NYC SRS tool by ashrafp


									New York City Supplemental Rating Scale (NYC-SRS)                                                                 Content Area:
                                                                                                                  Program Design and Management

    Inadequate                 Adequate                                                               Good                                     Excellent
        1           2             3           4                                                        5                      6                   7
                                         _____ 3.1 Teaching staff meets                 _____ 5.1 Teaching staff engage in         _____ 7.1 Teaching staff develop
 _____ 1.1 Teaching staff do not
                                         qualifications and receives ongoing            self-evaluation to reflect on their        professional development goals and
 meet qualification requirements and
                                         supervision and an annual performance          performance and to improve their           seek opportunities to continue their
 are not regularly supervised.
                                         evaluation, as per Article 47 of the NYC       practice.                                  education (workshops, conferences,
                                         Health Code.                                                                              coursework).

                                         _____ 3.2 Non-teaching staff meets             _____ 5.2 A professional develop-          ____ 7.2 Non-teaching staff are
 _____ 1.2 Non-teaching staff does
                                         qualifications and ongoing supervision         ment plan for addressing all               encouraged to participate in training
 not meet qualification requirements
                                         and an annual performance evaluation, as per   staff’s training needs is developed        activities (workshops, coursework,
 and are not regularly supervised.
                                         Article 47 of the NYC Health Code.             and implemented annually.                  CDA, FDC, conferences).

                                         _____ 3.3 Non-teaching staff participates      _____ 5.3 The director participates        _____ 7.3 The director is a member
 _____ 1.3 There is no evidence that
                                         in regular staff development, as per           in at least three professional             of an early childhood education
 non-teaching staff participates
                                         Article 47 of the NYC Health Code.             development activities annually.           professional organization.
 in staff development.

                                         _____ 3.4 The director participates in at
 _____ 1.4 There is no evidence
                                         least one professional development
 that the director attends any
                                         activity annually regarding supervision,
 professional development
                                         administration, and/or leadership.
 activity that relates to supervision,
 administration, or leadership.

                                                                                                                              Score: __________
New York City Supplemental Rating Scale (NYC-SRS)                                                                 Content Area:
                                                                                                                  Program Design and Management

 Notes / Documents

 1.1, 1.2 As per Article 47 of the NYC Health Code.

 3.1 [CC]: Documentation regarding teaching staff qualifications:
          Certifications;
          Copies of job descriptions;
          Group staff meetings, training, on/off site workshops, dated agendas and attendance sheets.
      [CC]: Documentation regarding supervision of teaching staff supervision:
          Recorded teacher observations;
          Evaluations.

 3.2 “Non-teaching” staff refers to “support" staff;
  [CC]: Documentation regarding staff qualifications:
          Certifications;
          Evidence of fire prevention training;
          Food handling certificate for the kitchen;
          A facility that has a food preparer or uses kitchen facilities for food preparation has a designated
           person in the facility with a valid certificate in food preparation from the New York City Health
           Academy; All staff are provided opportunities to receive training in the areas of medical, dental,
           nutrition, and mental (1304.40 (F)(1); 1304.52 (K)(3));
          NYC Fire Department certificate of fitness.
 [CC]: Documentation regarding supervision of non-teaching staff::
          Evidence of staff observations and evaluation.

 3.3, 3.4, 5.3, 7.2 As evidenced by dated certificates of training, agendas, attendance sheets, letters of

 5.2 Evidence of a professional development plan.

 7.3 Membership cards (e.g., NAEYC, BCDI, etc.)
New York City Supplemental Rating Scale (NYC-SRS)                                                                 Content Area:
                                                                                                                  Program Design and Management
     Inadequate                                             Adequate                                   Good                                       Excellent
         1         2                                           3                      4                 5                        6                   7
 _____ 1.1 The program does not             _____ 3.1 There is a system in place          _____ 5.1 An annual self-                  _____ 7.1 The program engages in a
 conduct program evaluations nor            for programs to evaluate their                assessment is conducted utilizing          systematic process of strategic planning
 self-assessments.                          adherence to applicable regulations,          evaluation tools to assess the             based on the self-assessment results.
                                            e.g., federal, state, city.                   program, Board members, staff,
                                                                                          and parents, who are also involved
                                                                                          in the program’s self-assessment

 _____ 1.2 There are no written             _____ 3.2 There is a written                  _____ 5.2 During the Self                   _____ 7.2 Teaching staff has access
 program goals and/or policies.             statement of goals for all modalities,        Assessment process, long-term               to and regularly utilizes computers
                                            as well as program policies, defining         and short-term program goals are            with internet access.
                                            the intended results that are updated         developed annually by the Board,
                                            periodically.                                 staff, and parents.

                                            _____ 3.3 The program adheres to              _____ 5.3 Program utilizes Nutrition
_____ 1.3 There is no evidence that
                                            Article 47 of the New York City Health        and Health Consultants as specified
the program adheres to Article 47 of
                                            Code and ACS health and safety                In the Head Start Performance
the New York City Health Code and
                                            requirements.                                 Standards (Head Start only*).
ACS health and safety

                                            _____ 3.4 There is appropriate                _____ 5.4 Administrative staff use
_____ 1.4 There is no appropriate
                                            technology for communication on the           computer database applications
technology for communication on
                                            premises, e.g., fax capability, working       for record keeping purposes, e.g.,
the premises, e.g., fax capability,
                                            copying machine, computer and                 inventories, purchases, etc.
working copying machine, computer
and printer.

* Applies only to Head Start and Head Start Collaborations and Partnerships                                                      Score: __________
New York City Supplemental Rating Scale (NYC-SRS)                                                           Content Area:
                                                                                                            Program Design and Management

 Notes / Documents

 3.1 Annual program assessment process.

 3.2 Goals demonstrate attention to all aspects of the developmental continuum for all ages and groupings
 service (including children with special needs). The following written policies are required:
     A copy of program’s personnel practices and policies;
           Policy of safety rules for supervising children on field trips;
           Authorized escort policy;
           Posted policy for notifying parent of children’s Injuries and illnesses;
           Posted parent observation policy;
           Policy on administration of medication;
           [CC] Posted policy on handling behavior.

 3.4 Documentation regarding ACS health and safety requirements:
         Conspicuous posting of program’s license or indication of pending approval;
         Health guidelines, illness logs, and infectious disease control log and procedures;
         Accident and incident reports (ACD1068);
         Custodian’s maintenance log;
         Documented emergency medical release form; other-than-parent emergency contacts;
         Listing for police;
         Fire, isolation, and First Aid certificates indicating CPR procedures;
         Parent contact telephone numbers;
         Emergency care telephone numbers.

 3.4, 5.4, 7.2 Specified equipment is functional and on the premises; Internet connection verified; and
 copies of database reports are available.

 5.1 Community assessment, family partnership agreements/family needs assessments, and self-
 assessment data are used to build on strengths and improve the program.

 5.2 Aggregated assessment results regarding child outcomes are utilized in long-range planning and/or
     program evaluation and improvement. School readiness goals are developed and aligned with the
     Head Start Child Outcomes Framework, State early learning standards as appropriate, and
     requirements and expectations of schools the children will attend. Documentation regarding school
     readiness includes self assessment information.

 7.1 E.g., Enrollment and recruitment plans.
New York City Supplemental Rating Scale (NYC-SRS)                                                                   Content Area:
                                                                                                                    Program Design and Management

  Inadequate             Adequate                                                                    Good                                                 Excellent
      1         2           3                                                  4                      5                            6                         7
_____ 1.1 There are no             _____ 3.1 There are written by-laws.            _____ 5.1 By-laws are reviewed and                    _____ 7.1 By-laws approved are by the
written by-laws.                                                                   approved annually by DAPC (HS only*).                 governing body(ies).

_____ 1.2 There is no              _____ 3.2 There is a structure for
                                                                                   _____ 5.2 Program governance has a                     _____ 7.2 The DAPC or PAC is charged with
structure for program              program governance.
                                                                                   structure that includes:                                Its roles and responsibilities by the Director
                                                                                        -    Parent Involvement                           and the Board during joint meetings.
_____ 1.3 There is no              _____ 3.3 Governance orientation is                  -    Parent Advisory Committee (PAC)
evidence of Governance /               provided to DAPC and PAC.                                                                          _____ 7.3 DAPC, PAC, and/or Governing
Sponsoring Board training.                                                              -    Classroom Parent Committee*;                 Board members attend workshops and
                                                                                        -    Site Parent Committee*;                      other outside conferences on governance
_____ 1.4 There is no              _____ 3.4 There is evidence of Board                                                                   (i.e., program management, administration,
evidence of Board meetings         meetings and/or participation.
                                                                                        -    Delegate Agency Policy                       board governance).
and/or participation.
                                                                                                                                          _____ 7.4 The Board has active committees
                                                                                   _____ 5.3 Training for governing body(ies) is          that oversee the delivery of high quality
_____ 1.5 There are no
                                                                                    provided annually to enable them to carry             services to children and families.
internal controls to the Board     _____ 3.5 There are internal controls to
                                                                                    out their program responsibilities.
structure.                         the Board structure:
                                            There is a policy in place that                                                              _____ 7.5 DAPC or PAC members attend the
                                                                                   _____ 5.4 Governing body(ies) meet(s) at               Board meetings and/or a member of the Board
                                             upholds fiduciary
                                                                                   least four times a year.                               attends the DAPC or PAC meetings.
                                                                                   _____ 5.5 Impasse procedures and internal
                                            Governing bodies receive
                                                                                   dispute resolution policy are reviewed and
                                             periodic reports of financial
                                                                                   approved annually.
                                             status and program

                                            Personnel practices and
                                             policies are in accordance
                                             with City, State, Federal, and
                                             union regulations;

                                            The Board is responsible for
                                             all directors’ tasks.

* Applies only to Head Start and HS Collaborations and Partnerships                                                                    Score:   __________

New York City Supplemental Rating Scale (NYC-SRS)                                                              Content Area:
                                                                                                               Program Design and Management

Notes / Documents

The governing body for Child Care is referred to as a “Sponsoring Board”; in Head Start, it is called a
“Governing Board” and includes the Delegate Agency Policy Council (DAPC), which is composed of

1.1, 3.1 [CC] There is a written conflict of interest policy/nepotism statement in the by-laws.
         [HS]: Both the Governing Board and the Delegate Agency Policy Council (DAPC) must approve the
by-laws, including a description of the Policy Committee (PC) structure and composition.

1.2 [CC]: No PAC formation.
    [HS]: DAPC is not charged with roles and responsibilities; neither the Governing Board nor the DAPC
has reviewed or approved the formation and composition of the DAPC within the last year.

3.3. 5.2, 7.2, 7.3, 7.5 [CC] Programs primarily serving homeless families, battered women, and housed in
the court system are exempt from establishing a certified PAC. These indicators should be skipped and not
taken into account when scoring.

1.3 [CC]: Training refers to Sponsoring Board only;
    [HS]: There is no formal governance training provided to the newly formed DAPC and/or Board,
    including annual DAPC training.

3.1 [CC]: Written by-laws are available; minutes of at least four annual meetings that involve discussions
    of the Child Care program(s).
    [HS]: By-laws describe PC composition and structure.

3.2 [CC]: Sponsoring Board has established functioning supportive committees, including personnel, fiscal,
program, and others as necessary.
     [HS]: Refers both to Governing Board and DAPC structure.

3.3, 5.3 “Orientation” includes an overview of the roles and responsibilities of the parent representatives;
“training” provides in-depth instruction of individual responsibilities.

3.4 [CC]: Evidence of Board meetings/participation at least four times a year.
    [HS]: Evidence that Governing Board and DAPC meet all requirements for shared decision-making and
approvals related to planning and general procedure, as stipulated in Appendix A to 13.04.50 of the
Performance Standards.

3.5 Evidence that all stated internal controls are established and implemented to safeguard funds.
        Financial status:
              o    [CC]: Sponsoring Board only;
              o    [HS]: Governing Board and DAPC.
        Personnel practices:
              o    [CC]: Board’s personnel practices and policies; first time director’s evaluation.

New York City Supplemental Rating Scale (NYC-SRS)                                                        Content Area:
                                                                                                         Program Design and Management

     Notes / Documents
         Board’s responsibilities:
              o     [CC]: Minutes of meetings.
              o     Board’s personnel practices;
              o     Director’s evaluations.

5.1 [HS] Composition and formation of DAPC is approved annually and is formally charged with its roles
    and responsibilities.

5.2 Classroom Parent Committee, Site Parent Committee, and Delegate Agency Policy Committee apply
only to Head Start.

5.3 [CC]: Training for Sponsoring Board takes place on an annual basis;
    [HS]: Training or orientation provided to both the Governing Board and the newly elected Policy
Committee members (DAPC).

5.5 [HS]: Reviewed and approved jointly by DAPC and the Governing Board.

7.1 [CC] Approved by the Sponsoring Board.
    [HS]: Approved by both DAPC and Governing Board.

7.3 Training takes place on an annual basis.

7.4 Could include finance, program, personnel policies and procedures, etc.

New York City Supplemental Rating Scale (NYC-SRS)                                                                        Content Area:
                                                                                                                         Education and Disabilities
   Inadequate           Adequate                                                              Good                                         Excellent
       1        2          3                                              4                    5                         6                    7
_____ 1.1 There is no                 _____ 3.1 The curriculum and                                                            _____ 7.1 There is evidence that
                                                                              _____ 5.1 A standards-based
evidence that the curriculum          all classroom practices comply                                                          Health, Dental Health, Nutrition, and
                                                                              curriculum is used and linked to
and all classroom practices           with Article 47 of the New York                                                         Mental Health are integrated into all
                                                                              measurable child outcomes that
comply with Article 47 of the         City Health Code.                                                                       aspects of the program activities.
                                                                              support long- and short-range goals for
New York City Health Code.
                                                                                                                              _____ 7.2 Child outcomes information
_____ 1.2 There is no                 _____ 3.2 There is a written                                                            is used for innovative planning of
written curriculum plan               curriculum plan based on sound          _____ 5.2 There is evidence that                classroom activities on a weekly basis
based on sound                        developmental principles.               Health, Dental Health, Nutrition                (i.e., strength-based groupings;
developmental principles.                                                     and/or Mental Health are part of the            interventions).
                                                                              curriculum during the program year.
_____ 1.3 There is no                  _____ 3.3 There is a                                                                   _____ 7.3 Child outcomes information
linguistically and                     linguistically and                     _____ 5.3 There is evidence that the            is shared with the child’s family at least
developmentally appropriate            developmentally appropriate            program provides pedestrian safety              three times a year.
educational model or                   educational model or approach.         training for parents and children
approach.                                                                     within the first 30days of the program          _____ 7.4 Child outcomes information
                                                                              year (Head Start only*).                        is shared with the child’s new school
_____ 1.4 There is no                  _____ 3.4 There is a system for                                                        environment for the transitioning child.
system for teachers to                 teachers to regularly observe          _____ 5.4 A valid and reliable child
observe and record                     and record children’s behaviors        assessment instrument is used to
children’s behaviors and               and progress in order to assess        document child outcomes in all areas
progress in order to assess            their development and learning.        of development and learning three
their development and                                                         times a year; information used for
learning.                                                                     referrals as necessary.
                                       _____ 3.5 There is evidence of
_____ 1.5 There is no                  regular curricular planning that       _____ 5.5 Child assessment
evidence of curriculum                 identifies and promotes the            information is used for developing
planning.                              development of program goals           goals for individual children, including
                                       for improving school readiness.        individualized school readiness goals,
_____ 1.6 No Information on                                                   and planning classroom activities for
each child’s development               _____ 3.6 Information on each          children.
and learning is shared with            child’s development and
the child’s family.                    learning is shared with the            _____ 5.6 Staff conducts home visits
                                       child’s family at least twice a        to share information and seek input
                                       year.                                  from parents about the program and
                                                                              children’s learning and social

*Applies only to Head Start and Head Start Collaborations and Partnerships                                                             Score: __________

New York City Supplemental Rating Scale (NYC-SRS)                                                                Content Area:
                                                                                                                 Education and Disabilities

Notes / Documents
1.1, 3.1 As per Article 47, the curriculum and physical activities are included on a daily basis.

1.2, 3.2 “Sound” developmental principles are embedded in a philosophy shared by the program and the
parents, and a planned, organized, and consistently implemented curriculum supports child development
and learning, provides experiences to meet such goals, identifies the roles of staff members, and identifies
appropriate materials and equipment.
[CC]: The educational program is not explicitly referred to as a “curriculum”. Documentation: statement of
goals; lesson plan books; classroom activity plans; written daily schedules.
[HS]: The educational program is referred to as a “curriculum” and explicitly identifies the roles of parents.

 1.3, 3.3 A developmentally and linguistically appropriate educational model is one that recognizes that
children have individual rates of development as well as individual interests, temperaments, languages,
cultural backgrounds, and learning styles.
[CC] There is a written statement of goals promoting a developmentally appropriate approach and
evidence of a comprehensive program plan that supports the model (Documentation: lesson plan book and
written goals).
[HS]: In addition, an explicit focus on language is required and parents are integrally involved in the
development of the curriculum and approach to Child Development and Education.

1.4, 3.4 Teachers conduct regular, on-going observations of each child that are recorded bi-weekly. There
is evidence of formal progress reports on children and documented discussions of director/staff regarding
individual children.
          Documented observations (CC: bi-weekly; HS: periodic);
          Formal progress reports on children;
          Director/staff documented discussion of individual children.

1.5, 3.5 Weekly classroom activity plans and written daily activity schedules are both reviewed and
approved by the Director/Education Director. There is a weekly lesson plan for each group served; the
weekly plan is reviewed and initialed by the director/education director; weekly lesson plans are posted
and written schedules are in a child-friendly format; there is written evidence that the Director/Educational
Director and teaching staff are in regular dialogue about the quality of the lesson plans.

1.6, 3.6 Individual parent-teacher conferences are held twice a year to discuss children’s progress and
provide written reports; Progress reports are dated and signed by teachers and parents indicating follow-

3.5 Goals for improving school readiness are aligned with the Head Start Child Outcomes Framework,
State early learning standards, as appropriate and the requirements and expectations of the schools the
children will be attending.

5.1 E.g., Creative Curriculum, High/Scope, Montessori, Reggio Emilia, etc.

5.4, 7.2, 7.3 Many standards-based curricula are linked to an assessment tool (e.g., for the Creative
Curriculum, the Creative Curriculum Developmental Continuum; for High Scope, the Child Observation
Record); others use independent assessment instruments (e.g. Work Sampling System).

7.4 There is evidence of written documentation to the new school environment.

New York City Supplemental Rating Scale (NYC-SRS)                                                                          Content Area:
                                                                                                                           Family and Community Partnerships

    Inadequate             Adequate                                                                Good                                               Excellent
        1         2           3          4                                                          5                           6                        7
 _____ 1.1 There is no Parent            _____ 3.1 Parents are                 _____ 5.1 An active DAPC or PAC provide                _____ 7.1 Parents participate in city-wide
 Advisory Committee (PAC)                represented in the PAC or                input on establishing program policy.               advocacy activities on behalf of the children
 or Parent Policy Committee              DAPC.                                                                                        and the program.
                                         _____ 3.2 There is communication       _____ 5.2 There is communication between               _____ 7.2 The program assists the parent
 _____ 1.2 Program activities do         between community agencies             the program and the family to support the               in visiting the next early care and education
 not facilitate children’s               and/or public schools to facilitate    transition to Kindergarten/first grade.                /elementary setting prior to transition.
 transition to Kindergarten/first        children’s transition to Kinder-
 grade.                                  garten/first grade.

 _____ 1.3 There are no parent           _____ 3.3 There are parent             _____ 5.3 Parents are offered opportunities            _____ 7.3 Parents are offered workshops
 orientations.                           orientations for families who are      to develop self-sufficiency and to respond             that are responsive to their needs.
                                         new to the program.                     to life stressors (e.g., domestic violence,
                                                                                substance abuse, depression, & other
                                                                                life stressors).
 _____ 1.4 There are no                  _____ 3.4 There are some                                                                      _____ 7.4 The program has on-going parent
                                                                                _____ 5.4 Parents have the opportunity to
 opportunities for parent                opportunities for parent                                                                       -initiated activities to benefit the program
                                                                                provide input into identifying subject matter
 education.                              education.                                                                                    and/or community.
                                                                                for parent workshops.

                                                                               _____ 5.5 Family goal-setting has taken
 _____ 1.5 Discussions have not         _____ 3.5 Discussions have taken
                                                                               place and is documented for the majority of
 taken place with families to help      place with families to help them
                                                                               the children (Head Start only*).
 them think about family goals.         think about family goals.

* Applies only to Head Start and Head Start Collaborations and Partnerships                                                         Score: __________

New York City Supplemental Rating Scale (NYC-SRS)                                                                  Content Area:
                                                                                                                   Family and Community Partnerships
 Notes / Documents

 1.1, 3.1, 5.1 [CC]: Programs primarily serving homeless families, battered women, and are housed in the
 court system are exempt from establishing a certified PAC but are expected to have a parent involvement
 program. These indicators should be skipped and not taken into account when scoring.

 3.1 [CC]: PAC certification or equivalent. PAC input is advisory on program policy.
     [HS]: DAPC must participate in establishing and approving program policy.

 3.2, 5.2 “Communication” refers to assisting parents for the child’s transition.

 3.3 Record of parent orientation and semi-annual conferences, e.g., parent orientation agenda, parent
 orientation guide, manual, brochure, or letter; e-mail communications, flyers, notices sent home, etc.

 3.4 Evidence of at least 2 workshops or referrals to outside educational sources.

 5.4 As evidenced by training curricula, dated agendas, attendance sheets, notification, letters, or social
 service agreements.

 5.5 [HS] E.g., through contact notes, or a Family Partnership Agreement demonstrating that the family
 goal-setting process has been initiated, as well as documented progress towards achieving family goals,
 including indication of follow-up. Also, parents have the option of not participating in additional activities,
 but there needs to be documentation that families have been invited (e.g., flyers, e-mails, notices sent

 7.1 E.g., Peer support groups, fatherhood involvement activities, community fairs, etc.

 7.3 Evidence of survey or other means of data collection.

 7.4 Evidence of parent-initiated activities.

New York City Supplemental Rating Scale (NYC-SRS)                                                                    Content Area:
                                                                                                                     Family and Community Partnerships

    Inadequate                                     Adequate                                    Good                                     Excellent
        1         2                                   3                       4                 5                    6                     7
 _____ 1.1 The program staff              _____ 3.1 The program staff             _____ 5.1 The program staff has         _____ 7.1 Community Partnership
 has not developed community              demonstrates knowledge of               written Partnership Agreement(s)        Agreements are updated annually.
 partnerships.                            community partnerships.                 with community agencies,
                                                                                  including up-to-date names of
                                                                                  contact people and their phone

 _____ 1.2 Program staff are                                                      _____ 5.2 When a family has            _____ 7.2 Health Service Advisory
 unable to identify community             _____ 3.2 Referrals are made for        used a community partner, there        Committee meets more than two times a
 agencies to which they refer             children and families.                  is evidence in the parent/family       year (Head Start only*).
 children and families.                                                           record.
                                                                                                                         _____ 7.3 Health Service Advisory
                                                                                  _____ 5.3 The program staff has        Committee has led efforts to increase
                                                                                  established and maintained a           community involvement with health issues
                                                                                  Health Service Advisory                in the community (Head Start only*).
                                                                                  Committee that meets a
                                                                                  minimum of two times a year (HS
                                                                                  only*).                                _____ 7.4 Program staff participates in
                                                                                                                         annual health fairs in collaboration with
                                                                                                                         other community agencies (HS only*).

* Applies only to Head Start and Head Start Collaborations and Partnerships                                                 Score: __________

New York City Supplemental Rating Scale (NYC-SRS)                                                    Content Area:
                                                                                                     Family and Community Partnerships

Notes / Documents

1.1, 3.1 [CC]: Social Service Resource Guide; social service contact person.

1.2, 3.2 The program demonstrates a basic commitment to family support needs by:
         Having social service referrals and follow-up records;
         Utilizing and/or accessing a social service resource guide (i.e.,

5.1 E.g., Programs have partnered with community health care providers/programs, such as
clinics, hospitals, dental programs, nutrition programs, social services, education partners, etc.

5.3 [HS]: E.g., Health Service Advisory Committees include Head Start parents, volunteers in the
community, and health professionals.

New York City Supplemental Rating Scale (NYC-SRS)                                                                    Content Area:
                                                                                                                     Family and Community Partnerships

    Inadequate                  Adequate                                                                   Good                                  Excellent
        1         2                3                                                        4               5                     6                 7
 _____ 1.1 The program does   _____ 3.1 Program staff members must receive NY-State              _____ 5.1 There is written            _____ 7.1 There is written
 not follow New York State    Approved “Mandated Reporter” Training within 90 days of            evidence that the program             evidence that the program invites
 Central Registry (NYS-SCR)   hire and every 2 years thereafter, and are aware of ACS            provides and/or identifies            its general community to attend
 and ACS Child Abuse          CA/M reporting procedures and their legal mandate to report        CA/M workshops for                    CA/M workshops annually (i.e.,
 & Maltreatment screening     suspected CA/M allegations.                                        parents annually.                     Board, partner program, etc.)
                                                                                                _____ 5.2 The program                  _____ 7.2 Parents provide peer
                               _____ 3.2 All current employees, substitutes, non-parent
_____ 1.2 Program has no                                                                        maintains records related to           support to families in crisis and/or
                               volunteers & WEP workers have been screened and
procedure for addressing                                                                        incidences of child abuse and          at risk of child abuse and
                               cleared by the NYS SCR and DOI for records.
prospective staff members’     Documentation is maintained on site.                             maltreatment that are easily           maltreatment.
lack of clearance.                                                                              accessible and current.

                               _____ 3.3 Program has a written/signed release/escort
                               form on file for each child.

                               _____ 3.4 There is a system in place in compliance with
                               Article 47 of the NYC Health Code, to supervise
                                children that ensures adequate coverage in classrooms
                               at all times.

                                                                                                                               Score: __________

New York City Supplemental Rating Scale (NYC-SRS)                                                             Content Area:
                                                                                                              Family and Community Partnerships

Notes / Documents

 3.1. The program has documentation necessary to substantiate compliance with key
 ACS indicators related to Child Abuse and Maltreatment:
          Valid CA/M certificates for all staff;
          Laminated cards for CA/M reporting are held by staff;
          Staff is aware of the procedures for reporting any suspected cases of child abuse and neglect;
          Documentation on reported CA/M incidents;
          Completed copies of form DSS 221-A and/or ACD 1149.
          Staff must participate in refresher training every 2 years, as mandated by Article 47 of the NYC
           Health Code.

 3.2 Screening and clearance records for staff and volunteers: Sponsoring Board / Governing Board
 is required to approve all hires. Documents: Staff/volunteer screening and clearance records
 from NYS SCR and Department of Investigations (DOI).
 [HS]: Records must be on file at the site prior to staff starting date.

  3.3 Approved policies and procedures.

  3.4 As evidenced by written staff scheduling patterns.

  5.1, 7.1 E.g., Training curricula, dated agendas, attendance sheets, training
  notifications or letters.

  7.2 E.g., Certificates of training; dated attendance sheets, letters of

New York City Supplemental Rating Scale (NYC-SRS)                                                                          Content Area: Health and Mental

    Inadequate                                    Adequate                                             Good                                                Excellent
        1         2                                  3                    4                             5                                  6                  7
                                                                              _____ 5.1 Each child is screened within 45 calendar
_____ 1.1 The program does not           _____ 3.1 All requirements in                                                                         _____ 7.1 Health services are co-
                                                                              days of the child’s entry.
meet all requirements in Article 47      Article 47 of the NYC Health                                                                          located in the program.
of the NYC Health Code.                  Code are met.
                                                                                                                                               _____ 7.2 Parents receive training on
_____ 1.2 Children’s medical             _____ 3.2 The majority of            _____ 5.2 Each child must have a schedule of well-               children’s health and the importance
records are missing or incomplete.       children have periodic and           child health care, with documented follow-up by                  of regular well-child health care.
                                         annual examinations as age           program staff.
                                                                                                                                               _____ 7.3 The program assists
_____ 1.3 Children do not have up-       _____ 3.3 The majority of            _____ 5.3 The program assists parents in accessing               parents to enroll and participate in a
to-date immunizations.                   children have up-to-date             an ongoing source of health care for their child                 system of ongoing family health care.
                                         immunizations.                       (medical home).
_____ 1.4 There is no relationship
                                                                                                                                                _____ 7.4 The program's contract
with a Mental Health Consultant          _____ 3.4 The program has an          _____ 5.4 Mental Health services are supported by
                                                                                                                                                with a Mental Health Consultant
(MHC) or community mental health         agreement with a Mental Health        staff or consultants who are licensed or certified
                                                                                                                                                specifies the sites that are covered,
provider.                                Consultant or community               Mental Health professionals with experience and
                                                                                                                                                the number of hours, and the
                                         mental health provider.               expertise in serving young children and their families
                                                                                                                                                services that are available (Head
                                                                               (Head Start only*).
                                                                                                                                                Start only*).

                                                                               _____ 5.5 There is an updated Mental Health Services
                                                                                                                                                _____ 7.5 Classrooms reflect
                                                                                Plan which contains a specific description of the
                                                                                                                                                emotionally responsive practices.
                                                                               mental health services, the designated staff, written
                                                                               procedures, including a schedule for mental health
                                                                               services and interventions (Head Start only*).

                                                                               _____ 5.6 There is an adequate system for tracking
                                                                               and documenting follow-ups related to mental health
                                                                               services (Head Start only*).

* Applies only to Head Start and Head Start Collaborations and Partnerships                                                             Score: __________

New York City Supplemental Rating Scale (NYC-SRS)                                                             Content Area: Health and Mental

Notes / Documents
1.1, 3.1 In particular:
          A completed age-appropriate medical examination for each child;
          Children’s health records, including new admissions medicals, current medicals (318K and 318
           K(a)), and age-appropriate immunizations and tests.

3.2, 3.3 Records of visits in children’s files for at least 75% of the children.

1.4, 3.4 [CC]: Social Service Agreement letter and/or contact.

5.1 Children have received age-appropriate developmental, sensory (visual and hearing), and behavioral
screenings within 45 calendar days of the child’s entry in the program.

5.2 Children are up to date with necessary dental follow-up and treatment; the program has established
an ongoing system of communication with the parents of children with identified health needs to assist in
the follow-up plans.

5.3 Utilized by the Early and Periodic Screening Diagnosis and Treatment (EPSDT). The program
determines children’s health status, in collaboration with parents and as quickly as possible, but no later
than 90 calendar days after enrollment. If a child does not have a source of ongoing health care, or is not
up-to-date with an age-appropriate well-child schedule, there is evidence that the program has assisted
the parents in accessing a source of care and bringing the child up to date; the program has established
procedures to track the provision of health care services for children.

5.4 [HS] There is evidence of a contractual agreement and that the Mental Health Consultant (MHC) has
the necessary credentials and experience servicing young children and their families (e.g., NYS license,
resumé, etc.)

5.5 [HS] There is an on-site schedule for the MHC that is posted or distributed to staff and parents; there
is a designated staff member to manage and/or coordinate mental health services with the MHC; there
are written procedures for tracking, scheduling, and implementing mental health services and

5.6 [HS] Program documentation (e.g., home visit forms, case conference notes, lesson plans, family
partnership agreements) is a source of mental health information; MHC’s referrals, observations, and
interventions are documented in mental health, family, and/or child files; mental health consultation and
follow-ups are monitored; following child screenings, there is evidence of MHC follow-up. While some
MHC will do the screening themselves, there must be evidence that each MHC has reviewed the
screening results and provided feedback and follow-up. Follow-up can include participation in case
conferences to discuss the results of screening.

7.2 As evidenced by a training curriculum, dated agendas, attendance sheets, notifications, or letters.

7.5 As evidenced by a research-based curriculum.

New York City Supplemental Rating Scale (NYC-SRS)

                          New York City Supplemental Rating Scale (NYC SRS)
                                           Program Profile

Program Name: ___________________________________________                   Fiscal #: ________________________________________

Date: ________________        Tel. #: _________________ E-mail address: _____________________________________________

 Content Areas                         Subscales                                           √   level

                                                                        1        2     3        4         5      6   7   Score
                 1. Staff Qualifications, Supervision, &   Leadership
 Design &        2. Program Administration
                 3. Governance / Governing Boards

 Education &     4. Curriculum Planning & Assessment
                 5. Parent Involvement & Family Partnerships
 Family &
 Community       6. Community Partnerships
                 7. Child Abuse and Maltreatment Prevention

 Health          8. Health & Mental Health

                 TOTAL SUBSCALE SCORE = SUM OF SUBSCALES                                               TOTAL =

Total Subscale Score __________ ÷ 8 (# Subscales) = Program Score: _____________

Site Director’s Name: __________________________                    Site Director’s Signature: ______________________________


To top