MDPGH Outreach Survey
100%
Exit Survey
 
 
Date Youth Was Seen
MonthDayYear
  
 
 
Outreach Worker
   
 
 
Name of Former Resident
   
 
 
Location Where the Meeting Took Place
   
 
 
 
Part One: Education and/or Employment
 
 
Please rate the youth’s overall education or work experience since leaving MDPGH or since last meeting with Outreach Worker
 
Very difficult transition from care. Not doing well.
 
Some efforts and improvement in adjusting.
 
Showing significant effort. Transition is generally positive.
 
Demonstrates significant transitional adjustment and change.
 
Doing extremely well and demonstrates resiliency to transitional challenges
 
 
Please describe the youth's successes and failures since leaving Martin De Porres Group Homes or since the last visit with the Outreach Worker. Some of the questions that should be answered in the summary are: How is the youth's attendance at school/work? How is the youth's grades? How is the youth's job performance? What is the youth's best/worst subject? - or - What is the youth's best attributes at work? Is the youth involved in any extra curricular activities or sports?
   
 
 
 
Part Two: Community
 
 
Please rate the youth's behavior and interactions in the community.
 
Very difficult transition from care. Not doing well
 
Some efforts and improvement in adjusting
 
Showing significant effort. Transition is generally positive
 
Demonstrates significant transitional adjustment and change
 
Doing extremely well and demonstrates resiliency to transitional challenges
 
 
Please provide a summary of the youth's life in the community since leaving placement or since the last visit with the Outreach Worker. Some of the questions that should be answered in the summary are: Has the youth had any trouble with the law? Is the youth complying with aftercare? Is the youth involved in any community activities? Is the youth interacting with the right people?
   
 
 
 
Part Three: Family
 
 
Please rate the youth on his family interaction and behaviors at home.
 
Very difficult transition from care. Not doing well
 
Some efforts and improvement in adjusting
 
Showing significant effort. Transition is generally positive
 
Demonstrates significant transitional adjustment and change
 
Doing extremely well and demonstrates resiliency to transitional challenges
 
 
Please provide a summary illustrating the youth's family interactions since leaving Martin De Porres Group Homes or since the last visit with the Outreach Worker. Some questions that should be considered are: How has the youth's interactions with the parents/guardians? Is the youth abiding by the curfew set by the parents/ACS? How is the youth getting along with his siblings? Has the youth shown improvement on the behaviors that got him placed originally? How is the youth ability to accept criticism and/or discipline?