HFNy Policy manual appendices
- Appendix A - TANF
- Site Quality Assurance Plan guidelines
TANF Services Application/Certification (LDSS-4726 REV 6/07)
Solicitud/Certification Para Servicios de TANF (LDSS-4726s- rev 10/00)
TANF Services Certification/Application Review Form (OTDA-4725- rev 6/07)
Non-Custodial Parent Referral to Child Support Enforcement Unit (LDSS-4728 7/00)
- Appendix B - Multi Site Policies
- Summary of Research Findings - Prenatal Talking Points
- Request to Add/Revise HFNY Policies and Procedure
- Policy Manual Review Tool
- PCANY FAW Observation Form
- PCANY FAW Supervision Observation Form
- PCANY Content Review Form
- PCANY FSW Home Visit Observation Form
- PCANY FSW Supervision Observation Form
- Site Support Plan
- Site Support Feedback Form (PCANY)
- TA Feedback Form (PCANY)
- Site Visit Protocol (OCFS)
- Quarterly Performance Targets
- Performance Indicators
- Appendix C - Critical Elements
- The sample forms listed in this appendix have been shared by various HFNY programs and may be copied and/or modified for your program's use.
Critical Element #1 - Initiate services prenatally or at birth
List of Outreach Sites
Outreach Tracking Calendar (pending)
Prenatal Outreach Talking Points
Critical Element #2 -Use a standardized assessment tool to systematically identify families
Self Screening Survey (Samples)
Return Referral Form
Consent for Assessment and Post Assessment Activities
Critical Element #3 - Offer services voluntarily & use positive, persistent outreach efforts to build family trust
Guidelines for engaging Families and Building Trust (pending)
Creative Outreach Pre and Post Enrollment Activities and Checklists
Initial Engagement and 92 Day Creative Outreach - Ontario (pending)
Level X-Creative Outreach Documentation - Broome
Supervisor Creative Outreach Checklist
Critical Element #4 - Offer services intensely with well-defined criteria for increasing or decreasing intensity of service over the long term
Service Agreement
Lourdes PACT
Sullivan
Criteria for Level Change and Level Completion Form -Madison
Completion of Level 1-Prenatal
Completion of Level 1
Completion of Level 2
Completion of Level 3
Completion of Level 4
Placement on Level 1-SS
Placement on Level X
Generic Level Change
Guidelines for Participant Transfer from one HFNY site to Another
Critical Element #5 -Services are culturally sensitive
Annual Service Review with Data Reports
Critical Element #6 - Supporting the parent(s) and the parent-child interaction and child development
IFSP Worksheet
IFSP Healthy Families Harlem
IFSP Ontario
IFSP Rules and Ideas
Home Visit records
Critical Element #7 - Linkages to health and other services
No appendices
Critical Element #8 - Caseload Management
No appendices
Critical Element #9 - Staff Recruitment and Select
Sample HFNY Job Descriptions
Program Manager
Program Manager's Supervisor
Program Supervisor of FSW's and/or FAW's
Family Support Worker
Family Assessment Worker
Interview Guidelines for Home Visiting Program Staff
Interview Questions
Manager and Supervisor FAW or FSW
Interpersonal Rating Scale for Interviewing Home Visiting Program Applicants
Critical Element #10 and #11- Training
Orientation Checklist Ulster
Orientation Checklist Ontario
Wraparound Training Checklist Sullivan
Guidelines for Participants in Healthy Families New York Trainings/Conferences
Critical Element #12 - Supervision
Supervisor Note FAW Harlem
Supervisor Note FAW Ontario
Supervisor Note FSW Harlem
Supervisor Note Supervisor Harlem
Supervisor Binder Review Form FSW Ulster
Supervisor Binder Review Form Supervisor Ulster
Supervisor Binder Review Form Supervisor Ontario
Sample Team Meeting Agenda Steuben
Governance and Administration
Participant Bill of Rights Lourdes PACT
Participant Bill of Rights Ulster
Quality Assurance Plan Sullivan
Quality Assurance Tracking Grid Ulster
Quality Assurance Tracking Grid Sullivan
Family Rights and Confidentiality Oneida
Family Rights and Confidentiality Sullivan
Service Agreement Sullivan
Service Agreement Lourdes PACT
Consent for Assessment and Post Assessment Activities (pending)
Critical Incident Report
Report of Suspected Child Abuse and Maltreatment
- Appendix D - Indicators of Excellence in Home Visiting
Indicators of Excellence in Family Assessment Work
Indicators of Excellence in Supervision
