Optional Template - SIRF_Peer Support Management and Benchmark Tool

Status: The document is viewable through fallback artifacts while conversion repair continues in the background.

Queue: A repair attempt failed. The document remains flagged for retry and verification. (priority 90 · attempts 1 · next 2026-05-08 20:03:48)

Missing: html

Download: Source copy (xlsx) | pdf

Peer Support_What Should Happen
Participant & Mentor Information
Scheduled Outreach Efforts
nFORM ID
Group
Participant StaMentor InitialsDate Mentor tPurpose of OuDate Mentor t
NSAMPLE
Active (Odds) Workshop ongOC
7/8/2021 Pre-session re 7/11/2021
NSAMPL2
Passive (Evens)
Passive
NSAMPL3
Active (Odds) Pre-workshop SE
7/9/2021 Pre-session re 7/21/2021

Page 1

Peer Support_What Should Happen
Purpose of OutDate Mentor tPurpose of OutDate Mentor tPurpose of OutDate Mentor tPurpose of Out
Missed session
Post-[session/week 1/3/5/etc.] check-in

Page 2

Peer Support_What Should Happen
Date Mentor tPurpose of OutDate Mentor tPurpose of OutDate Mentor tPurpose of OutDate Mentor t

Page 3

Peer Support_What Should Happen
Purpose of OutDate Mentor tPurpose of Outreach (10)

Page 4

Peer Support_What Did Happen
nFORM ID
N100001
N100047
N100083
N100044

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

Mentor InitialsInitiatied by
44385 OC
Mentor
44384 OC
Mentor
44402 DWF
Mentor
44386 RB
Mentee

Page 5

Outreach TypeMode of Conta
Scheduled
Text message
Scheduled
Text message
Scheduled
Text message
Spontaneous Text message

Peer Support_What Did Happen
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

Page 6

Peer Support_Activity Summary
Outreach:
Planned
Occurred
Outreach that Occurred
Active Outreach:
Total
Planned
ContactsActive
Occurred
# / spontaneous%
#
Incl. mentee-initiated
44388
3
3
2 0.666666667
44395
0
0
0
44402
1
1
1
1

Period Start Period End

Week #

Date

1
2
3

Date

44383
44389
44396

Page 7

Peer Support_Activity Summary
Benchmark: TABenchmark: REVIEW Active Outreach Occurring
0.9
0.6
0.9
0.6
0.9
0.6

Page 8

Percent of Planned Active Outreach that
Occurred
1

90% Target

Outreach & Contacts

0.66666666666666
7

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