Central AlbertaCFSA Family Wellness Worker Program

Quarterly Reporting FormatSeptember 1, 2012 – August 31, 2013

Program Name: ______

Agency Name: ______

Reporting Period:______

Number of FTE’s included in report: ______# funded by CFSA______

A. Case Work: Provide caseload data for the quarter

Caseload Stats:

Age of client / # of open files at beginning of quarter / # of new files in the quarter / # of closed files in the quarter
0 – years
7–18
Adults
Total

Open Files _____ + New Files _____ - Closed Files _____ = ______Caseload at end of quarter

Number of Contacts: Walk-in/One time consult

Age of client / # of clients
0 – 6 years
7–18
Adults
Total

Number of New Clients who live in town ______Year to date Total: ______

Number of New Clients who live out of town ______Year to date Total:______

Number of New Volunteers: ______Year to date Total:______

Number of New Volunteer Hours: ______Year to date Total: _____

Major / common issues addressed during this quarter on entire caseload: (Focus on primary 2 – 3 issues per client)

Child / Parent / Child / Parent
Abuse / Mental Illness
Academic performance / Parenting 0-6 years
Anger management / Parenting issues/strategies
Anxiety / stress management / Peer relations / social skills
Bullying/Being bullied / Pregnancy / sexuality
Depression / School attendance
Family / relationship violence / School conflict
Family / sibling conflict / Self esteem
Financial stress / Self harm (cutting, eating issues)
Grief and Loss / Separation/divorce
Health Concerns (Physical) / Substance Abuse
Inappropriate Behavior / Suicide
Life skills / style / Other

Referrals: Please report on the number of referrals received by the program by source as well as what referrals were made by the program to other agencies / programs.

Agency / # of referrals to FWW program / # of referrals by FWW program
CFSA
School
Parent
Self
Community Agency (e.g. food bank, employment centre, shelter)
Alberta Health Services (e.g. physician, Mental Health & Addictions)
Preventative Programs (e.g. FCSS, Parent Link, healthy Families, etc.)
Other (e.g. for profit supports such as private therapist)
TOTAL

B. Community Work

Preventative Education Presentations / Seminars / Workshops / Groups

Session name / Descriptor – describe program including target audience / # of Participants

C. Networking/ Collaborative activities

Event / meeting name / Descriptor – briefly describe (e.g. other organizations involved, number of times attended/quarter)

D. Staff Training / Professional Development

Session name / Descriptor / # of Staff Participated

D. Outcomes

Outcome / Performance Measures / Target / Actual numbers (raw data) / Actual %’s
Children, youth and families will be empowered and have improved levels of functioning. / Clients have achieved one or more of their goals identified in their case / service plan.
Or
Parents report that the services have improved their child’s ability to be successful. / 90%
80%
Children, youth and families are supported to live successfully in their community. / Number of referrals made to other community supports / services
and
Clients report that they are more knowledgeable about supports and services in their community through their involvement in the FWW program. / Baseline #’s
80%
Programs will have improved relationships with other community partners and service providers to facilitate improved collaboration when meeting client needs. / Feedback / evaluations from community agencies report a positive working relationship with the program.
Or
Clients that were involved with multiple service providers in the course of their involvement with the FWW program, (ie case conference, transfer to another service provider etc.) report that their worker played a supportive role in coordinating the delivery of those services. / 80%
80%

E. Other

Please provide any comments or anecdotal notes that you feel CFSA should be aware of.

ie. program highlights, challenges, staff absences, etc