Part 1: Program Information
Organizations may complete one template for all programs, or a separate template that addresses each program being reviewed under this section. Provide responses in the boxes located in the Service Narrative template.
Organizations being accredited for the first time: Please provide information for the last year.
Organizations being reaccredited: Please provide information for the period since the last accreditation review.
1. Describe any significant changes, challenges, awards received, changes in funding, or obstacles faced by the organization.
2. Provide an overview of the different program(s) being accredited under this section. The overview should describe:
- the programs' service philosophy and approach to delivering services;
- eligibility criteria;
- any unique programs or special services provided to specific populations;
- major funding streams; and
- any additional information referenced in The Table of Evidence.
3. If service components are provided to individuals through contract in cooperation with other organizations or through a formal, coordinated service delivery system provide a list that identifies the providers and the services for which they are responsible. Do not include services provided by referral.
4. Provide any other information your organization would like the peer review team to know about these programs.
Attachments
- A list of all program sites, including the following information for each program site: a) name of program/site director; b) address; c) phone number; d) hours of operation; e) number of FTEs; and f) directions or a map to each program site from the main organization office
- A demographic profile of persons served by the program(s) being reviewed under this service section with percentages representing the following: a) racial and ethnic characteristics; b) gender; c) age; d) major religious groups; and e) major language groups. Include an explanation of how the program ensures that it is providing culturally competent services
- A list that includes: a) the average number of participants per session (e.g., morning session, after-school session, etc.) for each program, in the last month; and b) the total number of participants per session for each program, in the last month
- A list of any programs that were opened, merged with other programs or services, or closed
- Two quarterly reports from the case record review process conducted for this service, with any related corrective action plans (See PQI 4.02/4.03)
- Two quarterly reports of accidents, incidents, and grievances related to this service (See RPM 2.02)
- All COA-approved NA Requests
- A list of all NAs applicable to your organization provided within the standards
Part 2: Program Outputs and Outcomes
Provide a response in each box describing how the program is making progress toward achieving its aims, and achieving better results for participants.
1. A summary of where the organization is in the development of its program for measuring program quality and outcomes, specific to the service.
2. A list or description of program outputs and desired outcomes and any outputs and outcomes being measured including measurement tools used.
3. An overview of the organization's process for analyzing data.
4. Examples of program improvements made based on the outcomes data.
Attachments
- Outcomes measurement/data collection procedures
- Outcomes results reported for the previous two quarters
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Self-Study Documents |
On-Site Documents |
On-Site Activities |
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YD 1
Outreach and Program Accessibility |
- Include description of outreach efforts in Service Narrative Part 1: Program Information
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- Outreach strategies and informational materials
- Copies of programming information made available to youth and families
- Attendance policies
- Program hours of operation
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- Program Administrator
- Site Director
- Program Personnel
- Youth and families
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YD 2
Program Philosophy |
- Include description of program philosophy in Service Narrative Part 1: Program Information
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- Program Administrator
- Site Director
- Program Personnel
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YD 3
Registration and Orientation |
- Include description of orientation procedures in Service Narrative Part 1: Program Information
- Policies and/or procedures for maintaining and accessing files of youth
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- Waiting list
- Informational materials provided to youth and families
- Registration or admission form
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- Program Administrator
- Site Director
- Program Personnel
- Youth and families
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YD 4
Building Healthy Relationships Between Youth and Adults |
- Include description of how personnel support youth and promote positive relationships in Service Narrative Part 1: Program Information
- Include description of how youth are involved in programming decisions in Service Narrative Part 1: Program Information
- Policies and/or procedured regarding enrolling and serving youth with special needs
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- Program Administrator
- Site Director
- Program Personnel
- Youth and families
- Review files of youth
- Observe staff interactions with youth
- Observe facility
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YD 5
Promoting Positive Behavior and Healthy Peer Relationships |
- Include description of how the program promotes positive behavior and healthy peer relationships in Service Narrative Part 1: Program Information
- Policies and/or procedures regarding youth with special behavioral needs or issues
- Policies for prohibited interventions
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- Program rules and behavioral expectations
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- Program Administrator
- Site Director
- Program Personnel
- Youth and families
- Review files of youth
- Observe youth interactions with staff and peers
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YD 6
Programming and Activities |
- Include description of programing and activities in Service Narrative Part 1: Program Information
- Include description of how youth are involved in developing, planning, and implementing activities in Service Narrative Part 1: Program Information
- Daily schedules for past month for all program components
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- Program curricula and/or lesson plans (for previous quarter)
- Program planning materials
- Permission slips or documentation indicating that permission slips have been obtained
- Attendance records (showing totals for each day and weekly averages)
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- Program Administrator
- Site Director
- Program Personnel
- Youth and families
- Review files of youth
- Observe facility
- Observe program activities
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YD 7
Indoor Environment |
- Include description of indoor environment in Service Narrative Part 1: Program Information
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- Program Administrator
- Site Director
- Program Personnel
- Youth and families
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YD 8
Outdoor Environment |
- Include description of outdoor environment in Service Narrative Part 1: Program Information
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- Program Administrator
- Site Director
- Program Personnel
- Youth and families
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YD 9
Nutrition, Health, and Safety |
- Menus (for previous month)
- Hygiene procedures, including expectations for hand washing
- Procedures for meeting health needs and minimizing risk of exposure to contagious or infectious disease
- Procedures for maintaining cleanliness and safety in the indoor and outdoor space
- Table of contents of emergency response training for youth, or include description of training in Service Narrative Part 1: Program Information
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- Menus (for previous quarter)
- Accident, injury, and illness reports
- Record of fire drills held
- Smoking policy
- Computer usage policies and procedures
- Training curricula and/or information on computer usage provided to youth and staff
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- Program Administrator
- Site Director
- Program Personnel
- Youth and families
- Review files of youth
- Observe snack and/or meal time
- Observe facility
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YD 10
Family Connections |
- Include description of family involvement in Service Narrative Part 1: Program Information
- Table of contents of handbook for families
- Policies and/or procedures regarding family involvement
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- Handbook for families
- Program information on activities and events for past quarter made available to families
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- Program Administrator
- Site Director
- Program Personnel
- Youth and families
- Review files of youth
- Observe arrivals and departures
- Observe staff interactions with families
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YD 11
Community Involvement and Partnerships |
- Include description of collaboration efforts in Service Narrative Part 1: Program Information
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- Documentation of collaboration efforts and activities that connect youth with their community
- List of community partners and resources
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- Program Administrator
- Site Director
- Program personnel
- Youth and families
- Program host, if applicable and possible
- School personnel, if applicable and possible
- Observe interactions between staff and program host where applicable and possible
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YD 12
Supervision |
- Include description of how the program ensures adequate and appropriate supervision at all times, and in all activities, in Service Narrative Part 1: Program Information
- Program ratio
- Staff coverage schedule (for previous quarter)
- Procedures or plan for coverage during absences or emergencies
- Procedures governing arrivals and dismissals
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- Policies and/or procedures governing one-on-one interactions between staff and youth
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- Program Administrator
- Site Director
- Program Personnel
- Youth and families
- Review files of youth
- Observe arrivals and dismissals
- Observe program supervision at different times of day and during different activities
- Observe facility
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YD 13
Personnel Qualifications |
- List of program personnel that includes:
- name;
- job title;
- degree held and/or other credentials;
- professional preparation;
- FTE or volunteer;
- length of service at the organization;
- time in current position
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- Program Administrator
- Site Director
- Program Personnel
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YD 14
Personnel Training and Support |
- Include description of how organization provides a positive work environment and promotes positive work conditions, in Service Narrative Part 1: Program Information
- Table of contents for orientation curriculum
- Table of contents for training curricula
- Program staffing chart that includes lines of supervision (including supervision of volunteers)
- Policies and/or procedures regarding the use of volunteers; including training, supervision, and recognition efforts
- Procedures and criteria used for assigning and evaluating workloads
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- Orientation curriculum
- Training curricula
- Orientation and training materials for volunteers
- Training requirements for different positions or job categories
- Documentation that required orientations and trainings have been attended (e.g., documentation from training files or personnel records)
- Documentation demonstrating that personnel are provided with paid time to plan, set up, etc.
- Documentation of benefits provided
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- Program Administrator
- Site Director
- Program Personnel
- Volunteers
- Review personnel records
- Review volunteer files or records
- Observe staff interactions
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