OMB # XXXX-XXXX
Exp. XX/XXXX
GRANTEE SURVEY
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)
Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.
NOTE: Some open-ended questions may be coded by interviewer to categorize answers (e.g., question # 5).
What is [name of agency] mission/goal?
Including your TLP program, how many programs does the agency operate? What types of programs are they? [e.g., street outreach, emergency shelter, employment program, permanent supportive housing, etc.]
What is the agency’s total annual budget? What percent of total budget is represented by the FYSB TLP grant?
What is the agency’s total number of full-time and part-time staff?
How would you describe your program’s approach to preparing youth to live independently and how is this approach reflected in your activities?
In some communities, agency’s serving homeless youth have organized themselves into a service continuum in which each agency serves a particular role or roles. Is this the case in your community? If so, please describe. [Probe for agency’s role in continuum, if not described.]
What is the total number of beds and units in the program? [Use RHYMIS data to complete columns 3-5 and confirm data with program:
Total # of beds |
Total # of units |
Total # of youth served (annually) |
Total # of exits (annually) |
Average length of stay |
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What criteria must youth meet to be eligible for the program? [Probe for age range, gender.]
Does the program serve a particular group of youth, such as migrant youth, immigrant youth, or minority youth (e.g., Native American youth)?
Does the agency partner or collaborate with any other organizations or health professionals to deliver services to youth?
Can you please describe the facility and how youth are physically accommodated?
Residents share bedrooms in one facility. Probes: How many residents per room?
Does each room have an adjoining bathroom?
Each resident has a private room in one facility. Probe: Does each room have a private bathroom?
Residents have own apartments in one building. Probe: Do residents have apartments in one building?
Residents have shared apartments in one building. Probes: What size units?
How many youth per unit?
Scattered site apartments (residents are placed in apartments in various buildings/neighborhoods). Probes: Are youth clustered in certain buildings? How many in each building?]
Host family homes. Probe: Do youth stay in host family homes?
Other types?
Do youth pay rent? Security deposit? If so, how much? [probe for whether youth pay a percentage of their income and what this percentage is]
Do youth sign a lease or housing agreement? If so, who is the lease/housing agreement with?
We already talked about the program eligibility criteria. Are there any other criteria that youth must meet in order to be admitted into the program? [Probe for any requirements regarding employment; education; length of sobriety; mental health treatment adherence, pregnancy, completion or participation in program separate from TLP.]
Does the program maintain a waiting list? If so:
How many youth are currently on the list?
How are youth on the list prioritized?
What steps are involved in the application process?
Must youth submit a written application? If so, what does this entail? Can we have a copy of the application?
Do youth have to complete any assessments (e.g., drug screening/assessment, mental health assessment)? If so, what assessment tools are used [probe for full name of each instrument]?
Is any sort of documentation required (e.g. identification, proof of income/savings, references)?
Of youth who complete the application process, what percentage is usually accepted into the program?
Once youth are accepted into the program, are there additional assessments that are conducted? If so, what are they and what do they entail? [probe for full title of instruments] And, how often are they given?
Service delivery
Is there 24-hour supervision of youth?
Overall, is the program characterized by group service delivery, individual services, or a combination of both?
To get as complete a picture as possible of the program, I’m going to ask you to list all the services provided by the program and then I’ll ask a series of questions about each service [refer to and complete addendum 1]. What services are provided as a part of [name of TLP program]?
What, if any, aftercare services are provided to youth who exit the TLP program? If yes, please describe. [Probe for frequency and duration of services.]
Do all exiting youth receive aftercare services? What is the process for determining who will receive aftercare services and what these services will be?
Do youth typically continue to be involved in other agency services following exit from the TLP? If so, what services?
Is there a school on site?
Service/action plans
We’d like to understand more about the service planning process that guides the delivery of services for each youth.
What areas does the service plan cover?
How is progress toward service plan goals and objectives/action steps monitored and tracked?
How are youth involved in the service plan?
Do youth have chores within the residential community [or say responsibilities within the residential community]? If so, how are they determined and what types of chores [responsibilities] are they? What happens when a youth fails to complete a given chore [follow through on a given responsibility]?
FYSB’s positive youth development philosophy emphasizes the importance of youth’s involvement in program development and decision making. In what ways are youth involved in program design, implementation, and governance/decision making? [Probe for whether there is a youth advisory committee; resident constitution or peer covenant; whether TLP youth are involved in service delivery within the agency.]
Are there specific strategies that the program employs to foster a sense of community among participants? If so, please describe.
What, if any, rules must a youth follow while staying at the TLP?
What happens when a youth fails to adhere to a given rule [probe for whether the program utilizes therapeutic time outs]?
Is there a grievance procedure for youth who feel unfairly treated?
Are there any incentives/rewards for a youth who follows the rules at the TLP?
What are the incentives and/or how do they work?
How does the program define a safe exit?
What criteria are used to determine when a youth has successfully completed the program and is ready to be discharged?
What support or services are provided to youth in preparing for discharge?
What type of follow-up is provided?
What techniques have been successfully utilized to maintain contact with the youth?
Are there factors that seem to contribute to a youth’s likelihood of success, or the likelihood that they will exit to a safe housing location? If yes, please describe?
Are there factors that seem to increase the likelihood that youth will become homeless again or leave the program without completing it?
Youth struggles with mental health issues
Youth struggles with substance abuse addiction
The program rules are too strict for the youth
There are a lack of educational/social support/vocational resources in the area
Limited public transportation is a challenge for youth to get to work each day
Other (please describe)
What services or aspects of the program do you feel most contribute to positive youth outcomes?
Clear code of conduct with consistent enforcement
The role of staff and leadership, including building connections between youth and adults
Service plans for youth
Experiential learning opportunities
Collaboration with other agencies to provide services to youth after they leave the program
Aftercare services
Other (please describe)
| File Type | application/msword |
| File Title | AGENCY OVERVIEW [ED] |
| Author | Daria Zvetina |
| Last Modified By | Julie E. Hocker |
| File Modified | 2009-04-22 |
| File Created | 2009-04-07 |