Form M-11E-UF Case Manager Questionnaire

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OMB 0970-0564 [valid through MM/DD/2026]

(Revised date: 3/16/2022)

Staff Questionnaire – Case Manager/Lead Case Manager – Unlicensed Facility (UF) Quarterly Health and Safety Visit

Interview Details
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. Questions in bold should be asked during the interview if possible. Other questions are optional prompts to assist the interviewer.

	NOTES
Tell me about your role and main responsibilities as a case manager. How many cases do you typically cover? In the last year, what was the highest number of cases on your caseload? Lowest number? Is your current caseload manageable? Has your caseload been unmanageable in the past? If so, why?
What are the things that you love/enjoy about your job? What are the challenges you face in your job?
How do you keep up-to-date on current and new ORR policies and procedures? How are you trained/notified when there is an update or a change to ORR policies and procedures? Cooperative Agreement? Flores Settlement Agreement? Do you know where to find the most up to date information? What is the last policy update you received? Tell me about a recent policy update you received and how it was implemented in case management service provision?
Do you feel that you receive adequate training to perform your case management duties? If not, please explain. (Lead Case Manager) Describe your system to assess ongoing staff training needs and opportunities for development? How is this working? Please describe any training needs that your staff currently has.
Tell me about your staff meetings? How do you communicate with staff? All staff? Case Managers and Lead Case Manager? Describe how your weekly case staffing works. Do you feel that your weekly staff meetings and case staffing meetings are helpful?
Describe your working relationship with stakeholders. GDIT Case Coordinators Legal Service Provider/Child Advocates Other Stakeholders – OSSI, ATIP, Immigration Court, etc.
How do you encourage the participation of UC in the case management and reunification process? What does trauma-informed care mean to you? How do you deliver trauma-informed care as part of the case management team? Describe how the case management team ensures that services are culturally sensitive and age appropriate?
Do you have any recommendations, suggestions or concerns regarding the way your cases are reviewed/staffed?  Please elaborate. Are there any current challenges to ensuring safe and timely release of UCs?
How do you collaborate with other teams to ensure that UCs’ physical, mental health, developmental, social, and educational needs are being met? What recommendations do you have to strengthen the collaboration and communication with other departments?
Tell me about staff and UC interactions. Are staff able to work with UC effectively? How does the program handle behavioral challenges among UCs? How effective do you think the behavior management system is? Are there issues? Explain concerns:
Describe the procedures when there is an allegation of child abuse or maltreatment. (Interviewer provide an example of child abuse or neglect and ask case management staff the procedures for reporting.)
Do you have any concerns about the treatment of UCs in care? Do you have concerns about any particular staff members (any staff members you think should NOT be working with UC)?
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 recommendations do you have for ORR that I can take back to share with our headquarter teams?

Additional Notes

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 contractor monitors to interview and document responses from case managers and lead case managers during unlicensed facility quarterly site visits. Public reporting burden for this collection of information is estimated to average 1 hour per response for the care provider and 1 hour per response for the 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.