DATA COLLECTION FORM FOR DETAIL SHEET #07

Using a scale of 0-3, please rate the degree to which the grant program has included families, youth, and consumers into their program and planning activities. Please use the space provided for notes to describe activities related to each element and clarify reasons for score.

0 1 2 3 Element
        1. Family members/youth/consumers participate in the planning, implementation and evaluation of the program's activities at all levels, including strategic planning, program planning, materials development, program activities, and performance measure reporting.
        2. Culturally diverse family members/youth/consumers facilitate the program's ability to meet the needs of the populations served.
        3. Family members/youth/consumers are offered training, mentoring, and opportunities to lead advisory committees or task forces.
        4. Family members/youth/consumers who participate in the program are compensated for their time and expenses.
        5. Family members/youth/consumers participate on advisory committees or task forces to guide program activities.
        6. Feedback on policies and programs is obtained from families/youth/consumers through focus groups, feedback surveys, and other mechanisms as part of the project's continuous quality improvement efforts.
        7. Family members/youth/consumers work with their professional partners to provide training (pre service, in-service and professional development) to MCH/CSHCN staff and providers.
        8. Family/youth/consumers provide their perspective to the program as paid staff or consultants.

0=Not Met
1=Partially Met
2=Mostly Met
3=Completely Met

Total the numbers in the boxes (possible 0-24 score) _________

NOTES/COMMENTS: