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Tier 1 Readiness Form
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Select Yes or No For Each Item Below
An agency strategic plan (action plan) exists that includes agency-wide expectations (i.e., behavior, agency culture, data collection to identify "are we doing it? Is it working") as one of the top agency goals
Yes
No
An Agency Implementation Team (A-Team) is formed and has broad representation of stakeholders
Yes
No
Administrator who is responsible for making program decisions is an active participant on A-Team and agrees to attend all team meetings and workshops
Yes
No
Administrator commits to Tiered Supports and is aware that Tiered Supports is a years-long process that requires ongoing training and revisions of the agency's Action Plan
Yes
No
At least 80% of staff and administration are interested in implementing Tiered Supports
Yes
No
Agency has started a process for identifying an individual at the supervisory level as the lead coach contact or Coordinator
Yes
No
Agency supervisors have been designated as Coach(es) and are identified to recieve additional training and actively participate in ongoing coaching and data collection of their staff's skill implementation
Yes
No
Agency is committed to development of an efficient data collection, tracking, and aggregation system
Yes
No
Agency is committed to sharing data components at least monthly with A-team and DMH-DD
Yes
No
Next Steps
Are you interested in setting up a consultative meeting? (if you answered yes, you will be asked to provide additional information
Yes
No
Date/Time #1
Date/Time #1: Date
Date/Time #2:
Date/Time #2:: Date
Date/Time #3:
Date/Time #3:: Date
Title of person completing form:
Are you interested in learning more about the Value Based Payment Incentives for Tiered Supports?
Yes
No
E-mail of person completing form:
Submit
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