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Catholic Charities of the Diocese of Palm Beach <br /> Samaritan Center for homeless families <br /> F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) <br /> 1. DEMOGRAPHICS: What information (data elements) will you need to collect in order <br /> to accurately describe your target population including demographics (age, gender, and <br /> ethnic background) required by the funder in Section H? What are the pieces of <br /> information that qualify them for your target population? How do you document their <br /> need for services or their "unacceptable condition requiring change" from Section Bl ? <br /> The Data elements collected for our target population are on our "Program Beneficiary <br /> Statistic" form. The information collected is 1 ) Unduplicated count of program beneficiaries; <br /> 2) Age group; 3) Sex; 4) Ethnic background; S) Program beneficiary characteristics (ex. Single <br /> parent, w/o GED or diploma, Veteran, Victim of rape/incest/domestic violence; physically <br /> disabled); 6) Income level; 7) Geographic residence in IRC; 8) Unit of service including census <br /> days, special programs, transportation, legal & miscellaneous; 9) Religion. <br /> In addition, a monthly census form is kept by day on families that are in residence. This <br /> information is carried over to the above form at the end of each month. This information is <br /> collected and entered into the data form once they enter the program. <br /> The pieces of information that qualify them for our target population and their need is <br /> documented before entering the program. A telephone intake is the first step in assessing <br /> their need. If it appears that they qualify for our program, an appointment is scheduled to fully <br /> explain the program to them and to have them complete the following forms: 1 ) Samaritan <br /> Center Personal Inventory that is designed to obtain information about a wide range of possible <br /> problems areas; 2) Subjective questionnaire (personal information including behaviors, mental <br /> health issues, druglalcohol issues, etc.) 3) A Statement regarding reason(s) or homelessness; <br /> 4) Written assignment (why they think they are a good candidate for the program; goals that they <br /> would like to accomplish and personal description of self. <br /> Once this information has been completed, a determination can be made if this family fits into <br /> our target population, and the depth of their need. <br /> 2. MEASURES: What data elements will you need to collect to show that you have <br /> achieved (or made progress toward) your Measurable Outcomes in Section D? What <br /> tools or items are you using as measures (grades, survey scores, attendance, absences, <br /> skill levels) for your program? Are you getting baseline information from a source on <br /> your Collaboration List in Section E? Are there results from your Activities in Section <br /> D that need to be documented? How often do you need to collect or follow-up on this <br /> data? <br /> The data elements needed to collect to show achievements/progress toward Measurable <br /> Outcomes are located in our "Master Stats" which include: the information in above form in <br /> addition to dates each family achieved a new Level, Level at time of exit, discharge information, <br /> forwarding address, phone and contact, 6 month contact information, 12 months contact <br /> information, rent/own home and whether employed. <br /> The toolstitems used are pre-post test, school grades, school attendance, counseling & parenting <br /> class attendance and the Levels stem. <br /> 12 <br />