Respite Pilot Initiative Evaluation
Data Collection Instruments
These data collection instruments (database, program survey, consent forms, etc.) were used for the Respite Pilot Initiative Evaluation. For a complete description of how these were used please consult the final report from the Evaluation. To read the evaluation, click here.

These instruments were developed collaboratively by researchers and respite care providers working in a variety of respite programs. They are provided here in hopes others will be able to adapt to their own program designs and needs. If you have any questions or seek additional information, please contact Suzanne Zerger at szerger@nhchc.org.


Download Files: Click on filename to download or open file:
Database Files Size     Format
Respite Database 20-MAR-2003
password: respitedb
requires Access software
679 Kb     .zip
Support Files Size     Format
Quarterly Data Checklist 27 Kb .pdf
Respite Database User Manual 2.5 Mb .pdf
Respite Verbatim Question Cheat Sheet 13 Kb .pdf
Respite Client Data Form 67 Kb .pdf
Respite Client Consent Form 8 Kb .pdf
Respite Client Consent Procedures 21 Kb .doc
Respite Client Consent Procedures 21 Kb .pdf
Client Data Paper Version 51 Kb .doc
Client Data Paper Version 104 Kb .pdf
Client Refusal Form 20 Kb .doc
Client Refusal Form 7 Kb .pdf
Non-Admit Form 61 Kb .doc