Optional Template - SIRF_Peer Support Management and Benchmark Tool

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Overview

Peer Support_What Should Happen
Peer Support_What Did Happen
Peer Support_Activity Summary
Peer Support_Outreach Dashboard
Peer Support_Interaction Dash
Peer Support_Reference Sheet

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Sheet 1: Peer Support_What Should Happen

Participant & Mentor Information

Scheduled Outreach Efforts

nFORM ID

Group

Participant Status

Mentor Initials

Date Mentor to Contact Mentee

Purpose of Outreach

Date Mentor to Contact Mentee (2)

Purpose of Outreach (2)

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)

NSAMPLE

Active (Odds)

Workshop ongoing

OC

7/8/2021

Pre-session reminder

7/11/2021

Missed session

NSAMPL2

Passive (Evens)

Passive

NSAMPL3

Active (Odds)

Pre-workshop

SE

7/9/2021

Pre-session reminder

7/21/2021

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

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Sheet 2: Peer Support_What Did Happen

nFORM ID	Group	Date	Mentor Initials	Initiatied by	Outreach Type	Mode of Contact	Structure	Outcome	Purpose
N100001	Active (Odds)	7/8/2021	OC	Mentor	Scheduled	Text message	One-on-one	Successful	Weekly check-in
N100047	Active (Odds)	7/7/2021	OC	Mentor	Scheduled	Text message	Small group	Successful	Weekly check-in
N100083	Active (Odds)	7/25/2021	DWF	Mentor	Scheduled	Text message	One-on-one	Successful	Missed session
N100044	Passive (Evens)	7/9/2021	RB	Mentee	Spontaneous	Text message	One-on-one	Successful	Non-program question

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Sheet 3: Peer Support_Activity Summary

Week #	Period Start Date	Period End Date	Active Outreach: Planned #	Total Contacts Occurred Incl. mentee-initiated / spontaneous	Active Outreach: Occurred #	Planned Outreach that Occurred %	Benchmark: TARGET Active Outreach Occurring	Benchmark: REVIEW Active Outreach Occurring
1	7/6/2021	7/11/2021	3	3	2	67%	90%	60%
2	7/12/2021	7/18/2021	0	0	0		90%	60%
3	7/19/2021	7/25/2021	1	1	1	100%	90%	60%
4	7/26/2021	8/1/2021	0	0	0		90%	60%
5	8/2/2021	8/8/2021	0	0	0		90%	60%
6	8/9/2021	8/15/2021	0	0	0		90%	60%
7	8/16/2021	8/22/2021	0	0	0		90%	60%
8	8/23/2021	8/29/2021	0	0	0		90%	60%
9	8/30/2021	9/5/2021	0	0	0		90%	60%
10	9/6/2021	9/12/2021	0	0	0		90%	60%
11	9/13/2021	9/19/2021	0	0	0		90%	60%
12	9/20/2021	9/26/2021	0	0	0		90%	60%
13	9/27/2021	10/3/2021	0	0	0
14	10/4/2021	10/10/2021	0	0	0
15	10/11/2021	10/17/2021	0	0	0
16	10/18/2021	10/24/2021	0	0	0
17	10/25/2021	10/31/2021	0	0	0
18	11/1/2021	11/7/2021	0	0	0
19	11/8/2021	11/14/2021	0	0	0
20	11/15/2021	11/21/2021	0	0	0
21	11/22/2021	11/28/2021	0	0	0
22	11/29/2021	12/5/2021	0	0	0
23	12/6/2021	12/12/2021	0	0	0
24	12/13/2021	12/19/2021	0	0	0
25	12/20/2021	12/26/2021	0	0	0
26	12/27/2021	1/2/2022	0	0	0
27	1/3/2022	1/9/2022	0	0	0
28	1/10/2022	1/16/2022	0	0	0
29	1/17/2022	1/23/2022	0	0	0
30	1/24/2022	1/30/2022	0	0	0
31	1/31/2022	2/6/2022	0	0	0
32	2/7/2022	2/13/2022	0	0	0
33	2/14/2022	2/20/2022	0	0	0
34	2/21/2022	2/27/2022	0	0	0
35	2/28/2022	3/6/2022	0	0	0
36	3/7/2022	3/13/2022	0	0	0
37	3/14/2022	3/20/2022	0	0	0
38	3/21/2022	3/27/2022	0	0	0
39	3/28/2022	4/3/2022	0	0	0
40	4/4/2022	4/10/2022	0	0	0
41	4/11/2022	4/17/2022	0	0	0
42	4/18/2022	4/24/2022	0	0	0
43	4/25/2022	5/1/2022	0	0	0
44	5/2/2022	5/8/2022	0	0	0
45	5/9/2022	5/15/2022	0	0	0
46	5/16/2022	5/22/2022	0	0	0
47	5/23/2022	5/29/2022	0	0	0
48	5/30/2022	6/5/2022	0	0	0
49	6/6/2022	6/12/2022	0	0	0
50	6/13/2022	6/19/2022	0	0	0
51	6/20/2022	6/26/2022	0	0	0
52	6/27/2022	7/3/2022	0	0	0

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Sheet 4: Peer Support_Outreach Dashboard

Outreach & Contacts

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Sheet 5: Peer Support_Interaction Dash

Interactions

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Sheet 6: Peer Support_Reference Sheet

Group	Mentor Initials	Participant Status	Purpose [TAILOR TO SITE]	Contact Initiatied by	Outreach Type	Mode of Contact	Structure	Outcome	Purpose	Benchmark (planned outreach)
Active (Odds)	DWF	Pre-workshop	Pre-session reminder	Mentor	Scheduled	Text message	One-on-one	Successful	First session attendance	Cycle 1
Passive (Evens)	OC	Workshop ongoing	Post-[session/week 1/3/5/etc.] check-in	Mentee	Spontaneous	Voice phone call	Small group	Pending/unsuccessful	Weekly check-in	90%
	RB	Workshop complete	Program completion			Video call			Missed session	Cycle 2
	SE	Dropped out/disengaged	Other milestone (e.g. job attainment)			In-person			Program/life milestone
	Passive		Missed session						Program question	Cycle 3
			Other						Non-program question
										Cycle 4