Seeking Safety Curriculum Implementation Fidelity Log



Nurturing Program for Families in Substance Abuse Treatment and RecoveryImplementation Fidelity FormGroup Co-facilitator 1: ____________________________________________ Group Co-facilitator 2: ____________________________________________Session Rater:____________________________________________________Group Location: __________________ Session Topic: __________________ Date: _____________ Length of Session: ____________ (minutes)1. How many women took part in today’s session? __________ 2. Please indicate below the extent to which you implemented the following Nurturing Families components during this session (circle one answer for each component):ComponentNot ApplicableNANot Done 0Done a Little1Done a Lot2Done Thoroughly3Ice BreakerNA01 23Wrap-UpNA0123Content Discussion and ActivitiesNA01233. Please indicate the degree to which you used the following strategies for facilitating this session (circle one answer for each strategy): StrategiesNot ApplicableNANot Done 0Done a Little1Done a lot2Done Consistently3Respected passing, but encouraged participationNA01 23Provided positive feedback NA0123Kept the group highly structuredNA0123Provided rules and guidelines for the groupNA0123Provided/encouraged self-nurturing activities for participantsNA01234. Were there any unexpected interruptions or events during today’s group that impacted your plan for the session? (i.e., you covered less or more than expected, you focused more or less intensely in one area, etc.) YES NOIf YES, please describe: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Thank you for completing this form!Please attach a copy of the Group Attendance Sheet ................
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