OMB 0970-0564 [valid through MM/DD/2026]
(Revised: 3/16/2022)
Staff Questionnaire - Youth Care Worker/Lead Youth Care Worker – Unlicensed Facility (UF) Quarterly Health and Safety Visit
Interview Details |
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Program Name:
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Past and Current Position(s) at Program: |
Level of Care: |
Date/Time of Interview: |
Full Name: |
Interviewer: |
*Note: Before beginning the interview and/or providing this questionnaire to staff, provide a brief introduction, including monitor role and purpose of monitoring visit, confidentiality of staff interview, and clarify any questions. See Introduction Prompt for Staff for additional guidance as needed. Questions in bold should be asked during the interview if possible. Other questions are optional prompts to assist the interviewer.
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NOTES |
Tell me about your role and main responsibilities as a Youth Care Worker.
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What are the things that you love/enjoy about your job? What are the challenges you face in your job?
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What formal/informal trainings have you received?
(Lead Youth Care Worker) Do you have a system to assess ongoing staff training needs?
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Tell me about how you usually handle behavioral challenges among UCs?
Have you received trainings on Behavior Management?
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What does trauma-informed care mean to you?
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How do you usually handle mental health concerns among UCs in the program?
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What are the required UC to staff ratios?
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What does line of sight supervision mean to you? How do you ensure line of sight supervision during the following periods?
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What activities are provided to UC every day?
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How often are youth required to be outside?
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When YCWs come on shift, how are updates/lingering issues communicated between shifts?
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Describe the procedures for the following situations: (Please note: any/multiple example(s) can be used for this question)
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What are some of the topics covered by the Code of Conduct?
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Do you have any concerns with the treatment of UC in care? Do you have concerns about any particular staff members (any staff members you think should NOT be working with UC)?
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What would you do to improve or strengthen the program here?
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What recommendations do you have for ORR that I can take back to share with our headquarter teams?
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Enter Additional Notes.
THE
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF
PUBLIC BURDEN: The purpose of this information collection is to
allow ORR contractor monitors to interview and document responses
from youth care workers during unlicensed facility quarterly site
visits. Public reporting burden for this collection of information
is estimated to average 1 hour per response for the care provider
and 1 hour per response for the contractor monitor, including the
time for reviewing instructions, gathering and maintaining the data
needed, and reviewing the collection of information. This is a
mandatory collection of information (Homeland Security Act, 6
U.S.C. 279). An agency may not conduct or sponsor, and a person is
not required to respond to, a collection of information subject to
the requirements of the Paperwork Reduction Act of 1995, unless it
displays a currently valid OMB control number. If you have any
comments on this collection of information please contact
[email protected].
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Almira, Ariadne (ACF) |
File Modified | 0000-00-00 |
File Created | 2023-08-20 |