Part 1: Program Information
Agencies 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.
Agencies being accredited for the first time: Please provide information for the last year.
Agencies 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 agency.
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 persons and families through contract in cooperation with other agencies 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 agency 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 agency 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 agency 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 agency 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 agency'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
 |
| |
|
Self-Study Documents |
On-Site Documents |
On-Site Activities |
 |
|
PA-FEC 1
Service Initiation |
- Screening, intake, and assessment procedures
- Procedures for telephone or internet counseling
- Procedures regarding DMP initiation
- Include description of service initiation in Service Narrative Part 1: Program Information
|
|
- Program director
- Relevant personnel
|
|
|
PA-FEC 2
Service Philosophy |
- Include Service Philosophy in Service Narrative Part 1: Program Information
|
|
- Program director
- Relevant personnel
|
|
|
PA-FEC 3
Information about Services |
- Privacy policy and disclosure statement
- Procedures regarding fees
|
|
- Program director
- Relevant personnel
- Clients
|
|
|
PA-FEC 4
Development of an Action Plan |
- Procedures for development of action plans
|
|
- Program director
- Relevant personnel
- Clients
|
|
|
PA-FEC 5
Financial Education and Counseling Services |
- Include description of services in Service Narrative Part 1: Program Information
- Financial counseling procedures
- Financial education materials provided to clients
- Program evaluations or other documents assessing the educational needs of the consumers and describing the agency's financial education and couseling services
|
- Educational program curricula
- Information about individual and group education and counseling
|
- Program director
- Relevant personnel
- Clients
|
|
|
PA-FEC 6
Housing Counseling and Education Services |
- Include description of services in Service Narrative Part 1: Program Information
- Housing counseling
- Housing education materials provided to clients
- Program evaluations or other documents assessing the educational needs of the consumers and describing the agency's housing counseling and education services
|
- Educational program curricula
- Information about individual and group counseling and education programs including program dates, subjects, number of participants, and participant evaluations
|
- Program director
- Relevant personnel
- Clients
|
|
|
PA-FEC 7
Debt Management Plans |
- DMP procedures
- Sample copy of the "Agreement for Services," "DMP Agreement," or other document that highlights client disclosures
|
|
- Program director
- Relevant personnel
- Clients
|
|
|
PA-FEC 8
Administration of the Debt Management Plan |
- debt management
- proposal letters
- development of client status reports
- discontinuation of DMPs
|
- Client status reports
- Procedures or sample agreement for services related to the impact of increasing frequency of client deposits
|
- Program director
- Relevant personnel
- Clients
|
|
|
PA-FEC 9
Responsible Management of Client Funds |
- Procedures regarding segregation and deposit of client funds
- Procedures for maintaining credit balances in accord with legal requirements
|
|
- Program director
- Relevant personnel
- Clients
|
|
|
PA-FEC 10
Creditor Relations |
- Procedures for providing creditor information about agency practice
- Procedures for informing and communicating with creditors
|
- Financial records
- Procedures that describe how the agency notifies creditors when clients discontinue DMPs
- Written information that describes fair share contributions
|
- Program director
- Relevant personnel
- Clients
|
|
|
PA-FEC 11
Referrals and System Collaborations |
|
|
- Program director
- Relevant personnel
- Clients
|
|
|
PA-FEC 12
Client File Review |
|
- Documentation of client file review
|
- Program director
- Relevant personnel
|
|
|
PA-FEC 13
Truth in Marketing |
- Provide information given to consumers
|
|
- Marketing personnel
|
|
|
PA-FEC 14
Business Ethics |
- Policy regarding financial incentives and penalties
- Referral policy
- Policy regarding client loans and debt
|
|
- Program director
- Relevant personnel
|
|
|
PA-FEC 15
Personnel |
- name
- title
- degree held and/or other credentials
- FTE or volunteer
- length of service at the agency
- time in current position
- Table of contents of training curricula
- Procedures and criteria used for assigning and evaluating workloads
|
- Documentation of training
- Training curricula
- Job descriptions
- Documentation of workload assessment
|
- Supervisors
- Personnel
|
|
| |
|
| |