Lifespan Respite Technical Assistance Center
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Sample Performance Measurement Tools
for Lifespan Respite Programs


To Measure Lifespan Respite Systems Change Outcomes 


State Lifespan Respite Grantee Sample Tools:


 
 
ARCH Sample Measurement Tools:
Systems Change Outcome #1 Tracking Form
Increase in Caregiver Access to Respite (1)
Increase in Caregiver Access to Respite (2)
MOU Fulfillment of Agreement Matrix
Coordination_Collaboration Tracking Form

 

To Measure Caregiver/Care Recipient/Family Outcomes

State Lifespan Respite Grantee Sample Tools:
AL HEARTS Pre and Post Respite Evaluation
DE Lifespan Respite Network Financial Assistance Evaluation Form
DE Lifespan Respite Network Respite Care Information and Referral Service Evaluation Form
NC Post-Respite Survey
NC Pre-Respite Survey
NC Setting Goals to Maximize Your Respite Time
2017 NE Lifespan Respite Family Caregiver Survey with supplemental questions
NE Family Caregiver Depression Screen
NV Rx Pre-Respite Survey
NV Rx Post-Respite Survey
TN Respite Coalition Caregiver Survey
VA Lifespan Respite Voucher Program Satisfaction Survey

Nationally Recognized Tools:



   
Measures for Assessing Caregiving Coping (APA):





Care Receiver Assessment Tools (APA):





Parent Caregiver Tools (APA):





ARCH Sample Measurement Tools:


References

American Psychological Association, Public Interest Directorate. Caregiver Assessment Tools. http://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/  

Family Caregiver Alliance and Benjamin Rose Institute on Aging (2012; 2nd Edition). Selected Caregiver Assessment Measures: A Resource Inventory for Practitioners http://caregiver.org/sites/fca.huang.radicaldesigns.org/files/pdfs/SelCGAssmtMeas_ResInv_FINAL_12.10.12.pdf

Friends National Resource Center for Community-based Child Abuse Prevention. Compendium of Annotated Tools. http://friendsnrc.org/evaluation-toolkit/compendium-of-annotated-tools

Lund, D; Wright, SD; Caserta, M; Utz, R; Lindfelt, C; Montoro-Rodriguez, J; and Shon, H (2014). Time for Living and Caring, Making Respite Services Work for You.  

US Administration on Aging. Performance Measurement Outcome Project (POMP).  

https://acl.gov/programs/pomp

Lifespan Respite

Technical Assistance Center

ARCH National Respite Network and Resource Center

4016 Oxford Street

Annandale, VA 22003

(703) 256-2084 www.archrespite.org

This project is supported, in part by grant number 90LT0002, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.

 

The ARCH National Respite Network and Resource Center is a division of the Chapel Hill Training-Outreach Project, Inc. | 800 Eastowne Drive, Chapel Hill, NC, 27514 | www.chtop.org

 

 

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