Form 1 Assessment Observation - Group Debrief

OMB Control No.: xxxx-xxxx

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average 15 minutes 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.

Expiration Date: xx/xx/20xx

ASSESSMENT OBSERVATION – GROUP DEBRIEF

Select questions most appropriate for the particular state meeting context.

PHASE OF DELIVERY	BEHAVIORS	DEBRIEF QUESTIONS
Engagement	Performing outreach	How well did the Center representatives demonstrate their understanding of your state’s context, needs, and strengths? How well did the Center explain the assessment process and its purpose to you? How clear were those explanations? How much confidence do you have in the Center’s ability to meet your needs?
	Being responsive
	Building credibility
	Providing clarity
	Collaborating
Working as a Team	Joining a team	How well did members of your agency and representatives from the Center work as a team? How successful was the team at achieving its goals? How satisfied are you with how the team interacted (i.e., supported one another, provided constructive feedback, communicated and shared information)?
	Integrating effort
	Building team support/cohesion
	Communicating and sharing information
Assessment	Using appreciative inquiry	How well did the Center representatives facilitate today’s meeting? (i.e., transparency, openness, honesty, solution-focused, strengths-based, respectful, inclusive inquiry) How well has the Center planned and organized meetings with you, including today’s meeting? How successful was the assessment process at identifying your state’s strengths and needs? How satisfied were you with this process?
	Being thorough and well prepared
	Promoting deeper jurisdictional awareness
	Ensuring accuracy and credibility of the assessment
Work Planning	Promoting partnership and ownership	How much ownership do you feel for what was created? Can you identify any specific things that happened during the meeting that might have contributed to your feeling of ownership? How satisfied are you with that level of ownership? How well did the Center help your state determine its readiness to move forward in particular areas, and prioritize those areas?
	Determining readiness and prioritizing
	Conducting analysis and establishing connections
	Planning effectively and building consensus

02/09/17