Form M-11N Form M-11N Foster Care Independent Living Life Skills Staff Questio

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OMB 0970-0564 [valid through MM/DD/2024]

(Updated: 09.17.2020)

Staff Questionnaire – Independent Living/Life Skills Coordinator

Interview Details
Program Name:	Date/Time of Interview:
Full Name:	Interviewer:
Past and Current Position(s) at Program:

*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.

**Note: If program does not have an Independent Living/Life Skills Coordinator, questions can be included in interview with staff who has oversight of these services.

	NOTES
Tell me about your role and main responsibilities.
How do you prepare LTFC clients for independent living? Please describe your life skills curriculum. At what age do youth begin receiving life skills training? How often do you meet with clients? Are there any types of life skills that seem to be particularly challenging for UACs?
Do you administer a life skills assessment? If so, how often and what topic areas are covered?
Do you feel that you have enough materials and resources to teach the minors successfully? If not, what additional resources would be helpful?
How are foster parents and/or direct care staff (group homes) included in preparing clients for independent living?
How do you collaborate with other departments/program areas (i.e. case management, clinical etc.) to ensure that clients receive well-rounded support to be successful upon discharge from the program?
What does trauma-informed care mean to you? How do you deliver trauma-informed care as the independent living/life skills coordinator?
Describe how you receive support and guidance from your supervisor. Do you feel that your supervisor provides appropriate and timely support, guidance, and feedback?
Do you feel that you receive adequate training to perform your duties? If not, please explain. What additional training do you think a person in your position would benefit from?
Do you have any concerns about the treatment of UACs? Do you have any concerns about any particular staff or foster parents (any person you think should NOT be working with UAC)?
What general recommendations do you have to strengthen the program? What improvements would you put in place? Have you shared these ideas with your supervisor or any other program staff?
What are the things that you love/enjoy about your job? What are the challenges you face in your job?
What recommendations do you have for ORR that I can take back to share with our headquarter teams?

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 independent living/life skills 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.