4-HSS-26-066 - CRC-AttC-OAAPS Mthly Rpt.xlsx
XLSX spreadsheet 101 KB Posted
- Attached to
- CAREGIVER RESOURCE CENTERS
- Solicitation number
- HSS-26-066
- Issued by
- Delaware
About this file
This is a monthly reporting template for the Caregiver Resource Centers (CRC) program administered by Delaware's Division of Services for Aging and Adults with Physical Disabilities (DSAAPD). The template establishes standardized data collection procedures for tracking caregiver services delivered throughout the federal fiscal year (October through September). The reporting structure requires monthly submission of demographic information for participants receiving case management, counseling, or training services, with specific instructions to count all participants in October and only new participants in subsequent months. The document defines six primary service categories: Case Management, Counseling (individual and group), Information and Assistance, Public Information Services, Support Groups, and Training, each with detailed federal definitions and corresponding reporting metrics.
The template captures service delivery metrics including hours of service (reported to two decimal places), number of contacts or sessions, and participant counts across all service categories. Demographic data elements collected include caregiver age, gender, poverty status, relationship to care recipient, race, ethnicity, English proficiency, and LGBT+ status, as well as care recipient dementia diagnosis information. The reporting structure includes co-location data tracking where CRC services are provided, such as public libraries, community centers, faith-based organizations, medical providers' offices, and pharmacies. Coordinator hours are tracked monthly, with cumulative totals calculated across the twelve-month reporting period. The document was revised on May 8, 2023, and references poverty guidelines from the U.S. Department of Health and Human Services for income qualification determinations. All monthly and cumulative data fields are currently showing zero values, indicating this is a blank template awaiting completion during contract performance.
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Other files
| File | Type | Posted |
|---|---|---|
| 7-HSS-26-066 - AppE-Budget Wkbk-CRC.xlsx | XLSX spreadsheet | |
| 2-HSS-26-066 - CRC-AttA.docx | DOCX document | |
| 5-HSS-26-066 - AppC-Vendor Frms.xlsx | XLSX spreadsheet | |
| 3-HSS-26-066 - CRC-AttB.docx | DOCX document | |
| 1-HSS-26-066 - CRC - Final.docx | DOCX document | |
| 6-HSS-26-066 - AppD-Templates-PSA, BAA DTI TCs.docx | DOCX document |
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Text version
Instructions
| Instructions Revision Date - 5/8/2023 |
| Definitions Tab |
| This tab is included for your convenience in determining which federally-defined category a service best fits in. |
| Demographics Tab |
| Participants who receive case management, counseling, or training must be included on the Demographics tab. |
| Age is the age the caregiver will be on the last day of the federal fiscal year (September 30th). |
| Poverty line information is available online here https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines |
| If caregiver identifies as only one race, please leave Caregiver Race 2 (Column I) blank. |
| Monthly Tabs |
| Unique Participants- |
| In October, please count all participants. |
| In subsequent months, please count only those participants who attended for the first time this fiscal year. |
| Participants who receive case management, counseling, or training must be included on the Demographics tab. |
https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines Definitions
| Data Element | Definition | Service Unit |
| Case Management (Caregiver) | Means a service provided to a caregiver, at the direction of the caregiver: | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) |
| · by an individual who is trained or experienced in the case management skills that are required to deliver the services and coordination described in subparagraph; and | ||
| · to assess the needs, and to arrange, coordinate, and monitor an optimum package of services to meet the needs, of the caregiver; and | ||
| Includes services and coordination such as— | ||
| · comprehensive assessment of the caregiver (including the physical, psychological, and social needs of the individual); | ||
| · development and implementation of a service plan with the caregiver to mobilize the formal and informal resources and services identified in the assessment to meet the needs of the caregiver, including coordination of the resources and services— | ||
| o with any other plans that exist for various formal services; and | ||
| o with the information and assistance services provided under the Older Americans Act; | ||
| o coordination and monitoring of formal and informal service delivery, including coordination and monitoring to ensure that services specified in the plan are being provided; | ||
| o periodic reassessment and revision of the status of the caregiver; and | ||
| o in accordance with the wishes of the caregiver, advocacy on behalf of the caregiver for needed services or resources. | ||
| (Source: OAA) | ||
| Counseling (Caregiver) | A service designed to support caregivers and assist them in their decision-making and problem solving. Counselors are service providers that are degreed and/or credentialed as required by state/territory policy, trained to work with older adults and families and specifically to understand and address the complex physical, behavioral, and emotional problems related to their caregiver roles. This includes counseling to individuals or group sessions. Counseling is a separate function apart from support group activities or training (see definitions for these services). (Source: ACT committee) | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) |
| Information and Assistance (Caregiver) | A service that: | Contact |
| · provides the individuals with current information on opportunities and services available to the individuals within their communities, including information relating to assistive technology; | ||
| · assesses the problems and capacities of the individuals; | ||
| · links the individuals to the opportunities and services that are available; | ||
| · to the maximum extent practicable, ensures that the individuals receive the services needed by the individuals, and are aware of the opportunities available to the individuals, by establishing adequate follow-up procedures; and | ||
| · serves the entire community of older individuals, particularly— | ||
| o caregivers who are older individuals with greatest social need; | ||
| o older individuals with greatest economic need; | ||
| o older relative caregivers of children with severe disabilities, or individuals with disabilities who have severe disabilities; | ||
| o family caregivers who provide care for individuals with Alzheimer’s disease and related disorders with neurological and organic brain dysfunction; and | ||
| o caregivers of “frail” individuals defined as: unable to perform at least two activities of daily living without substantial human assistance, including verbal reminding, physical cueing, or supervision; and/or cognitive or other mental impairment, requires substantial supervision because the individual behaves in a manner that poses a serious health or safety hazard to the individual or to another individual. (Source: OAA) | ||
| Public Information Services (public) | A public and media activity that conveys information to caregivers about available services, which can include an in-person interactive presentation to the public conducted; a booth/exhibit at a fair, conference, or other public event; and a radio, TV, or Web site event. (Source: SHIP) | Activity |
| Unlike Information and Assistance, this service is not tailored to the needs of the individual. | ||
| Support Groups (Caregiver) | A service that is led by a trained individual, moderator, or professional, as required by state/territory policy, to facilitate caregivers to discuss their common experiences and concerns and develop a mutual support system. Support groups are typically held on a regularly scheduled basis and may be conducted in person, over the telephone, or online. For the purposes of Title III-E funding, caregiver support groups would not include “caregiver education groups,” “peer-to-peer support groups,” or other groups primarily aimed at teaching skills or meeting on an informal basis without a facilitator that possesses training and/or credentials as required by state/territory policy. (See also definitions for training and counseling). (Source: ACT committee) | Session (a session is typically 30 minutes to 1 hour) |
| Training (Caregiver) | A service that provides family caregivers with instruction to improve knowledge and performance of specific skills relating to their caregiving roles and responsibilities. Skills may include activities related to health, nutrition, and financial management; providing personal care; and communicating with health care providers and other family members. Training may include use of evidence-based programs; be conducted in-person or on-line and be provided in individual or group settings. (Source: ACT committee) | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) |
Demographics Caregiver First Name Caregiver Last Name Caregiver Age Caregiver Sex Caregiver Poverty Status Caregiver Relationship to Recipient Caregiver Race 1 Caregiver Race 2 (if applicable) Caregiver Ethnicity Caregiver English Proficiency Caregiver LGBT+ Care Recipient Dementia Diagnosis Initial Service Month
October Data Element Service Unit Unique Participants Served Merrill, Molly (DHSS): Merrill, Molly (DHSS):
In October, please count all participants.
| In subsequent months, please count only participants who are new to the service this month. | Hours | Contacts/Sessions | Activity |
| Case Management (Caregiver) | Hours (partial hour may be reported to two decimal | ||
| Number of Caregiver Assessment Forms Initial Contact | places, e.g. 0.25 hours.) | ||
| Counseling (Caregiver) | |||
| Individual Counseling | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Counseling | |||
| Information and Assistance (Caregiver) | |||
| Number of 1:1 Contacts Providing General Program Information via Telephone or In-Person | Contact | ||
| Number of referrals to other services | |||
| Number of 1:1 Outreach | |||
| Public Information Services (Caregiver) | |||
| Number of Activities/Events | |||
| Media | Activity | ||
| Workshops/Professional Development Events | |||
| Dissemination Resource Materials | |||
| Number of Circulations | |||
| Support Groups (Caregiver) | Session (a session is typically 30 minutes to 1 hour) | ||
| Training (Caregiver) | |||
| Individual Training | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Training/Conferences | |||
| CRC Coordinator | Hours this month (partial hour may be reported to two decimal places, e.g. 0.25 hours.) |
| Total CRC Coordinator hours this month | 0 | |
| Co-Location Data | Address | Office Hours at Location/Frequency |
Merrill, Molly (DHSS): Merrill, Molly (DHSS):
(i.e. 2 hours every 3rd Wednesday)
| Public Library | ||
| Public or Private Community Center | ||
| Faith-Based Organization | ||
| Medical Providers Office | ||
| Pharmacy | ||
| Other: | Address | Why do you feel this is a setting where you may encounter caregivers? |
| Type |
November Data Element Service Unit Unique Participants Served Merrill, Molly (DHSS): Merrill, Molly (DHSS):
In October, please count all participants.
| In subsequent months, please count only participants who are new to the service this month. | Hours | Contacts/Sessions | Activity |
| Case Management (Caregiver) | Hours (partial hour may be reported to two decimal | ||
| Number of Caregiver Assessment Forms Initial Contact | places, e.g. 0.25 hours.) | ||
| Counseling (Caregiver) | |||
| Individual Counseling | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Counseling | |||
| Information and Assistance (Caregiver) | |||
| Number of 1:1 Contacts Providing General Program Information via Telephone or In-Person | Contact | ||
| Number of referrals to other services | |||
| Number of 1:1 Outreach | |||
| Public Information Services (Caregiver) | |||
| Number of Activities/Events | |||
| Media | Activity | ||
| Workshops/Professional Development Events | |||
| Dissemination Resource Materials | |||
| Number of Circulations | |||
| Support Groups (Caregiver) | Session (a session is typically 30 minutes to 1 hour) | ||
| Training (Caregiver) | |||
| Individual Training | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Training/Conferences | |||
| CRC Coordinator | Hours this month (partial hour may be reported to two decimal places, e.g. 0.25 hours.) |
| Total CRC Coordinator hours this month | 0 | |
| Co-Location Data | Address | Office Hours at Location/Frequency |
Merrill, Molly (DHSS): Merrill, Molly (DHSS):
(i.e. 2 hours every 3rd Wednesday)
| Public Library | ||
| Public or Private Community Center | ||
| Faith-Based Organization | ||
| Medical Providers Office | ||
| Pharmacy | ||
| Other: | Address | Why do you feel this is a setting where you may encounter caregivers? |
| Type |
December Data Element Service Unit Unique Participants Served Merrill, Molly (DHSS): Merrill, Molly (DHSS):
In October, please count all participants.
| In subsequent months, please count only participants who are new to the service this month. | Hours | Contacts/Sessions | Activity |
| Case Management (Caregiver) | Hours (partial hour may be reported to two decimal | ||
| Number of Caregiver Assessment Forms Initial Contact | places, e.g. 0.25 hours.) | ||
| Counseling (Caregiver) | |||
| Individual Counseling | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Counseling | |||
| Information and Assistance (Caregiver) | |||
| Number of 1:1 Contacts Providing General Program Information via Telephone or In-Person | Contact | ||
| Number of referrals to other services | |||
| Number of 1:1 Outreach | |||
| Public Information Services (Caregiver) | |||
| Number of Activities/Events | |||
| Media | Activity | ||
| Workshops/Professional Development Events | |||
| Dissemination Resource Materials | |||
| Number of Circulations | |||
| Support Groups (Caregiver) | Session (a session is typically 30 minutes to 1 hour) | ||
| Training (Caregiver) | |||
| Individual Training | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Training/Conferences | |||
| CRC Coordinator | Hours this month (partial hour may be reported to two decimal places, e.g. 0.25 hours.) |
| Total CRC Coordinator hours this month | 0 | |
| Co-Location Data | Address | Office Hours at Location/Frequency |
Merrill, Molly (DHSS): Merrill, Molly (DHSS):
(i.e. 2 hours every 3rd Wednesday)
| Public Library | ||
| Public or Private Community Center | ||
| Faith-Based Organization | ||
| Medical Providers Office | ||
| Pharmacy | ||
| Other: | Address | Why do you feel this is a setting where you may encounter caregivers? |
| Type |
January Data Element Service Unit Unique Participants Served Merrill, Molly (DHSS): Merrill, Molly (DHSS):
In October, please count all participants.
| In subsequent months, please count only participants who are new to the service this month. | Hours | Contacts/Sessions | Activity |
| Case Management (Caregiver) | Hours (partial hour may be reported to two decimal | ||
| Number of Caregiver Assessment Forms Initial Contact | places, e.g. 0.25 hours.) | ||
| Counseling (Caregiver) | |||
| Individual Counseling | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Counseling | |||
| Information and Assistance (Caregiver) | |||
| Number of 1:1 Contacts Providing General Program Information via Telephone or In-Person | Contact | ||
| Number of referrals to other services | |||
| Number of 1:1 Outreach | |||
| Public Information Services (Caregiver) | |||
| Number of Activities/Events | |||
| Media | Activity | ||
| Workshops/Professional Development Events | |||
| Dissemination Resource Materials | |||
| Number of Circulations | |||
| Support Groups (Caregiver) | Session (a session is typically 30 minutes to 1 hour) | ||
| Training (Caregiver) | |||
| Individual Training | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Training/Conferences | |||
| CRC Coordinator | Hours this month (partial hour may be reported to two decimal places, e.g. 0.25 hours.) |
| Total CRC Coordinator hours this month | 0 | |
| Co-Location Data | Address | Office Hours at Location/Frequency |
Merrill, Molly (DHSS): Merrill, Molly (DHSS):
(i.e. 2 hours every 3rd Wednesday)
| Public Library | ||
| Public or Private Community Center | ||
| Faith-Based Organization | ||
| Medical Providers Office | ||
| Pharmacy | ||
| Other: | Address | Why do you feel this is a setting where you may encounter caregivers? |
| Type |
February Data Element Service Unit Unique Participants Served Merrill, Molly (DHSS): Merrill, Molly (DHSS):
In October, please count all participants.
| In subsequent months, please count only participants who are new to the service this month. | Hours | Contacts/Sessions | Activity |
| Case Management (Caregiver) | Hours (partial hour may be reported to two decimal | ||
| Number of Caregiver Assessment Forms Initial Contact | places, e.g. 0.25 hours.) | ||
| Counseling (Caregiver) | |||
| Individual Counseling | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Counseling | |||
| Information and Assistance (Caregiver) | |||
| Number of 1:1 Contacts Providing General Program Information via Telephone or In-Person | Contact | ||
| Number of referrals to other services | |||
| Number of 1:1 Outreach | |||
| Public Information Services (Caregiver) | |||
| Number of Activities/Events | |||
| Media | Activity | ||
| Workshops/Professional Development Events | |||
| Dissemination Resource Materials | |||
| Number of Circulations | |||
| Support Groups (Caregiver) | Session (a session is typically 30 minutes to 1 hour) | ||
| Training (Caregiver) | |||
| Individual Training | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Training/Conferences | |||
| CRC Coordinator | Hours this month (partial hour may be reported to two decimal places, e.g. 0.25 hours.) |
| Total CRC Coordinator hours this month | 0 | |
| Co-Location Data | Address | Office Hours at Location/Frequency |
Merrill, Molly (DHSS): Merrill, Molly (DHSS):
(i.e. 2 hours every 3rd Wednesday)
| Public Library | ||
| Public or Private Community Center | ||
| Faith-Based Organization | ||
| Medical Providers Office | ||
| Pharmacy | ||
| Other: | Address | Why do you feel this is a setting where you may encounter caregivers? |
| Type |
March Data Element Service Unit Unique Participants Served Merrill, Molly (DHSS): Merrill, Molly (DHSS):
In October, please count all participants.
| In subsequent months, please count only participants who are new to the service this month. | Hours | Contacts/Sessions | Activity |
| Case Management (Caregiver) | Hours (partial hour may be reported to two decimal | ||
| Number of Caregiver Assessment Forms Initial Contact | places, e.g. 0.25 hours.) | ||
| Counseling (Caregiver) | |||
| Individual Counseling | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Counseling | |||
| Information and Assistance (Caregiver) | |||
| Number of 1:1 Contacts Providing General Program Information via Telephone or In-Person | Contact | ||
| Number of referrals to other services | |||
| Number of 1:1 Outreach | |||
| Public Information Services (Caregiver) | |||
| Number of Activities/Events | |||
| Media | Activity | ||
| Workshops/Professional Development Events | |||
| Dissemination Resource Materials | |||
| Number of Circulations | |||
| Support Groups (Caregiver) | Session (a session is typically 30 minutes to 1 hour) | ||
| Training (Caregiver) | |||
| Individual Training | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Training/Conferences | |||
| CRC Coordinator | Hours this month (partial hour may be reported to two decimal places, e.g. 0.25 hours.) |
| Total CRC Coordinator hours this month | 0 | |
| Co-Location Data | Address | Office Hours at Location/Frequency |
Merrill, Molly (DHSS): Merrill, Molly (DHSS):
(i.e. 2 hours every 3rd Wednesday)
| Public Library | ||
| Public or Private Community Center | ||
| Faith-Based Organization | ||
| Medical Providers Office | ||
| Pharmacy | ||
| Other: | Address | Why do you feel this is a setting where you may encounter caregivers? |
| Type |
April Data Element Service Unit Unique Participants Served Merrill, Molly (DHSS): Merrill, Molly (DHSS):
In October, please count all participants.
| In subsequent months, please count only participants who are new to the service this month. | Hours | Contacts/Sessions | Activity |
| Case Management (Caregiver) | Hours (partial hour may be reported to two decimal | ||
| Number of Caregiver Assessment Forms Initial Contact | places, e.g. 0.25 hours.) | ||
| Counseling (Caregiver) | |||
| Individual Counseling | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Counseling | |||
| Information and Assistance (Caregiver) | |||
| Number of 1:1 Contacts Providing General Program Information via Telephone or In-Person | Contact | ||
| Number of referrals to other services | |||
| Number of 1:1 Outreach | |||
| Public Information Services (Caregiver) | |||
| Number of Activities/Events | |||
| Media | Activity | ||
| Workshops/Professional Development Events | |||
| Dissemination Resource Materials | |||
| Number of Circulations | |||
| Support Groups (Caregiver) | Session (a session is typically 30 minutes to 1 hour) | ||
| Training (Caregiver) | |||
| Individual Training | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Training/Conferences | |||
| CRC Coordinator | Hours this month (partial hour may be reported to two decimal places, e.g. 0.25 hours.) |
| Total CRC Coordinator hours this month | 0 | |
| Co-Location Data | Address | Office Hours at Location/Frequency |
Merrill, Molly (DHSS): Merrill, Molly (DHSS):
(i.e. 2 hours every 3rd Wednesday)
| Public Library | ||
| Public or Private Community Center | ||
| Faith-Based Organization | ||
| Medical Providers Office | ||
| Pharmacy | ||
| Other: | Address | Why do you feel this is a setting where you may encounter caregivers? |
| Type |
May Data Element Service Unit Unique Participants Served Merrill, Molly (DHSS): Merrill, Molly (DHSS):
In October, please count all participants.
| In subsequent months, please count only participants who are new to the service this month. | Hours | Contacts/Sessions | Activity |
| Case Management (Caregiver) | Hours (partial hour may be reported to two decimal | ||
| Number of Caregiver Assessment Forms Initial Contact | places, e.g. 0.25 hours.) | ||
| Counseling (Caregiver) | |||
| Individual Counseling | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Counseling | |||
| Information and Assistance (Caregiver) | |||
| Number of 1:1 Contacts Providing General Program Information via Telephone or In-Person | Contact | ||
| Number of referrals to other services | |||
| Number of 1:1 Outreach | |||
| Public Information Services (Caregiver) | |||
| Number of Activities/Events | |||
| Media | Activity | ||
| Workshops/Professional Development Events | |||
| Dissemination Resource Materials | |||
| Number of Circulations | |||
| Support Groups (Caregiver) | Session (a session is typically 30 minutes to 1 hour) | ||
| Training (Caregiver) | |||
| Individual Training | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Training/Conferences | |||
| CRC Coordinator | Hours this month (partial hour may be reported to two decimal places, e.g. 0.25 hours.) |
| Total CRC Coordinator hours this month | 0 | |
| Co-Location Data | Address | Office Hours at Location/Frequency |
Merrill, Molly (DHSS): Merrill, Molly (DHSS):
(i.e. 2 hours every 3rd Wednesday)
| Public Library | ||
| Public or Private Community Center | ||
| Faith-Based Organization | ||
| Medical Providers Office | ||
| Pharmacy | ||
| Other: | Address | Why do you feel this is a setting where you may encounter caregivers? |
| Type |
June Data Element Service Unit Unique Participants Served Merrill, Molly (DHSS): Merrill, Molly (DHSS):
In October, please count all participants.
| In subsequent months, please count only participants who are new to the service this month. | Hours | Contacts/Sessions | Activity |
| Case Management (Caregiver) | Hours (partial hour may be reported to two decimal | ||
| Number of Caregiver Assessment Forms Initial Contact | places, e.g. 0.25 hours.) | ||
| Counseling (Caregiver) | |||
| Individual Counseling | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Counseling | |||
| Information and Assistance (Caregiver) | |||
| Number of 1:1 Contacts Providing General Program Information via Telephone or In-Person | Contact | ||
| Number of referrals to other services | |||
| Number of 1:1 Outreach | |||
| Public Information Services (Caregiver) | |||
| Number of Activities/Events | |||
| Media | Activity | ||
| Workshops/Professional Development Events | |||
| Dissemination Resource Materials | |||
| Number of Circulations | |||
| Support Groups (Caregiver) | Session (a session is typically 30 minutes to 1 hour) | ||
| Training (Caregiver) | |||
| Individual Training | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Training/Conferences | |||
| CRC Coordinator | Hours this month (partial hour may be reported to two decimal places, e.g. 0.25 hours.) |
| Total CRC Coordinator hours this month | 0 | |
| Co-Location Data | Address | Office Hours at Location/Frequency |
Merrill, Molly (DHSS): Merrill, Molly (DHSS):
(i.e. 2 hours every 3rd Wednesday)
| Public Library | ||
| Public or Private Community Center | ||
| Faith-Based Organization | ||
| Medical Providers Office | ||
| Pharmacy | ||
| Other: | Address | Why do you feel this is a setting where you may encounter caregivers? |
| Type |
July Data Element Service Unit Unique Participants Served Merrill, Molly (DHSS): Merrill, Molly (DHSS):
In October, please count all participants.
| In subsequent months, please count only participants who are new to the service this month. | Hours | Contacts/Sessions | Activity |
| Case Management (Caregiver) | Hours (partial hour may be reported to two decimal | ||
| Number of Caregiver Assessment Forms Initial Contact | places, e.g. 0.25 hours.) | ||
| Counseling (Caregiver) | |||
| Individual Counseling | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Counseling | |||
| Information and Assistance (Caregiver) | |||
| Number of 1:1 Contacts Providing General Program Information via Telephone or In-Person | Contact | ||
| Number of referrals to other services | |||
| Number of 1:1 Outreach | |||
| Public Information Services (Caregiver) | |||
| Number of Activities/Events | |||
| Media | Activity | ||
| Workshops/Professional Development Events | |||
| Dissemination Resource Materials | |||
| Number of Circulations | |||
| Support Groups (Caregiver) | Session (a session is typically 30 minutes to 1 hour) | ||
| Training (Caregiver) | |||
| Individual Training | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Training/Conferences | |||
| CRC Coordinator | Hours this month (partial hour may be reported to two decimal places, e.g. 0.25 hours.) |
| Total CRC Coordinator hours this month | 0 | |
| Co-Location Data | Address | Office Hours at Location/Frequency |
Merrill, Molly (DHSS): Merrill, Molly (DHSS):
(i.e. 2 hours every 3rd Wednesday)
| Public Library | ||
| Public or Private Community Center | ||
| Faith-Based Organization | ||
| Medical Providers Office | ||
| Pharmacy | ||
| Other: | Address | Why do you feel this is a setting where you may encounter caregivers? |
| Type |
August Data Element Service Unit Unique Participants Served Merrill, Molly (DHSS): Merrill, Molly (DHSS):
In October, please count all participants.
| In subsequent months, please count only participants who are new to the service this month. | Hours | Contacts/Sessions | Activity |
| Case Management (Caregiver) | Hours (partial hour may be reported to two decimal | ||
| Number of Caregiver Assessment Forms Initial Contact | places, e.g. 0.25 hours.) | ||
| Counseling (Caregiver) | |||
| Individual Counseling | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Counseling | |||
| Information and Assistance (Caregiver) | |||
| Number of 1:1 Contacts Providing General Program Information via Telephone or In-Person | Contact | ||
| Number of referrals to other services | |||
| Number of 1:1 Outreach | |||
| Public Information Services (Caregiver) | |||
| Number of Activities/Events | |||
| Media | Activity | ||
| Workshops/Professional Development Events | |||
| Dissemination Resource Materials | |||
| Number of Circulations | |||
| Support Groups (Caregiver) | Session (a session is typically 30 minutes to 1 hour) | ||
| Training (Caregiver) | |||
| Individual Training | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Training/Conferences | |||
| CRC Coordinator | Hours this month (partial hour may be reported to two decimal places, e.g. 0.25 hours.) |
| Total CRC Coordinator hours this month | 0 | |
| Co-Location Data | Address | Office Hours at Location/Frequency |
Merrill, Molly (DHSS): Merrill, Molly (DHSS):
(i.e. 2 hours every 3rd Wednesday)
| Public Library | ||
| Public or Private Community Center | ||
| Faith-Based Organization | ||
| Medical Providers Office | ||
| Pharmacy | ||
| Other: | Address | Why do you feel this is a setting where you may encounter caregivers? |
| Type |
September Data Element Service Unit Unique Participants Served Merrill, Molly (DHSS): Merrill, Molly (DHSS):
In October, please count all participants.
| In subsequent months, please count only participants who are new to the service this month. | Hours | Contacts/Sessions | Activity |
| Case Management (Caregiver) | Hours (partial hour may be reported to two decimal | ||
| Number of Caregiver Assessment Forms Initial Contact | places, e.g. 0.25 hours.) | ||
| Counseling (Caregiver) | |||
| Individual Counseling | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Counseling | |||
| Information and Assistance (Caregiver) | |||
| Number of 1:1 Contacts Providing General Program Information via Telephone or In-Person | Contact | ||
| Number of referrals to other services | |||
| Number of 1:1 Outreach | |||
| Public Information Services (Caregiver) | |||
| Number of Activities/Events | |||
| Media | Activity | ||
| Workshops/Professional Development Events | |||
| Dissemination Resource Materials | |||
| Number of Circulations | |||
| Support Groups (Caregiver) | Session (a session is typically 30 minutes to 1 hour) | ||
| Training (Caregiver) | |||
| Individual Training | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | ||
| Group Training/Conferences | |||
| CRC Coordinator | Hours this month (partial hour may be reported to two decimal places, e.g. 0.25 hours.) |
| Total CRC Coordinator hours this month | 0 | |
| Co-Location Data | Address | Office Hours at Location/Frequency |
Merrill, Molly (DHSS): Merrill, Molly (DHSS):
(i.e. 2 hours every 3rd Wednesday)
| Public Library | ||
| Public or Private Community Center | ||
| Faith-Based Organization | ||
| Medical Providers Office | ||
| Pharmacy | ||
| Other: | Address | Why do you feel this is a setting where you may encounter caregivers? |
| Type |
Total Data Element Service Unit Unique Participants Served Merrill, Molly (DHSS): Merrill, Molly (DHSS):
In October, please count all participants.
| In subsequent months, please count only participants who are new to the service this month. | Hours | Contacts/Sessions | Activity | |||
| Case Management (Caregiver) | Hours (partial hour may be reported to two decimal | |||||
| Number of Caregiver Assessment Forms Initial Contact | places, e.g. 0.25 hours.) | 0 | 0 | |||
| Counseling (Caregiver) | ||||||
| Individual Counseling | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | 0 | 0 | |||
| Group Counseling | 0 | 0 | ||||
| Information and Assistance (Caregiver) | ||||||
| Number of 1:1 Contacts Providing General Program Information via Telephone or In-Person | Contact | 0 | 0 | |||
| Number of referrals to other services | 0 | 0 | ||||
| Number of 1:1 Outreach | 0 | 0 | ||||
| Public Information Services (Caregiver) | ||||||
| Number of Activities/Events | 0 | 0 | ||||
| Media | Activity | 0 | 0 | |||
| Workshops/Professional Development Events | 0 | 0 | ||||
| Dissemination Resource Materials | 0 | 0 | ||||
| Number of Circulations | 0 | 0 | ||||
| Support Groups (Caregiver) | Session (a session is typically 30 minutes to 1 hour) | 0 | 0 | |||
| Training (Caregiver) | ||||||
| Individual Training | Hours (partial hour may be reported to two decimal places, e.g. 0.25 hours.) | 0 | 0 | |||
| Group Training/Conferences | 0 | 0 | ||||
| CRC Coordinator | Hours this month (partial hour may be reported to two decimal places, e.g. 0.25 hours.) |
Total CRC Coordinator hours this year 0
File details come from the government source that posted it. Updated .