name: agency/program: date:

directions:For each benchmark, use the score that most accurately describes current practices to rate the program. Develop desired outcomes theprogram should achieve over the next 6 months to improve upon benchmarks scoring 1 or 2. Determine the program's areas of strengthand those where progress is needed using the Overall Scoring for each section.

scoring:

overall scoring: Record how many 3’s, 2’s, and 1’s were scored for each section. Areas of strength are those scoring mostly 3’s. Areas scoring mostly 2’srequire refinement to achieve quality. Areas scoring mostly 1’s are priority areas for improvement.

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3 2 1

The mission and vision for the agencyand program are clearly defined.

PROGRAM RATING FORM

This tool was created to support programs in self-evaluating the quality of theirday program services. It is meant to be used for introspection with an eye towardprogram improvement and action planning. The information gathered can be usedto inform agency policy/procedures, staff development initiatives, technicalassistance requests, and/or overall education and training curricula.

MEANINGFUL DAY QUALITY BENCHMARK MEASUREMENTS FOR DAY PROGRAMS

Current and strongly in place inyour program

Currently in place in yourprogram but needs improvementto be effective

Not currently in place in yourprogram

MISSION/VISION

benchmark 6-month desired outcome

1.

3 2 1

Agency administration and programstaff have a clear understanding of themission and vision and are on the samepage with its implementation.

Program activities and practicesadvance the mission and vision.

3 2 1

Program staff receive training onperson centered thinking.

All program staff have completed therequired trainings necessary to provideservice.

name: agency/program: date:

benchmark 6-month desired outcome

STAFF TRAINING/COMMITMENT

benchmark 6-month desired outcome

overall scoringHow many 3's, 2's, 1's?

2.

3.

1.

2.

This area: is an area of strength needs refinement is a priority for improvement

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3 2 1benchmark 6-month desired outcome

A professional development plan isdeveloped and supervision provided foreach staff person based upon specificjob competencies/need.

Program supervisor receivesappropriate training and support tomanage staff effectively.

Staff members know and can explainthe ISP outcomes, strategies and bestinstructional methods to use for eachindividual they are supporting.

name: agency/program: date:

3 2 1

PROVISION OF QUALITY SERVICES

benchmark 6-month desired outcome

An effective process is used to“Discover” who each person is, theirlikes/dislikes, support needs, dreams,etc.

overall scoringHow many 3's, 2's, 1's?

3.

4.

5.

1.

This area: is an area of strength needs refinement is a priority for improvement

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3 2 1benchmark 6-month desired outcome

given opportunities to consent ordeny assistance. prepared ahead of time as to whenmovement will take placegiven opportunities to control theassistance by initiating movementor by giving staff an “OK” forassistance.

Program staff advocate with theindividual receiving services and otherswhen the demands of the system/agency override the needs of thosereceiving supports, or when individualpreferences, needs, or gifts areneglected for any reason.

Program staff honor those who cannotspeak by seeking other ways ofunderstanding them.

Supports are provided to individualsand small groups as appropriate tocommunity settings.

Individuals receiving services havechoice regarding the staff personproviding support and the otherindividuals they interact with.

When an individual receiving services isin need physical assistance they are:

name: agency/program: date:

2.

3.

4.

5.

6.

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3 2 1benchmark 6-month desired outcome

Program staff develop respectfulrelationships with individuals receivingservices that are based on mutual trustand maintain professional boundaries.

Program staff identify and report anysituation in which individuals receivingservice are at risk of abuse, neglect,exploitation, or harm.

Program staff understand and respectthe values of individuals receivingservices and facilitate their expressionof choices related to those values.

Social/communication skills are taughtto all individuals receiving servicesduring all aspects of the programschedule.

Program staff maximize the use ofnatural supports (e.g. peer to peerassistance, assistance from store clerk)

name: agency/program: date:

overall scoringHow many 3's, 2's, 1's?

7.

8.

9.

10.

11.

This area: is an area of strength needs refinement is a priority for improvement

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name: agency/program: date:

3 2 1

ACTIVITIES/SCHEDULES

benchmark 6-month desired outcome

Schedules for programs are individualand provide sufficient opportunity foreach individual receiving service towork towards their ISP outcome.

Individuals receiving service are part ofcreating the program schedules andhave informed choice into the activitieson their schedules.

Activities that individuals receivingservices are engaged in include age-appropriate materials and content.

Individuals receiving service areencouraged to explore new activitiesand new skills with support from staff.

Activities are selected based upon thelocal community, people’s interests,preferences, plan outcomes andsupport needs.

All activities are centered aroundbuilding meaningful relationships withother people in the community.

1.

2.

3.

4.

5.

6.

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name: agency/program: date:

3 2 1benchmark 6-month desired outcome

In-facility instruction is meaningful andleads to meaningful, integratedcommunity activities.

Activities in the community arecoordinated, meaningful and integrated.

Various types of activities areincorporated into the program.

Individuals receiving service are madeaware of and prepared prior toactivities (e.g. expectations of location,needed resources and supports, etc.).

Follow-up and reflection activities areconducted with individuals receivingservice after activities.

People receiving support are not deniedparticipation in exploring appropriatecommunity activities due to behavior concerns.

overall scoringHow many 3's, 2's, 1's?

7.

8.

9.

10.

11.

12.

This area: is an area of strength needs refinement is a priority for improvement

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name: agency/program: date:

3 2 1

COMMUNITY DEVELOPMENT

benchmark 6-month desired outcome

Agency administration and programstaff assist individuals receiving serviceto access opportunities and resourcesin the community that are available toeveryone.

Community development is an ongoingstaff activity which includes networkingand increasing connections to the localcommunity.

Program reaches out to communitypartners to have a regular opportunity/platform to provide feedback to theprogram.

The program encourages individuals touse a variety of community resourceson a daily basis.

overall scoringHow many 3's, 2's, 1's?

1.

2.

3.

4.

This area: is an area of strength needs refinement is a priority for improvement

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name: agency/program: date:

3 2 1

PHYSICAL/SOCIAL/EMOTIONAL ENVIRONMENT

benchmark 6-month desired outcome

The physical environment of theprogram promotes the health, safety,and independence of everyone.

The emotional climate of the programas a whole is positive, characterized bymutually respectful, supportive, andrelaxed interactions among staff andindividuals receiving service.

The program has clearly definedexpectations for individual and staffconduct that are well known to staff,people receiving support, and visitors.

Program staff provide appropriatefeedback to individuals about positivebehavior and accomplishments.

Program staff approach difficultsituations and/or conflicts with apositive attitude, in a non-threatening,calm manner.

overall scoringHow many 3's, 2's, 1's?

1.

2.

3.

4.

5.

This area: is an area of strength needs refinement is a priority for improvement

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name: agency/program: date:

3 2 1

MOVEMENT TOWARDS EMPLOYMENT

benchmark 6-month desired outcome

Program staff believe in EmploymentFirst and that all individuals can work.

Employment is discussed in terms ofinterests, support needs, how to moveforward, and service delivery options.

People receiving support can receivetravel training and utilize various formsof community transportation to accesscommunity locations (e.g. AccessLink,public bus/train, walking, etc.)

1.

2.

3.

overall scoringHow many 3's, 2's, 1's?

This area: is an area of strength needs refinement is a priority for improvement

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action plan

benchmark(use # to save space) when?who is

responsible?steps to achieve outcomedesired outcomearea forimprovement

name: agency/program: date:

directions:This Action Plan supports your program in prioritizing and organizing next steps to achieve quality. Use the Overall Scoring for eachsection in the Program Rating Form to identify Priority Areas for Improvement. List desired outcomes for benchmarks in these areasthat should be improved upon first. Record the steps needed to achieve each outcome, who is responsible for the completion of theoutcome, and the timeframe for completion. Repeat this process for Areas Needing Refinement next. The Action Plan is a workingdocument, and should be revised with new plans for improvement once desired outcomes are achieved.

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name: agency/program: date:

benchmark(use # to save space) when?who is

responsible?steps to achieve outcomedesired outcomearea forimprovement

Preparation of this document was supported by the NJ Department of Human Services, Division of

Developmental Disabilities (Contract #04ME21C).

October, 2020