Merced County Behavioral Health Program Review- COOP Program Staff Survey

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* 2. What contract services do you provide (check all that apply)?

Vocational Assessment

Employment Services

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* 3. If you checked Vocational Assessments on question #2, please describe which of the four components you provide (check all that apply):

Initial Evaluation

Functional Evaluation

Goal Setting Evaluation

Vocational Assessment Report

All of the above

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* 4. For question #3 above, please provide details of the specific activities within this service (i.e. specific curriculum or assessment tools used, etc.):

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* 5. If you checked Employment Services on question #2, please describe how the services are provided (check all that apply):

Job Club

One-on-one instruction

Special group instruction

All of the above

Other

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* 6. For question #5 above, please provide details of the specific activities within this service:

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* 7. Do you provide contract services to DOR consumers only or are these services provided to other consumers within the agency?

DOR Consumers only

Other Consumers within the agency

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* 8. If you work directly with consumers, do you maintain a list of the DOR consumers you serve?

Yes

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* 9. How do you document your time providing contract services and activities?

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* 10. Who are some of your program’s primary employers and community partners?

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* 11. Please describe the referral process for this program. (Please include any criteria that has been created, the established referral process, and any documentation provided with referrals).

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* 12. Does the program receive an authorizing case notes from DOR before services are started?

Yes

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* 13. Federal regulations require third-party cooperative partners to document services provided and progress toward outcomes. How do you document service provision and consumer progress in the services?

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* 14. Have any in-service or cross training with DOR taken place recently, or planned for the near future? If so, please list the topics discussed/planned.

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* 15. Who do you work with from DOR?

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* 16. How would you rate the communication and collaboration between DOR and the cooperative program? (Please include frequency of communications and meetings with the DOR Rehabilitation tea. 0 = poor; 10 = excellent).

0- Poor

10- Excellent

Clear

i We adjusted the number you entered based on the slider’s scale.

Merced County Behavioral Health Program Review- COOP Program Staff Survey

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* 1. What is your name and contract title?

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* 2. What contract services do you provide (check all that apply)?

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* 3. If you checked Vocational Assessments on question #2, please describe which of the four components you provide (check all that apply):

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* 4. For question #3 above, please provide details of the specific activities within this service (i.e. specific curriculum or assessment tools used, etc.):

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* 5. If you checked Employment Services on question #2, please describe how the services are provided (check all that apply):

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* 6. For question #5 above, please provide details of the specific activities within this service:

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* 7. Do you provide contract services to DOR consumers only or are these services provided to other consumers within the agency?

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* 8. If you work directly with consumers, do you maintain a list of the DOR consumers you serve?

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* 9. How do you document your time providing contract services and activities?

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* 10. Who are some of your program’s primary employers and community partners?

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* 11. Please describe the referral process for this program. (Please include any criteria that has been created, the established referral process, and any documentation provided with referrals).

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* 12. Does the program receive an authorizing case notes from DOR before services are started?

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* 13. Federal regulations require third-party cooperative partners to document services provided and progress toward outcomes. How do you document service provision and consumer progress in the services?

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* 14. Have any in-service or cross training with DOR taken place recently, or planned for the near future? If so, please list the topics discussed/planned.

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* 15. Who do you work with from DOR?

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* 16. How would you rate the communication and collaboration between DOR and the cooperative program? (Please include frequency of communications and meetings with the DOR Rehabilitation tea. 0 = poor; 10 = excellent).

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* 17. Please briefly explain your rating in question #19.

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* 18. Do you attend quarterly meetings? If so, what is your role in the meeting?

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* 19. Are the quarterly meetings of benefit to you in carrying out your contract duties If so, how?

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* 20. If you do not attend DOR Quarterly Meetings, how are you made aware of any changes/updates between DOR and the program?

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* 21. What are you most proud of regarding the program?

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* 22. What are the strengths of the program?

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* 23. Have any areas of the program presented challenges, and if so, what are your suggestions to improve those areas?

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* 24. What are some ideas you would implement to make the program better?

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* 25. Is there anything else you would like to share regarding the program?