Family Response evaluation
FAMILY RESPONSE DATA COLLECTION INSTRUCTIONS
Collect and submit client service documentation, including Crisis Assessment Tools and safety plans
We will collect documentation for each youth/family served through the Family Response program. Documentation will include records maintained by Family Response staff between referral and discharge, along with results from the Crisis Assessment Tool and a copy of the safety plan completed for each youth/family.
|Submission date||Period covered||Submission date||Period covered|
|January 5||November-December||July 5||May-June|
|February 5||December-January||August 5||June-July|
|March 5||January-February||September 5||July-August|
|April 5||February-March||October 5||August-September|
|May 5||March-April||November 5||September-October|
|June 5||April-May||December 5||October-November|
MONTHLY SERVICE DATA VARIABLE LIST
Upload monthly service data (or email file to email@example.com)
Upload individual Crisis Assessment Tool and/or safety plan (if not already included in monthly tracking file)
Enter Crisis Assessment Tool responses (if not already included in monthly tracking file)
Collect 30-day follow-up survey
Feedback from families should be collected 30-days post-discharge. Project staff can collect the information from each family using a variety of approaches based on convenience to staff and the family. Surveys can be completed via email or text, or completed over the phone.
Upload 30-day follow-up surveys (if not already included in monthly tracking file)
Enter the data for each 30-day follow-up as they are completed (if not already included in monthly tracking file)
Stabilization Services evaluation
STABILIZATION SERVICES DATA COLLECTION INSTRUCTIONS
EVALUATION TRAINING SLIDES (February 2023)
Collect consent forms
A signed consent form is needed in order for families to participate in the Stabilization Services discharge interviews. Please review the consent form with the family at intake, and answer any questions that they may have about the interview. Families may decline the interview if desired. Their choice to be interviewed or not does not impact any of the services that they will receive. A copy of the consent form should be submitted regardless of whether they have provided consent or declined.
Blank consent form: SUMMIT GUIDANCE, CHANGE INC., NEXUS-FACTS
Completed consent forms should be scanned or photographed and uploaded to Community Research Solutions within 7 days of intake.
Conduct baseline interviews with parents/ caregivers and submit intake data
SAMHSA requires some consistent information be collected at the time that a family enters Stabilization Services. The baseline interviews include some information about the youth/family background and presenting concerns. Some information is completed by the Stabilization Services provider on their own; other information is collected from the family.
INTAKE INTERVIEW QUESTION-BY-QUESTION GUIDE [NOTE: Questions in this guide may be in a different order than in the baseline interview]
All intake interviews should be completed and submitted to the evaluation team within 7 days of intake. There are two options for submitting this interview.
Option 1: Upload a completed copy of the intake interview.
Option 2: Manually enter the data for each intake interview as they are completed.
Submit discharge information
The discharge documentation provides information about the services received and notifies the evaluation team that a family has completed services.
All discharge summaries should be completed and submitted to the evaluation team within 2 days of discharge. There are two options for submitting this summary.
Option 1: Upload a completed copy of the discharge summary.
Option 2: Manually enter the data for each discharge summary as they are completed.
Collect 30-day follow-up surveys
Feedback from families should be collected 30-days post discharge. Project staff can collect the information from each family using a variety of approaches based on convenience to staff and the family. Surveys can be completed via email or text, or completed over the phone. If desired, the evaluation team can set up an online form for families to submit responses directly.
All completed 30-day follow-ups should be submitted to the evaluation team as completed. There are two options for submitting information:
Option 1: Complete the follow-up survey on paper and then upload a copy.
Option 2: Manually enter the data for each 30-day follow-up as they are completed.