Developing a Self-Assessment Toolfor Culturally - Office of Minority ...

Post-Interview Script (Continued)Topics covered in each questionnaire are as follows:Client Services Questionnaire – Total, 46 questionsSection A: Quality Monitoring and Improvement (QI)Includes 11 questions on your basic systems for tracking data about yourclients and services you provide, and how these data are used in planning,promoting, and evaluating services that address the specific needs of diversegroups in your community.Section B: Management Information Systems (MIS)Includes 8 questions on demographic data your agency may collect on yourclients.Section C: Translation and Interpretation ServicesIncludes 21 questions about translation services and interpretation servicesthat are provided by your agency or by individual or group providers that youcontract with or partner with.Section D: Other Related Client Services and BenefitsIncludes 6 questions on your agency’s culturally inclusive health careenvironment and benefits available to your clients.Staffing Questionnaire – Total, 49 questionsSection A: Quality Monitoring and Improvement (QI)Includes 9 questions on quality assessments of clinical services provided toyour clients. These would include internal routine information systems andquality monitoring and improvement procedures.Section B: Management Information Systems (MIS)Includes 12 questions about demographic data your agency may collect onyour employed staff, contractors, and/or partnership members.Section C: Diversity TrainingIncludes 21 questions about “diversity training” that may be provided to youremployed staff, contractors, and/or partnership members.Section D: Diversity, Recruitment and RetentionIncludes 7 questions about policies or plans your agency may have inplace that address diversity in your employed staff, contractors, and/orpartnership members, as well as questions about your agency’s culturallyinclusive health care environment and practice.Recommended Contact Person: (Name, title, mailing address, phone number)This concludes the interview. We will follow-up with these recommended individuals andlook forward to their participation in the study. Thank you again for taking the time to speakwith us.COSMOS Corporation, December 2003 11