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 references in the Table of Evidence.
3. If service components are provided to persons and families 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; f) average monthly number of clients served; and g) directions or a map to each program site from the main organization office
- A demographic profile of persons and families 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
- As applicable, a list of groups or classes including, for each group or class: a) the type of activity/group; b) whether the activity/group is short-term or ongoing; c) how often the activity/group is offered; d) the average number of participants per session of the activity/group, in the last month; and e) the total number of participants in the activity/group, 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. Note: Program outputs may include consumer satisfaction, number of clients served, number of visits, timeliness of assessments, etc.
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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CRI 1
Access to Services |
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- Outreach strategies and informational material
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- Program director
- Relevant personnel
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CRI 2
Screening and Assessment |
- Screening procedures
- Risk assessment tool and/or criteria included in assessment
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- Program director
- Relevant personnel
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CRI 3
Quality of Services |
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- Data on service use
- Procedures for evaluating referral resources
- Reviews for two most recent quarters
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- Program director
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CRI 4
Service Philosophy |
- Include Service Philosophy in Service Narrative Part 1: Program Information
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- Program director
- Relevant personnel
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CRI 5
Community Connections and Coordination |
- Service coordination procedures
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- Written service agreements, as necessary
- Community database
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- Program director
- Relevant personnel
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CRI 6
Crisis Intervention Services |
- Include description of crisis intervention services in Service Narrative Part 1: Program Information
- Crisis response procedures
- Treatment and referral procedures
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- Coverage schedules for a recent three-month period
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- Program director
- Relevant personnel
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CRI 7
Crisis Hotline and Information and Referral Services |
- Include description of crisis hotline and information and referral services in Service Narrative Part 1: Program Information
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- Database of community resources
- Procedures for evaluating and summarizing community needs
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- Program director
- Relevant personnel
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CRI 8
Crisis Hotline Services: Additional Requirements |
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- Coverage schedules for a recent three month period
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- Program director
- Relevant personnel
- Observe hotline operations including back up answering and dispatch system
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CRI 9
Personnel: Crisis Intervention Services and Crisis Hotline Services |
- name
- title
- degree held and/or other credentials
- FTE or volunteer
- length of service at the organization
- time in current position
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- Formal agreements with necessary professionals, as applicable
- Job descriptions
- Documentation of training
- Training curricula
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- Program director
- Relevant personnel
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CRI 10
Personnel: All Services |
- Program staffing chart that includes lines of supervision
- List of program personnel that includes:
- name
- title
- degree held and/or other credentials
- FTE or volunteer
- length of service at the organization
- time in current position
- The table of contents of training curricula
- Procedures and criteria used for assigning and evaluating workload
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- Documentation of training
- Job descriptions
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- Program director
- Relevant personnel
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