Mentoring Practices Survey

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Are you currently receiving funding, or are you a current applicant for funding, from the Health Care Authority as a Community Prevention and Wellness Initiative (CPWI) or Community Based Organization (CBO)? This funding is tied to substance use disorder prevention for community-based programs

Please provide the name & email of your Project System Manager and your Contract #

Demographic Information

Why Are We Collecting Demographic Questions? Our funding through HCA DBHR has state and federal reporting obligations. Collecting this information allows us to meet these standards. Please answer these questions for yourself (& whoever may be with you at the initial meeting) and not your organization. All questions are optional to answer.

Location (Tribe, County & School District)

Zip Code

Legislative District (Find HERE)

Congressional District (Find HERE)

Gender

Race

Ethnicity

Sexual Orientation

Please explain the reason for filling this form out

Please explain

Organization Information

Organization Name

Mentoring Programs Name, if different from Organization

Street Address

City

State

Zip Code

County (where office is located)

General Office Phone Number

General Office Email Address

Program's Website

Program's Facebook Page

Program's Instagram Page

Program's LinkedIn Page

Contact Person for Survey

Fist Name

Last Name

Email Address

Phone Number

The following questions tell us where your services are offered, structure of mentoring relationships, what type of commitment your mentors make, and the demographics of your mentors and mentees.

Served

All questions related to quantity of served can be answered by using your last full program years data. You may use calendar, academic or fiscal year as appropriate for your program we just ask that you use the same timeframe consistently throughout.

Youth Served

How many youth did you mentor in your program last year? If school-based, answer based on the school year not calendar year. If there are no youth, please enter "0". (Your closest estimate is fine.)

1 adult to 1 youth

1 adult to 2-5 youth

Group (6+ youth)

Total Youth

Mentors Served

How many mentors currently are mentoring youth in your program? If there are no mentors, please enter "0". (Your closest estimate is fine.)

1 adult to 1 youth (Mentors)

1 adult to 2-5 youth (Mentors)

Group of 6+ youth (Mentors)

Total Mentors

Counties Served

If you mentor youth in one county please use County 1. If you mentor youth in more than one county, please name the counties in which you work:

County 1: Name

County 1: # of Youth Mentored

County 2: Name

County 2: # of Youth Mentored

County 3: Name

County 3: # of Youth Mentored

County 4: Name

County 4: # of Youth Mentored

County 5: Name

County 5: # of Youth Mentored

Youth Racial Representation

Please record the approximate percentage of each racial/ethnic group within your youth/mentees. If exact percentages are unknown, please record your best approximation. (Please only use numbers and avoid symbols, e.g., %).

African American or Black

Arab American or Middle Eastern

Asian American or East Asian

Hawaiian or Pacific Islander

Latino

Multiple Ethnicities

Native American or Indigenous Alaskan

South Asian American or South Asian

White

Other Race

Mentor Racial Representation

Please record the approximate percentage of each racial/ethnic group within your mentors. If exact percentages are unknown, please record your best approximation. (Please only use numbers and avoid symbols, e.g., %).

African American or Black

Arab American or Middle Eastern

Asian American or East Asian

Hawaiian or Pacific Islander

Latino

Multiple Ethnicities

Native American or Indigenous Alaskan

South Asian American or South Asian

White

Other Race

Mentee Gender Representation

Please record the approximate percentage of each gender within your youth/mentees: If exact percentages are unknown, please record your best approximation. (Please only use numbers and avoid symbols, e.g., %).

Female

Male

Non-Binary

Unknown

Mentee System Invovlement

Please record the approximate percentage youth in your program that that are involved with or receive support from a State agency/system. (Please only use numbers and avoid symbols, e.g., %).

Foster care

Kinship care

Free or reduced lunch

Incarcerated parent/family member

Juvenile justice

Teen parent

Mentee Age Range

What ages of youth do you mentor?

Elementary SchoolMiddle SchoolHigh SchoolPost High School

Please record the percentage of your matches that reached the minimum length of your requested commitment. (If you operate a program that requests different commitment periods, please average the percentages.) (Please only use numbers and avoid symbols, e.g., %).

How many additional youth/mentees could you add to your program without adding paid staff?

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Mentor recruitment. Please indicate the degree to which each practice is implemented.

Program utilizes mentor recruitment strategies that build positive attitudes and emotions about mentoring.

Program recruits mentors whose skills, motivations, and backgrounds best match the goals and structure of the program.

Program encourages mentors to assist with recruitment efforts by providing them with resources to ask individuals they know, who meet the eligibility criteria of the program, to be a mentor.

Program trains and encourages mentees to identify and recruit appropriate mentors for themselves, when relevant.

Mentee and parent or guardian recruitment. Please indicate the degree to which each practice is implemented.

Program engages in recruitment strategies that realistically portray the benefits, practices, supports, and challenges of being mentored in the program.

Program recruits mentees whose needs best match the services offered by the program.

Mentor screening. Please indicate the degree to which each practice is implemented.

Program has established criteria for accepting mentors into the program as well as criteria for disqualifying mentor applicants.

Prospective mentors complete a written application that includes questions designed to help assess their safety and suitability for mentoring a youth.

Program conducts at least one face-to-face interview with each prospective mentor that includes questions designed to help the program assess his or her suitability for mentoring a youth.

Program conducts a comprehensive criminal background check on prospective adult mentors, including searching a national criminal records database, along with sex offender and child abuse registries and driving records.

Program conducts reference check interviews with multiple adults who know an applicant (ideally, both personal and professional references) that include questions to help assess his or her suitability for mentoring youth.

Prospective mentors agree in writing to a one-year minimum commitment for the mentoring relationship or a minimum time commitment set by the program.

Prospective mentors agree in writing to participate in face-to-face meetings with the mentees that average a minimum of once a week and a total of four or more hours per month over the course of the relationship, or meet the program's time requirement

Mentee screening. Please indicate the degree to which each practice is implemented.

Program has established criteria for accepting youth into the program as well as criteria that would disqualify a potential youth participant.

Parents(s)/guardian(s) complete an application or referral form.

Parent(s)guardian(s) provide informed permission for their child to participate.

Parent(s)guardian(s) agree in writing to a one-year (calendar or school) minimum commitment for the mentoring relationship, or the minimum time commitment that is required by the mentoring program.

Parent(s)/guardian(s) and the mentees agree in writing that mentees participate in face-to-face meetings that average a minimum or once a week and a total of four or more hours per month over the course of the relationship, or at a program minimum.

Mentor training. Program provides pre-match training for mentors on the following training components.

Program requirements (e,g, meeting frequency, match length, protocols for missing a meeting, etc.).

Mentor's goals and expectations for the mentee, parent or guardian, and the mentoring relationship.

Mentor's obligations and appropriate roles.

Relationship development and maintenance.

Ethical and safety issues that may arise related to the relationship.

Effective closure of the mentoring relationship.

Sources of assistance available to support mentors.

Opportunities and challenges associated with mentoring specific populations of youth.

Program provides a minimum of two hours of pre-match, in-person, mentor training.

Initiating the mentoring relationship.

Program provides a minimum of two hours of pre-match, in-person, mentor training.

Mentee training. Program provides pre-match training for the mentee and/or parent/guardian on:

Purpose of mentoring

Program requirements (e.g., length of match, frequency and duration of meetings, protocols for missing or being late to meetings, and match closure).

Mentee's goals for mentoring

Mentor's obligations and appropriate roles

Mentee's obligations and appropriate roles

Initiating the mentoring relationship

Effective closure of the relationship

Matching. Please indicate the degree to which each practice is implemented.

Program considers the characteristics of the mentor and mentee (e.g., interests, proximity, age, gender, race, ethnicity, personality, expressed preferences; goals; strengths; and previous experiences) in matching.

Program arranges and documents an initial meeting between the mentor and mentee as well as, when relevant, with the parent or guardian.

Program staff member is onsite and/or present during the initial match meeting of the mentor and mentee, and when relevant, parent or guardian.

Program has mentor, mentee, and when relevant, the parent or guardian sign a commitment agreement agreeing to the program's rules and requirements.

Monitoring and Support. Please indicate the degree to which each practice is implemented.

Program contacts mentors and mentees at a minimum frequency of twice per month for the first month of the match and once a month thereafter for the first year.

At each mentor monitoring contact, staff ask mentors about activities, mentee outcomes, child safety issues, relationship quality, and the impact of the mentoring using a standardized procedure (e.g. using a written protocol/questions).

At each mentee contact, staff ask mentees about activities, mentee outcomes, child safety issues, relationship quality, and the impact of the mentoring using a standardized procedure (e.g. using a written protocol/questions).

Program follows evidence-based protocol to elicit more in-depth assessment from mentors and mentees about relationship quality, and uses scientifically-tested relationship assessment tools.

Program contacts a responsible adult in each mentee's life at a minimum frequency of twice per month for the first month of the match and once a month thereafter.

At each staff contact, staff ask the responsible adult in the mentee's life about mentoring activities, mentee outcomes, child safety issues, relationship quality, and impact on mentee using a written protocol/questions.

Program regularly assesses all matches to determine if they should be closed or encouraged to continue.

Program documents information about each mentor-mentee meeting including, at a minimum, the date, length, and description of activity completed.

Program provides mentors with access to relevant resources (expert advise, publications, web-links, available social service referrals) to help mentors address needs and challenges as they arise.

Program provides mentees and parent(s)/guardian(s) with access or referrals to relevant resources (e.g., expert advise, publications, web-links, available social services) to help families address needs and challenges as they arise.

Program provides mentors with feedback on a regular basis regarding their mentees' outcomes and the impact of mentoring on their mentees to continuously improve mentee outcomes and encourage mentor retention.

Program provides one or more opportunities for mentors per year for post-match training (ongoing training).

Closure. Please indicate the degree to which each practice is implemented.

Program has a procedure to manage anticipated closures, when members of the match are willing and able to engage in the closure process.

Program has a procedure to manage unanticipated closures, when members of the match are willing and able to engage in the closure process.

Program has a procedure to manage closure when one member of the match is unable or unwilling to engage in the closure process.

Program conducts an exit interview with mentors.

Program conducts an exit interview with mentees, and when relevant, with parent(s) or guardian(s).

Program has a written policy and procedure, when relevant, for managing re-matching.

Program documents that closure procedures were followed.

Regardless of the reason for closure, the mentoring program has a discussion with mentors (feelings about the closure, post-closure contact, a plan for the final meeting, and possible re-matching).

Regardless of the reason for closure, the mentoring program has a discussion with mentees (feelings about the closure, post-closure contact, a plan for the final meeting, possible re-matching), and when relevant, with parent(s)/guardian(s).

Program has a written public statement to parent(s)/guardian(s), if relevant, as well to mentors and mentees that outlines the terms of match closure and the policies for contact after match end including social and digital media.

Would you like to receive a summary of the mentoring practices aggregated for all youth mentoring program respondents?

YesNo