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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 D: Quality Assurance
Program Assessment Form: Support Group Facilitator |
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TITLE: ________________ FACILITATOR: _________________
REVIEWER: ______________________
DATE: _____________
DIRECTIONS: Check the appropriate columns to indicate degree to which the
facilitator met performance 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 |
INTRODUCTIONS
- Introduces self by name and title.
- Facilitates introductions and stresses confidentiality among group members.
- Clearly states purpose, goals, objectives, and ground rules for session.
- Allows members to share their expectations from the group.
- Starts group at or within 10 minutes after starting time.
- Attends to group members' physical comfort.
- Makes required administrative announcements.
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| COMMENTS:
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GROUP FACILITATION
- Assures maintenance of group structure and schedule by promoting adherence to rules and guidelines.
- Guides members through group processes, e.g., group dynamics.
- Asks open-ended questions.
- Maintains focus of discussion.
- Synthesizes and abstracts pertinent information.
- Creates opportunities for questions, comments, clarifications, and expressions of opinions and feelings.
- Makes appropriate referrals and interventions, as needed.
- Provides members with educational materials and information to substantiate discussion.
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PROFESSIONAL PRESENCE
- Dresses in suitable attire.
- Remembers and uses names of group members, as appropriate.
- Is tactful when discussing controversial topics.
- Imparts attitudes and information consistent with agency goals and policy.
- Avoids careless or inappropriate use of slang words.
- Handles unexpected or difficult disclosures with minimal display of value
judgement, embarrassment, or confusion.
- Makes positive and tactful corrective statements.
- Acknowledges contrary viewpoints.
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PROCESS SKILLS
- Uses descriptive and reinforcing gestures.
- Maintains eye contact with group members.
- Speaks in vernacular that is germane to group.
- Clearly enunciates and projects voice.
- Sets stage for group session.
- Encourages all group members to be involved in activities.
- Listens actively.
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CONCLUSION
- Brings group to closure in a tactful manner.
- Summarizes group session.
- Reviews session objectives with group members.
- Helps group identify further human or material resources.
- Remains available for group members' questions and comments after the session.
- Uses a tool to assess participants' satisfaction with session and group impact.
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| COMMENTS:
COMMENTS ON CONCLUSION:
GROUP RESPONSE TO FACILITATOR:
OVERALL SUGGESTIONS AND REMARKS:
FACILITATOR'S COMMENTS AND SIGNATURE: |
Go to Appendix E |
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