"Office of Program Accountability Technical Assistance Referral Form" - Florida

Office of Program Accountability Technical Assistance Referral Form is a legal document that was released by the Florida Department of Juvenile Justice - a government authority operating within Florida.

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Office of Program Accountability
Technical Assistance Referral Form
Date:
To:
Program Area/Office:
From:
Programming and Technical Assistance is Requested for:
Program Name:
Program Director/Superintendent:
Phone #:
Provider Name:
Provider Address:
Provider CEO/President:
Phone #:
Monitor/Contact Name:
Phone #:
Indicate the urgency of the request:
1
2
3
4
5
Low
Moderate
High
Program Operations Regional Director completes the table below identifying service needs, reason for request and expected outcome.
Reasons For Referral
Indicate requested service by checking box
Describe the reason for
Expected outcome
the request
Evidence Based Training
1)
Verification of Evidence-Based Programming (assisting
program with verifying whether the program’s current
programming/treatment is evidence-based)
2)
Implementation of Evidence-based Practices (assisting
programs with the completion of action plans, scheduling
of groups, etc.)
3)
Staff Training: Facilitator Training on an Evidence Based
Curriculum – Other (training for program staff to
facilitate groups)
4)
Fidelity Monitoring: Other Evidence-Based Curriculum
(fidelity monitoring of program staff delivering other
evidence-based curriculum to youth groups)
5)
Coaching: Other Evidence-Based Curriculum (TAS co-
facilitates or provides coaching to facilitators to improve
fidelity)
Motivational Interviewing
6)
Staff Training: 2-Day Basics of Motivational Interviewing
and Stages of Change Training (this is a prerequisite
course for all evidence-based training provided by the
Department)
7)
Staff Training: MI Nuggets – A Behavior Modification
Strategy (train staff [coaches] on how to coach program
staff to effectively use basic MI techniques to effectively
interact with youth.)
Girls Moving On
8)
Staff Training: Facilitator Training on Girls Moving On
(GMO)
9)
Fidelity Monitoring: GMO (fidelity monitoring of program
staff delivering GMO to youth groups)
10)
Coaching: GMO (TAS co-facilitates or provides coaching
to facilitators to improve fidelity)
Office of Program Accountability
Technical Assistance Referral Form
Date:
To:
Program Area/Office:
From:
Programming and Technical Assistance is Requested for:
Program Name:
Program Director/Superintendent:
Phone #:
Provider Name:
Provider Address:
Provider CEO/President:
Phone #:
Monitor/Contact Name:
Phone #:
Indicate the urgency of the request:
1
2
3
4
5
Low
Moderate
High
Program Operations Regional Director completes the table below identifying service needs, reason for request and expected outcome.
Reasons For Referral
Indicate requested service by checking box
Describe the reason for
Expected outcome
the request
Evidence Based Training
1)
Verification of Evidence-Based Programming (assisting
program with verifying whether the program’s current
programming/treatment is evidence-based)
2)
Implementation of Evidence-based Practices (assisting
programs with the completion of action plans, scheduling
of groups, etc.)
3)
Staff Training: Facilitator Training on an Evidence Based
Curriculum – Other (training for program staff to
facilitate groups)
4)
Fidelity Monitoring: Other Evidence-Based Curriculum
(fidelity monitoring of program staff delivering other
evidence-based curriculum to youth groups)
5)
Coaching: Other Evidence-Based Curriculum (TAS co-
facilitates or provides coaching to facilitators to improve
fidelity)
Motivational Interviewing
6)
Staff Training: 2-Day Basics of Motivational Interviewing
and Stages of Change Training (this is a prerequisite
course for all evidence-based training provided by the
Department)
7)
Staff Training: MI Nuggets – A Behavior Modification
Strategy (train staff [coaches] on how to coach program
staff to effectively use basic MI techniques to effectively
interact with youth.)
Girls Moving On
8)
Staff Training: Facilitator Training on Girls Moving On
(GMO)
9)
Fidelity Monitoring: GMO (fidelity monitoring of program
staff delivering GMO to youth groups)
10)
Coaching: GMO (TAS co-facilitates or provides coaching
to facilitators to improve fidelity)
Office of Program Accountability
Technical Assistance Referral Form
LifeSkills Training
11)
Staff Training: Facilitator Training on LifeSkills Training
(LST)
12)
Staff Training: LST Overview
13)
Fidelity Monitoring: LST (fidelity monitoring of program
staff delivering LST to youth groups)
14)
Coaching: LST (TAS co-facilitates or provides coaching to
facilitators to improve fidelity)
Thinking for a Change
15)
Staff Training: Facilitator Training on Thinking for a
Change (T4C)
16)
Staff Training: T4C Overview
17)
Fidelity Monitoring: T4C (fidelity monitoring of program
staff delivering T4C to youth groups)
18)
Coaching: T4C (TAS co-facilitates or provides coaching to
facilitators to improve fidelity)
Behavior Management
19)
Staff Training: Effective Behavior Management (training
for staff on the components needed to have an effective
behavior modification system to effect prosocial changes
in youths’ problem behavior)
20)
Meeting Facilitator: Modification of Behavior
Management System (assist program in modification of
current BMS to include effective behavior management
and behavior modification strategies)
21)
Fidelity Monitoring: Behavior Management Strategies
(fidelity monitoring of program staff with regard to
utilizing effective behavior management strategies)
Other services
22)
Staff Training: Facilitator Training on Teaching
Alternatives to Gangs (TAG)
23)
Fidelity Monitoring: TAG (fidelity monitoring of program
staff delivering TAG to youth groups)
24)
Staff Training: Effective Group Facilitation (training for
staff on how to effectively facilitate groups. Coaching
and fidelity monitoring included)
25)
Staff Training: Intervention and Treatment Team
Meetings (train staff in best practices for building
relationships with youth and other team members)
26)
Staff Training: 3-Day R-PACT Training (train staff on the
Residential Positive Achievement Change Tool [R-PACT],
Youth Needs Assessment Summary [YNAS], Performance
Plan, Performance Summary, and case management
reports software in JJIS)
For TA Program Administrator Use Only
Date referral received:
Received by:
Referral accepted:
Yes
No
Approved by:
Technical Assistance Specialist Assigned:
Expected start date:
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