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Community Child Care Resorces Inc. " Psychological Service " Children' s Services Advisory Committee <br /> F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) <br /> • 1 . DEMOGRAPHICS : What information ) will elements) you need to collect in order <br /> ( <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 B19 <br /> Data Elements Describing "Services to Families " Targetpulation : <br /> a. ) Source of referral — (center, parent, CCCR, outside agency) <br /> b . ) Form of treatment plan — (child, parent, couple, family) <br /> C . ) Diagnostic code (DX) number <br /> d. ) Admission Global Assessment of Functioning (GAF) number <br /> e .) Anticipated number of service units that will be needed <br /> Data Elements Describing "Services to Classrooms " tar etPopulation: <br /> a. ) Number of children exhibiting behavioral concerns <br /> b .) Number of children scoring below standard norms on DECA assessment <br /> C . ) Type and number of unsuccessful teacher interventions prior to requesting services <br /> d.) Type and number of teacher requests for service in individual centers <br /> e .) Number of service units used per classroom <br /> f. ) Number of children referred for individual therapy. <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 /> "Services to Families " Measurement Elements <br /> a. ) The number of referrals made for psychological services will be collected by the <br /> Family Resource Coordinator (FRC) and compiled in the Psychological Services Log <br /> b .) Mental Health Provider Forms completed by the therapist will be collected quarterly <br /> and compiled in the Psychological Services Log. The form documents admission and <br /> discharge GAF ' s, Diagnosis Codes and descriptions, # of appointments made, kept, <br /> cancelled and "no Show", anticipated length of treatment, and other outside resources <br /> being used. <br /> "Services to Classrooms " Measurement Elements <br /> a.) Fall and spring DECA assessment scores will be collected in October and May <br /> and compiled in the Psychological Services Log. <br /> b .) The numbers and types of classroom concerns are collected through the <br /> completion of the Teacher Pre-Observation Forms. They are submitted along with <br /> the Psychological Support Classroom Report Form to the FRC who compiles <br /> them in the psychological Services log. <br /> • c.) The Psychological Support Classroom Report Form, upon completion by the <br /> 11 <br />