How do i wright & fill out a profenionalService Program Feedback Form template (provided below)with the information i have al ready got for client below form Service Program Development template (provided below).

Two (2)must be from clients andone (1)must be from a staff member.

SERVICE PROGRAM FEEDBACK FORM Who completed this feedback? Mario Smith What is the name of the program Community Mental Health Outreach Program being evaluated? What is your role? Participant Please tick. Staff Member Please answer the following specific questions: 1. Was everything you needed provided to you for each workshop? If not, give more information and what you would change next time. 2. Did you feel safe at each workshop? If not, give more information and what you would change next time. 3. Was there enough staff to help at each workshop? If not, give more information and what you would change next time. 4. How well did everyone get on at each workshop? Describe any issues. 5. Do you think the workshops were worth it? If not, what could be done better next time? Please describe three things that work well in this program Please provide three things that could be improved in this program Client signature: Date: 10/10/24SERVICE PROGRAM FEEDBACK FORM Who completed this feedback? Kim Manning What is the name of the program Community Mental Health Outreach Program being evaluated? What is your role? 2 Participant Please tick. O Staff Member Please answer the following specific questions: 1. Was everything you needed provided to you for each workshop? If not, give more information and what you would change next time. 2. Did you feel safe at each workshop? If not, give more information and what you would change next time. 3. Was there enough staff to help at each workshop? If not, give more information and what you would change next time. 4. How well did everyone get on at each workshop? Describe any issues. 5. Do you think the workshops were worth it? If not, what could be done better next time? Please describe three things that work well in this program Please provide three things that could be improved in this program Client signature: Date: 10/10/24SERVICE PROGRAM DEVELOPMENT TEMPLATE Name of organisation Community Health Services Program title Community Mental Health Outreach Program Detailed description of The program aims to provide mental health support services to adults in the community, including individual the program counseling, group therapy sessions and community outreach programs. It focuses on improving mental health and well-being by offering accessible and effective services tailored to client needs. (include an agenda where one apples) Section 1 - Action plan Consultation Priority (high, Due for required (YIN - with Action plan Details medium, low) completion by whom?) Person responsible What governance Governed by a steering committee High 30th October Yes, Bec John Doe, Program arrangements are in consisting of senior mental health 2024 Coordinator place for this project? professionals and community Sonia representatives Obtain input from Conduct regular meetings with staff. High ongoing Yes, Sam Sonia internal stakeholders mental health professionals to gather insights and suggestions for program implementation by feedback sessions. Obtain input from Engage with community representatives of High Completed gth Yes, Sam Sonia external stakeholders local mental health organizations and September 2024 community groups for feedback and collaboration and family members of clients to ensure the program meetsSection 1 - Action plan Consultation Priority (high, Due for required (Y/N - with Action plan Details medium, low) completion by whom?) Person responsible community needs. Community consultation meetings and surveys Engage clients in Involve clients through advisory High 20" October 2024 Yes, Bec Sonia decision-making committees and feedback sessions like processes focus groups to ensure their needs and preferences are considered. Organise internal Administrative support for processing Medium Completed 25th Yes, Sam Sonia services (such as signups September 2024 staffing/roles and Bilingual staff will provide interpretation responsibilities) when requested (section 2 to be completed) Counselors will provide individual therapy Social workers will lead group sessions Organise external Partner with local transportation Medium Completed 19th Yes, Sam Sonis services (such as companies to provide vouchers. September 2024 transport, service supply and so on) (Section 3 to be completed) Individual needs Provide bilingual counseling services and Mediun 20" October 2024 Yes, Bec Sonia planning - what flexible scheduling individual differences need to be supported?Section 1 - Action plan Consultation Priority (high, Due for required (YIN - with Action plan Details medium, low) completion by whom?) Person responsible List the resources that Financial: $150,000 for staff salaries Medium Completed 10th Yes, Bec Sonia will be required Human: 5 counselors, 2 social workers September 2024 (financial, human, and Physical: Office space, therapy rooms physical resources) (Section 4 to be completed) What systems and Consent forms, emergency contact High 30th October Yes, Sam Sonia processes will be protocols, risk assessments for high-risk 2024 required? clients (include risk assessment content, emergency planning and any others mat are applicablel (Section 5 to be completed for Risk Management Flan] What will be put in place Use digital records to minimize paper use Low Completed 19t Yes, Sam Sonia to ensure adequate and partner with eco-friendly service September 2024 environmental providers sustainability? How will the program be Regular feedback from clients and staff, Low Ongoing Yes, Bec Sonia monitored and quarterly reviews by the steering evaluated committeeSection 2 - Internal stakeholder planning Internal stakeholder planning task Special requirements Provide details of all tasks (Such as Ncencing, consent, Person that wiv be required? Details legal requirements, time frame) responsible Training required Staff roster Provide details of staff roster. Ensure all staff have Sonia Training in trauma-informed completed cultural care and cultural sensitivity 5 counselors, 9am-4pm competency training 2 social workers, 10am-2pm Staff roles and List roles and responsibilities: Nil Sonis Nil responsibilities Consider responsiouity for staff briefings, chant counselors for therapy supervision, went consent social workers for outreach frat sid, communications System) Client's responsibilities Clients to participate in standards of behaviour Time management Sonia NA Other (please specify) Click or tap here to enter text. Click or tap here to enter Click or tap here Click or tap here to enter text. to enter text text. Section 3 - External stakeholder planning External stakeholder planning task Special requirements Provide details of all tasks (such as licencing, consent, Person that wiv be required.] Details legal requirements, time frame) responsible Training requiredSection 3 - External stakeholder planning Obtain funding/ Apply for grants and seek donations from local Ensure all external Yes, Bec Nil donations businesses and organizations. providers have the necessary licensing Book/purchase Secure consultation rooms and educational Nil Yes, Bec Nil services/resources that materials. Purchase transportation vouchers, will be required hire bilingual counselors Other (please specify) Click or tap here to enter text. Click or tap here to enter Click or tap here Click or tap here to enter text. to enter text. text. Section 4 - Resources and budget Type of resource Cost Staffing resources (please specify) 5 counselors, 2 social workers. 450,000 annually Physical resources (please specify) Consultation rooms - $10,000 annually Transportation vouchers- $5,000 annually Educational materials- $2,000 annually Total cost $467,000 annually Financial resources available $467,500 annually Balance $500 annually Are there sufficient funds for this program? Yes _ No How will any shortfall be funded? No. additional funding through local fundraising eventsSection 5 - Risk management plan Level of risk (use Elimination/control Hazard matrix) measures Training required Who is responsible? When Client aggression High De-escalation training Program Sonia Mounthly staff traing CoordinatorSection 5 - Risk management plan Level of risk (use Elimination/control Hazard matrix) measures Training required Who is responsible? When development for staff Click or tap here to enter Click or tap here to Click or tap here to enter Click or tap here to Click or tap here to Click or tap here to enter text. enter text text. enter text enter text text. Click or tap here to enter Click or tap here to Click or tap here to enter Click or tap here to Click or tap here to Click or tap here to enter text. enter text text. enter text enter text text. SUPERVISOR DECLARATION I declare that this task was completed in the workplace by the student under my supervision. Yes _ No _ SUPERVISOR NAME Sam Morris SUPERVISOR SIGNATURE SM DATE: 9/9/24