Family Caregiver Assessment 2016 Home Page
Oregon State Unit on Aging OAA Family Caregiver Support Program Assessment Tool 2016Due July 29, 2016. Please submit only to SUA.Email@dhsoha.state.or.us.AAA: FORMTEXT ?????Date of Assessment: FORMTEXT ?????Contact person for assessment questions: FORMTEXT ????? Contact phone number: FORMTEXT ?????Part 1: Desk Audit on Program ConditionFamily Caregiver Support Program StandardsYesNoComments or Required DescriptionThe AAA provides which of the following core services to individuals who meet the eligibility program of the FCGSP: (check all that apply)Information Services FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????One-on-one family caregiver information FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Counseling FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Training FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Support Groups FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Respite Care FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Supplemental Services FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????The FCGSP provides access to caregiver training (e.g. Powerful Tools for Caregivers, or other evidenced based caregiver training). FORMCHECKBOX FORMCHECKBOX Please specify which training programs: FORMTEXT ?????Staff and/or partners have been trained to provide caregiver trainings listed in Question 3. FORMCHECKBOX FORMCHECKBOX Please specify who conducts the trainings. FORMTEXT ?????The FCGSP partners with other agencies (private or public programs, businesses, faith organizations, health agencies) either on formal or informal basis to provide services or information that benefits caregivers. FORMCHECKBOX FORMCHECKBOX Please provide a brief description of your FCSGP partnerships: FORMTEXT ?????There is a process (i.e. satisfaction surveys) in place that demonstrates that services provided help family caregivers successfully meet challenges of caregiving that allow the care receiver to remain in their home longer. FORMCHECKBOX FORMCHECKBOX Please describe your FCGSP process: FORMTEXT ?????Please describe the process for assessing the caregiver’s need for support and offering services that can be of benefit to them: (Please include a copy of the assessment or evaluation tool that you use.) RESPONSE: FORMTEXT ?????Please describe how services are provided to “at risk” family caregivers (“At risk groups” include people who speak limited English, specific ethnic groups, Tribes, caregivers at risk of institutionalization, non-traditional family caregivers, relatives raising children): RESPONSE: FORMTEXT ?????Please describe how the program identifies and provide services to caregivers who are:(a) older individuals with the greatest social and economic need; and (b) older individuals providing care to individuals (including children) with severe disabilities, -- Per OAA Title III Part E, Section373 (2) (A) (B) (Please include or reference any tools that you may use to determine this.) RESPONSE: FORMTEXT ?????Please describe any special activities, events or opportunities that your local FCSP provides or participates in that is of benefit to family caregivers. FORMTEXT ????? Part 2: Cause, Effect & RecommendationsIn the Five Findings model described in the AAA Monitoring Instructions, cause explains the difference between program standards (criteria) and what is actually happening (your program’s condition). Effect is the impact of that difference.Cause should detail what is preventing the AAA from fully meeting the standards, or is enabling the AAA to exceed the standards. Examples of cause could be trainings, staff issues, policies/procedures, or other factors that are contributing to success or impeding compliance. Effect should detail the result of not fully meeting, or of exceeding, program standards. Effect can be either positive or negative. An example of effect could be the impact the cause has on clients, program quality, or safety of services.Please identify items from the checklist above where your AAA is either not fully meeting, or is exceeding, the standards. Explain the cause, effect and recommendation for each in the table below.Issue where the AAA is not meeting, or is exceeding, standards.CauseEffectPlan remedy lack of compliance, or support continued successGoal date for completion FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Due 7/29/16. Please submit only to SUA.Email@dhsoha.state.or.us. ................
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