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LEGEND:
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Link to a PDF document |
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Link to non-governmental site and does not
necessarily represent the views of the CDC |
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Appendix B: Quality Assurance
Program
Assessment Form: Street and Community Outreach |
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OUTREACH SPECIALIST: ______________________
REVIEWER: ______________________
DATE: _____________
DIRECTIONS: Check the appropriate columns to indicate degree to which the outreach
specialist met criteria:
EXCELLENT indicates that performance met criteria beyond fully successful.
FULLY SUCCESSFUL indicates performance met criteria successfully.
NEEDS ATTN indicates performance needs supervisory guidance to meet criteria.
N/A indicates this criteria did not apply to this situation.
Check only within and not between the boxes. If undecided, use "comments" section to clarify.
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EXCELLENT |
FULLY
SUCCESSFUL |
NEEDS
ATTN |
N/A |
STAFF
- Staff respects client's privacy and confidentiality at all times.
- Staff is trained and experienced in health education.
- Staff is sensitive to community norms, values, cultural beliefs, and traditions.
- Staff advocates for the population served.
- Staff acts as liaison between the community and agency.
- Staff is representative of the population served.
- Staff is informed about community resources and is able to use them.
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PROGRAM
- Program proposes realistic, measurable, and attainable goals and objectives.
- Program identifies specific methodologies and activities to achieve stated goals and objectives.
- Program defines target population by geographic locale, risk behavior(s), gender, sexual orientation, and race and ethnicity.
- Program ensures adequate supplies of appropriate and relevant risk-reduction materials before conducting outreach activities (e.g., pamphlets, condoms, bleach, sexual responsibility kits).
- Program includes observation of potential outreach areas to determine the locations, times of day, and the day of the week that are most productive for reaching the population to be served.
- Program has regular and consistent hours for outreach activities.
- Program facilitates professional development of program staff.
- Program has a comprehensive and written field safety protocol.
- Program has a written policy and personnel procedures to address stress, burn-out, and relapse among staff.
- Program has written procedures for the referral of clients to appropriate services outside the agency.
- Program has long-range plans for the continuation of services.
- Program establishes and maintains a relationship between the agency and other local authorities.
- Program identifies and develops collaborative relationships with relevant gatekeepers (key informants) to the target population.
- Program coordinates intervention services with identified gate-keepers.
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EVALUATION
- Evaluation plan includes process evaluation measures.
- Evaluation plan has consistent, accurate data collection procedures.
- Evaluation plan includes staff supervision, observation, and feedback on a regularly scheduled basis.
- Evaluation plan provides findings for program modifications, as appropriate.
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TRAINING
- Training plan defines staff roles, duties, and responsibilities.
- Training plan includes staff orientation to the agency (organization) and the community served.
- Training plan includes ongoing staff professional development.
- Training plan uses role play, observation, and feedback.
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| COMMENTS:
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Go to Appendix C
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