Documents
Resources
Learning Center
Upload
Plans & pricing Sign in
Sign Out
Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

POPE

VIEWS: 26 PAGES: 4

POPE

More Info
									AGENCY NAME: PROGRAM NAME OR PROGRAM CLUSTER NAME:

Erie County Department of Mental Health Program Outcome Performance Evaluation (POPE) Contract Year: 2008 SUBMISSION TYPE: CONTRACT: _____ REPORTS: YTD Thru April 30th:_____ YTD Thru August 31st: _____

Year End: _____

Performance Targets

Performance Measurement
Description of methods, tools and/or process for valid measuring and analyzing performance targets' achievement. This should include the naming of any valid instruments and/or analytical methodologies to be employed and, should show formula to be used for calculating achievement level. If science-based measurement is not available, please attach a brief explanation, including brief description of your plan for developing accurate and valid measurement, if feasible. If infeasible, please briefly explain.

Performance Target Achievement

Variance
+/- from target value (negative values when target not achieved, positive when achieved or exceeded).

Required Comments

ECDMH Use Only:

Key behavior or indicator to be changed; Baseline level (if applicable); and, Target Value. Include brief definition and/or explanation if not self-explanatory.

Calculation of achievement level must be shown.

For those performance targets with YTD performance below expected contracted levels, state what management efforts have/will occur to address any shortfalls. If this is Check a subsequent report, provide an indication of the effectiveness of those efforts and if where appropriate, any additional action taken. Include description of any other issues "New" with the performance target here. Attach any related reports and, additional pages if necessary.

Credited % (Max 100%)

Performance Target # 1 New for contract yr.?: Y or N (There can be only one new one per program or cluster.)

Performance Target # 2 New for contract yr.?: Y or N (There can be only one new one per program or cluster.)

Performance Target # 3 New for contract yr.?: Y or N (There can be only one new one per program or cluster.)

Performance Target # 4 New for contract yr.?: Y or N (There can be only one new one per program or cluster.)

Performance Target # 5 New for contract yr.?: Y or N (There can be only one new one per program or cluster.)

ECDMH use only: Avg. Outcome Credited for Included Outcomes: Is Avg. Credited Outcome Achievement <95%; Y or N:

Excluded Outcome #(s) and reason:

If yes, % points below 95%:
Coordinator: Date:

Agency: Unit of Service Worksheet
PROGRAM CATEGORIES Program/Cluster Title:

COMPLETE SECTION A.1, A.2 OR A.3
A.1 CONTRACTED UNITS OF SERVICE THREE YEAR AVERAGING (OMH Program Codes 2100 & 0700 must attach U/S Detail) Program Code
u/s measure (i.e., hours, visits, etc.)

TOTAL 0 0 0 0 0 0

2004 2005 2006 Total Units of Service 0 0 0 0 3-year average 0 0 0 0 95% 0 0 0 0 U/S on ECCS-01 If 95% calculation differs from the U/S on the ECCS-01, please explain the rationale for the variance:

0 0 0

0 0 0

A.2 CONTRACTED UNITS OF SERVICE SUPPORTED HOUSING PROGRAMS Rent - Recipient Days Program Code Contracted # of beds x 365 days 0 0 0 0 x 95% 0 0 0 0 U/S on ECCS-01 Services - Face to Face Contacts Program Code Contracted # of beds x 12 contacts 0 0 0 0 x 95% 0 0 0 0 U/S on ECCS-01 If 95% calculation differs from the U/S on the ECCS-01, please explain the rationale for the variance: TOTAL 0 0 0 0 0 0 0 0 TOTAL 0 0 0 0 0 0 0 0

A.3 CONTRACTED UNITS OF SERVICE ALTERNATE CALCULATION METHOD Use this section to describe and illustrate the method for calculating units of service if different from either of the above methods:

Attach additional pages as needed Page 5 ECDMH 2008

Agency:

Unit of Service Worksheet - MENTAL HEALTH

U/S BY TYPE OF VISIT - SUPPLEMENT Complete for OMH program codes 2100 (exclude Child Enhancement) and 0700 only.

Brief Year

Regular

Group

Collateral

Crisis Totals
0

2004

2005

0

2006

0

x .5 wt
Totals

x .35 wt 0.0 0.0 0.0 0.0 0.0

Avg. 04-06 0 95%

0.0

2008 Total Contracted Units of Service (Should equal line 6 of the ECDMH Budget/Cost Report Summary for the corresponding program)

0

ECDMH 2008
Page 6

School Based Collaboration Program Plan/Units of Service
Agency School(s) Contract Year Type of Unit of Service:

Hour

School Year Contact/visit Spring Fall Units of Service 1/1-6/30 7/1-12/31

Service Activity Individual Counseling Group Counseling Case Management Group Therapy Group Rec Activities Tutoring Parent Advocacy School Consultations Teacher Training Parent Training FamilySupports Crisis Intervention Prevention Other

Description of Activity

TOTAL: (must tie out to page 5 if using the 3-year history) Agency Representative Site Facilitator School Representative Parent Representation Date: Date: Date: Date:


								
To top