Warning:

This document is being maintained for historical purposes, but is now out of date. To view current guidelines please visit:

• HIV/AIDS Guidelines and Recommendations   at http://www.cdc.gov/hiv/guidelines/index.html

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Table_A4

                                                   Appendix D

                                               QUALITY ASSURANCE

                              PROGRAM ASSESSMENT FORM - SUPPORT GROUP FACILITATOR
       
       
       TITLE: _______________________  FACILITATOR:______________________________
       
       REVIEWER: ______________________
       
       DATE: _____________
       
       DIRECTIONS:  Check the appropriate columns to indicate degree to which the facilitator met
       performance criteria:
       
                    EXCELLENT  indicates that performance met criteria beyond fully successful.
       
                    FULLY SUCCESSFUL  indicates performance met criteria successfully.
       
                    NEEDS ATTN  indicates performance needs supervisory guidance to meet criteria.
       
                    N/A  indicates this criteria did not apply to this situation.

Check only within and not between the boxes.  If undecided, use "comments" section to clarify.
                                                                      
                                                                                         EXCELLENT   FULLY        NEEDS      N/A
                                                                                                     SUCCESSFUL   ATTN
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 INTRODUCTIONS
 
 1.    Introduces self by name and title.                                                                
 
 2.    Facilitates introductions and stresses confidentiality among group members.
 
 3.    Clearly states purpose, goals, objectives, and ground rules for session.

 4.    Allows members to share their expectations from the group.                                        
 
 5.    Starts group at or within 10 minutes after starting time.                                         
 
 6.    Attends to group members' physical comfort.                                                       
 
 7.    Makes required administrative announcements.               

       COMMENTS:
 
-------------------------------------------------------------------------------------------------------------------------------- 
 GROUP FACILITATION
 
 1.    Assures maintenance of group structure and schedule by promoting 
       adherence to rules and guidelines.

 2.    Guides members through group processes, e.g., group dynamics.

 3.    Asks open-ended questions.                                                                        
 
 4.    Maintains focus of discussion.                                                                    
 
 5.    Synthesizes and abstracts pertinent information.                                                  
 
 6.    Creates opportunities for questions, comments, clarifications, and expressions 
       of opinions and feelings.

 7.    Makes appropriate referrals and interventions, as needed.                                         

 8.    Provides members with educational materials and information to substantiate 
       discussion.

       COMMENTS:

-------------------------------------------------------------------------------------------------------------------------------- 
 PROFESSIONAL PRESENCE
 
 1.    Dresses in suitable attire.                                                                       
 
 2.    Remembers and uses names of group members, as appropriate.                                        
 
 3.    Is tactful when discussing  controversial topics.                                                 
 
 4.    Imparts attitudes and information consistent with agency goals and policy.

 5.    Avoids careless or inappropriate use of slang words.                                              
 
 6.    Handles unexpected or difficult disclosures with minimal display of value 
       judgement, embarrassment, or confusion.

 7.    Makes positive and tactful corrective statements.                                                 

 8.    Acknowledges contrary viewpoints.                                                                 
       
       COMMENTS:
 
-------------------------------------------------------------------------------------------------------------------------------- 
 PROCESS SKILLS
 
 1.    Uses descriptive and reinforcing gestures.                                                         
 
 2.    Maintains eye contact with group members.                                                          
 
 3.    Speaks in vernacular that is germane to group.                                                     
 
 4.    Clearly enunciates and projects voice.                                                             
 
 5.    Sets stage for group session.                                                                      
 
 6.    Encourages all group members to be involved in activities.                                         
 
 7.    Listens actively.                                                                                  
       
       COMMENTS:
 
-------------------------------------------------------------------------------------------------------------------------------- 
 CONCLUSION
 
 1.    Brings group to closure in a tactful manner.                                                      
 
 2.    Summarizes group session.                                                                         
 
 3.    Reviews session objectives with group members.                                                    
 
 4.    Helps group identify further human or material resources.                                         
 
 5.    Remains available for group members' questions and comments after the 
       session.

 6.    Uses a tool to assess participants' satisfaction with session and group impact.
       
       COMMENTS:                                                                                         
 
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COMMENTS ON CONCLUSION:









GROUP RESPONSE TO FACILITATOR:











OVERALL SUGGESTIONS AND REMARKS:











FACILITATOR'S COMMENTS AND SIGNATURE:

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