by the Children and Families Section, Bureau of Family Health. In order to meet federal reporting requirements, all calendar year client encounter data shall be submitted to the State Agency by January 15 each year.


Quarterly  – due by October 15, January 15, April 15 and July 15 submit:

  1. Certified Affidavit of Revenues and Expenditures
  2. MCH Client Satisfaction Survey Cards
    The local health agency will distribute a client satisfaction survey card randomly to at least 20% of clients served. The survey cards will be supplied to the local health agency by the KDHE Children & Families Section. The client is asked to complete the card and then mail it to KDHE for review and feedback to the agency. Survey cards should be sent to KDHE prior to the end of each quarter. A survey card summary report will be e-mailed to the local health agency for program self-evaluation.

Mid–Year  and End-of-Year Narrative Progress Reports – due by January 15 and July 15

Using the Progress Report form, submit a narrative description of program activities covering six months of the contract period (July-December; January-June). The following areas should be addressed in each report:
A 5% penalty of total grant award amount will be assessed for delinquent end-of-year reports beyond August 15th.


  1. Outcome Objectives – list the objectives identified in your annual MCH grant application for a) medical home; b) pregnant women and infants; and c) children and adolescents.
  2. Progress – describe your progress toward meeting each outcome objective. Provide specific details about program services and activities, strategies and approaches, public education activities, collaboration and coordination within the agency and with community partners, numbers served and reached, etc.
  3. Outcome Measures – Report progress on your specified outcome indicators and briefly note how the measurement was calculated. Example: 60% of mothers served by the program in this reporting period breastfed their infants compared to 50% at the end of June 2013. Calculated by dividing number of mothers in program who breastfed by the total number of mothers served.
  4. Significant Accomplishments – describe any significant progress or impact, program highlights, and/or success stories.
  5. Challenges – Describe any barriers or challenges in working toward your objectives. Explain what steps have been taken and/or plans that have been developed to address or resolve the challenges.
  6. Training/Professional Development – List trainings and/or conferences staff attended.
  7. Technical assistance/Training Needs– List any needs or requests for training and technical assistance.
  8. Updates/Changes – Specify any changes in staff, administration, contact information, or program implementation.

Reporting Schedule


Grant Reporting Period

Due Date

Forms Due


7/1 to 9/30

October 15

  • Affidavit of Revenues and Expenditures
  • MCH Client Satisfaction Survey Cards


10/1 to 12/31

January 15

  • Affidavit of Revenues and Expenditures
  • MCH Client Satisfaction Survey Cards
  • Mid-Year Narrative Progress Report


1/1 to 3/31

April 15

  • Affidavit of Revenues and Expenditures
  • MCH Client Satisfaction Survey Cards


4/1 to 6/30

July 15

  • Affidavit of Revenues and Expenditures
  • MCH Client Satisfaction Survey Cards
  • End-of-Year Narrative Progress Report



Program Contact Persons

Jamie Klenklen, Fiscal 785-296-1234
Joe Kotsch, Maternal & Infant Health 785-296-1306
Jane Stueve, Child Health & Adolescent Health 785-296-7433


Forms Required:

Affidavit of Revenues and Expenditures


Progress Report