Form 6 Title VI Caregiver Focus Group

Form Approved

OMB No.: XXXX-XXXX

Expiration Date: XX/XX/2017

Evaluation of the ACL Title VI Programs

Title VI Tribal Caregiver Focus Group Moderator Guide

Questions	Probes	Time Guidelines
Introduction of Moderator/Guests and Purpose of Focus Group/ Logistics		5 minutes
Read Consent Form/Confirm Verbal Consent/ Confirm Permission to Audio Record		5 minutes
Opening Question Please tell us your first name and let us know how long you have been using Title VI services.		5 minutes
Introductory Question Can you tell me a little bit about the services you get through the program?	Provide examples of services specifically provided by the program: Information Counselling Education Support group Respite care Grandparent support	10 minutes
Transition Questions What do you like best about the services you receive through the program?	Which service is the most helpful to you?	10 minutes
Key Questions Which service is the most helpful to you?	Why is it the most helpful to you?	10 minutes
What else do you wish that the program had?	What other types of information might be valuable to you as a caregiver? What other types of services might you want to receive?	10 minutes
If you could change something about the program, what would that be?		10 minutes
What would happen if you didn’t have this program?	Components to talk about: Employment Stress Difficulty with providing care Chances to socialize/visit with others Getting out of the house, etc. Not be able to continue providing care Not be able to provide as good care	15 minutes
Can you talk a little bit about the different ways that the program helps you?	How has the program helped you stay connected to traditional AI/AN/NH ways of life (food choices, spirituality, etc.) Are there other ways that the program helps you feel connected to your community? How does the program help you with stress, time, resources, etc.? Does the program ease mental overload? Does the program improve your quality of life? Does the program improve the quality of life of the person you care for?	15 minutes
What is the best/most important thing that the program has done for you?	If you were telling someone else about the program, what would be the first thing you would tell them about? How has it helped you with providing care to your loved one? How has it helped you take better care of yourself?	15 minutes
Ending Question Thank you so much for sharing your stories with us today. Is there anything that we have missed? Is there anything that you came wanting to say that you didn’t get a chance to?		5 minutes
Total Time		120 minutes

Public Burden Statement: 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. The OMB control number for this project is xxxx-xxxx. Public reporting burden for this collection of information is estimated to average 5 minutes per respondent, per year, including the time to review instructions. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to [title], [address, city, state, zip].