Form 1 Service Deliver and Tracking and Adjustment Observation

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

SERVICE DELIVERY AND TRACKING AND ADJUSTMENT OBSERVATION – GROUP DEBRIEF

Select questions from the phase that is 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 service delivery 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
Service Delivery	Initiating service delivery	How well does the pacing of the Center’s involvement with your state meet your needs and expectations? (i.e., intensity, flexibility, thoroughness, pace, ensuring understanding) How satisfied are you with the quality of the Center’s service delivery? (i.e., level of support, collaboration on strategy/ tool identification/ selection, communication) How well did the Center help your state to identify and select the most appropriate strategies, activities, or tools for this work? How well has the Center integrated the capacity building framework and the change process into its services to your state? (i.e., usefulness, appropriateness, meaningfulness)
	Pacing the work
	Guiding agency self-reflection
	Selecting strategies, activities, tools
	Promoting use of the capacity building framework
	Communicating with CB and Collaborative partners
Tracking and Adjustment	Assessing capacity for tracking progress	How well is the Center helping your state to identify what data are needed and how to secure those data? How well is the Center helping your state to identify and conduct appropriate data analysis? How satisfied are you with the support provided by the Center in monitoring progress and making adjustments as needed? Can you share an example of how the team has used data to determine progress and inform its planning and decision making?
	Developing an approach to understanding progress
	Collecting data to understand progress
	Conducting analysis and building connections
	Discussing progress and planning effectively
	Managing perceptions of progress
Transition to Sustainability	Planning for transition	What led to the decision to end this project? How satisfied are you with how the project ended? How well did the Center help prepare your state to sustain capacity for this work? (probe on identifying and securing needed supports)
	Deciding to transition and close
	Transitioning to sustained capacity building
	Facilitating a final meeting
	Ending services prematurely

02/09/17