Collaboration Assessment Worksheets

Transcription

1 Part 1 f 5: Knwledge Base Cllabratin Assessment Wrksheets 1. Have the cllabrating agencies agreed upn a cmmn definitin fr the target ppulatin? Cllabrating agencies have nt determined a cmmn definitin f the target ppulatin. Cllabrating agencies have agreed t a general definitin f the target ppulatin. Cllabrating agencies have agreed t the clinical characteristics and legal circumstances that define the target ppulatin, and this definitin is available in writing. Cllabrating agencies have agreed t the clinical characteristics and legal circumstances that define the target ppulatin, and a written versin f the definitin has been disseminated t all representatives f the cllabrating agencies. 2. Have the cllabrating agencies develped screening prcedures t identify the ptential target ppulatin fr the initiative? Cllabrating agencies have nt develped a standard screening prcedure t identify the target ppulatin. Cllabrating agencies have develped a standard screening prcedure t identify the target ppulatin, but nt all individuals wh culd ptentially participate in the initiative are screened. Cllabrating agencies have develped a standard screening prcedure and the majrity f ptentially eligible participants are screened Cllabrating agencies have develped a standard screening prcedure, all ptentially eligible participants are screened, and screening results are filed in an electrnic database.

2 Cllabratin Assessment Wrksheets 3. Have the cllabrating agencies develped a standardized assessment prcess fr individuals whse screening results indicate that they may be part f the initiative s target ppulatin? Cllabrating agencies have nt established a standardized assessment prcess. Cllabrating agencies have develped a standardized assessment prcess, but nt all f the individuals wh were screened and may be part f the target ppulatin are assessed. Cllabrating agencies have develped a standardized assessment prcess fr individuals wh were screened and may be part f the target ppulatin, and almst all f these individuals are assessed. Cllabrating agencies have develped a standardized assessment prcess fr individuals wh were screened and may be part f the target ppulatin, all f these individuals are assessed, and the assessment results are stred in an electrnic database. 4. Have the cllabrating agencies cmmissined prcess and utcme evaluatins n services delivered t the target ppulatin? Cllabrating agencies have nt defined prcess and utcme measures Cllabrating agencies have independently defined prcess and utcme measures Cllabrating agencies have jintly defined prcess and utcme measures Cllabrating agencies have jintly defined Page 2 f 10

3 Cllabratin Assessment Wrksheets Part 2 f 5: System Cllabratin 1. D the gals and bjectives guiding the initiative reflect the cllabrating agencies shared understanding f the issues that affect the target ppulatin? Cllabrating agencies have nt develped gals and bjectives fr the initiative. Cllabrating agencies have independently develped gals and bjectives fr the initiative, which d nt reflect a shared understanding f the issued that affect the target ppulatin. Cllabrating agencies have independently develped but reviewed and agreed upn each ther s gals and bjectives fr the initiative. Cllabrating agencies have jintly develped gals and bjectives fr the initiative, which reflect a shared understanding f the issues affecting the target ppulatin. 2. Has a frmal gverning structure been established amng the cllabrating agencies t imprve cllabratin and prmte the gals f the cllabratin? A frmal gverning structure has nt been established and there are n plans t establish ne. A frmal gverning structure is in the prcess f being established and includes representatives frm all the rganizatins invlved in the cllabratin. A frmal gverning structure is established and is chaired by leaders frm each cllabrating agency. Minutes r ther recrds are frwarded t agency leaders. Members f the frmal gverning structure have the authrity t make decisins that guide the implementatin and peratin f the initiative. A frmal gverning structure is established, meets regularly, and rutinely cmmunicates plans and decisins with cllabrating agencies leadership, wh in turn infrm their respective staffs. 3. Has the gverning structure created subcmmittees t address specific tpics relevant t the cllabratin? The gverning structure has nt established subcmmittees and there are n plans t d s. The gverning structure is planning t create subcmmittees that will address specific tpics relevant t the cllabratin. The gverning structure has established subcmmittees that are c-chaired by staff frm each agency. The gverning structure has established subcmmittees that meet regularly and reprt back t the frmal gverning structure n at least a quarterly basis. Page 3 f 10

4 Cllabratin Assessment Wrksheets 4. Is there an interagency agreement, memrandum f understanding (MOU) r similar dcument that defines the relatinship amng the cllabrating agencies? Cllabrating agencies have nt develped an interagency agreement r MOU. Cllabrating agencies plan t develp an interagency agreement r MOU. Cllabrating agencies have drafted an interagency agreement r MOU. This dcument includes prtcls fr cllabrating agencies t share their respnse t challenges/crises invlving their shared ppulatin and utlines terms fr each cllabrating agency t crdinate with ther initiatives, prgrams, r activities. Cllabrating agencies have develped an interagency agreement r MOU, and this dcument has been signed by the chief executives f the cllabrating agencies. Agency staff are familiar with the dcument and understand and supprt the prtcls utlined in the terms f this agreement. 5. Have cllabrating agencies identified emplyees wh are cnsidered bundary spanners, whse jbs include cmmunicating and cnnecting with each ther s systems? Cllabrating agencies have nt identified bundary spanners and there are n plans t d s. Cllabrating agencies are planning t identify bundary spanners and define their rles and respnsibilities. Cllabrating agencies have identified at least ne bundary spanner, but this persn has nt yet been fully utilized. Cllabrating agencies have identified bundary spanners wh are fully utilized.. These bundary spanners receive explicit institutinal supprt fr any rle respnsibility that falls utside the scpe f traditinal agency wrk. Bundary spanners actively educate and invlve ther members f their agencies in the cllabrative wrk. Page 4 f 10

5 Cllabratin Assessment Wrksheets 6. Have the cllabrating agencies interfaced with elected fficials r legislatrs at the lcal r state levels regarding the initiative? Cllabrating agencies have nt interfaced with elected fficials/legislatrs and have n plans t d s. Cllabrating agencies are planning t interface with elected fficials/legislatrs at bth the lcal and state levels t prmte the initiative. Cllabrating agencies interface with lcal and state elected fficials/legislatrs by rutinely briefing them n the prgress f the initiative. Cllabrating agencies interface with lcal and state elected fficials/legislatrs, by submitting jintly authred reprts n the prgress f the initiative. Page 5 f 10

6 Cllabratin Assessment Wrksheets Part 3 f 5: Service Crdinatin 1. Have the cllabrating agencies cnducted a needs assessment fr their target ppulatin and an inventry f cmmunity-based services available t the target ppulatin? Cllabrating agencies have nt cnducted a needs assessment f the target ppulatin r the cmmunity capacity t serve the target ppulatin. Cllabrating agencies have independently cnducted needs assessments f the target ppulatin and the cmmunity s capacity t serve the target ppulatin. Cllabrating agencies have jintly cnducted needs assessments f the target ppulatin and the cmmunity s capacity t serve the target ppulatin. Cllabrating agencies have a frmal inventry f all services available t the target ppulatin, including thse utside the scpe f the cllabrative initiative, and have crdinated their respnse t gaps in service capacity and identified pprtunities t guide the initiative with current services r supprts. 2. Des the target ppulatin have access t cmprehensive health services? At least tw services are prvided by the service prviders. At least fur services are prvided by the service prviders and members f the target ppulatin have quick and easy access t these services. At least six services are prvided by the service prviders and members f the target ppulatin have quick and easy access t these services. All eight services are prvided by the services prviders and members f the target ppulatin have quick and easy access t these services. 3. D cllabrating agencies service prviders rutinely share individual- and systems-level data amng themselves? Service prviders d nt rutinely share individual- and systems-level data Service prviders share individual-level data by rutinely referring members f their target ppulatin t each ther. Service prviders share individual-level data n mutual clients and cllect it in writing at rutine cases cnferences Service prviders rutinely share, update, and analyze individual- and systems-level data, which is accessible in a cmputer database. Page 6 f 10

7 Cllabratin Assessment Wrksheets 4. D the cllabrating agencies cnduct rutine crss-training f relevant staff? Cllabrating agencies d nt cnduct crss-training activities. Cllabrating agencies prmte infrmal crss-training thrugh interactins amng staff. Cllabrating agencies have planned, but nt yet implemented, frmal crss-training. Cllabrating agencies cnduct regularly scheduled crss-trainings. Page 7 f 10

8 Cllabratin Assessment Wrksheets Part 4 f 5: Resurces 1. Have the cllabrating agencies created a budget fr this initiative? Cllabrating agencies have nt created a budget fr this initiative. Cllabrating agencies each have their wn budgets fr this initiative. Cllabrating agencies each have their wn budgets fr the initiative, but have shared these budgets with each ther. Cllabrating agencies have jintly created a shared budget fr this initiative. 2. Hw have cllabrating agencies sught funding surces fr this initiative? Cllabrating agencies have nt identified any funding surces fr the initiative. Cllabrating agencies have established a prcess t identify new funding surces fr the initiative. Cllabrating agencies have identified shared funding surces fr the initiative. Cllabrating agencies have identified funding surces and develped a strategy t identify additinal funding surces thrugh jint legislative apprpriatins and jint applicatins fr grant funding. 3. T what degree d the cllabrating agencies each dedicate staff r staff time t the initiative? Cllabrating agencies d nt dedicate staff r staff time t the initiative. Cllabrating agencies have develped plans t dedicate staff and staff time t the initiative. Cllabrating agencies dedicate staff time t the initiative. Cllabrating agencies supplement dedicated staff and staff time t the initiative. Page 8 f 10

9 Cllabratin Assessment Wrksheets 4. D the cllabrating agencies have a strategy t assess the csts and benefits f serving the target ppulatin? Cllabrating agencies d nt have a strategy t assess the csts and benefits f serving the target ppulatin. Cllabrating agencies have a prcess t identify the cst and benefits f serving the target ppulatin. Cllabrating agencies have jintly cnducted a cst/benefit analysis f serving the target ppulatin and have calculated the savings generated by the initiative. Cllabrating agencies have jintly cnducted a cst/benefit analysis f serving the target ppulatin, calculated the savings generated by the initiative, and determined hw t shift the saving generated by the initiative t ther services prvided t the target ppulatin. Page 9 f 10

10 Cllabratin Assessment Wrksheets Part 5 f 5: General 1. Fr this initiative t be successful, t what aspects f each agency's culture d the partner agencies need t be sensitive? 2. Are there ther unique aspects f yur initiative that yu believe represent sme aspect f cllabratin? Name and agency affiliatin f the individual(s) wh cmpleted these wrksheets: Page 10 f 10