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
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Self-Study Documents |
On-Site Documents |
On-Site Activities |
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PA-YIL 1
Access to Service and Support |
- Include in Service Narrative Part 1: Program Information description of agency’s work with community to promote service accessibility
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- Outreach strategies and informational materials
- List of community entities and agencies who are partners
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- Program director
- Relevant personnel
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PA-YIL 2
Service Philosophy |
- Include Service Philosophy in Service Narrative Part 1: Program Information
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- Program director
- Personnel
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PA-YIL 3
Youth Independent Living Casework |
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- Program director
- Relevant personnel
- Youth
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PA-YIL 4
Assessment |
- Assessment procedures
- Assessment tool and/or criteria
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- Qualifications of personnel who conduct assessments
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- Qualifications of personnel who conduct assessments
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PA-YIL 5
Service Plan |
- Service planning procedures including youth participation
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- Program director
- Relevant personnel
- Youth
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PA-YIL 6
Service Coordination for Youth with Special Needs |
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- Program director
- Relevant personnel
- Youth
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PA-YIL 7
Family, Community, and Workplace Connections |
- Include in Service Narrative Part 1: Program Information a description of family, community, and workplace resources and youth opportunities
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- Program director
- Relevant personnel
- Youth
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PA-YIL 8
Preparation for Community Membership |
- Include in Service Narrative Part 1: Program Information description of youth community involvement and decision making opportunities
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- Program director
- Relevant personnel
- Youth
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PA-YIL 9
Transition from the Service System |
- Transition activities list and planning procedures
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- Program director
- Relevant personnel
- Youth
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PA-YIL 10
Aftercare and Follow-Up |
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- Review contract with public authority, as applicable
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- Program director
- Relevant personnel
- Youth
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PA-YIL 11
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
- Average workload size per worker for the last month and criteria used to assign cases
- Supervisory ratios
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- Supervisors
- Personnel
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