Tribal Home Visiting Technical Assistance Evaluation Feedback and Immediate Feedback Forms

OMB Control No.: 0970-0401

Expiration Date: 05/31/2021

PATH Technical Assistance Evaluation Feedback Form

(administered annually via Survey Monkey)

Dear Grantee,

Thank you for providing feedback about the effectiveness of Technical Assistance (TA) provided by Programmatic Assistance for Tribal Home Visiting (PATH) to Tribal Home Visiting (THV) grantees. This form should take less than 20 minutes to complete. Your feedback is private since we do not collect personal identifiable information.

Your feedback provides valuable information to PATH and ACF. We analyze and review the results with rigor and incorporate your suggestions to continuously improve the TA.

Although you have received TA from other sources, we are asking you to answer the questions based on the individualized, targeted and universal TA provided specifically by PATH from [enter dates]. For your reference, please note that you will receive an email with a list of TA activities you and your team attended over the past year.

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. Public reporting burden for this collection of information is estimated to average .33 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Anne Bergan, Office of Child Care Administration for Children and Families, HHS, Mary E. Switzer Building 330 C Street, SW, Suite 3014F, Washington, DC 2020.

Thank you for taking the time to help us improve the support we provide to you and your team!

Please contact Petra Smith [email protected] or Tara Chico-Jarillo [email protected] if you have questions or concerns.

Please select the role that most closely aligns with your responsibilities related to the THV project.

Grantee Lead/Director/Coordinator Grantee Data/Evaluation Staff Grantee Program Staff/Consultant

Grantee Grants Management/Fiscal Staff Home Visitor

Provision of TA
	In the last 12 months did you participate in any TA related to these topics (check all that apply)?	If you received TA in this topic area, which two TA method(s) were the most helpful?	Briefly describe how the TA was effective.	Has your program implement new strategies or made changes related to this topic as a result of PATH TA?	To what extent has PATH TA assisted you in achieving your implementation plan goals related to this topic?	In the last 12 months did PATH meet your TA needs in these topics?		Please briefly describe your unmet TA needs.
Tribal/Organizational Leadership Support, Governance, and Administration
Quality Workforce
Fidelity Monitoring / Model Fidelity
Community and Partner Engagement
Recruitment, Enrollment, and Engagement of Families
Dissemination
Early Childhood Systems Building
Policies and Procedures
Sustainability
Other _______________________
Quality Relationship and Responsiveness of TA staff
My Path Specialist engages in inquiry to better understand my needs before engaging in TA.
My Path Specialist respects the unique position of tribes.
My Path Specialist understands the unique positions of home visiting within tribes and tribal communities.
My Path Specialist is responsive to our unique needs.
My Path Specialist is knowledgeable about our program.
I trust my PATH Specialist.
My Path Specialist engages in joint problem-solving.
My Path Specialist demonstrates feelings of care and empathy.
PATH effectively connected us with other grantees.
How would you describe your relationship with your TA Specialist?
Satisfaction with TA
I am satisfied with PATH TA.
In the past 12 months TA was delivered at a time when it was relevant for your program
How could we improve the TA provided by PATH?
Other feedback

Definitions:

Tribal/Organizational Leadership Support, Governance, and Administration: Refers to the administrative management and structure your program operates within, and the responsibility for ensuring successful implementation and oversight of your program. This also includes ensuring fiscal planning and oversight of your program, lead collaborative partners including subcontractors, advisory committee and legal oversight.

Quality Workforce/Program Workforce and Management: Refers to efforts to provide support and professional development to staff such as staff recruitment and hiring, professional development, staff retention, training to ensure well-trained, competent staff beyond model developer provided activities and high quality reflective, clinical, and administrative supervision.

Fidelity Monitoring/Model Fidelity (High-Quality Program): Refers to your programs use or access to curriculum and other materials to implement the home visiting model and whether the materials were useful, any training and professional development support obtained from the home visiting model(s) and whether the training helped when implementing the program. This also includes activities providing high quality home visiting program services such as ensuring the selected home visiting model(s) are being implemented with fidelity, making sure all staff delivers home visits the way the model was intended and developing and documenting program operations, policies and procedures to support implementation fidelity and program quality.

Community and Partner Engagement: Refers to how your program engages with the broader community(ies) (i.e. partner agencies, stakeholders within your community, tribal leadership, leadership within your organization, partner agencies, the families you serve) around your home visiting program.

Recruitment, Enrollment, and Engagement of Families: Refers to your programs efforts to recruit, engage, and retain program participants, including progress on meeting objectives related to recruitment of families, engaging families, retention of families and completion of the program.

Dissemination: Refers your program’s dissemination plan and efforts such as your dissemination purpose and goals, target audiences for dissertation and information sharing, products and materials developed and methods used to share these products and materials (i.e. newsletter, pamphlets, social media).

Early Childhood Systems Building: Refers to the development of a coordinated early childhood system, including coordination and collaboration between your home visiting program and other programs and resources for pregnant women, expectant fathers, young children, and families in the community(ies) this includes improving referrals and services between your program and others in the community and the partnerships your program has developed.

Policies and Procedures: Refers to your programs policies and procedures that are existing or need to be revised, refined or developed, strategies for engaging program staff and other stakeholders in the development of your programs policies and procedures manual and activities to ensure regular utilization and review of your programs policies and procedures manual.

Sustainability: Refers to how your program builds and ensures sustainability after the grant has ended including how your program engages with other tribal or organizational leaders, assesses the current infrastructure and resources for retaining and extending home visiting services beyond the federal funding period and how your program identifies resources that potentially may be leveraged to sustain home visiting (i.e. collaboration with service partners, various funding streams both private and public).

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