**Form Approved**

OMB No.: XXXX-XXXX

Expiration Date: XX/XX/2017

**Form Approved**

OMB No.: XXXX-XXXX

Expiration Date: XX/XX/2017

Evaluation of the ACL Title VI Programs

Title VI Program Staff Interview Guide

**Introduction and Informed Consent Statement**

Hi. My name is __________. 

Thank you for giving us this chance to discuss your Title VI Program. This discussion should take no more than 60 minutes of your time. We will do our best to stay on track.  

As you may remember, I work for ICF and we are helping the Administration on Aging conduct an evaluation of the Title VI Programs. Through this interview and others like it, we hope to get a better sense of how well the elders’ programs in our country are serving their communities.

You have been asked to participate because you are a staff person with an elders program in your community. We want to learn more about what these programs are doing for their communities and where they could use more help.

There are no right or wrong answers. You are the expert on your Title VI program, and your opinions and thoughts are really important to us. You can choose not to answer any question for any reason. Your answers will not give you any benefits or change any benefits that you currently may be receiving. Your input will be used to help improve programs in tribal communities.

This interview is strictly confidential; meaning information that identifies you will not be shared with anyone but study staff. To help with our notes, we also will audio tape the interview. We will keep the notes and tape records in locked files and only study staff will be allowed to see them. The information that we report will be grouped together with the results from all tribes and will not contain any information about you or your community.

Participation in the interview is completely voluntary. You can refuse to participate with no penalty or negative results. You do not have to answer questions that you do not want to answer. You may choose to end the interview at any time, for any reason.  

Do you have any questions before we get started? 

Do you agree to participate in this interview?

· Yes  *Thank you. I am confirming you are willing to answer questions during this interview and will note your verbal consent. We also would like to record the discussion to make sure we don’t miss anything.*

· No  *Thank participant for their time.*

Do I have your permission to turn on the audio recorder?

· Yes  Thank you. *Turn on recorder.*****

· No  *Thank you. I will refrain from recording the interview.*

**First, I want to ask you a couple of questions to get some background information on your Title VI Program. As a reminder, these questions are about the services you provide under the Title VI Program.**

1. How long have you been working for the Title VI program?

a. What is your title?

b. How long have you been in this role?

2. Can you talk a little bit about your Title VI Program? What kinds of services are offered?

a. *Nutrition: education, meals, home delivery, etc.*

b. *Supportive Services: transportation, home care, legal assistance, information/referral, etc.*

c. *Caregiving: respite care, palliative care, grandparents program, information/referral, counseling, support groups, etc*

3. What are the greatest needs for your Elders?

4. *(If they have a Caregiver program)* What are the greatest needs for Caregivers?

5. What kinds of services do you most often refer people (Elders and Caregivers) to?

6. Which services are the most used among Elders? Caregivers?

**I also want to understand how Title VI programs make ends meet for their programs in terms of staff, money, and other resources.**

7. Are there other sources of money that you use to supplement the Title VI funding? 

a. If YES where does the money come from? 

b. If NO do you feel like you are often trying to stretch the Title VI funding to go further each year?

8. Which parts of the program do you have to supplement with money from another source?

9. What about other resources? Volunteer time? Volunteered resources from other programs?

10. Can you give an example of a group of people you couldn’t help because of resource limitations?

**Now we’re going to shift the conversation to talk more about the impact of the Title VI Program on the people it serves.**

11. How does your program build on the strengths of your culture and community?

12. Which aspects of your program do you think have the most impact on people? Why/in what way?

13. What does your program do best for Elders?

a. How does the program affect their physical, emotional, mental and/or spiritual wellbeing?

14. What does your program do best for Caregivers?

a. How does the program affect their physical, emotional, mental and/or spiritual wellbeing?

15. What would happen if the Title VI program went away?

a. What would the impact on the Elders?

b. What would be the impact on caregivers?

c. What impact on the Tribe/community?

**Now I’m going to ask you to think more about the management aspects of the Title VI Program.**

16. What are some of the challenges that you face with running this program?

17. How do you manage all of the components of your program?

18. If you had unlimited funds, what else would you like to do with you Title VI program?

a. What would you change about your current program?

b. What other kinds of programming would you like to have?

19. Are there areas in which you could use more training?

a. *Implementation of best practices?*

b. *Maintaining food safety standards?*

c. *Grant management?*

d. *Grant writing?*

e. *Report writing?*

f. *Data collection?*

g. *Partnership development?*

**That wraps up my list of questions for you at this time. Do you have any questions for me? [ADDRESS ANY QUESTIONS]**

· **If no questions “Thank you again for taking the time to speak with me. We sincerely appreciate and value your input!”**

· **If you think of anything else after we get off the phone, please call me or email me.**

*Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is xxxx-xxxx. Public reporting burden for this collection of information is estimated to average 5 minutes per respondent, per year, including the time to review instructions. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to [title], [address, city, state, zip].*

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