Fathers and Continuous Learning in Child Welfare Project

Instrument 9: Action Planning Form

A Breakthrough Series Collaborative for

Engaging Fathers and Paternal Relatives in Child Welfare

The purpose of the information collection is to help improvement teams document goals for their efforts during each of the three action periods in this BSC.

This information will help the FCL project team identify which efforts were most successful for improving engagement of fathers and paternal relatives. Guidance for using this form will be described in more detail at the learning sessions.

The average estimated public reporting burden for this collection of information is about 15 minutes per response. Providing information is voluntary, and all responses that are collected are kept private to the extent permitted by law.

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB number for this information collection 0970-0531 and the expiration date is 07/31/2022.

Action Planning: Where Should We Begin?

Domain to be addressed	How will we do it?		How will we measure success?	Who will do it?	When will it get done?	How will we follow up?
What is the collaborative change framework goal we are trying to address with this Plan, Do, Study, Act ( PDSA) cycle?	What change will we test?	What tasks need to be done to prepare for the test? (collect data, bring in more people, create materials, inform staff or leader, etc.)	What metric, data, or outcome will we be watching to see if this change is making things better?	Who will have primary responsibility? Who else needs to be involved?	What is your target date for completing the PDSA cycle?	How will we keep track of the PDSA’s progress? How will it be shared with the rest of the team?