OMB 0970-0564 [valid through MM/DD/2024]
Staff Questionnaire – Medical Staff (Revised date: 5/12/2020)
Interview Details |
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Program Name: |
Past and Current Position(s) at Program: |
Level of Care: |
Date/Time of Interview: |
Full Name: |
Interviewer: |
Note: Before beginning the interview and/or providing this questionnaire to staff, provide a brief introduction, including monitor role and purpose of monitoring visit, confidentiality of staff interview, and clarify any questions. See Introduction Prompt for Staff for additional guidance as needed.
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NOTES |
Tell me about your role and responsibilities as the program’s Medical Coordinator.
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What are the things that you love/enjoy about your job? What are the challenges you face in your job? |
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Are you aware of ORR tools, such as the UAC MAP, and where to find ORR policies and procedures and any updates?
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Describe your system for tracking and documenting health and medical services.
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Do you have opportunities for ongoing training and development?
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Describe the procedures when there is an allegation of child abuse or maltreatment.
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Do you have any concerns related to the confidentiality of medical information or services for UACs?
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Describe how medical services are tailored for cultural sensitivity and age appropriateness.
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What does trauma-informed care mean to you?
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How does the medical department work with the other program areas to ensure that the health needs of children are being met?
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(If applicable) How do you accommodate a child with special health care needs or medication requirements? |
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What is the medical team’s policy/medical orders for youth with short-term injury or short-term contagious illness as it relates to participating in program activities?
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How are written P&P established and maintained regarding medication administration, labeling, storage of all medications?
What are the procedures for disposing of unused psychotropic medications?
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What are the plans of action for health emergencies requiring rapid response?
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Describe your working relationship with outside medical stakeholders.
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Do you have any concerns about the treatment of UACs in care? Do you have any concerns about any particular staff members (any staff members you think should NOT be working with UAC)?
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Describe your working relationship with the program’s ORR medical coordinator.
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Describe your relationship with your supervisor.
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What general recommendations do you have to strengthen the program?
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What recommendations do you have for ORR that I can take back to share with our headquarter teams?
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Enter Additional Notes.
THE
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF
PUBLIC BURDEN: The purpose of this information collection is to
allow ORR Monitoring Team staff to interview and document responses
from medical coordinators during biennial site visits. Public
reporting burden for this collection of information is estimated to
average 1.0 hour per response (plus an additional 1.0 hour if the
site visit is performed by a contractor monitor), including the
time for reviewing instructions, gathering and maintaining the data
needed, and reviewing the collection of information. This is a
mandatory collection of information (Homeland Security Act, 6
U.S.C. 279). An agency may not conduct or sponsor, and a person is
not required to respond to, a collection of information subject to
the requirements of the Paperwork Reduction Act of 1995, unless it
displays a currently valid OMB control number. If you have any
comments on this collection of information please contact
UCPolicy@acf.hhs.gov.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Persad, Amanda (ACF) (CTR) |
File Modified | 0000-00-00 |
File Created | 2023-08-25 |