Updated YEARS Obs Checklist - Track Changes

		(OMB Control # 0970 – 0470 and Expiration Date: 12/31/2016)
HMRE Program Observation Checklist
	Program Name:		Observer Name:				Notes:
	Setting (e.g., school, community setting, etc.):
	Start time:		Strategies observed (check all that apply):
	End time:		Lecture		Small-group activity
	Session duration:		Video		Social media
	Time of day session took place (AM/PM):
	# of staff:		Role-play		Internet
	Staff are peers/near peers (Yes/No) :
	Staff are adults (Yes/No):
	# of male participants:		Class discussion		Other (describe):
	# of female participants: Group is predominantly male/predominantly female/mixed:		Small-group discussion
A.	Staff is representative of [observed] population served (i.e., gender, race/ethnicity, language)	Yes	No	Notes:
1	Gender: staff represented all genders present in the group.
2	Race/ethnicity: staff were from the same racial and/or ethnic background as the predominant groups of youth in the program.
3	Language: staff were fluent in the language that program participants spoke.
B.	Program space	Yes	No	Notes:
1	Program space was clean and well-maintained.
2	Meeting space is informal. This means that participants sit in a circle or gather in different parts of the room, rather than sitting in rows, participants can get up and move around, the meeting space is colorful and has youth-friendly posters and other materials around the room.
3	There was enough furniture for the number of participants and type of activities.
C.	HMRE topics covered during this session	Information was presented		Notes related to topic? (Check box if additional notes are provided) Skills were practiced		Notes:
		Major focus	Minor focus	Major focus	Minor focus
	Healthy romantic relationships
	Sexual activity
	Violence/abuse prevention - including physical, sexual, and emotional/psychological
	Gender and sexuality
	Parenting/co-parenting
	Communication
	Social skills
	Conflict management
	Financial management
	Career goals
	Educational goals
	Housing
	Marriage and cohabitation
	Extended family relationships
	Any skills were practiced (Yes/No)
	If able to specify, note the types of skills practiced
D.	Physical and psychological safety	Strongly disagree	Disagree	Agree	Strongly agree	N/A	Notes:
	SESSION
1	The emotional climate of the session was predominantly positive. This was characterized by teamwork, inclusiveness, and an absence of negative youth and staff behaviors such as derogatory comments or bullying.
	STAFF
2	Staff interacted with youth in a respectful manner.
3	Staff members proactively resolved conflicts among youth. Staff helped youth to examine the relationship between their actions and subsequent consequences.
4	Staff members maintained a safe and respectful environment. There was mutual respect for, and inclusion of, others of different religions, ethnicities, classes, genders, abilities, appearances, and sexual orientations.
5	Staff members enforced ground rules for program participation.	NEVER	RARELY	SOMETIMES	ALWAYS
6	If anyone made derogatory comments about race, ethnicity, gender, sexual orientation, religion, or disability , instructors addressed it immediately and made it clear that such behavior is unacceptable.	NEVER	RARELY	SOMETIMES	ALWAYS
D.	Physical and psychological safety	Yes	No
7	Staff members reviewed or referenced ground rules for program participation.
E.	Appropriate structure	Yes	No	Notes:
	SESSION
1	Session started within 5 minutes of scheduled time.
2	Session ended within 5 minutes of scheduled time.
	STAFF
3	The session had a staff to participant ratio of 1:15.
4a	Staff warmly greeted (at least 50% of) youth.
4b	Staff greeted (at least 50% of) youth by name.
4c	Staff smiled at (at least 50% of) youth as they entered.
5	Staff used a checklist or other tool to monitor fidelity
	YOUTH
6a	Participants received incentives for participation.
6b	List the types of incentives
6c	Participants received refreshments.
6d	Refreshments were healthy.
E.	Appropriate structure	Strongly disagree	Disagree	Agree	Strongly agree	N/A	Notes:
	SESSION
7a	All necessary materials were prepared in advance.
7b	Materials were available in sufficient quantities.
8	There was sufficient time to complete the lesson.
9	If the program serves a specific target population (e.g., foster youth, juvenile justice, etc.), the content was inclusive of the population.
10	Program content appeared to be developed with youth in mind (versus adults). This means scenarios were youth-friendly, activities were catered to youth versus adults, and content was at an appropriate developmental and comprehension level for youth in the session.
11	Youth appeared to be able to understand the materials.
E.	Appropriate structure	Yes	No
12	Staff assigned homework.
E.	Appropriate structure	Strongly disagree	Disagree	Agree	Strongly agree	N/A	Notes:
	STAFF
13	Staff explained the goals of and objectives for the lesson clearly.	NOT EXPLAINED	EXPLAINED BUT NOT CLEAR	EXPLAINED AND CLEAR, BUT NOT RELATED TO WHAT WAS DONE	EXPLAINED AND CLEAR, RELATED TO WHAT WAS DONE
14	Staff stated expectations for participation at the beginning of activities.
15	Staff explained the rationale for all rules or requests.
16	Staff explicitly drew connections between the current lesson and previous lessons.
17	Staff delivered content in an engaging manner. This means activities that involved skill-building included guided practice for at least half of the skill-building time; staff provided structured opportunities to discuss what the youth were doing in the session and what they were thinking about (e.g., small group feedback); activities balanced concrete experiences (e.g., field trip or creative writing) with abstract learning (e.g., lecture, diagrams, or group discussion).	NO ENGAGING PRACTICES	ONE OF THREE ENGAGING PRACTICES	TWO OF THREE ENGAGING PRACTICES	ALL THREE ENGAGING PRACTICES
18	Staff used technology and/or social media to engage youth and/or deliver content.	NO TECH AVAILABLE	NO TECH USED	TO ENGAGE OR DELIVER	TO ENGAGE AND DELIVER
19	Staff were knowledgeable about the program (This means staff were very familiar with the concepts and answered questions with ease).	ANSWERED ALMOST NO QS	ANSWERED FEW QS	ANSWERED MOST QS	ANSWERED ALL QS (ACCURATELY)
20	Staff delivered the curriculum with confidence (This means staff did not hesitate in addressing questions and concerns. Staff were well organized and not nervous).	MANY NOTES AND DISORGANIZED	MANY NOTES AND/OR DISORGANIZED	FEW NOTES AND WELL ORGANIZED	NO NOTES AND WELL ORGANIZED
	YOUTH
21	Youth were engaged with the content and materials	NO YOUTH	SOME YOUTH	MOST YOUTH	ALL YOUTH
22	Youth actively participated in discussions and activities.
23	Youth had a chance to ask questions about topics or issues that came up during the session.
24	Youth engaged in positive, friendly interactions with each other.	NEVER	RARELY	SOMETIMES	ALWAYS
F.	Supportive relationships	Strongly disagree	Disagree	Agree	Strongly agree	N/A	Notes:
	STAFF
1	Staff responded to youth's questions in a nonjudgmental manner.
2	Staff appeared to be comfortable discussing sensitive topics, such as sexuality and relationships, in a nonjudgmental manner.
3	Staff members modeled healthy relationships in their interactions with youth (for example, communication and listening skills, conflict management skills, and social skills.)
4	Staff engaged in conversations with youth and asked youth questions in a supportive manner.
5	Staff members encouraged all youth to participate in a respectful manner.
6	Staff respected participants' right to privacy when discussing personal or sensitive topics.
7	Staff maintained professional boundaries when they interacted with youth.	NEVER	RARELY	SOMETIMES	ALWAYS
	YOUTH
8	Youth freely engaged in conversations with staff.
G.	Opportunities to belong	Strongly disagree	Disagree	Agree	Strongly agree	N/A	Notes:
	SESSION
1	Program materials (e.g., videos, posters, handouts, recruitment materials, etc.) were representative of the youth, including representations of LGBTQ youth, youth with disabilities, and youth from various racial and ethnic backgrounds, when relevant.	NEITHER	MATERIALS ONLY	CONTENT ONLY	MATERIALS AND CONTENT
2	Staff and materials used LGBTQ-inclusive terms to describe relationships.	NO INCLUSIVE TERMS USED	USED INCONSISTENTLY	INCLUSIVE LANGUAGE	AFFIRMITIVE LANGUAGE
3	Materials and content were available in languages other than English when appropriate.
4	The staff's efforts to create a "group identity" were apparent (e.g., shared traditions, shared language, or group name).
	STAFF
5	Staff asked youth for ideas and suggestions.
6	Staff provided opportunities for youth to get to know one another through icebreakers or other team-building activities.
7	Staff explicitly recognized the achievements and/or contributions of at least some participants.
8	Staff provided opportunities for youth to work together.
	YOUTH
9	Youth encouraged one another's participation in activities.
10	Youth held one another accountable for meeting program expectations.
11	Youth use ownership language, e.g. refer to the program as "ours", shared jokes, gestures, and traditions.
H.	Positive social norms	Strongly disagree	Disagree	Agree	Strongly agree	N/A	Notes:
	STAFF
1	When discussing relationships, staff members valued diverse relationships and family types.
2	Staff members encouraged youth to engage in respectful discussions, even when they disagreed.
3	Staff encouraged youth to consider how to engage with social media and other forms of communication in a respectful manner.
4	Staff encouraged youth to seek help when needed, including issues around abuse and mental health.
I.	Support for efficacy and mattering	Strongly disagree	Disagree	Agree	Strongly agree	N/A	Notes:
1	Staff provided opportunities for youth to take a leadership role.
2	Staff provided opportunities for youth assist their peers when appropriate.
3	Staff encouraged youth to consider how to make a difference in their own community.
4	Staff engaged youth in conversations about achieving their goals and referred youth to relevant resources when appropriate.
5	Staff provided youth with opportunities to reflect on what they have learned.
6	Staff allowed youth to make at least one choice about the process related to the activities during the program session (e.g. youth decide who presents, order of activities, who leads an activity, what materials to use).
J.	Opportunities for skill-building	Strongly disagree	Disagree	Agree	Strongly agree	N/A	Notes:
1	Staff made explicit mention of the skills that were targeted.
2	Staff broke difficult tasks into smaller, easier steps.
3	Staff provided opportunities for most youth to practice skills during the lesson.
4	Staff responded appropriately to youth who were struggling.
5	Staff helped youth make connections between the skills that were taught and their ability to achieve their goals related to relationships, education, and careers.
6	Staff discussed how youth can use the skills that were taught in relevant, real-world situations.
K.	Integration of family, school, and community	Strongly disagree	Disagree	Agree	Strongly agree	N/A
1	Staff referenced other relevant community resources/programs.
2	Staff helped youth to make connections between program content and their own lives.
3	Staff encouraged youth to have discussions with family members or adult caregivers about the program content.
The Paperwork Reduction Act Statement: This collection of information is voluntary and will be used to better understand ACF-funded HMRE programs for youth aged 14-24. Public reporting burden for this collection of information is estimated to average 90 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Mindy Scott; 7315 Wisconsin Avenue, Suite 1200W, Bethesda, MD 20814; Attn: OMB-PRA (0970-0470).
Additional Notes: