WAVE 2 - IP+SEEK Baseline: 1 to 5 Years Question Title * 1. Please choose your practice. UH Rainbow Babies and Children's Hospital-Child Development Center Hyde Park Pediatrics Mercy Navarre Pediatrics Children's Choice Pediatrics Medina Family and Internal Medicine/Pediatrics Olentangy Pediatrics Forest Park Internal Medicine-Pediatrics Mid-Ohio Pediatrics & Adolescents Blanchard Valley Hospital The HealthCare Connection Question Title * 2. Provider Name. Please seeking MOC IV credit and who saw the parents for the chart reviewed. Question Title * 3. For the chart reviewed and being entered, in which month did the well visit occur? November December Question Title * 4. Was there documentation of counseling provided, or was a referral made, for this child that has someone in the house that smokes tobacco? Counseling Provided Referral Made No Documentation of Either N/A - no one in the home smokes tobacco Question Title * 5. Was there documentation of counseling provided, or was a referral made, for this child’s caregiver who has had a problem with drugs or alcohol in the last year? Counseling Provided Referral Made No Documentation of Either N/A – caregiver did not have a problem with drugs or alcohol Question Title * 6. Was there documentation of counseling provided, or was a referral made, for this child’s caregiver who has needed to cut back on drinking or drug use during the last year? Counseling Provided Referral Made No Documentation of Either N/A – caregiver did not need to cut back on drinking or drug use Question Title * 7. Was there documentation of counseling provided, or was a referral made, for this child’s family that worried their food would run out before they got money or Food Stamps to buy more? Counseling Provided Referral Made No Documentation of Either N/A – Food Secure Family Question Title * 8. Was there documentation of counseling provided, or was a referral made, for this child’s family where the food they bought just did not last and they did not have money to buy more? Counseling Provided Referral Made No Documentation of Either N/A – Food Secure Family Question Title * 9. Was there documentation of counseling provided to this child’s caregiver who sometimes finds they need to hit/spank/shake their child? Yes No Documentation Question Title * 10. Was there documentation of counseling provided to this child’s caregiver who sometimes finds they get so angry they need to yell/scream at their child? Yes No Documentation Question Title * 11. Was there documentation of counseling provided to this child’s caregiver who sometimes finds they have been afraid of their partner? Yes No Documentation Question Title * 12. Was there documentation of counseling provided to this child’s caregiver who often feels that their child is difficult to take care of? Yes No Documentation Question Title * 13. Was there documentation of counseling provided to this child’s caregiver who wishes that they had more help with their child? Yes No Documentation Question Title * 14. Was there documentation of counseling provided to this child’s caregiver who often feels under extreme stress? Yes No Documentation Question Title * 15. Was there documentation of screening for Maternal Depression? Yes No Question Title * 16. If a screening tool was used for Maternal Depression, which tool: PHQ2 PHQ9 Edinburgh Did not screen for maternal depression Other (please specify the maternal depression screening tool used): Question Title * 17. If the rescreening result was positive, was there documentation of: Counseling Provided Referral Made No Documentation of Either N/A - screen was negative N/A - did not screen for maternal depression Question Title * 18. Some types of furniture have the potential to tip over when a child pulls on it or attempts to climb it (dressers, TV’s). Was there documentation of counseling provided to this child’s caregiver that all such pieces of furniture in their home should be secured to the wall? Yes No Documentation Question Title * 19. Was there documentation of counseling provided to this child’s caregiver about using safety gates to protect their child at the top and bottom of all stairways in their house? Yes No Documentation Question Title * 20. Was there documentation of counseling provided to this child’s caregiver about having the child restrained while riding in a car? Yes No Documentation Question Title * 21. Was there documentation of counseling provided to this child’s caregiver on the proper seat and direction (back seat, facing backward until 2 years of age or forward facing between 2-4 years) that a child should ride when in a car? Yes No Documentation Question Title * 22. Was there documentation of counseling provided to the child’s caregiver that they should use a car safety seat in the car - on every trip and at all times? Yes No Documentation Question Title * 23. Was there documentation of counseling provided to this child’s caregiver about having the car seat installed - or checked - by a healthcare (e.g., nurse, firefighter) or law enforcement professional? Yes No Documentation Question Title * 24. Was there documentation of providing the phone number for Poison Control? Yes No Documentation Question Title * 25. Was there documentation of counseling provided to this child’s caregiver about having all vitamins and medications in their home either in locked storage OR out of the reach of children? Yes No Documentation Question Title * 26. Was there documentation of counseling provided to this child’s caregiver about having all potentially harmful household cleaners and pesticides either in locked storage OR out of the reach of children? Yes No Documentation Question Title * 27. Was there documentation of counseling provided to this child’s caregiver about having guns in the home in locked storage AND unloaded? Yes No Documentation Question Title * 28. Was there documentation of counseling provided to this child’s caregiver about taking a course in child lifesaving techniques within the past 3 years? Yes No Documentation Question Title * 29. Was there documentation of counseling provided to this child’s caregiver about making sure small objects (like toy parts, coins, watch batteries, & small pieces of food) are out of reach? Yes No Documentation Question Title * 30. Was there documentation of counseling provided to this child’s caregiver about any situations in which they would consider leaving their child alone in a tub - with or without an infant tub seat? Yes No Documentation Question Title * 31. Was there documentation of counseling provided to this child’s caregiver about not allowing their child to ever swim unsupervised with - or without - some type of flotation device? Yes No Documentation Question Title * 32. Was there documentation of counseling provided to this child’s caregiver about having a smoke detector for their home? Yes No Documentation Question Title * 33. Was there documentation of counseling provided to this child’s caregiver about having the hot water heater in their house adjusted to less than 120 degrees? Yes No Documentation Question Title * 34. Was there documentation of counseling provided to this child’s caregiver about not holding their child while drinking hot liquids (e.g., while standing, sitting, or walking)? Yes No Documentation Question Title * 35. Was there documentation of counseling provided to this child’s caregiver about having a carbon monoxide detector in their home? Yes No Documentation Done