Safe, Respectful & Accessible Needs Assessment
Break-out Session
Louisville 2007 Grantee Meeting
May 20, 2008, 3:30 – 5:00 p.m. 
Just ASK – Kansas Collaboration

Just ASK Needs Assessment Plan
Appendix D.3

Check-in Checklist

* Welcome and thank the individual for participating
* Hand the individual the stipend
* Confirm universal access of focus group or interview
o On your RSVP you stated we should have ________ (Braille, large print, interpreter, childcare, etc.)  Does what we have meet your needs? Is there anything else that might make you more comfortable participating? 
* Explain who Just ASK is
o Stephanie, Jehan and Ann do not work for the local programs and will not share information with them.  The local programs will get a copy of a report at the end of the needs assessment.  
o Stephanie, Jehan and Ann do not make reports to SRS.
o Jehan is available during the meeting if you want to stop the interview or take a break from the focus group to talk one-on-one.
o  Hand participant the statement of purpose.
*  Explain confidentiality and its limits
o Stephanie, Jehan and Ann do not make reports to SRS
o We ask everyone to keep the discussion private
o We cannot guarantee everyone will keep your confidentiality
o If you are worried that something you say will jeopardize your safety, well-being, a job, your housing, etc., you can either talk to us privately or just not bring it up.  Your safety is the most important thing, and it is okay if you decide not to share certain things.
o Hand participant the confidentiality agreement.
*  Review the discussion topics and ask if there are any safety concerns
o Here is the list of questions we’re starting with for the group today.  We are asking questions to improve services for people with disabilities who experience sexual assault or domestic violence.  We will be talking about disability and safety and how agencies can be more helpful.  These topics sometimes bring up memories or feelings if something is or has happened in your life.  In the focus group we will be focusing on how to improve services and we will not ask about anyone’s personal experiences with violence.  If you are currently feeling unsafe because of something that is going on now or has happened in the past, please feel free to talk with me now.   Jehan is available all through the meeting today and here is information on the local CIL and SA/DV center if something comes up after we’ve gone.  You can always step out if the discussion becomes too intense or if you want to talk with us individually.  Do you have any safety concerns that you would like to talk about now? 
o Hand participant local CIL and SA/DV contact information.
o Hand participants the list of focus group questions.
*  Review the demographics survey and how information will be used
o We are collecting statistics on each person who participates.  We are doing this to make sure we have people with different life experiences participating in the groups.  I’d like to read this form and then we can fill it out together or you can fill it out and drop it in a box after the group.  Your name will not be attached to it. 
o Hand participant demographics form