BUILDING A FAMILY ORGANIZATION



Federation of Families for Children’s Mental Health~CO Chapter

Organizational Self Assessment: Phase I

This survey is to assist you in identifying the level of development of your organization in several key areas. Please answer each question and add comments at the end of each section as needed. Thanks so much.

| |Do you have this in place for |Would more information on this be|

| |your organization? |helpful? |

| |YES |NO |YES |NO |

|Board Development |

|A functioning Board of Directors | | | | |

|Regular Board meetings | | | | |

|Regular communications between the Board and the Executive Director | | | | |

|Updated by laws | | | | |

|Strategic plan for the Board and the organization | | | | |

|A Board that raises money for the organization | | | | |

|Member training on financial oversight | | | | |

|Member training on conflict resolution | | | | |

|Describe Board Membership: |

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|Additional Comments regarding Board Development: |

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|Vision and Mission |

|A clear vision statement | | | | |

|A clear mission statement | | | | |

|A vision and mission that is shared with other stakeholders | | | | |

|Additional Comments regarding vision and mission: |

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|FFCMHCC Organizational Self Assessment Document | | | | |

|Cultural and Linguistic Competence |

| | | |Yes |No |

|Staff and Board representing the cultures served by the organization | | | | |

|A policy and procedure for diversifying the staff, Board and volunteers in the organization | | | | |

|Materials and resources that are written in a languages the target population can understand | | | | |

|Additional Comments regarding cultural & linguistic competence: |

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|Family Driven-Youth Guided Practices |

|Strategies to outreach to emerging leaders | | | | |

|Strategies to engage families and youth in under represented communities | | | | |

|Strategies and policies to include other stakeholders and peers in organizational direction | | | | |

|Strategies to train and support emerging leaders | | | | |

|Additional Comments regarding peer representation: |

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|Program Development |

|Written organizational policies and procedures | | | | |

|Training for volunteers | | | | |

|Written description of each project and program within the organization | | | | |

|Strategic plan for supporting the future of programs and projects | | | | |

|Additional Comments regarding program development: |

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|Financial Management |

| | | |Yes |No |

|Generally accepted program for financial management (such as Excel, QuickBooks) | | | | |

|Written policies and procedures for financial management | | | | |

|Training on travel and reimbursement policies | | | | |

|Schedule of grant required reports | | | | |

|Annual operating budget | | | | |

|Procedures for sharing the budget and policies with Board | | | | |

|Process for monitoring the budget throughout the year | | | | |

|Procedures for financial reimbursement from insurance and Medicaid sources | | | | |

|Additional Comments regarding financial management: |

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|Human Resource Accountability |

|Adequate number of employees to accomplish organizational goals | | | | |

|Personnel policies and procedures | | | | |

|Reasonable accommodations | | | | |

|Staff training and development | | | | |

|Staff recruitment and retention plans | | | | |

|Additional Comments regarding human resource development: |

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|Program Evaluation |

|Process for collecting data on organizational activities and contacts | | | | |

|A process to collect and store data | | | | |

|A plan to incorporate evaluation outcomes into the organizations quality improvement (QI) | | | | |

|A plan to report data to stakeholders and peers | | | | |

|Additional Comments regarding program evaluation: |

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|Sustainability |

| | | |Yes |No |

|A fund development plan for raising revenue to support activities | | | | |

|Unrestricted dollars | | | | |

|A set (and accepted) administrative overhead rate | | | | |

|A plan for diversifying funds | | | | |

|Additional Comments regarding sustainability: |

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|Infrastructure |

|Adequate office space | | | | |

|Insurance – liability and otherwise | | | | |

|Furniture and Related Equipment | | | | |

|Information Technology | | | | |

|Additional Comments regarding infrastructure: | | | | |

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Other comments?

FFCMHCC Organizational Self Assessment Document

Organizational Self Assessment: Phase II

The CO Federation of Families for Children’s Mental Health~CO Chapter recognizes that each family-run organization will start from a unique point in developing infrastructure and will serve populations/communities with specific needs related to their own community and or county. The Phase II Organizational Self Assessment helps family-run organizations examine their progress in organizational development.

|Date: | |

|Name: | |

|Contact Information: | |

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FFCMHCC Organizational Self Assessment Document

Program Goals

|Describe how your organization: |

|Strengthens your organizational relationships with other partners and programs | |

|Foster leadership and business management skills among families of children and adolescents with serious| |

|emotional disturbance | |

|Identifies and addresses the technical assistance needs of children and adolescents with serious | |

|emotional disturbances and their families. | |

|Assists family members around the country to work with policy makers and service providers to improve | |

|services for children and adolescents with serious emotional disturbances and their families. | |

|Ensures that families are the catalysts for transforming the mental health and related systems in their | |

|State by strengthening coalitions among family members and between family members, policymakers and | |

|service providers, recognizing that family members are the best and most effective change agents. | |

FFCMHCC Organizational Self Assessment Document

Activities

| |Yes |No |

|Please indicate if your family organization funds are used to support the following types of infrastructure development activities: | | |

|Needs assessment | | |

|Strategic planning | | |

|Financing/coordination of funding streams | | |

|Organizational/structural change (e.g., to create locus of responsibility for a specific issue/population, or to increase access to, or efficiency of, services) | | |

|Development of interagency coordination mechanisms | | |

|Network development | | |

|Policy development to support needed service system improvements (e.g., rate-setting activities, establishment of standards of care, development/revision of | | |

|credentialing, licensure, or accreditation requirements) | | |

|Quality improvement efforts | | |

|Performance measurement development | | |

|Workforce development (e.g., training, support for licensure, credentialing, or accreditation) | | |

|Data infrastructure | | |

FFCMHCC Organizational Self Assessment Document

Data Collection and Performance Measurement

|Does your project measure and report on the following domains: |

| |YES |NO |

|Organizational efforts and outcomes in policy development | | |

|Workforce development (number trained and level of satisfaction) | | |

|Financing organizational restructuring | | |

|Accountability | | |

|Types/targets of practices | | |

|Cost efficiency | | |

|GPRA (Government Performance and Results Act Data Reporting Form) measures data collection tool which is under development | | |

|Other terms and conditions of the grant award ( Please specify terms or conditions) | | |

 

FFCMHCC Organizational Self Assessment Document

Performance Assessment

| |YES |NO |

|Do you regularly assess the progress of your project against the performance measures using outcome and process questions, such as the following: | | |

|Outcome Questions: | | |

|How closely did implementation match the plan? | | |

|What types of deviation from the plan occurred? | | |

|What led to the deviations? | | |

|What impact did the deviations have on the intervention and evaluation? | | |

|Who provided (program, staff) what services (modality, type, intensity, duration), to whom (individual characteristics), in what context (system, community), and at | | |

|what cost (facilities, personnel, dollars)? | | |

|Process Questions: | | |

|What was the effect of infrastructure development on service capacity and other system outcomes? | | |

|What program/contextual factors were associated with outcomes? | | |

|What individual factors were associated with outcomes? | | |

|How durable were the effects? | | |

|Do you use that assessment to help you determine whether you are achieving the goals, objectives and outcomes you intend to achieve and whether adjustments need to be| | |

|made to your project? | | |

|Do you regularly report on your progress achieved, barriers encountered, and efforts to overcome these barriers in a performance assessment report to be submitted at | | |

|least annually? | | |

|May we see a copy of your most recent assessment and outcomes? | | |

Grantee Meetings

| |YES |NO |

|Did you send a minimum of two people (including the Project Director) to training meeting? | | |

|Did you include funding for this travel in your budget? | | |

Organizational Structure

|Is your organization a: | | |

|domestic public and private nonprofit entities | | |

|faith-based | | |

|tribal family organization | | |

|Statewide | | |

|family-controlled organization | | |

|Is your organization dedicated to the improvement of mental health services Statewide? | | |

|How many Board members does your organization have? | |

|How many have the primary daily responsibility for the raising of a child, youth, adolescent or young adult with a serious emotional disturbance| |

|up to age 18, or 21 if the adolescent is being served by an Individual Educational Plan (IEP), | |

|How many have young adults up to age 26 are being served by an Individual Service Plan in transition to the adult mental health system. | |

| |YES |NO |

|Does your organization give preference to family members in hiring practices? | | |

|Will you share a copy of your applicant's personnel policy covering these hiring practices? | | |

|Is your organization incorporated in your State as a private non-profit entity and is designated under 501(c)(3) of the Internal Revenue Service Code? | | |

|Is your organization served by an “umbrella” organization or is it using another 501(c)3 as a fiduciary? | | |

|If yes, does your organization retain complete control over program activities and policies? | | |

INTERGOVERNMENTAL REVIEW REQUIREMENTS

| |YES |NO |

|Do you know if your State has their own processes for reviewing and commenting on proposed Federal assistance under covered programs such as Executive Order (EO) | | |

|12372, as implemented through Department of Health and Human Services (DHHS) regulation at 45 CFR Part 100? | | |

|Did you contact your SPOC to alert them of your grant and to receive any necessary instructions on the State’s review process? | | |

|Did your SPOC should send any State review process recommendations related to your application or grant award? | | |

FFCMHCC Organizational Self Assessment Document

Progress and Financial Reports

| |YES |NO |

|Did you submit your annual progress reports (Continuation)? | | |

|Were each of your financial reports submitted on time? | | |

|What did you state in your progress reports regarding sustainability of efforts initiated | |

|under this grant? | |

Publications

| |YES |NO |N/A |

|Have you developed any publications using grant funds? | | | |

|Did you submit them to the funding agency prior to publication? | | | |

|Did you include acknowledgment the grant funding agency as the source of funding for the project? | | | |

|Did you include a disclaimer stating that the views and opinions contained in the publication do not necessarily reflect those of the funding agency , and | | | |

|should not be construed as such? | | | |

FFCMHCC Organizational Self Assessment Document

Confidentiality and Participant Protection

| |YES |NO |

|Have you identified any foreseeable physical, medical, psychological, social, and legal risks or potential adverse effects as a result of the project itself or any data| | |

|collection activity? | | |

|How did you address this? | | |

|Explain if participation in the project is voluntary or required. Identify possible reasons why participation is required, for example, court orders requiring people | | |

|to participate in a program. | | |

|Did you compensate any participants in your program? | | |

|How did you let families know that they may receive services intervention even if they do not participate in or complete the data collection component of the project? | | |

|Do you collect data for your project from any of the following? |

|Family members | | |

|Youth | | |

|Policymakers | | |

|Program administrators | | |

|Providers of services | | |

|Schools or school personnel | | |

|Private business | | |

|Family organizations | | |

|Others | | |

|Was data collected through any of the following |

|Observation | | |

|Questionnaires or surveys | | |

|Interviews | | |

|Focus Groups | | |

|Will you be willing to share copies of your surveys, questionnaires, or other data collection tools with the CO Federation of Families? | | |

|Do you have written policies for gaining the consent of the families and youth serve to participate in your program? | | |

|Are you willing to share these policies? | | |

|Is your program required to follow HIPAA regulations? | | |

| |Yes |No |

|Do you have a HIPAA Compliance Officer in your organization? | | |

|Who? | |

|Do you have consent forms for: | | |

|Participation in organizational activities | | |

|Participation in data collection | | |

|Sharing family information | | |

|Using family stories | | |

|Using photos | | |

|Are you willing to share any of these forms? | | |

|Please describe how you ensure privacy and confidentiality of the families you serve. | |

| | |

|Is the approach you take with youth different? If so, please describe. | |

Productive Working Relationships

| |YES |NO |

|Do you have current relationships with state agencies? | | |

|Would you describe your relationship with state agencies as productive? | | |

|Do you have current relationships with local agencies? | | |

|Would you describe your relationship with local agencies as productive? | | |

| | | |

| What opportunities are associated with these working relationships? |

|What challenges are associated with these working relationships? |

| |Yes |No |

|Technical Assistance Needs | | |

|Legal advice for organizational issues? | | |

|Legal advice for individual families? | | |

|Legal advice regarding board issues? | | |

|Legal advice regarding education issues? | | |

|Legal advice regarding juvenile justice issues? | | |

|Legal advice regarding child welfare issues? | | |

|Legal advice regarding criminal justice issues? | | |

|Legal advice regarding the rights of families and children? |

|Legal advice regarding mental health issues? | | |

|Legal advice regarding health insurance issues? | | |

|Other: | | |

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Please return the completed form to Margie Grimsley at m_grimsley@. If you have any questions you may contact your TA Coordinator Margie Grimsley at 303 455-5928.

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