Veronica Awards — Self-Nomination/Application

1.1. Indicate the kind of human/social service organization for which you work (check all that apply):

1.2. Indicate the program or programs in which you work (check all that apply):

1.3. Indicate your position(s) – check all that apply:

1.4. Venue – indicate which of these apply:

1.5. Time – indicate which of these apply:

1.6. Are there limitations on contacts/sessions with participants?

1.7. Is there a limitation on the time you can spend with a participant?

2.1. What is the size of your current caseload?

2.2. As a direct service staff working with a number of program participants, how often do you contact participants on your caseload? (Assume a relatively new participant in the first two months of the program)

2.3. At what frequency do you document your interactions with participants on your caseload?

2.4. Which of the following best describes the duration of your case management services?

2.5. How often do you engage in creative, innovative activities in order to deepen the relationship with the participant?

2.6. How often do you intentionally revisit progress with program participants by reviewing your effort and participant effort towards progress on a treatment/progress plan over a given time period?

2.7. Do you have a mechanism in place that allows you to know the current status of your entire caseload?

2.8. Which of the following statements best represents your philosophy on case management: As a direct service worker, I am:

2.9. Respond to the following statement: I modify my own behavior to make sure that I am using myself appropriately to really meet the program participant where he/she is.

2.10. Respond to the following statement: I can stay engaged with program participants even when they get upset with me because I confront them on hard issues or inappropriate behavior and they respond to the higher standards I expect.

2.11. Respond to the following statement: Managing my own performance relative to the progress of participants I am working with allows me to better understand participant needs and enables me to build better relationships with participants.

2.12. Respond to the following statement: The most important indicator of my effectiveness as a direct service worker driving participants towards outcomes is the strength of the relationship I am able to build with them. I actively reflect on, and measure the quality of that relationship.

3.1. Discuss the philosophy or clinical/service approach that guides your work with participants and give specific examples of the approach in action (15 possible points)

3.2. List the outcomes that you are working to help your participants achieve (15 possible points) Indicate whether baseline measures are used and the frequency at which outcomes are measured. Please note the target population served.

3.3. List the activities you engage in with your participants to help them achieve those outcomes (15 possible points) Be specific about the types of activities, their purpose and their frequency.

3.4. Describe what you track with each program participant to know you are doing high quality work - i.e. quality indicators, services data (15 possible points):

3.5. Describe what data you track with each program participant to know they are successful – i.e., being effective, outcomes data (20 possible points) You may reference short term, intermediate term or long term outcomes or any combination thereof that is tracked through your work.

3.6. Upload non-anecdotal evidence and/or data that draws attention to your effectiveness. Comparative data with other staff serving in the same role is encouraged. While the data could be related to services provided or outcomes achieved by participants, our judging panel will use the following criteria:(20 possible points)

4.1. Please provide three professional references who have worked with the nominee (at least one in a supervisory capacity). Please note: The Superstar Foundation will likely contact all three if you are in serious consideration for an award.