Attachment J1 – TLP Grantee Program Overview Survey
TLP Program Overview Survey
Thank you for taking the time to complete this survey. This survey
is intended for research purposes ONLY. The information you
share will help us to better understand how TLPs work with youth.
The information reported is strictly confidential and will in no way
affect HHS’s view of your program’s performance. The
responses to the survey will be kept anonymous: neither the
respondent nor the agency will be identified by name when we report
findings from the study.
The TLP Objectives Program Survey is designed to gather information about your TLP program, such as who it serves, how it is structured, and what services it provides. TLP programs differ with regard to how they are funded and structured. In some cases, an agency’s FYSB TLP grant covers the entire cost of the program. In others, agencies combine multiple sources of funding to support their program, with FYSB funding used to cover a portion of the program’s beds, units, or services. In this survey, we want to understand the design and functioning of the program as a whole, not just those beds or services funded through your FYSB TLP grant.
General Program Information
1) How long has the TLP program been in existence?
Less than 1 year
1 to 5 years
6 to 10 years
More than 10 years
2) Where does the TLP program receive funding? (Check all that apply)
Federal government
State government
Tribal/local government
Community organizations
Non-profit organizations
Faith-based organizations
Private foundations
Citizen donations
Other: _____________________________________________________________________
Other: _____________________________________________________________________
3) What is the agency’s total annual budget (from all sources)?
4) What is the budget for the TLP program (from all sources)?
5) What is the total amount of FYSB TLP grant?
6) Including the TLP program, how many programs does the agency operate?
6a) What types of programs are they? (Check all that apply)
TLP
Emergency shelter program
Permanent supportive housing program
Basic center program
Drop-in program
Street outreach program
Employment program
Education program
Health/medical service program
Substance abuse program
Homelessness Prevention and/or Rapid Re-Housing
Other: _____________________________________________________________________
Other: _____________________________________________________________________
Staffing
7) In total, how many of the TLP’s workers are paid employees, either full time or part-time?
8) How many paid workers does the TLP have in each of the following categories?
Management
Direct care or service
Street outreach
Residential service
Case management
Administrative
Other: _____________________________________________________________________
Other: _____________________________________________________________________
9) In total, how many of the TLP’s workers are volunteers?
10) How many volunteers does the TLP have in each of the following categories?
Management
Direct care or service
Street outreach
Residential service
Case management
Administrative
Other: _____________________________________________________________________
Other: _____________________________________________________________________
11) How many members of your staff, both paid and volunteer, hold any of the following degrees, licenses, or certifications?
Associate’s degree
Bachelor’s degree in Social Work (BSW)
Bachelor’s degree in another field
Master’s degree in Social Work (MSW)
Master’s degree in another field
Doctorate in Social Work (DSW or Ph.D)
Doctorate in another field or other professional degree (e.g., J.D. or M.D.)
Licensed Clinical Social Worker (LCSW)
Credentialed by the Academy of Certified Social Workers (ACSW)
Credentialed by the Qualified Clinical Social Workers (QCSW)
Credentialed by the Diplomate in Clinical Social Work (DCSW)
Other post-secondary degree
Other certification
12) Would you say the demographic composition of TLP staff and volunteers is mostly similar to, or mostly different from, the composition of the homeless youth served in terms of:
Race/ethnicity
Gender
Sexual orientation
Languages spoken
Youth Served
13) What was the total number of youth served by the TLP in the last fiscal year?
14) What was the total number of youth who exited the TLP in the last fiscal year?
15) During the last fiscal year, what is the average age of youth when they enter the TLP?
16) What is the age range of youth served in your TLP program (e.g., 16 – 21)?
17) Does the TLP target a particular population of youth? (Check all that apply)
None
Pregnant youth
Couch surfers
Doubling-up
Employed but homeless
Parenting youth
GLBTQ youth (Gay, Lesbian, Bisexual, Transgender, Questioning)
Youth leaving foster care
Youth leaving the juvenile justice system
ESL or non-English speaking youth
Migrant youth (i.e., youth who move regularly in order to find work, especially in harvesting crops)
Youth who have been physically abused
Youth with substance use or abuse problems
Physically challenged/disabled youth
Mentally challenged youth
Immigrant youth (i.e., youth who move to the United States from another country)
Minority youth (If yes, check all that apply)
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Other: _____________________________________________________________________
Other: _____________________________________________________________________
Eligibility and Admission
18) What are the criteria for eligibility to the TLP? (Check all that apply)
Must be male
Yes No
Must be female
Yes No
Must be homeless, according to HHS definition [link to definition]
Yes No
Must be pregnant or parenting
Yes No
If substance abuse history, must be clean and sober
Yes No
If substance abuse history, must be in treatment
Yes No
Must have no serious mental health history/acute symptomatology
Yes No
If mental health diagnosis, must be in treatment
Yes No
Must be employed
Yes No
Must be enrolled in high school, if not yet graduated
Yes No
Other (describe): ___________________________________________________________
Other (describe): ___________________________________________________________
19) What steps are involved in the TLP application process?
Program orientation meeting
Yes No
Written application
Yes No
Document the youth’s identity
Yes No
Written references
Yes No
Application interview
Yes No
Psycho-social assessment or history
Yes No
Mental health assessment
Yes No
Physical health assessment
Yes No
Substance use assessment
Yes No
Urine drug screening
Yes No
Documentation of meaningful daily activity
Yes No
Documentation of school enrollment
Yes No
Documentation of employment
Yes No
Development of preliminary goals/action plan
Yes No
Permission of parent/guardian (for youth under 18)
Yes No
Other (describe): ___________________________________________________________
Other (describe): ___________________________________________________________
20) What are the main program rules that participants must follow?
Weeknight or Weekend Curfew
Yes No
If yes, please check those that apply.
Weeknight curfew is:
8:00 pm
9:00 pm
10:00 pm
11:00 pm
12:00 pm
1:00 am
2:00 am
3:00 am
4:00 am
no weeknight curfew
Weekend curfew is:
8:00 pm
9:00 pm
10:00 pm
11:00 pm
12:00 pm
1:00 am
2:00 am
3:00 am
4:00 am
Visitor restrictions
Yes No
If yes, please describe who can visit, when, and for how long:
Who?:
When?:
For How Long?:
No weapons
Yes No
No alcohol or drugs on program property
Yes No
Submit to random drug screening
Yes No
No smoking on program premises
Yes No
No threatening or violent behavior toward staff or residents
Yes No
No sexual activity between residents on premises
Yes No
Cell phone restrictions
Yes No
Searching of youth property by staff
Yes No
No borrowing/lending of possessions among youth
Yes No
Complete chores/cleanliness requirements
Yes No
Savings or budgeting requirement
Yes No
Other (describe): ________________________________________________________
Other (describe): ________________________________________________________
Other (describe): ________________________________________________________
21) Once enrolled in the TLP, what requirements must youth meet and maintain to participate in the program? (Check all that apply)
Attend high school/GED classes
Yes No
Acquire and maintain employment
Yes No
Place percentage of earnings in savings account
Yes No
Pay rent to the program
Yes No
Other (please describe): _____________________________________________________
Other (please describe): _____________________________________________________
Other (please describe): _____________________________________________________
22) Are there any rule violations that result in an immediate discharge? Yes No
If yes, what are they? (Check all that apply)
Fighting/assaulting on premises
Yes No
Destroying property
Yes No
Possession of weapon
Yes No
Pregnancy
Yes No
Substance use on premises
Yes No
Positive drug test
Yes No
Verbal aggression
Yes No
Other (please describe): _____________________________________________________
Other (please describe): _____________________________________________________
23) If immediate discharge is not mandatory, what other types of sanctions are applied to youth who violate program rules? (Check all that apply)
Stricter curfew
Required sign-in sheet
More housekeep duties/chores
Temporary suspension from residency program (e.g., time-out)
Loss of privileges
Other (please describe): _____________________________________________________
Other (please describe): _____________________________________________________
24) Is there an appeals or mediation process for youth who are at risk of being involuntarily discharged from the program?
Yes No
25) Are respites (or “time outs”) used for reasons other than punitive (e.g., the youth’s motivation declines considerably)?
Yes No
Program Structure
26) What is the total number of TLP beds?
27) What type of physical accommodations are available to TLP youth? (check all that apply)
Residents live in host family homes
Yes No
Residents share bedrooms in group home with house parents
Yes No
Residents have private bedrooms in group home with house parents
Yes No
Residents share bedrooms in one facility (no house parent)
Yes No
Residents have private bedrooms in one facility (no house parent)
Yes No
Residents share apartments, units clustered in one building (no house parent)
Yes No
Residents have private apartments, units clustered in one building (no house parent)
Yes No
Residents share scattered-site apartments (no house parent)
Yes No
Residents have private scattered-site apartments (no house parent)
Yes No
Other: _____________________________________________________________________
[If more than one physical accommodation is checked for Question 27, please answer Question 28. If only one answer is checked, please skip to Question 29.]
28) Does the TLP have a phased approach to housing in which youth move from more supervised accommodations (e.g., group homes) to less supervised accommodations (e.g., own apartments) as they move through the program?
Yes
No
If yes, please indicate this progression by ranking the housing options available in the program from the most supervised accommodation to the most independent. (For instance, if you have three types of housing accommodations, 1= most supervised, 2 = less supervised, 3= greatest level of independence.)
__ Residents live in host family homes
__ Residents share bedrooms in group home with house parents
__ Residents have private bedrooms in group home with house parents
__ Residents share bedrooms in one facility
__ Residents have private bedrooms in one facility
__ Residents share apartments, units clustered in one building
__ Residents have private apartments, units clustered in one building
__ Residents share scattered site apartments
__ Residents have private scattered site apartments
__ Other: _____________________________________________________________________
29) Do youth gain more privileges during their time in the TLP program? Yes No
If yes, what privileges do youth gain? (Check all that apply)
Use of personal car
Yes No
Cellular phone use
Yes No
Increased free time
Yes No
Overnight/weekend passes
Yes No
Later curfew or later wakeup
Yes No
Increased program allowance
Yes No
Visitor privileges
Yes No
Other (describe): __________________________________________________________
Other (describe): __________________________________________________________
Other (describe): __________________________________________________________
TLP Program Services
30) Which of the following services are provided to TLP residents? For those services provided to youth, please indicate (a) who provides the service; (b) how often is the service provided; and (c) whether the service is required.
Service |
(a) Who Provides (check all that apply) |
(b) Frequency |
(c) Required |
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Not Provided |
TLP Program Staff |
Other Agency Staff |
Partner Agency |
Through Referral |
Other: Describe |
More than Once a Week |
Weekly |
Every Two Weeks |
Monthly |
As Needed |
Yes |
No |
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Case management |
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Life skills classes/ training |
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Education assistance |
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Employment assistance |
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Mental health counseling |
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Substance abuse counseling |
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Health screening |
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Health care treatment/ nurse |
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Alternative medicine clinic/ services |
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Nutrition counseling |
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Legal services |
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Volunteer Community services or activities |
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Aftercare (describe):
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Other: |
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Other: |
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31) Where are most TLP program services delivered? (Check only one)
On-site at residential program
Yes No
At TLP agency offices
Yes No
At participants’ apartments
Yes No
At other community locations
Yes No
Other: ___________________________________________________________________
32) What life skills does the program work to build?
Budgeting/money management and saving
Yes No
If yes, is this a major focus of your TLP program’s approach to developing youths’ life skills? Yes No
Tenant rights and responsibilities
Yes No
If yes, is this a major focus of your TLP program’s approach to developing youths’ life skills? Yes No
Housekeeping
Yes No
If yes, is this a major focus of your TLP program’s approach to developing youths’ life skills? Yes No
Shopping on a budget
Yes No
If yes, is this a major focus of your TLP program’s approach to developing youths’ life skills? Yes No
Cooking
Yes No
If yes, is this a major focus of your TLP program’s approach to developing youths’ life skills? Yes No
Nutrition/healthy eating habits
Yes No
If yes, is this a major focus of your TLP program’s approach to developing youths’ life skills? Yes No
Time management
Yes No
If yes, is this a major focus of your TLP program’s approach to developing youths’ life skills? Yes No
Education planning (e.g., college search and application, financial assistance application)
Yes No
If yes, is this a major focus of your TLP program’s approach to developing youths’ life skills? Yes No
Study habits
Yes No
If yes, is this a major focus of your TLP program’s approach to developing youths’ life skills? Yes No
Employment search, resume writing, and interviewing
Yes No
If yes, is this a major focus of your TLP program’s approach to developing youths’ life skills? Yes No
Employment retention skills
Yes No
If yes, is this a major focus of your TLP program’s approach to developing youths’ life skills? Yes No
Social skills (e.g., conflict resolution)
Yes No
If yes, is this a major focus of your TLP program’s approach to developing youths’ life skills? Yes No
Emotion regulation/ constructive coping strategies
Yes No
If yes, is this a major focus of your TLP program’s approach to developing youths’ life skills? Yes No
Goal setting and planning for the future
Yes No
If yes, is this a major focus of your TLP program’s approach to developing youths’ life skills? Yes No
Civic awareness / community connectedness
Yes No
If yes, is this a major focus of your TLP program’s approach to developing youths’ life skills? Yes No
Other (describe): ____________________________________________________________
If other, is this a major focus of your TLP program’s approach to developing youths’ life skills? Yes No
Other (describe): ____________________________________________________________
If other, is this a major focus of your TLP program’s approach to developing youths’ life skills? Yes No
Other (describe): ____________________________________________________________
If other, is this a major focus of your TLP program’s approach to developing youths’ life skills? Yes No
33) What approaches does the program use to help youth develop life skills?
Group-based instruction/ life skills classes
Yes No
If mentioned, does the program use a particular curriculum? Yes No
If yes, please give title or describe: __________________________________________
Hands-on, one-on-one instruction (e.g., staff shop or cook with participants, model life skills)
Yes No
Life skills are developed through youths’ regular routines
Yes No
Other (please describe): _______________________________________________________
34) TLP programs differ in how they prioritize education and employment goals and the relative emphasis they place on one versus the other. Please describe your program’s approach or philosophy. (Check only one)
Program prioritizes/emphasizes employment over education
Program prioritizes/emphasizes education over employment
Program prioritizes/emphasizes education and employment equally
The relative priority of employment and education is determined on an individualized basis,
as part of the service/action planning process, in response to the goals of each youth
Other (describe): ____________________________________________________________
35) What types of services are provided to TLP youth by your agency or partnering agencies to assist them in advancing their educational goals and opportunities? Services may be provided by the TLP program, other staff at your agency, a partner agency, or through referral.
GED classes
Yes No
Alternative high school classroom
Yes No
Education planning/counseling
Yes No
Education scholarships
Yes No
Education application and enrollment assistance (high school or post-secondary)
Yes No
Education center with access to computers, internet, and other education resources
Yes No
Other (describe): ___________________________________________________
Other (describe): ___________________________________________________
Other (describe): ___________________________________________________
36) What types of services are provided to assist youth in preparing for, acquiring, and sustaining employment? Services may be provided by the TLP program, other staff at your agency, a partner agency, or through referral.
Employment readiness preparation (e.g., resume development, presentation and
interviewing guidance, job search strategies and resources)
Yes No
Employment/career center with access to computers, internet, on-line job search, etc.
Yes No
Job training (e.g. certificate programs in entry level career track fields)
Yes No
Employment internships (including job shadowing and mentoring opportunities)
Yes No
Transitional jobs program (i.e. time-limited, subsidized employment with services to address employment barriers)
Yes No
Employment placement
Yes No
Employment retention support (describe): _______________________________
Yes No
Other (describe): ___________________________________________________
Other (describe): ___________________________________________________
Other (describe): ___________________________________________________
37) What, if any, aftercare services are provided to youth who exit the TLP?
Staff-initiated check-in/follow-up phone calls
Yes No
Home visits
Yes No
Staff available as needed for follow-up support (youth-initiated)
Yes No
Alumni aftercare group
Yes No
Participation in other agency services
Yes No
Other (describe): ____________________________________________________________
Other (describe): ____________________________________________________________
Other (describe): ___________________________________________
38) In what, if any, ways do youth remain involved with the TLP once they have exited the program?
Participate in alumni group
Yes No
Serve on program committee or advisory group
Yes No
Share their experiences at community meetings, life skills groups, or other program events
Yes No
Invited to holiday events and graduation ceremonies
Yes No
Serve as peer mentors
Yes No
Speak at agency events (e.g., annual fundraisers)
Yes No
Attend other program alumni events
Yes No
Other (describe): ____________________________________________________________
Other (describe): ____________________________________________________________
Other (describe): ___________________________________________
Thank you for taking the time to complete this survey.
| File Type | application/msword |
| File Title | PYD Objectives/Constructs (taken from RWJ report): |
| Author | DARIA |
| Last Modified By | CortesA |
| File Modified | 2010-05-28 |
| File Created | 2010-03-01 |