Optional Template - SIRF_Peer Support Management and Benchmark Tool

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Participant & Mentor Information

nFORM ID

NSAMPLE
NSAMPL2
NSAMPL3

Group

Active (Odds)
Passive (Evens)
Active (Odds)

Participant Status

Workshop ongoing
Pre-workshop

Scheduled Outreach Efforts

Mentor
Initials

OC
Passive
SE

Date Mentor
to Contact
Mentee

7/8/2021
7/9/2021

cheduled Outreach Efforts

Purpose of Outreach

Date Mentor
to Contact
Mentee (2)

Purpose of Outreach (2)

Pre-session reminder

7/11/2021 Missed session

Pre-session reminder

7/21/2021 Post-[session/week 1/3/5/etc.] check-in

Date Mentor
to Contact
Mentee (3)

Purpose of Outreach (3)

Date Mentor
to Contact
Mentee (4)

Purpose of Outreach (4)

Date Mentor
to Contact
Mentee (5)

Purpose of Outreach (5)

Date Mentor
to Contact
Mentee (6)

Purpose of Outreach (6)

Date Mentor
to Contact
Mentee (7)

Purpose of Outreach (7)

Date Mentor
to Contact
Mentee (8)

Purpose of Outreach (8)

Date Mentor
to Contact
Mentee (9)

Purpose of Outreach (9)

Date Mentor
to Contact
Mentee (10)

Purpose of Outreach (10)

nFORM ID
N100001
N100047
N100083
N100044

Group
Active (Odds)
Active (Odds)
Active (Odds)
Passive (Evens)

Date
Mentor Initials
7/8/2021 OC
7/7/2021 OC
7/25/2021 DWF
7/9/2021 RB

Initiatied by
Mentor
Mentor
Mentor
Mentee

Outreach Type
Scheduled
Scheduled
Scheduled
Spontaneous

Mode of Contact
Text message
Text message
Text message
Text message

Structure
One-on-one
Small group
One-on-one
One-on-one

Outcome
Successful
Successful
Successful
Successful

Purpose
Weekly check-in
Weekly check-in
Missed session
Non-program question

Week #

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39

Period Start
Date

Period End
Date

Active
Outreach:
Planned
#

7/6/2021
7/12/2021
7/19/2021
7/26/2021
8/2/2021
8/9/2021
8/16/2021
8/23/2021
8/30/2021
9/6/2021
9/13/2021
9/20/2021
9/27/2021
10/4/2021
10/11/2021
10/18/2021
10/25/2021
11/1/2021
11/8/2021
11/15/2021
11/22/2021
11/29/2021
12/6/2021
12/13/2021
12/20/2021
12/27/2021
1/3/2022
1/10/2022
1/17/2022
1/24/2022
1/31/2022
2/7/2022
2/14/2022
2/21/2022
2/28/2022
3/7/2022
3/14/2022
3/21/2022
3/28/2022

7/11/2021
7/18/2021
7/25/2021
8/1/2021
8/8/2021
8/15/2021
8/22/2021
8/29/2021
9/5/2021
9/12/2021
9/19/2021
9/26/2021
10/3/2021
10/10/2021
10/17/2021
10/24/2021
10/31/2021
11/7/2021
11/14/2021
11/21/2021
11/28/2021
12/5/2021
12/12/2021
12/19/2021
12/26/2021
1/2/2022
1/9/2022
1/16/2022
1/23/2022
1/30/2022
2/6/2022
2/13/2022
2/20/2022
2/27/2022
3/6/2022
3/13/2022
3/20/2022
3/27/2022
4/3/2022

3
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Total Contacts
Occurred
Incl. menteeinitiated /
spontaneous

Active
Outreach:
Occurred
#

3
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

2
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

40
41
42
43
44
45
46
47
48
49
50
51
52

4/4/2022
4/11/2022
4/18/2022
4/25/2022
5/2/2022
5/9/2022
5/16/2022
5/23/2022
5/30/2022
6/6/2022
6/13/2022
6/20/2022
6/27/2022

4/10/2022
4/17/2022
4/24/2022
5/1/2022
5/8/2022
5/15/2022
5/22/2022
5/29/2022
6/5/2022
6/12/2022
6/19/2022
6/26/2022
7/3/2022

0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0

Planned Outreach that Occurred
%

67%
100%

Benchmark:
TARGET Active
Outreach
Occurring

Benchmark:
REVIEW
Active
Outreach
Occurring

90%
90%
90%
90%
90%
90%
90%
90%
90%
90%
90%
90%

60%
60%
60%
60%
60%
60%
60%
60%
60%
60%
60%
60%

Percent of Planned Active Outreach that
Occurred
100%

90% Target

Outreach & Contacts

67%

1

2

3

4

5

6

7

8

9

10

11

12

Week

Percent of Contacts that Were Successful:
Iniatiator

Mentor Initiated

100%

Mentee Initiated

100%

Percent of Contacts That Were Successful:
Outreach Method
Text message

100%

Voice phone call
0%

Video call
0%

In-person
0%

Percent of Contacts that Were Successful:
Mentor
DWF

100%

OC

100%

RB

100%

0%
SE

Purpose of Interaction
(Percentage of All Interactions)
Non-program question

25%

Program question
0%
Program/life milestone
0%
Missed session

Interactions

Weekly check-in
First session attendance
0%

25%
50%

Structure of Interaction
(Percentage of All Interactions)

One-on-one

Small group

75%

25%

Group
Active (Odds)
Passive (Evens)

Mentor Initials
DWF
OC
RB
SE
Passive

Participant Status
Pre-workshop
Workshop ongoing
Workshop complete
Dropped out/disengaged

Purpose [TAILOR TO SITE]
Pre-session reminder
Post-[session/week 1/3/5/etc.] check-in
Program completion
Other milestone (e.g. job attainment)
Missed session
Other

Contact Initiatied by
Mentor
Mentee

Outreach Type
Scheduled
Spontaneous

Mode of Contact
Text message
Voice phone call
Video call
In-person

Structure
One-on-one
Small group

Outcome
Successful
Pending/unsuccessful

Purpose
First session attendance
Weekly check-in
Missed session
Program/life milestone
Program question
Non-program question

Benchmark (planned outreach)
Cycle 1
90%
Cycle 2
Cycle 3
Cycle 4